758 vII. APPLICATIONS  AND  IMPLICATIONS
tioning the validity in understanding them 
as discrete categories (Clark, 2007; Lives -
ley, 2007; Skodol, 2012; Widiger & Trull, 
2007). Psychopathy has been of substantial 
clinical and social interest as a particular 
entity, probably because it is essentially the 
most dangerous and virulent constellation of 
personality traits one can perhaps imagine. 
It is bad enough for a person to be manipula -
tive, deceitful, exploitative, aggressive, cal -
lous, and cruel (traits of antagonism), but it 
is even worse for such a person to also be 
charming and fearless (traits of low neuroti -
cism), assertive, and interpersonally engag -
ing (traits of extraversion), and reckless, 
rash, and disinhibited (traits of low consci -
entiousness; Widiger & Lynam, 1998).
Borderline Personality  Disorder
Borderline personality disorder (BPD), a 
new addition to DSM-III (American Psychi -
atric Association, 1980), quickly became the 
single most frequently diagnosed and most 
heavily researched personality disorder. Its 
primary diagnostic criteria include frantic 
efforts to avoid abandonment, affective in -
stability, unstable and intense relationships, 
impulsivity (e.g., substance abuse and sexual 
promiscuity), recurrent suicidal thoughts 
and gestures (that at times can be manipula -
tive, but fatal as well), self-  mutilation, and 
episodes of rage and anger (American Psy -
chiatric Association, 2013).
BPD is among the most difficult syn -
dromes to treat, as patients with BPD tend 
to recreate their intense and dramatic rela -
tionships within the context of the therapeu -
tic relationship. Such patients can become 
intensely attached to their therapists, at 
times idealizing them as if they are the best 
therapists they ever had, and at other times 
devaluing them for failing when needed the 
most (Gunderson, 2001; Linehan, 1993). 
They can have a long history of treatment 
failures, interspersed with visits to the emer -
gency room, hospitalizations secondary to 
suicidal ideation or gestures, and treatment 
for an array of problems, including mood 
disorder, substance use, and eating and 
anxiety disorders. The majority of patients 
with BPD are females with a long history of 
failed relationships that were typically quite 
stormy, turbulent, and at times even violent.However, BPD is one of the few person -
ality disorders for which persons will seek 
treatment, as BPD is defined in large part by 
traits of negative affectivity (or neuroticism), 
which involve feelings of pain and suffering. 
BPD is also the only personality disorder for 
which empirically validated therapies have 
been developed. The two most predominant 
forms of treatment are mentalization-  based 
treatment (MBT; Bateman & Fonagy, 2012) 
and dialectical behavior therapy (DBT; 
Lynch, Trost, Salsman, & Linehan, 2007). 
MBT is a psychodynamic treatment that 
uses structured techniques to help patients 
“mentalize” or more accurately perceive the 
feelings within themselves and others. Pa -
tients with BPD tend to misperceive the in -
tentions and feelings of others, interpreting 
(for instance) innocent remarks as signs of 
rejection, responding with alarm, fright, dis -
may, terror, and/or rage. DBT is a cognitive- 
behavioral therapy that is coupled with Zen 
Buddhist principles of overcoming suffering 
through acceptance (Linehan, 1993). Mas -
tery of conflict is achieved in part through 
no longer fighting adversity. This principle is 
taught in part through the meditative tech -
nique of mindfulness, in which one attempts 
to focus attention solely on the present mo -
ment in a nonjudgmental way. This tech -
nique can be particularly useful to patients 
with BPD, because their thoughts naturally 
shift to feelings and memories of rejection 
and abuse.
Schizotypal Personality  Disorder
Schizotypal personality disorder (STPD) was 
also a new addition to DSM-III (American 
Psychiatric Association, 1980). Its diagnos -
tic criterion set was developed in part from 
interviews of biological relatives of persons 
with schizophrenia (Kwapil & Barrantes- 
Vidal, 2012). The researchers were seeking 
to confirm a family history of schizophrenia 
in persons diagnosed with schizophrenia. 
They found a surprisingly low rate of actual 
schizophrenia. However, they did find a cu -
rious prevalence of odd, eccentric persons 
with subthreshold symptoms. The diagnos -
tic criteria for STPD include odd beliefs and 
magical thinking that are below threshold 
for a delusion, social withdrawal, unusu -
al perceptual experiences that are below 