033- Using a Strengths-Based Biopsychosocial Approach to Addressing Antisocial Personality Disorder

 
 
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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