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How does a personality disorder arise, according to the cognitive-behavioral perspective? First, there are inherited predispositions that may represent primeval strategies. For example, Beck has suggested that the antisocial personality reflects a predatory strategy, whereas in contrast, the paranoid personality reflects a defensive strategy (see Pretzer&Beck, 2005). Second, the characteristics of personality disorders can result from social learning, especially when the social environment enhances genetic predispositions. A child born with a shy disposition, in a household that seems threatening and/or confusing, may naturally withdraw. That withdrawal, taken to its extreme, is a strategy compatible with the avoidant personality disorder. And finally, there is the possibility of traumatic experiences during development. Personality becomes well established during childhood. If one’s experiences during this important time are dysfunctional and traumatic, the individual is likely to develop a personality that has ingrained dysfunctional schemas, thus affecting the individual’s life from that point forward. In this model, personality disorders are not necessarily any different in form than other psychological conditions, but since they directly involve one’s relationship with others, they become significant, problematic features of one’s daily life:

…The cognitive view of “personality disorder” is that this is simply the term used to refer to individuals with pervasive, self-perpetuating cognitive-interpersonal cycles which are dysfunctional enough to come to the attention of mental health professionals. (pg. 61; Pretzer&Beck, 2005)

The basic approach to treating personality disorders with cognitive therapy is not different than usual, but does require some special attention to detail:

Personality disorders are among the most difficult and least understood problems faced by therapists regardless of the therapist’s orientation. The treatment of clients with these disorders can be just as complex and frustrating for cognitive therapists as it is for other therapists…For cognitive therapy to live up to its promise as an approach to understanding and treating personality disorders, it is necessary to tailor the approach to the characteristics of individuals with personality disorders rather than simply using “standard” cognitive therapy without modification. (pp. 44-45; Pretzer&Beck, 2005)

Based on this concern, Pretzer and Beck (2005) have offered a list of twelve key elements that require attention when using cognitive therapy to treat an individual with a personality disorder:

1. Interventions are most effective when based on an individualized conceptualization of the client’s problems.

2. It is important for therapist and client to work collaboratively toward clearly identified, shared goals.

3. It is important to focus more than the usual amount of attention on the therapist-client relationship.

4. Consider beginning with interventions which do not require extensive self-disclosure.

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Source:  OpenStax, Personality theory in a cultural context. OpenStax CNX. Nov 04, 2015 Download for free at http://legacy.cnx.org/content/col11901/1.1
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