Lecture on Psychodynamic Diagnostic Manual and Personality Types

Key Points and Concepts

Discussion on the Psychodynamic Diagnostic Manual (PDM)
Emphasis that everyone has a personality, not necessarily a disorder
Types of personalities mentioned: schizoid, paranoid, narcissistic, psychopathic, hysterical, obsessional, dissociative, dependent, masochistic, hypomanic, counter-dependent, sadistic, somatizing, and phobic

Personality develops gradually through a combination of temperament, upbringing, identification, self-esteem support, disappointment coping, and family interaction
Importance of temperament and how it interacts with family dynamics
Influence of neglect, trauma, and overcontrol on personality
Bayes' theorem and prediction machine concept in the brain

Trauma and substance use can disrupt personality
Alcoholic personality is a myth; sobriety reveals original personality
Individual differences in therapy influenced by various background factors (adoption, race, religion, class, etc.)

Different cultures have dominant personality types (e.g., schizoid in Sweden, hysterical in Italy, post-traumatic in Poland, masochistic in Russia, avoidant in Norway, counterdependent in Australia, obsessive-compulsive in Singapore, somatizing in Japan)
Americans are often perceived as narcissistic due to cultural emphasis on individual rights and status anxiety

Masochistic: Stay in abusive relationships due to survival strategies developed in abusive environments
Self-defeating: Approach therapy as an opportunity to complain and pressure therapists to fix their lives
Paranoid: Focus on trust and distrust, often have substance use disorders
Schizoid: Preoccupied with closeness and distance, need careful handling in therapy
Obsessive-Compulsive: Concerned with control, neatness, and punctuality, were more common in the past
Histrionic: Interested in gender, power, and sexuality; require careful handling to avoid reinforcing power disparities
Narcissistic: Use grandiosity to defend against shame; different types include overtly grandiose and more sensitive, "closet" narcissists
Dependent: Defined by relationships with others, problematic when attachments are lost
Counterdependent: Insist on self-reliance, often rooted in inability to trust others
Psychopathic: Seek omnipotent control, often in powerful positions, defined by a love of power

Differences in treatment effectiveness based on levels of personality organization (healthy, neurotic, borderline, psychotic)
High functioning: Most therapies are useful, patients can build a positive therapeutic relationship, use adaptive defenses
Borderline: Insecure attachment, intense affects, primitive defenses; require careful monitoring of the therapeutic relationship and boundaries
Psychotic: Confusion about self and other boundaries, need focus on safety and a respectful, egalitarian approach

Borderline: Emphasis on relationship monitoring, explicit boundaries, and managing intense countertransference
Psychotic: Emphasis on safety, normalization, and respectful, conversational approach

Focus on building a relationship, understanding the patient's theory of their suffering, and taking notes for organization
Importance of asking about substance use, eating disorders, sexual history, and early memories

Understanding patient's level of identity integration and capacity to mentalize
Working within the patient's current level to improve their self-management and coping strategies
Importance of therapists being themselves, being humble, and being open to correction by the patient
Seeking consultation and supervision when needed, especially with complex cases

Emphasis on caring about others, being humble, and continuously seeking improvement and consultation