Strengths Based Biopsychosocial Approach to Recovery from Addictions and Personality Disorders
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Podcast Host: Counselor Toolbox and Happiness Isnāt Brain Surgery
Earn Counseling CEUs for this presentation is at https://allceus.com/member/cart/index/product/id/507/c/
Objectives
~ Define Personality Disorders
~ Examine the similarities between the behaviors of certain personality disorders and addictions
~ Identify ways to address these behaviors and thought patterns
~ Encourage clinicians to critically examine behaviors in patients with addiction in order to effectively differentially diagnose
Why I Care/How It Impacts Recovery
~ When personality disorders are viewed as pervasive & perpetual, it
~ Provides an āexcuse for relapseā
~ Often derails treatment because patterns of behavior thought to be due to the PD are essentially ignored
~ Personality Disordered & Addictive Behavior often look the same
~ Goals for recovery from both:
~ Honesty with self & others about thoughts/feelings/needs/wants (Mindfulness)
~ Distress tolerance and the ability to self-soothe
~ Hope and faith in self/future/others through addressing cognitive errors
~ Development of self esteem to eliminate need for external validation
~ Development of healthy, supportive relationships
Personality Disorders
~ Represent a cluster of behaviors that is pervasive beginning before the age of 15.
~ Addictive behaviors also often begin before 15
~ Due to immature cognitive development, children tend to be more egocentric, overgeneralize and think in terms of dichotomies
~ From a survival perspective, most of these behaviors make perfect sense when viewed through the eyes of a child
Personality Disordered/Addictive Behaviors
~ Treatment
~ Since these behaviors formed the foundation for further development patients must:
~ Understand their function in the past
~ Identify how these behaviors and beliefs are faulty in the present
~ Develop alternative skills
~ Be empowered to interface with the world with the strengths, knowledge and tools of the adult
Addictions & Personality Disorders
~ Cluster A (Paranoid, Schizoid, Schizotypal)
~ Characterized by social awkwardness and withdrawal
~ Often co-occur with addictions
~ Cluster C (Obsessive-Compulsive; Dependent)
~ Characterized as anxious and fearful
~ May co-occur with addiction
~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)
~ Characterized by dramatic, emotional, erratic behavior
~ Behavioral patterns overlap with addiction
Addictions & Personality Disorders
~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)
~ Characterized by
~ Dramatic, emotional, erratic behavior
~ All or Nothing thinking
~ Hostility and Aggression
~ Hypersensitivity
~ Manipulative
~ Low Self-Esteem / Weak Self-Concept
What environment might perpetuate these behaviors?
What about those with decent childhoods?
Addictions & Personality Disorders
~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)
~ Antisocial:
~ Disregard for the rights of other people
~ Impulsivity
~ Hostility and/or aggression
~ Deceit and manipulation
~ Seem to lack empathy
What environment might perpetuate these behaviors?
What about those with decent childhoods?
Addictions & Personality Disorders
~ Cluster B
~ Histrionic
~ Excessive emotionality and attention seeking
~ May become enraged at perceived rejection
~ Need to be the center of attention
~ Inability to engage in authentic relationships but uncomfortable being alone
~ Imagine relationships to be more intimate in nature than they actually are
~ Tend to be suggestible and easily influenced by other people's suggestions and opinions.
Addictions & Personality Disorders
~ Cluster B (Borderline, Narcissistic, Histrionic, Antisocial)
~ Borderline:
~ Low self-esteem
~ Feel helpless, anxious and constantly fear abandonment
~ Perceptions of themselves and others may quickly vacillate back and forth
~ Hypervigilant
~ Extremely emotionally reactive with inability to de-escalate
~ Often have a history of neglect, abuse or a dismissive style of parent-child attachment
What environment might perpetuate these behaviors?
What about those with decent childhoods?
Addictions & Personality Disorders
~ Cluster B
~ Narcissistic
~ Powerful sense of entitlement
~ Believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive.
~ Need to be powerful, and admired
~ Lack of empathy for others
~ Relationships that are often superficial and devoid of real intimacy
What environment might perpetuate these behaviors?
What about those with decent childhoods?
Addictions vs. Personality Disorders
~ Take home message
~ Many behaviors characteristic of active addiction
~ Overlap with personality disorders
~ Begin in late childhood/early adolescence
~ Are pervasive
~ As peopleās experiences and knowledge expanded, their coping skills and behaviors remained relatively primitive
~ Recovery from these behaviors requires:
~ Development of effective coping skills
~ Addressing cognitive distortions
Addictions vs. Personality Disorders
~ Take home message
~ Recovery these behaviors requires addressingā¦
~ Dramatic, emotional, erratic behavior
~ Distress Tolerance
~ Mindfulness to identify and process the source of the distress
~ Coping skills
~ All or Nothing thinking
~ Awareness and elimination of cognitive distortions (CBT)
~ Hostility and Aggression
~ Understanding of the fight or flight response
~ Development of anger awareness and management skills
Addictions vs. Personality Disorders
~ Take home message
~ Recovery from these behaviors requires:
~ Hypersensitivity esp. to rejection
~ Awareness of and addressing thinking errors
~ Awareness and addressing abandonment issues
~ Development of self-esteem
~ Manipulative
~ Interpersonal skill development (boundary setting, communication skills)
~ Low Self-Esteem / Weak Self-Concept
~ Development of self-esteem and the ability to internally validate
Summary
~ Most patients with addictions have traits associated with personality disorders
~ These traits can be loosely classified into
~ Thinking errors ļ the perception of a threat
~ Behavioral reactivity to escape or eliminate the threat
~ The first steps in the recovery processā¦
~ Honesty with self and others (Mindfulness and Awareness)
~ Hope & faith (Identifying cognitive distortions and thinking errors to encourage and empower)
~ Courage and discipline to remain constantly mindful, accept and address thoughts and feelings, make conscious choices based on facts
Summary contā¦
~ A child growing up in an unstable, neglectful, emotionally detached environment may develop
~ PD traits to survive
~ Addictions to numb the pain and escape from the lack of control.
~ A person whose neurochemicals became imbalanced or who was born more emotionally reactive may also have experienced
~ Rejection / abandonment / lack of support
~ Difficulty interpreting the world (cognitive distortions)
~ A sense of near constant dyscontrol
Summary contā¦
~ A person whose neurochemicals became imbalanced or who was born more emotionally reactive may also have experienced
~ Rejection / abandonment / lack of support
~ Difficulty interpreting the world (cognitive distortions)
~ A sense of near constant dyscontrol