Personality Disorders

1. 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

2. 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

3. 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

4. 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?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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)