Personality Disorders Mario Maj

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.This contributesto the emotional shallowness and lack of authenticity often noted in HPD: aphenomenon akin to the As-If personality of the earlier analytic literature[147].The marked impulsivity of persons with HPD shows its conceptualkinship with BPD, and distinguishes the disorder from the milder HyP[127,148].HPD patients characteristically show an insecure attachment style[149] and a cognitive style that is global, diffuse, lacking in sharpness[127,150], tending to answer, in response to a question about how life is withtheir current partner: Oh, it s great, it s super! Some have stressed that theintermingling of logical and symbolical thought patterns seen in HPD (andHyP) amount to a kind of dissociation, which in pronounced degree canresemble a formal thought disorder [151,152].From the perspective of the Five Factor Model of personality [153], HPD isseen as the meeting point of extraversion and (marked) neuroticism [154].This would accord with the theatricality and emotional dyscontrol in HPD.Incontrast to the milder HyP, those with HPD manifest this dyscontrol in moreextreme ways: impulsivity with self-destructive overtones (alienating a lover,getting fired from a job), and novelty- or thrill -seeking [152].Characteristicsof HPD that are less often mentioned include secondary gain from illness,by way of both avoiding difficult situations and gaining sympathy; also, aninability to derive deep satisfaction from any activity or relationship,leading to a pervasive sense of unfulfillment and incompleteness.Other PerspectivesAs there are no long-term follow-up studies devoted exclusively to HPD,we can make only some rough estimates about the fate of persons with thisdisorder.One study found that Cluster B traits persisted from adolescenceto adulthood [155], and predicted an externalizing symptom pattern [156],218 __________________________________________________________________ PERSONALITY DISORDERSbut did not address treatment issues.Because HPD (as opposed to themilder HyP) is seldom encountered without an admixture of BPD traits, onelooks instead to the data on BPD patients who were co-morbid for HPD.In one report, there were 49 BPD inpatients (21 with HPD; 28 with therelated infantile personality) followed for 10 to 25 years [64].Two-thirdsof these were functioning, when traced, at levels consistent with GAS of 61or more, consistent with good occupational and interpersonal function.Four of the patients (8%) had committed suicide about average for theborderline patients in that large sample (n � 206 with BPD).The hysterical (we would call them HPD) patients from the Menninger Study [92] wereexpected to have the best prognosis (according to the psychoanalyticdevelopmental model) but the few long-term outcomes mentioned fell shortof original expectations.Patients with an HPD that is unalloyed with the traitsof other Cluster B disorders are exceedingly rare, and there are no evidence-based data, or follow-up results on this small group.Psychological tests on HPD reveal only what was already expected: theMinnesota Multiphasic Personality Inventory (MMPI) shows predominantly apattern of high scores on the hysteria and manic scales, and lower score onsocial introversion (since HPD is associated with extraversion [157]).TheRorschach testing of HPD patients showed higher than average responsesinvolving colour (FC, CF, and C) considered indices of emotionality [158].Typical of persons with HPD is a preoccupied attachment style, with somedismissive elements felt to be consistent with the shallow emotions, yetexaggerated emotionality of this group [159].Also consistent with thebehavioural instability and poor emotional control are the observations on thepresumably inborn or temperament parameters of HPD, with high scores onnovelty seeking and reward dependence, but low on harm avoidance (thelatter correlating with lowered serotonin activity in key brain pathways)[160,161] [ Pobierz całość w formacie PDF ]

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