Personality Disorders; Cluster B: Symptoms, Diagnostic Criteria and Prognosis Presenters Script Introduction “Personality disorders are becoming more common across the country due to an increase in mental health understanding. Most of these disorders have several similarities but just enough differences to distinguish between them. AllPsych. com provides readers with The Diagnostic and Statistical Manual of Mental Disorders, referred to as DSM, which was developed by the American Psychiatric Association. It is a system used in the mental health field as a way of classifying abnormal behaviors.There are 3 classes that the DSM-4 recognizes as personality disorders and they are Cluster A, Cluster B and Cluster C.
Cluster B disorders will be the topic of this discussion. Individuals with Cluster B Personality Disorders are known for being dramatic, emotional, erratic, manipulative, and having a sense of entitlement. Symptoms are prominent although it may take years to form a diagnosis, and the prognoses with these types of disorders are often poor. There are four disorders under Cluster B; they are Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders. ” Body Antisocial Personality Disorder (ASPD) The DSM-4 defines Antisocial Personality Disorder as “..
. a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood” (Hefner Media Group, Inc. , 2004). Childhood misconduct includes aggression, cruelty towards animals, vandalism and stealing. Adults with this disorder are known for their repeated unlawful offenses, lying, and disregard for others. They are impulsive, lack remorse, are irresponsible, and display reckless behavior.
Relationships with these individuals are usually very unstable and unpredictable. “For a concrete diagnosis of Antisocial Personality Disorder, an individual must meet the diagnostic criteria for the DSM. This includes signs of misconduct before the age of 15, the individual must be at least 18 years of age at the time of the diagnosis and have at least three of the previously mentioned behaviors. The DSM-4 specifically states “There is a failure to conform to society's norms and expectations that often results in numerous arrests or legal involvement as well as a history of deceitfulness where the individual attempts to con people or use trickery for personal profit.Impulsiveness if often present, including angry outbursts, failure to consider consequences of behaviors, irritability, and/or physical assaults” (Hefner Media Group Inc.
, 2004). “Prognosis for this disorder is poor since treatment is rarely sought voluntarily and these individuals are habitually noncompliant. The World Health Organization developed the ICD-10, a diagnostic tool much like the DSM-4 and it claims that “[Antisocial] behavior is not readily modifiable by adverse experience, including punishment” (World Health Organization, 2006). ” Borderline Personality Disorder Borderline personality disorder (BPD) is defined by The National Institute of Mental Health as “a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior” (National Institute of Mental Health, 2010). Individuals with this disorder display “disturbances in self-image, and internal preferences, chronic feelings of emptiness, intense and unstable interpersonal relationships, and a tendency to have self-destructive behavior, including suicide gestures and attempts” (World Health Organization, 2006).DSM criteria for diagnosis must be a pervasive pattern beginning in early adult hood that includes: five or more of the following observations: attempts to avoid real or imagined abandonment, persistent unstable relationships, poor self image, self destructive behavior, (such as excessive spending, promiscuity, drugs, alcohol, and/or recklessness), recurrent suicidal gestures or threats, chronic mood instability, chronic feelings of emptiness, inability to control anger or intense inappropriate anger.
NIMH states “Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone” (National Institute of Mental Health, 2010). The fear of abandonment “often acts as a self-fulfilling prophecy as the individual clings to others, is very needy, feels helpless, and becomes overly involved and immediately attached” (Hefner Media Group Inc. , 2004). Treatment for Borderline Personality is highly variable and depends on the individual.
BPD is frequently dually diagnosed with other disorders such as substance abuse or depression. It is also a common precursor to suicide. Despite the dim outlook, the NIMH states that “Group and individual psychotherapy are at least partially effective for many patients” (National Institute of Mental Health, 2010). Histrionic Personality Disorder Histrionic Personality Disorder is defined by the DSM-4 as “a pattern of excessive emotionality and attention seeking behavior” (Hefner Media Group, 2004).
These individuals are uncomfortable if they are not constantly the center of attention.More observations include inappropriate sexual or seductive behavior, emotional instability, and exaggerated expressions and emotions. They are also easily influenced and consider their relationships to be more intimate than they actually are. ICD-10 diagnostic criteria includes “shallow and labile affect, self-dramatization, exaggerated expression of emotions, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention” (World Health Organization, 2006).The textbook Foundations of Psychiatric Mental Health Nursing states that “The individual with HPD does not have insight to his or her role in breaking up relationships and may seek treatment for depression or another comorbid condition” (Varcarolis, et al.
2006, p282). Group and individual therapy can be helpful in the treatment of HPD, but the individual must be monitored because this situation provides an audience for the person, thus enabling the histrionic behavior. Narcissistic Personality DisorderPersons with Narcissistic Personality Disorder display a pattern of grandiosity, the need for admiration and a lack of empathy. These individuals have the primary feature of overconfidence and superiority.
In Foundations of Psychiatric Mental Health Nursing, it is written that narcissistic individuals have inward feelings of shame and fear that if they are “bad” they will be abandoned. Although they display proud and haughty attitudes they are “afraid of their own mistakes as well as the mistakes of others” (Varcarolis, et al. 2006, p284).The DSM-4 states that these individuals “often feel overly important and will exaggerate achievements and will accept, and often demand, praise and admiration despite worthy achievements” (Hefner Media Group, Inc.
, 2004). At least 5 of the following behaviors are present before a diagnosis can be made. * A grandiose sense of self-importance * Preoccupation with fantasies of unlimited success, or power, * Belief that he or she is "special" and can only be understood by, or should associate with, other special or high-status people * Requiring excessive admiration Having a sense of entitlement * Lacking empathy * They are often envious of others or believes others are envious of him or her * Show arrogant, haughty behaviors or attitudes NPD is thought of as a relatively stable condition when it is the primary disorder. However, individual therapy can be beneficial for underlying problems and emotions.
“With insight and long term therapy, the symptoms can be reduced in both number and intensity” (Hefner Media Group Inc. , 2004). Conclusion “These four personality disorders have several similarities. One is the obvious lack of empathy for others.
An individual with a personality disorder has a selfish motive and no concern for the consequences of their actions. A second similarity is mood instability. Where a mentally healthy person is able to adjust to stressful situations, persons with these disorders have an inability to cope with demanding circumstances, leading to severe depression, mania and even suicide. The third similarity between these four disorders is the poor prognoses. Although there is therapy and medication available, admitting they have a problem and seeking help is a hurdle that is often far too high for these individuals to clear.
Potential Questions: Q: What can family members do to help? A: The key to any successful treatment is having a strong support system there for the individual. Patience is something many family members have a hard time maintaining, but it is a huge step to recovery. Q: Are Personality Disorders hereditary? A: Usually. Genetics play a big role in psychological illnesses but environmental stressors are also responsible.
Q: What is the physiology behind the disorders? A: Abnormalities of the neurological system are the cause of the inappropriate behaviors and impaired cognitive and emotional functioning.The neurotransmitters involved include serotonin, norepinephrine, dopamine and glutamate. Medications that are prescribed are mood stabilizers, SSRI’s and anti-psychotics and are focused on regulating these neurostransmitters to help maintain a stable lifestyle. References Hefner Media Group, Inc. (November 5, 2004). AllPsych Online.
Index of Psychiatric Disorders. Retrieved on December 17, 2010 from http://allpsych. com/disorders/disorders_alpha. html. National Institute of Mental Health. (August 21, 2010).
NIMH. Borderline Personality Disorder.Retrieved on December, 16, 2010 from http://www. nimh. nih.
gov/health/publications/borderline-personality-disorder-fact-sheet/index. shtml. Varcarolis E. Carson V. Shoemaker N. (2006).
Foundations of Psychiatric Mental Health Nursing. St. Louis, MO: Saunders Elsevier. World Health Organization. (November, 12 2006). International Statistical Classification of Diseases and Related Health Problems.
Mental and Behavioral Disorders. Retrieved on December 16, 2010 from http://apps. who. int/classifications/apps/icd/icd10online/.
