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Tests of the Cognitive Theory of Personality Disorders

According to cognitive theory, the essence of a personality disorder is revealed in the dysfunctional beliefs that characterize and perpetuate it (Beck et al., 1990; Pretzer & Beck, 1996). Early investigations of the association between dysfunctional cognitions and personality disorders provide general support for the cognitive model. O’Leary et al. (1991) found that scores on the Dysfunctional Attitude Scale (DAS; Weissman, 1979) of patients with borderline personality disorder were signifi cantly higher than those of normal controls.

The scores of the borderline patients were not related to current major depression, a history of prior major depression, or to clinical status (outpatients and inpatients admitted for research studies vs. inpatients admitted because of clinical necessity). The authors conclude that dysfunctional attitudes may be trait phenomena in personality disorders, related to depressive symptoms rather than major depression. Later work by Arntz, Dietzel, and Dreessen (1999) found that assumptions characteristic of borderline personality disorder appeared stable even with mood induction.  Gasperini et al. (1989) used factor analysis of the Automatic Thoughts Questionnaire (ATQ; Hollon & Kendall, 1980) and the Self-Control Schedule (SCS; Rosenbaum, 1980) to identify the relationships among mood disorders, cognitive patterns, and personality disorders. They found that the fi rst factor that emerged from the factor analysis of the ATQ and the SCS items refl ected Cluster B (narcissistic, histrionic, borderline, and antisocial) personalities. The second factor that emerged refl ected Cluster C (obsessivecompulsive, dependent, avoidant, and passive–aggressive) personalities. The authors speculate that studying personality traits, rather than clusters, might be more useful in understanding the relationship between personality and cognitive characteristics.

More recently, studies have examined the relationships between maladaptive beliefs and personality disorders. Arntz et al. (1999) found that a subscale of the Personality Disorder Beliefs Questionnaire (PDBQ; Dreessen & Arntz, 1995), hypothesized to contain beliefs characteristic of borderline personality disorder, did indeed differentiate those with borderline personality disorder from subjects with Cluster C personality disorders. Beck and associates (Beck et al., 2001) used the PBQ (Beck & Beck, 1995) in a study of 756 outpatients who were assessed for personality disorders using standardized clinical interviews. The results showed that avoidant, dependent, obsessive–compulsive, narcissistic, and paranoid personality-disordered subjects preferentially endorsed sets of beliefs theoretically linked to their specific disorders and scored signifi cantly higher on the relevant subscale than did patients without a personality disorder. The other personality disorders were not examined in this study due to a lack of subjects.

Nevertheless, these fi ndings support the hypothesis that dysfunctional beliefs are related to at least some personality disorders. Two studies support the relationship betweenEMSand personality disorders. A study of 41 methadone-maintained outpatients who met criteria for either antisocial, borderline, avoidant, or depressive personality disorder found that each personality disorder was associated with a unique profile of presenting problems, underlying traits, and schemas (Ball & Cecero, 2001). The YSQ (Young & Brown, 1990), the NEO-Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992), and the Multiple Affect Adjective Checklist-Revised, Trait Version (MAACL-R; Zuckerman & Lubin, 1985) were administered along with a measure of presenting problems to subjects who received personality diagnoses based on the Structural Clinical Interview for DSM-IV Axis II (SCID-II; First et al., 1994). The fi ve personality traits assessed on the NEO-FFI are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. T

he MAACL-R was analyzed for Positive Affect and Sensation-Seeking. Antisocial personality disorder severity was found associated with very low Agreeableness and high Sensation-Seeking. Borderline personality disorder severity was not associated with the NEO-FFI or MAACL-R traits. Avoidant severity was associated with higher Neuroticism and lower Extraversion, Openness to Experience, Sensation-Seeking, and Positive Affect. Depressive severity was associated with lower Extraversion. In terms ofEMS, antisocial personality was linked to Mistrust/Abuse, Vulnerability to Harm, and Emotional Inhibition. Borderline severity was linked with Abandonment/Instability and Mistrust/Abuse schemas. Avoidant severity was associated with Subjugation, and depressive severity was associated with Mistrust/Abuse, Social Isolation, Defectiveness/Shame, Failure to Achieve, and Subjugation schemas.

Loper (2003) examined the relationship among the schema domains of the YSQ-S1 (Young, 1998), behavioral adjustment, and personality disorders among female prison inmates. The Impaired Limits domain score, representing Entitlement and Poor Self Control, was associated with paranoid, antisocial, borderline, histrionic, and narcissistic personality disorders. The Disconnection/Rejection domain score was associated with a wide array of symptoms. A significant relationship was found between the Impaired Autonomy domain score and dependent personality disorder. This study suggests that specific belief systems are associated with specific personality (and behavior) patterns.

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