The neurobiology of affective dyscontrol: Implications for understanding 'dangerous and severe personality disorder' [References]

Abstract

The purpose of this chapter is to explore links between personality disorder (PD), emotional self-regulation and violence. From the perspective of general systems theory, personality and its disorders can be expressed at (at least) three different levels: interpersonal, personal and intrapersonal. The focus of this chapter will be on affective self-control. It has been argued that the major feature of personality disorders is a failure of affect regulation and violence can be said to represent the extreme interpersonal manifestation of dysregulated affect. Some critical questions will be addressed here. Firstly, what is the relationship between PDs and violence? Secondly, what is the relationship between dysregulation of affect and PDs? Finally, and most importantly, how are PDs linked to both affective dyscontrol and violence-that is, what are the mechanisms that mediate any relationship that may exist between PDs on the one hand, and affective dyscontrol and violence on the other hand? The central thesis of this chapter is that the link between PD, affect regulation and violence has to be understood within a developmental context, and particularly within the context of a history of alcohol (and other substance) abuse occurring during adolescence, the period of life during which most young people initiate and escalate alcohol use. Evidence to be reviewed below suggests that neural circuitry involving orbital and lateral prefrontal cortex underlies affective impulsivity or affective dyscontrol (these terms are used here interchangeably). Affective dyscontrol, common to a number of PDs but antisocial and borderline in particular, is said to reflect impairment of this circuitry. While this impairment may, to some degree, be present in pre-adolescent children prior to exposure to alcohol and other drugs in the teenage years, it is argued that exposure to significant amounts of alcohol and other substances during adolescence, for a sufficiently long period of time, results in a progressive and incremental impairment of the neural circuitry underlying affective impulsivity, and hence in impaired emotional self-regulation in adulthood. (PsycINFO Database Record (c) 2016 APA, all rights reserved)