Christine Blue: Personality Disorder

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A relatively stable and enduring set of characteristic behavioral and emotional traits that characterize a person’s adaptation to life.

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Personality

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Conscious, Preconcious, Unconcious

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Freud's Structure of Personality

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Ideas, thoughts, and feelings of which we are aware

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Conscious

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Material that can easily be recalled

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Preconscious

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Well below the surface of awareness

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Unconscioius

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Self, reality principle

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Ego

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Ego ideal, moral guardian

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superego

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Pressure principle, unconscious urge and desires

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Id

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Response to Crisis:
The problem does not exist

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Primitive
Associated Clinical State: Psychotic state

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Response to crisis: The problem exists but it is neither my fault nor my responsibility to address

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Immature response; assocaited with personality disorders.

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Response to crisis: The problem exists and is my responsibility but I am not fully able to integrate cognitive and affective components in a way that works toward a satisfying solution

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Neurotic response. Associated with Mild depression, GAD, PTSD, adjustment disorders and much of “normal” adult population.

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Response to crisis: The problem exists and is my responsibility and I am able to work toward a solution that brings resolution and perhaps helpful contact with others

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Mature response; no impairment of associated clinical state.

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Introverted, Extroverted, emotionally stable, and emotionally unstable.

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DimensionalmModels of Personality

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Melancholic, choleric, plegmatic, saguine

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Categorical Model of Personality

all or nothing.

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Neuroticism ….Emotional Stability
Extraversion …….Introversion
Openness ….…….Closedness
Agreeableness ….Antagonism
Conscientiousness-.Undependability

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The Five Factor Model of Personality

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-Inflexible & maladaptive responses to stress
-Global, affecting work and relationships
-Non - psychotic, except under severe stress
-Ego - syntonic
-Distressing to others
-Multiple complications

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Personality Disorder

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An ENDURING pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. The pattern is manifested in 2 or more of the following areas:
Cognition, Affect, Interpersonal fx, and impulse control

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DSM-IV-TR General Criteria for a Personality Disorder

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Schizoid
Paranoid
Schizotypal

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Cluster A (Odd/eccentric)
DSM-IV-TR Classification

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Histrionic
Antisocial
Borderline
Narcissistic

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Cluster B (Dramatic/Erractic)
DSM-IV-TR Classification

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Avoidant
Dependent
Obsessive-Compulsive Personality disorder

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Cluster C Anxious/Fearful

DSM-IV-TR Classification

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What personality disorder is equally prevalent between males and females?

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Avoidant

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Dependent, borderline, and histrionic PD's are seen mostly in which sex?

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Females

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What should you think if there is an ABRUPT change in personality?

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organic problem!
(changes in brain, stroke, mi)

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How should personality disorders be treated in a group setting?

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-Group therapy – treatment of choice!
-Individual psychotherapy
-Pharmacologic therapy when indicated

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Distrust and suspiciousness about the motives of others
"SUSPECT"

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Paranoid Personality Disorder (CLUSTER A)

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Intervention of paranoid Personality disorder?

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-Give straightforward explanations
-Warn patients of possible side effects of treatments
-Get explicit consent to speak to family members or others

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Detachment from social relationships and a restricted range of emotional expression
(DISTANT)

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Schizoid Personality Disorder (cluster A)

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Acute discomfort in close relationships, cognitive or perceptual distortions, and behavioral eccentricities

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Schizotypal Personality Disorder

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How should you treat Schizotypal PD?

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-Guidelines for Schizoid PD apply
-Odd beliefs, magical thinking, or paranoid ideation may be mistaken for psychosis – when in doubt, consult a mental health specialist

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Disregard for and violation of the rights of others

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Antisocial Personality Disorder (Cluster B)
"CORRUPT"

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-Often involved with medical care because of drug use and trauma
-May lie about their history
-May try to manipulate prescriptions
-May make persistent inappropriate demand

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Antisocial Personality Disorder In the Medical Setting.

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Instability in emotions and interpersonal relationships, inadequate self image, fear of abandonment, and marked impulsivity

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Borderline Personality Disorder (Cluster B)

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-Relationship with providers unstable and intense
-“Splitting” may occur between members of the treatment team
-Treatment complicated by self-destructive behavior
-May have chronic suicidal behavior

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Borderline Personality Disorder

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Excessive emotionality and attention seeking, often dramatic
"PRAISE ME"

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Histrionic Personality Disorder

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-May have exaggerated concerns or worries and are prone to be hypochondriacal
-Provides vague nonfactual histories
-May display seductiveness
-Experiences illness as a threat to attractiveness

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Histrionic Personality Disorder in the medical setting.

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Grandiosity, a need for admiration, a lack of empathy for the problems and needs of others

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Narcissistic Personality Disorder

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-Experiences a damaged sense of superiority in accepting the sick role
-May make disparaging remarks about providers as a defense
-Often demands referral to a “specialist”
-May get into power struggles

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Narcissistic Personality Disorder in the Medical Setting

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Social inhibition, feelings of inadequacy, and hypersensitivity to criticism or negativism

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Avoidant Personality Disorder (Cluster C) Anxious Fearful

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-May develop symptoms justifying regular visits to alleviate their loneliness
-May be easily embarrassed and anxious in the medical setting
-May be predisposed to chronic anxiety and social phobia

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Avoidant Personality Disorder in the Medical Setting

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Submissive and clinging behavior and fears of separation

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Dependent Personality Disorder

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-Needs excessive reassurance
-Needs others to assume responsibility
-Has difficulty expressing disagreement due to fear of loss of support or approval
-May make frequent unnecessary visits or phone calls

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Dependent Personality Disorder

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Preoccupation with orderliness, perfectionism, and control

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Obsessive Compulsive Personality Disorder

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-May be non-compliant as a way of keeping control
-May be indecisive or inflexible regarding treatment

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Obsessive Compulsive Personality Disorder In the medical setting