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Chapter Fifteen

Chapter Fifteen. LATE ADOLESENCE TO EARLY ADULTHOOD EMERGENT PERSONALITY DISORDERS Developmental Psychopathology: From Infancy through Adolescence, 5 th edition By Charles Wenar and Patricia Kerig. Personality Disorders represent profound deviations from normal self- development

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Chapter Fifteen

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  1. Chapter Fifteen LATE ADOLESENCE TO EARLY ADULTHOOD EMERGENT PERSONALITY DISORDERS Developmental Psychopathology: From Infancy through Adolescence, 5th edition By Charles Wenar and Patricia Kerig

  2. Personality Disorders represent profound deviations from normal self- development • The pathology pervades the personality or lies within basic structure of the self, instead of being a problem or episode superimposed on it • This disrupts person’s sense of being, view of life, and ways of interacting with the world • Chronic interpersonal relationship difficulties are among primary impairments

  3. DSM-IV-TR Description of Personality Disorder • Enduring pattern of inner experience and behavior that is highly atypical for a culture • Pattern is inflexible and pervasive across broad range of situations • Cognition, affectivity, interpersonal functioning, or impulse control may be significantly impaired • Onset is typically in adolescence or early adulthood and tends to be stable and of long duration

  4. DSM-IV-TR Three Clusters of Personality Disorders • Cluster A • paranoid • schizoid • schizotypal • Cluster B • histrionic • narcissistic • borderline • Cluster C • obsessive-compulsive • avoidant • dependent

  5. Given negative stigma and pessimistic prognosis associated with many personality disorders, coupled with the notion that personality development is still a work in progress in early life, there is generally great reluctance to diagnosis children with a personality disorder

  6. DSM-IV-TR specifies that Personality Disorder diagnosis may be applied to people under age 18 only under exceptional circumstances: maladaptive personality traits are pervasive, long-lasting, and likely to persist across developmental periods

  7. BORDERLINE PERSONALITY DISORDER (BPD) • As example, we explore most widely studied personality disorder: Borderline Personality Disorder (BPD) • DSM-IV-TR criteria for BPD describe pervasive pattern of impulsivity and instability resulting in inconsistent self-image, emotions, and relationships • Highly changeable nature of people with BPD is present across multiple contexts

  8. DSM-IV-TR description of possible characteristics of people with BPD • Extreme distress in response to real or imaged abandonment • Intense and unstable relationships alternating between extremes of idealization and devaluation • Identity disturbance with unstable sense of self

  9. Potentially self-damaging impulsivity • Recurrent suicidal behavior, gestures, threats, and/or self-mutilating actions • Emotional instability and marked mood reactivity • Chronic feelings of emptiness • Difficulty controlling inappropriate, intense anger • Transient stress-related paranoia or dissociation

  10. “Splitting  Perceiving others as ‘all good’ or ‘all bad’ . . .”

  11. Several research groups have described features common to children with BPD • Proposed for inclusion in future DSMs to account for BPD characteristics in children  tentative diagnosis Multiple Complex Development Disorder (MCDD), which would likely be placed under broad category of Pervasive Developmental Disorders

  12. Characteristics of BPD • gender differences • differential diagnosis • comorbidity • developmental course

  13. Etiology of BPD • Individual Context • psychodynamic perspectives • Cognitive Behavioral Theory • emotional regulation and self-harm • Family Context • childhood trauma and maltreatment • parent psychopathology • the family system

  14. Social Context • projective identification • Biological Context • genetics • neurochemistry • neuropsychology

  15. Integrative Developmental Model of BPD (Judd and McGlashan) This developmental psychopathology model suggests BPD’s origins are in early life  development is set off course in infancy, and deviations cascade across all domains of development with cumulative effects over the life span: • biological and environmental contributions • insecure attachment and trauma • cognitive dysfunction • emotional and behavioral dysregulation • insecure and unstable relationships

  16. Intervention for BPD • Psychodynamic Perspectives • Cognitive Behavioral Approaches • Dialectical Behavior Therapy (DBT) • mindfulness • Family Therapy

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