Yaqi Zhang ID No.

37647

Personality Disorder

Borderline Personality Disorder（BPD)

Concept
BPD is a behavior pattern that markedly deviates from normal. It is mainly
characterized by unstable emotional, unstable interpersonal relationships, identity
disturbance, and a variety of impulsive behaviors. At the same time, it is comorbid
with depression, anxiety, bipolar disorder, schizotypal and antisocial, et,. Onset in
early adulthood, the women's prevalence is higher than men.

Etiology and Pathogenesis

The causes of BPD are unclear but seem to involve genetic, neurological,
environmental and social factors.
Studies have shown that genetics, childhood abuse, and childhood adverse life
environments can cause different degrees of symptoms.

Symptoms and Diagnostic Criteria

The characteristics of BPD can be generally classified into two types: "unstable" and
"impulsive", and the diagnosis should have at least the following 5 items.
Specific manifestations of "unstable":
1. Unstable interpersonal relationships, such as relationships with people that show
two extremes, excessive good or excessive bad, can lead to sustained affect crises and
difficulty to maintain a relationship for the long term.
2. Markedly disturbed sense of identity and distorted self-image, deficits self-identity,
and inner preferences and purposes were often vagued.
3. Affective Instability, such as being arguing last moment and becoming depressed
the next, and violent outbursts of anger often lead to violent behavior.
The specific performance of "impulse":
1. Impulsive or reckless behavior, such as impulsive spending, unsfae sex, reckless
driving, being eating, and substance abuse.
2. Recurrent Suicide, Self-Harm, Suicide Threats.
Other diagnostic criteria:
1. Intense fear of abandonment, unable to endure aloneness, frantically seeking a
partner.
2. Chronic feelings of emptiness, low ability to tolerate setbacks due to low self-
esteem.
3. Transient,stress-related paranoid ideation or severe dissociative symptoms.

Diagnosis Method
1. Clinical interview is a common diagnostic method, and a personality assessment is
carried out by asking about the client's situation and combining the DSM-5 personal
scale.
2. Using the Sixteen Personality Factor Questionnaire (16PF) or Eysenck Personality
Questionnaire(EPQ) for assessment.

Treatment Method
The treatment of BPD is difficult, long course and the poor compliance of clients that
all increasing challenges for therapists and clients. The main treatment methods are
psychotherapy and family therapy, the medication therapy should be used as an
auxiliary when accompanied by other psychosis.

Psychotherapy ： Methods include Dialectical Behavior Therapy(DBT) 、 Cognitive

Behavior Therapy(CBT)、Transference-Focused Therapy(TFT）、Schema Therapy and
so on. Treatment forms include individual therapy and group therapy. The purpose of
therapy is to help clients integrate positive and negative perspectives to form more
objective and comprehensive perspectives, thereby establishing good behavior
patterns. This article mainly introduces the most widely used Dialectical Behavior
Therapy (DBT), it was proposed by Professor Marsha Linehan. It is currently the
most empirical clinical intervention, and it has also been proven effective for eating
disorders, PTSD, and depression. It mainly helps clients to learn dialectical thinking,
find the middle point between the two extremes, integrate the opposite two extremes,
improve the ability to comprehensively and objectively to thinking, and ultimately
reduce emotional disorders and abnormal behaviors. DBT is based on four modules:
Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness.
Family Therapy : Family members play an important role in the formation of BPD.
Clients often interact in extreme ways. Therefore, improving family relationships and
communication way is necessary.
Medical Treatment: BPD is often accompanied by other psychiatric diseases.
Therefore, different symptoms are supplemented with specific medication to relieve,
but medication cannot change the personality structure, including antidepressants,
antipsychotics, anti-anxiety drugs, and antiepileptic drugs.

Conclusion
BPD is the most difficult mental disorder for therapists. During the treatment process,
clients may appear angry, extreme, paranoid, unstable emotions, violent, sex seductive
behaviors, and so on. However, therapists should enter the inner world of clients with
a gentle, empathic, and supportive attitude.

Narcissistic Personality Disorder (NPD)

Concept
NPD is manifested by self-centeredness, exaggeration of self-worth, an excessive
craving for admiration, lacking empathy ， unrealistic arrogant fantasies or behavior.
The men's prevalence is higher than women。

Etiology
Current research show inappropriate parental rearing styles such as neglect, apathy,
abuse, dotingand overvaluation in childhood

Symptoms
1. A grandiose sense of self-importance：Overconfidence can be manifested in many
ways, and patients can show anger, shame and depression when self-confidence was
hit. Sometimes failure is transformed into subjective success through imagination.
2. Unrealistic Fantasies: Preoccupation with fantasies of unlimited success, power,
brilliance, beauty, or ideal love.
3. Uniqueness : they believe that they are special, should associate with other special
or high-status people.
4. Requiring excessive admiration：belittle those who disapprove and do not admire
them
5. A sense of entitlement ： unreasonable expectations of especially favorable
treatment ， Unreasonably expecting special treatment, believing one has inalienable,
innate privileges that others do not have. Expecting others to give up their own wishes
in favor of the patient's wishes.
6. Being interpersonally exploitative ： taking advantage of others to achieve their
own ends. Does not consider the powers, feelings, desires of others ， even without
guilty.
7. Lacking Empathy: unwilling to understanding the feelings and needs of others ，
inability to observe the emotions of others.
8. Excessive Envious ： Often being envious of others or believing that others are
envious of them
9. Arrogant, Haughty Behaviors or Attitudes ： Exaggerating self-evaluation,
fabricating facts or lies in order to maintain a state of arrogance. Severe patient think
they can surpass all sociocultural norms and ethics.

Diagnosis Method
1. Through clinical interviews to understand the growth experience of client, parental
rearing style, and development processing of personality disorders, the assessment
was carried out in combination with DSM-5 diagnostic criteria。
2. The Narcissistic Personality Inventory (NPI) 40 items by Raskin & Terry (1988) is
the most widely used measure of narcissism in social psychological research.
3. The Millon Clinical Multiaxial Inventory (MCMI) by Theodore Millon is a widely
used diagnostic test developed,it includes a scale for narcissism, NPI and MCMI have
been found to be well correlated.
Treatment Method
Psychotherapy: Use role-playing technique to guide clients to recognize their inner
own, realize self-centered behavior, and learn to evaluate themselves objectively.
Medication is generally not required.

Conclusion
Parental rearing styles have a great impact on the shaping of a child’s personality.
During growing, parents should not spoil or highly praise children, but also should not
ignore and be indifferent to the child’s needs, at the same time, help the child to get
rid incorrect cognition of self-centeredness, guide children to learn to assume
corresponding responsibilities and obligations.

Obsessive Compulsive Personality Disorder（OCPD）

Concept
The patient is very cautious about everything, pursues perfectly, focus on details, pays
too much attention to order and cleanliness, treats the surrounding with a harsh
attitude, acts stereotype, difficult to adapt to the new environment, makes people
caught in a tense and anxious atmosphere, onset symptoms in adulthood, and more
prevalent in men than women. Based on research OPCD is a distinct disorder
from obsessive–compulsive disorder (OCD), for people with OCD, these behaviors
are egodystonic,unwanted and involuntary, being the product of anxiety-inducing and
involuntary thoughts. On the other hand, for people with OCPD, they are egosyntonic;
the person perceives them as rational and wanted, being the result of, for example,
strong adherence to routines, a desire for control, or a need for perfection. OCPD is
persistent from childhood to adulthood, and patients have realized that dysregulated
social functioning cause many problems in life

Etiology
Genetic factors：Parents with OCPD have an increased chance of inheriting it to their
children.
Environmental factors: strict discipline by parents, children must do as required,
otherwise, the child will be blamed, children will be timid and cautious over time, the
above factors all have an impact on the formation of OPCD.

Symptom
1. Excessive cautious, suspicious
2. Rigid, stubborn, unwilling to listen
3. Unwilling to throw away anything
4. Worry about delegating tasks to others
5. Stingy with self and others
6. Unreasonably asking others to do something according to their way
7. Excessive focus on detail, rules, order, requirements, cleanliness and pursuit of
perfection
8. Thoughts and behaviors that are imposed on others and disgust others, such as
asking others repeatedly about the same question.

Diagnosis Method
1. Through clinical interviews to ask the client whether family genetic history and to
know parental rearing style, growth background,and the relationship between parents,
the assessment was carried out in combination with DSM-5 diagnostic criteria。
2. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by Wayne Goodman(1985) is
a widely used measure.

Treatment Method
1. Analytical psychotherapy ： this methods proposed by Jung. Mainly include
(1)cathartic technique (2)interpretative technique (3)educational technique
(4)transformation technique (5)waking-imagery technique. Using the above
techniques carried out interview to help patients understand, analyze, and recognize
the source of symptoms.
2. Cognitive behavior therapy(CBT): a structured, short-term, cognitive-oriented
psychotherapy developed by Beck, which usesEllis’s "ABC" theoretical model, A
refers to activating events; B refers to Beliefs；C refers to Consequences；
Treatment steps: record automatic thinking using table sheet
Date Events Thoughts(Automatic Thinking) Emotional and Behavior Reaction

Formulate hypotheses, then list the test evidence to test the hypotheses
Supporting Evidence Rebuttal Evidence

Record Instead thinking using table sheet

Events Automatic Thinking Reaction Instead of Thinking Reaction

Challenging wrong extremes of thinking

With or Without Thinking Examples of Distorted Thinking Sometimes I can ....

The last, the patient needs to do homework, including the collection of personal data,
the verification of hypotheses, and the practice of cognitive therapy techniques, etc.,
through the above steps to change the patient's cognition and inappropriate behavior.

Conclusion
The affect of patients with OCPD are isolated, rigid, mentally inflexible, and have a
tendency to fight for power against the therapist and the whole world, which brings
great challenges to the treatment. The therapist needs to feel the patient's inner
conflict and pain with empathy, and help patients get out the spiritual bondage.

Histrionic personality disorder (HPD)

Concept
HPD onset in early adulthood, patients with excessively emotional and attention-
seeking psychological behavior patterns, and charismatic and attractive. HPD presents
in three dimensions, 1. dramatic (exposed, extravagant, unstable emotionally, overly
generous); 2. manipulative (attention-seeking, commanding, easily hurt, disregarding
the feelings of others, socially disorganized, dependent ) ； 3. Relevant self-function
(impulsive, scattered, disorganized, easily distracted, unpunctual, unreliable). The
prevalence of HPD is equally high in both sexes.

Etiology
Although direct causes are inconclusive, various theories and studies suggest multiple
possible causes, of a neurochemical, genetic, psychoanalytic, or environmental
nature. Studies based on twins found that heredity accounted for 67% of the
prevalence factors of HPD, followed by lack of attention and care from parents, which
may lead to children becoming histrionic personalities in order to attract the attention
of parents.

Symptoms
1. self-dramatization :exaggerated expression of emotions，continuous seeking for
appreciation, excitement and attention，attention like to express oneself and strong
performance with influence. feeling uncomfortable when oneself cannot be the focus.
2. Excessive fantasy and easily influenced by the external environment: even take
fantasy things as reality.
3. Shallow and labile affectivity：emotionally rich and enthusiastic but unstable and
not deep. Show excited to mild stimuli, often giving people a superficial and lacking
sincere impression due to the changeable mood.
4. Lack of maturity in behavior and psychosexual development: Sexual function
dysregular, such as sexual frigidity or sexual sensitivity, consistent using physical
appearance to seduce or verbally tease others.
5. Believing that relationships with others are closer than reality.

Diagnosis Method
1. Through clinical interviews to understand the growth experience of client, parental
rearing style, and the assessment was carried out in combination with DSM-5
diagnostic criteria。
2. Brief Histrionic Personality Scale (BHPS) has been created to assess specifically
for HPD.

Treatment Methods
1. Psychodynamic Therapy is one of the main methods for HPD. This treatment
allows patients to come to realize: (1) how their self-esteem is inappropriately tied to
their ability to gain attention, thus wasting opportunities to develop other skills; (2)
how their superficial interpersonal and emotional experiences reflect their
subconscious fear of a truly stereotyped relationship. Much of this awareness occurs
in relationships from analyzing the "here and now", and "patient and therapist", not
reconstructing childhood experiences.
2. Cognitive Behavioral Therapy(CBT)focuses on improving patients' interpersonal
interactions and teaching how to express their desires and needs. At present, there is
no better specific treatment, but a positive attitude should be taken.