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Mental Disorders

Cognitive-Behavioral Theory of Personality Disorders

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

Thus far, the theories we have described have focused on explaining the mental organizations and representations thought to create dysfunctional behavior. These theories are based on the inherent assumption that it is necessary to know why something works the way it does, in order to change, repair, or correct it. But theorists from a different school of thought, cognitive-behavioral theorists, have taken a more pragmatic approach. It is not always necessary to know why something works the way it does, in order to change or correct it (e.g., a damaged personality).

To illustrate this somewhat counter-intuitive concept:  Suppose you need to cross the street. Somehow it has become inexplicably flooded, thereby blocking your passage to the other side.  Now you could stand there and ponder how on earth the street got flooded like that, and wonder where all that water came from in the first place.  Or you could simply skip that step and immediately begin to work out a solution to get you over to the other side.  Cognitive-behavioral theorists prefer to immediately focus on a solution that works, to get to the other side so-to-speak, rather than focusing on the origins of the behavior that needs to be changed, repaired, or corrected.  

This is not to say that modern cognitive-behavioral theory (CBT) is silent about the origins of dysfunctional behavioral-emotional patterns. Originally based on the works of Aaron Beck, M.D.. and Albert Ellis, Ph.D., CBT emerged from the observation that people react emotionally and behaviorally to events according to their interpretation of those events. In other words, our thoughts (cognitions) lead to our emotions and subsequent behavior. By way of illustration, suppose someone stepped on your foot. You might interpret this action by concluding that this person was intentionally trying to hurt you. In response to this "assault," you might become angry and maybe even retaliate against the foot-stepper. Alternatively, you could interpret the same event as an indication of the other person's clumsiness. In this case you might laugh, and feel compassionate and forgiving.  Notice, the identical environmental event (someone stepping on your foot) resulted in two entirely different sets of emotions and behaviors, simply by the way your mind interpreted the event.

The way in which we interpret an event is critically linked to another type of cognition: our core beliefs. A complex blend of factors derived from both "nature" and "nurture" are thought to drive the formation of people's core beliefs. Cognitive theory assumes there are certain inherited dispositions such as temperament (nature), which interact with children's environments (nurture), to influence the ultimate shape of their personality, and their characteristic interpersonal strategies. Moreover, cognitive theory emphasizes the importance of social learning with respect to personality development. Childhood experiences, including childhood trauma and abuse, are seen as important factors that establish these core beliefs about the world. These core beliefs will later color, and potentially distort, people's perceptions and interpretations of subsequent experiences. For more information about this nature-nurture influence on personality development please refer to that section

Thus, our appraisal of events is influenced not only by our immediate experience of the situation or event before us, but also by preconceived ideas and beliefs formed in the past (i.e., our core beliefs).  When our core beliefs are faulty, biased, or distorted we may end up drawing incorrect, irrational conclusions about the meaning of events. We may subsequently behave in ways that cause us unnecessary distress.

Dr. Beck's cognitive explanation of personality disorders essentially asserts that people with personality disorders act in the dysfunctional ways that they do because their core beliefs. Core beliefs represent assumptions about ourselves, other people, and the world around us.  When these core beliefs are biased or distorted they cause people to consistently misinterpret situations.  In a rather ironic twist of fate, these dysfunctional interpretations lead people to behave in such a manner that they unwittingly provoke reactions from other people that are consistent with their misinterpretations. The unfortunate and ironic consequence is that the person ends up "proving" the correctness of their initial, albeit faulty, interpretation. This serves to further strengthen the erroneous core belief.

We can illustrate how this works by recalling our earlier example of the clumsy foot stepper. A person with a Paranoid Personality Disorder would be likely to interpret that event as an intentional provocation and attack. This interpretation is based on the core belief that "the world is a dangerous place." Applied consistently, this core belief leads the person with Paranoid Personality Disorder to become vigilant for potential danger, slights, and insults. This leads them to easily misinterpret another person's innocent, but clumsy behavior.  A natural consequence of this faulty interpretation (acted upon as though it was true even when it is not) is to experience anger or frustration. These negative feelings then motivate the paranoid person to attack the foot-stepper in retaliation.  A harsh and hostile reaction like that, directed toward the innocent but clumsy foot-stepper, will naturally provoke a defensive and angry reaction from the foot-stepper (because now she has been attacked without cause!). Ironically, this angry and defensive reaction by our clumsy foot-stepper only serves to confirm the initial faulty interpretation (i.e., the foot stepper was intent on harming me!). This validates the core belief "The world is a dangerous place" thereby creating a pervasive, self-perpetuating, interpersonal cycle.

Classic cognitive-behavioral therapies for personality disorder derived from this analysis, (described in the treatment section) were designed to help therapy clients to develop a conscious awareness of their dysfunctional core beliefs and to evaluate their validity. Once they learn to recognize when their core beliefs become activated, they can then work to modify or "restructure" their core beliefs to become more rational in nature, and more evidence-based.

 




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