personality disorders

personality

• individual differences in characteristic patterns of thinking, feeling, and behaving

• engrained and enduring of r/t oneself, others, and environment

• consistent; do not change easily

personality disorder

triats become so inflexible and maladaptive that they are severely impairing the person’s ability to function

difficulty in these areas of day-to-day functioning

• Inflexible & maladaptive responses to stress

• Inaccurate perception & interpretation of world & others

• Inappropriate emotional responses (moods fluctuate very easily)

• Difficulty with impulse control (don’t think about consequences)

• Significant disability in work & interpersonal relationships (always some kind of conflict; never think it’s their fault)

• They believe that their problems stem from others and the world itself; they never take responsibility for their part

cluster A personality types

• unusal level of suspicion (distrusting, questions motives)

• cognitive impairment (distorted)

• high level of social isolation and social detachment

cluster A examples

• schizotypal

• paranoid

• schizoid

schizotypical PD

Described as odd or eccentric

• Magical thinking

• Perceptual distortions

• Rigid & peculiar ideas

• few (if any) close relationships (don’t understand how relationships form); have tendency to isolate

• They are still grounded in reality; they know who they are, who others are, etc.; difference from schizophrenia

• This could advance into schizophrenia later on (not always)

paranoid PD thought patterns

• doesn’t trust others

• suspicious

• believes others want to exploit, harm, or deceive them

• hypersensitive; take criticism poorly

• always believe they’re right

paranoid PD behaviors

• hostile, stubborn, argumentative

• hypervigilant - always on guard

• jealous, controlling, unwilling to forgive

• cold and distant

schizoid PD

• Emotionally detached and distant

• Do not seek out or enjoy relationships (prefer solitary activities; put a lot of energy into things they could do by themselves)

• Show indifference to praise/criticism

• Reclusive, isolated, and dull

• Organize their lives in a manner that limits human interaction (may choose occupations with little to no social activity)

• No close friends; may only interact with first-relative family members

cluster B PD

• Dramatic, emotional, erratic behavior

• Problems with impulse control, emotional processing and regulation, and interpersonal relationships

• Very little insight into their disorder

• Use dysfunctional methods to ensure their needs are met (manipulation is common defense mechanism)

• Acting out behaviors and antisocial acts

• Usually treat them for other disorders (depression, suicidal ideation, substance abuse)

cluster B types

• antisocial

• borderline

• narcissistic

• histrionic

antisocial PD

• psychopath/sociopath

• manipulative, exploitative, disregard for others (callousness)

• arrogant

• no remorse

• takes no responsibility

• lies; engages in illegal acts

• disregards safety of others

• often have prob w/ substance abuse

• able to manipulate bc they have fake persona to get what they want

borderline PD

• Inability to regulate emotions (rapid mood swings; periods of intense depression, irritability, anxiety; may only last a few minutes)

• Unstable interpersonal relationships (unstable and chaotic)

• Impulsivity (dangerous behaviors; excessive spending, reckless driving, substance abuse, vengeance binge eating)

• Distorted self-image & identity

• Fear of abandonment

• They find the love of their lives several times a year, and then split because the other person was “crazy”

• Have periods of feeling boredom 

borderline PD - engaging in harmful behaviors

• cutting - doesn’t have to be suicidal; something casual or coping

• risky sexual behavior

• substance abuse

• splitting - find people sev times a year that they love sm. Then, see their faults (even if just 1) and think they’re crazy and have no use for them anymore. Aren’t able to separate good and bad. Love conflict

narcissistic PD

• Grandiose view of self, arrogant, self-centered

• Need for constant admiration

• Exaggerate talents & achievements (may take advantage of others to achieve goals)

• Feel “special” & unique & often misunderstood

• Inability to recognize viewpoints of others

• Sense of entitlement

• Lack of empathy for others

• Have fantasies focused on unlimited power, success, and intelligence

• Concealing a deep sense of insecurity and low self-esteem

histrioninc PD

• Attention-seeking behaviors

• Impulsive

• Melodramatic (as if they are performing for an audience)

• May act flirtatious or provocative

• Self-esteem based on others’ approval and does not arise from true self worth

• Love to be the center of attention (would do anything to be the center of attention)

• In relationships tend to “smother” other person because of the constant need of admiration and feeling desired

• May try to commit suicide to get attention

• Overly concerned with their physical appearance

• Very shallow in their reactions

• Emotions can shift very rapidly

cluster C PD

• anxious/fearful

• patterns of social shyness, hypersensitivity, need for orderliness, and relationship dependency

• difficulty functioning in social situations

• hypersensitive to criticism, disapproval, and rejection

• need constant reassurance

• often blame themselves

cluster C exames

• avoidant

• obsessive-compulsive

• dependent

avoidant PD

• Shy, timid

• Sensitive to rejection

• Low self-confidence (feelings of inadequacy)

• Avoid interpersonal situations

• Can’t stop thinking about their own shortcomings

• Form relationships only by people they feel they will not be rejected by 

• Would rather be alone than face the feeling of rejection

• Have the desire to be in a relationship

• Choose occupations with limited interactions with others (no leadership positions)

obsessive compulsive PD

• Preoccupied with orderliness & perfection

• Like to be in control (emotionally withdraw if they aren’t in control)

• Rigid standards (may keep them from carrying out tasks or projects)

• Overly concerned with details, rules, lists

• Very inflexible and stubborn

• Have difficult time of delegating tasks to other people (giving up control, trust, and responsibility)

• Don’t have the compulsion, repetitive thoughts that are seen with OCD

dependent PD

• in relationships - they are submissive, passive, and self-douting

• want others to assume responsibility for major areas of life

• stays in relationships (even abusive)

• avoid being alone

• difficulty talking ab disagreements bc scared of being alone

assessment of PD

Assess primitive defenses - suppression, humor; unable to use higher level defense mechanisms

Patient history:

• Medical history

• Past physical, sexual, or emotional abuse

• Risk of self- or other-directed harm (suicidal thoughts, homicidal thoughts, self-injurious behavior)

planning implementations for PD

• try to understand pt complaints

• need to build trust

• give realistic choices

• remain neutral

basic level interventions

• Milieu management (safety; involve in group therapy, calm and consistent approach)

• Pharmacological interventions - Antidepressants, antianxiety, mood stabilizers

• Case management - External resources, follow-up care, etc.

advanced practice interventions

• Dialectical behavioral therapy (DBT)

• Cognitive behavioral therapy

interventions for manipulative and impulsive behavior

• Establish what is acceptable and unacceptable (let them know everything ahead of time)

• Establish consequences for unacceptable behavior

• How to use healthier coping mechanisms

• How to assess impulsive cues and behaviors