Approximate number of words: 8028 words
Approximate reading time: 10 Minutes
Chapters of this article:
01. Nearly 60% of depression combined with personality disorders
02. Adolescent patients often have personality abnormalities
03. How do personality abnormalities develop?
04. Parents doing this will help correct their children's personality abnormalities.
Treatment-resistant depression has always been a major problem in psychiatric clinical diagnosis and treatment.
Resistant depression mainly refers to:
Patients with depression who use two or more antidepressant drugs with different mechanisms of action and are ineffective or ineffective with sufficient dosage and duration of treatment can be regarded as patients with refractory depression.
In psychiatric clinics, up to about 40% to 50% of patients have treatment-resistant depression.
Why is treatment-resistant depression so difficult to treat? What is special about depression in these patients? Some scholars believe that the so-called treatment-resistant depression should be depression combined with other mental illnesses or other comorbid diseases.
For example, depression may be comorbid with personality disorders, obsessive-compulsive disorder, addiction, or severe physical illness. Some scholars even believe that most patients with depression have comorbidities of one kind or another, and patients with simple depression are less common. These comorbidities make the patient's condition more complex and the treatment more difficult.
Today's article will provide an in-depth analysis of the topic of depression coexisting with personality disorders, thus developing into treatment-resistant depression . This type is likely to be a major component of treatment-resistant depression.
01. Nearly 60% of depression patients are complicated by personality disorders
In at least the past 20 years, more and more domestic and foreign scholars have discovered that a large number of clinically depressed patients have comorbid personality disorders. How many exactly are there? The relevant statistics may be beyond popular imagination.
Clinical studies have found that about 59% of patients with depression have personality disorders. Among them, the most common ones are combined avoidant personality disorder (38.4%), obsessive-compulsive personality disorder (31.7%), paranoid personality disorder (19.2%), dependent personality disorder (18.7%), borderline personality disorder (15.2%), etc.
Moreover, 18.9% of patients with depression have one personality disorder, and the number of patients with two personality disorders is even higher, reaching 39.8%.
The picture comes from the Internet
Regarding the various types of personality disorders mentioned above, most readers may have a certain understanding of obsessive-compulsive and paranoid types, but are unfamiliar with other types. Indeed, there are many types of personality disorders in psychiatry, and the identification and connections between them are complicated, making it difficult for non-professionals to clarify. We will open a column on personality disorders in the future, and then provide you with an in-depth analysis of the characteristics of various types of personality disorders and the specific differences between them.
The 10 types of personality disorders proposed in DSM-5
Since the comorbidity rate of depression and personality disorders is so high, and this phenomenon is both common and serious, why do most people with depression and their family members never hear psychiatrists mention the diagnosis of personality disorder when they go to domestic hospitals for treatment?
This is indeed a shortcoming of psychiatric clinical diagnosis and treatment in my country. For a long time, personality disorders have rarely been identified or formally diagnosed in psychiatric clinics in my country. Some scholars believe that there are several reasons.
One reason is that most domestic psychiatrists and psychologists lack understanding and awareness of the concept of personality disorders. Even if there is some understanding, everyone's understanding is not consistent.
Secondly, my country's diagnostic standards for mental disorders still mainly adopt uniaxial diagnosis, which is not enough for clinicians to diagnose personality disorders.
Third, many domestic psychiatrists do not accept multi-axial diagnosis. They believe that personality disorders and mental illnesses are mutually exclusive and cannot coexist.
Therefore, a phenomenon has emerged in clinical practice. Some doctors generally diagnose those patients who cannot diagnose mental illness but do have obvious mental and psychological problems as personality disorders, making them a "wastebasket" in psychiatric diagnosis.
As early as 1980, The American Psychiatric Association 's DSM-3 (Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition) proposed multi-axial diagnosis, placing the main mental diseases on axis I and the diagnosis of personality disorders on axis II. Doctors can make multiple diagnoses in the two axes according to the patient's condition needs.
The ICD-10 (the 10th revision of the International Classification of Diseases ), which is still used internationally and released by the WHO , recommends that clinicians follow a principle, that is, when summarizing clinical manifestations, record as many diagnoses as needed.
It can be said that multiaxial diagnosis provides clinical basis for the diagnosis of comorbidities and is a manifestation of the more advanced and closer multidisciplinary diagnostic model (MDT). From this perspective, my country's diagnostic model is still relatively backward, and the development of multiaxial diagnosis is very slow. It is hoped that relevant national departments can step up improvement and clinical psychiatrists will strengthen relevant awareness.
However, don’t think that Western developed countries will be much better. In fact, most foreign psychiatrists lack the awareness and ability to identify personality disorders, and they also lack effective means of treatment and solution. This diagnostic problem is not limited to our own country.
02. Adolescent patients often have personality abnormalities
Our Qingri Psychosomatic Medical Center is one of the very few medical institutions in China that adopts a multidisciplinary diagnosis and treatment model (MDT) and multi-axial diagnosis. Regarding the comorbidity of depression and personality disorders, our observations and statistics in clinical diagnosis and treatment are consistent with the above research findings.
In clinical practice, we have never encountered patients who come for treatment simply because of personality disorders. Patients with simple personality disorders lack the ability to reflect on themselves and do not think they have problems. Unless their social functions are severely impaired, causing them extreme pain, they generally will not take the initiative to seek medical treatment.
Therefore, the patients we receive generally come for treatment because of severe depression, bipolar disorder or addiction diseases, and they are often difficult and refractory cases. The patients have visited many major hospitals and psychiatrists, but the curative effects are not satisfactory. Through in-depth communication,
found that the proportion of personality abnormalities among these patients is very high. There are a small number of adult patients and even some adolescent patients whose personality abnormalities are very serious and have reached the level of personality disorders.
According to DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders compiled by the American Psychiatric Association), if the patient's symptoms have reached the criteria for a personality disorder and have lasted for at least 1 year, then even adolescents under the age of 18 can be diagnosed with a personality disorder (except for antisocial personality disorder).
However, we believe that we should still be cautious when diagnosing teenagers, and try not to diagnose personality disorders as much as possible.
The picture comes from the Internet
Because mainstream psychiatry and psychology practitioners believe that drug treatment of personality disorders is ineffective, and common psychological counseling/psychotherapy is also difficult to achieve results. If a patient is diagnosed with a personality disorder, it often means a poor prognosis and difficulty in recovery. Whether it is a clinical psychiatrist or a psychotherapist/counselor, there is a sense of helplessness. This will increase the psychological pressure on patients and their families, and is even more detrimental to diagnosis, treatment and recovery.
Moreover, we have found that adolescent patients, as well as adult college students and graduate students, often have a certain ability to self-reflect. Especially after we have established a full trust relationship with them, we point out their shortcomings and they are willing to accept them rationally.
Therefore, for this group of patients, I think we should be very cautious when making a diagnosis. It is best not to diagnose it as a personality disorder, but as a personality change.
Simply put, from the perspective of a multidisciplinary diagnosis and treatment model, we believe that "personality change" is the early stage of personality disorder.
In other words, the patient has obvious personality abnormalities and has many irrational cognitions. When encountering setbacks, it is easy to blame the outside world. However, when they are emotionally stable and relatively rational, they still have a certain ability of self-reflection, can recognize their own shortcomings, and have strong personality plasticity.
Of course, this is still controversial in the industry. Our views from the perspective of multidisciplinary diagnosis and treatment do not represent the opinions of mainstream psychiatry.
What we most often encounter in clinical practice are patients with depression combined with paranoid personality changes. They are sensitive and suspicious, and easily mistake other people's good intentions for bad intentions. They often interpret other people's words and deeds from a negative perspective, thinking that they have been deceived, used and harmed.
Especially when they are emotionally unstable and irrational, it is very easy for them to attribute all their setbacks and faults to others, such as parents, teachers, classmates or strangers who have caused superimposed psychological trauma to them. They fiercely blame their parents at home, smash things, and even punch and kick their parents.
But when their emotions calm down, they often realize that they have shortcomings, and some even apologize to their parents for their extreme behavior. Therefore, these patients have not actually reached the level of personality disorder, and the difficulty of correction and treatment is easier than that of personality disorders.
There is another type of personality disorder that attracts a lot of attention from parents. In recent years, borderline personality disorder in adolescents has received more and more clinical attention from European and American psychiatrists.
The characteristics of borderline personality disorder include violent and rapid mood swings, especially difficulty in controlling strong anger; always being afraid of worrying or thinking that one is abandoned; difficulty in forming close and stable interpersonal relationships, etc.
However, many psychiatrists in China regard the above symptoms as hypomanic/manic episodes and believe that the patient has bipolar disorder. However, the diagnosis and treatment plans for bipolar disorder in mainstream psychiatry are not specific to this group of patients, so the curative effect is often not ideal.
There is actually controversy as to whether teenagers can be diagnosed with borderline personality disorder.
Brace, an associate professor at Harvard Medical School and a well-known American expert on borderline personality disorder in adolescents, pointed out that borderline personality disorder in adolescents must be diagnosed in a timely manner. He found that Dialectical Behavioral Therapy (DBT), developed from traditional Cognitive Behavioral Therapy (CBT), can significantly improve the symptoms of patients with borderline personality disorder and even make the patients gradually recover.
However, currently DBT is far from being popularized in our country, and there is a lack of truly professional, experienced DBT therapists who can combine with our country's social culture. The vast majority of domestic psychological counseling/psychotherapy still relies on traditional CBT, humanistic , family therapy and psychoanalytic therapy, which are still very ineffective for personality disorders.
Based on many years of multidisciplinary diagnosis and treatment (MDT), especially combined with a large amount of experience in pathological memory repair under deep hypnosis, we have found that the root cause of adolescent borderline personality disorder is superimposed psychological trauma and a complete external attribution model, especially when they have suffered a traumatic event of "feeling abandoned".
When their corresponding superimposed psychological trauma is repaired and the wrong attribution pattern is corrected, their symptoms will be greatly relieved and even recover quickly. The patient we had treated, Cuiying, had a clear sense of abandonment, which was consistent with the symptoms of adolescent borderline personality disorder. After psychological intervention, her related symptoms quickly disappeared.
Therefore, this kind of personality abnormality can be reversed quickly. I still prefer not to diagnose borderline personality disorder in teenagers, but rather diagnose borderline personality change. This can avoid increasing the psychological pressure of patients and parents.
03. How do personality abnormalities develop?
Why do some patients with depression have paranoid personality changes/personality disorders, while others do not? Where does personality change/personality disorder come from?
According to our clinical findings, depression and paranoid personality change/personality disorder have the same root cause - superimposed psychological trauma. The two have the same origin, but have different manifestations, mainly because their attribution models are different.
Simple depression is mainly caused by complete internal attribution. After patients suffer from superimposed psychological trauma, they mainly focus on self-blame, guilt, and self-denial, such as thinking that they are stupid, incompetent, and cowardly. Patients with simple personality disorders mainly attribute their problems to other people and society for their setbacks and difficulties in life.
The picture comes from the Internet
On the surface, these two attribution models appear to be completely opposite. Why do they appear in the same patient at the same time? How did it develop?
According to a large number of practical cases in our clinical practice, it is mainly divided into the following three situations.
In the first type, patients first make internal attributions, and then develop external attributions. Depression is followed by personality changes/personality disorders.
Most of these patients are affected by bad family education. Their parents scold and belittle them for a long time. For example, they often use words such as "stupid", "stupid", "like a pig" and "useless".
Subtly, patients will "internalize" these negative comments. In other words, they internally agree with their parents' words and believe that they are incompetent and useless. When they encounter more and more setbacks, they continue to blame themselves and try their best to deny themselves, which often leads to depression.
But as they are exposed to external information, their attribution patterns will also change. For example, some patients have been negatively affected by some psychoanalysts.
Some patients with depression have received psychological counseling from psychoanalysts. Some psychoanalysts place too much emphasis on parents’ mistakes in family education. The patient
originally believed that it was all his fault, but under the guidance of the psychoanalyst, he instead believed that the culprit was his parents, and gradually became angry at his parents, "They are the fault of what I am now." Their attribution patterns began to include irrational external attributions.
Some patients do not receive psychological consultation from psychoanalysts, but psychoanalysis has a wide range of influence. Many people are also affected by psychoanalysis when browsing information and reading articles online.
For example, there are many netizens who strongly accuse their parents on the Internet, denounce their parents' faults, and believe that their parents "control" and "attack" them. These words are the language of psychoanalysis. Some online platforms even had post bars and discussion groups with themes such as "Both parents are a scourge".
Also, there are many "angry youths" and "trolls" on the Internet nowadays. They always attribute their frustrations and some social phenomena to sinister people's hearts, social injustice, systemic shortcomings, etc. The comments they make are very irrational and inflammatory.
When patients with depression are repeatedly exposed to this information, they will easily think of their own growth experiences and encounters, and the related psychological trauma will be greatly activated, and they will easily gradually accept the above-mentioned extreme concepts and develop an external attribution model.
As this situation occurs repeatedly, patients are prone to paranoid personality changes/personality disorders. When they encounter setbacks, their first reaction is likely to be loss, depression, self-denial, and complete internal attribution. But as the anger slowly emerges, they will turn to external attributions, blaming their parents and society.
The second situation is that the patient first has external attribution, then gradually develops internal attribution , and personality change/personality disorder is secondary to depression.
Patients of this type have also suffered from superimposed psychological trauma from family education, school, society or the Internet.However, the strong negative emotions caused by these traumas are mainly anger and grievance. They felt very dissatisfied, but they did not release their negative emotions in time, and they did not receive scientific and positive guidance, nor did they learn to deal with frustrations rationally.
Sometimes, their rights are indeed violated, but parents and teachers do not pay attention and do not take reasonable and fair measures. This caused them to suffer from superimposed psychological trauma.
When these events occur many times, they are prone to complete external attribution patterns, and some have even reached the point of personality disorder. They always love to cause trouble, get into fights, violate school and social norms many times, and refuse to change despite repeated admonitions, showing no intention of repentance.
In the past, " conduct disorder " in psychiatric departments often referred to this kind of underage patients. In the eyes of the public, they are "bad boys" with questionable conduct, but in fact they often have abnormal personalities.
Such patients will constantly encounter interpersonal conflicts in society, run into obstacles everywhere, and even repeatedly touch the legal bottom line, leaving a "criminal record". In a state of long-term depression, they may develop secondary depression and internal attribution, where they deny themselves while blaming others or society.
The third situation is the coexistence of internal and external attribution. These two attribution models develop during the same period. There is no obvious order in which depression and personality changes/personality disorders appear.
The most typical characteristic of this type of patients is "being in trouble". When faced with external setbacks, patients often make internal attributions. Although they are angry inside, they dare not express it. They mainly blame themselves for being too weak and useless. So he behaves like a coward, submissive, and afraid to fight back when bullied by others.
But at home, as long as the parents' words and deeds are slightly inappropriate, the patient's trauma will be activated, and he will almost completely lose control of his emotions, put all the blame on the parents, and even beat and kick the parents, which is manifested as external attribution.
Of course, their parents must have caused superimposed psychological trauma to them, inadvertently caused them psychological harm, and failed to establish a close parent-child relationship with them. This is an important prerequisite.
Therefore, when we provide psychological intervention to such patients in clinical practice, we must first use the Pathological Memory Repair Technology under Deep Hypnosis (TPMIH) to find and accurately repair their main superimposed psychological trauma, and guide them to strengthen self-reflection and realize that they also have shortcomings.
After the trauma has been repaired, we will conduct cognitive psychological intervention on them to strengthen the patients' self-reflection awareness and ability, and guide the patients to rationally self-reflect when they encounter subsequent setbacks, rather than blindly denying themselves, let alone blaming all responsibility on the outside world. In this way, we can try to avoid another depressive episode, actively summarize and improve our shortcomings, and enhance reverse quotient .
At this stage, we often find that after trauma repair, patients suddenly understand the "reasons" that they could not hear in the past. They are more likely to accept their own shortcomings and can rationally understand some of the ways others treat them, especially when they realize that their parents' intentions are actually good.
In addition to superimposed psychological trauma, some patients with personality disorders, such as narcissistic personality disorder and histrionic personality disorder, have pathological positive emotional experiences as their psychological roots. This term may sound a bit difficult to understand, but it can be understood simply as the patient's distorted cognition due to some exciting and happy positive emotional experiences.
For example, many teenagers have received excessive praise from adults since childhood, and they feel happy and happy. Their cognition is also prone to bias, and they become conceited and arrogant. They believe that they must maintain an excellent and beautiful personality and find it difficult to accept failure.
Another example is the "Electric Shock Maniac" Yang Yongxin . He seriously lacks empathy and laughs happily while watching teenagers being electrocuted to death by himself.Many parents who blindly worshiped him praised him, which caused him to develop pathological positive emotional experiences and become arrogant and arrogant.
Yang Yongxin actually meets the diagnostic criteria for narcissistic personality disorder. The attribution model of this type of people has a greater deviation. They will attribute all their achievements and honors to their own merits and completely internalize the attribution.
However, when encountering setbacks, difficulties, conflicts and contradictions with others, they will adopt a completely external attribution model, thinking that it is other people's fault and it is caused by external factors.
Also, Lin Shengbin, the husband of the hostess who was the victim of the "Hangzhou Nanny Arson Case", after the death of his wife and children, he performed grandly in front of the public, deliberately performed miserably, and created a "affectionate persona", which is consistent with the performance of histrionic personality disorder.
His "performance" initially received support and encouragement from a large number of netizens, which caused him to develop a pathological positive emotional experience and further strengthened his behavior.
04. If parents do this, it will help correct their children's personality abnormalities.
The above has analyzed in detail the causes, development and internal relationships of depression accompanied by personality changes/personality disorders. So what should parents do to prevent their children from developing personality abnormalities?
As parents, you must first set an example. You must first have the awareness and ability to self-reflect. That is, you must review things seriously and carefully when encountering problems. You must first see your own shortcomings and what you can do to improve. But at the same time, we should also see objective factors and not fall into excessive self-blame or self-sin. Then when children encounter setbacks, parents can guide their children to learn self-reflection.
But many parents lack this awareness. When their children make mistakes, they will only take some punishment methods, such as making the children face the wall to reflect on their mistakes, making them stand, etc.
Pictures come from the Internet
The ability to self-reflection is acquired. Many children do not know how to truly self-reflect. They may realize what they have done wrong, but they do not know how to change or improve. It is easy to repeat the same mistakes next time.
In the process of being punished by their parents, some children learn to watch their actions and tell their parents what they want to hear. They even lie to make their parents think they are really wrong, but in fact they still don't know how to change.
Even if parents see through their children's lies, many people will only accuse their children of being dishonest, without understanding the psychological activities and psychological needs behind their children's lies.
Therefore, we hope that parents can consciously guide their children to learn self-reflection. After their children make mistakes, reasonable punishments can be implemented so that children can realize the cost of making mistakes. But after punishment, when children feel sad, sad, or wronged, parents must learn the three steps of positive communication:
First, empathize with the children, understand their feelings, and provide comfort; then listen to their inner thoughts and feelings. Wait until the child is relatively calm and willing to listen to what his parents say, and then review the incident with the child to let the child realize where he did not do well enough and how to deal with it more intelligently next time; where the child is attributable to other people and external factors, we do not need to blindly blame ourselves.
Parents can also reflect on themselves and talk about their own responsibilities for insufficient education in this incident and how to improve in the future. This can not only reduce the child's psychological pressure, but also set a good example for the child.
This kind of education method is more conducive to children gradually forming a comprehensive attribution model and making them healthier mentally and physically.
In addition, if the child has been diagnosed with depression, but the drug treatment is not effective (it is likely to be treatment-resistant depression), then parents must also learn to identify whether the child has personality changes or personality disorders.
The relevant diagnostic criteria for different types of personality disorders can be easily found online. Parents can refer to them and actively communicate with their children's psychiatrists after summarizing their opinions. If the psychiatrist has expertise in personality disorders, he or she can often provide some helpful advice.
If parents or doctors believe that the child does have certain personality abnormalities, they can, on the basis of drug treatment, guide the child to strengthen his self-reflection awareness and ability when the child's mood is relatively stable. Of course, parents can also seek professional psychological counseling or psychotherapy. But for adolescent patients, you should be careful when choosing a psychological counselor/psychotherapist, and it is best not to choose a psychoanalyst.
At the same time, parents must also strengthen self-reflection, change and improvement. Clinical research and our clinical practice have found that many patients with personality abnormalities have parents or one of their parents who also have serious personality problems, and some may even have reached the diagnostic criteria for personality disorders.
Especially parents who have achieved little success in their careers and have some status and power in society are more likely to develop paranoid personality disorder, narcissistic personality disorder, and obsessive-compulsive personality disorder. They often appear to be authoritarian and dictatorial at home, and lack self-reflection awareness and ability.
Even if someone points out that their education methods and the way they get along with each other are inappropriate, it is difficult for them to listen. It's not until the child's condition becomes more and more serious that they really can't solve it, then they start to think about whether there is something wrong with their own education methods.
But what is the specific problem? They are often confused and do not know how to repair the parent-child relationship. Later, we used the Pathological Memory Repair Technology under Deep Hypnosis (TPMIH) to accurately find out the traumatic events they caused to the children, and pointed out their faults one by one. Only then did they begin to have the awareness and ability to self-reflect.
During clinical psychological intervention, I would say to some very stubborn parents: "You just don't hit the wall and don't look back. You don't realize your mistake until you hit your head and bleed!" When these parents are talked about their inner pain, they are often speechless and their faces turn red, like children who have made mistakes.
Of course, the self-reflection of these parents also has a process. Some parents have initially developed a sense of self-reflection under our guidance, but after returning home, it is difficult to change the attribution pattern that they have had for many years, and they have violent conflicts with their children.
Fortunately, after our psychological intervention, some children have become more mature, rational, and confident, and have the courage to express their own ideas and point out their parents' shortcomings with reasonable evidence. Only then do their parents wake up again and strengthen self-reflection. From this perspective, adult personality disorders are not completely irreversible.
Therefore, with psychiatric drugs, professional psychotherapy/psychological counseling, and parents’ continuous self-reflection, change and improvement, the personality changes and even personality disorders of many patients with refractory depression can be slowly corrected. Our Pathological Memory Repair under Deep Hypnosis (TPMIH) can quickly solve this problem, but it is not the only way.
I hope this article will be enlightening to parents. Self-reflection is not only a kind of awareness, but also a kind of ability and wisdom. If you want to speed up your child's recovery, parents must take the lead in setting an example!
In order to help everyone objectively and scientifically understand personality abnormalities, especially personality disorders, we will speed up and strive to launch the corresponding column as soon as possible, and provide in-depth professional interpretation from the perspective of the multidisciplinary diagnosis and treatment model (MDT).
If parents have a deep understanding of personality abnormalities, especially personality disorders, learn to self-reflect, and consciously improve the family atmosphere and parent-child relationship, this will greatly promote the recovery of their children and improve the entire family system.
References:
1. Shen Yucun Psychiatry, 6th edition, edited by Lu Lin
2. Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association
3. Analysis of personality characteristics of patients with treatment-resistant depression, Wu Wenjun et al., 2018
4. Major depressive disorder, anxiety disorder and personality disorder Research on comorbidities and related psychological factors, Xu Chenggang, 2007
5. Research on comorbidities of depressive disorders and personality disorders, Zhou Yuping et al., 2003
#Focus on depression# #How to judge whether a person has a personality disorder# #Psychology#
