Psychodynamic Diagnostic Manual Lecture

Introduction to Personality

• Psychodynamic approach to personality diagnostics
• Everyone has personality traits such as:
  • Schizoid
  • Paranoid
  • Narcissistic
  • Psychopathic
  • Hysterical
  • Obsessional
  • Dissociative
  • Dependent
  • Masochistic
  • Hypomanic
  • Counter-dependent
  • Sadistic
  • Somatizing
  • Phobic

Development of Personality

• Personality develops gradually through:
  • Temperament
  • Affects during upbringing
  • Defense mechanisms learned
  • Identification and counter-identification
  • Self-esteem support
• Coping mechanisms for disappointment
• Interaction with family dynamics
  • Family understanding or rejection of temperament
  • Handling of developmental challenges

Cultural Influence on Personality

• Different cultures have distinct dominant personality types:
  • Sweden – Schizoid
  • Italy – Hysterical
  • Poland – Post-traumatic
  • Russia – Masochistic
  • Norway – Avoidant
  • Australia – Counterdependent
  • Singapore – Obsessive-compulsive
  • Japan – Somatizing
  • USA – Narcissistic

Personality and Therapy

• Importance of understanding individual differences
• Influence of cultural and personal background on therapy:
  • Adoption, race, class, religion

Common Personality Types in Culture

• Depressive personality
  • Common among therapists
  • Self-critical, sensitive to separation and criticism
• Paranoid personality
  • Projection over introjection

Complexities in Personality

• Personality often a mix of various traits
• Influence of trauma and substance use
• Differentiation between substance use disorder and personality

Diagnosing and Treating Personality Disorders

Challenges in Categorical Diagnosis

• Drug companies and insurance influence on categorical diagnosis
• Importance of understanding complexity and dimensionality

Treatment Implications

• Different treatments based on personality type and level of functioning
• Differences in anxiety centers:
  • Fear vs. Panic/grief systems

Levels of Personality Organization

• High-functioning: Healthy to neurotic range
• Borderline: Intensity of affect, primitive defenses, insecure attachment
• Psychotic: Confusion with reality, primitive defenses

Borderline Personality Treatment

• Emphasis on therapeutic relationship
• Explicit boundaries and limits
• Emotional expressiveness from therapists

Working with Psychotic Patients

• Emphasis on safety and normalization
• Respectful and egalitarian therapist approach
• Need for conversational and active interaction

Initial Sessions and Building Rapport

• Focus on relationship building
• Understanding patient's theory of their suffering
• Importance of therapist's authentic self-presentation

Final Thoughts for Therapy Students

• Be humble, interested in others, and open to correction
• Continuous learning and seeking consultations when necessary

The lecture emphasized the complexity of personality and the importance of understanding individual differences and cultural influences in the context of therapy. It highlighted the need for a nuanced approach in diagnosis and treatment that goes beyond categorical labels.