Dramatic-Emotional Personality Disorders A core feature is lack of concern for others A related feature is lack of regard for safety of self or others May be hostile or violent Borderline Personality Disorder Formerly called ?pseudoneurotic schizophrenia? (on border between neurosis & psychosis) Girl Interrupted, Fatal Attraction Hostile & dependent Splitting - alternates between idealization, devaluation Borderline Pers. Dis. Intense, unstable relationship - idealization Unstable identity & self-concept Affective instability due to marked reactivity of mood (out of control emotions that can?t be soothed) More on Borderline Chronically feeling empty Hypersensitivity to abandonment, clingy, can?t be alone Recurrent suicidal thoughts, behavior Impulsive, self-damaging behavior (spending, sex, driving, substance, eating) Borderline cont. Poorly controlled &/or intense, inappropriate anger Transient stress-related paranoia or severe dissociation Complex, chronic disorder Borderline (#4) Manifestations differ from day to day in any 1 person and across persons w/ disorder 75% attempt, 10% commit suicide More common in women, slightly more in poor, people of color http://www.youtube.com/watch?v=eOphgCJX1FY Theories of Borderline Personality Disorder Mixed evidence of genetic transmission Related to family hx of mood disorder Impulsive beh. corr. w/ low serotonin Object Relations (Psychoanalytic) View of BPD Problems w/ separation-individuation stage (between 2 & 3 yrs.) Caregivers rewarded dependency, punished individuation Failure to fully differentiate selves from others Reject selves when perceive others as rejecting Psychodynamic Therapy Address transference, idealization-devaluation Limit setting Learn to problem solve, contain self-destructive impulses Dialectical Behavioral Therapy (Linehan) Combines cognitive-behavioral w/ psychodynamic approach Deficits in emotional regulation may be physiologically based Hx?s of discounting & criticism Dialectical Behavior Tx (cont.) Monitor self-disparaging thoughts, black-and-white thinking, evaluations (of people, situations) Teach assertion Learn alternatives to impulsive behavior Spiritual component emphasizing mindfulness, acceptance Supported by research Meds for Borderline Personality Disorder SSRI?s for impulsivity Antianxiety & antidepressants often used Antipsychotics occasionally used Narcissistic Personality Disorder Preoccupied w/ thoughts of self-importance & w/ fantasies of power, success, beauty, brilliance, ideal love Exploit others Display entitlement (make unreasonable demands on others) Are arrogant, demeaning More on Narcissism Requires excessive admiration Lacks empathy Often envies others or thinks is envied Feels superior & ?special,? will only assoc. w/ high-status people Typically seek tx for depression Theories of Narcissism Fixation at immature narcissism if caregiver indulgent, overvaluing, untrustworthy Defense against underlying low self-esteem (reaction formation), feelings of emptiness, pain, splitting off & projection of ?bad me? leaves only ?good me? (grandiosity) Respond to confrontation w/ rage, destructive to others in groups
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