By Dr Mike Neville
What makes you who and what you are? Where did your personality come from?
Well, we know some of it is inherited from your parents and grandparents; we all know that certain traits run in families. There are also many personality traits that we have learnt from our homes, schools, churches, friends - in fact, the whole of our culture. These are known as environmental factors.
There is also some degree of choice; there are parts of us that with hard work can be changed.
Our personalities are made up of a large number of traits. There are actions, attitudes and behaviours, hundreds and hundreds of them, such as being conscientious, dependable, honest, or more negative traits such as dishonest, pompous or just plain nasty.
There are, of course, hundreds of traits that can be measured, most of them existing within all of us to a greater or lesser degree. We all have them. This constellation of traits is only considered abnormal when groups of traits are either far too strong or completely absent. We all like our partners to be a little bit jealous but when the jeolousy trait has them inspecting underwear and making bizarre accusations then the jealousy trait is definitively abnormal.
It is when groups of traits are found together in abnormal quantities that the diagnosis of a personality disorder is made.
The concept of character goes back to ancient Greece; later in England the term ‘moral insanity’ came into use. Then psychopathic personality began to be used to describe anti-social behaviour not explained by psychosis. The current diagnosis of personality disorder is made when significant problems with relationships and self, along with certain pathological personality traits, are present over time.
They also must not be explained by a medical condition or in someone whose personality has not had time to develop.
These disorders tend to overlap and often co-exist and so are grouped into three clusters.
The first group consists of the paranoid, schizoid and schizotypal disorders: these people tend to be very odd, eccentric and often seem quite bizarre. They do not trust others and are suspicious, feel shame and hold on to grudges. It is difficult for them to build long-term stable relationships. There are similarities in thinking with people with the illness called schizophrenia but there is no evidence of psychosis.
A second group or cluster consists of avoidant, dependent and anankastic disorders and comprise of people who are excessively anxious and fearful. There is a severe lack of self confidence with an excessive need for others to look after them. There are great difficulties with relationships and social interactions. The anankastic type has similarities with the anxiety disorder OCD but the other personalty traits make relationships extremely difficult.
The third group of personality disorders is perhaps the most troublesome. The anti-social, borderline histrionic and narcissistic types combine to create great hardship to society. People with these disorders have a callous disregard for others, lack of empathy and remorse combined with an overvalued sense of self importance.
This group seems to be over-represented in the Bahamas, perhaps due to the high incidence of child abuse. These traits were valuable in times of war as these individuals have little fear and win medals for apparent bravery.
In times of peace, however, they are not constrained by a conscience - that little voice in the back of our heads that tells us when something is wrong and that nagging sense of guilt when we do mess up.
Imagine if that did not exist. It opens doors to despicable behaviour with absolutely no remorse. They can even pass lie detector tests.
These individuals miss out on so much it is clear they need help. Unfortunately, there are no pills or potions for these conditions and, whilst some benefit from talking therapies, those with a complete lack of a trait are blissfully unaware that there is something wrong with them. They are much more likely to blame others.
Present day psychiatry can help if someone really wants to change but with many there is little that can be done.
• Dr Mike Neville is a forensic psychiatrist who has practiced for more than 40 years in The Bahamas, working at Sandilands, the prison and in private practice. Comments and responses to firstname.lastname@example.org