Changes in psychological state in character disordered and neurotic patients

Abstract

This study was prompted "by the suggestion (Foulds, 1967) that hospitalized female character disorders tend to present with an ’’exaggerated” degree of mental suffering and that they would possibly show a markedly rapid ’’improvement” as assessed by psychological tests. In view of the poor prognosis usually carried by these patients it was considered worthwhile to compare the way in which character disorders and a control group of neurotics reacted to hospitalization. It was hoped that such an investigation might cast light on the nature of character disorder. Because of the confusion existing in the area of personality disorder, and because this study followed from Foulds1 work, it was decided to select the character disorders on the basis of a scale of the Symptom Sign Inventory (SSl) which attempts to identify persons having longstanding neurotic conditions marked by interpersonal difficulties, plaintiveness and the arousal of antipathy in those who treat them.

The relationship of these character disorders to the McCords (1964) type of psychopathy was discussed and previous studies involving the SSI character disorder scale were also reviewed, as was the literature on tests used in the present study.

Neurotic and character disordered women in three wards of the Royal Edinburgh Hospital were tested within three days of admission and again two weeks later. Retesting was carried out on twelve neurotics and eleven character disorders. The tests used provided symptom, attitude and trait measures and were chosen for their relevance to previous work.

The main findings were these:- 1) at initial testing character disorders had more symptoms, higher hostility and anxiety and were more expedient and socially naive than neurotics. 2) from test to retest, character disorders declined more than neurotics on symptom measures mainly due to a falling off of symptoms in anxiety and depression but there were no significant changes in general hostility or anxiety, 3) the scores of character disorders fell on acting-out hostility and increased on delusional hostility. 4) at retest only four character disorders would still have been classed as such on the SSI and these patients scored higher than the others on overt, symptomatic anxiety and delusional hostility; they were also more guilt-prone, apprehensive and naïve.

It was suggested that character disorders responded to a crisis with a display of symptoms of depression and anxiety which subsided rapidly, giving the appearance of improvement, but leaving chronic symptomatology and personality problems closely associated with very poor interpersonal relationships.