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Objectives|Define Personality Disorders|List the characteristics of Antisocial Personality|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
~Antisocial Personality Disorder|CORRUPT (3 criteria)|C: Conformity to law lacking|O: Obligations ignored|R: Reckless disregard for safety of self or others|R: Remorse lacking|U: Underhanded (deceitful, lies, cons others)|P: Planning insufficient (impulsive)|T: Temper (irritable and aggressive)
~Addictions vs. Personality Disorders|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 both requires|Development of effective coping skills|Addressing cognitive distortions
~Recovery Interventions|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|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|Important concepts in early recovery|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