Abstract
Divorce is associated with a multitude of outcomes related to health and well-being. Data from a representative community sample (N = 1,241) of St. Louis residents (ages 55–64) were used to examine associations between personality pathology and divorce in late midlife. Symptoms of the 10 DSM–IV personality disorders were assessed with the Structured Interview for DSM–IV Personality and the Multisource Assessment of Personality Pathology (both self and informant versions). Multiple regression analyses showed Paranoid and Histrionic personality disorder symptoms to be consistently and positively associated with number of divorces across all three sources of personality assessment. Conversely, Avoidant personality disorder symptoms were negatively associated with number of divorces. The present paper provides new information about the relationship between divorce and personality pathology at a developmental stage that is understudied in both domains.
Keywords: divorce, marital status, midlife, paranoid personality disorder, avoidant personality disorder
Symptoms of personality disorders (PDs) are associated with impairment in functioning across a variety of interpersonal domains, including marital relationships. Difficulty interacting with others is a trademark of the disordered personality, and the presence of personality pathology is associated with a significant increase in the likelihood of romantic conflict and marital termination (Chen et al., 2004; Emery, Waldron, Kitzmann, & Aaron, 1999; Whisman & Schonbrun, 2009). It has been suggested that the inability to sustain intimate relationships is a central feature of most forms of personality pathology (Krueger, Skodol, Livesley, Shrout, & Huang, 2007), yet we are still learning about the working relationship between personality disorder symptoms and divorce, particularly in individuals who are middle-aged and older.
Divorce is an important area of study that generates interest because of its well-documented negative effects on longevity and well-being. Marital termination is associated with diminished health, increased mortality, lower levels of subjective well-being, higher levels of depression and anxiety, and higher impairment in functioning (Emery, Shim, & Horn, 2012; Kiecolt-Glaser & Newton, 2001; Pagano et al., 2004). Divorce risks in the United States are high compared to other Western countries (Schoen & Canudas-Romo, 2006), with recent societal and cultural changes contributing to changing divorce patterns. The divorce rate per 1,000 people in the U.S. population rose from 2.2 in 1960 to 5.2 in 1980, an increase of 136% (Amato, 2010). Despite the increasingly common occurrence of divorce, few studies have investigated personality pathology in individuals who have divorced not just once, but multiple times. This is a particularly important area of study as second marriages are more likely to end in divorce than first marriages (Bramlett & Mosher, 2001). Individuals who have one or more prior divorces bring a qualitatively different background to a new marriage, which potentially includes children from a previous marriage, continued contact with a former spouse, and personality traits that are negatively suited to marital longevity or success (Teachman, 2008). Furthermore, negative consequences such as depression may be more likely following subsequent divorces compared with the first divorce (Robins & Reiger, 1991), making the study of multiple divorces an important topic.
Using data from a large, nationally representative community sample, Whisman, Tolejko, and Chatav (2007) found that each of the seven PDs assessed (Paranoid, Schizoid, Antisocial, Histrionic, Avoidant, Dependent, and Obsessive-Compulsive) was associated with a significantly increased occurrence of marital disruption. The approximate mean age of participants in that particular study was 35 years; thus, the cumulative impact of PDs on divorce across the life span remains open to question. The present study is concerned with the relation between personality pathology and divorce in a sample of participants between the ages of 55 and 64. The developmental stage of our sample is particularly beneficial for analyses on divorce, because these participants have had more time to begin and end marriages throughout their middle years prior to our assessment.
Relationship instability is expected when personality pathology is present, as PDs are interpersonal in nature and are associated with social impairment. Previous research has shown that individuals with multiple divorces exhibit higher global levels of distress, anxiety, and paranoid ideation than individuals who have divorced one time or not at all, although this finding held only for females and not for males (Kurdek, 1990). The increased rate of divorce in second marriages is congruent with the notion that PD symptoms involved in the dissolution of a first marriage will likely contribute to the dissolution of a second or third, due to the chronic and pervasive nature of PD symptomatology.
In terms of the relationships between specific types of PDs and marital dissolution, Borderline PD in particular has been connected to low relationship satisfaction, marital distress, separation, and divorce (South, Turkheimer, & Oltmanns, 2008; Whisman & Schonbrun, 2009); Antisocial PD is also associated with these negative outcomes (Afifi, Cox, & Enns, 2006; Humbad, Donnellan, Iacono, & Burt, 2010; Rogstad & Rogers, 2008). The association between these two disorders and marital interruption may be produced by the emotional lability, angry hostility, and impulsivity seen in both disorders. The interpersonal nature of the other PDs may also present barriers to intimacy and healthy relationships, however, and the impact on divorce is most likely not limited solely to Borderline and Antisocial PD. Rather, the wealth of findings attributed to ASPD and BPD may simply reflect the disproportionate amount of attention that they have received in the research literature.
Exclusive reliance on self-report in PD assessment introduces a serious risk of inaccuracy due to the trademark lack of self-understanding and unrealistic self-image so often noted in PDs (Furr, Dougherty, Marsh, & Mathias, 2007; Klein, 2003; Klonsky, Oltmanns, & Turkheimer, 2002; Oltmanns, Gleason, Klonsky, & Turkheimer, 2005; Vazire, 2010). Conversely, use of multiple sources in personality assessment provides a richer and more detailed portrait of the individual, and can help cancel out idiosyncratic bias coming from one particular source. Accordingly, the current study implements not one, but three sources of personality assessment to examine the relationship between divorce rate and personality disorder symptoms in later middle age.
Method
Participants
Participants ranging in age from 55–64 were recruited for a longitudinal study of personality and aging (titled St. Louis Personality and Aging Network; see Oltmanns & Gleason, 2011, for a more detailed description of study methods). Data reported in this paper are taken from the baseline assessment, which included a 2-hr interview and a battery of questionnaires. Of the total number of 1,630 recruited participants, 236 were excluded from analyses because they had never been married. Sixteen others were excluded because they did not complete the self-assessment of their own personality, and a further 137 because an informant did not complete an assessment of their personality. The final sample consisted of 1,241 participants.
Females made up 54% of the final sample (n = 664), with a mean age of 59.6 (SD = 2.7). In terms of current marital status, 57% of participants (n = 712) were currently married, 33% (n = 404) divorced, 8.1% (n = 101) widowed, and 1.9% (n = 24) separated. The racial distribution of the sample is representative of the greater St. Louis area: 67% Caucasian (n = 834), 30% African American (n = 377), and 3% from other racial backgrounds (n = 30). Regarding education level, 32% (n = 395) had a high school education or less; 16% (n = 204) had education beyond high school but not a bachelor’s degree; 25% (n = 313) had completed a bachelor’s degree; and 27% (n = 329) had a master’s degree or higher. Mean household income was between $40,000 and $59,000 annually, with 17% of households below $40,000 and 14% above $140,000 (47 participants declined to answer).
Measures
Participants were asked about their marital history as part of the Computerized Diagnostic Interview Schedule (C DIS-IV; Robins et al., 2000). The question of interest to the current analyses was “Number of times divorced,” which was recorded as a number between 0 and 5 (the highest number of divorces for any one participant in the sample).1 This variable was log-transformed and used as the dependent measure in the regressions. Gender was used as a covariate and was centered such that male was coded as 0.5 and female as −0.5.
Symptoms of personality disorders were assessed from three sources: an interviewer, the participant, and an informant selected by the participant. Trained interviewers administered the Structured Interview for DSM–IV Personality (SIDP-IV; Pfohl, Blum, & Zimmerman, 1997), which is a semistructured diagnostic interview that comprehensively assesses for the presence of the 10 personality disorders recognized by the DSM–IV, plus passive-aggressive PD. Participants were rated on a 4-point scale ranging from 0 (not present) to 3 (strongly present) for each personality disorder criterion. The mean score across all criteria was calculated for each disorder. Because this is a community sample, we chose to focus on personality disorder symptoms as a continuum rather than examining binary personality disorder diagnoses, in order to investigate the effects of subthreshold pathology on divorce.
Diagnostic interviews are conducted by carefully trained, full-time research assistants and graduate students in clinical psychology, and all were video-recorded. We randomly selected 265 interviews to be rated blindly again by an independent judge (another member of the team). The overall reliability (computed using intraclass correlations and the one-way random model) was .67. The reliability for specific DSM–IV PDs (treated as continuous scores) ranged from .86 for Avoidant PD to .53 for Paranoid PD. These values compare favorably to reliability estimates for PD diagnoses in other studies (Zanarini et al., 2000).
Participants and informants also completed the Multi-Source Assessment of Personality Pathology (MAPP; Oltmanns, Turkheimer, & Strauss, 1998). This instrument consists of statements corresponding to criteria of the 11 personality disorders but worded more colloquially. For instance, the Borderline criterion “A pattern of unstable and intense interpersonal relationships” appears as follows: “In close relationships (with friends and family members), I often switch back and forth between loving a person and hating him or her.” Participants indicated to what extent each statement applied to them on a 5-point scale ranging from 0 (I am never like this) to 4 (I am always like this). Informants filled out the same questionnaire and were asked to rate the participant’s personality. Mean scores for each personality disorder were calculated as described above for the SIDP-IV. The SIDP-IV and MAPP scores for each disorder were centered around zero. Descriptives for the SIDP-IV and participant/informant MAPP are presented in Table 1. It should be noted that these are scaled scores, which account for the low means. Rather than being a sum of scores across all criteria for a particular PD, these numbers indicate the average score the individuals received across all the criteria for a particular PD, thus the possible range for the mean scores was 0–3 for the SIDP and 0–4 for the MAPP. The level of personality pathology represented by the mean scores is in line with what we would expect to see in a community sample such as ours (vs. a clinical sample).
Table 1.
SIDP
|
Participant MAPP
|
Informant MAPP
|
|||||||
---|---|---|---|---|---|---|---|---|---|
Mean | SD | Range | Mean | SD | Range | Mean | SD | Range | |
Paranoid | 0.2 | 0.3 | 0–1.9 | 0.7 | 0.5 | 0–3.6 | 0.9 | 0.7 | 0–3.9 |
Schizoid | 0.1 | 0.2 | 0–2.1 | 1.0 | 0.5 | 0–3.6 | 1.0 | 0.6 | 0–3.4 |
Schizotypal | 0.1 | 0.1 | 0–1.1 | 0.5 | 0.4 | 0–3.7 | 0.6 | 0.5 | 0–3.0 |
Antisocial | 0.0 | 0.2 | 0–2.2 | 0.5 | 0.4 | 0–3.5 | 0.6 | 0.5 | 0–2.7 |
Borderline | 0.1 | 0.2 | 0–1.8 | 0.4 | 0.4 | 0–3.2 | 0.6 | 0.5 | 0–3.1 |
Histronic | 0.1 | 0.2 | 0–1.8 | 0.7 | 0.5 | 0–3.0 | 0.8 | 0.6 | 0–3.6 |
Narcissistic | 0.2 | 0.3 | 0–2.3 | 0.6 | 0.4 | 0–3.4 | 0.8 | 0.6 | 0–3.7 |
Avoidant | 0.2 | 0.3 | 0–2.9 | 0.6 | 0.6 | 0–3.9 | 0.6 | 0.6 | 0–3.0 |
Dependent | 0.1 | 0.2 | 0–1.6 | 0.3 | 0.4 | 0–2.9 | 0.4 | 0.5 | 0–3.8 |
Obs-Comp | 0.4 | 0.3 | 0–2.0 | 1.2 | 0.6 | 0–3.3 | 1.4 | 0.6 | 0–4.0 |
Pass-Agg | 0.1 | 0.2 | 0–1.9 | 0.7 | 0.5 | 0–3.4 | 0.8 | 0.6 | 0–3.4 |
Results
Divorce Frequency
The number of divorces per participant ranged from 0 to 5, with a mean of 0.7 (SD = 0.8) across the sample. Approximately half of the sample (44%, n = 547) had never been divorced, 41% (n = 510) had been divorced once, 12% (n = 146) had been divorced twice, and 3% (n = 38) had been divorced 3–5 times.
Regressions: Predicting Divorce Frequency From PD Symptoms
Three sources of personality assessment (SIDP, participant’s MAPP, and the informant’s MAPP) were used to independently predict divorce frequency (log-transformed). Mean scores for the 10 major types of PD plus passive-aggressive PD from one of the three personality assessments served as predictors in each regression, with gender included as a covariate. We chose to use simultaneous (forced entry) regressions for all of our analyses. Results of the three separate regressions are presented in Table 2, and bivariate correlations between the personality disorder scores and the DV in Table 3. To avoid committing a Type I error, we chose to interpret only the findings that were consistent across all three sources of personality assessment. Across all three regressions, gender had a significant effect on divorce frequency, with women reporting a higher number of divorces. The presence of Paranoid and Histrionic PD symptoms was positively associated with the number of divorces, consistently across all three sources of personality assessment (most strongly for the SIDP followed by the self-MAPP for both PDs). Conversely, the presence of Avoidant symptoms was a negative predictor of divorce frequency according to all three sources of personality. An inspection of the bivariate correlations (see Table 3) reveals that Antisocial PD is only related to the number of divorces when gender and scores on all other PDs are held constant. See Figures 1a–1c for predicted divorce frequency for different levels of Paranoid, Histrionic, and Avoidant symptoms across the three sources of assessment.
Table 2.
SIDP (b) | Self-MAPP (b) | Inf-MAPP (b) | |
---|---|---|---|
R2 | .08 | .07 | .07 |
Intercept | 0.45 | 0.45 | .45 |
Gender | −.12** | −.12** | −.09** |
Paranoid | .12* | .09* | .08* |
Schizoid | .17* | .06* | .00 |
Schizotypal | .04 | .04 | .04 |
Antisocial | .11 | −.02 | −.08* |
Borderline | .17* | −.01 | .01 |
Histrionic | .29** | .24** | .18** |
Narcissistic | −.01 | −.11* | .01 |
Avoidant | −.09* | −.08* | −.07* |
Dependent | .07 | −.02 | .04 |
Obsessive-Compulsive | −.04 | −.06* | −.05 |
Passive-Aggressive | −.08 | −.07 | −.12** |
Note. Independent variables were either effect coded (gender) or centered (PD scores). Bolded PDs are those that showed a consistent relationship with divorce across the three sources of personality assessment. b = unstandardized betas.
p < .05.
p < .005.
Table 3.
SIDP | Self-MAPP | Inf-MAPP | |
---|---|---|---|
Paranoid | 12** | .08 | .09** |
Schizoid | 08** | .05 | −.01 |
Schizotypal | 11** | .07 | .08** |
Antisocial | 09** | .02 | .02 |
Borderline | 15** | .03 | .07 |
Histrionic | 18** | .13** | .16** |
Narcissistic | .07 | .00 | .08** |
Avoidant | −.01 | −.02 | .01 |
Dependent | .06 | .01 | .06 |
Obsessive-Compulsive | .00 | .00 | .01 |
Passive-Aggressive | .05 | .01 | .01 |
Note. We chose a criterion level of p < .005 for the correlations to correct for the number of comparisons under each source of information about personality.
p < .005.
In addition to the main results described above, scores on various other disorders were related to divorce frequency, but not consistently so across all three source of personality disorder. Schizoid symptoms were positively related to divorce frequency according to the SIDP and self-MAPP; Antisocial symptoms were negatively related to divorce frequency according to the informant MAPP; Borderline symptoms were positively related to divorce frequency according to the SIDP; Narcissistic and Obsessive-Compulsive symptoms were negatively related to divorce frequency according to the self-MAPP; and Passive-Aggressive symptoms were negatively related to divorce frequency according to the informant MAPP. As discussed previously, we chose not to interpret these findings to avoid committing a Type I error.
To assess for the presence of multicollinearity, we calculated variance inflation for each variable in each regression. No variables had a variance inflation of above 3.6 (all tolerances > .28), indicating that multicollinearity was not a problem in our sample. Finally, we checked for the possibility of gender moderating the relationship between the three PDs that produced consistent patterns (Paranoid, Histrionic, and Avoidant), and the number of divorces. To do this, we reran the three regressions (SIDP, self-MAPP, and informant-MAPP) with the inclusion of three interaction variables: gender by Paranoid scaled score, gender by Histrionic scaled score, and gender by Avoidant scaled score. Only the self-MAPP regression produced a significant interaction between gender and one PD (Histrionic). Since our criterion for all analyses is consistency across all three sources of information about personality, we chose not to interpret this interaction.
Discussion
Divorce rates increased with higher levels of Paranoid and Histrionic PD symptoms in our community sample of middle-aged adults. These findings were consistent across all three sources of personality assessment (the interviewer, the informant, and the participant). Conversely, Avoidant PD symptoms were negatively associated with frequency of divorce across the three sources, with higher levels of these symptoms predicting lower rates of marital dissolution. In addition, a significant effect of gender on divorce frequency was demonstrated, with females reporting higher numbers of divorces than males.
With suspiciousness and distrust as their central features, Paranoid PD symptoms are by definition maladaptive for interpersonal relationships. The angry hostility, suspiciousness, intense and unfounded jealousy, and unusual (often persecutory) beliefs associated with this disorder interfere with the maintenance of social relationships. Individuals with Paranoid PD symptoms are hypersensitive to insults, both real and imagined. These patterns of perception and behavior create chronic tension that diminishes the social networks of paranoid individuals (Oltmanns & Okada, 2006). Confirmatory factor analysis has shown that the construct of Paranoid PD consists of two factors: suspiciousness and hostility (Falkum, Pedersen, & Karterud, 2009), both of which may hinder an intimate, trusting relationship. In addition, consistent and frequent negative appraisals, along with the maladaptive attitudes documented with Paranoid PD (Smith, Grandin, Alloy, & Abramson, 2006) are also likely to interfere in the building and rapport of a long-term romantic relationship.
Histrionic PD symptoms were also associated with an increased occurrence of marital dissolution. When a romantic partner displays chronic self-centeredness, attention-seeking behavior, inappropriate sexual seductiveness, exaggerated theatricality, and rapidly shifting and shallow emotions, it follows that the levels of equality and reciprocity of a healthy intimate relationship suffer (Rasmussen, 2005). Histrionic PD is associated with strong feelings of closeness toward multiple people (Lawton, Shields, & Oltmanns, 2011), to a pathological extent. This widespread closeness with others may pose a threat to the marital bond if one spouse is consistently searching for and experiencing intimacy in a nonselective fashion with other individuals. Additionally, the sexual seductiveness associated with Histrionic PD can manifest itself in the behavioral form of inappropriate flirting or in becoming disconsolate when one is not the center of attention (Kellett, 2007). Because monogamy is generally considered to be a core component of traditional matrimony, extramarital flirtatiousness and other attention-seeking symptoms associated with Histrionic PD can interfere with marriage longevity.
These results are somewhat surprising because Borderline and Antisocial PDs are the two PDs that are consistently associated with divorce (Afifi et al., 2006; South et al., 2008; Whisman et al., 2007). The fact that our results did not demonstrate the expected impact of Antisocial and Borderline raises an interesting issue. Perhaps Histrionic and Paranoid traits set the stage for serial marriage and divorce in a way that Antisocial and Borderline PDs do not. For example, Histrionic traits may be particularly appealing and charming in the beginning stages of a relationship, but then may become difficult to live with over time, leading to a cyclical pattern of marriage and divorce. In comparison, Borderline traits are presumably off-putting rather than appealing earlier on in a relationship. These behaviors could easily lead to divorce, but may be less likely than Histrionic symptoms to generate a series of marriages.
Another interesting finding was the inverse relationship between Avoidant PD symptoms and number of divorces. One way to interpret these findings is that Avoidant PD symptoms are related to marital longevity. It should be noted that marital satisfaction is a separate issue from marital longevity; what these findings suggest is that Avoidant PD symptoms may discourage the specific behavior of marital dissolution, though to speak to the satisfaction levels of these particular marriages is beyond the scope of the present paper. An individual high on Avoidant PD symptoms may prefer to stay married to a partner, perhaps even unhappily so, rather than attempt to navigate a new social circle and marital status identity. Avoidant PD is also associated with a reluctance to criticize others (Arntz, Weertman, & Salet, 2011), which could assist in maintaining a romantic relationship. In addition, this particular constellation of symptoms is associated with maladaptive levels of social inhibition along with a lack of assertiveness (Rodebaugh, Gianoli, Turkheimer, & Oltmanns, 2010). Accordingly, it may be very difficult for individuals with Avoidant PD to go through with a divorce; rather, they may prefer to “keep the peace” by keeping the marriage intact, satisfaction levels notwithstanding. The fact that Avoidant PD symptoms are related to a lower probability of getting divorced is an interesting and important area for future study, as personality disorder symptoms are generally thought to be maladaptive to the stability of interpersonal relationships. In addition, it is possible that individuals with more Avoidant PD symptoms are less likely to marry again after experiencing a divorce, which could explain why they experience fewer divorces overall.
In addition to symptoms of the three PDs discussed above, we found a significant effect of gender on divorce frequency, with females reporting higher numbers of divorce than males. One possible explanation of this intriguing finding is that divorced men in later life have a higher mortality rate, leaving their former spouses to overrepresent divorced females in our sample. This idea is congruent with earlier research, which suggests that while divorce is associated with a variety of detriments to health and well-being, this is particularly true for males (Amato, 2010; Sbarra, Law, & Portley, 2011). Alternatively, there could be a gender difference in the likelihood of reporting previous marriages, which is congruent with the finding that men tend to underreport the number of children they have had outside of their current marriage (Rendall, Clarke, Peters, Ranjit, & Verropoulou, 1999).
Features of personality disorders are most often long-standing, stable characteristics, and it seems likely that preexisting PD symptoms could have contributed to the divorces reported in our study. On the other hand, current features of personality pathology could be consequences of divorce and the circumstances that precipitated or surrounded the divorce. For example, suspiciousness, hypervigilance, and angry hostility might be likely reactions to repeated infidelity, particularly if more than one previous romantic partner had engaged in such behavior. One limitation of our study follows from its cross-sectional, correlational design: specifically, the direction of the relationship between divorce and personality cannot be determined. In addition, we acknowledge the nonclinical nature of the sample to be a limitation of the study. Because this was a community sample, most of our participants displayed minimal personality pathology. Future research could also examine the personality of participants’ spouses in order to assess for the presence of assortative mating.
This paper is one of the first to examine the relationship between PD symptoms and frequency of divorces, and our middle-aged sample provides a further unique perspective on this important issue. Because of the maladaptive nature of PDs, we expected to see a uniform positive association between divorce rate by later middle age and PD symptoms. However, while Paranoid and Histrionic PD were positively associated with divorce frequency, Avoidant PD showed the opposite relationship. This suggests that certain variants of personality pathology are associated with increased longevity (though not necessarily increased satisfaction levels) of marriage. This is an understudied yet important developmental stage in terms of furthering our understanding of the trajectory, stability, and outcomes of personality disorder symptoms across the life span. Because divorce is associated with a multitude of negative outcomes, such as increased mortality and lower levels of happiness and well-being (Amato, 2000; Kiecolt-Glaser & Newton, 2001), future research on divorce should continue to examine the factors involved in this stressful life event, particularly in middle age and beyond.
Acknowledgments
This research was supported by a grant from the National Institute of Mental Health (RO1 MH077840). We thank Merlyn Rodrigues, Andy Shields, Tami Curl, Rickey Louis, Amber Wilson, Christie Spence, Erin Lawton, and Abby Powers for their assistance with data collection and management.
Footnotes
We also considered using a categorical variable, grouping participants by whether they had ever been divorced or whether they had been divorced one or multiple times; however, preliminary analyses indicated that the continuous dependent variable (number of divorces) produced more nuanced results and was best suited to our research question.
References
- Afifi TO, Cox BJ, Enns MW. Mental health profiles among married, never-married, and separated/divorced mothers in a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology. 2006;41:122–129. doi: 10.1007/s00127-005-0005-3. [DOI] [PubMed] [Google Scholar]
- Amato PR. The consequences of divorce for adults and children. Journal of Marriage and the Family. 2000;62:1269–1287. doi: 10.1111/j .1741-3737.2000.01269.x. [DOI] [Google Scholar]
- Amato PR. Research on divorce: Continuing trends and new developments. Journal of Marriage and Family. 2010;72:650–666. doi: 10.1111/j.1741-3737.2010.00723.x. [DOI] [Google Scholar]
- Arntz A, Weertman A, Salet S. Interpretation bias in Cluster-C and borderline personality disorders. Behaviour Research and Therapy. 2011;49:472–481. doi: 10.1016/j.brat.2011.05.002. [DOI] [PubMed] [Google Scholar]
- Bramlett MD, Mosher WD. First marriage dissolution, divorce, and remarriage: United States. Advance Data. 2001;323:1–20. [PubMed] [Google Scholar]
- Chen H, Cohen P, Johnson JG, Kasen S, Sneed JR, Crawford TN. Adolescent personality disorders and conflict with romantic partners during the transition to adulthood. Journal of Personality Disorders. 2004;18:507–525. doi: 10.1521/pedi.18.6.507.54794. [DOI] [PubMed] [Google Scholar]
- Emery RE, Shim H, Horn E. Examining divorce consequences and policies and the question: Is marriage more than a piece of paper? In: Campbell L, Loving TJ, editors. Interdisciplinary research on close relationships: The case for integration. Washington, DC: American Psychological Association; 2012. pp. 227–250. [DOI] [Google Scholar]
- Emery RE, Waldron M, Kitzmann KM, Aaron J. Delinquent behavior, future divorce or nonmarital childbearing, and externalizing behavior among offspring: A 14-year prospective study. Journal of Family Psychology. 1999;13:568–579. doi: 10.1037/0893-3200.13.4.568. [DOI] [Google Scholar]
- Falkum E, Pedersen G, Karterud S. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, paranoid personality disorder diagnosis: A unitary or a two-dimensional construct? Comprehensive Psychiatry. 2009;50:533–541. doi: 10.1016/j.comppsych.2009.01.003. [DOI] [PubMed] [Google Scholar]
- Furr RM, Dougherty DM, Marsh DM, Mathias CW. Personality judgment and personality pathology: Self-other agreement in adolescents with conduct disorder. Journal of Personality. 2007;75:629–662. doi: 10.1111/j.1467-6494.2007.00451.x. [DOI] [PubMed] [Google Scholar]
- Humbad MN, Donnellan MB, Iacono WG, Burt SA. Externalizing psychopathology and marital adjustment in long-term marriages: Results from a large combined sample of married couples. Journal of Abnormal Psychology. 2010;119:151–162. doi: 10.1037/a0017981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kellett S. A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice. 2007;80:389–405. doi: 10.1348/147608306X161421. [DOI] [PubMed] [Google Scholar]
- Kiecolt-Glaser JK, Newton TL. Marriage and health: His and hers. Psychological Bulletin. 2001;127:472–503. doi: 10.1037/0033-2909 .127.4.472. [DOI] [PubMed] [Google Scholar]
- Klein DN. Patients’ versus informants’ reports of personality disorders in predicting 7 1/2 -year outcome in outpatients with depressive disorders. Psychological Assessment. 2003;15:216–222. doi: 10.1037/1040-3590.15.2.216. [DOI] [PubMed] [Google Scholar]
- Klonsky ED, Oltmanns TF, Turkheimer E. Informant reports of personality disorder: Relation to self-reports and future research directions. Clinical Psychology: Science and Practice. 2002;9:300–311. doi: 10.1093/clipsy.9.3.300. [DOI] [Google Scholar]
- Krueger RF, Skodol A, Livesley W, Shrout P, Huang Y. Synthesizing dimensional and categorical approaches to personality disorders: Refining the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research. 2007;16:S65–S73. doi: 10.1002/mpr.212. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kurdek LA. Divorce history and self-reported psychological distress in husbands and wives. Journal of Marriage and the Family. 1990;52:701–708. doi: 10.2307/352935. [DOI] [Google Scholar]
- Lawton EM, Shields AJ, Oltmanns TF. Five-factor model personality disorder prototypes in a community sample: Self- and informant-reports predicting interview-based DSM diagnoses. Personality Disorders: Theory, Research, and Treatment. 2011;2:279–292. doi: 10.1037/a0022617. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oltmanns TF, Gleason MEJ. Personality, health, and social adjustment in later life. In: Cottler LB, editor. Mental health in public health: The next 100 years. New York, NY: Oxford University Press; 2011. pp. 151–179. [Google Scholar]
- Oltmanns TF, Gleason MEJ, Klonsky ED, Turkheimer E. Meta-perception for pathological personality traits: Do we know when others think that we are difficult? Consciousness and Cognition. 2005;14:739–751. doi: 10.1016/j.concog.2005.07.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Oltmanns TF, Okada M. Paranoia. In: Fisher JE, TO’Donohue W, editors. Practitioner’s guide to evidence-based psychotherapy. New York, NY: Springer Science + Business Media; 2006. pp. 503–513. [DOI] [Google Scholar]
- Oltmanns TF, Turkheimer E, Strauss ME. Peer assessment of personality traits and pathology. Assessment. 1998;5:53–65. doi: 10.1177/107319119800500108. [DOI] [PubMed] [Google Scholar]
- Pagano ME, Skodol AE, Stout RL, Shea MT, Yen S, Grilo CM, Gunderson JG. Stressful life events as predictors of functioning: Findings from the Collaborative Longitudinal Personality Disorders Study. Acta Psychiatrica Scandinavica. 2004;110:421–429. doi: 10.1111/j.1600-0447.2004.00398.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pfohl B, Blum N, Zimmerman M. Structured interview for DSM-IV personality. Washington, DC: American Psychiatric Press, Inc; 1997. [Google Scholar]
- Rasmussen PR. The histrionic prototype. In: Rasmussen PR, editor. Personality-guided cognitive-behavioral therapy. Washington, DC: American Psychological Association; 2005. pp. 147–166. [DOI] [Google Scholar]
- Rendall MS, Clarke L, Peters E, Ranjit N, Verropoulou G. Incomplete reporting of men’s fertility in the United States and Britain: A research note. Demography. 1999;36:135–144. doi: 10.2307/2648139. [DOI] [PubMed] [Google Scholar]
- Robins LN, Cottler LB, Bucholz KK, Compton WM, North CS, Rourke KM. Diagnostic interview schedule for the DSM–IV (DIS-IV) St. Louis, MO: Washington University School of Medicine; 2000. [Google Scholar]
- Robins LN, Reiger D. Psychiatric disorders in America: The Epidemiological Catchment Area study. New York, NY: Free Press; 1991. [Google Scholar]
- Rodebaugh TL, Gianoli M, Turkheimer E, Oltmanns TF. The interpersonal problems of the socially avoidant: Self and peer shared variance. Journal of Abnormal Psychology. 2010;119:331–340. doi: 10.1037/a0019031. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rogstad JE, Rogers R. Gender differences in contributions of emotion to psychopathy and antisocial personality disorder. Clinical Psychology Review. 2008;28:1472–1484. doi: 10.1016/j.cpr.2008.09.004. [DOI] [PubMed] [Google Scholar]
- Sbarra DA, Law RW, Portley RM. Divorce and death: A meta-analysis and research agenda for clinical, social, and health psychology. Perspectives on Psychological Science. 2011;6:454–474. doi: 10.1177/1745691611414724. [DOI] [PubMed] [Google Scholar]
- Schoen R, Canudas-Romo V. Timing effects on divorce: 20th century experience in the United States. Journal of Marriage and Family. 2006;68:749–758. doi: 10.1111/j.1741-3737.2006.00287.x. [DOI] [Google Scholar]
- Smith JM, Grandin LD, Alloy LB, Abramson LY. Cognitive vulnerability to depression and axis II personality dysfunction. Cognitive Therapy and Research. 2006;30:609–621. doi: 10.1007/s10608-006-9038-5. [DOI] [Google Scholar]
- South SC, Turkheimer E, Oltmanns TF. Personality disorder symptoms and marital functioning. Journal of Consulting and Clinical Psychology. 2008;76:769–80. doi: 10.1037/a0013346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Teachman J. Complex life course patterns and the risk of divorce in second marriages. Journal of Marriage and Family. 2008;70:294–305. doi: 10.1111/j.1741-3737.2008.00482.x. [DOI] [Google Scholar]
- Vazire S. Informant reports. In: Gosling SD, Johnson JA, editors. Advanced methods for conducting online behavioral research. Washington, DC: American Psychological Association; 2010. pp. 167–178. [DOI] [Google Scholar]
- Whisman MA, Schonbrun Y. Social consequences of borderline personality disorder symptoms in a population-based survey: Marital distress, marital violence, and marital disruption. Journal of Personality Disorders. 2009;23:410–415. doi: 10.1521/pedi.2009.23.4.410. [DOI] [PubMed] [Google Scholar]
- Whisman MA, Tolejko N, Chatav Y. Social consequences of personality disorders: Probability and timing of marriage and probability of marital disruption. Journal of Personality Disorders. 2007;21:690–695. doi: 10.1521/pedi.2007.21.6.690. [DOI] [PubMed] [Google Scholar]
- Zanarini MC, Skodol AE, Bender D, Dolan R, Sanislow C, Schaefer E, Gunderson JG. The Collaborative Longitudinal Personality Disorders Study: Reliability of axis I and II diagnoses. Journal of Personality Disorders. 2000;14:291–299. doi: 10.1521/pedi.2000 .14.4.291. [DOI] [PubMed] [Google Scholar]