Rep36 Understanding Personality Disorder

2.2.2a Childhood neglect
Those infants raised in environments lacking in
individual attention, cognitive stimulation,
emotional affection or other enrichment have
consistently shown lower intelligence and a
greater tendency to display autistic spectrum
disorders (Perry, 2002). It is apparent that
childhood neglect leads to physiological changes
in children, with a lack of sensory input in
infancy being associated with decreased brain
size and decreased metabolic activity in the
orbital frontal gyrus, the infra-limbic prefrontal
cortex, the amygdala and head of the
hippocampus, the lateral cortex and in the
brainstem (Perry, 2002). These findings suggest a
global set of abnormalities matched by
functional abnormalities in cognitive, emotional,
behavioural and social functioning. Neglect
during childhood has also been associated with
diagnoses of antisocial, avoidant, borderline,
dependent, narcissistic, paranoid and schizoid
personality disorders (Johnson 
et al
., 1999).
2.2.2b Childhood abuse
A history of childhood abuse or neglect would
appear to be associated with personality disorder.
There is some indication that a history of
physical abuse is associated with antisocial,
borderline, passive aggressive and psychopathic
personality disorders, whereas sexual abuse is
associated with borderline, histrionic and
depressive personality disorders (Johnson 
et al
.,
1999). However, trauma alone is neither a
necessary nor sufficient cause of personality
disorders and other factors including
temperamental vulnerability and multiple
distressing life experiences are also necessary in
their aetiology (Paris, 1996). 
2.2.2c Post-traumatic stress disorder
Post-traumatic stress disorder occurs when an
individual has been overwhelmed by terror and
helplessness. It is manifest as reliving traumatic
events, avoidance of remembering the trauma,
and heightened arousal linked to perceived
threat. Many people abused in childhood have
been placed in terrifying situations where they
have felt helpless. Therefore, it is not surprising
that in clinical settings many individuals with
personality disorder, particularly borderline
personality disorder, are observed to suffer from
post-traumatic stress disorder (Herman, 1992). It
has been observed that neurophysiological
changes take place in individuals with post-
traumatic stress disorder. The speech area of the
left hemisphere of the brain decreases in activity
as the activity of visual cortex and right limbic
and para-limbic systems increase (Rauch, van der
Kolk, Fisler 
et al
., 1996). This could explain the
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tendency towards flashbacks and the difficulty
with speech noted when individuals with
personality disorder attempt to recall traumatic
material (de Zulueta, 1999).