- Email: [email protected]
Aesthetic preference and DSM-IIIR personality disorders
Person. individ. DifJ Vol. 18. No. 6. pp. 797-799. 199.5 Cmvrieht 0 1995 Elsevier Science Ltd Printed in &eat Britain. All rights reserved 0191-8869/95 $9.50+0.00
Pergamon
Aesthetic preference and DSM-IIIR personality disorders Roy King,* Evens Villeneuve,
Lisa Post, Christopher
Flowers and Kathy Moonshine
Department of Psychiatry, Stanford University, Stanford, CA 94305, U.S.A. (Received 25 August 1994)
Summary-Tbis report tested whether those individuals with a cluster B DSM-IIIR personality disorder (narcissistic, borderline, antisocial or histrionic) had higher scores for aesthetic preference for visually complex drawings using the Barron-Welch Art Scale. In a sample of 141 patients and controls, the 56 subjects who met the criteria for one of the cluster B personality disorder diagnoses displayed higher Barron-Welch Art Scale Scores. A multiple regression analysis showed that narcissistic and borderline personality disorder contributed positively, while dependent personality disorder, negatively to preference for complexity. The findings support the notion that aesthetic choices and values reflected through the dimension of openness to experience may contribute to the behavioral manifestations of the personality disorders.
INTRODUCTION The discovery of tools by which individuals with and without personality disorders can be distinguished has recently become an active field of investigation. Although many studies have focused on the biological, neuropsychological, and personality traits correlates of personality disorder (Siever & Davis, 1991; Costa & McCrae, 1990) other kinds of measures, such as those exploring aesthetic preference, have been relatively overlooked. Within the domain of personality research, aesthetic preference for visual complexity has been empirically linked to sensation-seeking traits (Zuckerman, Bone, Neat-y. Mangelsdotff & Brustman, 1972). psychoticism (Eysenck & Fumham, 1993). psychopathic deviancy (Barron, 1953), and emotional expressiveness (King, Curtis & Knoblich, 1991). Each of these traits, in the extreme, reveals a conceptual overlap with certain criteria comprising the defining features of the DSM-IIIR classification of the personality disorders (American Psychiatric Association, 1987). The dramatic cluster which is composed of the histrionic, borderline, narcissistic, and antisocial disorders resembles in form the personality correlates of complexity preference. Moreover, the four personality disorders contained within the dramatic cluster empirically cohere in factor-analytic studies (Bagby, Joffe, Parker & Schuller, 1993). demonstrate evidence of conjoint familial transmission (Reich, 1989), and correlate, as a cluster score, with psychoticism (O’Boyle and Barratt, 1993). A proclivity to reject the simple, orderly and structured therefore, may translate both into a rejection of order in the realm of the aesthetic and a disaffection for social regulations shown by the emotionally expressive, unruly, and nonconforming behavior characteristic of this group. In this report we test whether those Ss with a dramatic cluster diagnosis display a preference for complex visual stimuli using the Barron-Welch Revised Art Scale (Barron and Welch, 1963).
METHODS Ss were a series of 141 individuals of whom 61 were community volunteers, 48 were general psychiatric patients, and 32 were outpatients who had been specifically referred to a clinic specializing in the treatment of personality disorders. There were 99 male and 42 female volunteers and the mean + SD age of the Ss was 37 f 10 years (range: 20-70). All Ss completed the Barron-Welch Revised Art Test which consists of a subset of 60 figures from the Welch Figure Preference Test. Each figure varies in complexity from simple, symmetrical geometric designs to intricately shaded, asymmetrical patterns. Individuals rate each drawing according to personal preference. The total art score is formed from the sum of the number of complex patterns preferred out of a total of 30 complex drawings, and the number of simple patterns rejected, likewise from a sample of 30 simple designs. DSM-IIIR diagnoses fall into several axes, of which Axis-I is comprised of the major psychiatric syndromes, and Axis-II, the personality disorders. To diagnose the Axis-II personality disorders the 109 community volunteers and general psychiatric patients were administered the Personality Disorders Examination (PDE) (Loranger, Susman, Oldbam & Russakoff, 1987), a structured interview which assesses diagnoses of each of the 11Axis-II personality disorders, and the 32 Ss referred to the personality disorders clinic were administered a clinical interview. The PDE interviews and the clinical assessments were made blind to the individual’s art score. After each of the Axis-II personality disorders diagnoses was determined, the cluster diagnoses were computed. In addition to cluster B (the dramatic cluster of histrionic, borderline, narcissistic and antisocial personality disorders), cluster A (the eccentric cluster comprised of the schizoid, schizotypal, and paranoid personality disorders) and cluster C (the anxious cluster, aggregated from the dependent, avoidant, compulsive, and passive-aggressive personality disorders) determinations were made whether an individual had one of the defining personality disorders in a particular cluster. An a priori hypothesis that those individuals with a cluster B diagnosis would have higher preference for aesthetic complexity was tested using a comparison of means f-test performed on the Barron-Welch Art Score. In addition a forward multiple regression predicting the art score from sex and age, then adding, stepwise, the axis II personality disorders was calculated. *To whom all correspondence should be addressed. 797
Notes and Shorter Communications
798
Table 1. Comparisons of BarrowWelch art scores between the three DSM-IIIR personality disorder clusters Art score Cluster Dramatic Eccentric Anxious
Absent
Present (Ss in cluster)
25~13 (n=85) 28 f 13 (n = 121) 28514 (n=113)
32 -+ 13 (n = 56)* 26~ 13 @x=20) 28 t 12 (n = 28)
*P < 0.002. f-test.
Table 2. Forward multiple regression show /?-coefficients of the Barron-Welch art score using sex and age as fixed predictors, and the DSM-IIIR personality disorder diagnoses as stepwise entered predictors B
R2 Change
Age
- 0.02
Sex Narcissistic P.D. Borderline P.D. Dependent P.D.
- 0.08 0.17* 0.24* - 0.17*
0.000 0.001 0.053 0.028 0.028
Variable
Step
1 2 3 4 5
Final R’=O.ll, *P < 0.05.
F(5, 135)=3.33,
P
RESULTS AND DISCUSSION The mean 2 SD art scores of the sample was 28 2 13. Of the 141 Ss tested, 20 had diagnoses in the eccentric cluster, 56 in the dramatic cluster, and 28 in the anxious cluster. Table I shows the comparison of means in the art score across each of the Axis-II clusters. As can be seen a diagnosis in the dramatic cluster is significantly associated with a higher art score, while a diagnosis in the eccentric or the anxious cluster is not. The correlation of the art score with age was not significant (r = - 0.03), and using a two-way ANOVA with a clusterB diagnosis and sex as the independent categorical variables showed no effect of sex F (1, 137) = 0.21; n.s.; a retained effect of cluster B diagnosis F (I, 137) = 9.87, P < 0.002 and no sex by diagnosis interaction F (1, 137) = 0.82, n.s. In order to determine whether this increase in complexity preference for those with a cluster B diagnosis is explainable by differences between the three sample groups (normals, general psychiatric patients, outpatients suspected of having a personality disorder) a two-way ANOVA with cluster B diagnosis and selection group as the independent categories was executed. Likewise, the analysis showed that cluster B diagnosis maintained significance in determining the Barron-Welch Art Score: F (1, 135) = 4.36, P < 0.05; while there was no group effect: F (2, 135) = 0.18, n.s.; nor was there any group X cluster B interaction [F (2, 135) = 0.02, n.s.1. Thus the association of complexity preference with a cluster B diagnosis does not appear to be a function of a nonspecific presence of a psychiatric condition in this sample. Table 2 displays the multiple regression analysis of the art score with age, sex, and the personality diagnosis as independent variables. Here, the art score can be predicted positively by borderline and narcissistic personality disorders and negatively by dependent personality disorder. The results of this paper contribute to the utility of measures of aesthetic preference for the differentiation of the personality disorders. In contrast to the anxious and the eccentric clusters, the dramatic cluster appears to show some specificity in its association with complexity preference. The two disorders-narcissistic and borderline personality-share a substrate of emotional dysequilibrium coupled with an external display of these affective storms. Both kinds of individuals react intensely to a variety of social precipitants. Moreover they are prone to express their anguish through a variety of socially dysfunctional mechanisms. The negative association in the multiple regression between the art score and dependent personality disorders resemble Costa and McCrae’s (1990) findings that dependent traits, as measured by the Milton Clinical Multiaxial Inventory, were negatively correlated with openness to experience using the NBO-Personality Inventory. In that work, this association was interpreted as reflecting the dependent individual’s conventionalism and conformity. Additionally, in that study, as in the present report, narcissistic traits were positively correlated with openness to experience. It is interesting to note that Tetlock, Peterson and Berry (1993) have found that among business administration candidates, both the Barron-Welch art score and narcissistic personality traits were associated with integrative complexity in their cognitions. Perhaps the clinically described ‘looseness of boundaries’ typically ascribed to the borderline and narcissistic disorders might be mirrored in their preferential orientation toward complex, emotionally symbolic stimuli. Further studies would be important to delineate the contribution of biological and psychological factors to individual differences in aesthetic choice behavior, and the overlooked role that aesthetic values, attitudes, and choices may play in the manifestation of the personality disorders. Acknowledgemenrs-This
work was supported by a grant from the National Institute of Drug Abuse, No. DA-04789.
REFERENCES American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders. DSM-IffR (3rd edn revised). Washington, DC: APA. Bagby, R. M., Joffe, R. T., Parker, J. D. & Schuller, D. R. (1993). Re-examination of the evidence for DSM-III personality disorder clusters. Journal of Personality Disorders, 7, 320-328.
Notes and Shorter Communications Barron, F. (1953). Complexity-simplicity
799
as a personality dimension. Journal of Abnormal and Social Psychology, 48,
163-172.
Barron, F. and Welch, G. S. (1963). Barron-Welch art scale, a portion of the Welchjgure preference rest. Palo Alto, CA: Consulting Psychologists Press. Costa, P. T. & McCrae (1990).Personality disorders and the five-factor model of personality. Journal ofPersonality Disorders, 4,362-37 1. Eysenck, H. J. & Furnham, A. (1993). Personality and the Barron-Welch Art Scale. Perceptual and Motor Skills, 76.837-838. King, R., Curtis, D. & Knoblish, G. (1991). Complexity preference in substance abusers and controls: Relationships to diagnosis and personality variables. Perceptual and Motor Skills, 72, 35-39. Loranger, A. W., Susman, V. L., Oldham, J. M. & Russakoff, L. M. (1987). The Personality Disorder Exuminationt A preliminary report, I, l-l 3.
O’Boyle, M. & Barratt, E. S. (1993). Impulsivity and DSM-IIIR personality disorders. Personality and Individual DifJerences, 14,609-611.
Reich, J. H. (1989). Familiarity of DSM-III dramatic and anxious personality clusters. Journnl ofNervous and Mental Disease, 177,96-100.
Siever, L. J. & Davis, K. L. (1991). A psychobiological
perspective on the personality disorders. American Journal of
Psychiatry, 148, 1647-1658.
Tetlock, P. E., Peterson, R. S. & Berry, J. M. (1993). Flattering and unflattering personality portraits of integratively simple and complex managers. Journal of Personality and Social Psychology, 64,500-5 I I. Zuckerman, M., Bone, R. N., Neary, R., Mangelsdorff, D. & Brustman, B. (1972). What is the sensation seeker? Personality trait and experience correlates of the Sensation Seeking Scales. Journal of Consulting and Clinical Psychology. 38, 308-321.
Pergamon
Aesthetic preference and DSM-IIIR personality disorders Roy King,* Evens Villeneuve,
Lisa Post, Christopher
Flowers and Kathy Moonshine
Department of Psychiatry, Stanford University, Stanford, CA 94305, U.S.A. (Received 25 August 1994)
Summary-Tbis report tested whether those individuals with a cluster B DSM-IIIR personality disorder (narcissistic, borderline, antisocial or histrionic) had higher scores for aesthetic preference for visually complex drawings using the Barron-Welch Art Scale. In a sample of 141 patients and controls, the 56 subjects who met the criteria for one of the cluster B personality disorder diagnoses displayed higher Barron-Welch Art Scale Scores. A multiple regression analysis showed that narcissistic and borderline personality disorder contributed positively, while dependent personality disorder, negatively to preference for complexity. The findings support the notion that aesthetic choices and values reflected through the dimension of openness to experience may contribute to the behavioral manifestations of the personality disorders.
INTRODUCTION The discovery of tools by which individuals with and without personality disorders can be distinguished has recently become an active field of investigation. Although many studies have focused on the biological, neuropsychological, and personality traits correlates of personality disorder (Siever & Davis, 1991; Costa & McCrae, 1990) other kinds of measures, such as those exploring aesthetic preference, have been relatively overlooked. Within the domain of personality research, aesthetic preference for visual complexity has been empirically linked to sensation-seeking traits (Zuckerman, Bone, Neat-y. Mangelsdotff & Brustman, 1972). psychoticism (Eysenck & Fumham, 1993). psychopathic deviancy (Barron, 1953), and emotional expressiveness (King, Curtis & Knoblich, 1991). Each of these traits, in the extreme, reveals a conceptual overlap with certain criteria comprising the defining features of the DSM-IIIR classification of the personality disorders (American Psychiatric Association, 1987). The dramatic cluster which is composed of the histrionic, borderline, narcissistic, and antisocial disorders resembles in form the personality correlates of complexity preference. Moreover, the four personality disorders contained within the dramatic cluster empirically cohere in factor-analytic studies (Bagby, Joffe, Parker & Schuller, 1993). demonstrate evidence of conjoint familial transmission (Reich, 1989), and correlate, as a cluster score, with psychoticism (O’Boyle and Barratt, 1993). A proclivity to reject the simple, orderly and structured therefore, may translate both into a rejection of order in the realm of the aesthetic and a disaffection for social regulations shown by the emotionally expressive, unruly, and nonconforming behavior characteristic of this group. In this report we test whether those Ss with a dramatic cluster diagnosis display a preference for complex visual stimuli using the Barron-Welch Revised Art Scale (Barron and Welch, 1963).
METHODS Ss were a series of 141 individuals of whom 61 were community volunteers, 48 were general psychiatric patients, and 32 were outpatients who had been specifically referred to a clinic specializing in the treatment of personality disorders. There were 99 male and 42 female volunteers and the mean + SD age of the Ss was 37 f 10 years (range: 20-70). All Ss completed the Barron-Welch Revised Art Test which consists of a subset of 60 figures from the Welch Figure Preference Test. Each figure varies in complexity from simple, symmetrical geometric designs to intricately shaded, asymmetrical patterns. Individuals rate each drawing according to personal preference. The total art score is formed from the sum of the number of complex patterns preferred out of a total of 30 complex drawings, and the number of simple patterns rejected, likewise from a sample of 30 simple designs. DSM-IIIR diagnoses fall into several axes, of which Axis-I is comprised of the major psychiatric syndromes, and Axis-II, the personality disorders. To diagnose the Axis-II personality disorders the 109 community volunteers and general psychiatric patients were administered the Personality Disorders Examination (PDE) (Loranger, Susman, Oldbam & Russakoff, 1987), a structured interview which assesses diagnoses of each of the 11Axis-II personality disorders, and the 32 Ss referred to the personality disorders clinic were administered a clinical interview. The PDE interviews and the clinical assessments were made blind to the individual’s art score. After each of the Axis-II personality disorders diagnoses was determined, the cluster diagnoses were computed. In addition to cluster B (the dramatic cluster of histrionic, borderline, narcissistic and antisocial personality disorders), cluster A (the eccentric cluster comprised of the schizoid, schizotypal, and paranoid personality disorders) and cluster C (the anxious cluster, aggregated from the dependent, avoidant, compulsive, and passive-aggressive personality disorders) determinations were made whether an individual had one of the defining personality disorders in a particular cluster. An a priori hypothesis that those individuals with a cluster B diagnosis would have higher preference for aesthetic complexity was tested using a comparison of means f-test performed on the Barron-Welch Art Score. In addition a forward multiple regression predicting the art score from sex and age, then adding, stepwise, the axis II personality disorders was calculated. *To whom all correspondence should be addressed. 797
Notes and Shorter Communications
798
Table 1. Comparisons of BarrowWelch art scores between the three DSM-IIIR personality disorder clusters Art score Cluster Dramatic Eccentric Anxious
Absent
Present (Ss in cluster)
25~13 (n=85) 28 f 13 (n = 121) 28514 (n=113)
32 -+ 13 (n = 56)* 26~ 13 @x=20) 28 t 12 (n = 28)
*P < 0.002. f-test.
Table 2. Forward multiple regression show /?-coefficients of the Barron-Welch art score using sex and age as fixed predictors, and the DSM-IIIR personality disorder diagnoses as stepwise entered predictors B
R2 Change
Age
- 0.02
Sex Narcissistic P.D. Borderline P.D. Dependent P.D.
- 0.08 0.17* 0.24* - 0.17*
0.000 0.001 0.053 0.028 0.028
Variable
Step
1 2 3 4 5
Final R’=O.ll, *P < 0.05.
F(5, 135)=3.33,
P
RESULTS AND DISCUSSION The mean 2 SD art scores of the sample was 28 2 13. Of the 141 Ss tested, 20 had diagnoses in the eccentric cluster, 56 in the dramatic cluster, and 28 in the anxious cluster. Table I shows the comparison of means in the art score across each of the Axis-II clusters. As can be seen a diagnosis in the dramatic cluster is significantly associated with a higher art score, while a diagnosis in the eccentric or the anxious cluster is not. The correlation of the art score with age was not significant (r = - 0.03), and using a two-way ANOVA with a clusterB diagnosis and sex as the independent categorical variables showed no effect of sex F (1, 137) = 0.21; n.s.; a retained effect of cluster B diagnosis F (I, 137) = 9.87, P < 0.002 and no sex by diagnosis interaction F (1, 137) = 0.82, n.s. In order to determine whether this increase in complexity preference for those with a cluster B diagnosis is explainable by differences between the three sample groups (normals, general psychiatric patients, outpatients suspected of having a personality disorder) a two-way ANOVA with cluster B diagnosis and selection group as the independent categories was executed. Likewise, the analysis showed that cluster B diagnosis maintained significance in determining the Barron-Welch Art Score: F (1, 135) = 4.36, P < 0.05; while there was no group effect: F (2, 135) = 0.18, n.s.; nor was there any group X cluster B interaction [F (2, 135) = 0.02, n.s.1. Thus the association of complexity preference with a cluster B diagnosis does not appear to be a function of a nonspecific presence of a psychiatric condition in this sample. Table 2 displays the multiple regression analysis of the art score with age, sex, and the personality diagnosis as independent variables. Here, the art score can be predicted positively by borderline and narcissistic personality disorders and negatively by dependent personality disorder. The results of this paper contribute to the utility of measures of aesthetic preference for the differentiation of the personality disorders. In contrast to the anxious and the eccentric clusters, the dramatic cluster appears to show some specificity in its association with complexity preference. The two disorders-narcissistic and borderline personality-share a substrate of emotional dysequilibrium coupled with an external display of these affective storms. Both kinds of individuals react intensely to a variety of social precipitants. Moreover they are prone to express their anguish through a variety of socially dysfunctional mechanisms. The negative association in the multiple regression between the art score and dependent personality disorders resemble Costa and McCrae’s (1990) findings that dependent traits, as measured by the Milton Clinical Multiaxial Inventory, were negatively correlated with openness to experience using the NBO-Personality Inventory. In that work, this association was interpreted as reflecting the dependent individual’s conventionalism and conformity. Additionally, in that study, as in the present report, narcissistic traits were positively correlated with openness to experience. It is interesting to note that Tetlock, Peterson and Berry (1993) have found that among business administration candidates, both the Barron-Welch art score and narcissistic personality traits were associated with integrative complexity in their cognitions. Perhaps the clinically described ‘looseness of boundaries’ typically ascribed to the borderline and narcissistic disorders might be mirrored in their preferential orientation toward complex, emotionally symbolic stimuli. Further studies would be important to delineate the contribution of biological and psychological factors to individual differences in aesthetic choice behavior, and the overlooked role that aesthetic values, attitudes, and choices may play in the manifestation of the personality disorders. Acknowledgemenrs-This
work was supported by a grant from the National Institute of Drug Abuse, No. DA-04789.
REFERENCES American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders. DSM-IffR (3rd edn revised). Washington, DC: APA. Bagby, R. M., Joffe, R. T., Parker, J. D. & Schuller, D. R. (1993). Re-examination of the evidence for DSM-III personality disorder clusters. Journal of Personality Disorders, 7, 320-328.
Notes and Shorter Communications Barron, F. (1953). Complexity-simplicity
799
as a personality dimension. Journal of Abnormal and Social Psychology, 48,
163-172.
Barron, F. and Welch, G. S. (1963). Barron-Welch art scale, a portion of the Welchjgure preference rest. Palo Alto, CA: Consulting Psychologists Press. Costa, P. T. & McCrae (1990).Personality disorders and the five-factor model of personality. Journal ofPersonality Disorders, 4,362-37 1. Eysenck, H. J. & Furnham, A. (1993). Personality and the Barron-Welch Art Scale. Perceptual and Motor Skills, 76.837-838. King, R., Curtis, D. & Knoblish, G. (1991). Complexity preference in substance abusers and controls: Relationships to diagnosis and personality variables. Perceptual and Motor Skills, 72, 35-39. Loranger, A. W., Susman, V. L., Oldham, J. M. & Russakoff, L. M. (1987). The Personality Disorder Exuminationt A preliminary report, I, l-l 3.
O’Boyle, M. & Barratt, E. S. (1993). Impulsivity and DSM-IIIR personality disorders. Personality and Individual DifJerences, 14,609-611.
Reich, J. H. (1989). Familiarity of DSM-III dramatic and anxious personality clusters. Journnl ofNervous and Mental Disease, 177,96-100.
Siever, L. J. & Davis, K. L. (1991). A psychobiological
perspective on the personality disorders. American Journal of
Psychiatry, 148, 1647-1658.
Tetlock, P. E., Peterson, R. S. & Berry, J. M. (1993). Flattering and unflattering personality portraits of integratively simple and complex managers. Journal of Personality and Social Psychology, 64,500-5 I I. Zuckerman, M., Bone, R. N., Neary, R., Mangelsdorff, D. & Brustman, B. (1972). What is the sensation seeker? Personality trait and experience correlates of the Sensation Seeking Scales. Journal of Consulting and Clinical Psychology. 38, 308-321.