Personality Disorders

1
Personality Disorders

• Morganne Napoleoni
• Kati Tessmer
• Binisha Shrestha
• Judy Ndambuki
• Ron Person

2
Nine Types of Personality Disorders

• Schizoid Personality Disorder
• Paranoid Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Narcissistic Personality Disorder
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder
• (NMHA, 2006)

3
Characteristics of Personality Disorders

• Patients with Personality Disorders tend to
  disregard their physicians and their
  instructions.
• They see others as inferior to themselves
• Manipulative, exploitative, uncomfortable with
  the idea of trusting, sharing and loving
• This phenomenon is quite stable, but affects all
  the aspects of the patients life
• (Open-Site)

4
Characteristics Continued

• Depression and anxiety disorder surfaces
  sometimes
• Patient themselves unaware or unacceptable of
  their illness
• Risky behaviors and substance abuse most
  prominently seen
• Blame others, create imaginary world, conform
  surroundings to shoot their situation
• No hallucinations, illusions, or delusions
  present (except for Borderline PD)
• Senses are fully functional with good memory
  skills and normal functioning of the vital organs
• (Open-Site)

5
Common Symptoms and Manifestations of Personality
Disorder

• Distrust others, emotional detachment, and
  hostility (Paranoid)
• Showing no interest to others (Schizoid)
• Peculiar nature, inappropriate emotional
  responses, magical thinking, indifference to
  others (Schizotypal)
• Aggressive, violent, law breaker, lying,
  stealing, disrespect others (Antisocial)
• Impulsive, suicidal, volatile, and risky behavior
  (Borderline)
• Attention seeker, conscious about appearance,
  moody (Histrionic)

6
Common Symptoms/Manifestations Continued

• Over-confidence, indifferent towards others
  emotions and feelings (Narcissistic)
• Hypersensitive to criticism or rejection, and shy
  (Avoidant)
• Dependent nature, tolerant toward abusive
  treatments, constantly looking for new
  relationship when one ends (Dependent)
• Perfectionism, not flexible, controlling nature
  (Obsessive-compulsive)
• (Mayo Clinic, 2009)

7
Case Study

• Norman, age 9, brought to the hospital by his
  parents for increasingly disturbing behavior
• Has been described as a troubled child since
  the age of 2
• Family
• Father ? Successful business man, embarrassed and
  confused by his sons behavior
• Mother ? Actress/Entertainer, babied Norman
• Parents argued over the manner in which Norman
  should be disciplined
• Parents finally divorced when Norman was 9 years
  old

8
Case Study Continued

• Norman began to fail school in the 2nd grade
• School Psychologist suggested treatment
• Norman attended sessions with a psychotherapist
  from the age of 7 until he was 9
• Grades did not improve and behavior became
  increasingly frenzied, Normans therapist
  suggested the family seek treatment at a
  childrens hospital

9
Case Study Continued

• Intake interview at the Childrens Hospital
• Norman talked incessantly and rapidly
• Psychological testing showed fluctuating
  attention, word misusages, neologisms and
  disturbed associative processes
• Beginning to fill his inner world with fantasies
  and withdraw from reality
• IQ
• Age 6 120
• Age 9 110
• Initially diagnosed with childhood schizophrenia,
  later downgraded to a personality disorder

10
Case Study Continued

• The treatment team thought Norman would be able
  to tolerate and participate in psychoanalysis
  because he had not fully withdrawn into fantasies
• Treatment plan ? Psychologists believed the best
  course of treatment was to treat Norman as an
  inpatient, this would allow him a break from the
  strains of school and family life

11
Case Study Continued

• Treatment begins
• After becoming acquainted with the staff and
  hospital setting Norman openly spoke to his
  psychiatrist about what he described as serious
  problems
• This was the last time that Norman was
  cooperative for the better part of 3 years of his
  5 year stay
• Four months into treatment Normans psychiatrist
  informed him she was going to take a vacation in
  2 weeks
• After the psychiatrists vacation there was a
  notable change in behavior

12
Case Study Continued

• 16 months into treatment
• Norman had calmed down enough to transfer
  treatment from the playroom to the psychiatrists
  office
• 2 years into treatment
• Began to express interest in doctors life
• Both parents are planning to remarry at this
  point
• 3 years into treatment
• Norman becomes more open to directly talking
  about his emotions
• 4 years into treatment
• 5 years into treatment
• Started thinking over his problems on his own and
  then reporting the results to the psychiatrist
• Termination begins
• End results
• By removing Norman from the environment for a
  period of time his disorder and the
  manifestations were able to be significantly
  reduced
• (Appelbaum Stein, 2009)

13
Treatment

• It may take years to change a behavior, if any
  change is able to occur at all
• Personality disorders are very resistant to
  change, often people with personality disorders
  do not recognize that they present maladaptive
  behaviors
• (Townsend, 2009)

14
Interpersonal Psychotherapy

• Can be brief or long term
• Long term ? attempts to understand and modify
  the maladjusted behaviors, cognition and affects,
  the core element is the establishment of an
  empathetic therapist-client relationship
• Particularly appropriate because personality
  disorders largely reflect problems in
  interpersonal style
• It is suggested for clients with paranoid,
  schizoid, schizotypal, borderline, dependent,
  narcissist and obsessive compulsive personality
  disorders
• (Townsend, 2009)

15
Psychoanalytical Psychotherapy

• The treatment of choice for those with histrionic
  personality disorders
• Focuses on the unconscious motivation for seeking
  the total satisfaction from others and for being
  to be unable to commit oneself to a stable,
  meaningful relationship
• (Townsend, 2009)

16
Milieu or Group Therapy

• Is especially appropriate for antisocial
  personality disorders
• Main thing here is that one is getting feedback
  from peers
• Emphasizes the development of social skills
• (Townsend, 2009)

17
Cognitive Behavioral Therapy

• Behavior strategies offer reinforcement for
  positive change
• Social skills training
• Assertiveness training
• Alternate ways to deal with frustration
• Helps the client recognize and correct inaccurate
  internal mental schemata
• (Townsend, 2009)

18
Psychopharmacology

• Pharmaceutical treatments
• This approach does not have any effect in the
  direct treatment of the disorder but symptomatic
  relief can be achieved
• This is helpful with paranoid, schizotypal and
  borderline personality disorders
• SSRIs and MAOIs are examples (Townsend, 2009)
• Patients with borderline personality disorder
  typically receive psychiatric medication (Fonagy,
  2007)
• Antidepressants
• Anti-Anxiety medication
• Anti-Psychotic medication

19
Treatment Phases(Multiple Personality Disorders)

• Phase I Development of trust
• Phase II Therapist educating the client on the
  nature and function of the disorder
• Assist in improving cooperation between alters to
  decrease unwanted or intrusive switching
• Phase III Focuses on reintegrating or fusing
  the alters with each other and the host
• (Allers Golson, 1994)

20
Descriptions of Personality Disorders

• Cluster Aodd or eccentric Paranoid Pervasive
  pattern of mistrust and suspiciousness Begins in
  early adulthood Presents in a variety of contexts
  Schizoid Detachment from social relationships
  Restricted range of emotional expressions
  Schizotypal Social and interpersonal deficits
  Cognitive or perceptual distortions and
  eccentricities Cluster Bdramatic, emotional,
  or erratic Antisocial Disregard for rights of
  others Violation of rights of others Lack of
  remorse for wrongdoing Lack of empathy Borderline
  Instability of interpersonal relationships,
  self-image, and affects Marked impulsivity
  Histrionic Excessive emotionality
  Attention-seeking behavior Narcissistic
  Grandiosity Need for admiration
• Cluster Canxious or fearful Avoidant Social
  inhibition Feelings of inadequacy
  Hypersensitivity to criticism Dependent Excessive
  need to be taken care of Submissive behavior Fear
  of separation Obsessive-compulsive Preoccupation
  with orderliness and perfectionism Mental and
  interpersonal control

21
Assessment

• The Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV-TR), is published by the
  American Psychiatric Association. It is the
  manual that mental health professionals most
  commonly use to diagnose mental disorders
• The Ten Item Personality Inventory (TIPI)

22
TIPI

• 1 Disagree strongly
•  2 Disagree moderately
•  3 Disagree a little
•  4 Neither agree nor disagree
•  5 Agree a little
•  6 Agree moderately
•  7 Agree strongly
•  
• I see myself as
• 1. _____ Extraverted, enthusiastic.
• 2. _____ Critical, quarrelsome.
• 3. _____ Dependable, self-disciplined.
• 4. _____ Anxious, easily upset.
• 5. _____ Open to new experiences, complex.
• 6. _____ Reserved, quiet.
• 7. _____ Sympathetic, warm.
• 8. _____ Disorganized, careless.
• 9. _____ Calm, emotionally stable.
• 10. _____ Conventional, uncreative.

23
Intervention

• Build trust between therapist and client
• Maintain quiet environment for interaction
  between therapist and client
• Administer tranquilizing medications as ordered
  by the physician or obtain order if necessary
• Assist client in evaluating the positive and
  negative aspect in their life
• Have sufficient staff available to present a sow
  of strength to the client if necessary
• Frequently examine patients behavior to insure
  safety and security
• Encourage clients to speak of past behaviors
• Provide positive feedback for acceptable
  behaviors
• The staff should maintain and display a calm
  attitude toward the client
• (Townsend, 2009)

24
Referrals

• Physician
• Psychiatrist
• Psychologist
• Social worker
• Clinical psychiatric nurse
• Dietician
• (Townsend, 2009)

25
References

• (2008,September,11). Personality Disorder.
  Retrieved January 31, 2009,
• from Mayo Clinic Web site http//www.mayoclinic
  .com/health/personality-disorders/DS00562/DSECTION
  symptoms
•  
• Allers, C.T. Golson, J. (1994). Multiple
  personality disorder Treatment from an
• Adlerian perspective. Individual Psychology,
  50 (3), 262-270
•  
• Fonagy, P. (2007). Personality disorder.
  Journal of Mental Health, 16 (1), 1-4.
•  
• Hallsell Appelbaum, A., Stein, H. (2009). The
  Impact of Shame on the Psychoanalysis of a
  Borderline Child. American Psychological
  Association, 26(1), 26-41. Retrieved January 26,
  2009, from the JSTOR database.
•  
• National Mental Health America (NMHA). (2006).
  FactsheetPersonality
• Disorders. Retrieved January 31, 2009, from
• http//www.nmha.org/index.cfm?objectIdC7DF8E96-1
  372-
• 4D20-C87D9CD4FB6BE82F
•  
• Personality Disorder. Retrieved January 31, 2009,
  from Open-Site Web
• site http//www.nmha.org/index.cfm?objectIdC7DF
  8E96-1372-4D20-C87D9CD4FB6BE82F
•  
• Townsend, Mary (2009). Psychiatric mental health
  nursing concepts of