tag:theconversation.com,2011:/au/topics/personality-disorders-14660/articlesPersonality disorders – The Conversation2023-03-14T12:19:00Ztag:theconversation.com,2011:article/2012372023-03-14T12:19:00Z2023-03-14T12:19:00ZPeople with personality disorders are more likely to sign up for psychology studies – here’s why that’s a problem<figure><img src="https://images.theconversation.com/files/514663/original/file-20230310-20-h7b833.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5982%2C3399&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/women-dealing-mental-heath-issues-showing-1297141894">solarseven/Shutterstock</a></span></figcaption></figure><p>Many psychological studies rely on participants to give up their time to take part in experiments or complete questionnaires. They take part because they get paid or because they are required to as part of their university course. But, beyond this, not much is known about what motivates people to take part in these studies.</p>
<p>Some participants may be looking for help – perhaps seeking a diagnosis for a mental health issue they’re struggling with. A team of researchers in Poland theorised that taking part in a psychological study might be “perceived as a cheap substitute or alternative to acquire some professional help”. To this end, they set out to discover if participants in psychological studies were more likely to have a personality disorder or be experiencing depression or anxiety.</p>
<p>Their results are published in the open-access journal <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281046">PLOS ONE</a>.</p>
<p>“Researchers often take for granted that the way they advertise their studies and who they recruit do not appreciably affect their outcomes,” the study authors write. “In our studies, we have shown that those who have more personality pathologies are more drawn to studies where they can express their trauma and may be simply more likely to volunteer for studies.”</p>
<p>Izabela Kaźmierczak and colleagues at Maria Grzegorzewska University in Warsaw, Poland, conducted several studies, involving 947 participants in total (62% of whom were women), comparing people who had previously taken part in psychology studies with those who had never taken part in such studies.</p>
<p>They found that participants who had previously taken part in studies exhibited symptoms found in those with personality disorders, depression or anxiety. There are many different types of <a href="https://www.nhsinform.scot/illnesses-and-conditions/mental-health/personality-disorder">personality disorder</a> – including <a href="https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/overview/">borderline personality disorder</a> and <a href="https://www.webmd.com/mental-health/narcissistic-personality-disorder">narcissistic personality disorder</a> – but, in short, a person with a personality disorder thinks, feels, behaves or relates to others differently from those without it. They may, for instance, blame people for things, or behave aggressively and unpredictably. </p>
<h2>Why it matters</h2>
<p>What this new study has revealed is a potentially worrying issue of self-selection. Since participants in research choose which studies to take part in, the results of the research may be unduly influenced by a large number of participants of a particular type taking part. Study bias is a serious issue.</p>
<p>Like many other scientific disciplines, psychology research is designed and carried out <a href="https://slate.com/technology/2013/05/weird-psychology-social-science-researchers-rely-too-much-on-western-college-students.html">mainly in universities</a>. Unlike many disciplines, though, psychology requires human participation and, as such, students form a handy subject pool from which to draw. This has led many in the field to wonder how research carried out on predominantly 18 to 22-year-old western students can provide findings that are in any way relevant to any population other than 18 to 24-year-old western students. </p>
<p>Research needs to be valid, and if we cannot claim that our findings relate to the wider population (so-called “generalisability”) we have a serious issue. What this new study shows is that our findings may well be influenced by the psychological nature of the very people we are testing. </p>
<p>We cannot, however, control the students who give their time to sit through our procedures. For instance, we cannot provide instructions on recruitment posters that say: “Those with symptoms of personality disorders need not apply.” But we can and must be more careful in how we select our participants. </p>
<p>What we need to do is carry out research with large enough numbers of people, work that can be repeated, that can allow us to be more confident that our findings have relevance off campus. </p>
<h2>Bumpy road</h2>
<p>All sciences have their bumpy roads to travel, and psychology has certainly been travelling on one in recent years. Experiments that were once deemed to be groundbreaking, have <a href="https://www.nature.com/articles/s41562-018-0399-z">failed to produce the same results</a> when they were repeated by other psychologists. This is known as the “replication crisis” or “reproducibility crisis”.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FpCrY7x5nEE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The reproducibility crisis in science explained.</span></figcaption>
</figure>
<p>And the shockwaves caused by the scientific treason of <a href="https://www.nytimes.com/2013/04/28/magazine/diederik-stapels-audacious-academic-fraud.html">Diederik Stapel</a>, a Dutch psychologist who invented his data and even fabricated entire experiments, are still being felt. Psychology’s reputation has certainly taken a battering.</p>
<p>But psychologists are working carefully on developing transparency and techniques we hope will help us regain the faith of the wider scientific community. What this latest paper has shown is that the participants themselves may well be self-selecting – and, as a result, our findings may again be called into question. We may think we are drawing from as general a population as possible to make the results generalisable to the wider population, but that may not be the case. </p>
<p>This finding will set alarm bells ringing in those working to develop the reliability and reputation of psychology. It needs to be taken seriously. </p>
<p>The results tell us more formally something we should have already known. Those of us involved in psychological research involving participants drawn largely from a pool of psychology students need to be very careful in our recruitment strategies. We might, for instance, need to take care to design research that may not be influenced by the personality or mood of the participant, or we may need to assess the participants taking part in our research. For example, the authors of this latest study suggest winnowing out participants who have taken part in previous psychology studies. </p>
<p>Most importantly, we need to be very careful in the grand claims we make after we publish how our “groundbreaking” research relates to the wider population we look to be investigating. Such a claim may not, it seems, stand up to scrutiny.</p><img src="https://counter.theconversation.com/content/201237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nigel Holt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Psychology is in crisis and this new revelation only adds to the problem.Nigel Holt, Professor of Psychology, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990692023-03-03T13:25:28Z2023-03-03T13:25:28ZA little bit of narcissism is normal and healthy – here’s how to tell when it becomes pathological<figure><img src="https://images.theconversation.com/files/511043/original/file-20230220-24-35nquk.jpg?ixlib=rb-1.1.0&rect=21%2C14%2C4820%2C3615&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is a major distinction between healthy and pathological narcissism.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-leaning-out-car-window-looking-in-wing-mirror-royalty-free-image/200127466-001">Joos Mind/The Image Bank via Getty Images</a></span></figcaption></figure><p>During former President Donald Trump’s campaign and presidency, the word narcissism <a href="https://psychcentral.com/blog/podcast-donald-trump-and-narcissism#block-e94f1600-f05b-43e9-bd19-5efbeb307249">became something of a buzzword</a>. And in recent years the word has been popularized <a href="https://doi.org/10.1037/ppm0000137">on social media</a> and <a href="https://www.theguardian.com/commentisfree/2021/nov/07/social-media-fuels-narcissists-worst-desires-making-reasoned-debate-near-impossible">in the press</a>. </p>
<p>As a result, social media and other <a href="https://samvak.tripod.com">online platforms</a> are now rife with insights, tips, stories and theories from life coaches, therapists, psychologists and self-proclaimed narcissists about <a href="https://podcasts.apple.com/us/podcast/navigating-narcissism-with-dr-ramani/id1629909313">navigating relationships with narcissists</a> or managing one’s own symptoms. </p>
<p>The term “narcissism” is commonly used to describe anyone who is egotistical and self-absorbed. Someone who exhibits narcissistic traits may have a personality disorder known as narcissistic personality disorder.</p>
<p>Over the past decade, the rapid development of social networking sites has caused profound changes in the way people communicate and interact. Social media websites such as Facebook, TikTok and Instagram <a href="https://doi.org/10.1037/ppm0000137">can feel like a narcissistic field day</a>. In seconds, one can share self-enhancing content – flattering pictures, boastful statuses and enviable vacations – with a vast audience and receive immediate feedback in the form of “likes” and reinforcing comments from followers. </p>
<p>As a <a href="https://thecouplesclinic.com/our-staff/april-ilkmen/">licensed couple and family therapist</a> who specializes in <a href="https://www.psychologytoday.com/us/therapists/april-nisan-ilkmen-geneva-il/899204">relationship issues related to attachment</a>, I have worked with many couples with one partner who is on the narcissistic personality disorder spectrum. One reason the narcissistic partner is challenging to treat is that they’re adept at persuading their partner that they are the dysfunctional one.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_uJs0iGQN0M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The “malignant narcissist” may be the most worrisome type of all.</span></figcaption>
</figure>
<h2>Defining narcissism</h2>
<p><a href="https://www.psychoanalysis.columbia.edu/people/faculty/otto-kernberg-md">Dr. Otto Kernberg</a>, a psychiatrist who specializes in personality disorders, differentiates between normal and pathological narcissism using a framework that assesses a person’s capacity to participate in satisfactory romantic relationships. </p>
<p>Normal narcissism refers to a well-integrated sense of self that is generally for the greater good, such as a healthy sense of pride in oneself and one’s accomplishments. Pathological narcissism describes extreme fluctuations between feelings of inferiority and failure <a href="https://doi.org/10.1521/bumc.2013.77.1.1">with a sense of superiority and grandiosity</a>.</p>
<p>Each person has a bit of normal narcissism within them. This can take the form of having self-confidence and even a modicum of entitlement while still displaying empathy and emotion. Research shows the role of healthy narcissism occurs at <a href="https://www.researchgate.net/publication/309091021_The_Role_of_Healthy_Narcissism_in_Relating_Emotionally_to_Familiarity_and_the_Unknown">subclinical levels in everyday populations</a> and can help motivate people to enhance themselves and to progress in life.</p>
<p>But when striving for achievement or gain involves an excessive desire for attention and approval and an outsize, grandiose sense of self, it is <a href="https://theconversation.com/heres-what-to-do-when-you-encounter-people-with-dark-personality-traits-at-work-192316">no longer in the realm of healthy narcissism</a>.</p>
<p>A pathological narcissist sees everyone else as an extension of self. Those in a narcissist’s life, especially in their inner circle, must always demonstrate perfection because they contribute to the narcissist’s own self-image. Like many personality disorders, narcissism manifests itself in intimate relationships through the cycle of idealization and devaluation, creating the concept of the so-called toxic relationship.</p>
<h2>Finding a victim</h2>
<p>A narcissist chooses their partners based on whether the partner affirms their grandiose sense of self. And since having that affirmation is the key driver for a narcissist’s relationship, they are generally not interested in learning a lot about the other person.</p>
<p>The things that attract narcissists are not the personal characteristics of the other person or even the connection that comes from the relationship. If the person has a reputable status in their eyes and they find the person appealing, they are usually willing to move forward quickly in the relationship. Unfortunately, as a narcissist’s genuine interest in the other person is typically superficial, the narcissist often loses interest in the relationship just as suddenly as they began it. </p>
<p>Narcissistic abuse is a <a href="https://books.google.com/books/about/Women_who_Love_Psychopaths.html?id=I4g5SQAACAAJ">form of extreme psychological and emotional abuse</a> marked by manipulative communication and intentional deception for exploitation by a person who meets the criteria for pathological narcissism. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/cwuzgfFgLTM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some key traits of narcissism include a sense of entitlement, a lack of boundaries and a need for attention.</span></figcaption>
</figure>
<h2>Forms of narcissism</h2>
<p>Narcissistic abuse can be insidious and hard to recognize. Since the signs of narcissistic abuse aren’t always obvious, it’s important to name and recognize them.</p>
<ul>
<li><p>Gaslighting: The narcissist uses a manipulation strategy known as gaslighting to make the victim doubt his or her own ability to make a decision or take an action. People use this technique to maintain control over the other person’s sense of reality. When gaslighting occurs, victims are left feeling doubtful and insecure and some even have difficulty recognizing that they are being gaslighted. In some relationships, a co-dependency develops between the narcissist and the victim in which the victim accepts the narcissist’s position of authority.</p></li>
<li><p>Victim mentality: This mindset, which is common for those with narcissistic personality disorder, implies that <a href="https://doi.org/10.1177/0146167203029007007">everybody owes the narcissist something</a>. In my clinical experience, I have often witnessed the narcissist creating a false narrative about how they did not get what they were supposed to get in life because they were wronged by others. This story allows them to feel entitled to have anger and resentment toward anyone, especially toward people they perceive as successful. </p></li>
<li><p>Cycle of idealization and devaluation: Narcissists form polarized beliefs about themselves and others, meaning that their opinions of themselves and others <a href="https://doi.org/10.31234/osf.io/yvu2b">can be exceptionally positive or unrealistically negative</a>. </p></li>
</ul>
<p>During the idealization stage, the narcissist creates a sense of unbreakable connection with the victim. No matter what type of relationship it is – whether romantic, professional or familial – it moves fast and has an intense quality to it. </p>
<p>At some point, the narcissist’s partner will disappoint them in some way, usually not on purpose. As a response, the narcissist will criticize every move, jump to conclusions and react dramatically to these perceived disappointments. The narcissist will begin to see their partner as flawed and accuse them of not being the perfect partner they were supposed to be. This phase is characterized by <a href="https://doi.org/10.1037/pst0000111">verbal and physical abuse, humiliation, bullying and smearing</a>. </p>
<p>Feelings of emptiness: According to Kernberg, the psychiatrist mentioned above, the inability of narcissists to develop fulfilling and lasting relationships <a href="https://doi.org/10.3917/clini.014.0032">results in a chronically empty internal world</a>. </p>
<p>Narcissistic personality disorder patients will often find themselves “waking up” at age 40, 50 or 60 with a desperate sense of loss. The narcissist often struggles with feelings of emptiness that stem from relying on a false grandiose sense of self that prevents them from being vulnerable. In turn, they project their feelings of emptiness onto the partner in a relationship. Many of these patients suffer from a loss of identity and sense of helplessness and feel alienated from the world. </p>
<h2>Navigating relationships with a narcissist</h2>
<p>Since the narcissist often develops controlling and manipulative relationships with the partner’s friends and family, the victim may feel <a href="https://doi.org/10.1177/2158244019846693">reluctant to rely on their intimate circle for support</a>. Finding a therapist who specializes in narcissistic abuse recovery is the first step to start the healing process. </p>
<p>I have had a lot of patients tell me that their therapists aren’t familiar with the term “pathological narcissism.” If they’re not, I suggest that, if possible, these patients find therapists who specialize in emotionally focused therapy or <a href="https://doi.org/10.1521/pedi.2020.34.supp.159">transference focused therapy</a>. These therapies help identify destructive patterns of communication as they arise during a therapy session, rather than focusing only on interactions that arise outside of therapy. </p>
<p>From my perspective, relationships with a narcissistic partner are some of the hardest to treat. The narcissistic partners are often unwilling to participate in therapy because they will not admit that they need help and find it challenging to collaborate with the therapist. Effective couples therapy is rare but not impossible and can occur only when the narcissistic partner acknowledges that their expectations are unreasonable and destructive.</p><img src="https://counter.theconversation.com/content/199069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>April Nisan Ilkmen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Narcissistic abuse in relationships can take the form of extreme emotional abuse. Yet both the victim and the abuser may have difficulty recognizing it.April Nisan Ilkmen, PhD Candidate in Couple and Family Therapy, Adler UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1911662022-11-11T01:50:53Z2022-11-11T01:50:53ZWe’re taking the government to court to challenge New Zealand’s outdated Mental Health Act – here’s why<figure><img src="https://images.theconversation.com/files/491784/original/file-20221025-19469-olrwm5.jpg?ixlib=rb-1.1.0&rect=35%2C53%2C2962%2C1892&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>It’s been five years since an independent inquiry into mental health and addiction called on the government to <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/mental-health-legislation/repealing-and-replacing-mental-health-act">repeal and replace</a> the Mental Health Act (<a href="https://www.legislation.govt.nz/act/public/1992/0046/latest/whole.html">MHA</a>).</p>
<p>The <a href="https://mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/">He Ara Oranga inquiry</a> described New Zealand’s mental health law as out of pace with societal shifts and recommended it be replaced to reflect human rights and minimise compulsory or coercive treatment.</p>
<p>But the reform process has been so slow, so a colleague and myself decided to take a court case against the Attorney General and the Ministry of Health. We want to clarify the MHA’s legal provisions that force someone deemed to have a mental disorder to have compulsory treatment. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1589430631917768704"}"></div></p>
<p>In a New Zealand first, the courts have issued a protective costs order, ensuring the defentants (the Attorney-General and Ministry of Health) <a href="https://www.rnz.co.nz/news/national/478220/first-of-its-kind-academics-granted-right-to-challenge-mental-health-act-for-free">cannot apply to have their costs awarded</a> if we lose. </p>
<p>The act can currently be used to detain people under a compulsory treatment order, in a hospital or at home. This means they have to comply with treatment even if they have the capacity to refuse and don’t want to. Colleagues and I have referred to this as a <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/use-of-community-treatment-orders-in-competent-patients-is-not-justified/1D8B2498F53EE4805B3467D412412FA3">kafkaseque</a> situation. </p>
<p>The enforcement of unwanted medical treatment onto patients who may be fully competent to refuse it also violates New Zealand’s international human rights obligations under the United Nations Convention on the Rights of Persons with Disabilities (<a href="https://pubmed.ncbi.nlm.nih.gov/31823649/">CRPD</a>)
and is arguably <a href="https://pubmed.ncbi.nlm.nih.gov/30994070/">unethical</a>. </p>
<h2>Compulsory treatment doesn’t make things better</h2>
<p>Mental health legislation in New Zealand was developed to support the delivery of the best mental healthcare to people in psychological distress. This is also described as “psychosocial distress”, recognising it is partly individual but also caused by the structure of the society in which people live. </p>
<p>Such distress is common: one in five New Zealanders will <a href="https://pubmed.ncbi.nlm.nih.gov/16959010/">experience it</a> in any given year. Sometimes it follows major life changes such as relationship break-ups or bereavement, at other times it happens for no clear reason. We are all potentially within the remit of the MHA.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-transition-into-adolescence-can-be-brutal-for-kids-mental-health-but-parents-can-help-reduce-the-risk-180487">The transition into adolescence can be brutal for kids' mental health – but parents can help reduce the risk</a>
</strong>
</em>
</p>
<hr>
<p>Legislation has a profound impact on what we do and how we act, and this is also true for the MHA. It shapes much of the practice of psychiatry in New Zealand and internationally. </p>
<p>When the act came into force in 1992, the common view was that it would help keep people well and out of hospital and stop the revolving door of readmission. </p>
<p>But three randomised controlled <a href="https://pubmed.ncbi.nlm.nih.gov/28303578/">trials</a> now conclusively show detaining people using a compulsory community treatment order <a href="https://pubmed.ncbi.nlm.nih.gov/32921145/">does not prevent readmission</a>.</p>
<p>When we looked at real-world New Zealand data, we found being detained under compulsory treatments orders only reduced readmission for people with <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(21)00184-X/fulltext">psychotic disorders</a>. The opposite happened for people with a <a href="https://pubmed.ncbi.nlm.nih.gov/35913107/">range of other diagnoses</a>, including dementia, bipolar or major depressive disorder and personality disorders.</p>
<h2>Support is more effective in preventing worst-case outcomes</h2>
<p>Does the MHA prevent really bad outcomes such as suicide? We don’t think so. The suicide rate in New Zealand has been <a href="https://minhealthnz.shinyapps.io/suicide-web-tool/">stable for more than a decade</a> and has recently <a href="https://www.1news.co.nz/2021/10/04/nz-suicide-rate-drops-for-second-consecutive-year/">fallen</a>. </p>
<p>Between 1978 and 1998, over the period when the MHA came into force and became embedded in practice, the suicide rate actually <a href="https://www.moh.govt.nz/notebook/nbbooks.nsf/0/6A3A3EDA84465C03CC256DB6006E769B/$file/suicide78-98-2001.pdf">went up</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ai-could-help-predict-suicides-but-rushing-the-technology-could-lead-to-big-mistakes-192266">AI could help predict suicides – but rushing the technology could lead to big mistakes</a>
</strong>
</em>
</p>
<hr>
<p>We have recently reviewed the international literature on suicide and self-harm for the Lancet and are clear that a good <a href="https://www.thelancet.com/article/S0140-6736(22)00173-8/fulltext">assessment and support plan</a> is more effective than trying to predict if a person will follow through on suicidal thoughts.</p>
<p>All these issues have been brought to light in the He Ara Oranga inquiry. We encourage people to participate in the ongoing reform process to ensure any new legislation reflects the evidence, supports people’s human rights and helps shape a better mental health landscape for all New Zealanders. Our approach along a legal avenue is only one of many ways to remain engaged.</p><img src="https://counter.theconversation.com/content/191166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giles Newton-Howes is affiliated with The World of Difference, a service use led group in the department of Psychological Medicine at the University of Otago, Wellington. I am also a consultant psychiatrist and can act as a responsible clinician under the MHA. </span></em></p>New Zealand law allows people to be detained under a compulsory community treatment order – which they can’t refuse. But research shows compulsory treatment can make some mental health issues worse.Giles Newton-Howes, Associate Professor in Psychological Medicine, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1167312019-07-24T05:05:24Z2019-07-24T05:05:24ZDissociative disorders are nearly as common as depression. So why haven’t we heard about them?<figure><img src="https://images.theconversation.com/files/283635/original/file-20190711-173329-ayfx80.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some people feel so disconnected, they don't even recognise themselves in the mirror.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/reflection-stressed-woman-holding-her-head-651547174?src=jpM5GgtwUMRKd3nVisHdwA-1-77&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Dissociative disorders are often said to be <a href="http://www.teachtrauma.com/controversial-topics-trauma/myths-media-portrayals-dissociative-identity-disorder/">rare</a>. But our soon-to-be published analysis of <a href="https://www.researchgate.net/publication/334625332">international studies</a> suggest they affect 10-11% of the population at some point in their lives. This makes them nearly as common as <a href="https://journals.sagepub.com/doi/abs/10.1177/070674370404900208">mood disorders</a> (such as clinical depression).</p>
<p>So what are dissociative disorders, why is diagnosis controversial and how can people be treated?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mood-and-personality-disorders-are-often-misconceived-heres-what-you-need-to-know-94971">Mood and personality disorders are often misconceived: here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>What is dissociation?</h2>
<p>Dissociation occurs when a person experiences being disconnected from themselves, including their memories, feelings, actions, thoughts, body and even their identity. </p>
<p>People with dissociative disorders have one or more of the following <a href="https://psycnet.apa.org/record/1995-98841-000">symptoms</a>:</p>
<ul>
<li>amnesia and other memory problems</li>
<li>a sense of detachment or disconnection from their self, familiar people or surroundings</li>
<li>an inner struggle about their sense of self and identity</li>
<li>acting like a different person (identity alteration).</li>
</ul>
<p>For some people, symptoms can last days or weeks, but for others they can persist for months, years, or a lifetime. </p>
<p>Dissociation allows the person to compartmentalise and disconnect from aspects of traumatic and challenging experiences that could otherwise overwhelm their capacity to cope. </p>
<p>A person whose spouse has died may become emotionally numb, allowing them to focus on arranging the funeral; a man who has separated from his wife and lost his job soon afterwards may become so disconnected from his identity that he no longer recognises himself in the mirror and feels his life is happening to someone else; and a young woman who is sexually assaulted may remember her attacker moving too quickly towards her, recalls being safely back in her family home, but cannot remember the assault.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-childhood-trauma-changes-our-hormones-and-thus-our-mental-health-into-adulthood-84689">How childhood trauma changes our hormones, and thus our mental health, into adulthood</a>
</strong>
</em>
</p>
<hr>
<p>If the traumatic and overwhelming experiences happen repeatedly over a long period of time, the person’s <a href="https://books.wwnorton.com/books/detail.aspx?id=9227">personality may become fragmented</a>. The traumatised part of the personality that contains the emotions, thoughts, sensations and experiences relating to the trauma becomes separated from the part of the personality that is trying to get on with daily life.</p>
<p>This <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674068063&content=reviews">allows young children to be with frightening and abusive caregivers</a> they can neither fight nor flee from as they are dependent on them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">Dissociative identity disorder exists and is the result of childhood trauma</a>
</strong>
</em>
</p>
<hr>
<p>The person may have no (or only some) conscious awareness of the compartmentalised memories, thoughts, feelings and experiences. </p>
<p>These may, however, intrude into the person’s awareness. For example, the person may be aware of thoughts, feelings and internal voices that don’t “belong” to them, or may speak or act in ways that are completely out of character.</p>
<p>The most extreme form of structural dissociation is <a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">dissociative identity disorder</a>, once known as multiple personality disorder. This is where the person has at least two separate personalities that exist independently of one another and that emerge at different times.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Hv5VSEVrNrE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Australian actor Toni Collette plays Tara, who has dissociative identity disorder, in the US comedy The United States of Tara. But most dissociative disorders are far less extreme.</span></figcaption>
</figure>
<p>These personality differences are not just psychological. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-recognition-study-of-brain-biomarkers/DCF85A7D69652C06E61524593B266E8C">Neuroimaging confirms structural differences</a> in the brains of people with dissociative identity disorder.</p>
<h2>A controversial diagnosis</h2>
<p>There are two competing theories about what causes dissociation: trauma and fantasy.</p>
<p>With the <a href="https://psycnet.apa.org/record/2012-06384-001">trauma model</a>, dissociative symptoms arise from physical, sexual and emotional abuse; neglect, particularly in childhood; attachment problems if a child fears the caregiver or the caregiver is not adequately attuned to the child’s emotional or safety needs; and other severe stress or trauma, such as experiencing or witnessing domestic violence. </p>
<p>This trauma model is reflected in the <a href="https://icd.who.int/en/">World Health Organisation</a> and <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">American Psychiatric Association</a> past and present diagnostic criteria.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-soldier-and-a-sex-worker-walk-into-a-therapists-office-whos-more-likely-to-have-ptsd-71464">A soldier and a sex worker walk into a therapist’s office. Who's more likely to have PTSD?</a>
</strong>
</em>
</p>
<hr>
<p>However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24773505">fantasy model</a> is based on the idea that dissociative disorders are not “real”. Instead, they are the delusion of people who are troubled (and often traumatised), suggestible, fantasy-prone and sleep-deprived.</p>
<p>Fantasy model theorist <a href="https://www.cambridge.org/core/journals/bjpsych-advances/article/dissociative-identity-disorder-validity-and-use-in-the-criminal-justice-system/C1C27EE9731782570E1376A3EDA48CE4">Joel Paris</a> describes dissociative disorders as a North American “fad” that has nearly died out. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/going-it-alone-adds-to-tertiary-students-high-mental-health-risk-41362">'Going it alone' adds to tertiary students' high mental health risk</a>
</strong>
</em>
</p>
<hr>
<p>Yet <a href="https://www.researchgate.net/publication/334625332">my analysis of 98 studies</a> found rates are not declining. In fact, I found dissociation is an international phenomenon far more common in countries that are comparatively unsafe. This is supported by other research which finds dissociation more common in people that have experienced trauma, such as <a href="https://www.tandfonline.com/doi/abs/10.3109/08039488.2014.977344?src=recsys&journalCode=ipsc20">refugees</a>. </p>
<p>All up, the evidence indicates dissociative disorders are real (not imagined) and caused by trauma (not fantasy).</p>
<h2>Dissociative disorders are under-diagnosed and misdiagnosed</h2>
<p>Even though there are accurate ways of diagnosing dissociative disorders, most people will <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">never be diagnosed</a>. This is due to the lack of health professional education and training about dissociation, the symptoms being less obvious to observers, and scepticism that the disorder even exists. </p>
<p>The person also may not realise they have dissociative symptoms. Even if they do, they may not reveal them due to fear or embarrassment, or may find them difficult to put into words.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Misdiagnosis is common, as symptoms can overlap with ones commonly linked to other mental health issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-discussing-problems-counselor-384224875?src=-yuqkdmIX2ywDOabqmsqcA-1-43&studio=1">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>At least <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/assessment-of-the-prevalence-of-psychiatric-disorder-in-young-adults/5673B18071E22D850EF4E5F3241763FB">three-quarters of people with a dissociative disorder</a> will also have one or more other mental disorders. <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">They may be diagnosed with and treated for other mental health difficulties</a>, such as post-traumatic stress disorder, mood disorders, anxiety disorders, sleep disorders, borderline personality disorder, or psychosis. They may also be treated for addictions, self-harm, and/or suicidal thoughts (<a href="https://www.ncbi.nlm.nih.gov/pubmed/18195639">2% of those diagnosed complete suicide</a>). </p>
<p>They may also be misdiagnosed with schizophrenia because <a href="https://www.ncbi.nlm.nih.gov/pubmed/27209638">hearing voices is common to both</a>.</p>
<p>But their dissociative disorder usually remains undiagnosed. However, treatment for other mental health issues is not likely to be effective unless the underlying dissociation is addressed.</p>
<h2>How to treat? What does the evidence say works?</h2>
<p>The mental health and quality of life of people with a dissociative disorder <a href="https://psycnet.apa.org/record/2012-08580-001">improves</a> significantly with psychotherapy (a type of talk therapy) that recognises the impact of trauma <a href="https://besselvanderkolk.net/the-body-keeps-the-score.html">is physiological</a> (affecting the brain and body) as well as psychological.</p>
<p>In therapy consistent with international treatment <a href="https://www.tandfonline.com/doi/abs/10.1080/15299732.2011.537247">guidelines</a>, people can learn skills to cope with unbearable emotions, thoughts and physical sensations. Once people are stable and have constructive coping strategies, therapists can then help people process traumatic and dissociated memories. Dissociative, post-traumatic, and depressive <a href="https://psycnet.apa.org/record/2012-08580-001">symptoms improve</a>. And hospitalisations, self-harm, drug use, and physical pain declines.</p>
<p>There is no medication that specifically treats dissociation. </p>
<h2>Where to get help</h2>
<p>Dissociative disorders are one of the most common, yet most unrecognised, mental disorders. Symptoms are often debilitating, but significant improvements are possible if the dissociation is diagnosed and treated correctly. </p>
<p>If you are concerned, you can speak to your GP and ask for a referral to a therapist knowledgeable about trauma and dissociation. A list of therapists with this expertise in Australia is available from the <a href="https://www.blueknot.org.au/Helpline">Blue Knot Foundation</a> and worldwide from the <a href="https://isstd.connectedcommunity.org/network/network-find-a-professional">International Society for the Study of Trauma and Dissociation</a>.</p>
<hr>
<p><em>If this article has raised issues for you, or you’re concerned about someone you know, call Lifeline on 13 11 14 or the Blue Knot Helpline on 1300 657 380.</em></p><img src="https://counter.theconversation.com/content/116731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary-Anne Kate received an Australian Postgraduate Award from theDepartment of Education and Training. She is affiliated with International Society for the Study of Trauma and Dissociation. </span></em></p>Dissociation occurs when a person experiences being disconnected from their memories, feelings, actions, thoughts, body and even their identity. And one in ten might be affected.Mary-Anne Kate, Adjunct Associate Lecturer, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/949712018-04-16T04:19:19Z2018-04-16T04:19:19ZMood and personality disorders are often misconceived: here’s what you need to know<p>With each new version of the widely-used manual of mental disorders, the number of mental health conditions increases. The latest version (<a href="https://www.psychiatry.org/psychiatrists/practice/dsm">DSM-5</a>) lists around 300 disorders. To complicate things, many share common features, such as depression and anxiety. </p>
<p>The manual is a useful guide for doctors and researchers, but making a diagnosis is not a precise science. So if the “experts” are still debating what’s what when it comes to categorising disorders, it’s not surprising misconceptions abound in the community about certain mental health conditions.</p>
<p>We learn about mental health conditions in a number of ways. Either we know someone who has experienced it, we’ve experienced it ourselves, read about it or seen something on TV. Movies and TV series commonly portray people with mental illness as dangerous, scary and unpredictable. The most popular (mis)representations are of characters with multiple personalities, personality disorders, schizophrenia and bipolar disorder.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-emotion-centre-is-the-oldest-part-of-the-human-brain-why-is-mood-so-important-63324">The emotion centre is the oldest part of the human brain: why is mood so important?</a>
</strong>
</em>
</p>
<hr>
<p>While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And <a href="http://www.mindframe-media.info/for-media/reporting-mental-illness/evidence-and-research/evidence-about-mental-illness-in-the-media?a=6322">research shows</a> negative images of mental illness in the media (fictional and non-fictional) results in negative and inaccurate beliefs about mental illness. </p>
<h2>Dissociative identity disorder</h2>
<p>“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a <em>dissociative</em> disorder. </p>
<p>A personality disorder is a long-term way of thinking, feeling and behaving that deviates from the expectations of culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behaviour. The individual is usually unable to remember what happened when an alter takes over: there are noticeble gaps in their memory, which can be extremely distressing. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">Dissociative identity disorder exists and is the result of childhood trauma</a>
</strong>
</em>
</p>
<hr>
<p>The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.</p>
<p>While it used to be considered rare, dissociative identity disorder is estimated to affect <a href="https://www.uptodate.com/contents/dissociative-identity-disorder-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis#H1244373">1% of the general population</a>, and is typically related to early trauma (such as childhood abuse). People commonly confuse dissociative identity disorder with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out” and another appears in their place.</p>
<h2>Borderline personality disorder</h2>
<p>Borderline personality disorder is often misconstrued. People with this condition are often portrayed as manipulative, destructive and violent. In reality, these behaviours are driven by emotional pain: the person has never learned to ask effectively for what they need or want.</p>
<p>It is also often assumed “borderline” means the person <em>almost</em> has a personality disorder. The term “borderline” here creates some confusion. <a href="https://www.ncbi.nlm.nih.gov/books/NBK55415">First introduced in the United States in 1938</a>, the term was used by psychiatrists to describe patients who were thought to be on the “border” between diagnoses (mostly psychosis and neurosis). The term “borderline” has stuck in the diagnosis, but there is now a much better understanding of the causes, symptoms and treatment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/borderline-personality-disorder-is-a-hurtful-label-for-real-suffering-time-we-changed-it-41760">Borderline personality disorder is a hurtful label for real suffering – time we changed it</a>
</strong>
</em>
</p>
<hr>
<p>Those with borderline personality disorder have difficulties regulating their emotions. This contributes to angry outbursts, anxiety and depression, and relationships fraught with difficulties. It’s also commonly associated with trauma (such as childhood abuse or neglect). </p>
<p>Many actions of a person with borderline personality disorder (such as self-harm and overdose) are done out of desperation in an attempt to manage difficult and intense emotions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-borderline-personality-disorder-12523">Explainer: what is borderline personality disorder?</a>
</strong>
</em>
</p>
<hr>
<h2>Bipolar disorder</h2>
<p>While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behaviour and suicidal thinking), there are <a href="https://journals.lww.com/co-psychiatry/Citation/2014/01000/Clinical_differentiation_of_bipolar_II_disorder.4.aspx">several key differences</a>. </p>
<p>Bipolar disorder is characterised by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilises. </p>
<p>While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-bipolar-disorder-7502">Explainer: what is bipolar disorder?</a>
</strong>
</em>
</p>
<hr>
<p>Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.</p>
<p>We all have ups and downs, but bipolar disorder is much more than that with extreme, recurrent mood episodes that are not only distressing, but have a significant long-term impact on key areas of a persons’s life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.</p>
<h2>Schizophrenia</h2>
<p>Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not. </p>
<p>Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers) are also common. So too is disordered thinking, where the person jumps from one topic to another at random, or makes strange associations to things that don’t make sense. They may also exhibit bizarre behaviour including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.</p>
<p>Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/either-mad-and-bad-or-jekyll-and-hyde-media-portrayals-of-schizophrenia-12391">Either mad and bad or Jekyll and Hyde: media portrayals of schizophrenia</a>
</strong>
</em>
</p>
<hr>
<h2>Mental health conditions don’t come in neat packages</h2>
<p>Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment. </p>
<p>For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy. </p>
<p>Mental health conditions are serious – whether disorders of personality, mood or somewhere in between. Improved understanding and balanced representation of these conditions is needed to shift stigmas and misconceptions in the community.</p><img src="https://counter.theconversation.com/content/94971/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Media portrayals don’t help misconceptions about disorders such as bipolar, schizophrenia and borderline personality disorder. So what do these terms actually mean?Kathryn Fletcher, Postdoctoral Research Fellow, Swinburne University of TechnologyKristi-Ann Villagonzalo, Postdoctoral Research Fellow, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/638132016-09-29T20:08:14Z2016-09-29T20:08:14ZEveryone’s different: what parts of the brain make our personalities so unique?<figure><img src="https://images.theconversation.com/files/137686/original/image-20160914-4936-1ihm9d6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because everyone is different, psychologists have long debated how to characterise personality.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/beautyisintheeye2/15521669960/in/photolist-pDABHj-aiFiJD-a1XehG-9xrJQt-m7QQgG-agE9Pa-fSXY5-e3eqvr-zbaYaW-gBGYH-7z3iQx-zBwUYH-5jufDb-7seAyF-arMviZ-5jpWYa-8SQ5hq-8FxQQ6-7fBZu1-7z75Dw-pbDV69-kJxsec-4YpHr-8mTCZ3-6AUXhm-7F568S-6Ny7sN-7F5671-5Ly6k3-95E8D5-bBtVH-8SQ4VA-9QCvzw-KG98y-298da-Cxriz1-e8gQ4i-eVnL3r-c5xdef-pkTRug-6HMM3q-CA5dY9-DxpS5N-DvgpUQ-A9xfhH-eiYwS6-8SQ4y5-f83g4R-8SLZP4-kJyHNW">Szoki Adams/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>The brain is key to our existence, but there’s a long way to go before neuroscience can truly capture its staggering capacity. For now though, our <a href="https://theconversation.com/au/topics/brain-control-series-31489">Brain Control</a> series explores what we do know about the brain’s command of six central functions: <a href="https://theconversation.com/what-brain-regions-control-our-language-and-how-do-we-know-this-63318">language</a>, <a href="https://theconversation.com/the-emotion-centre-is-the-oldest-part-of-the-human-brain-why-is-mood-so-important-63324">mood</a>, <a href="https://theconversation.com/were-capable-of-infinite-memory-but-where-in-the-brain-is-it-stored-and-what-parts-help-retrieve-it-63386">memory</a>, <a href="https://theconversation.com/some-people-cant-see-but-still-think-they-can-heres-how-the-brain-controls-our-vision-63323">vision</a>, <a href="https://theconversation.com/how-our-brain-controls-movement-and-makes-new-connections-when-parts-are-damaged-63520">motor skills</a> and personality – and what happens when things go wrong.</em></p>
<hr>
<p>Personality is a broad term describing how people <a href="http://bjp.rcpsych.org/content/150/4/443">habitually relate to the world</a> and their inner self. After the developmental period through childhood and adolescence, these patterns of relating remain reasonably stable through life. They are then <a href="http://www.goodreads.com/book/show/1838804.Psychology">referred to as traits</a> and influence behaviour, thinking, motivation and emotion.</p>
<p>Since everyone is different in their own way, <a href="http://projects.ori.org/lrg/PDFs_papers/Goldberg.Am.Psych.1993.pdf">psychologists have debated</a> how to characterise personality. The most popular approach has so far been to <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev.ps.41.020190.002221">use five dimensions</a>: openness to experience (curious or cautious), conscientiousness (organised or careless), extraversion (outgoing or solitary), agreeableness (friendly or detached) and neuroticism (nervous or secure). </p>
<p>A <a href="http://psycnet.apa.org/psycinfo/1992-25763-001">self-report questionnaire</a> is often used to give a score to each dimension, which then describes someone’s personality. These descriptions have been used to understand normal and abnormal behaviour, and to predict work success, academic achievement and interpersonal relationships. </p>
<p>Both genetic and environmental factors determine someone’s personality. Genes <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1399-0004.1994.tb04214.x/abstract">account for between 30-50%</a> of the determination and the rest is made up largely of environmental experiences unique to the individual. </p>
<h2>History of personality</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1720&fit=crop&dpr=1 754w, https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1720&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/139385/original/image-20160927-20144-15ztr1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1720&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An iron rod was driven through Gage’s head, destroying most of his left frontal lobe and resulting in a profound change in his personality.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Phineas_Gage_GageMillerPhoto2010-02-17_Unretouched_Color_CroppedEmphasizingIron.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Understanding the neurological physiology of personality is sometimes seen as the holy grail of psychology, and was the topic of Sigmund <a href="http://www.ebay.com.au/itm/like/122132968218?lpid=107&chn=ps">Freud’s first paper</a>, Project for a Scientific Psychology, in 1895.</p>
<p>Early developments in this field came from historical case descriptions. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114479/">classical case is of Phineas Gage</a> (1823-60), an American railroad worker who had a large iron rod driven completely through his head in an accident, which destroyed most of his left frontal lobe and resulted in a profound personality change. </p>
<p>After the accident, Gage was described as having become “fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting… little deference for his fellows, impatient of restraint or advice when it conflicts with his desires.”</p>
<p>From this case, the frontal lobes, which occupy the front third of the brain, <a href="http://people.hss.caltech.edu/%7Esteve/files/grafman.pdf">emerged as the seat of higher functions</a> such as judgement, motivation, regulation of behaviour and social consciousness. </p>
<p>Later, in the early 20th century, neuroanatomists identified the limbic lobe – an arc-shaped part of the frontal, temporal and parietal lobes that sits in the middle of the brain – as the seat of emotion. It was recognised as <a href="http://www.springer.com/la/book/9783540346845">making an important contribution</a> to personality. </p>
<p>As our understanding evolved, personality has been regarded as a composite of character and temperament. </p>
<h2>Temperamental traits</h2>
<p>Temperament is understood as the way the body produces behaviour. It <a href="http://www.ncbi.nlm.nih.gov/pubmed/8038587">refers to certain biases</a> an individual has when responding to external stimuli.</p>
<p>A well-established model proposes that whereas personality traits are based on habitual behaviour, temperamental traits are <a href="http://www.lww.co.uk/kaplan-and-sadocks-comprehensive-textbook-of-psychiatry">someone’s predispositions</a> when it comes to four areas: harm avoidance, novelty seeking, reward dependence, and persistence. These are closely related to basic emotions such as fear, anger, attachment and ambition. </p>
<p>High harm-avoidance leads to avoiding behaviours that don’t produce reward or cause punishment; as in people who are shy, uncertain or socially inhibited.</p>
<p>Individuals with such traits have <a href="http://www.ncbi.nlm.nih.gov/pubmed/19904278">increased activity in the fear circuit of the brain</a>, involving the amygdala and other structures of the limbic lobe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/139505/original/image-20160927-30419-1c3barj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Individuals who are shy have high activity in the fear circuit of the brain.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>This activity has been linked to abnormalities in two neurotransmitters: serotonin and γ-amino butyric acid (GABA). Modulating these with drugs – such as selective serotonin reuptake inhibitors (SSRIs that include Prozac) and benzodiazepines, <a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">including Valium</a> – can help people with depressive, anxious and obsessive thoughts.</p>
<p>Novelty seeking leads to exploration and individuals high on this trait are curious, quick-tempered, impulsive and easily bored. They have <a href="http://www.nature.com/neuro/journal/v17/n8/full/nn.3743.html">increased activity in the basal ganglia</a>, which are clumps of neurons sitting in the middle of the brain. This trait has also been linked to the so-called pleasure molecule dopamine, which acts on the basal ganglia, and changes in this pathway are <a href="http://www.ncbi.nlm.nih.gov/pubmed/16715055">associated with seeking novelty in different ways</a>. </p>
<p>People with high reward dependence seek social rewards and are <a href="http://www.ncbi.nlm.nih.gov/pubmed/8038587">likely to be socially sensitive</a> and reliant on social approval. Those low on this trait are tough-minded, cold and aloof.</p>
<p>The temporal lobes of the brain play a major role in how we process social cues, and increased activity in the anterior part of these lobes and in a brain structure called the thalamus has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/21126511">related to higher levels of reward</a> dependence.</p>
<p>Persistence leads to the maintenance of a behaviour despite fatigue, repetitiveness and frustration, and often results in such qualities as industriousness and determination. The regions of the brain particularly important for this include the inner and lower parts of the frontal lobes, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21126511">especially those called the anterior cingulate and the orbitofrontal cortex</a>, and their networks that involve the basal ganglia.</p>
<p>Persistence is loosely related to motivation. Emotion plays a <a href="http://www.ncbi.nlm.nih.gov/pubmed/23329161">major role in maintaining this drive</a>, as basic emotions, such as happiness, tend to energise behaviour and lack of emotion has the opposite effect.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1153&fit=crop&dpr=1 600w, https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1153&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1153&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/139679/original/image-20160929-27026-18nqblu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-emotion-centre-is-the-oldest-part-of-the-human-brain-why-is-mood-so-important-63324">The emotion centre is the oldest part of the human brain: why is mood so important?</a>
</strong>
</em>
</p>
<hr>
<p>Researchers have attempted to examine whether brains of high achieving people, such as Einstein, are different. While there <a href="http://www.ncbi.nlm.nih.gov/pubmed/23161163">have been reports</a> that brain regions involved in numerical and spatial abilities (mid-frontal and inferior parietal regions) were larger and the bundle of <a href="http://brain.oxfordjournals.org/content/early/2013/09/24/brain.awt252">fibres connecting the two halves of the brain</a> (corpus callosum) was thicker, <a href="http://www.bic.mni.mcgill.ca/users/elise/Alberts_brain.pdf">there is no consensus</a> that Einstein’s brain was remarkably different from others. </p>
<p>There is, however, considerable evidence that people with higher intelligence, as measured on psychometric tests, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9246731">have larger brains on the average</a>. Geniuses whose brains have been studied and found to be large include Carl Gauss (mathematician), Rudolf Wagner (composer) and Vladimir Lenin (political leader), although there are also many exceptions to this rule.</p>
<h2>Character</h2>
<p>Character involves an individual’s goals and values in relation to oneself and others. It is the <a href="http://www.ncbi.nlm.nih.gov/pubmed/8038587">conceptual core of personality</a> and involves complex higher functions such as reasoning, abstraction, concept formation and interpretation of symbols.</p>
<p>A network involving the frontal, temporal and parietal lobes is <a href="http://www.cell.com/neuron/abstract/S0896-6273(15)00816-8">important for these functions</a>, with reasoning and abstraction being largely frontal lobe functions, symbolic representation served by the temporal and parietal lobes and formation of new memories facilitated by the hippocampus and the memory network. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-capable-of-infinite-memory-but-where-in-the-brain-is-it-stored-and-what-parts-help-retrieve-it-63386">We're capable of infinite memory, but where in the brain is it stored, and what parts help retrieve it?</a>
</strong>
</em>
</p>
<hr>
<p>Interaction of these networks with regions regulating temperament and emotion leads to the emergence of individual personality. It is important to emphasise that no particular personality characteristic comes from a specific brain region, as the brain operates as a complex network. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=860&fit=crop&dpr=1 600w, https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=860&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=860&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1080&fit=crop&dpr=1 754w, https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1080&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/139507/original/image-20160928-30448-1xniwas.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1080&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People suffering from dissociative identity disorder have been reported to have reduced volumes of the hippocampus and amygdala and reduced activity of the orbitofrontal cortex.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There is also considerable redundancy in these networks, as they have an innate ability to compensate, <a href="http://www.normandoidge.com/?page_id=1259">sometimes referred to as neuroplasticity</a>. An excellent example of neuroplasticity was demonstrated in <a href="http://www.pnas.org/content/97/8/4398.full">London taxi drivers who were shown</a> to have increased grey matter in the back part of their hippocampi – related to spatial representation of the environment - when compared to those who weren’t professional drivers. </p>
<p>Neuroplasticity is <a href="http://www.ncbi.nlm.nih.gov/pubmed/12783955">instrumental in recovery from brain injury</a>, such as after a stroke, when other parts of the brain take over some of the functions of injured regions.</p>
<p>Not uncommonly, a problem in brain development or the failure of adaptive mechanisms leads to the development of personality disorder. This is when a person has an enduring pattern of behaviour and ways of thinking that deviates from social and cultural norms, causing distress. </p>
<p>Researchers have begun to look at the neurological biology of various personality disorders. One subject of interest has been multiple personality disorder, now referred to as dissociative identity disorder. People suffering from this have been reported to have <a href="http://www.ncbi.nlm.nih.gov/pubmed/16585437">reduced volumes of the hippocampus and amygdala</a> and reduced activity of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17961993">orbitofrontal cortex</a>. These have been linked to childhood trauma which results in abnormal regulation of emotion. </p>
<p>While we have come a long way from the days of phrenology, when personality was read by feeling bumps on the head, the neurological biology of normal and abnormal aspects of personality is only beginning to be understood. What is clear though, is that personality comes from a complex neural construct, shaped by genetics and early developmental experiences that influence the structure and function of the brain.</p>
<hr>
<p><em>Read the other articles on Brain Control <a href="https://theconversation.com/au/topics/brain-control-series-31489">here</a>.</em></p><img src="https://counter.theconversation.com/content/63813/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Perminder Sachdev receives funding from the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC). He also has funding support from a number off oundations, including the Vincent Fairfax Foundation, the Holden Foundation, the Yulgilbar Foundation, and the Rebecca Cooper Foundation. </span></em></p>Both genetic and environmental factors determine someone’s personality. Genes account for between 30-50% of the determination and unique environmental experiences making up the rest.Perminder Sachdev, Scientia Professor of Neuropsychiatry, Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/450472015-07-28T02:32:06Z2015-07-28T02:32:06ZPsychopaths versus sociopaths: what is the difference?<figure><img src="https://images.theconversation.com/files/89862/original/image-20150728-7665-1sqj5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Television serial killer Dexter may be more of a psychopath than a sociopath due to his methodically delivered kills.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/pimkie_fotos/3484952865/in/photolist-6iXi5e-4jnui6-9b23AN-7QkLPc-6zeRjJ-9hx2Fa-6HrvLn-7sEQhy-qx8Juu-xA7Yk-7jQUms-7nQdZH-53uZoW-WziUP-dk4uiq-7UneFq-5r6Wzn-5r6W5F-GCr1C-ouSZjv-5r6Wdn-oUyotj-8WGR72-7xLpGf-xAzWK-dk4uzE-8UVdJT-8KCA3H-7nPxUM-9xsSwv-dk4sTB-7vuJif-5r6Wn8-8pWDFi-57Cu3f-6XZhsS-nbZTbj-7aGRzr-5F71sQ-rX1Ufb-GhzY4-pb1iLa-8UheFG-5uZdtm-8uVwGg-5r6WoM-5rbhmo-8uVwAZ-5r6VZa-b1U74i">Pimkie/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Psychopath and sociopath are popular psychology terms to describe violent monsters born of our worst nightmares. Think Hannibal Lecter in <a href="http://www.imdb.com/title/tt0102926/?ref_=nv_sr_1">Silence of the Lambs (1991)</a>, Norman Bates in <a href="http://www.imdb.com/title/tt0054215/">Psycho (1960)</a> and Annie Wilkes in <a href="http://www.imdb.com/title/tt0100157/?ref_=fn_al_tt_1">Misery (1990)</a>. In making these characters famous, popular culture has also burned the words used to describe them into our collective consciousness. </p>
<p>Most of us, fortunately, will never meet a Hannibal Lecter, but psychopaths and sociopaths certainly do exist. And they hide among us. Sometimes as the most successful people in society because they’re often ruthless, callous and superficially charming, while having little or no regard for the feelings or needs of others.</p>
<p>These are known as “successful” psychopaths, as they have a tendency to perform premeditated crimes with calculated risk. Or they may manipulate someone else into breaking the law, while keeping themselves safely at a distance. They’re master manipulators of other peoples’ feelings, but are unable to experience emotions themselves.</p>
<p>Sound like someone you know? Well, heads up. You do know one; at least one. <a href="http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596">Prevalence rates</a> come in somewhere between 0.2% and 3.3% of the population. </p>
<p>If you’re worried about yourself, you can <a href="http://vistriai.com/psychopathtest/">take a quiz to find out</a>, but before you click on that link let me save you some time: you’re not a psychopath or sociopath. If you were, you probably wouldn’t be interested in taking that personality test. </p>
<p>You just wouldn’t be that self-aware or concerned about your character flaws. That’s why both psychopathy and sociopathy are known as anti-social personality disorders, which are long-term mental health conditions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/89865/original/image-20150728-7665-7t46is.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Although most of us will never meet someone like Hannibal Lecter from Silence of the Lambs, we all know at least one sociopath.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What’s the difference?</h2>
<p>Psychopaths and sociopaths share a number of characteristics, including a lack of remorse or empathy for others, a lack of guilt or ability to take responsibility for their actions, a disregard for laws or social conventions, and an inclination to violence. A core feature of both is a deceitful and manipulative nature. But how can we tell them apart?</p>
<p>Sociopaths are normally less emotionally stable and highly impulsive – their behaviour tends to be more erratic than psychopaths. When committing crimes – either violent or non-violent – sociopaths will act more on compulsion. And they will lack patience, giving in much more easily to impulsiveness and lacking detailed planning.</p>
<p>Psychopaths, on the other hand, will plan their crimes down to the smallest detail, taking calculated risks to avoid detection. The smart ones will leave few clues that may lead to being caught. Psychopaths don’t get carried away in the moment and make fewer mistakes as a result.</p>
<p>Both act on a continuum of behaviours, and many psychologists still debate whether the two should be differentiated at all. But for those who do differentiate between the two, one thing is largely agreed upon: psychiatrists use the term psychopathy to illustrate that the cause of the anti-social personality disorder is hereditary. Sociopathy describes behaviours that are the result of a brain injury, or abuse and/or neglect in childhood.</p>
<p>Psychopaths are born and sociopaths are made. In essence, their difference reflects the nature versus nurture debate. </p>
<p>There’s a particularly interesting link between serial killers and psychopaths or sociopaths – although, of course, not all psychopaths and sociopaths become serial killers. And not all serial killers are psychopaths or sociopaths.</p>
<p>But <a href="https://www.fbi.gov/stats-services/publications/serial-murder/serial-murder-1#four">America’s Federal Bureau of Investigation (FBI)</a> has noted certain traits shared between known serial killers and these anti-social personality disorders. These include predatory behaviour (for instance, <a href="http://www.biography.com/people/ivan-milat-17169710">Ivan Milat</a>, who hunted and murdered his seven victims); sensation-seeking (think hedonistic killers who murder for excitement or arousal, such as <a href="http://www.abc.net.au/news/2014-10-24/thomas-hemming-sentenced-over-melbourne-double-murder/5839568">21-year-old Thomas Hemming</a> who, in 2014, murdered two people just to know what it felt like to kill); lack of remorse; impulsivity; and the need for control or power over others (such as <a href="http://www.biography.com/people/dennis-rader-241487">Dennis Rader</a>, an American serial killer who murdered ten people between 1974 and 1991, and became known as the “BTK (bind, torture, kill) killer”).</p>
<h2>A case study</h2>
<p>The Sydney murder of Morgan Huxley by 22-year-old Jack Kelsall, who arguably shows all the hallmarks of a psychopath, highlights the differences between psychopaths and sociopaths.</p>
<p>In 2013, Kelsall followed Huxley home where he indecently assaulted the 31-year-old before stabbing him 28 times. Kelsall showed no remorse for his crime, which was extremely violent and pre-meditated. </p>
<p>There’s no doubt in my mind he’s psychopathic rather than sociopathic because although the murder was frenzied, Kelsall showed patience and planning. He had followed potential victims before and had <a href="http://www.skynews.com.au/news/top-stories/2015/03/18/-worthless-psychopath--guilty-of-murder.html">shared fantasies he had about murdering a stranger</a> with a knife with his psychiatrist a year before he killed Huxley, allegedly for “<a href="http://www.dailytelegraph.com.au/news/nsw/daniel-jack-kelsall-found-guilty-of-morgan-huxleys-murder-indecent-assault/story-fni0cx12-1227267704006">the thrill of it</a>”.</p>
<p>Whatever Kelsall’s motive, regardless of whether his dysfunction was born or made, the case stands as an example of the worst possible outcome of an anti-social personality disorder: senseless violence perpetrated against a random victim for self-gratification. Throughout his trial and sentencing, Kelsall showed no sign of remorse, no guilt, and gave no apology.</p>
<p>A textbook psychopath, he would, I believe, have gone on to kill again. In my opinion – and that of the police who arrested him – Kelsall was a serial killer in the making.</p>
<p>In the end, does the distinction between a psychopath and sociopath matter? They can both be dangerous and even deadly, the worst wreaking havoc with people’s lives. Or they can spend their life among people who are none the wiser for it.</p><img src="https://counter.theconversation.com/content/45047/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Xanthe Mallett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Psychopaths and sociopaths have similar characteristics, lacking remorse or empathy for others. And they can both be violent, deceitful and manipulative. But what are the differences between the two?Xanthe Mallett, Senior Lecturer in Forensic Criminology, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/367802015-03-23T19:16:25Z2015-03-23T19:16:25ZExplainer: what are personality disorders and how are they treated?<figure><img src="https://images.theconversation.com/files/75327/original/image-20150319-1572-fx7wrq.jpg?ixlib=rb-1.1.0&rect=0%2C63%2C640%2C416&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Narcissism is a key trait in the subset of 'dramatic, emotional and erratic' personality disorders.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shellysblogger/2444973188/in/photolist-4J48m9-5yGWfW-qVPfN-6aFL5J-7mgvzk-4cCMaF-2QCHxC-7JKLt-4yCNvz-dZTe8P-76AeMd-5w9Kz-6htQfp-mdn2z-eCUtvR-7nmbBt-48oiUx-f9FzCh-mdqGU-3VkLs-3VkLv-2GHXN-aokpd-7FiNE6-mdmx7-hjkcyS-4xKw-g9mrA-ogDr6A-apr1FT-pwpkWy-5Ky7GE-6Z4RTF-7D9k8c-6cDxG4-oHcsx3-6mQMA2-amSiMy-8zXrV-pehEzB-4Pp4-HcKT-g9YLw-qvn7Z-7DEe5Q-PLeE-2qkDt-2kcgA-dRpyHF-Qps5">ShellyS/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Filmmakers know personality disorders make for compelling viewing. Think of attention-seeking Scarlett O'Hara in Gone with the Wind (1939). Or the manipulation and callous disregard for others in Silence of the Lambs (1991), The Talented Mr. Ripley (1999) and Chopper (2000). Then there are the fears of abandonment and emotional instability in Fatal Attraction (1987) and Girl, Interrupted (1999).</p>
<p>Cinema is less adept, however, at showing the ordinary joys, heartache and sometimes suicidal despair of the friends, workers or relatives we might know with personality disorders.</p>
<h2>What makes a personality ‘disordered’?</h2>
<p>Personality describes individual characteristic patterns of thinking, feeling and behaving. A personality disorder is a class of mental disorders that are diagnosed when these patterns are repeatedly and seriously inflexible and dysfunctional, over an extended period of time. </p>
<p>Personality disturbances have long been recognised through history. Narcissism takes its name from the Greek myth of 50BC. Beautiful Narcissus was transfixed by his reflection in a pool of water. The longer he stared, the more he was driven by both passion and heartache. Over time he died in this state of self-absorbed despair.</p>
<p>People with personality disorders behave and perceive themselves, and others, in a markedly different way to most in their culture. These ideas and behaviours tend to develop in adolescence or early adulthood and are enduring. This can cause significant distress and impairment in all facets of life. </p>
<h2>How common are they?</h2>
<p>Personality disorders represent one of the most prevalent and severe mental health conditions. Around <a href="http://link.springer.com/article/10.1007/s001270050276#page-1">6.5% of Australian adults</a> will have a personality disorder over their lifetime. Data samples of more than 21,000 people worldwide, including Europe, the Americas, Africa and Asia, show a similar prevalence of <a href="http://bjp.rcpsych.org/content/195/1/46.long">6.1%</a>. </p>
<p>About <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.149.2.213">40% to 60% of psychiatric patients</a> have a personality disorder, with similar rates in drug and alcohol units and prisons. </p>
<p>Personality disorders account for about <a href="https://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow177533.pdf">one in four</a> mental health emergency visits and inpatient hospitalisations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75053/original/image-20150317-11980-mvse0t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scarlett in Gone with the Wind is a classic illustration of histrionic personality disorder.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marysolra/12990592524/in/photolist-34D8Yw-bys4k1-nvZrLd-9cXNF6-7ofDdv-bMmKuR-9d1VsC-9d1SDJ-94WHhV-qCEUjM-nvZWVT-nQgqYp-nvZXpt-nLrjx5-nNqTy3-nvZgcW-nvZXDB-bys4os-kMWbzb-7HSegc-nK6enP-qnpjir-poLNBR-9d1Jso-9cXi1r-9d1y9d-9d1xnS-9d1FyY-9d1Ted-9cXN9D-9cXPui-9cXPPZ-4hPBzv-kMWbBL-nNqUdE-nvZrwA-5z4Avj-nvZgHA-nNbMNk-6ZLKvo-bys4sJ-nNtTwz-kMUNsr-bys4mS-nNjhQ5-nQgqoX-qnnXpX-5z4Jqs-nvZqx1-5yZwq2">Razi Marysol Machay/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>How are they diagnosed?</h2>
<p>Personality disorder is a diagnosed mental illness included in both the World Health Organization’s <a href="http://www.who.int/classifications/icd/en/">International Classification of Diseases</a> (ICD-10, 1994) and the American Psychiatric Association’s <a href="http://www.psychiatry.org/practice/dsm">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM-5, 2013). </p>
<p>Although there is considerable individual variation, four broad areas of difficulty are common:</p>
<ul>
<li>regulating emotions, such as sudden surges of anger or despair</li>
<li>disturbed relationships, such as being aloof or overly familiar</li>
<li>confused thinking: difficulty understanding the self and misperceiving others’ intentions</li>
<li>associated problem behaviours, such as impulsiveness with drug use, promiscuous sexual behaviour, or self-harm. </li>
</ul>
<h2>What are the causes?</h2>
<p>Personality disorders appear to have both genetic and environmental causes. Individual genetic differences in temperament and attachment patterns early in life seem to play a role, as some people appear pre-wired to be more hypersensitive or ambivalent about bonding with others. </p>
<p><a href="http://www.psyn-journal.com/article/S0925-4927%2812%2900040-6/abstract">Imaging studies</a> of brain functioning report reductions in amygdala and hippocampal regions, perhaps reflecting the difficulties in regulating emotions and integrating autobiographical memories. </p>
<p>Compounding these difficulties is environmental trauma, including experiences of neglect or abuse during childhood or young adulthood, often found in the histories of those with severe personality dysfunction. </p>
<h2>What are the sub-types?</h2>
<p>There is little consensus among experts about personality disorder subtypes. DSM-5 lists ten, clustered into three groups: </p>
<ul>
<li>the “odd and eccentric” (paranoid, schizoid, schizotypal)</li>
<li>the “dramatic, emotional and erratic” (antisocial, <a href="https://theconversation.com/explainer-what-is-borderline-personality-disorder-12523">borderline</a>, histrionic, narcissistic)</li>
<li>the “anxious and fearful” (avoidant, dependent and obsessive-compulsive).<br></li>
</ul>
<p>Yet a section at the back of DSM-5 proposes to reduce the subtypes to six: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal. This was meant to replace the current ten, but deep divisions in the DSM-5 personality disorder working group (two members resigned) forced the DSM committee to move this proposal into an “emerging measures and models” section. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75048/original/image-20150317-13671-pssz1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Personality patterns are difficult to change.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/genista/699082840">Kai Schreiber/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The ICD-11 system due 2017 will likely replace all subtypes with a single disorder – personality disorder – rated on severity: mild, moderate, severe. </p>
<p>This will help overcome the lack of consensus, as subtypes tend to significantly overlap, and will align the ICD system with <a href="http://health.vic.gov.au/abf/history.htm">activity-based or casemix</a> health funding models. Therefore, a diagnosis of severe personality disorder – whatever subtype – will justify funding longer-term and more intense treatments over those with milder severity. </p>
<p>ICD-11 has not altogether abandoned individual differences, allowing four descriptors, likely to be named dissocial (similar to antisocial), negative affective (similar to borderline), anankastic (similar to obsessive compulsive), and detached (similar to schizoid or schizotypal). </p>
<h2>How are they treated?</h2>
<p>Research over the past 20 years shows that psychological therapies work for many people with personality disorders. The <a href="http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2009.09010039">two-thirds</a> who remain in treatment for a year achieve significant benefits. </p>
<p>But personality patterns are difficult to change. The median duration of evidence-based therapy for adults is about one year – at least 32 sessions – but many require longer programs. </p>
<p>There is little evidence that medications are an effective treatment. </p>
<p>Recently published <a href="https://www.mja.com.au/journal/2013/198/9/improved-prognosis-borderline-personality-disorder">clinical practice guidelines</a> emphasise the importance of intervening early with adolescents. A diagnosis can be made in young people from about age 13 to 15 if problems persist for more than a year. </p>
<p>New models of care are being implemented, including our own <a href="https://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow177533.pdf">step down model</a> to better manage this disorder. This involves offering a brief personality disorders-friendly psychological <a href="https://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow188404.pdf">intervention</a> within one to three days of crisis, followed by assessment and care planning for <a href="https://ihmri.uow.edu.au/content/groups/public/@web/@ihmri/documents/doc/uow189005.pdf">appropriate</a> longer-term support. </p>
<p>This model is based on the findings from recent randomised controlled trials that weekly <a href="http://www.sciencedirect.com/science/article/pii/S0140673614613945">generalist psychological therapies</a> can be as effective as more intensive specialist programs, and are easier to learn and implement.</p>
<p>Psychotherapy can be hard for those involved, especially during the early months, as developing a secure trusting relationship with a psychologist is difficult because of the nature of the disorder. </p>
<p><a href="http://guilfordjournals.com/doi/abs/10.1521/pedi_2013_27_108">Research</a> from our team has demonstrated how ordinary therapists go into consultations with borderline and depressed patients with the same desire to help, but with the former they leave the consultation room more depleted and distressed – even if they are very trained and experienced. </p>
<p>Similarly, family, relatives and carers of people with the disorder <a href="http://guilfordjournals.com/doi/abs/10.1521/pedi_2014_28_136">also report</a> significant emotional burden in their caring role. </p>
<p>Maintaining compassion, hopefulness and patience despite setbacks is important, and better treatments and the experiences of people who have recovered, are now challenging the stigma surrounding personality disorder.</p><img src="https://counter.theconversation.com/content/36780/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brin F.S. Grenyer receives funding from NSW Health to direct the Project Air Strategy for Personality Disorders.</span></em></p>Personality disorders have been richly illustrated by filmmakers. Think of attention-seeking Scarlett in Gone with the Wind. Or the villains in Silence of the Lambs and The Talented Mr. Ripley.Brin F.S. Grenyer, Professor of Psychology, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/368372015-01-29T19:34:01Z2015-01-29T19:34:01ZWhy violent psychopaths don’t ‘get’ punishment<figure><img src="https://images.theconversation.com/files/70370/original/image-20150129-22322-12apw14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Compared to other antisocial people, psychopaths lack empathy and are less able to understand punishment.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-73189654/stock-photo-silhouette-in-a-subway-tunnel-light-at-end-of-tunnel.html?src=qm9bjW3ifZ5JXKSF1oLpqQ-1-1&ws=1">Viktor Gladkov/Shutterstock</a></span></figcaption></figure><p>The psychologist David Lykken <a href="http://books.google.com.au/books/about/The_Antisocial_Personalities.html?id=02EbH9bGEacC&redir_esc=y">once wrote</a> that most violent crime could be prevented by cryogenically freezing all males aged 12 to 28. Although this option might be appealing at times for high school teachers and parents of teenage boys, it has some fairly obvious problems. For one thing, 28-year-old men might react violently, after thawing out, when they realise they’ve been cheated of their youth.</p>
<p>More seriously, the cryogenic solution misses the point that a small minority of men commit the great majority of violent crime. Many of these men meet the diagnostic criteria for <a href="http://en.wikipedia.org/wiki/Antisocial_personality_disorder">antisocial personality disorder</a>. People with this condition have a history of impulsive aggression, risk-taking and irresponsibility that extends back into childhood.</p>
<p>Even within this small group of violence-prone men there is an important minority. Some are <a href="http://en.wikipedia.org/wiki/Psychopathy">psychopaths</a> and some are not. Compared to other antisocial people, psychopaths lack empathy, behave callously and manipulatively towards others, and have difficulty recognising emotional displays. Their aggression is more premeditated and instrumental, calculated to achieve a goal, rather than reactive to provocation. Their offending is more versatile, starts at an earlier age and is harder to rehabilitate.</p>
<p>Psychologists and psychiatrists have long tried to understand the roots of psychopathy, proposing an assortment of moral or emotional deficits to account for the psychopath’s callousness. To explain their impulsiveness, researchers argue that psychopaths lack anxiety, foresight or self-control. These deficiencies leave them unconcerned about the future consequences of their behaviour or unable to restrain their urges.</p>
<p>These explanations are attempts to make sense of psychopaths’ puzzling failure to learn from experience. The popular imagination is now saturated with successful psychopaths – expensively dressed office tyrants, fiendish ex-boyfriends, slick criminals who outwit thick cops – but most repeatedly make foolish decisions and suffer the predictable consequences. Life, often in the form of the criminal justice system, continues to punish them for their misbehaviour, but they fail to learn its lessons. </p>
<p>As psychiatrist <a href="http://en.wikipedia.org/wiki/Hervey_M._Cleckley">Hervey Cleckley</a>, an early authority on psychopathy, wrote, the psychopath’s “execrable judgement is not particularly modified by experience, however chastening his experiences may be”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=486&fit=crop&dpr=1 600w, https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=486&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=486&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=610&fit=crop&dpr=1 754w, https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=610&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/70374/original/image-20150129-22317-pctcsb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=610&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the popular imagination, the ‘successful psychopath’ is eventually caught out.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/the_warfield/4992455554">The_Warfield/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Research published this week in <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00071-6/abstract">The Lancet – Psychiatry</a> uses neuro-imaging in an attempt to clarify why psychopaths fail to learn from punishment. The researchers recruited a sample of 32 men with antisocial personality disorder who had committed murder, rape, attempted murder or grievous bodily harm. Twelve were assessed as high in psychopathic traits and 20 as lower. The researchers also studied 18 non-offender men.</p>
<p>All 50 men completed a “response reversal task” inside an <a href="http://en.wikipedia.org/wiki/Magnetic_resonance_imaging">MRI</a> scanner while researchers recorded their brain activity. Participants first viewed multiple pairs of images, choosing one image each time and winning or losing points for correct and incorrect choices. The correct choices were then changed unexpectedly so that previously rewarded choices were punished and vice versa. </p>
<p>This task offers an experimental analogue of life’s slings and arrows. It also provides a measure of the ability to deal with them in a flexible, adaptive manner. Failure to adapt following the unexpected reversal might reflect the psychopath’s difficulty learning from experience. Indeed, people with damage to the frontal regions of the brain, who have been described as having <a href="https://neurowiki2012.wikispaces.com/Neurobiology+of+Morality#20">“acquired sociopathy”</a>, experience difficulties with the task.</p>
<p>The psychopathic men actually made no more errors on the task than the other groups either before the reversal (which would suggest inferior learning of the correct choices) or after (which would imply inferior unlearning of them). </p>
<p>However, their neural responses to post-reversal errors differed. Compared to the non-psychopathic offenders, the psychopaths showed a stronger response in some brain regions when they were punished for these mistakes. These regions are involved in avoiding negative outcomes and responding to unexpected change. Non-psychopathic offenders and non-offenders did not differ in their brain activation patterns.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/70379/original/image-20150129-22292-ytpuga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The psychopaths showed stronger neural responses when punished for mistakes.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-167475890/stock-photo-mri-of-human-brain-tomography-background.html?src=fBAZphjcAWayAEfmpwK6dw-2-113&ws=1">Andrey Burmakin/Shutterstock</a></span>
</figcaption>
</figure>
<p>These findings suggest that psychopaths respond abnormally to prediction errors, where they expect reward but receive punishment. Contrary to the view that they are cold as stone, insensitive to punishment and untroubled by it, the findings imply the opposite. The psychopaths appeared more bothered and bewildered to be losing points for choices that had previously been winners, rather than coolly accepting that things had changed.</p>
<p>This work adds to the growing evidence that there is something anomalous about how psychopaths process reward and punishment. </p>
<p>However, it also shares some common limitations of neuro-imaging research. Samples are small and the task presents a pale imitation of real-world punishment. </p>
<p>There is also ambiguity about what the brain activation patterns mean. Does the stronger activation among psychopaths imply greater reaction to prediction errors or a dysfunctional network operating inefficiently? </p>
<p>The researchers suggest that their findings might help prevent and treat psychopathy, but offer no concrete proposals about how that might be achieved. One of the challenges of neuroscientific work of this kind is that the distance from brain dysfunction to psychological treatment and social policy is large. </p>
<p>Whether the heart of the psychopath can be unfrozen remains to be seen.</p><img src="https://counter.theconversation.com/content/36837/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Haslam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The psychologist David Lykken once wrote that most violent crime could be prevented by cryogenically freezing all males aged 12 to 28. Although this option might be appealing at times for high school teachers…Nick Haslam, Professor of Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.