Prof Sam Vaknin
Prof Sam Vaknin
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Never Both: Either Healing OR Behavior Modification in Cluster B Personality Disorders (Conference)

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April 29, 2021

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Presentation to the 33rd Edition of International Conference on Psychiatry and Mental Health

Most patients diagnosed with BPD lose the diagnosis spontaneously or with the help of DBT, but retain the dysfunctional behaviors associated with it. Same goes for NPD and AsPD.

This raises two questions:

1. What is the meaning of "healing" when the dysfunctional behaviors persevere?

2. Why this disconnect?

Answers:

Healing is a permanent alteration in the clinical profile of the patient and in her psychodynamics. In healthier clients, it induces behavior modification. But not in cluster B. In cluster B it is an either/or proposition: behavior modification OR healing.

The reasons for the disconnect: dissociative self-states (subpersonalities, pseudoidentities) in these post-traumatic conditions, anxiety, rich fantasy life, identity disturbance, reactance, external locus of control (outsourcing ego functions), learned helplessness (low personal autonomy and self-efficacy).

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Skodol AE, Gunderson JG, Shea MT, et al. The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. Journal of Personality Disorders. 2005;19(5):487–504.

Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of General Psychiatry. 2011;68(8):827–837.

Paris J, Zweig-Frank H. A 27-year follow-up of patients with borderline personality disorder. Comparative Psychiatry. 2001;42(6):482–487.

Zanarini MC, Frankenburg FR, Reich DB, et al. The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. American Journal of Psychiatry. 2007;164(6):929–935.

Hopwood CJ, Morey LC, Donnellan MB, et al. Ten-year rank-order stability of personality traits and disorders in a clinical sample. Journal of Personality. 2013;81(3):335–344.

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Guests & Subjects Covered

Never BothInternational ConferenceMental Health MostAsPD ThisAnswers HealingB InThe McLean StudyAdult Development MSAD

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Never Both: Either Healing OR Behavior Modification in Cluster B Personality Disorders (Conference) · Prof Sam Vaknin · Sentinel