5F PRESENTATION ON PERSONALITY

DISORDERS
MEMBERS

AGATHA WAIRIMU
KISERA SAMANTHA
HESBONE MOMANYI
 PERSONALITY DISORDERS
DEFINATION

The word personality is derived from the Greek term Persona

Personality traits -enduring patterns of perceiving, relating to and thinking about the environment
and oneself that are exhibited in a wide range of social and personal context

Personality disorders occur when These traits become infl exible and maladaptive and Cause
either significant functional impairment or subjective distress.

Individuals with personality disorders are not often Treated in acute care settings for the
personality disorder As their primary psychiatric diagnosis. However, many Clients with other
psychiatric and medical diagnoses Manifest symptoms of personality disorders. Nurses are
Likely to encounter clients with these personality characteristics frequently in all health-care
settings.

The DSM-IV-TR groups The personality disorders into three clusters. These Clusters, and the
disorders classifi ed under each, are Described as follows:

1. Cluster A: Behaviors described as odd or eccentric

a. Paranoid personality disorder

b. Schizoid personality disorder

c. Schizotypal personality disorder

2. Cluster B: Behaviors described as dramatic, emotional, or erratic

a. Antisocial personality disorder

b. Borderline personality disorder

c. Histrionic personality disorder

d. Narcissistic personality disorder

3. Cluster C: Behaviors described as anxious or Fearful

a. Avoidant personality disorder

b. Dependent personality disorder

c. Obsessive-compulsive personality disorder

PARANOID PERSONALITY DISORDER

Definition and Epidemiological Statistics

The DSM-IV-TR defi nes paranoid personality disorder As “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

Characteristic feature - a longstanding suspiciousness and mistrust of people in General.

Prevalence is difficult to establish because Individuals with the disorder seldom seek assistance
for their problem or require hospitalization

The disorder is more commonly diagnosed In men than in women.

CLINICAL PICTURE

 Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and
ready for any real or Imagined threat.
 They appear tense and irritable.
 They Have developed a hard exterior and become immune or Insensitive to the feelings
of others.
 They avoid interactions with other people, lest they be forced to relinquish Some of their
own power.
 They always feel that others Are there to take advantage of them.
 They are extremely oversensitive and tend to misinterpret even minute cues within the
environment, Magnifying and distorting them into thoughts of trickery and deception.
Because they trust no one, they are Constantly “testing” the honesty of others.
 Their intimidating manner provokes exasperation and anger in Almost everyone with
whom they come in contact.
 Individuals with paranoid personality disorder Maintain their self-esteem by attributing
their shortcomings to others.
 They do not accept responsibility for their own behaviors and feelings and project This
responsibility on to others.
 They are envious and Hostile toward others who are highly successful and Believe the
only reason they are not as successful is Because they have been treated unfairly.
 People who Are paranoid are extremely vulnerable and constantly On the defensive. Any
real or imagined threat can release hostility and anger that is fueled by animosities From
the past.
 The desire for reprisal and vindication Is so intense that a possible loss of control can
result In aggression and violence.
 These outbursts are usually brief, and the paranoid person soon regains the External
control, rationalizes the behavior, and reconstructs the defenses central to his or her
personality Pattern.
SCHIZOID PERSONALITY DISORDER

Definition and Epidemiological Statistics

Schizoid personality disorder is characterized primarily by a profound defect in the ability to

form personal relationships or to respond to other

The prevalence within the general population has been estimated at between 3 and 7.5 percent.
Significant numbers of people with the disorder are never observed in a clinical setting. Gender
ratio of the disorder is unknown, although it is diagnosed more frequently in men

Clinical Picture

 People with schizoid personality disorder appear cold, aloof, and indifferent to others.
 They prefer to work in isolation and are unsociable, with little need or desire for
emotional ties.
 They are able to invest enormous affective energy in intellectual pursuits.
 In the presence of others they appear shy, anxious, or uneasy.
 They are inappropriately serious about everything and have diffi culty acting in a
lighthearted manner.
 Their behavior and conversation exhibit little or no spontaneity.
 Typically they are unable to experience pleasure, and their affect is commonly bland and
constricted.

Etiological Implications

1. Although the role of heredity in the etiology of schizoid personality disorder is unclear,
the feature of introversion appears to be a highly inheritable characteristic.
2. Psychosocially, the development of schizoid personality is probably infl uenced by early
interactional patterns that the person found to be cold and unsatisfying. The childhoods of
these individuals have often been characterized as bleak, cold, and notably lacking
empathy and nurturing. A child brought up with this type of parenting may become a
schizoid adult if that child possesses a temperamental disposition that is shy, anxious, and
introverted.

Schizotypal Personality Disorder

Defi nition and Epidemiological Statistics

Individuals with schizotypal personality disorder were once described as “latent schizophrenics.”

Their behavior is odd and eccentric but does not decompensate to the level of schizophrenia.
Schizotypal personality is a graver form of the pathologically less severe schizoid personality
pattern.
Studies indicate that approximately 3 percent of the population has this disorder.

Clinical Picture
 Individuals with schizotypal personality disorder are aloof and isolated and behave in a
bland and apathetic manner.
 Magical thinking, ideas of reference, illusions, and depersonalization are part of their
everyday world. Examples include superstitiousness; beliefs that “others can feel my
feelings”
 The speech pattern is sometimes bizarre.
 People with this disorder often cannot orient their thoughts logically and become lost in
personal irrelevancies and in tangential asides that seem vague, digressive, and not
pertinent to the topic at hand. This feature of their personality only further alienates them
from others.
 Under stress, these individuals may decompensate and demonstrate psychotic symptoms,
such as delusional thoughts, hallucinations, or bizarre behaviors, but they are usually of
brief duration
 They often talk or gesture to themselves, as if “living in their own world.”
 Their affect is bland or inappropriate, such as laughing at their own problems or at a
situation that most people would consider sad.

Etiological Implications

1. Some evidence suggests that schizotypal personality disorder is more common among
the fi rst-degree biological relatives of people with schizophrenia than among the general
population, indicating a possible hereditary factor
2. Although speculative, other biogenic factors that may contribute to the development of
this disorder include anatomical defi cits or neurochemical dysfunctions resulting in
diminished activation, minimal pleasure-pain sensibilities, and impaired cognitive
functions. These biological etiological factors support the close link between schizotypal
personality disorder and schizophrenia and were considered when classifying schizotypal
personality disorder with schizophrenia
3. The early family dynamics of the individual with schizotypal personality disorder may
have been characterized by indifference, impassivity, or formality, leading to a pattern of
discomfort with personal affection and closeness. Early on, affective defi cits made them
unattractive and unrewarding social companions. They were likely shunned, overlooked,
rejected, and humiliated by others, resulting in feelings of low self-esteem and a marked
distrust of interpersonal relations. Having failed repeatedly to cope with these adversities,
they began to withdraw and reduce contact with individuals and situations that evoked
sadness and humiliation. Their new inner world provided them with a more signifi cant
and potentially rewarding existence than the one experienced in reality
Antisocial Personality Disorder
Defi nition and Epidemiological Statistics

Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless

behavior that refl ects a disregard for the rights of others.It is one of the oldest and best
researched of the personality disorders and has been included in all editions of the DSM.

Prevalence estimates range from 3 percent in men to about 1 percent in women . The disorder is
more common among the lower socioeconomic classes

Individuals with antisocial personality disorder are seldom seen in most clinical settings, and
when they are, it is commonly a way to avoid legal consequences.

Clinical Picture
 These individuals exploit and manipulate others for personal gain and have a general
disregard for the law.
 They have diffi culty sustaining consistent employment and in developing stable
relationships.
 They appear cold and callous, often intimidating others with their brusque and belligerent
manner.
 They tend to be argumentative and, at times, cruel and malicious.
 They lack warmth and compassion and are often suspicious of these qualities in others.
 Individuals with antisocial personality have a very low tolerance for frustration, act
impetuously, and are unable to delay gratifi cation.
 They are restless and easily bored, often taking chances and seeking thrills, as if they
were immune to danger.
 When things go their way, individuals with this disorder act cheerful, even gracious and
charming. Because of their low tolerance for frustration, this pleasant exterior can change
very quickly. Easily provoked to attack, their first inclination is to demean and dominate.
 They believe that “good guys come in last,” and show contempt for the weak and
underprivileged.
 They exploit others to fulfi ll their own desires, showing no trace of shame or guilt for
their behavior. Individuals with antisocial personalities see themselves as victims, using
projection as the primary ego defense mechanism.
 They do not accept responsibility for the consequences of their behavior.
 Satisfying interpersonal relationships are not possible because individuals with antisocial
personalities have learned to place their trust only in themselves.
 . One of the most distinctive characteristics of antisocial personalities is their tendency to
ignore conventional authority and rules.
Etiological Implications
  Biological Infl uences is more common among fi rst-degree biological relatives
of those with the disorder than among the general population
 The studies have also shown that children of parents with antisocial behavior are
more likely to be diagnosed with antisocial personality, even when they are
separated at birth from their biological parents and reared by individuals without
the disorder.
Diagnostic Criteria
A. There is a pervasive pattern of disregard for and violation of the rights of others
occurring since age 15 years, as indicated by three (or more) of the following:
 Failure to conform to social norms with respect to lawful behaviors as indicated
by repeatedly performing acts that are grounds for arrest.
 Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profi t or pleasure.
 Impulsivity or failure to plan ahead.
 Irritability and aggressiveness, as indicated by repeated physical fi ghts or
assaults.
 Reckless disregard for safety of self or others.
 Consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor fi nancial obligations.
B. Individual is at least 18 years old.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of
schizophrenia or a manic episode.
● CARE OF CLIENTS WITH PSYCHIATRIC DISORDERS
The temperament traits observed in newborns, such as irritability and emotional intensity,
may indicate a predisposition to antisocial behavior later in life. Children who exhibit
early signs of aggression, defiance, and resistance to discipline may be at risk for
developing antisocial personality traits. Factors such as ADHD and conduct disorder
during childhood, as well as parental delinquency or separation, can further increase this
risk. Early identification and intervention, along with targeted support and intervention
programs, can help mitigate these risks and steer children towards healthier
developmental outcomes.

Assigning Nursing Diagnoses to Behaviors Commonly Associated With

Antisocial Personality Disorder
Risk for other-directed violence -Behaviors Nursing Diagnoses Body language (e.g., rigid
posture, clenching of fi sts and jaw, hyperactivity, pacing, breathlessness, threatening stances);
cruelty to animals; rage reactions; history of childhood abuse; history of violence against others;
impulsivity; substance abuse; negative role-modeling; inability to tolerate frustration
Defensive coping -Disregard for societal norms and laws; absence of guilty feelings; inability to
delay gratifi cation; denial of obvious problems; grandiosity; hostile laughter; projection of
blame and responsibility; ridicule of others; superior attitude toward others

Chronic low-self esteem -Manipulation of others to fulfi ll own desires; inability to form close,
personal relationships; frequent lack of success in life events; passive-aggressiveness; overt
aggressiveness (hiding feelings of low self-esteem)

Impaired social interaction- Inability to form a satisfactory, enduring, intimate relationship with
another; dysfunctional interaction with others; use of unsuccessful social interaction behaviors

Ineffective health maintenance-Demonstration of inability to take responsibility for meeting

basic health practices; history of lack of health-seeking behavior; demonstrated lack of
knowledge regarding basic health practices; lack of expressed interest in improving health
behaviors

Histrionic Personality Disorder

Defi nition and Epidemiological Statistics

Characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.

Prevalence of the disorder is thought to be about 2 to 3 percent, and it is more common in

women than in men.

Clinical Picture
 Tend to be self-dramatizing, attention seeking, overly gregarious, and seductive.
 They use manipulative and exhibitionistic behaviors in their demands to be the center of
attention.
 People with histrionic personality disorder often demonstrate, in mild pathological form,
what our society tends to foster and admire in its members: to be well liked, successful,
popular, extroverted, attractive, and sociable. However, beneath these surface
characteristics is a driven quality—an all-consuming need for approval and a desperate
striving to be conspicuous and to evoke affection or attract attention at all costs.
 Failure to evoke the attention and approval they seek often results in feelings of dejection
and anxiety.
 They tend to be highly suggestible, impressionable, and easily infl uenced by others.
They are strongly dependent.
 Somatic complaints are not uncommon in these individuals, and fl eeting episodes of
psychosis may occur during periods of extreme stress

Etiological Implications
  Neurobiological correlates have been proposed in the predisposition to histrionic
personality disorder. They suggested that the trait of impulsivity may be associated with
decreased serotonergic activity.
 Heredity also may be a factor because the disorder is apparently more common among
first-degree biological relatives of people with the disorder than in the general population.
 From a psychosocial perspective, learning experiences may contribute to the
development of histrionic personality disorder. The child may have learned that positive
reinforcement was contingent on the ability to perform parentally approved and admired
behaviors. It is likely that the child rarely received either positive or negative feedback.
Parental acceptance and approval came inconsistently and only when the behaviors met
parental expectations.

Narcissistic Personality Disorder

Defi nition and Epidemiological Statistics

Persons with narcissistic personality disorder have an exaggerated sense of self-worth. They lack
empathy and are hypersensitive to the evaluation of others. They believe that they have the
inalienable right to receive special consideration and that their desire is suffi cient justifi cation
for possessing whatever they seek.

. It was viewed by early psychoanalysts as a normal phase of psychosexual development.

The DSM-IV-TR ) estimates that the disorder occurs in 2 to 16 percent of the clinical population
and less than 1 percent of the general population.

It is diagnosed more often in men than in women.

Clinical Picture
 Individuals with narcissistic personality disorder appear to lack humility, being overly
self-centered and exploiting others to fulfi ll their own desires.
 They often do not conceive of their behavior as being inappropriate or objectionable.
Because they view themselves as “superior” beings, they believe they are entitled to
special rights and privileges.
 If they do not meet self-expectations, do not receive the positive feedback they expect
from others, or draw criticism from others, they may respond with rage, shame,
humiliation, or dejection.
 They may turn inward and fantasize rationalizations that convince them of their
continued stature and perfection.
 The exploitation of others for self-gratifi cation results in impaired interpersonal
relationships. In selecting a mate, narcissistic individuals frequently choose a person who
 will provide them with the praise and positive feedback that they require and who will
not ask much from their partner in return.

Etiological Implications
 Several psychodynamic theories exist regarding the predisposition to narcissistic
personality disorder. suggest that, as children, these individuals had their fears, failures,
dependency needs responded to with criticism, disdain, or neglect.
 They grow up with contempt for these behaviors in themselves and others and are unable
to view others as sources of comfort and support.
 They project an image of invulnerability and self-suffi ciency that conceals their true
sense of emptiness and contributes to their inability to feel deeply.
 suggests that the parents of individuals with narcissistic personality disorder were often
narcissistic themselves. The parents were demanding, perfectionistic, and critical, and
they placed unrealistic expectations on the child. Children model their parents’ behavior,
giving way to the adult narcissist. Some clinicians have suggested that the parents may
have subjected the child to physical or emotional abuse or neglect.
 Narcissism may also develop from an environment in which parents attempt to live their
lives vicariously through their child. They expect the child to achieve the things they did
not achieve, possess that which they did not possess, and have life better and easier than
they did. The child is not subjected to the requirements and restrictions that may have
dominated the parents’ lives and thereby grows up believing he or she is above that
which is required for everyone else
 They are often lonely and express feelings of being unwanted. They view others as
critical, betraying, and humiliating.
 They desire to have close relationships but avoid them because of their fear of being
rejected.
 Depression, anxiety, and anger at oneself for failing to develop social relations are
commonly experienced.
 These children are often reared in families in which they are belittled, abandoned, and
criticized, such that any natural optimism is extinguished and replaced with feelings of
low self-worth and social alienation. They learn to be suspicious and to view the world as
hostile and dangerous.

Dependent Personality Disorder

Defi nition and Epidemiological Statistics

Characterized by “a pervasive and excessive need to be taken care of that leads to submissive
and clinging behavior and fears of separation”These characteristics are evident in the tendency to
allow others to make decisions, to feel helpless when alone, to act submissively.
The disorder is relatively common. results of one study of personality disorders in which 2.5
percent of the sample were diagnosed with dependent personality disorder. It is more common in
women than in men and more common in the youngest children of a family

Clinical Picture

 Have a notable lack of self-confi dence that is often apparent in their posture, voice, and
mannerisms.
 They are overly generous and thoughtful and underplay their own attractiveness and
achievements. They may appear to others to “see the world through rose-colored
glasses,” but when alone, they may feel pessimistic, discouraged, and dejected.
 Others are not made aware of these feelings; their “suffering” is done in silence.
 Assume the passive and submissive role in relationships. They are willing to let others
make their important decisions. Should the dependent relationship end, they feel helpless
and fearful because they feel incapable of caring for themselves.
 They may hastily and indiscriminately attempt to establish another relationship with
someone they believe can provide them with the nurturance and guidance they need.
 They avoid positions of responsibility and become anxious when forced into them.
 They have feelings of low self-worth and are easily hurt by criticism and disapproval.
They will do almost anything, even if it is unpleasant or demeaning, to earn the
acceptance of others.

Etiological Implications
 An infant may be genetically predisposed to a dependent temperament. Twin studies
measuring submissiveness have shown a higher correlation between identical twins than
fraternal twins.
 Psychosocially, dependency is fostered in infancy, when stimulation and nurturance are
experienced exclusively from one source. The infant becomes attached to one source to
the exclusion of all others. If this exclusive attachment continues as the child grows, the
dependency is nurtured. A problem may arise when parents become overprotective and
discourage independent behaviors on the part of the child. Parents who make new
experiences unnecessarily easy for the child and refuse to allow him or her to learn by
experience encourage their child to give up efforts at achieving autonomy. Dependent
behaviors may be subtly rewarded in this environment, and the child may come to fear a
loss of love or attachment from the parental fi gure if independent behaviors are
attempted

Obsessive-Compulsive Personality Disorder

Defi nition and Epidemiological Statistics
Individuals with obsessive-compulsive personality disorder are very serious and formal and have
diffi culty expressing emotions.

. The disorder is relatively common and occurs more often in men than in women. Within the
family constellation, it appears to be most common in oldest children.

Clinical Picture
 Individuals with obsessive-compulsive personality disorder are infl exible and lack
spontaneity.
 They are meticulous and work diligently and patiently at tasks that require accuracy and
discipline.
 They are especially concerned with matters of organization and effi ciency and tend to be
rigid and unbending about rules and procedures.
 Social behavior tends to be polite and formal.
 They are very “rank conscious,” a characteristic that is refl ected in their contrasting
behaviors with “superiors” as opposed to “inferiors.” They tend to be very solicitous to
and ingratiating with authority fi gures.
 With subordinates, however, the compulsive person can become quite autocratic and
condemnatory, often appearing pompous and self-righteous.
 People with obsessive-compulsive personality disorder typify the “bureaucratic
personality,” the so-called company man. They see themselves as conscientious, loyal,
dependable, and responsible, and are contemptuous of people whose behavior they
consider frivolous and impulsive.
 Emotional behavior is considered immature and irresponsible. Although on the surface
these individuals appear to be calm and controlled, underneath this a great deal of
ambivalence, confl ict, and hostility.
 Individuals with this disorder commonly use the defense mechanism of reaction
formation. Not daring to expose their true feelings of defi ance and anger, they withhold
these feelings so strongly that the opposite feelings come forth.
 The defenses of isolation, intellectualization, rationalization, reaction formation, and
undoing also are commonly evident

Etiological Implications
 Overcontrolled parenting entails imposing strict standards of behavior on children and
criticizing them for not meeting expectations.
 Positive behaviors are less frequently praised compared to the frequency of punishment
for undesirable behaviors.
 This environment fosters a focus on avoiding punishment rather than seeking positive
reinforcement.
  Individuals raised in such an environment become adept at adhering to rigid rules and
restrictions.
 Parents typically expect positive achievements, rarely acknowledging them, while
focusing on pointing out rule infractions.

Borderline Personality Disorder (

Historically, there have been a group of clients who did not classically conform to the standard
categories of neuroses or psychoses. The designation “borderline” was introduced to identify
these clients who seemed to fall on the border between the two categories. Other terminology
that has been used in an attempt to identify
this disorder includes ambulatory schizophrenia, pseudoneurotic schizophrenia, and emotionally
unstable personality.

Clinical Picture
 Borderline personality disorder (BPD) individuals are in constant crisis,
showing extreme emotions and behavior changes.
 They often display a dominant affect like depression, occasionally shifting to
anxiety or anger outbursts.
 Childhood feelings of abandonment by the mother contribute to depression
and underlying rage.
 BPD individuals fear being alone due to abandonment issues, seeking
constant companionship.
 They exhibit clinging behaviors towards certain individuals while displaying
hostility and distancing themselves from others.
 Clinging can lead to dependency and self-harm if separation occurs.
 Distancing arises from discomfort with closeness or in response to
confrontations.

Diagnostic Criteria for Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects and

marked impulsivity, beginning by early adulthood and present in a variety of contexts, as
indicated by fi ve (or more) of the following:
 1. Frantic efforts to avoid real or imagined abandonment. NOTE: Does not include suicidal or
self-mutilating behavior covered in criterion 5.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating

between extremes of idealization and devaluation.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

4. Impulsivity in at least two areas that are potentially selfdamaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). NOTE: Do not include suicidal or self-
mutilating behavior covered in criterion 5.

5. Recurrent suicidal behavior, gestures, or threats, or selfmutilating behavior.

6. Affective instability due to marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety, usually lasting a few hours and only rarely more than a few days). 7.
Chronic feelings of emptiness.

8. Inappropriate, intense anger or diffi culty controlling anger (e.g., frequent displays of temper,
constant anger, recurrent physical fi ghts).

Etiological Implications

Biological:

Borderline Personality Disorder (BPD) manifests as constant emotional turmoil and erratic
behavior, possibly influenced by neurobiological factors such as dysregulation in
neurotransmitter systems or abnormalities in brain structure and function.

Neurobiological research suggests that individuals with BPD may have altered serotonin and
dopamine levels, contributing to mood instability and impulsivity.

Genetic predispositions could also play a role in BPD, with studies indicating a higher likelihood
of the disorder in individuals with a family history of mood disorders or personality disorders.

Psychosocial:

The psychosocial perspective of BPD emphasizes the impact of early life experiences,
particularly childhood trauma and feelings of abandonment, on the development of the disorder.

Attachment theory suggests that disruptions in early attachment relationships, such as

inconsistent caregiving or neglect, may contribute to the fear of abandonment and intense
emotional reactions characteristic of BPD.

Environmental stressors, such as invalidating family environments or unstable relationships, can

exacerbate symptoms and contribute to maladaptive coping mechanisms seen in BPD
individuals.
Developmental:

 BPD is viewed through a developmental lens, considering how early experiences and
developmental milestones shape personality and behavior over time.
 Childhood experiences of neglect, abuse, or inconsistent caregiving may hinder the
development of emotional regulation skills and lead to maladaptive coping strategies.
 Developmental milestones, such as establishing a sense of identity and autonomy, may be
disrupted in individuals with BPD, leading to identity disturbances and difficulties in
interpersonal relationships later in life.

TREATMENT MODALITIES
Few would argue that treatment of individuals with personality disorders is difficult and, in some
instances, may even seem impossible.. The following is a brief description of various types of
therapies and the disorders to which they are customarily suited.

Interpersonal Psychotherapy

 Therapeutic approaches for personality disorders vary based on goals.

 Interpersonal psychotherapy (IPT) is suitable for personality disorders due to their
interpersonal nature.
 IPT can be brief and time-limited or long-term and exploratory.
 Long-term therapy aims to understand and modify maladjusted behaviors, cognition, and
affects.
 Core treatment involves establishing an empathic therapist-client relationship.
 Therapist serves as a role model, fostering collaboration and guided discovery.
 IPT is recommended for paranoid, schizoid, schizotypal, borderline, dependent,
narcissistic, and obsessive-compulsive personality disorders.

Psychoanalytical Psychotherapy
The treatment of choice for individuals with histrionic personality disorder has been
psychoanalytical psychotherapy (Skodol & Gunderson, 2008). Treatment focuses on the
unconscious motivation for seeking total satisfaction from others and for being unable to commit
oneself to a stable, meaningful relationship.

Milieu or Group Therapy

Treatment tailored for antisocial personality disorder (ASPD) emphasizes peer support and
feedback.
Milieu or group therapy is effective, as peer feedback is more impactful than one-to-one
interactions with a therapist.

Homogenous supportive groups are beneficial for avoidant personality disorder (APD)
individuals, aiding in social anxiety reduction and interpersonal skill development.

Feminist consciousness-raising groups are helpful for dependent clients grappling with social-
role stereotypes.

. Cognitive/Behavioral Therapy
Behavioral strategies offer reinforcement for positive change. Social skills training and
assertiveness training teach alternative ways to deal with frustration. Cognitive strategies help
the client recognize and correct inaccurate internal mental schemata. This type of therapy may be
useful for clients with obsessive-compulsive, passive-aggressive, antisocial, and avoidant
personality disorders.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a type of psychotherapy that was originally developed by
Marsha Linehan, PhD, as a treatment for the chronic self-injurious and parasuicidal behavior of
clients with borderline personality disorder Importance of dbt:

1. To enhance behavioral capabilities

2. To improve motivation to change

3. To ensure that new capabilities generalize to the natural environment

4. To structure the treatment environment such that client and therapist capabilities are
supported, and effective behaviors are reinforced

5. To enhance therapist capabilities and motivation to treat clients effectively

The four primary modes of treatment in DBT include the following: Group skills training,
Individual psychotherapy, Telephone contact, Therapist consultation/team meeting

Additionally, DBT has shown to decrease the drop-out rate from treatment and the number of
hospitalizations. This method of treatment is now being used with other disorders, including
substance use disorders, eating disorders, schizophrenia, and PTSD (Sadock & Sadock, 2007).

Psychopharmacology
Psychopharmacology may be helpful in some instances. Although these drugs have no effect in
the direct treatment of the disorder itself, some symptomatic relief can be achieved.

Antipsychotic medications are beneficial for treating psychotic decompensations in paranoid,

schizotypal, and borderline personality disorders.

SSRIs and MAOIs are effective in reducing impulsivity and self-destructive behaviors in
borderline personality disorder, with SSRIs being more commonly prescribed due to safety
concerns with MAOIs.

Combining SSRIs with atypical antipsychotics can effectively manage dysphoria, mood
instability, and impulsivity in borderline personality disorder.

Antipsychotics improve symptoms like illusions, ideas of reference, paranoid thinking, anxiety,
and hostility in some individuals.
Lithium carbonate and propranolol may help manage violent episodes in antisocial personality
disorder, but caution is needed due to the high risk of substance abuse.

Anxiolytics can assist clients with avoidant personality disorder in attempting previously avoided
behaviors, providing reassurance during stressful periods.

Antidepressants like sertraline and paroxetine may be beneficial if panic disorder develops in
clients with avoidant personality disorder.