jessem30(personality disorders)

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  1. How
    Personality Develops
    • —Biologic processes of sensation,
    • association, and motivation that underlie the integration of skills and habits
    • based on emotion.

    —4 temperament traits

    —Harm avoidance

    —Novelty seeking

    —Reward dependence

  2. How personality developls



  3. Define personality disorders
    • When
    • personality traits become inflexible and maladaptive and significantly
    • interfere with how a person functions in society or cause the person emotional
    • distress
  4. DSM-IV
    —Axis II: Personality disorders and MR
  5. How are they Diagnosis?
    • —Diagnosis is made when the person
    • exhibits enduring behavioral patterns that deviate from cultural expectations
    • in 2 or more of the following:

    • —Ways of perceiving and interpreting self,
    • others, events

    • —Range, intensity, lability, and
    • appropriateness of emotional response

    —Interpersonal functioning

    • —Ability to control impulses or express
    • behavior at the appropriate time and place

  6. Assessing clients with
    Personality Disorders
    • 1.What current problems in your life are
    • causing your distress?

    • 2.Who do you consider to be support persons
    • in your life?

    • 3.What changes would you like to make in
    • yourself or in your life?

    4.How do you handle anxious feelings?

    • 5.Have you ever done anything to hurt
    • yourself?

    • 6.Have you ever been in trouble with the
    • legal system?
  7. Personality dirsorders catagories?

    —Cluster A

    —Cluster B

    —Cluster C
  8. What goes with Cluster A
    Odd or Eccentric

  9. What goes in cluster B?
    Dramatic, Emotional or Erratic

  10. What goes in Cluster C?
    —Anxious or Fearful

  11. Personality disorders FACTS?
    10-15% of the general population

    —Higher in lower socioeconomic groups

    • —Higher in unstable or disadvantaged
    • population

    • —40-45% of those with a major mental
    • illness also have PD

    —Higher death rate (suicide)

    —Increased rates of separation/divorce

    • —High criminal behavior, alcoholism, and
    • drug abuse
  12. Name 2 THEORIES?

  13. TREATMENT for personality disorders?

    —Individual and Group Psychotherapy

    —Building trust

    —Teaching basic living skills

    —Providing support

    —Decreasing distressing symptoms

    —Improving interpersonal relationships

    Relaxation or meditation techniques

    • 2. Cognitive – behavioral therapy –
    • thought stopping; positive self-talk; Decatastrophizing

    3. Dialectical behavior therapy





    • Mood
    • may be labile…responses sarcastic for no apparent reason..constant mistrust and
    • suspicion may distort thoughts and thought processing.

    • May
    • spend a lot of time examining and analyzing the behavior and motives of others to discover hidden and threatening
    • meanings.

    • (blaming others for problems); Projection identification, denial, reaction
    • formation

    • JOBS: Law Enforcement, Security,
    • politics. EXAMPLES: Richard Nixon, Steve X, The Caine Mutiny (1954); Archie Bunker

    • Burn their bridges before they get
    • to them…

    • 1. Is the client suspicious and
    • mistrustful of others?

    • 2. Does the client use projection
    • as a defense mechanism?
  15. Paranoid PD Thought Patterns
    People will eventually try to hurt me

    —People cannot be trusted

    —People will try to bother or annoy me

    —Don’t get mad, get even.

    • —Any insult, no matter how slight,
    • directed at me should be punished.

    —Always be prepared for the worst.

    —To compromise is to surrender.

    —Avoid intimacy.

    • —If I get close to people they can find
    • out my weakness.

    • —Keep alert for anyone who has power. They
    • can hurt me.

  16. what to do with a paranoid p.d
    Form an effective working relationship

    —Approach in business like manner

    —Be on time, keep commitments, be straight-forward

    —Involve them in their plan of care

    —Teach to validate ideas before taking action
    • Pervasive
    • pattern

    of detachment from

    social relationships

    • Restricted
    • range of emotional expression. Aloof and indifferent, emotionally cold,
    • uncaring or unfeeling. No leisure or pleasurable activities…no
    • enjoyment…passive disinterested…This lack of
    • emotion doesn’t bother them

    • Rich and extensive fantasy life but
    • can distinguish fantasies form reality, and no disordered or delusional thought
    • processes are evident.

    More common in men.

    • Accomplished intellectually,
    • computers, electronics

    • Defense mechanisms: withdrawal,
    • intellectualization.

    • Indecisive, lack future goals or
    • direction. No planning. Insight impaired..self-absorbed, loners. No
    • relationships…but parents..

    EXAMPLE: Napoleon dynamite

    • 1.Does
    • the client withdraw socially and act emotionally aloof?

    • 2.Does
    • the client display odd mannerisms, speech, and behaviors?

    • 3.Does
    • the client show little interest in
    • having sexual experiences with another person?

    • 4.Does the client respond with indifference
    • to approval from or criticism by others?
  18. Schizoid PD thought patterns
    • —There are few reasons to be close to
    • people.

    —I am my own best friend.

    —Stay calm.

    • —Displays of emotion are unnecessary and
    • embarrassing.

    • —What others say is of little interest or
    • importance to me.

    —Sex is okay, but just for release.
  19. what
    to do with a schizoid p.d
    • —Focus: improved functioning in the
    • community

    —Primary relationship

    • Very
    • resistant to tx. Will get tx because significant other insists. VERY
    • confused with high functioning Aspergers.

    Problem with internet; porn
    Pervasive pattern

    Of social

    And interpersonal


    • Marked by acute discomfort with and reduced
    • capacity for close relationships as well as by cognitive or perceptual
    • distortions and behavioral eccentricities. Great anxiety around other
    • people….do not view their anxiety as a problem…have limited capacity for close
    • relationships even though they may be unhappy being alone. Not successful in
    • employment without support or assistance.

    • May experience transient psychotic
    • episodes in response to extreme stress……10-20% eventually develop
    • schizophrenia.

    • Wander aimlessly, speech is
    • coherent but loose, digressive, vague…..speech bizarre…restricted range of
    • emotions….affect flat / silly/ inappropriate/ word salad; they have their own
    • style/ free thinkers

    • EXAMPLES: doc in Back to the
    • future. Andy Warhol; Kramer; Phoebe Buttay (friends)

    • Cognitive distortions include ideas
    • of reference, magical thinking, odd or unfounded beliefs, preoccupation with
    • parapsychology, including esp and clairvoyance.

    • Defense Mechanisms: withdrawal,
    • fantasy.
    • MOVIE:
    • Jack Lemmon as the Christ figure in The Ruling Class

    • 1.Does
    • the client withdraw socially and act emotionally aloof?

    • 2.Does
    • the client display odd mannerisms, speech, and behaviors?

    • 3.Does
    • the client show little interest in
    • having sexual experiences with another person?

    • 4.Does the client respond with indifference
    • to approval from or criticism by others?
  21. what
    to do with a schizotypal
    Focus: self-care and

    Social skills and

    Improved functioning in


    Parallels treatment for schizophrenic
    • Pervasive
    • pattern

    • Of
    • disregard for and

    • Violation
    • of the rights

    • Of
    • others

    • 3-4
    • times more common in men than
    • women

    • In prison populations, 50% are
    • diagnosed with antisocial p.d.
    • Peak in 20s and diminish significantly after 45 yrs. Of age. 1% of the
    • population is responsible for 80% of the crime.

    • Shallow emotions, rationalization
    • of own behavior, poor judgment, irritable, lack of insight, thrill-seeking
    • behaviors, exploitation of people in relationships, poor work history,
    • consistent irresponsibility

    • EXAMPLES: Ray Mayoff; Ted
    • Bundy; A Clockwork Orange; Goodfellas; american Psycho; No country for OLD MEN

    • Defense Mechanisms: Omnipotent
    • control

    • Clients are skillful at deceiving
    • others…need to check and validate information from other sources. Childhood hx of
    • enuresis, sleepwalking, and acts of cruelty…lying, truancy, sexual promiscuity,
    • smoking, substance use, illegal activities. Violent parenting, home life

    • Do
    • not experience disordered thoughts, but their view of the world is narrow and
    • distorted.

    • 1.Does the client behave in a manipulative and
    • controlling manner?

    • 2.does the client act extroverted and have
    • a superficial and charming manner?

    • 3.Does the client lack respect for the
    • rights of others?

    • 4.Does the client have an impaired
    • conscience, with lying, cheating, and possible criminal behaviors?

    • 5.Does the client lack commitment to and
    • concern for a partner in a relationship?

    • 6.Does the client desire immediate pleasure
    • and gratification?

  23. Antisocial PD Thought Patterns
    —Rules are meant for others.

    —Only fools follow all the rules.

    —Rules are meant to be broken.

    —Look out for Number 1.

    —My pleasure comes first.

    • —If others are hurt, offended, or
    • inconvenienced by my behavior, that is their problem.

    —Do it now!

    —I will not allow myself to be frustrated.

    • —I will do whatever I must to get whatever
    • I want.

    • —I am really smarter than most everybody
    • else.
  24. what
    to do with the antisocial
    • Forming a Therapeutic Relationship and
    • Promoting Responsible Behavior

    • —Helping Clients Solve Problems and
    • control Emotions

    —Enhancing Role Performance

    • RARELY
    • SEEK TX
    • 1)
    • Provide structure

    • Identify acceptable and expected
    • behaviors and be consistent

    Limit setting


    • 2) Id the problem, explore
    • solutions, choose and implement alternatives; evaluate results

    • Problem solving skills
    • Time out
    • 3) jobs, substance abuse, work…
    • 4) Family therapy as well
    Pervasive pattern of:

    —Unstable interpersonal relationships

    —Self image


    • —Marked
    • by:



    • Hurts
    • inward whereas the antisocial hurts outward

    • 3
    • times more common in women; 8-10% commit suicide;
    • self mutilation. (The resulting physical pain is also

    • Under stress transient psychotic
    • symptoms are common.

    • EXAMPLE: Marilyn Monroe; BPD
    • brains; BPD slideshow; SINGLE WHITE FEMALE

    • The
    • pervasive mood is dysphoric,
    • involving unhappiness, restlessness, and
    • malaise

    • Defense Mechanisms: Splitting,
    • projective identification.

    • Thinking about self and others is
    • often polarized and extreme = splitting.

    • Unstable view of themselves that
    • shifts dramatically and suddenly. They may appear needy and dependent one
    • moment and angry, hostile, and rejecting the next.

    • Being stable only in their
    • unpredictability

    • MOVIE: Girl Interrupted and Glenn Close as the femme fatale in Fatal Attraction
    • 1.Does the client have unstable moods
    • and impulsive behavior?

    2.Does the client self-mutilate?

    • 3.Does the client have poor
    • self=concept and an intense fear of being alone?

    • 4.Does the client express
    • contradictory ideas or feelings about others?

    • 5. does the client usually view
    • others as all good or all bad (splitting)?

    • 6.Does the client manipulate others
    • in relationships?
  26. Borderline PD thought patterns
    —I am not sure who I am.

    —I will eventually be abandoned.

    • —My (psychic) pain is so intense that I
    • cannot bear it.

    • —My anger controls me. I am incapable of
    • modulating my behavior.

    • —My feelings control me. I cannot modulate
    • my feelings.

    • —He/ she is so very, very good that I am
    • so lucky.

    • —He/ she is so very, very awful that I
    • cannot bear them.

    —When I am overwhelmed I must escape.
  27. what
    to do with the borderline p.d
    • 1.Promote
    • safety

    • 2.Help
    • client to cope and control emotions

    • 3.Cognitive
    • restructuring techniques

    • 4.Structuring
    • time

    • 5.Teaching
    • social skills

    • 6.Teaching
    • effective communication skills

    • 7.Entering
    • therapeutic relationship

    • No-self-harm
    • contract

    • Lecturing
    • or chastising clients is punitive and has no positive effect on self-harm
    • behaviors.

    • Structure and limit setting…scheduled appointments
    • only. Limit-setting and confrontation techniques.

    Communication – see page 336

    • Keep a journal helps clients gain
    • awareness of feelings.

    Learn to delay gratification

    • Cognitive restructuring – changing
    • patterns of thinking by helping clients to recognize negative thoughts and
    • feelings and to replace them with positive patterns of thinking.

    • Thought stopping - technique to alter the process of negative
    • or self-critical thought patterns. Positive self talk.

    • Decatastrophizing – technique
    • involves learning to assess situations realistically rather than always
    • assuming a catastrophe will happen.

    • Prognosis is poor when there is: hx of
    • childhood sexual abuse; early age of psychiatric concerns; chronicity of sx;
    • affective instability and aggression, substance abuse.
  28. Dialectic
    Behavior Therapy
    Skills Training


    —Distress tolerance

    —Emotional regulation

    —Interpersonal effectiveness


    • —Integration of skills into real life
    • situations

    —Consultation Team

    • —Working together to avoid ,divide, and
    • conquer.

    —Compassion fatigue
  29. 7 Techniques to Deal with
    Borderline Behavior
    • —1. Don’t give into his or her
    • manipulating conducts and do not respond to blackmails.

    • —2. Be as collected as possible and lay it
    • out that you will discuss only after he/she cools down.

    • —3. If he/she endeavors to use other
    • peoples’ presence to force your hand, make it clear that this is an
    • inadmissible conduct and will settle the matter in private.

    • —4. Stimulate and support him/her when
    • he/she seems feeling low or scared concerning the job or demanding
    • undertakings.

    • —5. Seek to be creative when he/she speaks in belittling
    • modes regarding him/herself.

    • —6. Make it clear that he or she will have
    • to pay or make up for the material damages.

    • —7. criticize the demeanors and not him or
    • her as a whole.
    • Pervasive pattern of excessive
    • emotionality and attention seeking

    —More in women

    • Seductive,
    • flirtatious, rarely enjoy sex – they use it to
    • manipulate others, attention seeking, center of attention, demand constant
    • reassurance and immediate gratification, rapidly changing shallow moods,
    • quick-witted, patho9logically vain individuals.

    • Defense Mechanisms: repression,
    • regression, conversion, sexualizing, acting out

    • EXAMPLE: Jack on Will and Grace;
    • The bird Cage (1996); American Beauty (1999
    • Blanch
    • du Bois in A
    • Streetcar Named
    • Desire; and Zaza in La
    • Cage aux Folles
    • 1.Does the client have dramatic
    • behavior with exaggerated emotions?

    • 2.Does the client have frequent
    • temper tantrums?

    • 3.Does the client exhibit flamboyance
    • with sexual overtones?

    • 4.Does the client lack commitment in
    • relationships?
  31. HIstonic PD thought patterns
    Appearances are important.

    —People are judged on external appearance.

    —I must be noticed.

    —I must never be frustrated in life.

    • —I must get everything I think that I
    • want.

    • —Emotions should be expressed quickly and
    • directly.

    • —Beauty is the most important
    • considerations in judging someone.

    • —Same sex others are of little value,
    • opposite sex are powerful, exciting.
  32. what
    to do with a histrionic p.d
    • 1.
    • Feedback should focus on appropriate alternatives, not merely criticism

    • —2.
    • Discuss social situations

    • —3.
    • Teach social skills and role-playing

    • —4.
    • Self-esteem
    • 5.
    • Explore personal strengths and assets
    Pervasive pattern of grandiosity

    —Need fro admiration

    —Lack of empathy

    —Found most often in men

    —Self-esteem fragile

    • Defense
    • Mechanisms: idealization, devaluation, hostile and defensive
    • when confronted with their shortcomings.

    • MOVIE:
    • Uncle Rico in Napoleon
    • Dynamite and Gloria Swanson as an aging and
    • self=centered actress in Billy Wilders’ Sunset
    • Boulevard ; Wall Street (1987); To Die
    • For (1995)

    • 1.Does the client demonstrate
    • grandiose thinking and an exaggerated sense of self=importance?

    • 2.Does the client display
    • attention-seeking behaviors?

    • 3.Does the client rationalize
    • failures?
    PD thought process
    I must have my way in every interaction.

    • —I must not be, in any way, foiled in
    • seeking pleasure or status.

    —I am more special than anyone else.

    • —I should only have to relate to people
    • like me.

    • —I must be admired.
    • No
    • one should have more of anything than I have
  35. what
    to do with a narcissistic p.d
    • —Individual
    • psychotherapy is the most effective treatment

    • —Greatest
    • challenge

    • —Nurse
    • must use self-awareness skills to avoid anger and frustration

    • —Goal:
    • to gain cooperation

    • —Teach
    • in a matter-of-fact manner

    • —Set
    • limits on rude or verbally abusive behavior

    • —Explain
    • expectations
  36. Avoidant PD
    • Pervasive pattern of social
    • discomfort and reticence

    —Low self-esteem

    • —Hypersensitivity to negative
    • evaluation

    —Overly inhibited as a child

    • Cluster
    • C: very learned = better treatment

    • Pathologically
    • Shy
    • Defense
    • Mechanisms: symbolization, displacement, projection, rationalization, avoidance

    • 1.Does
    • the client respond with hypersensitivity to others’ reactions and criticisms?

    • 2.Does
    • the client fear rejection and failure?

    • 3.Does
    • the client desire attention but withdraw
    • socially?

    4.Does the client fear being alone?
  37. Avoident PD Thought process
    I must be liked.

    • —I must not look foolish to myself or
    • others at any time.

    —The world is a dangerous place.

    • —I must depend on others to take care of
    • me.

    —All criticism – massive condemnation.

    • —People must offer me unconditional
    • guarantees of acceptance before I commit to other person.

    • —Isolation is preferable to being put at
    • risk of being hurt.
  38. what to do with an avoidant p.d
    Individual psychotherapy

    —Require much support and reassurance

    • —Explore positive self-aspects, positive
    • responses from others, and possible reasons for self-criticism

    • —Practice self-affirmations and positive
    • self-talk



    —Teach social skills
  39. Dependent PD
    • Pervasive and excessive need to be taken
    • care of

    —Submissive and clinging behavior

    —Fears of separation

    —Seen more in women

    • All
    • C’s have componenet of
    • poor self image.
    • Any
    • relationship is better than none at all

    • Defense
    • Mechanisms: regression, reversal, avoidance
    • MOVIE:
    • Bill Murray in What About Bob?
    • 1.Does the client lack self-confidence and
    • have poor self=esteem?

    • 2.Does the client display subordination in
    • relationships?

    • 3.Does the client have difficulty making
    • decisions?

    • 4.Does the client devalue any personal
    • abilities?
  40. Dependent PD thought process
    • —I cannot function without the support of
    • others.

    • —Without the advice and reassurance of
    • others I cannot exist.

    —In any situation, I am probably wrong.

    • —Anger expression – people will abandon
    • me.

    —If I am abandoned, I will be destroyed.

    —I must keep people near me.

    • If
    • I am alone, I may be hurt
  41. what to do with a dependent p.d
    • Help to express feelings of grief and
    • loss over the end of a relationship while fostering autonomy and self-reliance.

    —Identify strengths

    —Cognitive restructuring

    —Teach activities of daily functioning

    —Teach problem solving and decision making

    • —Don’t
    • give advice
  42. Obsessive-Compulsive PD
    Preoccupied with orderliness


    • —Mental and interpersonal control to the
    • detriment of flexibility, openness, and efficiency.
  43. Obsessive-Compulsive PD Thought patterns
    —There are strict rules in life.

    • —By focusing on the details of a
    • situation, one will reduce the changes of making errors.

    —A person is defined by what they do.

    • —The better the job you do the better
    • person you are.

    • —Rules must be adhered to without
    • alteration.

    • —Never discard anything that may be of
    • some value.

    —Emotions must be controlled.
  44. Cluster A
    personality disorders
    • Paranoid PD
    • Schizoid PD
    • Schizotypal PD
  45. Cluster B
    Personality Disorders
    • Antisocial PD
    • Borderline PD
    • Histonic PD
  46. Cluster C
    Personality Disorders
    • Avoident PD
    • Dependent PD
    • Obsessive compulsive PD
    • Depressive PD
    • Passive aggressive PD
Card Set:
jessem30(personality disorders)
2012-02-29 03:08:12
Personality disorders

Personality disorders
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