CHALLENGING BEHAVIORS IN THE CLC: Personality Disorder and Mental Illness

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CHALLENGING BEHAVIORS IN THE CLC Personality
Disorder and Mental Illness

• Rebecca Fromme, Ph.D.
• McGuire VAMC
• Geriatrics and Extended Care

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WHAT IS PERSONALITY?

• A set of stable and enduring traits and ways of
  thinking about ourselves and the world which
  influences how we relate to others
• It is formed by our early life experiences with
  the world, our families, our friends, and the
  overall environment
• Genetics may also play a role in personality
  formation
• These traits dictate how we react to the world,
  how we interpret the actions of others, and our
  overall world view

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HOW DOES PERSONALITYAFFECT BEHAVIOR?

• Most people have a repertoire of coping skills
  that allow them to be flexible in handling
  stressful situations
• People with personality disorders tend to have an
  extremely LIMITED set of skills that are
  inflexible and not always appropriate to the
  situation
• Their world is experienced through a filter of
  either suspicion, anger, or judgment
• The most common responses to stress are
  anger/hostility, emotional dysregulation, and/or
  dependency (or a combination of these)
• The most common trigger is LACK OF CONTROL

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DSM-IV PERSONALITY DISORDERS

• an enduring pattern of inner experience and
  behavior that deviates markedly from the
  expectations of the culture of the individual who
  exhibits it
• Antisocial, Borderline, Narcissistic, Histrionic,
  Dependent.
• Disorder vs. Traits

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Chronic Mental Illnesses

• Schizophrenia
• Schizoaffective Disorder
• Bipolar Disorder

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Common Characteristics

• Self-centeredness
• Lack of individual accountability
• Lack of perspective-taking and empathy
• Manipulative and exploitive behavior
• Unhappiness
• Distorted understanding of events
• Socially maladaptive

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Are there times that these disordered methods
work?

• YES!

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How can we work with these patients in a
productive way?

• Understand that you are a human being and you are
  allowed to have negative feelings toward patients
  (and accept them!)
• Understand that in most cases, their response is
  not really about you, its about the situation
  and their own turmoil and inability to cope with
  it
• Understand that we CANNOT change them, we can
  only change OURSELVES and the ENVIRONMENT
• Understand that some situations cannot be fixed
• Consult with your local Psychologist or
  Psychiatrist to assist with treatment planning
  and behavior management