Unmasking personality disorders, psychopathy

PERSONALITY disorders, according to the minyardmorris.com website, are essentially “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 longterm difficulties in personal relationships or functioning in society”.

Personality disorders are grouped into three categories:

Odd/eccentric

This includes paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Dramatic, emotional and impulsive

In this category is antisocial personality disorder, emotionally unstable personality disorder, borderline/impulsive personality disorder, histrionic personality disorder and narcissistic personality disorder.

Anxious

In this category, we are talking about avoidant personality disorder, dependent personality disorder and obsessive compulsive personality disorder.

Each personality disorder type has its own set of diagnostic criteria that must be met to get the right diagnosis.

A series of psychological tests that are conducted over time provide the most accurate diagnosis compared to the ones carried out by psychiatrists based on self-reporting and maybe some history or noted patterns of behaviour, if any are available.

The criteria to be met is different for all types but it should always be more than one or two items. Meeting criteria for more than a single type may be called mixed or multiple personality disorders.

The main reason for diagnosis is to inform on the best type of treatment required, although this 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, personality assessment schedule, personality disorders examination — revised, personality disorder interview and structured clinical interview.

Psychopathy, on the other hand, is defined as a neuropsychological 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 aspect, although it largely manifests amoral behaviours and shows an inability to establish meaningful personal relationships.

In other words, psychopathy is a severe form of personality disorder, as indicated in the Hare Psychopathy Checklist.

Personality disorders and psychopathy are clinical diagnoses, whereas sociopathy is a social construct of all these.

The characteristics would be similar but focus is more on the observed social behaviours, including manipulation, deceit, aggression and exploitation.

Implications

Most serious criminals in prisons have strong psychopathy traits. Interaction with this group is largely manipulative. What we find is often a repetitive habit.

This is characterised by the Psychopathy Checklist Revised (PCL-R) items that include pathological lying, superficial charming, promiscuity, grandiose selfworth, impulsivity and a parasitic lifestyle.

Most businesspeople are largely manipulative. A small number seeks to give back and improve communities, as outlined in the book “Snakes in Suits: When Psychopaths Go to Work”.

It also suggests that the most successful businesspeople also score very highly on the PCL-R.

Remedies

Treatment of personality disorders and psychopathy is possible. However, it is complex and takes time. Delayed sleep phase disorder studies indicate at least five to eight years of intensive therapy in a contained environment, retraining prosocial skills.

Treatment largely involves talking therapies. It also involves skills training, to learn to talk about and manage 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.

But strong and positive psychosocial support is sometimes all that is needed for the required transformation.

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