Behavioral Health: Personality Disorders

Obsessive-Compulsive Personality Disorder is characterized by being perfectionistic, inflexible, and unable to express warm and tender feelings. Those suffering from this disorder are too concerned about trivial details and rules and do not appreciate changes in routine. They have a preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. Any illness is perceived as a threat to their control, and they may therefore struggle with their physician for control. In this case, the physician is handling the patient properly by allowing him to take part in the decisions and details of his medical care (like charting medication times).

People with Histrionic Personality Disorder are characterized by their excessive emotionality and attention-seeking. Five of the following criteria must be present: a need to be the center of attention, inappropriate sexual behavior such as seductiveness or provocativeness, shallow emotions which change quickly, excessively emotional speech, exaggerated emotional expression, and a history of believing that relationships with others are more intimate than they really are.

Violating the rights of others and being unable to conform to the norms of society are key characteristics of Antisocial Personality Disorder. People with this disorder often exhibit a disregard for the rights and feelings of others, engage in impulsive and irresponsible behavior, and have a lack of remorse for their actions. They may also have a history of criminal behavior, deceitfulness, and manipulation. This behavior is not seen in the other listed disorders, making Antisocial Personality Disorder the most appropriate answer.

The client experiences a preoccupation with lists and organization, excessive devotion to work, an inability to delegate tasks, and a need for perfectionism. Those with generalized anxiety disorder do not necessarily experience the extreme attention to detail and perfectionist attitude of those with OCPD. A Narcissitic Personality Disorder person would believe they have already achieved perfection, and are not as self-critical as those with OCPD.

This patient displays difficulty expressing disagreement with others; going to excessive lengths to please others; discomfort or helplessness when alone; an urgency in seeking another relationship; and difficulty making decisions without the advice of others.
This patient's symptoms are in reaction to his current situation and he does not report any symptoms of depression (suicidal ideation, depressed mood, or changes in sleep or appetite).
You can rule out Borderline Personality Disorder, because those patient's typically react to abandonment with anger, rage, and threatening behavior.
You can rule out Histrionic Personality Disorder because those patients are often flamboyant and demand attention from others.
You can rule out Narcissistic Personality Disorder because they typically have an inflated sense of self, seek to please themselves, and are arrogant. Whereas, Dependent Personality Disorder patients, such as the man in the above case study, seek to please others, have a deflated self of sense, and seek nurturance from others.

Dependent Personality Disorder is featured by a pervasive need to be cared for that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood. It is generally marked by a need to urgently seek relationships as a source of comfort, preoccupation with fear of being left alone, and a tendency to go to excessive lengths in obtaining nurturance and support from others.

The correct choice is Paranoid PD, because the patient presents with at least four of the criterion symptoms, including suspicion without cause, preoccupation with the loyalty or trustworthiness of others, reluctance to confide in others, misinterpretation of benign events, or perception that remarks made to them are threatening.
The only other choice that is a similar disorder is Schizoid PD. The reason this is not the correct diagnosis is because individuals with Schizoid PD tend to tbe socially isolated, display restricted affect, and almost always prefer to be alone. These individuals do not do well in jobs that require social performance.

Patients with OCD have obsessions, compulsions, and hoarding tendencies that are to the extreme that could present a danger to themselves and others. The OCPD patient, on the other hand, expresses a commitment to perfection, are self-critical, and has a discomfort with warm emotions. The OCPD patient is able to devote themselves to work and productivity, and exclude leisure activities. They are moral, inflexible, and preoccupied with making lists and organization. These patients are also unwilling to delegate duties to others and may be miserly because they fear the possibility of catastrophes.

Individuals with Dependent Personality Disorder tend to be clinging and submissive in their behaviors because their need to be taken care of is so pervasive. They have difficulty making everyday decisions without consulting others, they agree with others even if they believe the person to be wrong, due to their intense fear of rejection. They have difficulty doing things on their own and their most pervasive fear is that of being abandoned.

Within Cluster A, Paranoid Personality Disorder manifests as pervasive distrust of others and constant suspiciousness toward their motives. Interpretations of others' behavior made by these individuals will usually include maliciousness, hidden meanings, jealousy, and long-term grudges.

Avoidant personality disorder is characterized by social inhibition and feelings of inadequacy. Individuals who suffer from this disorder are extremely sensitive to negative feedback from others. They avoid social activities due to their fear of having to participate.

Persons with Antisocial Personality Disorder present with a history of theft, damaging property, physical cruelty to animals or people, forcing sex, using weapons to cause injury, starting fights, and threatening or stalking people.

This client is experiencing an inflated sense of self, believes he has special abilities, will only associate with those of "high status," and he believes that he deserves special recognition.

Instability of social and interpersonal relationships is the cornerstone of Borderline Personality Disorder (BPD). Constantly fighting to avoid real or imagined abandonment, BPD's alternate between extremes of idealizing and devaluing those who attempt to get involved with them.
Long-term drug use is more related to a Substance Abuse Disorder.
Paranoia is an essential feature of Paranoid Personality Disorder.
Theatricality is central to a diagnosis of Histrionic Personality Disorder.
Lack of remorse may be present in Antisocial Personality Disorder.

The patient's presentation is actually most consistent with Schizotypal Personality Disorder, characterized by a lifelong pattern of indifference to others as well as detachment and social isolation. Although isolated, patients are not usually unhappy with their lack of social contact. The personality traits of a Narcissist include an overblown sense of self-importance and self-centeredness with little concern for the needs of other people. As a result, people with NPD often antagonize people who try to befriend them and therefore have trouble maintaining long-term relationships. Irresponsible or erratic behavior is uncommon in patients with this condition.

Avoidant Personality Disorder is common. These patients are exceedingly timid, shy, lonely, and hypersensitive to rejection. They have low self-esteem and often would rather avoid personal contact than face any potential social rejection. Additionally, they have a strong desire for acceptance and affection, and thus are very distressed by their isolation and inability to relate comfortably to others. Patients with this type of PD often have increased rates of anxiety and depression as well.

There's no such thing as Cluster D!!

Conduct disorder is commonly a precursor to Antisocial Personality Disorder.
A diagnosis of Antisocial PD requires evidence of a Conduct Disorder before age 15. This patient meets all requirements of Antisocial PD including failure to conform to social norms relative to lawful behavior, repeated lying or conning other for personal profit or pleasure, impulsivity, aggressiveness around physical attacks, irresponsibility, and lack of remorse for hurting or mistreating others or stealing.
ADHD is not an appropriate diagnosis because the patient doesn't show any signs of inattention of hyperactivity-impulsivity, although there may be a learning disorder present.
Oppositional Defiant Disorder would not be the correct diagnosis either because this patient fails to meet the criteria for frequent loss of temper, arguing with adults, refusing to comply with requests, blaming, vindictiveness, and hostility.
He may have some of the symptoms from each category, but his prominent symptoms are shown in the way he conducts himself and violates the rights of others.

There's no such thing as Cluster D!!

People with Dependent PD allow others to make most of the decisions in their lives, both minor and major. Many adults depend on their parents or spouse to make decisions as to where to live, work, and with whom to socialize. They may not feel capable of functioning independently and will agree to things which they feel are wrong for them rather than risk losing the support of this individual. If involved in a marriage or relationship which ends, they will quickly seek another to provide them with the support they need.

To make this diagnosis you have to differentiate between OCD and OCPD. Patients with OCD have obsessions, compulsions, and hoarding tendencies that are to the extreme that could present a danger to themselves and others. The OCPD patient, on the other hand, expresses a commitment to perfection, are self-critical, and has a discomfort with warm emotions. The OCPD patient is able to devote themselves to work and productivity, and exclude leisure activities. They are moral, inflexible, and preoccupied with making lists and organization. These patients are also unwilling to delegate duties to others and may be miserly because they fear the possibility of catastrophes.

The central component of Histrionic Personality Disorder is a pervasive display of emotions and attention-seeking behavior, starting in early adulthood. Generally, such an individual has a need to be the center of attention in social circles, may engage in seductive and/or provocative behavior, displays shallow expression of emotions, employs excessively expressionistic speech, is dramatic and self-dramatizing, uses physical appearance to obtain attention, is suggestible by others, and considers relationships to be closer than they actually are.

There's no such thing as Cluster D!!

Although most prevalent in males, Paranoid Personality Disorder is found in 0.5 to 2.5% of the general population of the U.S. It's characteristics include an unknown etiology starting in childhood, but some evidence links it to chronic Schizophrenia and Delusional Disorder (Persecutory type). These individuals believe that others are constantly making unjust remarks about them, berating their reputation, attempting to exploit them, and they cannot trust their friends, mates, or sexual partners.

Schizotypal Personality Disorder is characterized by marked eccentricities and odd beliefs. People with this disorder often have unusual thoughts, perceptions, and behaviors. They may have superstitious beliefs, magical thinking, and peculiar speech patterns. They may also have difficulty forming and maintaining close relationships. While other personality disorders may have some overlapping symptoms, Schizotypal Personality Disorder is specifically known for its pronounced eccentricities and odd beliefs.

Schizotypal Personality Disorder characteristics include: behavior that is influenced by magical thinking, telepathy, aliens, unusual perceptions or bodily delusions, odd behavior and appearance, extreme anxiety in social situations, and affect that is blunted or inappropriate to the topic at hand.

Schizoid Personality Disorder is characterized by detachment, indifference towards others, and marked coldness of emotion. These patients are often life-long loners.

BPD is specifically marked by unstable relationships, self-image, affect, and impulsivity. It begins in early adulthood.

People with Schizoid Personality Disorder lack interpersonal relationships because they have no desire to get close to people. Avoidant Personality Disorder is different because those people are sad that they don't have social connections but are too AFRAID of social criticism and rejection that they avoid social situations.

Conduct Disorder is the necessary diagnosis before the age of 15 for an adult to be diagnosed with Antisocial Personality Disorder. Conduct Disorder is a childhood disorder characterized by a persistent pattern of violating societal norms and the rights of others. It involves behaviors such as aggression, destruction of property, deceitfulness, and violation of rules. Antisocial Personality Disorder is a more severe and persistent form of conduct disorder that continues into adulthood. Therefore, a history of Conduct Disorder is essential for the diagnosis of Antisocial Personality Disorder in adults.

False!! Its the other way around, more women are diagnosed with Borderline Personality Disorder.

Borderline Personality Disorder is most often associated with a pattern of unstable interpersonal relationships. Self-image is poor, affect is often labile or depressed, and these individuals are highly impulsive- especially with regard to self-destructive behaviors. Individuals with BPD are chronically bored and empty-feeling. They alternate between overly idealizing others and devaluing them. Their emotions are intense. Although individuals with BPD are said to have a need to be taken care of, they have difficulty accepting the help of others, because they mistrust their intentions.

Borderline Personality Disorder is characterized by intense feelings with marked fluctuations from idealization to devaluation, concerns of abandonment, impulsivity in at least two areas which are self-damaging (ie: spending, sex, substance abuse, reckless driving, binge eating), suicidal behavior, gestures, threats, or self-mutilating behavior, chronic feelings of emptiness, and occasionally, dissociative symptoms.
The histrionic personality is similar, although this patient didn't present with any patterns of craving to be the center of attention, using her physical appearance to get attention, self-dramatization, or being easily influenced by others.

This client expresses a lack of desire for social relationships, a preference for solitary activities, little interest in most activities or intimacy, and has demonstrated a flattened affect. The onset of symptoms is occurring in the beginning of adulthood (which rules out Autism), and she is not experiencing any psychotic symptoms or paranoid ideations. Since she avoids social situations due to a lack of DESIRE, this differentiates her from a diagnosis of Avoidant Personality Disorder, in which the person isolates themselves due to a FEAR of social situations.

Axis II diagnoses consist of personality disorders and mental retardation. This patient probably has an Axis I disorder such as dysthymic disorder or major depressive disorder. However, since the question asks for which Axis II diagnosis is appropriate, the best fitting would be Borderline Personality Disorder.
This client is experiencing unstable personal relationships, an unstable sense of self, unpredictable and unstable moods, and difficulty controlling his anger. He also expresses a sense of devaluation in his personal relationships. This case study shows that the client has made suicidal threats and attempts in order to manipulate others or make them feel guilty. Borderline Personality Disorder patients are different than Dependent Personality Disorder patients in their reaction to abandonment. BPD patients react to abandonment with an outward expression of anger, whereas DPD patients react with increased submissiveness. The fact that the patient is often self-destructive and displays angry disruptions in close relationships, differentiates him from a patient with a Histrionic Personality Disorder.

People with Avoidant Personality Disorder are afraid of rejection, and therefore, develop a lifestyle of isolation. They would like to have more friends, but feel inept to become socially involved.
Those with Schizoid Personality Disorder PREFER isolation and are unconcerned for others' opinions about them. They have a restricted range of emotions and lack warmth; thereby keeping others at bay.
The narcissist is a very social creature with egotistical and arrogant behaviors.

For a diagnosis of Schizophrenia, one must have an active case of bizarre delusions or hallucinations. Social withdrawal goes along with Schizoid PD. Flattened affect is true in both disorders. Drug abuse is not associated with either disorder, and would therefore have to be rules out before making either diagnosis. Active symptoms is a vague, made-up answer.

Psychoanalytic therapy uses techniques of free association, interpretation of defenses and conflicts among the ego, id and superego, external reality, and the interpretation of dreams. This approach was developed by Sigmund Freud and aims to explore the unconscious mind and bring repressed thoughts and emotions to the surface. The therapist helps the individual gain insight into their unconscious processes and unresolved conflicts, which can lead to personal growth and healing. Group therapy, cognitive therapy, biofeedback, and hypnosis do not specifically focus on these techniques and principles.

The two personality disorders that have "assertiveness training" as part of their treatment plan are Avoidant and Dependent. Assertiveness training helps individuals with Avoidant personality disorder to improve their self-confidence and overcome their fear of rejection. It also assists individuals with Dependent personality disorder to develop assertiveness skills and become more self-reliant, reducing their excessive need for others to make decisions for them.

Psychoanalytic therapy was developed by Freud and involves the concepts of Transference and Resistance. Transference refers to the displacement of attitudes and feelings from the past onto the analyst, while Resistance refers to the repression of unconscious ideas from reaching awareness because they are unacceptable. This therapy aims to bring these unconscious thoughts and emotions into conscious awareness, allowing the individual to gain insight into their behaviors and emotions.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking, which often includes a need to be the center of attention, sexually seductive behavior, rapidly shifting emotions, impressionistic speech, and an overestimation of the intimacy of personal relationships. All of the other choices are more consistent criteria for Borderline Personality Disorder.

Schizoid Personality Disorder consists of detachment from social relationships and a restricted range of emotional expression. Persons with this personality structure do not desire close relationships, have little interest in others, and enjoy very little. Schizotypal Personality Disorder, by contrast, consists of odd thoughts and behavior combined with a reduced CAPACITY for social relationships and an excessive social anxiety.

Symptoms for this diagnosis include a grandiose sense of self-importance, preoccupied with fantasies of unlimited success, a belief of being special, a sense of entitlement, lacking in empathy, and an arrogant attitude toward others.

Behavioral therapy is similar to cognitive therapy in the sense that it does not account for the unconscious. Importance is placed on changing maladaptive patterns of behavior that are believed to result from learning the behaviors from others. Behaviors can be changed by reinforcing new behaviors or providing consequences to continuing maladaptive behaviors.

Schizotypal Personality Disorder is a pervasive pattern of social deficits and cognitive and perceptual disturbances, which develops in early adulthood. (It therefore would not only be seen at home). Odd thinking, illusions, severe social anxiety, paranoid thoughts, and other disturbed thinking processes are evident, but not severe enough to warrant the diagnosis of schizophrenia.

Narcissistic Personality Disorder individuals do not fear abandonment, engage in self-destructive behavior, or have a problem with self-image. They do, however, have a grandiose sense of self-importance, are preoccupied with fantasies of success, power, love, require excessive admiration, show a sense of entitlement, and envy others while showing an arrogant manner.

Borderline personality characteristics include: unstable impulse control, early adult life instability in interpersonal relationships, frantic attempts to prevent abandonment, identity disturbance, self damaging behavior, self mutilating behavior, severe reactivity to moods, chronic feelings of being no good, and anger and paranoid behavior which may last for short or long periods of time.

Although superficially similar to Paranoid Personality Disorder, Schizotypal Personality Disorder is characterized more by pervasive social and interpersonal deficits that result in extreme discomfort with close relationships. Five or more of the following symptoms are present in the Schizotypal patient: ideas of reference (but not full blown delusions), odd beliefs or magical thinking, illusions or unusual perceptual experiences (but not classic hallucinations), odd thinking and speech, eccentric behavior or appearance, paranoid thinking or suspiciousness of others, no close friends, and social anxiety related to paranoid fears, rather than to negative feelings about oneself. Some of these symptoms are similar, but not nearly as severe as the symptoms of Schizophrenia.

Cognitive therapy includes cognitive errors such as overgeneralizing, selective abstraction, excessive responsibility, assuming temporal causality, self-references, catastrophizing, and dichotomous thinking. This type of therapy focuses on identifying and challenging these distorted thinking patterns in order to promote more realistic and adaptive thoughts and beliefs. By addressing these cognitive errors, cognitive therapy aims to improve individuals' emotional well-being and overall functioning.

Narcissists tend to be oversensitive to criticisms and may fear being found undeserving of success. They lack self-esteem and their grandiose behavior seems to be an elaborate and intricate defense mechanism.
Lack of empathy and insight are still Narcissistic qualities, but do not explain their grandiose behaviors. They can be successful or not. They envy others' success and tend to exaggerate their own. They have a great deal of trouble aging gracefully and may become depressed over what they see in the mirror.