Perspectives onPersonality Disorders

1) Biological 2) Psychoanalytic 3) Cognitive 4) Interpersonal 5) Evolutionary 6) Statistical 7) Descriptive

Perspectives

Biological Approaches

*Temperament◦ that which is inherited◦ present before learning has occurred

Character◦ that which is learned

Dimensions of Personality

A person’s characteristic mode of responding emotionally and behaviorally to environmental events

Dimensions: (genetically influenced)◦ Activity level◦ Negative emotionality◦ Soothability◦ Fearfulness◦ Sociability

Temperament

Activity level Irritability Sociability/shyness

Moderately stable through infancy, childhood, and even adulthood

Stability of Temperament

Thomas and Chess (1960s) N = 141, New York longitudinal study

1. Easy temperament (40%) 2. Difficult temperament (10%) 3. Slow to warm up (15%) 4. Hard to classify (35%)

Temperament Profiles

An Integration

EASYEASY

Slow to warm up Difficult

Behavioral Inhibition (Kagan)

FearfulnessNegative Emotionality

Sociability

Robert Cloninger

Novelty seeking - dopamine Harm avoidance - serotonin Reward dependence - norepinephrine

Biological Approaches

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Cloninger

Temperament Factors◦ Novelty Seeking (exploratory activity)◦ Reward Dependence (respond to signals of reward)◦ Harm Avoidance (behavioral inhibition)◦ Perseverance (in spite of fatigue, frustration)

Character Factors

◦ Self-Directedness (drive toward goals)◦ Cooperativeness (acceptance of others)◦ Self-transcendence (seeing totality of situation)

Cloninger (1993)

Temperament and Character Inventory – 226 items

“psychobiological model”

1) cognitive/perceptual organization 2) impulsivity aggression 3) affective instability 4) anxiety/inhibition

Siever and Davis (1991)

Cognitive/perceptual organization

◦ Disorganization of thought◦ Social isolation and detachment◦ Guardedness

◦ Schizophrenia (I)◦ Schizotypal, Paranoid, Schizoid (II)

Siever and Davis

Impulsivity and Aggression

◦ Outbursts of anger, suicide attempts◦ Violation of social standards

◦ Depression, Impulse control, drug abuse (I)◦ Borderline, Antisocial (II)

Siever and Davis

Affective Instability

◦ Rapidly shifting moods

◦ Mood Disorders (I)◦ Borderline, Histrionic (II)

Siever and Davis

Anxiety and Inhibition

Anxiety-related disorders (I) OCD, Social Phobia, GAD

Dependent, Compulsive, Avoidant (II)

Davis and Siever

Psychoanalytic Approach

ID – psychoanalytic - Freud

EGO – psychodynamic – Erickson, Anna Freud

SE – object relations - Kernberg

Phases

Levels of Consciousness

Conscious Preconscious Unconscious

Freud – Topographical Model

Interpretation of Dreams, 1900

ID – pleasure principle

EGO – reality principle

SE – morality principle

The Structural Model

Neurotic anxiety

Moral anxiety

Realistic anxiety

The Ego and the ID, 1923

Psychoanalytic

Employed by ego Employed unconsciously Many types Enduring contribution

Purpose:◦ ward off anxiety◦ bend reality

Defense Mechanisms

George Valliant (1992)

◦ Mature - sublimation◦ Neurotic – sexualization◦ Immature - regression◦ Narcissistic – distortion

Different Categories

Repression: Primary and Secondary

Primary - refers to stopping an idea or affect before it reaches consciousness

Secondary - removes from consciousness what was once experienced

Ego Defenses

Dissociation: sudden and drastic alteration of an aspect of consciousness, identity or behavior to relieve emotional distress

in order to cope with abuse, a person splits consciousness to remove self from situation

Ego Defenses

Identification: patients adopt many or all of the characteristics of another person as their own

e.g., rock star behavior

Ego Defenses

Displacement: Conflicts are displaced from a threatening object onto a less threatening one.

e.g., mad at spouse, slams the door

Ego Defenses

Introjection: involves internalizing the images or qualities of a person in order feel a constant connection with the individual

e.g., a physical representation of another becomes part of our psyche

Ego Defenses

Distortion: involves altering one's perception of the environment by replacing it with a more acceptable version in order to suit inner needs

Ego Defenses

Idealization-Devaluation: exceedingly positive (or negative) qualities are ascribed to a person

sometimes they work hand in hand

a star can do no wrong (idealization) until they snub someone for an autograph (devaluation)

Ego Defenses

Isolation of affect: separating the emotion from an idea

E.g., remembering the events of accident, but being unable to feel the emotions associated with it.

Ego Defenses

Passive-Aggressive: the expression of hostile feelings in a non-confrontational manner

e.g., agreeing to do something but not ever doing it because one is angry

e.g., always being late, pouting

Ego Defenses

Projection: casting one's thoughts onto another because the person can't tolerate the idea

by blaming others, the focus stays off the person

Ego Defenses

Splitting: this defense involves dividing self and others into categories

View self (or others) as all good or all bad (but not both at same time)

found in borderline PD considered a serious defense

Ego Defenses

Projective Identification:

beliefs about another are translated into behavior that confirms the original belief

This requires an explanation…

Ego Defenses

Rationalization: the process of covering up unreasonable or unacceptable acts and ideas with seemingly acceptable explanations

e.g., get rejected from grad school and say you did not really want to go anyway

Ego Defenses

Reaction formation: unacceptable wishes are transformed into their opposite

also called reversal formation

e.g., smiling at someone when you want to kill them…

Gay bashing

Ego Defenses

Regression: return to earlier levels of functioning to avoid conflict

e.g., a child curling up into a ball under a table when others are fighting

Ego Defenses

Schizoid fantasy: is used to escape and as a means of gratification whereby other people are not required for emotional involvement

e.g., day dreaming during conversations as a way to avoid intimacy or ward off boredom

Ego Defenses

Sexualization: situations and people are coloured with sexual overtones

e.g., frequent joking about sex

Ego Defenses

Somatization: psychological difficulties are expressed as physical complaints

e.g., when angry, you get a back ache

Ego Defenses

Denial - reality is ignored

Refusal to acknowledge some painful external or subjective reality obvious to others.

e.g., after hearing about health issue, you say it is no big deal

Ego Defenses

Sublimation: Unacceptable emotions are defused by being channeled into socially acceptable behavior.

e.g., an aggressive man becomes a football player or boxer (or surgeon)

Ego Defenses

Object Relations

Mother

Father

Identification

Self-Object

Object Representation

Introjection

Object Relations

Person

External Persons

Object relatedness

ME

Others

I become like mother (in this case)

I relate to others as if they are dad.

Object Relations

Mother

Father

Self-Object

Object Representation

Mother is….SubmissiveKindAfraid of AuthorityAvoids Conflict

Dad is..Abusive, dominant, unsympathetic

Object Relations

Person

External Persons

Object relatedness

ME

My partner

I am…SubmissiveKindAfraid of AuthorityAvoids Conflict

My partner is….Abusive, dominant, unsympathetic

Contemporary Perspectives

Cognitive Perspective

Depression◦ Standard CBT tends to work

Depression + PD◦ Standard CBT does not work◦ Frequent relapses◦ Difficult to treat

Cognitive PD Perspective

Much of mental illness is function of errors, biases, and distortions in perceiving and interpreting events.

Interactional ◦ T, F, and B

CBT Philosophical Foundations

Cognitive Model

Defined:

Pervasive, self-perpetuating cognitive-interpersonal cycles

Personality Disorders

Aaron Beck

Cognition plays a significant role in psychopathology

Cognition Forms◦ Schema (core

beliefs)◦ Automatic Thoughts◦ Processing Errors

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Schema◦ mental structures that guide behavior◦ influences what we see and remember◦ sometimes called rules or beliefs◦ a product of previous learning

Schema

Spontaneous appraisals Reflexive Considered “Truth” Appear in shorthand Persistent Fed by schema Habitual Themes

Automatic Thoughts

Filtering Polarized Thinking Overgeneralization Mind Reading Catastrophizing

Magnify/Minimize Personalization Shoulds Magical Reasoning Emotional

Distortions

AutomaticThoughts

EventsSchema

EmotionsBehavior

Others’Behavior

Distortions

Avoidant PD

Interpersonal

catastrophize

avoidsanxiety, fear

Film Example Mommie Dearest

Faye Dunaway

Joan Crawford

Warning – disturbing to watch

Mommie Dearest Questions to address.

1) What PD does she have? 2) Biological Explanation? 3) Psychoanalytic explanation? 4) Cognitive explanation?