Question about personality disorder origins

Discussion in 'Psychiatry' started by nancysinatra, Jun 16, 2008.

  1. nancysinatra

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    In July I am going to start an elective in personality disorders. I'm so excited! I'm trying to read up a bit on the topic, but there's one question I've always had that I've yet to see addressed. They say that personality disorders may have their origins very early in life as object relation problems. (Not that I fully understand the meaning of this, of course, but it's what I've learned so far.) But the disorders themselves don't appear until adulthood. Aside from children who have obvious conduct disorders or oppositional-defiant disorder, what is going on with these individuals when they are children? The future histrionics and narcissists, for example? Do they show signs as children? What is happening with them during those years?

    Thanks in advance for any input!
     
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  3. TheWowEffect

    TheWowEffect The Official WowRator
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    I don;t know if you have done a CAP inpatient rotation. You will see so many teenage girls who are almost full blown borderline PDs even before they are 18. Of course, DSM defines PDs as pervasive and nowhere defines any age range, although it is generally implied that these disorders are described in adulthood only.
     
  4. erg923

    erg923 Regional Clinical Officer, Cenpatico National

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    Object relations is born out of analytic theories, and is a very psychodynamically oriented theory. Not really my cup of tea, as I am more behavioral. Nonetheless, your question is a good one, but of course no one knows the answer to this. If you can develop the one theory of behavior/personalty that accounts and explains the development of personality pathology, I'm sure you'd win the noble prize.

    I think it is fairly obvious that the development of personality, and therefore, the development of pathological personalties is a complex interaction and mish-mash of temperaments, drives, environment, nature of reinforcers, goals (and limitations put ion those goals), etc. The DSM of course specifies that people cant technically get a PD diagnosis till age 18. That just a temporal issue, cause thats when we decided (voted actually) when personality is actually solidifying. Hence, lending more credence to the supposed temporal stability of personality and the behaviors that make up the diagnosis. Although the diagnosis can not officially be done until then, that certainly doesn't mean you can see one in the making. In essence, because the age thing is really an artificial specifier superimposed on top of the disorder, many PDs look similar in 16 year olds as they do in 30 year olds. The context and the environment the behaviors are occurring in maybe different, but the behaviors are much the same whether one is 16 or 30. But I really can not pinpoint all the factors that lead a individual to develop a Dependent PD or Narcissist PD. Certainly upbringing and experiences play a large role. Many consider schizoid and schizoptyal to have large biologic components that represent schizotaxia (if you read Meehl), or latent forms of schizophrenia. Ted Million and Thomas Widiger have many good reviews and empirical research on the subject of PDs. I would recommend reading some of their work
     
    #3 erg923, Jun 16, 2008
    Last edited: Jun 16, 2008
  5. BabyPsychDoc

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    In addition to excellent points made by the posters above, may I suggest a book:

    Tony Robinson
    "Disordered Personalities"
    RapidPsychler Press
    Do not remember the year (I THINK 2004, but I may be wrong).

    You will find answers to many of your questions in this book, which is well-written, informative and highly entertaining.
     
    #4 BabyPsychDoc, Jun 17, 2008
    Last edited: Jun 17, 2008
  6. BabyPsychDoc

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    For some reason, I can't edit my previous post, so...


    When you digest Tony Robinson's book (it took me a weekend to read it, but several weeks to digest), Otto Kernberg's Severe Personality Disorder may be a good next step.

    Good luck.
     
    #5 BabyPsychDoc, Jun 17, 2008
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  7. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Here are some general references that found helpful in regard to Narcissism and BPD (I may have posted some before, so pardon the repetition). They are all very psychodynamically focused, and should be approached as a philosophical discussion on the development and tx of the Dx's.
    IIRC, the Masterson article focuses on the development aspects of Narc. and BPD, and a bit on Narc treatment. The Knight and Oldham et al. articles talk about treatment of BPD.

    Narcissism

    Bromberg, P.M. (1983). The Mirror and the Mask: On Narcissism and Psychoanalytic Growth. Contemporary Psychoanalysis. 19, 359-387.

    Kernberg, O. (1970). Factors in the Psychoanalytic Treatment of Narcissistic Personalities. Journal of the American Psychoanalytic Association. 18, 51-86.

    Masterson, J. (1981). The Narcissistic and Borderline Disorders. Brunner/Mazel Publishing. New York, New York.

    BPD

    Gunderson, J.G., Singer, M.T. (1986). Defining Borderline Patients: An Overview. Essential Papers on Borderline Disorders: One Hundred Years at the Border. New York University Press. 453-474.

    Kernberg, O. (1967). Borderline personalityorganization. Journal of the American Psychoanalytic Association. 15, 641-685.

    Knight, R.P. (1986). Borderline States. Essential Papers on Borderline Disorders: One Hundred Years at the Border. New YorkUniversity Press. 159-173.

    Oldham, J.M., Gabbard, G.O., Goin, M.K., John Gunderson, J., Soloff, P., Spiegel, D., Stone, M. Phillips, K.A. (2001). Treatment of Patients With Borderline Personality Disorder. American Psychiatric Association.(Here is a link to the report. The PDF version req. login, web does not).

    Stone, M. H. (1986). The Borderline Syndrome: Evolution of the Term, Genetic Aspects, and Prognosis. Essential Papers on Borderline Disorders: One Hundred Years at the Border. New YorkUniversity Press. 475-497.
     
    #6 Therapist4Chnge, Jun 17, 2008
    Last edited: Jun 17, 2008
  8. nancysinatra

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    Thanks everyone! The references are especially helpful. After my personality disorders elective, I'll be doing an adolescent psych elective. I'm sure I'll learn a lot about this from both electives. I just remember in my 3rd year psych rotation how we were cautioned not to "diagnose" minors with personality disorders. But we weren't given an alternative framework to work in either. So I've always wondered what that would be... It will be great to read more and learn more about this.
     
  9. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Though you may not be able to formally dx them, being able to document can be helpful whomever is working with the pt down the road. I am not a fan of tagging someone with a PD before really getting to work with them. Providing a provisional Dx and listing PD R/O's can be a bit easier to work with....as it offers a bit of flexibility without incorrectly tacking it on. I can't tell you how many BPD I've seen because the pt self-harmed (it is a consideration, but not an automatic). I am far from an expert, but PDs are a particular interest of mine (especially the two above) and I think they are often misunderstood.
     
  10. toby jones

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    Don't forget that stuff that has been done on attachment styles in infants (avoidant, disorganized etc). Some theorists have claimed that those early attachment styles can be indicative of disorders / habitual ways of coping with interpersonal relationships later in life.

    The trouble is... That the behaviour of infants / children / adolescents isn't all *that* predictive of whether those behavioural patterns will become lifelong or whether the person will move on from them as they mature a little. Since there is major stigma around a dx of a personality disorder I think it is nice that the DSM says one should hold off until it is clear that is is more than a teenage phase.

    One some accounts borderline personality (for example) resembles certain dilemmas that are common to most adolescents. The difference is the lack of social supports etc such that people who later become borderline aren't able to successfully negotiate those aspects of their life during adolescence.

    Dunno... There are so many theories out there... There isn't agreement on the causes of personality disorders so even less agreement on how people with personality disorders present earlier in life...
     

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