Patients often show signs of two or more personality disorders occurring at the same time. Here's why—and how they can be treated effectively, writes Newtherapisthub
Why it's not unusual for someone to have more than one personality disorder.
and vilify their partner, impulsively, venomously, letting them know just what they think, and that they never should've bothered with them in the first place.This preemptive death blow allows our patient to beat their partner to the finish line, and thus save face; i.e.,"
Iyouaway. You didn't abandon me, I abandoned you!"Self-destructive activity ensues to distract our personality-disordered person from their emotional pain, perhaps even crescendoing in outrightsuicidalactivity. True to Borderline form, this is also used as a tool;"Look what you've done to me!" This draws the partner back in to rescue them, for who wants to be responsible for someone's demise? The rescue attention received demonstrates to the personality-disordered individual that they are not being abandoned, thus completing the cycle by assuaging the major
fearof both the Borderline and Avoidant.Though the waters have calmed back to a baseline Avoidant presentation, in the background runs Borderline software, scanning for signs of abandonment, ever ready to warn of threats like a Malware popup, and spring to desperate, face-saving action. headtopics.com
Treatment implicationsSome researchers, such as Silva et al. (2018), have found that having a mixed PDO presentation is not necessarily an impediment to psychotherapeutic intervention. Regardless, once a therapist realizes more than one PDO is at play, they would do well to understand how the conditions compliment/influence one another, as
therapymay become more of a balancing act than usual.In our example, for instance, it would be hard to address the Avoidant or the Borderline components in a vacuum. This is because they are symbiotically pathological, in that any social headway on the Avoidant front can be cut down by the Borderline behavior.
This leads to a self-fulfilling prophecy that people indeed don't find them acceptable, stoking the flames of"why bother?" and engendering a return to their ultra-sheltered life. Should they eventually continue to try and interact with someone in that tight circle whom they confronted, and they are held responsible, it may well engender another episode, and the cycle continues.
Disclaimer: Material provided in this post is for informational purposes only and not intended to diagnose, treat, or prevent any illness in readers. The information should not replace personalized care from your provider or formal supervision if you're a practitioner or student. headtopics.com
ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Grant, B., Stinson, F., Dawson, D., Chou, S., & Ruon, W. (2005). Co-ocurrence of DSM-IV personality disorders in the United States: Results from the epidemiological survey on alcohol and related conditions.
Comprehensive Psychiatry, 46(1), 1-5.Millon, T. (2011). Disorders of personality (3rd ed). Wiley.Silva, S., Donato, H., & Madeira, N. (2018). The outcomes of psychotherapy in mixed features personality disorders: A systematic review.Archives of Clinical Psychiatry, 45
(6).Skewes, S., Samson, R., Simpson, S., & van Vreeswijk, M. (2015). Short-terms group schema therapy for mixed personality disorders: A pilot study.Frontiers in Psychology.Turner, R.M., (1994). Borderline, histrionic and narcissistic personality disorders. In M. Hersen and R.T. Ammerman (Eds.),
Handbook of Prescriptive Treatments for Adults(pp. 393-420). Springer.Wongpakaran, N., Wongpakaran, T., Boonyanaruthee, V., Pinyopornpanish, M., & Intaprasert, S. (2015). Comorbid personality disorders among patients with depression.Neuropsychiatric Disease and Treatment, 11 headtopics.comRead more: Psychology Today »
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