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5 - Multiple Roads to Pathology

A Complex Systems Perspective on Personality Disorders

from Part II - Contemporary Approaches to Traditional Conceptual Perspectives

Published online by Cambridge University Press:  25 June 2025

By
Angélique O. J. Cramer  and
Denny Borsboom
Edited by
Konrad Banicki  and
Peter Zachar
Konrad Banicki
Affiliation:
Jagiellonian University, Krakow
Peter Zachar
Affiliation:
Auburn University, Montgomery
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Summary

In this chapter we outline a theoretical perspective in which personality (relatively normal or dysfunctional) is the ultimate outcome (i.e. equilibrium state) of a mutualistic, dynamical system in which the building blocks of personality (i.e. components) interact with one another over time. These interactions give rise to dynamical couplings between thoughts, feelings, behaviours and environment. These couplings arise through multiple potential mechanisms, for example resource competition and a drive for consistency. As a result of particular architectures of the dynamical system, dysfunctional states can become stable features of the system, and we recognize these states as personality disorders. By means of a toy simulation dynamical model, we show some of the, potentially many, roads to developing personality disorders. Finally, we highlight four implications of our systems perspective on personality disorders on future research.

Keywords

personality disorderscomplex systemsnetwork perspective
Type
Chapter
Information
Conceptualizing Personality Disorder
Perspectives from Philosophy, Psychological Science, and Psychiatry
 , pp. 86 - 107
Publisher: Cambridge University Press
Print publication year: 2025

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References

Ackerman, P. L., Beier, M. E., & Boyle, M. O. (2005). Working memory and intelligence: The same or different constructs? Psychological Bulletin, 131(1), 30–60. https://doi.org/10.1037/0033-2909.131.1.30CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.Google Scholar
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735–743. https://doi.org/10.1016/S0140-6736(14)61394-5CrossRefGoogle ScholarPubMed
Berrios, G. E. (1993). European views on personality disorders: A conceptual history. Comprehensive Psychiatry, 34(1), 14–30. https://doi.org/10.1016/0010-440X(93)90031-XCrossRefGoogle ScholarPubMed
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13. https://doi.org/10.1002/wps.20375CrossRefGoogle ScholarPubMed
Borsboom, D., Cramer, A. O. J., & Kalis, A. (2019). Brain disorders? Not really: Why network structures block reductionism in psychopathology research. Behavioral and Brain Sciences, 42, e2. https://doi.org/10.1017/S0140525X17002266CrossRefGoogle Scholar
Borsboom, D., Rhemtulla, M., Cramer, A. O. J., Maas, H. L. J. van der, Scheffer, M., & Dolan, C. V. (2016). Kinds versus continua: A review of psychometric approaches to uncover the structure of psychiatric constructs. Psychological Medicine, 46(8), 1567–1579. https://doi.org/10.1017/S0033291715001944CrossRefGoogle ScholarPubMed
Caruana, E., Cotton, S. M., Farhall, J., Parrish, E. M., Chanen, A., Davey, C. G., Killackey, E., & Allott, K. (2018). A comparison of vocational engagement among young people with psychosis, depression and borderline personality pathology. Community Mental Health Journal, 54(6), 831–841. https://doi.org/10.1007/s10597-017-0197-5CrossRefGoogle ScholarPubMed
Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current Psychiatry Reports, 22(5), 25. https://doi.org/10.1007/s11920-020-01144-5CrossRefGoogle ScholarPubMed
Condon, D. M., Wood, D., Mõttus, R., Booth, T., Costantini, G., Greiff, S., Johnson, W., Lukaszewski, A., Murray, A., Revelle, W., Wright, A. G. C., Ziegler, M., & Zimmermann, J. (2021). Bottom up construction of a personality taxonomy. European Journal of Psychological Assessment, 36, 923–934. https://econtent.hogrefe.com/doi/10.1027/1015-5759/a000626CrossRefGoogle Scholar
Cramer, A. O. J., Borkulo, C. D. van, Giltay, E. J., Maas, H. L. J. van der, Kendler, K. S., Scheffer, M., & Borsboom, D. (2016). Major depression as a complex dynamic system. PLoS One, 11(12), e0167490. https://doi.org/10.1371/journal.pone.0167490CrossRefGoogle ScholarPubMed
Cramer, A. O. J., van der Sluis, S., Noordhof, A., Wichers, M., Geschwind, N., Aggen, S. H., Kendler, K. S., & Borsboom, D. (2012a). Dimensions of normal personality as networks in search of equilibrium: You can’t like parties if you don’t like people. European Journal of Personality, 26(4), 414–431. https://doi.org/10.1002/per.1866CrossRefGoogle Scholar
Cramer, A. O. J., Van Der Sluis, S., Noordhof, A., Wichers, M., Geschwind, N., Aggen, S. H., Kendler, K. S., & Borsboom, D. (2012b). Measurable like temperature or mereological like flocking? On the nature of personality traits. European Journal of Personality, 26(4), 451–459. https://doi.org/10.1002/per.1879CrossRefGoogle Scholar
Cramer, A. O. J., Waldorp, L. J., Maas, H. L. J. van der, & Borsboom, D. (2010). Comorbidity: A network perspective. Behavioral and Brain Sciences, 33(2–3), 137–150. https://doi.org/10.1017/S0140525X09991567CrossRefGoogle ScholarPubMed
Crocq, M.-A. (2013). Milestones in the history of personality disorders. Dialogues in Clinical Neuroscience, 15(2), 147–153. https://doi.org/10.31887/DCNS.2013.15.2/macrocqCrossRefGoogle ScholarPubMed
Cui, J., Lunansky, G., Lichtwarck-Aschoff, A., Mendoza, N. B., & Hasselman, F. (2023). Quantifying the stability landscapes of psychological networks [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/nd8zcCrossRefGoogle Scholar
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026CrossRefGoogle ScholarPubMed
De Ron, J., Deserno, M., Robinaugh, D., Borsboom, D., & Van Der Maas, H. L. J. (2023). Towards a general modeling framework of resource competition in cognitive development. Child Development, 94(6), 1432–1453. https://doi.org/10.1111/cdev.13973CrossRefGoogle ScholarPubMed
Fleury, M.-J., Djouini, A., Huỳnh, C., Tremblay, J., Ferland, F., Ménard, J.-M., & Belleville, G. (2016). Remission from substance use disorders: A systematic review and meta-analysis. Drug and Alcohol Dependence, 168, 293–306. https://doi.org/10.1016/j.drugalcdep.2016.08.625CrossRefGoogle ScholarPubMed
Frances, A. (1993). Dimensional diagnosis of personality – Not whether, but when and which. Psychological Inquiry. https://doi.org/10.1207/s15327965pli0402_7CrossRefGoogle Scholar
Grenyer, B. F. S., Townsend, M. L., Lewis, K., & Day, N. (2022). To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder. Personality and Mental Health, 16(2), 138–154. https://doi.org/10.1002/pmh.1547CrossRefGoogle Scholar
Gueorguieva, R., Chekroud, A. M., & Krystal, J. H. (2017). Trajectories of relapse in randomised, placebo-controlled trials of treatment discontinuation in major depressive disorder: An individual patient-level data meta-analysis. The Lancet Psychiatry, 4(3), 230–237. https://doi.org/10.1016/S2215-0366(17)30038-XCrossRefGoogle ScholarPubMed
Harmon-Jones, E., & Mills, J. (2019). An introduction to cognitive dissonance theory and an overview of current perspectives on the theory. In Harmon-Jones, E. (ed.), Cognitive dissonance: Reexamining a pivotal theory in psychology, 2nd ed. (pp. 3–24). American Psychological Association.CrossRefGoogle Scholar
Hastrup, L. H., Kongerslev, M. T., & Simonsen, E. (2019). Low vocational outcome among people diagnosed with borderline personality disorder during first admission to mental health services in Denmark: A nationwide 9-year register-based study. Journal of Personality Disorders, 33(3), 326–340. https://doi.org/10.1521/pedi_2018_32_344CrossRefGoogle Scholar
Hochstein, S. (2012). Reciprocal effects of attention and perception. In Wolfe, J., & Robertson, L. (eds), From perception to consciousness: Searching with Anne Treisman (pp. 278–287). Oxford University Press.CrossRefGoogle Scholar
Juurlink, T. T., Lamers, F., van Marle, H. J. F., Michon, H., van Busschbach, J. T., Beekman, A. T. F., & Anema, J. R. (2020). Employment in personality disorders and the effectiveness of individual placement and support: Outcomes from a secondary data analysis. Journal of Occupational Rehabilitation, 30(2), 255–262. https://doi.org/10.1007/s10926-019-09868-9CrossRefGoogle ScholarPubMed
Katakis, P., Schlief, M., Barnett, P., Rains, L. S., Rowe, S., Pilling, S., & Johnson, S. (2023). Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: Systematic review and meta-analysis. BMC Psychiatry, 23(1), 57. https://doi.org/10.1186/s12888-022-04483-0CrossRefGoogle ScholarPubMed
Kendler, K. S. Parnas, J. and Zachar, P. (Eds.). (2025). Causal concepts in psychiatry. Cambridge University Press.Google Scholar
Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42(9), 1879–1890. https://doi.org/10.1017/S0033291711002674CrossRefGoogle ScholarPubMed
Krueger, R. F., & Hobbs, K. A. (2020). An overview of the DSM-5 Alternative Model of personality disorders. Psychopathology, 53(3–4), 126–132. https://doi.org/10.1159/000508538CrossRefGoogle ScholarPubMed
Laws, D. R., Hudson, S. M., & Ward, T. (2000). Remaking relapse prevention with sex offenders: A sourcebook. SAGE.CrossRefGoogle Scholar
Leichsenring, F., Fonagy, P., Heim, N., Kernberg, O. F., Leweke, F., Luyten, P., Salzer, S., Spitzer, C., & Steinert, C. (2024). Borderline personality disorder: A comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry, 23(1), 4–25. https://doi.org/10.1002/wps.21156CrossRefGoogle ScholarPubMed
Leichsenring, F., Steinert, C., Rabung, S., & Ioannidis, J. P. A. (2022). The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: An umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry, 21(1), 133–145. https://doi.org/10.1002/wps.20941CrossRefGoogle ScholarPubMed
Lunansky, G., van Borkulo, C., & Borsboom, D. (2020). Personality, resilience, and psychopathology: A model for the interaction between slow and fast network processes in the context of mental health. European Journal of Personality, 34(6), 969–987. https://doi.org/10.1002/per.2263CrossRefGoogle Scholar
McCrae, R. R., Costa, Jr., Paul T., & Martin, T. A. (2005). The NEO-PI-3: A more readable revised NEO personality inventory. Journal of Personality Assessment, 84(3), 261–270. https://doi.org/10.1207/s15327752jpa8403_05CrossRefGoogle ScholarPubMed
McCrae, R. R., & Costa, P. T. (2008). Empirical and theoretical status of the five-factor model of personality traits. In Boyle, G. J., Matthews, G., & Saklofske, D. H. (eds), The SAGE handbook of personality theory and assessment: Volume 1 – Personality theories and models (pp. 273–294). SAGE Publications Inc.CrossRefGoogle Scholar
Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2023). The serotonin theory of depression: A systematic umbrella review of the evidence. Molecular Psychiatry, 28(8), Article 8. https://doi.org/10.1038/s41380-022-01661-0CrossRefGoogle ScholarPubMed
Moran, P., Romaniuk, H., Coffey, C., Chanen, A., Degenhardt, L., Borschmann, R., & Patton, G. C. (2016). The influence of personality disorder on the future mental health and social adjustment of young adults: A population-based, longitudinal cohort study. The Lancet Psychiatry, 3(7), 636–645. https://doi.org/10.1016/S2215-0366(16)30029-3CrossRefGoogle ScholarPubMed
Mõttus, R., Kandler, C., Bleidorn, W., Riemann, R., & McCrae, R. R. (2017). Personality traits below facets: The consensual validity, longitudinal stability, heritability, and utility of personality nuances. Journal of Personality and Social Psychology, 112(3), 474–490. https://doi.org/10.1037/pspp0000100CrossRefGoogle ScholarPubMed
Mõttus, R., Wood, D., Condon, D. M., Back, M. D., Baumert, A., Costantini, G., Epskamp, S., Greiff, S., Johnson, W., Lukaszewski, A., Murray, A., Revelle, W., Wright, A. G. C., Yarkoni, T., Ziegler, M., & Zimmermann, J. (2020). Descriptive, predictive and explanatory personality research: Different goals, different approaches, but a shared need to move beyond the big few traits. European Journal of Personality, 34(6), 1175–1201. https://doi.org/10.1002/per.2311CrossRefGoogle Scholar
Roberts, B. W., & Mroczek, D. (2008). Personality trait change in adulthood. Current Directions in Psychological Science, 17(1), 31–35. https://doi.org/10.1111/j.1467-8721.2008.00543.xCrossRefGoogle ScholarPubMed
Roberts, B. W., Wood, D., & Caspi, A. (2008). The development of personality traits in adulthood. In John, O. P., Robins, R. W., & Pervin, L. A. (eds), Handbook of personality: Theory and research, 3rd ed. (pp. 375–398). The Guilford Press.Google Scholar
Skodol, A. E. (2016). Personality pathology and population health. The Lancet Psychiatry, 3(7), 595–596. https://doi.org/10.1016/S2215-0366(16)30084-0CrossRefGoogle ScholarPubMed
Van Der Maas, H. L. J., Dolan, C. V., Grasman, R. P. P. P., Wicherts, J. M., Huizenga, H. M., & Raijmakers, M. E. J. (2006). A dynamical model of general intelligence: The positive manifold of intelligence by mutualism. Psychological Review, 113(4), 842–861. https://doi.org/10.1037/0033-295X.113.4.842CrossRefGoogle ScholarPubMed
von Klipstein, L., Borsboom, D., & Arntz, A. (2021). The exploratory value of cross-sectional partial correlation networks: Predicting relationships between change trajectories in borderline personality disorder. PLoS One, 16(7), e0254496. https://doi.org/10.1371/journal.pone.0254496CrossRefGoogle ScholarPubMed
Widiger, T. A. (1993). The DSM-III-R categorical personality disorder diagnoses: A critique and an alternative. Psychological Inquiry, 4(2), 75–90. https://doi.org/10.1207/s15327965pli0402_1CrossRefGoogle Scholar
Widiger, T. A., & McCabe, G. A. (2020). The alternative model of personality disorders (AMPD) from the perspective of the five-factor model. Psychopathology, 53(3–4), 149–156. https://doi.org/10.1159/000507378CrossRefGoogle ScholarPubMed
Widiger, T. A., & Mullins-Sweatt, S. N. (2009). Five-factor model of personality disorder: A proposal for DSM-V. Annual Review of Clinical Psychology, 5, 197–220. https://doi.org/10.1146/annurev.clinpsy.032408.153542CrossRefGoogle ScholarPubMed

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