Alternative Model of Personality Disorders
Discussion 1: Alternative Model of Personality Disorders
The DSM-5 contributors did not make any changes to the DSM-IV criteria for the personality disorders (pp. 645-684). However, the contributors added an entirely new, alternative model for personality disorders (pp. 761-781) that the APA plans to transition towards.
For this Discussion, read the case study “Working with Clients with Dual Diagnosis (attached): The Case of Cathy” and review Cathy’s DSM-IV diagnosis.
Post an update of Cathy’s diagnosis into DSM-5 and ICD-10-CM. Then analyze how the addition of the alternative model for personality disorders affects Cathy’s DSM-5 diagnosis. What behaviors and/or symptoms may be a personality trait for her, versus criteria for a required diagnosis? How might the “Other Conditions That May Be a Focus of Clinical Attention” affect Cathy’s diagnosis?
References (use 3 or more)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
“Personality Disorders” (pp. 645–684)
“Alternative DSM-5 Model for Personality Disorders” (pp. 761–782)
Ferguson, C. (2010). Genetic contributions to antisocial personality and behavior: A meta-analytic review from an evolutionary perspective. The Journal of Social Psychology, 150(2), 160–180.
Gunderson, J. (2008). Borderline personality disorder. Social Work in Mental Health, 6(1), 5–12.
Ogrodniczuk, J. S., Piper, W. E., & Joyce, A. S. (2006). Treatment compliance among patients with personality disorders receiving group psychotherapy: What are the roles of interpersonal distress and cohesion? Psychiatry: Interpersonal & Biological Processes, 69(3), 249–261.
Widiger, T. A., & Simonsen, E. (2005). Alternative dimensional models of personality disorder: Finding a common ground. Personality Disorders, 19, 110–130.
Akehurst, S., & Thatcher, J. (2010). Narcissism, social anxiety and self-presentation in exercise. Personality and Individual Differences, 49(2), 130–135.
Allik, J. (2005). Personality dimensions across cultures. Personality Disorder, 19, 212–232.
Buffardi, L. E., & Campbell, W. K. (2008). Narcissism and social networking web sites. Personality and Social Psychology Bulletin, 34, 1303–1314.
Discussion 2: Are Social Networking Sites for Narcissists?
The term “narcissist” is used commonly in society to describe someone who is self-centered or self-absorbed. However, the DSM-5 requires much more extreme behaviors for someone to be diagnosed as having narcissistic personality disorder. See the list of criteria for this diagnosis (p. 669) and also review the “Alternative DSM-5 Model for Personality Disorders” (pp. 761 to 781). Personality disorders develop throughout the lifespan. Most social networking sites are based on individuals sharing information about themselves with very few limitations. Consider if these individuals are just participating in a cultural way of relating, or are they presenting behaviors of a narcissistic personality disorder?
For this Discussion, read the Buffardi and Campbell (2008) article (attached). Then review the DSM-5 on the traditional Narcissistic Personality Disorder and the Alternative DSM-5 Model for Personality Disorders to compare the models.
Post an analysis of your view on this topic using both types of DSM-5 personality criteria. Are individuals who use social networking sites displaying traits of narcissism? Is this a developmental stage in the lifespan?
Remember, this is not a place for personal opinion; this is a forum for professional, clinical discussion. Support your argument with evidence-based information (DSM-5, research) and other professional articles that you may find. Include examples of social networking websites. Remember you are to articulate your thoughts as a professional clinician.
Support your post with specific references to the resources. Be sure to provide full APA citations for your references.
References (use 3 or more)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
“Personality Disorders” (pp. 645–684)
“Alternative DSM-5 Model for Personality Disorders” (pp. 761–782)
Ferguson, C. (2010). Genetic contributions to antisocial personality and behavior: A meta-analytic review from an evolutionary perspective. The Journal of Social Psychology, 150(2), 160–180.
Gunderson, J. (2008). Borderline personality disorder. Social Work in Mental Health, 6(1), 5–12.
Ogrodniczuk, J. S., Piper, W. E., & Joyce, A. S. (2006). Treatment compliance among patients with personality disorders receiving group psychotherapy: What are the roles of interpersonal distress and cohesion? Psychiatry: Interpersonal & Biological Processes, 69(3), 249–261.
Widiger, T. A., & Simonsen, E. (2005). Alternative dimensional models of personality disorder: Finding a common ground. Personality Disorders, 19, 110–130.
Akehurst, S., & Thatcher, J. (2010). Narcissism, social anxiety and self-presentation in exercise. Personality and Individual Differences, 49(2), 130–135.
Allik, J. (2005). Personality dimensions across cultures. Personality Disorder, 19, 212–232.
Buffardi, L. E., & Campbell, W. K. (2008). Narcissism and social networking web sites. Personality and Social Psychology Bulletin, 34, 1303–1314.
Discussion 3:
Policies and the Influence of Values
Ideology, politics, and the influence of values often override evidence-based policy. When there is evaluation conflict, a policy advocate must be prepared to defend his/her reasons for wanting to implement a policy. Because almost all proposed policies are circumscribed by politics (for reasons brought up by Jansson throughout the course when discussing the subtleties of policy implementation), you should be prepared for some conflict, ranging from having your research ignored, to having the accuracy of your data questioned, to having your personal values brought into question.
In this Discussion, you consider the assertion that the evaluation of specific policies is often strongly influenced by values. You also examine and evaluate ways to mitigate evaluation conflict to defend the feasibility of your policy.
By Day 3
Post a response to Jansson’s assertion that evaluating specific policies is strongly influenced by values with respect to the case of the evaluation of special services. How do the values of evaluation conflict adhere to social work values? What practices would you use to defend the feasibility of and effectiveness of your evidence-based policy?
References (use 3 or more)
Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice (8th ed.). Pacific Grove, CA: Brooks/Cole Cengage Learning Series.
· Chapter 33, “The Future of Social Policy” (pp. 557–569) (PDF)
English, D. J., Brummel, S., & Martens, P. (2009). Fatherhood in the child welfare system: Evaluation of a pilot project to improve father involvement. Journal of Public Child Welfare, 3(3), 213–234. Doi:10.1080/15548730903129764.
Swank, E. W. (2012). Predictors of political activism among social work students. Journal of Social Work Education,48(2), 245–266. Doi:10.5175/JSWE.2012.200900111.
Discussion 4:
Becoming a Lifelong Advocate
It is not enough to be compassionate. You must act.
—Tenzin Gyatso
As this course comes to a close, consider and reflect on how you can become a lifelong advocate for social change in your future social work practice. As a motivated policy advocate and social worker, your actions in your chosen profession will reflect your motivation to help relatively powerless, disenfranchised groups of people improve their resources, their opportunities, and their quality of life.
In this Discussion, you reflect upon your responsibility as a social worker, politically and professionally.
Post your thoughts on this question: As a social worker, what is your responsibility to engage in political action? Identify an area of social welfare where social work policy advocacy is needed.
References (use 3 or more)
Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice (8th ed.). Pacific Grove, CA: Brooks/Cole Cengage Learning Series.
· Chapter 33, “The Future of Social Policy” (pp. 557–569) (PDF)
English, D. J., Brummel, S., & Martens, P. (2009). Fatherhood in the child welfare system: Evaluation of a pilot project to improve father involvement. Journal of Public Child Welfare, 3(3), 213–234. Doi:10.1080/15548730903129764.
Swank, E. W. (2012). Predictors of political activism among social work students. Journal of Social Work Education,48(2), 245–266. Doi:10.5175/JSWE.2012.200900111.
***Each response needs to be 1 page or more***
Working With Clients With Dual Diagnosis: The Case of Cathy / Page 1 of 4 © 2016 Laureate Education, Inc.
Working With Clients With Dual Diagnosis: The Case of Cathy
Cathy is a 32-year-old, divorced, heterosexual African-American female. She came to her
first initial intake session with complaints of depression with passive suicidal thoughts,
anxiousness, and trouble sleeping. Cathy’s primary concern is that she has been having episodes
three to five times a week during which she reports she cannot breathe, her heart feels like it will
explode, and she feels like the “walls close in.” She states that this has been going on for about a
year, but lately it is getting worse. She self-referred after being prompted by her sister to contact
a social worker. The following is a summary of the initial appointment and assessment we
completed.
Cathy is the oldest of four children (two brothers and one sister), all of whom are married
and live in the same community. Cathy works in a doctor’s office and lives in a one-bedroom
apartment. She is the primary caretaker of her mother, who was involved in a car accident 20
years ago and was left a quadriplegic, going to her home daily to help with her personal hygiene.
Cathy has an arrest history and was incarcerated for 3 years for drug-related charges. She
was charged with possession and intent to distribute. Cathy states that at that time she was
addicted to heroin and using daily. When she completed her prison sentence, she was paroled
and mandated to attend a 1-year outpatient drug treatment program, which she successfully
completed. Cathy reported that she started using cocaine 2 years ago, stating that it helps her do
her fast-paced job better and it keeps her energy up so she can help her mother early in the
morning and late at night. She said no one in her family or at her job knows that she has been
doing drugs. She drinks alcohol daily (two to three drinks). Cathy also takes numerous
medications prescribed to her by her primary care doctor, including an antidepressant and pain
medication.
Working With Clients With Dual Diagnosis: The Case of Cathy / Page 2 of 4 © 2016 Laureate Education, Inc.
As we discussed her presenting concerns, multiple issues came up. Cathy shared her
feelings about being her mother’s primary caretaker, stating, “I love my mom, but everyone
expects me to care for her. It feels so unfair, but it’s because I am not married and don’t have any
children.” She said her father does not help with the care of her mother and that all he does is
“hang out.” She feels increasingly frustrated with this added responsibility and resentful that her
father and siblings have relegated this job to her. She also stated that she recently allowed one of
her brother’s friends to move in with her as a favor because he was homeless and had nowhere to
go. She said she believed he was a sweet person who just has had a hard time in life, and she
wanted to help him. She has been supporting him financially over the last month, and she has
become concerned because it appears that he has not made any effort to get a job. She fears she
made a mistake allowing him into her home and worries she will not be able to get him to leave.
Cathy said that she and this new roommate had sex one time when he first moved in. She
said they both got very intoxicated, and she is not sure exactly what happened, but she blacked
out and found him in her bed, undressed. She then told him she had herpes, and he responded
that it had been a “mistake” and that he did not want to have sex with her again because he was
afraid of getting infected. Cathy explained that her ex-husband’s cheating had resulted in this
lifelong disease, and she expressed anger and resentment toward him. She said even though the
herpes is controlled with medication, she feels embarrassed and fears she will never have another
healthy relationship. She also feels used and humiliated by this man now living in her home.
Cathy then shared that when she was 12 years old her father began molesting her. She
stated that she tried to forget what happened to her, but this recent incident with her new
roommate brought it up again. Cathy complained of recent nightmares related to the abuse and
exaggerated startle reactions to other people’s movements.
Working With Clients With Dual Diagnosis: The Case of Cathy / Page 3 of 4 © 2016 Laureate Education, Inc.
Plan:
Cathy agreed to go into a 30-day residential treatment program. She completed this
program successfully and, once discharged from the program, resumed individual treatment. Her
trauma and depression were effectively addressed with the combined use of eye movement
desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT).
Cathy currently continues in treatment and no longer reports experiencing panic attacks
or nightmares related to her past trauma. Cathy is working on mindfulness and the establishment
of healthy relationships using dialectical behavior therapy (DBT).
Reflection Questions The social worker in this case answered these additional questions as follows. 1. What specific intervention strategies (skills, knowledge, etc.) did you use to address this
client situation?
Cathy was resistant to seeking treatment for her substance abuse. She initially refused to seek out help and stated that she knew all about the 12 steps and could quit on her own. Motivational interviewing was used effectively, and she agreed to go into treatment after several failures to stop using cocaine on her own. In addition, she had many symptoms related to her abuse from her father as well as three other incidents (a gang rape, a stranger rape, and a date rape) she revealed later in treatment. Eye movement desensitization reprocessing (EMDR) was used effectively to address her flashbacks and negative associations with this abuse.
2. Which theory or theories did you use to guide your practice?
A combination of theoretical frameworks was used to address each area of concern. Motivational interviewing was used for her substance addiction, EMDR for her post- traumatic stress disorder, cognitive behavioral therapy for her anxiety/panic attacks and depression, and lastly dialectical behavior therapy to address her symptoms related to borderline personality disorder.
3. What were the identified strengths of the client(s)?
Cathy had many strengths, including being a caretaker for her mother, having a job, and being seen as a very helpful and loving woman by her family and friends.
Working With Clients With Dual Diagnosis: The Case of Cathy / Page 4 of 4 © 2016 Laureate Education, Inc.
4. What were the identified challenges faced by the client(s)?
Drug addiction and trauma were the primary challenges that initially needed to be addressed. Once Cathy had become clean and sober and no longer self-medicated, her trauma symptoms escalated and became the main focus, so she was at great risk for relapse.
5. What were the agreed-upon goals to be met to address the concern?
Our treatment goals included maintaining sobriety, building a clean and sober network for support, reducing panic attacks, decreasing flashbacks, decreasing depressive symptoms, and increasing self-efficacy and mindfulness.
6. What local, state, or federal policies could (or did) affect this case?
After a year of treatment, Cathy became actively suicidal and had to be involuntarily hospitalized several times. State laws related to involuntary hospitalization were used to ensure she was in a safe environment.
7. How would you advocate for social change to positively affect this case?
Although Cathy had health insurance, it was minimal, and she had to privately pay for drug treatment. Her family helped with a deposit of $1,000 but she still owes close to $25,000 to the drug treatment program and is still making payments. Advocacy is needed on both state and federal levels to allow for easy access and free drug/alcohol treatment for all.
8. Were there any legal or ethical issues present in the case? If so, what were they and how were they addressed?
Legal and ethical issues include her family’s desire to know what was happening in treatment and her need to consent to release of information so I might speak with them when they called concerned. In addition, within a year of treatment commencing, Cathy was hospitalized five times as a result of being a danger to herself and holds were written to keep her hospitalized.
9. Is there any additional information that is important to the case?
Cathy continues to receive treatment in my private practice after 2 ½ years of treatment. Due to the extent of her sexual abuse and rape, it has taken time to address her symptoms in an effective manner. Currently Cathy has had no hospitalizations for 3 months and continues to maintain her sobriety.
Adapted from: Working with clients with dual diagnosis: The case of Cathy. (2014). In Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). Social work case studies: Concentration year (pp. 22–24, 104– 106). Baltimore, MD: Laureate Publishing. [Vital Source e-reader]
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
