Personality Disorder And Cognitive Therapy

According to the DSM-5, the person with a personality disorder has an excessive and dominant need to be cared for. This leads her to have a submissive behavior, an exaggerated attachment to things and people and an exaggerated fear of separation.

According to the Diagnostic and Statistical Manual of Mental Disorders, personality disorder appears in the early stages of adulthood.

Personality Disorder Symptoms

This pathology manifests itself in different contexts with five (or more) of the following behaviors:

• Difficulty making day-to-day decisions without the advice and support of other people.
• You need others to take responsibility for decisions that affect important aspects of your life.
• Has difficulty expressing disagreement for fear of losing people’s support or approval (note: does not understand “realistic” fears about punishment).

• She finds it difficult to start new projects or act alone (due to a lack of confidence in her own skills and judgment, not a lack of motivation or energy).
• In order to gain acceptance and support from others, he voluntarily does things he does not like.
• She feels uncomfortable when she is alone, due to the excessive fear of not being able to take care of herself.
• When an emotional relationship ends, she urgently seeks another relationship to be assisted and supported. She has an uncontrolled fear of being abandoned and having to take care of herself.

Those who have these thoughts tend to look for a partner or people who can take care of their life. Finding someone who can provide protection is the perfect solution for those who feel weak and inadequate in a hostile, frightening world.

Cognitive-behavioral therapy in treating personality disorders tries to change this thought pattern by improving the patient’s self-image. To do this, he uses cognitive techniques such as guided discovery, Socratic dialogue, behavioral experiments and other techniques specific to psychotherapy.

How does personality disorder develop?

As in most cases, this disorder also develops as a result of experiences lived by children or adolescents. At the base, there is an extreme fear of loneliness due to the belief that one is unable to defend oneself from the world.

Often these are people who have suffered from emotional deficiencies in childhood. These individuals grow up with an inner emptiness that causes suffering that they seek to alleviate through contact with others, usually a partner. It can occur in cases of adopted children or those who have been ill for a long time and have had no choice but to depend on other people.

In general, we can say that these people tend to look for a partner who complements them. In this way, they consolidate their dependence on someone. They are people who have narcissistic personality disorders, who impose their own decisions or who have no qualms about expressing their opinion in an authoritarian way, even if no one has asked for their opinion.

The person who depends on someone does not have to make any effort in everyday life: the partner is responsible for what you eat, how to furnish the house or whether to have children or not.

Cognitive-behavioral therapy in personality disorder

Cognitive-behavioral therapy in personality disorder seeks, first of all, to identify which is the patient’s main cognitive distortion. In particular, his dichotomous thinking on independence is analyzed.

People with personality disorder tend to have recurring thoughts such as “I can’t survive without someone to take care of me”, “with the resources I have (or could have) I am unable to manage myself” or “independence means living only For themselves”.

It is necessary to change this erroneous perception of their autonomy and help them to abandon negative thoughts gradually, also preparing them to separate from the therapist. It is important that terms such as “addiction” or “autonomy” are not used at the beginning of therapy. Usually, patients don’t recognize them as part of their problem. It is also preferable that the subject understands the problems by himself and is able to express them.

Dependence on the therapist

When starting therapy, some degree of dependence on the therapist is acceptable. Typically, he does most of the work in the beginning. Later, during the sessions, this situation will change.

Socratic dialogue becomes very important because it guarantees patients an active role. It is not good for them to be explained why they feel one way or another, otherwise their addiction is strengthened. The patient is the one who, little by little, will give the “material” for the therapy, will decide which topics to deal with and, through the questions and answers, will draw his conclusions.

Establish professional boundaries

It is of fundamental importance to establish professional boundaries. It is not uncommon to find patients who claim to have fallen in love with their therapist. It must be clear from the outset that there is no possibility of going beyond the limits set by professional ethics.

A very common technique is to give the patient an agenda in which to write the topics they want to cover during the therapy. It is also helpful to keep a record of concrete actions that have tested your personal abilities.

A hierarchy of decision making

Gradual exposure to situations that were previously avoided because you thought you couldn’t handle them may help. It is important to establish a hierarchy of decision making; from the choice of fruit to be consumed after lunch to the most important ones relating to work and place of residence.

For these patients, Rehm’s self-control therapy may also be helpful. This therapy teaches people to observe themselves, to self-evaluate, and to set realistic goals to achieve. Since addicted people tend to have very high goals and standards, while underestimating their chances of achieving them, self-control therapy can be of great help.