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A Training Module for Personality Disorders

Personality Disorders

Kacey L.

on 12 June 2013

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Transcript of A Training Module for Personality Disorders

A Training Module
Personality Disorders
What is Personality?
Types of Personality Disorders
What is a Personality Disorder?
Cluster A:
A distinctive set of traits, behavior styles, and patterns that make up our character or individuality.

Our attitudes, thoughts, feelings, and our perception of the world.

One’s social skills, impulse control, emotion control, and learning from past experiences
Causes distress or impaired functioning
Difficulty participating in social actitivies
Holding a narrow world view
Inability to respond to changes and demands
A tendency to be inflexible and rigid
Difficulty dealing with other people
odd or eccentric behaviors
Schizoid, Paranoid, Schizotypal
Cluster B:
dramatic, emotional, or erratic behaviors
Antisocial, Borderline, Narcissistic, Histrionic
Cluster C:
anxious and fearful behaviors
Avoidant, Dependent, Obsessive-Compulsive
Prevalence of Personality Disorders
An estimated 11% to 22% of people with an average IQ have a personality disorder.

Rates among persons with developmental disabilities are estimated between 23% and 31%
Personality disorders are generally diagnosed in persons with mild intellectual deficits as moderate and severly impaired persons are difficult to assess.

IQ Classification Needs
50/55 -70

35/40 - 50/55

20/25 - 34/40

below 20/25
Mild MR

Moderate MR

Severe MR

Profound MR

intermittent support
(episodic needs)

limited support
(specific periods of time)
pervasive support
(life-long, intense need)
extensive support
(regularly for an extended period of time)
Cluster Type Percentage


Paranoid 5
Schizoid 10

Antisocial 3
Histrionic 1
Impulsivity 7

Dependent 3
Schizotypal Personality Disorder


ule out psychotic disorder and pervasive developmental disorder
aranoid ideation
ccentric behavior or appearance
onstricted (inappropriate) affect
nusual (odd) thinking and speech
acks close friends
deas of reference
nxiety in social situations
agical thinking or odd beliefs
xperiences unusual perceptions
Paranoid Personality Disorder

pouse infidelity suspected
nforgiving (bears grudges)
uspicious of others
erceives attacks (and reacts quickly)
nemy or friend (suspects either)
onfiding in others is feared
hreats are perceived, even in benign situations
Schizoid Personality Disorder

etached (or flattened affect)
ndifferent to criticism and praise
exual experiences of little interest
asks (activities) done alone
bsence of close friends
either desire/enjoy close relationships
akes pleasure in few activities
Cluster C
Cluster B
Cluster A
Antisocial Personality Disorder
onformity to the law is lacking
bligations are ignored
eckless disregard for safety of self and others
emorse is lacking
nderhanded (deceitful, lies, cons others)
lanning is insufficient (impulsive)
emper (irritability and aggression)
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Personality Disorder
uicidal or self mutilating behavio
nstable and intense relationships
mpulsivity in potentially damaging areas
ontrol of anger
dentity disturbance
issociate or (paranoid) symptoms that are transient or stress related
bandonment/chronic emptiness
acking mood stability
rovacative or sexually seductive behavior
elationships considered more intimate than they actually are
ttention seeking and uncomfortable when not center of attention
nfluenced easily
tyle of speech is impressionistic and lacks detail
motions are rapidly shifting and shallow
"made up" (appearance draws attention to self
motions are exaggerated and theatrical
pecial and believes he/she is unique
reoccupied with fantasies of unlimited success, power, brilliance, beauty, and ideal love
onceited (grandiose sense of self-importance)
nterpersonal exploitation
rrogant or haughty behaviors
acks empathy

of acceptance and being liked required before willing to get involved with others
ejection or criticism preoccupies one's thoughts in social situations
ntimate relationships restrained due to fear of being shamed
ew interpersonal relationships (is inhibited in)
ets around occupational activities involving significant interpersonal contact
mbarrassment (potential) prevents new activities or taking personal risks
elf viewed as unappealing, inept, or inferior
eassurance required for decisions
xpressing disagreement is difficult due to fear of loss of support or approval
ife responsibilites need to be assumed by others
nitiating projects is difficult due to lack of self-confidence
lone (feels helpless and discomfort when alone)
urturance (goes to excessive lengths to obtain nurturance and support)
ompanionship is sought urgently when another relationship ends
xaggerated fears of being left to care for self
oses the point of the activity due to preoccupation with detail
bility to complete tasks is compromised by perfectionism
orthless objects (are unable to discard)
riendship and leisure activities are excluded due to a preoccupation with work
nflexible, scrupulous, over conscientious (on ethics, values, or morality, not accounted for by religion or culture)
eluctant to delegate unless others submit to exact deadlines
iserly (toward self and others)
tubborn and rigid
Alan A. Godwin, Psy. D. 2007

American Psychological Association

Gregory Lester, Ph.D. (Personality Disorders in Social Work and Health Care)


Problem Solving with Reasonable People
4 types of problems we have:
1 Preferences:
I prefer this way and you prefer that way
2 Perception:
One person interprets something or a non-action to mean something that is not true to what the other person intended
3 Pressure:
External forces (problems that need to be extinguished) use up all your energy to keep you from solving the problem.
4 Process:
How you conduct yourself in the midst of a dispute; either pressing buttons or having buttons pressed.

Reasonable People Possess
the ability to acknowledge actual wrongness
the ability to feel bothered if my wrongness hurts others
the ability to acknowledge potential wrongness
the ability to change wrongness
the ability to feel bothered by wrongness
in Action
5 Steps
in Problem Solving
Unreasonable Alternative to Problem Solving:

How the DRAMA affects you...
Reasonable Person
Unreasonable Person
"It bothers me when I hurt you."
Reasonable Person
Unreasonable Person
Reasonable Person
Reasonable Person
Unreasonable Person
Reasonable Person
Unreasonable Person
"It bothers me when you hurt me."
"I see where I am wrong."
"I only see where I am right."
Unreasonable Person
"I could be wrong, you could be right, let's talk about it."
"I'm right, you're wrong, end of discussion."
"When I'm wrong, I'll change."
"I won't change, because I'm not wrong."
"It bothers me when I'm wrong." *cringes*
"So what if I'm wrong." *shruggs*
the issue to one thing. Which problem do you want to address?

the other person. Hear, understand, and appreciate the other person's point of view. This does not mean one must agree with the other person, but when a person does not feel heard, they become defensive.

the option that comes closest to satisfying both sides.
collaborative solution:
both parties feel good about the outcome
we meet in the middle
your way:
I am willing to forfeit my preference and genuinely be okay with it. This does not mean saying "fine".
agree to disagree:
agreeing to disagree agreeably is a healthy option.
the actions to follow.
the issue. Problem solved.
The goal of conflict with unreasonable people is to be right.
Levels of Unreasonable People
It makes you sick:
stress can compromise your immune system

It drives you crazy:
their understanding of reality is so different that it makes you start to question yourself, "Is it me?"

It wears you out:
you replay situations in you r mind over and over until it wears you out
Issues of Communication...
Causes of Personality Disorders
possible genetic factors being identified
genetic links to aggression, anxiety, and fear

Childhood Trauma:
links between number and types of childhood traumas
borderline linked with high rates of sexual trauma

Verbal Abuse:
A study of 793 mothers and children revealed that children who had experienced verbal abuse such as being screamed at, threatened to be sent away, or told they were not loved were 3 times as likely to have borderline, narcissistic, OCPD, or paranoid personality disorders in adulthood

High Reactivity:
sensitivity to light, noise, texture, and other stimuli may play a role
kids who are overly sensitive or have "high reactivity" are more likely to develop shy, timid, anxious personalities
debatable as 20% of infants are highly reactive, but only 10% develop social phobias
a strong relationship with a relative, teacher, or friend can help offset negative influences
Application of Information: Role Play
Client X and his roommates have just finished eating lunch on paper plates, but used water glasses for their beverages. It is Client X’s roommate's turn to do the dishes, so his roommate begins to clear the table. Client X becomes upset as his roommate is clearing the table and throwing the paper plates away. Client X states, “Don’t throw the paper plates away! We can still use them!! Reduce, re-use, recycle!!”

**Staff redirects Client X as they can tell he is escalating.

Despite being redirected Client X is still disgruntled. Client X begins to pace and stare at his roommate as he is washing the dishes. Client X has a verbal outburst due to his roommate not washing the dishes “the right way.”

**Staff intervention
1. A friend comes to visit with his wife and she recounts that he is constantly videotaping the garbage collector because he suspects he is an undercover CIA agent. He also has been cold and hostile with many of his relationships, often commenting on how he “can’t trust anyone anymore.” After talking with your friend for a while, she tells you that he was diagnosed with paranoid personality disorder. What would be the best way for his wife to respond to his suspicions?

A. Acknowledge his concerns but neither reinforce nor dispute them
B. ”Play along” with his suspicions
C. Tell him his suspicions are completely ridiculous
D. Immediately send him for electroconvulsive therapy
2. Your friend is telling you about her profession as “The manager of finance” at the company where she works. When asked about her job she stated, “I am the most important person at the office. Without me the company I work for would crash and burn.” When you talk to her mom later, she tells you that she is actually just one of hundreds of accountants at her company. Which disorder do you suspect?

A. Narcissistic Personality Disorder
B. Obsessive Compulsive Personality Disorder
C. Antisocial Personality Disorder
D. Paranoid Personality Disorder
3. Your friends meet you for dinner. One is wearing a short skirt and a plunging blouse. As soon as she sees you she smiles and asks, “How do I look?” When you begin talking to your other friend, she becomes uncomfortable and quickly interrupts and shifts the conversation back towards herself. Throughout the course of the visit she laughed, cried, and became excessively angry. Which disorder do you think she may have?

A. Paranoid Personality Disorder
B. Avoidant Personality Disorder
C. Dependent Personality Disorder
D. Histrionic Personality Disorder
4. Your coworker is picked up at work and taken into the custody of police officers. It seems he recently burned down a building and is being forced to undergo psychological evaluation. When he is evaluated, it turns out that he has a history of cruelty to animals as well as lying and stealing. Which personality disorder comes to mind?

A. Schizotypal Personality Disorder
B. Histrionic Personality Disorder
C. Antisocial Personality Disorder
D. Dependent Personality Disorder
5. Your busy day gets busier as you are stopped in the break room on your way back to your office from lunch and a coworker approaches you and offers you “magic crystals” that will heal any ailment. While you are speaking to him, he interrupts you and says, “Wait, do you feel that? An invisible force just came into the room.” Which personality disorder is most likely?

A. Borderline Personality Disorder
B. Narcissistic Personality Disorder
C. Schizotypal Personality Disorder
D. Histrionic Personality Disorder
7. You are a doctor and your patient comes into your office wearing a very nice shirt. You compliment him on it and he doesn’t seem to care. In the interview you discover that he has very few relationships outside of his family. Which disorder is most likely?

A. Paranoid Personality Disorder
B. Schizoid Personality Disorder
C. Histrionic Personality Disorder
D. Avoidant Personality Disorder
6. Your friend tends to threaten you with committing suicide whenever she feels slighted and has many cut marks on her arms. Some days she states, “You are the best friend I have ever had!” while on other days she says, “I hate you! How did you even become my friend?” Which disorder is she most likely experiencing?

A. Borderline Personality Disorder
B. Schizotypal Personality Disorder
C. Antisocial Personality Disorder
D. Paranoid Personality Disorder
8. Your friend is accompanied by her husband to therapy and it takes a good ten minutes to convince her to have the session alone. During the session, her therapist discovers that the she makes no decisions for herself without consulting with her husband. She frequently calls him to consult about what she can eat, wear, and where she should go. She comments that it “drives him crazy, but I just feel like I need the reassurance.” Which disorder does the patient likely have?

A. Avoidant Personality Disorder
B. Paranoid Personality Disorder
C. Narcissistic Personality Disorder
D. Dependent Personality Disorder
9. Your coworker is a middle age man who confesses to you that he has never married or even dated because of an intense fear of rejection. He works as a mail sorter in the basement of a large law firm where he feels he can do his job without fear of being criticized or disapproved of. He states that his thoughts are usually preoccupied with fears of someone rejecting him. From which disorder is this man suffering?

A. Schizotypal Personality Disorder
B. Paranoid Personality Disorder
C. Schizoid Personality Disorder
D. Avoidant Personality Disorder

10. While talking with your coworker, you find that he is an extremely productive individual and takes pride in being orderly and in control. He finds it difficult to yield control over to you and your team but has improved since you saw him last. He is obsessed with perfection and has little empathy for those who can’t “shape up.” Which personality disorder might he have?

A. Borderline Personality Disorder
B. Obsessive-Compulsive Personality Disorder
C. Histrionic Personality Disorder
D. Dependent Personality Disorder
Knowledge Assessment
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