Personality disorders: Treatment of the nonpsychotic chronic patient

Abstract

Nonpsychotic chronic patients are troublesome not only because of their psychosocial dysfunction, cognitive and affective impairments, and behavioral problems but also because they fail to meet the expectations of health care providers. All of these conditions can cause problems of interactive fit between these patients and their clinicians.

Assessment and DSM‐IV Diagnosis of Personality Disorders: A Primer for Counselors

“…It is my experience that frequently it is the manner in which the client with a personality disorder describes his or her problems and daily life and the context of seeking help that first indicates the need for further inquiry. Any of the following signs could indicate a possible personality disorder: (a) counseling seems to come to a sudden stop in progress after initial success, (b) the client seems entirely unaware of the effect of his or her behavior on others, (c) the problems seem acceptable to client, (d) the client is underresponsive or noncompliant with therapeutic regimen, and (e) the client enters into intense conflictual relationships with institutional systems (Adler, 1990;Beck et al, 1990;Overholser, 1989).…”

“…Despite overall good reality testing, cognitive impairments may be noted that are related to the personality disorder (Adler, 1990) The client may show evidence of vague, sometimes near psychotic symptoms such as derealization, paranoia, projections, and magical thinking that are transient and often stress related. Judgment may be impaired because of the client's inaccurate perceptions of abilities.…”

“…Stable patterns of impairment in behavioral functioning, both interpersonal and occupational, are the hallmark of personality disorders. Adler (1990) described these clients this way: "Whether they are described using the terms of Freud or the DSM-III-R, they fail to find success or satisfaction in loving and working" (p. 4). The counselor will note difficulty in role performances such as parent, long-term intimate friend, student, or worker.…”

“…The counselor will note difficulty in role performances such as parent, long-term intimate friend, student, or worker. The client will be seen by others as having interpersonal behaviors such as being demanding, intolerant, competitive, or oppositional (Adler, 1990).…”

“…The presence of personality disorders will be a contributing factor to the development of clinical Axis I clinical syndromes and alter the presentation, course, and treatment of those syndromes (Adler, 1990;Widiger, Frances, & Trull, 1989). Consider the following two clients:…”