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Personality Disorders, An Introduction

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Personality Disorders, An Introduction

Postby TheLonelyStranger » Fri Feb 27, 2004 9:06 pm

In order to begin to understand a specific personality disorder, it is important to understand what a personality disorder is in general and understand the basics of each one. This is not something that comes easy. Even professionals often disagree. In order to diagnose someone, you must have observed each of the personality disorders with the guidance of some mentor, usually a professor where they gained their training.

I am not a professional and I have no such training so I cannot make diagnosis. Proper diagnosis and treatment is essential if progress is going to be made. I have found that learning as much as I can though has helped me a great deal but only because I have the guidance of a gifted professional. With that said, I'm going to provide some basic information. It will be expanded over time.

Personality Disorder Defined:

    Personality disorders: Pervasive, inflexible, and stable personality traits that deviate from cultural norms and cause distress or functional impairment.

    Personality traits are patterns of thinking, perceiving, reacting, and relating that are relatively stable over time and in various situations. Personality disorders occur when these traits are so rigid and maladaptive that they impair interpersonal or vocational functioning. Personality traits and their potential maladaptive significance are usually evident from early adulthood and persist throughout much of life.

Diagnosis and Classification:

    Diagnosis is based on observing repetitive patterns of behavior or perception that cause distress and impair social functioning, even when the patient lacks insight about these patterns and despite the fact that the patient often resists change.

    The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), divides personality disorders into three clusters: A) odd/eccentric, B) dramatic/erratic, and C) anxious/inhibited

The personality disorders are divided into three clusters.

    Cluster A

    Paranoid personality
    Schizoid personality
    Schizotypal personality

    Cluster B

    Borderline personality
    Antisocial personality (previously called psychopathic or sociopathic)
    Narcissistic personality
    Histrionic (hysterical) personality

    Cluster C

    Dependent personality
    Avoidant personality
    Obsessive-compulsive personality

Some of the above information was quoted from:
The Merck Manual of Diagnosis and Therapy
Section 15. Psychiatric Disorders
Chapter 191. Personality Disorders
Last edited by TheLonelyStranger on Thu Mar 25, 2004 9:58 pm, edited 2 times in total.
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Brief Description of the Various Personality Disorders

Postby TheLonelyStranger » Sat Mar 06, 2004 6:19 pm

This article intended to help lawyers handle troublesome clients, it happens to cover those with personlaity disorders. They are a bit over simplified but it is a good brief description of each of the personality disorders:

Strategies for handling troubled clients.

Florida Bar News; 8/15/2001; Silverman, Dr. Wade

Most of you have had to deal with people who give you major problems. They are uncooperative and irresponsible. They resist direction and/or act obnoxiously. These people probably have a personality disorder. Here are 10 different types of personality disorders, with strategies for dealing with each one.

1. An individual with a paranoid personality disorder is characteristically suspicious and distrustful of others. He may not even trust his own family member, and is indeed incapable of truly trusting anyone.

Strategy: Stick with the facts of the case scrupulously. Do not attempt to argue or reason with this client. Explanations are futile. Merely recite the facts and the law as applied to them. Document all your activities in the case, particularly your billing. Describe in fine detail your proposed actions and the various options available to the client. Don't try too hard to sway the client's course of action if you consider it imprudent or unreasonable. You can either accommodate the client's requests or resign. Such people tend to "cry wolf," and their claims are suspect.

2. A person with schizoid personality disorder is withdrawn and cold and exhibits socially inappropriate behavior. This individual may alienate others by seeming insensitive and unfriendly. You may find these individuals difficult to counsel, particularly if you are an engaging person who likes to interact with your client. This would be impossible since these individuals could care less about how you feel. They are not malevolent, just indifferent.

Strategy: You will neither be appreciated nor criticized for your work. Your reward will be your fee and your own sense of accomplishment. This can actually be an asset in corporate or criminal matters because decisions can be made without emotions. However, in divorce and/or custody matters you will be working at a distinct disadvantage, as they do not make good parents or spouses.

3. The schizotypal personality disorder is marked by bizarre tendencies. You may recall Tiny Tim, who was an example of this disorder. The physical appearance may be outlandish and the behavior odd.

Strategy: Their appearance and behavior, of course, can harm or even wreck their chances of success in a case. Work with them with care, tact, and firmness. Let them know that you are on their side, and accept them for who they are. Indicate to them that preparing for a case is like preparing for another role, and that their success may ride on their performance. That means toning down their wardrobe, behaviors and mannerisms. If necessary, that means sticking to the script, not deviating from it, and working with your cues. Gently remind them that you are on their side and want them to succeed.

4. People with antisocial personality disorder are similar to psychopaths. Such individuals have no conscience. They are dishonest and will harm others in order to satisfy their own needs. This type of individual leaves a consistent and easily traceable trail of broken promises, failed responsibilities, and physical and/or psychological abuse.

Strategy: Never trust such an individual at his/her word. If you need to represent such an individual, collect your fees in advance of your work, document all of your agreements, and have them witnessed. Everyone deserves a defense, but this type of individual stretches that sentiment to its limits.

5. People with borderline personality disorder are subject to extreme and variable emotional states, usually anger or anxiety. They miss deadlines and appointments and are prone to extreme interpersonal conflicts. It is important for you to be able to determine when this client requires treatment. For when they are depressed, they are at risk for suicide. Otherwise, they are merely management problems.

Strategy: They require you to set strict guidelines for appointment times, paying of bills, and for providing you with documentation. It is essential that you set limits on them by charging for missed appointments, after-hours calls, and repeated correspondence. Otherwise they will take up ever-increasing periods of your time. You must micromanage their conduct for their own self-interest. This might include specific instruction about decorum.

6. Histrionic personality disorder behavior is shallow and dramatic. These people are flighty, highly emotional, and crave personal attention. They are too insecure to carry through in an adult relationship.

Strategy: You will need to instruct them how to display appropriate behavior and keep them calm. In the short run, the behavior of a histrionic personality disorder may be entertaining or flattering. In the long run, it is self-defeating. You may want to refer them to a psychologist.

7. Self-centeredness is at the core of the narcissistic personality disorder. A sense of entitlement makes it difficult to share or to compromise with these people. They are never wrong; they are self-indulgent. You might react with either jaw-dropping incredulity or extreme anger.

Strategy: Remember that these people actually believe what they are saying. Their orientation masks feelings of inferiority. Avoid reacting emotionally to overblown rhetoric and arrogant attitudes and you can succeed. As long as you concentrate on the issues at hand, you should not be caught in the client's self-delusions. These clients are easily co-opted by compliments and flattery, and like most clients, will ultimately focus on the merits of their case.

8. People with avoidant personality disorder cannot bear conflict; nor can they assert themselves. They are basically scared.

Strategy: Do not feel guilty about assuming a dominant role with them. They give you no other choice. Do not show irritation or disrespect for their lack of assertion and self-respect. This will only exacerbate their self-loathing, and they will withdraw from the relationship. Reassurance and acceptance are the keys to success in working with this person. Most avoidant personalities will improve with assertiveness training and psychotherapy.

9. Individuals exhibiting a dependent personality disorder cannot function on their own. They will ask others to make decisions for them. They will always ask for half rather than do something on their own. Dependent personality disorder will tax your energy. They will call constantly and maybe at odd hours to seek reassurance. They will want you to make their decisions and will equivocate on the follow-through of any decision made. Or they will back down under pressure and cave in when security needs are threatened.

Strategy: These are classic high maintenance clients. You may need some professional consultation or referral to make your job more manageable. You may find yourself becoming furious because of this client's demands. Remember to separate your professional responsibilities from their personal needs. All personal decisions, even bad ones, are the client's responsibility. You are being retained for your legal advice and for your professional time. You cannot make personal decisions for your client. Most of these clients, weaned or abruptly removed from their psychological dependence, are capable of functioning at an acceptable level.

10. Finally, the obsessive-compulsive personality disorder individual will probably drive you to distraction with a preoccupation with minutiae and need for perfection. They are overly neat and organized. This friend, roommate, or spouse can be your worst nightmare. Essentially nothing you do is good enough. These are the most difficult people to work with. They focus on "the trees" rather than on "the forest" by burying themselves in minutiae. They tend to be both stubborn and negative.

Strategy: Don't personalize their criticisms. Their perfectionism is a disease that may not affect you. Do not let them tell you how to do your job, spend your money, or meet their notion of your responsibilities. Do not attempt to reason with them, for they are basically unreasonable. Explain to them how you will determine your own standards and set your own performance level. Set limits on their complaints and enforce them. You may want to encourage them to seek professional help.

Consultation with a psychologist on how to work with individuals with any of these disorders may be useful to you. In most cases, it will be necessary to refer them for help.

Dr. Wade Silverman is president of the Dade County Psychological Association and editor of the journal Psychotherapy for the American Psychological Association, and the MindReader newsletter, archived at www.wadesilverman. corn He practices forensic and clinical psychology in Coral Gables and Bal Harbour, and can be reached at 305-669-3605, whsilverman@aol.com.
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