 36. Personality and Personality Disorder  763
Maladaptive  Openness
Maladaptive openness has typically been 
understood to be the aberrant, odd, and pe -
culiar thinking and perception of STPD. For 
instance, many studies have documented an 
association between open-  mindedness and 
paranormal beliefs (Nettle, 2006). Howev -
er, the relationship between FFM openness 
and DSM-IV STPD has been consistently 
the weakest (Samuel & Widiger, 2008; 
Saulsman & Page, 2004), and at times ques -
tioned (Watson, Clark, & Chmielewski, 
2008). Nevertheless, factor-  analytic studies 
have supported an alignment of schizotypal 
thinking with openness (e.g., Gore & Widi -
ger, 2013; Stepp et al., 2012; Thomas et al., 
2012).
Costa and McCrae (1992) conceptualized 
openness in a manner that is largely equiva -
lent to a disposition for self-  actualization 
and self-  realization (Gore & Widiger, 2013). 
Alternative models (as well as measures) 
have since been developed for openness, for 
which a clear relationship with schizotypal 
thinking is much more readily apparent (Wi -
diger & Crego, 2019b), such as the Big Five 
Aspects Scale of De  Young, Grazioplene, and 
Peterson (2012) and the HEXACO Person -
ality Inventory (HEXACO-  PI) of Lee and 
Ashton (2004). Tellegen (1993) included an 
unconventionality domain with his dimen -
sional trait model that is aligned explicitly 
with FFM openness, the scale for which 
contains items that assess normal openness 
(e.g., curious, inquisitive, imaginative, and 
creative), as well as abnormal variants, such 
as having ideas or beliefs that have little basis 
within reality, dwelling on fantasies, or en -
gaging in activities that are bizarre, deviant, 
or aberrant. Tellegen (1993) suggested years 
ago that with respect to his conceptualiza -
tion of openness, “markers of this type are 
clinically suggestive, particularly of schizo -
typal personality disorder” (p. 126).
Maladaptive Low  Neuroticism
Low neuroticism might be considered the 
sine qua non of mental health, being es -
sentially equivalent to emotional stability 
(Goldberg, 1993). However, even here one 
can identify problematic variants, particu -
larly evident in the personality syndrome of psychopathy. Cleckley (1955) included low 
anxiousness in his highly influential descrip -
tion of psychopathy: “Within himself he 
appears as incapable of anxiety as of pro -
found remorse ” (p. 384). Low anxiousness 
is included as well within the more recently 
developed models of psychopathy, including 
the TriPM (Patrick et al., 2009), the PPI-R 
(Lilienfeld & Widows, 2005), and the EPA 
(Lynam et al., 2011). However, the boldness, 
fearlessness, and invincibility within these 
measures is controversial precisely because 
they refer to socially adaptive strengths 
rather than deficits (Crego & Widiger, 2015; 
Marcus, Fulton, & Edens, 2012; Miller & 
Lynam, 2012). What makes a personality 
disorder a disorder is the presence of malad -
justment, not superior personality strengths 
(Livesley, 2007). If low anxiousness is in -
cluded, perhaps it should be problematically 
low anxiousness, contributing, for example, 
to a failure to be concerned about negative 
consequences of risky, dangerous, and/or 
criminal behavior (Crego & Widiger, 2015).
Advantages of  Dimensional Trait Model 
of Personality  Disorder
There are many advantages in reformulat -
ing the DSM-5 Section II personality disor -
ders in terms of the domains and facets of 
FFM. Notably, the problems of heterogene -
ity within the diagnostic categories and the 
excessive diagnostic co-  occurrence would 
be largely resolved. Rather than force an in -
dividual into a category that includes traits 
that he or she does not have and fail to rec -
ognize additional personality traits that are 
important for understanding the patient’s 
adjustment and maladjustment, the FFM 
would allow the clinician and researcher to 
provide an individualized profile of precisely 
the traits that are present (Clark, 2007; Wi -
diger & Trull, 2007). This form of descrip -
tion is considerably more precise and ac -
curate than a diagnostic category and, as a 
result, would have obvious benefits for treat -
ment planning, research, insurance, and 
other social–  clinical decisions. It is simpler 
to just apply one diagnostic category to a pa -
tient (e.g., “antisocial”), but Verhuel (2005) 
argued compellingly that the problems with 
the imprecision of diagnostic categories, the 
lack of adequate coverage, and the confus -