Personality

Please view the post, ‘Personality’ for a definition and discussion on development of a personality. This also includes a brief outline of the clusters that personality disorders are grouped into. Personality disorders are also used as classifiers with depression.

There are many types of personality disorders and to simplify things, they are grouped into three clusters: Cluster A, Cluster B, and Cluster C.

Cluster A Personality Disorders

Cluster A disorders are characterized by odd and eccentric behavior or thinking. These disorders include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

  • Paranoid personality disorder is characterized by a lack of trust and suspicion of others, unjustified belief that others are ‘out to get you’, hesitancy to confide in others, angry or hostile reactions and a tendency to hold grudges. The essential feature for paranoid disorder is interpreting the actions of others as threatening or demeaning. This type of person may appear jealous, secretive and emotionally ‘cold’.
  • Schizoid personality disorder is characterized by a lack of interest in social or personal relationships, a preference to be alone, a limited range of emotional expression, inability to have pleasure in activities, and inability to pick up on normal social cues. The essential feature for schizoid disorder is appearing introverted, withdrawn, and distant. This type of person is often absorbed in their own thoughts and fears closeness with others.
  • Schizotypal personality disorder is characterized by peculiar dress, thinking, beliefs or behaviors, odd perceptual experiences, flat emotions, “magical thinking”, and the belief that casual incidents or events have hidden messages. The essential feature for schizotypal disorder is a pattern of peculiarities. This type of person has difficulty forming relationships and may act inappropriately during social interactions.

Cluster B Personality Disorders

Cluster B disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. These disorders include borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder.

  • Borderline personality disorder is characterized by impulsive and risky behaviors, unstable self-image and self-esteem, up and down moods, intense fear of abandonment, ongoing feelings of emptiness and intense displays of anger. The essential feature for borderline disorder is abrupt and extreme mood changes and self-destructive actions. This type of person is impulsive, self-destructive, socially dependent and have a difficulty with their sense of identity. This disorder is often misdiagnosed as bipolar disorder.
  • Antisocial personality disorder is characterized by a disregard for other’s needs or feelings, persistent lying and stealing, recurring problems with the law, aggressive behavior and lack of remorse for behavior. The essential feature for antisocial disorder involves ignoring social norms while acting out their conflicts, no respect for others and no remorse for their actions. They are at a higher risk for substance abuse because of their behaviors.
  • Narcissistic personality disorder is characterized by fantasies of power, success and attractiveness, failure to recognize other’s needs and feelings, exaggeration of achievements or talents, arrogance, and expectation of constant praise and admiration. The essential feature for narcissistic disorder involves having an exaggerated sense of self-importance and a constant need for attention. This type of person is over sensitive to failure and prove to extreme mood swings between self-admiration and insecurity.

Cluster C Personality Disorders

Cluster C disorders are characterized by anxious, and fearful behavior or thinking. These disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

  • Avoidant personality disorder is characterized by sensitivity to criticism or rejection, feelings of inadequacy, inferiority or unattractiveness, avoidance of interpersonal contact, social inhibition and fear of disapproval, embarrassment or ridicule. The essential feature for avoidant disorder is excessive social discomfort. This type of person usually has no close relationships, although they would like to and are upset at their inability to relate well to others.
  • Dependent personality disorder is characterized by excessive dependence on others and the need to be taken care of, submissive or clingy behavior, fear of fending for yourself, lack of self-confidence, difficulty disagreeing with others and tolerance of poor or abusive treatment. The essential feature is a pattern of submissive and dependent behavior, rely on others to make decisions. This type of person is usually uncomfortable and helpless if they are alone and can be devastated if a relationship ends.
  • Obsessive-compulsive personality disorder is characterized by a preoccupation with details, orderliness and rules, extreme perfectionism, a desire to be in control, excessive commitment to work and an inability to discard broken or worthless objects.The essential feature for  obsessive-compulsive disorder is a striving for perfection and rare satisfaction with their achievements. This type of person is reliable, dependable and methodical, but inflexible to change. They are highly cautious and pay specific attention to detail.

This is just a brief summary of a few of the more typical personality disorders. Although you may identify with the traits of various disorders, a doctor would need to decide whether or not you should be diagnosed with it. Every person can identify with various aspects of personality disorders because no one person’s personality is perfect. We’re all different and that’s ok.

  1. Mayo Clinic
  2. Mental Health America
  3. American Psychological Association
  4. US National Library of Medicine
  5. Psychology Today
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My Life In Outpatient Treatment: Week 5

This is a continuation, part 5, of my daily journal while in outpatient treatment for depression, anxiety and avoidant personality disorder. Please click for Week 1, Week 2, Week 3 and Week 4.

Week 5, Day 23:
They don’t think I’m ready to change. That I’m holding myself back but I don’t know what is holding me back.
I have a whole list of things I need to work on with my outside therapist. I will be discussing this in more detail in “Reprogramming Myself”.
I’m supposed to focus on myself. Focus on accepting myself, 24/7.
I’m holding onto ideals that I need to let go of. I have to let go of the old relationship with myself.
But I don’t want or like to put effort into something, unless I know the results.

Day 24:
How do you keep your mind occupied and/or disengaged from negative thinking? Especially when you’re doing something that doesn’t require much thought and your mind begins to wander.
Use games, distractions, ask myself what, and why; be logical about it, and breath.
“Rumination is like fire. You feed it fuel and it grows.”

Day 25:
I decided that I would like to write a letter to myself saying goodbye to the negative me and to the expectations that I had for myself before I became depressed. See letter.
How can I forgive myself for not meeting the expectations I set for myself? Or the expectations I feel are coming from other sources, namely my family? Is that what is holding me back from being able to change?
“He who angers you, controls you.”
We also talked about acceptance today. Acceptance is: “It is what it is”; making space; and letting yourself off the hook (from suffering).
Acceptance is not: denial, forgiveness, forgetting, letting it go, being ok, agreeing with it, allowing it or understanding it.

Day 26:
Today is my final day. I thought it would be more difficult than it was.
I discovered that May in mental health month and the ribbon is a dark green. One of my fellow patients is helping me create a logo for ADAPT. I’m so excited about that!!
After talking with my therapist, I realized I need to write down my goals. I need to have short term and long term goals. During session today, I felt very much in control of myself, my thoughts & my emotions. Let’s hope this continues!!!!
“Wake up from your thoughts and experience life!”

This is the end of journaling while during the outpatient treatment program. I’m interested to hear your thoughts and comments on my journey and I hope that my journey will help yours! Believe me, that it isn’t an easy fight. Sometimes you have to slog through mud, blizzards, ice and treacherous terrain, but I know that any fight is worth my chance of becoming a better and healthier person. You can view Week 1, Week 2, Week 3, and Week 4 at each link.

My Life In Outpatient Treatment: Week 4

This is a continuation, Week 4, of my daily journal while in outpatient treatment for depression, anxiety and avoident personality disorder. Please click for Week 1, Week 2 and Week 3.

Week 4, Day 19:
My doctor informed me today that they believe my depression is caused by ingrained personality traits which are linked with my avoidant personality disorder tendencies. Supposedly I can fix this by thinking positive things and making positive situations and decisions. I consider this ‘Reprogramming Talia’.
We also discussed change in group therapy today and the therapist had each person write down their top 5 necessities for change. Here are mine:

  1. You have to want to change (willingness)
  2. You have to have help to make change occur (therapist, doctors, etc)
  3. You have to have a solid support system
  4. You have to have the ability to be flexible
  5. You have to allow the change to happen (don’t fight it)

Everyone came up with different answers and it was interesting to see how other people view change and how much needs to happen for change to occur.
Change wouldn’t be worth it, if it was easy.

Day 20:
After yesterday and the realization about the ingrained personality traits, my thoughts have become increasingly negative about myself.
How did I become like is? Is it my fault that these personality traits evolved? Did I make myself like this (unconsciously, of course)? “I am wrong. I am messed up. I made this.”
I want to know why I’m like this. I want to know why I developed in this way.
I want to blame someone, anyone for me turning out this way. Maybe because then I would be the victim and not the perpetrator. And in a way, aren’t I still a victim? A victim of circumstances, situations and environments? Something had to have happened for me to turn out this way.

Day 21:
I feel like I can’t talk. I just get looked over. My issues aren’t important enough. I asked to see my therapist today, but I doubt he’s going to pull me out.
I feel like I’m not getting any better. I’ve been here for a month. I just don’t matter.

Day 22:
Today I talked about how I felt. The group therapist gave me the suggestion to look at situations in my life that have caused me pain and hurt. I am supposed to pick situations that still bother me; situations I still need to process. I am supposed to journal it and hopefully reprocess the situation. I should look at it as a learning experience rather than allowing it to hurt me.
I have a very ‘all or nothing’ attitude. I don’t want to invest time and energy into something if it isn’t going to work out.
My therapist also discussed my discharge from the program today. We decided that I would discharge in a week. I don’t know how I feel about this.

Please stay tuned for Week 5. Here are the links for Week 1, Week 2 and Week 3.

Outpatient Treatment Center

To make the next few posts easier to understand, I want to describe to you the treatment center that I was admitted to, the various programs they have and the types of therapies we learned about.

At this center, there are three levels of treatment; Inpatient Hospital Treatment, Partial Hospitalization Program, and Intensive Outpatient Program. There is also a residential facility for patients with eating disorders. In all of these programs, the adults are separated from the adolescents.

With inpatient treatment, there are various units to which a patient could be assigned. This includes the Special Intensity Unit for patients who are experiencing more acute symptoms of their mental illness. While in inpatient care the doctors, therapists and nurses work together to address the patient’s disorder and work towards long-term recovery. After discharge from inpatient treatment, the patient continues care with the Partial Hospitalization Program or PHP.

Partial Hospitalization Program or PHP, is considered the highest level of outpatient treatment. PHP is a full day program that consists of group, individual, family and other various therapies. PHP is the follow up to inpatient treatment but can also be the starting point for another patient. Each patient is placed within different programs where it is deemed that they will receive the most amount of beneficial therapy.

Intensive Outpatient Program or IOP, is a half day program that helps patients transition to life outside of the program. It is often a follow-up to inpatient treatment and PHP. IOP offers group, individual and family therapy along with transitioning to daily routines. It is considered the lowest level of outpatient treatment for the program and transitions patients to life outside of treatment including setting up schedules and appointments with outside therapists and psychologists.

The center also includes an after care program which is a once a week group therapy session. This allows for continued group therapy alongside your individual outside therapist and doctors.

Each day started with our morning check-ins. With these, we described how we felt at the moment, any questions or concerns we had with medications or therapies and how our previous evenings had occurred. After check in, we had our one hour group therapy session which met daily. During these sessions anyone was free to talk about anything and everyone was allowed to talk, discuss and suggest ideas and solutions. After group therapy, we would either have expressive (art) therapy, music therapy, medication education, emotional regulation, or weekend planning depending on the day. The last hour before lunch, which was also the last hour for the IOP patients, was spent learning about different therapies, issues and ideas dealing with mental health or if you were fighting an addiction, learning about co-dependence on drugs and/or alcohol Many of these classes have given me ideas and information to use for posts.

After lunch the PHP program would continue with two more class periods. During the first class period, patients would learn about distress tolerance, cognitive behavioral therapy or CBT, expressive therapy and anger management. During the second class, patients learned about mindfulness skills, healthy alternatives, communication skills, expressive therapy, and interpersonal effectiveness. Expressive therapy is taught often because it allows patients to express how they feel in a safe environment. Please read Alternative Medications & Therapies for more information on expressive therapy. During the day, we are also pulled out by our doctors, therapists and APNs for meetings and check-ups.

At the end of the day, we would fill out our daily wrap up sheets, detailing how we felt and if we felt we could stay safe during the evening. After the program, our doctors, therapists and staff would meet to discuss our continuing treatment and eventual discharge.

The program I attended is an accredited program within the nation. But if you think you need more help than a weekly therapist appointment please check within your area for a program that can teach you to manage your mental illness.

Therapies for Depression

Therapy is one of the best ways to face mental disorders head on. It gives you a chance to confront your issues and learn to cope with them, if not completely solve them. This post is going to focus on a variety of the therapies offered, however it will only touch upon some of the most popular forms of treatment.

Psychotherapy, known as ‘talk therapy’, is a form of treating depression by counseling patients and helping them understand their illness. It helps them develop strategies and tools for dealing with their symptoms, stress, and behaviors. There are many different kinds of psychotherapies as it is not a ‘one-size-fits-all” approach. The kind of psychotherapy a person receives depends on his or her needs.  While psychotherapy may be the best, and only option for those with mild or moderate mental illnesses, those with severe depression may need medication as well. Several, but not all, forms of psychotherapies will be discussed.

Cognitive Behavioral Therapy, or CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses on a person’s thoughts and beliefs while behavioral therapy focuses on a person’s learning, actions, and behaviors. Both of these can influence a person’s mood and actions. CBT attempts to change a person’s thinking to be more positive, healthy and adaptable. CBT helps restructure negative thought patterns so a person can interpret their environment and personal interactions in a positive and realistic way. It also helps a person recognize things that could be contributing to the depression and teaches realistic coping skills.

Interpersonal Therapy, or IPT focuses on the interactions and behaviors a person has with important people in their life on a day-to-day basis. IPT is used to treat depression and dysthymia and focuses on helping a person improve their communication skills and increase their self-esteem. This therapy focuses on emotions and depression that is usually situational, such as loss/grief, relationship conflicts and major life events. The therapist helps the patient identify their troubling emotions and triggers and teaches them how to express their emotions in a more appropriate and healthy manner. A variation of IPT, known as Interpersonal and Social Rhythm Therapy or IPSRT is used to treat bipolar disorder

Dialectic Behavioral Therapy, or DBT is a form of CBT developed to treat people with suicidal thoughts and actions. Dialectical refers to a discussion of two opposing views until a balance of the two extremes is found. The therapist assures the patient that their behaviors are valid and understood but also teaches that it is the patient’s responsibility to change disruptive or unhealthy behaviors. DBT involves both individual therapy, to learn new skills and group therapy, to practice them. DBT is also an effective treatment for patients with borderline personality disorder.

Family focused therapy, or FFT was designed specifically for treating bipolar disorder. FFT includes family members in therapy sessions to improve relationships and identify difficulties and conflicts which could be detrimental to a patient’s treatment. This therapy specifically focuses on educating the family about the disorder, teaching family members how to effectively communicate, and solving problems together as a family. FFT focuses on the stress families feel when they are caring for their relative, and aims to prevent ‘burning out’ but also holds the patient responsible for their own well being and actions. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses.

There is also the therapies developed by Sigmund Freud, psychodynamic and psychoanalytic therapies. These therapies will discussed in a future post, as well as an explanation for why there therapies are no longer used by today’s therapists.

National Institute of Mental Health

The Mayo Clinic

Medication

In this post I’m going to discuss the various types of antidepressants that a doctor may prescribe. I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

The initial group of antidepressants a doctor may prescribe are reuptake inhibitors. The first medication a doctor will generally choose will be a Selective Serotonin Reuptake Inhibitors, or SSRIs. This type of medication blocks the reuptake of serotonin to the nerve, which increases the level of serotonin in the brain. SSRIs are the most commonly prescribed, generally non-sedating and best tolerated by patients.

The second most popular medication is Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs. This medication blocks the reuptake of serotonin and norepinephrine to the nerve, which increases the level of these chemicals in the brain. SNRIs are often prescribed for severe depression and are safer if a person overdoses. SSRIs and SNRIs have fewer side effects than older antidepressants, although some people tend to experience sexual problems which may be fixed by switching medication or adjusting the dosage.

Norepinephrine and Dopamine Reuptake Inhibitors, or NDRIs, block the reuptake of dopamine and norepinephrine and increases these chemicals in the brain. This is one of the few antidepressants not associated with sexual side effects. There are various other types of reuptake inhibitors including but not limited to Serotonin Antagonist and Reuptake Inhibitors (SARIs) and Noradrenalin Reuptake Inhibitors (NARIs), which affect various brain chemicals.

Another group is cyclic antidepressants. These are generally known as the first generation of antidepressants. Tricyclics (TCAs) and Tetracyclics act in the same way as reuptake inhibitors by blocking serotonin and/or noradrenaline which increases these chemicals in the brain, elevating mood. Cyclic antidepressants are designated by tri or tetra dependant on the number of rings in their chemical structure. Cyclics are powerful but less used today because of the serious nature of their potential side effects.

The last type of antidepressant I’m going to discuss is Monoamine Oxidase Inhibitors, or MAOIs. MAOIs block the natural enzyme that breaks down serotonin, epinephrine and dopamine which increases the level of these chemicals in the brain. Using MAOIs requires a strict diet because of dangerous, even deadly, interactions with foods and other medications. MAOIs cannot be combined with SSRIs. They can also be especially effective in cases of ‘atypical’ depression.

Finding the right medication takes time and patience. You may need to try several medications before you find one that works. It can take several weeks for the medication to go into effect. Medication should only be stopped under a doctor’s supervision. Make sure to report side effects to a doctor immediately. Your doctor may recommend combining two antidepressants or adding mood stabilizers or anti-psychotics.

On some occasions, antidepressants can worsen depression or lead to unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant immediately contact your doctor or get emergency help. Remember, that antidepressants improve mood and reduce suicide risk in the long run.

Occasionally, hospitalization is needed because depression is so severe. Inpatient hospitalization is necessary is you are in danger of harming yourself or others. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Many hospitals have partial hospitalization or day treatment programs to help people while they get their symptoms under control.

Please remember I am not a doctor and I will not claim anything other than a basic understanding of medicine. If you have questions about any of these medications please ask your doctor.

National Institute of Mental Health

Mayo Clinic

Beyond Blue, Depression & Anxiety

Being Diagnosed

If you think you have depression, the first step you need to take is to make an appointment with your primary care physician.

Before your appointment, you should get an in-depth family history. You should also include any symptoms and behaviors, whether they seem related or not, as well as personal information including stress, life changes and lifestyle habits (exercise, diet, sleep, alcohol & drug use). The doctor will also ask for all medications, vitamins and supplements, both prescribed and over-the-counter, that you are taking. It is usually best to sit down and write out this information before your appointment, to insure that you remember everything.

During your appointment, your doctor will ask a lot of questions. Many of these questions may seem extremely personal, but you need to answer them as honestly as possible. The doctors won’t judge you, they want to make sure you get the help you need. The doctor may do a physical exam to rule out a physical health problem. They may also do lab test including a blood test to check your thyroid. An overactive or underactive thyroid will also present the same symptoms as depression. You might also have to have a psychological evaluation. Don’t hesitate to ask questions anytime you don’t understand anything.

To be diagnosed with depression, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. As previously discussed, major depression is characterized as having more than 5 of the symptoms discussed in a previous post, for over a 2 week period.

If you see your primary care physician, get referrals for a psychiatrist and/or a psychologist. I will go into more detail on the differences between the two in another post.

If you are diagnosed with depression, seek the help that you need. Be your own advocate & realize you are not alone.