Abstract

Personality Pathology and Marital Adjustment

The symptoms that delineate Axis II personality pathology inevitably lead to difficulties in interacting with the interpersonal world. As others have noted, there are aspects of personality disorders (PDs) beyond trouble with relating to others (e.g., chronicity and dysfunction in multiple social roles; Pilkonis, Kim, Proietti, & Barkham, 1999), but a common overriding theme to all disorders is marked impairment in relationships. Indeed, it is well argued that an inability to pursue fundamental adult life tasks, including “close and meaningful intimate relationships” is at the core of the concept of personality disorder (Krueger, Skodol, Livesley, Shrout, & Huang, 2007). There is research linking personality pathology to the most extreme forms of maladaptive intimate relationships (i.e., partner violence); yet, there is no study to date that examines more normative measures of marital functioning in relation to PD features. This is a surprising gap considering that these disorders are a collection of cognitive, behavioral, and affective traits which are severe and chronic (American Psychiatric Association, 2000) and that lead to significant impairment in social functioning (Skodol et al., 2002).

The current study aims to examine the association between personality disorder symptoms and key features of marital relationships, from satisfaction to verbal conflict and physical violence. Personality pathology is currently represented in the DSM (APA, 2000) as ten disorders which are purportedly distinct from each other and from other forms of psychopathology, although they are grouped together into odd (Cluster A: Paranoid, Schizoid, Schizotypal), dramatic (Cluster B: Antisocial, Borderline, Histrionic, Narcissistic), and fearful (Cluster C: Avoidant, Dependent, and Obsessive-Compulsive) clusters. In practice, there is a great deal of comorbidity among the PDs (Zimmerman, Rothschild, & Chelminski, 2005) and between PDs and normal personality (O’Connor, 2002). There is now a general consensus that PDs are best conceptualized as dimensional constructs (Widiger & Simonsen, 2005) and that abnormal personality is best characterized as extremes of normal personality variation (O’Connor & Dyce, 2001). Krueger et al. (2007) discuss how the reconceptualization of Axis II, particularly defining the boundary between normal and abnormal, will most likely hinge on how to define the “impairment” associated with the specific constellation of traits that define a PD. An important consideration for PD research is to begin to understand when personality pathology results in clinically significant impairment. Thus, in this study we focused on how personality disorder dimensional scores in a community sample are cross-sectionally related to impairment in marital functioning.

The notion that maladaptive personality styles are linked to dysfunction in marriage is not a new concept. Almost 70 years ago, Terman and colleagues posited that certain people’s individual characteristics predispose them to experiencing dissatisfaction within their relationships (Terman, Buttenwieser, Ferguson, Johnson, & Wilson, 1938). More recently, Karney and Bradbury (1995) have proposed a vulnerability-stress-adaptation model of marital quality which describes how the effect of individual differences on marital satisfaction is mediated by interpersonal processes. The enduring vulnerabilities of each spouse, including personality traits, are hypothesized to affect both the stressful events that couples encounter and the types of behavioral exchanges that occur between spouses. Within the last two decades, there has been a renewed interest in personality traits in relation to marital adjustment. This follows from several areas: resurgence in the field of personality generally (c.f., Funder, 2001); statistical advances that allow examination of the joint influence and interdependence of couples on each other (e.g., Campbell & Kashy, 2002); and the relatively modest, and at times, inconsistent, associations found between marital functioning and more process-oriented, interpersonal variables (Bradbury & Karney, 2004).

So far, research on individual differences and marital functioning has not extended to pathological personality features, even though there is growing evidence that the romantic relationships of persons with PDs are often marked by discord (Craig, 2003; Gondolf & White, 2001). In a college student sample, Oltmanns, Melley, and Turkheimer (2002) found that self-reported Paranoid, Schizoid, Schizotypal, Borderline, and Avoidant features, and peer reported Schizoid, Schizotypal, and Obsessive-compulsive features, were all correlated with poor social functioning, which included dating history. Looking specifically at relationship difficulties, Daley, Burge, and Hammen (2000) found that 4-year romantic relationship dysfunction (i.e., chronic stress, relationship quality, partner satisfaction) was best accounted for by general Axis II symptomatology. Chen et al. (2004) examined the amount of conflict in the relationships of a community sample of young adults assessed in adolescence for presence of PD criteria. Individuals with PDs experienced significantly more discord throughout the 10 year follow-up period (from age 17 to 27). Cluster B PDs were associated with the greatest sustained amount of conflict over time. Cluster A and C PDs were related to higher conflict until the age of 23, when relationship conflict in persons with PDs actually declined relative to the no-PD controls.

Personality disorder symptoms have also been repeatedly linked with more serious forms of marital conflict, including intimate partner violence. This research comes from two lines of inquiry. Factor-analytic and behavioral analogue studies of partner-violent spouses, particularly men, have identified the importance of antisocial and borderline personality traits for intimate relationship violence (Dutton, 1995; Edwards, Scott, Yarvis, Paizis, & Panizzon, 2003; Holtzworth-Munroe, 2000; Holtzworth-Munroe, Meehan, Herron, Rehman, & Stuart, 2000; Holtzworth-Munroe & Stuart, 1994; Tweed & Dutton, 1998). Developmental research has also shown links between early temperament and personality traits in childhood and adolescence and later abusive behavior in romantic relationships (Capaldi & Clark, 1998; Ehrensaft, Cohen, & Johnson, 2006; Giordano, Millhollin, Cernkovich, Pugh, & Rudolph, 1999; Magdol, Moffitt, Caspi, & Silva, 1998; Moffitt, Krueger, Caspi, & Fagan, 2000; Moffitt, Robins & Caspi, 2001).

The samples utilized in these studies of intimate partner violence are varied in composition and design. They range from unselected birth cohorts (Giordano et al., 1999; Magdol et al., 1998; Moffitt et al., 2000) to at-risk community samples (Capaldi & Clark, 1998) to men who were court mandated to treatment for domestic violence (Dutton, 1995; Tweed & Dutton, 1998) or were incarcerated at the time of the study (Edwards et al., 2003). Studies examining the most severe or at-risk populations are important, in that they provide information on individuals whose level of impairment has become most detrimental to society. However, these samples may be more likely to include individuals who show a general tendency toward violence, as there is considerable overlap between intimate partner violence and both general violence and non-violent crime (Fagan & Browne, 1994; Fagan & Wexler, 1987). Given our interest in individual difference personality variables that are specifically related to partner violence (Moffitt et al., 2000), for the current study we recruited a community sample that would include individuals who had experienced all levels of conflict, thus increasing the generalizeability of our findings (Karney et al., 1995).

To our knowledge, the current study is the first to examine symptoms across the range of all DSM-IV personality disorders in relationship to marital satisfaction, and the first to examine the association between PD features and both normative (marital satisfaction) and dysfunctional (physical violence) forms of marital functioning in the same study. Previous research linking PDs to partner violence, particularly in men, have all relied on self-reported PD symptoms collected through questionnaires or interviews. Ehrensaft et al. (2006) utilized a composite PD report based on self- and parent-report, but did not directly compare the two types of report. A reliance on self-report may be a particularly important limitation for the assessment of PD criteria, as there are significant discrepancies between self- and informant report of PDs (Klonsky, Oltmanns, & Turkheimer, 2002; Oltmanns & Turkheimer, 2006). There is growing support for supplementing self-report with informant report in the assessment of psychopathology (Achenbach, Krukowski, Dumenci, & Ivanova, 2005), particularly personality disorders (Klein, 2003).

Thus, in the current study, we assessed whether self- and spouse report of PD would be related to marital satisfaction, verbal aggression, and physical violence. It was expected that higher levels of total self-reported personality disorder symptoms would be related to lower levels of one’s own and one’s spouse’s marital satisfaction and higher levels of marital conflict. Further, we expected that the presence of personality pathology as reported by one’s spouse would have a negative impact on own and spouse marital functioning, above and beyond self-report. We also explored whether any of the 10 individual PD scales would add to the explanation of marital functioning after controlling for other personality pathology. Again, we examined marital satisfaction and conflict from self- and spouse-reports from each partner. Based on previous research (e.g., Ehrensaft et al., 2006), we expected that Cluster A and Cluster B disorder symptoms would be negatively related to measures of marital aggression. We viewed the examination of marital satisfaction from PD features as exploratory, and thus made no a priori predictions regarding specific PD scales.

Method

Results

Personality disorder symptoms of both spouses as assessed by self- and spouse report were used to explain the three outcome measures: Marital Satisfaction, Verbal Aggression, and Physical Violence. Marital satisfaction was the target’s own self-reported level of satisfaction with the relationship. The partner conflict measures were composite scores based on both target-and spouse-report of the target’s behavior, reflecting 1) the target’s level of verbal aggression toward his or her partner in the past year, and 2) whether the target had perpetrated any physical violence toward his or her partner in the past 12 months. A series of stepwise multilevel models were conducted by regressing the outcome variables on Total PD scores and each of the 10 individual PD scales. To account for comorbidity among the PD symptom scales, a variable summing all of the other PD symptoms was included in each of the ten separate PD models (e.g., for Paranoid PD, a variable summing all of the symptoms from the nine other PDs). In the first step, gender, age, education level, and other PD symptoms (for the ten individual PD scales) were entered into the equation as covariates. Next, in the second step, Actor—the self-report of the target, and Partner—self-report of the target’s spouse, were entered. Finally, the third step included Partner-by-Spouse—how the target rated their spouse, Actor-by-Spouse—how each target was rated by their spouse, and Discrepancy—the absolute value of the difference between Actor and Actor-by-Spouse, or how different your view of yourself is from your spouse’s view of you. Gender interactions for each independent variable and the interaction of the two spouse reports (Actor X Partner, Actor-by-Spouse X Partner-by-Spouse) were also added to the model; if an interaction was significant, it remained in the model.

Discussion

Overall personality pathology was robustly associated with all three forms of marital functioning. As expected, we found that a person’s own self-reported level of total PD symptoms was associated with verbal aggression and partner violence, confirming previous research which has found significant links between greater number of PD symptoms and higher frequency of partner violence (Ehrensaft et al., 2006; Holtzworth-Munroe et al., 2000; Holtzworth-Munroe & Stuart, 1994). The evidence also demonstrated a significant partner effect for perpetration of physical violence, such that a person’s level of total PD features was significantly related to greater levels of violence perpetrated by his or her partner. Findings for both the Actor and Partner effect for partner violence suggest that people with higher levels of personality pathology may be particularly likely to end up in a relationship that is marked by aggressive behavior by both members of the couple. For marital satisfaction, the target’s self-report of PD symptoms explained a substantial amount of the variance, with higher levels of pathology associated with lower levels of satisfaction. Certainly, this should not be surprising in light of research which suggests that people with personality disorders intensify their interpersonal problems because they are rigid, inflexible, and either unwilling or unable to adapt to the social challenges they encounter (Chen et al., 2004; Johnson, Chen, & Cohen, 2004; Pagano et al., 2004).

A main contribution of the present study is the identification of spouse report as an important source of PD assessment in association with relationship dysfunction. It appears that self- and spouse report of personality are not mutually exclusive with regard to examining relationships with marital functioning The addition of spouse-reported information regarding personality pathology revealed patterns of association with marital functioning not shown by the use of self-reports alone. This was true for spouse-reports of total PD symptoms and all three outcome measures, although which spouse effects were significant differed by outcome. Differences between verbal aggression and physical violence are particularly intriguing, and may indicate either that verbal aggression precedes physical aggression (Murphy & O’Leary, 1989) or that these two forms of conflict are taxometrically different from each other and from satisfaction (Heyman & Smith-Slep, 2006).

Of the individual PDs, Borderline and Dependent PD features were strongly related to low satisfaction and high verbal aggression. The symptoms of emotional lability and identity dysregulation which define borderline PD may predispose an individual to the most serious and maladaptive forms of dysfunction, a finding that fits well with evidence that the most longitudinally stable borderline criteria are impulsivity, anger, and affective instability (McGlashan et al., 2005). It would be difficult for any marriage to survive if one partner was never sure how the other was going to function emotionally on a day to day basis. Of note, in the final model, self-reports of Dependent features were positively related to satisfaction, as has been found in previous research (e.g., Ehrensaft et al., 2006), such that higher levels of dependent PD symptoms were related to greater satisfaction. However, spouse-reports of Dependent symptoms were negatively related to satisfaction, with higher levels of Dependent features as reported by one’s spouse related to lower levels of satisfaction. A similar pattern was found in regard to Verbal Aggression—in the final model, higher levels of self-reported Dependent symptoms were related to the target reporting less verbal aggression against their partner, while higher levels of spouse-report were related to higher levels of verbal aggression. Thus, if I think that I’m dependent, my partner may find that acceptable, possibly even reassuring; however, if my spouse thinks that I’m dependent, her or she may find that aggravating within the context of the relationship. This seems to indicate that the form of dependent PD which is most maladaptive for the marital relationship is best captured by informant report.

Two mechanisms may operate to produce the association between partner-reports of personality pathology and poor marital functioning. First, these individuals may lack insight into their behavior, a notion inherent in most conceptualizations of personality disorder. People with PD traits may have distressed marriages because they do not understand how their dysfunctional behavior will trigger negative reactions from their spouse, thus intensifying their own distress. This hypothesis is supported by the association between ratings of the target by his or her spouse (Actor-by-Spouse) and lower levels of satisfaction and higher levels of verbal aggression. Certainly, disagreement between self- and spouse report does not necessarily imply that the target lacks knowledge of how he or she is viewed by his or her spouse. Previous research has shown that people have some incremental knowledge of how they are viewed by others along PD trait dimensions, but they do not report this information unless specifically queried (Oltmanns, Gleanson, Klonsky, & Turkheimer, 2005). Future research would do well to incorporate reports of how each target expects to be rated on PD symptoms by his or her spouse.

Development of greater insight into their behavior may be an important therapeutic goal for individuals with PD pathology. Therapists who are treating a couple in which one spouse presents with co-morbid personality pathology and marital distress may wish to encourage development of self-knowledge, perhaps by incorporating how one partner interprets the actions of another. Meta-perception, or the ability to see yourself as others see you, is a well-known concept in the normal personality literature (Norman, 1969). Laboratory studies which provide people with opportunities to carefully observe specific aspects of their behavior in group situations result in greater accuracy of meta-perception (Albright & Malloy, 1999). With marital intervention, focusing on how we might come to know more about ourselves (Wilson, 2002) may be one of the most important elements of the therapeutic process. Marital therapy may, in fact, be an ideal setting in which to address personality pathology. To date, there are few available therapeutic approaches for personality disorder (for exceptions, see Beck, Freeman, & Davis, 2004; Benjamin, 2003; Linehan & Dexter-Mazza, 2008). Addressing maladaptive personality dynamics in the context of their effect on relationship functioning may be a novel method of treating these disorders in a supportive and non-threatening manner.

The second possible mechanism to explain the association between partner-reported PD symptoms and general marital distress is sentiment override. A person’s global evaluation of his or her marital relationship can easily bias the knowledge that they can provide regarding their partner’s personality (Kurtz & Sherker, 2003) or influence perceptions of that partner’s behavior (Christensen, Sullaway, & King, 1983; Jacobson & Moore, 1981). Individuals in distressed marriages report higher daily frequencies of negative events, tend to overestimate the rate of occurrence of negative behaviors, and focus on displeasing behavior by their spouse (Floyd & Markman, 1983; Jacobson, Follette, & McDonald, 1982; Johnson & O’Leary, 1996; Sillars, Roberts, Leonard, & Dun, 2000; Weiss, 1980). We found some support for this process, in that the target’s report of his or her partner for total PD symptoms (Partner-by-Spouse) was negatively related to the target’s own satisfaction and perpetration of physical violence. The target’s rating of their partner was also significantly related to Satisfaction and Verbal Aggression for several of the individual PDs, but not to Physical Violence (although there was a trend for Narcissistic PD).

Acknowledgments

Footnotes

Contributor Information

Susan C. South, University of Minnesota.

Eric Turkheimer, University of Virginia.

Thomas F. Oltmanns, Washington University.

References