Task 2 Flashcards
Characteristics of neurotic-level personality structure
- high level of capacity to function despite emotional suffering
- integrated sense of identity
- behaviours show consistency and inner experience is of continuity of self
- in touch of reality
- therapeutic split
- successfully traversed Erikson’s first two stages => integration and sense of initiative
Therapeutic split
- capacity of a patient to distinguish between the observing and the experiencing parts of the self
Therapeutic split example in paranoid people
Neurotic Paranoid: consider the possibility that the suspicions derive from an internal disposition to emphasize the destructive intent of others
Borderline or Psychotic Paranoid: convince the therapist about his convinctions
Erikson’s stages of life
Stage 1: Trust vs. Mistrust. Stage 2: Autonomy vs. Shame and Doubt. Stage 3: Initiative vs. Guilt. Stage 4: Industry vs. Inferiority. Stage 5: Identity vs. Confusion. Stage 6: Intimacy vs. Isolation. Stage 7: Generativity vs. Stagnation.
Psychotic level of personality structure McWilliams
- internally desperate and disorganized
- difficult to diagnose because overt state of psychosis: hallucination, delusions, ideas of references and illogical thinking
- psychotic level expressed mostly under considerable stress
- function sometimes effectively but strike as confused and deeply terrified
- dizorganised and paranoid thinking
- immobilizing dread of their fantasied superhuman potential for destructiveness
- no sense of continuity in identity: body concept, age, gender, sexual orientation
- not anchored in reality
- lack reflective functioning
- boundary confusion between outside and inside experience
- mortal fear and confusion
- existential crisis
- appreciate sincerity and respond well to normalization
Useful to conceive people who may not be diagnosed with psychotic level as
living in a symbiotic psychotic internal world or in a consistently paranoid schizoid state
Psychotic personality level people use techniques of defense, like:
- withdrawal
- denial
- omniponent control
- primitive idealization
- devaluation
- primitive forms of projection and introjection
- splitting
- extreme dissociation
- acting out
- somatization
Despite being unusual and sometimes frightening, patients in the psychotic range induce a
positive countertransference because psychotic patients need respect and hope and induce parental protectiveness
omnipotent control
phantasy that the source of everything that happens is oneself
Splitting
the failure in a person’s thinking to bring together the dichotomy of both positive and negative qualities of the self and others into a cohesive, realistic whole
Acting out
behavioral expression of emotions that serves to relieve tension associated with these emotions or to communicate them in a disguised, or indirect, way to others. Such behaviors may include arguing, fighting, stealing, threatening, or throwing tantrums
Characteristics of Borderline Personality Organization McWilliams
- use of primitive defenses: denial, projective identification, splitting
- experience of self is full of inconsistency and discontinuity
- lack theory of mind and mentalizing
- are insecurely attached
- trouble with affect tolerance and regulation
Projective identification
individual projects qualities that are unacceptable to the self onto another person, and that person introjects the projected qualities and believes him/herself to be characterized by them appropriately and justifiably
The difference when confronting a patient with psychotic or borderline personality
is that a borderline patient will at least show temporary responsiveness, while a psychotic patient will get more agitated
Psychotic and borderline patient differ in reality testing hence
borderline patients, during interview, demonstrate an appreciation of reality no matter how crazy their symptoms look
Kernberg approach to differentiate between diagnosis of borderline and psychotic level of organization
- investigating the person’s appreciation of conventional notions of reality by picking out some unusual feature of self-presentation, commenting on it and asking if the patient is aware that others might find this feature peculiar
=> B acknowledges that the feature is unconventional and that outsiders might not understand it
=> P will become frightened because they don’t understand their symptoms are disturbing
For a borderline level personality, they have a limited capacity to
observe their own pathology
Borderline level of organization patients have little emotional basis for
having identity integration mature defenses the capacity to defer gratification tolerance for ambivalence and ambiguity ability to regulate effects
First clue for a therapist that the patient has a borderline structure is that they perceive interventions as
attacks
The dilemma of borderline structure
- when close to a person => panic because they fear engulfment and total control
- when alone => traumatically abandoned
Materson view on the fixation of borderline patients
fixated at the rapprochement sub phase of separation-individuation process, when the child has attained some autonomy but still needs reassurance that a caregiver remains available
Transference for borderline patients
strong
unambivalent
resistant to intervention
therapist perceived as all good or all bad
Defense mechanisms Granier
mental operation, usually unconscious, directed against the expression of drives and impulses
Defense mechanisms serve to
control or modulate the expression of unacceptable impulses and as reactions to external as well as internal sources of stress
The specific function of defense mechanisms is to
protect the self from anxiety, conflict, shame, loss of self-esteem, unacceptable feelings or negative thoughts
Defense mechanisms are ordered and differ based on
ordered on a continuum
differ in degree of maturity
Mature defense mechanisms
sublimation humor suppression altruism anticipation
= ability to adapt to reality so that they can effectively distance threatening feelings without distorting reality
Sublimation
changing the outlet, or means, of expression from something base and inappropriate to something more positive or acceptable
Suppression
conscious process of pushing unwanted, anxiety-provoking thoughts, memories, emotions, fantasies and desires out of awareness
the only defense M to have some conscious effort
- not thinking about memory (ideally only temporary)
Primitive defense mechanisms
projection splitting acting out autistic fantasy devaluation dissociation displacement isolation passive aggression projection rationalization regression somatization
= severe alteration of painful contents or radical distortions of external reality
Splitting
seeing someone as either good or bad, idealised or devalued
Autistic fantasy
deals with emotional conflict and stressors by indulging in excessive daydreaming as a substitute for active problem solving
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
Anticipation
defer immediate gratification by anticipating and planning achievement of future goals
Devaluation
underestimation of worth
Displacement
emotion remains the same but target of emotional outlet is changed (being angry at boss but showing anger to partner instead)
Intellectualization
dealing with emotions is avoided but instead focus on theory
Isolation
separate feelings from the rest of thoughts => becomes strange when areas of life are completely separated
Passive aggression
setting up and expectation and not meeting it (i’m ignoring you = oh, did not notice you were talking, whatever)
Projection
attribute one’s feelings and desires to someone else
I’m not angry, you are
Pseudo-altruism
helping so that you feel better about yourself + avoid negative personal feelings + receive gratification from reactions of others
Reaction formation
manifestation of feeling or action that is completely opposite to that underlying impulse
Regression
reverting to a behaviour that is childlike
Undoing
behaving it a way so as to reverse the unacceptable behaviour or past mistake
Neurotic defense mechanisms
idealization intellectualization pseudo-altruism reaction formation repression undoing
Repression
unpleasant feeling is pushed out from consciousness
diff from suppression because the feelings is unconsciously eliminated and the content can no longer be obtained
Immature/primitive defenses predict
higher scores on maladaptive personality domains
Mature defenses were negative predictors of
PID-5-BF scores
Negative affectivity is associate with the PD’s
avoidant
schizotypal
borderline
obsessive-compulsive
Negative affectivity was predicted by
increased use of reaction formation, pseudo altruism, isolation, displacement, projection acting out
+ reduced use of humor and suppression
Negative affectivity is characterized by personality facets such as
anxiousness emotional lability hostility perseveration lack of restricted affectivity separation insecurity submissiveness
Reaction formation is observed in
APD and OCPD as a defense against negative feelings, that allows to control and transform components in opposite and less-threatening polarities
Acting out is a central defense mechanism in
BPD => tendency to an immediate discharge of impulses and feelings for the inability to endure them and reflect on them
Detachment was predicted by
older age
higher level of autistic fantasy
isolation
projection
low levels of humor and reaction formation
Detachment is associated with PD’s like
avoidant
obsessive-compulsive
schizotypal
Detachment expresses personality facets like
anhedonia depressivity intimacy avoidance suspiciousness withdrawal
Autistic fantasy represents the main defense for
schizoid personality organization against a conflict between the desire to get in touch with others and the fear of being overwhelmed => leads to withdrawal
Reduced use of reaction formation indicated
lower tendency to deny ambivalence
Isolation is the main defense of
OCPD => overestimate cognitive activity and avoid emotionally charged situations for fear of losing control
Increased scores on isolation and projection can help people high in detachment to
defend themselves from unconscious feelings of shame and inadequacy => related to lack of relatedness and a vicious circle of not using humor, therefore intensifying such unconscious feelings
Antagonism is predicted by
male gender high levels of isolation dissociation autistic fantasy pseudo altruism acting out
+lower levels of idealization and reaction formation
Antagonism is associated with PD’s
antisocial
narcissistic
Antagonism included personality facets such as
attention seeking callousness deceitfulness grandiosity manipulativeness
In personalities showing antagonism, is present a
grandiose sense of self => defense against investment in others and dependence on others
A pseudo self-sufficiency allows individuals with increased antagonism traits to
deny need for care and love and to exclude feelings such as anger and resentment towards a rejecting figure
=> explains the role of isolation and dissociation in predicting antagonism domain scores
People with antagonism traits can use pseudo altruism to
force other people to feel submissive
Decreased idealization in antagonisms
shows lower investment in values of others
Reduced use of reaction formation in antagonism indicates
lower tendency to feel guilt an to repair damage they inflicted to others
Disinhibition is predicted by
younger age
low level of education
high levels of: acting out dissociation isolation autistic fantasy pseudo altruism
low levels of devaluation and anticipation
Disinhibition includes personality facets such as
distractibility impulsivity irresponsibility lack of rigid perfectionism risk talking
PD’s associated with disinhibition
narcissistic
antisocial
borderline
People with increased disinhibition might act impulsively and use acting out due
to their difficulty integrating internal representations, reflecting on experience and verbalizing feelings when facing disturbing emotions
Dissociation is a predictor of
disinhibition => possible lack of sense of continuity of self, memory, conscience
and allow to keep the illusion of psychological control
Autistic fantasy in people with increased disihibition acts as
not engaging emotionally with others and preferring to focus on personal needs
Reduced devaluation is used in disinhibition as tool to
generate intense relationships that will serve the individual
Psychoticism scores were predicted by
high levels of isolation and autistic fantasy
Psychoticism includes personality facets such as
eccentricity
cognitive perceptual dysregulation
unusual beliefs and experiences
PD’s associated with high psychoticism
borderline
schizotypal
People high in psychoticism have problems in
dealing effectively with emotional conflict => leading to compartmentalize the emotional aspects of the experience
The study by Granier supports the general hypothesis that
maladaptive personality traits are modulated by dominant defense mechanisms
Personality organization is based on different levels of severity (Otto Kernberg), therefore the organization is
the foundation of the house,
while the PD = the house
A continuum of levels of personality organization is used to
identify the severity of mental illness
NPO
neurotic personality organization = the “healthy one”
BPO
Borderline personality organization
not the same as BPD
PBO
psychotic personality organization
not equivalent with schizophrenia or meaning that you suffer from psychosis all the time
Identity integration
knowing who you are and what you stand for
Reality testing
knowing what is and what is not true
Observing ego
thinking of oneself in the third person, being able to reflect on own functioning
Oedipal
tending to struggle with things we want, need and goals we have
not about identity
Neurotic PO
- mature defense
- identity integration
- intact reality testing
- observing ego
- oedipal primary conflict
- working alliance as counter/transference
Borderline PO
- immature defense
- no identity integration
- intact reality testing
- limited observing ego
- separation-individuation as primary conflict
- all good/all bad as counter/transference
Psychotic PO
- immature defense
- no identity integration
- no reality testing
- no observing ego
- existential primary conflict
- parental counter/transference
More mature defense mechanisms are related to
extraversion
openness
agreeableness
Immature defense mechanisms are related to
neuroticism
lower conscientiousness
Women use more
internalizing DM’s
Men use more
externalizing DM’s
