Personality disorders
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Personality Disorders. Lifelong pattern of deviant/maladaptive cognitions, affects, behaviors, interpersonal functioning, impulse control Not a mental illness Incurable Viewed as extreme ends of various personality dimensions. Personality Disorder Clusters. Odd/Eccentric

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Personality disorders l.jpg
Personality Disorders

  • Lifelong pattern of deviant/maladaptive cognitions, affects, behaviors, interpersonal functioning, impulse control

  • Not a mental illness

  • Incurable

  • Viewed as extreme ends of various personality dimensions


Personality disorder clusters l.jpg
Personality Disorder Clusters

  • Odd/Eccentric

    • Paranoid, Schizoid, Schizotypal

  • Dramatic/Erratic

    • Antisocial, Borderline, Histrionic, Narcissistic

  • Anxious/Fearful

    • OCPD, Avoidant, Dependent

  • Theodore Millon and combination PD

  • PD NOS


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Borderline Personality Disorder

  • Instability in mood/self identity

    • Constantly altering aspects of self

  • Feelings of disconnectedness/unloved

    • Fears of being abandoned

    • Testing relationships

  • Manipulative

  • Reactive mood swings (Emotionally Labile)

    • Parasuicide

  • Anger Control Problem

    • Domestic violence

  • Impulsivity

    • Sexual/spending/crime/drug use (patterns of drug use)

    • Self-mutilation


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Borderline Part 2

  • Considered “third rail” of psychology/psychiatry

  • Generally maligned group

  • Like all personality disorders, empirically validated treatments lacking

  • No pharmacological improvement above placebo

  • Secondary mental illnesses, particularly depression

  • Sometimes misdiagnosed as Bipolar

  • More common in women

  • Etiology unknown

    • Combination of chaotic background/genetics?


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Dialectical Behavior Therapy

  • Designed by Marsha Linehan

  • Combines traditional CBT with Zen Buddhism

  • Dialectics

    • Reconciliation of opposites

  • Focus on therapist as consultant to patient, not others (i.e. family, courts)

  • Blends confrontation and supportive approaches to treatment


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Treatment Components

  • Individual therapist

    • 1x/weekly sessions

    • Explore problem behavior

      • Functional “chain” analysis

      • Self monitoring

      • Discussing alternative solutions

      • Exploring why didn’t use alternative solutions

      • Reinforce adaptive behavior

    • Is available by phone contact between sessions


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Self-Mutilation Reduction

  • Viewed as means of replacing emotional pain with “fake pain”, or physical pain that is under control of patient

    • Non-adaptive approach to distraction

  • To replace anger: Engage in physical task. Punch bo-bo doll, crush aluminum cans, make doll (cloth or play-doh) cut or tear instead of self. Exercise

  • Craving sensation, feeling depersonalized: Replace self-mutilation with something that hurts: Squeeze ice-cube for 1 minute. Put ice on spot you want to burn. Slap tabletop hard. Snap wrist with rubber band. Take cold bath

  • Wanting focus: Do other task (cleaning room, play computer game) that requires focus. Find simple object (paper clip) and try to name 30 uses for it


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Self-Mutilation Reduction Part 2

  • Wanting to see blood: Draw on self with red felt pen. Use food coloring bottle (red, naturally) and draw it across area you want to cut as if it were a knife.

  • Wanting to see scars, pick scabs: Use henna tattoo kit. Put henna on as paste. Picking it off when dry feels like scab, leaves red mark like a scar


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The abrasive side:

  • DBT sometimes seen as abrasive

  • Challenging patients

    • Reducing therapy-interfering behavior

      • Lateness/absenteeism

      • Calling at inappropriate hours

      • Attempts to switch topic off of uncomfortable areas

      • Getting patients to take responsibility for actions

    • Consequences of suicidal ideation


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Treatment Effectiveness

  • Small n (1991 paper, 16 in control TAU and experimental group)

  • Effective at reducing self harm/SI

  • Effective at reducing days inpatient hospitalization (8 vs. 38)

  • Reduced treatment drop out (16 vs 50%)

  • Reduced self-reported distress

  • Not a panacea (at least one person in exp. Group committed suicide)

  • More effective than pharmacological or psychodynamic treatments

  • Treatment lasts 1 year


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Antisocial personality Disorder

  • Psychopath/sociopath

  • Lack of conscience

  • Do not learn from punishment

  • Thrill seeking/hedonistic

  • View others as objects

  • View world as “dog eat dog”

  • May be cruel/demeaning

  • Some engage in criminal/violent activity


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Robert Hare

  • APD due to low cortical arousal

    • Particularly in front lobes

    • Boredom tolerance

  • Seen particularly in small % of APD prone to violent behavior “Psychopaths”

  • Diathesis-stress explanations.


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Born or Made?

  • Evidence suggests APD largely inborn

    • “Conduct disorder” in children

  • May be exacerbated by environment

  • Difficult to tell

    • APD may lie about their background

    • Most people with negative backgrounds do not get APD

  • May be constant rate of APD in all cultures across all times

  • No evidence violent media increases APD prevalence (4% men, 1% women)


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