also be made with caution. The data do suggest, however, that
Cluster B and C traits are prevalent, and perhaps not evenly
distributed among those with schizophrenia spectrum disorders.
Furthermore, when entered together into regressions to predict
emotional discomfort and inpatient hospitalization, some over-
lap was noted between Clusters B and C, suggesting that they
may not exist entirely independently of one another.
Lastly, there are limitations to this study. First, gener-
alization of ﬁndings is limited by sample composition. We
examined a rehabilitation sample composed of persons gen-
erally in their 40s, many of whom were receiving consider-
able amounts of outpatient psychiatric service with both
schizophrenia and schizoaffective disorder. It may be that
personality traits and treatment utilization have a different
relationship among younger persons, persons less open to
treatment or in a different phase of illness, or persons with
schizophrenia versus schizoaffective disorder not referred for
rehabilitation. Symptoms and personality were also assessed
at one point in time, and personality was assessed exclusively
by self-report. Without a control group of persons with other
disorders, it is also unclear whether what was measured here
is unique to schizophrenia or perhaps common to psychiatric
disorders in general. Finally, multiple analyses were con-
ducted, including several that were exploratory in nature, and
while two-tailed tests were conducted despite unidirectional
hypotheses, these have inﬂated the chances of spurious ﬁnd-
ings. Ultimately, therefore, replication is needed with larger
samples including females and males in earlier phases of
illness, along with research that measures personality symp-
toms and neurocognition at multiple points in time in a
variety of settings. Such research has the potential to examine
whether changes in personality may precede, proceed from,
or be unrelated to changes in symptom levels and treatment
utilization. It may also be possible to detect associations
among symptoms, service utilization, and personality that
have important implications for treatment and rehabilitation.
American Psychiatric Association (1994) Diagnostic and Statistical Manual
(4th ed). Washington DC: American Psychiatric Association.
Bell MD, Lysaker PH, Goulet JG, Milstein RM, Lindenmayer JP (1994) Five
component model of schizophrenia: Factorial invariance of the Positive
and Negative Syndrome Scale. Psychiatry Res. 52:295–303.
Bell MD, Milstein RM, Goulet JG, Lysaker PH, Cicchetti D (1992) The
positive and negative syndrome scale and brief psychiatric rating scale:
Reliability and predictive validity. J Nerv Ment Dis. 180:723–728.
Bender DS, Dolan RT, Skodol AE (2001) Treatment utilization by patients
with personality disorders. Am J Psychiatry. 158:295–302.
Benjamin LS (1993) Interpersonal Diagnosis and Treatment of Personality
Disorders. New York: Guilford.
Carr VJ, Johnston PJ, Lewin TJ, Rajkumar S, Carter GL, Issakidis C (2003)
Patterns of service use among persons with schizophrenia and other
psychotic disorders. Psychiatr Serv. 54:226 –235.
Casey PR, Tyrer P (1990) Personality disorder and psychiatric illness in
general practice. Br J Psychiatry. 156:261–265.
Dickerson F, Ringel N, Parente F (1998) Subjective quality of life in
out-patients with schizophrenia: Clinical and utilization correlates. Acta
Psychiatr Scand. 98:124 –127.
Donat DC, Geczy B, Helmrich J, LeMay M (1992) Empirically derived
personality subtypes of public psychiatric patients: Effect on self-reported
symptoms, coping inclinations and evaluation of expressed emotion in
caregivers. J Pers Assess. 58:36 –50.
Gurrera RJ, Nestor PG, O’Donnel BF (2000) Personality traits in schizo-
phrenia. J Nerv Ment Dis. 188:31–35.
Hogg B, Jackson HJ, Rudd RP, Edwards J (1990) Diagnosing personality
disorders in recent-onset schizophrenia. J Nerv Ment Dis. 178:194 –199.
Hulbert CA, Jackson HJ, McGorry PD (1996) Relationship between person-
ality and course and outcome in early psychosis: A review of the literature.
Clin Psychol Rev. 16:707–727.
Kay S, Opler L, Lindenmeyer J (1989) The positive and negative syndrome
scale (PANSS): Rationale and standardization. Br J Psychiatry. 155(suppl
7):59 – 65.
Kentros M, Smith TE, Hull J, McKee M, Terkelsen K, Capalbo C (1997)
Stability of personality traits in schizophrenia and schizoaffective disor-
der: A pilot project. J Nerv Ment Dis. 185:549 –555.
Kessler RC, Zhao S, Katz SJ, Kouzis AC, Frank RG, Edlund M, Leaf P
(1994) Past-year use of outpatient services for psychiatric problems in the
National Comorbidity Survey. Am J Psychiatry. 156:115–123.
Kraus G, Reynolds D (2001) The “A-B-C’s” of the Cluster B’s: Identifying,
understanding and treating Cluster B personality disorders. Clin Psychol
Lysaker PH, Bell M, Bryson G, Kaplan E (1998) Insight and interpersonal
function in schizophrenia. J Nerv Ment Dis. 186:432– 436.
Lysaker PH, Bell MD, Kaplan E, Conway Greig T, Bryson G (1999)
Personality and psychopathology in schizophrenia: The association be-
tween personality traits and symptoms. Psychiatry. 62:36 – 62.
Lysaker PH, Bryson GJ, Marks KA, Greig T, Bell MD (2004a) Coping in
schizophrenia: Associations with neurocognitive deﬁcits and personality.
Schizophr Bull. 30:113–121.
Lysaker PH, Wickett AM, Lancaster RS, Campbell K, Davis LW (2004b)
Heightened interpersonal dependency in schizophrenia: Associations with
graver impairment in neurocognition but not with negative or positive
symptoms. Bull Menninger Clin. 68:164 –173.
Lysaker PH, Wilt MA, Plascek-Hallberg CD, Brenner C, Clements CA
(2003) The association of personality with symptoms and coping in
schizophrenia. J Nerv Ment Dis. 191:80 – 86.
Millon T, Davis RD, Millon C (1997) Millon Clinical Multiaxial Inventory-
III (MCMI-III) Manual (2nd ed). Minneapolis (MN): National Computer
Modestin J, Oberson B, Emi T (1997) Possible correlates of DSM-III-R
personality disorders. Acta Psychiatr Scand. 96:424 – 430.
Narrow WE, Regier DA, Rae DS, Manderscheid RW, Locke BZ (1993) Use
of services by persons with mental and addictive disorders: Findings from
the National Institute of Mental Health Epidemiologic Catchment Area
Program. Arch Gen Psychiatry. 50:95–107.
Nielsen AD, Hewitt PL, Habke AM (1997) Borderline and schizophrenic
patients: A comparison using the MCMI-II. J Psychopathol Behav Assess.
Olfson M, Pincus HA (1994) Outpatient psychotherapy in the United States,
II: Patterns of utilization. Am J Psychiatry. 151:1289 –1294.
Rees A, Hardy GE, Barkham M (1997) Covariance in the measurement of
depression/anxiety and three Cluster c personality disorders. J Affect
Rossi G, Van Den Brande I, Tobac A, Sloore H, Hauben C (2003) Conver-
gent validity of the MCMI-III personality disorder scales and the MMPI-2
scales. J Pers Disord. 17:330 –340.
Semerari A, Carcione A, Dimaggio G, Nicolo` G, Pedone R, Procacci M (In
press) Metarepresentative functions in Borderline Personality Disorder.
J Pers Disord.
Smith TE, Shea MT, Schooler NR, Levin H, Deutch A, Grabstein E (1995)
Studies of schizophrenia: Personality traits in schizophrenia. Psychiatry.
Snyder S, Pitts WM, Pokorny AD (1986) Borderline personality traits in
psychiatric inpatients. Psychol Rep. 58:51– 60.
Solano J, Chavez M (2000) Premorbid personality disorders in schizophre-
nia. Schizophr Res. 44:137–144.
Tyrer P, Manley C, Van Horn E, Leddy D, Ukoumunne OC (2000) Person-
ality abnormality in severe mental illness and its inﬂuence on outcome of
intensive and standard case management: A randomized controlled trial.
Eur Psychiatry. 15:7–10.
Widiger TA, Rogers JH (1989) Prevalence and comorbidity of personality
disorders. Psychiatr Ann. 19:132–136.
The Journal of Nervous and Mental Disease • Volume 194, Number 9, September 2006 Personality Traits in Schizophrenia
© 2006 Lippincott Williams & Wilkins 653