Cognitive theories relating to personality disorder

Personality disorder refers to enduring character traits and maladaptive behaviours which are egosyntonic and accepted by the patient as part of their personality. Cognitive treatments are longer-term treatments than those generally applied to conditions such as depression, anxiety and OCD and are aimed at modifying the underlying fundamental beliefs of the individual which are causing problems.

In Chapters 8 and 9, the basic principles of cognitive therapy were described. The basic triad was explored whereby our interactions with the environment and other people lead to certain beliefs about self, others and the world. These beliefs vary in accuracy and functionality and are fundamental, usually not articulated and accepted as ‘absolute truths’ Beck (1995). Cognitions (verbal or pictorial) are based on attitudes or assumptions (schematas), which develop from previous experiences (Beck, 1967, 1979). Another term used to describe schemata is core beliefs. The evidence of these schemata are the NATs that arise from underlying assumptions that in turn are ‘rules’ which are a product of these schemata.

The schemata are thus patterns of beliefs which are developed in early life in an attempt to make sense of the world and the environment. They are not logical but are held with complete conviction as absolute truths. The hierarchy of these thoughts is shown in Fig. 14.1.