746 vII. APPLICATIONS  AND  IMPLICATIONS
levels of disinhibition—  in this case, the pres -
ence of a specific personality trait (disinhibi -
tion) modifies the specific nature of disorder 
expression. The experience of major depres -
sive disorder without disinhibition would 
not show this same modification (i.e., in -
creased risk of suicidality).
Spectrum
The spectrum model proposes that person -
ality and psychopathology are part of the 
same continuum, ranging from general traits 
to subclinical characteristics to diagnostic 
disorders (DeBolle, Beyers, De Clercq, & De 
Fruyt, 2012). The spectrum model is largely 
consistent with a “common cause” explana -
tion, such that the traits and disorders lying 
on the same spectrum are expected to be 
both quantitatively related, rather than qual -
itatively distinct, and influenced by similar 
causal factors. One example of this model 
is the “schizophrenia spectrum” of disorders 
(i.e., schizophrenia, schizotypal personality 
disorder, and paranoid personality disor -
der), which is commonly described as dif -
fering manifestations of a common etiology 
(e.g., Nicolson et al., 2003). Research link -
ing neuroticism to other disorders, as well as 
latent psychopathology factors (such as the 
“general factor” of psychopathology) has 
also supported a spectrum association by 
defining shared causal factors underlying an 
individual’s neuroticism level and psychopa -
thology manifestation (e.g., Hettema, Neale, 
Myers, Prescott, & Kendler, 2006; Miko -
lajewski, Allan, Hart, Lonigan, & Taylor, 
2013; Tackett, Lahey, et al., 2013). Evidence 
for the risk–  vulnerability model may actu -
ally support a spectrum model conceptual -
ization, if not directly tested (ideally with 
strong tests of potential common causes that 
may account for trait–  disorder associations).
How Do We Organize These Relationships?
There are a number of important questions to 
consider when examining the organizational 
structure of personality–  psychopathology 
associations. For example, what is the best 
way to organize the extensive corpus of re -
search findings on trait–  disorder associa -
tions (which we have only briefly highlighted 
here)? How do personality findings advance our understanding of psychopathology, and 
vice versa? Can such findings inform our 
understanding of disorder emergence or 
trait change? In this section, we tackle these 
broad but interconnected questions.
Personality as Context
Personality trait structure has been studied 
for a century now, with hierarchical mod -
els of personality traits well established in 
the literature, connecting models of normal 
and abnormal personality traits, clinical 
and community samples, and age groups 
across the lifespan (Markon et al., 2005; 
Tackett et al., 2012). Personality models 
are comprehensive and far-  reaching, offer -
ing an empirically validated framework for 
organizing the myriad individual differences 
across many populations. As such, they can 
serve a useful and powerful framework for 
organizing and understanding other psy -
chological constructs—  including psychopa -
thology (Watson, Clark, & Harkness, 1994; 
Widiger et al., 2019). Use of personality as 
a framework can occur in various ways. 
For example, personality trait associations 
may be used to answer questions regard -
ing relatedness between various symptom 
dimensions or disorders, distinctiveness 
between symptom subdomains or subfac -
tors, and even broader questions of whether 
certain behaviors should be considered psy -
chopathology. Although many examples of 
personality serving these functions can be 
found throughout the literature, we high -
light some illustrative examples below.
Most disorders evidence moderate to 
high correlations with neuroticism, includ -
ing virtually all of the disorders typically 
characterized as “internalizing” disorders. 
However, only some internalizing prob -
lems show moderate associations with low 
extraversion, or positive emotionality (Wat -
son, Gamez, & Simms, 2005; Watson et 
al., 2019). This particular pattern of asso -
ciations indicates common groupings of in -
ternalizing disorders that may be otherwise 
masked using a rational sorting approach 
(e.g., differentiations between anxiety and 
depressive disorders). Specifically, internal -
izing disorders showing moderate correla -
tions with low extraversion include both 