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Personality DIsorders (Attachment Theory (Mary Ainsworth - strange…

- - - - personality integration is prevented by trauma, abuse, neglect
      - if bad so far outweighs the good, when they come together, only bad is left - this is why they split - in order to keep the good
      - borderlines actually induce staff splitting - good staff will see pt as fragile and misunderstood, bad staff will see pt as phony (often along pre-existing lines of staff tension)
      - both sides of split see each other negatively - care of pt becomes contradictory - pt responds to fragmentation by getting worse - split w/in the pt is now enacted w/in the staff - morale drops
      - they recreate the environment they know - this has a sense of safety for them - solidifies that the problem is the world, not them - not good bc then you can't change things
      - also split the same person and themselves during different points of time - when idealizing, doc feels like they alone have the power and skill to help the patient (this is seductive) - but when the balance shifts, patient retaliates and seeks revenge against bad dr
      - your lapse of judgment as doc will NOT be excused
      - staff splitting should alert you to Cluster B; staff should talk it out and agree to one treatment plan; beware of feelings toward pt - looking forward to appointment, confiding about yourself, seeing them outside of hours; also beware of hatred - and do not respond to their anger; be clear w/ limits and your availability
- - - - temperament - biological
      - character - social/cultural