The Development of Personality Disorders
In an effort to explain the different psychological and behavioural profiles between the diagnostic categories of “personality disorders” and “neurotics”, current clinical thinking and practice offers a neuro-social model of psychological developmental.
The heart of this model is that there are fundamental differences in the character structure of individuals associated with these two diagnostic categories which originate from the early stages of neurological and psychological development; a position supported by increasing evidence in genetic-biological studies as well as psychodynamic-psychoanalytic research.
This model suggests that during the early years of childhood, a predictable and invariant sequence of distinct and increasingly complex psychological stages accompanies normal brain development. As each successive stage unfolds, unique psychosexual, cognitive, moral, and affective capacities come into existence; the emerging combination of which produces noticeable developments in the personality of the infant.
If a sufficiently healthy environment is provided for the child, then the fundamental groundwork for a normal healthy adult will be laid. However, should trauma occur during any of these stages, pathological development results which if not corrected early, will manifest in personality disturbances in later life.
Accordingly, when trauma occurs during any of the stages of development, a variety of physiological reactions are triggered within the child.
The greater and more prolonged the trauma, the more these reactions occur.
It is hypothesized that these charged physiological states induce lasting neurochemical alterations in brain chemistry, produce significant modifications in neural connections between and within various brain structures, and also become encoded into the existing memory system of the child.
Not only do children develop different neurochemical and psychological processes in response to trauma, but every subsequent stage of mental and emotional development will be affected by these changes.
Over the years and into adulthood a psychological structure still develops, but it is a structure based on neurological and psychological distortions reaching far back into the infantile stages of development.
Based on this reasoning, the earlier that trauma occurs, the greater are the number of subsequent stages of development which will then be affected, and thus the greater and more serious is its effect.
Thus, an individual diagnosed with a personality disorder is understood to have suffered some form of trauma at an earlier developmental stage than the neurotic because their emotional and cognitive processes are generally more poorly developed, their defense mechanisms more immature, their behavioural responses to stress typically less effective, and their relational capabilities more limited.
What is of most importance to emphasize from a psychological perspective however, is that the degree to which the diagnostic categories of personality disorders and neurotics do reflect real and enduring differences in character structure, then specific treatment approaches are also required.
For example, psychoneurotic versus borderline depression and anxiety are two very different phenomenon, each requiring different treatment modalities. The same is also true for reports of relationship disturbances, self-esteem issues, mid-life crises, and almost every other psychological symptom which people experience.
Any effective and appropriate intervention thus depends upon an accurate diagnosis. This in turn rests upon a skilled understanding of the particular types of needs, motivations, cognitions, defense mechanisms, and pathologies presented by the patient which reflect disturbances originating during specific and identifiable stages of early development.
It is the failure to recognize this fact that has led to many unsuccessful therapy hours which have been frustrating for both the patient and the therapist.