Therapy for clients with personality disorders

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Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Also attach and submit PDFs of the sources you used.

USE THE ATTACHED APA 7 TEMPLATE FORMAT ATTACHED.

PLEASE WATCH THE REQUIRED MEDIA VIDEOS. I HAVE THE LINK IN THE UPLOAD.

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Assignment: Therapy for Clients With Personality Disorders

Individuals with personality disorders often find it difficult to overcome the enduring patterns of thought and behavior that they have thus far experienced and functioned with in daily life. Even when patients are aware that personality-related issues are causing significant distress and functional impairment and are open to counseling, treatment can be challenging for both the patient and the therapist. For this Assignment, you examine specific personality disorders and consider therapeutic approaches you might use with clients.

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide about treating clients with personality disorders.

· Select one of the personality disorders from the DSM-5 (e.g., paranoid, antisocial, narcissistic). Then, select a therapy modality (individual, family, or group) that you might use to treat a client with the disorder you selected.

The Assignment:

Succinctly, in 1–2 pages, address the following:

· Briefly describe the personality disorder you selected, including the DSM-5 diagnostic criteria.

· Explain a therapeutic approach and a modality you might use to treat a client presenting with this disorder. Explain why you selected the approach and modality, justifying their appropriateness.

· Next, briefly explain what a therapeutic relationship is in psychiatry. Explain how you would share your diagnosis of this disorder with the client in order to avoid damaging the therapeutic relationship. Compare the differences in how you would share your diagnosis with an individual, a family, and in a group session.

Support your response with specific examples from this week’s Learning Resources and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

Also attach and submit PDFs of the sources you used.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

Paris, J. (2015). Psychotherapies. In A concise guide to personality disorders (pp. 119–135). American Psychological Association.

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

Chapter 18, “Dialectical Behavior Therapy for Complex Trauma”

REQUIRED MEDIA

Symptom Media. (2020). Antisocial personality disorder ASPD online CNE CEU courses for nurses [Video]. YouTube. https://www.youtube.com/watch?v=ewBFri65Quw

Symptom Media. (2020). Histrionic disorder NP mental health continuing education [Video].

Symptom Media. (2020). Narcissistic personality disorder online LPN CE credit CEU unit classes [Video]. YouTube. https://www.youtube.com/watch?v=knfVjj3P9es

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Level 3 Heading

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Level 1 Heading

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References

(Note that the following references are intended as examples only.)

American Counseling Association. (n.d.). About us.
https://www.counseling.org/about-us/about-aca

Anderson, M. (2018). Getting consistent with consequences. Educational Leadership, 76(1), 26-33.

Bach, D., & Blake, D. J. (2016). Frame or get framed: The critical role of issue framing in nonmarket management. California Management Review, 58(3), 66-87.
https://doi.org/10.1525/cmr.2016.58.3.66

Burgess, R. (2019). Rethinking global health: Frameworks of Power. Routledge.​

Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival times of terminally ill patients. Health Psychology, 24(2), 225–229.
https://doi.org/10.1037/0278-6133.24.2.225

Johnson, P. (2003). Art: A new history. HarperCollins.
https://doi.org/10.1037.0000136-000

Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure and serious illness at end of life: A national study of children in the U.S. foster care system from 2005 to 2015. Journal of Pain and Symptom Management, 56(3), 309–317.
https://doi.org/10.1016/j.jpainsymman.2018.06.001

Osman, M. A. (2016, December 15). 5 do’s and don’ts for staying motivated. Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/5-dos-and-donts-for-staying-motivated/art-20270835

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley.

Walden University Library. (n.d.). Anatomy of a research article [Video].
https://academicguides.waldenu.edu/library/instructionalmedia/tutorials#s-lg-box-7955524

Walden University Writing Center. (n.d.). Writing literature reviews in your graduate coursework [Webinar].
https://academicguides.waldenu.edu/writingcenter/webinars/graduate#s-lg-box-18447417

World Health Organization. (2018, March). Questions and answers on immunization and vaccine safety.
https://www.who.int/features/qa/84/en/

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Paranoid personality disorder

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Mental disorder involving paranoid delusions and mistrust of others

Not to be confused with paranoid schizophrenia.

Medical condition

Paranoid personality disorder
Specialty Psychiatry, clinical psychology
Symptoms Paranoid delusions, pervasive suspiciousness, generalized mistrust of others, hypersensitivity, scanning of environments for clues or suggestions that may validate fears or biases
Differential diagnosis Delusional disorder, schizophrenia, cluster A personality disorders, borderline personality disorder
Frequency Estimated between 0.5% and 2.5% of the general population[1]
Personality disorders
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
Not otherwise specified
Depressive
Others

Paranoid personality disorder (PPD) is a mental illness characterized by paranoid delusions, and a pervasive, long-standing suspiciousness and generalized mistrust of others. People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers. They think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.[2]

They tend to be guarded and suspicious and have quite constricted emotional lives. Their reduced capacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience.[3][verification needed] People with PPD may have a tendency to bear grudges, suspiciousness, tendency to interpret others’ actions as hostile, persistent tendency to self-reference, or a tenacious sense of personal right.[4] Patients with this disorder can also have significant comorbidity with other personality disorders, such as schizotypal, schizoid, narcissistic, avoidant and borderline.

Contents

Causes[edit]

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. A large long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with the other cluster A personality disorders, schizoid and schizotypal.[5]

Psychosocial theories implicate projection of negative internal feelings and parental modeling.[1] Cognitive theorists believe the disorder to be a result of an underlying belief that other people are unfriendly in combination with a lack of self-awareness.[6]

Diagnosis[edit]

ICD-10[edit]

The World Health Organization‘s ICD-10 lists paranoid personality disorder under (F60.0). It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. It is also pointed out that for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and other obligations.[7]

PPD is characterized by at least three of the following symptoms:

  1. excessive sensitivity to setbacks and rebuffs;
  2. tendency to bear grudges persistently (i.e. refusal to forgive insults and injuries or slights);
  3. suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
  4. a combative and tenacious sense of self-righteousness out of keeping with the actual situation;
  5. recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
  6. tendency to experience excessive self-aggrandizing, manifest in a persistent self-referential attitude;
  7. preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large.

Includes: expansive paranoid, fanatic, querulant and sensitive paranoid personality disorder.

Excludes: delusional disorder and schizophrenia.

DSM-5[edit]

The American Psychiatric Association‘s DSM-5 has similar criteria for paranoid personality disorder. They require in general the presence of lasting distrust and suspicion of others, interpreting their motives as malevolent, from an early adult age, occurring in a range of situations. Four of seven specific issues must be present, which include different types of suspicions or doubt (such as of being exploited, or that remarks have a subtle threatening meaning), in some cases regarding others in general or specifically friends or partners, and in some cases referring to a response of holding grudges or reacting angrily.[8]

PPD is characterized by a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts. To qualify for a diagnosis, the patient must meet at least four out of the following criteria:[8]

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

The DSM-5 lists paranoid personality disorder essentially unchanged from the DSM-IV-TR
[9] version and lists associated features that describe it in a more quotidian way. These features include suspiciousness, intimacy avoidance, hostility and unusual beliefs/experiences.

Other[edit]

Various researchers and clinicians may propose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist Theodore Millon has proposed five subtypes of paranoid personality:[10]

Subtype Features
Obdurate paranoid (including compulsive features) Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict.
Fanatic paranoid (including narcissistic features) Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride reestablished with extravagant claims and fantasies.
Querulous paranoid (including negativistic features) Contentious, caviling, fractious, argumentative, faultfinding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish.
Insular paranoid (including avoidant features) Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hypervigilant and defensive against imagined dangers.
Malignant paranoid (including sadistic features) Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions.

Differential diagnosis[edit]

Paranoid personality disorder can involve, in response to stress, very brief psychotic episodes (lasting minutes to hours). The paranoid may also be at greater than average risk of experiencing major depressive disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder and substance-related disorders. Criteria for other personality disorder diagnoses are commonly also met, such as:[11] schizoid, schizotypal, narcissistic, avoidant, borderline and negativistic personality disorder.

Treatment[edit]

Because of reduced levels of trust, there can be challenges in treating PPD. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when a person is receptive to intervention.[12]

Epidemiology[edit]

PPD occurs in about 0.5–4.4% of the general population.[13]
[1]
[11] It is seen in 2–10% of psychiatric outpatients.[citation needed] In clinical samples men have higher rates, whereas epidemiologically there is a reported higher rate of women.[14]

History[edit]

See also: History of paranoia

Paranoid personality disorder is listed in DSM-V and was included in all previous versions of the DSM. One of the earliest descriptions of the paranoid personality comes from the French psychiatrist Valentin Magnan who described a “fragile
personality” that showed idiosyncratic thinking, hypochondriasis, undue sensitivity, referential thinking and
suspiciousness.[15]

Closely related to this description is Emil Kraepelin’s description from 1905 of a pseudo-querulous personality who is
“always on the alert to find grievance, but without delusions”, vain, self-absorbed, sensitive, irritable, litigious,
obstinate, and living at strife with the world. In 1921, he renamed the condition paranoid personality and described
these people as distrustful, feeling unjustly treated and feeling subjected to hostility, interference and
oppression. He also observed a contradiction in these personalities: on the one hand, they stubbornly hold on to their
unusual ideas, on the other hand, they often accept every piece of gossip as the truth.[15] Kraepelin also noted that paranoid personalities were often present in people who later developed paranoid psychosis. Subsequent writers also considered traits like suspiciousness and hostility to predispose people to developing delusional illnesses,
particularly “late paraphrenias” of old age.[16]

Following Kraepelin, Eugen Bleuler described “contentious psychopathy” or “paranoid constitution” as displaying the
characteristic triad of suspiciousness, grandiosity and feelings of persecution. He also emphasized that these people’s false
assumptions do not attain the form of real delusion.[15]

Ernst Kretschmer emphasized the sensitive inner core of the paranoia-prone personality: they feel shy and inadequate but at
the same time they have an attitude of entitlement. They attribute their failures to the machinations of others but
secretly to their own inadequacy. They experience constant tension between feelings of self-importance and experiencing
the environment as unappreciative and humiliating.[15]

Karl Jaspers, a German phenomenologist, described “self-insecure” personalities who resemble the paranoid personality.
According to Jaspers, such people experience inner humiliation, brought about by outside experiences and their
interpretations of them. They have an urge to get external confirmation to their self-deprecation and that makes them
see insults in the behavior of other people. They suffer from every slight because they seek the real reason for them in
themselves. This kind of insecurity leads to overcompensation: compulsive formality, strict social observances and
exaggerated displays of assurance.[15]

In 1950, Kurt Schneider described the “fanatic psychopaths” and divided them into two categories: the combative type that is
very insistent about his false notions and actively quarrelsome, and the eccentric type that is passive, secretive,
vulnerable to esoteric sects but nonetheless suspicious about others.[15]

The descriptions of Leonhard and Sheperd from the sixties describe paranoid people as overvaluing their abilities
and attributing their failure to the ill-will of others; they also mention that their interpersonal relations are
disturbed and they are in constant conflict with others.[15]

In 1975, Polatin described the paranoid personality as rigid, suspicious, watchful, self-centered and selfish, inwardly
hypersensitive but emotionally undemonstrative. However, when there is a difference of opinion, the underlying mistrust,
authoritarianism and rage burst through.[15]

In the 1980s, paranoid personality disorder received little attention, and when it did receive it, the focus was on its
potential relationship to paranoid schizophrenia. The most significant contribution of this decade comes from Theodore Millon who
divided the features of paranoid personality disorder to four categories:[15]

1) behavioral characteristics of vigilance, abrasive irritability and counterattack,

2) complaints indicating oversensitivity, social isolation and mistrust,

3) the
dynamics of denying personal insecurities, attributing these to others and self-inflation through grandiose fantasies

4) coping style of detesting dependence and hostile distancing of oneself from others.

Controversy[edit]

Due to repeated concerns of the validity of PPD and poor empirical evidence, it has been suggested that PPD be removed from the DSM.[17] This is also believed to contribute to low research output on PPD.[18]

See also[edit]

References[edit]

  1. ^ Jump up to: a b c Personality Disorders at eMedicine
  2. ^ Waldinger, Robert J. (1 August 1997). Psychiatry for Medical Students. American Psychiatric. ISBN 978-0-88048-789-4.
  3. ^ Meissner & Kuper, 2008
  4. ^
    MacManus, Deirdre; Fahy, Tom (August 2008). “Personality disorders”. Medicine. 36 (8): 436–441. doi:10.1016/j.mpmed.2008.06.001.
  5. ^
    Kendler KS, Czajkowski N, Tambs K, et al. (2006). “Dimensional representations of DSM-IV cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study”. Psychological Medicine. 36 (11): 1583–91. doi:10.1017/S0033291706008609. PMID 16893481. S2CID 21613637.
  6. ^
    Aaron T. Beck, Arthur Freeman (1990). Cognitive Therapy of Personality Disorders (1st ed.). The Guilford Press. ISBN 9780898624342. OCLC 906420553.
  7. ^ The Classification of Mental and Behavioural Disorders (ICD-10) by WHO: “Diagnostic guidelines Archived 2014-03-23 at the Wayback Machine, p.158
  8. ^ Jump up to: a b
    “Schizoid Personality Disorder (pp. 652–655)”. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013). 2013. ISBN 978-0-89042-555-8.
  9. ^ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.
  10. ^
    Millon, Théodore; Grossman, Seth (6 August 2004). Personality disorders in modern life. Wiley. ISBN 978-0-471-23734-1.
  11. ^ Jump up to: a b
    “Internet Mental Health — paranoid personality disorder”. Archived from the original on 2013-01-31. Retrieved 2004-06-01.
  12. ^
    “”Paranoid Personality Disorder” at Cleveland Clinic”. Archived from the original on 2012-03-04. Retrieved 2008-02-13.
  13. ^
    Schulte Holthausen, Barbara; Habel, Ute (2018-10-11). “Sex Differences in Personality Disorders”. Current Psychiatry Reports. 20 (12): 107. doi:10.1007/s11920-018-0975-y. ISSN 1535-1645.
  14. ^
    Grant, Bridget F.; Hasin, Deborah S.; Stinson, Frederick S.; Dawson, Deborah A.; Chou, S. Patricia; Ruan, W. June; Pickering, Roger P. (2004-07-01). “Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions”. The Journal of Clinical Psychiatry. 65 (7): 15404. ISSN 0160-6689. Retrieved 2022-04-24.
  15. ^ Jump up to: a b c d e f g h i Salman Akhtar (1990). Paranoid Personality Disorder: A Synthesis of Developmental, Dynamic, and Descriptive Features Archived 2018-04-01 at the Wayback Machine. American Journal of Psychotherapy, 44, 5–25.
  16. ^ Bernstein, D. P., Useda, D., Siever, L. J. (1995). Paranoid Personality Disorder. In: J. W. Livesley (Ed.). The DSM-IV Personality Disorders. (pp. 45-57). New York: Guilford.
  17. ^
    Schulte Holthausen, Barbara; Habel, Ute (2018-10-11). “Sex Differences in Personality Disorders”. Current Psychiatry Reports. 20 (12). doi:10.1007/s11920-018-0975-y. ISSN 1523-3812.
  18. ^
    Triebwasser, Joseph; Chemerinski, Eran; Roussos, Panos; Siever, Larry J. (December 2013). “Paranoid Personality Disorder”. Journal of Personality Disorders. 27 (6): 795–805. doi:10.1521/pedi_2012_26_055. ISSN 0885-579X.

External links[edit]

Classification D

External resources
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Personality disorder classification

General classifications
ICD classifications (ICD-10)
Schizotypal
Specific
Other
Organic
Unspecified
DSM classifications
DSM-III-R only
DSM-IV only Personality disorder not otherwise specified

Appendix B (proposed)
DSM-5
(Categorical
model)
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
DSM-5 Alternative hybrid categorical and dimensional model in Section III included to stimulate further research

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