Etiology - Personality Disorders

ETIOLOGY

Biologic Theories

Personality develops through the interaction of hereditary dispositions and environmental influences. Temperament refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion. Genetic differences account for about 50% of the variances in temperament traits.

The four temperament traits are harm avoidance, nov-elty seeking, reward dependence, and persistence. Each of these four genetically influenced traits affects a person’s automatic responses to certain situations. These response patterns are ingrained by 2 to 3 years of age (Svrakic & Cloninger, 2005).

People with high harm avoidance exhibit fear of uncer-tainty, social inhibition, shyness with strangers, rapid fati-gability, and pessimistic worry in anticipation of problems. Those with low harm avoidance are carefree, energetic, outgoing, and optimistic. High harm-avoidance behaviors may result in maladaptive inhibition and excessive anxi-ety. Low harm-avoidance behaviors may result in unwar-ranted optimism and unresponsiveness to potential harm or danger.

A high novelty-seeking temperament results in some-one who is quick tempered, curious, easily bored, impul-sive, extravagant, and disorderly. He or she may be easily bored and distracted with daily life, prone to angry out-bursts, and fickle in relationships. The person low in nov-elty seeking is slow tempered, stoic, reflective, frugal, reserved, orderly, and tolerant of monotony; he or she may adhere to a routine of activities.

Reward dependence defines how a person responds to social cues. People high in reward dependence are tender-hearted, sensitive, sociable, and socially dependent. They may become overly dependent on approval from others and readily assume the ideas or wishes of others without regard for their own beliefs or desires. People with low reward dependence are practical, tough minded, cold, socially insensitive, irresolute, and indifferent to being alone. Social withdrawal, detachment, aloofness, and dis-interest in others can result.

Highly persistent people are hardworking and ambi-tious overachievers who respond to fatigue or frustration as a personal challenge. They may persevere even when a situation dictates they should change or stop. People with low persistence are inactive, indolent, unstable, and erratic. They tend to give up easily when frustrated and rarely strive for higher accomplishments.

These four genetically independent temperament traits occur in all possible combinations. Some of the previous descriptions of high and low levels of traits correspond closely with the descriptions of the various personality disorders. For example, people with antisocial personality disorder are low in harm-avoidance traits and high in novelty-seeking traits, whereas people with dependent personality disorder are high in reward-dependence traits and harm-avoidance traits.

Psychodynamic Theories

Although temperament is largely inherited, social learn-ing, culture, and random life events unique to each person influence character. Character consists of concepts about the self and the external world. It develops over time as a person comes into contact with people and situations and confronts challenges. Three major character traits have been distinguished: self-directedness, cooperativeness, and self-transcendence. When fully developed, these character traits define a mature personality (Svrakic & Cloninger, 2005).

Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Self-directed people are realistic and effective and can adapt their behavior to achieve goals. People low in self-directedness are blaming, helpless, irresponsible, and unre-liable. They cannot set and pursue meaningful goals.

Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Highly cooperative people are described as empathic, tol-erant, compassionate, supportive, and principled. People with low cooperativeness are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic; that is, they look out for themselves without regard for the rights and feelings of others.

Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the uni-verse. Self-transcendent people are spiritual, unpretentious, Reward dependence defines how a person responds to social cues. People high in reward dependence are tender-hearted, sensitive, sociable, and socially dependent. They may become overly dependent on approval from others and readily assume the ideas or wishes of others without regard for their own beliefs or desires. People with low reward dependence are practical, tough minded, cold, socially insensitive, irresolute, and indifferent to being alone. Social withdrawal, detachment, aloofness, and dis-interest in others can result.

Highly persistent people are hardworking and ambi-tious overachievers who respond to fatigue or frustration as a personal challenge. They may persevere even when a situation dictates they should change or stop. People with low persistence are inactive, indolent, unstable, and erratic. They tend to give up easily when frustrated and rarely strive for higher accomplishments.

These four genetically independent temperament traits occur in all possible combinations. Some of the previous descriptions of high and low levels of traits correspond closely with the descriptions of the various personality disorders. For example, people with antisocial personality disorder are low in harm-avoidance traits and high in novelty-seeking traits, whereas people with dependent personality disorder are high in reward-dependence traits and harm-avoidance traits.

Psychodynamic Theories

Although temperament is largely inherited, social learn-ing, culture, and random life events unique to each person influence character. Character consists of concepts about the self and the external world. It develops over time as a person comes into contact with people and situations and confronts challenges. Three major character traits have been distinguished: self-directedness, cooperativeness, and self-transcendence. When fully developed, these character traits define a mature personality (Svrakic & Cloninger, 2005).

Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Self-directed people are realistic and effective and can adapt their behavior to achieve goals. People low in self-directedness are blaming, helpless, irresponsible, and unre-liable. They cannot set and pursue meaningful goals.

Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Highly cooperative people are described as empathic, tol-erant, compassionate, supportive, and principled. People with low cooperativeness are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic; that is, they look out for themselves without regard for the rights and feelings of others.

Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the uni-verse. Self-transcendent people are spiritual, unpretentious, Reward dependence defines how a person responds to social cues. People high in reward dependence are tender-hearted, sensitive, sociable, and socially dependent. They may become overly dependent on approval from others and readily assume the ideas or wishes of others without regard for their own beliefs or desires. People with low reward dependence are practical, tough minded, cold, socially insensitive, irresolute, and indifferent to being alone. Social withdrawal, detachment, aloofness, and dis-interest in others can result.

Highly persistent people are hardworking and ambi-tious overachievers who respond to fatigue or frustration as a personal challenge. They may persevere even when a situation dictates they should change or stop. People with low persistence are inactive, indolent, unstable, and erratic. They tend to give up easily when frustrated and rarely strive for higher accomplishments.

These four genetically independent temperament traits occur in all possible combinations. Some of the previous descriptions of high and low levels of traits correspond closely with the descriptions of the various personality disorders. For example, people with antisocial personality disorder are low in harm-avoidance traits and high in novelty-seeking traits, whereas people with dependent personality disorder are high in reward-dependence traits and harm-avoidance traits.

Psychodynamic Theories

Although temperament is largely inherited, social learn-ing, culture, and random life events unique to each person influence character. Character consists of concepts about the self and the external world. It develops over time as a person comes into contact with people and situations and confronts challenges. Three major character traits have been distinguished: self-directedness, cooperativeness, and self-transcendence. When fully developed, these character traits define a mature personality (Svrakic & Cloninger, 2005).

Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Self-directed people are realistic and effective and can adapt their behavior to achieve goals. People low in self-directedness are blaming, helpless, irresponsible, and unre-liable. They cannot set and pursue meaningful goals.

Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Highly cooperative people are described as empathic, tol-erant, compassionate, supportive, and principled. People with low cooperativeness are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic; that is, they look out for themselves without regard for the rights and feelings of others.

Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the uni-verse. Self-transcendent people are spiritual, unpretentious, humble, and fulfilled. These traits are helpful when dealing with suffering, illness, or death. People low in self-transcendence are practical, self-conscious, materialistic, and controlling. They may have difficulty accepting suffer-ing, loss of control, personal and material losses, and death.

Character matures in stepwise stages from infancy through late adulthood. Each stage has an associated developmental task that the person must perform for mature personality development. Failure to complete a developmental task jeopardizes the person’s ability to achieve future developmental tasks. For example, if the task of basic trust is not achieved in infancy, mistrust results and subsequently interferes with achieve-ment of all future tasks.

Experiences with family, peers, and others can signifi-cantly influence psychosocial development. Social educa-tion in the family creates an environment that can support or oppress specific character development. For example, a family environment that does not value and demonstrate cooperation with others (compassion or tolerance) fails to support the development of that trait in its children. Like-wise, the person with nonsupportive or difficult peer rela-tionships growing up may have lifelong difficulty relating to others and forming satisfactory relationships.

In summary, personality develops in response to inher-ited dispositions (temperament) and environmental influ-ences (character), which are experiences unique to each person. Personality disorders result when the combination of temperament and character development produces mal-adaptive, inflexible ways of viewing self, coping with the world, and relating to others.