What is a personality disorder?

A personality disorder is when the individual displays persistent and consistent unhealthy patterns of thinking, behaviour and social functioning. It is common that they do not see themselves as having a problem so seeking treatment can be rare sometimes.

Individuals with PD have difficulty not only understanding themselves but also relating to other people. PD is different from other mental illnesses due to its enduring nature and the fact that it cannot be compared to a physical illness.  The individual’s behaviour varies from the norm in society but they may manage their own life without medical help in a way that someone with a more severe condition such as Schizophrenia cannot.

One method of treating PD is schema focused CBT but what is a schema?  A schema provides the basis by which someone relates to the events that he or she experiences.

Schema Therapy is based upon CBT, but it is focused much more on early childhood experiences which have caused lifelong difficulties. Assessment includes the use of questionnaires to identify the individual’s schemas, coping styles and preferred modes, enabling the client to understand and develop an ability to change their unhelpful thinking styles and patterns of behaviour.

Schema Therapy was developed by Jeffrey Young, to treat individuals with borderline personality disorder, but can also be used with other presentations caused by difficult childhood experiences. Schemas can be described as our belief systems or ‘lifetraps’. The theory on which Schema Therapy is based has four main concepts:

Early Maladaptive Schemas, Schema Domains, Coping Styles and Schema Modes.

Early Maladaptive Schemas are our core patterns or behaviours that we tend to repeatedly use throughout our lives.

Schema Domains relate to the emotional needs of a child. If these needs were not met during our childhoods, unhealthy schemas develop, which then result in unhealthy patterns of behaviour.

Coping Styles are the way we adapt to schemas and early life experiences. These are often unhealthy and tend to maintain or worsen the problems.

Modes are emotional states that we all use from time to time. They can sometimes lie dormant for a long time, being activated by certain triggers. Whilst we can be in a dominant state or mode for some time, we can flip over into other modes. The different modes are listed below.

Schema Modes

Vulnerable Child:  feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimized, worthless, unloved, unlovable, lost, directionless, fragile, weak, defeated, oppressed, powerless, left out, excluded, pessimistic.

Angry Child: feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met.

Impulsive/Undisciplined Child: acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met.; may appear “spoiled”.

Happy Child: feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous.

Maladaptive Coping Modes

Compliant Surrenderer: acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behaviour that directly maintains the self-defeating schema-driven pattern.

Detached Protector: cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalized, empty or bored; pursues distracting, self-soothing, or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities.

Over-compensator: feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, over-controlled, controlling, rebellious, manipulative, exploitative, attention-seeking, or status-seeking way.  These feelings or behaviours must originally have developed to compensate for or gratify unmet core needs.

Maladaptive Parent Modes

Punitive Parent: feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others.  This mode refers to the style with which rules are enforced rather than the nature of the rules.

Demanding Parent:  feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others needs before one’s own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously.  This mode refers to the nature of the internalised high standards and strict rules, rather than the style with which these rules are enforced; these rules are not compensatory in their function.

Healthy Adult: nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralises or moderates the maladaptive parent modes. 

This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, aesthetic, and cultural interests; health maintenance; and athletic activities.

Another type of treatment for PD is Dialectic Behaviour Therapy. A brief explanation of DBT is as follows:

DBT is closely related to CBT, and was initially developed by Marsha Linehan for individuals with borderline personality disorder who cope with distressing emotions and situations by using self-destructive behaviours such as self-harm, substance abuse and eating disorders. DBT is now being used for treating other mental health problems.

Individuals learn more helpful coping skills to deal with distressing emotions and situations, and to improve their relationships.

Dialectics is the theory that opposites can co-exist. In therapy, different points of view are discussed, and clients are then helped to select appropriate skills to either change or accept situations.