Learning Objectives
- Describe the biological causes of personality disorders.
- Describe the psychological causes of personality disorders.
- Describe the social causes of personality disorders.
Research regarding the development of personality disorders is limited compared to that of other mental health disorders. The following is a general overview of contributing factors to personality disorders. While there is some research lending itself to specific causes of specific personality disorders, the overall contribution of biological, psychological, and social factors will be reviewed.
Biological
Research across the personality disorders suggests some underlying biological or genetic component; however, identification of specific mechanisms have not been identified in most disorders, except for those below. Because of this lack of concrete evidence, researchers argue that it is difficult to determine what role genetics plays into the development of these disorders compared to that of environmental influences. Therefore, while there is likely a biological predisposition to personality disorders, exact causes cannot be determined at this time.
Research on the development of schizotypal personality disorder has identified similar biological causes to that of schizophrenia—high activity of dopamine and enlarged brain ventricles (Lener et al., 2015). Similar differences in neuroanatomy may explain the high similarity of behaviors in both schizophrenia and schizotypal personality disorder.
Surprisingly, antisocial personality disorder and borderline personality disorder also have similar neurological changes. More specifically, individuals with both disorders reportedly show deficits in serotonin activity (Thompson, Ramos, & Willett, 2014). These low levels of serotonin activity in combination with deficient functioning of the frontal lobes—particularly the prefrontal cortex which is used in planning, self-control, and decision making—as well as an overly reactive amygdala, may explain the impulsive and aggressive nature of both antisocial and borderline personality disorder (Stone, 2014).
Psychological
Psychodynamic, cognitive, and behavioral theories are among the most common psychological models used to explain the development of personality disorders. Although much is still speculation, the following are general etiological views with regards to each specific theory.
13.4.2.1. Psychodynamic. The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individual’s inability to establish healthy relationships in adulthood. More specifically, individuals with personality disorders report higher levels of childhood stress, such as living in impoverished environments, exposure to domestic violence, and experiencing repeated maltreatment (Kumari et al., 2014). Additionally, high levels of childhood neglect and parental rejection are also observed in personality disorder patients, with early parental loss and rejection leading to fears of abandonment throughout an individual’s life (Newnham & Janca, 2014; Roepke & Varter, 2014; Caligor & Clarkin, 2010).
Psychodynamic theorists believe that maltreatment in early childhood has the potential to negatively affect an individual’s sense of self and their perception of others, leading to the development of a personality disorder. For example, an individual who was neglected as a young child and deprived of love may report a lack of trust in others as an adult, a characteristic of antisocial personality disorder (Meloy & Yakeley, 2010). Difficulty trusting others or beliefs that they are unable to be loved may also impact one’s ability or desire to establish social relationships, as seen in many personality disorders, particularly schizoid. Because of these early childhood deficits, individuals may also overcompensate in their relationships to convince themselves that they are worthy of love and affection (Celani, 2014). Conversely, individuals may respond to their early childhood experiences by becoming emotionally distant, using relationships as a sense of power and destructiveness.
13.4.2.2. Cognitive. While psychodynamic theory emphasizes early childhood experiences, cognitive theorists focus on the maladaptive thought patterns and cognitive distortions displayed by those with personality disorders. Overall deficiencies in thinking can lead individuals with personality disorders to develop inaccurate perceptions of others (Beck, 2015). These dysfunctional beliefs likely originate from the interaction between a biological predisposition and undesirable environmental experiences. Maladaptive thought patterns and strategies are strengthened during aversive life events as a protective mechanism and ultimately come together to form patterns of behavior displayed in personality disorders (Beck, 2015).
Cognitive distortions such as dichotomous thinking, also known as all-or-nothing thinking, are observed in several personality disorders. More specifically, dichotomous thinking explains rigidity and perfectionism in OCPD, and the lack of self-sufficiency among individuals with dependent and borderline personality disorders (Weishaar & Beck, 2006). Discounting the positive also explains the underlying mechanisms for avoidant personality disorder (Weishaar & Beck, 2006). For example, individuals who have been routinely criticized or rejected during childhood may have difficulty accepting positive feedback from others, expecting only to receive rejection and harsh criticism. In fact, they may employ these misattributions to positive feedback to support their ongoing theory that they are constantly rejected and criticized by others.
13.4.2.3. Behavioral. Behavioral theorists apply three major theories to explain the development of personality disorders: modeling, reinforcement, and lack of social skills. In modeling, an individual learns maladaptive social patterns and behaviors by directly observing family members engaging in similar behaviors (Gaynor & Baird, 2007). While we cannot discredit the biological component of the familial influence, research does support an additive modeling or imitating component to the development of personality disorders, especially antisocial personality disorder (APA, 2022).
Reinforcement, or rewarding of maladaptive behaviors is also observed in the development of many personality disorders. Parents may unintentionally reward aggressive behaviors by giving in to a child’s desires to cease the situation or prevent escalation of behaviors. When this is done repeatedly over time, children (and later as adults) continue with these maladaptive behaviors as they are effective in gaining their needs and wants. On the other side, there is some speculation that excessive reinforcement or praise during childhood may contribute to the grandiose sense of self observed in individuals with narcissistic personality disorder (Millon, 2011).
Finally, failure to develop normal social skills may explain the development of some personality disorders, such as avoidant personality disorder (Kantor, 2010).
Social
13.4.3.1. Family dysfunction. High levels of psychological and social dysfunction within families have also been identified as contributing factors to the development of personality disorders. High levels of poverty, unemployment, family separation, and witnessing domestic violence are routinely observed in individuals diagnosed with personality disorders (Paris, 1996). While formalized research has yet to explore the relationship between SES and personality disorders fully, correlational studies suggest a link between poverty, unemployment, and poor academic achievement with increased levels of personality disorder diagnoses (Alwin, 2006).
13.4.3.2. Childhood maltreatment. Childhood maltreatment is among the most influential argument for the development of personality disorders in adulthood. Individuals with personality disorders often struggle with a sense of self and the ability to relate to others—something that is generally developed during the first four to six years of a child’s life, and it is affected by the emotional environment in which that child was raised. This sense of self is the mechanism in which individuals view themselves within their social context, while also informing attitudes and expectations of others. A child who experiences significant maltreatment, whether it be through neglect or physical, emotional, or sexual abuse, is at-risk for an underdeveloped or absent sense of self. Due to the lack of affection, discipline, or autonomy during childhood, these individuals are unable to engage in appropriate relationships as adults as seen across the spectrum of personality disorders.
Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers. John Bowlby thoroughly researched the relationship between attachment and emotional development as he explored the need for affection in Harlow monkeys (Bowlby, 1998). Based on Bowlby’s research, four attachment styles have been identified: secure, anxious, ambivalent, and disorganized. While securely attached children generally do not develop personality disorders, those with anxious, ambivalent, and disorganized attachment are at an increased risk of developing various disorders. More specifically, those with an anxious attachment are at-risk for developing internalizing disorders, ambivalent are at-risk for developing externalizing disorders, and disorganized are at-risk for dissociative symptoms and personality-related disorders (Alwin, 2006).
Key Takeaways
You should have learned the following in this section:
- Biological causes of personality disorders have not been identified in most disorders, the exception being schizotypal which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes.
- Psychological causes of personality disorders include negative early childhood experiences; maladaptive thought patterns and cognitive distortions; and modeling, reinforcement, and lack of social skills.
- Social causes of personality disorders include high levels of psychological and social dysfunction within families and maltreatment.
Review Questions
- What personality disorders are most explained by the biological model?
- How does the psychodynamic model explain the development of personality disorders?
- What cognitive distortions are most discussed with respect to personality disorders?
- What are the three behavioral theories used to explain the development of personality disorders?
- Discuss the roll of attachment and how theorists have used it to explain the development of personality disorders.
