Residential Treatment of Personality Disorders at CooperRiis
The residential treatment of personality disorders — long-term patterns of thinking, feeling, and behaviors that are unstable and inflexible personality characteristics that often hinder a person in specific ways — is always person first at CooperRiis.
We want to know people as whole people, not only for how they experience difficulties. And since symptoms of personality difficulties differ and range from mild to severe, our goal is to help all our residents build a life that is meaningful and purposeful for them. We want to know what they envision as a happy life. Our approach is tailored accordingly.
For example, if a resident has been diagnosed with Avoidant Personality Disorder, we will take small, incremental steps toward fostering connection and providing a warm, accepting experience. Person-centered care is the guiding principle. For a resident with a diagnosis of Borderline Personality Disorder, our partnership might focus on emotional regulation. Practices that support emotional regulation, such as mindfulness, DBT, personal therapy, yoga and structured work, might become core to a person’s recovery, depending on personal preferences.
We have found it essential to build a strong foundation of physical health. Whatever type of personality challenges someone may experience, growth and healing can be fostered through healthy eating and sleeping habits, regular exercise, and mindfulness practices. We get to know our residents’ overall health and then work on healthy habits. For most, this holistic wellness approach is a big change from previous treatments. At CooperRiis, our attention is on wellness and possibility rather than concentration on personality diagnoses or diagnoses of illness.
Joining a Community
For residents to have success at CooperRiis, they must be able to function in our open community. We are a voluntary, non-crisis setting and do not operate with locked doors. We work with people diagnosed with personality disorders who are ready and able to take advantage of what we offer. Many of the residents in our program have had some treatment for symptoms of a personality disorder and are sufficiently ready to move forward with building a life.
The Dream Statement
All our residents write or articulate a Dream Statement when joining us at CooperRiis. By writing down their hopes and dreams for the future, our residents have a goal to work toward. We empower them to take ownership of their recovery journey. The Dream Statement is a roadmap that can be returned to any time. The Dream Statement reminds residents of the life they want to build for themselves, and offers purpose for the hard work they are doing to get well.
Using the Dream Statement, residents make smaller daily, weekly, and monthly goals. For example, if a resident diagnosed with Dependent Personality Disorder wants to start a business (Dream Statement) then a smaller goal would be to begin to keep a list of accomplishments in a journal. Over time, as this list gets longer, this resident may begin to recognize all the ways he or she is able to live in a more self-directed fashion. This may lead to trying new things and increased self-confidence; steps to achieving the larger dream of opening a small business. Daily and weekly goals are connected back to the Dream Statement as much as possible so that the resident is always working toward valued goals.
Medications and Supplementation
Medication optimization is the lowest dose of medication for the highest effect with the fewest side effects. Medication optimization is our goal with each of our residents. Residents are fully involved in this process by keeping us apprised of how they are feeling, and if their symptoms have subsided. We also strive for a sustainable solution. The resident’s overall quality of life should improve along with symptom reduction. Our goal is for the medication to work long-term for the resident, with the fewest symptoms and side effects possible.
In addition to prescription medication, we also utilize supplements such as vitamins, minerals, and plant extracts to get the best results for our residents. Melatonin, for example, works just as well for some people as prescription sleeping pills, without the disturbing side effects.
Medication is helpful in tempering the symptoms of the 10 personality disorders. For example, medication helps to stabilize the mood and emotions of those diagnosed with Borderline Personality Disorder, and may help to reduce fear and anxiety in those with Avoidant Personality Disorder.
A Healing Community for the Whole Person
In addition to medication and supplementation, CooperRiis offers an array of psychiatric services, individual psychotherapy, social opportunities, structured work, and holistic wellness coaching. Every facet of the resident’s life is addressed. We treat the whole person.
- Physical wellness
- Emotional and psychological health
- Intellectual creativity and learning
- Social and community connectedness
- Purpose, productivity, and fulfillment
- Empowerment and independence
Our residents work with a multidisciplinary recovery team, comprised of representatives with expertise in the above domains. Because every person is different, some domains will receive more emphasis than others. An extremely conscientious person, for instance, may receive support to enjoy more leisure and relaxation.
Our program helps residents build new habits, find balance and practice new behaviors. The daily structure is calming and helps reduce distress. Healing modalities such as mindfulness meditation, yoga, and therapy bring calm to emotional storms and turmoil.
Social and Community Connectedness
The community aspect of our program is central for those struggling with personality disorders because it prepares our residents to be with the people in their lives in a new way. Personality disorders often contribute to problems in relationships, so being in a supportive and non-judgmental social environment can help people experiment with changes in behavior. If someone has an emotional outburst, or becomes rigid, there is an opportunity to learn more about what the person needs to heal and grow.
What are personality disorders?
Personality is the combination of qualities and attributes that form a person’s distinctive character. The way an individual behaves, thinks, and feels makes them different from other people. Personality is also shaped by a person’s background, experiences, environment, and inherited traits.
Personality disorders are long-term patterns of thinking, feeling, and behaving that are maladaptive and inflexible. These patterns markedly differ from social norms and cause serious problems at work and in relationships, often manifesting in at least two of the following ways:
- Cognition and thinking, including distortions in our views of ourselves or others
- Emotional expression
- Interpersonal functioning, especially how we relate to others
- Impulse control and how we manage feelings
Normal traits that have become extreme often characterize personality problems. For example, being conscientious is generally a desired work attribute. Someone whose work devotion, however, that comes at the expense of all else can experience hardship. While extra work projects and commitments often do arise for people, the difference is the ability to adapt flexibly. An overly conscientious person may be unable or unwilling to attend flexibly to other areas of her or his life, such as friendships and leisure. These areas suffer.
Extreme conscientiousness is one way to describe Obsessive Compulsive Personality Disorder (OCPD), an adaptation that often feels like the way things should be for the person with such traits. It often takes a crisis, such as a spouse leaving, a failure at work, or other hardship for someone to recognize the limits of an adaptation. After all, for the person afflicted with Obsessive Compulsive Personality Disorder, ‘symptoms’ such as obsessive preoccupation with minor details or work output don’t seem like symptoms at all. They feel normal. These traits define who they are.
Note: The main differences between people with OCD (Obsessive Compulsive Disorder) and OCPD is that people with OCD are bothered by their symptoms. They do not view their symptoms, such as intrusive thoughts about germs or compulsive behaviors like hand washing, as desirable. They are uncomfortable with the way they are forced to live because of OCD.
The Ten Personality Disorders and Their Clusters
There are 10 specific types of personality disorders. People can have more than one personality disorder or traits of differing personality disorders. For example, Borderline Personality Disorder and Narcissistic Personality Disorder can be diagnosed together. There are three clusters of personality disorders.
Personality Disorder Clusters
The three personality disorders in this cluster share distorted thinking, social awkwardness and social withdrawal as symptoms.
- Paranoid PD
- Schizoid PD
- Schizotypal PD
The four personality disorders in this cluster share difficulties with impulse control and emotional regulation.
- Antisocial PD
- Borderline PD
- Histrionic PD
- Narcissistic PD
Cluster C The three personality disorders in this cluster share a high level of fear and anxiety. People in this cluster need lots of reassurance from other people.
- Avoidant PD
- Dependent PD
- Obsessive Compulsive PD
Paranoid PD is characterized by:
- generalized mistrust and suspicion of others
- rarely confide in others
- misinterpret others’ behavior as malicious
- looking for ‘clues’ that validate their fears
Schizoid PD is characterized by:
- indifference to social relationships and relationship avoidance
- indifferent to praise
- limited range of emotional expression and emotionally cold and detached
- lack of close friends and no desire for close relationships
Schizotypal PD is characterized by:
- disturbed thoughts and behavior
- unusual or odd beliefs (aliens, UFOs, etc.) and fears
- odd behavior and/or speech
- difficulty making/keeping friendships
- suspiciousness and/or paranoia
Antisocial PD is characterized by:
- antisocial behavior
- externalization and minimization of responsibility
- impulsive and risk-taking behavior
- hostility and aggression
- lack of restraint
- general discontent
Borderline PD is characterized by:
- heightened reactivity and sensitivity
- emotional dysregulation and volatility, including emotional reactions that go to extremes
- crisis prone
- self-destructive behavior
- difficulty managing slights
- feelings of worthlessness and insecurity
- impaired social relationships and pattern of unstable intense relationships
- mood swings
- intense fear of abandonment
Histrionic PD is characterized by:
- needs to be the center of attention
- intense and dramatic
- thinks relationships are closer than they are
- easily influenced by others
- emotions change rapidly
- deeply felt insecurity
Narcissistic PD is characterized by:
- preoccupied with own interests disregard for others’ feelings
- unable to empathize
- bolster themselves through praise and admiration of others
- excessive need for admiration
- inability to handle any criticism
- a sense of entitlement
Avoidant PD is characterized by:
- extremely shy
- fear of ridicule, criticism, and rejection
- overly concerned with looking foolish
- low threshold for criticism
- low self-esteem
Dependent PD is characterized by:
- no trust in their own abilities and lack of self-confidence
- emotionally dependent on other people
- spend great effort trying to please others
- difficulty being alone
- needy and clinging behavior
- fear of separation and/or abandonment
- inability to make decisions without help from others
- devastated when relationships end
- oversensitivity to criticism
- inability to start projects or tasks
- tolerate mistreatment and abuse in order to stay in a relationship
Obsessive-compulsive PD is characterized by:
- concern with orderliness and excessive attention to detail
- need to be in control
- excessive devotion to work
- finds it difficult to relax and enjoy leisure time
- overly meticulous planner
About the Author
Michael Groat, PhD, MS is President and CEO of CooperRiis residential treatment program located in Asheville and Mill Spring, North Carolina. Michael earned his Ph.D. in Counseling Psychology from SUNY-Albany. Prior to joining CooperRiis, he was associate professor of psychiatry and behavioral sciences at the Baylor College of Medicine, Houston, TX, where he also served as director of the division of adult services at the Menninger Clinic.
Michael is also a former candidate in adult psychoanalysis at the Center for Psychoanalytic Studies, Houston, and completed a 4-year fellowship in psychodynamic psychotherapy at the Austen Riggs Center. He has published on suicide prevention, applications of attachment research, and uses of clinical outcomes, and has lectured nationally and internationally on the same. Michael has long-standing interest in suicide prevention, therapeutic communities, organizational and systemic interventions, personality assessment, and intensive psychotherapy.