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About personality disorders, in general

October 19, 2009 Leave a comment Go to comments

From the book Practical Management of Personality Disorder by W. John Livesley (2003).
Definition of “personality disorder”:
“Personality disorder may be defined as the failure to achieve adaptive solutions to life tasks (Livesley et al., 1994). These adaptive failures involve one or more of the following:
1. Failure to establish stable and integrated representations of self and others.
2. Interpersonal dysfunction, as indicated by the failure to develop the capacity for intimacy, to function adaptively as an attachment figure, and/or to establish the capacity for affiliative relationships.
3. Failure to function adaptively in the social group, as indicated by the failure to develop the capacity for prosocial behavior and/or cooperative relationships.
To complete this definition it is necessary to add that these failures or deficits are only indicative of personality disorder when they are enduring and can be traced to adolescence or early adulthood, and when they are not due to a pervasive mental state disorder, such as a cognitive or schizophrenic disorder. This definition, derived from evolutionary psychology and normal clinical literature suggests that personality disorder involves two related problems: severe and chronic difficulties with interpersonal relationships, and problems with a sense of self or identity.” (p.19-20)
–>me:  I don’t like the use of negative words like “failure”.

“Most treatments emphasize the psychosocial origins of personality disorder, although most also acknowledge the importance of biological factors. […] For this reason, it seems unrealistic to assume that a resolution of self problems or developmental conflicts will inevitably lead to changes in maladaptive traits. […]

Internal factors also include psychological structures and processes that promote stability. Externally, environmental
factors promote stability by constraining the person to react in certain ways, by limiting the behavioral options available, and by reinforcing some actions but not others. Because individuals seek out environments that are conducive to their characteristic ways of thinking and behaving, stability also arises from interaction between personal dispositions and environmental factors.” (p.76)

About stability & change:
“Personality disorder is defined in terms of its stability: According to the DSM-IV, personality disorder is “an enduring pattern of inner experience and behavior” (American Psychiatric Association, 1994, p. 630). Yet we seek to treat personality disorder, and treatment implies change. […] Although the goal of treatment is to change personality, we need to consider what this goal really means and whether it is even possible to change all components of personality disorder.

Many aspects of personality are remarkably stable and resist change (Caspi & Bem, 1990; Heatherton & Weinberger, 1994; Tickle, Heatherton, & Wittenberg, 2001). Intellectual traits are the most stable, followed by broad personality traits
such as neuroticism and extroversion, although personality traits are nearly as stable as intelligence (Brody, 1994).
Modest changes, however, do occur: neuroticism, extroversion, and openness to experience decrease slightly over the life span, and agreeableness and conscientiousness increase a little (Costa & McCrae, 1994). Between the mid-20s and middle adulthood, psychological adjustment improves, sociability decreases, and social concern and responsibility increase (Haan, Millsap, & Hartka, 1986; Helson & Moane, 1987; Jessor, 1983; Mortimer, Finch, & Kumka, 1982)”.

“Basic Principle: The goal of treatment is to help individuals to adapt to their basic personality traits and express them more constructively, rather than to change the trait structure of personality. As MacKenzie (1994) noted, both psychoanalytically oriented and cognitive therapists may find it “somewhat a culture shock to consider personality as something that one simply has and must live with, like being excessively tall” (p. 238). “(p.73)

Pretty pessimistic, isn’t it?

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