Understanding 5 High Conflict Personality Disorders

Transcription

1 Understanding 5 High Conflict Personality Disorders Bill Eddy, LCSW, Esq. Attorney, Mediator, Therapist, Author Family Law Institute March 19, Minneapolis Copyright 2013 High Conflict Institute

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3 Disclaimer This seminar does not train you to diagnose personality disorders. It may be harmful to tell someone that you believe that they have a personality disorder. Just recognize potential patterns and adapt your approach accordingly. Just develop a Private Working Theory

4 Personality Disorders (DSM-IV and DSM 5) Enduring pattern of distress and impairment: (1) Cognition (all-or-nothing thinking, etc.) (2) Emotions (disproportionate responses) (3) Interpersonal functioning (dysfunctional) (4) Impulse control (extreme behaviors) Lack of insight/defensive about behavior Unwilling/unable to change own behavior Extremely sensitive to negative feedback Some preoccupied with blaming others (HCPs)

5 BORDERLINE ( Love You, Hate You ) Pattern 1. Fear of abandonment 2. Idealization and devaluation of others 3. Unstable self-image 4. Impulsive behavior 5. Suicidal behavior or threats 6. Unstable moods 7. Chronic emptiness 8. Sudden, intense and extreme anger 9. Paranoia or dissociative

6 Abusive Personalities: Cyclical domestic violence Borderline Batterers 1. Internal tension builds up 2. Violent outburst (impulsive) 3. Period of remorse and de escalation Generally occurs within the family Generally not violent outside of family Generally benefits from Batterers treatment program, to learn impulse control and relapse prevention

7 Borderline: Some Parenting Concerns Fear of Abandonment parent clings to child Over-identifies with child Lack of boundaries with child in all areas All-or-nothing approach; splitting children Physical abuse alternating with neglect Mood swings-hits, attacks child, apologizes Impulsive behavior with child, excuses DV Can t tolerate child s independence

8 BORDERLINE - Treatment Treatment: Hopeful 2-5 years, with highly-effective therapist and learning skills, may overcome diagnosis Types: Individual Psychodynamic Individual Therapy Secure relationship Balance support and gentle confrontation Group for learning relationship skills DBT: Dialectical Behavior Therapy Thoroughly researched as very effective IF done right (group plus individual plus consult) Other cognitive therapies (Schema Therapy, etc.)

9 ANTISOCIAL ( Con Artist ) Pattern 1. Repeated violation of social norms/laws 2. Lying and Conning 3. Impulsive and fails to plan ahead 4. Irritable and aggressive 5. Reckless 6. Irresponsible 7. Lack of Remorse Conduct Disorder Before Age 15

10 Abusive Personalities: Antisocial Batterers Instrumental violence drive for dominance Purposeful, rather than impulsive Violent inside and outside of family; gets in fights Generally does not benefit from Batterers treatment program not about impulse control Does not benefit from individual therapy; learns to be more manipulative Primary restraining factor is consequence of jail time

11 Antisocials: Some Parenting Concerns Dominates child psychological as well as physical abuse Teaches child antisocial behaviors Engages child in antisocial schemes Teams up with child against adult partner May not abuse child, while abuses partner Or may sexually abuse child for dominance Or, no interest in child; child seen as inconvenient

12 ANTISOCIAL - Treatment Treatment: Slightly Hopeful BEFORE age 20 After age 20, extremely unlikely to change May change a specific behavior (drugs, domestic violence) in intensive program, but not personality Types: Individual Not recommended They manipulate therapists and learn how to manipulate all people better Group Disrupt group therapies and D.V. groups Best treatment is threatening jail and putting in jail

13 NARCISSISTIC ( I m Very Superior ) Pattern 1. Grandiose sense of self-importance 2. Fantasies of success, power, brilliance 3. Demands special treatment 4. Demands admiration 5. Sense of entitlement 6. Relationship Exploitation 7. Lack of empathy 8. Envious 9. Arrogant

14 NARCISSISTIC 2Subtypes Vulnerable Narcissists Truly feels superior to others An underlying deep sense of shame; mostly unconscious Often the result of abuse or neglect Child grows up tooting his own horn to feel okay When life gives set-backs ( narcisssistic injuries ) this narcissist feels terrible and may attack those nearby Grandiose Narcissists Truly feels superior to others No underlying sense of shame The result of entitlement Child grows up being told he s special, great, deserves a lot in life (money, power, etc) When life gives set-backs, this narcissist considers it irrelevant, feels fine maybe getting even, but not upset

15 Vulnerable Narcissists: Abusive Personalities: Narcissistic Batterers Pattern similar to borderlines when feels narcissistic injury can go into a rage Benefits from batterers treatment programs learns impulse control, calming self-talk Grandiose Narcissists: Pattern similar to antisocials may plan revenge, but stay cold and calm; calculating Doesn t benefit from batterers treatment programs not an impulse control problem

16 Narcissists: Some Parenting Concerns Sees child as possession--extension of self Belittles child as inferior Authoritarian, controlling discipline style More angry at child than normal parent Spanks child more often and hard Power-assertive responses to conflicts But also swings to permissive parenting; or swings to no interest in child at all Child sexual abuse as right of ownership Has child join in belittling other parent

17 NARCISSISTIC - Treatment Treatment: Slightly Hopeful Usually don t stay in therapy 5 years, with highly-effective therapist and learning skills, may overcome diagnosis Types: Individual Psychodynamic Individual Therapy Secure relationship Balance support and gentle confrontation Group does best in Substance Abuse groups Cognitive Therapies: Schema Therapy DBT?

18 PARANOID ( I ll Never Trust You ) Pattern 1. Fear of being exploited 2. Endless doubts about friends loyalty 3. Fearful of confiding in others 4. Misinterprets as demeaning or threatening 5. Bears long-term grudges 6. Misperceives others as attacking his/her character, so reacts with counter-attacks 7. Suspects sexual infidelity of spouse/partner

19 Paranoid Some Parenting Concerns Tells child to fear everyone else in the world (Except this parent) Suspicious of other parent uses child to snoop or ask questions Conspires with child against other parent Wants total control of child so can have a relationship without fear

20 PARANOID - Treatment Treatment: Minimally Hopeful Usually don t stay in therapy Very slow to trust Types: Individual Psychodynamic Individual Therapy Secure relationship Balance support and gentle confrontation Some cognitive therapy skills may help Group generally not recommended

21 HISTRIONIC ( Always Dramatic ) Pattern 1. Demanding of attention 2. Inappropriately seductive or provocative 3. Shifting and shallow emotions 4. Physical appearance draws attention 5. Speech is impressionistic and lacks detail 6. Dramatic, theatrical, and exaggerated 7. Suggestible 8. Believes relationships deeper than then are

22 Histrionics Some Parenting Concerns Often neglectful Role reversal with child Overly protective, dramatic about child May exaggerate minor health complaints Highly inconsistent parenting

23 HISTRIONIC - Treatment Treatment: Hopeful Usually don t stay in therapy 5 years, with highly-effective therapist and learning skills, may overcome diagnosis Types: Individual Psychodynamic Individual Therapy Secure relationship Balance support and gentle confrontation Group can be disruptive Cognitive Therapies: Schema Therapy DBT?

24 CAUSES 1. Biological factors, such as genetic tendencies and temperament at birth. 2. Early childhood factors, such as early parenting attachment disruptions, child abuse or other trauma before age Social learning, such as invalidating environments : being ignored for positive behaviors and getting more attention for mood swings and extreme emotions; family and community tolerance of bad behavior; role models w personality disorders. 4. Larger Culture: Attention and rewards for Drama, Mood Swings, Narcissism & Violence

25 Prevalence of Personality Disorders (US NIH Study ) National Institutes of Health study of over 35,000 people had following results for 5 high conflict personalities: Narcissistic = 6.2% Borderline = 5.9% Paranoid = 4.4% Antisocial = 3.6% Histrionic = 1.8% All have substantial overlap with other personality disorders, substance abuse, depression, anxiety, bipolar disorder and suicide ----Journal of Clinical Psychiatry, 7/2004, 4/2008 & 7/2008

26 Prevalence of Personality Disorders (NIH Study by Age Groups) Narcissistic = 6.2% 65+= = = = 9.4 Borderline = 5.9% 65+= = = = 9.3 Paranoid = 4.4% 65+= = = = 6.8 Antisocial = 3.6% 65+= = = = 6.2 Histrionic = 1.8% 65+= = = = 3.8