Personality Disorders

SPRING 2012

Personality• is essentially the “style” of how a person deals with the

world. Personality traits then are stylistic peculiarities that all people bring to social relationships, including traits such as shyness, seductiveness, rigidity, or suspiciousness (Groves, 2004). In people with a personality disorder (PD), these traits are exaggerated to the point that they cause dysfunction in their relationships (Groves, 2004).

• The DSM-IV-TR classifies personality disorders as Axis II diagnoses (along with mental retardation). It also defines a PD as: An enduring pattern of inner experience and behavior that deviates markedly form the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescent or early adulthood, is stable over time and leads to distress or impairment.

Clinical Picture• Personality disorders (PDs) involve long-term and

repetitive use of maladaptive and often self-

defeating behaviors.

• Do not recognize their symptoms as uncomfortable;

thus they do not seek treatment unless a severe

crisis occurs.

Clinical Picture• All PDs have four characteristics in common: (1)

inflexible and maladaptive response to stress; (2)

disability in working and loving; (3) ability to evoke

interpersonal conflict; (4) capacity to frustrate

others.

• Tend to be perceived as aggravating and

demanding by health care workers, so the potential

for value judgments is high, and effective care is at

risk.

Personality disorders• DSM-IV-TR Cluster A Disorders—Odd or Eccentric

Behavior

Cluster A Personality Disorders

• Paranoid Personality Disorder

• Schizoid Personality Disorder

• Schizotypal Personality Disorder

Cluster B Personality Disorders

• Antisocial Personality Disorder

• Borderline Personality Disorder

• Histrionic Personality Disorder

• Narcissistic Personality Disorder

Cluster C Personality Disorders

• Avoidant Personality Disorder

• Dependent Personality Disorder

• Obsessive-Compulsive Personality Disorder

Epidemiology and Comorbidity

• In the general population, is 10% to 15%, depending

on severity.

• Personality disorders are predisposing factors for

many other psychiatric disorders

• Etiology

Assessment• Patient History

o Suicidal or homicidal ideation

o Current use of medications and other substances, food, and money

o Involvement with the courts; and current or past physical, sexual, or

emotional abuse.

o Information about the patient’s current level of crisis and dysfunctional

coping styles

• Self-Assessment

Diagnosis• Ineffective coping

• Anxiety

• Risk for other-directed violence

• Risk for self-directed violence

• Impaired social interaction, Social isolation

• Fear, Disturbed thought processes

• Defensive coping

• Self-mutilation

Outcomes Identification

• Realistic goal setting (change occurs so slowly)

• Small steps are necessary

• Minimizing self-destructive or aggressive behavior

• Reducing the effect of manipulative behaviors

• linking consequences to both functional and dysfunctional behaviors

• Initiating functional alternatives to prevent a crisis

• Ongoing management of anger, anxiety, shame, and happiness

Planning• Patients with personality disorder are usually

admitted to the hospital for reasons other than their

personality disorder (borderline, antisocial).

• Plan for the following Behaviors:

• impulsive, suicidal, self-mutilating, aggressive,

manipulative

• Possibly psychotic under stress

• manipulative, aggressive, and impulsive.

Borderline Personality Disorder

Ineffective Coping/ Self-mutilation

Implementation/Evaluation• Management of behaviors/limit setting

• Milieu Management

• Pharmacological Interventions

• Case Management

• Psychotherapy

• Evaluation

Summary• People with PD present complex behavioral

challenges for people around them

• People with PD have (1) inflexible and maladaptive

responses to stress (2) disability in working and loving

• (3) ability to evoke strong intense personal conflict

(4) capacity to “get under the skin”

• PDs often occur with axis 1 comorbidities

• Do not believe there is anything wrong with them

• Use more primitive defenses in response to stress

• Self assessment when working with PD patients