personality & mental illness

what is mental illness?

• significant clinical disturbance in cognition, emotion/emotion regulation, or behaviour

• associated with distress & impairment in functioning

• due to biological, developmental, and/or psychosocial factors

what is mental health?

state of well-being involving realizing one’s abilities, coping with life stressors, learning/working well, & constributing to one’s community

explain the mental health/illness diagram

how is society impacted?

• up to 1/8 people will experience mental illness in their lifetime (underestimated)

  • several estimates are as high as 1/5

• ~50% of mental health difficulties emerge by age 14

• ~75% of mental health difficulties emerge by 24

how is stigma tied to mental illness?

a major barrier to help-seeking, treatment, recovery

• public stigma

  • enacted stigma

• self-stigma

  • anticipated stigma

what are the 4 types of stigma?

more extrenal:

• public stigma: negative attitudes/views, prejudices, etc.

• enacted stigma: discrimination, mistreatment (behavioural in nature)

more internal:

• self-stigma: internalization of public stigma

• anticipated stigma: expectation of being stigmatized (with or without prior stigma experiences)

what is the general health questionnaire (GHQ)?

brief but reliable measure of mental health

• social dysfunction + anhedonia

  • poor concentration, feeling disconnected, lack of enjoyment

• depression + anxiety

  • feeling unhappy, overwhelmed, under pressure

• loss of confidence

  • feeling worthless

how is the big 5 associated to mental health?

data from >12k participants

• high neuroticism

  • higher levels of ALL GHQ domains

• lower extraversion

  • higher social dysfunction & anhedonia

• lower agreeableness & conscientiousness

  • higher social dysfunction & anhedonia

• lower openness

  • higher depression & anxiety

what is DID?

• 2 or more distinct identities (aka alters) - each with its own pattern of perceiving, relating to, & thinking about the self/environment

• 2 or more identities recurrently yielded discontinuity in sense of self and thus changes in affect, behaviour, memory, perception, cognition, etc.

• recurrent gaps in memory regarding personal information, daily life events, and/or past trauma (concerning 1 or more identity) - not simple forgetting

what is DID associated with?

PTSD, somatic complaints, depression, anxiety, self-harm, aggression, suicidal behaviour

• rate: ~1.5% (based on DSM-5)

  • rates have been debated historically

what does DID report?

• reports of sexual & physical abuse are common

• as are reports of repressed memories (often in relation to past trauma)

  • 1+ identity is often hostile/aggressive/protective

  • amnesia is common (less so for hostile/aggressive identity)

what are treatments for DID?

psychotherapy

• promote safe, secure environment & help re-integrate identities

• treat comorbid disorders

pharmacotherapy

• treat comorbid disorders & symptoms

what are some personality traits & depression?

several traits often implicated… but they are non-specific risk factors

• high neuroticism

• high self-criticism & perfectionism

• low extraversion/positive emotionality

• low conscientiousness

• part of the personality-depression link may be due to shared etiology

• unlikely that depressive episodes yield enduring personality changes…

• but, personality may affect the course of depression & it treatments

how is depression treated?

• high neuroticism may indicate better response to medication

• high agreeableness may indicate better response to psychotherapy

• high extraversion may indicate better overall response treatment

• high conscientiousness + high openness may indicate better overall treatment response

what is anorexia nervosa?

• persistent restriction of energy intake that yields significantly low body weight (relative to one’s age, sex, developmental stage & physical health)

• intense fear of gaining weight/becoming obese or enduring behaviours that impact weight gain (even in presence of low body weight)

• disturbance in how one views/body shape; very low self-evaluation based on weight; denial/lack of recognition of the seriousness of low body weight

what is bulimia nervosa?

• recurrent binge-eating episodes which include:

  • eating high quantities in short time intervals (more than most:) ~2hrs sense of lack of control over-eating during the episode

• recurrent compensatory behaviour to prevent weight gain

  • induced vomitting, laxative misuse, fasting, excessive exercise

• binge-eating & compensatory behaviour occur >= 1 per week for >= 3 months

• self-evaluation influenced by bod shape/weight

• does not occur exclusively during episodes of anorexia nervosa

explain personality & ED models

what is the predisposition model?

personality traits should predict future ED & trait levels should be higher among those with an ED (even after treatment) vs. those with no ED

• longitudinal data → high levels of neuroticism → predicts ED over 1.5-2 yrs

• pre-post treatment → negative affectivity, drive for thinness, perfectionism, & obsessiveness → reduced but still higher among people with an ED, both pre & post-treatment vs. people with no ED history

• empirical support for → perfectionism + obsessiveness → anorexia nervosa

what is the complication model?

personality traits should be higher among those currently diagnosed vs. recovered

anorexia

• obsessiveness: currently ill » recover » no diagnosis

• over treatment neuroticism decreases, extraversion increases

bulimia

• impulsivity decreases post-treatment

• emotional instability decreases post-treatment

what is the pathoplasty model?

personality impacts the course effectiveness of ED treatment

anorexia

• higher levels of obsessive-compulsiveness & perfectionism may be more difficult to treat

bulimia

• comorbid traits related to borderline personality disorder more difficult to treat

what are major features of BPD?

• unstable self-image

• unstable affect

• unstable relationships

• marked impulsivity