MindMap-DSM-IV-Personality Disorder

MindMap-DSM-IV-Personality Disorder

• About The Book
  • Title: Handbook of Diagnosis and Treatment of DSM-IV Personality Disorder
  • Author: Len Sperry
  • ISBN: 0-203-43909-0
  • Chapters: 11
  • Pages: 297
• Personality Disorder
  • Antisocial
    • Triggering Event: Social standards and rules.

      Behavioral Style: Impulsively angry, hostile, cunning; forceful, risk-taking, thrill-seeking; temper, verbally or physically abusive.

      Interpersonal Style: Antagonistic to belligerent; slick” and calculating; highly competitive and poor losers; distrustful of others. ”

      Cognitive Style: Impulsive, inflexible, and externally oriented; hard-nosed, realistic, and devious; acting-out defense.

      Feeling Style: Glib, shallow, superficial; avoid softer” emotions (i.e. warmth and intimacy) which connote weakness. ”

      Temperament: Ill-tempered infantile pattern; aggressive, impulsive adult pattern.

      Attachment Style: Fearful and dismissing.

      Parental Injunction: The end justifies the means.” ”

      Self-View: I’m cunning and I’m entitled to get what I want.” They view themselves as strong, competitive self-reliant energetic and tough.

      World View: Life is devious and hostile and rules keep me from fulfilling my needs. Therefore I’ll bend or break them because my needs come first and I’ll defend any efforts to be controlled or degraded.” ”

      Maladaptive Schemas: Mistrust/abuse; entitlement; insufficient self-control; defectiveness; emotional deprivation; abandonment; social isolation.

      Optimal DSM-IV-TR Criteria: Criminal, aggressive, impulsive, irresponsible behavior.

  • Avoidant

    • Triggering Event: Demands for close interpersonal relating and/or social and public appearances.

      Behavioral Style: Shy, mistrustful, aloof; apprehensive; socially awkward; controlled, underactive behavior; feelings of emptiness and depersonalization.

      Interpersonal Style: Guardedly tests others; rejection sensitive as self-protectant; desires acceptance but maintains distance; has basic interpersonal skills, but fears using them.

      Cognitive Style: Perpetual vigilance; thoughts easily distracted by hypersensitivity

      Feeling Style: Shy and apprehensive.

      Temperament: Irritable.

      Attachment Style: Preoccupied and fearful.

      Parental Injunction: We don’t accept you and probably nobody else will either.

      Self-View: I’m inadequate and frightened of rejection.” Chronically tense , fatigued self-conscious; devalue their achievement self-critical. ”

      World View: Life is unfair. People reject and criticize me but I want someone to like me. Therefore be vigilant demand reassurance and if all else fails fantasize and daydream.

      Optimal DSM-IV-TR Criteria: Avoids occupational activities that involve significant interpersonal contact, fearing criticism, disapproval, or rejection.

  • Borderline

    • Triggering Event : Expectation of meeting personal goals and/or maintaining close relations.

      Behavioral Style : Hemophiliacs” of emotion; resentful acting out; helpless, dysphoric, empty void; irregular circadian rhythms (sleep-wake, etc.).

      Interpersonal Style : Paradoxical—idealizing and clinging vs. devaluing and oppositional; rejection sensitivity- abandonment and depression; separation anxiety as prime motivator; role reversal.

      Cognitive Style : Inflexible, rigid; abstraction—grandiosity and idealization, splitting; reasons by analogy: doesn’t learn from experience; external loss of control-blaming; poorly developed evocative memory.

      Feeling Style : Extreme lability of mood and affect.

      Temperament : Dependent type: passive infantile pattern—low autonomic nervous system reactivity. Passive-aggressive type: difficult” infantile pattern-” affect irritability.

      Attachment Style : Disorganized.

      Parental Injunction : If you grow up (parent). Overprotective or demanding or ” inconsistent parenting.

      Self-View : I don’t know who I am or where I’m going.” Identity problems involving gender, career, loyalties, and values. Self-esteem fluctuates with current emotion.

      World View: People are great. No good. No, it’s not. If life doesn’t go my way, I can’t tolerate it. Don’t commit to anything.

      Maladaptive Schemas : Abandonment; defectiveness; abuse/mistrust; emotional deprivation; social isolation; insufficient self-control.

      Optimal DSM-IV-TR Criteria : Frantic efforts to avoid real or imagined abandonment.

  • Dependent

    • Triggering Event : Expectations of self-reliance and/or being alone.

      Behavioral Style : Docile, passive, nonassertive, lack of self-confidence.

      Interpersonal Style : Pleasing; self-sacrificing; clinging, compliant; expect others to take responsibility.

      Cognitive Style : Suggestible: Pollyanna-like about interpersonal relations; overprotective—the too good parent.” ”

      Feeling Style : Pleasant but anxious, timid, or sad when stressed.

      Temperament : Low energy level; fearful, sad, or withdrawn during infancy; melancholic.

      Attachment Style : Preoccupied.

      Parental Injunction : You can’t do it by yourself.” ”

      Self-View : I’m nice but inadequate (or fragile).” Self-doubting. ”

      World View: Others are here to take care of me” (because I can’t do it myself) ”

      Maladaptive Schemas : Defectiveness; self-sacrifice; approval-seeking.

      Optimal DSM-IV-TR Criteria : Needs others to assume responsibility for most major areas of his or her life.

  • Histrionic

    • Triggering Event : Opposite sex relationships.

      Behavioral Style : Charming/excitement-seeking; labile, capricious, superficial.

      Interpersonal Style : Attention-getting/manipulative; exhibitionistic/ flirtatious.

      Cognitive Style : Impulsive, thematic, field-dependent; avoid awareness of their hidden dependencies.

      Feeling Style : Exaggerated emotional display.

      Temperament : Hyper responsive infantile pattern externally oriented for gratification.

      Attachment Style : Preoccupied.

      Parental injunction : I’ll give you attention when you do what I want.

      Self-View : I need to be noticed”; externally oriented for gratification.

      World View: Life makes me so nervous so I’m entitled to special care and consideration.

      Maladaptive Schemas : Approval-seeking; emotional deprivation; defectiveness.

      Optimal DSM-IV-TR Criteria : Uncomfortable in situations in which they are not the center of attention.

  • Narcissitic

    • Triggering Event : Evaluation of self.

      Behavioral Style : Conceited, boastful, snobbish; self-assured, self-centered, pompous; impatient, arrogant, thin-skinned.

      Interpersonal Style : Disdainful, exploitive, irresponsible; socially facile but without empathy; use others to indulge themselves.

      Cognitive Style : Cognitive expansiveness and exaggeration; focus on images and themes: take liberties with facts; persistent and inflexible.

      Feeling Style : Self-confidence—narcissistic rage.

      Temperament : Active and responsive; special talents, attractiveness,

      : early language development.

      Attachment Style : Fearful and dismissing.

      Parental Injunction : Grow up and be wonderful—for me.” ”

      Self-View: I’m special and unique and I’m entitled to extraordinary rights and privileges whether I’ve earned them or not.” ”

      World View: Life is a banquet table to be sampled at will. People owe me admiration and privilege. Therefore I’ll expect and demand this specialness.” ”

      Maladaptive Schemas : Entitlement; defectiveness; emotional deprivation; insufficient self-control; unrelenting standards.

      Optimal DSM-IV-TR Criteria : Have grandiose sense of self-importance.

  • Obsessive

    • Triggering Event: Authority, unstructured situations, and/or demands of intimate and close relations.

      Behavioral Style: Workaholic, dependable, stubborn, possessive; procrastination, indecisive, perfectionistic.

      Interpersonal Style: Autocratic to peers and subordinates but deferential to superiors; polite and loyal.

      Cognitive Style: Constricted—rule-based, unimaginative; assertive (defiance) vs. pleasing (obedience).

      Feeling Style: Grim and cheerless, feeling avoidance.

      Temperament: Irritable, difficult, or anxious.

      Attachment Style: Preoccupied.

      Parental Injunction: You must do/be better to be worthwhile.

      Self-View: “I’m responsible if something goes wrong.” See themselves as reliable, competent, righteous

      World View: Life is unpredictable and expects too much. Therefore be in control be right and proper and don’t make mistakes

      Maladaptive Schemas: Unrelenting standards; punitiveness; emotional inhibition.

      Optimal DSM-IV-TR Criteria: Shows perfectionism that interferes with task completion.

  • Paranoid

    • Triggering Event: Close interpersonal relationships and/or personal queries.

      Behavioral Style: Guarded, defensive, and hypervigilant; resistant of external influence; chronically tense because constantly mobilized against perceived threats.

      Interpersonal Style: Distrustful, secretive, isolated; blaming; provocative, counterattacking, hypersensitive.

      Cognitive Style: Mistrusting, preconceptions; tendency to disregard evidence to the contrary; may become conspiratorial or delusional under stress.

      Feeling Style: Aloof, humorless; restricted affect, jealous; easily provoked.

      Temperament: Narcissistic type: active, hyperresponsive. Compulsive type: irritable. Passive-aggressive type: affective irritability.

      Attachment Style: Fearful.

      Parental Injunction: You’re different. Keep alert. Don’t make mistakes.”

      Self-View: I’m so special and different. I’m alone and no one likes me because I’m better than others. ”

      World View: Life is unfair ,unpredictable and demanding. It will sneak up and harm you. Therefore be wary counteract trust no one and excuse yourself from failure by blaming others.” ”

      Maladaptive Schemas: Abuse/mistrust; defectiveness.

      Optimal DSM-IV-TR Criteria: Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

  • Schizoid

    • Triggering Event: Close interpersonal relationships.

      Behavioral Style: Slow and monotonous speech; lethargic, inattentive, nonspontaneous.

      Interpersonal Style: Minimal human” interests and friends; “cold fish”; fades into social background; rarely responsive to others’ feelings or actions; isolative and content to remain aloof. ”

      Cognitive Style: Cognitively distracted in thinking and communications; easily derailed and tangential; absent-minded; minimally introspective.

      Feeling Style: Aloof, indifferent.

      Temperament: Passive and anhedonic infantile pattern.

      Attachment Style: Dismissing.

      Parental Injunction: Who are you? What do you want?” ”

      Self-View: I’m a misfit from life, so I don’t need anybody.” ” I’m indifferent to everything.”

      World View: Life is a difficult place and can be harmful. Therefore trust nothing and keep a distance from others so that you won’t get hurt.” ”

      Maladaptive Schemas: Social isolation; emotional deprivation; defectiveness; subjugation; undeveloped self.

      Optimal DSM-IV-TR Criteria: Neither desires nor enjoys close relationships, including being part of a family.

  • Schizotypal

    • Triggering Event : Close interpersonal relationships.

      Behavioral Style : Eccentric, erratic, bizarre speech; markedly peculiar but not incoherent; tends to drift from job to job.

      Interpersonal Style : Socially isolative, peripheral relationships; with apprehension or apathy; if married, relationship is utilitarian and superficial.

      Cognitive Style : Cognitive slippage scattered, ruminative; engages in magical thinking, superstitious.

      Feeling Style : Hypersensitive, hostile, and aloof; may experience intense social anxiety.

      Temperament : Schizoid type: passive infantile pattern. Avoidance type: fearful infantile pattern.

      Attachment Style : Fearful and dismissing.

      Parental injunction : You’re a strange bird.” ”

      Self-View : I’m on a different wavelength than others.” Experience of being “selfless empty, estranged, depersonalization, dissociation.

      World View: Life is strange and unusual and others have special magic intentions. Therefore observe with caution while being curious.” ”

      Maladaptive Schemas : Alienation; abandonment; dependence; vulnerability to harm.

      Optimal DSM-IV-TR Criteria : Odd thinking and speech: behavior or appearance that is odd, eccentric, or peculiar.

• Personality Style

  • Triggering Event

    • Antisocial : Social standards and rules.
    • Avoidant: Demands for close interpersonal relating and/or social and public appearances.
    • Borderline: Expectation of meeting personal goals and/or maintaining close relations.
    • Dependent: Expectations of self-reliance and/or being alone.
    • Histrionic: Opposite sex relationships.
    • Narcissitic: Evaluation of self.
    • Obsessive: Authority, unstructured situations, and/or demands of intimate and close relations.
    • Paranoid: Close interpersonal relationships and/or personal queries.
    • Schizoid: Close interpersonal relationships.
    • Schizotypal: Close interpersonal relationships.

  • Behavioral Style

    • Antisocial : Impulsively angry, hostile, cunning; forceful, risk-taking, thrill-seeking; temper, verbally or physically abusive.

      Avoidant: Shy, mistrustful, aloof; apprehensive; socially awkward; controlled, underactive behavior; feelings of emptiness and depersonalization.

      Borderline: Hemophiliacs” of emotion; resentful acting out; helpless, dysphoric, empty void; irregular circadian rhythms (sleep-wake, etc.).

      Dependent: Docile, passive, nonassertive, lack of self-confidence.

      Histrionic: Charming/excitement-seeking; labile, capricious, superficial.

      Narcissitic: Conceited, boastful, snobbish; self-assured, self-centered, pompous; impatient, arrogant, thin-skinned.

      Obsessive: Workaholic, dependable, stubborn, possessive; procrastination, indecisive, perfectionistic.

      Paranoid: Guarded, defensive, and hypervigilant; resistant of external influence; chronically tense because constantly mobilized against perceived threats.

      Schizoid: Slow and monotonous speech; lethargic, inattentive, nonspontaneous.

      Schizotypal: Eccentric, erratic, bizarre speech; markedly peculiar but not incoherent; tends to drift from job to job.

  • Interpersonal Style

    • Antisocial : Antagonistic to belligerent; slick” and calculating; highly competitive and poor losers; distrustful of others. ”

      Avoidant: Guardedly tests others; rejection sensitive as self-protectant; desires acceptance but maintains distance; has basic interpersonal skills, but fears using them.

      Borderline: Paradoxical—idealizing and clinging vs. devaluing and oppositional; rejection sensitivity- abandonment and depression; separation anxiety as prime motivator; role reversal.

      Dependent: Pleasing; self-sacrificing; clinging, compliant; expect others to take responsibility.

      Histrionic: Attention-getting/manipulative; exhibitionistic/ flirtatious.

      Narcissitic: Disdainful, exploitive, irresponsible; socially facile but without empathy; use others to indulge themselves.

      Obsessive: Autocratic to peers and subordinates but deferential to superiors; polite and loyal.

      Paranoid: Distrustful, secretive, isolated; blaming; provocative, counterattacking, hypersensitive.

      Schizoid: Minimal human” interests and friends; “cold fish”; fades into social background; rarely responsive to others’ feelings or actions; isolative and content to remain aloof. ”

      Schizotypal: Socially isolative, peripheral relationships; with apprehension or apathy; if married, relationship is utilitarian and superficial.

  • Cognitive Style

    • Antisocial : Impulsive, inflexible, and externally oriented; hard-nosed, realistic, and devious; acting-out defense.

      Avoidant: Perpetual vigilance; thoughts easily distracted by hypersensitivity

      Borderline: Inflexible, rigid; abstraction—grandiosity and idealization, splitting; reasons by analogy: doesn’t learn from experience; external loss of control-blaming; poorly developed evocative memory.

      Dependent: Suggestible: Pollyanna-like about interpersonal relations; overprotective—the too good parent.” ”

      Histrionic: Impulsive, thematic, field-dependent; avoid awareness of their hidden dependencies.

      Narcissitic: Cognitive expansiveness and exaggeration; focus on images and themes: take liberties with facts; persistent and inflexible.

      Obsessive: Constricted—rule-based, unimaginative; assertive (defiance) vs. pleasing (obedience).

      Paranoid: Mistrusting, preconceptions; tendency to disregard evidence to the contrary; may become conspiratorial or delusional under stress.

      Schizoid: Cognitively distracted in thinking and communications; easily derailed and tangential; absent-minded; minimally introspective.

      Schizotypal: Cognitive slippage scattered, ruminative; engages in magical thinking, superstitious.

  • Feeling Style

    • Antisocial : Glib, shallow, superficial; avoid softer” emotions (i.e. warmth and intimacy) which connote weakness. ”

      Avoidant: Shy and apprehensive.

      Borderline: Extreme lability of mood and affect.

      Dependent: Pleasant but anxious, timid, or sad when stressed.

      Histrionic: Exaggerated emotional display.

      Narcissitic: Self-confidence—narcissistic rage.

      Obsessive: Grim and cheerless, feeling avoidance.

      Paranoid: Aloof, humorless; restricted affect, jealous; easily provoked.

      Schizoid: Aloof, indifferent.

      Schizotypal: Hypersensitive, hostile, and aloof; may experience intense social anxiety.

  • Temperament

    • Antisocial : Ill-tempered infantile pattern; aggressive, impulsive adult pattern.

      Avoidant: Irritable.

      Borderline: Dependent type: passive infantile pattern—low autonomic nervous system reactivity. Passive-aggressive type: difficult” infantile pattern-” affect irritability.

      Dependent: Low energy level; fearful, sad, or withdrawn during infancy; melancholic.

      Histrionic: Hyper responsive infantile pattern externally oriented for gratification.

      Narcissitic: Active and responsive; special talents, attractiveness,

      Obsessive: Irritable, difficult, or anxious.

      Paranoid: Narcissistic type: active, hyperresponsive. Compulsive type: irritable. Passive-aggressive type: affective irritability.

      Schizoid: Passive and anhedonic infantile pattern.

      Schizotypal: Schizoid type: passive infantile pattern. Avoidance type: fearful infantile pattern.

  • Attachment Style

    • Antisocial : Fearful and dismissing.
    • Avoidant: Preoccupied and fearful.
    • Borderline: Disorganized.
    • Dependent: Preoccupied.
    • Histrionic: Preoccupied.
    • Narcissitic: Fearful and dismissing.
    • Obsessive: Preoccupied.
    • Paranoid: Fearful.
    • Schizoid: Dismissing.
    • Schizotypal: Fearful and dismissing.

  • Parental Injunction

    • Antisocial : The end justifies the means.” “
    • Avoidant: We don’t accept you and probably nobody else will either.
    • Borderline: If you grow up (parent). Overprotective or demanding or ” inconsistent parenting.
    • Dependent: You can’t do it by yourself.” “
    • Histrionic: I’ll give you attention when you do what I want.
    • Narcissitic: Grow up and be wonderful—for me.” “
    • Obsessive: You must do/be better to be worthwhile.
    • Paranoid: You’re different. Keep alert. Don’t make mistakes.”
    • Schizoid: Who are you? What do you want?” “
    • Schizotypal: You’re a strange bird.” “

  • Self-View

    • Antisocial : I’m cunning and I’m entitled to get what I want.” They view themselves as strong, competitive self-reliant energetic and tough.

      Avoidant: I’m inadequate and frightened of rejection.” Chronically tense , fatigued self-conscious; devalue their achievement self-critical. ”

      Borderline: I don’t know who I am or where I’m going.” Identity problems involving gender, career, loyalties, and values. Self-esteem fluctuates with current emotion.

      Dependent: I’m nice but inadequate (or fragile).” Self-doubting. ”

      Histrionic: I need to be noticed”; externally oriented for gratification.

      Narcissitic: I’m special and unique and I’m entitled to extraordinary rights and privileges whether I’ve earned them or not.” ”

      Obsessive: “I’m responsible if something goes wrong.” See themselves as reliable, competent, righteous

      Paranoid: I’m so special and different. I’m alone and no one likes me because I’m better than others. ”

      Schizoid: I’m a misfit from life, so I don’t need anybody.” ” I’m indifferent to everything.”

      Schizotypal: I’m on a different wavelength than others.” Experience of being “selfless empty, estranged, depersonalization, dissociation.

  • World View

    • Antisocial : Life is devious and hostile and rules keep me from fulfilling my needs. Therefore I’ll bend or break them because my needs come first and I’ll defend any efforts to be controlled or degraded.” ”

      Avoidant: Life is unfair. People reject and criticize me but I want someone to like me. Therefore be vigilant demand reassurance and if all else fails fantasize and daydream.

      Borderline: People are great. No good. No, it’s not. If life doesn’t go my way, I can’t tolerate it. Don’t commit to anything.

      Dependent: Others are here to take care of me” (because I can’t do it myself) ”

      Histrionic: Life makes me so nervous so I’m entitled to special care and consideration.

      Narcissitic: Life is a banquet table to be sampled at will. People owe me admiration and privilege. Therefore I’ll expect and demand this specialness.” ”

      Obsessive: Life is unpredictable and expects too much. Therefore be in control be right and proper and don’t make mistakes

      Paranoid: Life is unfair ,unpredictable and demanding. It will sneak up and harm you. Therefore be wary counteract trust no one and excuse yourself from failure by blaming others.” ”

      Schizoid: Life is a difficult place and can be harmful. Therefore trust nothing and keep a distance from others so that you won’t get hurt.” ”

      Schizotypal: Life is strange and unusual and others have special magic intentions. Therefore observe with caution while being curious.” “

  • Maladaptive Schemas

    • Antisocial : Mistrust/abuse; entitlement; insufficient self-control; defectiveness; emotional deprivation; abandonment; social isolation.

      Borderline: Abandonment; defectiveness; abuse/mistrust; emotional deprivation; social isolation; insufficient self-control.

      Dependent: Defectiveness; self-sacrifice; approval-seeking.

      Histrionic: Approval-seeking; emotional deprivation; defectiveness.

      Narcissitic: Entitlement; defectiveness; emotional deprivation; insufficient self-control; unrelenting standards.

      Obsessive: Unrelenting standards; punitiveness; emotional inhibition.

      Paranoid: Abuse/mistrust; defectiveness.

      Schizoid: Social isolation; emotional deprivation; defectiveness; subjugation; undeveloped self.

      Schizotypal: Alienation; abandonment; dependence; vulnerability to harm.

  • Optimal DSM-IV-TR Criteria

    • Antisocial : Criminal, aggressive, impulsive, irresponsible behavior.

      Avoidant: Avoids occupational activities that involve significant interpersonal contact, fearing criticism, disapproval, or rejection.

      Borderline: Frantic efforts to avoid real or imagined abandonment.

      Dependent: Needs others to assume responsibility for most major areas of his or her life.

      Histrionic: Uncomfortable in situations in which they are not the center of attention.

      Narcissitic: Have grandiose sense of self-importance.

      Obsessive: Shows perfectionism that interferes with task completion.

      Paranoid: Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

      Schizoid: Neither desires nor enjoys close relationships, including being part of a family.

      Schizotypal: Odd thinking and speech: behavior or appearance that is odd, eccentric, or peculiar.

• Treatment
  • Antisocial
    • diagnosis is reserved for individuals over age 18

      focus on helping the individual understand the nature and consequences of his disorder so he can be helped to control his behavior

      need to repeatedly confront the patient’s minimization and denial of antisocial behavior

      avoid exploratory or insight-oriented forms of psychotherapy

      focus on here-and-now behavior

      analyzing unconscious material from the past

      Relaxation exercises and a merging intervention

      reduce the amnestic barriers that maintained this compartmentalization

      improved daily functioning

      set guidelines for the patient’s involvement, including regular attendance, active participation and completion of any necessary work outside of office visits

      help the patient understand how he creates his own problems and how his distorted perceptions prevent him from seeing himself the way others view him

      develop trust between patients

      establish rapport

      work gradually to establish trust

      explicitly acknowledge the antisocial individual’s strengths and capabilities

      refrain from pressing the individual to acknowledge weaknesses

      focusing on specific problem situations with problem-solving

      behavioral strategies is suggested

      Therapists must be aware of their own feelings and remain vigilant to prevent their emotional responses to their patients from disrupting the therapy process

      anticipate their emotions and present an attitude of acceptance without moralizing

      point out that continuing in therapy

      identifying any remaining distress that the individual may be denying or minimizing

      anticipate consequences of their actions

      shift therapeutic focus to automatic thoughts and underlying schemas is possible

      focus shifts to the social pressures the individual faces due to continued antisocial behavior

      sensitize patients to people, places, and circumstances

      social skills training is a relatively potent bottom-up treatment strategy

  • Avoidant
    • long-term psychotherapy

      individual therapy is usually the preferred modality, group therapy can be useful if the client can agree to attend enough sessions

      focus on improving poor self-esteem

      encourage social interaction

      take a more detailed evaluation than usual, while doing so in a relatively unobtrusive fashion

      be sensitive to nonverbal cues of the client

      psychotherapy is usually most effective when it is relatively short-term and oriented toward finding solutions to specific life problems

      solid therapeutic relationship founded with good rapport and listening to the client is important to the therapist’s effectiveness.

  • Borderline
    • Psychotherapy is nearly always the treatment of choice for this

      stabilize mood swings

      show different coping skills, emotion regulation skills

      encourage new important changes in a person’s life

      teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring

      help distinguish between reality from their own misperceptions of the world and their surrounding environment

      focus on social learning theory and conflict resolution

      target lowering overwhelming regular cognitive functioning

      target and expose faulty cognitions

      avoid labeling them as “trouble-makers.”

      Provide a structured therapeutic setting

      help patient realize away from “black-and-white” terms

      be aware of this “all-or-nothing” lability most often found in individuals with this disorder and be careful not to validate it

      tolerate repeated episodes of primitive rage, distrust, and fear

      Uncovering is to be avoided in favor of bolstering of ego defenses

      allow the patient to be less anxious

      The goals of therapy should be in terms of life gains toward independent functioning, and not complete restructuring of the personality.

      learn to be like a rock when dealing with a person who has this disorder

      should offer his or her stability to contrast the client’s lability of emotion and thinking

      be aware of client’s constant demands on a clinician, the constant suicidal gestures, thoughts, and behaviors, and the possibility of self-mutiliating behavior

      Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most

  • Dependent
    • psychotherapy is the treatment of choice

      effective psychotherapeutic approach is one which focuses on solutions to specific life problems

      the shorter the length of the therapy the better to server as the litmus test

      self-reliant failure – should not be seen as a therapeutic failure during treatment, solution-focused is the criteria

      Examining the client’s faulty cognitions and related emotions

      understand lack of self-confidence, autonomy versus dependency

      Assertiveness training and other behavioral approaches

      Aggressive self-assurance; given to making bold assertions

      use the act of affirming, asserting or stating something

      termination of therapy is important

      should not allow the patient to use new symptoms to keep therapy

      goal is to end a relationship at an agreed-upon time and way

      the client should be reinforced for the positive gains made in therapy

      encouraged the patient to explore their new-found autonomy or improved management of their anxious feelings

  • Histrionic
    • Psychotherapy, as with most personality disorders, is the treatment of choice

      Group and family therapy approaches are generally not recommended

      individual who suffers from this disorder often draws attention to themselves and exaggerates every action and reaction

      People with disorder often come across as “fake” or shallow in their interpersonal relationships with others

      Therapy should generally be supportive and good rapport

      be “rescuer” role, in which the therapist will be asked to constantly reassure and rescue the client from daily problems

      therapist will be perceived as sexually attractive to the patient

      Boundary issues in relationships and a clear delineation of the therapeutic framework are relevant and important aspects of therapy

      take advantage of matter-of-fact and realistic assessment of situations and problems

      Solution-focused therapy is often appropriate

      Most therapy approaches should not be focused on the long-term, personality change of the individual

      focus on short-term alleviation of difficulties within the person’s life

      must explicitly state up-front at the onset of therapy to dismiss any thoughts the client may have of a “magical” cure for this disorder

      Suicidal behavior is often apparent in a person, be aware

      Suicidality should be assessed on a regular basis and suicidal threats should not be ignored or dismissed

      Suicide sometimes occurs when all that was intended was a gesture, so all such thoughts and plans should be taken with the same seriousness as with any other disorder

      Self-mutilation behavior may also be present in this disorder and should also be taken seriously as an issue of importance to discuss within therapy

      Self-mutilation is a gesture of “help me”

      watch for usual exaggeration of events and problems by the patient

      discover the unrealistic expectations and fears associated with many behaviors and thoughts

      histrionic personality disorder will emphasize attractiveness (“style over substance”) in their lives and relationships

      discuss alternatives and trying out new behaviors may be helpful

      point out, in session, when the client is using shallow criteria in which to judge another

      patient should eventually look to be able to identify shallow criteria themselves throughout their lives

      avoid insight and cognitive-oriented approaches, generally largely ineffective in treatment

      Help the client to examine interactions from a more objective point of view and emphasizing alternative explanations for behavior

      Examining and clarifying a client’s emotions are also important components of therapy

      Clinicians will often experience reactions to treating this disorder, because of the dramatic nature of the patient.

      Because of this possibility, therapists should be more attuned to their own feelings within the therapy setting

      Ensure that they are treating the patient fairly and with respect

  • Narcissitic
    • differential diagnosis includes:

      1. histrionic personality disorder

      2. antisocial personality disorder

      3. paranoid personality disorder

      Axis I syndromes:

      1. acute anxiety reactions

      2. dysthymia

      3. hypochondriasis

      4. delusional disorders

      Treatment Goals:

      1. short term

      2. crisis oriented

      3. long term and focused on personality restructuring

      Crisis-oriented psychotherapy- focuses on alleviation of the symptoms such as anxiety, depression, or somatic symptoms associated with the narcissistic injury or wound.

      Longer-term therapy often involve restructuring of personality

      1. increasing empathy [Understanding and entering into another’s feelings] [“the capacity to think and feel oneself into the inner life of another person”] [when one is able to step into the shoes of another, to see the world through the other’s eyes that one is able to generate a response that is authentic, accurate, and fitting]

      2. decreasing rage [A feeling of intense anger]

      3. decrease cognitive distortions

      4. increase the individual’s ability to mourn losses

      5. increase valuing of others

      6. use confrontation

      7. use mirroring technique

      8. decrease entitlement

      9. decrease envy

      10. heal incomplete self-structure

      11. use transmuting internalization

      12. use expressive psychotherapy the therapeutic effort focuses on the negative transference in which early manifestations of anger are explored and interpreted

      13. explore the individual’s exquisite sensitivity to the therapist’s empathic failures and the importance of therapeutically exploring this vulnerability

      14. use predictive interpretation.

      15. abandon entitlement and grandiosity

      16. expand ego functions, skills, and capacities [supportive psychotherapy]

      17. teach the individual to become a better narcissist

      18. shows the individual how excessive self-adoration actually interferes with the ability to receive more realistic, wanted, and needed adoration from others

      19. awareness of self-deficit-increasing the individual’s self-esteem and self-cohesion

      20. awareness and anticipation of personal vulnerability to injury, shame, and disappointment; containment

      21. ability to modulate affects [have an effect upon], especially narcissistic rage; and adaptation

      22. behavioral interventions

      23. focus between increasing responsibility for behavior

      24. decreasing cognitive distortions and dysfunctional affects such as rage reactions

      25. developing healthier attitudes and beliefs

      26. decrease black-white thinking

      27. exercise relating to others

      28. use roleplay and roler reversal

      29. new statements of belief, such as “others’ feelings count too,”

      30. decrease demands for approval and special treatment

      31. use social skill training/reflect specific skill deficits

      32. identify maladaptive schemas and planning specific strategies and interventions

      33. use imagery exercises, empathic confrontation, homework assignments, and “limited reparenting” (i.e., a form of corrective emotional experience)

      34. learning to tolerate his or her faults

      35. internalize this empathic affirmation of self

      36. Empathy affirmation

      37. learn self-regulation.

      Core Problem of Narcissist:

      1. anger

      2. envy

      3. distorted self-sufficiency

      TRANSMUTING INTERNALIZATION-The growth-producing process by which patients are able to internalize the needed selfobject functions and to acquire the missing self structure

      THE SELF OBJECT-means the experience of another – more precisely, the experience of impersonal functions provided by another – as part of the self

      1. analysis of defense and resistance

      2. unfold selfobject transference

      3. establish emphatic intuneness between self and selfobject on mature adult level

      3 Treatent Objectives

      1. developing a collaborative working relationship

      2. socializing the individuals to the cognitive theory and model of treatment

      3. agreeing on treatment goals.

      components of grandiosity

      1. hypersensitivity to criticism

      2. emphatic deficits

      5 Maladaptive schemas

      1. entitlement—that is, the belief that one is superior to others and not bound by the rules and norms that govern normal social interaction;

      2. emotional deprivation—that is, the belief that one’s desire for emotional support will not be met by others;

      3. defectiveness—that is, the belief that one is defective, bad, unwanted, or inferior in important respects;

      4. unrelenting standards—that is, the belief that striving to meet unrealistically high standards of performance is essential to being accepted and avoiding criticism;

      5. insufficient self-control— that is, the belief that one is incapable of self-control and frustration tolerance

  • Obsessive
    • Supportive-Expressive Theraphy
    • Expose extreme feelings of insecurity and uncertainty
    • switch from impossible expectations for self and others to more realistically achievable ones
    • avoid qualifying and quantifying descriptions of perfections
    • focus on real feeling and expression limit intellectual discussions of emotions
    • focus on recent events
    • Schema-focused approach
    • target dysfunctional conditions
    • target restricted behavioral reportoires
    • target negative affective dispositions
    • target issues related to attachment and identity
    • goal-modify and restructure maladaptive schemas that underlie behaviors and effects
    • maladpative schemas: unrelenting standards, punitiveness, emotional inhibitions
    • step#1-establish a collaborative working relationship
    • target rigidity
    • target feeling of avoidance
    • target maximizing of interpersonal relationships
    • develop a closer relationship very slowly
    • introduce to cognitive theory of emotion [thoughts dictates emotion]
    • identify dysfunctional thoughts
    • refute dysfunctional thoughts
    • setting agenda
    • prioritize problems
    • problem solving
    • thought-stopping
    • target rumination, procrastination and indecisiveness
    • use flooding
    • use desensitization
    • use response prevention
    • use satiation training [The act of achieving full gratification]
    • don’t dwell in the past or future
    • practice/emphasize here and now exercise
    • avoid the fear of making mistakes
    • encourage risk taking and decision making
    • avoid the need for absolutes and certainties to make decision
    • achieve some degree of balance and compromise
    • avoid thinking that you are superhuman
    • function as fallible humans [likely to fail or make errors]
    • identify/avoid anticipatory anxiety
    • accept anxiety is a part of life and will occur throughout life
    • inflate self-esteem
    • identify constricted emotions
    • think/go back to general function of self when under attack by obessesion
  • Paranoid
    • psychotherapy is the treatment of choice

      Individuals with paranoid personality disorder, however, rarely present themselves for treatment

      emphasizes a simple supportive, client-centered approach will be most effective.

      Rapport-building with a person who has this disorder will be much more difficult than usual because of the paranoia associated with the disorder.

      Early termination, therefore, is common.

      As the therapy progresses, the patient will likely begin to trust the clinician more and more.

      The client then will likely begin disclosing some of his or her more bizarre paranoid ideation.

      Be careful to balance being objective in therapy and with regards to these thoughts

      Care must be used not to challenge the client too firmly or risk the individual leaving therapy permanently

      Control issues should be dealt with in much a similar manner, with great care

      paranoid beliefs are delusion and not based in reality, arguing them from a rational point of view is useless

      Challenging the beliefs is also likely to result in more frustration on both the part of the therapist and client

      be more keenly aware of being straight-forward with this individual

      Subtle jokes are often lost on them and allusions to information about the client not received directly from the client’s mouth will raise a great deal of suspicion

      avoid trying to have the patient sign a release of information for information not essential to the current therapy.

      Items in life which usually wouldn’t give most people a second thought can easily become the focus of attention to this client

      care must be exercised in discussions with the client.

      An honest, concrete approach will likely gain the most results, focusing on current life difficulties

      Clinicians should generally not inquire too deeply into the client’s life or history, unless it’s directly relevant to clinical treatment.

      Long-term prognosis for this disorder is not good.

      Individuals who suffer from this disorder often remain afflicted with prominent symptoms of it throughout their lifetime.

      It is not uncommon to see such people in day treatment programs or state hospitals. Other modalities, such as family or group therapy, are not recommended.

  • Schizoid
    • Treatment of choice is individual psychotherapy.

      People with this disorder are unlikely to seek treatment unless they are under increased stress or pressure in their life.

      Treatment will usually be short-term in nature to help the individual solve the immediate crisis or problem.

      The patient will then likely terminate therapy.

      Goals of treatment most often are solution-focused using brief therapy approaches.

      The development of rapport and a trusting therapeutic relationship will likely be a slow, gradual process

      People who suffer from this disorder often maintain a social distance with people in their lives, even those close to them

      The clinician should work to help ensure the client’s security in the therapeutic relationship.

      Acknowledging the client’s boundaries are important and the therapist should not look to confront the client on these types of issues.

      Long-term psychotherapy should be avoided because of its poor treatment outcomes

      Psychotherapy should focus on simple treatment goals to alleviate current pressing concerns or stressors within the individual’s life.

      Cognitive-restructuring exercises may be appropriate for certain types of clear, irrational thoughts which are negatively influencing the patient’s behaviors.

      The therapeutic framework should be clearly defined at the onset.

      Stability and support are the keys to good treatment with someone who suffers from schizoid personality disorder.

      The therapist must be careful not to “smother” the client and be able to tolerate some possible “acting-out” behaviors.

      Group therapy may be an alternative treatment modality to examine, although it is usually not a good initial treatment choice.

      A person who suffers from this disorder who is assigned to group therapy at the onset of therapy will likely terminate treatment prematurely.

      Encourage to tolerate of being in a social group.

      Person graduating from individual to group therapy, they may have enough minimal social skills and abilities to tolerate group much better.

      People who suffer from this disorder see little to no reason for social interactions

      Patient will be quite quiet in group, contributing little to others and offering little of themselves.

      This is to be expected and the individual who has schizoid personality disorder

      They should not be pushed into participating more fully group until he or she is ready and on their own terms.

      Group leaders must be careful to help protect the individual from criticism from other group members for their lack of participation.

      tolerate the initially-silent member with this disorder, the individual may gradually participate more and more, although this process will be very slow and drawn out over months.

      the patient may eventually, “reveal a plethora of fantasies, imaginary friends, and fears of unbearable dependency – even of merging with the therapist.

      Oscillation between fear of clinging to the therapist may be followed by fleeing through fantasy and withdrawal.

      These types of feelings must be normalized by the clinician and brought into proper focus in the therapeutic relationship.

  • Schizotypal
    • As with most personality disorders, schizotypal personality disorder is best treated with some form of psychotherapy.

      Individuals with this disorder usually distort reality more so than someone with Schizoid Personality Disorder.

      As with Delusional Disorder and Paranoid Personality Disorder, the clinician must exercise care in therapy to not directly challenge delusional or inappropriate thoughts.

      A warm, supportive, and client-centered environment should be established with initial rapport.

      As with Avoidant Personality Disorder, the individual lacks an adequate social support system

      usually avoids most social interactions because of extreme social anxiety.

      The patient often reports feelings of being “different” and not “fitting in” with others easily, usually because of their magical or delusion thinking.

      There is no simple solution to this problem.

      Social skills training and other behavioral approaches which emphasize the learning of the basics of social relationships and social interactions may be beneficial.

      Consider group therapy as the client progresses. Such a group should be for this specific disorder, though, which may be difficult to form or find in smaller communities.

• Compiled By
  • Rigel Arcayan, 20131128
  • blindcaveman.wordpress.com
  • ~ https://dl.dropboxusercontent.com/u/80421698/QuickGuide-DSM-IV-PersonalityDisorder.xls
  • ~ https://dl.dropboxusercontent.com/u/80421698/BookSummary-DSM%20IV-Diagnosis%20and%20Treatment.pdf