Transcript There are nine different types of Personality Disorders

Personality Disorders
Morganne Napoleoni
Kati Tessmer
Binisha Shrestha
Judy Ndambuki
Ron Person
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)
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 patient’s life
(Open-Site)
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)
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)
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)
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 son’s 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
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, Norman’s therapist
suggested the family seek treatment at a
children’s hospital
Case Study Continued
• Intake interview at the Children’s 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
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
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 Norman’s psychiatrist
informed him she was going to take a vacation in 2
weeks
– After the psychiatrist’s vacation there was a notable
change in behavior
Case Study Continued
•
16 months into treatment
– Norman had calmed down enough to transfer treatment from the playroom to the
psychiatrist’s office
•
2 years into treatment
– Began to express interest in doctor’s 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)
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)
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 therapistclient 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)
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)
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)
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)
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
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)
Descriptions of Personality Disorders
• Cluster A—odd 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 B—dramatic, •
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, selfimage, and affects
Marked impulsivity
Histrionic Excessive
emotionality
Attention-seeking
behavior Narcissistic
Grandiosity Need for
admiration
Cluster C—anxious
or fearful Avoidant
Social inhibition
Feelings of
inadequacy
Hypersensitivity to
criticism Dependent
Excessive need to be
taken care of
Submissive behavior
Fear of separation
Obsessivecompulsive
Preoccupation with
orderliness and
perfectionism
Mental and
interpersonal
control
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)
TIPI
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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
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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.
_____________________________________________________________________________
TIPI scale scoring (“R” denotes reverse-scored items):
Extraversion: 1, 6R; Agreeableness: 2R, 7; Conscientiousness; 3, 8R; Emotional Stability: 4R, 9; Openness to Experiences: 5, 10R.
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 patient’s 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)
Referrals
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Physician
Psychiatrist
Psychologist
Social worker
Clinical psychiatric nurse
Dietician
(Townsend, 2009)
References
(2008,September,11). Personality Disorder. Retrieved January 31, 2009,
from Mayo Clinic Web site: http://www.mayoclinic.com/health/personalitydisorders/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). Factsheet:Personality
Disorders. Retrieved January 31, 2009, from
http://www.nmha.org/index.cfm?objectId=C7DF8E96-13724D20-C87D9CD4FB6BE82F
Personality Disorder. Retrieved January 31, 2009, from Open-Site Web
site: http://www.nmha.org/index.cfm?objectId=C7DF8E96-1372-4D20-C87D9CD4FB6BE82F
Townsend, Mary (2009). Psychiatric mental health nursing: concepts of
care in evidence-based practice. Philadelphia, PA: F.A. Davis Company.