Personality Disorders

Jeanette Klaber

DSM-IV-TR
Axis II- Chronic, long lasting
Cluster A:Odd and Eccentric Behavior Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Cluster B: dramatic or erratic behavior Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Nassisitic Personality Disorder Cluster C: Anxious and fearful behavior Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder

Cluster A
Paranoid Personality Disorder:
distrusting, suspicious that others ant to cause harm

Schizoid Personality Disorder:

detachment from social relationships and limited emotional expression

Schizotypal Personality Disorder:

uncomfortable in close relationships, cognitive/perceptual distortions, eccentric

Cluster B
Antisocial Personality Disorder:
disregard and violations of others rights

Borderline Personality Disorder:

unstable relationships, self-image, and affects, impulsive

Histrionic Personality Disorder:

emotional, dramatic, attention seeker

Narcissistic Personality Disorder:

Grandiosity, lack empathy

Cluster C
Avoidant personality Disorder:
socially inhibited, feelings of inadequacy, hypersensitive to neg. evaluations

Dependent Personality Disorder:

submissive or clingy behavior, excessive need to be taken care of

Obsessive Compulsive Personality Disorder:

order, control, perfection

Antisocial Personality Disorder

Antisocial personality disorder is a type of chronic mental illness in which a person's ways of thinking, perceiving situations and relating to others are abnormal and destructive. They may lie, behave violently, and have drug and alcohol problems. May not be able to fulfill responsibilities to family, work or school. Antisocial personality disorder is sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder.

Antisocial Symptoms
Antisocial personality disorder symptoms may include: Disregard for right and wrong Persistent lying or deceit Using charm or wit to manipulate others Recurring difficulties with the law Repeatedly violating the rights of others Child abuse or neglect Intimidation of others Aggressive or violent behavior Lack of remorse about harming others Impulsive behavior Agitation Poor or abusive relationships Irresponsible work behavior antisocial

Cause
The cause is unknown genetic and environmental factors Adoption studies indicate that incidences of antisocial personality disorder are reduced in children of parents with antisocial personality disorder if they are adopted physically or sexually abused and antisocial personality disorder caregivers

Treatment
Psychotherapy Cognitive behavioral therapy. replace unhealthy behaviors with healthy, positive ones. Psychodynamic psychotherapy. This approach aims to raise awareness of unconscious thoughts and behaviors and by bringing them to light change their negative impact. Psycho education. This education-based therapy teaches about all aspects of a condition, including treatments, coping strategies and problem-solving skills. Stress and anger management skills Medications Antidepressant medications. Mood-stabilizing medications.. Anti-anxiety medications. help with anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior. Antipsychotic medications. helpful if symptoms include losing touch with reality (psychosis) Hospitalization

Antisocial Prognosis Symptoms tend to peak during the late teenage years and early 20's, with symptoms dissipating by 40. Individuals rarely seek treatment or and no know effective treatment is currently available. A study by Black, Gunter, Loveless, Allen, and Sieleni (2009), evaluated 320 newly incarcerated men and women. Of the 320, 113 (35.3%) could be categorized as having antisocial personality disorder. OT socialization, work, leisure, activities of daily living (ADL), and instrumental activities of daily living (IADL), with an emphasis on finances (Reed, 2001).

Avoidant Personality Disorder

People with avoidant personality disorder are preoccupied with their own shortcomings. They form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these people will choose to be lonely rather than risk trying to connect with others.

Symptoms
Avoids jobs or activities that would involve interpersonal contact, due to fears of criticism, rejection and disapproval (DSM-IV-TR, 2000). Interactions with other people are limited to instances where the individual is assured the other person will like the individual (Fundukian & Wilson, 2008). Persistent fears of shame and ridicule from intimate relationships (DSM-TR-IV, 2000). Preoccupation with being criticized and rejected (DSM-TR-IV, 2000). When meeting unfamiliar people or placed in new situations, persons feel inhibited and overcome with feelings of inadequacy and minimal self confidence (DSM-TR-IV, 2000). Self perceptions are unappealing, socially inept, and inferior to others (DSM-TR-IV, 2000). Social risks and new activities are done only when the individuals is assured acceptance, and minimal humiliation or embarrassment (DSM-TR-IV, 2000). Avoidant personality disorder

Cause
Cause is unknown Combination of social, genetic and biological factors children who are victims of chronic parental criticism and rejections Treatment psychodynamically oriented therapy cognitive behavioral therapy group therapy
focus on social skill training, in an effort to improve individuals self confidence and social functioning

Medication
Monoamine oxidase inhibitors (MAOIs) are used to decrease feelings of unease when in now social situations.

Prognosis People with this disorder may develop some ability to relate to others, and this can be improved with treatment. Without treatment, a person with avoidant personality disorder may seek total isolation and or develop a second psychiatric disorder such as substance abuse or a mood disorder OT Social Work leisure cluster C diagnosis is in the area of socialization, as such clients may benefit from the use of social skills training (ot ref )

Borderline Personality Disorder

Self image is distorted, Causing feelings of worthless or broken. Prone to anger, impulsivity and frequent mood swings that push others away, even though loving relationships are desire (mayo)

Symptoms
Impulsive and risky behavior, such as risky driving, unsafe sex, gambling sprees or illegal drug use Strong emotions that wax and wane frequently Intense but short episodes of anxiety or depression Inappropriate anger, sometimes escalating into physical confrontations Difficulty controlling emotions or impulses Suicidal behavior Fear of being alone Borderline video

Causes
Factors that seem likely to play a role include: Genetics.
twins and families Studies suggest inheritance.

Environmental factors:
history of childhood abuse, neglect and separation from caregivers or loved ones.

Brain abnormalities.
changes in certain areas of the brain involved in emotion regulation, impulsivity and aggression. brain chemicals like serotonin

Most likely, a combination

Treatments and drugs

Psychotherapy Dialectical behavior therapy (DBT). uses a skills-based approach to teach you how to regulate your emotions, tolerate distress and improve relationships. Transference-focused psychotherapy (TFP). understand the emotions and difficulties that develop in that relationship. You can then use what you have learned in other relationships. Medications
Medications can't cure ,but they can help associated problems,. Medications may include antidepressant, antipsychotic and anti-anxiety medications.

Hospitalization

Prognosis Onset of symptoms usually observable in young adulthood and trend toward stabilization after age 30. High risk for suicide!! What Occupational Therapists can do Work Leisure Social Activities of daily living (ADL) and IADL s Be aware of suicide= 8-10% will successfully commit suicide

Dependent Personality Disorder

Marked by feelings of nervousness and fear, helplessness, submissive and have a constant need for reassurance and to be taken care of One of the most frequently diagnosed personality disorders. It appears to occur equally in men and women, and usually appears in early to middle adulthood.

Symptoms
frantic efforts to avoid real or imagined abandonment. A pattern of unstable and intense interpersonal relationships characterized by alternating between extreme idealization and devaluation. Similar to a love-hate relationship. identity disturbance: markedly and persistently unstable selfimage or sense of self. Impulsive self-damaging behavior in at least two areas (e.g., spending, sex, substance abuse, reckless driving, binge eating). Suicidal behavior, threats or gestures or self mutilating behavior that is recurrent. Mood instability as the result of short lived but intense episodic dysphoria, irritability or anxiety. (suicidal risk should be assessed) Persistent feelings of emptiness. Difficulty regulating anger or inappropriately intense anger that may result in recurrent fights Stress related , brief, paranoia and or severe dissociative symptoms such as feeling disconnected from oneself. http://www.youtube.com/watch?v=eHEvXKh15xg

Cause
No known cause Environmental
caregiver is overly involved and intrusive or caregivers that reinforce their Childs dependency and shun attempts for freedom and or independence A history of social humiliations during developmental years has also been linked to dependent behaviors.

Treatment
Psychodynamic Therapy
Visit # predetermined to limit attachments

Cognitive behavioral therapy

Social skills training interpersonal therapy, group therapy and family and marital therapy
increase the individuals ability to function independently and autonomy.

Medication
rare anti-depressant or anti-anxiety medication

Dependent Prognosis generally good, even better for those who have a significant relationship with at least one parent. Through the use of therapy individuals learn how to become autonomous and function independently. OT Social work leisure benefit from the use of social skills training

Histrionic
intense, unstable emotions and distorted selfimages. For people with histrionic personality disorder, their self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. The word histrionic means dramatic or theatrical. Cleveland clinic

Symptoms
Experience feelings of discomfort when not the center of attention. Displays of sexually provocative and inappropriate behavior toward others, often with the goal being attention or protection not the act of having sexual relations. Emotional expressions are shallow and frequently shifting. Physical appearance is consistently used to gain attention of others. Verbal communications often lack detail and are aimed at pleasing and impressing others. Dramatic and exaggerated displays of emotion Individuals are easily influenced. The level of intimacy within personal relationships is overestimated. Anna nicole video

Cause
Cause unknown learned and inherited factors
run in families suggests that a genetic susceptibility for the disorder might be inherited. repeating learned behavior lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain approved behaviors unpredictable attention given to a child by his or her parent(s

Treatment
Psychodynamic Therapy Cognitive behavioral therapy Medication
rarely to treat symptoms depression and anxiety that may cooccur with this diagnosis.

Prognosis Many people with this disorder are able to function well socially and at work. Those with severe cases, however, might experience significant problems in their daily lives. OT identify thoughts and personal feelings and then identify appropriate responses to those emotions. Work Leisure Social

Narcissistic Personality Disorder

inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile selfesteem, vulnerable to the slightest criticism. http://www.mayoclinic.com/health/narcissisticpersonality-disorder/DS00652

Symptoms
Individuals aggregated accomplishments and demands other to recognize their superiority. He or she has a grandiose sense of selfimportance (Gale encyclopedia) Preoccupied with fantasies of exceptional success, power, genius and ideal love.(gale and dsm-iv-tr) He or she thinks of themselves as special and unique and can only be understood or associated with others or institutions who are of the same caliber and status. Demands excessive amounts of praise and admiration from others. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations. DSM-IV-TR) Exploits others for own personal gains. Lacks the ability to recognize or identify the feelings and needs of others. Unable to be empathetic. Frequent feels envious of others and believes others are consistently envious of him or herself. Frequently behaves or has an attitude of haughtily or arrogant.

Cause

Cause unknown dysfunctional childhood excess pampering extremely high expectations abuse or neglect genetics or psychobiology Societal pressures

Treatment
cognitive behavioral therapy group and family therapy
Short term goals of these therapies often include; addressing issues of substance abuse, depression and low self-esteem. Long term goals often focus on reshaping self-image and creating healthy patterns of thinking(mayo clinic)

Psychotherapy
relate to others creating meaningful more intimate relationships.

Medication
lessen or eliminate symptoms of anxiety and depression

Prognosis The younger someone is at the onset of treatment the more likely they are to diminish their symptoms older they become increasingly depressed especially during the retirement years OT Approach should be consistent and firm with clearly defined limits from the beginning

Paranoid Personality Disorder

People with paranoid personality disorder are highly suspicious of other people. They are usually unable to acknowledge their own negative feelings towards other people

Symptoms
Suspicions that others are trying to exploit, harm, or deceive with out justification for the suspicions. Preoccupation with thoughts that friends are not worthy of trust or incapable of offering loyalty. Confide and share as little personal information as possible due to fears that the information will be used maliciously. Misreading benign comments or remarks as threatening, insulting or demeaning. Unwillingness to forgive others for real or imagined slights or insults. Aggressive and or hostile responses to incorrectly perceived attacks by others. Unfounded suspicions about spouses or sexual partners fidelity

Cause
No known cause Familial
families where a member sufferers from schizophrenia or delusional disorder Twin studies have also shown a genetic link with the disorder.

Treatment
Psychotherapy group therapy self-help groups
gaining the trust of the patient and eliminating unfounded thoughts of deception.

Medications
anti-anxiety medications anti-psychotics anti-depressants

Prognosis The prognosis of paranoid personality disorder is poor as it is considered ca chronic lifeline disorder. Some symptoms of paranoia can be controlled with treatment but not significantly OT Work Leisure social Focus on trust building

Schizoid Personality Disorder

Often described as introverted, prefer to be alone, unwilling or fearful of intimacy with others(Merck). Spend a lot of time daydreaming or fantasizing as opposed to talking or acting as they have no desire for actual relationships with others. Have been know to show very little emotion

Symptoms
Avoid nor desire close relationships. They rarely date or marry, nor maintain familial relationships. Most always chose activities that require no additional persons. Has little to no desire to engage in sexual activities with another person. Daily tasks or activities provide little or no pleasure. Lacks close or intimate relationships with people outside the persons immediate family. Neither negative or positive comments invoke any sort of emotional response. Emotionally detached with tendencies to seem emotionally cold or aloof

Cause
No known cause Environment
Children cared for by individuals that show inadequate amounts of affection and emotional stimulation are prone to a disinterest in development close meaningful relationships in the future Children of parents with ineffective communication have been shown to imitate this style and or fail to learn how to effectively socialize

Treatment
Cognitive behavioral therapy
social skills training and role playing

psychodynamic group therapy.

The goal of treatment for someone with schizoid personality disorder is to combat habits to retreat from society, through enhancing the individuals selfawareness and sensitivities to others and the environment.

Medication
anti-anxiety and anti-depressant medications are often used to manage symptoms of anxiety and depression.

Prognosis
rare that individuals with schizoid personality disorder independently initiate seeking treatment, as such overall prognosis is poor Those who successfully complete treatment often relapse and return to withdrawal behaviors if no support system is in place

OT
courteous, honest and respectful as well as be tolerant of silence or level of involvement the client is willing to participate Eventual social skill training may be utilized once a therapeutic relationship is developed Sensory Integration techniques Work leisure social

Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by odd patterns of communication, behavior, thought and perception that resemble symptoms of someone with schizophrenia but are less severe.

Symptoms Ideas of reference Meaning they incorrectly interpret events, Odd beliefs or magical thinking that influences behavior and is inconsistent with culture norms Unusual perceptual experience, including bodily illusions. Bodily illusions are most often tactile and can be the feeling that an arm is missing,. Odd thinking and speech Suspiciousness or paranoid ideation inappropriate or constricted affect behavior or appearance that is odd, eccentric or peculiar Lack of close friends Excessive social anxiety that does not diminish with familiarity

Cause
no known cause bio-psycho-social model
combination of genetics, environment, and psychological factors that lead to the disorder. Seen more commonly in children of individuals with schizophrenia and or form of modeling of the relationship with parent

Treatment
Psychodynamic therapy cognitive-behavior therapy interpersonal therapy group therapy family and marital therapy Medications
antipsychotics such as Amoxapine anti-depressants like fluoxine (Prozac)

Prognosis poor due to the inflexibility and ingrained patterns of behavior associated with the disorder. OT ADL IADL Leisure Work Sensory Integration

As Occupational Therapists .
We treat the person NOT the diagnosis Be knowledgeable, safety of your patient and your safety It is not our job to change their personality but we can supply ways to ease access, modify the environment, increase safety and awareness

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