1. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Chapter 16 Personality Disorders Menu F

2. Slide Copyright © 2002 by W. B. Saunders Company. All rights reserved. Mental health continuum for personality disorders 16-2 (Fig. 16-1) Menu FB

3. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Personality Disorders Cluster C Anxious, Fearful l Dependent l Avoidant l Obsessive Compulsive Cluster B Dramatic, Emotional, Erratic l Borderline l Antisocial l Histrionic l Narcissistic Cluster A Odd or Eccentric l Schizotypal l Paranoid l Schizoid Menu FB

4. Copyright © 2002 by W. B. Saunders Company. All rights reserved. Limits: clear, consistent, enforceable Team: aware of limits, need for consistency l Communicate expectations to client l Be realistic re: which behaviors to limit l Clear consequences of exceeding limits l Follow through with consequences in non-punitive manner l Assist client to limit own behavior l Assess insight and motivation to change l Avoid power struggles Limits: clear, consistent, enforceable Team: aware of limits, need for consistency l Communicate expectations to client l Be realistic re: which behaviors to limit l Clear consequences of exceeding limits l Follow through with consequences in non-punitive manner l Assist client to limit own behavior l Assess insight and motivation to change l Avoid power struggles Limit Setting Menu FB

5. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Identify antecedent needs and feelings l Discuss current/previous impulsive acts l Explore impact on self and others l Recognize cues to impulsive behavior l Refer or teach needed coping skills l Discuss alternatives to impulsive behavior l Role play new skills l Provide feedback l Support new skills l Identify strengths and effective communication l Identify antecedent needs and feelings l Discuss current/previous impulsive acts l Explore impact on self and others l Recognize cues to impulsive behavior l Refer or teach needed coping skills l Discuss alternatives to impulsive behavior l Role play new skills l Provide feedback l Support new skills l Identify strengths and effective communication Impulsive Behavior: Interventions Menu FB

6. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Be aware of client isolation, suspiciousness l Avoid being “too nice,” overly friendly l Use neutral, kind approach l Clear, straightforward explanations l Simple, clear language l Give warning about changes, reasons for delay, medication side effects l Be aware of client isolation, suspiciousness l Avoid being “too nice,” overly friendly l Use neutral, kind approach l Clear, straightforward explanations l Simple, clear language l Give warning about changes, reasons for delay, medication side effects Cluster A Clients: Interventions Menu FB

7. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Set clear, realistic goals l Be aware of manipulative behaviors l Clear, consistent boundaries/limits l For behavioral problems, review therapeutic goals and treatment boundaries l Avoid rejecting, rescuing l Assess for suicidal, self-mutilating behavior l Set clear, realistic goals l Be aware of manipulative behaviors l Clear, consistent boundaries/limits l For behavioral problems, review therapeutic goals and treatment boundaries l Avoid rejecting, rescuing l Assess for suicidal, self-mutilating behavior Borderline Personality Disorder: Interventions Menu FB

8. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Set clear, realistic limits on specific behavior l All limits adhered to by all staff l Document objective physical signs of manipulation or aggression l Provide clear boundaries, consequences l Guard against letting client make you feel guilty l Guard against being manipulated l Set clear, realistic limits on specific behavior l All limits adhered to by all staff l Document objective physical signs of manipulation or aggression l Provide clear boundaries, consequences l Guard against letting client make you feel guilty l Guard against being manipulated Antisocial Personality Disorder: Interventions Menu FB

9. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Stay neutral, avoid power struggles l Don’t be defensive when disparaged l Convey unassuming self-confidence l Stay neutral, avoid power struggles l Don’t be defensive when disparaged l Convey unassuming self-confidence Narcissistic Personality Disorder: Interventions Menu FB

10. Copyright © 2002 by W. B. Saunders Company. All rights reserved. l Understand seductive behavior as a response to stress l Keep relationship professional l Encourage/model use of concrete descriptive language l Teach and model assertiveness l Understand seductive behavior as a response to stress l Keep relationship professional l Encourage/model use of concrete descriptive language l Teach and model assertiveness Histrionic Personality Disorder: Interventions Menu B