Abnormal Psychology

Personality Disorders 577

The attachment style established during childhood often continues into adulthood,

affecting how the individual relates to others (Waller & Shaver, 1994). Most chil-

dren develop a secure attachment (Schmitt et al., 2004), which is marked by a posi-

tive view of their own worth and of the availability of others. However, a signifi cant

minority of children develop an insecure attachment, which can involve a negative

view of their own worth, the expectation that others will be unavailable, or both

(Bretherton, 1991). People with personality disorders are more likely to have inse-

cure attachment (Crawford et al., 2006).

People can develop insecure attachments for a variety of

reasons, such as childhood abuse (sexual, physical, or verbal),

neglect, or inconsistent discipline (Johnson, Bromley, & McGeoch,

2005; Johnson, Cohen, Chen, et al., 2006; Paris, 2001). Consider

Reiland’s experience with her father:

My father hadn’t spared me because I was Daddy’s little girl. It was

because he worked such long hours and because I had witnessed so

much I had become adept at avoiding him. Often his explosive vio-

lence had been irrational and triggered by the slightest provocation;

a facial expression he found disrespectful, tears he didn’t want to

see, any expression of emotion he didn’t have patience for. And the

rules changed all the time. Something that could bring him to smile

or laugh one day could provoke him to angrily pull off his belt a few

days or hours later.... Dad had been far harsher on his daughters

than his sons, particularly verbally. To a man who coveted control

and saw any emotion, particularly tears, as weakness, his daughters

could provoke the worst in him. In his mind, women were weak, ma-

nipulative, overemotional, and inferior.

(2004, p. 84)

Reiland’s father abused her physically and verbally, alternating the

abuse with bouts of neglect. However, such social risk factors may

lead to psychopathology in general, not personality disorders in particular (Kendler

et al., 2000). A single traumatic event does not generally lead to a personality disorder

(Rutter, 1999).

FEEDBACK LOOPS IN ACTION: Understanding Personality Disorders

Neurological, psychological, and social factors create feedback loops with each

other (see Figure 13.3). As with other kinds of psychological disorders, no one

factor reigns supreme as the underlying basis of personality disorders. People must

have several adverse factors—whether neurological, psychological, or social—to

develop a personality disorder, and social adversity will have the biggest effect

on those who are neurologically vulnerable (Paris, 2005). Careful examination of

social risk factors, for instance, shows the importance of their infl uence on other

factors: People with personality disorders tend to have parents with Axis I or II

disorders (Bandelow et al., 2005; Siever & Davis, 1991). In Reiland’s case, her

father’s unpredictable rages suggest some type of disorder, and neither parent

functioned very well at home. Parents’ dysfunctional behavior clearly creates a

stressful social environment for children, and the children may also inherit a pre-

disposition toward a specifi c temperament (neurological factor). Similarly, chronic

stress and abuse, such as Reiland experienced, affects brain structure and function

(neurological factor; Teicher et al., 2003), which in turn affects mental processes

(psychological factor).

The specifi c personality disorder an individual develops depends on his or her

temperament and family members’ reactions to that temperament (Linehan, 1993;

Rutter & Maughan, 1997). For instance, children with diffi cult temperaments—

particularly behaviorally inhibited or passive temperaments—tend to have more

confl ict with their parents and peers (Millon, 1981; Rutter & Quinton, 1984), which

leads them to experience a higher incidence of physical abuse and social rejection.

These children may then come to expect (psychological factor) to be treated poorly

by others (social factor). Thus, social factors can amplify underlying temperaments

Insecure attachment to a

parent can make a child

vulnerable to developing

a personality disorder.

Insecure attachment can

arise from abuse, neglect,

or inconsistent discipline.

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