PERSONALITY DISORDERS

PERSONALITY DISORDERS Introduction

Clients with personality disorders are among the most difficult to treat. Most will never enter a psychiatric hospital, seek or receive outpatient treatment, or even undergo a diagnostic evaluation. Some will enter the mental health system through family pressure or because of a court order.
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PERSONALITY DISORDERS Introduction (contd)

In the majority of cases, people with personality disorders perceive their problems and difficulties in dealing with other people to be external to them. They feel victimized and blame others. Those who develop an awareness of their selfdefeating behaviour still remain at a loss as to how they got that way or how to begin to change.
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PERSONALITY DISORDERS Introduction (contd)

There is a high degree of overlap among the personality disorders and many individuals exhibit traits of several disorders. Typically, personality disorders become apparent before or during adolescence and persist throughout life. In some cases, the symptoms become less obvious by middle or old age.

PERSONALITY DISORDERS TYPES

There are ten personality disorders, grouped into THREE CLUSTERS. The disorders within each cluster are considered to have similar characteristics.

PERSONALITY DISORDERS Clusters

The clusters and corresponding disorders are: CLUSTER A 1. Paranoid 2. Schizoid 3. Schizotypal CLUSTER B 1. Antisocial 2. Borderline 3. Histrionic 4. Narcissistic CLUSTER C 1. Avoidant 2. Dependent 3. Obsessive-compulsive

PERSONALITY DISORDERS Clusters (contd)

General description CLUSTER A: appear eccentric, exhibit much withdrawal behaviour CLUSTER B: appear dramatic, emotional or erratic. Tend to be very exploitative in their behaviour CLUSTER C: appear anxious or fearful. Behaviour pattern one of compliance.
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PERSONALITY DISORDERS Special note

The three unstable disorders of category B: borderline, histrionic and narcissistic personality disorders, can barely be distinguished from one another. Antisocial personality is easier to diagnose

PERSONALITY DISORDERS Cluster A: Paranoid Personality D.

Very secretive-not likely to trust anyone or confide in anyone Hyperalert to danger Argumentative-keep distance that way Rarely seek help Severe jealousy Seldom require hospitalization
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PERSONALITY DISORDERS Cluster A: Schizoid Personality D.

Prefer solitary activities social situations increase their anxiety Can perform in a job that does not require interaction with others (e.g. night watch) Their affect is blunted or flat do not express feelings verbally or nonverbally. Passive.

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PERSONALITY DISORDERS Cluster A: Schizotypal P.D.

Have a considerable disability Have the most severe distortions of any of the personality disorders: inappropriate affect, odd beliefs, magical thinking, illusions (such as seeing people in the shadows). Preoccupation with paranormal phenomena and magical control. Peculiarities of ideation, appearance and behaviour restrict their lives Very isolative and usually avoided by others Related to schizophrenia but not as severe appears among biological relatives of people suffering from schizophrenia for some reason
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PERSONALITY DISORDERS Cluster B: Antisocial Personality D.

A diagnosis of antisocial personality disorder (ASPD) requires that the characteristic appear before the age of 15, and the client is usually given the diagnosis of conduct disorder The diagnosis ASPD is not applied until after the age of 18 Behaviour includes lying, stealing, truancy, vandalism, fighting, running away from home In adulthood, obligations and rules pose a problem. Hard to keep a steady job or relationship or to honour commitments. Grandiose ideation, irritability, aggression, no guilt, low tolerance for frustration. Hard to learn from own mistakes
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PERSONALITY DISORDERS Cluster B: Borderline Personality D.

People with BPD are characterized by identity disturbances. Their vision of themselves and body image keeps changing Often practice self-mutilation They are unable to see both good and bad at the same time Great overlap with other personality disorders Psychotic episodes are common for some and result in repeated hospitalizations Appears early in boys and later in girls but two thirds of diagnosed people are female. The explanation for this may be societys expectations of girls and women
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PERSONALITY DISORDERS Cluster B: Histrionic Personality D.

People with HPD characteristically seek stimulation and excitement in life they are on a rollercoaster of joy and despair Very self-centered and exaggerate their experiences. Verbose, dramatic, emotional; although arrogant, submissive to authority figures. Flights of romantic fantasy and a lot of acting out Seek attention through seduction Exaggerated attentiveness to own physical appearance Suicidal gestures and threat to get attention
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PERSONALITY DISORDERS Cluster B: Narcissistic P. D.

People with NPD strive for power and success. Their perfectionistic standards make failure intolerable. Preoccupied with fantasies of success brilliance and ideal love Arrogant and egotistical. Exploit others. Emotionally shallow. Exaggerate their accomplishments. Expect special treatment, whether or not they achieve anything.
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PERSONALITY DISORDERS Cluster C: Avoidant P. D.

Social discomfort and avoiding all contact Fearful and shy. Easily hurt by criticism Often depressed and anxious Overly sensitive to opinions of others low self-esteem

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PERSONALITY DISORDERS Cluster C: Dependent P. D.

Dependent and submissive Do not do things alone and always agree with others Volunteer to do unpleasant and demeaning things Severe lack of selfconfidence Avoid all decisions
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PERSONALITY DISORDERS Cluster C: Obsessive-compulsive P.D.

People with OCPD exhibit perfectionism and inflexibility They need to check and recheck objects and situations. Rule-conscious behaviour Industrious workers, but uncreative Very polite and emotionally distant Very protective of their status and possessions difficulty sharing anything Unable to express emotions Preoccupation with logic and intellect Torment themselves with guilt and negative thoughts Has many differences with OCD, especially passion for productivity and excessive devotion to work. OCD is ego-dystonic while OCPD is ego-syntonic.
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PERSONALITY DISORDERS Not otherwise specified (NOS)

The label personality disorder not otherwise specified is used when a person does not meet the full criteria for any one personality disorder, yet there is significant impairment in social or occupational functioning or in subjective distress.

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PERSONALITY DISORDERS Prognosis and Onset

Guarded. By definition, individuals with personality disorders have demonstrated pervasive and inflexible behaviours and thoughts that are characterized by long-standing, maladaptive patterns of relating to others, which deviate markedly from the expectations of the individuals culture. Onset is before adolescence, in adolescence or in early adulthood.
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PERSONALITY DISORDERS Applied Therapy

by helping in self-exploration and substitution of dysfunctional patterns with functional ones through cognitive and long-term treatment aimed at educating the client, particularly in the area of problem-solving.

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PERSONALITY DISORDERS

Always make sure to conduct assessment of the following areas in all mental health conditions:
BEHAVIOUR AFFECT COGNITIVE PATTERNS SOCIAL SKILLS SPIRITUAL COMFORT OR DISTRESS

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PERSONALITY DISORDERS Therapies

Occupational Art Music Movement Recreational Medication Individual Group Family Milieu
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PERSONALITY DISORDERS Goals

Impulse control training: assisting the patient to gain control of impulses through reflection Limit setting: establishing the parameters of desirable and acceptable behaviour Behaviour modification: gaining social skills and improving interaction. Developing healthy peer and other relationships. Anxiety reduction: minimizing apprehension, dread, foreboding or uneasiness related to identified or unidentified sources of anticipated danger.
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PERSONALITY DISORDERS Goals Assessment

Keep in mind that clients may respond to intervention very slowly Define small steps at a time toward the achievement of therapeutic goals Some clients are in so much pain that they wish to grow and change Others do not perceive themselves as having a problem and choose not to become involved in the therapy Suicide risk is high in the 20 age bracket and keeps decreasing with age

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PERSONALITY DISORDERS Change cannot be forced ...

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