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Week 11-Main Post-PDs
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For this week’s discussion post, we have been asked to pick and describe a personality disorder from the DSM-5. We have been asked to include a therapeutic approach (including medications) that may be used to treat a patient presenting with this disorder. This posting is also to include how we might share this diagnosis with or client while maintaining the therapeutic relationship. Information obtained for this discussion post will be supported by evidence-based literature.
There are several disorders listed in the DSM-5 that fall under the category of a personality disorder. For the sake of this discussion, I have chosen to further elaborate on paranoid personality disorder (PPD). According to the DSM-5, an essential feature of PPD is a “pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent” (American Psychiatric Association, 2017).
Research regarding PPD has been limited due to the low numbers of patients seeking and maintaining care for this disorder (Vyas, et al., 2017). Individuals who suffer from PPD believe that others will harm, exploit, or deceive them without evidence to support this as being true (American Psychiatric Association, 2017). For this reason, the therapeutic alliance will have a big impact on these patients and will be difficult to maintain at times due to their paranoid perceptions and lack of insight (Vyas, et al., 2017). Therapeutic approaches for patients with PPD may include cognitive behavioral therapy with a focus on the management of boundaries, therapeutic alliance, and safety for the patient as well as those close to him/her (Vyas, et al., 2017). Studies have shown that patients receiving treatment in an inpatient setting have shown higher rates of improvement over those receiving outpatient treatments (Dixon-Gordon, et al., 2011).
Individuals with PPD often have co-morbidities such as anxiety, depression, obsessive-compulsive disorder, and have an increased risk for substance misuse disorders (Völlm, et al., 2011). Pharmacological approached used in many personality disorders, especially in PPD is aimed towards stabilizing symptoms in order to increase functioning (Ripoll, Triebwasser, & Siever, 2011, pp. 1257-1288). These medications may include anti-anxiety, anti-depressant, and anti-psychotics, depending on the severity of their symptoms (Cleveland Clinic, 2020).
Due to the importance of the therapeutic relationship with these patients, stabilization will be of priority. Whether treating the psychosis or the substance abuse, this stabilization process may help the patient rationalize the diagnosis more readily. Allowing the patient to maintain a sense of control as well during the process may help build on their sense of an alliance with their therapist (Vyas, et al., 2017).
As stated above, working with patients who have a diagnosis of PPD can be a difficult task. The likelihood of seeing a patient with this disorder voluntarily in an outpatient setting is rare due to their denial that anything is wrong (Vyas, et al., 2017). Individuals with this diagnosis are often difficult to get along with and are often express suspiciousness or hostility towards others (American Psychiatric Association, 2017). PPD is a chronic condition that will require life-long treatment and the prognosis for individuals with this disorder is often poor (Cleveland Clinic, 2020).
American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: Dsm-5. Arlington, VA.
Dixon-Gordon, K. L., Turner, B. J., & Chapman, A. L. (2011). Psychotherapy for personality disorders. International Review of Psychiatry (Abingdon, England), 23(3), 282–302. https://doi-org.ezp.waldenulibrary.org/10.3109/09540261.2011.586992
Paranoid Personality Disorder Management and Treatment. (2020). Retrieved May 4, 2020, from https://my.clevelandclinic.org/health/diseases/9784-paranoid-personality-disorder/management-and-treatment
Ripoll, L. H., Triebwasser, J., & Siever, L. J. (2011). Evidence-based pharmacotherapy of personality disorders. Essential Evidence-Based Psychopharmacology, 14(9), 278–315. doi: 10.1017/cbo9780511910395.015
Vyas, A., Khan, M., Vyas, Torgerson, Grant, Gabbard, … Vollm BA. (2017, May 16). Paranoid Personality Disorder. Retrieved May 4, 2020, from https://psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2016.110103
Völlm, B. A., Farooq, S., Jones, H., Ferriter, M., Gibbon, S., Stoffers, J., … Lieb, K. (2011). Pharmacological interventions for paranoid personality disorder. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd009100
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