Antisocial personality disorder is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others.
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content, please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
Antisocial personality disorder is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others.
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content, please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
All you need to know in order to tell if someone is antisocial or not
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content, please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
All you need to know in order to tell if someone is antisocial or not
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content, please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
Presentation of Dependent Personality Disorder based on DSM5 (Diagnositc and Statistical Manual Fifth Edition) published by American Psychiatric Association in 2013.
Personality Disordet#T h is C h s p te r b e g i n s .docxkarlhennesey
Personality
Disordet#
T h is C h s p te r b e g i n s with a general definition of personaliiy disorder that applies
to each of the 10 specific personality disorders. A personality disorder is an enduring pattern
of inner experience and behavior that deviates markedly from the expectations of the in
dividual's culture, is pervasive and inflexible, has an onset in adolescence or early adult
hood, is stable over time, and leads to distress or impairment.
With any ongoing review process, especially one of this complexity, different view
points emerge, and an effort was made to accommodate them. Thus, personality disorders
are included in both Sections II and III. The material in Section II represents an update of
text associated with the same criteria found in DSM-IV-TR, whereas Section III includes
the proposed research model for personality disorder diagnosis and conceptualization de
veloped by the DSM-5 Personality and Personality Disorders Work Group. As this field
evolves, it is hoped that both versions will serve clinical practice and research initiatives,
respectively.
The following personality disorders are included in this chapter.
• Paranoid personality disorder is a pattern of distrust and suspiciousness such that oth
ers' motives are interpreted as malevolent.
• Schizoid personality disorder is a pattern of detachment from social relationships and
a restricted range of emotional expression.
• Schizotypal personality disorder is a pattern of acute discomfort in close relationships,
cognitive or perceptual distortions, and eccentricities of behavior.
• Antisocial personality disorder is a pattern of disregard for, and violation of, the rights
of others.
• Borderline personality disorder is a pattern of instability in interpersonal relation
ships, self-image, and affects, and marked impulsivity.
• Histrionic personality disorder is a pattern of excessive emotionality and attention
seeking.
• Narcissistic personality disorder is a pattern of grandiosity, need for admiration, and
lack of empathy.
• Avoidant personality disorder is a pattern of social inhibition, feelings of inadequacy,
and hypersensitivity to negative evaluation.
• Dependent personality disorder is a pattern of submissive and clinging behavior re
lated to an excessive need to be taken care of.
• Obsessive-compulsive personality disorder is a pattern of preoccupation with order
liness, perfectionism, and control.
• Personality change due to another medical condition is a persistent personality dis
turbance that is judged to be due to the direct physiological effects of a medical condi
tion (e.g., frontal lobe lesion).
• Other specified personality disorder and unspecified personality disorder is a cate
gory provided for two situations: 1) the individual's personality pattern meets the gen
eral criteria for a personality disorder, and traits of several different personality
disorders are present, but the criteria for any specific ...
This slide is part of a collection of slides, I have created for exam revision from Atypical Child development. The contents of the slide are based on several different research papers.
This slide is part of a collection of exam revision slides from Atypical Child Development. The slides have been created by me, and based on several different research papers. The slides were created for essay exam.
This slide is part of a collection of exam revision slides from Atypical Child Development. The slides have been created by me, and based on several different research papers. The slides were created for essay exam.
This slide is part of a collection of exam revision slides from Atypical Child Development. The slides have been created by me, and based on several different research papers. The slides were created for essay exam.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Personality disorders (Antisocial & Borderline)
1. Personality disorders
DSM – IV. General Criteria
An enduring pattern of inner experience and behaviour the deviates
markedly from the expectations of the individual's culture. This
pattern is manifested in two (or more) of the following areas:
Cognition (i.e., ways of perceiving and interpreting self, other people and
events)
Affectivity (i.e., the range, intensity, liability, and appropriateness of
emotional response)
Interpersonal functioning
Impulse control
The enduring pattern is inflexible and pervasive across a broad range of
personal and social situations.
The enduring pattern leads to clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back
at least to adolescence or early adulthood.
The enduring pattern is not better accounted for as a manifestation or
consequence of another mental disorder.
The enduring pattern is not due to the direct physiological effects of a
substance (e.g., a drug abuse, a medication) or a general medical
condition (e.g., head trauma).
DSM-V. General Criteria
The essential features of a personality disorder are impairments in personality
(self and interpersonal) functioning and the presence of pathological
personality traits. To diagnose a personality disorder, the following criteria
must be met:
Significant impairments in self (identity or self-direction) and interpersonal
(empathy or intimacy) functioning.
One or more pathological personality trait domains or trait facets.
The impairments in personality functioning and the individual‟s personality
trait expression are relatively stable across time and consistent across
situations.
The impairments in personality functioning and the individual‟s personality
trait expression are not better understood as normative for the individual‟s
developmental stage or socio-cultural environment.
The impairments in personality functioning and the individual‟s personality
trait expression are not solely due to the direct physiological effects of a
substance (e.g., a drug of abuse, medication) or a general medical
condition (e.g., severe head trauma).
2. Antisocial Personality Disorder
DSM IV. Criteria (APA, 2000)
There is a pervasive pattern of disregard for and violation of the
rights of others occurring since age 15 years, as indicated by three
(or more) of the following: having hurt, mistreated, or stolen from
another.
Failure to conform to social norms with respect to lawful behaviours
as indicated by repeatedly performing acts that are grounds for
arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or
conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
Irritability and aggressiveness, as indicated by repeated physical
fights or assaults.
Reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated failure to sustain
consistent work behaviour or honour financial obligations.
Lack of remorse, as indicated by being indifferent to or rationalizing.
DSM V. Criteria (APA, 2011)
The essential features of a personality disorder are impairments in
personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose antisocial personality
disorder, the following criteria must be met:
Significant impairments in personality functioning manifest by:
Impairments in self functioning (a or b):
Identity: Ego-centrism; self-esteem derived from personal gain, power, or
pleasure.
Self-direction: Goal-setting based on personal gratification; absence of
prosocial internal standards associated with failure to conform to lawful
or culturally normative ethical behaviour.
AND
Impairments in interpersonal functioning (a or b):
Empathy: Lack of concern for feelings, needs, or suffering of others; lack
of remorse after hurting or mistreating another.
Intimacy: Incapacity for mutually intimate relationships, as exploitation is
a primary means of relating to others, including by deceit and coercion;
use of dominance or intimidation to control others.
3. (DSM IV. Continue):
The individual is at least age 18 years.
There is evidence of Conduct Disorder with onset before age 15 years.
The occurrence of antisocial behaviour is not exclusively during the
course of Schizophrenia or a Manic Episode.
(DSM V. Continue):
counter boredom; lack of concern for one's limitations and denial of
the reality of personal danger
C. The impairments in personality functioning and the individual's
personality trait expression are relatively stable across time and
consistent across situations.
D. The impairments in personality functioning and the individual‟s
personality trait expression are not better understood as normative for
the individual‟s developmental stage or socio-cultural environment.
E. The impairments in personality functioning and the individual's
personality trait expression are not solely due to the direct physiological
effects of a substance (e.g., a drug of abuse, medication) or a general
medical condition (e.g., severe head trauma).
F. The individual is at least age 18 years.
(DSM V. Continue)
Pathological personality traits in the following domains:
Antagonism, characterized by:
Manipulativeness: Frequent use of subterfuge to influence or
control others; use of seduction, charm, glibness, or ingratiation to
achieve one„s ends.
Deceitfulness: Dishonesty and fraudulence; misrepresentation of
self; embellishment or fabrication when relating events.
Callousness: Lack of concern for feelings or problems of others;
lack of guilt or remorse about the negative or harmful effects of
one„s actions on others; aggression; sadism.
Hostility: Persistent or frequent angry feelings; anger or irritability in
response to minor slights and insults; mean, nasty, or vengeful
behavior.
Disinhibition, characterized by:
Irresponsibility: Disregard for – and failure to honour – financial and
other obligations or commitments; lack of respect for – and lack of
follow through on – agreements and promises.
Impulsivity: Acting on the spur of the moment in response to
immediate stimuli; acting on a momentary basis without a plan or
consideration of outcomes; difficulty establishing and following
plans.
Risk taking: Engagement in dangerous, risky, and potentially self-
damaging activities, unnecessarily and without regard for
consequences; boredom proneness and thoughtless initiation of
activities to
4. Borderline Personality Disorder
DSM IV. Criteria
A pervasive pattern of instability of interpersonal relationships, self-image,
and affects, and marked impulsivity beginning by early adulthood and
present in a variety of contexts, as indicated by five (or more) of the
following:
Frantic efforts to avoid real or imagined abandonment. Note: Do not
include suicidal or self-mutilating behaviour covered in Criterion 5.
A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation.
Identity disturbance: markedly and persistently unstable self image or
sense of self.
Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, sex, substance abuse, reckless driving, binge eating).
Note: Do not include suicidal or self-mutilating behaviour covered in
Criterion 5.
Recurrent suicidal behaviour, gestures, or threats, or self-mutilating
behaviour.
Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours
and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical
fights).
Transient, stress-related paranoid ideation or severe dissociative
symptoms.
DSM V. Criteria
The essential features of a personality disorder are impairments in
personality (self and interpersonal) functioning and the presence
of
pathological personality traits. To diagnose borderline personality
disorder, the following criteria must be met:
Significant impairments in personality functioning manifest by:
Impairments in self functioning (a or b):
Identity: Markedly impoverished, poorly developed, or The
essential features of a personality disorder are impairments in
personality (self and interpersonal) functioning and the
presence of pathological personality traits. To diagnose
borderline personality disorder, the following criteria must be
met:
Significant impairments in personality functioning manifest by:
Impairments in self functioning (a or b):
Identity: Markedly impoverished, poorly developed, or
Separation insecurity: Fears of rejection by – and/or
separation from – significant others, associated with fears of
excessive dependency and complete loss of autonomy.
Depressivity: Frequent feelings of being down, miserable,
and/or hopeless; difficulty recovering from such moods;
pessimism about the future; pervasive shame; feeling of
inferior self-worth; thoughts of suicide and suicidal behaviour.
5. DSM V. Continue
Disinhibition, characterized by:
Impulsivity: Acting on the spur of the moment in
response to immediate stimuli; acting on a momentary
basis without a plan or consideration of outcomes;
difficulty establishing or following plans; a sense of
urgency and self-harming behavior under emotional
distress.
Risk taking: Engagement in dangerous, risky, and
potentially self-damaging activities, unnecessarily and
without regard to consequences; lack of concern for
one’s limitations and denial of the reality of personal
danger.
Antagonism, characterized by:
Hostility: Persistent or frequent angry feelings; anger or
irritability in response to minor slights and insults.
The impairments in personality functioning and the
individual’s personality trait expression are relatively
stable across time and consistent across situations.
The impairments in personality functioning and the
individual’s personality trait expression are not better
understood as normative for the individual's
developmental stage or socio-cultural environment.
The impairments in personality functioning and the
individual's personality trait expression are not solely
due to the direct physiological effects of a substance
(e.g., a drug of abuse, medication) or a general
medical condition (e.g., severe head trauma)
6. Treatments for Borderline Personality Disorder I.
Cognitive Behaviour Therapy
CBT can help Borderline patients to identify and change core beliefs/behaviours that underlie inaccurate
perceptions of themselves and others and problems interacting with others. CBT may help to reduce anxiety and
mood symptoms and reduce the number of suicidal and self- harming behaviours.
Dialectical Behaviour Therapy
This type of therapy focuses on mindfulness, or being aware of / attentive to the current situation. DBT teaches skills
to control intense emotions, reduces self- destructive behaviours and improves relationships. This therapy differs from
CBT in that it seeks a balance between changing and accepting beliefs and behaviours
Schema focused therapy
This type of therapy combines elements of CBT with other forms of therapy that focus on reframing schemas (a
mental concept that informs a person about what to expect from a variety of experiences and situations), or the
way people view themselves. This approach is based on the idea that borderline personality disorder stems from
dysfunctional self- image – possibly brought on by negative childhood experiences- that affect how people react to
their environment, interact with others, and cope with problems or stress.
Psychodynamic therapy
Mentalization therapy
(Davidson et al, 2006, McMain, 2007)
7. Borderline Disorder treatments
II.CBT:
Place emphasis on the observable behaviours and on the psychic schemata or “inner scripts” (habitual patterns of thought about
the self and the interpersonal world, built up during one’s developmental years)
therapy is based on the assumption that behaviours and their underlying schemata have become maladaptive for variety of
causative factors: hereditary predisposition, humiliations and other psychological hurts experiences from the caretakers or in some
cases trauma due to physical or sexual abuse.
Important cognitive distortions of BPD patients; polarized all-or-none attitudes or dichotomous thinking.
CBT focuses on decreasing the tendency to dichotomous thinking, helping the patient to develop better control over his emotions
and impulses, and strengthening the patient’s sense of identity.
(Stone, 2006)
Treatment can be divided into 5 stages; 1. construction of working relationship 2. symptom management 3. correction of thinking
errors 4. trauma processing and schema changes 5. termination
Challenges in stage 1:
constructing working relationship with BPD patients is difficult, as strong ambivalence dominates the contact; on one hand there is
a desire for help and acceptance, on the other there is fear of rejection.
In crisis periods demands on the therapist for immediate relief of despair can be great. Typical BPDs mistrust others very strongly,
therefore much of the help offered by the therapist is rejected.
Therapists may feel themselves facing and impossible task thus may let themselves easily be provoked into rejecting situations.
Physical proximity, confrontation (telling the patient “you don’t want to change”), lack of clarity (long silence, or no answer,
returning the question) will increase the level of fear in the patient.
However, attempts to offer clarity, consistency and prescribing strict standard programs, or directive approach by the therapist will
not meet success because the patient does not dare relinquish control.
(Arntz,1994)
8. Challenges in Stage 2:
The goal of this stage is not the banishing of symptoms, but making life more bearable and evening the path towards the next
stages of therapy.
For example, crises periods, self mutilation and self- threatening behaviour (that normally is the expression of despair, severe
feelings of fear and aggression) can be changed to an alternative behaviour that is harmless to the patient, such as placing hands
on ice, dancing to music, cold showers.
Frequent misunderstanding occurs that the patient thinks the therapist has told them they MUST behave differently. However the
goal of the therapy is to increase the freedom of choice pertaining to the expression of emotions. Therefore the patient choses an
alternative – the therapist does not prescribe this.
In the long term the goal is to cope with emotions in a more adequate fashion: gradually the focus of therapy is replaced from the
problem behaviour to the motive.
(Leibenluft et al, 1987)
Challenges in stage 3:
The aim of this stage is to change dichotomous thinking in the patient. (According to Jean Piaget’s theory dichotomous thinking is
characteristic of children and distinguishes itself from more adult thinking, which is multidimensional and more nuanced)
Other frequent thinking factors in BPD are; personalization (blaming themselves excessively), double standard ( strict rules they
judge themselves by do not apply to others). Egocentric thinking (inability to distinguish one’s own interpretations or wishes from
those of others). Catastropihizing (fear of catastrophes if they do not fulfil other’s wishes and expectations).
Approaching these patterns with standard cognitive techniques may not be enough. Intellectually the patient understands the
arbitraty character of his / her thinking, but claims that “it just feels this way”
(Westen, 1991)
9. Challenges in Stage 4:
Changing thinking errors is not easy in borderlines: the core schemas are deeply anchored. Moreover, the patients
fear the consequences of letting these assumptions go.
At this stage the aim of therapy is to modify representation of traumatic childhood experiences which led to the
development of the faulty assumptions (thinking errors)
Exposure to traumatic memories and emotions thereby incurred may cause the patient to withdraw, therefore
therapy at this stage must proceed slowly, gradually and predictably, and must be controlled by the patient.
It is also important that previous childlike interpretations are reconstructed. (it has to be made clear to the patient
that their assumption were reasonable then, but do not necessarily apply to the present situation.
Mostly however, more is needed: the change has to take place at the child- level, so to speak; thereto, use can
be made of imagination techniques or of psychodrama.
( Edwards, 1990)
BPD patients commonly possess other comorbid disorders as well such as, depressive episodes, eating disorders
(anorexia, bulimia), panic and other anxiety disorders, alcohol / substance abuse, dissociative disorder, PTSD
10. Psychodynamic treatments
Psychodynamic methods are based on the assumption that unconscious forces and conflict are buffeting the borderline patient and are
responsible for the sharply polarized attitudes and often wildly osciallting behavioural patterns seen in BPD.
This approach aims to integrate the disparate elements of personality that have been disintegrated by splitting defence mechanism
(Splitting is a very common ego defense mechanism. It can be defined as the division or polarization of beliefs, actions, objects, or persons
into good and bad by focusing selectively on their positive or negative attributes)
This approach strives to promote psychic integration through the careful examination of the polarized attitudes (that are outside awareness),
transference.
In early stages of work, the therapist may be confronted with all manner of life- threatening or self- mutilative behaviours, interpersonal crises,
disruptions in the treatment.
(Stone, 2006)
In recent years a number of treatment guidelines have been developed:
Transference Focused Psychotherapy (Kernberg et al. 2002)
Mentalization- Based treatment (Mentalization: ability to read mental states of others and self more accurately, so to develop a more
coherent sense of self and better regulated set of emotions in relation to the external world) (Bateman & Fonagy, 2004)
Self psychology (borderline state is not analysable, therefore converts such patients over time into an “analysable narcissistic personality”)
(Kohut, 1971)
However, Kernberg and Bateman & Fonagy made the case in numerous publications of efficacy of psychodynamic approach in a
respectably high proportion of borderline patients. The presumption is that the important dynamic constellations in the borderline patient’s
everyday life will eventually play themselves out within the transference relationship, there to be brought to light, clarified, and modulated
along more adaptive paths.
11. APD treatments
Family Therapy:
Parent management training, structured family therapy have been shown to be effective in children with conduct disorder. There is
no published research however on family therapy with adults with APD.
Severely psychopathic patient with APD or severely psychopathic person who does not meet the criteria for APD is not advised;
information learned by the patient from both the therapist and other family members is likely to be used to hurt or control in the
service of sadism and omnipotent fantasy
(Meloy, 1992)
However, reductions in criminal recidivism as a result of family therapy have been reported (Gendreau and Ross, 1987)
Milieu and Residential Therapy:
The term Milieu is used to describe any treatment method in which control of the environment surrounding the antisocial
environment is the primary agent for change.
1. approach token economy program: empirically found to shape patient and staff behaviour within institutions. Although effective,
such programs may be legally challenged by patients with APD on the basis of an arguable constitutional right to unwanted
therapy (Rice et al, 1990)
2. approach therapeutic community: Members of the community care for one another, follow the rules, submit to the autihority of
the community, and rewarded or disciplined by the group. The primary intervention is the daily group meeting that functions as
psychotherapeutic and policy- making body. Peer problemsolving is encouraged, and staff are the facilitators of this largely
democratic group culture.
Few controlled studies of therapeutic communities have been done, they have shown modest positive effects
(Harris & Rice, 1994)
12. CBT
Cognitive behavioural and social learning techniques are the most frequently used methods for treating APD. Clear and
unambiguous rules, clearly established and enforced consequences, teaching life skills and cognitive skills that are
congruent with the patient’s developmental level, identification and modification of cognitive distortions and cirimnal
lifestyle patterns, addressing effects of patient’s behaviours on others is highly recommended in therapy (Gacono et al,
2000)
Patients with APD are likely to respond to this method of treatment if they are motivated to change and it is used in a
milieu or residential setting.
This is most predictable in the mild to moderately psychopathic patient with APD, who normatively respond to aversive
consequences and has felt the emotional and practical pain of his or her antisocial acts.
It is however highly unlikely to have any effect on severely psychopathic patient with APD, because of deficits in passive
avoidance learning (inhibiting new behaviour when faced with punishment), the inability to foresee the long- term
consequences of his or her actions and the lack of capacity to reflect on the past.
The cognitive deficits of the psychopathic patient such as moderate formal thought disorder and impairments in
understanding the connotative meaning of words would also interfere with the success achieved with this mode of
therapy
(Hare, 2003)
Psychodynamic Approaches:
There is no clinical evidence that psychopathic or APD patients will benefit from any form of psychodynamic therapy,
including the expressive or supportive psychotherapies or any psychodynamically based group therapies.
13. Challenges in APD treatment
Anxiety and Attachment:
Anxiety is a necessary correlate of any successful mental health treatment that debepnd on interpersonal methods,
because it marks a capacity for internalized object relations. As the severity of psychopathi increseas in patients with APD
anxiety likely lessens and with it the personal discomfort that can motivate a patient to change.
The ability to form an alliance with a therapist, a behaviour related to attachment, has been shown to be positive
prognostic marker in the psychotherapeutic treatment of males with ADP
Without attachment capacity, any treatment that depends on the emotional relationship with the psychotherapist will fail
and may pose an explicitdanger to the professional because a lack of empathy for the therapist will not inhibit aggression.
(Gerstley et al, 1989)
Narcissism:
Psychopathic patients can be conceptualized as aggressive narcissists.
In clinical and treatment setting, the more severe the psychopathic disturbance in the patient with APD the greater the
likelihood that aggressive devaluation will be used to shore up feelings of grandiosity and repair emotional wounds.
In addition to the devaluation of others, the severity of psychopathy will determine the degree of control the patient will
try to control other patients and the staff. (This “omnipotent control” often felt by the staff as “being under the patient’s
thumb” and usually serves the purpose of stimulating the patient’s grandiose fatnasies and waring off his fears of being
controlled be others around him)
When the grandiosity of the mild and moderately psychopathic patient with APD is challenged by failure, there will be
clinical manifestations of anxiety or depression - both which are positive prognostic predictors
(Gabbard & Coye, 1987)
14. Psychological Defences:
APD patients with severe psychopathy most predictably use the following psychological defences:
projective identification, devaluation, denial, omnipotence, splitting
For instance, projective identification is most apparent in treatment when the psychopathic patient
attributes certain negative characteristics to the clinician and then attempts to control the clinician.
If neurotic defences are present in patient with APD they suggest amenability of the treatment.
Internal experience will more likely be expressed with thought rather than just trough feeling and
impulse.
(Hare, 2003)
Object relations:
The severely psychopathic patient’s internal representations of self are aggressive and larger than life
– he is a legend in his on mind. At the same time he does not represent others as a whole, real, and
meaningful individuals deserving of respect and empathy but as objects to dominate and exploit.
Unlike patients with BPD, in whom impulses to aggress against the self or others may be frightening,
the psycho[athic patient may wholly identify with the aggressor and have no inhibitions.
A histort of violence, coupled with predatory nature of their violence, makes APD patients with severe
psychopathy very dangerous in a hospital milieu without appropriate security
(Gacono et al, 1997)
15. Affects:
The emotions of the patient with APD lack the subtlety, depth and modulation of normal individuals.
The APD patient with severe psychopathy appears to live in “presocialized” emotional world, where
feelings are experienced in relation to the self but not to others.
The patient’s emotional life instead is dominated by feelings of anger, sensitiveness to shame or
humiliation, envy, boredom, contempt and pleasure through dominance.
Both male and felmale adults with APD apper to modulate affect about as well as a 5 to 7 year old
child.
These factors pose difficult treatment problems, as these factors predict treatment failure for
modalities that depend on emotional access to the patient, such as cognitive- behavioural relapse
prevention or psychodynamic approaches that require capacity to feel emotion in relation to the
psychotherapist and talk about it.
Most troublesome and difficult to detect is the patient who imitates certain emotional states for
secondary gain or to manipulate the psychotherapist.
(Gacono & Meloy, 1994)
16. APD treatment challenges II.
Nature of APD pose additional threats to treatment success due to Clinician’s reactions to the patient:
Common countertransference reactions, that are likely to occur regardless of the treatment
modality being applied and ill be felt more intensely when psychopathy is more severe in the APD
patient.
Therapeutic Nihilism (rejection of all patients with APD as being completely untreatable)
Illusory Treatment Alliance (the illusion that there is treatment alliance when in fact there is none.
Such alliance should be viewed with clinical suspicion and may actually be imitations to please and
manipulate the psychotherapist)
Fear of Assault or Harm (Obvious)
Helplessness and Guilt (especially prevalent among novice clinicians; feeling og quilt and
helplessness when the patient with APD does not change despite treatment efforts)
Devaluation and loss of professional identity (patient with APD is source of continuous professional
disappointment. In long term- treatment the APD patient’s resistance to change may compel the
clinician to question his or her own professional value and identity)
(Gabbard et al, 2005)
17. General treatment findings
There is yet no body of controlled empirical research concerning the treatment of APD or
psychopathy. No demonstrateably effective treatment is available
Meta- analytic studies of the effectiveness of treatment in juvenile delinquents, however, have
consistently found a modest overall positive effect.
The most useful treatments are skills- based and behavioural, targeting higher risk offenders in
the community
A review of the research on the treatment of APD indicates that these patients have a poor
response to hospitalization. The prognosis may be improved, however, if a treatable anxiety or
depression is present.
(Lipsey, 1992, Hare, 2003)