Classification & Management of Personality Disorders PDF

Classification & Management of Personality Disorders Objectives At the end of this lecture, participants will be able to: State an overview of personality disorders Identify the (i) clusters (ii) types of personality disorders which exist. Describe the Epidemiology Personality...

Classification & Management of Personality Disorders Objectives At the end of this lecture, participants will be able to: State an overview of personality disorders Identify the (i) clusters (ii) types of personality disorders which exist. Describe the Epidemiology Personality Disorders Symptoms of Personality Disorders State some Symptoms of Personality Disorders DIAGNOSIS & TESTS FOR PERSONALITY DISORDERS DISCUSS THE MANAGEMENT OF PERSONALITY DISORDERS OVERVIEW OF personality disorders Personality disorders are a group of a 10 mental health conditions that involve long-lasting, disruptive patterns of thinking, behavior, mood and relating to others. People with personality disorders often don’t realize their thoughts and behaviors are problematic A personality disorder is a mental health condition that involves long-lasting, all- encompassing, disruptive patterns of thinking, behavior, mood and relating to others. These patterns cause a person significant distress and/or impair their ability to function. There are 10 types of personality disorders, each with different characteristics and symptoms. Personality is vital to defining who we are as individuals. It involves a unique blend of traits — including attitudes, thoughts and behaviors — as well as how we express these traits in our interactions with others and with the world around us. Personality disorders may cause distorted perceptions of reality, abnormal behaviors and distress across various aspects of life, including work, relationships and social functioning. Additionally, people with a personality disorder may not recognize their troubling behaviors or the negative effect they have on others. Types of Personality Disorders The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the standard reference publication for recognized mental illnesses, organizes the 10 types of personality disorders into three main clusters (categories). Each cluster has different symptoms in common. Cluster A personality disorders Cluster A personality disorders involve unusual and eccentric thinking or behaviors. These include:  Paranoid personality disorder: The main feature of this condition is paranoia, which is a relentless mistrust and suspicion of others without adequate reason for suspicion. People with paranoid personality disorder often believe others are trying to demean, harm or threaten them.  Schizoid personality disorder: This condition is marked by a consistent pattern of detachment from and general disinterest in interpersonal relationships. People with schizoid personality disorder have a limited range of emotions when interacting with others.  Schizotypal personality disorder: People with this condition display a consistent pattern of intense discomfort with and limited need for close relationships. Relationships may be hindered by their distorted views of reality, superstitions and unusual behaviors. Cluster B personality disorders Cluster B personality disorders involve dramatic and erratic behaviors. People with these types of conditions display intense, unstable emotions and impulsive behaviors. Cluster B personality disorders include:   Antisocial personality disorder (ASPD): People with ASPD show a lack of respect toward others and don’t follow socially accepted norms or rules. People with ASPD may break the law or cause physical or emotional harm to others around them. They may refuse to take responsibility for their behaviors and/or display disregard for the negative consequences of their actions.  Borderline personality disorder (BPD): This condition is marked by difficulty with emotional regulation, resulting in low self-esteem, mood swings, impulsive behaviors and subsequent relationship difficulties.  Histrionic personality disorder: This condition is marked by intense, unstable emotions and a distorted self-image. For people with histrionic personality disorder, their self-esteem depends on the approval of others and doesn’t come from a true feeling of self-worth. They have an overwhelming desire to be noticed by others, and may display dramatic and/or inappropriate behaviors to get attention.  Narcissistic personality disorder: This condition involves a consistent pattern of perceived superiority and grandiosity, an excessive need for praise and admiration and a lack of empathy for others. These thoughts and behaviors often stem from low self-esteem and a lack of self-confidence. Cluster C personality disorders Cluster C personality disorders involve severe anxiety and fear. They include:  Avoidant personality disorder: People with this condition have chronic feelings of inadequacy and are highly sensitive to being negatively judged by others. Though they would like to interact with others, they tend to avoid social interaction due to the intense fear of being rejected.  Dependent personality disorder: This condition is marked by a constant and excessive need to be cared for by someone else. It also involves submissiveness, a need for constant reassurance and the inability to make decisions. People with dependent personality disorder often become very close to another person and spend great effort trying to please that person. They tend to display passive and clinging behavior and have a fear of separation.  Obsessive-compulsive personality disorder (OCPD): This condition is marked by a consistent and extreme need for orderliness, perfectionism and control (with no room for flexibility) that ultimately slows or interferes with completing a task. It can also interfere with relationships. This is a separate condition from obsessive-compulsive disorder (OCD), which is classified as an anxiety disorder. While people with OCD usually are aware that OCD is causing their behavior and accept they need to change, people with OCPD usually have little, if any, self-awareness of their behaviors. People might have mixed symptoms of more than one personality disorder. Anyone can have a personality disorder. But different types of personality disorders affect people differently. Most personality disorders begin in the teen years when your personality further develops and matures. As a result, almost all people diagnosed with personality disorders are above the age of 18. One exception to this is antisocial personality disorder — approximately 80% of people with this disorder will have started to show symptoms by the age of 11. Antisocial personality disorders are more likely to affect people assigned male at birth. Borderline, histrionic and dependent personality disorders are more likely to affect people assigned female at birth. Epidemiology Personality Disorders Approximately 9% of adults in the U.S. have some type of personality disorder, and about 6% of the global population has a personality disorder. Borderline personality disorder (BPD) and antisocial personality disorder are the most frequently diagnosed personality disorders. Personality disorders are among the least understood mental health conditions. Scientists are still trying to figure out the cause of them. So far, they believe the following factors may contribute to the development of personality disorders:  Genetics: Scientists have identified a malfunctioning gene that may be a factor in obsessive-compulsive personality disorder. Researchers are also exploring genetic links to aggression, anxiety and fear, which are traits that can play a role in personality disorders.   Brain changes: Researchers have identified subtle brain differences in people with certain personality disorders. For example, findings in studies on paranoid personality disorder point to altered amygdala functioning. The amygdala is the part of your brain that’s involved with processing fearful and threatening stimuli. In a study on schizotypal personality disorder, researchers found a volumetric decrease in the frontal lobe of their brain.  Childhood trauma: One study revealed a link between childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates of childhood sexual trauma. People with borderline and antisocial personality disorders have issues with intimacy and trust, both of which may be related to childhood abuse and trauma.  Verbal abuse: In one study, people who experienced verbal abuse as children were three times as likely to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.  Cultural factors: Cultural factors may also play a role in the development of personality disorders, as demonstrated by the varying rates of personality disorders between different countries. For example, there are remarkably low cases of antisocial personality disorders in Taiwan, China and Japan, along with significantly higher rates of cluster C personality disorders. Symptoms of Personality Disorders Each of the 10 types of personality disorders has its own specific signs and symptoms. But, in general, personality disorders involve problems with:  Identity and a sense of self: People with a personality disorder generally lack a clear or stable image of themselves, and how they see themselves often changes depending on the situation or the people they’re with. Their self-esteem may be unrealistically high or low.  Relationships: People with a personality disorder struggle to form close, stable relationships with others due to their problematic beliefs and behaviors. They may lack empathy or respect for others, be emotionally detached or be overly needy of attention and care. Another distinguishing sign of personality disorders is that most people who have one often have little to no insight or self-awareness of how their thoughts and behaviors are problematic. You can’t know for sure if someone has a personality disorder unless they receive a professional, medical diagnosis. It’s important to understand the difference between personality types and personality disorders. A person who is shy or likes to spend time alone doesn’t necessarily have an avoidant or schizoid personality disorder. The difference between personality style and a personality disorder can often be determined by assessing how the person’s personality affects different parts of their life, including:  Work.  Relationships.  Feelings/emotions.  Self-identity.  Awareness of reality.  Behavior and impulse control. Some general signs of people with a personality disorder include:  Their behavior is inconsistent, frustrating and confusing to loved ones and other people they interact with.  They may have issues understanding realistic and acceptable ways to treat others and behave around them.  They may be unaware of how their behaviors cause problems for themselves and/or others.  If they’re a parent, their parenting style may be detached, overemotional, abusive or irresponsible. This can sometimes lead to physical, emotional or mental issues in their children. DIAGNOSIS & TESTS FOR PERSONALITY DISORDERS Personality disorders can be difficult to diagnose since most people with a personality disorder don’t think there’s a problem with their behavior or way of thinking. Because of this, people with a personality disorder typically don’t seek help or a diagnosis for their condition. Instead, their loved ones or a social agency may refer them to a mental health professional because their behavior causes difficulty for others. When they do seek help, it’s often due to conditions such as anxiety, depression or substance use, or because of the problems created by their personality disorder, such as divorce or unemployment, not the disorder itself. Healthcare providers base the diagnosis of a specific personality disorder on criteria provided in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. When a mental health professional, like a psychologist or psychiatrist, suspects someone might have a personality disorder, they often ask broad, general questions that won’t create a defensive response or hostile environment. They ask questions that will shed light on:  Past history.  Relationships  Previous work history.  Reality testing.  Impulse control. Because a person suspected of having a personality disorder may lack insight into their behaviors, mental health professionals often work with the person’s family, friends and/or parole officers to collect more insight about their behaviors and history. Personality disorders are generally under diagnosed because providers sometimes focus on the symptoms of anxiety or depression, which are much more common in the general population than personality disorders. These symptoms may overshadow the features of any underlying personality disorder. MANAGEMENT AND TREATMENT OF PERSONALITY DISORDERS Personality disorders are some of the most difficult disorders to treat in psychiatry. This is mainly because people with personality disorders don’t think their behavior is problematic, so they don’t often seek treatment. Therapy is a general term for the application of techniques used to improve a person’s mental or physical well-being. Psychotherapy is the main way of dealing with and treating mental conditions like personality disorders. Also called “talk therapy,” therapists deal with the patients by encouraging them to talk about their condition, feelings, thoughts, mood and behavior. Several types of psychotherapy for mental illnesses include:  Cognitive behavioral therapy (CBT)  Dialectical behavior therapy (DBT)  Interpersonal therapy (IPT)  Family-focused therapy Cognitive behavioral therapy, also known as CBT, helps patients to recognize and alter their inaccurate perception about themselves, other people and the world around them. Most therapists combine cognitive and behavioral therapies to replace a person’s unhealthy thoughts with positive and healthier perceptions. Aside from cognitive and behavioral, another branch of CBT is dynamic, or an examination of a person’s early childhood to identify the possible cause of that person’s personality disorder. Cognitive Behavioral Therapy Treatments And even if a person with a personality disorder seeks treatment, modern medicine is still lacking in available treatment options — there are no medications currently approved to treat any personality disorder. But there are medications that can help with symptoms of anxiety and depression, which are common in people with a personality disorder. But psychotherapy (talk therapy) can help manage personality disorders. Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, like a psychologist or psychiatrist, can provide support, education and guidance to you and your family. The main goals of psychotherapy for treating personality disorders include:  Reducing immediate distress, such as anxiety and depression.  Helping the person understand that their problems are internal and not caused by other people or situations.  Decreasing unhealthy and socially undesirable behavior.  Modifying the personality traits that are causing difficulties. There are several different types of psychotherapy, and each personality disorder requires different types. For example, studies show that dialectical behavior therapy (DBT) is effective for treating those with borderline personality disorder, and people with histrionic personality disorder often benefit from cognitive-behavioral therapy (CBT). PREVENTION OF Personality disorders At this time, there’s no known way to prevent personality disorders, but many of the related problems might be lessened with treatment. Seeking help as soon as symptoms appear can help decrease the disruption to the person’s life, family and friendships. OUTLOOK / PROGNOSIS for Personality Disorders Since people with personality disorders often don’t seek proper medical attention, the overall prognosis for personality disorders is poor. Untreated personality disorders may result in:  Poor relationships.  Occupational difficulties.  Impaired social functioning. Studies show that personality disorders are associated with elevated rates of:  Unemployment.  Divorce.  Domestic abuse.  Substance use.  Homelessness.  Crime (especially antisocial personality disorder). In addition, people with personality disorders are more likely to visit the emergency room (ER), experience traumatic accidents and have early deaths by suicide. Although the outlook is dire, studies show that collaborative care management can greatly improve outcomes for people with personality disorders if they stay committed to treatment. Inpatient Personality Disorder Treatment Residential Centers Personality disorders tend to be chronic and often require long-term treatment. When the symptoms are severe or other physical or mental conditions are present, hospitalization inside a personality disorder facility could be required to treat the disorder. Residential or inpatient treatment centers can offer acute or long-term treatment program, depending on the type and severity of the personality disorder of the patient. Patients with borderline personality disorder, which make up about 6 percent of the US adult population, utilize inpatient treatment programs because of their inability to control and regulate their emotions and behaviors. Many people who have personality disorders require the care of skilled general psychiatrists and a disciplined staff due to their pervasive behavior and emotional problems. A residential treatment facility offers a supportive environment and 24- hour monitoring and medical care. The disorders also require complex handling, which can be managed immediately in an acute setting like a residential personality disorder facility. Most residential centers also provide therapeutic communities (TC) where patients undergo a more intensive form of therapy. Participating in TCs requires a high level of commitment as well as a willingness to take part in group therapy and activities. Luxury Personality Disorder Facilities A luxury disorder center offers the same treatment as a standard residential facility, but often provides more amenities. Most luxury centers provide patients with personal staff and attendants as well as private rooms in posh settings. It isn’t surprising to find a luxury treatment center located in a highly secluded area where patients can relax and enjoy their stay without fear of their privacy being exposed. A luxury center might emphasize the physical and emotional well-being of their patients. Most have fitness centers where one can take Pilates or yoga classes or have one-on-one sessions with physical fitness trainers. Executive Personality Disorder Programs An executive personality disorder treatment program focuses on people with personality disorders in the business and professional arena. The programs are designed to help patients cope with their condition as well as manage the stress acquired from a loaded workday. The patient who chooses to undertake an executive treatment program can enter a private facility in secrecy in order to keep the patient’s condition confidential. Outpatient Personality Rehab and Treatment Programs About 10 percent of outpatient admission involve borderline personality disorder. Outpatient treatment for personality disorders is recommended for people who don’t display disruptive and violent behavior because of their conditions. Outpatient care and treatment are similar to those provided in inpatient settings, but patients are required come for the recommended number of sessions for therapies and medications. A note from Cleveland Clinic It’s important to remember that personality disorders are mental health conditions. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors. The family members of people with personality disorders often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.