Personality Disorders Responses
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Respond to at least two colleagues in the following ways:
- Explain whether you agree with your colleague about the potential effects of labeling an individual with a personality disorder.
- Explain how to engage in trauma-informed treatment with this client given the effects of trauma identified by your colleague.
Colleague 1:Vanessa
- Provide the full DSM-5 diagnosis.
It is possible that Ms. Precious has the diagnosis of:
Antisocial Personality Disorder (F60.2)
General Personality Disorder
Opioid Use Disorder (F11.20) Severe
Z59.1 Discord with neighbors, lodgers and landlord Z62.82 Parent-child conflict Z62.891 Sibling rivalry Z63.6 Dependent relative needing care at home Z62.79 Other stressful life events affecting family and household Z72.5 High risk sexual behavior Z72.811 Adult Antisocial behavior Z72.89 Other problems related to lifestyle Z71.5 Drug abuse counseling and surveillance
- Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. Ms. Precious has a history of breaking the law and spent time in jail. Reckless disregard for safety of self or others Ms. Precious will utilize drugs regardless of the safety of herself or of her mom, who is dependent on her. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Ms. Precious will take care of her mom but has a history of not showing up. The individual is at least age 18 years. Ms. Precious is 32 years old. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: Impulse control. Ms. Precious has a history of impulsive behaviors that has caused her to utilize drugs and end up in the legal system.
- The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Although she is close to her family, Ms. Precious chooses not to interact with many other people.
- Close differentials and why they were eliminated.
Paranoid personality disorder was considered due to her believing that her family members think that they are better than her. Borderline personality disorder was also considered, however there is no mention of Precious having a lot of the symptoms that come with that including Frantic efforts to avoid real or imagined abandonment, A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, or reoccurring suicidal ideations or attempts.
- How diagnosing a client with a personality disorder may affect their treatment.
There is a large stigma against personality disorders. Working in the mental health field myself, I often catch myself dreading working with the clients who have a personality disorder. Many psychiatrists agree that personality disorders are difficult to identify and treat without the proper training (Carey & Lenzenweger 2012). Diagnosing them with a personality disorder can affect their treatment due to them needing a different course of action when it comes to treatment. For an example, a person with borderline personality disorder will need different treatment than someone who was diagnosed with schizophrenia.
- How power and privilege may influence who is labeled with a personality disorder.
Power and privilege may influence who is labeled with a personality disorder due to the fact that there is such high stigma against the diagnosis. Someone who is in a powerful position may attempt to get their family members not diagnosed with a personality disorder in order to not label them the rest of their lives.
- How trauma affects the case.
Childhood abuse is a risk factor for the development of externalizing characteristics and disorders, including antisocial personality disorder and psychopathy (Dargis, et al., 2015). Abuse that Ms. Precious could have gone through while she was younger could have an effect on her case with both precipitating the diagnosis and resulting from related symptoms or treatment of the diagnosis. For an example, if a trauma occurred it could later precipitate the diagnoses due to the fact that Precious may have developed a new way of coping.
Carey, B., & Lenzenweger, M. (2012, December 4). The challenges of treating personality disorders. NPR. https://www.npr.org/2012/12/04/166503627/the-challenges-posed-by-personality-disorders.
Dargis, M., Newman, J., & Koenigs, M. (2016, July). Clarifying the link between childhood abuse history and psychopathic traits in adult criminal offenders. Personality disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801766/.
DMS. (2020, December 22). What Is the Purpose of Policies in the Workplace? Policy Management Software. https://www.powerdms.com/policy-learning-center/what-is-the-purpose-of-policies-in-the-workplace.
Colleague 2: Caneshia
F 14.20 Stimulant Use Disorder, Cocaine, Severe
F 11.21 Opioid Use Disorder, Moderate in early remission
F 60.3 Borderline Personality Disorder
Z 62.898 Child Affected by parental Relationship Distress
A. A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
- The stimulant is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.
- A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects.
- Craving, or a strong desire or urge to use the stimulant.
- Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home.
- Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant.
- Important social, occupational, or recreational activities are given up or reduced because of stimulant use.
- Recurrent stimulant use in situations in which it is physically hazardous.
- Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant.
- Tolerance, as defined by either of the following:
- Precious has an increased amounts of the stimulant to achieve intoxication or desired effect.
- b. Precious has a markedly diminished effect with continued use of the same amount of the stimulant.
- Withdrawal, as manifested by either of the following:
- a. Precious uses withdrawal syndrome for the stimulant.
F 11.21 Opioid Use Disorder, Moderate in early remission
Per the case study reports heroin use began when she was 21 years old. When she completed her prison sentence, she was paroled and mandated to attend a 1-year outpatient drug treatment program, which she successfully completed.
F 60.3 Borderline Personality Disorder
Moderate or greater impairment in personality functioning; two or more of the following criteria:
- Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress.
- Self-direction: Instability in goals, aspirations, values, or career plans.
- Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
- Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over-involvement and withdrawal.
Differentials:
MDD
Schizophrenia
Explain how diagnosing a client with a personality disorder may affect their treatment.
Diagnosing a client with a personality disorder may affect their treatment due to the stigma of the diagnosis. When informing a client that they are being diagnosed with a personality disorder, they may start to self-stigmatized themselves. Studies have found that personality disorders might be more stigmatized than other psychiatric diagnoses (Sheehan, Nieweglowski & Corrigan, 2016). The stigma of the disorder can cause people to be seen as difficult and misbehaving ratherthan being sick. As there is a public stigma, this causes the individual to self-stigmitize themselves. The client does not want to be seen as a “crazy person”. The client may feel ashamedof their diagnosis and avoid treatment due to self-labeling (Sheehan, Nieweglowski & Corrigan, 2016). The way to work with this barrier is to educate the mental illness and provide information to change the stigma.
Analyze how power and privilege may influence who is labeled with a personality disorder and which types of personality disorder
Power and privilege can influence someone who is a narcissist. According to Markman (2014), the socioeconomic status can be a contributing factor to narcissism. Studies have shown a small correlation between SES and narcissism (Markman, 2014). Those who feel they are entitled can lead to a high ego. Those who believe they are more privileged than others have a sense of entitlement. These individuals lead to narcissism.
Reference:
Markman, A. (2014). Rich, Entitled, and Narcissistic. Retrieved from https://www.psychologytoday.com/us/blog/ulterior-motives/201401/rich-entitled-and[1]narcissistic.
Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016). The Stigma of Personality Disorders. Current Psychiatry Reports, 18(1). doi: 10.1007/s11920-015-0654-1
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