HD 3700 1st Edition Lecture 22 Outline of Last Lecture I Play within the play II More on personality disorders III Object relations model of self development Outline of Current Lecture I Hamlet II Personality disorders final thoughts III Psychotherapy Current Lecture I Hamlet Claudius calls for light it will stop the play and keep the play from revealing his crime o Call for light really about call for continued darkness Hamlet is manic at this point I m so great I should have part ownership in a group of players Hamlet wants to kill his mother he s so enraged now he knows that Claudius killed his father Hamlet has shown difficulty regulating his emotions Before he goes to see his mother he knows he has to cool down he does not have good control over his affect and judgment II Personality Disorders final thoughts People suffering from personality disorders have difficulty maintaining an independent cohesive integrated sense of their own experience Their selfworth sometimes the meaning of their lives feels most of the time to be dependent on their relationship with others For some they literally feel they can t live without a specific person for others they can t bear themselves if those around them don t worship them Still for others they feel dead and empty if they aren t in an intense aggressive relationship with a romantic partner The idea There has been an interference with the development of their personality And because of this they depend on primitive defenses that involve splitting projecting and merging with others rather than higher order defenses such as intellectualization isolation of affect rationalization Borderline Personality Disorder o Diagnostic criteria o A person who suffers from this disorder has labile interpersonal relationships characterized by instability This pattern of interacting with others has persisted for years and is usually closely related to the person s self image and early social interactions The pattern is present in a variety of settings e g not just at work or home and often is accompanied by a similar lability fluctuating back and forth sometimes in a quick manner in a person s affect or feelings Relationships and the person s affect may often be characterized as being shallow A person with this disorder may also exhibit impulsive behaviors and exhibit a majority of the following symptoms frantic efforts to avoid real or imagined abandonment a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation identity disturbance markedly and persistently unstable selfimage or sense of self impulsivity in at least two areas that are potentially self damaging e g spending sex substance abuse reckless driving binge eating recurrent suicidal behavior gestures or threats or self mutilating behavior affective instability due to a marked reactivity of mood e g intense episodic dysphoria irritability or anxiety usually lasting a few hours and only rarely more than a few days chronic feelings of emptiness inappropriate intense anger or difficulty controlling anger e g frequent displays of temper constant anger recurrent physical fights transient stress related paranoid ideation or severe dissociative symptoms o Experimental Study 1 Object Relations and Social Cognition in Borderlines Major Depressives and Normals in TAT Measuring level of object relations and quality of social cognition by coding stories told to the Thematic Apperception Test Put simply the ways people with BPD make up stories is quantifiably different from people without the disorder Complexity of relationships people with BPD aren t really perceiving people but are projecting Affect tone of relationship BPD have malevolent representations in relationships Capacity for emotional investment everything is need gratifying for BPD Understanding of social causality cannot explain why things happen More malevolent primitive representations of people low expectations of other Results BPD associated stories to the TAT that were significantly different from normals on 4 dimensions Complexity of Representations BPD patients made up characters who were less differentiated from the others that is they often blurred with other characters Social causality their stories had fewer plausible reasons for interpersonal motivations and events Affect tone their stories had a marked presence of malevolent motivations and events Capacity for emotional investment their characters were much less likely to show mutuality and trust in each other o Experimental Study 2 Taking the same database the researchers looked at the early memories given by their reliably diagnosed BPD BPD Depressed Depressed Only and Normal group The memories were coded for affect tone of relationship paradigms by coders blind to the diagnoses of the subjects or the purpose of the study Looked at all early memories and scored for physical injuries affect tone Results Affect tone representations of people and relationships were malevolent hostile negative More malevolent responses More deliberate injuries Helpers were rated as ineffective BPD told memories of malevolent actions with negative affect with deliberate injuries with poor helper effectiveness o Experimental Study 3 Study of Earliest Memories If you included a significant injury in your story you had a history of sexual abuse So having a sexual abuse history was priming and affecting the associations in earliest memory Results Instances of harm in the earliest memory distinguished abused from non abused subjects at a very significant rate High scores on affect tone increased malevolence between people in the memory also sorted out abused from non abused subjects Dependent Personality Disorder o This personality disorder is characterized by a long standing need for the person to be taken care of and a fear of being abandoned or separated from important individuals in his or her life This pervasive fear leads to clinging behavior and usually manifests itself by early adulthood It includes a majority of the following symptoms o hasdifficulty making everyday decisions without an excessive amount of advice and reassurance from others o needs others to assume responsibility for most major areas of his or her life o hasdifficulty expressing disagreement with others because of fear of loss of support or approval o hasdifficulty initiating projects or doing things on his or her own because of a lack of self