personality disorders

Movie Versus Reality

  • Reality: Evidence-based personality breaks or multiple personalities are rare occurrences.

  • Movie Examples:

    • Fatal Attraction

    • Mommie Dearest

    • Shutter Island

    • American Psycho

What is a Personality Disorder?

Definition of Personality

  • Personality: The way individuals perceive and interact with the world; their social relationship characteristics.

Traits of Personality

  • Personality Traits: Inflexible patterns of inner experiences and outward behavior that deviate from one's culture.

Characteristics of Personality Disorders

  • Personality Disorders: Deeply ingrained, inflexible traits that are maladaptive, causing distress or impairing functioning.

  • Traits of Personality Disorder:

    • Maladaptive patterns of relating to environments and themselves.

    • Subjective distress influencing cognition, affect, and behavior.

    • Significant functional impairment.

Predisposing Factors to Personality Disorders

Neurobiological Factors

  • Brain abnormalities in the frontal, temporal, and parietal lobes have been observed, but the exact relationship to personality disorders is unclear.

Psychological Influences

  • Childhood trauma is a significant risk factor for developing personality disorders.

  • These disorders exist across races, ethnicities, and socioeconomic groups.

Clinical Questions

  • Intervention for Manipulative Behavior: In care plans, it is essential to Institute consequences for manipulative behavior while avoiding enabling actions.

Characteristics of Individuals with Personality Disorders

  • Show maladaptive patterns in:

    • Cognition

    • Affectivity (emotional responses)

    • Interpersonal functioning

    • Impulse control

Interventions for Patients

  • Combine limit-setting with therapeutic interactions to manage manipulative and impulsive behaviors effectively.

Risk Factors for Self-Harm Behaviors

  • Risk factors include:

    1. Dependent personality disorder.

    2. History of bulimia nervosa.

    3. Recently received a promotion at work.

    4. Borderline personality disorder (most concerning).

Types of Personality Disorders

Cluster A: Odd Behavior

  • Types:

    • Paranoid

    • Schizoid

    • Schizotypal

Cluster B: Dramatic Behavior

  • Types:

    • Antisocial

    • Borderline

    • Narcissistic

    • Histrionic

Cluster C: Anxious Behavior

  • Types:

    • Avoidant

    • Dependent

    • Obsessive-Compulsive

Clinical Situations

  • Communication with Clients: Review daily schedules calmly, balancing assertiveness and understanding while managing negative responses.

Interactions with Personality Disorders

Paranoid Personality

  • Key Strategies: Be honest, acknowledge mistakes, set clear limits, and minimize confrontation.

Borderline Personality

  • Approaches include maintaining stable communication, being aware of defense mechanisms, and setting limits on acting out behaviors.

Dependent Personality

  • Respect their attachment needs and support autonomy cautiously to avoid exploitation.

Avoidant Personality

  • Interact supportively and non-critically, given their potential embarrassment.

Obsessive-Compulsive Personality

  • Ensure clear and precise explanations and allow patient control over care to foster autonomy.

Primitive Defense Mechanisms

  • Common primitive defenses include splitting, dissociation, and projection.

Assessment Guidelines for Personality Disorders

  • Assess for suicidal thoughts, underlying medical or psychiatric conditions, cultural background, significant losses, and the impact of acute stressors on the patient.

Treatment Strategies

Short-Term Goals

  • Focus on crisis stabilization and symptom control through modifying dysfunctional thoughts and behaviors.

Long-Term Goals

  • Aim for skill development and personality change through structured therapy and self-management.

Milieu Therapy

  • Facilitates management of affect in group contexts through peer interactions and skill-based groups.

Psychotherapy

  • Dialectical Behavior Therapy: An effective treatment for borderline personality disorder focusing on:

    • Mindfulness

    • Interpersonal effectiveness

    • Distress tolerance

    • Emotional regulation

Staff Planning and Education

  • Training staff in handling disruptive behaviors is vital for crisis management. Regular communication ensures coordinated positive care in challenging situations.

Common Characters in Media Representing Disorders

  • Examples include:

    • Willie Wonka (The Chocolate Factory)

    • Sheldon Cooper (The Big Bang Theory)

    • Ted Bundy or Donald Trump as controversial figures representing certain traits in personality disorders.