Interventions for Antisocial Personality Disordered Behavior

Strengths Based Biopsychosocial Approach

to Recovery from Narcissistic Personality

DisorderDr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC

Executive Director, AllCEUs

Recovery & Resilience International in partnership with AllCEUs.com Unlimited CE for $59 | Webinars $5 | Specialty Certificates $89


Objectives Define Personality Disorders List the characteristics of Narcissistic

Personality Examine the similarities between the behaviors

of certain personality disorders and addictions Identify ways to address these behaviors and

thought patterns Encourage clinicians to critically examine

behaviors in patients with addiction in order to effectively differentially diagnose

Why I Care/How It Impacts Recovery When personality disorders are viewed as pervasive & perpetual, it

Provides an “excuse for relapse” Often derails treatment because patterns of behavior thought to be due

to the PD are essentially ignored Personality Disordered & Addictive Behavior often look the same Goals for recovery from both:

Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness)

Distress tolerance and the ability to self-soothe Hope and faith in self/future/others through addressing cognitive errors Development of self esteem to eliminate need for external validation Development of healthy, supportive relationships



Personality Disorders Represent a cluster of behaviors that is

pervasive beginning before the age of 15. Addictive behaviors also often begin before 15 Due to immature cognitive development, children

tend to be more egocentric, overgeneralize and think in terms of dichotomies

From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child


Personality Disorders Treatment

Since these behaviors formed the foundation for further development patients must

Understand their function in the pastIdentify how these behaviors and beliefs are faulty

in the presentDevelop alternative skillsBe empowered to interface with the world with the

strengths, knowledge and tools of the adult


Addictions Represent one way to cope with distress Can begin early in life Have overlapping symptoms with personality

disorders, especially Cluster B


Addictions & Personality Disorders Cluster A (Paranoid, Schizoid, Schizotypal)

Characterized by social awkwardness and withdrawal

Often co-occur with addictions Cluster C (Obsessive-Compulsive; Dependent)

Characterized as anxious and fearful May co-occur with addiction

Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) Characterized by dramatic, emotional, erratic

behavior Behavioral patterns overlap with addiction


Addictions & Personality Disorders Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)

Characterized by Dramatic, emotional, erratic behaviorAll or Nothing thinkingHostility and AggressionHypersensitivityManipulativeLow Self-Esteem / Weak Self-Concept


Antisocial Personality Disorder CORRUPT (3 criteria)

C: Conformity to law lackingO: Obligations ignoredR: Reckless disregard for safety of self or othersR: Remorse lackingU: Underhanded (deceitful, lies, cons others)P: Planning insufficient (impulsive)T: Temper (irritable and aggressive)


Addictions vs. Personality Disorders Many behaviors characteristic of active

addiction Overlap with personality disorders Begin in late childhood/early adolescence Are pervasive

As people’s experiences and knowledge expanded, their coping skills and behaviors remained relatively primitive

Recovery from both requires Development of effective coping skills Addressing cognitive distortions


Recovery Interventions Dramatic, emotional, erratic behavior

Distress Tolerance Mindfulness to identify and process the source of the

distress Coping skills

All or Nothing thinking Awareness and elimination of cognitive distortions (CBT)

Hostility and Aggression Understanding of the fight or flight response Development of anger awareness and management

skills


Addictions vs. Personality Disorders Hypersensitivity esp. to rejection

Awareness of and addressing thinking errors Awareness and addressing abandonment issues Development of self-esteem

Manipulative Interpersonal skill development (boundary

setting, communication skills) Low Self-Esteem / Weak Self-Concept

Development of self-esteem and the ability to internally validate


Summary Most patients with addictions have traits associated with

personality disorders These traits can be loosely classified into

Thinking errors the perception of a threat Behavioral reactivity to escape or eliminate the threat

Important concepts in early recovery Honesty with self and others (Mindfulness and Awareness) Hope & faith (Identifying cognitive distortions and thinking errors to

encourage and empower) Courage and discipline to remain constantly mindful, accept and

address thoughts and feelings, make conscious choices based on facts


Summary cont… A child growing up in an unstable, neglectful,

emotionally detached environment may develop PD traits to survive Addictions to numb the pain and escape from the lack

of control. Behaviors characteristic of addictions and

personality disorders Were learned and reinforced Will always be in the recesses of the toolbox Must be made less rewarding than alternative, healthy

behaviors

Education

Interventions for Antisocial Personality Disordered Behavior