Personality Disorders and Human Evolution: An Integrative Meta-synthesis

An increasing body of evidence, spanning both qualitative and quantitative methodologies, points to the clinical utility of an evolutionarily informed conceptualization of personality disorders. Evolutionarily informed measures and mechanisms exhibit associations with a range of clinical indicators. Concurrently, various theoretical studies and narrative reviews suggest the predictive power of evolution-based models. The aim of this integrative mixed methods meta- synthesis was to investigate the state-of-the-art regarding various forms of evolutionarily informed conceptualization of personality disorders. Following an initial systematic review, 352 papers were screened from PubMed, PsycInfo, and Web of Science. Subsequently, 50 papers were selected, comprising 18 utilizing quantitative methodologies and 32 qualitative. Two exploratory meta-analyses were conducted on the first set of papers, while an adapted grounded theory methodology was applied to the second. Finally, findings from both analyses were integrated by identifying recurrent interpretive categories, then organized hierarchically into three distinct evolutionarily informed conceptualization models: (i) personality disorder as evolutionary mismatch, (ii) as emergency mode, and (iii) as an extreme of variation. While empirical evidence remains emerging and further research is needed, the evolutionary perspective on personality disorders appears to offer important theoretical and applied tools for clinicians.