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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
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
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
borderline personality disorder
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
borderline part 2
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?
dialectical behavior therapy
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
treatment components
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
self mutilation reduction
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
self mutilation reduction part 2
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
the abrasive side
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
treatment effectiveness
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
antisocial personality disorder
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
robert hare
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.
born or made
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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