Moshe Almagor, in Comprehensive Clinical Psychology , Individuals with this profile usually receive a diagnosis of Personality Disorder. His response content is consistent with the antisocial features in his history. These factors should be taken into consideration in arriving at a clinical diagnosis.
His self-reported tendency toward experiencing a depressed mood should be taken into consideration in any diagnostic formulation. He has a number of personality characteristics that are associated with a substance-use or abuse disorder. The client's scores on the addiction proneness indicators, along with the personality characteristics reflected in the profile, suggests that he resembles some individuals who develop addictive disorders.
QUESTIONS POSED AND UNANSWERED DURING THE EVENT
A substance-abuse evaluation should explore this possibility through a careful review of his personality traits and typical behaviors. In his responses to the MMPI-2, he has acknowledged some problems with excessive use or abuse of addictive substances. Clarkin, in Comprehensive Clinical Psychology , Linehan's a, b cognitive-behavioral treatment of the parasuicidal individual is an example of the application of a specific school of psychotherapy adapted to a specific patient population defined both by a personality disorder diagnosis BPD and repetitive self-destructive behavior.
The rationale and data upon which the patient pathology is understood as related to the treatment is well described and thorough.
The assumption behind DBT is that of dialectics. The world view of dialectics involves notions of inter-relatedness and wholeness, compatible with feminist views of psychopathology, rather than an emphasis on separation, individuation, and independence. A related principle is that of polarity, that is, all propositions contain within them their own oppositions.
As related to the borderline pathology, it is assumed that within the borderline dysfunction there is also function and accuracy. Thus, in DBT, it is assumed that each individual, including the borderline clients, are capable of wisdom as related to their own life and capable of change. At the level of the relationship between borderline client and DBT therapist, dialectics refers to change by persuasion, a process involving truth not as an absolute but as an evolving, developing phenomenon.
Borderline pathology is conceptualized as a dialectical failure on the part of the client. The thinking of the BPD patient has a tendency to become paralyzed in either the thesis or antithesis, without movement toward a synthesis. There is a related dialectical theory of the development of borderline pathology.
Diagnosis of Personality Disorder
BPD is seen primarily as a dysfunction of the emotion regulation system, with contributions to this state of malfunction from both biological irregularities and interaction over time with a dysfunctional environment. In this point of view, the BPD client is prey to emotional vulnerability, that is, high sensitivity to emotional stimuli, emotional intensity, and a slow return to emotional baseline functioning. In such an environment, the developing individual does not learn to label private experiences, nor does the individual learn emotion regulation. These assumptions and related data on the developmental histories and cross-sectional behaviors of those with BPD provide the rationale and shape of the treatment.
The major tasks of the treatment are, therefore, to teach the client skills so that they can modulate emotional experiences and related mood-dependent behaviors, and to learn to trust and validate their own emotions, thoughts and activities. The relevant skills are described as four in type: The manual provides extensive material on basic treatment strategies e.
Problem solving consists of analysis of behavior problems, generating alternate behavioral solutions, orientation to a solution behavior, and trial of the solution behavior.
Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment
The core of the treatment is described as balancing problem-solving strategies with validation strategies. This manual is exceptional, and provides a new and very high standard in the field for treatment manuals. There are a number of exemplary features. First, the patient population is defined by DSM criteria in addition to specific problematic behaviors, that is, parasuicidal behaviors. Second, the treatment manual was generated in the context of clinical research.
The treatment was developed in the context of operationalization and discovery, that is, how to operationalize a treatment for research that fits the pathology of the patients who are selected and described by specific criteria. The treatment generated in this context has been used in diverse treatment settings to teach therapists of various levels of expertise and training to address BPD patients. This process of teaching the treatment to therapists of multiple levels of competence and training can foster the articulation of the treatment and enrich its adaptability to community settings.
This treatment has a duration of one year or more because it is addressed to a very difficult and seriously disturbed group of individuals, and provides the challenge of extending treatment manuals beyond brief treatments. A most important and practical addition to the book is an accompanying workbook with work sheets for therapist and patients.
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Many offenders fulfil the diagnostic criteria for one or more of the neurotic stress-related or somatoform disorders. Any causal connection, however, between the offence and a psychiatric diagnosis is more likely found with diagnoses of personality disorders. It is important to note that there is a close link between having a diagnosis of a personality disorder and suffering from neurotic symptoms whether or not these would amount to a separate diagnosis of neurotic disorder. It can be helpful to examine these neurotic conflicts and the symbolic meanings of particular offences for a given individual through offering psychodynamic psychotherapy.
Prevalence studies of abnormal personality usually use the type model. Some personality disorders are more common in men e. More general associations of personality disorder include an increased risk of social, employment and medical problems.
Genetic factors play a substantial role in determining personality. Siblings usually have very different personalities despite receiving similar upbringings, and twin studies have confirmed a genetic effect.
The role of childhood environment has been most studied in dissocial personality disorder. Risk factors include social deprivation and parental disharmony and violence, whereas protective factors include having at least one positive relationship with an adult. Borderline personality disorder is often associated with childhood sexual abuse.
There is some evidence that brain function is abnormal in some personality disorders. Old Age Psychiatrist, 55, Personality disorder in older people: Advances in Psychiatric Treatment, 14, International Journal of Geriatric Psychiatry, 20, Personality disorders in later life: Annual Review Clinical Psychology, 27, 7, Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment. Van Alphen, et al. The relevance of a geriatric sub-classification of personality disorders in the DSM-V. Personality Disorders and Aging Live webinar held April 24, What are you considering "Older Adults" here?
In this presentation, older adults are considered to be 65 years old and older. What approach would you take with OA that is depressed, combative, dependent on spouse but shows none of these signs when seeing physician? What are the best current successful practices with schizophrenia? We need a sequel to this training. That would be a lot of fun! I would love to see a webinar on PD, Aging and determining capacity. Should PRN psychoactive medication be prescribed for older adults? Reference data was dated 15 years ago.
Any research that is more current? Is medication effective for Dysthymia? How would you suggest differentiating OA paranoia in a personality disorder from psychotic paranoia? Generational knowledge gaps such as fear of technology and others?
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But i could be lack of knowledge or miss information. How can you motivate a client who is borderline, narcissistic, a pathological liar, medically unstable and unsafe at home and speaks although she speaks eloquently, is resistant to follow through and self care? How can one relate to an OA who has cycles of behaviors unlike their usual self.
How can CBT work for persons with dementia? Could it be possible the beginning research in the Webinar may be a bit different for the general population vs. Can you speak to reporting requiring. When should APS be called? Can one fit into more than one Cluster? At what point do you assign a diagnosis?
What was the possible diagnosis for cluster A case vignette? Are most older adults with personality disorde never formally diagnosed?
Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment
It has enough material to not only provide basic information to satisfy the curiosity of a lay person but to also cater to the needs of a senior professional dealing with the care of the elderly. The book provides a comprehensive review of each cluster of personality disorders and addresses the issues of comorbidity, epidemiology, diagnosis, and treatment of the elderly with personality disorder. Case vignettes highlighting each of the clusters of personality disorders make the narrative more interesting.
The authors have also done an excellent job of providing a comprehensive framework for conceptualizing personality disorders combining the psychodynamic, cognitive, and biological realms. It is a tribute to the authority of Drs. Segal, Coolidge, and Rosowsky on the concept of personality disorders in older adults that they have been able to provide such a comprehensive narrative on this difficult to understand and treat condition.
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