Richard G. Petty, MD

Does Anakin Skywalker Have Borderline Personality Disorder?

It is often very helpful to use books and movies to illustrate psychological and psychiatric issues, and that old chestnut, “when is it an illness?”

There was an amusing paper (NR193) about a serious problem that was presented last week at the 2007 Annual Meeting of the American Psychiatric Association in San Diego. The writers, from Toulouse in France entitled their offering; “Is Anakin Skywalker Suffering from Borderline Personality Disorder?”

Borderline personality disorder can be an extremely difficult problem to treat in practice, and it often causes a great deal of suffering. There is an interesting sidebar here: Borderline Personality Disorder has been described throughout the world. But it seems to be more common in the United States and Canada than it is in Western Europe, though the rates now appear to be rising in Europe.

Borderline personality disorder is defined as a mental illness primarily characterized by emotional dysregulation, extreme "black and white" thinking, or "splitting", and chaotic relationships. It typically includes a pervasive instability in (1) mood, (2) interpersonal relationships, (3) self-image, (4) identity, and (5) behavior, as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation. 

These problems can have a pervasive negative impact on many or all of the psychosocial aspects of life, including employability and relationships in work, home, and social settings. Comorbidity is very common. People with borderline personality disorder frequently have substance use disorders and affective disorders. Sadly, self-harm , including cutting and suicidality and completed suicide are altogether too common, and there is a lot of discussion about the effectivess of treatment.

The writers of the report concluded that Anakin met five criteria of Borderline Personality Disorder:

1. Difficulty controlling anger
2. Impulsivity
3. Transient stress-related paranoid ideas and sever dissociative symptoms (after killing the sand people and in the final confrontation at the end of Episode 3)
4. Frantic efforts to avoid real or imagined abandonment (as when trying to save his wife)
5. Pattern of intense and unstable interpersonal relationships, alternating between extremes of idealization and devaluation (as in his relationships with the Jedi Masters)

They also suggested that the identity disturbance, when he changed into Darth Vader was more evidence of Borderline Personality Disorder.

An amusing piece, but it helps to highlight a problem that can cause great suffering.

A Very Helpful Website for Parents with Children at Risk of ADHD, Addiction or Anti-social Personality Disorder

Though I've said a hundred times that biology is not destiny, there is no question that some genes can predispose us to rect to th environment in certain ways. Some people are genetically-loaded for some specific illnesses. It is not always inevitable that the illness will emerge, and there is more and more evidence that there are strategies that can reduce the risk of many illnesses appearing.

There is a most helpful website maintained by Dr. Liane Leedom. I recently reviewed her book at Amazon.com.

The website is full of helpful advice on helping with people with children at risk for attention-deficit/hyperactivity disorder, addiction or antisocial behavior. Liane's interest is in parenting strategies for  children who have genetic risk for these problems.

Well worth a visit.

Schizophrenia, Psychosis and Psychopathy

Ever since the tragedy in Virginia earlier this week, everyone has been trying to second guess what happened. As I said, to the trained eye there is a lot to suggest that he had a psychotic condition, but whether it was schizophrenia, bipolar disorder or psychotic depression is guess work.

One of the things that has been worrying in all the media coverage has not only been the sensationalism that we have seen in some quarters, but the mistakes that reporters - and even some of the "experts" - have made in talking about mental illness. I have heard people constantly mixing up schizophrenia and psychopathy, which is more accurately called antisocial personality disorder. I have even heard an old mistake that I had thought died years ago: that schizophrenia is a "split personality." I think that mistake probably goes back to a misunderstanding of the roots of the term "schizophrenia," and it was perpetuated by Alfred Hitchcock's movie Psycho in 1960.

Let me just repeat: schizophrenia is NOT a split personality. Neither is it multiple personality disorder. There is even a lot of discussion whether multiple personality disorder, now known as "Dissociative identity disorder" really exists: a discussion for another day.

Because there has been so much confusion, I thought that it would be good to clarify what each of these disorders is.

You can get some of the information from Wikipedia. What has worried me a bit is that some websites have slightly questionable infrmation. Many people know that I do a great deal of advocacy work for the mentally ill, so these notes are from my own lectures.

For reliable back up information, I recommend using Healia.com to search, and you can check out at Wikipedia, Schizophrenia.com, the National Institute of Mental Health website, Medline Plus and the National Alliance for the  Mentally Ill.


Psychosis
Psychosis is simply a generic term for a mental illness in which people have a "loss of contact with reality." There are often other symptoms, such as hallucinations, delusional beliefs, disorganized thinking and a lack of insight into the unusual or bizarre nature of his or her behavior. Almost anything that stresses the nervous system enough may lead to psychosis. I have often told students that it is possible to induce psychosis in just about anyone. It is a symptom and not a disease. We sometimes call it the "fever of the nervous system."


Schizophrenia
This is a group of illnesses that describe a mental disorder characterized by impairments in people's perception or expression of reality and by significant social or occupational dysfunction. The point is that other people don't share their view of reality and it is causing suffering. There is always some smart Alec student who says, "But isn't religion a delusion?" The answer is no, of course it isn't. Millions of people share the same beliefs. The second piece is also important: is it causing suffering, distress or disability? Many people have ideas that are "different." That does not mean that they are mentally ill. Professionals should not get involved unless the beliefs are causing a problem.

A person experiencing schizophrenia typically has disorganized thinking, and may experience delusions or hallucinations. In Western cultures these are most commonly auditory hallucinations. Simply having hallucinations does NOT mean that someone is mentally ill. I seem to be one of the few psychiatrists that supports the aims of the Hearing Voices Network. The Network tries to help people who are experiencing hallucinations and to educate the public and professionals that there are many possible reasons for hearing voices and many have nothing to do with mental illness.

One of the most disabling things about the schizophrenic group of illnesses is that they primarily affect  cognition, and that is one of the things that can lead to chronic problems with behavior and emotion. For a long time there was a worry that the cognitive problems were a result of being on some of the older medications. But these cognitive problems were identified decades before the introduction of these medicines. Hence the old name of schizophreia: dementia praecox.

The diagnosis is based on self-report and observation. We do not have a laboratory test for these illnesses, but we are finding reproducible changes in the brain and in many genes. The main evidence for the illnesses is still based on their response to treatment.

There has been a lot of discussion about whether we should abandon the term "schizophrenias," since the current diagnostic approach is flawed: many people have psychotic experiences without becoming dsitressed or disabled. Neither can they - or should they - be diagnosed. This gets back to the categorical and dimensional argument that I have talked about before. The second point is that the label "schizophrenia" can be so stigmatizing.


Antisocial Personality Disorder
Antisocial personaity disorder is also referred to as psychopathy, sociopathy or dyssocial personality disorder. It is a condition characterized by lack of empathy or conscience, and poor impulse control or manipulative behaviors. The term originally came from the Greek psyche (meaning soul, breath or mind) and pathos (to suffer). At one time the term was used to describe all mental illness, and that is why there is confusion. It is quite different from psychosis. Psychosis is a chronic or intermittent symptom that comes on at some time in life. Antisocial personality disorder should have been present all the time, even though we cannot formally diagnose it until the age of eighteen. The term "psychopath" is not a good one: it has no precise equivalent in either the DSM-IV-TR or the ICD-10.

Only a minority of diagnosable psychopaths are violent offenders . There has been a lot of discussion about whether the manipulative skills of some of the non-violent psychopaths are valuable in corporate America, the military and academia, because they may bold and often charismatic leaders. The has even been a suggestion that becoming a "psychopath" may be an adaptation to working in a highly competitive environment: it gets results for both the individual and for their corporations or countries.

There is a recent book - Snakes in Suits - that does a good job of exploring these ideas.

In summary:
Psychosis = A symptom
Schizophrenia = A group of acute or chronic illnesses in which psychosis is a central feature
Antisocial Personality Disorder = a.k.a. "Psychopathy:" life long personality trait

   

Madness and Genius Revisited

I must have heard a thousand times that there’s a fine line between genius and insanity. I have talked before about the possible link between the two through schizotypal personality disorder. It is quite well known that there are two living Nobel Prize winners who have a diagnosis of schizophrenia and many more who have first-degree relatives with it.

There is some very interesting research in the current issue of the Journal of Clinical Investigation from a team of scientists at the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH).

In the latest installment of a story that has been unfolding over the last three decades, they report on their findings concerning a human gene for a master switch in the brain called DARPP-32. Most people inherit a version of a gene that optimizes their brain's thinking circuitry, yet paradoxically also appears to increase risk for schizophrenia, an illness marked by impaired thinking. The main kinds of thinking involve reasoning, abstraction and creativity.

Over the last two decades, studies in animals, most notably by Nobel Laureate Paul Greengard at Rockefeller University, have established that DARPP-32 in the striatum switches streams of information coming from multiple brain chemical systems so that the cortex can process them. Both the neurotransmitter that DARPP-32 works through – dopamine - and the chromosomal site of the DARPP-32 gene have been implicated in schizophrenia.

The NIMH researchers in this new study have identified a common version of the gene and showed how it impacts the way in which two key brain regions exchange information, so affecting a range of functions from general intelligence to attention.

To understand DARPP-32's role in the human brain, they used genetic, structural and functional magnetic resonance imaging and also post-mortem studies to identify the human gene's variants and their functional consequences.

Seventy five percent of subjects had the most common version of the gene, which boosted the activity of circuits in the prefrontal cortex of the brain. This region is the major filter, controller and processor of cognitive information. When active, it increases structural and functional connections and our performance on tasks that involve thinking. It almost certainly does so by increasing gene expression. In 257 affected families, people with schizophrenia were also more likely to have this common version of the DARPP-32 gene.

DARPP-32 appears to shape and control a circuit running between the striatum and prefrontal cortex. The circuit affects key brain functions implicated in schizophrenia, such as motivation, working memory and reward-related learning.

The senior investigator is Daniel Weinberger, who had this to say,

"Our results raise the question of whether a gene variant favored by evolution, that would normally confer advantage, may translate into a disadvantage if the prefrontal cortex is impaired, as in schizophrenia. Normally, enhanced cortex connectivity with the striatum would provide increased flexibility, working memory capacity and executive control. But if other genes and environmental events conspire to render the cortex incapable of handling such information, it could backfire -- resulting in the neural equivalent of a superhighway to a dead-end."

Although several groups of researchers have looked for the possible clinical relevance of DARPP-32, they have had much success. This study shows a strong connection between the molecule and human cognition and also, perhaps, with schizophrenia.

What is also interesting about this finding is that it helps provide us with a mechanism by which environmental stress could lead to cognitive problems.

Apart from the uninformed tirades of Tom Cruise, I see a lot of opinion pieces on websites and YouTube expressing the opinion that psychiatry is baseless, ostensibly because there is no science behind it. By anyone’s standards, this is high level science utilizing a series of state-of-the-art approaches. And another piece of evidence that psychiatry is becoming more science than art, linking the mind, the brain and the environment into one harmonious whole.

The Seat of the Emotions and the Gateway to Reason

“If passion drives, let reason hold the reins.”
--Benjamin Franklin (American Author, Inventor and Diplomat, 1706-1790)

For many centuries reason and emotion have usually been held to be two poles of a magnet, the North and South of the psyche. Every now and then someone has proposed some other psychological lodestone, but most have finally devolved into this simple binary model.

Yet a moment’s introspection shows us that reason and emotion are inextricably linked. We know from people with alexithymia and a dizzying array of “personality disorders,” that a real-life Mr. Spock would be a hobbled creature. Yet we also know that simple binary models of pleasure and pain as the drivers or behavior are over simplified. It appears that one of the great attainments of many mammalian species - and who knows how many others - is an ability to be moved by more complex considerations of loyalty, propriety and even morality.

There is an important study in this month’s issue of the Journal of Neuroscience. The amygdala is a central processing station in the brain for emotions and is involved in laying down emotional memories. A shock or extreme pleasure may both leave their traces in the amygdala, so it plays a key role in survival.

But this new research shows that the amygdala also plays a role in working memory, a higher cognitive function that is critical for reasoning and problem solving. If you ask someone for a telephone number and you instantly dial the number and then forget it, that is working memory in action. If you choose to remember the number for later, it moves out of working memory into longer term memory stores. In some senses working “memory” is a little bit of a misnomer: it is a function that enables us to manipulate information extremely rapidly.

In two different functional magnetic resonance imaging (fMRI) studies with a total of 74 participants, individual differences in amygdala activity predicted behavioral performance on a working memory task. The experimental subjects were asked to look either at words, such as rooster, elbow, and steel, or faces of attractive men and women. Then they were asked to indicate whether or not the current word or image matched the one they saw three frames earlier. Try it for yourself, and you will see that this is quite challenging. The subjects’ brains were scanned while completing the tasks.

People with stronger amygdala responses during the working memory task also had faster response times.

This is exceptionally important for anyone interested in thinking and learning: it shows that a region of the brain thought to be involved primarily, or perhaps even exclusively, in processing emotions is also involved in higher cognition, even when there is no emotional content.

I think it most likely that the amygdala may be involved in vigilance, perhaps preparing people to better cope with challenging situations and also improving their ability to sort information according to its relevance to the current situation. This is something that people with poor resilience find hard to do, so it may be that the amygdala is involved in developing and maintaining resilience.

This study helps to prove the total inter-relatedness of emotion and cognition and supports learning strategies that are based upon integrating emotion with facts. One of the ways in which health care students are able to remember enormous numbers of facts is by attaching them to patients with whom they have worked. Emotion, interest and empathy can dramatically accelerate learning.

Posttraumatic Stress Disorder and Brain Laterality

I’ve just received an intriguing article from an individual who’s really been through the mill with an array of psychiatric problems going back to childhood.

The last diagnosis that he attracted was posttraumatic stress disorder (PTSD), and he seems to have cured himself by a combination of omega-3 fatty acids and learning to play the banjo left-handed.

This may sound like a bit of an odd claim, but although the writer did not realize it, there is actually some solid science behind his observation.

For years now we have known that if someone is paralyzed down one side after a stroke, binding the good arm or leg leads to rapid reorganization in the cerebral cortex, as a result of which the paralyzed arm or leg may begin to regain function.

One of the most potent ways to improve the functioning of regions of the brain is to try doing things with the opposite hand: if your are right-handed, brushing your teeth or writing with your left hand or using your knife and fork the other way round can all be very illuminating, and can help train your brain. A common tactic in couple’s therapy is to get people to change some habits, like switching the sides of the bed on which a couple sleeps.

The hippocampus of the brain is involved in many functions, but key amongst them is the laying down of short-term memories. People with several stress-related psychiatric disorders, including PTSD, borderline personality disorder with early abuse, depression with early abuse, alcoholism and dissociative identity disorder all have smaller hippocampi, presumably because this part of the brain is exquisitely sensitive to cortisol: high levels can damage and destroy hippocampal cells. Antidepressant medications and some types of cognitive training are thought to lead to the growth of new cells in the hippocampus. It is also possible that having a small hippocampus may predispose someone to the development of PTSD. There is also some evidence that mixed lateral preferences and parental left-handedness may all predispose someone to the development of PTSD.

In PTSD, the left hippocampus and two other brain regions: the left anterior cingulate cortex and both sides of the insula are all smaller than normal. Regions of this small left hippocampus associated with episodic and autobiographical memory is activated by stimuli that wouldn’t have much effect in people without the problem. Some researchers have also found that if the right hippocampus is smaller and more active, it correlates with the severity of PTSD symptoms.

Adults with PTSD have a higher incidence of mixed laterality with respect to handedness than the rest of the population. This has recently also been found in children: there is a positive correlation between PTSD symptom severity and mixed laterality. This strongly suggests that neurological abnormalities may be related to the severity of symptoms in PTSD.

In PTSD, the right amygdala, a region involved in fear and rapid emotional learning and processing, is smaller than the left. In healthy volunteers it’s the same on both sides.

When people with PTSD recall the traumatic event, especially if it involved assault, they over-activate the right hemisphere of the brain. It is not just cerebral blood flow: recent experimental work has shown that PTSD may be associated with a functional asymmetry of the brain, which favors the right hemisphere.

There are actually a number of therapeutic techniques that involve trying to switch the way in which the hemispheres interact. EMDR (which the writer had tried) is one. It is also amongst the techniques developed by Paul Dennison to aid learning.

I also wonder whether the writer has accidentally happened upon a method for treating psychological reversal.

I do wish the writer well, and I also hope that some of my colleagues in research might be interested in exploring some of these training techniques in PTSD.

Cutting and Self-injury

There’s an extremely disturbing trend: ever-increasing numbers of young people who are cutting themselves. Once rare, and something usually seen only in people with serious psychiatric illness, many school children encourage and goad each other into doing it, and there are websites dedicated to cutting, on which young people compare notes and even give each other advice on how to conceal what they are doing, by cutting themselves in places like the lower back.

We have been offered a great many explanations for this worrying development, but not much in the way of evidence. We know that most people who cut themselves are female adolescents or young adults, and apart from the obvious physical dangers, there is evidence that this behavior may lead to a more serious psychological condition called Borderline Personality Disorder. This can be a serious problem that carries a high risk of suicide. It is also of some theoretical interest, because there seem to be genuine cultural differences in borderline personality disorder. An estimated 5.8 million to 8.7 million Americans, mostly women, suffer from it, but it is far less common in most of Western Europe and Australia. Research over the last decade has indicated that the condition is becoming more common in these regions. People with the borderline personality disorder have a wide spectrum of difficulties that are marked by emotional instability, difficulty in maintaining close relationships, eating disorders, impulsivity, chronic uncertainty about life goals and addictive behaviors such as using drugs and alcohol. They also have major impact on the medical system by being among the highest users of emergency and in-patient medical services. Glen Close’s character Alex Forrest in the movie Fatal Attraction, had some of the features that we might expect in some with borderline personality disorder.

Researchers from the University of Washington in Seattle have reported that adolescent girls who engage in cutting behavior have lower levels of the chemical transmitter serotonin in their blood. They also have reduced levels of activity in the parasympathetic nervous system as measured by what is called respiratory sinus arrhythmia, a measure of the ebb and flow of heart rate as we breath. Low levels of this measure are typically found in people who are anxious or depressed. The study included 23 girls aged 14 to 18, who engaged in what psychologists call “parasuicidal” behavior. Participants were included if they had engaged in three or more self-harming behaviors in the previous six months or five or more such behaviors in their lifetime. The comparison group consisted of an equal number of girls of the same ages who did not engage in this behavior.

In line with previous research, the adolescents in the parasuicide group reported far more incidents of self-harming behavior than did their parents.

The findings of low serotonin and low parasympathetic activity support the idea that the inability to regulate emotions and impulsivity can trigger self-harming behavior. The primary problem is an inability to manage their emotions: the people who cut themselves have excessively strong emotional reactions and they have extreme difficulty in controlling those emotions. Their self-harming behavior may serve to distract them from these emotions.

A characteristic feature of borderline personality disorder is not just self-injurious behavior but also stress-induced reduction of pain perception. Reduced pain sensitivity has been experimentally confirmed in patients with the condition. The increasing incidence of the condition in Europe is attracting many European investigators and colleagues from Mannheim in Germany have recently traced the neurological circuits involved in this stress-induced reduced pain perception.

There is good evidence that people who cut themselves are more likely to have been victims of sexual abuse or violence as children, though that obviously does not mean that every person who harms themselves has had something bad happen to them in childhood. Sadly the research has become more complex because of the numbers of people who have been given false memories of abuse by well-meaning psychologists.

Treating people who cut themselves, whether or not they have borderline personality disorder can be very challenging. The first thing is to treat any underlying mood or anxiety disorder. A combination of medications and psychotherapy is normally used, with people making claims for the value of different types of therapy. Many therapists also say that they have helped people who cut themselves with tapping therapies, acupuncture, homeopathy and qigong. I’ve not been able to find any credible research evidence to support the use of those therapies, though I’ve also seen some success stories.

We also have the puzzle about why cutting and borderline personality disorder seems to have been less common in other parts of the world and are now increasing. There is research to show that it’s not just a matter of recognition or of calling the illness something else in Europe. I have a friend who is a senior academic at an Ivy League University, and an expert on borderline personality disorder. During a sabbatical in Scotland some 15 years ago, he could not find a single case. This matters, because if we can identify what’s changed, we may have some clues about treatment. There are hundreds of candidates, including environmental stress, diet and toxins.

There’s an important new study in which 13 children with autism showed marked improvement in some of their challenging behaviors when they were given 1.5gms of omega-3 fatty acids each day. This was only a six week study, but it needs to be replicated using larger numbers. It is also important to be alert to the possibility that some makes of omega-3 fatty acids on the market contain mercury. The one that we have found best so far has been OmegaBrite. http://www.omegabrite.com/ It will also be useful to see if dietary supplementation will help self-injurious behavior in other types of people.

Here is a list of some of the better information sites about self-harm.

The key to success with helping complex problems, as I point out in great detail in Healing, Meaning and Purpose, is a comprehensive approach:

Combinations are Key

Medical Terminology and Clear Communication

During the Second World War, there was so much worry about the possibility that Axis spies had penetrated the United Kingdom, that there was a whole campaign entitled, “Careless Talk Costs Lives.”

We sometimes see a similar problem in medicine, and in particular in psychiatric practice when we use terms that may cause great and unnecessary distress.

When somebody is unwell, it is hard for them and for their family to take everything in. research has shown that people only remember accurately 30-40% of what a doctor, nurse or therapist says to them. That is why I recently wrote the piece on clarity of communication.

Another problem is vocabulary. It is calculated that a medical student has to learn aorund 6,000 new words during his or her training. Young doctors and nurses often forget that what they mean by a word is often very different from what a non-medic may mean. That is why we try hard to define eveything on this blog.

You might be interested to look at an example on the Psychiatric Resource Forum blog. This one discusses paranoia. It's an important word, but one which means something diferent to the specialist from its common use in conversation.

I think that it is valuable for you to be armed with as much information as you can, and I plan to continue highlighting terms that can lead to distress and misunderstanding.

Mel's Madness

In the midst of all the furor about Mel Gibson and his self-admittedly foul behavior while under the influence of alcohol, an important point has been missed: when someone is drunk or brain damaged, is their behavior just disinhibition? Are they behaving this way because they’ve lost the cerebral censor that normally maintains our social demeanor? The Romans certainly thought so: in banqueting halls they would have roses carved into columns and the ceiling. The rose - the symbol of secrets - was a reminder to be discrete when alcohol might begin to lossen the tongue.

When the frontal lobes are on strike, does our “true” personality emerge? Or can alcohol, drugs and brain injury produce brand new behaviors that are not just totally out of character, but predictable by the drug or type of injury?

The answer is a mixture of the two. I know a man who is in the running for the Nobel Prize in medicine. But a couple of years ago it was all over the press when he shattered the arm of an innocent man in the middle of an alcohol-fueled frenzy. Was it the alcohol? Yes, I’m sure that it was. But the scientist has had a very long history of anger problems and of bullying younger colleagues. The alcohol was the catalyst to behavior that he normally keeps in check, but which was just waiting to come out of its cage. I’ve treated hundreds of alcohol abusing people, and the amiable ones far outnumber the violent ones. And the majority of the violent ones had also been violent when not drinking.

Some drugs and chronic alcohol abuse can produce stereotyped hallucinations and behaviors. Some alcoholic people really do see bugs and pink elephants, and there are many other examples of predictable perceptual and behavioral disturbances with drugs and with brain injuries.

Students of the healing arts learn that damage to certain regions of the brain is associated with specific behavioral and emotional consequences. This teaching goes back more than a century, and generations of students have been told that, “Damage here causes depression, and damage here causes mania, and over there a lesions will damage one type of language.” Yet for three decades we have known that much of this teaching is fictitious. I was taught brain localization by some of the finest neurologists in the world, and yet each would admit the inaccuracy of their methods. A new study from Brisbane, Australia supports that nihilism. The investigators examined 61 consecutive people admitted to a stroke unit. “Strokes” are either vascular blockage or bleeds affecting the brain.

They could find no significant relationship between the side or location of a lesion and the development of post-stroke depression. But the kinds of people that they were before the stroke had a big impact:  pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke.

So why all the fuss about Mel? Because people are asking if deep down inside he really has been harboring some of the dark, mean spirited thoughts that he expressed to the police, and that the alcohol was the catalyst and not the creator of his diatribe.

“The intoxication of anger, like that of the grape, shows us to others, but hides us from ourselves. We injure our own cause in the opinion of the world when we too passionately defend it.”
-- Charles Caleb Colton (English Clergyman and Author, c.1780-1832)

Technorati tags: Mel Gibson Alcohol abuse Pre-morbid personality Brain

Temperament, Depression, Class and Resilience

Within the first few weeks of life, infants show marked individual differences in their level of activity, their responsiveness to change in the environment and their irritability. Some clearly enjoy being touched and mold their bodies to the person holding them, while other stiffen and squirm and do less to adjust their bodies to another person. These mood-related personality characteristics are called temperaments. There is some evidence that temperament is one of the basic building blocks of the personality. Temperament appears to consist of inborn traits, but they can be modified by parental contact: there is actually a reciprocal relationship between child and parent. The child modifies the behavior and attitude of the parent.

It is commonly said that a child’s temperament is as fixed as handedness or eye color, but this is inaccurate: we have overwhelming evidence that temperament can be changed by environmental influences. This makes sense. In Healing, Meaning and Purpose, we discuss the implications of the new findings about genes in the brain: they do not so much determine behavior as predispose you to the way that you will handle the environment. An important questions is just how plastic is human temperament? To what extent can you overcome your genetic programming and early rearing? Some recent research has indicated that the environment of the first three years of life is not as critical to later development as we used to believe. But I think that it’s dangerous to read too much into this research. Early emotional deprivation may leave the deepest scars and also be associated with physical deprivation. If a developing brain is deprived of key nutrients, it is difficult to catch up later.

More and more research is finding key genes that contribute to temperament. There is important evidence from animal research that the temperament of infant female rats can predict life span in those who develop spontaneous tumors. It is difficult to extrapolate from that to humans, but it is a further demonstration of the incredibly subtle interactions between genes, the environment, behavior and physical illness.

Some important recent research has examined the impact of temperament on the clinical features of bipolar disorder and of ADHD and autistic spectrum disorders. As expected, people with ADHD reported high levels of novelty seeking and high levels of harm avoidance. Patients with autism spectrum disorders were low on measures of novelty seeking, they had little dependence on rewards and high harm avoidance. Cluster B personality disorders, the dramatic, emotional, or erratic disorders ones (antisocial, borderline, narcissistic and histrionic), were more common in people with ADHD and the other clusters A and C were more common in autistic spectrum disorders. This tells us that these tow clinical conditions can have some specific effects on the structure of temperament, and on the risk of developing specific personality disorders.

In a new study in next month’s issue of the Journal of Personality, Kati Heinonen and colleagues from the Department of Psychology at University of Helsinki, have found a correlation between adult pessimism and childhood temperament in low socioeconomic status (SES) families. It is no surprise to learn that children raised in higher socioeconomic groups have a more optimistic outlook on life. But this is what is interesting, and the thing that will launch a great many more studies. It was discovered that the effect of childhood socioeconomic status on pessimism tended to remain the same despite opportunities for socioeconomic fluidity. A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in a high SES environment. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES. This indicates that children who had the chance to develop coping strategies during childhood and subsequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES. By contrast children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources. They are thus unable to benefit as much as possible from later experiences of success.

We already know that pessimism is related to physical and mental health, so this new study provides a critical link between socioeconomic status and long-term outcome. This is essential information for policy makers and for parents interested in helping children develop more effective coping strategies.

This research really proves that some of the excessive optimism of the self-help movement can sometimes be misplaced: just wanting something to be different does not make it so. If you had a lousy up-bringing in impoverished surroundings, it will make it more difficult to bounce back and learn essential coping skills.

More difficult, but not impossible.

Research on resilience has provided us with a great deal of information about developing mastery and coping skills in the face of being in a low SES, and we shall return to some of that work in the near future.

Technorati tags: Temperament Socioeconomic status Resilience Depression Attention deficit hyperactivity disorder Autistic spectrum disorders Personality disorders

Pathological Lying

“To tell a falsehood is like the cut of a saber; for though the wound may heal, the scar of it will remain.” --Saadi (a.k.a. Sa’di or Sadi or Musharrif-uddin, Persian Poet, c. 1213-1292)

If you are a regular reader, you know that I try to examine issues in five basic realms:  physical, psychological, relational (relationships), subtle and spiritual.  In this post, I am going to show you what is so different about our approach to handling problems by using the example of pathological lying.

I want to use this example because you may well have come across people who are pathological liars and I have seen an extraordinary case myself quite recently. Though none comes close to a young woman whom I once tried to help several years ago. To get to the bottom of her problems, I did background research on her that would have made Sherlock Holmes proud, finally marshaling the evidence in several very thick files of information about fabricated life events, relationships with famous people that never happened and false employment and medical records. When I proudly produced the fruits of several weeks’ work, I was greeted with a sly smile, as she said, “Oh those are only the ones where I used six aliases; you haven’t got the records from the other thirty names that I’ve use.” I was crestfallen.

Pathological lying is also called pseudologia fantastica or mythomania. The lies are usually fluent and plausible and the untrue statements and often grandiose and extreme. Particularly in times of heightened emotion, memory is falsified and distorted and events and circumstances misinterpreted.

In a recent case an individual claimed to have already been pre-selected for the United States Olympic team for 2008, despite being only a good average performer and being unknown to the team selectors. The pathological liar usually believes their false answers: as a rule of thumb, deliberate liars know when they are lying, and pathological liars do not always.

Pathological lying may accompany certain types of personality disorder, particularly borderline, histrionic and antisocial types as well as conduct disorder. It is related to the so-called Munchausen’s syndrome in which people mimic real diseases. There was a famous case in the UK of a man who was subjected to all manner of investigations during his many years of wandering from one hospital to another with all manner of fabricated medical conditions. I was once walking past the Emergency Room when a friend asked me to stop by and look at a patient, telling me that there seemed to be something familiar about him. I’ve always had a decent memory, so as soon as saw him I told the patient and my friend that he was last in hospital on November the 7th the year before, I gave him the alias that he had then used and that he had claimed to be a truck driver from a town in the English Midlands. The patient immediately left the hospital. A shame: it would have been good to know why he did it.

Sometimes people make things up when there is a defect in their ability to reason or judge: it may happen in schizophrenia, as well as a condition called Korsakov’s psychosis that can happen in severe chronic alcoholism and malnutrition. We sometimes still see it in people suffering from older people suffering from cerebral syphilis and in people with AIDS-related dementia. Another related problem is of confabulation in which people with amnesia make up false memories to cover the gaps in their memory.

Physical

There has been recent data from a study published in the British Journal of Psychiatry. The team from the University of Southern California team studied 49 people and found those known to be pathological liars had up to 26% more white matter than others with antisocial personality disorder who were not liars and healthy volunteers. In general, white matter transmits information and grey matter processes it. Having more white matter in the prefrontal cortex may aid lying. This study could help research into areas such as people who feign illness. There is also something else: the findings are in line with previous studies that have shown that children with autism are less capable of lying than other children. Some studies of the brain in individuals with autism show that they have more grey matter than white matter: the opposite pattern to the liars in this study.

This neurological study gets back to the problem of understanding how much of a person’s behavior is under voluntary control and how much is innate. Some distinguished psychiatrists are already suggesting that this supports the notion that pathological lying is a separate psychiatric entity. I’m sure that it’s only a matter of time before this data is introduced by the defense in a criminal case. But is that the end of the question? No, because we also need to consider the other four aspects or domains of a person.

Psychological

Apart from psychotic and organic syndromes, pathological lying may occur in people with very low self-esteem. I have written elsewhere about self-esteem and the data indicating that boosting self-esteem is valueless. What does help is genuine accomplishment from which self-esteem arises. The exception is in those poor souls whose self-esteem seems to be held in a kind of leaky bucket: however much they achieve, they still feel badly about themselves. Though sometimes such people need outside help, in my most recent book I present a number of methods for dealing with the “leaky bucket syndrome.” These involve precise methods for:

• Identifying and working to re-integrate your ego-fears
• Avoiding self-consciousness
• Detaching from the opinions of others
• The practice of gratitude
• Pinpointing and following your True Purpose
• Practicing personal integrity
• Liberating yourself from negative experiences, cognitions and emotions

Relationships

A recent Anglo-Italian study published in the Journal of Nonverbal Behaviour and reported by the BBC has shown that although most people believe that they can spot liars,when in fact, they cannot. It is commonly believed that liars can be detected by body movements and by avoiding eye contact. But the research shows that liars tended to stay still as they were acutely aware their body language might give them away. The popular perception that when people lie they scratch their nose and play with their hair is also not true. These small “nervous” movements are known as “self-adaptor gestures” that are thought to serve to comfort a person feeling vulnerable or exposed. But instead of giving into these urges, liars try very hard to stay still and are just as likely as an honest person to look the questioner in the eye.

But there were some signs of lying:

1. Liars use certain types of hand gestures more in order reinforce the point
2. The use of metaphoric gestures - such as touching the heart to show love and or the holding of hands apart to indicate size - are used 25% more often when people lie
3. Rhythmic gestures such as repeated pointing to emphasize statements are also used more often by liars

People lie in and about relationships all the time, and it can have a dreadfully corrosive effect on a relationship. But I am strongly opposed to the constant chant of “Get real.” Although it is a worthy ultimate goal, simply to kick away someone’s psychological support system – for the lies will have had some causes – without putting anything in their place, can have a devastating effect.

And if the lies are covering any form of infidelity, stop the activity before it is too late.

I am also reminded of the statement once made by Abraham Lincoln: “No man has a good enough memory to make a successful liar.”

Subtle

How do lies impact the subtle systems of the body? Profoundly. The subtle systems are animated by thought, and if your thoughts are scattered by having to keep track of what you said to whom, or if you are trying to come to terms with the true intent of another person in a relationship, it can drag energy from where it is needed. It is another reason why so many interpersonal difficulties can translate into physical problems. Conversely, working with the subtle systems of the body may help cure people who needlessly lie.

Spiritual

There is a reason why many religious traditions refer to the devil as the Prince of Lies. Lying has always been regarded not just as a moral failing but as a spiritual one as well.

Pathological liars may actually benefit from finding a spiritual orientation. For one thing s certain lying to oneself or lying to others is sure to paralyze any spiritual aspirations.

“This above all: to thine own self be true. And it must follow, as the night the day, thou can’st not then be false to any man.” {Hamlet, Act I, Scene iii}

--William Shakespeare (English Poet and Dramatist, 1564-1616)

Technorati tags: Lying, personality disorders, psychology

The Ethical Brain

There is a nice blog, Brainethics, that discusses an interesting new book Hardwired Behavior by Laurence Tancredi. This really is an outstanding piece of work. The author is both a psychiatrist and a lawyer who argues that Society's assumptions about free will and individual responsibility must be drastically revised in the light of scientific discoveries about the brain.

This is part of a large debate that is going on within psychiatry and psychology and within the legal profession. As an example, at what age should a young person be able to drive a car or be legally liable for their decisions? The driving question comes up because the brain and nervous system of a fifteen-year-old is still far from being fully mature, and may lead to poor coordination and decision-making. Can an eighteen-year-old be held liable for his behavior, at a time that his brain is not fully formed? Yet he is able to fight for his country. You will see that your answers to those questions are likely to be a mixture of political positions and personal experience. But there is also no doubt that the explosion of knowledge about the brain will be factored into some future legal decisions.

In Tancredi’s book, he applies knowledge derived from recent research to such traditional moral concerns as violence, sexual infidelity, lying, gluttony and sloth, and even financial fraud and gambling. For anybody working in the field, it is very clear that hormones, nutritional status, drugs, genetic abnormalities, injuries and traumatic experiences all have profound effects on the structure and functioning of the brain. Therefore they may all have an impact on our moral choices. Some experimental work implies that our actions are initiated by pre-conscious and unconscious processes in the brain before we are consciously aware of them. Does that mean that our sense of moral agency is a retrospective illusion? And what about free will?? Is that an illusion too?

I like this book, and also the recent book by Michael Gazzaniga, entitled The Ethical Brain. But I need to sound a note of caution: we are bewilderingly complex creatures, and there is powerful evidence for the existence of systems that can over-ride some of the neurological ones. So even after reading and studying hundreds of books and scientific papers and talking to hundreds of scientists around the world, I remain convinced that free will is not an illusion, and that there really is a genuine morality which is a great deal more than the firing of neurons in the brain.

Technorati tags: ethics, free will, morals,brain

Creativity and Promiscuity

What do Lord Byron, Dylan Thomas and Pablo Picasso have in common? Not only were they all creative, they also had lively and probably exhausting sex lives. British researchers have recently found evidence that this connection may be no coincidence.

Daniel Nettle from the University of Newcastle upon Tyne and Helen Clegg of the Open University have spent some years examining the puzzle of schizophrenia. This is without doubt one of the most savage and distressing illness to afflict humanity. There is a heritable component, yet sufferers themselves often find it very hard to maintain relationships, have many physical illnesses and tend to have fewer children themselves. Yet the illness persists, and indeed appears to have become far more common in the middle of the 18th century, roughly coinciding with the beginning of the Industrial Revolution. The question then is whether some mild forms of the illness may have survival advantage. Theses investigators have been looking at some of the personality traits that may be predictive of schizophrenia. They found high rates of what is known as “Schizotypy” amongst the artists and poets.

The typical features of schizotypal personality disorder are:

1. Unusual experiences, including odd perceptions, magical thinking and sometimes hallucinations

2. Cognitive disorganization

3. Impulsivity

4. Non-conformity with regard to rules and social conventions

5. Often introverted, though some become overly sociable

People with schizotypal personality may develop schizophrenia symptoms if stressed, and they are found more commonly in the families of people with full-blown schizophrenia.

Psychologists have previously found that the creativity of professional artists and poets acts almost like a sexual magnetic, and it has long been thought that creative people are more likely to engage in increased sexual activity, but this research is the first to prove it. The average number of sexual partners for artists and poets was between four and ten, compared with three for non-creative types. Statistics also showed that the average number of sexual partners for both men and women rose in line with an increase in the amount of creative activity.

Links have been made before between bipolar disorder and creativity and also between creativity and schizotypy. An essential feature of creativity is the ability to put together unusual associations and ideas. In the schizotypal person who is creative, this is kept in balance, but in schizophrenia these association can become bizarre. Schizotypy tends to be associated with cognitive activation and sometimes greater sociability.

Apart from art and poetry, it is an open secret in the psychiatric community that several Nobel Prize-winning scientists have schizotypy, at least two have been diagnosed with schizophrenia, including John Nash of Beautiful Mind fame, and several famous Nobel Laureates have first-degree relatives with schizophrenia. The numbers are much higher than in the general population.

Some commentators have suggested that if you want to be lucky in love, perhaps you need to be more creative. We cannot all be a Byron or a Picasso, but I would suggest that injecting a little more creativity into your current relationships and if you are looking for new ones, being more open and creative about how and whom you meet, will likely make encounters more congenial for both of you.

Technorati tags: creativity, schizotypy, Picasso,