Common Characteristics of Personality Disorders (PDs)
Inflexible and maladaptive response to stress
Disability in working and loving
Ability to evoke interpersonal conflict
Capacity to "get under the skin" of others PD Commonalities
Thinks problem is someone else’s, project own problems onto others
Manipulative and controlling
Hx failed relationships & lost jobs
Emotional immaturity
Tx
Come to Tx for help with depression, anxiety, alcoholism or difficulties in work or personal relationships not to have their personalities changed
Come as result of other’s insistence
Avoid hospitalization (if possible)
Pharmacology less useful (than in Axis I disorders)
Therapy not usually sought by cluster A & C
Set limits with cluster B
Prevalence and Comorbidity
10% to 15% in general populations
Often co-occur with depression and anxiety
Onset usually occurs before onset of other psychiatric disorders
Various PDs often coexist
Biological Determinants
Certain inherited traits present at birth
Genetic alterations may result in an extreme variation
Unfavorable environmental conditions may affect development of disorder
Potentially Inherited Traits
Novelty seeking
Harm avoidance
Reward dependence
Persistence
Neuroticism (negative affect) versus emotional stability
Introversion versus extraversion
Conscientiousness versus undependability
Antagonism versus agreeableness
Closeness versus openness to experiences
Psychosocial Factors
Learning theory
Cognitive theory
Environmental factors
Assessment of PDs
Minnesota Multiphasic Personality Inventory (MMPI) to evaluate personality
Full medical history
Psychosocial history
Suicidal or aggressive thoughts
Risk of harm from self or others
Use of medications or illegal substances
Ability to handle money
Legal history
Current or past abuse
Effect of Clients with Personality Disorders on Caregivers
Overwhelming needs of clients may also be overwhelming for caregivers
Caregivers may feel
Confused
Helpless
Angry
Frustrated
Three Clusters of PDs
Characterized by similar behavior patterns
Cluster A: Odd or eccentric
Cluster B: Dramatic, emotional, erratic
Cluster C: Anxious or fearful
Personality Disorders
Cluster A: Interventions
Be aware of client isolation, suspiciousness
Avoid being “too nice,” overly friendly
Use neutral, kind approach
Clear, straightforward explanations
Simple, clear language
Give warning about changes, reasons for delay, medication side effects
Cluster B: Borderline Personality Disorder Interventions
Set clear, realistic goals
Be aware of manipulative behaviors
Clear, consistent boundaries/limits
For behavioral problems, review therapeutic goals and treatment boundaries
Avoid rejecting, rescuing
Assess for suicidal, self-mutilating behavior
Cluster B: Splitting Behaviors
Primary defense used by clients with borderline PD
Client labels one person “all good” and the others
“all bad”
When all-good person has not met client's needs, that person becomes all bad
Someone else then labeled all good, others all bad
Creates conflict in staff members
To decrease conflict among staff
Open communication in staff meetings
Ongoing clinical supervision
Cluster B: Antisocial Personality Disorder Interventions
Set clear, realistic limits on specific behavior
All limits adhered to by all staff
Document objective physical signs of manipulation or aggression
Provide clear boundaries, consequences
Guard against letting client make you feel guilty
Guard against being manipulated
Cluster B: Narcissistic Personality Disorder Interventions
Stay neutral, avoid power struggles
Don’t be defensive when disparaged
Convey unassuming self-confidence
Cluster B: Histrionic Personality Disorder Interventions
Understand seductive behavior as a response to stress
Keep relationship professional
Encourage/model use of concrete descriptive language
Teach and model assertiveness
Cluster C:
Avoidant, Dependent, or OCPD
Presents as primarily anxious or fearful
