How to Manage Personality Disorders with Emotional Intelligence

wow thank you thank you very much it's great to to be here I believe that I've worked or am working with a number of you that may be here today so in my practice we do evaluations for Texas Workforce so hello to those of you that I know and welcome to those that's having a first experience getting to know me I really love this topic I have been studying personality personality disorders personality development so on and so forth a really long time and uh I still get very passionate about it I still get excited about the topic I find it exceptionally fascinating and uh in the last about six seven years or so there's been more money towards research for Personality Disorder so we're finding out even more uh we're discovering a lot of interesting facets and factors related to personality disorders and I'm going to share a lot of that with you guys today so let's get started because I've just probably got you all pumped up you're all excited so here we go let's go so what we're gonna do is I'm hoping to build skills to identify clients with personality disorders to effectively inform your choice of effective interventions so how can you use this information so I always think when I'm doing a presentation is the individuals that are participating how can I give them something that they can use five minutes after the seminar the presentation is over so that's my goal so hopefully you can inform your choice for Effective interventions and then the case studies that we're going to talk about and the different samples and case vignettes that I'm going to talk about they're used to differentiate some symptom overlap effective interventions and the emotional management of personality disorders we're also going to learn about those basic elements of emotional intelligence so how to apply them to benefit your clients for the people that you're working with providing services for and we want to build skills to recognize emotional intelligence deficits often seen those individuals with personalities disorder particularly those that are in help seeking settings so a lot of times you'll get some resistance and you don't and there's a bit of a complexity there so why is this person resistant to to me helping them and why do they seem like they don't want to go forward and we will talk about that as well so let's get into it here we go so the way I like to conceptualize personality disorders is to look at it in two categories is we have some that are treatment accepting and we have some that are treatment rejecting now when we say treatment accepting or rejecting what we're talking about is the willingness to go into treatment and explore their issues the problems that they're having and how they're affecting others so in some ways it's very similar to what Texas Workforce is doing to what a lot of different types of counselors are providing in the services that they're providing as well so accepting and rejecting again is more therapy focused in this sense but also those that are maybe looking for help but they may not accept that help as well so let's just go through these a little bit so you know your individuals with borderline personality disorder histrionic personality disorder independent personality disorder now we're going to bring break all of these down in just a moment kind of talk a little bit about them but when we say again that their treatment accepting if these are folks that are willing to go into treatment they're open to the idea of going in and exploring their thoughts feelings beliefs behaviors patterns and the images that pop in their head when they get triggered and activated your treatment rejecting folks now there's a longer list on treatment rejecting folks and part of the complexity of personality disorders is that they're very challenging to treat so many of them as you can see by the list is treatment rejecting right and that's your paranoid personality disorder schizoid personality disorder schizotypal I don't say personality disorder you guys know narcissistic anti-social dependent avoidant and obsessive compulsive now about this what I do want to say though is even though I am talking about individuals and their Psychopathology right their personality disorders and I may say you know those with paranoid personality disorder or or borderline personality disorder I'm not defining those individuals by their pathology just makes it easier than saying an individual along the spectrum of borderline personality disorder or an individual along the spectrum of schizoid Personality Disorder so I'll I'll simplify it as as we go along so again we've got your your treatment rejecting folks now interestingly this is a group that even though their Psychopathology and their personality characteristics and traits cause great problems for those around them that they don't really see it because one of the universal criteria for all personality disorders is impairment so they have that sense of impaired Insight so I realize I said impairment what I meant was impaired Insight right it's Insight impairment and that's because they have difficulty understanding and seeing that if I do a it equals B and that's because a lot of their behaviors 10 tends Not to cause ego dystonic Behavior right or an egoistonic reaction and what that is is a sense of dissonance where they feel uncomfortable what they did they may feel a sense of shame or guilt or doubt or fear related to the behavior that they engaged in so if they don't have that it's hard to correct our Behavior imagine if you did anything right so let's say that you were backing out of the driveway and you drove over your neighbor's kid's bike if I did that I would feel really bad but imagine that you're backing up you run over the bike and you're like uh shouldn't have parked there or you don't really care at all and you're like and you just drive to work and you don't even have a second thought because you're not thinking about that kid you're not thinking about the parents that they might be mad at you they might be disappointed you they're your neighbors are giving you the evil the evil neighbor eye which is worse than just the regular evil eye so that's what we're talking we're talking about the individuals that have that impaired insight and there's no ego dystonia right that it's not ego dystonic that they don't have any regret they may back up over the bike and they're like and they just keep going they don't so then when the neighbor would come over right and the neighbor says you ran over my kid's bike typically most of us would be like Oh I'm really sorry I apologize I didn't mean to I didn't even see it completely my mistake and whatnot these folks are going to respond in a way that it is what are you talking about just a bike I don't know what are you talking about wasn't me I didn't run it over we saw you run it over because everybody's got cameras now right all over their house you know we have you on the camera nope not me wasn't me I don't know what you're talking about I don't know and then you show it to them and then they try to Gaslight you a little bit they're like nope because the bike really shouldn't have been there anyway so it's really not there so it doesn't really count and it doesn't really count that I backed over it and then drove off so I don't see what your problem is and then you're kind of like huh what so that's part of it right we have that lack of insight and we have that it's not egotistonic okay so it's ego syntonic things that are ego syntonic means that we're comfortable with what we do we're in our comfort zone so those are the individuals that are treatment rejecting as far as like they're paranoia their schizoid behaviors and perceptions their narcissistic perceptions and traits and interactions and patterns that there's really no sense of remorse regret tendency to think twice before they engage in behaviors because a lot of times it's stimulus and response whereas for most of us we probably consider the outcome and ramifications of our behaviors on others on our co-workers on our friends on our family people that we know and things of that nature but these folks don't so it really adds to that sense of treatment rejecting they don't see why they should change and if we go down to the bottom there I think a really good example his obsessive compulsive personality disorder many of individuals with obsessive-compulsive personality disorder which will Define in just a moment are really comfortable with their behavior with their perfectionism with their issues right so it's ego syntonic means that they're comfortable with it right it's not ego disc down it doesn't cause them any dissonance but what's interesting is is that when you try to correct it or you try to give them strategies because it's causing a lot of disarray around them people are usually very stressed out these are very perfectionistic highly organized individuals and they don't like to be corrected they don't like to hear that you know everything doesn't have to be just perfect it's okay to have a 95 percent it's okay to have 99 and a lot of times what I'll hear when when I'm working with these individuals in therapy is they're like see I don't have the problem the rest of you do because I'm comfortable with my perfectionism I don't have a problem with it and that's at ego syntonic so they're rejecting why would I go into therapy for something that doesn't cause me any problems because why is it causing you any problems because it's not like I you know drove over your kid's bike because I don't see the problem in that you shouldn't have the bike there to begin with and it's just a bike and it wasn't me to begin with anyway and it's like what so that's just to give us this idea of the complexity initial complexity of personality disorders and what we're going to do is we're going to go forward and we're going to talk about the descriptions we're going to Define each so that we can have a really good idea of what encompasses or what makes up a personality disorder now we talk about a general definition this is a prevalent and ongoing pattern of emotional and behavioral deviation from one's cultural expectations that are influenced by one's cognitive effective interpersonal and impulse control now the important Point here to look at is that it's cultural the cultural expectations so we can't necessarily say well that it's the majority culture we have to consider the individual's culture when we're talking about their personalities how they in personality from my perspective is not only how we see ourselves but how we see others and how we see circumstances and it also that adds to how we encode different information such as memories or instructions or rules so it's important to realize that we have to look at that individual's culture and how it deviates from that culture okay also we have to make sure that these behaviors are prevalent and ongoing patterns so it can't be something that maybe something horrible has happened or trauma has occurred and then this individual develops a very narrow perspective of the world also they don't trust anyone all of a sudden they feel very unsafe things of that nature because that's because of the trauma when we talk about personality we're talking about prevalent and ongoing so meaning that many instances may occur along the line and we see that in various settings these behaviors emotional patterns effective States and tendency of an interpersonal interaction patterns remain consistent even though they're maladaptive so let's kind of break break it down a little bit so when we talk about cognitive we talk about cognitive we're talking about one's way of perceiving and interpreting not only themselves other people but also events how they interpret the world around them the people in it as well as themselves within that interpersonal domain and the intra personal domain which is inside themselves next we have effective this includes the range intensity lobility and appropriateness of emotional response so a lot of times you might see someone who's in the middle of a depressive episode and they may have very flat or restricted affect which is it would look more like this like yeah no no and it's very limited right it's very flat it's very restricted now that would be their affect now if we were going to attribute this to a personality trait or component again we would see it across a wide variety of different situations and circumstances it would be prolonged pattern of behavior in response to the world around them and also they would impact interpersonal functioning and we talk about interpersonal functioning this is how an individual gets along with others as well as their social flexibility or their lack of social flexibility now I tend to believe that personality disorders if we had to break it down and Define it we would say that it's the inability to adjust your behavior based upon the environment that you're in so what that means is is that whether you're at the Cheesecake Factory you're at work or you're at home on the couch your behavior stays the same so it doesn't matter if you're talking to your kid if you talk talking to your spouse if you're talking to your mom or you're talking to the neighbor or the neighbor's kid you respond the same to everyone you interact with them the same you use the same social patterns and strategies regardless of who it is so it's the inability to adjust your behavior based upon the environment that you're in and who's in that environment and the more severe the personality disorder then the more restrictive the response pattern is because there are some folks that are like that low moderate because everything's on a dimension so you can have someone who's low moderate or even mild personality traits and types and you wouldn't really even know it right because they're kind of flexible but they're a little mild and Moody and they're maybe overreactive and they major in the minors a little bit they may be a little theatrical they may be a little perfectionistic things like that and we see that so what happens is is that these individuals have some degree of flexibility but underneath that there is a degree of in inflexibility there's an inability to perhaps self-soothe or manage themselves in particular situations so and then there's impulse control impulse control is super important so pulse control includes one's poor ability to manage thoughts feelings and behaviors impulse control and all of us have a different degree of impulse control and we all have a different threshold so for example some of you may be big coffee Drinkers and you may really like Starbucks a lot no matter how much they raise the price you're like man I love it I'm going and that's you and that's okay but let's say right you're on your way to work and you're having a performance review and you got to get there on time and you got to go to your Starbucks right so you pull in and it's a long line and maybe you just like the drip coffee but you know they have coffees that are mocha lattes upside down with a little dash of coconut cream splash of whip foam cream on top I don't know all that other stuff you know what I'm saying so you're getting frustrated because you're thinking oh everybody in front of me is ordering right the whipped foam mocha upside down and all I want is a drip that's all I want just a drip coffee and you sit there and you stew on it and finally you reach that threshold and you just start laying on the horn you roll down the window you're screaming out there you know move it right and all of that you're getting more and more excited more and more frustrated so then you finally get up you know you order and then you chew out the person you know who has their little headgear on right and you let them have it and then you get up to the window and then you really chew them out and you make them cry and then you drive off right and it's just this lack of impulse control but let's say it's just at Starbucks remember it is the inability to adjust your behavior based upon the environment that you're in but it has to be prevalent and ongoing so if it's just that Starbucks because you're stressed out because you're going to work doesn't count but if it's Starbucks then it work then it's with your kids then it's with your significant other right or your spouse or it's with your neighbor then that would be part of your personality trait we would see that it would go across a wide variety of different types of situations and then we would know that it's part of your personality whoa you know he or she they have really bad impulse controlling when they get worked up they really get worked up so let's talk about the different personality disorders specifically okay so there's a total of 10 personality disorders now the first one we're going to talk about is paranoid personality disorder now this is a pattern of distrust and suspiciousness such that others motives are interpreted as malevolent now this is not paranoid psychosis this is not you know the government is spying on me the government's out to get me I hear voices that are telling me Oh you know they're going to get you you know don't trust them this is different these individuals may have a psychotic break but if they do it tends not to be as long or severe as an individual perhaps with schizophrenia someone who has a history of psychosis or someone who follows along that schizophrenia Spectrum when we talk about paranoid personality disorder this is that individual who is your conspiracy theorist but it goes one level deeper than that because remember it has to be prolonged it has to affect their ability not only how they see themselves but how they see others now within your field as counselors you're likely to encounter these individuals because they have a lot of Serial unemployment and that means that they're employed for a little while they lose their job typically because of their rigidity right their distrust of their boss their suspiciousness and then they're let go and then they come back to you and they're like well I don't know why I got fired and then you find out well you know they refuse to take out the trash right because they felt you know that they were the only ones that was being asked to take out the trash you know and they were being treated unfairly and they were purposely by this boss or the supervisor so you start to see this pattern of distrust and suspiciousness so again this is a treatment rejecting type they won't come see me they don't want to come and see me they're very suspicious of psychologist mental health providers so again you folks are likely to see them because you're trying to get them back in the workforce you're trying to get them you you know some services and initially they may be okay but the longer they're there the harder it is to maintain and control those personality patterns because traits come out over time traits come out that's how it works so that paranoia which of course causes socioeconomic dysfunction which means that it impairs their ability to earn money go to school or in their relationships so of course that affects their employment stability let's go to the next one schizoid personality disorder now this is a pattern of Detachment from social relationships in a restricted range of emotional expression now interestingly and I'm not going to go too deep into it but a lot of individuals with schizoid personality disorder are misdiagnosed with autistic Spectrum Disorder because what happens is now a lot of these personality stories our personalities aren't really solidified until 18 we start to see those Trends and patterns really sort of solidify at 16 and from 16 to 18 they really really solidify and 18 onward those patterns are pretty much in place unless the individual chooses to change their behavior change their Outlook so on and so forth so for your schizoid individuals what we see is is that it's a very restricted emotional patterns they don't see a lot of value in relationships right they're very rigid and restricted in the need for social relationships they don't care about social relationships but we can separate it from autism spectrum disorder because we don't see those repetitive patterns also we don't see those early developmental issues that we see with individuals with autistic Spectrum Disorder which is you know we see those developmental delays things like that we don't see that in schizoid personality disorder that's why it's always important I think that if we're getting that history we got to go all the way back to birth I know we gotta go all the way back to birth get a little idea about the development Social Development interaction repetitive patterns were they there were they not so a lot of these schizoid individuals again particularly lately we'll be misdiagnosed with autistic Spectrum but when you look for the history it's not there now interestingly these folks the way I see them in my practice I also do evaluations for Social Security and I'll see them because a lot of times we don't have basements here in in Texas but up north where I'm from they do have basements so what happens is these individuals tend to stay in the basement they're big video Gamers they may do different things just on the computer again they don't have that social need that need for social engagement so what happens is when their caregiver passes away a brother sister someone in the family sometimes or could be a caseworker then who applies for Social Security that's how I would typically see them during those Social Security evaluations now you may see them as well because they want they're going to try to get into the workforce now these individuals may do well at a very restricted concrete job where there isn't a lot of social interaction but again it's not autistic Spectrum it's excuse my personality disorder also autistic individuals were always looking for what we're looking for intellectual impairment and language impairment these individuals have neither they're going to have an average level of intelligence typically and they're also not going to have any type of language impairment let's go to the next one schizo typo there's a pattern of acute discomfort in close relationships and cognitive and perceptual distortions and eccentricities of Behavior now these individuals now schizo typo personality disorder is on the schizophrenia Spectrum but it's on the low ends on the very very low end because they don't necessarily have hallucinations and delusions these folks are just very eccentric and they're very different and they're very unique and they see the world in a very new and unique way so when we see them whether it's me or it's yourself they present as very odd very peculiar we get that initial sense like something's just not right here maybe some thing just isn't flowing the conversation tends to be a little broken a little distorted they may believe that they have special powers they may believe that they are particularly unique that goes to the perceptual distortions they may you know feel certain things oh when the wind blows it always blows cold across my crystal skin and you're like huh now that's an eccentricity and so we we see this in these individuals and again it's pervasive and we typically see that they've had a pretty let's just air quotes on this one a normal development and then an adulthood about 16 you know sometimes a little earlier you might start to see those you know there aren't a lot of friends again they may have tried to have a job but they can't hold it down just because of those eccentricities of that uniqueness of behavior and perceptions the things that they say they may have their own slang or slogans for their life things like that so it's very unique in in how they approach the world they may a dress very uniquely again they also perceive the world very uniquely they don't like to be close with others they may be very distant with their parents with their significant others which goes back to the I typically see these folks not through Texas Workforce but more through Social Security again for the same reason I would see the schizotypal individual as well now we're going into this is the cluster B this is another group okay the previous three that we covered are cluster a so this is cluster B now these are folks that all of us have heard of these are those personalized sources that are much more common even though their prevalence is very very low the reason why we have heard of them is because they are particularly destructive and I don't just mean anti-social I mean anti-social histrionic borderline and narcissistic personality Source they are particularly destructive but also they tend to be more social whereas your paranoid schizo and schizo typo tend to be a little more reclusive so when we talk about anti-social personality disorder we're talking about here again it's that pattern of disregard form violation of the rights of others and these these are individuals that they are remorseless they have no sense of regret they run over that bike we talked about and they're going to think it's hysterical and they could care less and it's really ego syntonic and they're going to be just fine with it and the reason why you know they would apply for Social Security or Texas Workforce is because you know they want to game the system they want to get something out of it how can they get something for free how can they manipulate somebody in order to get something that they want right and it's all about power and profit and dominance of others and that's what we see in those behaviors over and over again now next is borderline personality disorder now this is a pattern of instability in a personal relationships self-image and affect and marked impulsivity we're going to do a little deeper dive into BPD in just a moment because I think that it is it is one of the most researched personality disorders it's also one of the most misunderstood personality disorders as well but borderline personality disorder you have a lot of emotional instability you have a a lot of relationship disruption but it tends to be very dark the individual tends to fear relationships in a lot of ways but want to be close in those relationships I call it a push pull type of relationship I want to be close but not that close but why aren't you closer because we should be closer why are we close enough because we're not close enough but shouldn't we be close enough you wanted to be close enough but we're not and then because of that that causes me to believe that I am negative I am broken I am worthless and I respond to that sense of internalized Brokenness with acting out behaviors destructive behaviors we have histrionic personality disorder this is a pattern of excessive emotionality and attention seeking these are folks that need to be in the spotlight they need to be the center of attention and the way they go about it tends to be very maladaptive and destructive these folks are really high energy they can be a lot of fun initially because they again they love novelty they love engagement but they will will drain you because they take and they take and they take energy from you on a consistent basis so you get exhausted and then they lose friends and relationships that way narcissistic personality disorder which all of us have heard which is a pattern of grandiosity Need for admiration and lack of empathy this is that I'm going to engage in maladaptive patterns that show how great special and unique I am and those maladaptive patterns are going to cause you a lot of stress and really cause you a lot of anxiety and various levels of impairment whether it's Financial impairment emotional impairment social impairment whatever it is but because I cause that I feel empowered and that makes me feel great not great like but great like unique special and Powerful so now you're avoidant personality disorders these individuals are exceptionally rare because they tend to be Hermits they tend to stay in their homes they don't like to go out because of this intake hence social inhibition feeling of inadequacy and hypersensitivity to negative evaluation now these folks it's not like you they're just oh well you know Tim is anxious it's like anxious times a thousand it's that they may show a lot of just intense Panic type of symptoms when they're interacting with others they tend not to they tend to have a lot of self-doubt a lot of great fear and they desperately seek any type of evaluation because of that fear of it being negative of not being accepted Woody Allen if if you know who that is he has a pretty strong avoidant personality because he is so afraid of being negatively evaluated but the way he manages that is by doing the exact opposite it's called reaction formation so he he now he's brilliant in his writing and things like that but he puts himself out there to purposely be negatively evaluated in some cases or to be perceived as unique and odd so that then anything that comes out of that it's not his true self it's this Persona that he has presented out so he would be pretty high functioning for avoidant personality disorder and then we have dependent personality disorder this is a pattern of submissive and clinging Behavior related to an excessive need to be taken care of now this isn't codependency codependency is very different codependency is the need to be needed dependent personality they have intensive need to rely on someone else for even basic questions basic Clarity basic understanding of themselves so they're like an empty jar and they find this it's called an external object or another person that's that external object who then is to fill them up because without that other person filling them up they don't know who they are so they become dependent on that individual and that dependency runs across every facet of their life what they should wear what they should think how they should behave what job should they have if they should have a job should they go to therapy that's why they're treatment accepting because that other that depended the object that they're dependent on tells them that they need to go to therapy so they do and then lastly we have obsessive compulsive personality disorder this is a pattern of preoccupation with orderliness perfectionism and control so I talked about this one earlier but it's not OCD OCD is that you have obsessive thoughts feelings right or drives or a sense of urgency that is quelled that is attenuated by compulsive behaviors with obsessive-compulsive personality disorder there really isn't any specific behavior that's going to lessen any anxiety because sometimes they have anxiety sometimes they don't this is ocpd obsessive repulsive personality disorder sometimes have anxiety sometimes they don't because their behavior is ego syntonic but I'll tell you if you ever hire someone who has obsessive compulsive personality disorder the first three weeks you're gonna love them because they're gonna organize everything they're going to structure everything you're gonna put everything like on on the desk everything's gonna be nice and neat and clean and beautiful and all this other stuff but they don't get anything done when you give them a task they get lost in the details and they can't go beyond those details so that's where a lot of that dysfunction comes from so finding them a job that might be great but they're not task completers their task engagers so they get stuck in those tasks over and over and over again without any completion let's talk about the complex city of personality disorders and I think this is really important not only will this give us a really good perspective I think on BPD but also give us a perspective of the complexity of BPD of personality disorders overall now all personality disorders there's a pretty high likelihood that's going to be comorbid with another condition that could be depression bipolar disorder PTSD could be panic disorder could we generalize anxiety unspecified anxiety could be anything okay to go with it we're going to talk about this specifically about BPD just to give you an idea so approximately three to fifteen percent of all individuals diagnosed with BPD don't have a co-occurring condition or comorbid condition this is what's called Pure BPD when it's only the personality disorder it's called Pure but the other side of this coin because we have three and fifteen percent is pure the other side is 85 and 97 percent of all individuals with BPD have at least one comorbid condition so we know that if we find a personnel disorder there's usually something else lurking around that's also adding to the complexity and the challenge of working with this individual of this person helping themselves as well now when we talk about BPD and bipolar disorder so if they're comorbid in about 27.6 percent of cases now to work with this we have to stabilize those bipolar episodes first because we can't work on the personality disorder if we don't have those manic phases under control or those depressive episodes under control because they're very disruptive to the treatment process also when we look at major depressive disorder 83 percent of individuals with BPD also qualify major depressive disorder so BPD that core content what those issues are that's underneath that drives a lot of those maladaptive beliefs behaviors and patterns we have to address those first so this is different than bipolar disorder because we have to get to that core content we've got got a deal with the BPD in order to manage the major depressive disorder because if we don't what happens is is that if we just focus on the depression let's say we give him Zoloft let's say we we try some CBT cognitive behavioral therapy but they're not really going to engage in those strategies because the BPD maladaptive patterns are too strong and keep pulling them towards those depressive episodes and then we have psychosis when we talk about psychosis hallucinations which is a central component of brief psychotic disorder and other psychotic disorders have been estimated to occur in 26 to 54 percent of individuals diagnosed with BPD now what that tells us is that there's a high prevalence of those with BPD to have a psychotic break just as I mentioned also in paranoid personality disorder also in that schizotypal personality disorder we know that they are along that spectrum of schizophrenia now delusions that's another key component of psychotic disorders and this is found in about 17 to 29 of BPD those delusions those are beliefs right their beliefs in that the world is out to get you there's beliefs that you love me or that I love you when I really don't right and that you may see oh well I mean you know he's not coming in today because he's probably going to get a haircut so he can look just beautiful for me tomorrow because I know he's got this huge crush on me right that you would say that about me but I really maybe I don't feel well maybe I stub my toe and I'm not coming in I don't know but it's part of that delusion now psychotic symptoms must be controlled prior to working with BPD so we have to get those psychotic episodes managed and that's typically with with medication and over the years many more medications have had greater degree of efficacy with fewer side effects so it's really been able to manage those psychotic episodes as well as decreasing the probability of individuals with BPD or other personality disorders having psychotic breaks but by the way I'm not saying that everybody with BPD or person I sort of needs an antipsychotic I'm not saying that at all so it's estimated that 10 to 24 percent of individuals with BPD also meet criteria for dissociative identity disorder and this is a really controversial diagnosis and dissociative identity disorder again is on a spectrum on the far end extreme end it's individuals who believe that they have separate selves inside themselves and come out under different degrees of stress or under different situations whereas at the lower end these are individuals who separate from themselves and sort of live more in like a Twilight not the book Twilight but more like in a sense of Twilight dreamy kind of world because they are physically or cognitively or psychologically pulled back from the world in which they live in now when these two disorders are comorbid BPD into associative identity disorder clinical symptoms are more severe as opposed to when they occur separately so now grounding strategies have to be in place this is your mindfulness strategy so they're grounding techniques and you have to learn those first if we know there's any dissociation associated with any personality disorder but in this case we're talking about BPD now ADHD that's estimated to occur in about 38 percent of individuals with BPD and 14 of those diagnosed with ADHD in childhood later develop BPD so we see that there is some connection is it a massive connection no but there is something there so it's something that we have to pay attention to so we know if the BPD what is that attention could they meet criteria for ADHD yes is it going to be higher than likelihood for someone who doesn't have BPD yes hey it's probably going to be about a third higher now it's best to have ADHD symptoms under control because when you're trying to teach management techniques if you can't attend to it or sit down and pay attention to it because you're too hyperactive and impulsive it of course is hard to learn a new skill because we're not paying attention to it now PTSD or complex PTSD what you find is 71 of those diagnosed with BPD experienced at least one instance of childhood adversity and this includes emotional physical or sexual abuse or neglect now one of the falsities or the false beliefs about BPD is that everyone develops BPD out of sexual trauma that's absolutely not true as this research shows here and this research has been found over and over again not all individuals with BPD have experienced sexual trauma so it's important to know that and when we break it down we see that 49 report physical neglect 42 report emotional abuse 36 percent report physical abuse a 32 sexual abuse and 25 percent report emotional neglect so it's estimated PTSD co-occurs in about 24 to 58 of those with BPD trauma is common but it's not a prerequisite for BPD and it's important because a lot of people believe trauma BPD BPD oh they they must have trauma in their past not everybody does so a study that focused on looking at PTSD complex PTSD and BPD found that 55 percent of those who had BPD also met criteria for PTSD and 45 of those with BPD met criteria for complex PTSD so we see a lot of this connection we see that the complexity of these disorders and if we see complex PTSD and or PTSD and BPD we treat them simultaneously so we work with the trauma while we're also building skills and behavior management skills as well so our personality sort is treatable they are treatable but in the individual we have to see motivation and we have to see a degree of insight some degree of insight a willingness to accept insight and the areas that we're going to address this includes their thoughts feelings and emotions about not only how they see themselves but how they see others and we're working to change those maladaptive patterns to adaptive strategies so instead of them being being destructive hurting themselves hurting others acting out violently what we want to do is teach them to slow down and process and think right let's say if you have a personality disorder and you're very impulsive and you're in that Starbucks line instead of laying on your horn you're like let me just send a text or an email to my boss let them know I'm currently stuck in traffic you don't tell them it's Starbucks traffic it's okay all right you're stuck in traffic you're going to be a little late right that's an Adaptive strategy and you want to build pro-social interpersonal skills those are interpersonal interactions that help to build positive relationships and connections to others now the ability to recognize understand and manage our own emotions and to recognize understand and influence the emotions of others is emotional intelligence it's the ability to recognize not only how I feel and how I think but also be able to interpret those thoughts feelings and behaviors and degree of comfort or being uncomfortable in someone else so let's talk about so our low EQ person a lot of times you'll hear people with low emotional intelligence say if I only had a different job if I only had finished graduation if I only had been hands and beautiful only my spouse to stop drinking if only I had been born rich and famous if only I had good contact if only I had better friends if only I had married someone else and that's low EQ right and because because it's all of these things matched together and it's this expectation of not looking at strategies not looking at ways of doing it differently but being stuck in these phrases that keep them stuck because they don't realize that they have to take responsibility for their behavior to do it differently so for your high IQ person it's a time to wait and a time to watch it's a time to be aggressive and a time to be passive it's a time to be together and a time to be alone a time to fight and a time to love and a time to work in a time to play so you get the idea of the balance right it's a balance between the two and you're reading yourself the situations and the environment and you're able to interpret that and you're able to recognize that there's particular behaviors that's going to increase the probability of success Within These different environments with these different people and that's what emotional intelligence is and people with high emotional intelligence are typically very charismatic and when we say charismatic this is exactly what we mean is that they know how to interact they feed off your emotions they respond to your emotions they can tell how you feel they can tell certain phrases and reactions that you like and you respond to in those that you don't and they're able to adjust as opposed to we go back to our definition of that inability to adjust your behavior based upon the environment that you're in most individuals with a personality disorder have low emotional intelligence so let's talk about the 10 habits that can help us build emotional intelligence and what we want to do is build what I call emotional literacy and this is labeling our feelings rather than labeling people or situations right to say I feel impatient as opposed to this is ridiculous I feel hurt and bitter as opposed to you're an insensitive jerk emotional literacy is I feel afraid you recognize your own emotions and how you're feeling as opposed to you're driving like an idiot so one is low emotional intelligence because it's external you're blaming others as opposed to taking that sense of responsibility number two is to distinguish between your thoughts and feelings a thought as I feel like I feel as if I feel that and then you use a feeling word right happy mad sad glad shy afraid bored whatever it may be but you're able to connect those thoughts I think this I feel this that recognition and attach that feeling word to it you're going to take more responsibility for your feelings such as I feel jealous as opposed to you're making me jealous and then next is use your feelings to help make decisions now how I feel if I lay on my horn and chew out the Starbucks person you're likely to get spit in your coffee I would imagine and you don't want that right nope or how will I feel if I don't so again we're looking for that balance emotionally intelligent people look for that balance in there they read themselves as well as the environment they show respect for other people's feelings how will you feel if I do this how will you feel if I don't do this so you consider other people those feelings and reactions and value and next is you feel energized not angry because anger makes you ignorant that's just kind of how it is right we use what others call anger to help you feel energized to take productive action that's the purpose of what anger is the purpose of anger is to drive you to do something hopefully it's something adaptive High emotionally intelligent people engage in adaptive behaviors even when they get angry getting angry is understandable right but we have to recognize it see it and know where it comes from and use adaptive strategies in order to manage it you want to validate other people's feelings you want to show that empathy understanding and acceptance of other people's feelings and where they're coming from doesn't mean you're okay with it we have to recognize that this is where they're coming from and that's their perspective and then practice getting a positive value from emotions such as asking yourself how do I feel what would make me feel better you could ask others how do you feel what would help you feel better and again these are emotional Intel intelligence strategies and these are things to build in as habits so that you are building your emotional intelligence building that skill because it's a skill it's not an either or it's not you have it or you don't it's a degree right it's a skill don't advise command control criticize judge or lecture others instead you want to listen with empathy right and you don't want to judge them you want to hear other people's thoughts feelings beliefs right and what's going to drive them to their behavior as opposed to telling them what to do and then they say well why because I said so that's really not a good rationalization but I all heard that from our folks right not a really good reason to motivate people to do it and then lastly avoid people who invalidate you we have to make choices of having people in our interpersonal Circle that are caring that move us forward that help us grow not those who take from us take away from us our sense of value our sense of purpose and while it's not always possible we have to try to spend less time with those who take your energy and take your happiness and take your hope and Outlook and instead focus on those who Build You Up move you forward and encourage your sense of growth but also if there are people in your life that are sappers you know they kind of sap your energy what you want to do is you want to psychologically insulate yourself from them the way you do that is recognizing this person is like this this is how they are this is how I perceive them to be but I don't have to let their comments their reactions and their beliefs and perspective of the world influence me if I don't want it to the lot of power choice and balance in emotional intelligence but those with higher emotional intelligence earn more money have more successful relationships with their kids have better sex better relationships and tend to achieve more than those with low emotional intelligence so is there a connection between what we try to do with our clients co-workers friends and loved ones in the 10 habits well absolutely right because it's a lot like the stock return right stock market we want to focus and teach these goals on an ongoing basis not only to ourselves but we want to really live these habits every day because humans are adaptable whatever we do on a regular basis we will adapt to it whether it's healthy or unhealthy whether it's junk food and cigarettes or it is a healthy lifestyle and it is believing in ourselves and managing our emotions recognize that growth is in no way linear not at all but it is cyclical and Jagged just like the stock market and you'll notice here that even though you have high highs and low lows and all of that volatility there's growth continually if you look at the average of 20 years in the stock market even though you have crashes and even though you have high highs you have continuous growth over 20-year period it's the same thing we're all going to have bad days and we're all going to have great days we're all going to have good relationships we're all going to have Army ones and but the idea is to recognize and have the hope and belief that by using these adaptive strategies these healthy strategies that I just talked about and using that sense of balance that you will grow right you'll grow as an individual you'll grow in your relationships you'll grow in a spouse you'll grow as a boss you'll grow as a co-worker you'll grow as a friend and you'll see that start to pay off not immediately because there's no immediate returns even in the stock market right but over time you will see a return on that investment so thank you all for your time I've got time if you do if you have any questions please let me know and I would love to hear them thank you Dr Fox for that very Illuminating presentation on personality disorders we do have a few questions so the very first one the attendees asking what are your recommendations for dealing with families that are treatment rejecting when the patient is treatment accepted so I think that most kids are treatment accepting so I think that then what we have to do when parents are the most complex so what we have to do is I believe that if you're going to work with a kid you have to work with the family system and the family system is what has to be open to accepting that sense of change and even though it's scary I think that you have to have a sense of trust in the family I think that we have to have a sense of willingness just as I mentioned in the individual you have to have insight and motivation I think that someone who lacks insight and has no motivation whether it's a kid a family or an adult they're not going to engage in treatment and they're not going to be helpful I think that as adults if the adult is treatment seeking and their partner is she even rejecting that's usually out of fear so sometimes what I'll recommend is if if they're willing it depends on the circumstances but we can do couples therapy in some cases or talking about specifically what are those rejecting beliefs a lot of times and you know just we'll throw to some generalities out is that you have females that are more treatment accepting men nails are dreaming rejecting and a lot of times males are dreaming rejecting because of low self-esteem because they question or you're gonna be in therapy you're going to talk about me what are you going to say about me I don't want you to say anything bad about me and that fear and things like that so explaining that to the adult individual who's a potential client I think talking about that but also certainly helping that client explain to their significant other what therapy is what the purpose of that therapy is and that can also lessen some of that fear and concern excellent thank you for that explanation there is one more question and the attendees asking about the difference in interpersonal relationships and parasocial relationships in the context of personality disorders I think this is when you were talking about cluster a this is when the question came up so they're saying for instance feeling as though an internet personality especially in the day and age of social media is an actual friend versus identifying friendship in real life yeah so I think that if we look at just that cluster a you know they may be feel more comfortable in those online relationships because there isn't as much depth right so those online relationships there really isn't a lot of depth and that's why right now we have the highest degree of loneliness in the world population than we ever have but we have also the highest degree of connectivity and so that's leading to all of these mental health issues such as depression anxiety and things of that nature so if we look at sort of friends and things like that I think that those that are in your cluster a don't really have let's say adaptive social skills so it's easier for them to have those linear friendships and connections as opposed to having that in person because those in person related tend to be deeper so typically you won't see someone in cluster a want to increase their socialization because again their comfort zone is in that online relationship perhaps or having no no relationships the attendee did provide some more clarification they're saying how would you help a customer understand the difference between parasocial and in real life type relationships as well as how to support them and creating new strong relationships but it sounds like some of it is motivational as well they may just not be interested in pursuing some real life relationships if they're connecting with the online absolutely and I think that we see this a lot in individuals that are in their early 20s late teens and those who grew up with social media they don't really know how to approach significant others a lot of times they don't really know they have this sense of lose they don't know how to make friends they know how to how to like stuff and heart stuff you know on Instagram and things like that but they don't really know how to engage and build those deeper relationships so I think that a way to to help someone do that is to first of all normalize that so you know what it's real a lot of folks feel that way and connect it with loneliness and say you know a lot of folks feel like you know they're online friends but then yet they they have a lot of online friends but they also have a lot of loneliness and you will be surprised 99 of the time you're going to see them say yeah yeah yeah and say you know it's interesting because I think a lot of people feel that way and they don't sometimes they struggle with kind of connecting with folks and clicking and things like that and you should get more yeah yeah and so you know so then what you can find them is find them a socialization group or I know a lot of libraries do have like book clubs and socialization groups and things like that that they've started to bring back since you know covet is relatively under control I don't know it depends on your perspective but so I think again you know recognizing that difference but again because what we're trying to do is build that motivation in order for them to seek out more real life friendships because those are the ones that create depth those are the ones that the research shows decrease anxiety decrease depression and increase emotional intelligence by teaching those habits in the real world emotional intelligence utilize online have no or very little impact on the individual self-esteem and self-concept so we want to build Insight by pairing that loneliness with online friendships which typically they're going to experience and then connecting it with building that motivation to seek out positive treatment and a relationship depth so I should thank you thank you questions that we had but there are numerous compliments and positive feedback for your presentation thank you so much for your time we do appreciate you being here and sharing this in a site and giving us all some food for thought about emotional intelligence and working with our customers with BPD or other personality disorders yeah well thanks and I I really enjoyed it so so thank you I hope everyone enjoyed it as well and thank for everyone's time I appreciate it that way thank you

Channel: Dr. Daniel Fox

Views: 40,536

Keywords: personality disorders and emotional intelligence, personality disorders, emotional intelligence, antisocial personality, npd, EQ, dr fox bpd, dr fox narcissism, dr fox splitting, dr fox favorite person, dr fox bpd splitting, histrionic personality, bpd, borderline personality disorder, borderline personality, paranoid personality, schizoid, schizoid personality disorder, avoidant personality disorder, ocpd, dependent personality disorder, narcissistic personality disorder, dsm, dsm-5

Id: eU29njXBGts

Length: 53min 53sec (3233 seconds)

Published: Fri Nov 11 2022