People with personality disorders can find close relationships to be a challenge. By definition, personality disorders involve interpersonal processes. Disturbances in relationships are included in the diagnostic criteria for several personality disorders. Additionally, the qualities that lead people to develop personality disorders also interfere with their relationship-building abilities to express themselves, respect boundaries, and manage conflict. Yet being in a long-term intimate relationship can also benefit people with these disorders by providing them with support and stability if their partners can weather the occasional storms that can erupt in the course of everyday life.
According to a research team headed by University of Pittsburgh’s Joseph Beeney and colleagues (2019), “romantic relationships of those with PDs are often conflictual, violent, and unstable” (p. 1). Beeney et al. regard disturbances in attachment style as having a primary role in leading to these problematic interactions. People with personality disorders, they note, are particularly likely to have insecure attachment styles, meaning that they lack stable “internal working models” of the self and of other people. Furthermore, when confronted with conflict, people with insecure attachment styles show patterns of communication that create further relationship difficulties. Specifically, they engage in “demand/withdrawal” behaviors such as being overly critical (demanding the partner to change) and disengaging emotionally (withdrawal).
Beeney and his coauthors explain further the role of demand and withdrawal as problematic relationship behaviors associated with insecure attachment. People making excessive demands on their partners seek greater intimacy due to their constant need for reassurance. Those who engage in withdrawal, by contrast, try to distance themselves from their partners as much as possible in attempts to steer clear of conflict, to avoid being overwhelmed by intimacy, or to signal their objection if they feel their partner isn’t connecting with them at a level they desire. The Pittsburgh research team notes that previous researchers have investigated these theorized processes only within individuals, not by looking at both members of the dyad. However, it makes sense that in order to gain insight into the true picture, both partners need to be studied in relationship to each other.
One intriguing question the researchers raise is whether people with personality disorders form relationships with partners who themselves have personality disorders. Similarly, do people with insecure attachment styles pair up with partners who also have disturbed patterns of attachment? On the one hand, if both partners have similar levels of attachment insecurity, they could help each other out. However, if both partners have higher attachment insecurity, this could set their relationship on an ill-fated path. As the authors explain, “Pairings of elevated attachment anxiety in one person and elevated attachment avoidance in another are thought to lead to relationship dysfunction because each person has a pathway to ‘felt security’ that may activate central concerns and fears in the other” (p. 2).
The Beeney et al. study tested the two questions of whether partners would share similar levels of personality disorder severity, attachment insecurity, and relationship distress. For couples higher in personality disorder severity, the authors predicted that high levels of avoidant attachment in one partner would relate to high levels of avoidant in the other. Second, the authors tested the hypothesis that attachment style and demand/withdrawal patterns would serve as links between personality disorder severity and relationship satisfaction. This second hypothesis was tested via a complex statistical model known as Actor Partner Interaction Model (APIM) that examined the “actor effects,” or patterns due to each individual’s personality and “partner effects,” or the effects that each person has on the other.
Participants in the University of Pittsburgh study were drawn from psychiatric patients who were in treatment and who were involved in a relationship lasting at least one month in which they interacted with their partners at least four times per week (two of them in person). Of the 618 potential participants screened by the research team, a final sample of 260 representing 130 couples completed the study. They were in a relationship lasting an average of four and a half years; most of the couples lived together (72%) and a minority (33%) were married. Their average age was 30 years old and almost all had at least some college education. Three-quarters were heterosexual, with the remainder bisexual or homosexual. Of the personality disorder diagnoses, there was no one largest grouping, as they were divided almost equally across categories.
To obtain diagnostic information, the researchers employed clinical evaluators who administered standardized interviews, and each diagnosis was assigned via a team of judges meeting in a diagnostic case conference. Clinicians also rated the attachment styles of the participants, as well as interpersonal dysfunction. Each partner in the dyad completed a self-report measure of relationship satisfaction. Finally, to assess conflict resolution methods, the couple engaged in a 10-minute discussion of their highest problem area which trained observers then rated on the dimensions of demand and withdrawal.
As is evident from this description of the methods used in the study, the Beeney et al. investigation avoided most of the limitations of many of the relationship studies involving undergraduate participants, self-report ratings, and non-clinical levels of personality disorder dysfunction. The in-vivo method further allowed the researchers to watch the couples in action rather than relying on self-report. The APIM analyses provided the researchers with the ability to examine the all-important individual and joint effects involving personality disorder levels, attachment style, and conflict resolution methods as well as relationship satisfaction.
The results, then, can be seen as providing a comprehensive test of the individual and joint contributions of personality disorders to relationship distress via attachment style and conflict resolution methods. In keeping with the first aim, whether partners with similar levels of personality disorder pathology gravitate toward each other, the findings showed surprisingly no tendency to support what’s known as “assortive mating.” Nevertheless, partners with similar attachment styles did tend to partner with each other, as did people with comparable degrees of social impairment. Adding complexity to the findings was the fact that, only when both partners had personality disorders did people high in anxious attachment style tend to pair with partners high in attachment avoidance.
Looking next at partner communication methods during conflict resolution using the APIM, Beeney et al. found that partners high in attachment anxiety were more likely to withdraw during conflict. Contrary to previous research, though, higher levels of attachment anxiety were not related to more demands for intimacy. People whose partners were high in attachment anxiety may withdraw, the authors suggest, “in response to unmeasured conflict behaviors or previous experiences in conflict with the romantic partner” (p. 8). In other words, they withdraw because they just don’t want to get drawn into yet another fight. “Attempts for connection experienced by the partner as clingy, smothering, or excessively burdensome are more likely to be met with distancing behaviors, which further activates the actor’s attachment system” (p. 9).
There are two major clinical implications of this comprehensive and important study. First, the authors suggest that couples therapy among people with personality disorders should focus on replacing withdrawal with better communication methods. Second, recognizing when people with attachment anxiety make “bids for connection” could help their partners provide reassurance to calm and allay their worst fears.
To sum up, fulfillment in relationships, even among people with personality disturbance, may not be completely out of reach. The Beeney et al. study provides insights into how couples who might seem to have the least favorable odds of staying together can overcome these challenges as they learn to recognize and respond to each other’s needs.
Beeney, J. E., Stepp, S. D., Hallquist, M. N., Ringwald, W. R., Wright, A. G. C., Lazarus, S. A., … Pilkonis, P. A. (2019). Attachment styles, social behavior, and personality functioning in romantic relationships. Personality Disorders: Theory, Research, and Treatment. doi: 10.1037/per0000317