Neuroscience 20b & c – Personality & Personality Disorders
Anil Chopra
1. Show how personality can be identified as a separate level of functioning from
other mental disorders
2. Illustrate the effect of personality disturbance on the outcome of mental disorders
3. Describe some of the treatments for personality disorder
4. Give a brief idea of how the UK government deals with dangerous and severe
personality disorder
Schizophrenia
- 1 in 100 affected
- Onset 15-35 years.
- More common in city areas.
- Positive symptoms
o Hallucinations etc
o Delusions,
o Thought disorder, poor concentration, not finishing off work, muddled thinking
o Feelings of being controlled,
- Negative symptoms
o Lack of drive
o Inability to look after oneself.
o Losing insight into reality
- Strong genetic link (1 in 10 with parents, 1 in 2 for identical twin)
- Offspring of wartime famine has increased risk due to poor nutrition.
- Drugs and alcohol exacerbate symptoms
Treatment for Schizophrenia
Cognitive Behavioural Therapy – CBT for Psychosis
- Coping with psychotic symptoms (e.g. reading aloud, listening to music)
- Dealing with delusion
- Dealing with beliefs about self and others.
- Discussing family interventions and reactions
Double Bind: a communicative situation where a person receives 2 contradictory messages.
People suffering from schizophrenia are believed to be more or less vulnerable as a
result of biological or psychological factors. This can arise from previous events that
have taken place in the person’s life, problems that occur when an environmental
stress is present even at a low level.
Personality
Personality is defined as how people differ on life history, needs, motives, goals, traits
and specific behaviours:
Eysenck’s theory: he proposed 3 factors to personality, extraversion – E (positive
traits), neuroticism - N (negative traits), and psychoticism (evil traits), which could be
measured and analysed by factor analysis to produce 4 main personality types
originally proposed by Hippocrates.
• High E, High N (‘Choleric)
• Low E, High N (‘Melancholic’)
• High E, Low N (Sanguine’)
• Low E, Low N (‘Phlegmatic’)
Costa and McCrae: proposed 5 personality traits using the anagram OCEAN:
• Openness - creative, independent, seeking new experiences
• Conscientiousness - reliable, persistent, hardworking
• Extraversion - sociable, outgoing, cheerful
• Agreeableness - cooperative, trusting, conciliatory
• Neuroticism - nervous, worrying, subject to negative emotions
DSM IV
Personality Disorder – enduring patterns over a range of social and personal contexts.
Generally inflexible and persistent across a broad range of personal and social
situation.
The DSM – Diagnostic and statistic manual of mental disorders has guidelines on
whether people can legally be defined as having a personality disorder. It groups the
disorders into 5 different clusters:
CLUSTER A (Odd, eccentric):
• Paranoid: distrust and suspiciousness
• Schizoid: social detachment, restricted emotional expression
• Schizotypal: acute discomfort in close relationships, cognitive or perceptual
distortions, and eccentricities of behaviour
CLUSTER B (Dramatic, emotional):
• Antisocial: disregard/violation of others’ rights
• Borderline: instability in interpersonal relationships/self-image/affects, and
marked impulsivity
• Histrionic: excessive emotionality/attention seeking
• Narcissistic: grandiosity, need for admiration, and lack of empathy
CLUSTER C (Anxious):
• Avoidant: social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation
• Dependent: submissive and clinging behaviour related to an excessive need to
be taken care of
• Obsessive-Compulsive: preoccupation with orderliness, perfectionism, and
control.
Treatment Of Personality Disorders
Livesely: The goal of personality disorder is to adapt people’s traits so that they are
socially acceptable, not to change them. Livesely proposed that they are 4 stages to
treatment:
• Problem recognition - how personality problems affect other aspects of
his/her life
• Exploration - patient is helped to recognise connections between different
aspects of thinking, feeling and behaviour, to reframe negative thoughts more
adaptively, and to observe and monitor his/her behaviour
• Acquisition of alternative behaviours, development of new skills and
inhibition of maladaptive patterns of behaviour
• Consolidation and generalization - the application of new skills to everyday.
Young: He proposed a schema-focused cognitive therapy. This took place in 2 phases:
Phase 1 – Assessment and education:
• Identify & educate the patient about his/her schema
• Link schemas to presenting problems & life history
• Bring patient in touch with emotions surrounding their schema (imagery, role
play)
• Observe patterns in therapy sessions
• Identify dysfunctional patterns of maintenance, avoidance & compensatory
behaviour
Phase 2 – Change techniques
• Restructure thinking related to schema: develop a “healthy voice”
• Experiential exercises to rediscover early emotions: anger, distress etc
• Institute behavioural & interpersonal changes
• Reframe past events
• Utilise therapy relationship to understand schemas & carry out limited
“parenting”
Government Acts
Mental Health Act 1983: this defines mental illness as “persistent disorder or
disability of mind…which results in abnormally aggressive or seriously irresponsible
conduct”
It outlines how those with mental illness should be treated according to their
condition:
» Detention in hospital only if the individual is likely to benefit from treatment,
including prevention of deterioration
» Special Hospital if the individual presents a grave and immediate danger and
cannot be treated in lesser security
Psychopathy
It also defines the criteria for a patient to be “psychopathic” using the PCL-R
(Psychopathy Check-List Revised) and has a series of 20 items, each of which can be
rated with either 0 points (absent), 1 point (partial), or 2 points (present). A score of
30 or more indicates psychopathy.
Treatment for psychopathy involves:
• Highly structured environment
• Strong staff support and supervision
• Active and entertaining programme
• Control treatment interfering behaviours
• Focus on risk reduction interventions
• Emerging evidence of brain dysfunction