Never Both: Either Healing OR Behavior Modification in Cluster B Personality Disorders (Conference)
Channel: Prof. Sam Vaknin
Date: 2021-04-29

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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