Mental Disorders

I

Introduction

Mental Disorders, abnormal or unstable behaviour, thoughts, or feelings. People are defined as mentally disordered because they behave, think, or feel differently from most others. However, even the most bizarre and strange behaviour can often make sense, once it is understood why the person is thinking and feeling that way.

Psychiatrists have developed systems for classifying mental disorders that describe the kinds of symptoms and behaviour that are commonly seen among those considered to be mentally disordered. These fall into two main groups: personality disorders and psychoses. Another common group of disorders is usually termed anxiety disorders.

II

Personality Disorders

Personality disorders are demonstrated in many forms. In severe cases it affects the person’s ability to lead a normal life; in milder instances it may mean that a person is seen as being slightly eccentric, or as having mildly compulsive habits, or finding it difficult to make friends. Serious personality disorder is more often associated with anti-social behaviour, and problems in dealing with others. The most widely known form of personality disorder is psychopathic disorder. Personality disorders involve personality traits that are so inflexible that they make it impossible for the person to exist socially or to hold down a job and may cause considerable distress to others if not to the people themselves.

A

Types of Personality Disorder

The paranoid personality is unduly suspicious and mistrustful. Schizoid personalities are devoid of the capacity, or the desire, for love and social relationships. Schizotypal disorders are marked by disconnected thought, speech, perception, and behaviour. Histrionic personalities have overly dramatic behaviour and expression. Self-importance and the need for constant attention and admiration are the marks of narcissistic personalities.

Those with anti-social personality disorders have a history of violating the rights of others and failing to observe socially accepted norms. Borderline personality disorder is marked by unstable behaviour towards others, and in mood and self-image. A person with an avoidant personality disorder is hypersensitive to potential rejection, humiliation, or shame. The dependent personality is overly passive, always allowing others to assume responsibility. Compulsive personalities are perfectionists and unable to express warm feelings. The passive-aggressive personality resists demands indirectly by procrastination and dawdling. These latter four may be considered in the milder range of personality disorders.

Personality disorder is not a mental illness that tends to develop quite suddenly and usually in response to particular stresses. Personality disorder develops slowly, as the person grows up, and is thought to be mainly due to environment and upbringing. For example, someone who grows up in a family where they are constantly criticized and shouted at may develop an anxious, neurotic personality. Similarly, someone who grows up in a family where everyone is aggressive and violent may develop an anti-social or paranoid personality. A growing body of evidence suggests that early sexual abuse also distorts personality development.

The psychopathic personality, or psychopath, usually shows the signs of being abnormal very early in life. Truanting and stealing are common, and some will enjoy showing deliberate cruelty to animals or to other children. Typically such people have a long history of anti-social and violent behaviour by the time they become adults. Sometimes their violent behaviour includes sexual offences such as rape, and some become murderers.

B

Causes of Personality Disorder

The exact causes of personality disorder are not known. It may be learned or it may be genetically inherited. The problem is in knowing how much may be due to inherited characteristics, and how much may be learned. Anxiety, depression, and violence all seem to run in families, but it is not certain (and very hard to prove) whether they are inherited or learned characteristics.

Research done mainly in the United States suggests that serious personality disorder, such as psychopathy, may be linked to brain abnormality. The cause of the abnormality is also disputed: while some believe it is genetic, others think that it is the result of brain injury which may have happened when the child was physically abused by a violent parent, or it may come from birth difficulties or an early head injury.

Abnormal personality development probably results from a distortion of the interaction between the growing child and its environment. If, for example, a child has problems of learning, problem solving, or emotional control, this not only affects the way that he or she behaves, but may also result in other people responding negatively. The child then comes to expect the worst from the world around him or her, and thus tends to behave in a way that actually makes hostility and rejection more likely. So develops a vicious circle which, if it continues over years, distorts the child’s psychological development.

Psychological treatment can try to correct this distortion by helping the person to understand their problems and why they react as they do. The treatment involves the patient not only reaching this understanding, but also re-learning how to relate to others. Both psychotherapy and cognitive behavioural therapy can be helpful. Psychotherapy attempts to look at the way in which the person’s earliest experiences have contributed to their problems. Cognitive behavioural therapy is more concerned with the here and now, and tries to encourage the patient to learn new ways of thinking and behaving that are more effective.