Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

BACKGROUND
Most professionals agree that the most helpful approach to
understanding the development of personality disorder is the
biopsychosocial model. This is based on the idea that three
types of factors interact to give rise to personality disorder:
• Biological sensitivities (‘bio’).
• Early childhood experiences with important others (‘psycho’).
• Broader social and environmental factors, including school,
neighbourhood and culture (‘social’).
It is often thought that
trauma and different types
of abuse ‘cause’ personality
disorder because these
experiences figure
prominently in the histories
and narratives of people
receiving help for personality
disorder. However, it has
become clearer from the
results of community studies
that some people suffer
abuse and trauma and do not
go on to develop personality
disorder. It is also true that
some people with personality
disorder have not experienced
significant abuse and trauma
during childhood. Negative
or adverse early experiences
may be much more likely to
give rise to negative
consequences in a person
who is biologically sensitive.
What is biological
sensitivity?
This refers to characteristics of
the individual’s nervous system
that are present at birth, and
are usually genetically
inherited. The human nervous
system is not a machine that
passively responds to inputs
from the environment. The
brain actively organizes
incoming information in a way
that substantially affects
whether and how an event is
experienced. Individuals vary in
their brain’s sensitivity and may
attend to, select and register
the same events very
differently. For example, one
person might feel devastated
and rejected if they arrived for
a doctor’s appointment and
found that the doctor had left
already; for another, this might
be experienced as a small
irritation and a nuisance.
This is part of what we mean by
differences in temperament, or
basic personality predispositions.
It is thought that about half
of the variation between
people in basic temperamental
or personality characteristics is
due to genetic differences. So
that equivalent adverse life events
can be experienced quite
differently by different people.
For example, two twelve year old
boys, Liam and Danny, both live
alone with their mothers who
have developed serious problems
with alcohol. Liam who has an
outgoing, easy temperament,
notices when his mother is
starting to drink to excess and
keeps out of her way, staying
late at school, and inviting
himself to friends for
sleepovers. Danny, who is much
more shy, withdraws into himself,
hides out in his bedroom playing
computer games, and dreads
seeing his mother out-of-control
when she neglects herself and
is verbally abusive to him.
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