Personality Disorders: Theory, Research, and Treatment ® (PD:TRT) publishes a wide range of cutting edge research on personality disorders and related. Similarly, they perceive their relationship partners as having very different A highly effective treatment for personality disorders, based upon this theory is. METHODS: A manual research was performed in the author's private collection of mental disorders, but suggesting changes in diagnostic criteria, theoretical frameworks The interpersonal relation with a Personality Disorder (PD) patient can be considered There is no response as to the adequate place for treatment .
These theoretical applications result in various forms of therapy which are then tested by research for efficacy. These research findings subsequently aid in the refinement of the theory and its application psychotherapy.Borderline Personality Disorder and Facial Expression Recognition
This process has produced modern methods of treatment for personality disorder that are highly effective and evidence-based. Today, we now know that people can, and do, heal and recover from these devastating disorders. However, such was not always the case. As recently as the midth century, people with personality disorders were viewed as willful, weak, and deviant, and were thought to be resistant to treatment.
Thus, treatment for personality disorders was often not provided, or if offered, it was seen as a "heroic effort" based on the belief that the treatment was taxing on the clinician with little hope for a promising outcome.
For a more thorough review of this interesting history please refer to the section " The history of the current diagnostic system. Treatment of Personality Disorders and the Current State of Research1 It is important to note that despite all our progress in this important area, the research investigating the treatment of personality disorders is still somewhat in its infancy.
Most of what is known about the treatment of a specific personality disorder cannot be generalized to all personality disorders. This is similar to research findings regarding any broad category of disorders.
For instance, cancer is a broad category of disorders. While certain treatment protocols may apply to all cancer treatments, each specific type of cancer, such as breast cancer and bone cancer, will have unique and specific treatment protocols that do not apply to both.
Researchers do not generally study cancer, but rather study specific types of cancers. This experience is stored along with the intense emotional states that accompanied these interactions with the "object" caregiver. It is assumed that infants do not yet experience nuanced emotions so these emotional states are generally of extreme pleasure or extreme displeasure.
It is during these intense emotional states that infants develop a representation of self in relation to the other person object. Depending on how such interactions go, these representations can take different forms.
Studies of personality disorders Antisocial and Borderline
An example would be a representation of a terrified, weak self the child and a powerful, threatening object the caregiver linked together through the affect of fear. Although object relationships are based upon actual interactions, they are not necessarily realistic and unbiased records of those interactions. Instead, they combine early impressions and memories, with fantasized interactions with others. The factual and fantasized information become blended together, all organized according to the dominant affect that is characteristic of that relationship.
Once formed, these object relationship pairs self-other dyads function as templates through which later relationships may be understood. These internal object relation dyads are activated in future relationships and influence, or even determine, how people will experience and relate to others. Another patient subgroup can exist with a combination between Borderline and Antisocial disorder, turning them even more capable of manifesting bad conducts and violence Antisocial and Borderline personality disorders Understanding these disorders as actual mental disorders, one may say that these people present deeply imbedded, inflexible and badly adjusted patterns of relationships and perception of the environment and themselves.
The Treatment of Personality Disorders
They very frequently do not perceive their "symptoms" as harmful for themselves or others and, therefore, do not usually seek professional help, and are also considered unrecoverable in many cases.
The interpersonal relation with a Personality Disorder PD patient can be considered a unilateral relationship, due to the inability of healthy or satisfactory interpersonal relations 7. The debate about criminality practiced by people who fit into the diagnostic criteria for these two disorders is considered highly polemic and widespread. There is no response as to the adequate place for treatment. Although the authors sustain great diagnosis and intervention difficulties, they suggest antisocial PD behavior is a mental disorder 8besides the fact that there is no scientific evidence yet to associate the violence these subjects cause as a part of the personality disorder, as the association with drugs and alcohol use is frequent.
In some cases, a connection between both exists, which makes one cause the other 6,9. In the medical-legal discussion sphere, the reformulation of laws applicable to criminal Antisocial and Borderline personality disorder patients is defended A possible etiology A literature review of 56 other studies 5 about violence and personality disorders, among other important findings, indicates that behavioral factors in childhood and the presence of attention deficit hyperactivity disorder ADHD could predispose individuals to the development of personality disorders as, within the cognitive model, antisocial behavior is a phylogenetically determined strategy to facilitate survival, in which each person acts motivated by an internal control system, which regulates its perceptions and responses to the environment.
Thus, children who grow up in an environment where parents are violent tend to reproduce violent behavior when adult. This reinforces the idea that social determinants are interconnected, that is, inability to attend to basic needs, divorces, unemployment, drugs abuse and low education levels are associated with intra and extra-domestic violence, hence acting as survival responses learned at home Different dysfunctional behavior problems among parents have been associated with the development of this disorder, including their low emotional sensitivity.
In some cases, mothers report feeling anxious, impulsive and uncontrolled since their own childhood, suggesting that families whose parents have this disorder seem to transmit their maladjusted behaviors to their children.
Thus, it is fundamental for impulsiveness, low anger control, mood instability, egocentrism, among others, to be treated early, as they interfere in fatherhood or motherhood skills Families of these patients showed the highest psychopathology rates, particularly in cases of depression, substance abuse and antisocial conducts. The quality of the family relationship, however, seems to lead towards two possible routes: An analysis of this problem according to the theory of Interpersonal Relations 12 reveals that the development of this problem is related with the experiences lives and one's ability to assess them.
Although that author has not published on the application of her theory to this kind of clientele, one of her basic premises sustains that all people tend towards a positive development and need to receive unconditional positive attention. In a large majority of cases, however, people with an Antisocial or Borderline PD do not see that they have problems and, therefore, do not understand the need for therapeutic help, so that no therapeutic contract can be started in practical terms.
Epidemiology In the general population, PD rates can range from 0.
The Treatment Of Personality Disorders
These data suggest a relation between drugs use, these disorders and involvement with crimes, although no scientific proof exists yet to associate criminal conduct with the co-existence of one of these PD. However, involvement with illegal drugs is associated with criminal practices, a known fact.
This makes it more complex to truly understand the therapeutic possibilities to treat people with these diagnoses and undoes the existing prejudice regarding the complete dangerousness of people with these diagnoses 9. People with personality disorders are more susceptible to other psychiatric disorders. Changes in diagnostic and psychotherapeutic criteria A study 14 involving psychiatrists and clinical psychologists used a questionnaire called SWAP, with personality description items, aimed at getting to know these professionals' clinical judgments.
The study selected professionals with large clinical experience to decrease the risk of diagnosis difficulties, which decreased the possibilities of subjects having some signs and symptoms classified as comorbidities. In this study 14it was verified that there are different empirical characteristics not included in the diagnostic criteria the DSM-IV uses to classify all PD.
To give an example, Antisocial PD seems to involve certain impenetrability, sadism and a trend to manipulate other people's emotions.
Object Relations Theory Of Personality Disorders
Despite crime-related events, there are reports on successful treatment through therapeutic and psychotherapy communities 9. The impulsiveness of Borderline PD can depend on the presence of a negative emotional state. A study involving subjects diagnosed with Borderline PD 15 suggests that people with this disorder can present a negative emotional state, which allows them to interrupt or inhibit their behavior in the presence of punishment, that is, negative emotions can be associated with increased impulsiveness among people with this disorder.
According to biosocial theory 16people with Borderline PD are characterized by a combination of emotional vulnerability and affective disequilibrium. Emotional vulnerability involves a low threshold for emotional response, involving intense and long-lasting responses to emotionally suggestive stimuli.
Affective disequilibrium refers to the inability to control or modulate emotional experiences. Within this structure, impulsive and self-harming behavior that is generally observed in this type of disorder occurs in response to negative emotions and to the function of frequently regulating these emotions.
Consequently, the presence of negative emotional states can increase the probability of impulsive behavior in these clients. The risk of violence, a very noteworthy characteristic for this class of PD, can be understood in terms of four fundamental personality dimensions: A study that used a item questionnaire to assess personality functioning, aimed at analyzed the diagnostic criteria for personality disorders, was applied to community people.
These questions were distributed among the following components: The data showed a high level of internal consistency, suggesting that the results can represent larger populations and serve as a base for alterations in the diagnostic criteria for type B PD Until then, in both studies, the need for diagnostic reformulation is mentioned as very important, suggesting that the criteria should be reviewed.
Subsequent studies also suggest changes in assessment forms, but mention the need to reformulate the model, moving from criteria to dimensions. Controversies also exist regarding diagnostic classification According to those studies, current assessment needs modification, which requires changes in classification parameters.
The five-factor model is suggested, which is considered more integrative and preeminent in comparison with the current category-based model. According to this theory, personality is organized in five main large traits: Disorders are characterized as acute dysfunctional behaviors dissipated in a relatively short period of time.
The modification of assessment and classification criteria is also suggested. It is observed that some of these items, such as the ability to create and maintain interpersonal relations and self-protection from stress are also items the World Health Organization 20 appoints as mental health indicators, as well as targets of therapeutic interpersonal relationship practice Therapists report more treatment failure when PD are diagnosed.
They do not define, however, the actual motives involved, which can be their own inadequacy and, consequently, the inefficacy of the proposed interventions. There are signs that cognitive-behavioral therapy can be an effective method in PD treatment