Personality Disorders: Causal Factors of BPD

The cause of Borderline Personality Disorder (BPD) is not clear; but according to research, genetics, brain structure and function; as well as environmental, cultural, and social factors; play a role or may increase the risk of developing the disorder. People with BPD tend to have chaotic personal histories marked by interpersonal strife, abuse, and inconsistent parenting. This history, at times, may reflect their earliest memories (childhood memories).

In a study conducted with those with BPD and healthy participants, the two parties were asked to describe their earliest life memories. When the contents of the research were analyzed, researchers discovered that individuals suffering from Borderline Personality Disorder recalled times they had been treated in a malevolent manner six times more than the other party did. Furthermore, the individuals suffering from BPD had also viewed potential helpers as far less helpful to them.

Many BPD patients' parents are described as abusive, rejecting, and non-affirming; and some theorists suggest that an early lack of acceptance by their parents may cripple their self-esteem and lead to a clinging dependency as well as an inability to cope with separation. As they mature, the behaviours of these individuals tend to evoke negative reactions and rejections from others, which causes them to affirm a sense of worthlessness and a view of the world as being wicked towards them.

Not everyone suffering from Borderline Personality Disorder experiences all these symptoms; some may experience just a few of them, while others experience all of the symptoms. BPD patients may feel distressed by minor separations from the people whom they feel close to (even as simple as a business trip, or visiting a sick relative or friend). The severity and frequency of these symptoms depend on the individual, and his or her illness.

Psychological factors

Psychoanalysts Kernberg and Caligor's focus was on the dramatic changes exhibited by individuals with BPD, in their relationships with other people. Their sudden and vitriolic shifts from extreme love and clinging dependence to intense hate or feelings of abandonment, is a reflection of cognitive process called Splitting: the failure in interrogating negative and positive aspects of another's behaviour (for example, a parent who is mostly accepting but at times, voices disapproval) into a coherent whole.

This may result in BPD patients reacting as if the other person has two separate identities: one deserving of love; and the other, of hatred. Whichever of these seemingly independent images such an individual is reacting to at the moment determines how they relate or feel. Together with severe problems in emotional control, splitting makes for chaotic and unpredictable relationships in such individuals.

Biological factors

Biological factors also seem to play a part in this disorder (Depue & Lenzenweger). Close relatives of BPD individuals, such as siblings and parents, have five times more likelihood of having the disorder than those in the general population with the disorder (Torgerson). The impulsivity and emotional explosiveness of BPD individuals may also be a reflection of some biological abnormality in neurotransmitter systems, or areas of the brain that contribute to emotional self-regulation (Gurvitz).

It seems to be entirely possible that BPD reflects an interaction between biological factors and early history of trauma, rejection, as well as psychological and/or physical abandonment. Sociocultural factors also may contribute to the emergence of the disorder. Cases of Borderline Personality Disorder seem to be more prevalent in rapidly-changing, unstable societies, leaving some of its members with a sense of emptiness, problems with identity, and fear of abandonment.

Although individuals with BPD are said to have experienced traumatic events such as abuse, abandonment, or adversity during childhood, it doesn't necessarily mean that all such individuals would develop the disorder, although it is likely. And even though biological factors do contribute to the development of Borderline Personality Disorder, it doesn't necessarily mean such persons will get the disorder. Moreover, persons with no family history of the disorder could get the disorder nevertheless.

Diagnosis and Treatment

Borderline Personality Disorder was viewed as a difficult disorder to treat in the past, but with newer evidence-based treatment options, BPD patients are able to live better lives with fewer or milder symptoms, as well as improvements in the quality of life. It is important for patients of the disorder to receive specialized treatment from an appropriately-trained provider. Other types of treatment, or treatment provided by doctors or therapists who aren't properly trained, may not benefit these individuals.

It takes time for BPD symptoms to improve, once the treatment is begun; and it depends on many factors, so it is important for such individuals and their loved ones to be patient and to receive appropriate support during the treatment. A licensed mental health professional would be able to diagnose this disorder by; completing a thorough interview, which includes a discussion on symptoms; performing a thorough medical exam in order to rule out other possible causes of symptoms; as well as inquiring about family medical history, including any history of mental illness.

Borderline Personality Disorder may often occur with other mental disorders and hence, co-occurring disorders may make it difficult to diagnose and treat BPD, especially when symptoms of other disorders tend to overlap with it. For example, individuals with BPD may be more likely to experience symptoms of depression, anxiety disorders, Bipolar Disorder, eating disorders, and substance abuse disorders as well. According to studies, individuals who do not receive adequate treatment have a likelihood of developing other chronic mental or physical illnesses, and are more likely to fail in healthy lifestyle choices. They are also at high risk of self-harm and suicide.

Medication is not typically used for BPD patients as the benefits are unclear, but medications may be provided to treat other conditions associated with the disorder, such as mood swings, depression, and other co-occurring disorders. Treatment may be needed from more than one medical professional and medication could cause different side-effects, which need to be discussed with the medical practitioner. Some patients may be severely affected by the disorder and need intensive care, while others may be able to do with just outpatient treatment with no need for hospitalization.

Personality Disorders: Introduction to BPD

Borderline Personality Disorder (BPD) has been the focus of intense interest among clinical researchers due to the chaotic effects it has on the individuals suffering from it, as well as their families and therapists. There may be an occurrence rate of 3 to 5 percent among the general population, and around two-thirds of those diagnosed are women.

Black and White Vision

Individuals suffering from Borderline Personality Disorder see the world as black and white, with no grey areas around. They tend to change the way they feel about a person from one moment to the next, making a person they once adored and respected someone they distrust and despise. Their views and values tend to change rapidly.

Before 1980, the term Borderline was referred to an intermediate level of disturbance between psychotic and neurotic symptoms. However, at present, BPD refers to a collection of symptoms characterised primarily due to serious instability in emotion, behaviour, identity, and interpersonal relationships.

Borderline individuals tend to have intense and unstable interpersonal relationships. They also experience chronic feelings of extreme anger, loneliness, emptiness, distrust (due to the irrational fear of not knowing a person’s intentions); as well as fear of abandonment and momentary loss of personal identity, such as feeling cut-off from oneself or seeing oneself out of their body. They tend to engage in impulsive behaviours, such as going on shopping sprees, running away, promiscuity, binge-eating, as well as drug and alcohol abuse. Their lives are often marked by repetitive self-destructive behaviours such as reckless driving, self- mutilation, and suicide attempts, calling forth saving responses from the people in their lives.

The following is an example of the complex nature of Borderline Personality Disorder:

A 27-year-old married woman with two small children, had undergone a stormy adolescence. She had been forced into sexual relations with a brother six years her senior; whom, at first, she idolised; and later, feared. Their relationship had continued until just before she left home for college, at which time she confessed to her parents about it. In the ensuing emotional turmoil, she made a gesture of suicide (overdose of aspirin) but was hospitalised. 

Outwardly flirtatious, although inwardly shy and ill at ease, she felt intensely lonely, causing her to go through a period of mild alcohol abuse and brief sexual affairs in order to cope with feelings of anxiety and a sense of inner emptiness, which was halted at the age of 19 when she married a classmate and dropped out of school.

For the first few years of marriage, she was fairly at ease. But with the birth of her second child, she became anxious, bored and got into fits of sadness and fearfulness. Her mood started fluctuating from hour to hour and day to day, but the negative feelings were greatly intensified on the 3 or 4 days before her period. As the family expanded, the husband had become less attentive towards her.

As a response, she became increasingly irritable, provocative, and even abusive at times (hurling insults and breaking plates). This resulted in her husband beginning an extramarital relationship, which she eventually discovered. This caused her to get seriously depressed, which caused her a loss of appetite and sleep. She then began abusing alcohol and sedatives and also made several gestures of suicide, including an instance where she cut her wrists. On two occasions, she hid for several nights in motels without informing anyone of her whereabouts (Stone).

Association with Other Disorders

BPD is highly associated with a number of other disorders, which include mood disorders, PTSD, and substance abuse disorders. In one study, BPD's symptoms of impulsivity and emotional instability had predicted recurrent problems in academic achievements and social relationships two years later (Bagge). In one intensive study of 57 individuals diagnosed with BPD, a total number of 42 suicide threats, 40 drug overdoses, 38 episodes of drug abuse, 36 instances of self-mutilation, 36 instances of promiscuity with near strangers, as well as 14 accidents mainly caused by reckless driving, were revealed.

The chaos that marks the lives of BPD patients extends to their relationships with their psychotherapists. These individuals are considered to be among the most difficult patients to treat, owing to their clinging dependency, irrational anger, and tendency to engage in manipulative suicidal gestures and threats as an effort of controlling the therapist (Linehan).

Every individual with Borderline Personality Disorder does not experience all these symptoms. Some may experience a few symptoms, while others experience the whole array of them. Symptoms can be triggered by ordinarily simple events; for example, individuals with BPD may feel angry and distressed due to minor separations from the people they are close to, even if it’s just a business trip. The severity and frequency of symptoms, as well as the lengths of the periods, may vary depending on the individual and their illness.

These behaviours and symptoms occur primarily during a period of elevated mood and energy. Therefore, If you know anyone like this, you may need to consider that they may not be suffering from Borderline Personality Disorder; instead, they may be signs of a mood disorder.

Borderline Personality Disorder, though historically viewed as a difficult disorder to treat; with new evidence-based treatment, many individuals with this disorder suffer fewer or less severe symptoms—and an improved quality of life.

ASPD and Experimental Psychopathology

Punishment seems to have little effect on future destructive behaviour of individuals with Antisocial Personality Disorder (ASPD). One explanation of this is a deficiency in fear of arousal, which appears to cause antisocial behaviour in normal individuals. The lack of fear arousal is a contributor to poor avoidance learning, which in turn causes these individuals to get themselves into trouble, repeatedly.

What would happen if there was a possibility to make people with ASPD more psychologically reactive or fearful? Would it cause their deficiency in avoidance learning to disappear?

Stanley Schachter and Bibb Latane set out to answer this important question.

Method

Schachter and Latane selected two groups of inmates at state prisons on the basis of psychologists diagnoses and life history data. One group consisted of people with ASPD. These prisoners were described by prison psychologists as being completely free from any symptoms of anxiety, lacking any sense of responsibility or shame, being manipulators and habitual liars, able to commit antisocial acts without guilt or remorse, as well as lacking insight and unable to profit from negative experiences.

Most, if not all of these prisoners, would meet current diagnostic criteria for ASPD. A normal (non-psychopathic) group consisted of prisoners matched in age and intelligence, who did not exhibit this pattern of behaviour. Life history data showed that the psychopaths had been arrested more often (8.3 versus 3.3 arrests), and had spent most of their adult lives in prison (36.2% versus 18.1%).

The two groups of prisoners were recruited as paid participants in an investigation of a newly-developed hormone thought to enhance learning. "The researcher used an experimental apparatus which required the participants to learn a complicated mental maze, which consisted of a counter mounted on a metal cabinet, two pilot lights, and four switches.

The maze consisted of 20 choice points. At each choice point, the participant selected one of the four switches. If it was the correct one, a green light flashed and the learner advanced to the next point. If one of the three incorrect switches had been selected, a red light flashed; recording an error on the counter visible to the participant. When the 20th choice point was reached, the procedure began again from the start. The learner repeated the maze 21 times, with the objective being to learn the correct response at each choice point, minimising the total number of errors.

To study avoidance learning, one of the three incorrect switches at each choice point not only activated the red light and recorded an error, but it also resulted in a moderately painful electric shock to the learner. Thus, the learner would do well to learn to avoid not just the correct switch at each point, but also the one that delivered the shock (i.e. to do good and avoid evil).

To manipulate emotional arousal, the prisoners were injected with the experimental hormone, Suproxin, to see if it enhanced learning ability. The prisoners were informed that there would be no side effects. The injection was used to manipulate autonomic arousal. The contents of the injection were adrenaline, which would increase arousal; or placebo, which would inhibit it. Each participant worked until he learned two different mental mazes; one while under the influence of adrenaline and the other, while under the placebo. Half of them received adrenaline on the first maze and placebo for the second. The other half received injections in the reverse order.

Results

In the overall learning, the two groups of prisoners did not differ; their number of responses and errors were similar. This meant they did not differ in ability to learn the positively-reinforced 'correct' responses. Then, a major interest was the avoidance learning measure, which is the ability to learn the positively-reinforced 'correct' responses. Of major interest then, was the avoidance learning measure, (the ability to learn to avoid choosing the switch at each point of choice which would result in an electric shock). The variables of the dependents here were the percentage of incorrect responses made by each participant that resulted in electric shocks. The lower the percentage of shocked incorrect responses, the better the avoidance learning over trials through each maze. 

Avoidance learning under the placebo condition, in which both, those with ASPD and normal prisoners, experienced their normal arousal levels; the normal prisoners made a lower percentage of shock responses during later trips through the maze, indicating avoidance learning. In contrast, the psychopaths showed almost no evidence of learning during their later trials through the maze; they were still as likely to choose the shocked switch as in their previous trials.

If the lack of fear present in those with ASPD underlies their lack of conditioning, what would happen if one artificially increased their arousal levels? When injected with adrenaline, psychopaths showed dramatic evidence of avoidance learning. They actually performed better than the normal prisoners, whose performance on this complex task may have been somewhat impaired by increasing their already-existing fear responses.

Critical discussion

This study was done a half-century ago, but it's still considered a classic. Schachter and Latane tested a clinical explanation for a behaviour disorder under controlled laboratory conditions. They not only demonstrated that the deficiency in avoidance learning was presumed to underlie antisocial behaviour; but also showed that it could be reversed, if there was a possibility to experimentally create psychological arousal, which people with ASPD lacked.

The increased arousal produced by the adrenaline injection had a notable effect on the psychopaths, who learned to avoid even better than the normal prisoners did in the placebo condition. This could be due to the former's arousal in this fear-inducing was different from their normal experience.

It is important, however, to rule out other possible explanations for the results, such as whether the pain was experienced differently due to the injections motivating their shock avoidance? The researchers rule this out with evidence of the two groups' rates of pain being equally unpleasant under both injection conditions. Therefore, the psychopathic and normal prisoners apparently experienced pain equally when shocked.

This study exemplifies a research area known as Experimental Psychopathology, a study process on clinical populations in order to underlie a particular disorder under controlled conditions; such as a laboratory, using state-of-the-art science techniques from other areas of psychology such as social psychology, cognitive psychology, and behavioural neuroscience. This kind of research helps in identifying the mechanisms contributing to behavioral disorders.

It also allows researchers to test hypotheses derived from existing theories of psychopathology and, sometimes, to directly pit competing theories against each other. In this manner, clinical observation informs science, and science helps inform clinical understanding and the hopeful treatment of behavioural disorders.

Personality Disorders: Causal Factors of ASPD

Biological Factors

Research on the biological factors of Antisocial Personality Disorder (ASPD) has focused on both genetic and psychological factors. The concordance rate of genetic predisposition shows a higher evident rate among identical twins than in fraternal twins for ASPD. Adoption study conclusions are similar, too. When researchers compared criminal records of men who were adopted, the rate of criminality was almost twice as high when the biological father had a criminal record and the adoptive father did not—a clear sign of genetic predisposition.

The clue to genetic predisposition factors of antisocial behaviour in individuals could be the relative absence of anxiety and guilt, which seems to characterize Antisocial Personality Disorder. According to many researchers' beliefs, the psychological basis for the disorder may be a dysfunction in the brain structures governing emotional arousal and behavioral self-control. This can result in impulsive behaviour and a clinically under-aroused state; impairing avoidance learning, causing boredom, and encouraging a search for excitement. According to psychological basis, children and adults alike with antisocial behaviour patterns tend to have lower heart rates, particularly under stress.

MRIs of antisocial individuals have shown subtle neurological deficits in their prefrontal lobes—the seat of executive function; which are planning, reasoning, and behavioral inhibition; such neurological deficits are associated with a reduction of autonomic activity. This supports a long-suspected idea of severely antisocial individuals being wired differently at a neurological level, causing them to respond with less arousal and a greater sense of impulsiveness to pleasurable and unpleasurable stimuli alike.

Psychological & Environmental Factors

According to psychodynamic theorists, antisocial personalities are individuals with no conscience. Psychoanalytic theorists believe that such individuals lack anxiety and guilt because they did not develop an adequate superego. The absence of a well-developed superego causes reduction of the restraints on the identity, resulting in impulsive behaviour. Inadequate identification with appropriate adult figures is thought to cause these individuals' failure to develop a strong superego because these figures weren’t either physically or psychologically available to the child. Supporting this position, the absence of the father from home has a higher related incidence of antisocial symptoms in children, even with socioeconomic status equated.

Cognitive theorists believe that an important feature of antisocial individuals is their consistent failure in thinking about—or to anticipate the long-term negative consequences—of their acts. This results in impulsive behaviour, with thought only of their wants of the moment. From this perspective, the key to preventing these individuals from getting themselves into trouble is to help them develop cognitive control (executive function) necessary to think before acting. Learning through modelling can play an important role too.

Many antisocial personalities come from homes of aggressive and inattentive parents. Such parents become role models for aggressive behaviour and disregard for others' needs. Another important environmental factor is exposure to deviant peers. Antisocial children often learn some of their deviant behaviour from peer groups that help model antisocial behaviour and reinforce it with social approval. When environmental factors are combined with a possible genetic predisposition for antisocial behaviour, it clearly encourages a pattern of deviant behaviour.

According to the learning explanations of some biological theorists, it suggests that individuals with antisocial behaviour lack impulse control. Learning theorists believe that the reason for poor impulse control in these individuals occur due to impaired ability to develop conditioned fear responses when they are punished. This results in a deficit of avoidance learning. Hans Eysenck said a person's ability to develop a conscience depended on that person’s ability to learn fear and inhibitory avoidance responses. Individuals who fail in these aspects will have less ability to inhibit their behaviour.

Clinical studies

In accordance with this hypothesis, Adrian Raine and his co-workers did a 14-year follow-up on males who had been subjected to classical conditioning at the age of 15, in which a soft tone had been used as the conditioned stimulus (CS) and a loud averse tone as the unconditioned stimulus (UCS). Conditioned fear was measured by the participant’s skin conductance response when the CS occurred after a number of pairings with the loud UCS. According to the research findings, the men who accumulated a criminal record by the age of 29 had shown poorer conditioning at the age of 15 than those with no criminal record.

According to further studies, major damage to the grey and white matter in the prefrontal cortex, as well as autonomic deficits, can result in pseudo-psychopathic personality in patients with neurological disorders, but it is not known whether individuals with antisocial personality disorder in the community, with no discernible brain trauma, also have subtle prefrontal deficits.

When prefrontal grey and white matter volumes were assessed using structural magnetic resonance imaging in 21 community volunteers with ASPD; as well as in two control groups which comprised of 34 healthy subjects, 26 subjects with substance dependence, and 21 psychiatric controls. The autonomic activity of (skin conductance and heart rate) was assessed during a social stressor in which the participants gave a videotaped speech of their faults.

The ASPD group showed an 11 percent reduction of prefrontal grey matter volume in the absence of ostensible brain lesions and reduced autonomic activity during the stressor. These deficits were a prediction of group membership independent of psychosocial risk factors. These findings are said to be the first evidence of structural brain deficits in ASPD. This prefrontal structural deficit may underlie the low arousal, poor fear conditioning, lack of conscience, and decision-making deficits known to characterize antisocial behaviour.

Personality Disorders: Introduction to ASPD

People diagnosed with personality disorders exhibit stable, ingrained, inflexible and maladaptive thinking, feeling, and behavioural patterns. When encountered by situations where their typical pattern of behaviour does not work, their inappropriate coping skills are likely to intensify, causing their emotional controls to breakdown and unresolved conflicts to reemerge.

Personality disorders happen to be an important part of the DSM (Diagnostic and Statistical Manual of Mental Disorders) system due to the increased likelihood of them acquiring several Axis I (symptom) Disorders, particularly depression, anxiety, and substance abuse. They are also associated with a poorer recovery course from such disorders. Ann Mason and her coworkers followed anxiety patients for five years. They discovered that those who were diagnosed with additional personality disorders were 30 to 40 percent less likely to recover from their anxiety disorders.

There are ten personality disorders in the Axis II Disorders, which are divided into three clusters capturing important commonalities: dramatic and impulsive behaviours, anxious and fearful behaviours, as well as odd and eccentric behaviours.

In Europe and America, around 10 to 15 percent adults may have personality disorders. A study conducted in Norway on personality disorders has found that 13.4 percent of the condition equally distributed among both genders. The most frequently encountered were paranoid, histrionic, avoidant, and obsessive-compulsive personality disorders.

Among these personality disorders, the most destructive to society is Antisocial Personality Disorder.  Therefore, this disorder has got the most attention from clinicians and researchers over the years. A second personality disorder that attracts a great deal of attention is Borderline Personality Disorder.

Antisocial Personality Disorder (ASPD)

In the past, people with ASPD were referred to as 'sociopaths' or 'psychopaths': such terms are still in use today, though not for the purpose of formal diagnosis. In the 19th century, at times, such individuals were referred to as moral imbeciles. Individuals with Antisocial Personality Disorder are among the most inter-personally destructive and emotionally-harmful individuals. Men outnumber women by 3 to 1 according to diagnosis.

Individuals with Antisocial Personality Disorder show lack of conscience: they exhibit less guilt and anxiety, and tend to be impulsive and unable to delay gratification of their needs. They lack emotional attachment towards others. For example, a report from a person diagnosed with the disorder was as follows:

When I was in high school, my best friend died of leukaemia, and I went to his funeral. Everybody there was crying...but I suddenly realised that I didn't feel a thing. That night, I thought more about it and realised I wouldn't miss my parents if they were to die. I also realised that I didn't care for my siblings either. There was no one I cared for, but I didn't need any of them to begin with, so I rolled over and slept.

The lack of capacity to care about others may make antisocial individuals a danger to society. For example, murderers such as Ted Bundy, Charles Manson, and Jeffrey Dahmer failed to show remorse for the crimes they committed, or sympathy for their victims.

Behavioural contradictions

Antisocial individuals may often verbalise feelings and commitments with great sincerity, but their behaviours tend to indicate otherwise. They often appear to be very intelligent and charming. They also have the ability to rationalise their inappropriate behaviour, making it appear reasonable and justifiable. Consequently, they often tend to be virtuosos at manipulating others in order to talk their way out of trouble.

The aforementioned antisocial characteristics can be reflected in psychological test responses and in social behaviours. According to the Multiphasic Personality Inventory (MMPI) profile of Milwaukee killer Jeffrey Dahmer, over a period of three years, he killed and dismembered at least 17 male victims. He slept with the dead bodies, engaged in sexual acts with them, stored body parts in jars and cannibalised many of them. He was convicted for the serial murders, for which he was sentenced to 1,070 years in prison.

According to MMPI expert Alex B. Caldwell, several aspects of this profile can help explain Dahmer's bizarre and destructive behaviour. His extraordinary high score on the psychopathic deviate scale is a reflection of antisocial impulsiveness coupled with a total lack of capacity for empathy and compassion. In all likelihood, his victims were regarded as no more than objects to satisfy his perverse needs.

Depression-Anxiety Discrepancies

According to Caldwell, there was a marked discrepancy between the depression and psychasthenia (anxiety) scales, which is rarely seen on the MMPI, reflecting Dahmer's sense of being fated or doomed to repeat his acts until he's caught: the high depression score, together with an absence of fear that, in normal people, may inhibit murderous behaviour (the low psychasthenia score).

Even though his profile was an indication of his high levels of psychological disturbance, it also reflects Dahmer's ability to mask his pathology under the normal facade which he used for years to fool law enforcement officials. Dahmer's general demeanour looked so normal that despite the horrific acts and the level of psychopathology shown in his results, his plea of not guilty by reason of insanity was rejected by the jury. Instead, he was sent to prison, where he was murdered by another inmate.

Individuals with antisocial personalities tend to display a perplexing failure in response to punishment due to their lack of anxiety, making the threat of punishment not a reason to deter from engaging in self-defeating or illegal acts over and over. This results in some of them developing imposing prison records.

An individual has to be at least 18 years old to be diagnosed with antisocial personality disorder. However, there is a requirement of substantial diagnostic criteria before the age of 15, which includes acts of habitual lying, excessive drinking, use of drugs, theft, vandalism, early and aggressive sexual behaviour, and chronic rules violations at home and school. Thus, Antisocial Personality Disorder is the culmination of deviant patterns of behaviour typically beginning at childhood.

Causal Factors of Schizophrenia

Schizophrenia has long been a focus of research due to the seriousness of the disorder as well as the many years of anguish and incapacitation experienced by the patients. Predisposition to schizophrenia is high if an immediate family member has the disorder, but there are chances of developing Schizophrenia even without a family history of the disorder.

Biological factors

Genetic predisposition:

Strong evidence exists of genetic predisposition to schizophrenia, but some develop the disorder without family history. The more closely an individual is related to a person with the disorder, the higher the chances are of him developing it. According to studies, identical twins have a higher rate of developing the disorder than fraternal twins. Adoption studies show a higher concordance with biological parents than with adoptive parents.

But genetics is not the only cause; if it was, the concordance rate of schizophrenia in twins would be at 100 percent. Schizophrenia develops in adulthood. Men develop symptoms of schizophrenia in their late teens or early twenties, while women show symptoms of the disorder in their twenties or thirties. More subtle signs of the disorder maybe present earlier, such as poor performance in school, troubled relationships, and lack of motivation.

Brain abnormalities:

Brain scans of such individuals indicate a number of structural abnormalities. According to the Neurodegenerative Hypothesis, the destruction of neural tissue can cause schizophrenia. MRI studies have shown mild to moderate brain atrophy; a general loss or deterioration of neurons in the cerebral cortex and limbic system, together with enlarged ventricles (cavities containing cerebrospinal fluid).

The atrophy is centered in the brain region influencing cognitive process and emotion. This may explain the thought disorders and inappropriate emotions seen in such patients. Likewise, MRI images of the thalamus, which collects and routes sensory input to various parts of the brain, reveal abnormalities as well. This may help account for the disordered attention and perception reported by the patients whose cerebral cortex may be getting garbled with unfiltered information of the thalamus. These structural differences are more common in patients exhibiting negative symptoms.

Biochemical factors:

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the Dopamine Hypothesis, the symptoms of schizophrenia, specifically the positive symptoms, are produced by overactivity of the dopamine system in areas of the brain which regulate emotional expression, motivational behaviour, and cognitive function.

Individuals diagnosed with schizophrenia have more dopamine receptors on neuron membranes than non-schizophrenics. These receptors seem to be overactive to dopamine stimulation and additionally, the effectiveness of antipsychotic drugs used to treat this disorder are positively related to their ability to reduce dopamine-produced synaptic activity. Other neurotransmitter systems could be involved in this complex disorder, too. Considering the biochemical and brain findings concerning schizophrenia, it is not clear whether they cause the disorder or vice versa.

Psychological factors

Freud and other psychoanalytic thinkers' view of schizophrenia was that it is a retreat from unbeatable stress and conflict. To Freud, schizophrenia represented an example of an extreme defence mechanism of regression, in which such a person retreats to an earlier and more secure (even infantile stage) of psychological development, when faced with overwhelming anxiety. Other psychodynamic thinkers, focusing on the interpersonal withdrawal, which is an important feature of schizophrenia, tend to view the disorder as a retreat from an interpersonal world that’s too stressful to deal with.

Even though Freud’s explanation on regression hasn’t received much direct research support, the belief of stress as a causal factor is accepted today. Some cognitive theorists believe that people with schizophrenia have a defect in the attention mechanism which filters out irrelevant stimuli, making them feel overwhelmed by both internal and external stimuli and in turn, causing sensory input to become a chaotic flood, resulting in irrelevant thoughts and images flashing into consciousness. The stimulus overload produces distractability, thought disorganisation, and a sense of being overwhelmed by disconnected thoughts and ideas.

As one schizophrenic noted, “Everything seems to come pouring in at once…I can’t seem to keep  anything out” (Carson). The recent MRI findings on thalamic abnormalities described earlier may help explain how the stimuli overload could occur through a malfunction of the brain's switchboard.

Environmental factors

Stressful life events seem to play an important role in the emergence of schizophrenic behaviour. Two to three weeks preceding a 'psychotic break', when acute signs of schizophrenia appear, these events tend to cluster. Stressful life events seem to interact with such a person's personality or biological vulnerability factors. A highly-vulnerable individual may require just a small stressful event to reach the breaking point. In a study, psychotic and non-psychotic individuals rated their emotional responses as they encountered stressful events in their daily lives. The psychotic individuals' reactions to their stresses were more intense with negative emotions, suggestive of emotional overactivity being a vulnerability factor.

Family dynamics have for long been a prime suspect in the origins of this disorder, but the search for characteristics of a parent or family causing the disorder has largely been unsuccessful. Significantly, children with biologically normal parents who are raised by adoptive parents with the schizophrenic disorder do not show an increased risk of developing the disorder. Although schizophrenic individuals often are from families with problems, the nature of the seriousness of such problems is not different from those of which non-schizophrenics are raised.

This does not mean that family dynamics are unimportant; it may just mean that a person must have a biological vulnerability factor in order to be affected by stressful family events to such a degree. There is indeed evidence that this vulnerability factor may appear early in life. In a study conducted by researchers, pre-schizophrenic children and their non-schizophrenic brothers and sisters were analysed using home movies of schizophrenic children. Even at these early ages, sometimes a child as young as two years old seem to show more odd and uncoordinated movements and less emotional expressiveness, especially for positive emotions. These odd behavioural patterns may not just reflect a vulnerability factor, but may also help create environmental stress by evoking negative reactions from others.

Although researchers have had difficulty pinpointing family factors contributing to the initial appearance of this disorder, one finding is consistent of previously-hospitalised schizophrenics being more likely to relapse when returned to a home environment that is high in a factor called 'Expressed Emotion'. Expressed emotion involves high levels of criticism, hostility, and over-involvement. One review of 26 studies showed that within 9-12 months of returning home, an average relapse of 48% in patients with  families who were high in expressed emotion, compared with a relapse rate of 21% with families that were low in this factor.

However, before we conclude on high expressed emotions causing relapses in patients, there is a finding from another study worth noting; which are videotapes of actual interactions between patients and their families. Analysis of the videotapes revealed that families who were high in expressed emotion did indeed make more negative comments to patients when they engaged in strange behaviours, but they also showed these patients behaving around four times as many strange behaviours, clouding the issue of what causes what. Thus, high expressed emotion may be a cause of a response to these patients' disordered behaviours; because people with this disorder can be overly sensitive to stress and even mildly negative family reactions could trigger underlying biological vulnerabilities, resulting in a relapse.

Sociocultural factors 

Sociocultural factors are undoubtedly linked to schizophrenia. According to many studies, the highest prevalence of schizophrenia is found in lower socioeconomic populations.Why is this? Is schizophrenia caused due to poverty, or is it an affect of the disorder? Two views tend to give opposite answers. The Social Causation Hypothesis attributes the higher prevalence of schizophrenia  to the higher levels of stress experienced by low-income people, particularly in urban environments.

In contrast, the Social Drift Hypothesis proposes that with the development of schizophrenic disorder, these individuals' personal and occupational functions tends to deteriorate, causing them to drift down the socioeconomic ladder into poverty and migrate to economically depressed urban environments. Perhaps both social causation and social drift maybe at work, for the factors linking poverty, social and environmental stressors, as well as schizophrenia, are undoubtedly complex.

In contrast to most disorders, schizophrenia may be a culture-free disorder. According to a worldwide epidemiological study sponsored by the World Health Organisation, the prevalence of schizophrenia  is not dramatically different throughout the world. Researchers have, however, found that the likelihood of recovery is greater in developing countries than in the developed nations, such as North America and Western Europe. This may be due to stronger community orientation and greater social support extended to disturbed individuals in developing countries.

Schizophrenia reflects complex interactions among psychological, biological, and environmental factors and presents prominent causal factors identified by analysis. Some patients do well with treatment and live productive lives, while others continue to be symptomatic. As this disorder starts in early adulthood, these individuals can benefit from rehabilitation and help them develop management skills, complete education or vocational training, and hold onto a job. This helps with self-sufficiency in people afflicted with schizophrenia.

There is no cure for schizophrenia, but management of symptoms with medication, cognitive behavioural therapy, and supportive psychotherapy. Substance abuse is high in schizophrenic patients, owing to the misuse of drugs, which can make diagnosis harder.

Schizophrenia: The Split Mind

According to Hogarty, schizophrenia is the most bizarre and, in many ways, the most puzzling of all psychological disorders. It is also one of the most challenging disorders to treat effectively. Despite many theories and thousands of research studies, schizophrenia remains one of the least understood disorders.

Schizophrenic symptoms include severe disturbances in thinking, speech, perception, emotion, and behaviour. Schizophrenia is one of a family of psychotic disorders which involve a certain amount of loss of contact with reality and bizarre behaviours and experiences.

The term 'Schizophrenia' was introduced by Swiss psychiatrist Eugene Bleuler in 1911. It literally means 'split mind'. This has led people to confuse it with Dissociative Identity Disorder (Multiple Personality Disorder). However, when Bleuler came up with the term 'Schizophrenia', multiple personalities were not on his mind. What he intended to suggest was that certain psychological functions such as emotions, thoughts, or languages; which are usually integrated with one another; were somehow split apart or disconnected in patients with the disorder.

Characteristics of Schizophrenia

Diagnosis of schizophrenia is based on evidence that such a person misinterprets reality and exhibits disordered attention, thought or perception. In addition, this individual will withdraw from social interactions, communicate in strange or inappropriate ways, neglect personal grooming, and behave in a disorganised fashion.

Schizophrenic thoughts tend to be delusional at times, which consist of false beliefs sustained in the face of evidence that normally could be sufficient to destroy them. An individual with schizophrenia may tend to believe that his brain is being turned to glass by ray guns operated by his enemies from outer space (a delusion of persecution or that Jesus Christ is one of his special agents or a delusion of grandeur). During the period of recovery, a patient with schizophrenia described several aspects of thought disorders.

The most wearing aspects of this disorder are the fierce battles going on inside their heads with unresolvable conflicts. Their minds can divide on a subject, and the two parts can subdivide over and over again until they feel as if their minds are in pieces. At other times, they may feel like they are trapped inside their heads, banging against its walls in a desperate attempt to escape.

As individuals progress into schizophrenic condition, their perception becomes disorganised and their discarded thoughts tend to become more pronounced. Unwanted thoughts constantly tend to intrude their consciousness. Some patients experience hallucinations; false perceptions with a compelling sense of reality. Auditory hallucinations, which are typically voices speaking to such patients, are the most common, but visual and tactical hallucinations may occur, too. The following is an individual's description of his hallucinations:

As of recent, my mind has played tricks on me, creating people inside my head who come out at times to haunt and torment me. They surround me in rooms, hide behind trees and under the snow outside. They taunt me and scream at me while devising plans to break my spirit. The voices tend to come and go, but the people never leave and are always real.

The language of schizophrenic people is often disorganised and may contain strange words. A patient's language, at times, may contain word assassinations based on rhymes or other associations, rather than meaning. Consider the following conversation between a psychologist and a hospitalised  schizophrenic patient:

After two weeks, the psychologist said to the patient, "As you say, you are wired precisely wrong. But why won't you let me see the diagram?" The patient answered, "Never ever will you find the lever; the external lever which will sever me forever with my real, seal, deal, heel. It is not in my shoe, not even in the sole. It walks away." (Rosenhan &Seligman).

Schizophrenia can affect emotions in a number of ways. Many individuals with schizophrenia have Blunted Affect. Manifesting less sadness, joy, and anger than most people do. Others have a Flat Affect, showing almost no emotions at all. Their voices are monotonous, their faces impassive. Inappropriate Affect can occur, too, as in the following case:

The psychologist noted that the previous patient smiled when he felt uncomfortable, and more so when he was in pain. He cried during television comedies and seemed to be angry when justice was served. He got frightened when complimented by someone, and roared in laughter upon reading of a young child being burnt in a fire.

Subtypes of Schizophrenia

Schizophrenia has cognitive, emotional and behavioural facets that can widely vary from case to case. The Diagnostic and Statistical Manual of Mental Disorders differentiates among four major subtypes of schizophrenia.

• Paranoid Schizophrenia, whose most prominent features are delusions of persecution, making them believe that others want to harm them, and delusions of grandeur, which makes them believe that they are of enormous importance. Suspicion, anger or anxiety may company their delusions, and hallucinations are also possible. 

• Disorganised Schizophrenia, whose central features happen to be confusion and incoherence, together with severe deterioration of adaptive behaviours such as social skills, personal hygiene, and self-care. Their thought disorganisation, at times, is so extreme that it makes it hard to communicate with them. At times, their behaviour appears to be silly and childish, with emotional responses that are highly inappropriate. Individuals with disorganised schizophrenia are usually unable to function on their own.

• Catatonic Schizophrenia is characterized by striking motor disturbances which range from muscle rigidity to random or recitative movements. Individuals with repetitive schizophrenia, at times, alternate between stuporous states, in which they seem to be oblivious to reality, and agitated excited, during which they can be dangerous to others. During this stuporous state, they may exhibit waxy flexibility, in which their limbs can be moulded by another into grotesque positions, which can be maintained for hours.

Undifferentiated Schizophrenia is a category assigned to individuals who exhibit some symptoms and thought disorders of the above categories.

In addition to these categories, many health workers and researchers divide schizophrenia reactions into two main categories on the basis of two classes of symptoms. One type is characterised by a predisposition of positive symptoms, which are bizarre behaviours like delusions, hallucinations, and disordered speech and thinking. These symptoms are called positive in the account of them representing the pathological extremes of normal processes. The second type features are negative symptoms, which is the absence of normal reactions such as the lack of emotional expression, loss of motivation, and an absence of speech.

The distinction between positive and negative symptoms seem to be an important one. Researchers have found differences in brain functions in both schizophrenics with positive symptoms and primarily negative symptoms. These subtypes show differences in life history and prognosis, too. The negative feelings are likely to be associated with a long history of poor functioning prior to diagnosis, and a poor outcome following treatment.


Schizophrenia affects around 1 percent of the world's population and 1.2 percent of Americans have schizophrenia. Some who are not hospitalised barely function on their own.