Abnormal Psychology

Personality Disorders 599

psychopathy who are in prison are likely to commit additional crimes after their release

(Ogloff, Wong, & Greenwood, 1990; Seto & Barbaree, 1999). When an individual with

psychopathy is violent, managing the patient, rather than treating the patient’s personal-

ity problems, may be the more realistic and appropriate goal (Ogloff, 2006).

People with antisocial personality disorder who are most likely to respond to

treatment have a comorbid anxiety disorder, and this capacity for anxiety may sug-

gest that such people are not psychopaths (Meloy, 1988). A challenge in treating

people with antisocial personality disorder is their utter lack of motivation. Because

they aren’t disturbed by their behavior, they are rarely genuinely motivated to change,

which makes any real collaboration between therapist and patient unlikely; patients

often will attend therapy only when required to do so. Treatment generally focuses

on changing overt behaviors (Farmer & Nelson-Gray, 2005).

Treatments for people with antisocial personality disorder who are not psy-

chopathic have some success—at least in the short term. These treatments focus on

comorbid substance abuse and aggressive behavior (Henning & Frueh, 1996). The

most effective treatments provide clear rules about behavior (including clear and

consistent consequences for rule violations) and target behavior change and behav-

ioral control, as is addressed with CBT. Such treatment programs teach patients to

recognize triggers for problematic behaviors, devise more adaptive solutions, and

foster impulse control (Fabiano, Robinson, & Porporino, 1990; MacKenzie, 2001).

In contrast, treatments that target emotional and social factors, such as empathy

training or social skills training, are less effective (Gacono et al., 2001).

Treatments that target social factors include family therapy aimed at decreasing in-

advertent support from family members for antisocial behavior. These social treatments

teach the patient and family members new ways of interacting (Gacono et al., 2001).

In jail (or as a court-mandated alternative to jail time), some people may participate in

therapeutic communities, 24-hour programs that tightly control the patient’s behavior;

some therapeutic communities are situated in prisons or jails. Research indicates that

therapeutic communities can be effective for people who have both antisocial personal-

ity disorder and substance abuse (McKendrick et al., 2007; Woodall et al., 2007).

In sum, there is little research on treatments for antisocial personality disorder

in people who do not also have comorbid substance use disorders. Treatment is usu-

ally court-ordered, and its effectiveness depends on whether the individual also has

psychopathy or other psychological problems, and hinges in large part on his or her

motivation to change.

Borderline Personality Disorder

The term “borderline personality” originally was used by psychodynamic thera-

pists to describe patients whose personality was on the border between neurosis

and psychosis (Kernberg, 1967). Now, however, it is generally used to describe the

DSM-IV-TR personality disorder that includes some features of that type of person-

ality:borderline personality disorder, which is characterized by volatile emotions, an

unstable self-image, and impulsive behavior in relationships (American Psychiatric

Association, 2000). The diagnostic criteria for borderline personality disorder are

noted in Table 13.14. A key criterion is emotional dysregulation (also known as

affective instability, Criterion 6), which leads the individual frequently to respond

more emotionally than a situation warrants and to display quickly changing emo-

tions (Glenn & Klonsky, 2009). Another prominent criterion refers to a relationship

pattern of idealizing the other person at the beginning of the relationship, spending

a lot of time with the person and revealing much, thus creating an intense intimacy.

But then positive feelings quickly switch to negative ones, which leads the individual

with this disorder to devalue the other person (Criterion 2). Rachel Reiland’s pat-

tern of thoughts, feelings, and behaviors meet the criteria for borderline personality

disorder. Reiland describes the switch in how she viewed other people:

I saw people as either good or evil. When they were “good,” I vaulted them to the top

of a pedestal. They could do no wrong, and I loved them with all of my being. When

they were “bad,” they became objects of scorn and revenge.

Borderline personality disorder

A personality disorder characterized by

volatile emotions, an unstable self-image,

and impulsive behavior in relationships.