MANAGING NARCISSISTIC, BORDERLINE AND ANTISOCIAL PERSONALITY DISORDERS (DSM-5) Cardwell C. Nuckols, PhD Axis II Personality Disorders • Totality of emotional and behavioral traits • Onset teens • Enduring, inflexible, consistent, and maladaptive • Causes significant impairment and/or distress • Traits vs. Disorder Psychobiological Model of Personality • Personality (Cloninger, 1993) –Temperament-50% heavily influenced by genetics • Affective Tone • Intensity and Reactivity –Character-50% heavily influenced by environment • Moral and Value System Psychobiological Model of Personality • Temperament – Novelty-Seeking – Harm-Avoidance – Reward-Dependence – Persistence • Character – Self-Directedness (Responsible, Purposeful & Resourceful) – Cooperativeness – Self-Transcendence – Altruism Psychobiological Model of Personality • Genetics – Example-Antisocial Personality Disorder • Increased Impulsivity • Decreased Empathy • Low Frustration Tolerance • High Drive • High Sensation Seeking Treatment Considerations • Egosyntonic and Characterological • Character traits more amenable to treatment • Transference/Countertransference • Stress a variable in intensity Treatment Considerations • Psychotherapeutic Treatment Strategies – Increase acceptance and tolerance –Reduce intensity of trait expression –Promote adaptive trait-based behavior –Create conducive environments Psychotherapeutic Treatment Strategies • Increase acceptance and tolerance – Psycho-education – Identify adaptive features • Reduce intensity of trait expression – Restructure triggering situations – Modify amplifying cognitions – Enhance incompatible behaviors – Medication Psychotherapeutic Treatment Strategies • Promote adaptive trait-based behavior – How and when to ask for help • Create conducive environments – Modify environment to match client instead of asking the client to adapt to the environment that has been problematic Create Conducive Environment • Help them find an environment they can flourish in –Especially true with Borderline PD • Set appropriate limits • Environmental Enrichment