Personality Disorders

Personality Disorders- Normal is Hard-INSTABILITY

• All personality disorders deal w/ unstable relationships and sense of self

  • BADLs are typically fine, But there are big problems w/IADLs socialization and employment

    • Examples include:

      • Repeatedly suspect their partner is cheating (Paranoid)

      • Is uncomfortable when not the center of attention (Histrionic)

      • Believes that he or she is “special” and unique (Narcissitic)

      • Unwilling to interact unless certain of being liked (Avoidant)

Personality Disorders: Coddle them

• Before we address their problems, We first need to build rapport, which is much more DIFFICULT than normal

  • We are gentle, at front right & Honest until is good to challenge them

    • EXCEPTION: pt that are VIOLENT or AUTHORITARIAN

      • We set clear limits and boundaries

Personality Disorders: Clusters

• Cluster A: “A-typical” -Very strange

• Cluster B: “Big Personality”- Dramatic, self-obsessed

• Cluster C: “ Cowardly”- Fearful, anxious

Personality Disorders Coddle them: Cluster A

• Person appear odd, eccentric, different, or bizarre

  • Paranoid (Suspicious)

    • Gain their trust

    • Gentle attempts to engage (not force)

  • Schizoid (Detached)

    • Tolerated silence

    • Client’s choice of engagement

  • Schizotypal (“stranger things”)

    • Tolerate attitude

    • Be curious, but not fascinated or confrontational

Personality Disorders: Cluster A Interventions

• Help them to socialize/interact despite their oddities

  • Interventions:

    • Social Skills training

    • Psychodynamic therapy (expressive activities)

    • CBT

    • Socially undemanding jobs (jobs where they don’t have to interact directly w/others)

Personality Disorders Coddle them: Cluster B

• Persons are extremely emotional, unpredictable and manipulative. They go from 0 to 100 real quick

  • Coddle them: Limit setting!-Clear expectations, Look out for “splitting” (black/white mentality), Monitor your emotional response- supporting without getting sucked into power struggles

    • Antisocial (Anti-rules, Anti-rights and Anti-responsibilities)

    • Borderline (Emotionally unstable)

    • Histrionic (Attention-seeking)

    • Narcissistic ( Big Ego)

Personality Disorders: Cluster B Interventions

• Groups

  • Life skills, social skills

• DBT- Dialectical Behavior Therapy

  • CBT but focus on emotions & relationships

    • The training includes DIME:

      • Distress Tolerance

      • Interpersonal Effectiveness

      • Mindfulness

      • Emotional Regulation

Personality Disorders Coddle them: Cluster C

• Person appear fearful, anxious, or avoidant of social stuff

  • Avoidant (Fear of rejection)

    • Respectful, honest, warm, accepting

  • Dependent (Fear of separation)

    • Accept initial dependency

  • Obsessive-Compulsive Personality Disorder (Perfectionist)

    • Initially accept boring conversation

    • Interrupt as able

Personality Disorders: Cluster C - Avoidant Interventions

• Social Skills Training

• Realistic Self Appraisal

• CBT

Personality Disorders: Cluster C - Dependent Interventions

• Gradually expect and require independent problem solving and actions

Personality Disorders: Cluster C - OCDP Interventions

• Encourage spontaneity & expression (order vs disorder)

• CBT

Personality Disorders Keyline

• Cluster A: A-typical

• Cluster B- Big Personality

• Cluster C- Cowardly

• Initially Coddle them (meet them where they are!), then challenge them!

• STRUCTURE & LIMIT SETTING for rebellious/violent disorders!