Personality Disorders Research and Social Decontextualization: What it Means to be a Minoritized Human

Abstract

Models of personality disorders have overwhelmingly developed in a socially decontextualized manner. Some historical models of personality pathology formally embraced the interactions between the individual and their environment. However, the field of personality disorder theory, research, and treatment has evolved in a manner that situates dysfunction within intra-individual deficiency processes. By doing so the field limits its applicability to populations that do not represent the norm in clinical psychological science (e.g., sexual/gender minority [SGM] persons for our purposes). Assumptions about personality disorders conflict with evidence-based ways of understanding psychosocial dysfunction among minoritized populations. Using research on SGM populations, and the detrimental impact of minority stress, we demonstrate how sociocultural context is inextricably linked to psychosocial functioning, which remains at odds with personality disorder theory and research. We first briefly review the historical roots of personality disorder theory; explore how sociocultural context is currently instantiated in official nosologies as the Diagnostic and Statistical Manual (DSM) and the Psychodynamic Diagnostic Manual (PDM); and illustrate how intra-individual personality disorder conceptualization fails to align with the accepted understanding of how minority stress impacts the health of SGM populations. Finally, we end with a few recommendations for (1) future research on personality disorders and (2) clinical work with SGM individuals who might demonstrate behaviors typically associated with a personality disorder diagnosis.

ParTy ’n’ Play: Associations Between Sex-Related Substance Use and the Disinhibited Externalizing Spectrum Among Gay and Bisexual Men

“…Further, psychosocial and psychiatric health among sexual minority populations cannot be understood solely using intra-individual models and assumptions. We direct interested readers to one recent publication that expands upon the ways that traditional conceptualization of psychopathology-in this case personality pathology-is not always aligned with understanding psychosocial health of sexual minority populations (Rodriguez-Seijas et al, 2022). Note: Odds Ratios have been re-expressed to signify the odds of reporting specific sex-related substance use compared with the odds of not reporting sex-related substance use.…”

“…Indeed, that little research on the HiTOP model-from which the disinhibited externalizing spectrum is derived-has included sexual minority participants or appreciated the sociocultural context in which sexual minority participants exist, makes it unclear if the model is indeed applicable in the same way for sexual minority populations as it might be for heterosexual populations. Recent scholarship has outlined how the conceptualization of personality pathology, to which the HiTOP domains bear striking resemblance (Markon, 2010;Wright et al, 2012), is misaligned with evidence-based ways of understanding the psychosocial needs of sexual and gender minority populations (Rodriguez-Seijas et al, 2022).…”

Methodological and quantitative issues in the study of personality pathology.

“…In our second sampling-related manuscript, Rodriguez-Seijas et al (2023) suggest that predominant models of personality pathology are insufficiently socially contextualized, particularly for minoritized individuals, with a specific focus on sexual/gender minorities (SGMs). These scholars argue that PD research largely situates the pathology as existing within the individual (i.e., deficit models), ignoring the important role that stress plays in minoritized individuals, which is contrary to minority stress models of psychological health and well-being.…”