a pervasive pattern of maladaptive traits and behaviours
beginning in early adult life
it usually has its first manifestations in childhood and is clearly evident in
adolescence
it is not diagnosed before early adult life because these maladaptive traits are
very common in childhood and adolescence, but most individuals age-out of these
traits before early adulthood
leading to substantial personal distress and/or social dysfunction, and
disruption to others
is of long duration, typically lasting at least several years
Mild Personality Disorder: There are notable problems in many interpersonal relationships and the performance of expected
occupational and social roles, but some relationships are maintained and/or some
roles carried out. Mild personality disorder is typically not associated with substantial harm to self or others.
Moderate Personality Disorder: There are marked problems in most interpersonal relationships and in the performance of expected
occupational and social roles across a wide range of situations that are
sufficiently extensive that most are compromised to some degree. Moderate
personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a
degree that causes long-term damage or has endangered life.
Severe Personality Disorder: There are severe problems in interpersonal functioning affecting all areas of life. The individual's
general social dysfunction is profound and the ability and/or willingness to perform
expected occupational and social roles is absent or severely compromised. Severe
personality disorder usually is associated with a past history and future expectation of severe harm to self or others that
has caused long-term damage or has endangered life.
Onset:
Typical features of borderline personality disorder are instability (of self-image, personal
goals, interpersonal relationships, and emotions), accompanied by impulsivity, risk taking,
and/or hostility. Borderline Personality Disorder occurs in between 1.6% to 5.9% of the U.S.
population. It's prevalance is 6% in primary care settings, 10% in outpatient mental health
clinics, and 20% in psychiatric inpatients.
For this diagnosis to be given, the individual must be at least in early adulthood. This
disorder is only diagnosed when these behaviors become persistent and very disabling or
harmful to others.
Both Borderline Personality Disorder and Cyclothymic Disorder have marked shifts in mood. If
the criteria are met for each disorder, both Borderline Personality Disorder and Cyclothymic
Disorder may be diagnosed.
In clinical practice, "personality disorder is seldom diagnosed and
accounts for less than 5% of all hospital admissions. Those who are diagnosed are almost
always assigned the categories of borderline, antisocial, or not otherwise specified. Those
who repeatedly self-harm are automatically given a diagnosis of borderline personality
disorder and those who are aggressive and have a history of offending behaviour are given a
diagnosis of antisocial personality disorder, irrespective of the complexity of their
issues."
Treatment:
There is insufficient (randomized controlled trial) evidence to prove the effectiveness of
any medication for adults with this disorder. However, research shows
that Dialectical Behaviour Therapy is helpful for people with Borderline
Personality Disorder. Effects included a decrease in inappropriate anger, a reduction in
self-harm and an improvement in general functioning. Overall, none of the psychotherapies
for this disorder have a very robust evidence base. Dialectical behavior therapy and general
psychiatric management have been shown to be equally
effective. There are too few studies to allow firm conclusions to be drawn about
other psychological therapies for Borderline Personality Disorder.
Prognosis:
Borderline Personality Disorder can persist for a lifetime. At 7 to 10 years
follow-up, half of patients with BPD had achieved a symptomatic
remission (i.e., would no longer be diagnosed as having this
disorder). Unfortunately, full recovery (having stable relationships and
full-time employment - as well as having no symptoms) takes much longer. After 10 years,
only about 20% have stable relationships or full-time employment. A 10-year hospital
discharge follow-up study of former inpatients with this disorder found that
(depending on the follow-up year) 41% to 52%
were receiving social security disability income (SSDI).
Fifteen- and 27-year follow-up studies of patients with Borderline Personality Disorder show
that "most of them no
longer meet full criteria for the disorder by age 40 ... Suicide rates in patients
with this disorder are close to 10%, with most completions occurring late in the course of
illness; early mortality from all causes exceeds 18%."
Individuals with this disorder often have substance use disorders, mood disorders, anxiety
disorders, and other personality disorders.
"People with personality disorder have far higher morbidity and mortality than do those
without. Life expectancy at birth is shorter by 19 years for women and 18 years for men than
it is in the general UK population. Increased mortality can be explained partly by increased
incidence of suicide and homicide in people with personality disorder. However, increased
mortality from cardiovascular and respiratory diseases suggest that other factors are also
important. Difficulties in interpersonal relationships, which lie at the heart of
personality disorder, might have an effect on relationships with health-care professionals,
resulting in misunderstandings, miscommunication, and poor quality care. Lifestyle factors
are probably also important, with high prevalence of smoking, alcohol, and drug misuse in
people with personality disorders."
Individuals with this
disorder would have a significant impairment in the behaviors that are displayed in
red
:
Most of the time and in most situations:
In general, do you
have difficulty making and keeping friends?
Would you normally describe yourself as a
loner?
In general, do you trust other people? Do you normally lose
your temper easily? Are you normally an
impulsive sort of person?
Are you normally a worrier?
In general, do you depend on others a lot?
In general, are you a
perfectionist?
Answer "Yes" or "No" to each of these 8 questions.
7-Question Well-Being Screening Test (By P. W. Long MD, 2020
Individuals with
this disorder would have a significant impairment in the behaviors that are displayed in
red
:
Agreeableness:I was kind and honest. (Instead had hostility) Conscientiousness: I was diligent and self-disciplined. (Instead had impulsivity, reckless risk taking) Openness/Intellect: I showed good reasoning and learning ability. (Instead had transient,
stress-related paranoid ideation and severe dissociative symptoms) Sociality: I was gregarious, enthusiastic,
and assertive. Emotional
Stability: I was emotionally stable and calm. (Instead had
emotional instability, unstable self-image, social instability, separation anxiety,
depressed mood, self-harm) Physical Health: I was physically
healthy. Socio-Occupational
Functioning: I functioned well in my social relationships and
work. (Instead had significant impairment in social, academic, or
occupational functioning.)
How often in the past week did you do each of
these 7 behaviors:
Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder
requires assessment by a qualified practitioner trained in psychiatric diagnosis and
evidence-based treatment.
However, if no such professional is available, our free computerized diagnosis is usually
accurate when completed by an informant who knows the patient well. Computerized
diagnosis is less accurate when done by patients (because they often lack insight).
Example Of Our Computer Generated Diagnostic Assessment
Borderline Personality Disorder 301.83
This diagnosis is based on the following findings:
Frantic efforts to avoid real or imagined abandonment (still present)
Unstable and intense 'love-hate' relationships (still present)
Identity disturbance: markedly and persistently unstable self-image or sense of
self (still present)
Impulsivity in at least two areas that are potentially self-damaging (still
present)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(still present)
Rapidly shifting emotions (still present)
Chronic feelings of emptiness (still present)
Inappropriate, intense anger or difficulty controlling anger (still present)
Transient, stress-related paranoid ideation or severe dissociative symptoms
(still present)
Treatment Goals:
Goal: overcome fear of abandonment.
If this problem persists: She will continue to show frantic efforts to avoid
real or imagined abandonment. Her frantic efforts to avoid abandonment might
include impulsive actions such as self-mutilating or suicidal behaviors.
Goal: have less unstable and intense "love-hate" relationships.
If this problem persists: She will continue to show a pattern of unstable and
intense relationships. She will switch quickly from idealizing other people to
devaluing them. She will see things in terms of extremes, either all good or all
bad.
Goal: develop a positive, stable self-image or sense of self.
If this problem persists: Her self-image ("who-am-I?") will continue to be very
unstable. There will be sudden and dramatic shifts in her self-image,
characterized by shifting goals, values, and vocational aspirations. She will
see herself as a "victim" (taking
little responsibility for any problem).
Goal: stop impulsive, self-damaging behavior.
If this problem persists: She will continue to show impulsivity in at least two
areas that are potentially self-damaging (i.e., gambling, spending money
irresponsibly, binge eating, abusing substances, engaging in unsafe sex, driving
recklessly, or being
impulsively suicidal).
Goal: stop self-mutilating or suicidal behavior.
If this problem persists: She will continue to have recurrent suicidal gestures
such as wrist cutting, overdosing, or self-mutilation. Her self-destructive acts
will be precipitated by threats of separation or rejection.
Goal: stop over-reacting to stress.
If this problem persists: She will continue to have rapidly shifting moods due
to extreme reactivity to interpersonal stress (e.g., intense unhappiness, anger,
or anxiety usually lasting a few hours and only rarely more than a few days).
Goal: discover a meaning or purpose to life.
If this problem persists: She will continue to have chronic feelings of
emptiness. She will be easily bored and constantly seeking something to do.
Goal: better control anger.
If this problem persists: She will continue to be inappropriately angry. Her
anger will be triggered when a caregiver or lover is seen as neglectful,
withholding, uncaring, or abandoning.
Goal: stop becoming paranoid or dissociating under stress.
If this problem persists: During periods of extreme stress, she will continue to
have transient paranoid ideation or dissociative symptoms (e.g.,
depersonalization). This will occur most frequently in response to a real or
imagined abandonment.
"Emotionally unstable [borderline] personality disorder is characterized by a definite
tendency to act impulsively and without consideration of the consequences; the mood is
unpredictable and capricious. There is a liability to outbursts of emotion and an incapacity
control the behavioural explosions. There is a tendency to quarrelsome behavior and to
conflicts with others, especially when impulsive acts are thwarted or censored. Two types
may be distinguished: the impulsive type, characterized predominantly by emotional
instability and lack of impulse control, and the borderline type, characterized in addition
by disturbances in self-image, aims, and internal preferences, by chronic feelings of
emptiness, by intense and unstable interpersonal relationships, and by a tendency to
self-destructive behavior, including suicide gestures and attempts" (ICD10). It is "a
pervasive pattern of instability of interpersonal relationships, self-image, and affects,
and marked impulsivity, beginning by early adulthood and present in a variety of contexts"
(DSM-5)
In terms of the "Big-6"
Dimensions of Mental Health this disorder is characterized by
emotional distress
(emotional instability, depressed mood, separation anxiety, self-harm, unstable
self-image, and social instability),
antagonism
(hostility),
disinhibition
(impulsivity, reckless risk taking), and
impaired intellect
(transient dissociative states). This leads to substantial personal distress and/or
social dysfunction, and disruption to others.
This is not diagnosed before early adulthood because these maladaptive traits are very
common in childhood and adolescence, but most individuals age-out of these traits before
early adulthood. This disorder is of long duration, typically lasting at least several
years.
The diagnosis requires having 5 (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. (Note: Do not include
suicidal or self-mutilating behavior here.)
A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of
self.
Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, sex, Substance Abuse, reckless driving, binge eating). (Note: Do not
include suicidal or self-mutilating behavior here.)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more
than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
Like all personality disorders, Borderline (Emotionally Unstable) Personality Disorder is an
enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual's culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress or impairment.
The acute symptoms resolve the most quickly. These acute symptoms are impulsivity (e.g.,
self-mutilation and suicide efforts) and active attempts to manage interpersonal
difficulties (e.g., problems with demandingness/entitlement and serious treatment
regressions).
The chronic symptoms can persist for a decade or more. These chronic symptoms are affective
symptoms reflecting areas of chronic dysphoria (e.g., anger and loneliness/emptiness)
and interpersonal symptoms reflecting abandonment and dependency issues (e.g.,
intolerance of aloneness and counterdependency problems).
In the general population, rapid mood shifts, impulsivity, and hostility are normal in
childhood and early adolescence, but disappear with maturity. However, in Borderline
Personality Disorder, rapid mood shifts, impulsivity, and hostility intensifies in
adolescence and
persists into adulthood. Fortunately, in their 30's and 40's, the majority develop emotional
stability and adequate coping skills.
Borderline Personality Disorder is quite different from Bipolar I Disorder. The mood swings
seen in Borderline Personality Disorder seldom last more than one day; whereas mood swings
in Bipolar I Disorder last much longer. Borderline Personality Disorder doesn't exhibit
the
prolonged episodes of decreased need for sleep, hyperactivity, pressured speech, reckless
over-involvement, and grandiosity that are characteristic of Bipolar I Disorder.
Completed suicide occurs in 8%-10% of individuals with Borderline Personality Disorder.
Self-mutilation (e.g., cutting or burning), suicide threats and attempts are very common.
Recurrent job losses, interrupted education, and broken marriages are common.
No laboratory test has been found to be diagnostic of this disorder.
Prevalence
The prevalence of Borderline Personality Disorder is about 1.6% of the general population.
It is seen in 20% of psychiatric inpatients. This disorder is equally
prevalent among men and women.
Familial Pattern
If individuals have Borderline Personality Disorder; their first-degree biological relatives
are 5 times more likely to have this disorder. These relatives also have an increased risk
of having Substance Use Disorders, Antisocial Personality Disorder, and Depressive or
Bipolar
Disorders.
Controlled Clinical Trials Of Therapy
Click here for a list of all the controlled clinical trials of
therapy for this disorder.
Psychotherapy
Dialectical Behavior Therapy is helpful for people with borderline personality disorder in
decreasing their inappropriate anger and self-harm, and in increasing their general
functioning. There are generally too few studies to allow firm conclusions to be drawn about the
value of all the other kinds of psychotherapeutic interventions. Overall, none of
the psychotherapies for this disorder have a very robust evidence base. Dialectical behavior therapy and general
psychiatric management have been
shown to be equally
effective. Individuals with this disorder usually suffer from 2 or more psychiatric
disorders. Two years
after
therapy, even though two-thirds achieve diagnostic remission and significant
improvement in quality of life, 53% are neither employed nor in school, and 39% are still
receiving psychiatric disability financial support. Research has shown that individuals with
this
disorder need long-term therapy that teaches less emotional, aggressive and impulsive ways
of coping.
Individuals with this disorder need to have a long-term therapist or mentor to establish a
stable, supportive relationship in which clear and consistent boundaries are established.
This therapist or mentor must have the patience and strength to withstand the patient's many
crises and limit-testing episodes. Communication should always be clear, honest, optimistic
and directed towards teaching more mature coping skills.
Pharmacotherapy
There are currently no medications approved by the FDA to treat this disorder.
Antidepressants are not helpful for treatment of this disorder, but may be helpful in the
presence of comorbid conditions. Total severity of this disorder was not significantly influenced by any drug.Vitamins, nutritional supplements, and special diets are all
ineffective for all Personality Disorders.
Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder
Research has shown that genetic, environmental, and prenatal factors all play important
roles in the development of personality disorder. Research has also shown that low
parental
affection and harsh
parenting increase the risk of a child later developing a personality disorder.
"Low affection" was defined as: low parental affection, low parental time spent with the
child, poor parental communication with the child, poor home maintenance, low educational
aspirations for the child, poor parental supervision, low paternal assistance to the child's
mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh
punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the
parents, difficulty controlling anger toward the child, possessiveness, use of guilt to
control
the
child, and verbal abuse.
(USE SLIDER ON RIGHT SIDE OF THE ABOVE PAGE TO SEE FULL CHECKLIST)
This disorder is characterized by pathological personality traits in the following
domains:
Antagonism
, characterized by:
Hostility:
Having angry outbursts; being verbally abusive; having mean,
bullying, or vengeful behavior. Question: "Has your temper
gotten you into trouble? Do you insult people? Do you argue or fight
when people try to stop you from doing what you want?"
"Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical
fights)." (DSM-5)
"Liability to outbursts of anger or violence, with inability to
control the resulting behavioural explosions." (ICD-10)
"A marked tendency to quarrelsome behavior and to conflicts with
others, especially when impulsive acts are thwarted or criticized."
(ICD-10)
Disinhibition
, characterized by:
Impulsivity and Reckless Risk Taking:
Acting suddenly or rashly without a plan or consideration of the
consequences. Question: "Do you like doing things that are
risky or dangerous? Do you often disregard your safety or that of
others? Are you easily distracted so you don't carry out your plans? Do
you ofen get into trouble because you act without thinking ahead? Do you
have problems with impulsive behavior - like over-spending, risky sexual
behavior, substance abuse, reckless driving, or binge eating?"
"Impulsivity in at least two areas that are potentially
self-damaging (e.g., spending, sex, Substance Abuse, reckless
driving, binge eating). (Note: Do not include suicidal or
self-mutilating behavior here.)" (DSM-5)
"A marked tendency to act unexpectedly and without consideration of
the consequences." (ICD-10)
Impaired Intellect
, characterized by:
Perceptual Dysregulation:
Having odd or unusual perceptions e.g. feeling unreal, things
looking unreal, out-of-body feeling. Question: "Do you often
feel empty inside? Do you sometimes feel paranoid or like you are losing
touch with reality?"
"Transient, stress-related paranoid ideation or severe dissociative
symptoms." (DSM-5)
"Chronic feelings of emptiness." (DSM-5 and ICD-10)
Stress-related dissociative states,
including depersonalization, derealization, analgesia, and emotional
numbing, are a clinical hallmark of borderline personality disorder
(BPD), occurring in about 75–80% of patients." Functional
neuroimaging studies have shown this is associated with altered
functioning in the fronto-limbic regions and temporoparietal areas
of the brain.
Emotional Distress
, characterized by:
Emotional Instability:
Having unstable emotions with frequent mood changes;
over-reacting with intense emotions. Question: "Are you very
moody? Do minor events cause major shifts in moods? Do you have severe
mood swings several times a day?"
"Affective instability due to a marked reactivity of mood (e.g.,
intense episodic dysphoria, irritability, or anxiety usually lasting
a few hours and only rarely more than a few days)." (DSM-5)
"Unstable and capricious mood." (ICD-10)
Unstable Self-Image:
Having unstable: self-image (“who-am-I”), core personal values,
life goals and career plans. Question: "Can you not decide
what kind of person you want to be? Do you have extreme changes in how
you see yourself - like shifting from feeling confident about who you
are to feeling like you are evil or that you don’t even exist?"
"Identity disturbance: markedly and persistently unstable self-image
or sense of self." (DSM-5)
"Disturbances in and uncertainty about self-image, aims and internal
preferences (including sexual)." (ICD-10)
"Difficulty in maintaining any course of action that offers no
immediate reward." (ICD-10)
Social Instability:
Having a pattern of unstable and intense social
relationships. Question: "Do you get into very intense
relationships that don't last? Do you have major shifts in your opinions
about others such as switching from believing someone is a loyal friend
or partner to believing the person is untrustworthy and hurtful?"
"A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation." (DSM-5)
"Liability to become involved in intense and unstable relationships,
often leading to emotional crises." (ICD-10)
Separation anxiety:
Finding it difficult to handle separation or rejection from
significant others. Question: "Do you worry a lot that someone
important in your life is tired of you or is planning to leave you? Do
you go to extremes to try to keep someone from leaving you?"
"Frantic efforts to avoid real or imagined abandonment. (Note: Do
not include suicidal or self-mutilating behavior here.)"
(DSM-5)
"Excessive efforts to avoid abandonment." (ICD-10)
Depressed Mood and Self-Harm:
Having thoughts of deliberate self-harm or suicide OR showing
severe self-neglect. Question: "Do you ever feel suicidal?
Have you ever threatened suicide or injured yourself on purpose?"
"Recurrent suicidal behavior, gestures, or threats, or
self-mutilating behavior." (DSM-5)
"Recurrent threats or acts of self-harm." (ICD-10)
Emotionally unstable [borderline] personality disorder is characterized by a definite
tendency to act impulsively and without consideration of the consequences; the mood is
unpredictable and capricious. There is a liability to outbursts of emotion and an
incapacity control the behavioural explosions. There is a tendency to quarrelsome
behavior and to conflicts with others, especially when impulsive acts are thwarted or
censored. Two types may be distinguished: the impulsive type, characterized
predominantly by emotional instability and lack of impulse control, and the borderline
type, characterized in addition by disturbances in self-image, aims, and internal
preferences, by chronic feelings of emptiness, by intense and unstable interpersonal
relationships, and by a tendency to self-destructive behavior, including suicide
gestures and attempts.
A. The general criteria of personality disorder must be met:
Evidence that the individual's characteristic and enduring patterns of inner
experience and behavior
deviate markedly as a whole from the culturally expected and accepted range
(or 'norm').
The deviation must manifest itself pervasively as behavior that is
inflexible, maladaptive, or otherwise
dysfunctional across a broad range of personal and social situations (i.e.
not being limited to one specific
'triggering' stimulus or situation).
There is personal distress, or adverse impact on the social environment, or
both, clearly attributable to the
behavior.
There must be evidence that the deviation is stable and of long duration,
having its onset in late childhood
or adolescence.
The deviation cannot be explained as a manifestation or consequence of other
adult mental disorders.
Organic brain disease, injury, or dysfunction must be excluded as possible
cause of the deviation.
Impulsive Subtype:
A. The general criteria of personality disorder (above) must be met:
B. Quarrelsome behavior:
A marked tendency to quarrelsome behavior and to conflicts with others,
especially when impulsive acts
are thwarted or criticized.
(E.g., "I argue or fight when people try to stop me from doing what I
want.")
C. At least two of the following must be present:
A marked tendency to act unexpectedly and without consideration of the
consequences.
(E.g., "I take chances and do reckless things.")
Liability to outbursts of anger or violence, with inability to control the
resulting behavioural explosions.
(E.g., "Sometimes I get so angry I break or smash things.")
Difficulty in maintaining any course of action that offers no immediate
reward.
(E.g., "I don't stick with a plan if I don't get results right away.")
Unstable and capricious mood.
(E.g., "I'm very moody.")
Borderline Subtype:
A. The general criteria of personality disorder (above) must be met:
B. At least three of the following must be present:
A marked tendency to quarrelsome behavior and to conflicts with others,
especially when impulsive acts
are thwarted or criticized.
(E.g., "I argue or fight when people try to stop me from doing what I
want.")
A marked tendency to act unexpectedly and without consideration of the
consequences.
(E.g., "I take chances and do reckless things.")
Liability to outbursts of anger or violence, with inability to control the
resulting behavioural explosions.
(E.g., "Sometimes I get so angry I break or smash things.")
Difficulty in maintaining any course of action that offers no immediate
reward.
(E.g., "I don't stick with a plan if I don't get results right away.")
Unstable and capricious mood.
(E.g., "I'm very moody.")
C. At least two of the following must be present:
Disturbances in and uncertainty about self-image, aims and internal
preferences (including sexual).
(E.g., "I can't decide what kind of person I want to be.")
Liability to become involved in intense and unstable relationships, often
leading to emotional crises.
(E.g., "I get into very intense relationships that don't last.")
Excessive efforts to avoid abandonment.
(E.g., "I go to extremes to try to keep people from leaving me.")
Recurrent threats or acts of self-harm.
(E.g., "A number of times, I've threatened suicide or injured myself on
purpose.")
A pervasive pattern of instability of interpersonal relationships, self-image, and
affects, and marked impulsivity, beginning by early adulthood and present in a variety
of contexts, as indicated by 5 (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. (Note: Do not include
suicidal or self-mutilating behavior here.)
A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of
self.
Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, sex, Substance Abuse, reckless driving, binge eating). (Note: Do not
include suicidal or self-mutilating behavior here.)
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely
more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.
This enduring pattern of inner experience and behavior must deviate markedly from
the expectations of the individual's culture.
This enduring pattern is inflexible and pervasive across a broad range of personal
and social situations.
This enduring pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Proposed New Diagnostic Criteria:
Typical features of borderline personality disorder are instability of self-image,
personal goals, interpersonal relationships, and affects, accompanied by impulsiveity,
risk taking, and/or hostility. The individual is at least 18 years of age.
A. Moderate or greater impairment in personality functioning, manifested by
characteristic difficulties in two or more of the following four areas:
Identity:
Markedly impoverished, poorly developed, or unstable self-image, often
associated with excessive self-criticism, chronic feelings of emptiness;
dissociative states under stress.
Self-direction:
Instability in goals; aspirations, values, or career plans.
Empathy:
Compromised ability to recognize the feelings and needs of others associated
with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted);
perceptions of others selectively biased toward negative attributes or
vulnerabilities.
Intimacy:
Intense, unstable, and conflicted close relationships, marked by mistrust,
neediness, and anxious preoccupation with real or imagined abandonment; close
relationships often viewed in extremes of idealization and devaluation and
alternating between overinvolvement
and withdrawal.
B. Four or more of the following seven pathological personality traits, at least one of
which must be impulsivity, risk taking, or hostility.
Antagonism
Hostility:
Persistent or frequent angry feelings; anger or irritability in response to
minor slights and insults.
Disinhibition
Reckless Risk Taking:
Engagement in dangerous, risky, and potentially self-damaging activities,
unnecessarily and without regard for consequences; lack of concern for one's
limitations and denial of the reality of personal danger.
Impulsivity:
Acting on the spur of the moment in response to immediate stimuli; acting on a
momentary basis without a plan or consideration of outcomes; difficulty
establishing and following plans; a sense of urgency and self-harming behavior
under emotional distress.
Negative Emotion
Emotional Instability:
Unstable emotional experiences and frequent mood changes; emotions that are
easily aroused, intense, and/or out of proportion to events and circumstances.
Anxiety:
Intense feelings of nervousness, tenseness, or panic, often in reaction to
social situations; worry about the negative effects of past unpleasant
experiences and future negative possibilities; feeling fearful, apprehensive, or
threatened by uncertainty; fears of
embarrassment; fears of falling apart or losing control.
Separation Anxiety:
Fears of rejection by - and/or separation from - significant others, associated
with fears of excessive dependency and complete loss of autonomy.
Depressed Mood:
Frequent feelings of being down, miserable, and/or hopeless; difficulty
recovering from such moods; pessimism about the future; pervasive shame,
feelings of inferior self-worth; thoughts of suicide and suicidal behavior.
(This section uses an alternative classification system to that of the ICD-10 or the
American Psychiatric Association.)
These individuals:
Are emotionally unstable, and overreact to stress with extremes of sadness,
anxiety, and anger. Their emotions tend to change rapidly and unpredictably.
Feel unhappy, depressed, or despondent; feel life has no meaning; are
preoccupied with death and dying; feel empty; and find little or no pleasure,
satisfaction, or enjoyment in life’s activities.
Are angry or hostile, and feel misunderstood, mistreated, or victimized.
Feel like an outcast or outsider; feel inadequate, inferior, or a failure; are
overly needy or dependent.
May act on self-destructive impulses, including self-mutilating behavior, "cry
for help" suicidal threats or gestures, and genuine suicidality, especially when
an attachment relationship is disrupted or threatened.
"Catastrophize," seeing problems as disastrous or unsolvable, and are often
unable to soothe or comfort themselves without the help of another person.
Become irrational when strong emotions are stirred up, showing a significant
decline from their usual level of functioning.
Lack a stable sense of self. Their attitudes, values, goals, and feelings about
themselves may seem unstable or ever-changing.
Have difficulty maintaining stable, balanced views of others. When upset, they
see others in extreme, black-or-white terms. Consequently, their relationships
tend to be unstable, chaotic, and rapidly changing.
Fear rejection and abandonment, fear being alone, and tend to become attached
quickly and intensely.
May repeatedly re-experience or re-live a past traumatic event (e.g., having
intrusive memories or recurring dreams of the event, or becoming startled or
terrified by present events that resemble or symbolize the past event).
Can play the role of "victim", often eliciting intense emotions in other people
who they manipulate into playing the role of "villan" or "rescuer".
Stir up conflict or animosity between other people.
Act impulsively.
Their work life or living arrangements may be chaotic and unstable.
(Editor's Note: Many of these behaviors would be considered normal in 14-year-olds going through the emotionally
turbulent phase of adolescence. Most adolescents mature out
of their personality disorders within 2 years. Thus the question is: what factors prevent
individuals with this disorder from maturing and losing these adolescent borderline
features?)
How Narcissistic, Borderline and Antisocial Personality Disorder Overlap
Impulsivity
in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, reckless driving, binge eating.)
Present
Present
Present
Irritability and aggressiveness
, as indicated by repeated physical fights or assaults.
Present
Present
Present
Reckless
disregard for safety of self or others.
Present
Present
Present
Is interpersonally
exploitative
, i.e., takes advantage of others to achieve his or her own
ends.
Present
Present
Present
Is often
envious
of others or believes that others are envious of him or her.
Present
Present
Present
Lacks empathy
: is unwilling to recognize or identify with the feelings and needs of
others.
Present
.
Present
Recurrent
suicidal
behavior, gestures, or threats, or self-mutilating behavior.
.
Present
Present
Transient, stress-related
paranoid
ideation or severe dissociative symptoms.
Present
Present
.
Fantic efforts to avoid real or imagined
abandonment
.
Present
Present
.
Is preoccupied with
fantasies
of unlimited success, power, brilliance, beauty, or ideal love.
Present
Present
.
The significant overlap of symptoms in Narcissistic, Borderline, and Antisocial Personality
Disorder illustrates how similar these personality disorders are. It could be argued that
these overlapping symptoms are the
core features
of the Narcissistic, Borderline, and Antisocial cluster of Personality Disorders.
Although these disruptive behaviors slowly disappear as the individual ages; these
maladaptive behaviors may cause decades of unemployment or be very damaging to social
relationships.
Where Do Narcissistic, Borderline and Antisocial Personality Disorder Not Overlap?
Has a
grandiose
sense of self-importance (e.g., exaggerates achievements and talents,
expects to be recognized as superior without commensurate achievements)
Present
.
.
Believes that he or she is
"special" and unique
and can only be understood by, or should associate with, other special
or high-status people (or institutions)
Present
.
.
Requires excessive admiration
Present
.
.
Has a sense of
entitlement
, i.e., unreasonable expectations of especially favorable treatment or
automatic compliance with his or her expectations
Present
.
.
Shows
arrogant
, haughty behaviors or attitudes
Present
.
.
A pattern of
unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation
.
Present
.
Identity disturbance:
markedly and persistently unstable self-image or sense of self
.
Present
.
Affective instability
due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lastig a few hours and only rarely more
than a few days)
.
Present
.
Chronic feelings of
emptiness
.
Present
.
Failure to conform to social norms with respect to lawful behaviors as
indicated by repeatedly
performing acts that are grounds for arrest
.
.
Present
Deceitfulness
, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure
.
.
Present
Consistent irresponsibility
, as indicated by repeated failure to sustain consistent work behavior
or honor financial obligations
.
.
Present
Lack of remorse
, as indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from another
.
.
Present
What Is The Opposite Of The Narcissistic, Borderline and Antisocial Personality
Disorders?
The following lists the unhealthy core features of Antisocial, Borderline and Narcissistic
Personality Disorders. Opposite each unhealthy core behavior is listed its healthy
alternative.
UNHEALTHY CORE FEATURES OF ANTISOCIAL, BORDERLINE, AND NARCISSISTIC
PERSONALITY DISORDERS
HEALTHY ALTERNATIVE
Impulsivity
in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, reckless driving, binge eating.)
Self-Control
Irritability and aggressiveness
, as indicated by repeated physical fights or assaults.
Peacefulness
Reckless
disregard for safety of self or others.
Caution
Is interpersonally
exploitative
, i.e., takes advantage of others to achieve his or her own
ends.
Generosity
Is often
envious
of others or believes that others are envious of him or her.
Contentment
Lacks empathy
: is unwilling to recognize or identify with the feelings and needs of
others.
Kindness
Recurrent
suicidal
behavior, gestures, or threats, or self-mutilating behavior.
Life Having Purpose and Meaning
Transient, stress-related
paranoid
ideation or severe dissociative symptoms.
Trust
Fantic efforts to avoid real or imagined
abandonment
.
Confidence
Is preoccupied with
fantasies
of unlimited success, power, brilliance, beauty, or ideal love.
Being Realistic
This suggests that effective treatment for Antisocial, Borderline, and Narcissistic
Personality Disorder should concentrate on increasing these healthy alternative behaviors.
Symptoms That Are Good Predictors Of Borderline (Emotionally Unstable) Personality
Disorder
As well as having unstable emotional functioning and unstable interpersonal functioning;
individuals with Borderline Personality Disorder have a poorly developed, or unstable
self-image, often associated with excessive self-criticism, chronic feelings of emptiness,
and
dissociative states under stress. Thus the main characteristic of this disorder is its
instability.
Borderline Symptoms Which Statistically Best Predict A Diagnosis Of Borderline
Personality Disorder
(0.8 Loading)
I thought of hurting myself
I didn't believe in my right to live
I experienced stressful inner tension
I hated myself
I wanted to punish myself
My mood rapidly cycled in terms of anxiety, anger, and depression
The idea of death had a certain fascination for me
Everything seemed senseless for me
I was afraid of losing control
(0.7 Loading)
It was hard for me to concentrate
I felt helpless
I was lonely
I had images that I was very much afraid of
Criticism had a devastating effect on me
I felt vulnerable
(0.6 Loading)
I was absent-minded and unable to remember what I was actually doing
I felt disgust
I didn't trust other people
I suffered from shame
I felt disgusted by myself
(0.5 Loading)
I suffered from voices and noises from inside or outside my head
(0.4 Loading)
I felt as if I was far away from myself
I felt worthless
Note: These symptoms suggest that Borderline Personality Disorder is
characterized by self-hatred and emotional instability.
Is Borderline Personality Disorder A Developmental Delay?
Borderline personality traits are seen in 10%
of male and 18% of female adolescents. In adolescence, abnormal personality traits
usually
disappear within 2 years. However, 17% of adults
display borderline personality traits; thus they did
not grow out of their adolescent borderline personality traits. In their twenties, they have
the maturity of a young teenager. Thus the question is, what factors
prevented these individuals from
maturing?
Impulsiveness vs. Conscientiousness
Ozlem
Ayduk found that individuals with Borderline Personality Disorder are hypersensitive
to rejection and have poor self-control. Their poor self-control was
evident on
testing even at age 4.
In adulthood, individuals with Borderline Personality Disorder often act like adolescents
and do impulsive, harmful activities (e.g., over-spending, reckless sex, substance abuse,
reckless driving, binge eating). They want immediate gratification, and act without
consideration of future consequences. In personality measurement, reckless impulsiveness is
the opposite of conscientiousness. Research has shown that conscientiousness (or "grit")
is even
more important than intelligence in predicting scholastic and vocational success.
Social Skills That Are Lacking In Borderline Personality Disorder
SOCIAL SKILL
BORDERLINE PERSONALITY
NORMAL
Emotional Stability
Emotional instability (emotions change rapidly and unpredictably)
Having a predictable mood which does not quickly change
Stable Self-Image
Unstable self-image
Being certain about "who-am-I" and "where-am-I-going-in-life"; having
meaning & purpose to life
Stable Relationships
Unstable, intense, chaotic relationships
Having a stable and peaceful social life
Chastity
Desire for casual or illicit sex
Avoidance of casual sex ("one night stands") AND absence of intense desire
for illicit sex
Caution
Harmful impulsiveness (acting without forethought or concern for
consequences)
Thinking carefully before acting or speaking; being cautious
Control of Anger
Hostility (often angry or hostile)
Absence of anger or irritability in response to minor slights; absence of
mean or vengeful behavior
An Anxious, Emotionally Unstable Life (Emotional Distress)
How does one live an anxious, emotionally unstable life?
The following table summarizes the personality traits of individuals with Avoidant,
Dependent and Borderline Personality Disorder. Individuals with these emotional distress
personality disorders have marked anxiety or emotional instability. (This
table uses ICD-10 diagnostic criteria.)
Anxious and Emotionally Unstable Personality Traits
Examples
Avoidant Personality Traits:
Persistent and pervasive feelings of tension and apprehension.
"I usually feel tense or nervous."
Belief that oneself is socially inept, personally unappealing, or inferior
to others.
"I feel awkward or out of place in social situations."
Excessive preoccupation about being criticized or rejected in social
situations.
"I worry a lot that people may not like me."
Unwillingness to get involved with people unless certain of being liked.
"I won't get involved with people until I'm certain they like me."
Restrictions in lifestyle because of need of security.
"A lot of things seem dangerous to me that don't bother most people."
Avoidance of social or occupational activities that involve significant
interpersonal contact, because of fear of criticism, disapproval or
rejection.
"I keep to myself even when there are other people around."
Dependent Personality Traits:
Encouraging or allowing others to make most of one's important life
decisions.
"I let others make my big decisions for me."
Subordination of one's own needs to those of others on whom one is
dependent, and undue compliance with their wishes.
"I find it hard to disagree with people if I depend on them a lot."
Unwillingness to make even reasonable demands on the people one depends on.
"I don't ask favors from people that I depend on a lot."
Feeling uncomfortable or helpless when alone, because of exaggerated fears
of inability to care for oneself.
"I usually feel uncomfortable or helpless when I'm alone."
Preoccupation with fears of being left to take care of oneself.
"I worry about being left alone and having to care for myself."
Limited capacity to make everyday decisions without an excessive amount of
advice and reassurance from others.
"I often seek advice or reassurance about everyday decisions."
Borderline Personality Traits:
A marked tendency to quarrelsome behavior and to conflicts with others,
especially when impulsive acts are thwarted or criticized
"I argue or fight when people try to stop me from doing what I want."
A marked tendency to act unexpectedly and without consideration of the
consequences
"I take chances and do reckless things."
Liability to outbursts of anger or violence, with inability to control the
resulting behavioural explosions
"Sometimes I get so angry I break or smash things."
Difficulty in maintaining any course of action that offers no immediate
reward
"I don't stick with a plan if I don't get results right away."
Unstable and capricious mood
"I'm very moody."
Disturbances in and uncertainty about self-image, aims and internal
preferences (including sexual)
"I can't decide what kind of person I want to be."
Liability to become involved in intense and unstable relationships, often
leading to emotional crises
"I get into very intense relationships that don't last."
Excessive efforts to avoid abandonment
"I go to extremes to try to keep people from leaving me."
Recurrent threats or acts of self-harm
"A number of times, I've threatened suicide or injured myself on purpose."
Chronic feelings of emptiness
"I often feel empty inside."
A Emotionally Stable Life (Emotional Stability)
How does one live a Emotionally Stable life?
One approach to answering this question is to study the behavior of individuals who live
anxious, emotionally unstable lives. Could the opposite of their maladaptive behavior
define how to live a Emotionally Stable life?
Research has shown that anxiety and emotional instability highly correlates with low scores
on the emotional stability personality dimension. The personality disorders that have the
lowest scores on the emotional stability personality dimension are the Avoidant, Dependent,
and Borderline Personality Disorders.
Could the opposite of the personality traits seen in the Avoidant, Dependent, and
Borderline Personality Disorders be a clue as to how to live a Emotionally Stable life? If
so, the right side of the following table would define a calm,
emotionally stable life. (This table uses DSM-5 diagnostic criteria.)
Avoidant Personality Disorder
The Opposite Of Avoidant Personality Disorder
Avoidance:
Sociality:
Avoids occupational activities that involve significant interpersonal
contact, because of her fear of criticism, disapproval, or rejection
Doesn't avoid occupational activities that involve significant interpersonal
contact, because of any fear of criticism, disapproval, or rejection
Is unwilling to get involved with people unless she is certain of being
liked
Is willing to get involved with people even if she is uncertain of being
liked
Shows restraint within intimate relationships because of her fear of being
shamed or ridiculed
Is not reluctant in intimate relationships because of any fear of being
shamed or ridiculed
Is preoccupied with being criticized or rejected in social situations
Doesn't worry excessively about being criticized or rejected in social
situations
Social Anxiety:
Self-Confidence:
Is inhibited in new interpersonal situations because of her feelings of
inadequacy
Is not inhibited in new interpersonal situations because of any feelings of
inadequacy
Views herself as socially inept, personally unappealing, or inferior to
others
Does not view herself as socially inept, personally unappealing, or inferior
to others
Is unusually reluctant to take personal risks or to engage in any new
activities because they may prove embarrassing
Is not reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing
Dependent Personality Disorder
The Opposite Of Dependent Personality Disorder
Dependency:
Independence:
Has difficulty making everyday decisions without an excessive amount of
advice and reassurance from others
Can make everyday decisions without an excessive amount of advice and
reassurance from others
Needs others to assume responsibility for most major areas of her life
Assumes responsibility for most major areas of her life
Has difficulty expressing disagreement with others because of her fear of
loss of support or approval
Can express disagreement with others
Has difficulty initiating projects or doing things on her own
No difficulty initiating projects or doing things on her own
Goes to excessive lengths to obtain nurturance and support from others
Does not go to excessive lengths to obtain nurturance and support from
others
Feels uncomfortable or helpless when alone because of her exaggerated fears
of being unable to cope
Feels comfortable when alone
Urgently seeks another relationship as a source of care and support when a
close relationship ends
Does not urgently seek another relationship as a source of care and support
when a close relationship ends
Is unrealistically preoccupied with fears of being left to take care of
herself
Is not preoccupied with fears of being left to take care of herself
Borderline (Emotionally Unstable) Personality Disorder can present
with suicidal behavior; hence the following treatment protocal for suicide is
important.
The following are general principles applicable to the treatment of
every disorder.
When a person with borderline personality disorder presents during a crisis, consult the
crisis plan and:
maintain a calm and non-threatening attitude
try to understand the crisis from the person's point of view
explore the person's reasons for distress
use empathic open questioning, including validating statements, to identify
the onset and the course of the current problems
seek to stimulate reflection about solutions
avoid minimising the person's stated reasons for the crisis
refrain from offering solutions before receiving full clarification of the
problems
explore other options before considering admission to a crisis unit or
inpatient admission
offer appropriate follow-up within a time frame agreed with the person.
Drug treatment during crises
Short-term use of drug treatments may be helpful for people with borderline
personality disorder during a crisis.
Before starting short-term drug treatments for people with borderline personality
disorder during a crisis:
ensure that there is consensus among prescribers and other involved
professionals about the drug used and that the primary prescriber is
identified
establish likely risks of prescribing, including alcohol and illicit drug use
take account of the psychological role of prescribing (both for the
individual and for the prescriber) and the impact that prescribing decisions
may have on the therapeutic relationship and the overall care plan,
including long-term treatment strategies
ensure that a drug is not used in place of other more appropriate
interventions
use a single drug
avoid polypharmacy whenever possible.
When prescribing short-term drug treatment for people with borderline personality
disorder in a crisis:
choose a drug (such as a sedative antihistamine[3]) that has a
low side-effect profile, low addictive properties, minimum potential for
misuse and relative safety in overdose
use the minimum effective dose
prescribe fewer tablets more frequently if there is a significant risk of
overdose
agree with the person the target symptoms, monitoring arrangements and
anticipated duration of treatment
agree with the person a plan for adherence
discontinue a drug after a trial period if the target symptoms do not improve
consider alternative treatments, including psychological treatments, if
target symptoms do not improve or the level of risk does not diminish
arrange an appointment to review the overall care plan, including
pharmacological and other treatments, after the crisis has subsided.
Follow-up after a crisis
After a crisis has resolved or subsided, ensure that crisis plans, and if necessary
the overall care plan, are updated as soon as possible to reflect current concerns
and identify which treatment strategies have proved helpful. This should be done in
conjunction with
the
person with borderline personality disorder and their family or carers if possible,
and should include:
a review of the crisis and its antecedents, taking into account
environmental, personal and relationship factors
a review of drug treatment, including benefits, side effects, any safety
concerns and role in the overall treatment strategy
a plan to stop drug treatment begun during a crisis, usually within 1 week
a review of psychological treatments, including their role in the overall
treatment strategy and their possible role in precipitating the crisis.
If drug treatment started during a crisis cannot be stopped within 1 week, there
should be a regular review of the drug to monitor effectiveness, side effects,
misuse and dependency. The frequency of the review should be agreed with the person
and recorded in the
overall care plan.
The management of insomnia
Provide people with borderline personality disorder who have sleep problems with
general advice about sleep hygiene, including having a bedtime routine, avoiding
caffeine, reducing activities likely to defer sleep (such as watching violent or
exciting television
programmes or films), and employing activities that may encourage sleep.
Be aware of the potential for misuse of many of the drugs used for insomnia and
consider other drugs such as sedative antihistamines.
Discharge to primary care
When discharging a person with borderline personality disorder from secondary care
to primary care, discuss the process with them and, whenever possible, their family
or carers beforehand. Agree a care plan that specifies the steps they can take to
try to manage their
distress, how to cope with future crises and how to re-engage with community mental
health services if needed. Inform the GP.
Inpatient services
Before considering admission to an acute psychiatric inpatient unit for a person
with borderline personality disorder, first refer them to a crisis resolution and
home treatment team or other locally available alternative to admission.
the management of crises involving significant risk to self or others that
cannot be managed within other services, or
detention under the Mental Health Act (for any reason).
When considering inpatient care for a person with borderline personality disorder,
actively involve them in the decision and:
ensure the decision is based on an explicit, joint understanding of the
potential benefits and likely harm that may result from admission
agree the length and purpose of the admission in advance
ensure that when, in extreme circumstances, compulsory treatment is used,
management on a voluntary basis is resumed at the earliest opportunity.
Arrange a formal CPA review for people with borderline personality disorder who have
been admitted twice or more in the previous 6 months.
Ensure that young people with severe borderline personality disorder have access to
tier 4 specialist services if required, which may include:
inpatient treatment tailored to the needs of young people with borderline
personality disorder
specialist outpatient programmes
home treatment teams.
Patients with
Borderline Personality Disorder in Emergency Departments - Frontiers In
Psychiatry 2017
For the patients with agitation, symptom-specific
pharmacotherapy is usually recommended, while for non-agitated patients,
short but intensive psychotherapy especially dialectical behavior therapy
(DBT) has a positive effect.
The effects of psychotherapies on BPD outcomes are small to
medium.
Proper risk management along with developing a positive attitude and empathy
toward these patients will help them in normalizing in an emergency setting after
which treatment course can be decided.
Psychosocial
interventions for self-harm in adults - Cochrane Database of Systematic
Reviews 2016
Cognitive Behavioral Therapy can result in fewer individuals
repeating self-harm
;
however, the quality of this evidence ranged between moderate
and low
.
Dialectical behaviour therapy for people with multiple
episodes of self-harm/probable personality disorder may lead to a reduction
in frequency of self-harm
,
but this finding is based on low quality evidence.
Case management and remote contact interventions did not
appear to have any benefits
in terms of reducing repetition of self-harm. Other therapeutic approaches were
mostly evaluated in single trials of moderate to very low quality such that the
evidence relating to these interventions is inconclusive.
Pharmacological interventions for self-harm in adults -
Cochrane Database of Systematic Reviews 2015
Given the low or very low quality of the available evidence, and the small number of
trials identified, it is
not possible to make firm conclusions
regarding pharmacological interventions in self-harm patients.
Interventions
for self-harm in children and adolescents - Cochrane Database of Systematic
Reviews 2015
The quality of evidence was mostly very low.
There is little support for the effectiveness of group-based psychotherapy for
adolescents with multiple episodes of self-harm based on the results of three
trials, the evidence from which was of very low quality. Results for therapeutic
assessment, mentalisation, and dialectical behaviour therapy indicated that these
approaches warrant further evaluation. Despite the scale of the problem of self-harm
in children and adolescents
there is a paucity of evidence of effective interventions
.
Effectiveness,
response, and dropout of dialectical behavior therapy for borderline personality
disorder in an inpatient setting - Behavior Research and Therapy 2013
The effectiveness of dialectical behavior therapy was assessed for 1423
consecutively admitted inpatients with Borderline Personality Disorder. At the end
of the 3-month inpatient treatment; approximately 15% had
a full remission
(i.e., showed a symptom level equivalent to that of the general population), 45% had a partial remission, 31% remained unchanged, and
11% deteriorated.
Psychological
therapies for people with borderline personality disorder - Cochrane
Database of Systematic Reviews 2012
There are indications of beneficial effects
for both comprehensive psychotherapies as well as non-comprehensive
psychotherapeutic interventions for borderline personality disorder core pathology
and associated general psychopathology. However,
none of the treatments has a very robust evidence base.
Attainment
and stability of sustained symptomatic remission and recovery among patients
with borderline personality disorder and axis II comparison subjects: a 16-year
prospective follow-up study - American Journal of Psychiatry 2012
Borderline patients were significantly slower to achieve remission or recovery
(which involved good social and vocational functioning as well as symptomatic
remission) than axis II comparison subjects. However,
by the time of the 16-year follow-up assessment, both groups
had achieved similarly
high rates of remission (range for borderline patients:
78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery
(40%-60% compared with 75%-85%)
. In contrast, symptomatic recurrence and
loss of recovery occurred more rapidly and at substantially
higher rates among borderline patients than axis II comparison subjects
(recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared
with 9%-28%).
Dialectical
behavior therapy compared with general psychiatric management for borderline
personality disorder: clinical outcomes and functioning over a 2-year
follow-up - American Journal of
Psychiatry
2012
"Both treatment groups showed similar and statistically significant improvements on
the majority of outcomes 2 years after discharge. The original effects of treatment
did not diminish for any outcome domain, including suicidal and nonsuicidal
self-injurious
behaviors.
Further improvements were seen on measures of depression, interpersonal functioning,
and anger. However, even though two-thirds of the
participants achieved diagnostic remission and significant
increases in quality of life, 53% were neither employed
nor in school, and 39% were receiving psychiatric disability support after
36 months."
Crisis interventions for people with borderline personality
disorder - Cochrane Database of Systematic Reviews 2012
A comprehensive search of the literature showed that currently there is no RCT-based
evidence for the management of acute crises in people with BPD and therefore we
could not reach any conclusions
about the effectiveness of any single crisis intervention.
Time to
attainment of recovery from borderline personality disorder and stability of
recovery: A 10-year prospective follow-up study - American Journal of
Psychiatry 2010
50% of participants achieved recovery from borderline personality disorder, which was
defined as remission of symptoms and having good social and
vocational functioning during the previous 2 years
. Overall,
93% of participants attained a remission of symptoms
lasting at least 2 years
, and 86% attained a sustained remission lasting at least 4 years. Of those who
achieved recovery,
34% lost their recovery
.
Drug treatment for borderline personality disorder -
Cochrane Database of Systematic Reviews 2010
Total borderline personality disorder severity was
not significantly influenced by any drug
. No promising results are available for the core BPD symptoms of chronic
feelings of emptiness, identity disturbance and abandonment.
TRIGGER: what did you do that could have triggered this problem?
GOAL: what life skill(s) do you have to work on? (from checklist)
Example Of Setting Goals In Interviewing A Person With Borderline Personality
Disorder
In The Past Week:
WHO: was your problem?
"My husband."
EVENT: what did he/she do?
"My husband is always angry at me, and is turning our children against me."
RESPONSE: how did you respond to that event?
"I stood my ground and yelled back at him."
OUTCOME: did your response help?
"No, my kids can't take all this fighting. I think our marriage is nearly
over."
TRIGGER: what did you do that could have triggered this
problem?
"Ever since my husband found out about my affair; he's been impossible to
live with."
GOAL: what life skill(s) do you have to work on? (from
checklist)
"I want to work on: (1) Social Stability ("having a stable and peaceful
social life"), and (2) Stable Self-Image ("being certain about "who-am-I"
and "where-am-I-going-in-life"; having meaning & purpose to life")."
Some individuals are constantly at war with themselves.
They believe: "I am stupid", "I am a failure", "Nothing goes right for me". They constantly
analyze themselves and their behavior for flaws. They are cynical and pessimistic. Because
of their gloomy, depressed or angry mood, they withdraw and socially isolate themselves.
This
lack of cooperation with others makes them feel even more hopeless, depressed or angry.
These individuals are at a high risk for developing Persistent Depressive Disorder or Major
Depressive Disorder. Healthy people are self-confident, optimistic, sociable, and feel
accepted and supported by friends. Individuals suffering from excessive self-blaming are
pessimistic,
socially withdrawn, and feel rejected by others.
If you suffer from excessive self-blaming; here are ways you can remedy this by learning
increased self-compassion and social cooperation:
Self-Confidence vs. Self-Blaming:
You must be kind towards yourself, instead of always blaming yourself for
everything. Accept and love yourself for who you are - with all your human
imperfections. You must strive to have a good opinion of yourself and your
abilities, and to be socially confident.
Quit
constantly comparing yourself to others.
Optimism vs. Pessimism:
Strive to replace your unrealistic, pessimistic, negative thinking with more
realistic, optimistic, positive thinking.
Sociality vs. Social Withdrawal:
In order to feel good, you have to do good. Thus to feel better, you have to get out
and help others (and remember to frequently smile).
Feeling Accepted vs. Feeling Rejected:
You can not control how other people behave towards you. All you can do is control
how you behave towards other people. Much of your life is not under your control;
hence you can not change it. You are only responsible for the small part of your
life which is under
your
control - the part you can change. Thus remain friendly and out-going - especially
towards people that haven't accepted you.
Monitoring Your Progress
NOTE: When each of the following presentations finish; you must exit
by manually closing its window in order to return to this webpage.
The Healthy Social Behavior Scale lists social behaviors that research has
found to be associated with healthy social relationships. You can keep score (totaling its
4-point scale answers) on a separate piece of paper to monitor your progress.
The Mental Health Scale lists behaviors and symptoms that research has found
to be associated with mental health (or disorder). You can keep score (totaling its 4-point
scale answers) on a separate piece of paper to monitor your progress.
The Life Satisfaction Scale lists the survey questions often used to measure
overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a
separate piece of paper to monitor your progress.
This website uses these 5 major dimensions of human behavior (i.e., Agreeableness,
Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional
Stability) to describe all mental disorders. This website adds one more dimension,
"Physical Health", to create the "Big 6" dimensions of mental health.
The behaviors of the "Five Factor Model of Personality" represent five adaptive functions
that are vital to human survival. For example, when one individual approaches another, the
individual must: (1) decide whether the other individual is friend or foe [
"Agreeableness"
], (2) decide if this represents safety or danger [
"Emotional Stability"
], (3) decide whether to approach or avoid the other individual [
"Extraversion/Sociability"
], (4) decide whether to proceed in a cautious or impulsive manner [
"Conscientiousness"
], and (5) learn from this experience [
"Openness/Intellect"
].
"In physical science a first essential step in the direction of learning any
subject is to find principles of numerical reckoning and practicable methods for
measuring some quality connected with it. I often say that
when you can measure what you are speaking about and express it in
numbers you know something about it; but when you cannot measure it,
when you cannot express it in numbers, your knowledge is of a meagre and
unsatisfactory kind: it may be the beginning of knowledge,
but you have scarcely, in your thoughts, advanced to the stage of science,
whatever the matter may be."
Lord Kelvin (1824 – 1907)
The best
summary on bad research is given by Laura Arnold in this TEDx lecture.
If you read nothing else about research, you owe it to
yourself to watch this short video - it is excellent!
The active placebo effect: 2300 years ago, the Greek Stoic philosophers
taught that it is not the objective event, but our subjective
judgment about the event, that determines our behavior. The active placebo
effect bears witness to this ancient wisdom.
Randomized Controlled Trial:
Ask: Was the trial randomized? Was the randomization
procedure described and was it appropriate?
The best research design is to have research subjects randomly assigned
to an experimental or control group. It is essential that confounding
factors be controlled for by having a control group or comparator condition
(no intervention, placebo, care as usual etc.).
Representative Sample:
Ask: Do the research subjects represent a normal
cross-section of the population being studied?
Many psychological research studies using university students are
flawed because their subjects are not representative of the normal
population since they are all W.E.I.R.D. (White, Educated, Intelligent,
Rich, and living in a Democracy).
Single Blind Trial:
Ask: Was the treatment allocation concealed?
It is essential that the research subjects are kept "blind" as to
whether they are in the experimental or control group (in order to control
for any placebo effects).
Double Blind Trial (Better Than Single Blind Trial):
Ask: Were blind outcome assessments conducted?
In a double blind study, neither the research subjects nor the outcome
assessors know if the research subject is in the experimental or control
group. This controls for both the placebo effect and assessor bias.
Baseline Comparability:
Ask: Were groups similar at baseline on prognostic
indicators?
The experimental and control groups must be shown to be comparable at
the beginning of the study.
Confounding Factors:
Ask: Were there factors, that weren't controlled for,
that could have seriously distorted the study's results?
For example, research studies on the effectiveness of mindfulness cognitive therapy in
preventing depressive relapse forgot to control for whether the research
subjects were also simultaneously receiving antidepressant medication or
other psychological treatments for depression.
Intervention Integrity:
Ask: Was the research study protocal strictly
followed?
The research subjects must be shown to be compliant (e.g., taking their
pills, attending therapy) and the therapists must be shown to be reliably
delivering the intervention (e.g., staying on the research protocol).
Statistical analysis:
Ask: Was a statistical power calculation described?
The study should discuss its statistical power analysis; that is
whether the study size is large enough to statistically detect a difference
between the experimental and control group (should it occur) and usually
this requires at least 50 research subjects in the study.
Ask: Are the results both statistically
significant and clinically significant?
Many medical research findings are statistically significant
(with a p-value <0.05), but they are not clinically significant
because the difference between the experimental and control groups is
too small to be clinically relevant.
For example, the effect of a
new drug may be found to be 2% better than placebo. Statistically (if
the sample size was large enough) this 2% difference could be
statistically significant (with a p-value <0.05). However,
clinicians would say that this 2% difference is not
clinically significant (i.e., that it was too small to really
make any difference).
Statistically, the best way to test for
clinical significance is to test for effect size (i.e., the
size of the difference between two groups rather than confounding
this with statistical probability).
When the outcome of
interest is a dichotomous variable, the commonly used measures of
effect size include the odds ratio (OR), the relative risk (RR), and
the risk difference (RD).
When the outcome is a continuous
variable, then the effect size is commonly represented as either the
mean difference (MD) or the standardised mean difference (SMD)
.
The MD is the difference in the means of the treatment
group and the control group, while the SMD is the MD divided by the
standard deviation (SD), derived from either or both of the groups.
Depending on how this SD is calculated, the SMD has several versions
such, as Cohen's d, Glass's Δ, and Hedges' g.
Clinical Significance: With Standard Mean Difference, the
general rule of thumb is that a score of 0 to 0.25 indicates
small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate
to large benefit, and above 1.0 a huge benefit. It is a
convention that a SMD of
0.5
or larger is a standard threshold for clinically
meaningful benefit.
The statistical summary
should report what percentage of the total variance of the dependent
variable (e.g., outcome) can be explained by the independent
variable (e.g., intervention).
In clinical studies, the study
should report the number needed to treat for an additional
beneficial outcome (NNTB), and the number needed to treat for
an additional harmful outcome (NNTH).
Number Needed To Benefit (NNTB): This is defined as the
number of patients that need to be treated for one of them to
benefit compared with a control in a clinical trial. (It is
defined as the inverse of the absolute risk reduction.)
Note: Statistically, the NNTB depends on which control group is used for
comparison - e.g., active treatment vs. placebo
treatment, or active treatment vs. no
treatment.
Number Needed To Harm (NNTH): This is
defined as the number of patients that need to be treated for
one of them to be harmed compared with a control in a clinical
trial. (It is defined as the inverse of the absolute increase in
risk of harm.)
Ask: Does the researcher accept full
responsibility for the study's statistical analysis?
The researcher should not just hand over the study's raw
data to a corporation (that may have $1,000 million invested in the
study) to do the statistical analysis.
Completeness of follow-up data:
Ask: Was the number of withdrawals or dropouts in each
group mentioned, and were reasons given for these withdrawals or
dropouts?
Less than 20% of the research subjects should drop out of the study.
The intervention effect should persist over an adequate length of time.
Handling of missing data:
Ask: Was the statistical analysis conducted on the
intention-to-treat sample?
There must be use of intention-to-treat analysis (as opposed to a
completers-only analysis). In this way, all of the research subjects that
started the study are included in the final statistical analysis. A
completers-only analysis would disregard those research subjects that
dropped out.
Replication of Findings:
Ask: Can other researchers replicate this study's
results?
The research study's methodology should be clearly described so that
the study can be easily replicated. The researcher's raw data should be
available to other researchers to review (in order to detect errors or
fraud).
Fraud:
Ask: Is there a suspicion of fraud?
In a research study, examine the independent and dependent variables
that are always measured as a positive whole number (e.g., a variable
measured on a 5-point Likert-type scale ranging from "1 = definitely
false to 5 = definitely true" etc.). For each of these
variables, look at their sample size (
n
), mean (
M
) and standard deviation (
SD
) before they undergo statistical analysis. There is a high suspicion of
fraud in a study's statistics:
If the M is mathematically impossible (online
calculator): This is one of the easiest ways to
mathematically detect fraud. The mean (
M
) is defined as "the sum (
Sum
) of the values of each observation divided by the total number
(
n
) of observations". So:
M
=
Sum
/
n
. Thus: (
Sum
) = (
M
) multiplied by (
n
). We know that, if a variable is always measured as a positive
whole number, the sum of these observations always has to be a whole
number. For these variables to test for fraud: calculate (
M
) multiplied by (
n
). This calculates the
Sum
which MUST be a positive whole number. If the calculated
Sum
isn't a positive whole number; the reported mean (
M
) is mathematically impossible - thus the researcher either
cooked the data or made a mistake. A recent study of 260 research papers
published in highly reputable psychological journals found that
1 in 2 of these research papers reported at
least one impossible value
, and 1 in 5 of these research papers reported multiple
impossible values. When the authors of the 21 worst offending
research papers were asked for their raw data (so that its
reliability could be checked) - 57% angrily refused. Yet such
release of raw data to other researchers is required by most
scientific journals. (Here is an example of a research paper filled with mathematically
impossible means.)
If the SD is mathematically impossible (online
calculator): When researchers fraudulently "cook" their
data, they may accidently give their data a mean and standard
deviation that is mathematically impossible.
If the
SD/M is very small
(i.e., the variable's standard deviation is very small compared
to the mean suggesting data smoothing).
If the
SD's are almost identical
(i.e., the variables have different means but almost identical
standard deviations).
If the 4th digit of the values of the variables aren't uniformly
distributed - since each should occur 10% of the time (Benford's Law).
If the researcher is
legally prevented from publishing negative
findings
about a drug or therapy because that would violate the
"nondisclosure of trade secrets" clause in the research contract
(i.e., it is a "trade secret" that the drug or therapy is
ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical
trials fail to publish their results.
If the
researcher refuses to release his raw data to
fellow researchers
(so that they can check its validity). In order to be published
in most scientific journals, a researcher must promise to share his
raw data with fellow researchers. Thus a researcher's refusal to do
so is almost a sure indicator of fraud.
If the
research study's data contradicts the study's
own conclusions
- surprisingly, this often occurs.
Calling Bullshit
In The Age of Big Data - "Bullshit is language, statistical figures,
data graphics, and other forms of presentation intended to persuade by
impressing and overwhelming a reader or listener, with a blatant disregard for
truth and logical coherence." Reading the syllabus of this university course
should be required reading for every student of mental health. This syllabus is
absolutely fantastic!
This website uses these 5
major dimensions of human behavior to describe all mental disorders. (This website adds
one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.)
The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that
are vital to human survival. For example, when one individual approaches another, the individual
must: (1) decide whether the other individual is friend or foe [
"Agreeableness"
], (2) decide if this represents safety or danger [
"Emotional Stability"
], (3) decide whether to approach or avoid the other individual [
"Extraversion/Sociability"
], (4) decide whether to proceed in a cautious or impulsive manner [
"Conscientiousness"
], and (5) learn from this experience [
"Openness/Intellect"
].
Which "Big 6" Dimensions of Mental Health are Impaired in Borderline Personality Disorder?
THE POSITIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH
THE NEGATIVE SIDE OF THE "BIG 6" DIMENSIONS OF MENTAL HEALTH
THIS DISORDER
Agreeableness Being kind and honest.
Antagonism Being unkind or dishonest.
Antagonism
Conscientiousness Being diligent and self-disciplined.
Disinhibition Being distractible, impulsive, or undisciplined.
Disinhibition
Openness/Intellect Showing good reasoning or learning ability.
Impaired Intellect Showing poor reasoning or learning ability.
Impaired Intellect
Extraversion Being gregarious, assertive and
enthusiastic.
Detachment Being detached, unassertive,
and unenthusiastic.
Emotional Stability Being emotionally stable and
calm.
Emotional Distress Being emotionally unstable/distressed.
Emotional Distress
Physical Health Being physically fit and healthy.
Physical Symptoms Being physically unfit or ill.
The Following Will Only Discuss The Dimensions of Mental Illness That Are Abnormal In This Disorder
The problems that are
characteristic of this disorder are highlighted with this pink background
color.
AGREEABLENESS VS. ANTAGONISM
AGREEABLENESS (Helping Others)
Description:
Agreeableness is synonymous with compassion and
politeness. Compassion reflects empathy, sympathy, and caring for others.
Politeness reflects respect for others. Individuals with high
Agreeableness do not hold grudges, are lenient in judging others, are
willing to compromise and cooperate with others, and can easily control their
temper. The Agreeableness dimension measures the behaviors that are
central to the concept of JUSTICE and equality (fair, honest, and helpful
behavior - living in harmony with others, neither harming nor allowing harm).
Basic human rights are enshrined in the UN Universal Declaration of Human Rights.
Individuals with high Agreeableness avoid manipulating others for
personal gain, feel little temptation to break rules, are uninterested in lavish
wealth and luxuries, and feel no special entitlement to elevated social status.
High Agreeableness is associated with better: longevity, helping others,
giving to charity, job [team] performance, and marital success. (This dimension
appears to measure the behaviors that differentiate friend from
foe.)
Descriptors:
Honest, humble, compassionate, polite, cooperative, nonaggressive.
Chimpanzees:
The Agreeableness-Antagonism dimension of human behavior can be traced back
to our chimpanzee ancestory. Chimpanzee communities, like every social species, organize
themselves according to status (video). In such status hierarchies, the
dominant members actively protect their privileged status within the community
by using domineering, antagonistic behavior towards subordinate members. This
antagonistic, competitive behavior by high-status dominant members of the
community is in contrast to the agreeable, cooperative behavior of the
low-status, subordinant members. In humans, this same antagonistic behavior is
used by those seeking to dominate others.
Evolution:
The brains of social species evolved to allow cooperation and altruism which require coordinating
one’s goals with those of others. The core features of Agreeableness are
empathy and fairness. In more intelligent species, there appears to be an almost
instinctual sense of empathy and fairness (video). Language Characteristics: Pleasure talk, agreement,
compliments, empathy, few personal attacks, few commands or global rejections,
many self-references, few negations, few swear words, few threats, many insight
words.
Research:
Higher scores on Agreeableness are associated with deeper
relationships. Are you a giver or taker? (video). *MRI research found that Agreeableness was associated
with increased volume in regions that process information about the intentions
and mental states of other individuals.
"I am helpful and unselfish with others."
"I have a forgiving nature."
"I am generally trusting."
"I am considerate and kind to almost everyone."
"I like to cooperate with others."
"I don't find fault with others."
"I don't start quarrels with others."
"I am not cold and aloof."
"I am not rude to others."
"I feel other's emotions."
"I inquire about others' well-being."
"I sympathize with others' feelings."
"I take an interest in other people's lives."
"I like to do things for others."
"I respect authority."
"I hate to seem pushy."
"I avoid imposing my will on others."
"I rarely put people under pressure."
ANTAGONISM (Harming Others)
Description:
Antagonism is synonymous with being very self-centered and lacking
empathy. They find it hard to forgive, are critical of others' shortcomings, are
stubborn in defending their point of view, and readily feel anger when provoked.
They will flatter others to get what they want, break rules for personal profit, and
feel a strong sense of self-importance.
ICD-11 Description:
The core feature of the Antagonism (or Dissociality) trait domain is
disregard for the rights and feelings of others. Common manifestations of
Antagonism (or Dissociality) include: self-centeredness (e.g., sense of
entitlement, expectation of others’ admiration, positive or negative
attention-seeking behaviors, selfishness); and lack of empathy (i.e., indifference
to whether one’s actions hurt others, which may include being deceptive,
manipulative, and exploitative of others, being mean and physically aggressive,
callousness in response to others' suffering, and ruthlessness in obtaining one’s
goals).
Descriptors:
Dishonest, arrogant, callous, rude, manipulative, aggressive,
irresponsible.
Language Characteristics: Problem talk,
dissatisfaction, little empathy, many personal attacks, many commands or global
rejections, few self-references, many negations, many swear words, many threats,
little politeness, few insight words.
Video Example:
Here is an example of a very antagonistic person - President
Trump at a Mississippi political rally. Screening Questions:
"It’s no big deal if I hurt other peoples’ feelings."
"I crave attention."
"I often have to deal with people who are less important than me."
"I use people to get what I want."
"It is easy for me to take advantage of others."
"Others see me as irresponsible."
* Hostility:
"It makes me really angry when people insult me in even a minor way."
"I argue or fight when people try to stop me from doing what I want."
"I am usually pretty hostile."
"I can be mean when I need to be."
"I resent being told what to do, even by people in charge."
"I always make sure I get back at people who wrong me."
Description:
Conscientiousness is synonymous with being industrious and orderly. The Conscientiousness dimension
measures the behaviors that are central to the concept of SELF-CONTROL - organizing and
controlling one's behavior in order to achieve one's goals. This involves traits like paying
attention, controlling impulses, and delaying gratification. Individuals with high
Conscientious work hard to achieve goals, pursue accuracy and perfection, show prudent,
careful decision making, and are orderly with things and time. High Conscientiousness is
associated with better: longevity, health, school and job performance. (This dimension appears to
measure the behaviors that differentiate industriousness from distractibility [or
order from chaos]).
Descriptors:
Cautious, self-disciplined, industrious, efficient, organized.
Chimpanzees:
The Conscientious-Disinhibited dimension of human behavior is also evident in chimpanzees. Chimpanzees can plan for the
future and control their impulses (video). Goal-directed behavior requires good impulse
control, otherwise it becomes distracted and disorganized.
Evolution:
The brains of sentient species evolved to allow the pursuit of non-immediate goals, keeping
behavior on track by orienting attention away from distractions and toward goal-relevant
stimuli. Language Characteristics: Many positive emotion words (e.g. happy,
good), few emotional distress words (e.g. hate, bad), more perspective, careful to check that
information is conveyed correctly, straight to the point, formal, few negations, few swear words,
few references to friends, few disfluencies or filler words, many insight words, not impulsive.
Research:
Higher scores on Conscientiousness predict greater success in school and at work. *MRI
research found that Conscientiousness was associated with increased volume in the lateral
prefrontal cortex, a region involved in planning and the voluntary control of behavior.
Video Example:
Here is an example of a very conscientious person - President Obama discussing
the Iranian nuclear treaty.
"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
"I am careful."
"I am a reliable hard-worker."
"I am organized. I follow a schedule and always know what I am doing."
"I like order. I keep things tidy."
"I see that rules are observed."
"I do things efficiently. I get things done quickly."
"I carry out my plans and finish what I start."
"I am not easily distracted."
DISINHIBITION
(Impaired Self-Control)
Description:
Disinhibition is synonymous with Being distractible, impulsive or undisciplined. Individuals
with high Disinhibition avoid difficult tasks or challenging goals, don't mind incompleteness or
inaccurracy, act without thinking of the consequences, have disorganized surroundings and
schedules.
ICD-11 Description:
The core feature of the Disinhibition trait domain is the tendency to act rashly based on
immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of
potential negative consequences. Common manifestations of Disinhibition include: impulsivity;
distractibility; recklessness; and lack of planning.
Descriptors:
Impulsive, uncontrolled, distractible, inefficient, disorganized.
Language Characteristics: Few positive emotion words, many emotional
distress words, less perspective, less careful, more vague, informal, many negations, many swear words,
many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words,
impulsive.Few positive emotion words, many emotional distress words, less perspective, less careful,
more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy),
many disfluencies or filler words, few insight words, impulsive. Screening Questions:
"People would describe me as reckless."
"I feel like I act totally on impulse."
"Even though I know better, I can’t stop making rash decisions."
"I’m not good at planning ahead."
* Impulsivity:
"I usually do things on impulse without thinking about what might happen as a result."
"Even though I know better, I can't stop making rash decisions."
"I feel like I act totally on impulse."
"I'm not good at planning ahead."
* Reckless Risk Taking:
"I like to take risks."
"I have no limits when it comes to doing dangerous things."
"People would describe me as reckless."
"I don't think about getting hurt when I'm doing things that might be dangerous."
Description:
Emotional Stability is synonymous with stability and calm. The Emotional Stability dimension measures the
behaviors that are central to the concept of COURAGE - having calm composure and endurance
when confronting adversity. Individuals with high Emotional Stability are relatively tough,
brave, and insensitive to physical pain, feel little worry even in stressful situations, and have
little need to share their concerns with others. High Emotional Stability is associated with
better: longevity, leadership, job [team] performance, and marital success. (This dimension appears
to measure the behaviors that differentiate safety from danger.)
Descriptors:
Calm, rarely angry, rarely depressed or moody, rarely anxious or embarrassed.
Language Characteristics: Pleasure talk, agreement, compliment, low
verbal productivity, few repetitions, neutral content, calm, few self-references, many short silent
pauses, few long silent pauses, many tentative words, few aquiescence, little exaggeration, less
frustration, low concreteness.
"I am relaxed, and I handle stress well."
"I am emotionally stable, and not easily upset."
"I remain calm in tense situations."
"I rarely get irritated."
"I keep my emotions under control."
"I rarely lose my composure."
"I am not easily annoyed."
"I seldom feel blue."
"I feel comfortable with myself."
"I rarely feel depressed."
"I am not embarrassed easily."
EMOTIONAL
DISTRESS (Impaired Stability)
Description:
Emotional Distress is synonymous with emotional volatility and negative emotion.
Individuals with high emotional volatility are easily upset or angered. They often are very
moody and emotionally labile. Individuals that have high negative emotion exhibit
over-sensitivity to threat or stress. They exhibit excessive fear, anxiety, depression, or
irritability.
ICD-11 Description:
The core feature of the Emotional Distress (or Negative Affectivity) trait domain is the
tendency to experience a broad range of negative emotions. Common manifestations of Emotional
Distress include: experiencing a broad range of negative emotions with a frequency and
intensity out of proportion to the situation; emotional lability and poor emotion regulation;
negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness.
Descriptors:
Easily upset, angry, depressed, moody, anxious, embarrassed.
Evolution:
All animals have evolved a "fight or flight" response to threat to ensure their survival.
Mammals went one step further and evolved a "fight, flight, or freeze" response to threat. In
humans, this mammalian "freeze" response to threat involves inhibition of behavior in response to
threat, punishment, and emotional distress. This threat response of "freezing", shutting down or
passively avoiding is commonly seen in human anxiety or depression (e.g., freezing with fear or
being immobilized by indecision, worry or depression). Language Characteristics: Problem talk, dissatisfaction, high verbal
productivity, many repetitions, polarised content, stressed, many self-references, few short silent
pauses, many long silent pauses, few tentative words, more aquiescence, many self references,
exaggeration, frustration, high concreteness. Screening Questions:
"I worry about almost everything."
"I get emotional easily, often for very little reason."
"I fear being alone in life more than anything else."
"I get stuck on one way of doing things, even when it’s clear it won’t work."
"I get irritated easily by all sorts of things."
Research:
Lower scores on Emotional Stability are associated with unhappiness, dysfunctional
relationships, and mental health problems. *MRI research found that Low Emotional Stability
(= Emotional Distress or Neuroticism) was associated with increased volume of brain regions
associated with threat, punishment, and emotional distress.
* Emotional Instability:
"I get emotional easily, often for very little reason."
"I get emotional over every little thing."
"My emotions are unpredictable."
"I never know where my emotions will go from moment to moment."
"I am a highly emotional person."
"I have much stronger emotional reactions than almost everyone else."
"My emotions sometimes change for no good reason."
"I get angry easily."
"I get upset easily."
"I change my mood a lot."
"I am a person whose moods go up and down easily."
"I get easily agitated."
"I can be stirred up easily."
* Irritability:
"I get irritated easily by all sorts of things."
"I am easily angered."
"I have a very short temper."
"I snap at people when they do little things that irritate me."
* Separation Anxiety:
"I fear being alone in life more than anything else."
"I can't stand being left alone, even for a few hours."
"I’d rather be in a bad relationship than be alone."
"I'll do just about anything to keep someone from abandoning me."
"I dread being without someone to love me."
* Depressed Mood:
"I have no worth as a person."
"Everything seems pointless to me."
"I often feel like a failure."
"The world would be better off if I were dead."
"The future looks really hopeless to me."
"I often feel just miserable."
"I'm very dissatisfied with myself."
"I often feel like nothing I do really matters."
"I know I'll commit suicide sooner or later."
"I talk about suicide a lot."
"I feel guilty much of the time."
"I'm so ashamed by how I've let people down in lots of little ways."
The "Five Factor Model of Personality" as Shown In Dogs
All animals have
personalities - that is, consistent individual differences in behavior. Within virtually
any population, some individuals are consistently more active, more aggressive, or are more
willing to engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality
found in humans can be found in dogs.
AGREEABLENESS VS. ANTAGONISM
Agreeableness ("Friend")
Dog is friendly towards unfamiliar people.
Dog is friendly towards other dogs.
When off leash, dog comes immediately when called.
Dog willingly shares toys with other dogs.
Dog leaves food or objects alone when told to do so.
Antagonism ("Foe")
Dog is dominant over other dogs.
Dog is assertive with other dogs (e.g., if in a home with other dogs, when
greeting).
Dog behaves aggressively towards unfamiliar people.
The "Five Factor Model of Personality" In A Social Species
The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human
survival. For example, when one individual approaches another, the individual must: (1) decide whether
the other individual is friend or foe [
"Agreeableness"
], (2) decide if this represents safety or danger [
"Emotional Stability"
], (3) decide whether to approach or avoid the other individual [
"Extraversion/Sociality"
], (4) decide whether to proceed in a self-controlled or disinhibited manner [
"Conscientiousness"
], and (5) learn from this experience [
"Openness to Experience"
].
Spider Personalities
All animals
have personalities (defined as consistent behavioral differences among individuals). Animals can
consistently differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk
taking), (3) Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and
(5) Emotional Stability (e.g., calmness).
Some social spiders live in colonies of up to
several hundred individuals, and exhibit cooperative behaviours such as prey capture and maternal care.
Researchers have found that spider personalities differ in aggressiveness:
Aggressive spiders are more likely to attack their mirror image than are
shy spiders who are more likely to run away.
In a spider colony, individual spiders differ in degree of boldness
(aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack
prey and to resume movement after a disturbance.] Hunting prey for these social spiders is a
collective effort. The presence of a bold spider causes the shy spiders to become bolder which
increases the effectiveness of their collective hunting effort. A positive feedback loop is
established whereby hunting success increases spider boldness which increases future collective
hunting success. However, when researchers removed these bold "leader" spiders, the collective
hunting by the remaining spiders became less successful. The bold "leader" spiders thus were
shown to have a disproportionately large impact on the group, and so were named "keystone
individuals". Because of their special personality characteristic (boldness) the "leader"
spiders performed a vital function (making the shy spiders bolder) which fascilitated collective
social action.
This research made the very important finding that the spiders modified
each other's personalities. The bold spiders became bolder because of their hunting success.
However their hunting success was entirely dependent upon gaining the collective support of
the shy spiders. Likewise, the shy spiders owed their hunting success to being made bolder
by association with the bold spider. Thus for more successful collective action, the bold
"leader" spider needed to have followers, and the shy "follower" spiders needed to have a
"leader". To make their collective social action more successful, the different spider
personalities had to bring out the "best" in each other.
The "Five Factor Model of Personality" and Personality Disorders
Note: Due to their low prevalence in this study, Histrionic and Narcissistic Personality
Disorder were not included. However, these 2 missing personality disorders were inserted
into the 3D model (by PWL) where other research suggested they should occur.
This statistical model shows that all of the personality disorders are highly correlated - they are
overlapping entities that blend into each other with no clear boundaries. This 3D model groups
personality disorders into two highly interrelated large clusters (named "greed" and "fear" by
PWL).
The fact that these personality disorders are so highly interrelated suggests that it is common for
individuals to have multiple personality disorders.
Section III of the DSM-5 presents an alternative model for
personality disorders. Based on research findings, this model drops four personality disorders:
Schizoid, Paranoid, Dependent, and Histrionic.
The above 3D model shows the statistical
correlations between personality disorders in this alternative DSM-5 model.
Note:
Borderline Personality Disorder plays a central role in this model. It is correlated to
all of the other major personality disorders (except Schizotypal Personality Disorder). It
could be argued that Borderline Personality Disorder may not be a true personality disorder.
Instead, it may more represent chaotic instability - an advanced stage in which a previous
stable personality disorder becomes unstable and goes from order into chaos. This would
explain why Borderline Personality Disorder is usually diagnosed in combination with another
personality disorder.
Thus, it is argued, instead of diagnosing someone as having
both "Antisocial and Borderline Personality Disorders"; it would be more correct to diagnose
"Antisocial Personality Disorder with Emotionally Unstable Traits".
Chaos theory states
that balanced systems under stress can be pushed into instability. Specifically, as stress
on a stable system is increased, a "tipping point" is reached wherein the system quickly
goes from stability to instability. The following animated graphs illustrate this
mathematical principle. The vertical (y) axis represents the stress level. As the stress
level increases, a tipping point is reached whereafter the system becomes more unstable.
(These animations recycle.)
According to chaos theory, these animations could represent what happens when a
personality disorder is under increasing stress. Initially, the personality disorder remains
stable; then under increasing stress a tipping point is reached wherein the previously
stable personality disorder becomes chaotic. Any further stress makes the personality
disorder even more unstable.
Thus the emotional instability, chaotic social
functioning, and self-harming behavior of Borderline Personality Disorder could represent a
chaotic, unstable state of a previously stable personality disorder.
Primate Evolution
There appears to be three different ways in which primates have evolved socially:
The chimpanzees have evolved to be socially antagonistic, competitive, callous, and
manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war.
Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of
the antisocial-paranoid-narcissistic-histrionic-borderline cluster of personality
disorders.
In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative,
and loving. Thus bonobo social behavior most closely mirrors the emotional distress
(anxious) behavior of the avoidant-dependent cluster of personality disorders.
Another separate evolutionary path was followed by the orangutans. They evolved to
become solitary hermits. Thus orangutan social behavior most closely mirrors the detached
behavior of the schizoid-schizotypal cluster of personality disorders.
The Blueprint For Virtue Is Built Into Your DNA
More than 2,300 years ago, the ancient Greek philosopher, Aristotle (384–322 BC), said: "
What is the essence of life? To serve others and to do good.
" Aristotle taught that "doing good" was synonymous with living a life of virtue. He believed these
virtues were in keeping with the laws of nature.
Aristotle and other ancient Greek philosophers believed that the main virtues were justice,
self-control/moderation, wisdom, sociality, courage, and physical health.
Psychological research now has shown that these virtues do predict success and good health. It can be
argued that these virtues represent basic evolutionary principles that are evident at every level of our
existence: physiological, psychological, and social.
The DNA molecule is the foundation of all life on earth. DNA is a double helix molecule that is
like a spiral ladder with rungs. Each rung on this ladder consists of 2 base pairs; altogether
there are 4 bases used by DNA. These four bases are abbreviated A, T, C, and G. These 4 bases
form the "4 letter chemical code" in DNA which stores all the chemical information necessary for
life.
The DNA molecule's spiral ladder has millions of rungs (base pairs). Part of DNA's chemical code
is read by messenger RNA (which takes it out of the cell nucleus to the nearby ribosomes who use
this code to create proteins). All the DNA chemical code in our 46 chromosomes is estimated to
be about 3.2 billion base pairs long.
Proteins are built as chains of amino acids, which then fold into unique three-dimensional
shapes that have different functions. Proteins compose structural and motor elements in the
cell, and they serve as the catalysts for virtually every biochemical reaction that occurs in
living things.
DNA Replication
The mutual attraction between opposite bases (G-C and A-T) allows for DNA replication, since the
DNA molecule can divide lengthwise into two halves. Then each half can attract the necessary
opposite bases to create a complementary new strand of DNA.
This chemical replication only works because of the mutual attraction between opposite base
pairs.
Virtues Manifested at The Physiological, Psychological, and Social Levels
Justice:
In terms of survival, it is better that members of a species cooperate. With one's
own species, cooperation requires that an individual neither harms nor allows harm (which is the
definition of justice). Justice requires mutually beneficial interaction in which no party gains an
unfair advantage. It ensures service to the common good - not just good for the privileged few.
Physiological Level:
[Evolutionary Principle] The Most Adaptable Survive
Evolution isn't survival of the fittest; it is survival of the
most adaptable.
In evolution, it is not the strongest or smartest
organism that survives - it is the organism that can best adapt to its changing
environment.
[Evolutionary Principle] Live In Harmony
An organism must be able to flourish in harmony with its environment.
For example, all the cells in a healthy body grow in harmony. Cancer represents the harmful
breakdown in these harmonious cellular relationships. Cancer results from mutated DNA that
is self-destructive because it causes uncontrollable growth which kills the organism and
itself.
[Evolutionary Principle] No Species Escapes Extinction
Nothing lives forever; nearly all species that ever lived are now
extinct. They did not survive the sudden climate changes that caused mass
extinctions of nearly all life on earth. Fortunately, a few species did survive the
last mass extinction.
There have been five mass extinction events in
Earth's history. In the worst one, 250 million years ago, 96 percent of marine species and
70 percent of land species died off. Humans almost went extinct 60,000 years ago when only approximately
1,000 humans survived a global drought. Nowadays, many scientists are predicting that we're
on track for a sixth mass extinction due to human destruction of the environment. This
human-caused mass extinction of life on earth is the greatest injustice that humanity
has ever created.
Psychological Level:
Justice means neither harming nor allowing harm.
Injustice is more than just being deceitful (e.g., lying, stealing, cheating). Justice
requires that we neither harm nor allow harm to others and our environment. Justice
is the public manifestation of love.
Social Level:
Social injustice occurs when one group unfairly harms another. Social justice requires
that we treat others the way we want them to treat us.
Evolution doesn't care if we are beautiful, strong, intelligent, or happy. Evolution only
cares if we can flourish by living in harmony with others and our environment.
Injustice occurs when groups or nations harmfully violate the rights of others. Once
there is a breakdown in the rule of law, it is just a matter of time until the group or
nation degenerates into corruption and a violent struggle for power.
To survive, all organisms have homeostatic mechanisms that strive to balance their
functioning at an optimal level between excess and deficiency. Some organisms have strong
homeostatic mechanisms; hence their functioning is highly regulated and orderly. Other organisms
have weak homeostatic mechanisms; hence their functioning is weakly regulated and disorderly or
chaotic. [Golden Mean: The Greek poet Hesiod (c.700 bc) said that "moderation is best in all
things'. Ancient Greek philosophers taught that self-control or moderation is about finding the
Golden Mean or balance between two extremes, excess and deficiency.]
Physiological Level:
[Evolutionary Principle] Maintain Stability By Self-Regulation
(Homeostasis)
Life involves constant change, and all organisms evolve ways to moderate these
changes to maintain their stability (i.e., homeostasis). The goal of this
homeostasis is to maintain optimal conditions for life (i.e., to avoid deficiency or
excess).
For example, DNA is self-controlling; it moderates its functioning by turning itself on or
off depending upon its environment. Thus, by moderating its own functioning, DNA can better
survive environmental change. However, there is a limit to how much change organisms can
withstand (e.g., a fish out of water).
[Evolutionary Principle] Certain Vices Shorten Life
Certain excesses (smoking, obesity, and alcohol) damage DNA; hence
must be seen as vices.
"A major cause of aging is 'oxidative stress.'
It is the damage to DNA, proteins, and lipids (fats) caused by oxidants, which are highly
reactive substances containing oxygen. These oxidants are produced normally when we breathe,
and also result from inflammation, infection, and consumption of alcohol and cigarettes. In
one study, scientists exposed worms to two substances that neutralize oxidants, and the
worms' lifespan increased an average 44%.
Another factor in aging is 'glycation.' It
happens when glucose, the main sugar we use as energy, binds to some of our DNA, proteins,
and lipids, leaving them unable to do their jobs. The problem becomes worse as we get older,
causing body tissues to malfunction, resulting in disease and death. Glycation may explain
why studies in laboratory animals indicate that restricting calorie intake extends
lifespan." [reference]
Psychological Level:
Self-control and moderation in all things (i.e., good behavioral homeostasis) is the
core feature of conscientiousness.
Conscientious individuals have good homeostatic control of their behavior - it is neither
excessively inhibited nor disinhibited. They are careful, responsible, hard-working,
cautious, focused, and organized. In contrast, individuals lacking conscientiousness are
careless, irresponsible, impulsive, easily distracted, and disorganized.
Social Level:
Vices (behavioral excesses or deficiencies) must be controlled or they will destroy a
group or nation.
When a group or nation is overcome by its excesses (e.g. alcoholism, drug abuse, or
corruption) or deficiencies (e.g. injustice or massive poverty); it withers and dies.
Wisdom:
Learning requires attention, reasoning, and memory. Of the 21 different hominids
that have existed; 20 are now extinct. Only our species, homo sapiens, has survived. It appears
evolution has favored our species, compared to the extinct hominids, because of our superior
adaptability and ability to learn. [Our Attention May Blind Us: The biggest problem with
learning is that our selective
attention may blind us to much of what we see. We create our own reality - seeing only what
we are interested in seeing. Thus we are blinded by our desires and biases.].
Physiological Level:
[Evolutionary Principle] Experiment To Improve Adaptation
Evolution creates better adapted organisms by using mutation and natural
selection.
The sugar-phosphate backbone of DNA preserves the specific order of the rungs on the DNA
ladder. Chance mutation causes deletion (or multiplication) of these rungs. Sometimes the
rung of one DNA molecule breaks off and attaches itself to another DNA molecule. Natural
selection then determines if the mutated DNA survives better than the original DNA. If so,
this mutated DNA creates a more adaptable organism. Without this constant experimentation
and evaluation (mutation and natural selection), evolution would stop.
[Evolutionary Principle] Replicate Experiments
Evolution uses the scientific experimental method to discover the
truth.
Evolution is constantly experimenting - comparing the adaptive
success of new DNA mutations against the success of their original DNA. As in science,
evolution requires that the findings of its experiments be repeatedly replicated.
This requirement for repeated replication of success eliminates unstable mutant DNA which
can't successfully replicate its initial adaptive success.
[Evolutionary Principle] Share Information
Organisms survive because they genetically share adaptive information from one
generation to the next.
For example, all the information needed to create an elephant is coded in its 56
chromosomes. This also includes all the elephant's instinctual behaviors. That's an
incredible amount of adaptive information passed by DNA from one generation to the next.
[Evolutionary Principle] Have Contingency Plans
In evolution, most of the information stored in DNA is contingency plans.
Only a tiny amount of the information stored in DNA's base pairs tells how to make proteins.
Far more of the information stored in DNA determines when and where these proteins are to be
produced. Thus, DNA stores more information on contingency plans for "when" and "where" to
do a task (e.g., produce protein) than it stores information on "how" to do it.
[Evolutionary Principle] Use A Standardized Language To Share
Information
Every living cell stores all of the adaptive information that evolution has taught it
by using the same "4 letter chemical code" (4 base pairs repeated billions of times)
in its DNA.
Without using this universal, standardized language to store information, evolution could
not pass on adaptive information within the body or between generations.
In evolution,
there is no evidence of a grand plan, and that everything happened for a reason according to
this universal plan. Instead, each organism's evolution was solely determined by random DNA
mutation and natural selection.
For example, our hominid lineage diverged from the
ape lineage 7 to 8 million years ago. There were 21 hominid species - and 20 became extinct.
Thus evolution tried 21 different experiments in creating hominids, and all proved to be
evolutionary dead-ends - except our species, Homo sapiens. Our species has existed for about
100,000 years, and now we could be on the verge of extinction due to nuclear war or climate
change.
Making a small change in a complex system will often cause major
unintended consequences.
For example, when nature causes a DNA mutation
or humans engineer a genetic modification, the unintended consequence can be: (1) a positive
unexpected benefit (e.g. a recent spontaneous mutation in crayfish has produced a "super crayfish" that
clones itself), or (2) a negative unexpected detriment (e.g. Monsanto genetically engineered its plants to make them resistant to the
most used herbicide, Roundup [glyphosate], in order to help their plants survive during weed
spraying. Monsanto's plants did become resistant to this herbicide, but this promoted the
development of the same resistance in several weed species and insects. Now millions of acres of
U.S. farmland have been destroyed by these pesticide resistent "superweeds" and
insects.)
DNA
has a built-in time bomb (shortening of its telomeres with each reproduction) that causes it to
age. Old DNA doesn't divide: thus all organisms eventually die.
Cancer occurs when DNA
fails to age and keeps dividing until the resulting unchecked cell growth destroys the organism.
Thus, nature prevents continuous growth; hence "no tree grows to heaven". Similarly, the
competing forces in nature ensure that nothing remains the same - everything cycles.
Psychological Level:
Humans are rational animals that evolution has given the ability to reason and learn.
Wise, open-minded individuals that ask "why?" consistently outperform close-minded
individuals that never question "why?". The hallmark of open-minded individuals is
their curiosity and willingness to logically experiment and make mistakes in order
to learn.
Throughout human history, open-minded, inventive, quick learning individuals prospered
better than close-minded, uncreative, and slow learning individuals. Open-minded individuals
are more likely to gather relevant information and create contingency plans before they act.
Wise individuals that keep a record of their progress (in diaries, business records,
etc.) outperform those individuals that don't keep such records.
Such records allow individuals to look back over the years to analyze their successes and
failures. Otherwise, without these backup records, individuals must rely on their
notoriously faulty memories. The most efficient record keeping involves using: (1)
standardized language to avoid confusion, and (2) mathematically quantified data.
Social Level:
War is the greatest threat to civilization and the accumulation of knowledge. Those
that start wars never foresee war's unexpected consequences.
History's Dark Ages occur when wars cause a collapse of civilization. The worst Dark Age
occurred at the end of the Bronze Age around 1200 BC. For 40-50 years, war destroyed all the
ancient Mediterranean civilizations (except Egypt's, which came close to collapsing). Almost
every significant city in the eastern Mediterranean world was destroyed. These cultures
(except Egypt) lost their literacy, political organization, and ability to build cities or
conduct international trade. Their people barely survived and were forced to return to
simple, small village life.
Sociality:
In a social species, social networking is vital for survival since it permits
cooperation and sharing of information. Single celled organisms banded together to form
multicellular organisms because of the additional survival benefits that such multicellular
cooperation bestowed upon them.
Physiological Level:
[Evolutionary Principle] Combine Forces
Sharing of genetic diversity speeds up evolution.
The genetic sharing of DNA during sexual reproduction increases genetic diversity, which
speeds up evolution. Even single-celled organisms, like bacteria, survive better in diverse
communal groups (where they can exchange their DNA), rather than surviving as solitary
organisms.
Psychological Level:
Sociality increases one's chances for survival.
Individual humans are too weak to survive solo; human survival requires that individuals
cooperate for mutual benefit. Socially outgoing individuals, compared to solitary
individuals, are more likely to acquire adaptive information from others in a social group.
Also socially outgoing individuals belong to more social networks; hence are more likely to
receive social support in times of need.
Social Level:
Like all social species, humans form dominance hierarchies ("pecking orders").
Humans survive better living in social groups. These groups permit specialization of labor
which dramatically increases the group's productivity - hence its chances for
survival.
All social species, including humans, organize their social groups in terms
of dominance hierarchies ("pecking orders"). Such dominance hierarchies unequally distribute
power and wealth within the group. For humans, a child on the bottom of our dominance
hierarchy is often chronically hungry, unsafe, or neglected.
Nature establishes
social dominance hierarchies as a cruel survival strategy which maximizes the adaptive
advantages for those at the top of the dominance hierarchy at the expense of those at the
bottom. This is often a matter of life and death because, when the social group is stressed
by famine or disease, it is those at the bottom of a social dominance hierarchy who are most
likely to starve or die.
Social groups and nations that freely share adaptive information are the most likely
to succeed.
Nations that freely share information democratically support freedom of speech and of the
press, universal education, social equality, social mobility, and social mixing of their
members. This social sharing and mixing strengthens the social cohesiveness of these groups
and improves their quality of life.
Courage:
An organism's primary objective is to stay alive; hence it must be able to
differentiate safety from danger. Courage, like everything else, must be exercised in moderation.
Too little courage results in cowardice, and too much courage results in foolish recklessness.
[Fight-Flight-Freeze-Fantasize: There are three main coping strategies that all animals use:
(1) "Fight" or angry attack, (2) "Flight" or fearful retreat, and (3) "Freeze"
or depressive immobilization. Humans uniquely have a fourth main coping strategy,
"Fantasize", in which they respond to stress by creating comforting delusions or false
beliefs which are strongly held against all evidence to the contrary.]
Physiological Level:
[Evolutionary Principle] Remain Stable
The DNA molecule is extremely stable.
During evolution, natural disasters have caused repeated near-total mass extinctions of all
life on earth; yet life has always recovered. Now DNA life forms have spread to virtually
every corner of our planet, and humans have spread to every continent.
Psychological Level:
Courage involves remaining calm and emotionally stable in the face of
adversity.
Courage doesn't mean rushing headlong into danger. The courageous person will assess the
situation, and take the appropriate "fight/flight/freeze/fantasize" response that best
solves the problem. There is no one response that is always right. Individuals must remain
calm and emotionally stable while facing adversity - otherwise strong emotion can severely
impair their problem-solving ability.
Social Level:
Leaders must instill courage in their followers in order to maintain morale.
Once a group loses its courage, and its morale is broken, it quickly becomes dysfunctional.
Physical Health:
In order to stay alive; an organism must maintain its physical health.
Physiological Level:
[Evolutionary Principle] Evolution's Only Goal Is Survival
Evolution selects for traits that help organisms survive, but doesn’t necessarily
find optimal solutions.
The goal of evolution is to create living organisms - even if they aren't perfect. Thus,
evolution has produced many types of organisms - some are in a gray area between living and
nonliving (e.g., viruses), the majority are single-celled (e.g., bacteria), and a few are
multicellular (e.g., most animals and plants). It is an error to believe that the sole
purpose of evolution is to create more complex or intelligent organisms. In terms of global
biomass, single-celled organisms far outweigh multicellular organisms. So, in that sense,
evolution has favored single-celled, unintelligent organisms.
[Evolutionary Principle] Avoid Extremes
Nature hates extremes and rewards moderation.
The
optimal conditions for DNA survival are usually the midpoint between deficiency and excess.
For example, DNA thrives at the temperature of liquid water, but is destroyed when water
freezes or boils. Organisms flourish when they maintain their functioning in the midpoint
between deficiency and excess. Nature punishes those organisms that slip into conditions of
deficiency or excess.
Psychological Level:
Our physical vices are leading causes of disability and death.
Usually virtue is physically helpful; whereas vice is physically harmful.
The modern vices of cigarette smoking, alcohol and drug abuse,
sedentary lifestyle, obesity, and unsafe sex are leading causes of physical
disability and death.
Chronic users of cigarettes lose 13% of their expected lifespan, chronic users of alcohol lose
29%, chronic users of cocaine lose 44%,
chronic users of methadone lose 49%, chronic users of heroin
lose 52%, and chronic users of methamphetamine lose 53% of their expected lifespan.
The leading global risks for mortality in the world are high blood pressure
(responsible for 13% of deaths globally),
tobacco use (9%)
, high blood glucose (6%),
physical inactivity (6%)
, and
overweight and obesity (5%)
.
The leading global risks for burden of disease as measured in
disability-adjusted life years (DALYs) are underweight (6% of global DALYs)
and
unsafe sex (5%)
, followed by
alcohol use (5%)
and unsafe water, sanitation, and hygiene (4%).
Globally, it appears that "modernization" increases addiction, sedentary lifestyle, obesity,
unsafe sex, environmental destruction, and disastrous climate change. Thus, our modern
civilization may severely impair our future evolution, or lead to our own extinction.
[The Second Law of Thermodynamics: In physics, this law states that, in order to
create order in one part of a system, more disorder (entropy) is automatically created in
another part of the system. This law would predict that, in order to create and maintain our
civilization, we will automatically create greater disorder and chaos in our environment.
This is a chilling prediction given what is currently happening with climate change.]
The "Five Factor Model of Personality" as Shown In Dogs
All animals have
personalities - that is, consistent individual differences in behavior. Within virtually any
population, some individuals are consistently more active, more aggressive, or are more willing to
engage in risk-taking behavior. Thus the same "Big 5 Factors" of personality found in humans can
be found in dogs.
AGREEABLENESS VS. ANTAGONISM
Agreeableness ("Friend")
Dog is friendly towards unfamiliar people.
Dog is friendly towards other dogs.
When off leash, dog comes immediately when called.
Dog willingly shares toys with other dogs.
Dog leaves food or objects alone when told to do so.
Antagonism ("Foe")
Dog is dominant over other dogs.
Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).
Dog behaves aggressively towards unfamiliar people.
The "Five Factor Model of Personality" In A Social Species
The behaviors of the "Five Factor Model of Personality" serve adaptive functions that are vital to human
survival. For example, when one individual approaches another, the individual must: (1) decide whether the
other individual is friend or foe [
"Agreeableness"
], (2) decide if this represents safety or danger [
"Emotional Stability"
], (3) decide whether to approach or avoid the other individual [
"Extraversion/Sociality"
], (4) decide whether to proceed in a self-controlled or disinhibited manner [
"Conscientiousness"
], and (5) learn from this experience [
"Openness to Experience"
].
Spider Personalities
All animals have
personalities (defined as consistent behavioral differences among individuals). Animals can consistently
differ on: (1) Antagonism (e.g., aggression), (2) Disinhibition (e.g., risk taking), (3)
Intellect (e.g., inventiveness), (4) Extraversion (e.g., assertiveness), and (5) Emotional
Stability (e.g., calmness).
Some social spiders live in colonies of up to several hundred
individuals, and exhibit cooperative behaviours such as prey capture and maternal care. Researchers have
found that spider personalities differ in aggressiveness:
Aggressive spiders are more likely to attack their mirror image than are shy
spiders who are more likely to run away.
In a spider colony, individual spiders differ in degree of boldness
(aggression) vs. shyness (nonaggression). [Aggressive spiders show shorter latencies to attack prey
and to resume movement after a disturbance.] Hunting prey for these social spiders is a collective
effort. The presence of a bold spider causes the shy spiders to become bolder which increases the
effectiveness of their collective hunting effort. A positive feedback loop is established whereby
hunting success increases spider boldness which increases future collective hunting success.
However, when researchers removed these bold "leader" spiders, the collective hunting by the
remaining spiders became less successful. The bold "leader" spiders thus were shown to have a
disproportionately large impact on the group, and so were named "keystone individuals". Because of
their special personality characteristic (boldness) the "leader" spiders performed a vital function
(making the shy spiders bolder) which fascilitated collective social action.
This research
made the very important finding that the spiders modified each other's personalities. The bold
spiders became bolder because of their hunting success. However their hunting success was
entirely dependent upon gaining the collective support of the shy spiders. Likewise, the shy
spiders owed their hunting success to being made bolder by association with the bold spider.
Thus for more successful collective action, the bold "leader" spider needed to have followers,
and the shy "follower" spiders needed to have a "leader". To make their collective social action
more successful, the different spider personalities had to bring out the "best" in each
other.
The "Five Factor Model of Personality" and Personality Disorders
This statistical model shows that all of the personality disorders are highly correlated - they are
overlapping entities that blend into each other with no clear boundaries. This 3D model groups
personality disorders into two highly interrelated large clusters (named "greed" and "fear" by
PWL).
The fact that these personality disorders are so highly interrelated suggests that it is common for
individuals to have multiple personality disorders.
Section III of the DSM-5 presents an alternative model for
personality disorders. Based on research findings, this model drops four personality disorders:
Schizoid, Paranoid, Dependent, and Histrionic.
The above 3D model shows the statistical
correlations between personality disorders in this alternative DSM-5 model.
Note:
Borderline Personality Disorder plays a central role in this model. It is correlated to all
of the other major personality disorders (except Schizotypal Personality Disorder). It could be
argued that Borderline Personality Disorder may not be a true personality disorder. Instead, it
may more represent chaotic instability - an advanced stage in which a previous stable
personality disorder becomes unstable and goes from order into chaos. This would explain why
Borderline Personality Disorder is usually diagnosed in combination with another personality
disorder.
Thus, it is argued, instead of diagnosing someone as having both "Naricissistic
and Borderline Personality Disorders"; it would be more correct to diagnose "Narcissistic
Personality Disorder with Emotionally Unstable Traits".
Chaos theory states
that balanced systems under stress can be pushed into instability. Specifically, as stress on a
stable system is increased, a "tipping point" is reached wherein the system quickly goes from
stability to instability. The following animated graphs illustrate this mathematical principle.
The vertical (y) axis represents the stress level. As the stress level increases, a tipping
point is reached whereafter the system becomes more unstable. (These animations
recycle.)
According to chaos theory, these animations could represent what happens when a
personality disorder is under increasing stress. Initially, the personality disorder remains
stable; then under increasing stress a tipping point is reached wherein the previously stable
personality disorder becomes chaotic. Any further stress makes the personality disorder even
more unstable.
Thus the emotional instability, chaotic social functioning, and
self-harming behavior of Borderline Personality Disorder could represent a chaotic, unstable
state of a previously stable personality disorder.
Primate Evolution
There appears to be three different ways in which primates have evolved socially:
The chimpanzees have evolved to be socially antagonistic, competitive, callous, and
manipulative. Chimpanzees are the only primates (apart from humans) that wage organized war.
Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of
the antisocial-paranoid-narcissistic-histrionic-borderline cluster of personality
disorders.
In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and
loving. Thus bonobo social behavior most closely mirrors the emotional distress (anxious)
behavior of the avoidant-dependent cluster of personality disorders.
Another separate evolutionary path was followed by the orangutans. They evolved to become
solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of
the schizoid-schizotypal cluster of personality disorders.
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