personality disorders

What is a personality disorder

an enduring pattern of behavior and inner experience that deviate from what is expected of a person based on their cultural background, The pattern should be present in at least 2 out of 4 areas.

what are the 4 areas of personality disorders

1. Cognition (ways of perceiving and interpreting self, other people and events)

2. Affectivity (the range, intensity, liability, and appropriateness of emotional response)

3. Interpersonal functioning

4. Impulse control

what are the steps

• seeing it happen in a specific moment

• seeing it in a specific relationship

• stress induced reaction

• happens subthreshold, so like a trait

• personality disorder

what are the 3 clusters of personality disorders

Cluster A: odd

• Paranoid personality disorder

• Schizoid personality disorder

• Schizotypal personality disorder

Cluster B dramatic

• Antisocial personality disorder

• Borderline personality disorder

• Histrionic personality disorder

• Narcissistic personality disorder

Cluster C: anxious

• Avoidant personality disorder

• Dependent personality disorder

• Obsessive-compulsive personality disorder

difference between OCD and OCPD

People with obsessive-compulsive disorder typically do not want or like their symptoms: those with obsessive-compulsive personality disorder often embrace their symptoms and rarely wish to resist them. (OCD insight, OCPD often lack of insight)

OCPD lacks the obsessions and compulsive behavior associated with OCD

Dimentional model of diagnosis (mentioned in DSM 5 but not too much focus, may be central in DSM 6)

describes the traits on a continumum ex. how much innatention of impulsivity someone has)
example: Measuring severity of depression symptoms using a scale (e.g., 1–10)

captures individual variation

Classification model of diagnosis (current model)

places people into discrete categories (has ADHD or not)

better for research and diagnosis

Problems with PD diagnoses

Stability: personality disorders are not as stable as the DSM suggests.

Comorbidity: personality disorders co-occur: more than half who meet criteria for one PD meet criteria for at least one other PD.

Dialectical behavior therapy

developed for borderline personality disorder, but is also used for PD’s with rapid changes in emotional state

• Focus: Emotional regulation, mindfulness, distress tolerance, interpersonal effectiveness.

• Approach: Combines acceptance (validation) with change strategies

GOOD FOR: accept current situation, and discover healthy coping mechanisms, and keeping calm

strengths:

• reducing self-harm, suicidality, and emotional instability

• Highly structured with clear skills training

weaknesses:

• requires a lot of commitment (individual and group sessions)

Schema therapy

• Origin: Integrates CBT, attachment theory, and psychodynamic ideas

• Focus: Changing maladaptive schemas (deep emotional patterns from childhood)

Strengths:

• Targets core emotional needs

• Effective for comorbid disorders (e.g., PD + depression)

Limitations:

• Long-term and emotionally intense

• Can trigger painful memories

Recommended for:

• BPD, Avoidant PD, Dependent PD, Narcissistic PD, Obsessive-Compulsive PD

Example Technique:

Imagery Rescripting

• Patient reimagines traumatic memory with a supportive adult (therapist or inner “healthy self”)

Cognitive behavioral therapy

• Focus: Identifying and restructuring distorted thoughts and maladaptive behaviors

• Adapted for PDs to target long-term personality patterns, not just symptoms

Strengths:

• Structured, shorter-term, and practical

• Easier to apply

Limitations:

• May not reach deep-rooted issues

• Less effective alone for severe emotional dysregulation

Recommended for:

• Avoidant PD, Obsessive-Compulsive PD, Dependent PD

Example Technique:

Behavioral Experiments

• Patient with Avoidant PD takes a small social risk and gathers evidence (e.g., Was I judged?)

mentalization based therapy

• Focus: Strengthening the ability to understand mental states (self and others)

• Based on the idea that impaired “mentalizing” causes relational/emotional issues

Strengths:

• Effective for interpersonal conflicts and emotional dysregulation

• Focus on present moment (less past-focused)

Limitations:

• Can feel abstract for patients lacking insight

• Slow progress in resistant individuals

Recommended for:

• BPD, and other PDs with interpersonal instability

Example Technique:

Pause-and-Reflect Dialogue

• Patient describes a conflict; therapist pauses and asks:
  “What do you think they were feeling or thinking?”

Transference based therapy

• Origin: Psychodynamic therapy

• Focus: Uses the therapist-patient relationship to understand internal conflicts

• Aims to integrate split-off self-parts and reduce black-and-white thinking

Strengths:

• Enables deep identity restructuring

• Targets splitting and transference reactions

Limitations:

• Emotionally intense

• Requires a strong alliance and trained therapist

Recommended for:

• BPD, Narcissistic PD, (limited use for Antisocial traits)

Example Technique:

Here-and-Now Interpretation

• Therapist explores patient accusations (e.g., "You don’t care") in light of abandonment fears