Personality Disorders

PERSONALITY DISORDERS:

Although varied, personality disorders appear to have some things in common. These include:

a) a tendency to over-interpret (although usually with little psychological insight): Zen Meditation is a valuable tool for 1) recognizing one's tendency to over-interpret (and indeed, to interpret at all), 2) gain control over the tendency to interpret when it is not necessary by "letting go" of the "pull" to reflect/worry, and 3) focus sensorially on the moment at hand.

b) an inability to self-soothe ("comfort" being described as the absence of pain"): Chi Kung and relaxing Hatha Yoga are great methods for helping the patient to initially experience a deep state of relaxation and comfort and for teaching simple self-comforting on a daily basis.

c) a difficulty trusting: Leading a patient through comforting experiential exercises (in private sessions or groups) goes a long way toward developing an initial therapeutic bond and progressive trust. The two-person interactive Tai Chi exercise of Push Hands is a simple and useful non-competitive way of teaching interactive give and take in relationships.

d) poor insight: Mindfulness meditation, a technique of the Southern Buddhist Vipassana tradition, is helpful in noticing one's thoughts, feelings, and physiological arousal prior to and independent of one's reactions to salient stimuli. (This is similar to the goals of cognitive therapy, but predates it by about 2500 years and offers experiential techniques rather than intellectual cognitive exercises).

I have found that specific personality disorders can benefit from specific experiential techniques as well.

Dependent Personality Disorder: Tai Chi form and Push Hands is useful for gaining confidence and inner strength when expressing to others.

Avoidant Personality Disorder / Social Phobia: Chi Kung is useful for self-soothing and becoming more "simple" - not reacting to social situations with one's usual cognitive-affective reactivity. Mindfulness is also useful here.

Borderline Personality Disorder: Chi Kung is helpful to achieve and develop a sense of self-comforting, and for becoming simpler in one's interpretations. Zen Meditation is also helpful for focusing on the moment (although I have found this to be more useful in more functional cases, or later on in therapy for more disturbed borderlines).

Schizoid Personality Disorder: Chi Kung is valuable for establishing a comfortable base. Two person meditation (tantric sitting or Tai Chi Push Hands) is helpful to practice comfortable relating with others. Mindfulness may not be as useful as Zen Meditation here, as these persons often need to reduce their distancing and reflection about their actions and engage more fully with each moment.

Narcissistic and Anti-Social Personality Disorder: I have not had great clinical success with these. However in one study I conducted with Type A personalities (may of whom have a tendency toward Narcissism), subjects were able to practice Zen Meditation and Tai Chi for 40 minutes a day for 8 weeks, and reduce Type A behaviors while improving mood. Those with ASPD and NPD I have treated in stress management groups with these methods have typically spaced out or fallen asleep, or improved to the point where their state distress (e.g. MMPI 2/7) was improved such that their trait personalities could go back to their prior defensive stance (e.g. MMPI 3/1).

Which goes to show that motivation to improve and change one's fundamental personality is paramount to the benefits of meditation in psychotherapy. The greater the motivation, the greater the potential for improvement using these (and all other) techniques. Specifically, those with low motivation use these techniques as a bandage (e.g. "Stress reduction") while those with higher motivation can gain tremendous insight into their nature and effect significant personality change. Of course, the former can in many cases lead to the latter.

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