PERSONALITY AND PSYCHOLOGICAL DISORDERS Dedication To the 21 Oxford students on whom we tested an early version of this book. PERSONALITY AND PSYCHOLOGICAL DISORDERS G O R D O N C L A R I D G E a n d C A R O L I N E D AV I S First published in Great Britain in 2003 by Arnold, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.arnoldpublishers.com Distributed in the United States of America by Oxford University Press Inc. 198 Madison Avenue, New York, NY10016 © 2003 Gordon Claridge and Caroline Davis All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, recording or any information storage or retrieval system, without either prior permission in writing from the publisher or a licence permitting restricted copying. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP. The advice and information in this book are believed to be true and accurate at the date of going to press, but neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN 0 340 807148 (hb) iv ISBN 978 0 340 807156 (pb) 2 3 4 5 6 7 8 9 10 Typeset in 11/12.5pt Garamond 3 by Dorchester Typesetting Group Ltd Printed and bound in India What do you think about this book? Or any other Arnold title? Please send your comments to [email protected] Contents Preface ix Chapter 1 Connecting personality and disorder 1 Some theoretical issues 1 An historical perspective 6 Layout of the book 8 Chapter 2 Description, classification, and models of disorder 11 The medical classification 11 The dimensional approach 16 Historical considerations: HJ Eysenck 16 Comments on Eysenck’s theory 19 A dimensional model of psychological disorder 20 From continuity to discontinuity 23 Summary and conclusions 28 Chapter 3 Personality dimensions: description and biology 31 Historical antecedents and Eysenck’s theory 31 The Eysenck dimensions 33 v Eysenck’s ‘causal’ theories 34 A note on the status of Psychoticism (P) 37 Temperament and personality compared 38 Contemporary theorists 40 Gray 40 Cloninger 44 Zuckerman 46 Five-factor theory (Costa & McCrae) 48 An integrated view of the theories 50 Genetic considerations 53 Behaviour genetics 53 Molecular genetics 56 The developmental perspective 57 Summary and conclusions 59 Chapter 4 Personality disorders 60 Some basic features 60 Personality disorders in DSM-IV 62 Personality disorders and models of the abnormal 66 Approaches to the explanation of personality disorders 67 Five-factor theory and Axis II 68 Cloninger revisited 70 The work of Millon 71 Beck’s cognitive approach 72 Particular personality disorders 74 Antisocial personality disorder (psychopathy) 75 Borderline personality disorder 80 Summary and conclusions 86 Chapter 5 Mood and anxiety disorders 88 Introduction 88 Animal models 91 Common symptoms of mood and anxiety disorders 95 Fearfulness 96 Anxiousness 101 Melancholy 106 vi Chapter 6 Obsessive–Compulsive Disorder 113 Introduction 113 Natural history of the disorder 115 Causal explanations of OCD 117 Biological models 117 Cognitive models of OCD 121 Personality factors in OCD 124 Obsessive-Compulsive spectrum disorders 128 Chapter 7 Addictive behaviours 131 Introduction 131 Clinical features 133 The neurobiology of addiction 136 Chronic use of addictive behaviours 140 Vulnerability to addiction 141 Sensitivity to reward (SRT) 143 Impulsive behaviour 147 Proneness to anxiety and negative mood 150 Chapter 8 Eating disorders 155 Introduction 155 Clinical features 156 Historical perspectives 158 Research methodology 160 Temperament and personality 164 Obsessionality and the eating disorders 165 Perfectionism and the eating disorders 167 Impulsivity and the eating disorders 169 Anxiousness and the eating disorders 170 Sensitivity to reward, addiction, and the eating disorders 175 The pathophysiology of eating disorders 177 Conclusions 180 Chapter 9 Psychotic disorders 181 Definitions and descriptions 181 The issue of heterogeneity 185 vii One psychosis or two? 185 One schizophrenia or several? 186 Dimensional aspects of schizophrenia 187 Quasi- versus fully dimensional models 188 Measurement of schizotypy 190 Explaining schizophrenia 192 Research problems and strategies 192 Genetics and risk for schizophrenia 193 Experimental psychopathology of schizophrenia 197 Brain systems in schizophrenia 201 Manic depression 205 The unitary psychosis issue 205 Dimensionality of manic depression 206 Conclusions 207 Chapter 10 Final remarks 211 References 217 Index 245 viii P r e f a c e As is often the case, this book had a serendipitous beginning. More precisely, it started after one of us could not resist voicing his opinion to Arnold that there was a need for a book like ‘Personality and Psychological Disorders’. Before we knew it, we were writing one! And having finished it we can now see why there hasn’t been one before, at least one at a factual level of complexity sufficient to be informative, but not too detailed to be inaccessible to the readers for whom it is mainly intended. We hope we have come some way towards striking that difficult balance; for each of the two areas covered is itself a huge branch of psychology, with many different viewpoints and examples that clamour to be represented. Indeed, the two topics – individual differences and psychological disorders – are generally taught separately in psychology degree courses and, in our experience, reference from one to the other, even if occurs, is sketchy and tentative. This is a pity because, as we try to show in this book, the study of personality may be usefully enriched by looking beyond the average and the healthy; whilst the deviant states of mind ix and behaviour that constitute the subject matter of abnormal and clinical psychology can scarcely be understood without reference to some concept of normality. As described in the early chapters of the book, the arguments we develop and the material we present, concentrate on a certain way of thinking about the connection between normal and abnormal: one that draws particularly on its biology, yet without embracing a straightforwardly disease view of psychological disorder. This perspective has not always been uncontroversial – and that is still the case in some quarters. We chose it because it is well- grounded in the history of ideas about the topic, is supported by considerable past and present scientific evidence, and, looking to the future, is likely to