Do personality disorders exist? On the validity of the concept and its cognitive‐behavioral formulation and treatment
Abstract
Since the introduction of personality disorders as important diagnostic categories in the DSM-III [APA (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association] the concept of personality disorder (PD) has met both skepticism and enthusiasm. This paper addresses criticisms, reviews theoretical and empirical evidence for the concept of personality disorders (PD), critically discusses widespread clinical ideas about PDs, and reviews cognitive-behavioral models and treatments of PDs. It is concluded that there is enough evidence for the usefulness of PDs as diagnostic categories. A confirmatory factor analysis for instance yielded very reasonable evidence for the categories hypothesized by the DSM. Contradicting widespread ideas, research indicates that PDs are not a contraindication for cognitive-behavioral treatments of axis-I problems, and that there are even indications that PD pathology itself can be successfully treated using modified CBT methods. In stark contrast to the generally rich empirical history of CBT, research on cognitive models and treatment of PDs is virtually absent. However, the sparse attempts indicate that cognitive models may be fruitful in this area. Future research should be directed at further developing and testing cognitive conceptualizations and treatment models.
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Avoidance is a dominant coping strategy not only in social but also in non-social situations in avoidant personality disorder.
“Furthermore, on the basis of empirical findings, it has been suggested that avoidance is a dominant coping strategy not only in social but also in non-social situations in APD [9–11].”
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders, 3rd ed
Cooper, A. M., & Michels, R. (1981) · American Journal of Psychiatry · doi:10.1176/ajp.138.1.128 · Cited by 7,417 · see citing works
(1993) · Cited by 7,136 · see citing works
Initial reliability and validity of a new retrospective measure of child abuse and neglect
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1132 · Cited by 3,577 · see citing works
Resilience and development: Contributions from the study of children who overcome adversity
Masten, A. S., Best, K. M., & Garmezy, N. (1990) · Development and Psychopathology · doi:10.1017/s0954579400005812 · Cited by 3,397 · see citing works
Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults
Breslau, N. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810270028003 · Cited by 2,544 · see citing works
Cognitive-behavioral treatment of chronically parasuicidal borderline patients
Linehan, M. M. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810360024003 · Cited by 2,203 · see citing works
Cognitive therapy of personality disorders
(1991) · Choice Reviews Online · doi:10.5860/choice.28-2993 · Cited by 1,770 · see citing works
Validity of the Childhood Trauma Questionnaire in an Adolescent Psychiatric Population
BERNSTEIN, D. P., AHLUVALIA, T., POGGE, D., & HANDELSMAN, L. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199703000-00012 · Cited by 1,574 · see citing works
Childhood trauma in borderline personality disorder.
Herman, J., Perry, J., & van der Kolk, B. A. (1989) · American Journal of Psychiatry · doi:10.1176/ajp.146.4.490 · Cited by 1,277 · see citing works
Obsessional-compulsive complaints
HODGSON, R. J., & Rachman, S. (1977) · Behaviour Research and Therapy · doi:10.1016/0005-7967(77)90042-0 · Cited by 1,238 · see citing works
Childhood sexual and physical abuse as factors in adult psychiatric illness.
Bryer, J., Nelson, B. A., Miller, J., & Krol, P. A. (1987) · American Journal of Psychiatry · doi:10.1176/ajp.144.11.1426 · Cited by 814 · see citing works
Disorders of Personality: DSM-III: Axis II
Millon, T. (1981) · Medical Entomology and Zoology · Cited by 757 · see citing works
Obsessions, responsibility and guilt
Rachman, S. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90066-4 · Cited by 598 · see citing works
Childhood sexual and physical abuse in adult patients with borderline personality disorder.
Ogata, S., Silk, K., Goodrich, S., Lohr, N., Westen, D., & Hill, E. M. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.8.1008 · Cited by 529 · see citing works
The diagnostic interview for borderline patients
Gunderson, J. G., Kolb, J. E., & Austin, V. (1981) · American Journal of Psychiatry · doi:10.1176/ajp.138.7.896 · Cited by 521 · see citing works
Thought Action Fusion in Obsessive Compulsive Disorder
ÇÝFTÇÝ, &., & Kuru, T. (2013) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 501 · see citing works
Treatment of childhood memories: Theory and practice
Arntz, A., & Weertman, A. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00173-9 · Cited by 488 · see citing works
Self-citationSchema change processes in cognitive therapy
Padesky, C. A. (1994) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.5640010502 · Cited by 403 · see citing works
Social cognition and object relations.
Westen, D. (1991) · Psychological Bulletin · doi:10.1037/0033-2909.109.3.429 · Cited by 350 · see citing works
Treatment of Chronic Obsessive-Compulsive Neurosis by in-vivo Exposure
Marks, I. M., HODGSON, R. J., & Rachman, S. (1975) · The British Journal of Psychiatry · doi:10.1192/bjp.127.4.349 · Cited by 315 · see citing works
Obsessive-compulsive disorder: theory, research, and treatment
(1998) · Choice Reviews Online · doi:10.5860/choice.36-2444 · Cited by 313 · see citing works
Psychodynamic Psychotherapy Of Borderline Patients
Kernberg, O. F., Selzer, M. A., Koenigsberg, H. W., Carr, A. C., & Appelbaüm, A. H. (1989) · Medical Entomology and Zoology · Cited by 302 · see citing works
Harter, S., & Buddin, B. J. (1987) · Developmental Psychology · doi:10.1037/0012-1649.23.3.388 · Cited by 283 · see citing works
Social phobia: A comparison of specific and generalized subtypes and avoidant personality disorder.
Turner, S. M., Beidel, D. C., & Stemberger, R. M. T. (1992) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.101.2.326 · Cited by 281 · see citing works
Perceived responsibility and compulsive checking: An experimental analysis
Lopatka, C., & Rachman, S. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00089-3 · Cited by 281 · see citing works
Comorbidity of personality disorders and depression: Implications for treatment.
Shea, M. T., Widiger, T. A., & Klein, M. H. (1992) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.60.6.857 · Cited by 255 · see citing works
Validity of the distinction between generalized social phobia and avoidant personality disorder.
Herbert, J. D., Hope, D. A., & Bellack, A. S. (1992) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.101.2.332 · Cited by 237 · see citing works
The treatment of chronic obsessive-compulsive neurosis
Rachman, S., HODGSON, R. J., & Marks, I. M. (1971) · Behaviour Research and Therapy · doi:10.1016/0005-7967(71)90009-x · Cited by 232 · see citing works
Cognitive-Developmental Processes in the Integration of Concepts about Emotions and the Self
Harter, S. (1986) · Social Cognition · doi:10.1521/soco.1986.4.2.119 · Cited by 219 · see citing works
Westen, D., Lohr, N. E., Silk, K. R., Gold, L. J., & Kerber, K. (1990) · Psychological Assessment · doi:10.1037/1040-3590.2.4.355 · Cited by 218 · see citing works
The reliability of axis II of DSM-III
Mellsop, G. W., Varghese, F. T. N., Joshua, S., & Hicks, A. (1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.10.1360 · Cited by 217 · see citing works
Prevalences of Personality Disorders (DSM-III-R) in the Community
Maier, W., Lichtermann, D., Klingler, T., Heun, R., & Hallmayer, J. F. (1992) · Journal of Personality Disorders · doi:10.1521/pedi.1992.6.3.187 · Cited by 205 · see citing works
Perceived responsibility: Structure and significance
Rachman, S., Thordarson, D. S., Shafran, R., & Woody, S. R. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00016-q · Cited by 200 · see citing works
Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients
Boon, S., & Draijer, N. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.3.489 · Cited by 198 · see citing works
Validity in the diagnosis of personality disorders: The use of the LEAD standard.
Pilkonis, P. A., Heape, C. L., Ruddy, J., & Serrao, P. (1991) · Psychological Assessment · doi:10.1037/1040-3590.3.1.46 · Cited by 197 · see citing works
Rotation to Perfect Congruence and the Cross Validation of Component Weights Across Populations
ten Berge, J. M. F. (1986) · Multivariate Behavioral Research · doi:10.1207/s15327906mbr2101_3 · Cited by 189 · see citing works
Early family environments and traumatic experiences associated with borderline personality disorder.
Weaver, T. L., & Clum, G. A. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.61.6.1068 · Cited by 183 · see citing works
Obsessional-compulsive checking: Experimental replication and development
Röper, G., & Rachman, S. (1976) · Behaviour Research and Therapy · doi:10.1016/0005-7967(76)90041-3 · Cited by 164 · see citing works
How to remain neutral: An experimental analysis of neutralization
Rachman, S., Shafran, R., Mitchell, D., Trant, J., & Teachman, B. A. (1996) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(96)00051-4 · Cited by 162 · see citing works
Behavior Therapy vs Insight-Oriented Therapy for Repeated Suicide Attempters
Liberman, R. P. (1981) · Archives of General Psychiatry · doi:10.1001/archpsyc.1981.01780350060007 · Cited by 156 · see citing works
Cognitive Therapy of Borderline Personality Disorder
Layden, M. A., Newman, C. F., Freeman, A., Mors, S. E., & Stein, D. J. (1998) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.12.3.282 · Cited by 153 · see citing works
A comparison of clinical and self-report diagnoses of DSM-III personality disorders in 552 patients
Hyler, S. E., Rieder, R. O., Williams, J. B. W., Spitzer, R. L., Lyons, M. J., & Hendler, J. (1989) · Comprehensive Psychiatry · doi:10.1016/0010-440x(89)90070-9 · Cited by 146 · see citing works
Winters, K. C., & Neale, J. M. (1985) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.94.3.282 · Cited by 146 · see citing works
Short-term structured treatment for avoidant personality disorder.
Alden, L. E. (1989) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.57.6.756 · Cited by 142 · see citing works
Social Skills Problems in Neurotic Outpatients
Stravynski, A. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290120014003 · Cited by 142 · see citing works
Prepared phobias and obsessions: Therapeutic outcome
de Silva, P., Rachman, S., & Seligman, M. E. P. (1977) · Behaviour Research and Therapy · doi:10.1016/0005-7967(77)90089-4 · Cited by 140 · see citing works
Clinical Assessment of Object Relations Using the TAT
Westen, D. (1991) · Journal of Personality Assessment · doi:10.1207/s15327752jpa5601_6 · Cited by 139 · see citing works
The spontaneous decay of compulsive urges
Rachman, S., de Silva, P., & Röper, G. (1976) · Behaviour Research and Therapy · doi:10.1016/0005-7967(76)90091-7 · Cited by 139 · see citing works
An experiment on obsessional checking
Röper, G., Rachman, S., & HODGSON, R. J. (1973) · Behaviour Research and Therapy · doi:10.1016/0005-7967(73)90003-x · Cited by 126 · see citing works
A Controlled Trial of Short-Term Group Treatment for Borderline Personality Disorder
Munroe-Blum, H., & Marziali, E. (1995) · Journal of Personality Disorders · doi:10.1521/pedi.1995.9.3.190 · Cited by 118 · see citing works
Multidimensional Dichotomous Thinking Characterizes Borderline Personality Disorder
Veen, G., & Arntz, A. (2000) · Cognitive Therapy and Research · doi:10.1023/a:1005498824175 · Cited by 114 · see citing works
Self-citationDreessen, L., & Arntz, A. R. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00026-6 · Cited by 110 · see citing works
Self-citationMarzillier, J. S., Lambert, C., & Kellett, J. M. (1976) · Behaviour Research and Therapy · doi:10.1016/0005-7967(76)90015-2 · Cited by 110 · see citing works
Brief Psychotherapy of Personality Disorders
Winston, A., POLLACK, J., McCullough, L., FLEGENHEIMER, W. V., Kestenbaum, R. S., & Trujillo, M. (1991) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199104000-00002 · Cited by 109 · see citing works
Arntz, A., Dietzel, R., & Dreessen, L. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00152-1 · Cited by 109 · see citing works
Self-citationObsessional-compulsive checking
Rachman, S. (1976) · Behaviour Research and Therapy · doi:10.1016/0005-7967(76)90002-4 · Cited by 103 · see citing works
Generalized social phobia versus avoidant personality disorder: A commentary on three studies.
Widiger, T. A. (1992) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.101.2.340 · Cited by 101 · see citing works
Zeigler‐Hill, V., & Shackelford, T. K. (2020) · Springer eBooks · doi:10.1007/978-3-319-24612-3_302302 · Cited by 99 · see citing works
Psychotherapy of personality disorders.
Gabbard, G. O. (2000) · PubMed Central · Cited by 83 · see citing works
Intensive behavioral group treatment of avoidant personality disorder
Renneberg, B., Goldstein, A. J., Phillips, D., & Chambless, D. L. (1990) · Behavior Therapy · doi:10.1016/s0005-7894(05)80337-5 · Cited by 83 · see citing works
Social skills training and psychotherapy: a comparative study
Argyle, M., Bryant, B., & Trower, P. (1974) · Psychological Medicine · doi:10.1017/s003329170004589x · Cited by 81 · see citing works
Dreessen, L., Arntz, A. R., Luttels, C., & Sallaerts, S. J. M. (1994) · Comprehensive Psychiatry · doi:10.1016/0010-440x(94)90018-3 · Cited by 79 · see citing works
Self-citationObject representations in the early memories of sexually abused borderline patients
Nigg, J. T., Silk, K. R., Westen, D., Lohr, N. E., Gold, L. J., Goodrich, S., & Ogata, S. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.7.864 · Cited by 69 · see citing works
Predictors of dropout in psychodynamic psychotherapy of borderline personality disorder.
Smith, T. E., Koenigsberg, H. W., Yeomans, F. E., Clarkin, J. F., & Selzer, M. A. (1995) · PubMed Central · Cited by 62 · see citing works
Harter, S. (1977) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.45.3.417 · Cited by 62 · see citing works
Personality disorders and features in social phobia and panic disorder.
Jansen, M. A., Arntz, A. R., Merckelbach, H. L. G. J., & Mersch, P. P. A. (1994) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.103.2.391 · Cited by 50 · see citing works
Self-citationCappe, R. F., & Alden, L. E. (1986) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.54.6.796 · Cited by 33 · see citing works
Dreessen, L., Arntz, A. R., Hendriks, T., Keune, N., & van den Hout, M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00154-5 · Cited by 33 · see citing works
Self-citationPsychosocial treatment of personality disorders
Shea, M. T. (1993) · Journal of Personality Disorders · Cited by 27 · see citing works
What can functional analytic psychotherapy contribute to empirically-validated treatments?
Hopko, D. R., & Hopko, S. D. (1999) · Clinical Psychology & Psychotherapy · doi:10.1002/(sici)1099-0879(199911)6:5 · Cited by 18 · see citing works
Obsessive-Compulsive Disorder: The Facts, 2nd edition.
Warneke, L. B. (1999) · Europe PMC (PubMed Central) · Cited by 8 · see citing works
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Bögels, S. M., Alden, L., Beidel, D. C., Clark, L. A., Pine, D. S., Stein, M. B., & Voncken, M. (2010) · Depression and Anxiety · doi:10.1002/da.20670 · Cited by 526 · see citing works
Thombs, B. D., Bernstein, D. P., Lobbestael, J., & Arntz, A. (2009) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2009.03.001 · Cited by 313 · see citing works
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Bieling, P. J., & Kuyken, W. (2003) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.10.1.52 · Cited by 174 · see citing works
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Lobbestael, J., Arntz, A., & Sieswerda, S. (2005) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2005.05.006 · Cited by 147 · see citing works
Self-citationGiesen-Bloo, J. H., Wachters, L. M., Schouten, E., & Arntz, A. (2010) · Personality and Individual Differences · doi:10.1016/j.paid.2010.03.023 · Cited by 135 · see citing works
Self-citationThoma, P., Friedmann, C., & Suchan, B. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.01.024 · Cited by 134 · see citing works
Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A., & Lysaker, P. H. (2007) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.541 · Cited by 105 · see citing works
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Karos, K., Niederstrasser, N., Abidi, L., Bernstein, D. P., & Bader, K. (2014) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2014.896840 · Cited by 78 · see citing works
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Baljé, A., Greeven, A., van Giezen, A., Korrelboom, K., Arntz, A., & Spinhoven, P. (2016) · Trials · doi:10.1186/s13063-016-1605-9 · Cited by 39 · see citing works
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- Authors
- Arntz, A.
- Affiliations
- Maastricht University (NL)
- Corresponding author
- Arntz, Arnoud
- ORCID
- Arntz, Arnoud
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 1999-07
- Volume
- 37
- Pages
- S97-S134
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2051469220
- Cited by
- 82
- References
- 72
- Citations by year
- 2024: 2 · 2023: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 6 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 4.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- personality disorders, diagnostic validity, DSM-III, cognitive behavioral therapy, confirmatory factor analysis
- MeSH terms
- Adult, Behavior Therapy, Child, Female, Humans, Male, Models, Psychological, Personality Disorders, Psychiatric Status Rating Scales, Reproducibility of Results, Cognitive Behavioral Therapy
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