Contemporary Perspectives on Personality Disorders PDF

Contemporary Perspectives on Personality Disorders Contemporary Perspectives on Personality Disorders The Interpersonal Perspective Allen Frances – “The essence of being a mammal is the need for, and the ability to participate in, interpersonal relationships. The interpersonal dance begins at least...

Contemporary Perspectives on Personality Disorders Contemporary Perspectives on Personality Disorders The Interpersonal Perspective Allen Frances – “The essence of being a mammal is the need for, and the ability to participate in, interpersonal relationships. The interpersonal dance begins at least as early as birth and ends only with death. – Virtually all of the most important events in life are interpersonal in nature and most of what we call personality is interpersonal in expression.” The Interpersonal Perspective Interpersonal Perspective – Personality is best conceptualized as the social product of interactions with significant others – Few needs, goals, wishes, or potentials pertain to a nonsocial world – Even when we are alone, we interact with others Reflections when trying to sleep Realizations when in the shower – We do not dream of doorknobs or hamsters The Interpersonal Perspective Interpersonal Perspective – We are always interacting with real or imagined others and their expectations – Personality cannot be understood from the insideout Intrinsically immersed in an interpersonal context Personality develops in the context of interpersonal relationships Origins of the Interpersonal Approach Harry Stack Sullivan – father of the interpersonal perspective Origins of the Interpersonal Approach Sullivan – Approach was a reaction to Freud’s, which made pathology a private affair – Main contribution Mental disorders dramatically and tangibly manifest through the individual Mental disorders are created and perpetuated through maladaptive patterns of social interaction and communication – Definition of personality “The recurrent set of interpersonal situations which characterize a person’s life.” Origins of the Interpersonal Approach Sullivan and the nature of the self – Built upon Freud’s view that self-consciousness is inaccessible and remote According to Sullivan – No essential self lies hidden beneath consciousness – Only a concept of the self exists Continually being defined and redefined by the interpersonal communications of others Example – Keep telling a child that he or she is bad, and the child will soon believe you Origins of the Interpersonal Approach The consequences of Sullivan’s approach bridge psychology with existentialism – Not self-containing entities – We are never exactly sure who and what we are – Self concept is a collection of probabilistic hypotheses Some we seek to support; others we seek to deny – Existentialism We exist, then we define ourselves – Interpersonalism Others are essential to the formation of our self-identity Origins of the Interpersonal Approach Timothy Leary Origins of the Interpersonal Approach Timothy Leary’s levels of personality – First level – public communication What is observable and objective in interpersonal behavior – Second level – conscious description Expressed through the verbal content of statements made about self or others – Third level – private symbolization Concerned with preconscious and unconscious attributions – Expressed through “projective indirect fantasy materials” » e.g. projective tests fantasies, artistic productions, wishes, dreams, and free associations Origins of the Interpersonal Approach Timothy Leary’s levels of personality – Fourth level – unexpressed unconscious Issues that are censored from consciousness and “systematically and compulsively avoided by the subject at all other levels of personality… and are conspicuous by their inflexible absence” – Fifth level – values Expressed not only in the ego ideal, but in the standards through which self and others are judged Origins of the Interpersonal Approach Origins of the Interpersonal Approach Timothy Leary’s Interpersonal Circumplex – Often called the “interpersonal circle” – Differs from the DSM’s categorical representation of discrete disorders – Each personality shades gently into its neighbors Origins of the Interpersonal Approach Timothy Leary’s Interpersonal Circumplex – Crosses content dimensions of dominance and affiliation Each personality receives a different name and a unique blend of dominance and affiliation – Segments near each other are closely related – Opposing segments are opposites in real life – Noted relationships with other perspectives: Four quadrants capture temperaments or humors of Hippocrates Vertical axes capture two basic drives of psychoanalysis: sexuality and aggression Origins of the Interpersonal Approach Origins of the Interpersonal Approach Complementarity – “Our interpersonal actions are designed to invite, pull, elicit, draw, entice, or evoke ‘restricted classes’ of reactions from persons with whom we interact, especially from significant others.” Kiesler (1983) – Each interpersonal bid is intended to implicitly Exclude invalidating responses – Those incongruent with how we would like others to see us Include only validating responses – Those that confirm our self-presentation Origins of the Interpersonal Approach Complementarity – If each party successfully controls the response class of the other, needs of each party are satisfied – Responses that are irrelevant or inconsistent with the self-presentation are likely to be ignored or to arouse insecurity and tension Origins of the Interpersonal Approach Complementarity – On the interpersonal Circumplex Behaviors are considered complementary when on – Opposite sides of the vertical axis (control) – Similar sides on the horizontal axis (affiliation) – Results Dominance pulls for submission Submission pulls for dominance Friendliness pulls for friendliness Hate pulls for hate Origins of the Interpersonal Approach Origins of the Interpersonal Approach Normality and Abnormality – “A person brings about the very consequences of his or her own prediction… simply by virtue of the effects of the prediction itself” (Kiesler, 1996) Example – A highly competitive individual tends to view others as highly competitive and begins to compete even harder » This produces a competitive atmosphere that draws out competition from others – The social reality associated with any particular interpersonal style evokes responses that confirm that reality Results in a self-fulfilling prophecy. Origins of the Interpersonal Approach Normality and Abnormality cont. – This can be highly adaptive for a friendly individual – For those with personality disorders, the result is often a vicious circle Only one type of response from others is – Seen as validating – Sought from interpersonal interactions Example Narcissistic Personality Disorder – Require constant indulgence and flattery to support their sense of specialness or superiority Example Obsessive Compulsive Personality Disorder – Present as rational, logical, and controlled » In response, people feel bored, impatient, or evaluated Results in disengagement – Disengagement from others results in increased anxiety and attempts to control Cognitive Therapy Thoughts Disorders or styles? – All along a continuum No judgements – Each of these styles has positive and negative aspects to them Goldwater Rule Cognitive conceptualization – – – – Key conflicts Beliefs Strategy Affect Cognitive Profiles: Avoidant Personality Disorder Key Conflict: – Desire to be close to others and live up to their intellectual and vocational potential – Fear of being hurt, rejected, and unsuccessful Self view: As socially inept and incompetent in academic or work situations View of others: They see others as potentially critical, uninterested, and demeaning Cognitive Profiles: Avoidant Personality Disorder Beliefs – “I am no good”, “I am worthless”, “I am unlovable”, “I cannot tolerate unpleasant feelings” Cognitive Profiles: Avoidant Personality Disorder Threats: – Being discovered to be a “fraud,” being put down, demeaned, or rejected Strategy: – To avoid situations in which they could be evaluated Tend to hang back in social groups, avoid attracting attention Avoid taking on new responsibilities at work or seeking advancement – Due to a fear of failure and subsequent reprisals from others Affect: – Dysphoria – a combination of anxiety and sadness Related to deficits in obtaining the pleasures they would like to receive from close relationships and a sense of mastery Cognitive Profiles: Dependent Personality Disorder Key Feature: – Picture themselves as helpless and therefore try to attach themselves to some stronger figure who will provide resources for their survival and happiness Self-view: As needy, weak, helpless, and incompetent View of others: See the strong “caretaker” in an idealized way – Nurturing, supportive, and competent – Can function quite well as long as a strong figure is accessible Cognitive Profiles: Dependent Personality Disorder Beliefs – “I need other people – specifically, a strong person – in order to survive” That their happiness depends on having such a figure available That they need a steady, uninterrupted flow of support and encouragement – “I am completely helpless”, “I am all alone” Cognitive Profiles: Dependent Personality Disorder Threats: – Rejection and/or abandonment Strategy: – Cultivate a dependent relationship – Subordinate themselves to a “strong” figure and trying to placate or please this person Affect: – Anxiety – the concern over possible disruption of the dependent relationship Anxiety is heightened when they perceive that the relationship is strained May sink into a depression if the figure is removed – Gratification and/or euphoria when their dependent wishes are granted Cognitive Profiles: Obsessive-Compulsive Personality Disorder Key features: – “Control” and “Should” and key words – To them, “orderliness is godliness” Self-view: As responsible for themselves and others – Believe that they can only depend on themselves to see that things get done – They are accountable for their own perfectionistic conscience – Driven by “shoulds” – Core image of self as inept or helpless Fear that they will become overwhelmed, unable to function Cognitive Profiles: Obsessive-Compulsive Personality Disorder View of others: sees others as too casual, often irresponsible, self-indulgent, or incompetent – Liberally apply “shoulds” to others in attempt to shore up their own weaknesses Cognitive Profiles: Obsessive-Compulsive Personality Disorder Cognitive Profiles: Obsessive-Compulsive Personality Disorder Beliefs: – “I could be overwhelmed”, “I am basically disorganized or disoriented”, “I need order, systems, and rules in order to survive” Cognitive Profiles: Obsessive-Compulsive Personality Disorder Threats – Flaws, mistakes, disorganization, and imperfections – Tend to catastrophize “Things will get out of control” “I won’t be able to get things done” Strategy – In applying rules, they evaluate and rate other people’s performance as well as their own Affect – Prone to experience regrets, disappointment, and anger towards self and others – Anxiety or anger in anticipation of substandard performance – Depression when serious “failure” occurs Cognitive Profiles: Antisocial Personality Disorder Key Feature: – Many forms varying from conniving, manipulating, and exploiting to direct attack Self-view: as loners, autonomous, and strong – Some see themselves as abused and mistreated by society – Some cast themselves in the predatory role in a “dog-eatdog” world View of others: see others as exploitative and thus deserving to be exploited in retaliation – Can also view others as weak and vulnerable, thus deserving to be preyed upon Cognitive Profiles: Antisocial Personality Disorder Beliefs: – “I need to look out for myself”, “I need to be the aggressor or I will be the victim” Strategy: – Overt antisocials will openly attack, rob, and defraud others – Subtle antisocials (“con artists”) seek to inveigle others and exploit or defraud them Affect: – Anger over injustice that other people have possessions that they (the antisocial personalities) deserve Cognitive Profiles: Narcissistic Personality Disorder Cognitive Profiles: Narcissistic Personality Disorder Cognitive Profiles: Narcissistic Personality Disorder Key feature: – “Self-aggrandizement” Self-view: as special and unique – almost as princes or princesses – Consider selves superior and entitled to special favors and favorable treatment – Above rules that govern other people View of others: as inferior (not as in antisocial personality disorder) – See selves as prestigious and as elevated above the average person – See others as their vassals and potential admirers – Seek recognition from others in order to Document their own grandiosity Preserve their superior status Cognitive Profiles: Narcissistic Personality Disorder Beliefs – “Since I am special, I deserve special dispensations, privileges, and prerogatives”, “I’m superior to others and they should acknowledge this”, “I’m above the rules” – Many have covert beliefs of being unlovable or helpless Cognitive Profiles: Narcissistic Personality Disorder Strategy: – Plans revolve around activities that can reinforce their superior status and expand their “personal domain” – Seek glory, wealth, position, power, and prestige This is a means of reinforcing their superior image – Tend to be highly competitive with others who claim an equally high status Affect: – Anger when others do not accord them the admiration or respect they believe they are entitled to – Prone to depression if strategies are foiled Cognitive Profiles: Narcissistic Personality Disorder Cognitive Profiles: Histrionic Personality Disorder Key feature: – Expressiveness Tendency to dramatize or romanticize all situations Trying to impress or captivate others Self-view: as glamorous, impressive, and deserving of attention View of others: favorably… as long as they can elicit their attention, amusement, and affection – Self-esteem depends on their receiving continuous expressions of appreciation – Are more involved within interpersonal interactions than those with narcissistic personality disorder Cognitive Profiles: Histrionic Personality Disorder Cognitive Profiles: Histrionic Personality Disorder Beliefs: – “I am basically unattractive”, “I need other people to admire me in order to be happy” Strategy: – To use dramatics and demonstrativeness to bind people to them When they do not succeed, they believe they are being treated unfairly Coerce compliance through expressions of pain and anger Affect: – Gaiety mixed with mirth when successful in engaging other people – Undercurrent of anxiety reflecting their fear of rejection Cognitive Profiles: Schizoid Personality Disorder Key feature – Isolation. The embodiment of the autonomous personality – Willing to sacrifice intimacy to preserve detachment and autonomy Self-view: as self-sufficient and as loners – Prize mobility, independence, and solitary pursuits View of others: as intrusive and controlling Cognitive Profiles: Schizoid Personality Disorder Beliefs: – “I am basically alone”, “Close relationships with other people are unrewarding and messy”, “I can do things better if I’m not encumbered by other people”, “Close relationships are undesirable because they interfere with my freedom of action” Strategy: – To keep their distance from other people, insofar as this is feasible Affect: – Sadness, as long as they keep their distance – Anxious when forced into an encounter