lecture 1&2 Flashcards
3P’s
persistent (over time), pervasive (across different contexts), pathological (markedly deviates from normal).
diathesis-stress model
there’s a lot of comorbidity, which suggests a role of genes, but we
don’t know a lot about that.
Paranoid PD
“We all have a certain degree of paranoia, which is healthy, but if you question everyone it becomes pathological”
Schizoid PD
Dexter in the very first episodes, no desire in social relationships, lives very limited, doesn’t need any social
interaction, little connectedness
Schizotypal PD
Willy Wonk
Antisocial PD
“I just do my own thing, whatever I’m doing I don’t really care about rights and boundaries and consequences”
Borderline PD
Angelina Jolie, Amy Winehouse, Lindsay Lohan, Brittney Spears
Histrionic PD
Regina George (Mean Girls), Kim Kardashian
Narcissistic PD
Kim Kardashian, Donald Trump, Kanye West
“me, myself, and I”
Avoidant PD
Michael Jackson
Dependent PD
If they don’t cling to others, they don’t know what to do with their fear
Obsessive-compulsive PD
Steve Jobs; I care about the rules because the rules are important to me and they should be important to you too
Neurotic level personality structure
a high level of capacity to function despite emotional suffering; somewhat integrated sense of identity; in solid touch with reality
Therapeutic split (TS)
capacity of the patient to distinguish between the observing and experiencing parts of the self
Neurotic level people
- basic trust
- basic autonomy
- at least some progress toward identity integration and a sense of initiative
Reason of therapy - neurotic level ppl
- running into obstacles in getting what they want
- patient and therapist are on the same side
Psychotic level personality structure
internally desperate and disorganised, illogical thinking, hallucinations and delusions, especially during stress;
They have great difficulties with identity; no sense go continuity of identity of self and others.
-> lack reflective functioning ( difficulties with abstraction)
symbiotic-
psychotic internal world
“paranoid-schizoid”; They function, sometimes quite effectively, but they strike one as confused and deeply terrified, and their thinking feels disorganized
or paranoid.
defences used by psychotic level PS
withdrawal,
denial, omnipotent control, primitive idealization and devaluation, primitive forms of projection and introjection, splitting, extreme
dissociation, acting out, and somatization.
Energic aspects of psychotic level
hey were expending so much energy fighting off existential terror that none
was left to use in the service of coping with reality.
Primary conflict psychotic level
life versus death, existence versus
obliteration, safety versus terror
Positive countertransference
Psychotic people are so desperate for respect and hope that they may be deferential and grateful to any therapist who does more than classify and medicate them. Their gratitude is naturally touching.
Therapeutic relation with psychotic level patients
People with psychotic tendencies are particularly appreciative of sincerity. Psychotic-level clients may also appreciate educative efforts and may respond with relief to the normalization or reframing of their preoccupations.
• They are wonderful in their attachment, yet terrifying in their needs. This consuming feature of their psychology is one reason that many therapists prefer not to work with individuals with schizophrenia and other psychoses.
Borderline personality organization
- -> use of primitive defences
- -> it is possible to confront
- -> their self is full of inconsistency and discontinuity
- -> unable to mentalist (lack of theory of mind)
- -> trouble with affect tolerance and regulation –> results in anger
- -> may have identity confusion but they know they exist
Defences used by borderline PL
denial, projective identification, and splitting
–> sometimes hard to distinguish from psychotic PL
Reality testing
The borderline person will acknowledge that the feature is unconventional and that outsiders might not understand its significance. The psychotic person is likely to become frightened and confused because the sense that he or she is not understood is deeply disturbing.
Treatment of borderline PL
- -> interventions that the therapist intends to be helpful are received as attacks.
- -> When they feel close to another person, they panic because they fear engulfment and total control; when they are alone, they feel traumatically abandoned.
- -> Transference in borderline clients tend to be strong, unambivalent, and resistant to ordinary kinds of intervention. The therapist may be perceived as all good or all bad.
- -> Countertransference reactions with borderline clients tend to be strong and upsetting.
Defense mechanism
a mental operation, usually unconscious, directed against the expression of drives and impulses.
• Serve to control or modulate the expression of unacceptable impulses and as reactions to external sources of stress as well as to internal forces.
• Have the specific function to protect the self from anxiety, conflict, shame, loss of self-esteem, or other unacceptable feelings and negative thoughts.
Mature defence mechanism
a great ability to adapt to reality, so that they can effectively distance threatening feelings without distorting reality (sublimation, humor, suppression, altruism)
Immature defence mechanism
severe alteration of painful contents and/or radical distortions of external reality (projection, splitting, acting out, autistic fantasy)
Autistic fantasy (immature)
An autistic retreat into an imaginary life to avoid facing unacceptable feelings or the unpleasant reality (e.g., imaging a bulb around you which makes it unable for anyone to touch you)
–> represents the pathognomic defense of the schizoid personality organization against a conflict between the desire to get in touch with others and the fear of being engulfed and overwhelmed by others, which often leads these individuals to social withdrawal.;
May help people high in detachment to defend themselves from other people who could be perceived as overly controlling and invading
Acting out (immature)
A strong display of emotions or behavior in order to hide the unacceptable underlying feelings or ideas; may be socially inappropriate; actual emotion being masked (e.g., storming out of a meeting but inside being hurt, difficult to show that they’re hurt or vulnerable instead showing aggression or walking away)
Aniticipation (mature)
To defer an immediate gratification by anticipating and planning the achievement of future goals
Denial (immature)
Avoiding an obvious aspect of reality by pretending that it is false or that it does not exist thus blocking the external events from awareness (e.g., denying you have secret feelings for your best friend’s partner, not just for a little bit but totally ignoring)
Devaluation (immature)
The reduction or underestimation of the worth or importance of something
Displacement (immature)
The emotion remaining the same, the target of the emotional outlet is changed (different from acting out in that the primary emotion is not masked, only redirected) (e.g., being angry at your boss but getting angry with your partner instead)
Dissociation (immature)
To momentarily lose connection to the world around, feeling separated from the outside world, as though one exists in another realm (e.g., pulling out of reality to not deal with feelings, “after a really stressful day, tonight I’ll only watch Netflix” 3 hours gone because you were zoned out)
Humor (mature)
Reduce a sense of discomfort or unpleasant affections finding ironic elements in difficult situations
Idealization (neurotic)
Creating an ideal impression of a person, place or object by emphasizing their positive qualities and neglecting the negative (distorting reality, could turn into an immature defense style if used in extreme ways)
Intellectualisation (neurotic)
Using higher functions (excessively) instead of affect to deal with unpleasant facts or situations; dealing with emotions is avoided, and the intellectual content may be too academic in nature, drained of any affective content (e.g., talking about theory instead of nerves)
Isolation (immature)
To separate ideas or feelings from the rest of your thoughts; in distinguishing an emotion or impulse from others in this way, a person attempts to protect the ego from anxieties caused by a specific situation (e.g., during a stressful day you’re totally separating your job from your family life, doesn’t have to be bad but if the two never touch that becomes strange)
Passive agression (immature)
A passive (indirect) way of expressing aggression; manifested as setting up an expectation and then not meeting it; however, this feeling often operates at a subconscious level (e.g., instead of saying “I’m ignoring you” saying “oh, didn’t notice you were talking, whatever”)
Projection (immature)
Attributing one’s own feelings, desires, or thoughts to someone else; associate with or may lead to paranoia (e.g., “I’m not angry, you’re angry!”, immature because distortion of reality, not realizing that you’re feeling/doing that, somebody accuses someone of stealing while they’re stealing themselves)
Pseudo-altruism (neurotic)
Helping others to feel better about oneself, thereby avoiding negative personal feelings; gratification is achieved from the response of others (e.g., not necessarily a bad thing, instead of worrying about your own you worry about other people)
–> significant and positive predictor of negative affectivity
Rationalisation (immature)
The action of attempting to explain or justify behavior or an attitude with logical reasons, even if these are not appropriate
Reaction formation (neurotic)
A manifestation of a feeling and/or action that is diametrically opposite to that of the underlying unacceptable impulse; thus, there is a transformation of the feeling to its exact opposite (e.g., “plagen is liefde vragen”)
Regression (immature)
Reverting to a behavior that is more childlike (or otherwise younger than age); seen in people without any mental disabilities who are sick or otherwise uncomfortable (e.g., going back to how you would respond as a 3-year-old)
Repression (neurotic)
An unpleasant or unacceptable feeling or thought is pushed out from consciousness, differ from suppression in that the thought or feeling is unconsciously eliminated and the content can no longer be obtained (e.g., with victims of sexual abuse)
Somatization (immature)
Occurs when the internal conflict between the drives of the id, ego and super-ego take on physical characteristics
Splitting (immature)
Occurs when the ego attempts to reconcile multiple aspects of rationales, but resorts to understanding the world in “black and white” terms; a person who experiences splitting may take an “either-or” approach when making evaluations of the world around them, including objects, situations, and people (key to BPD)
Sublimation (mature)
Expressing a personally unacceptable or unattainable feeling in a socially acceptable or useful way, can transform negative anxiety into positive energy (e.g., artistic expression, sports)
Suppression (mature)
Pushing the unpleasant or unacceptable feeling, thought, or desire deliberately out of consciousness; is the only DM to have some sort of conscious effort albeit partial; involves attempting not to think about a memory or feelings (ideally only temporary)
Undoing (neurotic)
Behaving or acting in a way so as to reverse unacceptable behavior; ‘correcting’ a past mistake; may involve rituals to ‘un-do’ a sinful thought or action
Defence mechanisms findings
- Immature defenses predicted higher scores on maladaptive personality domains.
- An increased use of immature DMs were positive predictors of the PID-5-BF total scores (psychopathology).
- Mature defenses were negative predictors of the PID-5-BF scores.
Negative affectivity
predicted by an increased use of reaction formation, pseudo-altruism, isolation, projection, and acting out and a reduced use of humor and suppression.
displacement,
- Negative affectivity is associated with avoidant, schizotypal, borderline, and obsessive-compulsive PDs.
- Characterized by personality facets such as anxiousness, emotional lability, hostility, perseveration, lack of or restricted
affectivity, separation insecurity, and submissiveness.
Detachment
predicted by older age, higher levels of autistic fantasy, isolation, and projection and lower levels of humor and reaction formation.
- Seems to be associated with avoidant, obsessive-compulsive, and schizotypal PDs.
- Expresses personality facets such as anhedonia, depressivity, intimacy avoidance, suspiciousness, and withdrawal.
Antagonism
redicted by male gender, a combination of higher levels of isolation, dissociation, autistic fantasy, pseudo- altruism, acting out, and lower levels of idealization and reaction formation.
- Includes personality facets such as attention seeking, callousness, deceitfulness, grandiosity, and manipulativeness.
- Associated with antisocial and narcissistic PDs.
- A grandiose self is present in these personalities, which can be conceptualized as a defense against investment in others
and dependence on others.
pseudo-self-sufficiency
may allow individuals with increased antagonism traits to deny any need for care and love, and to defensively exclude from consciousness disturbing feelings such as anger and resentment toward a needed but frustrating or rejecting figure, which might explain the role of isolation and dissociation in predicting the antagonism domain scores.
Disinhibition
younger age, lower levels of education, higher levels of acting out, dissociation, isolation, autistic fantasy, and pseudo-altruism, and lower levels of devaluation and anticipation.
- Includes personality facets such as distractibility, impulsivity, irresponsibility, lack of rigid perfectionism, and risk taking.
- Associated with narcissistic, antisocial and borderline PDs.
- A tendency to act impulsively is related to younger age, when the prefrontal cortex is not fully mature and behavioral and
mental states are not fully integrated into a consistent sense of self.
- Lower education reduces the possibility to use symbols and words to resolve internal conflicts.
Psychoticism
predicted by higher levels of isolation and autistic fantasy.
- Includes personality facets such as eccentricity, cognitive perceptual dysregulation, unusual beliefs and experiences
- Associated with borderline and schizotypal PDs
- May reflect the difficulty of people who report high psychoticism to effectively deal with emotional conflicts, which may
lead them to compartmentalize the emotional aspects of the experience
Study by Granier “the relationship between defense patterns and dsm5 maladaptive personality domains”
The study supports the general hypothesis that maladaptive personality traits are modulated by dominant defense patterns.
A continuum to identify the severity of mental illness by Otto Kernberg
- Neurotic personality organization (NPO) = the healthy one
- Borderline personality organization (BPO) = not the same as BPD
- Psychotic personality organization (PPO) = doesn’t mean that you’re schizophrenic or suffer from psychosis all the time
Neurotic personality organization (NPO)
defence - mature identity integration - yes reality testing -intact observing ego - yes primary conflict - oedipal counter/transference - working alliance
Borderline personality organization (BPO)
Defense - immature Identity integration - no reality testing - intact observing ego - limited primary conflict - separation-individuation counter/transference - all good/all bad
Psychotic personality organization (PPO)
Defense - immature Identity integration - no reality testing - no observing ego - no primary conflict - existential counter/transference - parental
Defense mechanisms women
internalizing
defence mechanisms men
externalizing
Mature DM
extraversion, openness, agreeableness
Immature DM
Neuroticism, lower conscientiousness
