Paranoid and obsessive compulsive personality disorders essay examples
Paranoid and obsessive-compulsive personality disorders essay examples
Obsessive-compulsive personality disorder (ocpd)
QUESTION
• Explain the diagnostic criteria for Obsessive compulsive personality disorder (ocpd)
• Explain the evidenced-based psychotherapy for the above personality diosrder
• Explain psychopharmacologic treatment for Obsessive compulsive personality disorder (ocpd .
• Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.
• Support your rationale with references to the Learning Resources or other academic resources.
Diagnostic Criteria for Paranoid Personality disorder (PPD)
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Paranoid Personality Disorder (PPD) is one of a group of mental health conditions called Cluster “A” Personality Disorders which involve the exhibition of odd/ eccentric ways of thinking; individuals with this disorder suffer from paranoia which is an unrelenting/ unending mistrust and suspicion of other people, even when there is no apparent reason to be suspicious (WebMD, 2018) Paranoid and obsessive compulsive personality disorders essay examples. PPD typically begins by early adulthood in the affected individuals and is usually more common in the male gender (men) than in the female, and individuals who suffer from PPD are always on guard because they believe that others are constantly trying to harm, humiliate, or threaten them (WebMD, 2018). The habits of blame, distrust and generally the unfounded beliefs might interfere with the sufferer’s ability to form close relationships (WebMD, 2018). The exact cause of this disorder is not known, but it is thought to be a combination of both biological and psychological factors; the fact that PPD is increasingly common in individuals who have close relatives with a diagnosis of schizophrenia suggests some genetic link between these two disorders, and early childhood experiences, such as physical or emotional trauma, also play a role in developing PPD during young adult life (WebMD, 2018).
In diagnosing PPD, the client may present as very formal in manner, and act frustrated/ baffled about having to seek mental health care and evidently showing muscle tension, restlessness, suspicion or the need to scan the environment for clues; the client will also show a humorless and serious mood but with goal-directed and logical speech, although, their arguments may not be true (Sadock, Sadock, & Ruiz, 2014). Moreover, PPD clients have thought contents that show evidence of projection, occasional ideas of reference, and they are always prejudiced (Sadock, Sadock, & Ruiz, 2014).
Evidenced-based Psychotherapy and Psychopharmacologic Treatment for PPD
Currently, there are no Food and Drug Administration (FDA)-approved medications for PPD; medication is generally not a major focus of treatment for this disorder (Vyas & Khan, 2016). However, medications such as antidepressants, antianxiety, or anti-psychotic drugs, might be prescribed if the client’s symptoms are extreme or suffer from an associated psychological problem such as anxiety/ Depression in addition to PPD (WebMD, 2018). Cognitive-behavioral therapy (CBT) and psychodynamic therapy (PT) have been shown to be the effective treatment modalities for individuals diagnosed with PPD (Vyas & Khan, 2016). Furthermore, individuals with PPD do not typically seek treatment on their own because they believe that they do not have any problem, and when treatment is sought, psychotherapy (CBT/ PT) is the first line/ treatment of choice for PPD (WebMD, 2018). Psychotherapy treatment will focus on increasing the client’s general coping skills, improving social interaction, communication skills, and self-esteem as well as ways to help reduce paranoia; however, because trust is an important factor in psychotherapy, treatment is usually challenging since individuals with PPD have extreme distrust of others and as a result, most clients with PPD do not follow/ stay compliant with their treatment plans (WebMD, 2018).
Clinical Features that Confirms Paranoid Personality Disorder using DSM-5
Mr. Jones is a 25-year-old white male with no prior psychiatric history brought to our office accompanied by his mother and sister who thinks that the client is getting worse with “bizarre behavior” which they started noticing about 2 years ago after he graduated from the University and has now become a big problem. This client is always suspicious of everything around him and thinks that his family and friends are against him and so, has stopped communicating with most of his friends and family members to his own detriment; his uncle recently helped him to get a banking job (he studied accountancy in the University) but refused to go or talk to his uncle because he believes that “it is all a set up.” He suspects that his mother is trying to encourage him to start working so that she can start exploiting him and making him pay all the bills. He is also preoccupied with doubts about his sister’s loyalty to him and unjustifiably questions her trustworthiness with anything or any situation that has to do with him.
Furthermore, the client’s mother verbalized his reluctance to confide in her as his mother because the client fears that his information will be known to everybody and be used to blackmail him in some ways. He also verbalized “I don’t like when people make unnecessary jokes around me because I believe that there is always a hidden meaning to every joke.” This client is able to hold grudges against people for an extended amount of time regardless of their relationship with him (family, friend, etc); he had held grudges with his mother for over a year over a very trivial issue in the past and even tried to attack her sister for intervening in the situation. Mr. Jones broke up with his girlfriend last summer due to the suspicion that she was having an affair; this issue also resulted in family problems because his family told him that his suspicion was unfounded.
This client’s signs and symptoms fit clearly into the 2013 DSM-5 manual by the American Psychiatric Association based on all the diagnostic features explained/ analyzed above by the client and his family. For a diagnosis of PPD to be made, the client must meet the two primary diagnostic criterion called A and B; four (4) out of the seven sub-features of criterion “A” must be met (he met six of these features) in addition to criterion “B” which explains that the client should not have his symptoms better explained by any psychotic episode in schizophrenia, or depressive disorder/ bipolar disorder with psychotic features (American Psychiatric Association, 2013). Mr. Jones does not have any other psychiatric history/ diagnosis and moreover, he does not have any diagnosed medical condition to which his current psychological symptoms can be attributed; this shows that he also met with criterion B to make a diagnosis of PPD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/ clinical psychiatry (11th Ed.). Philadelphia, PA: Wolters Kluwer.
Vyas, A., & Khan, M. (2016). Paranoid Personality Disorder. The American Journal of Psychiatry Resident’s Journal. Retrieved from: https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp-rj.2016.110103
WebMD. (2018). Paranoid Personality Disorder. Retrieved from: https://www.webmd.com/mental-health/paranoid-personality-disorder#2
Obsessive Compulsive Personality Disorder (OCPD)
There are many different types of personality disorders that affect many people today. Unfortunately, unlike other mental health disorders personality disorders often present a great challenge when considering treatment options. Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood due to the fact that a child or teen is under constant development, personality changes, and maturation, it is uncommon for them to be diagnosed in childhood or adolescence years (Bressert, 2017), In the discussion this week, I will define the Obsessive-Compulsive Personality Disorder, identify the diagnostic criteria for the disorder, and describe clinical features from a client that led you to believe this client had this disorder.
What is Obsessive Compulsive Personality Disorder
According to the American Psychiatric Association, (2016) Obsessive-compulsive personality disorder 301.4 (F60.5) is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. According to Bressert, (2017), Obsessive-compulsive personality disorder is approximately twice as prevalent in males than females and occurs in between 2.1 and 7.9 percent of the general population. Because this type of personality disorder cause a person to focus so much on being perfect, and they are usually pre-occupied with with logic and intellect, the process of making simple daily life decisions and prioritizing which one to do first becomes extremely difficult for them to do.
Diagnostic Criteria
There are several identified symptoms of Obsessive-compulsive personality disorder (OCPD) when the disorder is present. However, four (or more) of the following must be present for one to receive a diagnosis:
Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
Is unable to discard worn-out or worthless objects even when they have no sentimental value
Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
Shows significant rigidity and stubbornness
Psychotherapy and Psychopharmacologic Treatment
As previously stated, it is not always easy finding the right treatment for someone suffering from a personality disorder. According to Ripoll, Triebwasser, and Siever (2011) In the USA there are no FDA-approved medications for the treatment of these disorders, so pharmacotherapy usually results off-label and pharmacological strategies remain lacking. However, evidence-based practice recommends a combined approach including both psychotherapy and pharmacotherapy. This is a very common form of treatment for all types of personality disorders especially those identified as Cluster C personality disorders which is what OCPD falls under. According to Bateman, Gunderson, and Mulder (2015), there are no randomized controlled trials of drug treatment for cluster C personality disorders, although it can be argued that antidepressants might be of some help, particularly, in patients with obsessive–compulsive personality disorder, as the use of SSRIs may decrease anxiety if it is present. When it comes to the therapy side of treatment for this disorder, the therapist will likely use a three-pronged approach to treatment, which typically includes: Cognitive Behavioral Therapy, medication and relaxation training. This type of treatment is typically long-term and is performed with a therapist that has experience in treating this kind of personality disorder (Healthline, 2016).
Clinical Features from a Client with OCPD
During clinicals we see a lot of clients with personality disorder who also present with other co-morbidities and mental health diagnosis like depression and anxiety. However, I recent assessed a client who present to the client with a chief complaint of anxiety. The client explained how she worked as a secretary at a law firm and how it was so important to her to make she that she did everything “perfectly” and how it bothered her to work with other people unless they made sure to do the job exactly how she did it. She expressed her concerns of increased stress and the need for a vacation with family and friends but is apprehensive about leaving for to long out of fear of the job not getting “done the right way”. When trying to explain to the client that there may me more than one way to complete the task and still get it done the right way, she quickly disagreed and became very defensive and increasingly anxious with just the idea of someone changing the process of getting the job done because it wasn’t her way. The client reported that her husband and children both have asked her to quit the job and spend some time at home as they can all see her obsession for it but refuses to step back at this time. Paranoid and obsessive compulsive personality disorders essay examples With all of these symptoms present, the client was diagnosed with OCPD.
References
American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia (5th ed.). Washington, DC.
Bateman AW, Gunderson J, Mulder R. Treatment of personality disorder. Lancet. 2015;385:735–743
Bressert, S. (2017, December 17). Obsessive Compulsive Personality Disorder. Retrieved from https://psychcentral.com/disorders/obsessive-compulsive-personality-disorder/
Healthline. (2016, May 12). Psychotherapy vs. Medications: The Verdict Is In. Retrieved from https://www.psychologytoday.com/blog/fulfillment-any-age/201507/psychotherapy-vs-medications-the-verdict-is-in
Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol. 2011;14:1257–1288. Paranoid and obsessive compulsive personality disorders essay examples.
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Washington, DC: Author.
- Standard 12 “Leadership” (pages 76-77)
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)
- Chapter 22, “Personality Disorders” (pp. 742–762)
- Chapter 13, “Psychosomatic Medicine” (pp. 451–464)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications Paranoid and obsessive compulsive personality disorders essay examples.
- Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”
- Chapter 69, “Antisocial Personality Disorder”
- Chapter 70, “Borderline Personality Disorder”
- Chapter 71, “Histrionic Personality Disorder”
- Chapter 72, “Narcissistic Personality Disorder”
- Chapter 73, “Cluster C Personality Disorders
Note: You will access this book from Walden Library databases.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- “Personality Disorders”
Note: You will access this book from Walden Library databases.
Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry: Interpersonal & Biological Processes, 76(1), 32–52. doi:10.1521/psyc.2013.76.1.32 Paranoid and obsessive compulsive personality disorders essay examples
Note: You will access this article from Walden Library databases.
Rees, C. S., & Pritchard, R. (2015). Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52(1), 45–55. doi:10.1037/a0035158
Note: You will access this article from Walden Library databases.
Required Media
SUBJECTIVE
Rhonda is a 32-year-old Hispanic female who presents to your office for her initial appointment. When you ask what brought her to your office, she states: “I’m at the end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda explains that she goes out of her way to help other people, and to be nice to them, but this does not seem to help.
Rhonda then stands up and begins to pace around your office at times using wild hand gestures to explain the circumstances that led up to her making the appointment with you. She describes the recent breakup with her boyfriend as traumatic and explains “when we first met, he was the best guy in the world. He treated me really well. But he just became a complete monster! Even though he broke off the relationship with me, I was glad to see it end. I hate his guts!” Paranoid and obsessive compulsive personality disorders essay examples.
Rhonda explains that her current financial situation is also precarious. She states that she recently purchased an automobile, and is not certain how she is going to pay for it. She states that she had a car that was repossessed last year at that time, and that she borrowed some money from a friend to help pay for the car; the friend later turned around and accused her of theft. “It was my friend’s fault. She told me she would loan me the money and then backed out. I only took the money because she said she would loan it to me … people just can’t go back on their word like that when other people are counting on them.”
Rhonda reports that she was “always in trouble” as a kid. She states that people were always picking on her, to which she adds: “the other kids my age were just stupid. Paranoid and obsessive compulsive personality disorders essay examples . They didn’t know how to have fun.” She says “I have always been impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once, so you have to make the best of it.”
OBJECTIVE
Rhonda is currently single. She has no children. Educationally, she had completed two semesters toward her bachelor of arts degree in fine arts. Rhonda currently works as a waitress at a local restaurant. She has held this job for about 2 weeks. Prior to this, Rhonda worked as a housekeeper for a local hotel chain. She states that she was fired from this job because her coworkers were jealous of her and “planted” evidence of her stealing from hotel patrons. She was also arrested for cashing checks under an alias, for which she spent 120 days in jail. Paranoid and obsessive compulsive personality disorders essay examples.
Rhonda has a history of multiple incarcerations for offences ranging from larceny to possession of controlled substances to possession of an illegal firearm. She was also arrested several times for fighting and on at least one occasion, used a baseball bat to beat up a girl who she thought was trying to “set her up” with the police.
MENTAL STATUS EXAM
Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change rapidly with the subject being discussed. Her eye contact is normal, but at times, she appears to stare at you. Rhonda is oriented to person, place, and time. She denies visual/auditory hallucinations, no overt paranoia or delusional thought processes noted. Rhonda denies any suicidal or homicidal ideation Paranoid and obsessive compulsive personality disorders essay examples.
Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO RHONDA?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis.
Refer to psychologist for psychological testing RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- The psychologist’s report indicates that a comprehensive psychological battery was performed for the purposes of diagnostic clarification. The end result suggested that Rhonda has traits of multiple personality disorder, but scores highest in antisocial personality traits, suggesting antisocial personality disorder (APD).
- When Rhonda returns to the office, you review the psychologist’s report with her Paranoid and obsessive compulsive personality disorders essay examples. Rhonda seems upset, but also states “well, that’s why I am here, to get better … what do I need to do?”
Begin group-based cognitive behavioral therapy Guidance to Student
DBT has not been demonstrated as an effective means of treating APD. There are currently no FDA-approved medications to treat APD either, and Abilify has been associated with an increase in impulse control issues (such as gambling). Also, prescribing medications to someone with antisocial personality disorder could lead to misuse or diversion.Of the available choices, group-based cognitive behavior therapy may be useful in treating individuals with this personality disorder, but all “improvement” in signs/symptoms should be met with great skepticism.
Kernberg, O. (n.d.). Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg, MD. [Video file]. Mill Valley, CA: Psychotherapy.net
Note: This video is approximately 94 minutes of length. Paranoid and obsessive compulsive personality disorders essay examples You will access this article from Walden Library databases.