[15.2] Personality and Dissociative Disorders

Question 1

Aileen Wuornos

Answer 1

• one of the distinct features of personality disorders are their stability, generally over the person’s entire life, and as these patterns unfold in an individual’s life, damage is invariably done to many others
• Aileen Wuornos grew up in a complete chaos of abuse and mental illness
• was given to her grandparents at age 4, and sexually abused by her grandfather
• impregnated at 13, gave the baby up for adoption, and by 15 she was thrown out of the house and supporting herself through prostitution
• met a wealthy yatch owner at 20, but the relationship was abusive and the marriage quickly annulled
• at age 33, she killed seven men across the state of Florida
• although diagnosed with borderline personality disorder and antisocial personality disorder ,Wuornos was determined to be sane at the time of her killings and fit to stand trial
• she was convicted and sentenced to death in the state of Florida in 1994; in 2002, she was executed by lethal injection

Question 2

Defining and Classifying Personality Disorders

Answer 2

• personality disorders: particularly unusual patterns of behaviour (relative to one’s cultural context) that are maladaptive, distressing to oneself or others, and resistant to change
• the DSM-5 identifies 10 distinct personality disorders, which are categorized into three different clusters based on shared features
  
  • Cluster A: odd or eccentric behaviour; e.g. Schizoid Personality Disorder
  • Cluster B: dramatic, emotional, and erratic behaviour; e.g. Borderline Personality Disorder
  • Cluster C: ancious, fearful, and inhibited behaviour; e.g. Obsessive-Compulsive Personality Disorder

Question 3

Borderline Personality (Cluster B)

Answer 3

• borderline personality disorder (BPD): characterized by intense extremes between positive and negative emotions, an unstable sense of self, impulsivity, and difficult social relationships
• relationships with people who have BPD are are characterized by instability and intensity
• believed that BPD arises out of the person’s attempts to deal with deeply rooted insecurity and severe emotional disturbances that are ultimately rooted in traumatic or emotionally difficult experiences, such as inconsistent, abusive, or neglectful parenting

Question 4

Narcissistic Personality (Cluster B)

Answer 4

• narcissistic personality disorder (NPD): characterized by an inflated sense of self-importance and an excessive need for attention and admiration, as well as intense self-doubt and fear of abandonment
• little room for empathy for others, and instead, they will tend to be manipulative, putting themselves first and ensuring that their own needs are met in their relationships
• in public situations, people with NPD have a strong sense of “entitlement”

Question 5

Histrionic Personality (Cluster B)

Answer 5

• histrionic personality disorder (HPD): characterized by excessive attention seeking and dramatic behaviour
• are typically high-functioning because their dramatic nature makes them seem vibrant and attractive in social situations
• they use flirtatiousness, sexuality, and flattery to garner the social attention they crave
• often engages in indulgent and risky behaviours, and tends to be highly sensitive to criticism and generally manipulative in relationships
• difference between other disorders in this cluster is the flamboyance and exhibitionistic tendencies in histrionic behaviour

Question 6

Antisocial Personality Disorder (Cluster B)

Answer 6

• antisocial personality disorder (APD): characterized by a profound lack of empathy or emotional connection with others, a disregard for others’ rights or preferences, and a tendency toward inserting their own desires, often violently, onto others regardless of the consequences for other people or, often when younger, other animals
• highly resistant to treatment, in part because individuals with APD are not alarmed or distressed by their actions (although others frequently are), and they are thus rarely motivated to change
• the term “psychopath” is often used colloquially to describe a person who exhibits these types of behaviour
• serial killers represent only a very small subset of people with antisocial tendencies; in fact, people with APD are often very successful, particularly in business
• an extreme stress response (i.e. when someone “snaps”) does not characterize APD
• antisocial patterns are often detectable during childhood and adolescence, which are critical periods of brain development
• if a system of early diagnosis and treatment could be instituted, it might be possible to more effectively intervene before the person develops the full manifestation of the disorder

Question 7

Psychological Factors When Approaching Personality Disorders

Answer 7

• Do people with personality disorders think differently from normal people?
• people with narcissistic (NPD) or histrionic (HPD) personality disorder tend to have deeply rooted negative beliefs about the self, how they are regarded, and whether they are loved by others
  
  • a person with NPD may continually seek attention, adoration, and reassurance from others, avoiding negative information about the self at all costs
• adults with APD and children with conduct disorders (often a precursor to APD) have difficulty learning tasks that require decision making and following complex rules
• these children perform worse at these tasks and have reduced activity in the frontal lobes compared with healthy controls and even children with ADHD

Question 8

Sociocultural Facotrs When Approaching Personality Disorders

Answer 8

• troubled homes and communities can contribute to the development of psychopathy or antisocial personality disorder
• individuals often have a history of being treated as objects rather than as sensitive human beings
• personality disorders often involve extensive emotional damage from childhood experiences, ranging from physical violence and sexual abuse to the profound invalidation and insecurity
• due to their need to defend themselves against and dissociate from their intensely negative emotions and experiences, they may have effectively shut down and never sufficiently developed the emotional circuitry for empathy
• even less severe cases of borderline personality disorder may arise from a child having his emotions treated as if they were unreal or unimportant

Question 9

Biological Factors When Approaching Personality Disorders

Answer 9

• not everyone who experiences extreme stress and abuse develops a personality disorder
• a number of specific genes seem to contribute to emotional instability through serotonin systems in the brain
• research also points to unique activity in the limbic system and frontal lobes—brain regions that are associated with emotional responses and impulse control, respectively

Question 10

Comorbidity and Personality Disorders

Answer 10

• comorbidity: the presence of two disorders simultaneously
• the presence of the two disorders interferes with their functioning or treatment
• substance abuse is often comorbid with personality disorders; is it the personality disorder or the substance abuse that is at the root of the problem?
• comorbidity rates between the personality disorder subtypes have led some psychologists to suggest that the DSM-IV identified far too many different types of personality disorders
• APD and BPD are the most reliable to diagnose

Question 11

Dissociative Identity Disorder

Answer 11

• dissociative experiences may arise while you are intensely focused on one activity, or when you drift off while not doing anything in particular, such as daydreaming during a long lecture
• people differ in their tendencies to dissociate, but such experiences seem completely normal
• dissociative disorder: a category of mental disorders characterized by a split between conscious awareness from feeling, cognition, memory, and identity
  
  • dissociative fugue: a period of profound autobiographical memory loss
  • depersonalization disorder: a strong sense of the surreal, the feeling that one is not connected to one’s body
  • dissociative amnesia: a severe loss of memory, usually for a specific stressful event, when no biological cause for amnesia is present
• dissociative identity disorder (DID; sometimes referred to as multiple personality disorder): a person experiences a split in identity such that they feel different aspects of themselves as though they were separated from each other; this can be severe enough that the person constructs entirely separate personalities, only one of which will generally be in control at a time
  
  • these distinct personalities, or alters, may be so different from one another as to have different genders, sexual orientations, memories, personality, and autobiographical sense of self and “who they are”
• dissociative disorders such as DID are thought to be brought on by extreme stress
• DID is very difficult to test for in a rigorous fashion, given how personal and subjective the experience of identity is
• cases of DID skyrocked between the 1970s and 1980s; the most likely explanation is that a small subset of psychologists foundd the disorder compelling and were more willing to diagnose it, so they interpret symptoms through that framework, and may have (even unintentionally) provoked dissociative symptoms in the context of therapy
• DID also has a strong cultural component; e.g. Americans with DID switch from alters upon suggestion, whereas people in India who have DID switch alters only upon awakening