A Peer Trade-off Model of Personality Disorder Traits During Adolescence

Abstract

This Viewpoint paper argues for a peer trade-off model of personality disorder (PD) traits during adolescence that allows for both positive (e.g., popularity, peer acceptance) and negative (e.g., peer rejection, peer victimization, peer exclusion) peer outcomes. The need for new interpersonal (dsy)function models of PD traits during adolescence is urgent because most research has focused on internalizing and externalizing psychopathology, as well as adults, who differ from adolescents in the value that they place on different social behaviors. Available clinical treatments for PD traits have also been based on findings with adults. Thus, new models are not only needed but would have profound etiological, diagnostic, and treatment implications. We describe preliminary findings that support our proposed peer trade-off model. In conclusion, we describe promising new directions to further evaluate the model and advance knowledge about PD traits during adolescence.

Keywords

Personality disorder traits trade-offs peer-nomination popularity rejection adolescence

Personality disorder (PD) traits, such as perfectionism, affective lability, rudeness, and risk-taking, refer to enduring patterns of thoughts, feelings, and behaviors that result in interpersonal dysfunction (Williams & Simms, 2016). Substantial evidence supports PD traits as substantial risk factors for psychopathology (e.g., Andersen & Bienvenu, 2011). Much of this evidence, however, is from studies that focused exclusively on PD traits in relation to internalizing and externalizing outcomes (e.g., aggression; Salekin & Frick, 2005). Relatively little has been published on PD traits in relation to interpersonal dysfunction outcomes, such as peer rejection, especially in adolescent samples. This is a notable research gap, as adolescence is the developmental period when many PDs are first diagnosed and when interpersonal dysfunction can become increasingly impairing and resistant to change (e.g., Krueger, 1999). A related question not yet addressed is whether certain PD traits, such as risk-taking, might be socially impairing in adulthood but lead to positive peer experiences during adolescence due to developmental differences in the types of social behaviors valued. Evidence of positive and negative peer “trade-offs” of PD traits during adolescence would have important etiological, diagnostic, and treatment implications. Accordingly, in this Viewpoint paper, we argue that to advance understanding and treatment of PD traits during adolescence, a peer trade-off model is needed. We offer preliminary findings that support this approach and conclude with recommendations for future research.

Research on PD Traits During Adolescence

Since the shift from categorical to trait approaches, there has been a tendency to focus on PD traits in relation to internalizing and externalizing symptomology, especially in studies of adolescents. Past research on PD traits during adolescence also has been limited by its general focus on only one or two specific PD traits (e.g., affective instability, impulsivity). This does not align with more recent comprehensive trait-focused PD models (Krueger et al., 2012) and creates uncertainty about which PD traits in comprehensive PD trait models are uniquely socially impairing during adolescence.

Of course, there is some indication that adolescents with certain personality traits, such as disagreeableness, struggle with peers in terms of peer rejection (active peer dislike), victimization (repeated peer abuse), exclusion (actively left out of group activities), and unpopularity (e.g., Laursen et al., 2010). The same is true for those adolescents with personality-based tendencies to withdraw from peers (Bowker & White, 2021). Such peer difficulties likely occur because adolescents find some personality traits and their associated behaviors to be aversive, non-normative, or developmentally inappropriate. We were not, however, able to locate any past research that specifically considered PD traits in relation to the aforementioned negative group-level peer outcomes during adolescence.

Another limitation to past research: only one past study considered positive peer outcomes, such as popularity and peer acceptance (or liking; see See et al., 2021, which showed that certain classes of PD traits are related negatively to popularity and social preference during adolescence). As a result, it is not established whether there are any positive trade-offs of some PD traits during adolescence. We speculate that certain PD traits, such as grandiosity and risk-taking, are viewed as confident and pseudo-mature by adolescents during this developmental period, and in turn, also afford positive peer outcomes. For instance, relationally aggressive behavior, which is similar to the PD trait manipulativeness, has been related to both peer rejection and popularity; adolescents might not like the behavior, but they do appear to respect and admire it, unlike in adulthood (Casper et al., 2020). In general, trade-off models in peers research have increased in popularity as growing evidence shows that certain social behaviors and processes (e.g., co-rumination) can have both positive and negative adjustment implications (e.g., Tilton-Weaver & Rose, 2023).

Peer Trade-off Model of Adolescent PD Traits

We propose a peer trade-off model of adolescent PD traits such that some PD traits, such as social withdrawal, are likely viewed as non-normative or aversive by peers and therefore should only be related to negative peer outcomes. We further speculate that other PD traits, such as exhibitionism, risk-taking, and grandiosity, may be judged by adolescents as both distressing and admirable and thus be related to both negative and positive peer outcomes.

Table 1

Correlations between PD Traits and Peer Outcomes

Trait	Items (abbreviated)	Acceptance	Rejection	Popularity	Unpopularity	Victimization	Exclusion
Affective Lability (1)	Moods are often up and down	0.37**	0.28*	0.53**	–0.08	–0.03	–0.06
Affective Lability (2)	Often has trouble coping with stress	0.09	0.31*	0.37**	0.11	0.09	0.22
Anger	Often angry or mad	0.36*	0.29*	0.29*	0.05	0.07	0.02
Anhedonia	Not excited to do much of anything	–0.05	0.11	0.00	0.23	0.22	0.35*
Anxiousness	Often worries or is nervous	0.34*	0.00	0.12	0.11	00.05	–0.01
Callousness	Does not seem to care about the feelings of others	0.29*	0.35*	0.25	–0.02	–0.13	–0.11
Depressiveness	Often sad, gloomy, or depressed	0.03	0.33*	–0.07	0.51**	0.63**	0.82**
Domineering	Bossy and likes to tell everyone else what to do	0.14	0.25	0.29*	–0.10	–0.06	0.03
Emotional Detachment	Avoids talking about his/her feelings	0.35*	0.10	0.02	0.16	0.17	0.02
Exhibitionism	Do almost anything to be the center of attention	0.23	0.34*	0.74**	–0.01	–0.04	0.04
Fantasy Proneness	Daydreams a lot or seems to get lost in fantasies	–0.02	–0.05	0.00	0.10	0.17	0.20
Grandiosity	Often brags or thinks that he/she is better than other kids	0.26	0.49**	0.47**	–0.02	–0.11	–0.08
Health Anxiety	Often worries about his/her health or being sick	0.12	0.27	0.33*	–0.01	0.07	0.16
Hostile Aggression	Mean and gets into fights with others	0.13	0.17	–0.07	–0.13	–0.08	–0.10
Irresponsibility	Can’t be depended on to do things right	0.10	0.34*	0.14	–0.02	–0.07	–0.07
Manipulative	Tricks others to get what he/she wants, even if it hurts others	0.20	0.44**	0.57**	0.04	–0.07	–0.07
Mistrust	Does not trust others	–0.07	0.41**	0.07	0.37**	0.39**	0.47**
Non-Perseverance	Gives up easily when he/she is not having fun	0.11	0.13	–0.02	0.38**	0.60**	0.51**
Non-Planfulness	Does things without thinking	0.32*	0.43**	0.64**	0.01	0.00	0.13
Norm Violation	Often breaks the rules or gets in trouble with teachers	0.16	0.12	–0.10	–0.13	–0.04	–0.07
Peculiarity	Dresses, talks, or acts differently than most others	0.08	–0.05	–0.22	0.24	0.37**	0.26
Trait	Items	Acceptance	Rejection	Popularity	Unpopularity	Victimization	Exclusion
Perfectionism	Tries hard to do things perfectly	0.23	0.26	0.37**	–0.08	–0.08	0.01
Relationship Insecurity	Gets jealous or worries about not being liked by others	0.36*	0.25	0.68**	–0.02	–0.09	–0.06
Rigidity	Has strong and rigid (not flexible) beliefs	0.10	0.37**	0.01	0.36**	0.42**	0.66**
Risk Taking	Does risky things, just for the thrill	0.43**	–0.22	0.35*	–0.15	–0.11	–0.09
Rudeness	Says rude thing to people	–0.04	0.58**	–0.01	0.14	0.14	0.29*
Social Withdrawal	Likes or prefers to be alone	0.12	0.21	–0.04	0.53**	0.46**	0.43**
Submissiveness	Would rather make others happy than him/herself	0.40**	–0.19	0.01	0.17	–0.05	–0.10
Workaholism	Cares more about schoolwork than their friends, family, or having fun	0.07	0.30*	0.18	–0.05	–0.07	0.01

Table 2

Regression Results

	Acceptance	Rejection	Popularity	Unpopularity	Victimization	Exclusion
	β
Affective Lability	0.22	–	0.12	–	–	–
Affective Lability	–	–	–0.01	–	–	–
Depressiveness	–	–	–	0.17	0.43*	0.69**
Exhibitionism	–	–	0.66**	–	–	–
Grandiosity	–	0.24	0.13	–	–	–
Manipulative	–	0.28*	–0.22	–	–	–
Mistrust	–	0.21	–	0.18	0.20	0.17*
Non-Perseverance	–	–	–	0.08	0.40**	0.23*
Non-Planfulness	–	–0.11	0.04	–	–	–
Peculiarity	–	–	–	–	0.14	–
Perfectionism	–	–	0.03	–	–	–
Relationship Insecurity	–	–	0.16	–	–	–
Rigidity	–	0.12	–	0.07	–0.03	0.15
Risk Taking	0.39**	–	–	–	–	–
Rudeness	–	0.41**	–	–	–	–
Social Withdrawal	–	–	–	0.30	–0.14	–0.22*
Submissiveness	0.42**	–	–	–	–	–
Adjusted R²	0.38**	0.50**	0.56**	0.30**	0.50**	0.74**

Note. Only CAT-PD traits correlated (p < 0.01) with each peer outcome were included. *p < 0.05. **p < 0.01.

A pilot study provided preliminary support for this model. Participants were sixth-grade middle school students (N = 50; M_age= 12.10 years, SD = 0.39; 56% female, 40% ethnic minority). We developed peer-nomination items for 28 PD traits assessed by the Comprehensive Assessment of Traits relevant to Personality Disorder (CAT-PD; Simms et al., 2011). The CAT-PD is a comprehensive PD trait model consistent with the DSM-5 Alternative Model for Personality Disorders (American Psychiatric Association, 2013; Wright & Simms, 2014). In our study, individual traits were assessed with single peer nomination items, with the exception of affective lability, which was measured with two items (Table 1). Five CAT-PD traits were excluded—cognitive problems, romantic disinterest, self-harm, unusual beliefs, and unusual experiences—as these traits were deemed inappropriate for young adolescents or unable to be measured through peer-nomination. We also included six peer outcome items: “likes most” (acceptance), “likes least” (rejection), “very popular” (popular), “not popular” (unpopularity), “picked on or teased by other kids” (victimization), and “left out of things that other kids are doing or kids don’t let him/her play with them” (exclusion). All participants had signed parental consent and provided assent (participation rate = 60%) and made unlimited nominations for their other-sex and same-sex grade-mates. Nominations received for each item were summed, proportionalized, and standardized (Cillessen, 2009). Although peer nomination of PD traits is new, peer nomination of personality traits (e.g., extraversion, agreeableness) are not, and peer-nomination assessments have many strengths, including the use of multiple informants (Cillessen, 2009).

Bivariate correlations and regression models evaluated links between the peer-nominated PD traits and peer outcomes. Due to the small sample size and large number of analyses, we only considered findings significant at p < 0.01. In the correlational analyses, 16 (of 28) PD traits were related significantly to at least one peer difficulty (Table 1). Regression analyses (Table 2) showed unique links between several PD traits and peer difficulties. Correlational analyses also showed that the PD traits of manipulativeness, grandiosity, and exhibitionism were associated with popularity. In regression analyses, exhibitionism was a unique positive correlate of popularity, and risk-tasking and submissiveness were associated uniquely and positively with acceptance.

Conclusions and Future Directions

Our pilot study offers initial support for our proposed peer trade-off model of adolescent PD traits. As expected, several PD traits were related to only negative peer outcomes. For instance, adolescents nominated as withdrawn, rigid in their beliefs, and likely to give up when not having fun tended to be victimized, excluded, and unpopular. Adolescents rejected by peers received nominations for these same traits, but they were also rated as manipulative, impulsive, and rude. Replication is needed, but these findings may suggest that intervention should be tailored to the peer difficulty experienced, with the goal of targeting specific contributing PD traits. Several PD traits, however, were also associated with popularity and acceptance, and a number of PD traits (manipulativeness, grandiosity, non-planfulness) were related to both popularity and rejection. In addition to supporting our model, these findings suggest that some of the difficulty targeting PD traits may stem from positive, reinforcing peer feedback.

Going forward, additional research with larger samples of both adolescents and adults is needed to further validate our model. In such work, researchers should collect longitudinal data to evaluate our model as a prospective, and potentially bidirectional, one. Of course, there are important cultural differences in the extent to which different social behaviors are valued. For instance, social withdrawal is less impairing in cultures that tend to be more interdependent in their values and norms relative to those that are more independent (Bowker & White, 2021). Thus, it may also be the case that some PD traits are more socially impairing in some cultures than others, and future research should explore this possibility. Nevertheless, we hope our new proposed model and preliminary findings generate new research questions and set the stage for future research.

Footnotes

Bio Sketches

Jenna Weingarten is a doctoral student in the Clinical Psychology Program at the University at Buffalo. She received her B.A. in Psychology from the University of Pennsylvania. Her research interests focus on the impact of child and adolescent peer relationships on well-being.

Dr. Julie Bowker received her BS in Human Development from Cornell University and her PhD in Human Development from the University of Maryland. She is Professor of Psychology at the University at Buffalo, SUNY. Her research program focuses on the roles that peer relationships, particularly friendships, play in social and emotional development during late childhood and early adolescence.

Dr. Len Simms received his PhD in Clinical Psychology from the University of Iowa. He is currently Professor of Psychology at the University at Buffalo, SUNY. His research focuses on applied and basic psychological assessment, dimensional models of personality and psychopathology, and item response theory applications to personality measures and computerized adaptive testing.

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