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PERSONALITY DISORDERS:

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PERSONALITY DISORDERS: An enduring (long-standing) pattern in two or more of the following areas: 1) Cognition (thoughts) - ways of interpreting and perceiving events – PowerPoint PPT presentation

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Title: PERSONALITY DISORDERS:


1
PERSONALITY DISORDERS
  • An enduring (long-standing) pattern in two or
    more of the following areas
  • 1) Cognition (thoughts) - ways of interpreting
    and perceiving events
  • 2) Affectivity (emotions) - range, intensity,
    lability, appropriateness
  • 3) Interpersonal functioning (behavior)
  • 4) Impulse control (behavior)

2
Personality Traits vs. Disorders
  • Deviation from social cultural norms consider
    contribution of situational cultural context
  • Inflexibility rigid patterns of behaviors
    responses
  • Pervasive present in a variety of contexts
  • Clinically significant distress for self or
    others
  • Impairment in functioning highly maladaptive
  • Stable long-lasting - onset by early adulthood,
    long-term pattern vs. occasional

3
CLUSTER A PERSONALITY DISORDERS
  • Characterized by
  • Odd behavior, reactions, emotions
  • Eccentric thoughts behaviors e.g. illusory or
    magical thinking, inappropriate social
    interactions
  • Isolative behavior social withdrawal
  • Suspiciousness paranoia
  • Includes
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
  • May represent mild variations of Schizophrenia,
    but reality testing is intact

4
PARANOID PERSONALITY DISORDER
  • A. A pervasive pattern of distrusting, being
    suspicious of, and attributing malevolent
    intention to others
  • B. Pattern of behavior is not due to
    Schizophrenia, a Mood Disorder with Psychotic
    Features, another Psychotic Disorder, the effects
    of a substance, or a general medical condition

5
PARANOID PERSONALITY DISORDER
  • Indicated by 4 or more of the following 7
  • Assuming others will exploit, harm, or deceive
    them
  • Continually doubting the loyalty or
    trustworthiness of friends or associates
  • Reluctance to confide in others because fear info
    will be used against them
  • Reading hidden demeaning or threatening meanings
    into benign remarks or events
  • Persistently bearing grudges
  • Often believing they have been attacked or
    slighted and are quick to react angrily or with
    counterattack
  • Continually suspecting spouse or sexual partner
    of being unfaithful

6
PARANOID PERSONALITY DISORDER
  • What it looks like
  • Chronically suspicious of others
  • Distrusting of others
  • Assuming the worst intention
  • Not open
  • Continually doubting loyalty of others
  • Unforgiving
  • Hold grudges

7
PARANOID PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 0.5-2.5 in general population
  • Gender more common in males
  • Onset often first apparent in childhood and
    adolescence
  • Cultural Factors need for caution in diagnosing
    members of minority, ethnic, immigrant, refugee
    groups
  • Treatment Considerations
  • Importance of developing trust a solid
    therapeutic alliance
  • Cognitive therapy to counter mistaken assumptions
    and negative beliefs about others
  • No evidence that therapy is very successful

8
SCHIZOID PERSONALITY DISORDER
  • A.Characterized by a pervasive pattern of
  • -detachment from social relationships
  • -restricted range of emotional expression in
    interpersonal settings
  • B. Pattern of behavior is not due to
    schizophrenia, a Mood Disorder with Psychotic
    Features, another Psychotic Disorder, or a
    Pervasive Developmental Disorder.

9
SCHIZOID PERSONALITY DISORDER
  • Indicated by 4 or more of the following 7
  • 1. Neither desiring nor enjoying close
    relationships, including being part of a family
  • Almost always choosing solitary activities
  • Having little, if any, interest in sexual
    experiences/relationships
  • 4. Taking pleasure in few, if any, activities
  • 5. Lacking close friends or confidants
  • 6. Indifference to praise or criticism
  • 7. Emotional coldness, detachment, or flatness

10
SCHIZOID PERSONALITY DISORDER
  • What it looks like
  • Emotionally cold distant
  • Great difficulty forming relationships
  • Social isolation loner
  • Restricted affect lack of emotional
    expressiveness
  • Lack of interest in people, relationships, most
    activities

11
SCHIZOID PERSONALITY DISORDER
  • Facts Figures
  • Prevalence uncommon lt1
  • Gender slightly more common and impairing in
    males
  • Onset often first apparent in childhood and
    adolescence
  • Cultural need for caution in diagnosing people
    from different cultural backgrounds,
    environments, or immigrants

12
SCHIZOID PERSONALITY DISORDER
  • Contributing factors
  • Childhood shyness
  • Genetics
  • Parenting neglectful cold parenting intrusive
    mother absent father
  • Lower density of dopamine receptors
  • Traumatic experiences
  • Treatment
  • Modeling healthy relationship skills emotional
    expression
  • Empathy training teaching the person how to
    identify, express, respond to emotion
  • Social skills training, including role playing
  • Building a support network

13
SCHIZOTYPAL PERSONALITY DISORDER
  • A. A pervasive pattern of social and
    interpersonal deficits marked by
  • -acute discomfort with close relationships
  • -a reduced capacity for close relationships
  • -cognitive or perceptual distortions
  • -eccentric behaviors
  • B. Pattern is not due to schizophrenia, a Mood
    Disorder with Psychotic Features, another
    Psychotic Disorder, or a Pervasive Developmental
    Disorder

14
SCHIZOTYPAL PERSONALITY DISORDER
  • Indicated by 5 or more of the following 9
  • 1. Ideas of reference
  • 2. Odd beliefs or magical thinking
  • 3. Unusual perceptual experiences
  • 4. Odd thinking speech
  • Suspiciousness or paranoid ideation
  • 6. Inappropriate or constricted affect
  • 7. Odd, eccentric or peculiar behavior or
    appearance
  • 8. Lack of close friends or confidants
  • 9. Excessive social anxiety that does not
    diminish with familiarity and tends to be
    associated with paranoid fears

15
SCHIZOTYPAL PERSONALITY DISORDER
  • What it looks like
  • Social impairment isolation
  • Social discomfort anxiety
  • Variety of odd beliefs cognitions
  • Unusual perceptions perceptual experiences
  • Odd speech presentation
  • Eccentric peculiar behavior
  • Inappropriate or blunted affect

16
SCHIZOTYPAL PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 3-5 of general population
  • Gender slightly more common in males
  • Onset often first apparent in childhood and
    adolescence
  • Course chronic some go on to develop
    Schizophrenia
  • Cultural need to consider cultural context
    when evaluating symptoms

17
SCHIZOTYPAL PERSONALITY DISORDER
  • Contributing Factors
  • Biological and genetic factors have been
    emphasized Schizotypal PD as a milder variant
    of schizophrenia
  • Treatment Considerations
  • Psychotropic medication antidepressants,
    antipsychotics
  • Cognitive-behavioral therapy
  • Social skills training

18
Cluster A Scenario
  • An individual receives an invitation to attend
    the birthday party of a supervisor at work. This
    supervisor is not well known to the individual,
    in fact, they have only spoken on a couple of
    occasions.

19
Paranoid Personality Disorder
  • Cognitions include
  • This person reached their position through
    dishonesty or fraud they are not to be trusted.
  • My colleagues are out to get me it will not be
    safe to be in an unfamiliar setting with them.
  • My job security is being threatened.
  • Behaviors include
  • Approaching the supervisor to research these
    suspicions in a hostile and accusatory manner
  • Finding an excuse to not attend the birthday
    party
  • Increased irritability in the workplace
  • Hypervigilance for suspicious behavior from
    colleagues

20
Schizoid Personality Disorder
  • Cognitions Include
  • Not wanting to go to the party
  • I would rather be alone.
  • This party wont be enjoyable.
  • Behaviors include
  • Not attending the party
  • Telling the supervisor she wont attend in a
    cold, detached way

21
Schizotypal Personality Disorder
  • Cognitions Include
  • I was meant to go to this birthday party because
    something supernatural will occur
  • I wonder why the supervisor chose me?
  • Will I be prepared to handle what is to come?
  • Behaviors Include
  • Wearing an unusual ceremonial costume to the
    party
  • Remaining detached from others at the party
  • Speaking to others in an elaborate way

22
CLUSTER B PERSONALITY DISORDERS
  • Characteristics
  • Dramatic
  • Emotional
  • Erratic behavior
  • Impulsiveness
  • Reduced capacity for empathy
  • Unstable emotions relationships
  • Includes
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder

23
ANTISOCIAL PERSONALITY DISORDER
  1. Pervasive pattern of disregard for and violation
    of the basic rights of others
  2. Beginning in childhood or early adolescence (must
    have evidence of Conduct Disorder prior to 15
    years)
  3. Continuing into adulthood (must be at least 18
    years)
  4. Occurrence of antisocial behavior is not
    exclusively during a course or Schizophrenia or
    Mania

24
ANTISOCIAL PERSONALITY DISORDER
  • Indicated by 3 or more of the following 7
  • Failure to conform to social norms and laws, e.g.
    repeatedly performing acts that are grounds for
    arrest
  • Deceitfulness manipulation, e.g. repeated
    lying, using aliases, or conning others for
    personal profit or pleasure
  • Impulsivity or failure to plan ahead
  • Irritability and aggressiveness, e.g. repeated
    physical fights or assaults
  • Reckless disregard for safety of self or others
  • Consistently extremely irresponsible, e.g.
    repeated failure to sustain consistent work or
    honor financial obligations
  • Lack of remorse, e.g. being indifferent to or
    rationalizing having hurt, mistreated, or stolen
    from another

25
ANTISOCIAL PERSONALITY DISORDER
  • What you see
  • Aggressiveness
  • Superficial charm
  • Self-centered
  • Bore easily, high need for stimulation,
    sensation-seeking, thrill-seeking
  • Lie easily
  • Conning, manipulative
  • Relationships of utility
  • Lack of remorse little or no guilt about the
    harm they cause others
  • Lack of empathy may seem cold insensitive
  • Enjoy testing, provoking, pushing, playing with
    others
  • Criminal behavior feel rules dont apply to them

26
ANTISOCIAL PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 3 males lt1 females
  • Gender more common in males
  • SES associated with low SES urban settings
    important to consider the social and economic
    context for behaviors
  • Course chronic, but symptoms tend to lessen or
    remit by 4th decade of life

27
Antisocial Personality Disorder
  • Contributing Factors
  • Strong biological roots
  • Genetic influence
  • Low levels of 5HT
  • Low arousability
  • Excessive theta waves
  • Poor impulse control
  • Fearlessness
  • Environmental factors
  • Parenting harsh, inconsistent, neglectful,
    uninvolved, abusive
  • Chronic stress, trauma
  • Treatment
  • Psychotherapy is not very effective often
    court-mandated
  • Lithium SSRIs may help control impulsive,
    aggressive behaviors

28
BORDERLINE PERSONALITY DISORDER
  • A pervasive pattern of marked impulsivity and
    unstable relationships, self image, and emotions
  • Indicated by 5 or more of the following 9
  • Frantic efforts to avoid real or imagined
    abandonment
  • A pattern of unstable and intense interpersonal
    relationships shifts from extreme idealization
    to devaluation
  • 3. Identity disturbance sudden dramatic
    shifts in self image, e.g. goals, values, career
    plans aspirations, sexual identity, types of
    friends

29
BORDERLINE PERSONALITY DISORDER
  • 4. Impulsive behavior that is potentially
    self-damaging, e.g. spending, sex, substance
    abuse, reckless driving, binge eating
  • 5. Recurrent suicidal behavior, gestures, or
    threats, or self-mutilating behavior
  • 6. Affective instability due to highly reactive
    mood, e.g. episodes of dysphoria, anxiety, panic,
    irritability, anger, despair
  • 7. Chronic feelings of emptiness
  • 8. Inappropriate, intense anger or difficulty
    controlling anger e.g. frequent temper, biting
    sarcasm, enduring bitterness, verbal outbursts,
    recurrent fights
  • 9. Transient, stress-related paranoia or
    dissociative symptoms, such as depersonalization

30
BORDERLINE PERSONALITY DISORDER
  • What it looks like
  • Unstable mood emotions lack control over
    emotions
  • Unstable self-concept
  • Unstable interpersonal relationships
  • Poor impulse control
  • Self-destructive
  • Good at splitting
  • Vacillating between extremely positive negative
    evaluations of self others

31
BORDERLINE PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 1-3 of general population
  • Gender 75 female
  • Completed suicide rate 6-10
  • Course
  • greater instability, impairment, and suicide risk
    in adolescence young adulthood
  • symptoms gradually wane with advancing age
  • by 30s 40s, most attain greater stability in
    relationships and vocational functioning

32
BORDERLINE PERSONALITY DISORDER
  • Contributing Factors
  • Biological factors low levels of serotonin
  • Family history of mood disorders
  • Environmental factors invalidating neglectful
    parenting history of abuse trauma
  • Treatment
  • Drug therapies SSRIs for dysphoria mood
    stabilizers for mood instability
  • Long-term therapy
  • Dialectical Behavior Therapy
  • Trauma work

33
HISTRIONIC PERSONALITY DISORDER
  • A pervasive pattern of excessive emotionality and
    attention-seeking behavior
  • Indicated by 5 or more of the following 8
  • Feels uncomfortable or unappreciated when not the
    center of attention
  • Inappropriately seductive or provocative behavior
  • Displays rapidly shifting and shallow emotions

34
HISTRIONIC PERSONALITY DISORDER
  1. Consistently uses physical appearance to draw
    attention to self
  2. Have strong opinions impressions, but cant
    back up with facts, details, examples, evidence
  3. Is overly dramatic, theatrical and emotionally
    expressive
  4. Is suggestible, i.e. easily influenced by others,
    fads, or circumstances
  5. Considers relationships to be more intimate than
    they actually are

35
HISTRIONIC PERSONALITY DISORDER
  • What it looks like
  • Flamboyant self expression presentation
  • Over-blown, overly dramatic emotional rxns
  • Needy solicitous of others
  • Require excessive approval reassurance
  • Frequently dependent
  • Impressionistic superficial
  • Overly concerned with appearance
  • Seductive charming

36
HISTRIONIC PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 2-3 in general population
  • Gender diagnosed more frequently in women
    prevalence may be equal for males females
  • Sex role stereotypes influence the behavioral
    expression of the disorder
  • Aging presents special difficulties
  • Course chronic, but sx may improve with age
  • Contributing Factors
  • Unmet needs for attention success

37
NARCISSISTIC PERSONALITY DISORDER
  • Pervasive pattern of grandiosity in fantasy or
    behavior, need for admiration, and lack of
    empathy
  • Indicated by 5 or more of the following 9
  • Grandiose sense of self importance, e.g.
    overestimating ones abilities, exaggerating
    ones accomplishments, underestimating/devaluing
    others.
  • Fantasies about unlimited success, power,
    brilliance, beauty, or love.
  • Belief that one is special, superior, or unique.

38
NARCISSISTIC PERSONALITY DISORDER
  • 4. Need for excessive admiration and/or constant
    attention
  • 5. Sense of entitlement, i.e. expecting
    especially favorable treatment or automatic
    compliance from others
  • 6. Conscious or unwitting exploitation of others
  • 7. Lack of empathy for others e.g.
    insensitivity, emotional coldness, lack of
    interest in others
  • 8. Envying others believing others envy them
  • 9. Arrogant, haughty, patronizing, snobby, or
    disdainful behaviors or attitudes

39
NARCISSISTIC PERSONALITY DISORDER
  • What it looks like
  • Self-enhancing, self-aggrandizing
  • Self-centered, self-absorbed
  • Readily dismiss opinions of others
  • Need to feel special
  • Love to receive special treatment
  • Can become rageful attacking in response to
    perceived threat

40
NARCISSISTIC PERSONALITY DISORDER
  • Facts Figures
  • Prevalence lt1 in general population
  • Gender up to 75 male
  • Age narcissistic traits are particularly common
    in adolescents
  • Course the aging process presents special
    difficulties may improve over time

41
NARCISSISTIC PERSONALITY DISORDER
  • Causes
  • Parental factors failure in modeling empathy
    rejecting, abandoning, or cold capricious,
    unreliable treating the child as an extension of
    themselves overvaluation lack of genuine,
    sincere affection
  • Treatment
  • Usually seek treatment at insistence of family
    member or as a result of a major life crisis
  • Coping skills to improve ability to accept
    criticism rejection and to help person develop
    a more realistic view of their abilities and
    talents
  • Empathy building
  • Addressing depression other underlying problems
    that may exist

42
Cluster B Scenario
  • An individual sees someone they occasionally date
    out at the movies with another date.

43
Antisocial Personality Disorder
  • Cognitions Include
  • Thoughts about what could be done to ensure that
    they are the one selected for the date next time
    it is, after all, a dog eat dog world.
  • Behaviors Include
  • Socially unacceptable or unlawful behavior to
    interrupt the date (calling in a bomb threat to
    the movie theatre)
  • Starting rumors about the person who their
    romantic interest was on a date with, or about
    the romantic interest themselves.

44
Borderline Personality Disorder
  • Cognitions Include
  • She must hate me now.
  • I am worthless.
  • I will never have a relationship.
  • My life is over.
  • I was in love with her.
  • Behaviors Include
  • An emotional outburst
  • Self injurious behavior
  • Calling attention to himself impulsively in the
    moment

45
Histrionic Personality Disorder
  • Cognitions Include
  • I cant stand that person (either the romantic
    interest or the date).
  • Didnt someone tell me he was promiscuous?
  • We were in love.
  • Behaviors Include
  • A dramatic outburst
  • Sexually seductive behavior
  • Excessive emotional response that is prolonged
    and involves many people

46
Narcissistic Personality Disorder
  • Cognitions Include
  • A brief thought of being rejected
  • Thoughts of being superior to the other date
  • Thoughts that the date would be envious if they
    knew who she was
  • Behaviors Include
  • Loudly discussing accomplishments in the movie
    theatre so the romantic interest and date are
    sure to hear
  • Showing how well known they are by greeting every
    acquaintance in the movie theater
  • Approaching the romantic interest and asking them
    to call or actually starting up a conversation

47
Cluster C Personality Disorders
  • Characterized by
  • Anxious behavior
  • Chronic fears
  • Perfectionism
  • Constant self-doubt
  • Includes
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive- Compulsive Personality Disorder

48
AVOIDANT PERSONALITY DISORDER
  • A pervasive pattern of social inhibition, feeling
    inadequate, and hypersensitivity to negative
    evaluation
  • Indicated by 4 or more of the following 7
  • 1. Avoid work or school activities involving
    significant interpersonal contact because fear
    disapproval, criticism, or rejection
  • 2. Resist getting involved with people without
    assurance that they will be liked and accepted
    without criticism
  • 3. Are restrained in intimate relationships
    because fear being shamed or ridiculed

49
AVOIDANT PERSONALITY DISORDER
  • Continued
  • 4. Are preoccupied with being criticized or
    rejected in social situations (confirmatory bias)
  • 5. Inhibited in new interpersonal situations due
    to feeling inadequate having low self-esteem
  • 6. See self as socially inept, unappealing, or
    inferior to others
  • 7. Unusual reluctance to take personal risks or
    engage in any new activities because these may
    prove embarrassing

50
AVOIDANT PERSONALITY DISORDER
  • What it looks like
  • Feel inadequate
  • Low self-esteem
  • Socially incompetent
  • Worry about being criticized
  • Avoid situations, activities, relationships, and
    people where there is any potential for them to
    be criticized, rejected, ridiculed, embarrassed,
    or disapproved of

51
AVOIDANT PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 0.5-1.0 in general population
  • Gender equally frequent for men women
  • Course avoidant/shy behavior often starts in
    infancy or childhood increases during
    adolescence early adulthood
  • Prognosis modest improvements with treatment
  • Need for caution with (1) different
    cultural/ethnic groups (2) immigrants (3)
    children adolescents
  • Causal Factors
  • Parental rejection
  • Sensitive temperament
  • Treatment
  • Behavioral interventions systematic
    desensitization, behavioral rehearsal, social
    skills assertiveness training

52
DEPENDENT PERSONALITY DISORDER
  • A pervasive and excessive need to be taken care
    of that leads to submissive and clinging behavior
    and fears of separation.
  • Indicated by 5 or more of the following 8
  • Difficulty making everyday decisions without an
    excessive amount of advice and reassurance from
    others.
  • Allow others to assume responsibility for major
    areas of his/her life.
  • Difficulty expressing disagreement with others
    because they fear losing support or approval.

53
DEPENDENT PERSONALITY DISORDER
  • 4. Difficulty initiating projects or doing things
    on own because lack self confidence
  • 5. Go to excessive lengths to obtain nurturance
    and support from others, e.g. volunteering to do
    things that are unpleasant
  • 6. Feel uncomfortable or helpless when alone due
    to exaggerated fears of being unable to take care
    of self
  • 7. Urgently seek another relationship as a source
    of care and support when a close relationship
    ends become quickly indiscriminately attached
    to people
  • 8. Preoccupied with fears of being left to take
    care of self

54
DEPENDENT PERSONALITY DISORDER
  • What it looks like
  • Worry about being abandoned
  • Lack self-confidence
  • Submissive, clingy, needy
  • Urgency, desperation with relationship-seeking
  • Need for others to assume responsibility for them
  • Rely on others for almost everything
  • To take care of them
  • To do things for them
  • To make decisions for them
  • To support and nurture them

55
DEPENDENT PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 2 one of the most frequently
    reported personality disorders in mental health
    clinics
  • Age cultural factors need to be considered
  • Gender diagnosed more frequently in females may
    be equally prevalent for men women
  • Causes
  • Disruption in early bonding/attachment due to
    early death of a parent or neglect or rejection
    by caregivers
  • Treatment
  • Long-term psychotherapy
  • Assertiveness training, self-esteem work, skills
    building

56
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
  • A pervasive pattern of preoccupation with
    orderliness, perfectionism, and control, at the
    expense of flexibility, openness, and efficiency
  • Indicated by 4 or more of the following 8
  • So preoccupied with procedures, details, lists,
    order, and schedules that the major point of the
    activity is lost.
  • Perfectionism interferes with task completion and
    causes significant dysfunction and distress.
  • Excessive devotion to work and productivity to
    the exclusion of leisure activities and
    friendships (not accounted for by obvious
    economic necessity).

57
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
  • 4. Excessively conscientious, scrupulous, and
    inflexible about matters of morality, ethics or
    values (not accounted for by cultural or
    religious identification)
  • 5. Inability to discard worn-out or worthless
    objects, even when they have no sentimental value
  • 6. Reluctance to delegate tasks or work to others
    unless they submit to exactly their way of doing
    things
  • 7. Overly miserly and stingy with money hoard
    money for future catastrophes
  • 8. Rigidity and stubbornness

58
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
  • What it looks like
  • Controlling have to have control over
    everything in their life
  • Believe they have to be perfect to be accepted by
    others
  • Follow rigid routines become anxious when
    routines are disrupted
  • Orderly
  • Lose the forest for the trees
  • Inefficient at completing tasks
  • Workaholics unable to delegate
  • Rigid morals values
  • Pack rats
  • Rigid and stubborn
  • Overly frugal and stingy with money

59
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
  • Facts Figures
  • Prevalence 1-4 of community samples
  • Gender diagnosed twice as often among males
  • Special considerations individuals reference
    group
  • Treatment Considerations
  • May seek Tx due to depression or slipping
    productivity
  • Dont like the loss of control inherent in
    therapy tend to counter by providing a
    detailed, orderly account of Sx issues
  • Therapist needs to avoid competing with client to
    direct the session
  • Antidepressants may be helpful for underlying
    anxiety depression

60
Cluster C Scenario
  • This individual is going to meet her boyfriends
    parents in another city for the first time.

61
Avoidant Personality Disorder
  • Cognitions Include
  • Is it possible to get out of this?
  • They wont approve of me.
  • They might be mean to me.
  • How could they ever like me?
  • Behaviors Include
  • Speaking very little around the family
  • Avoiding the situation altogether
  • Taking excessive measures to ensure that she is
    approved of (bringing luxurious gifts)

62
Dependent Personality Disorder
  • Cognitions Include
  • What will I wear, do, say? (Followed by asking
    her boyfriend for input about this.)
  • I have to make sure they like me.
  • Behaviors Include
  • Volunteering to babysit all the children while
    the adults go out to dinner
  • Sticking by her boyfriends side the entire time
  • Agreeing to everything the family suggests and
    with all the opinions they offer

63
Obsessive-Compulsive Personality Disorder
  • Cognitions Include
  • Everyone here is doing everything wrong.
  • Distress about having to delegate work tasks
    while away, and about the dogsitters ability to
    perform tasks (or the babysitters)
  • Behaviors Include
  • Planning out activities to fill the entire trip.
  • Making extensive lists of things to bring but not
    packing until the last minute.
  • Exhibiting a great deal of distress when
    conforming to others ways of doing things or
    being stubborn and ensuring that things are done
    her way.

64
Theories of Personality Disorders
  • Family dynamics growing up in a dysfunctional,
    abusive, invalidating, overprotective,
    controlling, or uncaring environment poor
    parenting parent-child relationship
  • Genetic Influences
  • Biological/biochemical Influences
  • Trauma other significant experiences
  • Continuum model personality disorders represent
    extreme variations of normal personality traits

65
Treatment for Personality Disorders
  • Long-term supportive, structured psychotherapy
  • Dialectical Behavior Therapy (DBT) accepting
    validating client, setting limits, skills
    training
  • Cognitive Behavioral Therapy (CBT) challenging
    maladaptive thoughts, beliefs, schemas skills
    training behavioral experimentation
  • Psychodynamic/Object Relations Therapy emphasis
    on transference, the effect of past relationships
    on the present, raising insight
  • Relational/Interpersonal Therapy using the
    therapeutic relationship and other significant
    relationships to foster growth, change, and
    healing
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