Personality Disorder Functioning Style Correlates Of Different States Of Consciousness

BackgroundA personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, moreover, is the underlying variable of the psychological processes and mental disorders. Altered state of consciousness is any condition which deviates from the normal waking state of consciousness and has an increased tendency to produce misrepresentations such as hallucinations, delusions, and memory distortions. These misrepresentations are of great significance in studying clinical mental disorders. Neurocognitive sciences have paid much attention on this phenomenon, however, few on the social psychological factors of the altered state of consciousness, especially the personality disorder. The altered state of consciousness could be occurring spontaneously, evoked by physical and physiological stimulation, induced by psychological means, caused by diseases and induced pharmacologically. Dreaming, hypnosis and psychotic episodes are the paradigm examples of such generally misrepresentational, temporary, and reversible states respectively occurring spontaneously, induced by psychological means, and caused by diseases. Among which, nightmare and panic disorder with comparably severe syptoms are typical examples of dreaming and psychotic episodes. Individuals always experience intense negative emotions in the nightmare, which may influence the social and occupational functions in waking state; a person in a panic attack hardly transforms his/her narrow attention from the physical sense, feeling going crazy or dying, moreover, the loss of control at times escalates into losing consciousness or dispersonalization, and the state of consciousness may also be altered with the intervened psychotherapy; while a person in hypnosis may experience somatoform or cognitive dissociation, part of the cognitive executive function is lost. However, the associations between various personality disorder functioning styles and above three altered states of consciousness remain unknown. Moreover, the measurements of nightmare experience and hypnotic susceptibility need to be further developed or validated. The cognitive-behavioral therapy for panic attack is usually effective, but how personality disorder functioning styles influence it also remains unclear.Aims1. To explore the association between the personality disorder functioning styles and the nightmare experience--an altered state of consciousness occurring spontaneously, meanwhile, to develop a structure-validated questionnaire to measure the nightmare contents and effects of nightmare contents on the physical, psychological and behavioral aspects.2. To explore the association between the personality disorder functioning styles and the hypnosis experience--an altered state of consciousness induced by psychological means, meanwhile, to test the Chinese version of the Stanford Hypnotic Susceptibility Scale:Form C, and to explore the group difference of the hypnotic susceptibility factors between the patients with multiple personality disorder and healthy volunteers. 3. To explore the association between the personality disorder functioning styles and the panic attack--an altered state of consciousness caused by diseases, meanwhile, to explore the association between the personality disorder functioning styles and outcome of cognitive-behavioral therapy for panic disorder.Methods 1. Participants For aim one,321 healthy volunteers completed the study.For aim two,569 healthy volunteers and 43 patients with the multiple personality disorder completed the study. For aim three,30 healthy voluteers and 44 patients with panic disorder (22 treated and 22 in waiting list) completed the study. 2. Instruments The Paker Personality Measure, the Plutchik-van Praag Depression Inventory, the Life Event Scale, the Chinese version of the Stanford Hypnotic Susceptibility Scale:Form C and the self-designed nightmare experience questionnaire were administered to the participants evaluating the personality disorder functioning styles, depression tendency, bad life events, hypnotic susceptibility and nightmare experience. All the panic disorder patients were asked to record their every panic attack using the Panic Attack Record. The panic disorder patients in the treated group were received a highly structured short-term cognitive-behavioral therapy.3. AnalysisBoth exploratory and confirmatory factor analyses were employed to validate the structure of the nightmare experience questionnaire and the Chinese version of the Stanford Hypnotic Susceptibility Scale:Form C, moreover, the internal reliability (the Cronbach alphas) of each scale was calculated by the reliability and item analysis.The repeated measures ANOVA or independent-samples t test was employed to evaluate the gender difference of scale scores of nightmare experience or hypnotic susceptibility; the group difference of the hypnotic susceptibility factors between the patients with multiple personality disorder and healthy volunteers; the group difference of the personality disorder functioning styles or depression tendency between the panic disorder patients and healthy voluteers; the group differences of the mean scores of panic attack intensity, panic attack duration, total-sensation, total-thought, and the total numbers of symptom before and after cognitive-behavioral therapy (or waiting period) between the treated and waiting list groups.The regression analysis was employed to discover the correlations between the personality disorder functioning styles, depression tendency, and bad life events and factors of the nightmare experience.The correlation test was employed to discover the correlations between personality disorder functioning styles and hypnotic susceptibility and its factors, panic attack symptoms (intensity, duration, total-sensation, total-thought and the total number of all the symptoms) before cognitive behavioral therapy (or waiting period) in all patients, and the changes of the above panic parameters after cognitive-behavioral therapy in treated patients. Results1. Nightmare experience, the altered state of consciousness occurring spontaneously, included four factors, namely Physical Effect, Negative Emotion, Meaning Interpretation and Horrible Stimulation. Women scored significantly higher on Negative Emotion and Positive Cognition scales than men did.2. The nightmare experience frequency was positively predicted by the dependent personality disorder functioning style, depression while negatively predicted by the schizoid style; the Physical Effect was positively predicted by the antisocial and borderline while negatively by the avoidant style; the Negative Emotion was positively predicted by histrionic, avoidant styles and bad life events while negatively by the schizoid style; the Meaning Interpretation was positively predicted by the borderline, obsessive-compulsive styles and bad life events; the Horrible Stimulation was positively predicted by the borderline, passive-aggressive styles. 3. The hypnosis, an altered state of consciousness induced by psychological means, included two factors, namely Somatoform Dissociation and Cognitive Dissociation. The Chinese version of the Stanford Hypnotic Susceptibility Scale:Form C was of good reliability and validity. 4. Patients with multiple personality disorder scored significantly higher on the total hypnotic susceptibility scale and the Somatoform Dissociation factor, the schizoid and passive-aggressive personality disorder functioning styles were negatively correlated with the hypnotic susceptibility in a low level, especially the passive-aggressive style was also negatively correlated with the Somatoform Dissociation. 5. Patients with panic disorder scored significantly higher on the antisocial, borderline, histrionic, avoident, dependent, and passive-aggressive styles and on depression. The obsessive-compulsive style was positively correlated with the duration and the total-thought of panic attack, an altered state of consciousness induced by disease, before the cognitive-behavioral therapy or waiting period in all patients. 6. After the cognitive-behavioral therapy, all panic attack symptoms were significantly reduced in the treated group. In treated patients, the decreased panic attack duration was positively correlated with histrionic, obsessive-compulsive and passive-aggressive styles; the decreased total symptom number was positively correlated with antisocial and histrionic styles; the decreased total-sensation was positively correlated with antisocial style; and the total-thought was positively correlated with narcissistic style.ConclusionWe have found that personality disorder functioning styles affect the altered states of consciousness differently. The clusters B and C personality disorder functioning styles with the characteristic of emotional dysfunction (obvious negative emotion) had great effect on the aspects of nightmare experience (an altered state of consciousness occurring spontaneously) and the panic disorder (an altered state of consciousness caused by diseases). The comorbids with antisocial and obsessive-compulsive personality disorders took the positive role on the cognitive-behavioral therapy for panic disorder. While the personality disorder functioning styles made little significant contribution to the hypnosis experience (an altered state of consciousness induced by psychological means).