Summary of Persönlichkeitsstörungen | HPE Österreich

Understanding Personality Disorders

• Personality Disorders are persistent patterns of behavior and experience that deviate from socio-cultural norms.
• Diagnosis depends on cultural context, functional impairment, and suffering of the individual or their environment.
• Personality Disorders affect:
  • Cognition (thinking)
  • Affectivity (emotions)
  • Interpersonal functioning (relationships)
  • Impulse control

Core Psychological Concepts

• Identity Disturbance: Difficulty maintaining a stable self-image or perception of others, often seen as "black and white" thinking.
• Defense Mechanisms:
  • Intrapsychic defense: Healthy suppression of distressing feelings to maintain function.
  • Interpersonal defense: Projecting one’s own unacceptable feelings onto others, leading to conflict.
• Object Constancy: Ability to maintain a stable emotional image of others even during absence or conflict; often impaired in Personality Disorders.
• Dependency Tolerance: Capacity to tolerate emotional dependency and potential loss without severe distress; often reduced.
• Impulse Control: Ability to regulate emotions and impulses; often impaired leading to self-harm, aggression, or risky behaviors.
• Moral Functioning: Internalized values guiding behavior; can be diminished, especially in antisocial or narcissistic Personality Disorders.

Types of Personality Disorders (Brief Overview)

• Cluster A (Odd/Eccentric): Paranoid, Schizoid, Schizotypal
• Cluster B (Dramatic/Emotional/Erratic): Antisocial, Borderline, Histrionic, Narcissistic
• Cluster C (Anxious/Fearful): Avoidant, Dependent, Obsessive-Compulsive

Development and Causes

• Personality Disorders arise from a combination of genetic predisposition (~50%) and early childhood experiences (neglect, trauma, abuse).
• Positive early relationships or psychotherapy can compensate for predispositions.
• Personality traits (e.g., impulsivity, empathy) are inherited, but environment shapes outcomes.

Therapeutic Approaches

• Psychotherapy is the first-line treatment; medication is not approved specifically for Personality Disorders and should be used cautiously and short-term.
• Effective therapies include:
  • Transference-Focused Psychotherapy (psychoanalytic)
  • Dialectical Behavior Therapy (DBT)
  • Other evidence-based behavioral therapies
• Therapy duration is often long-term (2-6 years), with gradual improvement.
• Early intervention, especially in adolescents, improves outcomes.

Practical Advice for Families and Caregivers

• Avoid blame; Personality Disorders are not chosen behaviors.
• Set clear boundaries and communicate using “I-messages” rather than accusatory “you-messages” to reduce conflict.
• Protect yourself if abuse or violence occurs; involve authorities if necessary.
• Encourage and support affected individuals to seek professional help persistently.
• Understand that Personality Disorders are complex and require patience and consistent support.
• Use available resources such as psychotherapy clearing centers, outpatient clinics, and specialized networks (e.g., borderline networks).

Crisis Management

• In emergencies (self-harm, intoxication), seek immediate medical or psychiatric help.
• Psychiatric clinics provide 24/7 emergency care in all regions.
• Day clinics are beneficial for young people, allowing therapy while maintaining everyday life.

Additional Insights

• People with Personality Disorders are often fascinating and emotionally intense, sometimes enriching relationships.
• Some Personality Disorders (e.g., narcissistic) are prevalent in leadership roles.
• Diagnosis should be handled carefully and communicated thoughtfully to avoid stigma.
• Complex trauma and Personality Disorders often overlap and require integrated treatment.

Key Wellness and Productivity Tips

• Set boundaries clearly and kindly in relationships.
• Use “I feel” statements to express emotions and needs.
• Support early psychotherapeutic intervention.
• Encourage consistent treatment adherence despite challenges.
• Protect your own mental health when dealing with affected individuals.
• Recognize the importance of stable relationships and social support in recovery.
• Understand and respect cultural differences in behavior and personality expression.

Presenters / Sources

• Dr. Martina (Psychiatrist and Psychotherapist, Psychoanalyst) — main presenter and expert in Personality Disorders, involved in research and clinical treatment.
• References to:
  • Karl Jaspers (Philosopher and Psychiatrist)
  • DSM-5 diagnostic criteria
  • Various psychotherapy methods (Transference-Focused, DBT)
  • Research by James Fallon (neuroscientist on psychopathy)