Encyclopedia of Psychology and Law

individuals would also meet the criteria for psychopa-

thy. The “psychopathic personality” was described by

Emil Kraepelin in 1915 while referring to a subgroup

of criminals who lacked a sense of morals. In 1941, Hervey

Cleckley elaborated the construct through detailed case

studies in his groundbreaking book, The Mask of

Sanity. Cleckley’s conceptualization of the psycho-

pathic personality as manipulative, selfish, impulsive,

and lacking empathy, remorse, and anxiety has since

remained more or less intact. The defining characteris-

tics of psychopathy include a combination of both

interpersonal and affective deficits as well as overt anti-

social behavior. These two factors were referred to as

primary and secondary psychopathy, respectively, and

remain at the foundation of modern assessment.

BBoorrddeerrlliinnee PPeerrssoonnaalliittyy DDiissoorrddeerr

The term borderline personality was originally

used to refer to individuals who were thought to be on

the “border” between neurosis and psychosis. As it is

currently defined, however, borderline personality dis-

order (BPD) is characterized by instability in affect,

interpersonal relationships, and self-image, as well as

markedly impulsive behavior. Individuals with BPD

exhibit serious disturbances in basic identity. As

a result of their unstable self-images, they also have

highly unstable and intense interpersonal relation-

ships, characterized by alternating between extremes

of idealization and devaluation of others. They make

desperate efforts to avoid real or imagined abandon-

ment. Borderline individuals commonly have an intol-

erance for being alone. Their behavioral impulsivity

may be in the areas of sex, gambling, spending sprees,

substance abuse, reckless driving, or binge eating.

Recurrent suicidal behavior is common, including

self-mutilation or “cutting” behavior. Suicide attempts

or gestures are often clearly manipulative, intended to

elicit the response of others. They report chronic feel-

ings of emptiness and often have difficulty controlling

inappropriate expressions of anger. They may experi-

ence transient stress-related symptoms such as para-

noid ideation or severe dissociative symptoms. BPD is

one of the most lethal psychiatric disorders, with up to

10% of identified patients completing suicides. Those

who successfully suicide are more likely to have

comorbid major depressive disorder and/or a family

history of substance abuse. Recent studies estimate

that prevalence rates in the general population are at

about 1% and about 9% in an outpatient psychiatric

setting. Women are three times more likely than men

to be diagnosed with the disorder. There is an ongoing

debate regarding the possibility of gender bias and the

power of applying the label of borderline to a female

patient. BPD is associated with increased utilization

of psychological services and psychopharmacological

treatment. Recent research has suggested that the eti-

ology of BPD can be explained by an interaction of

genetic/biological and environmental factors. Comor-

bidity is found with substance abuse, PTSD, eating

disorders, mood disorders, and personality disorders

from Cluster A.

AAvvooiiddaanntt PPeerrssoonnaalliittyy DDiissoorrddeerr

Individuals with avoidant personality disorder

(AVPD) have a pattern of extreme social inhibition and

withdrawal due to the fear of being rejected, embar-

rassed, or criticized. They often report feelings of inad-

equacy. Because of their hypersensitivity to criticism

and potential rejection, they avoid other people, but,

unlike schizoid individuals, they desire interpersonal

contact and are often lonely or bored. DSM-IVdiagnos-

tic criteria include at least four of the following charac-

teristics: avoidance of occupational activities that

involve significant interpersonal contact due to a fear of

criticism, disapproval, or rejection; unwillingness to get

involved in relationships unless certain of being liked;

restraint in intimate relationships due to a fear of being

shamed or ridiculed; preoccupation with being criti-

cized or rejected in social situations; inhibition in new

interpersonal situations due to feelings of inadequacy;

view of self as socially inept, unappealing, or inferior;

reluctance to take personal risks or engage in new activ-

ities that might result in embarrassment. Behaviorally,

individuals with AVPD are described as shy and

guarded, and although they desire interpersonal rela-

tionships, they are unlikely to engage in them. They

may present as aloof and apprehensive and are likely to

make little eye contact. Epidemiological estimates

place the prevalence of AVPD at between 2% and 5%

in the general population and at about 15% in an outpa-

tient psychiatric setting.

DDeeppeennddeenntt PPeerrssoonnaalliittyy DDiissoorrddeerr

Individuals with dependent personality disorder

(DPD), due to a lack of both self-confidence and

autonomy, have an intense need to be taken care of.

They view themselves as weak and incompetent and

others as strong, leading to submissive and clinging

behaviors due to an extreme fear of separation. They

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