HD 3700 1st Edition Lecture 21 Outline of Last Lecture I What is healthy functioning II Varieties of Jan III Approaching the idea of personality disorders Outline of Current Lecture I Play within the play II More on personality disorders III Object relations model of self development Current Lecture I Play within the play Opening night in Elsinore Being able to know someone else as well as the struggle to know oneself the degree to which you know others is dependent on the degree to which you can know yourself Theater is a formalized role play pretending to be someone else play within the play Speaking to queen lines are slightly old fashioned more formal Hamlet is now completely manic Shakespeare gave us a way of thinking psychologically II Personality Disorders Diagnostic criteria an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual s culture is pervasive and inflexible has an onset in adolescence or early adulthood is stable over time and leads to distress or impairment These disorders have been a part of human history forever in every culture although they may be described differently whenever human beings are together they create an idiosyncratic culture Psychiatry and clinical psychology have come to the point where we re naming and categorizing symptoms and trying to understand childhood experiences cultural influences and neurobiological influences shape disorders as well as treatments After WWII when soldiers come back with PTSD there is a cultural shift in which psychotherapy becomes more common someone else s mind observes yours Personality disorders come out in the 1960s culture with enough clinicians that a common vocabulary arises Some like it hot Marilyn Monroe was the sex symbol of her day she had Borderline Personality Disorder she cut herself did drugs drank public love affair with JFK killed herself with drug overdose Therapists become aware of patients that would come in seem to improve then drop out and see another therapist people who consumed psychotherapy without improving very sensitive vigilant became attached very easily very impulsive promiscuous drug use this cluster of symptoms became known as borderline on border between psychosis and neurosis personality was so infantile even though they were adults How to treat them provide structure become predictable ask them to stop acting out behaviorally don t cut don t drink etc reparenting these patients providing a basis of attachment so much expected rejection betrayal and abuse often had major depression and suicide attempts Three clusters of PDs these are suggestive categories there is a spectrum o Cluster A spectrum disorders of SCZ have 1st degree relatives with SCZ these are schizotypes Schizoid Personality Disorder Negative symptoms flat affect Schizotypal Personality Disorder Has a few positive symptoms i e magical thinking might have odd beliefs overvalued ideas computer geek who plays dungeons and dragons and you get the feeling that they might actually believe it Paranoid Personality Disorder Richard Nixon mild paranoid beliefs All of these people are functioning but just different o Cluster B Borderline Personality Disorder Very impulsive often experiences feelings of emptiness has attachment hunger makes best friends in a day but then next month diff friends spend money without thinking about it drug use etc Fragmented self Narcissistic Personality Disorder Organized around maintaining his or her self esteem feel like they re not being recognized for being the brilliant person they are preoccupation is their greatness surround themselves by people who worship them may actually hate themselves or think themselves are great Antisocial Personality Disorder Criminals take pleasure in humiliating dominating others have no remorse absent in morals Histrionic Personality Disorder Seem to be dramatizing everything in their life constantly o Cluster C Dependent Personality Disorder Comorbid with anxiety doesn t believe he she can survive without advice 24 7 frantic when alone Avoidant Personality Disorder Like Schizoid Obsessive Compulsive Personality Disorder Ignore this Personality Disorder NOS Not Otherwise Specified III Object relations model of self development separation and individuation We re all born with a temperament impulsive emotions anxious how intelligent we are how reactive we are at 9 months you see the whole range of temperaments The self the capacity to regulate one s feelings behaviors the capacity to reflect on one s experience to be in touch with wants and fears negotiate relationships where you get some and give some the self will develop in part depending on the experiences one has Borderline personality disorder a lot of these people came from disrupted turbulent households often had a history of sexual abuse o Led therapists to think trauma caused BPD but then there were the resilient children Women are overdiagnosed as BPD Stages of development o Autism 0 2 months o o o o o An unfortunately chosen term Autism implies that the infant is immersed in sensory motor experience which will lead to attachment and awareness of others Mainstream developmentalists argue that the processes of awareness and engagement begins immediately Symbiosis 2 6 months In these first two months parents and babies mirror each other and it is thought that babies are in symbiotic relationship with their caregivers they don t yet have ideas about self and other parents are an experience which seems to occur often Separation Individuation 6 24 months Hatching Subphase 6 10 months When infants begin to crawl explore tolerate momentary separation from caregivers they have begun to experience themselves as separate from their caregivers in some basic ways Peek a Boo games appear and babies check back visually when their crawling off away from their parents Practicing Subphase 10 16 months The child is now walking and exploring ventures out to play then rushes back to be held by parents for emotional refueling Some theorists refer to this phase as the toddler s love affair with the world Play is often about running away and coming back Children are rarely stubborn or oppositional everything is exciting Children seem to be constructing mental images of their caregivers to reflect on when they re away and often choose a favorite stuffed animal or blanket as a transitional object Rapprochement Subphase 16 24 months Children begin to realize the