Personality disorders are illnesses or acquired behaviors

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When relationships fail

Personality disorders are not innate, but arise from problematic relationships in childhood and adolescence, in which central basic needs were not adequately met. In such relationships, unhealthy, unhelpful thought patterns arise both about oneself and about relationships, as well as unfavorable coping strategies in the long term. This also makes it clear that personality disorders must be understood as interaction disorders. Our therapeutic approach is based on this principle.

In the past, problematic coping strategies were used to try to meet one's own needs in relationships. They represent quasi “solutions” for early interaction problems in disturbed relationships. These strategies become problematic because they later do not work well in healthy relationships. For example, a child may have had the experience in the past that they received a gift for very good performance. However, a strong striving for high performance can later lead to difficulties in social relationships or, due to excessive demands, favor a depressive illness. This is an example of how problem-solving strategies learned at an early stage to meet one's own needs can be harmful to oneself and social relationships in the long term.

For normal personality development it is essential that in childhood ... [read more]

For normal personality development, it is essential that the child's basic needs are met by their caregivers in childhood. The basic needs of a child include the need for security, attachment, reliability, solidarity, autonomy, competence, recognition, importance, a sense of identity, realistic boundaries and for spontaneity and play as well as the freedom to express needs and emotions. If these needs are not met, insufficiently or excessively (e.g. through overprotection), problematic coping strategies develop.
Unhealthy thought patterns can relate to oneself (e.g. “I am not important”) or to caregivers (e.g. “In relationships I am abandoned”).
From these thought patterns problematic coping strategies can develop, which represent an attempt to protect one's own self-esteem and to fulfill basic needs in relationships (e.g. "Submit to others"). In the problematic relationships of childhood, these coping strategies were often helpful and enabled the child to survive under adverse circumstances and at least meet their needs as best as possible. These coping strategies become problematic in later, potentially healthy relationships, as they lead to interaction disorders there and also prevent a correction of unhealthy thought and behavior patterns.

General characteristics of personality disorders

One thing that all personality disorders have in common is relatively stable and overarching negative basic assumptions (also called thought patterns or schemata) about oneself and about relationships. As a result, those affected often notice low self-esteem and recurring difficulties in social relationships.

Every person develops a certain personality style over time ... [read more]

Everyone develops a certain personality style over time, which is completely normal and functional. His innate temperament as well as his life experiences play a role in this. Personality styles are general experience and behavior patterns in relationships that make it easier for people to react to similar situations with tried and tested (relationship) strategies. A personality style only becomes a personality disorder when it is very extreme and inflexible, leads to undesirable consequences and causes suffering in the person concerned.
Such personality disorders arise when a person's early life experiences lead to the development of problematic thought and behavior patterns. Depending on the individual characteristics of these patterns, the temperament and developed coping strategies, various personality disorders can develop, which are described in more detail on the following pages.

Get out of problematic relationship strategies

Personality disorders can be treated well with the methods of modern cognitive behavioral therapy. First of all, it is crucial that the patient can recognize his problematic thinking and behavioral patterns in order to then be able to initiate steps towards change.

Unhealthy thought and behavior patterns are not permanent. With the help of ... [read more]

Unhealthy thought and behavior patterns are not permanent. With the help of clarification-oriented and schema-therapeutic strategies, patients can learn to recognize their unfavorable patterns and to develop alternative, more functional thinking and behavioral strategies. The Christoph Dornier Clinic for Psychotherapy in Münster has specialized, among other things, in the treatment of personality disorders and offers disorder-specific therapy concepts tailored to the individual. In order to successfully treat a personality disorder, it is very important to know exactly the specific manifestations and backgrounds of the disorder in each individual patient, to understand how the disorder arose and how it is perpetuated. In addition to classic cognitive-behavioral methods, individually selected elements of current developments in behavioral therapy, such as schema therapy, clarification-oriented psychotherapy or dialectical behavioral therapy, are used in the treatment.

diagnosis

Personality traits represent enduring patterns of perception, the formation of relationships and thinking about the environment and about oneself. They are expressed in social and personal situations. Only when personality traits are inflexible and unadapted and lead to functional impairments (e.g. inability to work) or suffering do they form a personality disorder.
The World Health Organization (WHO) and the leading psychiatric associations in the USA and European countries have developed very precise classification systems so that mental illnesses can be identified precisely and reliably.

General diagnostic criteria according to DSM-5

a. An enduring pattern of inner experience and behavior that deviates noticeably from the expectations of the socio-cultural environment. This pattern manifests itself in at least two of the following areas:

  1. Cognition (i.e. the way of perceiving and interpreting yourself, other people and events)
  2. Affectivity (i.e. the range, intensity, lability, and appropriateness of emotional responses)
  3. Shaping interpersonal relationships
  4. Impulse control
  5. The enduring pattern is inflexible and profound in a wide range of personal situations.

b. The persistent pattern leads in a clinically meaningful way to suffering or impairment in social, professional or other important functional areas.

c. The pattern is stable and long-lasting, and its onset can be traced back to at least adolescence or early adulthood.

d. The persistent pattern cannot be better explained as a manifestation or consequence of another mental disorder.

e. The persistent pattern is not the result of the physiological effect of a substance (e.g. substance with potential for abuse, drug) or a medical disease factor (e.g. brain injury).

Incidence and comorbidity

According to epidemiological studies, the estimated prevalence for any personality disorder is around 9.1 percent. Data from the National Epidemiologic Survey on Alcohol and Related Conditions from 2001 to 2002 suggest that approximately 15 percent of American adults have at least one personality disorder. Overall, it is therefore not a question of rare clinical pictures.
The comorbidity, i.e. H. the parallel occurrence of personality disorders and other mental illnesses is high. Common comorbid illnesses are depression, anxiety disorders, addictions and psychosomatic complaints.

course

The characteristics of a personality disorder usually appear in adolescence or early adulthood. Personality disorder, by definition, is a persistent pattern of thinking, feeling, and behavior that is relatively stable over time. Untreated is therefore i. d. As a rule, to reckon with a long-lasting to chronic course of the symptoms. Some personality disorder types (e.g. borderline personality disorder) tend to be less obvious or even remitting with age, while other types of disorders tend to be less so (e.g. obsessive-compulsive personality disorder).

A general model of the development of personality disorders

Several factors probably always play a role in the development of a personality disorder. Important general influencing factors are genetic predisposition, biological factors, temperament, traumatic experiences, upbringing factors, insufficient fulfillment of children's basic needs and model learning from caregivers.

Research indicates that some temperament factors ... [read more]

Research suggests that some temperament factors are inherited and therefore innate. Any temperament can develop in a favorable environment in such a way that the person develops mentally healthy. Personality disorders only arise in conjunction with traumatic experiences, unfavorable parenting factors, unfulfilled child's basic needs or model learning.
Studies show that people with personality disorders had an above-average number of traumatic experiences such as physical, sexual or emotional abuse and neglect in their childhood. The parenting style was often very critical, derogatory or chaotic. Expressing feelings or needs often led to disadvantages for the child.
In addition, there was usually at least one caregiver who, due to their own mental illness, represented an unfavorable model for dealing with emotions and needs. These conditions then gave rise to unfavorable beliefs (schemata) about oneself, others and the environment as a whole. Due to the emotional pain associated with these environmental conditions and developed thought patterns, those affected then developed coping strategies (e.g. always putting their own needs aside in order to maintain relationships) in order to be able to survive in their environment.
These survival strategies, which are necessary at the beginning, become problematic strategies later in a healthy environment, as they protect against unpleasant feelings, but also block access to feelings and needs and hinder the development of healthy relationships. Ultimately, the coping strategies prevent corrective experiences and lead to a solidification of unhealthy ways of thinking and behaving. As a result, the needs of those affected cannot be adequately met even in adulthood.
Depending on the characteristics of the temperament and environmental factors, various personality disorders can develop.

therapy

Even if personality disorders appear complex, are accompanied by numerous very different symptoms and secondary problems and, if left untreated, usually run a chronic course - a successful therapy of personality disorders is possible. With the help of qualified psychotherapists who specialize in the treatment of personality disorders, lasting therapeutic success can be achieved even in the case of severe and long-lasting illnesses. The intensive therapy concept of the Christoph Dornier Clinic offers an optimal framework for recognizing and changing your own unfavorable schemata and relationship patterns.

Treatment of personality disorders in the Christoph Dornier Clinic

When treating personality disorders, the focus is first on clarifying and modifying problematic ways of thinking and behaving, and later on deriving and practicing more functional (interactional) behaviors. In addition to tried and tested classical behavioral therapeutic techniques, our treatment is based in particular on emotion-focused developments in behavioral therapy, such as schema therapy according to Jeffrey Young, clarification-oriented psychotherapy according to Rainer Sachse and, in the case of borderline personality disorder, dialectical behavioral therapy (DBT) according to Marsha Linehan .

Jeffrey Young schema therapy

Jeffrey Young's schema therapy is a further development of the cognitive-behavioral therapeutic approach. Jeffrey Young initially developed schema therapy primarily for those patients who did not experience sufficient therapeutic success in treatment with classic cognitive behavioral therapy. These were typically patients with interactional difficulties. Schema therapy is now being used successfully for the treatment of various personality disorders.

Schema therapy assumes that personality disorders are based on acquired problematic ... [read more]

Schema therapy assumes that personality disorders are based on acquired problematic ... [read more]

Schema therapy assumes that personality disorders are based on acquired problematic schemas that arise when the basic needs of a child are not adequately met. A schema is understood to be a basic assumption about life that includes cognitions, emotions, memories, perceptions and behavioral impulses.
The schemes correspond to the underlying relatively stable basic assumptions or personality traits. Since there are often many unfavorable patterns in personality disorders, it can be more productive in therapeutic work to work with the current states of experience. A distinction is made here between emotionally stressful experience states, which are associated with strong painful childhood emotions such as anger, sadness, fear or abandonment, and self-deprecating or performance-demanding experiences, which depict aspects of the experience in which patients put themselves under pressure or hate themselves. This conflict between strong emotions and, at the same time, demands on oneself often gives rise to problematic coping strategies, which are uncovered with the help of schema therapy and pave the way to healthier solution strategies and a more benevolent way of dealing with oneself.

In principle, schema therapy is particularly characterized by the following three characteristics in therapeutic work:

  1. The emotional experience is placed in the foreground alongside the cognitive and behavioral aspects of the problem. In particular, emotion-activating interventions such as chair dialogues or imagination exercises are used for this purpose.
  2. Biographical aspects are increasingly included in the therapy. Biographical information is used primarily to classify and understand the patient's current problems based on his or her developmental history.
  3. The therapy relationship plays a prominent role in schema therapy. On the one hand, the therapeutic relationship is understood as limited parental care in the sense that the therapist adopts an active, caring and sometimes parent-like style of relationship with the patient. In addition, especially in the case of patients with personality disorders, it is assumed that the therapeutic relationship is the relationship in which changed interactional patterns can and should be tried out first.

Clarification-oriented psychotherapy according to Rainer Sachse

Clarification-oriented psychotherapy understands personality disorders primarily as relationship disorders. She assumes that personality disorders can be traced back to normal psychological processes, which only become a problem because they lead to high costs for the person concerned and thereby disturb them themselves. It is believed that personality disorders are developed as a "solution" to early interaction problems when children and adolescents were exposed to difficult relationships and interaction situations with their primary caregivers.
Clarification-oriented psychotherapy (KOP) is a psychologically sound, empirically validated form of psychotherapy that pursues two main tasks.A main task relates to clarification: On the basis of a trusting therapist-patient relationship actively established by the therapist, current motives of the patient, to which the patient does not have sufficient access at the moment, are clarified. On the other hand, it is important to clarify the problem-causing patterns of a patient. It is assumed that interactional problems and personality disorders are based on unfavorable self-schemas (e.g. "I am not important") and unfavorable relationship patterns (e.g. "In relationships one is let down").
The second main task of the KOP is the modification of the schema, i.e. the therapeutic processing and modification of the problematic schemas. The aim of the KOP is that the patient can act more constructively and flexibly in everyday life, show fewer or no more disturbing "symptoms", be able to cognitively and affectively process everyday situations better and live more self-regulatively and happily.

Dialectical behavioral therapy according to Marsha Linehan for borderline personality disorder

Dialectical Behavioral Therapy (DBT) was specially developed by Marsha Linehan for the treatment of borderline personality disorder. The basis of DBT is cognitive behavioral therapy. However, in order to meet the requirements of such a complex disorder, fundamental modifications were necessary. The most important differences from conventional cognitive therapy are the emphasis on acceptance of a behavior that is currently occurring, the emphasis on treatment of behaviors that endanger the therapy or the patient, and the emphasis on the importance of the therapeutic relationship.

According to Linehan's understanding, borderline personality disorder is central ... [read more]

According to Linehan's understanding, borderline personality disorder is central ... [read more]

According to Linehan's understanding, borderline personality disorder is based on a disorder of emotional regulation. This disorder is attributed to a high level of emotional vulnerability combined with an inability to control emotions. In addition to an already innate emotional sensitivity, a negative and harmful environment during childhood is assumed to be the cause of the disturbance in emotional regulation. Using a tiered treatment structure, the DBT tries to make previously uncontrolled processes predictable for both the patient and the therapist. An essential part of the therapy is therefore the teaching of skills, which should enable the patient to better self-regulation. Skills in the areas of stress tolerance, emotion regulation, mindfulness, social competence and self-esteem stabilization are specifically practiced. These skills are usually taught primarily in a skills training group. At the same time, the motivation for change is strengthened in individual therapy and the specific application of the skills to the everyday life of the patient is discussed using problem, behavior and solution analyzes. DBT has been shown to be successful in treating patients with borderline personality disorder in several studies.