Lecture Notes: Psychodynamic Diagnostic Manual and Personality Disorders

Introduction to Personality Types

• Personality Types: Schizoid, paranoid, narcissistic, psychopathic, hysterical, obsessional, dissociative, dependent, masochistic, hypomanic, counterdependent, sadistic.
• Additional Types: Somatizing, phobic.
• Personality development influenced by:
  • Temperament
  • Childhood experiences
  • Learned defenses
  • Identifications
  • Self-esteem support mechanisms

Cultural Impact on Personality

• Different countries exhibit dominant personality types:
  • Swedes: Schizoid
  • Italians: Hysterical
  • Poles: Post-traumatic
  • Russians: Masochistic
  • Norwegians: Avoidant
  • Australians: Counter-dependent
  • Singaporeans: Obsessive-compulsive
  • Japanese: Somatizing
  • Americans: Narcissistic

Common Personalities in Therapy

• Depressive Personality:
  • Self-critical, sensitive to separation and criticism.
  • Use introjection as a defense.
• Paranoid Psychology:
  • Use projection, focus on trust/distrust.

Personality and Defense Mechanisms

• Masochistic Personality:
  • Tendency to self-sabotage, often stay in abusive relationships.
• Paranoid Personality:
  • Preoccupation with trust/distrust.
  • Can exhibit overtrust in idealized figures.
• Schizoid Personality:
  • Withdrawing from closeness while desiring it.

Implications for Therapy

• Treatment Adjustments: Requires different approaches based on personality type.
• Cultural Variations: Needs awareness of cultural influences on personality.
• Use of defense mechanisms varies across personality types and affects therapeutic approaches.

Clinical Challenges

• Diagnosis and Treatment:
  • Categorical diagnosis favored by drug companies.
  • Complexity and context often overlooked.
  • Importance of understanding dimensionality in disorders.

Anxiety Systems in the Brain

• Two Anxiety Systems:
  • Fear system: Mediated by different neurotransmitters than the panic-grief system.
  • Separation anxiety: Involves attachment system.
• Medication Considerations: Different anxiety types require different medications.

Working with Borderline and Psychotic Patients

• Borderline Range:
  • Requires monitoring the therapeutic relationship.
  • Need for explicit boundaries and contracts.
  • Emotional expressiveness and boundary setting important.
• Psychotic Range:
  • Focus on safety and respecting the patient.
  • Requires understanding primitive defenses and reality confusion.

First Session Strategy

• Building Relationship: Establish connection and understand the patient's perspective.
• Questions to Ask:
  • Reason for seeking therapy.
  • Understanding of their suffering.
  • Personal history and possible unconscious triggers.
  • Substance use and early memories.

High-Functioning Clients

• Characteristics:
  • Use of adaptive defenses: humor, sublimation.
  • Ability to grieve and handle denial.
• Therapeutic Goals:
  • Realistic treatment expectations and boundary acceptance.

Final Thoughts on Practice

• Therapist's Approach:
  • Be humble, interested, and willing to learn from patients.
  • Utilize supervision and consultations as needed.
• Therapeutic Process:
  • Goal is to improve adaptation and coping mechanisms, not eradicate personality traits.