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Transcript of Personality Disorder
Disorders What are they? "Personality disorders are a class of personality types and enduring behaviors, which appear to deviate from social expectations. The behaviors are ingrained and inflexible, are enduring rather than episodic, and have their onset in adolescence or early adulthood.” (Hayward 2007) ("Wikipedia," 2012)" In other words: they are long enduring patterns of behavior that deviate from social norms. What are the causes? Genetics, temperament, development, and environment all contribute to the formation of adult personality disorders. (Weston, Riolo, 2007) Types Personality disorders are divided into clusters.
Cluster A is defined by odd or eccentric behavior or thinking. This cluster has disorders such as Paranoid, Schizoid and Schizotypal.
Cluster B is characterized by dramatic or over emotional behavior or thinking. Included in this cluster is Antisocial, Borderline, Histrionic and Narcissistic.
Cluster C has fearful and anxious thinking or behavior. Avoidant, Dependent and Obsessive-Compulsive are the Personality Disorders in this cluster.
There is also a Non-specified category which has disorders that are not included in a specific cluster. These are Depressive, Passive-Aggressive, Sadistic, Self defeating and Psychopathy. (mayo clinic staff, 2010) (Wikipedia, 2012) What is the DSM? The DSM is the Diagnostic and Statistical Manual of Mental Disorders. It's published by the American Psychiatric Association or the APA. It gives Clinicians a common language for the criteria used in diagnosing mental disorders.
While we are currently using the DSM-IV it is being revised and the DSM-V will be released May of next year. (American Psychiatric Association, 2012) By: Michelle L, Anna, Zoë, Courtney and Margaret. Cluster A Cluster B Cluster C Non-Specified Avoidant Personality Disorder (AvPD) Typically described as having long standing low-self esteem, extreme sensitivity to what others say about them and severe social inhibition. (Grohol, 2010) Symptoms of AvPD are;
- Avoids activities that involves significant social interactions because they fear criticism or rejection.
- Unwilling to get involved with people unless they are sure of being liked.
- Shows restraint within interpersonal relationships (no necessarily romantic) because of fears of being ridiculed.
- Is preoccupied by being criticized or rejected in social situations.
- Views themselves as socially inept, unappealing or inferior to others.
- Uses fantasy as a form of escapism.
- Is reluctant to take risks because they may be embarrassing. (Grohol, 2010) How are they diagnosed? To be diagnosed with a personality disorder, a certified mental health professional will look for the following criteria:
- The symptoms have been present for an extended period of time and are not a result of substance abuse or another mental disorder.
-The symptoms cause significant distress or negative consequences in different aspects of the person's life.
- Symptoms are seen in at least two of the following areas:
a) Thoughts (ways of looking at the world, thinking about self or others, and interacting)
b) Emotions (appropriateness, intensity, and range of emotional functioning)
c) Interpersonal Functioning (relationships and interpersonal skills)
d) Impulse Control
("Allpsych online the," 2011) Treatment The most common approach to treating AvPD is Cognitive Behavior Therapy. Like with most personality disorders therapy is more effective when used for specific problems instead of long term use. Things that may be addressed are providing the patient with a better self image and helping them to overcome specific social anxiety problems.
Group therapy is possible but because of the specific nature of the disorder can be difficult to get the patient to attend.
Medication is normally not recommended unless there is a severe Axis I diagnoses in conjunction with AvPD. (Grohol, 2010)(Hofmann, 2007) (Hofmann, 2007) Dependent Personality Disorder Dependent Personality Disorder is defined by the long standing need to be taken care of and fear of being abandoned by those close to them.(Psych Central Staff, 2011) Symptoms: - Has difficulty making decisions without excessive advise and reassurance from others.
- Has difficulty expressing disagreement out of fear of loss of approval.
- Rarely starts projects or does things on one's own because of a lack of self confident in their abilities.
- Goes to excessive lengths to get approval and support.
- Feels uncomfortable and helpless when alone because of the belief that they are unable to take care of themselves.
-Urgently seeks another relationship when another one ends out of the need for care and support.
- Is excessively preoccupied with the fear of being left to take care of themselves. (Psych Central Staff, 2011) Treatment Dependent Personality Disorder in particular can be difficult to treat because of the dependent nature of the patient. The clinician has to be careful not to allow to patient to transfer dependency onto them. This same fear is present within group therapy. The patient's tendency to "latch on" to group members should be avoided.
Keeping this in mind; cognitive behavioral therapy can be useful in treating specific problems. However in this case termination will be the ultimate test. Whether or not the patient is willing to terminate their therapy at a reasonable time is a very good indicator of how successful the treatment was.
As with most other disorders medication is normally not recommended unless a severe Axis I diagnoses accompanies the DPD. (Psych Central Staff, 2011) Obsessive Compulsive Personality Disorder Prevalence About 10% of the population has a Personality Disorder. (Sansone, 2011) Long standing pattern of preoccupation with orderliness, perfectionism, personal and interpersonal control. (Grohol, 2010) Symptoms: -Is preoccupied with details, order, organization and lists to the extent that the point of the activity is lost.
- Shows perfectionism that interferes with the completion of a task.
- Is so devoted to work and productivity that family and friendships are excluded.
- Are inflexible in their morals, ethics and values. (not accounted for by cultural or religious stand points)
- Is unable to discard worn out or worthless objects even if they have no sentimental value.
- Is reluctant to work with others unless they abide by his way of doing things.
- Very miserly in spending. Sees money as something to be hoarded for hypothetical future catastrophes.
- Shows significant rigidity and stubbornness.
(Grohol, 2010) Treatment Treating somebody with Obsessive Compulsive Personality disorder can be challenging because part of the disorder involves the patient believing that their way is the right way. It can be very difficult for a clinician to work with a patient who is unwilling to compromise or open their mind to new possibilities. For this reason, group therapy can also become problematic. (Grohol, 2010) Differences between Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder. The disorders have many similar properties but one of the biggest differences is this;
Obsessive Compulsive Personality disorder is considered egosyntonic which means that the person believes that his or her actions is in their best interest.
Obsessive Compulsive Disorder is considered egodystonic which means that the person knows that their thoughts and compulsions are not reasonable. (Pollak, 1987) Sadistic Persuasive pattern of cruel, demeaning, aggressive behavior and lack of empathy. (O'Meara, Davies, Hammond, 2011) Symptoms •has used physical cruelty or violence for the purpose of establishing dominance in a relationship (not merely to achieve some non-interpersonal goal, such as striking someone in order to rob him or her)
•humiliates or demeans people in the presence of others
•has treated or disciplined someone under his or her control unusually harshly, e.g., a child, student, prisoner, or patient
•is amused by, or takes pleasure in, the psychological or physical suffering of others (including animals)
•has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other goal)
•gets other people to do what he or she wants by frightening them (through intimidation or even terror)
•restricts the autonomy of people with whom he or she has a close relationship, e.g., will not let spouse leave the house unaccompanied or permit teen-age daughter to attend social functions
•is fascinated by violence, weapons, martial arts, injury, or torture Treatment These conditions present treatment challenges, because they are often concealed, and are often associated with guilt and shame. They are generally treated with psychotherapy and/or medication. The type and setting (inpatient vs. outpatient) of treatment utilized is dependent upon the degree of dysfunction the condition causes, as well as the threat the behaviors pose to others.
Examples of treatment are;
- Psychotherapy - Cognitive behavioral therapy - Orgasmic reconditioning
- 12 step programs - Similar to Alcoholics Anonymous, designed for sexual addicts - Social skills training and sex education - Hypnosis - Medications - Antidepressants - Long-acting gonadotropin-releasing hormones (GnRH, ie, medical castration) Self-Defeating Is a pervasive pattern of self-defeating behavior. People with SDPD avoid or undermine pleasurable experiences and are drawn to situations they will suffer. (("Psychnet-uk," 2012)) Symptoms •Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available.
•Rejects or renders ineffective the attempts of others to help him of her.
•Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain ( e.g., an accident)
.•Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, than feels devastated).
•Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure).
•Fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, (e.g., helps fellow students write papers , but is unable to write his or her own).
•Is uninterested in or rejects people who consistently treat him or her well, (e.g., is not attracted to caring sexual partners).
•Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice;
•The behaviors do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused.
•The behaviors do not occur only when the person is depressed.
•The behaviors do not occur exclusively in response to, or in anticipation of, being physically, sexually, or psychologically abused. ("Psychnet-uk," 2012) Treatment Treatments include counseling, group therapy, family therapy and cognitive behavioral therapy. ("Psychnet-uk," 2012) Depressive Personality Disorder •Mood generally characterized by unhappiness, despondency
•Poor self-concept, including low self-esteem and beliefs of inadequacy
•Being critical and disparaging of oneself
•Being critical and judgmental of others•Brooding, worrying
•An outlook of pessimism
•Predisposition to feelings of guilt
(Kuehnel, 2010) Symptoms Consistent patterns of thoughts, feelings, and behaviors. DPD struggle with being able to cope as new situations arise. (Kuehnel, 2010) Treatment Group therapy
Dialectical Behavioral Therapy (DBT)
(Kuehnel, 2010) Passive Aggressive Disorder Passive-aggressive personality disorder is a chronic condition in which a person accepts the desires and needs of others, but actually passively resists them, becoming increasingly hostile and angry. (Sirgan, 2007) Symptoms •Resisting suggestions from others
•Avoiding responsibility by claiming forgetfulness •Blaming others
•Chronic lateness and forgetfulness
•Not expressing hostility or anger openly
•Fear of competition
•Making excuses and lying
•Fear of dependency
•Fear of intimacy
•Fear of authority
(Sirgan, 2007) Treatment Counseling may be helpful to a person with passive-aggressive personality disorder identify and change behaviors. Treatment is aimed at helping the person better relate to others. However, treatment may also increase the patient's hostilities. This happens when he or she is forced to look at the negative behavior.
Group therapy can be extremely useful because it provides individuals with this personality disorder an opportunity to learn how to manage their hostility.When their hostility emerges, group leaders can comment on hostile behavior and encourage other group members to respond. The group leader can assist these individuals to process what it is they want or need at that moment and to rehearse the appropriate behavior within the group context.
Unfortunately, there is no cure for passive-aggressive personality disorder but there are medications which may help reduce some symptoms. Medications used to treat depression, called antidepressants, may reduce irritability. (Sirgan, 2007) Histrionic Histrionic personality disorder is a condition in which people act in a very emotional and dramatic way that draws attention to themselves. (A.D.A.M. Medical Encyclopedia, 2012) Symptoms •Acting or looking overly seductive
•Being easily influenced by other people
•Being overly concerned with their looks
•Being overly dramatic and emotional
•Being overly sensitive to criticism or disapproval
•Believing that relationships are more intimate than they actually are
•Blaming failure or disappointment on others
•Constantly seeking reassurance or approval
•Having a low tolerance for frustration or delayed gratification
•Needing to be the center of attention (self-centeredness)
•Quickly changing emotions, which may seem shallow to others
(A.D.A.M Medical Encyclopedia, 2012) Treatment People with this disorder are often more likely to seek out treatment and exaggerate their symptoms. The challenge for the therapist is to discover which symptoms are exaggerated and which aren't.
Group therapy is typically not recommended because the nature of this disorder often leaves the patient coming across as "shallow" or "fake."
(Grohol, 2011) Lets see what you learned You get candy if you win Question 2: In the 1983 movie Zelig, Woody Allen portrays a character who is so desperate to be liked that he has developed the ability to change his appearance, even the language he speaks. The fact that he feels he has to change his entire persona to be liked indicates a very low self esteem. This along with his fantasy escape into the life of another person leads to a common belief among many viewers that the character suffers from which cluster C disorder? Question 3: Scarlett O'Hara from Gone With the Wind is known for her dramatic nature. She has to be the center of attention, often achieving that goal by acting seductive or theatrical.
She believes her relationship with Ashley is more than it really was and her emotions are often shallow and fast changing. These are all symptoms of what Cluster B disorder? Question 1: Some people say that Christian Grey (Fifty Shades of Grey) is sadist because of which personality trait.
A) He gives Ana expensive gifts.
B) His need to control and cause pain
C) He wants her to sign a non-disclosure about their 'relationship.' Question 5: Adrian Monk knows his compulsions are troublesome and not normal. This indicates that he suffers from;
A) Obsessive Compulsive Personality Disorder (OCPD)
B) Obsessive Compulsive Disorder (OCD) Question 4 Anti-social personality Disorder Symptoms - Lack of guilt; unaware of what they do; blames others
- Do not learn from experience or change behavior after punishment
- No sense of responsibility; lack of moral sense; emotional immaturity
- Failure to plan ahead; act on impulse
- Disregard for rights of others; lies and manipulates (Schwartz, 2011) Treatment Manipulative Blame others Fail to believe they need therapy (Hoermann, 2011) Anti-social personality disorder is a characterized by a long held pattern of disregard for other people's rights. Narcissistic Personality Disorder A long standing pattern of grandiosity and the belief that they are the most important figure in the lives of the people they encounter. Symptoms - Constant need for admiration; manipulative in order to fulfill need
- Lack empathy for others because of arrogance
- Often brag about selves & achievements; want power
- Attempt to make others believe they are perfect & brilliant
- Fragile; sensitive to criticism
- Feelings of shame, self-doubt, emptiness; often lonely
(Hoermann, 2011) Treatment - General recommendation: Combination pharmacotherapy & psychotherapy; cognitive-behavioral therapy
- Often drop out – Idealize and then undervalue therapist, sabotaging treatment for themselves (Hoermann, 2011) Borderline Personality Disorder Marked by a long standing pattern of instability in relationships, self image and emotions. Symptoms - Childhood: consistent physical or sexual abuse/severe neglect
- Lack of safety felt as a child à confusion à unstable moods
- No clear sense of self (who they are, how others see them)
- Tendency to alienate selves from family, friends, loved ones
- Black & white/concrete thinking
- Dramatic interpretation of situations; quickly become suicidal
- Worst fears Rejection & abandonment
- Chronic feelings of emptiness.
(Hoermann, 2011) (Schwartz, 2009) Treatment o Form of cognitive therapy
o Learn to identify how thoughts are unrealistic
o Learn to replace with reality based/accurate ways of thinking
o Meditation & visualization: reduce & control unstable emotions In Girl Interrupted Susanna Kaysen was diagnosed with Borderline Personality Disorder because of her;
A) Friendship with Lisa Rowe, the sociopath.
B) Positive response to therapy.
C) Unstable and quick changing emotions.
D) All of the Above Paranoid Personality Disorder A long standing pattern of disregard for other people's rights that often leads to those rights being violated. Symptoms Symptoms: (Millon 2006)
- Project own faults to others
- Unalterable beliefs
- Self- Exalted
- Provoking Treatment Hard to treat due to extreme lack of trust. Anti-social personality disorder is more common among men. (Hayward, 2007) Schizoid Personality Disorder Characterized by a long standing pattern of social detachment. They have difficulty expressing their emotions. Symptoms -Socially isolated
(Hoermann 2007) (Hayward 2007) Treatment (Millon, 2006) (Millon, 2006) Individual psychotherapy is recommended but it is often the patient that terminates the treatment early on. Cognitive restructuring may be helpful for specific irrational thoughts that are negatively harming the patient. ("Psych central," 2010) Schizotypal Personality Disorder Long term pattern of a person who has difficulty developing and maintaining a close relationship with others. Symptoms -Expressively Peculiar
-Chaotic Object Representation
(Millon, 2006) Treatment Reduce social isolation. (Hayward 2007) Question 6: In the movie The Remains of the Day the butler shows several traits of a Cluster A personality disorder. They include his emotional coldeness, the fact that he has no close friends and does not desire any, he chooses solitary activities and is indifferent to praise and criticism. These traits are what causes many to speculate that he has _______. Question 7: Travis, the main character in Taxi Driver is often called schizotypal because of which of these traits?
A) His awkward conversation with the other cabbie?
B) He sensed "an energy" between himself and Betsy?
C) His attempt to assassinate a presidential candidate?
D) All of the Above ("Wikipedia," 2012) ("Adrian monk," 2010) Question 8: There is no argument that Hannibal Lecter is a sadist and a sociopath but his lack of remorse, deceitfulness and impulsivity that led to his murder spree could also indicate what Cluster B Personality Disorder? ("Msm making james," 2012) Answers: Question 1:
Question 8: B
Avoidant Personality Disorder
Histrionic Personality Disorder
Schizoid Personality Disorder
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