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 intraindividual 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 of Mental Disorders and the Psychodynamic Diagnostic Manual; and illustrate how intraindividual 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 (a) future research on personality disorders and (b) clinical work with SGM individuals who might demonstrate behaviors typically associated with a personality disorder diagnosis.

Examining Measurement Invariance in the Personality Inventory for DSM-5 Brief Form Across Sexual and Gender Minority Status

“…SGM individuals contend with elevated rejection sensitivity as a consequence of repeated exposure to rejection due to one’s sexual orientation and/or gender expression (Feinstein, 2020). If attention-seeking behaviors in response to the threat of rejection present a maladaptive emotion-regulation strategy in SGM individuals (Rodriguez-Seijas et al, 2022), this could explain the observed pattern of results. In addition, stereotypes about SGM individuals as being attention-seeking abound and might be internalized by SGM persons (Boysen et al, 2011), non-SGM persons (Boysen et al, 2006, 2011), and even clinical care providers (Boysen et al, 2006).…”

“…Understanding the many environmental factors that can influence self-reported symptoms and maladaptive traits in SGM populations is critical to the development and validation of maladaptive trait measures. Personality disorder disparities in SGM groups may emerge due to processes other than intraindividual deficits, such as environmental and structural factors that systematically affect SGM individuals as well as their reporting styles (Cano et al, 2022; Cardona et al, 2022; Rodriguez-Seijas et al, 2022). External processes that are nonspecific to personality disorders such as minority stress or structural stigma (e.g., Hatzenbuehler, 2009; Pachankis et al, 2014, 2021) may inflate maladaptive trait endorsement among SGMs.…”

“…Although disparities may represent true differences between groups, clinical measures may have some level of measurement bias at the item level that can result in overreporting or underreporting of clinical symptoms, signs, and traits. For SGM populations specifically, unique sociocontextual factors may make certain items easier to endorse than others (Rodriguez-Seijas et al, 2023). For example, SGM individuals are more likely to experience suicidal ideation and attempt suicide relative to cisgender heterosexual individuals; suicidality is often correlated with minority stress experiences such as SGM-based victimization (e.g., Baams et al, 2015;De Luca et al, 2021).…”

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

“…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 whether 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).…”

“…Furthermore, psychosocial and psychiatric health among sexual-minority populations cannot be understood solely using intraindividual models and assumptions. We direct interested readers to one recent publication that expands on 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).…”