outline

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Personality Disorder
Dr.DrewChenelly
What is a Personality Disorder?
An inflexible, maladaptive, pattern of thinking, feeling, perceiving and
behaving which leads to significant problems in important areas of life
such as: work, social relationships and family interactions.
Characteristics of Personality Disorder:
 Other people seen as cause of problems.
 Relationships are shallow.
 Emotions are unstable.
 Lack empathy … unable to identify with the needs and feelings
of others.
 Try to make others feel the need to solve their problems by
playing on other’s need for approval
 Seek special treatment and immediate compliance with demands
to control others in order to feel important and special.
 Lack a strong sense of self… self-esteem is dependent on
constant external approval.
 Over idealize individuals if they gratify needs …devalue those
who fail to respond to demands.
 Grandiose sense of self-importance compensates for underlying
feelings of worthlessness.

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Vicious Cycles:
Paranoid viciouscycle: They expect to be rejected  As a result, they are hostile
to others and reject before they are rejected  Because of their defensiveness and
hostility, others reject them  This confirms their original belief that most people
are hostile to them and the cycle is repeated over and over again with each new
interpersonal contact.
Hostile-dependentviciouscycle: Constantly seeks supportand assistance from
others. This creates a conflict. If others solve problems … feel inadequate. If
others refuse to solve problems…feel rejected. Resent those upon whom
dependent because contact with them leads to feeling of inadequacy.
Types of Personality Disorder:
Paranoid PersonalityDisorder. These individuals are mistrustful of others
and suspicious of the motives and intentions of those around them. They tend to
be loners with few close, personal relationships. They can be impressive and even
charming, but are always looking for hidden meanings in the speechand behavior
of the people they encounter. They can be argumentative and quarrelsome and their
impatience is often expressed in angry, emotional outbursts. They sometimes
convey an attitude of superiority, arrogance and grandiosity which antagonizes
other people. They can unconsciously create the following self defeating vicious
cycle: They expect to be rejected; As a result, they are hostile to others and reject
before they are rejected; Because of their defensiveness and hostility, others reject
them; This confirms their original belief that most people are hostile to them and
the cycle is repeated over and over again with each new interpersonal contact.
Narcissistic personalitydisorder is characterized by a pattern of grandiosity, need
for admiration, and lack of empathy. . . . An exaggerated sense of self-importance
is manifest in a pretentious, boastfuloverestimation of abilities and
accomplishments and preoccupationwith restitution for not having been
recognized for their "true" talents. They believe that they are exempt from the
duties and responsibilities of everyday people. They crave excitement to ward off
boredomand emptiness.

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Histrionicpersonalitydisorder which is characterized by: difficulty achieving
intimacy in relationships… depression when needs are not met …use of physical
symptoms as an appeal for help…. symptoms which are dramatically described
and vague …a belief that all problems stem from an impossible life situation…
alienate others with demands for constant attention…become depressed and upset
when not the center of attention…frustrated by situations that involve delayed
gratification …actions usually directed at obtaining immediate satisfaction… when
dependency needs are not met, become angry, demanding and coercive.
Borderlinepersonalitydisorder:Seeks special treatment, immediate compliance
with demands and tries to controlothers in order to feel important and
special…tries to make others feel the need to solve problems by unconsciously
playing on their need for approval (i.e. “If you do what I demand, I will like you
and if you don’t, I will condemn you”). Also employs “splitting” (e.g. shifting
views of others as all good versus all bad) and will attempt to manipulate staff by
trying to lure them into joining in a condemnation of other staff (i.e. “Your great
but they are incompetent”).
How to respond, the rules:
 Stay calm…do not respond with anger.
 Think of the behavior as a clinical problem which needs to be managed.
 Do not take the hostility personally.
 Do not be drawn into an argument or be forced into defending yourself.
 Do not be lured into agreeing with criticism of another staff member.
 One personshould be designated to hear all complaints. The designated staff
member should schedule contacts with during which concerns and
complaints can be heard. These contacts should be time limited and the staff
member must be available for the scheduled appointments.

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 Neither downplay nor react strongly to complaints; be mater-of-fact.
 All behavioral expectations of the resident should be made explicit and staff
should always be consistent.
 Present a unified front…supportand back each other up.
 Do not attempt to satisfy unreasonable demands. Say you will help with a
task but you will not do the job for the resident. Say that doing the job for
him implies a lack of competence on his part and you intend to treat him as a
competent adult.
 Do not apologize or be intimidated or explain yourself.
 Avoid confrontation.
 Place appropriate responsibility in the resident's hands.
 Always respond in a calm, matter-of-fact and professional manner.
 Develop a consistent plan for intervening and insure that all staff are aware
of the plan.
 When a resident is verbally abusive, terminate the contact with the following
statement: “I can see you’re not in a mood to speak with me now; I’ll speak
with you again later when you are less angry.” A resident will perceive any
angry responseby staff as a victory in a verbal battle.
 When it seems appropriate, try to diffuse a tense situation with humor.
 Model self-regulation by speaking and moving, calmly and slowly
 Avoid any statements which could be perceived as judgmental or moralistic.