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Definition of Personality Trait. Enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts . Definitional Features of Personality Disorder.
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Definition of Personality Trait Enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts
Definitional Features of Personality Disorder Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture and is manifested in at least two of the following areas:
Definitional Features of Personality Disorder • The pattern is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control (Criterion A) • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations (Criterion B) • Leads to significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C)
Definitional Features of Personality Disorder • The pattern is stable and of long duration, and its onset can be traced back to adolescence or early adulthood (Criterion D) • The pattern is not better accounted for as a manifestation or consequence of another mental disorder (Criterion E) • The pattern is not due to the direct physiologic effects of a substance or a general medical condition (Criterion F)
Three Clusters of Personality Disorders • Cluster A (odd eccentric) • Paranoid • Schizoid • Schizotypal
Three Clusters of Personality Disorders • Cluster B (dramatic-emotional) • Antisocial • Borderline • Histrionic • Narcissistic
Three Clusters of Personality Disorders • Cluster C (anxious-fearful) • Avoidant • Dependent • Obsessive-compulsive
The Challenge of Working With Personality Disorders • Patients typically come for therapy with presenting problems other than personality problems • They require more work within the session • Longer duration of treatment • Greater strain on the therapist’s skills and patience • Greater difficulty in treatment compliance
“Red Flags” for Identifying Personality Disorders • A patient or significant other reports that the patient “has always donethat” or has always been that way” • The patient is not compliant with the therapeutic regimen • Therapy progress seems to have come to a complete stop for no apparent reason • Patients often will seem unaware of the effect their behavior has on others • Patient’s problems appear to be acceptable and natural for them
Beck’s Theory of Personality Disorders • Certain behavioral patterns or strategies that had adaptive value in evolutionary terms, become maladaptive in today’s society when these “strategies” become exaggerated
Beck’s Theory of Personality Disorders • A strong relationship exists between the cognitive patterns on the one hand and the affective and behavioral patterns on the other
Definition of Schemas Schemas are relatively stable information processing structures that operate in a feed-forward system to guide the processing of information. They are not themselves conscious, although they can be recognized, evaluated, and their interpretations tested.
Characteristics of Schemas • They integrate and attach meaning to events • They can be described in terms of valence or level of activation • They can be of a highly idiosyncratic content
Characteristics of Schemas • They vary according to their function • When particular schemas are hypervalent, the threshold for activation of the constituent schemas is low
Beck’s Theory of Personality Disorders • Each personality disorder has its own profile that can be characterized by core beliefs about the self and others and compensatory strategies associated with those core beliefs
Cognitive Therapy for Personality Disorder Background
Therapeutic Assumptions • Therapy will often evoke anxiety because the patient is being asked to change “who they are” • Patients with personality disorders often come to therapy with presenting issues other than personality problems • Patients with personality disorders are more difficult to treat • Therapy must take a tripartite approach • Schema work takes a much more central role in CT with personality disorders • A much greater emphasis is placed on the client-therapist relationship
Problems in Collaboration • Therapist or patient may lack the skill to be collaborative • Patients’ beliefs regarding the potential failure in therapy • Patients’ beliefs (fears) regarding the effects of changing on significant others or himself • Poor socialization to the cognitive therapy model • Frustration due to lack of progress
Cognitive Techniques • Guided discovery • Labeling of inaccurate inferences • Collaborative empiricism • Examining explanations of others’ behavior • Scaling • Reattribution training • Deliberate exaggeration • Decatastrophizing
Goals of Behavioral Techniques • Alter self-defeating compensatory behaviors • Skill building (e.g., assertiveness) • Behavioral experiments designed to weaken maladaptive beliefs
Specific Behavioral Techniques • Role playing • Use of imagery • Reliving childhood experiences • Assisting in decision-making
Significance of BPD • 2% of general population meet for BPD • 11% of outpatients and 19% of inpatients meet criteria for BPD (Widiger & Francis, 1989) • Of those meeting for some personality disorder, 33% of outpatients and 63% of inpatients meet for BPD • 70-75% of BPD patients have a history of self-injurious acts
Significance of BPD Cont. • Estimates of suicide rates for BPD patients are approximately 10% • 74% of BPD referred patients are women
Diagnostic Features of BPD • Hypersensitivity to abandonment • Pattern of unstable and intense interpersonal relationships • Unstable self-image or sense of self • Marked impulsivity • Recurrent suicidal behavior • Affective instability • Chronic feelings of emptiness • Inappropriate or intense anger or difficulty controlling anger • Transient stress-related paranoid ideation or dissociative symptoms
