PERSONALIPERSONALITY TY

DISORDERS DISORDERS IN THE IN THE

ELDERLYELDERLYOR………..”WORKING IN A SALT MINE OR………..”WORKING IN A SALT MINE IN SIBERIA HAS TO BE EASIER THAN IN SIBERIA HAS TO BE EASIER THAN

THIS”, OR ……..“HOW DOES ONE THIS”, OR ……..“HOW DOES ONE BECOME A MONK IN THE BECOME A MONK IN THE

HIMALAYAS”HIMALAYAS”

WHAT IS WHAT IS “PERSONALITY”?“PERSONALITY”?

Personality refers to a distinctive set of Personality refers to a distinctive set of traits, behavior styles, and patterns that traits, behavior styles, and patterns that make up our character or individuality. make up our character or individuality. How we perceive the world, our How we perceive the world, our attitudes, thoughts and feelings are all attitudes, thoughts and feelings are all part of our personality. People with part of our personality. People with healthy personalities are able to cope healthy personalities are able to cope with normal stresses and have no with normal stresses and have no trouble forming relationships with trouble forming relationships with family, friends, and co-workers.family, friends, and co-workers.

WHAT IS A PERSONALITY WHAT IS A PERSONALITY DISORDER?DISORDER?

Those who struggle with a personality Those who struggle with a personality disorder have great difficulty dealing disorder have great difficulty dealing with other people. They tend to be with other people. They tend to be inflexible, rigid, and unable to respond inflexible, rigid, and unable to respond to the changes and demands of life. to the changes and demands of life. Although they feel that their behavior Although they feel that their behavior patterns are “normal” or “right”, people patterns are “normal” or “right”, people with personality disorders tend to have with personality disorders tend to have a narrow view of the world and find it a narrow view of the world and find it difficult to participate in social difficult to participate in social activities.activities.

RECOGNIZING A RECOGNIZING A PERSONALITY DISORDERPERSONALITY DISORDER

Must fulfill several criteriaMust fulfill several criteria A deeply ingrained, inflexible pattern of A deeply ingrained, inflexible pattern of

relating, perceiving, and thinking serious relating, perceiving, and thinking serious enough to cause distress or impaired enough to cause distress or impaired functioning is a personality disorderfunctioning is a personality disorder

Usually recognizable by adolescence or Usually recognizable by adolescence or earlier, continue throughout adulthood, earlier, continue throughout adulthood, and become less obvious throughout and become less obvious throughout middle agemiddle age

DSM-IVDSM-IV

PERSONALITY PERSONALITY DISORDER DISORDER CRITERIACRITERIA

AN ENDURING PATTERN OF AN ENDURING PATTERN OF INNER EXPERIENCE AND INNER EXPERIENCE AND BEHAVIOR THAT DEVIATES BEHAVIOR THAT DEVIATES MARKEDLY FROM THE MARKEDLY FROM THE EXPECTATIONS OF THE EXPECTATIONS OF THE INDIVIDUALS CULTURE. THIS INDIVIDUALS CULTURE. THIS PATTERN IS MANIFESTED IN PATTERN IS MANIFESTED IN TWO OR MORE OF THE TWO OR MORE OF THE FOLLOWING AREAS: FOLLOWING AREAS:

PERSONALITY PERSONALITY DISORDER/CRITERIADISORDER/CRITERIA

COGNITION, I.E., WAYS OF COGNITION, I.E., WAYS OF PERCEIVING AND INTERPRETING PERCEIVING AND INTERPRETING SELF, OTHER PEOPLE, AND EVENTSSELF, OTHER PEOPLE, AND EVENTS

AFFECTIVITY, THEIR RANGE, AFFECTIVITY, THEIR RANGE, INTENSITY, LABILITY, AND INTENSITY, LABILITY, AND APPROPRIATENESS OF EMOTIONAL APPROPRIATENESS OF EMOTIONAL RESPONSERESPONSE

INTERPERSONAL FUNCTIONINGINTERPERSONAL FUNCTIONING IMPULSE CONTROL IMPULSE CONTROL DSM-IVDSM-IV

CRITERIA/ CONT’DCRITERIA/ CONT’D The enduring pattern is inflexible and pervasive The enduring pattern is inflexible and pervasive

across a broad range of personal and social across a broad range of personal and social situationssituations

The enduring pattern leads to clinically The enduring pattern leads to clinically significant distress or impairment in social, significant distress or impairment in social, occupational, or other important areas of occupational, or other important areas of functioningfunctioning

Not better accounted for as a manifestation or Not better accounted for as a manifestation or consequence of another mental disorderconsequence of another mental disorder

Not due to direct physiological effects of a Not due to direct physiological effects of a substance or a general medical conditionsubstance or a general medical condition

Is stable and long duration, onset can be traced Is stable and long duration, onset can be traced back at least to adolescence or early adulthood back at least to adolescence or early adulthood DSM-IVDSM-IV

CAUSES OF PERSONALITY CAUSES OF PERSONALITY DISORDERSDISORDERS

Some experts believe that events occurring Some experts believe that events occurring in early childhood exert a powerful in early childhood exert a powerful influence upon behavior later in life.influence upon behavior later in life.

Others indicate that people are genetically Others indicate that people are genetically predisposed to personality disorderspredisposed to personality disorders

Environmental facts may cause a person Environmental facts may cause a person who is already genetically vulnerable to who is already genetically vulnerable to develop a personality disorderdevelop a personality disorder

TYPES OF PERSONALITY TYPES OF PERSONALITY DISORDERS/FALL INTO DISORDERS/FALL INTO

THREE DIFFERENT THREE DIFFERENT CATEGORIES OR CLUSTERSCATEGORIES OR CLUSTERS CLUSTSER A: ODD OR ECCENTRIC CLUSTSER A: ODD OR ECCENTRIC

BEHAVIORBEHAVIOR CLUSTER B: DRAMATIC, CLUSTER B: DRAMATIC,

EMOTIONAL OR ERRATIC BEHAVIOREMOTIONAL OR ERRATIC BEHAVIOR CLUSTER C: ANXIOUS FEARFUL CLUSTER C: ANXIOUS FEARFUL

BEHAVIORBEHAVIOR

CLUSTER ACLUSTER A SCHIZOID PERSONALITY DISORDERSCHIZOID PERSONALITY DISORDER1.1. Neither desires nor enjoys close Neither desires nor enjoys close

relationships, including being a part of relationships, including being a part of a familya family

2.2. Almost always chooses solitary Almost always chooses solitary activitiesactivities

3.3. Has little, if any, interest in having Has little, if any, interest in having sexual experiences with another sexual experiences with another personperson

4.4. Takes pleasure in few, if any, activitiesTakes pleasure in few, if any, activities5.5. Lacks close friends or confidants other Lacks close friends or confidants other

than first-degree relativesthan first-degree relatives DSM-IVDSM-IV

SCHIZOID CONT’DSCHIZOID CONT’D Shows emotional coldness, detachment, or flattened affectivityShows emotional coldness, detachment, or flattened affectivity Appears indifferent to the praise or criticism of othersAppears indifferent to the praise or criticism of others Does not occur exclusively during the course of Schizophrenia, Does not occur exclusively during the course of Schizophrenia,

a Mood Disorder with Psychotic Features, another Psychotic a Mood Disorder with Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder, not due to Disorder, or a Pervasive Developmental Disorder, not due to the direct physiological effects of a general medical condition the direct physiological effects of a general medical condition DSM-IVDSM-IV

DSM-IVDSM-IV

PARANOID DISORDERPARANOID DISORDER ((PERVASIVE DISTRUST AND PERVASIVE DISTRUST AND

SUSPICIOUSNESS OF OTHERS SUCH THAT SUSPICIOUSNESS OF OTHERS SUCH THAT THEIR MOTIVES ARE INTERPRETED AS THEIR MOTIVES ARE INTERPRETED AS MALEVOLENT, BEGINNING BY EARLY MALEVOLENT, BEGINNING BY EARLY

ADULTHOODADULTHOOD ) ) Suspects, without sufficient basis, that others Suspects, without sufficient basis, that others

are exploiting, harming, or deceiving him or herare exploiting, harming, or deceiving him or her Is preoccupied with unjustified doubts about the Is preoccupied with unjustified doubts about the

loyalty or trustworthiness of friends and loyalty or trustworthiness of friends and associatesassociates

Perceives attacks on his or her character or Perceives attacks on his or her character or reputation that are not apparent to others and reputation that are not apparent to others and is quick to react angrily or to counterattack is quick to react angrily or to counterattack DSM-IVDSM-IV

PARANOID PERSONALIT

PARANOID, CONT’DPARANOID, CONT’D Reluctant to confide in others because Reluctant to confide in others because

of unwarranted fear that information of unwarranted fear that information will be used maliciously against him/herwill be used maliciously against him/her

Reads hidden demeaning or threatening Reads hidden demeaning or threatening meanings into benign remarks or eventsmeanings into benign remarks or events

Persistently bears grudges, i.e., is Persistently bears grudges, i.e., is unforgiving of insult, injuries, or slightsunforgiving of insult, injuries, or slights

Has recurrent suspicions, without Has recurrent suspicions, without justification, regarding fidelity of spouse justification, regarding fidelity of spouse or sexual partneror sexual partner

DSM-IVDSM-IV

Schizotypal Personality Schizotypal Personality DisorderDisorder ( (PervasivePervasive

Pattern of social and interpersonal deficits marked Pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviorperceptual distortions and eccentricities of behavior

Odd beliefs or magical thinking that influences Odd beliefs or magical thinking that influences behavior is inconsistent with sub cultural norms behavior is inconsistent with sub cultural norms (e.g., superstiousness, belief in clairvoyance, (e.g., superstiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)adolescents, bizarre fantasies or preoccupations)

Ideas of reference (including delusions of Ideas of reference (including delusions of reference)reference)

Unusual perceptual experiences, including bodily Unusual perceptual experiences, including bodily illusions illusions

DSM-IVDSM-IV

AtAt

SCHIZOTYPAL , CONT’DSCHIZOTYPAL , CONT’D

Excessive social anxiety that does not Excessive social anxiety that does not diminish with familiarity and tends to be diminish with familiarity and tends to be associated with paranoid fears rather than associated with paranoid fears rather than negative judgments about selfnegative judgments about self

Odd thinking and speechOdd thinking and speech Suspiciousness or paranoid ideationSuspiciousness or paranoid ideation Inappropriate or constricted affectInappropriate or constricted affect Behavior or appearance that is odd, Behavior or appearance that is odd,

eccentric, or peculiareccentric, or peculiar DSM-IVDSM-IV

CLUSTER B/ DRAMATIC, CLUSTER B/ DRAMATIC, EMOTIONAL OR ERRATIC EMOTIONAL OR ERRATIC

BEHAVIORBEHAVIORANTISOCIAL PERSONALITYANTISOCIAL PERSONALITY Failure to reform to Failure to reform to

conform to social norms conform to social norms with respect to lawful with respect to lawful behaviors, repeatedly behaviors, repeatedly performing acts that are performing acts that are grounds for arrestgrounds for arrest

Deceitfulness, repeated Deceitfulness, repeated lying, use of aliases, lying, use of aliases, conning others for personal conning others for personal profit or pleasureprofit or pleasure

At least 18 years of ageAt least 18 years of age DSM-IVDSM-IV

ANTISOCIAL, CONT’DANTISOCIAL, CONT’D Impulsivity, failure to plan aheadImpulsivity, failure to plan ahead Irritability or aggressiveness, repeated Irritability or aggressiveness, repeated

physical fights or assaultsphysical fights or assaults Reckless disregard for safety of self or Reckless disregard for safety of self or

othersothers Consistent irresponsibility, repeated Consistent irresponsibility, repeated

failure to sustain consistent work or failure to sustain consistent work or honor financial obligationshonor financial obligations

Lack of remorse Lack of remorse DSM-IVDSM-IV

Borderline Personality Borderline Personality DisorderDisorder A pervasive pattern of instability of A pervasive pattern of instability of

interpersonal relationships, self-interpersonal relationships, self-image, and affects, marked image, and affects, marked impulsivity beginning in early impulsivity beginning in early adulthood, must have 5 of the adulthood, must have 5 of the followingfollowing::

1.1. Frantic efforts to avoid real or Frantic efforts to avoid real or imagined abandonmentimagined abandonment

2.2. Pattern of unstable and intense Pattern of unstable and intense interpersonal relationships interpersonal relationships characterized by idealization and characterized by idealization and devaluationdevaluation

3.3. Identity disturbance, markedly and Identity disturbance, markedly and persistently unstable image of self or persistently unstable image of self or sense of self sense of self DSM-IVDSM-IV

BORDERLINE, CONT’DBORDERLINE, CONT’D1.1. Impulsivity in at least two areas that are self-Impulsivity in at least two areas that are self-

damaging (e.g. spending, sex, substance damaging (e.g. spending, sex, substance abuse, binge eating, reckless drivingabuse, binge eating, reckless driving

2.2. Recurrent suicidal behavior, gesturing, Recurrent suicidal behavior, gesturing, threats, self-injurythreats, self-injury

3.3. Affective instability, marked reactivity of Affective instability, marked reactivity of mood, intense dysphoria, anxiety, irritabilitymood, intense dysphoria, anxiety, irritability

4.4. Chronic feelings of emptinessChronic feelings of emptiness5.5. Inappropriate intense anger, or difficulty Inappropriate intense anger, or difficulty

controlling anger, physical fights, constant controlling anger, physical fights, constant angeranger

6.6. Transient , stress-related paranoid ideation Transient , stress-related paranoid ideation or severe dissociative symptoms or severe dissociative symptoms DSM-IVDSM-IV

HISTRIONIC HISTRIONIC PERSONALITYPERSONALITY(5 OR MORE OF THE FOLLOWING)(5 OR MORE OF THE FOLLOWING) Uncomfortable when not center of attentionUncomfortable when not center of attention

Interactive with others sexually inappropriate, Interactive with others sexually inappropriate, seductiveseductive

Displays rapidly shifting emotion, shallowDisplays rapidly shifting emotion, shallow Consistently uses physical appearance to draw Consistently uses physical appearance to draw

attention to selfattention to self Considers relationships to be more intimate than Considers relationships to be more intimate than

they really arethey really are Suggestible, easily influenced by others or Suggestible, easily influenced by others or

circumstancescircumstances Self-dramatization, theatricality, and exaggerated Self-dramatization, theatricality, and exaggerated

expression of emotionexpression of emotion Style of speech that is excessively impressionistic Style of speech that is excessively impressionistic

and lacking in detail and lacking in detail DSM-IVDSM-IV

Narcissistic Personality Narcissistic Personality DisorderDisorder Pervasive pattern of Pervasive pattern of

grandiosity, need for grandiosity, need for admiration, lack of admiration, lack of empathyempathy

Preoccupied with Preoccupied with fantasies of power, fantasies of power, brilliance, beauty, or brilliance, beauty, or ideal loveideal love

Believes he/she special Believes he/she special and unique and can and unique and can only be understood by, only be understood by, or should associate or should associate with high-status peoplewith high-status people

Requires excessive Requires excessive admirationadmiration

Interpersonally Interpersonally exploitative, i.e. takes exploitative, i.e. takes advantage of others to advantage of others to achieve his/her own endsachieve his/her own ends

Lacks empathy is Lacks empathy is unwilling to recognize or unwilling to recognize or identify with the feelings identify with the feelings and needs of othersand needs of others

Is often envious of others Is often envious of others or believes that others or believes that others are envious of him/herare envious of him/her

Shows arrogant, haughty Shows arrogant, haughty behaviors or attitudesbehaviors or attitudes

Sense of entitlementSense of entitlement DSM-IVDSM-IV

CLUSTER C CLUSTER C DISORDERS/Avoidant DISORDERS/Avoidant Personality DisorderPersonality Disorder

PERVASIVE PATTERN OF SOCIAL PERVASIVE PATTERN OF SOCIAL INHIBITION, FEELINGS OF INHIBITION, FEELINGS OF INADEQUACY, AND HYPERSENSITIVITY INADEQUACY, AND HYPERSENSITIVITY TO NEGATIVE EVALUATIONTO NEGATIVE EVALUATION

Views self as socially inept, personally Views self as socially inept, personally unappealing, or inferior to othersunappealing, or inferior to others

Avoids occupational activities that involve Avoids occupational activities that involve significant interpersonal contact, because significant interpersonal contact, because of fears of criticism, disapproval, or of fears of criticism, disapproval, or rejectionrejection

DSM-IVDSM-IV

AVOIDANT/CONT’DAVOIDANT/CONT’D Shows restraint within intimate Shows restraint within intimate

relationships because of fear of relationships because of fear of being shamed or ridiculedbeing shamed or ridiculed

Preoccupation with being Preoccupation with being criticized or rejected in social criticized or rejected in social situationssituations

Inhibited in new relationships Inhibited in new relationships due to fear of inadequacydue to fear of inadequacy

Views self as socially inept, Views self as socially inept, inferior, personally inferior, personally unappealingunappealing

Unusually reluctant to take Unusually reluctant to take personal risks or to engage in personal risks or to engage in any new activities because they any new activities because they may prove embarrassing may prove embarrassing DSM-IVDSM-IV

DEPENDENT DEPENDENT PERSONALITYPERSONALITY PERVASIVE NEED TO BE TAKEN CARE OF, PERVASIVE NEED TO BE TAKEN CARE OF,

LEADING TO SUBMISSIVE AND CLINGING LEADING TO SUBMISSIVE AND CLINGING BEHAVIORS , FEAR OF SEPARATION, BEGINNING BEHAVIORS , FEAR OF SEPARATION, BEGINNING EARLY ADULTHOODEARLY ADULTHOOD

Difficulty making everyday decisions without Difficulty making everyday decisions without an excessive amount of assurance and advise an excessive amount of assurance and advise from othersfrom others

Difficulty expressing disagreement with Difficulty expressing disagreement with others due to fear of loss of support or others due to fear of loss of support or approvalapproval

Difficulty initiating projects or doing things on Difficulty initiating projects or doing things on his/her own because of a lack of self-his/her own because of a lack of self-confidence in judgment or abilities rather confidence in judgment or abilities rather than a lack of motivation or energy than a lack of motivation or energy DSM-IVDSM-IV

DEPENDENT, CONT’DDEPENDENT, CONT’D Excessive lengths to obtain nurturance and Excessive lengths to obtain nurturance and

support from others, to the point of volunteering support from others, to the point of volunteering to do things that are unpleasantto do things that are unpleasant

Feels uncomfortable or helpless when alone Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to because of exaggerated fears of being unable to care for him/her selfcare for him/her self

Urgently seeks another relationship as a source Urgently seeks another relationship as a source of care and support when a close relationship of care and support when a close relationship endsends

Is unrealistically preoccupied with fears of being Is unrealistically preoccupied with fears of being left to take care of him/her selfleft to take care of him/her self

Needs others to assume responsibility for most Needs others to assume responsibility for most areas of his/her life DSM-IVareas of his/her life DSM-IV

OBSESSIVE-COMPULSIVE OBSESSIVE-COMPULSIVE DISORDERDISORDER

A PERVASIVE PATTERN OF PREOCCUPATION A PERVASIVE PATTERN OF PREOCCUPATION WITH ORDERLINESS, PERFECTIONISM, AND WITH ORDERLINESS, PERFECTIONISM, AND MENTAL AND INTERPERSONAL CONTROL, AT MENTAL AND INTERPERSONAL CONTROL, AT THE EXPENSE OF FLEXIBILITY, OPENNESS, THE EXPENSE OF FLEXIBILITY, OPENNESS, AND EFFICIENCY, BEGINNING EARLY AND EFFICIENCY, BEGINNING EARLY ADULTHOOD AND BY FOUR OF FOLLOWING:ADULTHOOD AND BY FOUR OF FOLLOWING:

Preoccupied with details, rules, Preoccupied with details, rules, lists, order, organization, or lists, order, organization, or schedules to the extent that the schedules to the extent that the major point of the activity is lostmajor point of the activity is lost

Perfectionism that interferes with Perfectionism that interferes with task completion (unable to complete task completion (unable to complete because of overly strict standards)because of overly strict standards)

Rigidity and stubbornness Rigidity and stubbornness DSM-IVDSM-IV

OCD DISORDER, CONT’DOCD DISORDER, CONT’D Excessively devoted to work and productivity Excessively devoted to work and productivity

to the exclusion of leisure activities and to the exclusion of leisure activities and friendships friendships

Over conscientious, scrupulous, and inflexible Over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values about matters of morality, ethics, or values ( not accounted for by cultural or religious ( not accounted for by cultural or religious identification)identification)

Unable to discard worn-out /worthless objects Unable to discard worn-out /worthless objects even when they have no sentimental valueeven when they have no sentimental value

Reluctant to delegate tasks or to work with Reluctant to delegate tasks or to work with others unless they submit to exactly his/her others unless they submit to exactly his/her way of doing thingsway of doing things

Adopts a miserly spending style toward both Adopts a miserly spending style toward both self and others, money is viewed as something self and others, money is viewed as something to be hoarded for future catastrophes to be hoarded for future catastrophes DSM-IVDSM-IV

STAFF BEHAVIORSSTAFF BEHAVIORS BACKBITINGBACKBITING TEAM “SPLITTING”TEAM “SPLITTING” ““I CAN DO IT BETTER I CAN DO IT BETTER

THAN YOU”THAN YOU” NEGATIVITY REGARDING NEGATIVITY REGARDING

PATIENTPATIENT INCREASED GOSSIPING, INCREASED GOSSIPING,

MISTRUSTMISTRUST ENERGY SPENT OFF ENERGY SPENT OFF

HOURS TALKING ABOUT HOURS TALKING ABOUT “YA-DA-YA-DA-YA-DA”“YA-DA-YA-DA-YA-DA”

AWFULIZING, “AIN’T IT AWFULIZING, “AIN’T IT AWFUL”AWFUL”

TALKING AT DESK ,PT’S TALKING AT DESK ,PT’S OVERHEARINGOVERHEARING

SO WHAT TO SO WHAT TO DO??????????DO?????????? SELF-AWARENESS SELF-AWARENESS

(OBSERVE BODY (OBSERVE BODY REACTION, FEELING IN REACTION, FEELING IN “GUT”“GUT”

TIME OUT, DISTANCETIME OUT, DISTANCE FREQUENT STAFF FREQUENT STAFF

MEETINGS (INFORMAL, MEETINGS (INFORMAL, BRING FOOD, HUMOR)BRING FOOD, HUMOR)

SELF-CARE, TEAM-CARESELF-CARE, TEAM-CARE PRACTICE “V”S, VALIDATE, PRACTICE “V”S, VALIDATE,

VENT, VOLUNTEER, VENT, VOLUNTEER, VIGILANCEVIGILANCE

WHAT TO DO, CONT’DWHAT TO DO, CONT’D ASK FOR HELP!!ASK FOR HELP!! EMPATHY WHEN YOU EMPATHY WHEN YOU

FEEL LIKE, FEEL LIKE, EXPLETIVE, EXPLETIVE, EXPLETIVE, EXPLETIVE, EXPLETIVE!!!!!!!!!!!!!!EXPLETIVE!!!!!!!!!!!!!!

NON-JUDGEMENTAL NON-JUDGEMENTAL APPROACH, USE APPROACH, USE BUDDY SYSTEMBUDDY SYSTEM

VALIDATE YOURSELF VALIDATE YOURSELF AND RESIDENT, AND RESIDENT, PATIENT, FAMILYPATIENT, FAMILY

WHAT TO DO CONT’DWHAT TO DO CONT’D SET LIMITSSET LIMITS AS OFTEN AS AS OFTEN AS

POSSIBLE, USE POSSIBLE, USE SAME PRIMARYSAME PRIMARY

CHECK IT OUTCHECK IT OUT TELL TELL

CLIENT/RESIDENCLIENT/RESIDENT WHEN YOU T WHEN YOU WILL RETURNWILL RETURN

TIME OUT FOR TIME OUT FOR SELF!SELF!

DON’T SHOULD DON’T SHOULD ON ON

YOURSELF!!!!YOURSELF!!!!

HOW DO HOW DO YOU EAT YOU EAT

AN AN ELEPHANELEPHAN

T,ONE T,ONE BITE AT A BITE AT A

TIME!TIME!