Keep in mind that clients with PDs do not often have good insight. For instance, a client with narcissistic PD will not come in saying, “I have a high need for admiration from others” or “I lack empathy.” Rather, the diagnostician has to infer these traits from the client’s interpersonal style and history.
Each case example should describe behaviors that lead the diagnostician to conclude a PD might be present. Please review Clusters A, B and C – Case Examples of Personality Disorders Scoring Guide prior to submission so that you address all required grading criteria.
For this assignment, you are expected to meet the following requirements:
Title page: Include your name, course, date, and instructor.
Abstract: No abstract is required for the assignment.
Reference: No references are required beyond the assigned readings. Additional references may be used.
Written communication: Written communication is free of errors that detract from the overall message.
APA formatting: Resources and citations are formatted according to APA sixth edition style and formatting.
Length of paper: Three to six typed, double-spaced pages (One to two pages per case example).
Font and font size: Arial, 11 point
What is personality? One definition would be that it is a relatively stable set of traits that characterize an individual’s behavior. These traits are behaviors that we reliably display, and that others have come to recognize in us. We may occasionally surprise the people we know well by doing something out of character. But generally, we behave in somewhat predictable patterns. Of course, we all have traits that are maladaptive. We may worry too much about things we cannot control, act possessively toward a loved one, be chronically late, et cetera. Hopefully, however, we have enough insight into these traits that we are able to manage our behavior, as well as compensatory positive traits that make up for our less-than-exemplary conduct. Ideally, a person’s typical response patterns will be flexible enough that she or he can respond adequately to unique situations.
Imagine, however, a person with a restricted way of perceiving, a narrow range of intrinsic motivations, or a limited set of coping skills. For instance, this person may see all interpersonal reactions as threatening, or among the many goals inherent in social relationships may only be motivated to achieve a sense of superiority, or might lack the coping skills that allow successful resolution of difficult situations. Rather than displaying a few mildly problematic traits, the person may exhibit a number of traits that are problematic, have limited insight into the existence, nature, and consequences of these behaviors, and fail to develop compensatory mechanisms. A personality disorder (PD) is just such an extremely rigid way of responding to the surrounding environment. PDs are evident across a variety of situations and across the lifespan. Typically, the disorder begins in adolescence or early adulthood, and then persists through much of the person’s life. The rigid coping style associated with a PD makes the individual more susceptible to other forms of psychopathology. The disorder may also significantly impact the client’s willingness to enter and ability to benefit from treatment.
Recognizing and diagnosing a PD can be difficult. As noted, individuals often have poor insight into their maladaptive traits, and thus cannot report them to an interviewer. Even when there is some recognition of a maladaptive behavioral repertoire, the individual may be unwilling to report this in an attempt to maintain social desirability. Even when the interviewer can identify potentially maladaptive behaviors from a client’s presentation in the interview or from anecdotes the client reported, it can still be difficult to establish that these are long-standing and pervasive traits.
Cluster A Paranoid Personality Disorder
The Paranoid Personality Disorder* is characterized by a pervasive distrust and suspiciousness of other people. People with this disorder assume that others are out to harm them, take advantage of them, or humiliate them in some way. They put a lot of effort into protecting themselves and keeping their distance from others. They are known to preemptively attack others whom they feel threatened by. They tend to hold grudges, are litigious, and display pathological jealously. Distorted thinking is evident. Their perception of the environment includes reading malevolent intentions into genuinely harmless, innocuous comments or behavior, and dwelling on past slights. For these reasons, they do not confide in others and do not allow themselves to develop close relationships. Their emotional life tends to be dominated by distrust and hostility.
Cluster B Narcissistic Personality Disorder
People with Narcissistic Personality Disorder* have significant problems with their sense of self-worth stemming from a powerful sense of entitlement. This leads them to believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive. Their sense of entitlement can lead them to act in ways that fundamentally disregard and disrespect the worth of those around them.
People with Narcissistic Personality Disorder are preoccupied with fantasies of unlimited success and power, so much so that they might end up getting lost in their daydreams while they fantasize about their superior intelligence or stunning beauty. These people can get so caught up in their fantasies that they don’t put any effort into their daily life and don’t direct their energies toward accomplishing their goals. They may believe that they are special and deserve special treatment, and may display an attitude that is arrogant and haughty. This can create a lot of conflict with other people who feel exploited and who dislike being treated in a condescending fashion. People with Narcissistic Personality Disorder often feel devastated when they realize that they have normal, average human limitations; that they are not as special as they think, or that others don’t admire them as much as they would like. These realizations are often accompanied by feelings of intense anger or shame that they sometimes take out on other people. Their need to be powerful, and admired, coupled with a lack of empathy for others, makes for conflictual relationships that are often superficial and devoid of real intimacy and caring.
Status is very important to people with Narcissistic Personality Disorder. Associating with famous and special people provides them a sense of importance. These individuals can quickly shift from over-idealizing others to devaluing them. However, the same is true of their self-judgments. They tend to vacillate between feeling like they have unlimited abilities, and then feeling deflated, worthless, and devastated when they encounter their normal, average human limitations. Despite their bravado, people with Narcissistic Personality Disorder require a lot of admiration from other people in order to bolster their own fragile self-esteem. They can be quite manipulative in extracting the necessary attention from those people around them.
Cluster C – Obsessive-Compulsive Personality Disorder
Persons with Obsessive-Compulsive Personality Disorder* are preoccupied with rules, regulations, and orderliness. This preoccupation with perfectionism and control is at the expense of flexibility, openness, and efficiency. They are great makers of lists and schedules, and are often devoted to work to such an extent that they often neglect social relationships. They have perfectionist tendencies, and are so driven in their work to “get it right” that they become unable to complete projects or specific tasks because they get lost in the details, and fail to see the “forest for the trees.” Persons with Obsessive-Compulsive Personality Disorder tend to be rigid and inflexible in their approach to things. It simply isn’t an option for them to do a “sub-standard” job just to get something done. Often, they are unable to delegate tasks for fear that another person will not “get it right.” Sometimes people with this disorder adopt a miserly style with both themselves and others. Money is regarded as something that must be rigidly controlled in order to ward off future catastrophe. People with this disorder are often experienced as rigid, controlling, and stubborn.
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