Discussion 11 PDF

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Discussion 11...

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Let’s move on to personality disorders. DSM-5 includes 10 personality disorders that are divided into three clusters: Cluster A (odd or eccentric) includes paranoid, schizoid, and schizotypal personality disorders; Cluster B (dramatic, emotional, or erratic) includes antisocial, borderline, histrionic, and narcissistic personality disorders; and Cluster C (anxious or fearful) includes avoidant, dependent, and obsessive-compulsive personality disorders. These personality disorders represent long-standing and ingrained ways of thinking, feeling, and behaving that can cause significant distress. Because people may display two or more of these maladaptive ways of interacting with the world, considerable disagreement remains over how to categorize personality disorders. Treating people with personality disorders is often difficult because they usually do not see that their difficulties are a result of the way they relate to others. Let’s consider these questions… If everyone has a “different” personality (i.e., if no two are alike), then how can we say that someone has a “disordered” personality? What truly makes a personality pathological? Though everyone has a different personality, there are characteristics that can categorize a person’s personality as “disordered”. These characteristics are ones that cause some sort of distress either in themselves or people around them. For some, aspects of other people’s personalities may seem odd but this doesn’t mean that those individuals have a personality disorder. However, “when such personality characteristics interfere with relationships with others, cause the person distress, or in general disrupt activities of daily living, we consider these to be personality disorders” (Skodol, 2012 as sited in Barlow et al., 2019). This distinction helps clarify which personality traits are representative of a disorder or just “unusual”. Additionally, these traits are lasting, not fleeting traits. “A personality disorder is therefore a persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships” (American Psychiatric Association, 2013 as sited in Barlow et al, 2019). In many cases the individual with the personality disorder may not realize that their disorder is disrupting their lives or that it is causing anguish in others around them. Sometimes the personality disorder doesn’t bother the sufferer but instead affect those around the individual much more, in other words “individuals with personality disorders may not feel subjective distress; indeed, it may be others who acutely feel distress because of the actions of the person with the disorder” (Barlow et al., 2019). Therefore, the individual themselves does not need to be the one that identifies the problem and sometimes “someone other than the person with the personality disorder must decide whether the disorder is causing significant functional impairment because the affected person cannot make such a judgment” (Barlow et al., 2019).

Personality disorders are some of the most stigmatizing psychological disorders. Why might this be the case? How does such a stigma impact those who receive a personality disorder diagnosis? Because personality disorders affect exactly what they are named after, individuals personalities, they are likely the most stigmatized because they determine the way an individual interacts and relates to the world around them. This means that these disorders can encompass the beings entire way of interacting with others which can affect relationships negatively creating damaging connotations of the individual and their associated disorder. ...imagine a party where all the people had PERSONALITY DISORDERS. Indicate which diagnosis is most likely for each person. (Please note these are exaggerated vignettes to aid in differential diagnosis.)

Donna danced into the party and immediately became the center of attention. With sweeping gestures of her arms and dramatic displays of emotion, she boasted about her career as an actress in a local theater group. During a private conversation, a friend inquired about the rumors that she was having some difficulties in her marriage. In an outburst of anger, she denied any problems and claimed that her marriage was "as wonderful and charming as ever." From the description I believe Donna has Histrionic Personality Disorder. According to the textbook “Individuals with histrionic personality disorder tend to be overly dramatic and often seem almost to be acting, which is why the term histrionic, which means theatrical in manner, is used” (Barlow et al., 2019) which was portrayed by Donna as she “danced into the party”, and portrayed “dramatic displays of emotion“, “with sweeping gestures”. Additionally from the description she represents some of the characteristics from DSM-5. These being “is uncomfortable in situations in which he or she is not the center of attention”, “displays rapidly shifting and shallow expression of emotions”, and as previously mentioned “shows self-dramatization, theatricality, and exaggerated expression of emotion”. William wandered into the party, but didn't stay long. The "negative forces" in the room were unsettling to his "psychic soul-spot." The few guests he spoke to felt somewhat uneasy being with this aloof "space cadet." William seems to have Schizotypal Personality Disorder based from his description. What I first noticed was his beliefs in “negative forces” and his “psychic soul-spot”. A few of the DSM-5 characteristics William seems to fit for this disorder are “(1) ideas of reference (excluding delusions of

reference), (2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations), (3) unusual perceptual experiences, including bodily illusions, (4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped), (6) inappropriate or constricted affect, (7) behavior or appearance that is odd, eccentric, or peculiar”. Not only was William uncomfortable in the social setting but his way of interacting made others around him uncomfortable. Charles paraded into the party laughing and giggling. He flirted with many of the women and to two of them expressed his "deep affection." After a violent argument with one of them, because they took "too long" to get him a drink, he locked himself into the bathroom. His friends encouraged him to go home, but he did not want to be left alone. Charles seems to fit multiple DSM-5 characteristics for Borderline personality Disorder. When Charles is described as flirting with some of the women and expressing “deep affection” for them then becoming violently angry with one for taking “too long” to get him a drink this shows the DSM-5 criteria’s “frantic efforts to avoid real or imagined abandonment”, “A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation”, “affective instability due to a marked reactivity of mood”, and “inappropriate, intense anger or difficulty controlling anger”. Though it isn’t outrightly said when Charles says he does not want to be left alone this could insinuate that when he is left along he has negative feelings or thoughts and could meet the criteria of “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” but would need further investigation to find out. Winston spent most of the time talking about his trip to Europe, his new Mercedes, and his favorite French restaurants. People seemed bored being around him, but he kept right on talking. When he made a critical remark about how one of the women was dressed and hurt her feelings - he could not apologize for his obvious blunder. Winston seems to present behavior indicative of Narcissistic Personality disorder. He likes to have people’s attention focused on him, only talking about his life and achievements and leaving no room for others to join the conversation. He also upset a women by being critical with the way she dressed but couldn’t be bothered to apologize for hurting her feelings. These characteristics represent “people with narcissistic personality disorder [who] have an unreasonable sense of self-importance and are so preoccupied with themselves that they lack sensitivity and compassion for other people”

(Caligor, Levy, & Yeomans, 2015; Ronningstam, 2012 as sited in Barlow et al., 2019). Charles also seems to match multiple DSM-5 criteria for Narcissistic Personality Disorder such as; “has a grandiose sense of selfimportance”, “requests excessive admiration”, “has a sense of entitlement”, “lacks empathy: is unwilling to recognize or identify with the feelings and needs of others”, “shows arrogant, haughty behaviors or attitudes” and could display all of the criteria but we are unable to see the others in this description. Peter arrived at the party exactly on time. He made a point of speaking to every guest for five minutes. He talked mostly about technology and finance, and avoided any inquiries about his feelings or personal life. He left precisely at 10 PM because he had work to do at home. According to the behavior Peter shows it seems that he has ObsessiveCompulsive Personality Disorder. I came to this conclusion because of Peters meticulousness to arrive on time, talk to everyone for the same amount of time, avoidance of emotions/personal life, and him leaving at 10pm to make sure his socializing doesn’t interfere with his work. “People who have obsessive-compulsive personality disorder are characterized by a fixation on things being done ‘the right way’” (Diedrich & Voderholzer, 2015 as sited in Barlow et al., 2019). It’s clear to see that Peter is extremely rigid when it comes to schedules and social interactions and “because of [his] general rigidity,” this can lead to “poor interpersonal relationships”(Samuels & Costa, 2012 as sited in Barlow et al., 2019). The DSM-5 criteria that Peter fits are that he “is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost” and “is excessively devoted to work and productivity to the exclusion of leisure activities and friendships”. Before entering, Doreen watched the party for several minutes from outside through the window. Once she went in, she seemed very uncomfortable. When people tried to be nice to her, she looked guarded and distrustful. People quickly became uncomfortable with her habit of finding fault with everything little thing you said or did. Based on her behavior Doreen seems to present symptoms of Schizoid personality disorder. Doreen observed the environment of the party before going in and once in she uncomfortable and weary. This seems to portray the DSM-5 criteria of “(1) neither desires nor enjoys close relationships, including being part of a family”, “(2) almost always chooses solitary activities”, “(4) takes pleasure in few, if any, activities”, “(5) lacks close friends or confidants other than first-degree relatives,” and “(7) shows emotional coldness, detachment, or flattened affectivity”. She was reserved in while in the party but when she did interact with others she only did so negatively which made the other attendees uncomfortable interacting with her.

Margie didn't come to the party, even though she promised the hostess that she would bring the ice. She was afraid no one would talk with her and judge her outfit. Lastly, Margie seems to portray the characteristics of Avoidant Personality Disorder. From this it doesn’t seem that Margie promised to bring the ice and then intentionally did not show up but instead maybe she genuinely wanted to come but when the time came she was overcome with anxiety about the situation and therefore was unable to get herself to go. “People with avoidant personality disorder are extremely sensitive to the opinions of others, and although they desire social relationships, their anxiety leads them to avoid such associations”(Barlow et al., 2019). By the description of her being afraid “no one would talk to her and would judge her outfit” we can tell she has a degree of anxiety about what others think of her. The DSM-5 criteria she presents are that she “is unwilling to get involved with people unless certain of being liked”, “is preoccupied with being criticized or rejected in social situations”, “is inhibited in new interpersonal situations because of feelings of inadequacy”, and “is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing”.

Donna: Histrionic Personality Disorder William: Schizotypal Personality Disorder Charles: Borderline personality Disorder Winston: Narcissistic Personality disorder Peter: Obsessive-Compulsive Personality Disorder Doreen: Schizoid personality disorder Margie: Avoidant Personality Disorder...