{"id":4207,"date":"2018-09-18T17:23:45","date_gmt":"2018-09-18T21:23:45","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4207"},"modified":"2019-05-26T00:08:41","modified_gmt":"2019-05-26T04:08:41","slug":"personality-disorders","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/abnormal-psychology\/personality-disorders\/","title":{"rendered":"Personality Disorders"},"content":{"rendered":"

Defined by enduring problems with forming a stably positive identity and with sustaining close and constructive relationships<\/li>\n
Extreme and inflexible traits, 10 different disorders, highly heterogeneous o Paranoid \u2013 chronic tendencies to be mistrustful and suspicious<\/li>\n<\/ul>\n
o Antisocial \u2013 patterns of irresponsibility and callous disregard for rights of others o Dependent \u2013 overreliance on others<\/p>\n
- Persistent, pervasive and maladaptive ways in which the traits are expressed \uf0b7 Unstable, positive sense of self<\/li>\n<\/ul>\n
  1. The DSM-5 Approach to Classification <\/strong>\n
    \n
    10 different personality disorders, in 3 clusters:<\/li>\n
    A) <\/strong>Odd\/eccentric \uf0e0 paranoid, schizoid, schizotypal, B) <\/strong>Dramatic\/erratic \uf0e0 antisocial, borderline, C)<\/strong> Anxious\/fearful \uf0e0 avoidant, dependent, obsessive-compulsive \uf0b7 1\/10 meet diagnostic criteria<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
    More common among those with a psychological disorder (MDD, anxiety)<\/p>\n
    \n
    People with PD 7x more likely to have anxiety\/mood disorder, and 4x as likely to have a substance disorder *especially cluster B<\/li>\n
    More severe, poorer social functioning and worse treatment outcome when comorbid PDs are present o Doubles the risk of depression Assessment of DSM-5 Personality Disorders<\/li>\n
    List of criteria and structured interviews for each PD *most clinicians do not used the structured interviews<\/li>\n
    Low Interrater reliability for schizoid PD<\/li>\n
    Low agreement rates in diagnoses and often miss diagnoses<\/li>\n
    Interviews with people who know the patient will improve the accuracy of diagnosis *rarely occurs Problems with the DSM-5 Approach to Personality Disorders \uf0b7 PDs are Not Stable over Time:\n
    \n
    Half patients diagnosed with a PD at one point in time achieved remission after 2 years o 99% remitted 16 years later<\/li>\n
    Symptoms most common during adolescence *PDs may not be as enduring, decline in 20s and late life<\/li>\n
    Many people still have some symptoms after remission o After remission many problems in functioning still persist<\/li>\n
    Risk of relapse still remains high, years after remission *symptoms wax and wane over time \uf0b7 Personality Disorders are Highly Comorbid:<\/li>\n
    More than 50% with PD meet diagnosis for another PD<\/li>\n
    DSM system may not be ideal for classifying PDs, lack of test-retest stability and high comorbidity<\/li>\n<\/ul>\n<\/li>\n
    Some PDs are extremely rare (< 2%)<\/li>\n
    People with PD can vary a good deal from one another in the nature of their personality traits & severity of condition<\/li>\n<\/ul>\n
    \n
    Alternative DSM-5 Model for Personality Disorders <\/strong>\n
    \n
    Recommend reducing the number of PDs, incorporating personality trait dimensions, and diagnosing PDs on the basis of extreme scores on personality trait dimensions ***Found in appendix of DSM-5<\/li>\n
    Includes only 6 of the 10 PDs: schizoid, histrionic, dependent were excluded because they are rare, paranoid was excluded because it overlaps with other PDs<\/li>\n
    Diagnosis based on personality traits<\/li>\n
    5 personality trait domains and 25 more specific personality trait facets, rated using self-report *related to 5-factor model<\/li>\n
    Diagnosed is person shows persistent and pervasive impairments in self and interpersonal aspects of functioning from early adulthood<\/li>\n
    Provides richer detail for diagnosis, individuals diagnosed with same PD can vary lots in personality traits from another<\/li>\n
    Personality trait ratings tend to be stable over time, more than PD diagnoses<\/li>\n
    Personality trait dimensions are related to many aspects of psychological adjustment \uf0b7 Captures subsyndromal symptoms better<\/li>\n<\/ul>\n<\/li>\n
    Common Risk Factors Across the Personality Disorders<\/strong>\n
    \n
    Psychoanalytic and behavioural theory placed emphasis on parenting and early developmental influences<\/li>\n
    Recent evidence of strong biological component<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
    Children in the Community Study:<\/p>\n
    \n
    Assessed links between childhood adversity and PDs<\/li>\n
    Assessed 2 aspects of parenting style: aversive parental behaviour and lack of parental affection<\/li>\n
    Kept track of child maltreatment, assessed with clinical interview for diagnosing PDs o Findings suggested that PDs were strongly related to early adversity o Parenting style also predicted certain PDs \uf0b7 Norwegian Birth Registry \u2013 sample of twins:<\/li>\n
    High heritability estimates for all PDs (.55-.77)<\/li>\n<\/ul>\n
    \n
    Clinical Description and Etiology of the Odd\/Eccentric Cluster <\/strong>\n
    \n
    Similar bizarre thinking\/experiences seen in schizophrenia *less severe<\/li>\n<\/ul>\n<\/li>\n
    Paranoid PD<\/strong>\n
    \n
    Presence of 4+ of the following signs of distrust<\/strong> and suspiciousness<\/strong> from early adulthood across many contexts:\n
    \n
    1) Unjustified suspiciousness of being harmed, deceived, or exploited o 2) Unwarranted doubts about the loyalty or trustworthiness of friends or associates o 3) Reluctance to confide in others because of suspiciousness o 4) Tendency to read hidden meanings into the benign actions of others o 5) Bears grudges for perceived wrongs<\/li>\n
    6) Angry reactions to perceived attacks on character or reputation o 7) Unwarranted suspiciousness of the partner\u2019s fidelity<\/li>\n<\/ul>\n<\/li>\n
    Expect to be mistreated\/exploited, are very secretive and continually on the lookout for signs of trickery\/abuse<\/li>\n
    Hostile and angry in response to perceived insults, seen as difficult and critical<\/li>\n
    Other symptoms of schizophrenia are not present (hallucinations), less impairment in social\/occupational functioning, no cognitive disorganization<\/li>\n
    Full-blown delusions are not present<\/li>\n
    Co-occurs most often with schizotypal, borderline and avoidant PD<\/li>\n<\/ul>\n<\/li>\n
    Schizoid PD<\/strong>\n
    \n
    Presence of 4+ of the following signs of aloofness<\/strong> and flat affect<\/strong> from early adulthood across many contexts:\n
    \n
    1) Lack of desire for or enjoyment of close relationships o 2) Almost always prefers solitude to companionship o 3) Little interest in sex o 4) Few or no pleasurable activities o 5) Lack of friends<\/li>\n
    6) Indifference to praise or criticism<\/li>\n
    7) Flat affect, emotional detachment, or coldness<\/li>\n<\/ul>\n<\/li>\n
    Appear dull, bland, aloof, no warm feelings for others<\/li>\n
    Rarely experience strong emotions Schizotypal PD<\/strong><\/li>\n
    Presence of 5+ of the following signs of unusual thinking<\/strong>, eccentric behaviour<\/strong>, and interpersonal deficits<\/strong> from early adulthood across many contexts:\n
    \n
    1) Ideas of reference<\/li>\n
    2) Odd beliefs or magical thinking e.g. beliefs in extrasensory perception\n
    \n
    Unusual perceptions<\/li>\n
    Odd thought and speech<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
    <\/p>\n
    \n
    Suspiciousness or paranoia<\/li>\n
    Inappropriate or restricted affect<\/li>\n
    Odd or eccentric behaviour or appearanceo 8) Lack of close friends<\/li>\n<\/ul>\n
    \n
    9) Social anxiety and interpersonal fears that do not diminish with familiarity<\/li>\n<\/ul>\n
    \n
    Recurrent illusions (inaccurate sensory perceptions), flat\/constricted affect, aloof from others<\/li>\n
    Most do not develop delusions or schizophrenia (some do)<\/li>\n
    Similar genetic vulnerability as for schizophrenia \u2013 enlarged ventricles, less temporal grey matter (also cognitive and neuropsychological deficits)<\/li>\n
    60% heritable<\/li>\n<\/ul>\n
    Clinical Description and Etiology of the Dramatic\/Erratic Cluster <\/strong><\/p>\n
    \n
    Highly inconsistent behaviour, inflated self-esteem, rule breaking behaviour, exaggerated emotional displays<\/li>\n
    Most well-known<\/li>\n<\/ul>\n
    \n
    Antisocial PD (APD) and Psychopathy <\/strong>\n
    \n
    1) Age at least 18<\/li>\n
    2) Evidence of conduct disorder before age 15<\/li>\n
    3) Pervasive pattern of disregard for the rights of others since the age of 15 as sown by at least 3 of the following:\n
    \n
    Repeated law breaking, deceitfulness\/lying, impulsivity, irritability\/aggressiveness, reckless disregard for own safety & that of others, irresponsibility as seen in unreliable employment\/financial history, lack of remorse<\/li>\n<\/ul>\n<\/li>\n
    Used interchangeably with psychopathy by public *antisocial behaviour is important for both, but they differ in important ways \uf0b7 Psychopathy is not included in DSM-5 \uf0b7 Antisocial PD:\n
    \n
    Core feature: pervasive pattern of disregard for the rights of others<\/li>\n
    Presence of conduct disorder, little regard for truth, lack of remorse for misdeeds o Men are 5x more likely to meet criteria, \u00be meet criteria for another disorder *substance abuse is common<\/li>\n
    \u00be convicted felons meet criteria o Poverty of emotion:\n
    \n
    Negative \u2013 lack of shame\/remorse\/anxiety, doesn\u2019t learn from mistakes \uf0a7 Positive \u2013 merely an act to manipulate others, superficially charming \uf0b7 Psychopathy:<\/li>\n<\/ul>\n<\/li>\n
    Predates APD diagnostic criteria o \u201cMask of Sanity\u201d \u2013 Hervey Cleckley<\/li>\n
    Criteria focuses on person\u2019s thoughts and feelings *poverty of emotions (positive and negative)<\/li>\n
    No sense of shame, positive feelings for others is an act o Superficially charming<\/li>\n
    Impossible to learn from mistakes due to lack of anxiety o Impulsive rule-breaking behaviour o Boldness, meanness, and impulsivity<\/li>\n
    Assessed using Psychopathy Checklist-Revised (PCL-R)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n
    Symptoms do not need to show before age 15 *will not obtain high scores on PCL-R if have APD<\/p>\n
    Etiology<\/p>\n
    \n
    Most research done on those convicted as criminals, use different measures (APD vs. psychopathy) \uf0b7 Interactions of Genes and the Social Environment:\n
    \n
    Role of social environment is key in APD: parenting qualities of negativity, inconsistency and low in warmth<\/li>\n
    Poverty and exposure to violence also predict antisocial behaviour o Those with CD, if impoverished, 2x more likely to develop APD<\/li>\n
    Polymorphism of MAO-A gene predicts psychopathy in males who had experienced childhood abuse or maternal rejection<\/li>\n
    Anti-social behaviour is 40-50% heritable<\/li>\n<\/ul>\n<\/li>\n
    Psychological Risk: Insensitivity to Threat and to Others\u2019 Emotions:\n
    \n
    Psychopaths are unable to learn from experience, immune to anxiety that keeps us from breaking the law\/lying<\/li>\n
    Deficits in experience of fear and threat, lower than normal levels of skin conductance o Deficits in developing conditioned fear responses *no increased amygdala activity for CS o Even more unresponsive to threat when trying to obtain a reward<\/li>\n
    Inattentiveness to threats when pursing a goal \u2013 deficits in regions of prefrontal cortex involve in attending to negative information during goal pursuit<\/li>\n
    Lack of empathy \u2013 especially difficult to recognize fear in others<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
    Borderline PD <\/strong>(BPD)<\/p>\n
    \n
    \n
    \n
    Presence of 5+ of the following signs of instability<\/strong> in relationships, self-image<\/strong>, and impulsivity<\/strong> from early adulthood across many contexts:\n
    \n
    Frantic efforts to avoid abandonment<\/li>\n
    Unstable interpersonal relationships in which others are either idealized or devalued o 3) Unstable sense of self<\/li>\n
    Self-damaging, impulsive behaviours in at least two areas, such as spending, sex, substance abuse, reckless driving, and binge eating<\/li>\n
    Recurrent suicidal behaviour, gestures or self-injurious behaviour o 6) Marked mood reactivity o 7) Chronic feelings of emptiness<\/li>\n
    Recurrent bouts of intense or poorly controlled anger<\/li>\n
    Curing stress, a tendency to experience transient paranoid thoughts and dissociative symptoms<\/li>\n<\/ul>\n<\/li>\n
    Very common in clinical settings, very hard to treat, associated with recurrent periods of suicidality<\/li>\n
    Core features: impulsivity and instability in relationships and mood, emotional reactivity<\/li>\n
    Emotions are intense, erratic, shift abruptly *passionate idealization to contemptuous anger<\/li>\n
    Overly sensitive to small signs of emotions in others<\/li>\n
    No clear\/coherent sense of self<\/li>\n
    Cannot bear to be alone (fear of abandonment), chronic depression and emptiness<\/li>\n
    Psychotic and dissociative symptoms when stressed<\/li>\n
    2\/3 engage in self-mutilation<\/li>\n
    Likely to have comorbid PTSD, mood disorders, substance related disorders, eating disorders = more likely to last longer<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
    Etiology<\/p>\n
    \n
    Neurobiological Factors:<\/li>\n<\/ul>\n
    Highly heritable (60%)<\/p>\n
    Lower serotonin function \u2013 general dysregulation<\/p>\n
    Increased activation of amygdala to emotional pictures \u2013 emotion dysregulation<\/p>\n
    Deficits in prefrontal cortex \u2013 impulsivity<\/p>\n
    Disrupted connectivity between prefrontal cortex and amygdala \uf0b7 Social Factors: Childhood Abuse in the Context of Genetic Vulnerability:<\/p>\n
    \n
    Parental separation, verbal & emotional abuse during childhood o Tied to high rates of childhood abuse\/neglect and high heritability o Childhood abuse doesn\u2019t predict BPD after genetic risk is controlled o Childhood trauma accounts for less than 1% in variance<\/li>\n
    Genetically driven impulsivity, emotionality and risk-seeking in parents could increase risk of abusing children<\/li>\n<\/ul>\n
    \n
    Linehan\u2019s Diathesis-Stress Theory:\n
    \n
    BPD develops when people who have difficulty controlling their emotions because of a biological diathesis are raised in a family environment that is invalidating<\/li>\n
    Emotional regulation diathesis interactions with experiences of invalidation = BPD development\n
    \n
    Biological diathesis: Emotional dysregulation in the child \uf0e0 great demands on the family \uf0e0 invalidation by parents through punishing\/ignoring \uf0e0 emotional outbursts<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
    by child to which parents attend \uf0e0 emotional dysregulation of child<\/p>\n
    \n
    Histrionic Personality Disorder <\/strong>(HPD)\n
    \n
    Presence of 5+ of the following signs of excessive emotionality<\/strong> and attention seeking<\/strong> from early adulthood across many contexts:\n
    \n
    1) Strong need to be the centre of attention o 2) Inappropriate sexually seductive behaviour o 3) Rapidly shifting and shallow expression of emotions o 4) Use of physical appearance to draw attention to self o 5) Speech that is excessively impressionistic and lacking in detail<\/li>\n
    6) Exaggerated, theatrical emotional expression o 7) Overly suggestible<\/li>\n
    8) Misreads relationships are more intimate than they are<\/li>\n<\/ul>\n<\/li>\n
    Key feature: overly dramatic and attention-seeking behaviour<\/li>\n
    Use physical appearance to draw attention to themselves<\/li>\n
    Emotionally shallow, overly concerned with physical attractiveness, uncomfortable when not the centre of attention<\/li>\n
    Easily influenced by others<\/li>\n<\/ul>\n<\/li>\n
    Narcissistic Personality Disorder<\/strong>\n
    \n
    Presence of 5+ of the following signs of grandiosity<\/strong>, need for admiration<\/strong>, and lack of empathy<\/strong> from early adulthood across many contexts:\n
    \n
    1) Grandiose view of one\u2019s importance<\/li>\n
    2) Preoccupation with one\u2019s success, brilliance, beauty<\/li>\n
    3) Belief that one is special and can be understood only by other high-status people o 4) Extreme need for admiration o 5) Strong sense of entitlement o 6) Tendency to exploit others o 7) Lack of empathy o 8) Envious of others<\/li>\n
    9) Arrogant behaviour or attitudes<\/li>\n<\/ul>\n<\/li>\n
    Interpersonal relationships disturbed by lack of empathy, arrogance and envy, self-centeredness<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
    <\/p>\n
    \n
    Overly reactive to criticism<\/li>\n
    Seeks out higher-status partner<\/li>\n<\/ul>\n
    Etiology<\/p>\n
    \n
    Parenting:\n
    \n
    Parents who are overly indulgent foster children\u2019s belief that they are special and behavioural expressions of their specialness will be tolerated by others \uf0b7 Self-Psychology:<\/li>\n
    Variant of psychodynamic theory (Heinz Kohut) o Characteristics mask low SE (parent & patient)<\/li>\n
    In childhood, narcissist valued as a means to increase parent\u2019s own SE\n
    \n
    Not valued for his\/her own self-worth and competencies o Parental emotional coldness & overemphasis on child\u2019s achievement reported by narcissist o Person with NPD projects self-importance, self-absorption, and fantasies of limitless success o Fragile self-esteem \uf0b7 Social-Cognitive Model:<\/li>\n<\/ul>\n<\/li>\n
    1) People with NPD have fragile self-esteem, in part because they are trying to maintain the belief that they are special<\/li>\n
    2) Interpersonal interactions are important to them for bolstering SE rather than for gaining closeness or warmth<\/li>\n
    Overestimate attractiveness to others and contributions in group activities o Attribute success to abilities rather than to chance\/luck ***cognitive biases<\/li>\n
    Show more reactivity when falsely told they have done poorly on an IQ test (also when told they have succeeded)<\/li>\n
    Primary goal in interactions is to bolster their own self-esteem brag a lot, denigrate others who perform better<\/li>\n<\/ul>\n<\/li>\n
    Clinical Description and Etiology of the Anxious\/Fearful Cluster <\/strong><\/li>\n
    Prone to worry and distress<\/li>\n<\/ul>\n
    IIX. Avoidant Personality Disorder<\/strong><\/p>\n
    \n
    A pervasive pattern of social inhibition<\/strong>, feelings of inadequacy<\/strong>, and hypersensitivity<\/strong> to criticism as shown by 4+ of the following from early adulthood across many contexts:\n
    \n
    Avoidance of occupational activities that involve significant interpersonal contact, because of fears of criticism or disapproval<\/li>\n
    Unwilling to get involved with people unless certain of being liked<\/li>\n
    Restrained in intimate relationships because of the fear of being shamed or ridiculed o 4) Preoccupation with being criticized or rejected<\/li>\n
    Inhibited in new interpersonal situations because of feelings of inadequacy o 6) Views self as socially inept, unappealing or inferior<\/li>\n
    Unusually reluctant to try new activities (taking risks) because they may prove embarrassing<\/li>\n<\/ul>\n<\/li>\n
    Often co-occurs with social anxiety disorder \u2013 similar diagnostic criteria and genetic vulnerability overlaps *maybe a more chronic variant of social anxiety disorder<\/li>\n
    80% have comorbid major depression, alcohol abuse is also common<\/li>\n
    <\/li>\n
    Dependent Personality Disorder <\/strong>\n
    \n
    An excessive need to be taken care of<\/strong>, as shown by the presence of at least 5 of the following from early adulthood across many contexts:\n
    \n
    1) Difficulty making decisions without excessive advice and reassurance from others\n
    \n
    Need for others to take responsibility for most major areas of life<\/li>\n
    Difficulty disagreeing with others for fear of losing their support<\/li>\n
    Difficulty doing things on own or starting projects because of lack of self-confidence<\/li>\n
    Doing unpleasant things as a way to obtain the approval and support of otherso 6) Feelings of helplessness when alone because of fears of being unable to care for self o 7) Urgently seeking new relationships when one ends o 8) Preoccupation with fears of having to take care of oneself<\/li>\n<\/ul>\n<\/li>\n
    See themselves as weak, fear being alone<\/li>\n
    Very passive<\/li>\n
    Can do what is necessary to maintain a close relationship<\/li>\n
    Men with higher levels of dependency are at elevated risk of perpetrating domestic violence<\/li>\n
    Likely to develop depression after interpersonal losses, show high suicidality when depressed<\/li>\n
    Elevated risk of developing anxiety disorders and bulimia<\/li>\n
    Overprotective parents may reinforce children for dependency<\/li>\n
    Authoritarian discipline may limit opportunities for children to develop feelings of self-efficacy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
    Obsessive-Compulsive Personality Disorder <\/strong>\n
    \n
    Intense need for order<\/strong>, perfection<\/strong>, and control<\/strong> as shown by the presence of at least 4 of the following from early adulthood across many contexts:\n
    \n
    Preoccupation with rules, details, and organization to the extent that the point of an activity is lost<\/li>\n
    Extreme perfectionism interferes with task completion o 3) Excessive devotion to work to the exclusion of leisure and friendships\u00a0 Inflexibility about morals and values o 5) Difficulty discarding worthless items<\/li>\n
    Reluctance to delegate unless others conform to one\u2019s standards o 7) Miserliness<\/li>\n
    Rigidity and stubbornness<\/li>\n<\/ul>\n<\/li>\n
    More oriented towards work than pleasure *causes social relationships to suffer, little time for leisure, family, friends<\/li>\n
    Difficulty making decisions and allocating time<\/li>\n
    Serious, rigid, formal, and inflexible<\/li>\n
    Does not include obsessions and compulsions of OCD, often co-occurs with OCD, some overlapping genetic variability<\/li>\n<\/ul>\n<\/li>\n
    Treatment of Personality Disorders <\/strong><\/li>\n
    Many enter treatment for condition other than PD (e.g. substance abuse, anxiety, depression)<\/li>\n<\/ul>\n
    General Approaches to the Treatment of PDs<\/p>\n
    \n
    Psychotherapy is the treatment of choice \u2013 small but positive effects, often supplemented with medication<\/li>\n
    Weekly sessions, or day-treatment programs (several hours\/day), occupational therapy provided<\/li>\n
    Psychodynamic theory \u2013 childhood problems are at the root of PDs, help patient reconsider those early experiences, become more aware of how they drive current behaviour and reconsider beliefs\/responses to early events<\/li>\n
    Cognitive theory \u2013 negative cognitive beliefs are at the heart of PDs, help person become aware of those beliefs and challenge maladaptive cognitions o Explore biases in thinking\n
    \n
    Look for dysfunctional schemas\/assumptions the underline person\u2019s thoughts\/feelings<\/li>\n<\/ul>\n<\/li>\n
    Cannot change underlying traits of PD, but can change disorder into a style or more adaptive way of approaching life<\/li>\n<\/ul>\n
    Treatment of Schizotypal Disorder and Avoidant Personality Disorder<\/p>\n
    \n
    Antipsychotic drugs (risperidone) for schizotypal, reduces unusual thinking<\/li>\n
    Avoidant PD responds to same treatments as social anxiety disorder \u2013 antidepressant medications and cognitive behavioural treatment o Help person challenge negative beliefs about social interactions, teach behavioural strategies for dealing with social situations, exposure treatment<\/li>\n
    Psychopathy \u2013 psychotherapy, either CBT or psychodynamic<\/li>\n<\/ul>\n
    Treatment of Borderline Personality Disorder<\/p>\n
    \n
    ***Difficult to treat<\/li>\n
    Show interpersonal problems in therapeutic relationship<\/li>\n
    Client finds it difficult to trust others, idealize and vilify the therapist<\/li>\n
    Difficult to tell if call at 2:00 from patient is call for help or a manipulative gesture to test the therapist<\/li>\n
    Medications \u2013 anti-depressants, mood stabilizers<\/li>\n
    Hospitalization is often necessary to protect against suicide<\/li>\n
    Many therapist consult with others due to high stress of treatment<\/li>\n
    Metallization based therapy<\/strong> \u2013 fail to think about their own and other\u2019s feelings<\/li>\n
    Schema-focused cognitive therapy<\/strong> \u2013 identify maladaptive assumptions that underlie cognitions<\/li>\n
    Dialectical behaviour therapy<\/strong> \u2013 combines client-centered empathy and acceptance with cognitive behavioural problem solving, emotion-regulation techniques and social skills training o Constant tension between any phenomenon and its opposite is resolved by creating a new phenomenon (the synthesis) *term dialectical used on 2 main ways:\n
    \n
    1) Seemingly opposite strategies that the therapist must use when treating BPD \u2013 accepting them as they are and yet helping them change<\/li>\n
    2) The patient\u2019s realization that splitting the world into good and bad is not necessary; instead one can achieve a synthesis of these apparent opposites<\/li>\n<\/ul>\n<\/li>\n
    4 stages:\n
    \n
    1) Dangerously impulsive behaviours are addressed with the goal of promoting greater control<\/li>\n
    2) Learning to modulate the extreme emotionality \u2013 learn to tolerate emotional distress<\/li>\n
    3) Improving relationships and self-esteem<\/li>\n
    4) Designed to promote connectedness and happiness<\/li>\n
    Learn more effective and socially acceptable ways to handle day-to-day problems<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
    Defined by enduring problems with forming a stably positive identity and with sustaining close and constructive relationships Extreme and inflexible traits, 10 different disorders, highly heterogeneous o Paranoid \u2013… Continue Reading Personality Disorders<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[104],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4207"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4207"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4207\/revisions"}],"predecessor-version":[{"id":4892,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4207\/revisions\/4892"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4207"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4207"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}