Paranoid Personality Disorder PDF

11/27/23, 3:33 AM Realizeit for Student Paranoid Personality Disorder Clinical Picture Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Clients with this disorder interpret others’ actions as potentially harmful. During periods of stress, they may...

11/27/23, 3:33 AM Realizeit for Student Paranoid Personality Disorder Clinical Picture Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Clients with this disorder interpret others’ actions as potentially harmful. During periods of stress, they may develop transient psychotic symptoms. Incidence is estimated at 2% to 4% of the general population; the disorder is more common in males than females. Data about prognosis are limited because most people do not readily seek or remain in treatment. Generally, they tend to have lifelong problems living and working with others (Lee, 2017). Clients appear aloof and withdrawn and may remain a considerable physical distance from the nurse; they view this as necessary for their protection. Clients may also appear guarded or hypervigilant; they may survey the room and its contents, look behind furniture or doors, and generally appear alert to any impending danger. They may choose to sit near the door to have ready access to an exit or with their backs against the wall to prevent anyone from sneaking up behind them. They may have a restricted affect and may be unable to demonstrate warmth or empathic emotional responses such as “You look nice today” or “I’m sorry you’re having a bad day.” Mood may be labile, quickly changing from quietly suspicious to angry or hostile. Responses may become sarcastic for no apparent reason. The constant mistrust and suspicion that clients feel toward others and the environment distorts thoughts, thought processing, and content. Clients frequently see malevolence in the actions of others where none exists. They may spend disproportionate time examining and analyzing the behavior and motives of others to discover hidden and threatening meanings. Clients often feel attacked by others and may devise elaborate plans or fantasies for protection. These clients use the defense mechanism of projection, which is blaming other people, institutions, or events for their own difficulties. It is common for such clients to blame the government for personal problems. For example, the client who gets a parking ticket says it is part of a plot by the police to drive him out of the neighborhood. He may engage in fantasies of retribution or devise elaborate and sometimes violent plans to get even. Although most clients do not carry out such plans, there is a potential danger. Conflict with authority figures on the job is common; clients may even resent being given directions from a supervisor. Paranoia may extend to feelings of being singled out for menial tasks, treated as stupid, or more closely monitored than other employees. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 1/11 11/27/23, 3:33 AM Realizeit for Student Schizoid Personality Disorder Clinical Picture Schizoid personality disorder is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. It may affect 5% of the general population and is more common in males than females (Cloninger & Svrakic, 2017). People with schizoid personality disorder avoid treatment as much as they avoid other relationships unless their life circumstances change significantly. Clients with schizoid personality disorder display a constricted affect and little, if any, emotion. They are aloof and indifferent, appearing emotionally cold, uncaring, or unfeeling. They report no leisure or pleasurable activities because they rarely experience enjoyment. Even under stress or adverse circumstances, their response appears passive and disinterested. There is marked difficulty experiencing and expressing emotions, particularly anger or aggression (Chun, Barrantes-Vidal, Sheinbaum, & Kwapi, 2017). Clients do not report feeling distressed about this lack of emotion; it is more distressing to family members. Clients usually have a rich and extensive fantasy life, though they may be reluctant to reveal that information to the nurse or anyone else. The ideal relationships that occur in the client’s fantasies are rewarding and gratifying; these fantasies, though, are in stark contrast to real-life experiences. The fantasy relationship often includes someone the client has met only briefly. Nevertheless, these clients can distinguish fantasies from reality, and no disordered or delusional thought processes are evident. Clients generally are accomplished intellectually and often involved with computers or electronics for work or to pass their time. They may spend long hours solving puzzles or mathematical problems, though they see these pursuits as useful or productive rather than fun. Clients may be indecisive and lack future goals or direction. They see no need for planning and have no aspirations. They have little opportunity to exercise judgment or decision-making because they rarely engage in these activities. Insight might be described as impaired, at least by the social standards of others; these clients do not see their situation as a problem and fail to understand why their lack of emotion or social involvement troubles others. They are self-absorbed and loners in almost all aspects of daily life. Given an opportunity to engage with other people, they often decline. They are also indifferent to praise or criticism and are relatively unaffected by the emotions or opinions of others. They also experience dissociation from or no bodily https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 2/11 11/27/23, 3:33 AM Realizeit for Student or sensory pleasures. For example, the client has little reaction to beautiful scenery, a sunset, or a walk on the beach. Clients have a pervasive lack of desire for involvement with others in all aspects of life. They do not have or desire friends, rarely date or marry, and have little or no sexual contact. They may have some connection with a first-degree relative, often a parent. Clients may remain in the parental home well into adulthood if they can maintain adequate separation and distance from other family members. They have few social skills, are oblivious to the social cues or overtures of others, and do not engage in social conversation. Schizotypal Personality Disorder Clinical Picture Schizotypal personality disorder is characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. Incidence is about 3% of the population; the disorder is slightly more common in men than in women. Clients may experience transient psychotic episodes in response to extreme stress. Persons with schizotypal personality disorder may develop schizophrenia (Racioppi et al., 2018). Clients often have an odd appearance that causes others to notice them. They may be unkempt and disheveled, and their clothes are often ill-fitting, do not match, and may be stained or dirty. They may wander aimlessly and, at times, become preoccupied with some environmental detail. Speech is coherent, but may be loose, digressive, or vague. Clients often provide unsatisfactory answers to questions and may be unable to specify or to describe information clearly. They frequently use words incorrectly, which makes their speech sound bizarre. For example, in response to a question about sleeping habits, the client might respond, “Sleep is slow; the REMs don’t flow.” These clients have a restricted range of emotions; that is, they lack the ability to experience and to express a full range of emotions such as anger, happiness, and pleasure. Affect is often flat and is sometimes silly or inappropriate Cognitive distortions include ideas of reference, magical thinking, odd or unfounded beliefs, and a preoccupation with parapsychology, including extrasensory perception and clairvoyance. Ideas of reference usually involve the client’s belief that events have special meaning for him or her; however, these ideas are not firmly fixed and delusional, as may be seen in clients with schizophrenia. In magical thinking, which is normal in small children, a client believes he or she has special powers—that by thinking about something, he or she can make it happen. In addition, clients may express ideas that https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 3/11 11/27/23, 3:33 AM Realizeit for Student indicate paranoid thinking and suspiciousness, usually about the motives of other people (Cloninger & Svrakic, 2017). Clients experience great anxiety around other people, especially those who are unfamiliar. This does not improve with time or repeated exposures; rather, the anxiety may intensify. This results from the belief that strangers cannot be trusted. Clients do not view their anxiety as a problem that arises from a threatened sense of self. Interpersonal relationships are troublesome; therefore, clients may have only one significant relationship, usually with a first-degree relative. They may remain in their parents’ home well into the adult years. They have a limited capacity for close relationships, even though they may be unhappy being alone. Clients cannot respond to normal social cues and hence cannot engage in superficial conversation. They may have skills that could be useful in a vocational setting, but they are not often successful in employment without support or assistance. Mistrust of others, bizarre thinking and ideas, and unkempt appearance can make it difficult for these clients to get and to keep jobs. Antisocial Personality Disorder Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others—and by the central characteristics of deceit and manipulation. This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder. It occurs in about 3% of the general population, up to 30% in clinical settings, and is three to four times more common in men than in women. In prison populations, about 75% are diagnosed with antisocial personality disorder. Antisocial behaviors tend to peak in the 20s and diminish significantly after 45 years of age in many individuals. Borderline Personality Disorder BPD is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity. About 2% to 3% of the general population has BPD; it is five times more common in those with a first-degree relative with the diagnosis. BPD is the most common personality disorder found in clinical settings. It is three times more common in women than in men. Under stress, transient https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 4/11 11/27/23, 3:33 AM Realizeit for Student psychotic symptoms are common. Between 8% and 10% of people with this diagnosis commit suicide, and many more suffer permanent damage from self-mutilation injuries, such as cutting or burning. Up to three-quarters of clients with BPD engage in deliberate self-harm, sometimes called nonsuicidal self-injury (Merza, Papp, Molnar, & Szabo, 2017). Typically, recurrent self-mutilation is a cry for help, an expression of intense anger or helplessness, or a form of self-punishment. The resulting physical pain is also a means to block emotional pain. Clients who engage in self-mutilation do so to reinforce that they are still alive; they seek to experience physical pain in the face of emotional numbing. Working with clients who have BPD can be frustrating. They may cling and ask for help 1 minute and then become angry, act out, and reject all offers of help in the next minute. They may attempt to manipulate staff to gain immediate gratification of needs and, at times, sabotage their own treatment plans by purposely failing to do what they have agreed. Their labile mood, unpredictability, and diverse behaviors can make it seem as if the staff is always “back to square one” with them. Histrionic Personality Disorder Clinical Picture Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. It is found in 1% to 3% of the general population but in as much as 10% to 15% of inpatient populations. Clients often seek assistance for depression, unexplained physical problems, and difficulties with relationships. However, clients do not see how their own behavior has an impact on their current difficulties. This disorder is diagnosed more frequently in females than in males (Cloninger & Svrakic, 2017). The tendency of these clients to exaggerate the closeness of relationships or to dramatize relatively minor occurrences can result in unreliable data. Speech is usually colorful and theatrical, full of superlative adjectives. It becomes apparent, however, that though colorful and entertaining, descriptions are vague and lack detail. Overall appearance is normal, although clients may overdress (e.g., wear an evening dress and high heels for a clinical interview). Clients are overly concerned with impressing others with their appearance and spend inordinate time, energy, and money to this end. Dress and flirtatious behavior are not limited to social situations or relationships, but also occur in occupational and professional settings. The nurse may think these clients are charming or even seductive. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 5/11 11/27/23, 3:33 AM Realizeit for Student Clients are emotionally expressive, gregarious, and effusive. They often exaggerate emotions inappropriately. For example, a client says, “He is the most wonderful doctor! He is so fantastic! He has changed my life!” to describe a physician she has seen once or twice. In such a case, the client cannot specify why she views the doctor so highly. Expressed emotions, though colorful, are insincere and shallow; this is readily apparent to others but not to clients. They experience rapid shifts in moods and emotions and may be laughing uproariously one moment and sobbing the next. Thus, their displays of emotion may seem phony or forced to observers. Clients are self-absorbed and focus most of their thinking on themselves with little or no thought about the needs of others. They are highly suggestible and will agree with almost anyone to get attention. They express strong opinions firmly, but because they base them on little evidence or facts, the opinions often shift under the influence of someone they are trying to impress. Clients are uncomfortable when they are not the center of attention and go to great lengths to gain that status. They use their physical appearance and dress to gain attention. At times, they may fish for compliments in unsubtle ways, fabricate unbelievable stories, or create public scenes to attract attention. They may even faint, become ill, or fall to the floor. They brighten considerably when given attention after some of these behaviors; this leaves others feeling they have been used. Any comment or statement that could be interpreted as uncomplimentary or unflattering may produce a strong response, such as a temper tantrum or crying outburst. Clients tend to exaggerate the intimacy of relationships. They refer to almost all acquaintances as “dear, dear friends.” They may embarrass family members or friends by flamboyant and inappropriate public behavior such as hugging and kissing someone who has just been introduced or sobbing uncontrollably over a minor incident. Clients may ignore old friends if someone new and interesting has been introduced. People with whom these clients have relationships often describe being used, manipulated, or exploited shamelessly. Clients may have a wide variety of vague physical complaints or relate exaggerated versions of physical illness. These episodes usually involve the attention the client received (or failed to receive) rather than any particular physiological concern. Narcissistic Personality Disorder Clinical Picture https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 6/11 11/27/23, 3:33 AM Realizeit for Student Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. It occurs in 1% to 6% of the general population. Of people with this diagnosis, 50% to 75% are men. Narcissistic traits are common in adolescence and do not necessarily indicate that a personality disorder will develop in adulthood. Individual psychotherapy is the most effective treatment, and hospitalization is rare unless comorbid conditions exist for which the client requires inpatient treatment. Clients may display an arrogant or haughty attitude. They lack the ability to recognize or empathize with the feelings of others. They may express envy and begrudge others any recognition or material success because they believe it rightfully should be theirs. Clients tend to disparage, belittle, or discount the feelings of others. They may express their grandiosity overtly, or they may quietly expect to be recognized for their perceived greatness. They are often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. These fantasies reinforce their sense of superiority. Clients may ruminate about long-overdue admiration and privilege and compare themselves favorably with famous or privileged people (Miller, Lynam, Hyatt, & Campbell, 2017). Thought processing is intact, but insight is limited or poor. Clients believe themselves to be superior and special and are unlikely to consider that their behavior has any relation to their problems; they view their problems as the fault of others. Underlying self-esteem is almost always fragile and vulnerable. These clients are hypersensitive to criticism and need constant attention and admiration. They often display a sense of entitlement (unrealistic expectation of special treatment or automatic compliance with wishes). They may believe that only special or privileged people can appreciate their unique qualities or are worthy of their friendship. They expect special treatment from others and are often puzzled or even angry when they do not receive it. They often form and exploit relationships to elevate their own status. Clients assume total concern from others about their welfare. They discuss their own concerns in lengthy detail with no regard for the needs and feelings of others and often become impatient or contemptuous of those who discuss their own needs and concerns. At work, these clients may experience some success because they are ambitious and confident. Difficulties are common, however, because they have trouble working with others (whom they consider to be inferior) and have limited ability to accept criticism or feedback. They are also likely to believe they are underpaid and underappreciated or should have a higher position of authority even though they are not qualified. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 7/11 11/27/23, 3:33 AM Realizeit for Student Avoidant Personality Disorder Clinical Picture Avoidant personality disorder is characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation. It occurs in 2% to 3% of the general population. It is equally common in men and women. Clients are good candidates for individual psychotherapy (Cloninger & Svrakic, 2017). These clients are likely to report being overly inhibited as children and that they often avoid unfamiliar situations and people with an intensity beyond that expected for their developmental stage. This inhibition, which may have continued throughout upbringing, contributes to low self-esteem and social alienation. Clients are apt to be anxious and may fidget in chairs and make poor eye contact with the nurse. They may be reluctant to ask questions or to make requests. They may appear sad as well as anxious. They describe being shy, fearful, socially awkward, and easily devastated by real or perceived criticism. Their usual response to these feelings is to become more reticent and withdrawn. Clients with avoidant personality disorder have low self-esteem. They are hypersensitive to negative evaluation from others and readily believe themselves to be inferior. Clients are reluctant to do anything perceived as risky, which for them is almost anything. They are fearful and convinced they will make a mistake, be humiliated, or embarrass themselves and others. Because they are unusually fearful of rejection, criticism, shame, or disapproval, they tend to avoid situations or relationships that may result in these feelings. They usually strongly desire social acceptance and human companionship; they wish for closeness and intimacy but fear possible rejection and humiliation. These fears hinder socialization, which makes clients seem awkward and socially inept and reinforces their beliefs about themselves. They may need excessive reassurance of guaranteed acceptance before they are willing to risk forming a relationship. Clients may report some success in occupational roles because they are so eager to please or to win a supervisor’s approval. Shyness, awkwardness, or fear of failure, however, may prevent them from seeking jobs that might be more suitable, challenging, or rewarding. For example, a client may reject a promotion and continue to remain in an entry-level position for years, even though he or she is well qualified to advance. Dependent Personality Disorder Clinical Picture https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 8/11 11/27/23, 3:33 AM Realizeit for Student Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit caretaking from others. This disorder occurs in about 1% of the population and is three times more common in females than males. It runs in families and is more common in the youngest child. People with dependent personality disorder may seek treatment for anxious, depressed, or somatic symptoms (Cloninger & Svrakic, 2017). Clients are frequently anxious and may be mildly uncomfortable. They are often pessimistic and self-critical; other people hurt their feelings easily. They commonly report feeling unhappy or depressed; this is associated most likely with the actual or threatened loss of support from another. They are excessively preoccupied with unrealistic fears of being left alone to care for themselves. They believe they would fail on their own, so keeping or finding a relationship occupies much of their time. They have tremendous difficulty making decisions, no matter how minor. They seek advice and repeated reassurances about all types of decisions, from what to wear to what type of job to pursue. Although they can make judgments and decisions, they lack the confidence to do so. Clients perceive themselves as unable to function outside a relationship with someone who can tell them what to do. They are uncomfortable and feel helpless when alone, even if the current relationship is intact. They have difficulty initiating projects or completing simple daily tasks independently. They believe they need someone else to assume responsibility for them, a belief that far exceeds what is age or situation appropriate. They may even fear gaining competence because doing so would mean an eventual loss of support from the person on whom they depend. They may do almost anything to sustain a relationship, even one of poor quality. This includes doing unpleasant tasks, going places they dislike, or, in extreme cases, tolerating abuse. Clients are reluctant to express disagreement for fear of losing the other person’s support or approval; they may even consent to activities that are wrong or illegal to avoid that loss. When these clients do experience the end of a relationship, they urgently and desperately seek another. The unspoken motto seems to be: “Any relationship is better than no relationship at all.” Obsessive-Compulsive Personality Disorder Clinical Picture https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyU… 9/11 11/27/23, 3:33 AM Realizeit for Student Obsessive–compulsive personality disorder is characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. It is one of the most prevalent personality disorders, occurring in about 2% to 8% of the population, affecting twice as many men as women. Incidence is higher in oldest children and people in professions involving facts, figures, or methodical focus on detail. These people often seek treatment because they recognize that their life is pleasureless or they are experiencing problems with work or relationships. Clients frequently benefit from individual therapy. The demeanor of these clients is formal and serious, and they answer questions with precision and much detail. They often report feeling the need to be perfect beginning in childhood. They were expected to be good and do the right thing to win parental approval. Expressing emotions or asserting independence was probably met with harsh disapproval and emotional consequences. Emotional range is usually quite constricted. They have difficulty expressing emotions, and any emotions they do express are rigid, stiff, and formal, lacking spontaneity. Clients can be stubborn and reluctant to relinquish control, which makes it difficult for them to be vulnerable to others by expressing feelings. Affect is also restricted; they usually appear anxious and fretful or stiff and reluctant to reveal underlying emotions. Clients are preoccupied with orderliness and try to maintain it in all areas of life. They strive for perfection as though it were attainable and are preoccupied with details, rules, lists, and schedules to the point of often missing “the big picture.” They become absorbed in their own perspective, believe they are right, and do not listen carefully to others because they have already dismissed what is being said. Clients check and recheck the details of any project or activity; often, they never complete the project because of “trying to get it right.” They have problems with judgment and decisionmaking—specifically, actually reaching a decision. They consider and reconsider alternatives, and the desire for perfection prevents a decision from being reached. Clients interpret rules or guidelines literally and cannot be flexible or modify decisions based on circumstances. They prefer written rules for each and every activity at work. Insight is limited, and they are often oblivious that their behavior annoys or frustrates others. If confronted with this annoyance, these clients are stunned, unable to believe others “don’t want me to do a good job.” These clients have low self-esteem and are always harsh, critical, and judgmental of themselves; they believe that they “could have done better” regardless of how well the job has been done. Praise and reassurance do not change this belief. Clients are https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhy… 10/11 11/27/23, 3:33 AM Realizeit for Student burdened by extremely high and unattainable standards and expectations. Although no one could live up to these expectations, they feel guilty and worthless for being unable to achieve them. They tend to evaluate self and others solely on the basis of deeds or actions without regard for personal qualities. These clients have much difficulty in relationships, few friends, and little social life. They do not express warm or tender feelings to others; attempts to do so are stiff and formal and may sound insincere. For example, if a significant other expresses love and affection, a client’s response might be “The feeling is mutual.” Marital and parent–child relationships are often difficult because these clients can be harsh and unrelenting. For example, most clients are frugal, do not give gifts or want to discard old items, and insist that those around them do the same. Shopping for something new to wear may seem frivolous and wasteful. Clients cannot tolerate lack of control and hence may organize family outings to the point that no one enjoys them. These behaviors can cause daily strife and discord in family life. At work, clients may experience some success, particularly in fields where precision and attention to detail are desirable. They may miss deadlines, however, while trying to achieve perfection or may fail to make needed decisions while searching for more data. They fail to make timely decisions because of continually striving for perfection. They have difficulty working collaboratively, preferring to do it themselves so that it is done “correctly.” If clients do accept help from others, they may give such detailed instructions and watch the other person so closely that coworkers are insulted, annoyed, and refuse to work with them. Given this excessive need for routine and control, new situations and compromise are also difficult. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhy… 11/11