1. ISA as an Approach to Personality Disorder Anne Malone Undergraduate Dissertation, UUJ

2. Format  Definition of personality disorder  Aims  Method  Key ISA concepts  Theoretical postulates  Results  Reflections  Conclusion

3. Definition of Personality Disorder  Inflexible and maladaptive patterns of personality that begin by early adulthood and result in either social or occupational problems or distress to the individual  10 Subgroups: Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, Obsessive-Compulsive

4. Aims  Investigate utility of ISA as an approach to ‘personality disorder’  Capture complexity of complex psychological difficulties  Focus on biographical experience and identity formation

5. Method  Four respondents identified as having a diagnosis of PD -Borderline PD - PD NOS  Customised Identity Instrument – based on existing literature on PD and past ISA research in clinical areas  Also completed EPQ-R short version

6. Customised Identity Instrument  Entities and Constructs  E.g. of bipolar construct: …is trustworthy/is not trustworthy  E.g. of entities: Me as I am now Me at my best Me at my worst

7. Key ISA Concepts  Empathetic identification: The degree of similarity between the qualities one attributes to the other, whether ‘good’ or ‘bad’, and those of one’s current self-image

8. Key ISA Concepts  Metaperspectives of Self: Respondent’s interpretations of other people’s perspectives of them  Me as my mother/father sees me  Me as most other people see me

9. Key ISA Concepts  Identification Conflicts: function of the respondent’s empathetic identification with an entity and the degree of contra-identification with that entity

10. Theoretical Postulates  (1)The PD group will display dissociative states of identity, with markedly different patterns of empathetic identifications with others across identity states, in contrast to the comparison group.  Psychoanalytic object relations theory (Kernberg 2005)

11. Theoretical Postulates  (2)Higher conflicted identifications with metaperspectives of self will be evident for the PD group than the comparison group  Evidence for interpersonal problems as core pathology of PD (Pincus, 2005)

12. Overall Results  Individual case analyses revealed quantifiable evidence of underlying psychological processes  Explain clinical presentation and symptomology in terms of past biographical experiences and resultant identity structure  EPQ-R: no conflicting findings, but ISA provides much greater depth of info

13. Postulate (1)  PD group displayed markedly different patterns of empathetic identification across self states, in contrast with the comparison group  Results in each case reveal processes underlying current difficulties

14. Postulate 1  Example from case study:  Presenting problems include recurrent suicide attempts and history of perpetrating domestic violence  Reports history of severe physical abuse by mother  ISA results indicate defensive identification with ‘mother as abuser’ when at worst

15. Postulate (2)  PD group displayed highly conflicted identifications with parental and general metaperspectives of self, in contrast to the comparison group  Problematic identifications with caregivers as risk factor for PD?

16. Postulate 2  Example from case studies:  2 cases: antisocial behaviour  ‘Me at my worst’ involves partial resolution of identification conflict  Fulfilling deviant social role?  Both reported being bullied at school

17. Reflections  Respondents found format engaging  Assesses emotions associated with discourses  Quantified info regarding belief system  Use with interventions such as CAT?  Dynamic – indicates direction of identity processes

18. Conclusion  Indicates that ISA can provide insight into the psychological processes underlying PD, both within and across individual cases  Research tool that could potentially uncover the psychological processes underlying the development and maintenance of personality disorders

19. Quotes from respondents  “I remember asking her if she would have fired the gun. She just shrugged her shoulders and kept on washing the dishes”  “They said in court I have a Personality Disorder. What does that mean? Am I sick? Will I be able to work?”

20. Thank you for listening Any questions?