Session 5 Notes 339

What Causes Personality Disorders? (9) [?/?, ??/?, ??, ?, ?, ?/? ?, ?, ?, ??]

Biology/Genetics, Childhood abuse/ trauma, High reactivity (sensitivity), Peers, Poverty, Ineffective/inadequate Parenting, Divorce, Parental sociopathy, adult incarceration

Differential Diagnosis

process of ? one ? from ?

distinguishing, disorder, another

Depression and PD Differentials:

True hypomanic/manic behavior (Bipolar Disorder) OR chronic
affective storms (Personality Disorder)?

Likely PD if…
If ?? + absence of ? & ? ?? + ?
in work +/or ?-?, then likely PD

affective instability, significant, mature interpersonal relationships, instability, self-image

SUICIDALITY and PD Differentials:
Suicidal tendencies and parasuicidal (self harm) behavior indicative of depressive episode or PD?

Likely PD if… 

Suicidal gestures are ? or ? + under conditions of emotional ? or ? ?

acute, chronic, agitation, acute, frustrations

Major Depressive Disorder & PD Differentials:
Symptoms of self-devaluations, low mood, hopelessness signs of depressive episode Or chronic dysthymic reaction corresponding to a characterological disposition?

Likely PD if…
symptoms accompanied with ? reactions, are rapidly ?, less
severe in ? and closely tied to ? circumstances

rageful, shifting, intensity, social

PTSD and PD (Borderline) Differentials:
Question: Are the trauma-related symptoms (irritability, insomnia, anger,
exaggerated startle response, etc.) related to PTSD or PD?

If symptoms develop or remain many years after the? ? and include
? symptoms (in the body, ex. numbness) + emotional ? + chronic ? difficulties

trauma event, somatization, immaturity, interpersonal

ADHD and PD (i.e.. Borderline, Narcissistic) Differentials:
Inattentiveness, concentration difficulties, impulsivity and school or work failures symptoms of ADHD or PD?

Likely PD if…

? (not necessarily from early childhood) + history of poor ? to
? aspects of school + marked difficulties at ? with parents or siblings +
? disturbance

symptoms, adjustment, social, home, identity

Double Depression

? ? of major ? in the context of a ? ?
depression

acute episode, depression, chronic, characterological

Dissocial Disorder

? ? that is an ? to involvement in a ? ?

Antisocial behavior, adaptation, negative subculture

Dissocial Disorder example

antisocial traits in prison system

Cost of Incorrect Diagnosis

1. Postpone ? of adequate ?

2. Expose Patients to add’l and unnecessary risks
   (including psychopharmacological ? and risk of
   addiction)

3. Allow pathological traits and behaviors to become more
   ? and ?

time, treatment, drugs, ingrained, unchallenged

Psychobiological Model (Siever & Davis)
Based on dimensions of :
1.?/? organization
2 ?/?
3.? instability
4.?/inhibition

Cognitive, perceptual, impulsive, aggression, emotional, anxiety

Key Assertions of PsychoBIOSOCIAL MODEL
• major ? and ? influences on ? development & functioning

• Core features of major psychiatric disorders (formerly Axis
I disorders) can be conceptualized as ? in 1 or
more of the four psychobiological dimensions

• Personality Disorders are phenomenologically and
biologically linked to major ? disorders
(advocating a dimensional or spectrum approach)

• Adult personality may be the product of “goodness of fit”
between ? predispositions & vulnerabilities and
? resources & demands

genetic, biological, personality, disturbances, psychiatric, child, parent

Key Assertions of PsychoBIOSOCIAL MODEL
A child’s interpretation and representation of the world
around him will be influenced by his/her unique
constellation of intensity and regulation of :
• ?
• ?/ Perceptions
• ?/?
• ?/Inhibition

Emotions, cognitive, impulses, aggression, anxiety

Ekleberry: Substance Abuse & PDs
?% of individuals with alcohol abuse or
dependence also have a PD

Why are substances so appealing to people with
PD?
• Keep ? ? ? ? (allows one to
ignore or alter aspects of reality that are not
acceptable)

69, misery at a distance

Why are drugs so dangerous for People with PDs?
• More likely to engage in use at ? ?. and
? ? abuse with greater ? (? difficulties, poor ?)
• More vulnerable to having a ? and ? use
pattern
• More likely to develop ?
• More likely to ?
• Have more difficult time keeping effective tx ?

    ex. sponsor

earlier age, polysubstance, frequency, impulse, relationships, compulsive, rigid, dependence, relapse, relationships

Commonalities between Substance Abuse & PDs
•Both are ways to sustain ? patterns of behavior & escape the pain of life
•Both entail use of ? strategies- denying, minimizing,
hiding
•Both can be seen on a ? from ? to ?
•Both exist in ? forms (polysubstance abuse;
polypersonality disorder)

maladaptive, defense, spectrum, normal, pathological, multiple

3. The nature of relationship between Substance Abuse & PD
IT IS ?!
•Personality disorders increase vulnerability to ? ?
disorders
•Substance abuse disorders reduce what ? may be found in
PDs
•Chronic use of drugs or alcohol on personality functioning is marked by
impulsivity, decreased frustration tolerance, self-centeredness (stubbornness, lack of empathy), grandiosity, passivity, and affect
tolerance (Nace, 1995)

BI-DIRECTIONAL, substance abuse, adaptability

(Greg Lester, 2014)
1. Personality is: A psychological ?
It contains resources for living
The resources in personality are called “?”
2. A “Normal” Personality is a ? Set of Tools
Possesses a variety of traits
Enables the person to handle the diverse demands of life
“ A personality disorder is a human being who persists in a
behavior in the face of clear evidence it is inappropriate, and has
ongoing bad consequences” (W. John Livesley)

toolkit, traits, diverse

What a personality is...
(Lester, 2014)
1. A “Psychiatric Disorder” is a ? System

• Mood disorder: Limbic system/serotonin malfunction
• PTSD: Amygdala malfunction
• ADHD: Executive function malfunction
• Addiction: Dopamine malfunction
• Psychotic: Cognitive Malfunction

2. A “Disordered Personality” is an “Insufficient Personality
Toolkit “
• Insufficiently ? traits (excessive use of one way of being or doing)
• Insufficient productive ??

malfunctioning, diverse, self-awareness

What A Personality Does....
(Lester, 2014)
1.The Primary Characteristics of Normal
Personality is the Ability to:
1. To be ? and ?
• To be “?”
• Produce more ? than negative consequences
• Handle the unexpected ? life take

2. To improve one’s results
• Observe when one has made a ?
• Take corrective action

3. When facing something in life, engage in ??

flexible, adaptive, “appropriate”, positive, turns, mistake, Problem Solving

Problem Solving Approach of the
“Disordered Personality”
(Lester, 2014)
1. Protection and validation of an insufficient ?
2. Avoidance of the internal ?
3. Distraction from one’s ?
4. Justification of ? behavior
5. The creation of ?

identity, emptiness, deficiencies, inappropriate, “drama”

Types of Therapies
-?
-?
-?
-?
-?

psychodynamic, behavioral, cognitive, Humanistic, Eclectic

psychodynamic

Founded by ?

emphasizes the influence of the
? mind on behavior.

Vehicle of change: ? material
(dreams, slips of tongue, free
association)

Relevant theorists & authors (Sigmund
Freud, Anna Freud, Karen Horney, Carl
Jung, Alfred Adler, Melanie Klein, Heinz
Kohut, Otto Kernberg)

Freud, unconscious, unconscious

Behaviorism became the dominant school of thought
during the 1950’s. Based on the work of ?, ?
and ?, behaviorism holds that all behavior can be
explained by environmental causes, rather than by
internal forces
Vehicle for change= ?? & patterning

Watson, Pavlov, Skinner, observable behaviors

Cognitive Psychology is the branch of psychology that
studies ? processes including how people ?,
?, ? and ?. The cognitive approach is a
relatively modern approach to human behaviour that
focuses on how we think. It assumes that our thought
processes affect the way in which we behave.
Vehicle for change: our ?
Relevant theorists & authors (Piaget, Martin Seligman,
Leon Festinger , Aaron Beck, etc)

mental, think, perceive, remember, learn, thoughts

Humanistic psychology developed as a response to
? and ? Humanistic
Psychology instead focuses on free will, personal growth
and ??
Vehicle of change: therapeutic ? &
???
Relevant theorists & authors: Carl Rogers, Abraham
Maslow, etc)

psychoanalysis, behavioralism, self-actualization, relationship, unconditional positive regard