 36. Personality and Personality Disorder  757
that time strong interest in these personality 
syndromes. Avoidant personality disorder 
was also a new addition to DSM-III, but it 
was a creation of one work group member 
and did not represent a strong wider inter -
est (Gunderson, 1983). It might be the case 
that paranoid, schizoid, histrionic, and 
obsessive–  compulsive disorders represent 
relatively old, if not archaic, personality 
syndromes developed during the early his -
tory of the diagnostic manual, dominated at 
that time by psychodynamic theory. How -
ever, that should not be interpreted as sug -
gesting that they are not worthy of scientific 
research or fail to identify important mal -
adaptive personality traits. In any case, we 
cover herein the five personality disorders 
for which there has been significant research 
interest: antisocial, borderline, schizotypal, 
dependent, and narcissistic personality dis -
orders.
Antisocial Personality Disorder 
and Psychopathy
Psychopaths are “social predators who 
charm, manipulate, and ruthlessly plow 
their way through life. . . . Completely lack -
ing in conscience and feeling for others, they 
selfishly take what they want and do as they 
please, violating social norms and expecta -
tions without the slightest sense of guilt or 
regret” (Hare, 1993, p. xi). Psychopathy is 
one of the more heavily researched and in -
triguing personality disorders. Some of the 
most famous, or perhaps infamous, crimi -
nals, real or imagined, have been considered 
to be psychopathic (e.g., Clyde Barrow, Dex -
ter, Ted Bundy, Tony Soprano, Hannibal 
Lector, Bernie Madoff, Henry Hill).
The DSM-5 diagnosis for this disorder 
is antisocial personality disorder (ASPD; 
American Psychiatric Association, 2013). 
For many years there was a contrast between 
psychopathy as defined by Hare’s (2003) 
Psychopathy Checklist—  Revised (PCL-R) 
and ASPD as defined by the APA (Crego & 
Widiger, 2015). The PCL-R placed relatively 
more emphasis on personality traits, such as 
glib charm, manipulation, arrogance, im -
pulsivity, irresponsibility, and callous lack 
of empathy, whereas the APA diagnostic 
criteria placed relatively more emphasis on 
behavioral indicators, particularly criminal acts. Most research now concerns psychopa -
thy rather than DSM-5 Section II ASPD. 
This may reflect the fact that psychopathy, 
as assessed by the PCL-R, was much closer 
to the conceptualization of this disorder by 
the historically influential theorist and clini -
cian, Hervey Cleckley (1955).
The optimal definition for what consti -
tutes psychopathy, though, remains unclear 
(Lilienfeld, Watts, Francis Smith, Berg, & 
Latzman, 2015). Three recently developed 
models and measures have deviated impor -
tantly from the influential and predomi -
nant PCL-R, converging with one another 
through the inclusion of such comparable 
traits of boldness within the Triarchic Psy -
chopathy Measure (TriPM; Patrick, Fowles, 
& Krueger, 2009), fearlessness with the Psy -
chopathic Personality Inventory—  Revised 
(PPI-R; Lilienfeld & Widows, 2005), and 
invincibility within the Elemental Psychopa -
thy Assessment (EPA; Lynam et al., 2011).
Psychopaths are largely comfortable in 
their skin, even though their psychopathic 
traits cause considerable trouble for them. 
The life of a psychopath is at times glam -
orized, and is typically very appealing at 
a young age. The New York City mobster 
Henry Hill famously stated, “At the age of 
twelve my ambition was to be a gangster” 
(Pileggi, 1985. p. 13). However, the exciting 
psychopathic lifestyle can come with a heavy 
cost. Psychopathic persons have a very dif -
ficult time maintaining employment, their 
relationships are unstable, they are at risk of 
serious injury and even death, they are prone 
to drug and alcohol abuse, and many spend 
a considerable amount of time imprisoned 
(Hare, Neumann, & Widiger, 2012), much 
of which was true for Henry Hill.
For many years, researchers have searched 
for the specific etiology and pathology for 
psychopathy, including a cognitive deficit 
in response modulation, deficits in anxious -
ness, incapacity for empathy, impulsive dis -
inhibition, and inadequate autonomic arous -
al (Derefinko & Widiger, 2016; Hare et al., 
2012). However, it has become increasingly 
evident that there is no specific etiology or 
pathology. Psychopathy is a constellation 
of diverse personality traits (Crego & Wi -
diger, 2015; Lilienfeld et al., 2015; Lynam 
& Widiger, 2007a), a view that applies to all 
of the DSM-5 personality disorders, ques -