DBT, CBT, MORE
Personality refers to individual differences in characteristic patterns of thinking, feeling, and behaving. The study of personality focuses on two broad areas:
Understanding individual differences in particular personality characteristics, such as sociability or irritability.
Understanding how the various parts of a person come together as a whole.
Research suggests that genetics, abuse, and other factors contribute to the development personality disorders. People with personality disorders experience abnormal thoughts and behaviors that keep them from functioning as well as they should. The nature of those thoughts and behaviors depends on which personality disorder a person has, such as obsessive-compulsive disorder, paranoid personality disorder or borderline personality disorder. The disorders do have one thing in common: They usually do not go away without treatment.
Now psychologists are finding new approaches to treating these notoriously hard-to-treat disorders. Two interventions show promise for treating borderline personality disorder (BPD), the most-studied personality disorder:
Dialectical Behavior Therapy.
While they often seek help, people with BPD also tend to drop out of therapy. While they’re quick to open up, they’re even quicker at shutting down. And while they crave approval, a small provocation can result in abusive or violent behavior toward those trying to help. Dialectical behavior therapy helps clients stop bouncing between these two extremes. The approach features weekly one-on-one sessions with a counselor, plus group skills training.
Helping clients regulate emotion is key, especially since many harm themselves as a way of stabilizing their emotions. Dialectical behavior therapy teaches clients alternative ways to control overwhelming or confusing feelings. Therapists might share a technique called mindfulness, which allows clients to observe their emotions without reacting.
In a study comparing Dialectical Behavior Therapy and traditional psychotherapy, women who underwent DBT were more successful at reducing suicide attempts, self-mutilating and such self-damaging behaviors as gambling and substance abuse. They were also almost twice as likely to stay in therapy.
Cognitive therapy. This therapy focuses on thoughts rather than emotions. In weekly sessions, therapists help clients identify and change dysfunctional beliefs about themselves, others, and the world.
People with borderline personality disorder, for instance, often think they’re bad and then interpret everything that happens to them in a way that confirms that belief. Cognitive therapy helps clients eliminate such dysfunctional beliefs by revisiting and reinterpreting childhood experiences. For instance, a client who feels inadequate may come to understand that that belief comes from his parents giving him responsibilities he wasn’t ready for. Once clients understand the origins of dysfunctional beliefs, they can work on changing them. In one study of cognitive therapy, borderline personality symptoms dropped significantly after a year. At follow-up, 55 percent of study participants no longer met the criteria for a diagnosis of borderline personality disorder.
In the past, some believed that people with personality disorders were just lazy or even evil. But new research has begun to explore such potential causes as genetics, parenting and peer influences:
Genetics. Researchers are beginning to identify some possible genetic factors behind personality disorders. One team, for instance, has identified a malfunctioning gene that may be a factor in obsessive-compulsive disorder. Other researchers are exploring genetic links to aggression, anxiety, and fear—traits that can play a role in personality disorders.
Childhood trauma. Findings from one of the largest studies of personality disorders, the Collaborative Longitudinal Personality Disorders Study, offer clues about the role of childhood experiences. One study found a link between the number and type of childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma.
Verbal abuse. Even verbal abuse can have an impact. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, told them they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children to have borderline, narcissistic, obsessive-compulsive, or paranoid personality disorders in adulthood.
High reactivity. Sensitivity to light, noise, texture, and other stimuli may also play a role. Overly sensitive children, who have what researchers call “high reactivity,” are more likely to develop shy, timid, or anxious personalities. However, high reactivity’s role is still far from clear-cut. Twenty percent of infants are highly reactive, but less than 10 percent go on to develop social phobias.
Peers. Certain factors can help prevent children from developing personality disorders. Even a single strong relationship with a relative, teacher or friend can offset negative influences, say psychologists.
Adapted from “Treatment for the ‘untreatable’” APA Monitor on Psychology (http://www.apa.org/monitor/mar04/treatment.aspx)
Adapted from “Where personality goes awry” APA Monitor on Psychology (http://www.apa.org/monitor/mar04/awry.aspx)