Personality Disorders over Time: Implications for Psychotherapy

By Paris, Joel | American Journal of Psychotherapy, January 1, 2004 | Go to article overview

Personality Disorders over Time: Implications for Psychotherapy


Paris, Joel, American Journal of Psychotherapy


Personality disorders have an early onset, and are associated with dysfunction over the course of adult life. Antisocial and borderline personality disorders tend to remit with age, but other categories do not usually show improvement. The chronicity of personality disorders is both a challenge and a frame for treatment planning. Psychotherapy for these patients can focus on rehabilitation and the development of social niches that match their personality profiles.

THE NATURE OF PERSONALITY DISORDERS

Patients with personality disorders are common in clinical practice (51). But this population presents a number of difficulties for effective treatment (17,29). These conditions are associated with strikingly low levels of functioning (23,44). Moreover, by definition, personality disorders begin early in development and go on to have a chronic course (1).

This degree of chronicity and dysfunction requires an explanation. It has long been assumed that "deep-seated" problems must originate in early childhood, and that problems present for years require years of therapy. This point of view has led to therapeutic approaches designed to discover and repair conflicts arising in early development.

However, recent evidence suggests that these etiological assumptions are, at least in part, mistaken. In medicine, diseases that begin early in life and go on to chronicity tend to be associated with higher genetic vulnerability (7), and similar principles apply to most mental disorders (25). Behavioral genetic studies show that about half the variance affecting personality traits (12), as well as personality disorders themselves (46), is accounted for by genetic factors. There is strong evidence that personality disorders are rooted in heritable traits that reflect temperament (40,43,29).

However, these findings do not mean that personality disorders are purely genetic, or that their causes lie only in "chemical imbalances." Environmental factors, most particularly childhood adversities, are also important (13). These risk factors have been most consistently identified in research on antisocial personality (38) and on borderline personality (50).

The real issue is that the impact of adverse events can only be understood in interaction with temperament. This principle is supported by research showing that in most cases, childhood trauma does not lead to pathological sequelae (41). In general, life events have greater effects on those who are vulnerable (25). The development of a diagnosable personality disorder depends on a complex combination of genetic and environmental factors, which are best formulated in a stress-diathesis model (22,25).

PRECURSORS, COURSE AND OUTCOME OF PERSONALITY DISORDERS

Personality disorders do not arise in adulthood de novo. These conditions have a continuous relationship with normal personality traits (17), and differences are only a matter of degree. These trait profiles also reflect patterns of vulnerability that can be identified prior to the onset of a diagnosable disorder.

Although personality disorders may only be present clinically at adolescence, they usually have childhood precursors. The best documented example concerns antisocial personality, for which conduct disorder is an established precursor (38). Patients who later develop borderline personality may also have had difficulties during childhood, probably a combination of externalizing and internalizing symptoms (27). Patients who develop avoidant personality disorder in adulthood may have been unusually shy ("behaviorally inhibited") as children (14,25). Finally, patients who develop schizoid or schizotypal personality disorders may show similar symptoms during childhood (48).

Childhood precursors reflect temperamental variations that shape trait profiles, and temperament also explains why personality is highly stable over the life course (18). But traits do not, by themselves, lead to psychopathology. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Personality Disorders over Time: Implications for Psychotherapy
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.