Monday, December 22, 2014

9 personality disorders: getting to the bottom of who and why - organized by 3 DSM clusters

Cluster A Personality Disorders

Paranoid Personality Disorder

Suspects, without sufficient basis, that others are exploiting or deceiving them.

Preoccupied with unjustified doubts about loyalty.

Is reluctant to confide in others because of unwarranted fear that the information will be used against him/her.

Persistently bears a grudge.

Perceives attacks on character that are not apparent to others.

Recurrent suspicions without justification regarding fidelity of a spouse or partner.

Schizoid Personality Disorder

Neither desires nor enjoys close relationships, including being part of a family.

Almost always chooses solitary activities.

Little, if any, interest in having sexual experiences with another person.

Takes pleasure in few, if any, activities.

Lacks close friends or confidants other than first- degree relatives.

Appears indifferent to praise and criticism.

Emotional coldness, detachment or flattened affect.

Schizotypal Personality Disorder

Ideas of reference (excluding delusions of reference).

Odd beliefs or magical thinking that influence behaviors and are consistent with cultural norms.

Unusual perceptual experiences, including bodily illusions. Odd thinking and speech.
Suspiciousness or paranoid ideation.
Inappropriate or constricted affect.

Behavior or appearance that is odd, eccentric.

Lack of close friends or confidants other than first-degree relatives.

Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments.

Cluster B Personality Disorders

Antisocial Personality Disorder

Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.

Deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure.

Impulsivity or failure to plan ahead.

Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

Reckless disregard for safety of self or others.

Consistent irresponsibility – i.e. lack of consistent work behavior or honoring financial obligations.

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Borderline Personality Disorder

Frantic efforts to avoid real or imaginary abandonment.

A pattern of unstable and intense interpersonal relationships categorized by alternating between extremes of idealization and devaluation.

Identity disturbance: persistent and markedly disturbed, distorted, or unstable self-image or sense of self.

Impulsivity in at least two areas that are potentially self- damaging (spending, substance abuse, binge eating, etc.).

Recurrent suicidal behavior, gestures, or threats or self mutilating behavior.

Affective instability due to marked reactivity of mood. Chronic feelings of emptiness.
Inappropriate, intense anger or lack of control of anger.

Transient, stress related paranoid ideation or severe dissociative symptoms.

Histrionic Personality Disorder

Uncomfortable in situations in which he or she is not the center of attention.

Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

Displays rapidly shifting and shallow expression of emotions.

Consistently uses physical appearance to draw attention to self.

Style of speech that is excessively impressionistic and lacking in detail.

Self-dramatization, theatricality, and exaggerated expression of emotion.

Suggestible, i.e., easily influenced by others or circumstances.

Considers relationships to be more intimate than they actually are.

Cluster C Personality Disorders

Avoidant Personality Disorder

Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection.

Is unwilling to get involved with people unless certain of being liked.

Restraint within intimate relationships due to the fear of being shamed or ridiculed.

Preoccupation with being criticized or rejected in social situations.

Inhibited in new interpersonal situations because of feelings of inadequacy.

Belief that one is socially inept, personally unappealing, or inferior to other.

Is usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Dependent Personality Disorder

Is unable to make everyday decisions without an excessive amount of advice and reassurance from others.

Needs others to assume responsibility for most major areas of his or her life.

Has difficulty expressing disagreement with others because of fear of loss of support or approval.

Has difficulty initiating projects or doing things on his/her own due to lack of self confidence in judgment or ability

Goes to excessive lengths to obtain nurturance and support from others, to the point volunteering to do things that are unpleasant.

Feels uncomfortable or helpless when alone, because of exaggerated fears of being unable to care for oneself.

Urgently seeks another relationship as a source of care and support when a close relationship ends.

Unrealistic preoccupation with fears of being left to take care of himself or herself.

Obsessive-Compulsive Personality Disorder

Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

Perfectionism that interferes with task completion.

Excessive devotion to work and productivity to the exclusion of leisure activities and friendships.

Overconscientiousness, scrupulousness, and inflexibility about matters of morality, ethics, or values.

Inability to discard worn-out or worthless objects even when they have no sentimental value.

Reluctance 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. Rigidity and stubbornness.

82 facts about schizophrenia and other psychotic disorders: clinical diagnosis and differential assessment



Thought disorder (delusions & hallucinations)

Disorganized speech or behavior



Catatonic behavior (motor activity) - not moving, "frozen"

Emotional response lacking

Poverty of speech

Lack of initiative

Persistent inability to experience pleasure

Typical behavior of people with Schizophrenia

Often sees things, experiences sensations or hears voices that do not exist (hallucinations)

Persistently believe in fixed ideas despite proof that they are false (delusions)

Unable to think in a logical manner (thought disorder)

Lack will or motivation to complete a task or accomplish something

Function at much lower level than in the past at work, relationships or taking care of themselves

Develop symptoms of major depression or of mania along with other symptoms on this list

Have delusions involving real life situations, such as that they are being followed, poisoned, infected, loved from a distance, or deceived by a spouse.

Less common behavior of people with Schizophrenia

Talking in rambling, disconnected or incoherent ways

Make odd or purposeless movements; not talk or move at all

Repeat others’ words or mimic their gestures

Show few, if any feelings; respond with inappropriate emotions

5 Types of Schizophrenia

Disorganized Type (Hebrophrenic) Catatonic Type
Paranoid Type
Undifferentiated Type
Residual Type

Disorganized Type

Marked incoherence, lack of systemized delusions and blunted or silly affect.

Catatonic Type

Marked by stupor, negativism, rigidity, bizarre posturing, and excessive motor activity.

Paranoid Type

Marked by one or more systemized delusions, auditory hallucinations with a single theme, absence of incoherence, marked loosening of associations, flat or inappropriate affect, catatonic behavior, and grossly disorganized behavior

Undifferentiated Type

Marked by delusions, hallucinations, incoherence, and/or grossly disorganized behaviors. Diagnosed when symptoms don’t meet the criteria for one of the specific types.

Residual Type

Diagnosed when the individual is not currently displaying psychotic symptoms but has displayed these symptoms in the past and continues to exhibit residual symptoms – eccentric behavior, illogical thinking, or inappropriate affect

The Experience of Schizophrenia

Visual Experience

Heightened sensitivity to light and color

Loss of perspective of figures

Illusionary changes in faces and objects

Distortions in size

Auditory Experience

Heightened sensitivity to noise Hallucinations

Inability to screen out background noise

Distortions in voices Muting of sounds

Physical Experience

Heightened sensitivity to touch Tactile hallucinations

Inability to interpret internal sensations

Olfactory hallucinations

Cognitive Experience

Loose associations
Inability to filter out irrelevant data
Over stimulation of thoughts (flooding) Increased or decreased speed of thinking Idiosyncratic explanatory systems

Three phases of Schizophrenia

Prodromal or Residual Phases

Significant social isolation or withdrawal

Impairment in role functioning

Peculiar behavior

Blunted or inappropriate affect
Odd beliefs or magical thinking

Unusual perceptual experiences

Lack of initiative, interests or energy

Impaired hygiene/grooming Impaired speech

Interventions for people diagnosed with schizophrenia

First, establish a relationship by...

Respecting the client’s inner experiences

Making no suggestions of change.

Accepting client’s agenda.

Concrete and formal communication style.

Affirming strengths and sense of self.

Allowing maintenance of protective defenses.

After relationship has been established...

Education and advice Encouragement and praise.

Manipulate environment to strengthen competence.

Treating Schizophrenia:

adverse psychological effects of medication

Dependency issues

Normal ambivalence, issues of self-determination Negative self-image, inability to function without medication. Powerlessness.

Dependence on doctor or social worker.

Anger. Why me? "You've changed."
Social Stigma
Abdicate Self-Responsibility - playing the sick role. Unresponsible for behavior - problems with discrimination of can & can’t.

Flat out non-compliance and/or inappropriate activities.

Shared Psychotic Disorder

Disturbance that develops in a person who is influenced by someone else who has established delusion with similar content.

Brief Psychotic Disorders

Psychotic disturbance that lasts more than 1 day and remits within 1 month.

Schizoaffective Disorder

Disturbance in which a mood episode and the active phase symptoms of schizophrenia occur together.

Preceded or followed by at least 2 weeks of hallucinations or delusions without prominent mood symptoms.

Schizophreniform Disorder

Symptomatic presentation equivalent to schizophrenia, except for duration.

One to six months in duration.

Absence of the requirement of a decline in functioning.

Delusional Disorder

Many types of delusional disorder.

Eromantic, grandiose, jealous, persecutory, somatic (body/physical), mixed (combo).

Tend to have more ability to function "normally."

The false beliefs are not bizarre.

HIPAA - 26 historical facts for practitioners and students

Health Information Portability and Accountability Act

 Passed in 1996
 Intends to protect private health information
from being shared without consent  Includes genetic information
 Minimum penalty for individual: $100
 Maximum penalty for individual: $1.5 million
 2009 HIPAA violations for over 500 patients at a time: 108 violations, 4,089,670 people, $834.3 million

HIPAA: great intent with poor execution

 The primary complaint with HIPAA is of the policy’s ambiguity
◦ Ambiguity leaves both the agency/practitioner and consumer at risk
 HIPAA does not apply to everyone who has access to health information

For example:

◦ “The rule generally prohibits a covered entity from using or disclosing [private health information] unless authorized by patients, except where this prohibition would result in unnecessary interference with access to quality healthcare or with certain other important public benefits or national priorities,“


◦ Court decisions on HIPAA can disagree with one
another from jurisdiction to jurisdiction
◦ Agencies and individual practitioners are vulnerable to lawsuits due to not understanding the complexities of HIPAA policy and court decisions

More Results of HIPAA

◦ Many agencies are reluctant to share information
and foster relationships with other providers
◦ Less collaboration and continuity of care
◦ When collaboration does occur, it is less timely
◦ Practitioners from different fields are even less likely to share health information due to fear of different standards (e.g. medicine and social work)

 Can lead to bloated agencies due to the need to define every action related to health information and how it is intended to be in agreement with HIPAA guidelines
◦ Money is spent on HIPAA compliance and not on services to clients/patients/consumers/employee benefits
 Paper shredding services
 Frequent HIPAA trainings
 Clinicians may keep two sets of notes
 Sophisticated security technology takes money and time to implementgreater sophistication leads to greater failure ratewasted time

◦ Adoption of technology for Electronic Medical Records [EMR] has been slow due to fears of the safety of technology
◦ Lack of EMR makes healthcare process much slower than necessary
 Longer to get treatment  worse problems, lost productivity
 Healthcare costs are much higher due to inefficiency: massive and slow paper filing systems, transcription services, fax vs. email, longer consult fees while records are found, duplication of tests and services due to lack of proof they already occurred, etc.

HIPAA only applies to:

◦ Healthcare providers
◦ Health plans / insurance
◦ Companies which act as a middleman between healthcare providers and insurance companies

HIPAA does NOT apply to:

◦ Life insurance companies
◦ Workers compensation
◦ Social security and welfare benefit agencies
◦ Automobile insurance that includes health benefits (which is nearly all of them)
◦ Researchers obtaining information health data from healthcare providers (which is surprisingly legal under HIPAA)
◦ Law enforcement
◦ Internet self-help sites
◦ Information you give voluntarily on surveys or research projects
◦ Any part of a health organization which does not process claims or make payments
◦ Workers conducting screenings at fairs, malls, pharmacies, etc
◦ Credit reporting agencies

Everyone in the United States has health information

◦ Everyone is vulnerable to the lack of HIPAA coverage
 Most social workers deal with private health information
◦ Social workers can never be too careful with health information, lest they get sued
 Private health information can be given away to people or companies in foreign countries
 Law enforcement can access private health information, but are not covered by HIPAA
 In many cases, employers can obtain private health information if they employer provides health insurance benefits
 Parents can release a child’s private health information, but they can not have access to it
 Business associates of HIPAA providers can be given protected information without the patient’s consent
 You lose the right to sue under HIPAA – only the federal government can take action

You never know how many people see your private health information

 Any disclosure required by federal, state, or local regulation, regardless of the scope of the disclosure or the purpose of the disclosure.
 Public health authorities.
 A person subject to the jurisdiction of the federal Food and Drug Administration.
 A person who may have been exposed to a communicable disease.
 An employer to (1) conduct workplace medical surveillance or (2) to evaluate whether you have a work-related illness or injury.
 Victims of abuse, neglect or domestic violence.
 A health oversight agency for audits and investigations.
 Court or administrative proceedings in response to a court order, subpoena, or discovery request.
 A collection agency for unpaid medical bills.
 Coroners and medical examiners.
 Funeral directors.
 Organ procurement organizations.
 A medical researcher with institutional review board approval.
 A threat to public safety or public health.
 U.S. and foreign military commanders.
 U.S. Department of Veterans Affairs to determine eligibility for benefits.
 Federal government national security and intelligence officials.
 U.S. Department of State to verify health fitness of employees and their families for foreign duty.
 Correctional institutions involved in health care of inmates.
 Workers compensation uses authorized by state law.


 y_Act
 managing-your-practice/coding-billing-insurance/hipaahealth-insurance- portability-accountability-act/hipaa-violations-enforcement.shtml
 HHS-Breaches_Update_August2010.pdf
 technology-exacerbates-problems/

Saturday, August 2, 2014

Resolving clutter

Everything has a place.

Or rather, everything must have a place. 

When things lack their own place, they clutter the places of other things. 

Consider the two options:
Make it a place. 
Remove it from your life.

Life is already too full. Space is limited. Finding a place for something new means removing something old. 

All of this begs the question: what do I really need? 

I am happier with simplicity. I am happier with less. People are often happier than me, and they have less stuff.

Perhaps: stuff displaces happiness.