Personality Disorders

1
Personality Disorders Chronic Medical Conditions

• Jeff Baker, Ph.D.
• Chief Psychologist, Anesthesiology, Orthopaedics
  Rehabilitation, Surgery
• Director, SAHS Counseling Student Services

2
Objectives

• Identify psychological influences of personality.
• Understand the influence of stress on
  personality.
• Types of Stressors that influence patients
  rehabilitation.
• Effective ways of managing patients with major
  psychosocial stressors

3
Personality Disorders Stress

• Adjustment Reactions to Medical Conditions
• PTSD
• Long Term Effect
• 11 Personality Disorders (DSMIV TR)
• Differentiation of Personality Disorders
• Case Studies Managing Psychosocial stress.

4
Adjustment Disorders

• Development of emotional or behavioral symptoms
  in response to an identifiable stressor(s) within
  3 months of the onset of the stressor(s).
• Evidenced by either of the following

5
Adjustment Disorders

• 1. Marked distress that is in excess of what
  would be expected.
• 2. Significant impairment in social or
  occupational functioning.

6
Adjustment Disorders

• The stress-related disturbance does not meet the
  criteria for another AXIS I or AXIS 2 disorder.
• The symptoms do not represent bereavement.
• Once the stressor has terminated, the symptoms do
  not persist for more than an additional 6 months.

7
Adjustment Disorders

• 309.0 Adj Disorder with Depressed Mood
• 309.24 Adj Disorder with Anxiety
• 309.28 with mixed anxiety and depression
• 309.3 with disturbance in conduct
• 309.4 with disturb of emotions and conduct
• 309.9 Adj Disorder unspecified

8
Posttraumatic Stress Disorder

• The symptoms develop after a psychologically
  traumatizing event or events outside the range of
  normal human experience. May experience symptoms
  alone or in groups. The stressors contain a
  psychological component and frequently a
  concomitant physical component that may directly
  damage people's nervous systems. In adjustment
  disorder the precipitating stress event need not
  be severe or unusual.

9
Personality Disorders Effect on the Individual
Depression Phobias Elevated family
violence Drug use Exacerbation of Existing
Issues Inhibit Healing Rehabilitation
Without Treatment
10
Identifying Personality Disorders
11
Mini Self-Test
1. What are the characteristics of a person that
would warrant a personality disorder
diagnosis? 2. How would that effect my ability
to provide treatment/therapy for the
patient? 3. How is this going to effect the
patients quality of life.
12
Definition of Personality Disorder

• It is pervasive and inflexible.
• It has on onset in adolescence or early
  adulthood.
• It is stable over time.
• It leads to distrust or impairment.
• P.D. Is thought to be It is an enduring pattern
  of inner experience and behavior that deviates
  markedly from the expectations of the
  individuals culture.
• coping or defense mechanisms, which are used to
  deal with high levels of stress that have been
  left untreated.
• Coping with pain, loss of identity, mobility, and
  independence all may have profound effects on
  personality.

13
What are Personality Disorders Like?

• People with personality disorders typically have
  problems in many areas of their lives, including
  social skills, moods, and emotional states.
  People with these disorders have difficulty
  establishing normal, health relationships.

14
Personality Disorders

• In many of the disorders, sufferers lack the
  ability to have genuine emotions including
  empathy for others.
• In some disorders, some have no desire to have
  social relationships or they want relationships,
  but are scared to reach out to people.
• Personality disorder symptoms stem from basic
  personality traits that developed over time. A
  person does not get a personality disorder.

15
Personality Disorders

• Because personality disorder traits are deeply
  ingrained in the personality, there is no quick
  treatment. Treatment is typically based on
  psychotherapy which evaluates faulty thinking
  patterns and teaches new thinking and behavior
  patterns.
• A problem in treating individuals with
  personality disorders is that many do not believe
  they have a problem.

16
Diagnosis Criteria
1) There are 11 personality disorders listed in
the DSM-IV. 2) DSM-IV Diagnostic and
Statistical Manual of Mental
Disorders-Fourth Edition, TR APA 2001. 3) The
criteria for each Personality Disorder is listed
in the DSM-IV TR.
17
Differentiation of Personality Disorder and
Disorder

• Personality Disorder tends to be EgoSyntonic
• Disorder tends to be EgoDystonic

18
Types of Personality Disorders
Cluster A Odd or Eccentric 1. Paranoid
Personality Disorder 2. Schizoid Personality
Disorder 3. Schizotypal Personality
Disorder Cluster B Dramatic, Emotional, or
Erratic 4. Antisocial Personality Disorder 5.
Borderline Personality Disorder 6. Histrionic
Personality Disorder 7. Narcissistic Personality
Disorder Cluster C Anxious or Fearful 8.
Avoidant Personality Disorder 9. Dependent
Personality Disorder 10. Obsessive-Compulsive
Personality Disorder 11. Personality Disorder NOS
19
Diagnosis
20
Case Examples

• Patient who is verbally abusive and aggressive to
  staff and family.
• Patient who is suspicious and questions your
  treatment methods.
• Patient who wants to go have a cup of coffee with
  you and be your friend.

21
Case Examples

• Patient who is seductive and always seems dressed
  up and wearing lots of cologne when they come in
  for therapy.
• Patient who cries while in therapy and appears
  very sad about their future.
• Patient who denies that their SCI will bring
  about any changes in their lifestyle.

22
Psychological Factors Affecting Medical Condition

• A general medical condition
• Psychological factors adversely affecting the
  medical condition
• Disorder Psych symptoms Personality traits
  Maladaptive health behaviors Stress related
  physiological response Other (cultural
  religious)

23
Chronic Pain

• Explain the nature of the pain
• Maximize placebo effect
• Explain realistic expectations
• degree and course of pain
• analgesic, reframe side effects

24
Chronic Pain

• Chronic pain requires special arrangements
• Eliminate doubts about the availability of meds.
• No meds requiring proof of need (lost, stolen)
• Focus on strengths, do not reinforce obsession
  with pain.
• Do not make contact with cared system contingent
  on pain remove that contingency.

25
Clinical Use of the MMPI2 Patients with Chronic
Pain
26
Conclusions

• Individuals Diagnosed with Personality Disorders
  vs Individuals with exacerbated Stressors
• Difficult to Treat, Difficult to Manage
• How Does it Affect Your Treatment of the Patient