Disorders are often known to display the core characteristics from childhood, things like being cruel to animals and general antisocial behaviours like throwing tantrums

By Psychotherapist Mertha Mo Nyamande

This week on the Sunday Express: Personality Disorders, Psychopathy and Sociopathy, and the key questions: is there any difference?

Personality Disorders (PDs) are defined as “a deeply ingrained pattern of behaviour of a specified kind that deviates markedly from the norms of generally accepted behaviour, typically apparent by the time of adolescence, and causing long-term difficulties in intra and interpersonal relationships or functioning in society.”

Common mental health presentations like depression, anxiety and OCD can become PDs because of prolonged nature, and the sufferers start to identify themselves with their lived experiences.

PDs are grouped into three categories: Odd / Eccentric (Paranoid and depressive PD, etc), Dramatic, Emotional and Impulsive (Antisocial PD, Emotionally Unstable PD – Borderline/impulsive types, Narcissistic PD) and Anxious (Avoidant, Dependent, and Obsessive-Compulsive PDs).

A series of psychological tests are typically conducted over time to provide the most accurate diagnosis to inform on the best type of treatment, although PD diagnosis has been used as an exclusion criterion in some services. There are also specific tools used to test for these, including the International Personality Disorder Examination (IPDE).

 

 

Psychopathy on the other hand is defined as “a neuropsychiatric disorder marked by deficient emotional responses, lack of empathy, and poor behavioural controls, commonly resulting in persistent antisocial deviance and criminal behaviour.” This definition suggests a physical component to the disorder beyond just the mental although it largely manifests amoral behaviours and shows an inability to establish meaningful personal relationships.

They tend to express extreme egocentric characteristics and an inability to learn from experiences. They also lack the ability to show empathy or show remorse. In other words, psychopathy is a severe form of Personality Disorders as indicated by the Hare’s Psychopathy Checklist- revised version (PCL-r) scoring.

Personality Disorders and Psychopathy are treatable clinical diagnoses whereas Sociopathy is a social construct of all these. The characteristics and would be similar but focus more on the observed social behaviours, including manipulation, deceit, aggression, and exploitation.

Causes

It’s not clear what causes PDs, but they’re thought to result from a combination of the genes a person inherits and early environmental influences. People who end up with personality

Disorders are often known to display the core characteristics from childhood, things like being cruel to animals and general antisocial behaviours like throwing tantrums. Parents often report that the children would have had problems with conduct disorders from childhood, due to nature or nurture.

PDs are often a result of people getting used to maladaptive coping that has been normalised in their environment, home or society.

There is also reporting that people who end up with PDs would have had numerous Adverse Childhood Experiences (ACEs), these include Abuse (physical, sexual and verbal), Neglect (emotional and physical) and environmental (growing up in a household where, there was Domestic Violence or Sexual and Gender Based Violence, adults had Mental Health, Alcohol and Drug problems, adults who have Spent time in Prison, and parents have separated) and other losses of significant other support systems.

 

 

ACEs are created from Extreme Environments (EEs) where hope in goodness is lost and thereby left with the mentality that doing bad is the only way to get attention from parents or significant others, or to get things done.

Instead of parents taking time to work with their child to understand their wants and needs, they become quick to take them to mental health services that assign them with labels and see them as problematic, ignoring the environmental factors that contribute to their frustration of unmet needs.

These can be mistakenly seen as resilience from a distance, but close observations often reveal serious systemic cracks and insidious behaviours, not only limited to the individual but universal and often across generations. This is what often misinforms the biological inference of genetics.

Implications

Interaction with PDs is largely seen as manipulative in a negative way that seeks to benefit the individual at the expense of another or others, often a repetitive habit of merely survival at any cost. This is characterised by the PCL-r items that include pathological lying, superficial charming, promiscuity, grandiose self-worth, impulsivity, parasitic lifestyle, among other traits.

The book “Snakes in Suits” suggests that the most successful businesspeople are largely as manipulative, but a small number seeks to give back and improve their communities, also score very highly on the PCL-r.

The behaviours displayed often lead to chronic self-harming and suicides or harming of others, including single and serial rapes and or killing activities, as such create detriment in societies.

 

Remedies and recommendations

 

Treatment of PDs and Psychopathy is possible, but complex and takes a long time, indicating at least 5-8 years in a contained environment retraining prosocial skills as per the Dangerous and Severe Personality Disorders (DSPD) programmes in western civilisations.

This recovery works alongside therapeutic risk management to retrain behaviours enough to alter the disordered personalities. Treatment largely involves talking therapies in therapeutic communities and skills training to learn to talk about and managing emotions and disruptive behaviours. These are done in both group and individual sessions. The therapists will also identify problematic thoughts and behaviours and train better coping mechanisms to help them change their attitudes and behaviour.

Medicine may also be used to help manage problematic emotions and or behaviours to allow for the psychological work to occur, but strong and positive psychosocial support is sometimes all that’s needed for the required transformation. Recruitment of staff teams to work with this clientele is crucial as these will demonstrate pro-social role modelling.

 

Psychotherapist Mertha Mo Nyamande @ www.i-wellbeing.weebly.com. Insightwellbeing.mo@gmail.com

 

 

 

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