Personality is defined as a fixed continuing pattern of behaving and relating to self, others and the environment; it includes perceptions, attitudes and emotion

Personality disorders 

− Are diagnosed when personality traits become fixed and interfere with how a person functions in society or cause the person emotional distress

Behavioural patterns can be traced early in childhood or adolescence

• Usually there is significant impairment relating to a number of areas:

− Family

− Academic

− rmployment

− Other functional roles

 

Diagnosis 

• Made when an individual displays continuing behavioural patterns that differ from cultural expectations in two (2) or more areas:

− Ways of perceiving & interpreting self, other people & events (cognition)

− Range, intensity, lability & appropriateness of emotional response (affect)  − Social/personal functioning

− Ability to control impulses or express behaviour at appropriate time & place (impulse control)

 

Aetiology 

• Biological theories
• Psychodynamic theories
• Behavioural theories

− Hereditary/environment

− Temperament trait (harm avoidance, novelty seeking, reward dependence, persistence)

• Character traits

− Self-directedness

− Cooperativeness

− Self-transcendence

• Cultural context

− rthnic, cultural, social background

− Minority groups, marginalised groups  − Gender specificity

 

DSM-5 Criteria  •       An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: −  Cognition (i.e., ways of perceiving and interpreting self, other people, and events) −  Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) −  Interpersonal functioning −  Impulse control •       The enduring pattern is inflexible and pervasive across a broad range of personal and social situations •       The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning •       The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood

 

CLUSTER A 

Cluster A- Odd or eccentric

• Paranoid Personality disorder

− Individual feels distrust of other people

− Individual expects to be taken advantage of or be harmed by others  − Tend to hold grudges/don’t forgive

• Schizoid Personality disorder

− Individuals have restricted range of motions and restricted affect

− Wont seek out close relationships with other people, or sexual relationships

− Don’t react to criticism or praise

− Will find social interactions difficult, don’t like being in groups

• Schizotypal Personality disorder

− Closely related to schizophrenia

− May dress differently, may look odd in their appearance

− Individuals may have very poor academic achievements  − Quite unsociable, don’t interact with others

 

 

CLUSTER B

Cluster B- Dramatic, erratic and emotional

• Antisocial Personality Disorder

− In order to diagnosis an individual, they must have experienced conduct disorder by the age of 15

− Lack of remorse and empathy

− This is a trait seen right through childhood, not something that just develops

− Failure to plan ahead, impulsive actions/thoughts

• Borderline Personality Disorder

− Frantic efforts to avoid real or imagined abandonment

− Unstable and intense relationships, unstable and intense mood, unstable self image

− Chronic feelings of emptiness

− Inappropriate intense ager

− Stress related paranoid symptoms

− Will often engage in deliberate self harm (recurrent suicidal behaviour)

• Histrionic Personality Disorder

− Attention seeking behaviours

− Individuals may use their physical appearance to attract attention (seduction)

− Prone to exaggeration

• Narcissistic Personality Disorder

− Very arrogant behaviours

− A need for admiration

− Lack empathy

− Individuals wont engage with others who aren’t on “their level”

CLUSTER C

Cluster C- Anxious and fearful

• Avoidant Personality Disorder

− Individuals are socially inhibited

− They fear disapproval and rejection from other people

− They’ll avoid intimate relationships due to fear of rejection/dislike

• Dependent Personality Disorder

− Individuals avoid making decisions, they depend on others to make decisions for them

− They need to be taken care of, very clingy

− They lack confidence in their ability

• Obsessive-compulsive Personality Disorder

− Individuals need everything to be perfect

− They avoid others doing things for them, due to others not doing things properly/their way − They tend to be very rigid; rules are rules

 

 

Transference & Countertransference 

• Transference:

− Where a person transfers beliefs, feelings, thoughts or behaviours that occurred in one situation

(usually in their past) to a situation that is happening in the present

− e.g., you remind the client of a past nurse who secluded her and she is wary of you

 

• Countertransference:

− The response of the clinician to the client

− Having strong feelings for the patient, either negative or positive, may be the cue for experiencing countertransference

− e.g., you meet a client who reminds you of a close friend of yours, and you transfer those positive feelings/emotions to the client

 

Assessments-

− MSr and risk assessments

 

−	Complex assessment requirements, include:
	o   Drug and alcohol use (drug screen, detox, withdrawal needs) o   Self harming behaviour  o Suicidal ideation o Suicidal gestures	o o o o	Relationship history Forensic history  Medications  rxclusion criteria (hyperthyroidism, Cushing’s, anxiety disorder etc)
−	Care and interventions:
	o Setting clear limits  o Crisis management  o Mindfulness	o o	Problem solving rstablishing a team approach