Personality and Mental Disorders

This page was last updated on Tuesday, September 22, 2009

Mental Health authorities in the United States recognizes ten personality disorders.  This paper briefly describes five personality disorders as they may relate to false allegations of domestic violence and abuse.  My experience suggests that these disorders are a significant factor in these incidents.  However, untreated Depression, Bipolar Disorder, or Schizophrenia can be a factor in these incidents. 

This paper is not intended to be used as a diagnostic tool.  Individuals should seek the help of a qualified psychologist or psychiatrist when they believe that they or another may have a mental health disorder.

 

 

A personality disorder is a pattern of deviant, antisocial, or abnormal behavior that adversely affects oneself and others.  The literature on personality disorders is not definitive and mental health practitioners may observe behaviors common to more than one disorder. Diagnosis is made by exclusion of other disorders and factors (such as substance abuse). Some texts mention the lack of empathy (the ability to share and understand another's feelings, thoughts, or emotions) as one of the defining features of a particular disorder.

However, it is my observation that some abusive individuals understand the pain and emotional distress they inflict on others. Such persons feed on the distress they cause and derive pleasure from it.

Another point is that there is very little evidence that low self-esteem leads to violence. The low self-esteem theories run counter to what we know about aggressive initiators of abuse. Persons with high self-esteem tend to be more violent and aggressive. They are often able to persuade others to do their bidding while they sit on the sidelines and enjoy the spectacle.

No one knows what causes most personality disorders.  The Diagnostic and Statistical Manual on Mental Disorders (DSM-IV) contains a standard classification of mental disorders.  This manual, published in 1994, is not the current edition.  The current edition (DSM-IV-TR), published in 2000, corrects errors and reflects updates to the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) adopted by the United States Government.

Here is a summary of five personality disorders with some links to government sites.

General Information

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000939.htm

 

Antisocial Personality Disorder

The incidence of this disorder is higher in individuals who have an antisocial biological parent.  Persons with this disorder usually have a history of antisocial behavior before age 15 such as repetitive lying, delinquency, truancy, and substance abuse.  This disorder occurs more often in persons whose predominate role mode had antisocial traits.  Symptoms include:

Genetic inheritance may have some effect on the development of this disorder but research has not established how this may occur. Children who live with others who have antisocial personality traits or other personality disorders are more likely to acquire this disorder. Therefore, removing children from this environment could help in staving off the onset of this disorder.

Prompt intervention is required. As time passes, treatment options are more limited and a favorable outcome is less likely.

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000921.htm

 

Borderline Personality Disorder

Researchers are examining the effects of childhood abandonment, abuse, and disruptive family life.  Women are three times more likely than men to have this disorder. A child is 5 times more likely to acquire this disorder when one parent has it.  Symptoms include:

Interdisciplinary studies show that early childhood maltreatment appears to contribute to the onset of this disorder in some individuals. Those studies have revealed malformation and abnormal activity in areas of the brain.  Those who have BPD frequently suffer from anxiety and severe depression.  Psychotherapy combined with antidepressants and other medications may significantly improve the patient's behavior and mood.  Treatment options are dependent upon the severity of the disorder and the will of the patient to improve. Due to the nature of this disorder, the prospect of improved outcome is not promising in highly affected individuals.

 

"Girl, Interrupted" (Columbia Pictures, 1999) is a true story of a young woman's stay at a psychiatric hospital.  Psychiatrists diagnosed the woman as having Borderline Personality Disorder.  She eventually recovers but first she has to confront the person within her.  This is an excellent work but due its intensity, I do not recommend its viewing by children under 18.

http://www.nimh.nih.gov/publicat/bpd.cfm  

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000935.htm

 

Narcissistic Personality Disorder

Narcissistic individuals are extremely self-centered and are preoccupied with their own abilities  appearance, comfort, and importance. Very few narcissists seek help.  Researchers believe that the onset of this disorder occurs in early adulthood. Symptoms include:

Narcissists are very manipulative and clever. Some are addicted to the upset that they cause in others. Due to this addiction, the prospect of improved outcome for these individuals is poor.  Otherwise, the possibility of a positive outcome varies with the severity of the disorder.

"A Woman Scorned: The Betty Broderick Story" is a true story about a California woman who has narcissistic personality disorder.  This woman was accusative, manipulative, and violent.  For several years she harassed and stalked her ex-husband and his wife.  She claimed that the couple were abusing her but she was destroying their property and peace of mind.  She bought a gun, took shooting lessons, and practiced at a shooting range.  Then one night, she entered the couple's home and cold bloodedly murdered them in their sleep.

She steadfastly claims that she had planned to commit suicide that night, an act that narcissist's rarely do, but ran out of bullets.  She fired three bullets into her ex-husband and two bullets into his wife.  Then, she ripped the telephone from its jack so that no one could use it to call for help.

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000934.htm

 

Histrionic Personality Disorder

No one knows what causes this disorder but learned behavior and possibly genetic inheritance are thought to play a role in this disorder. This personality disorder is more often diagnosed in women.

Though people with this disorder are successful socially and at work, they are unable to cope with their disappointment when romantic or intimate relationships end. They tend to over dramatize and blame others for their disappointment. Symptoms include:

Medication does not affect this personality disorder.  However, medication used to treat depression and anxiety disorders.

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/001531.htm

 

Paranoid Personality Disorder

No one knows what causes this disorder but its incidence is higher in families where schizophrenia is present. People with this personality disorder are suspicious of others and they are usually unable to acknowledge their negative feelings towards others. Symptoms include:

People with paranoid personality disorder generally do not lose touch with reality. They tend to avoid people and some are prone to violence a.  Treatment can be difficult when the person is suspicious of a physician's motives.  Without treatment, this disorder will become chronic and disabling.  Medications and therapy are very effective in treating this disorder.

http://medlineplus.nlm.nih.gov/medlineplus/ency/article/000938.htm

 

Mood Disorders

This section briefly describes mood disorders of Depression and Manic Depression (now called Bipolar Disorder). The very limited material presented in this section only describes the relationship between these disorders, their symptoms, and the possibility of abuse and violence. This section is not a diagnostic tool but a few references are cited at the end of this section.

Delusions may accompany depression or mania. Delusions are false personal beliefs. For an example, some persons had the delusion that they are Napoleon Bonaparte. Recently (March 2004), a man thought he was destined to become the state's next Governor and went to the State Capital to accept the reins of government. Those who have paranoid delusions feel conspired against. Others believe that they are being controlled by cosmic aliens. Delusions of guilt, worthlessness, and ruination may appear during depression.

Hallucinations reflect the sensation (hearing, seeing, tasting, smelling or feeling) of a stimulus that is not there. A common hallucination is hearing spoken voices. Command hallucinations, where voices tell a person to hurt themselves or others, are extremely serious presentations that must not be ignored. Command hallucinations can be difficult to resist and may lead to violence.

If you have or know someone that does have recurrent thoughts of death or suicide, delusions, or hallucinations get help now. Call 911, a mental health facility, or an emergency room to get immediate help.


The following drawings represent the mood states of bipolar disorder and the mood states of depression.   I did not scale these drawings to represent the extent of discreet mood states. Boundary lines appearing between mood states simply represent fuzzy or transitional zones.

Bipolar Mood States - Arbitrary Scale

 Severe Mania

Mild Mania (Hypomania)

Normal Mood

Mild Depression

Severe Depression

 

Mood States of Depression - Arbitrary Scale

Normal Mood

Mild Depression

Severe Depression

 

Depression affects more than 8 percent of the American adult population. In this disorder, a person's mood state switches between normal state and depression. Depression is more than having a bad day or experiencing brief bouts of grief or sadness. Depression affects the way a person lives, feels, and acts. Women have a greater risk of depression than men.

Depression includes these symptoms:

Five or more of these symptoms that last most of the day, nearly every day for two weeks or longer indicates depression.

(1) These symptoms are regarded as the first signs of depression.
(2) Increased irritability, hallucinations, and delusions may lead to violence.
(3) Women do attempt suicide, leading to self-inflicted injuries, far more often than men. However, men's suicide rates are far higher then women's, especially as men grow older. Recurrent thoughts of death or suicide and suicide attempts are extremely serious and must not be ignored.


 Bipolar Disorder is probably the most difficult psychiatric disorder to diagnose and manage because a person's mood switches between depression, normal state, and mania. In Bipolar Disorder, Dr. Frank Mondimore described bipolar disorder as "the chameleon of psychiatric disorders." He wrote that bipolar disorder changes in "symptom presentation from one patient to the next, and from one episode to the next even in the same patient." Persons with bipolar disorder are sometimes mistakenly diagnosed as having schizophrenia.

Mania includes these symptoms:

Three or more of these symptoms that last most of the day, nearly every day for a week or longer indicates mania.  If one of the symptoms is irritability then three to four additional symptoms must present.

(1) These symptoms are regarded as the first signs of mania.

(2) Excessive irritability, hallucinations, or delusions may lead to violence.

(3) The symptoms of erratic thinking and poor judgment are a part of mania.  Since abnormal euphoria is also a symptom of mania,  some people become addicted to their manic mood and stop taking their medication.  Untreated hypomania can become severe mania in some people.

(4) Abuse of certain drugs, alcohol, or sleeping medications can induce the appearance of mania. 


There are three types of Bipolar Disorder. Recurrent episodes of mania and depression is called Bipolar I. Recurrent episodes of hypomania and depression is called Bipolar II. Rapid Cycling Bipolar Disorder presents the symptoms of four or more bipolar events within a 12 month period. Some individuals experience multiple bipolar events within a 7 day period and sometimes within 24 hour period.

Some authors write that Rapid Cycling Bipolar Disorder can be mistaken for Borderline Personality  Disorder (BPD).  However, the consensus is that those who have BPD frequently suffer from anxiety and severe depression.  Proper psychotherapy combined with antidepressants and other medications may significantly alleviate these symptoms with positive changes in the patient's behavior.

Schizophrenia

Schizophrenia is not split personality as in Robert Louis Stevenson’s fictional tale about Doctor Jekyll and Mr. Hyde. Multiple identity (dissociative identity) syndrome is a separate and very rare mental disorder exhibiting the existence of two or more distinct and independent personalities in an individual.  Reservedly, each personality has its own identity, a set of behaviors and memories, and is not aware of the other personalities and their experiences.

Individuals who are affected with the symptoms of schizophrenia often suffer from terrifying hallucinations and delusions. Anyone whose life is dominated these symptoms may become fearful and confused and may have difficulty expressing their thoughts in a logical and coherent manner.

Some individuals who exhibit the symptoms of schizophrenia may also experience prolonged episodes of depression or elation similar to bipolar disorder. This is why it is sometimes difficult to determine whether a person has schizophrenia or bipolar disorder or severe depression.

Persons whose symptoms cannot be clearly ascertained are sometimes diagnosed as having schizoaffective disorder. Persons with schizoaffective disorder are more likely to return to an almost normal level of function than those with schizophrenia. However, these disorders may require long term treatment with mixed results. I have always thought that each individual has their own chemistry regardless of genetic inheritance and current research shows this.

Schizophrenia poses some puzzling presentations. One part of the puzzle is that this disorder affects men and women in nearly equal frequency but the onset of schizophrenia often occurs earlier in males than in females. Sometimes but not always, the symptoms of this disorder first appear in males between the ages of 17 through 23 and in females between the ages of 20 through 33. However, the first symptoms of this disorder can appear after age 45.

In theory, identical twins are genetically identical. So if one identical twin has schizophrenia, the other twin should have this disorder, this is not so. The other twin has slightly more than a 50 percent chance of having this disorder. Then again, 10 percent of lineal first degree lineal relatives develop this disorder even though they share about 50 percent of the genes from the affected individual.

Childhood-onset schizophrenia begins after five years of age and, in most cases, after relatively normal development. Childhood schizophrenia is rare and can be difficult to differentiate from other pervasive developmental disorders of childhood, such as autism.

Autism is a disorder affecting communication development. It generally appears in the first three years of life and it’s symptoms may continue throughout life. No one knows why autism appears in males four times more often than in females and no one knows why one sibling has autism while another does not.

Prevailing literature recognizes five types of schizophrenia: catatonic, disorganized, paranoid, residual, and undifferentiated. The practitioner tries to determine the type of schizophrenia from the patient’s symptoms. Current papers define symptoms as positive, cognitive, and negative.

The positive symptoms of schizophrenia include severe agitation and confusion resulting from hallucinations, and paranoid delusions. These symptoms mark the acute or psychotic phase of schizophrenia. Some individuals have only one psychotic episode while others have many episodes during their lifetime but still retain a high degree of normalcy between episodes.

Many afflicted individuals need long term treatment. The problem is that some patients may stop using their medication because of side effects, loss of medical coverage, or have become addicted to abnormal elation that may occur in psychotic episodes.

These are some of the cognitive and negative symptoms of schizophrenia:

When any person has thoughts of suicide or threatens or tries to commit suicide, immediately seek professional help. No one can predict who of those with schizophrenia will commit suicide but we do know that younger adult males are at greater risk.

 

Creutzfeldt-Jakob Disease

Creutzfeldt-Jakob Disease (CJD) is an extremely rare degenerative brain disorder (a type of spongiform encephalopathy) not caused by Mad Cow Disease. Spongiform encephalopathy refers to the characteristic appearance of infected brains that are filled with holes resembling sponges under a microscope. The initial symptoms may include behavioral changes, confusion, depression, impaired vision, and impaired coordination. Over time, there may be a rapid deterioration of memory and cognition leading to agitation, increased irritability, and changes in personality.

http://www.ninds.nih.gov/disorders/cjd/cjd.htm

http://www.ninds.nih.gov/disorders/cjd/detail-cjd.htm

 

References:

Bipolar Disorder, Francis Mark Mondimore, M.D.
Decoding Schizophrenia, Daniel C. Javitt and Joseph T. Coyle, Scientific American (Jan 2004)
Diagnosis Schizophrenia, Rachel Miller and Susan E. Mason
Mayo Clinic on Depression, Keith Kramlinger, M.D.

Information on Autism from the National Institute of Mental Health.
http://www.nimh.nih.gov/publicat/autism.cfm

Information on Bipolar Disorder from the National Institute of Mental Health.
http://www.nimh.nih.gov/publicat/bipolar.cfm

Information on Depression from the National Institute of Mental Health.
http://www.nimh.nih.gov/publicat/depression.cfm

Information on Schizophrenia from the National Institute of Mental Health.
http://www.nimh.nih.gov/publicat/schizophrenia.cfm

 

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