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Define Personality Disorders | Examine the similarities between the behaviors of certain personality disorders and addictions | Identify ways to address these behaviors and thought patterns | Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose
Why I Care/How It Impacts Recovery | When personality disorders are viewed as pervasive & perpetual, it | Provides an “excuse for relapse” | Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored | Personality Disordered & Addictive Behavior often look the same | Goals for recovery from both: | Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness) | Distress tolerance and the ability to self-soothe | Hope and faith in self/future/others through addressing cognitive errors | Development of self esteem to eliminate need for external validation | Development of healthy, supportive relationships
Personality Disorders | Represent a cluster of behaviors that is pervasive beginning before the age of 15. | Addictive behaviors also often begin before 15 | Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies | From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child
Personality Disorders | Treatment | Since these behaviors formed the foundation for further development patients must |Understand their function in the past |Identify how these behaviors and beliefs are faulty in the present |Develop alternative skills |Be empowered to interface with the world with the strengths, knowledge and tools of the adult
Addictions | Represent one way to cope with distress | Can begin early in life | Have overlapping symptoms with personality disorders, especially Cluster B
Addictions & Personality Disorders | Cluster A (Paranoid, Schizoid, Schizotypal) | Characterized by social awkwardness and withdrawal | Often co-occur with addictions | Cluster C (Obsessive-Compulsive; Dependent) | Characterized as anxious and fearful | May co-occur with addiction | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by dramatic, emotional, erratic behavior | Behavioral patterns overlap with addiction
Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Characterized by |Dramatic, emotional, erratic behavior |All or Nothing thinking |Hostility and Aggression |Hypersensitivity |Manipulative |Low Self-Esteem / Weak Self-Concept
Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Antisocial: |Disregard for the rights of other people |Impulsivity |Hostility and/or aggression |Deceit and manipulation |Seem to lack empathy
Addictions & Personality Disorders | Cluster B | Histrionic |Excessive emotionality and attention seeking | May become enraged at perceived rejection |Need to be the center of attention |Inability to engage in authentic relationships but uncomfortable being alone |Imagine relationships to be more intimate in nature than they actually are |Tend to be suggestible and easily influenced by other people’s suggestions and opinions.
Addictions & Personality Disorders | Cluster B (Borderline, Narcissistic, Histrionic, Antisocial) | Borderline: |Low self-esteem |Feel helpless, anxious and constantly fear abandonment |Perceptions of themselves and others may quickly vacillate back and forth |Hypervigilant |Extremely emotionally reactive with inability to de- escalate |Often have a history of neglect, abuse or a dismissive style of parent-child attachment
Addictions & Personality Disorders | Cluster B | Narcissistic |Powerful sense of entitlement |Believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive. |Need to be powerful, and admired |Lack of empathy for others |Relationships that are often superficial and devoid of real intimacy
Addictions vs. Personality Disorders | Take home message | Many behaviors characteristic of active addiction |Overlap with personality disorders |Begin in late childhood/early adolescence |Are pervasive | As people’s experiences and knowledge expanded, their coping skills and behaviors remained relatively primitive | Recovery from addiction requires |Development of effective coping skills |Addressing cognitive distortions
Addictions vs. Personality Disorders | Take home message | Recovery from addiction requires addressing… |Dramatic, emotional, erratic behavior | Distress Tolerance | Mindfulness to identify and process the source of the distress | Coping skills |All or Nothing thinking | Awareness and elimination of cognitive distortions (CBT) |Hostility and Aggression | Understanding of the fight or flight response | Development of anger awareness and management skills
Addictions vs. Personality Disorders | Take home message | Recovery from addiction requires |Hypersensitivity esp. to rejection | Awareness of and addressing thinking errors | Awareness and addressing abandonment issues | Development of self-esteem |Manipulative | Interpersonal skill development (boundary setting, communication skills) |Low Self-Esteem / Weak Self-Concept | Development of self-esteem and the ability to internally validate
Summary | Most patients with addictions have traits associated with personality disorders | These traits can be loosely classified into | Thinking errors  the perception of a threat | Behavioral reactivity to escape or eliminate the threat | The first steps in the recovery process… | Honesty with self and others (Mindfulness and Awareness) | Hope & faith (Identifying cognitive distortions and thinking errors to encourage and empower) | Courage and discipline to remain constantly mindful, accept and address thoughts and feelings, make conscious choices based on facts
A child growing up in an unstable, neglectful, emotionally detached environment may develop | PD traits to survive | Addictions to numb the pain and escape from the lack of control. | Behaviors characteristic of addictions and personality disorders | Were learned and reinforced | Will always be in the recesses of the toolbox | Must be made less rewarding than alternative, healthy behaviors