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A cognitive model of personality disorders

Although there are ten personality disorders (or personality types), Beck et al. attempted to develop a single, unitary, explanatory model for the development of them all. In doing so, they adopted an evolutionary perspective. They suggested that key neuro-cognitive responses, including those affecting perception, mood and behaviour, are genetically pre-programmed and that these responses may be adaptive in some evolutionary times, but less adaptive in others. Competitive behaviour, for example, may be of benefi t at times of scarcity but not at times of social cohesion and mutual cooperation. According to Beck and colleagues, what we term personality disorders are the inappropriate expression of these pre-programmed responses. They suggested that it is not the behaviour per se that is problematic, but the individual’s lack of adaptability and responsiveness to the environment. Most of us learn to adapt our behaviour as a result of life experiences, particularly those in childhood. For some people, however, childhood experiences may maintain or reinforce inappropriate pre-programmed responses. The naturally shy child, for example, whose parents’ responses are to be overprotective, may not experience any other way of dealing with the world. As a result, they may fail to develop alternative coping skills and come to believe that the only way to survive in the adult world is to be dependent and subservient. Adult personality is the combined result of these pre-programmed responses and childhood experiences. Rigid cognitive schemata develop over time, each of which governs behaviour. Beliefs of ‘being bad’, for example, will lead to self-punishment; beliefs of ‘not being worthy of love’ will result in the avoidance of closeness, and so on. As in his model of depression, Beck considered the core schema that drive personality disorders to be the cognitive triad concerning the self, others and the future. Instead of being episodically activated as in the case of depression, however, these underlying schemata are chronically activated in people with personality disorders. Placing these schema as the central driving factor in all personality disorders provides an explanation for an apparently diverse set of attributes and behaviours. The content of the schemata may vary, as a result of different child and adult experiences (and perhaps the pre-programmed neuro-cognitive responses), but the underlying structures are the same. Some of the key beliefs for the different personality ‘types’ include:

Avoidant personality

– self: socially inept and incompetent– others: potentially critical, uninterested and demeaning– beliefs: the self as worthless and unlovable: ‘If people get close to me, they will discover the real me and reject me – that would be intolerable.’

Dependent personality– self: needy, weak, helpless and incompetent– others: need a strong ‘caretaker’ in an idealized way; can function well in their presence, but not without them– beliefs: ‘I need other people – specifi cally a strong person – in order to survive.’

Schizoid personality disorder

– self: self-suffi cient and a loner– others: intrusive; closeness provides an opportunity for others to fence the individual in– beliefs: ‘I am basically alone’; ‘I can do things better when I am unencumbered by other people.’ According to Young and Lindemann , the schema most involved in personality disorders are those that relate to the need for security, autonomy, desirability, self-expression, gratifi cation and self-control. Once formed, they become self-fulfi lling, and are maintained through three different processes: schema maintenance, schema avoidance and schema compensation. Schema maintenance involves resistance to information or evidence that would disconfi rm the schema through cognitive distortions and self-defeating behavioural patterns. Avoidance involves avoiding situations that may test or provide information counter to the schema. Finally, schema compensation involves overcompensating for a negative schema by acting in the direction opposite to the schema’s content. This may reinforce the initial schema, as the outcome of such actions may not be positive. A shy woman, who believes herself unattractive to men, yet acts fl irtatiously, for example, may fi nd herself in situations in which she feels unsafe, or hurt by men drawn to her fl irtatiousness who reject her when they fi nd her withdrawn and quiet, thus supporting her schema of being unattractive. Although a great deal of successful clinical work has been based on the schema model, until recently there have been few experimental studies of the phenomenon. However, what studies have been conducted support the schema models developed by both Beck and Young .

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