Personality Disorders represent enduring, generally intractable patterns of thinking, behaving and feeling that characterize the individual’s functioning across a wide variety of situations
WEEK THIRTEEN
Personality Disorders
Personality Disorders represent enduring, generally intractable patterns of thinking, behaving and feeling that characterize the individual’s functioning across a wide variety of situations. These patterns are seen as self-defeating, inflexible and beginning by early adulthood. Personality Disorders cause significant impairment, particularly in the individual’s interpersonal life. It is rare that a patient presents with a request for treatment of their personality problem. More commonly, they experience a more acute, symptom oriented problem like depression, anxiety or substance abuse that has resulted in distress and causes them to seek treatment. Often these personality problems are ego-syntonic, cause no personal distress to the patient but create a great deal of difficulty to others in their environment. The diagnosis of a Personality Disorder tends to be more unreliable than most other clinical disorders due to the rather subjective nature of the judgments that must be made about the person. Drawing the line between a Personality Disorder and the normal variation in personality can be difficult. You may even see some of your own characteristics in some of the Personality Disorder descriptions.
Personality Disorders can be divided into three groups, each having many characteristics in common: The Odd, Anxious and Dramatic Clusters. The Odd cluster includes Schizoid, Schizotypal and Paranoid Disorders. The Anxious Cluster includes Dependent, Obsessive Compulsive and Avoidant Disorders. Finally, the Dramatic Cluster includes the Histrionic, Narcissistic, Borderline and Anti-Social Disorders. Treatment for these disorders is extremely difficult and time consuming and should be undertaken only by highly skilled clinicians. In any case the prognosis for any significant change in personality structure is very poor.
READ: Chapter 12 (B & D) www.mentalhealth.com (Links to an external site.) (Schizoid, Schizotypal, Paranoid, Histrionic, Narcissistic, Borderline, Anti-Social, Avoidant, Obsessive-Compulsive and Dependent Personality Disorders).
CASE STUDY: Read and answer questions on the following case study. Submit via ADB.
Ms. Seeker
Ms. Seeker is a 23 year old medical assistant who was hospitalized after she recently attempted to slash her wrists with a tin can. She told the staff on admission, “I don’t really need to be here.” Three months before admission she learned her mother was pregnant and she began drinking heavily in order to “sleep at night.” During her heavy drinking she began sleeping around in a variety of 1 night stands. Before admission she reported feeling panicky and having the feeling like she was removed from her body and in a trance. At one point she claims she heard a voice telling her to jump off a bridge.
At admission to the hospital, Ms. Seeker appeared disheveled and frail. She was cooperative and coherent and looked forward to being free of her anxiety. She reported feelings of loneliness and inadequacy and brief periods of depression and anxiety since adolescence. She claimed that she was “just an empty shell that is transparent to everyone.”
Ms. Seeker’s parents divorced when she was three and she was raised by her grandmother who was an alcoholic. She had night terrors and had to sleep with her grandmother. She was sent to a boarding school when she was 6 years old when she reports she was sexually abused by a teacher. As an adolescent she had an active but unsatisfying sex life but her relationships with men would end abruptly after she became angry with them for disappointing her in some way. She could not establish a stable living arrangement with roommates with whom she would often become quite jealous and angry. She was living alone at the time of admission.
Questions:
What is her diagnosis?
What are the symptoms that helped you make this diagnosis? What diagnostic criteria do they relate to?
What are two other possible diagnoses and why did you not choose them?
What is her prognosis?
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