Human Behavior Week 9

American Psychiatric Association (2013). Desk Reference Guide to the Diagnostic Criteria from 

DSM 5. Washington, D.C.: APA  Personality Disorders in DSM-5

Barnhill, J.W. (2014).  Clinical cases. John W. Barnhill (Ed).  Washington, D.C.: APA. Select 

Case Studies from Chapter 18

Goodman, M., Hazlett, E.A., New, A.S., Koenigsberg, H.W., Siever, L. (2009).  Quieting the 

affective storm of borderline personality disorder.  The American Journal of Psychiatry 166(5), 422-529.

ANSWER QUESTIONS 1-5 IN 4-6 SENTENCES. ANSWER QUESTION 6 AS THOROUGHLY AS POSSIBLE SENTENCES. THEN CRITICALLY RESPOND TO 6a & 6b

1. What is a personality disorder? What is the age, when a person can be diagnosed with a personality disorder?
2. Describe the general features for cluster a personality disorders. Which disorders are part of cluster A?
3. Describe the general features for cluster b personality disorders. Which disorders are part of cluster B?
4.  Describe the features for cluster c personality disorders. Which disorders are part of Cluster C?
5. Describe the difference between borderline personality disorder and Bipolar Disorder.
6. As a clinician, you may encounter a person who has various traits of various personality disorders? Or you may see that the person may also have a mood disorder. Can a person have both a mood disorder and a personality disorder? How should you support this person? Should you get diagnostic clarity?  What do you need to assess for? How do you support this person in engaging with treatment? Does it depend on what type of referral the client is  ( Self versus Mandated)? 

There are several ways this individual needs to be supported by a social worker. Creating a therapeutic alliance and safe environment for the person is key. It cannot be easy to learn that one has a personality disorder (even if the condition is ego-syntonic), a mood disorder, or both. In one study, patients preferred to be diagnosed with mood disorders rather than a personality disorder. The reason is that personality disorders are seen to be more stigmatizing as it is a sign of a bad personality rather than a mood disorder, which can be understood as a chemical imbalance, and therefore not the patients fault. Working with someone with a personality disorder is fraught with potential insults to the clients ego which must be avoided. Working with someone with both a personality disorder and a mood disorder takes many different skills and types of knowledge to weave together an appropriate treatment plan. Also, preparing the individual and giving information regarding DBT, a likely course of treatment, will help prepare them for the work ahead (Choi-Kain & Gunderson, 2015).

The type of referral the client is may have some impact on how a social worker can engage a client in treatment. Someone who visits a social worker on their own, because they believe something is wrong or they need help, may still have a disorder that is ego-syntonic, but may be more agreeable to treatment, such as DBT groups, because they sought help themselves. One who is mandated may or may not have a much different opinion of their situation. If they do not believe they have a problem, and do not want to be at the sessions, then convincing them of the benefits of a treatment like DBT may take more time and nuance, as well as information.

It is important to come to a determination of diagnostic clarity when working with a client with a personality disorder, or co-occurrent mood disorder. For example, some clinicians may be more likely to diagnose a patient with bipolar disorder than borderline personality disorder (BPD) due to the fact that BPD can be both difficult to diagnose and treat, and a front-line treatment for bipolar disorder is medication, in which the treatment is more straightforward and the client can be referred to a psychiatrist (Choi-Kain & Gunderson, 2015). This could be a situation in which a client with BPD, who would benefit greatly from a focused therapy method like DBT, is instead receiving medication for a disorder that has no known effective pharmacological treatment (Choi-Kain & Gunderson, 2015).

Getting diagnostic clarity is important, since the best treatment for that person will depend on what the diagnosis or diagnoses are. Part of getting diagnostic clarity means taking particular caution if someone is having an episode of their mood disorder, since this could seem like a personality disorder and result in misdiagnosis (American Psychiatric Association, 2013). Its important to look at the persons long-term patterns when diagnosing a personality disorder (American Psychiatric Association, 2013). 

Dialectical behavior therapy (DBT) can be a very effective form of therapy for people with personality disorders. It is an evidence-based treatment that helps people change how they think and feel. It can include individual and group therapy and medication management. It can be especially helpful for clients who are experiencing suicidal ideation or self-harm (Psych Hub, 2019). I think this form of therapy can be effective whether someone was mandated or self-referred. That said, I think in in the case of someone mandated, there may be additional hurtles. It is especially important in these cases to hear from the client about how they perceive their own mental health and quality of life, and to find out what their goals are. They are more likely to feel some degree of investment in the treatment program if it is tailored to fit their needs.