Therapy

The paranoid personality is a challenging psychotherapy case. Most paranoids resist serious delusions they come into contact with psychological services only at the request of others, as in two of the case studies in this chapter. A spouse may insist on either therapy or divorce, or a boss may insist on either therapy or termination. Most paranoids are regarded as suspicious, testy, and emotionally closed. The greatest improvement is likely to occur in subjects who are fairly high functioning,...

Summary

Borderlines are characterized by their unstable relationships and emotional reactions. Everything about them seems frantic, chaotic, and impulsive. They swing rapidly from adoration to hatred within minutes and seemingly without provocation. The very construct and term borderline personality has remained controversial throughout the years and has produced an extensive literature with each new incarnation. Given the severity of this disorder, it is difficult to imagine a normal variant of the...

Early Historical Forerunners

The histrionic personality was first officially recognized in DSM-III, published in 1980, replacing the psychoanalytic school's older, gender-biased hysterical personality. No longer an officially recognized term, hysteria nevertheless remains in widespread currency. Its several meanings refer to a state of intense emotional overexcitement, the neurosis that presumably eventuates in such states, and the conversion of emotional conflicts into physical symptoms (also known simply as conversion...

From Normality to Abnormality

Although the schizotypal personality is considered a severe personality disorder, some readers will find isolated schizotypal traits reflected in their own personalities. The more such characteristics possessed, the more the whole picture becomes different. Oldham and Morris (1995) refer to the idiosyncratic style, a different drummer nourished by a unique belief system that contributes to an unconventional or even eccentric lifestyle. Such persons require few intimate relationships and are...

The Biological Perspective

More than anything else, the intense moodiness and rapidly shifting emotions of the borderline personality have caused observers to wonder whether some biological abnormality might underlie the disorder or at least create a predisposition that favors its development. Some biological basis seems necessary to fuel the intense emotional reactivity of the borderline, as seen in Jenny and Georgia. After all, anger is an intensely arousing emotion, as Jenny shows us consistently throughout her case...

The Cognitive Perspective

The strong cognitive traits of the compulsive personality were recognized and written about by analytic theorists long before the cognitive perspective was ever popular. Whereas contemporary information-processing accounts are concerned with flowcharting the architecture and processes of cognition, analytic accounts were more concerned with cognitive style and the close connection between character and cognition. W. Reich (1933, p. 211) regarded compulsives as indecisive and doubting, and just...

Self Report Inventories

A self-report inventory is simply a list of questions completed by the subject. Most are in paper-and-pencil form, though some are also computer administered. Self-report tests are available for almost every conceivable theoretical concept and clinical condition. Each usually consists of a minimum of about eight items to a maximum in the several hundreds. Answer formats vary from simply true versus false, to never, seldom, often, and always. The variations are endless. Short tests usually...

The Self Destructive Borderline

All borderlines are at times self-destructive, perhaps to the point of self-mutilation. In the self-destructive borderline subtype, however, self-destruction serves the needs of a comorbid masochistic pattern. Like the petulant borderline, the self-destructive type is unable to find a comfortable niche with others. Unlike the petulant type, self-destructive borderlines do not become increasingly testy and bitter over time. Instead, their masochistic traits cause them to turn inward, where...

Pathogenic Experiential History

In the previous section, we stressed the view that biological functions play an active role in regulating what, when, and how events will be experienced the nervous and endocrine systems do not accept passively what is fed into them. This active process means that unusual biological sensitivities or defects may result in perceptual distortions, thought disorders, and pathological behaviors. Although behavior pathology may be triggered by biogenic abnormalities, the mere specification of a...

The Interpersonal Perspective

As stated in previous chapters, the interpersonal perspective focuses on transactions between sender and receiver in interpersonal communication. Each participant negotiates the content of the exchange so that, ideally, both parties receive messages congruent with their self-image and feel validated. Communications that are not validating support some alternative conception of self and are experienced as anxiety provoking. Leary (1957) developed the interpersonal circle in an effort to refine...

Variations of the Narcissistic Personality

Few individuals in real life exist as the incarnation of an abstract psychological ideal. Instead, most persons combine aspects of two or more personality styles, though some combinations are more common than others. Whereas the previous section sharpened the contrast between various prototypes for explanatory purposes, in this section we portray narcissistic variants that are found as the disorder begins to shade toward other personalities (see Figure 10.2 for a summary). Actual cases may or...

The Psychodynamic Perspective

After the ancient historical incarnations of this personality pattern, many centuries passed before narcissism was given an explicit psychological definition. In 1898, Havelock Ellis, an English psychologist, used the term narcissus-like (A. P. Morrison, 1986) in reference to excessive masturbation, whereby the individual becomes his or her own sexual object. Rank (1911) published the first psychoanalytic paper specifically concerned with narcissism, linking it to vanity and self-admiration...

Variations of the Schizotypal Personality

The evolutionary model (Millon, 1990) holds that the schizoid and avoidant shade gently into the schizotypal thus, these personalities naturally form structural subtypes for this pattern (see Figure 12.1). Actual cases may or may not fall into one of these combinations. The insipid schizotypals represent a structural exaggeration of the passive-detached pattern. Like the schizoid, they are notably insensitive to feelings, seem indifferent to the external world, and appear drab, unmotivated,...

The Case of the Cantankerous Couple How Does Personality Affect Couples

As part of her prepracticum class, Jenna observed an experienced psychologist interview a middle-age couple, who wanted to discuss their relationship and consider the possibility of divorce. The wife felt that she had no separate identity. She wanted to get a college degree and start her own career. Whenever she discussed it, however, she noticed that her husband became overcontrolling, long an issue in their marriage. Inevitably, any discussion of her attending school led to hostile argument,...

Can Schizotypal Disorder Disintergrate Into Frankschizophrenia

Schizotypals are often described as odd and eccentric and seemingly engrossed in their own world. Most researchers believe that the schizotypal personality lies on a continuum with schizophrenia called schizotypy. Schizotypals, like schizophrenics, experience both positive and negative symptoms. As one of the three structurally defective personalities (the paranoid and the borderline are the other two), schizotypals are set apart from other personalities in that they rarely find a comfortable...

Variations of the Paranoid Personality

Although the paranoid personality is a tightly knit syndrome, its features nevertheless combine with those of several other personalities, producing variations of the core prototype, described in the following paragraphs and summarized in Figure 13.1. Actual cases may or may not fall into one of these combinations. FIGURE 13.1 Variants of the Paranoid Personality. FIGURE 13.1 Variants of the Paranoid Personality. The fanatic paranoid pattern often resembles its less troubled cousin, the...

The Evolutionary Neurodevelopmental Perspective

In terms of the evolutionary model that unifies this text, borderlines fail to attach themselves strongly to any single polarity. This is signified by their intense ambivalence and inconstancy, emotional lability, behavioral unpredictability, identity diffusion, and tendency to swing from one position or opinion to its opposite. Many readers will assert that, because a personality consists of traits that endure across time and situation, the borderline's lack of consistent traits across time...

The Minimizing Antisocial Personality and Frame of Reference

Still studying the art of psychotherapy that she would begin to practice in her second year, Jenna sat in with an experienced clinician conducting therapy with a group of prisoners, most of whom had been diagnosed as antisocial personalities. Gradually, their cognitive core beliefs and distortions became evident. Defending his actions in the outside world, one convict protested, Look, you're either a goody-goody or you're out for yourself in this world, and everyone I've ever known has been out...

The Item Level

Most test items are so specific that they usually have little relevance to the overall assessment. For example, the item, I like to go to parties, may or may not be indicative of a histrionic personality not everyone who likes parties is a histrionic. Some items, however, are so dramatic that they are interpreted on their own terms. For example, if a patient responds true to the item, I have been thinking strongly about killing myself, the assessing clinician has the responsibility to establish...

Maximizing Supervision Finding the Most Suitable Therapeutic Approach

Having learned much from her first supervisor, a psychodynamic sage, Jenna was eager to begin studying with her second supervisor, known for his knowledge of cognitive techniques. When her first client, a depressed male graduate student, scored in the narcissistic range on the MCMI-III, her new supervisor recommended that she educate the client in the principles of cognitive therapy, focusing particularly on the discovery of automatic thoughts and their connection with his self-image, which...

Variations of the Dependent Personality

In addition to the more prototypal cases described in this chapter, there are several variations of the dependent that express its combination with other personalities. Figure 8.1 provides a summary of these subtypes. Actual cases may or may not fall into one of these combinations. A mixture of both the dependent and avoidant patterns, the disquieted dependent is often found in an extreme form in institutional settings that minister to chronic ambulatory patients. Most live a parasitic...

The Sadistic Personality

Sadistic Borderline Personality Disorder

When most of us think of sadism, we think of either the violent psychopath or the use of dominance and pain to accentuate sexual pleasure. But there is a difference between sadistic behavior and a sadistic personality. Although psychopaths can be instrumen-tally aggressive and hostile to the point of murder, only when the knowledge that others are suffering gives the individual pleasure does behavior become sadistic. And only when the inflicting of psychological or physical pain becomes the...

Therapeutic Strategies and Techniques

An important goal is to bring calm to the borderline's chaotic relationships. According to Benjamin (1996), the borderline is in a Catch-22 that sabotages therapy, whether there is progress or no progress. Although therapy usually has a good beginning, eventually the subject realizes that the therapist is not an infinite fountain of nurturance and begins to enact extreme behaviors, such as overdoses, self-mutilation, and suicidal gestures. As Benjamin explains, this causes the therapist to...

Looking at Significant Stressors What Else Can Account for Somatic Symptomatology

One of Jenna's most challenging clients during her first semester of training was a histrionic female freshman who presented with vague somatic complaints, including headache, muscle aches, and weakness. Examination at the campus medical center failed to find any physical cause to account for the symptoms. During the standard intake interview, the student was asked to report significant recent stressors, which included leaving home to attend the university and a breakup with her boyfriend back...

Gender Bias in the Diagnosis of Personality Disorders Do Clinicians Have Gender Expectations

Do certain personality disorders favor men and others favor women The answer may depend on where you look. Because more women than men seek treatment for mental disorders, there are usually more women among the patients in mental health centers. Conversely, because more men than women are veterans, you would expect more male patients at Veterans Administration hospitals. Nevertheless, certain personality disorders do seem weighted toward a particular gender. For some researchers (Kaplan, 1983...

The DSM Multiaxial Model

The disorders in the DSM are grouped in terms of a multiaxial model. Multiaxial literally means multiple axes. Each axis represents a different kind or source of information. Later, we concentrate on exactly what these sources are now, we just explain their purpose. The multiaxial model exists because some means is required whereby the various symptoms and personality characteristics of a given patient can be brought together to paint a picture that reflects the functioning of the whole person....

The Negativistic Passive Aggressive Personality

Some people just seem unsure of which way to turn in life. Ever ambivalent, they vacillate between uneasy feelings of dependence and an equally uneasy desire for self-assertion. Simultaneously needy and independent, they agree to conform to requests for performance, but nevertheless have strong issues with authority and resent external control. Inevitably, they feel misunderstood, unappreciated, and disillusioned. As their discontent deepens, they begin to find fault with the way others treat...

Carl G Jung Jungs Contribution to Personality Theory

Histronie Wut

Although Jung is among the seminal thinkers in personality, his contributions have rarely been applied in the personality disorders. Once Freud's primary disciple, Jung broke from Freud, insisting that there is more to mental life than sex. Most students are acquainted with his distinction between extroversion and introversion. Extroverts explain events from the viewpoint of the environment. They see the focus of life as being driven by events outside themselves and fix their attention firmly...

The Depressive Personality

Personality Disorder Scheme

Almost imperceptibly at first, then more and more, you begin to feel sad, empty, or irritable. Gradually, things that used to fascinate you are no longer interesting. Hobbies, favorite recreations, and spending time with the ones you love are no longer pleasurable and may even seem burdensome. The day becomes dominated by feelings of lethargy, being tired, run down, or overwhelmed by life. Your movements and mental processes may seem to move in slow motion, thoughts crawling like molasses....

Variations of the Avoidant Personality

Avoidant Personality Subtypes

Allison represents a reasonably pure or prototypical representation of an avoidant personality. However, as with most personality patterns, whether problematic or not, not all avoidant patterns closely resemble our panicky undergraduate. While Allison's style doesn't really combine characteristics of other disorders with her basic avoidant pattern, most avoidants exhibit features of other personality disorders, such as the schizoid, dependent, depressive, negativistic, schizotypal, and paranoid...

Variations of the Histrionic Personality

Histrionic Personality Disorder

The norm is to receive more than one personality disorder diagnosis. Combinations with secondary patterns lead to colorations of the primary pattern, though occasionally subtypes appear merely as a combination of the major traits. Frequently seen subtypes of the histrionic personality are described in the following sections and summarized in Figure 9.1. Actual cases may or may not fall into one of these combinations. FIGURE 9.1 Variants of the Histrionic Personality. FIGURE 9.1 Variants of the...

The Self Defeating Masochistic Personality

Life is tough enough without making things even more difficult. Some people, however, deliberately put obstacles in their own way, seem to court suffering, and need to fail. Such individuals are called masochistic personalities, though they were termed self-defeating personalities in the DSM-III-R. Cursed with an uncanny sense for defeating themselves, they routinely set sail for stormy weather and call down setback, loss, frustration, and grief on themselves. When they do experience good...

Variations of the Compulsive Personality

Having described the pure compulsive in some detail, we now move on to variations of the basic pattern. The compulsive combines with several other personality disorders, giving a different coloration to the resulting pattern. A brief guide to the subtypes of the compulsive personality is given in Figure 7.1. Actual cases may or may not fall into one of these combinations. FIGURE 7.1 Variants of the Compulsive Personality. FIGURE 7.1 Variants of the Compulsive Personality. More than any other...

Variations of the Antisocial Personality

Antisocial Personality Disorder

Subclassifying antisocials, psychopaths, and criminals has been a hobby of social scientists for more than a century. Some schemes are based on the types of crimes committed or the severity of the crime, rather than on clusters of trait characteristics. Other schemes are based on methodology-driven approaches, such as cluster analysis. All such schemes fail to recognize the importance of considering other personality characteristics in addition to those of the major pattern. In contrast, the...

Albert Ellis and Carl Rogers Finding Your Own Therapeutic Style

Although Albert Ellis was originally trained as a psychoanalyst, he is an important figure in the history of the cognitive therapy movement. His transformation is striking, as it represents a philosophical shift from that which is deep and mysterious in human nature, namely the unconscious, to that which is more or less obvious, the rational process and errors of reasoning. The movement Ellis founded is called rational-emotive therapy. According to Ellis, logical reasoning is the foundation of...