Personality Disorders
Your personality is the way you view, understand and relate to the outside world as well as to yourself. It is how your thoughts, feelings, and behaviors combine to make you unique. Personality forms during childhood and is shaped by genetic influences (parents’ own personalities) as well as by environmental influences (life experiences, friends, etc.).
Some people have difficulty understanding situations and relating to others. These people can have a rigid and unhealthy pattern of thinking and behaving which can lead to problems in relationships, social encounters, work, and school. When someone’s personality style and/or behaviors cause significant distress to themselves or to others, or when their behaviors consistently go against the expectations of society, the person may have what is known as a Personality Disorder. Some behaviors/beliefs that may indicate a personality disorder include:
- Mood swings
- Stormy or unstable relationships
- Social isolation
- Sudden angry outbursts
- Suspicion or mistrust of others
- Difficulty making or keeping friends
- Need for instant gratification
- Poor impulse control
- Alcohol and/or substance abuse
It is important to note that many of these traits appear in childhood or adolescence and resolve themselves by early adulthood. It is not uncommon for a child to have sudden angry outbursts, or for a teen to have poor impulse control. It is considered a personality disorder when these problems continue, unchanged, into adulthood (18 years or older).
If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. Appropriate intervention for Personality Disorders includes:
- Medical Evaluation: Medication may be useful in treating certain symptoms of the personality disorder, or in treating co-occurring conditions that exist alongside the personality disorder.
- Individual Therapy: Individual therapy starts by identifying the client’s faulty cognitive and/or behavioral patterns that contribute to interpersonal difficulty. Then therapist and client work together to identify and practice Self-Management skills to replace ineffective patterns.
- Family Therapy (including couples/marital therapy): Family members often carry the lion’s share of the burden as they are the ones who are most often in contact with the client. Family therapy helps family members better understand the nature of the client’s disorder, and better prepare themselves to provide the empathy and support that the client will need.
- Group Therapy: Group therapy, specifically Dialectical Behavioral Therapy, provides clients with a supportive atmosphere to learn emotional regulation, practice self-calming techniques, and work on their interpersonal relationships.
Relational Problems
Relational problems refer to problematic interactions between or among members of a “relational unit” (family, co-workers, etc.). It is expected that people who live together and/or work together will have conflicts from time to time. Siblings fight over who gets to sit up front, spouses argue over how to discipline their child, and co-workers often deal with work-related conflict. But these conflicts become a problem when they become excessive, or when the conflicts begin to impair one’s usual ability to function. Some behaviors and symptoms commonly associated with relational problems include:
- Recurring arguments and conflicts that do not resolve themselves
- Lack of communication, or hurtful communication
- Avoiding family members or co-workers who are believed to be the cause of the problem
- Irritability, sleeplessness, depression or social withdrawal
- “Kicking the cat,” or taking anger/frustration out on an uninvolved third party such as children or spouse
- Overprotection or over involvement in another persons life
TREATMENT GOALS:
Treatment of relational problems focuses on education and insight. It is important that each member in a conflict understands his/her own role in starting and in maintaining the conflict. What are each person’s triggers? What are the internal warning signs that communication is breaking down? From here, therapists work with the client to learn, develop, and practice effective communication strategies.
Specific treatment depends on the nature of the conflict.
- Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.
- Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.
- Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.
- Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.
Sleep Problems and Sleep Disorders in Adulthood
Sleep problems are pretty clear: If you’re not sleeping, you’ve got a problem. A healthy night’s sleep is crucial to help you recover from one day’s activities and prepare for the next day’s pursuits. For adults, “healthy” means at least 8 hours of sleep per night. If you’re not getting that, you’re opening the door to a host of problems in your personal and professional life. Consider that:
A tired person looks…
- Depressed
- Irritable
- Anxious
- Distracted
- Sloooooow
A rested person looks…
- Energetic
- Happy
- Calm
- Focused
- On point
It’s easy to see how someone who looks depressed, anxious, or ADHD may just need a good night’s sleep. Many times, making some adjustments to your evening routine can make a world of change in your sleep hygiene. Some tips include:
- Make a Routine – Set daily goals for when you’re going to lay down to sleep, and when you’re going to wake up. But the quickest way to reset your internal clock is to wake up at the same time every morning. Eventually, your bed time will adjust itself. When setting your goals, you want to get those 8 hours, but make sure and allow enough time to...
- Relax – Your brain needs time to transition from the activity of the day to the calm needed for sleep. It helps to have a calming activity that you do in preparation for a good night’s sleep. Reading is an excellent way to make this transition: lying in bed prepares the body for sleep, and following a story helps you to let go of the day’s events. But don’t do your reading on the computer, because you need to…
- Unplug! – Kids aren’t the only ones who have addictions to screens. As adults, we also have too many gadgets that stimulate the brain and are so much more exciting than sleep. Television, iPod, iPad, computer, smart phone. All have the ability to get your brain humming, which moves you farther and farther away from the relaxation required to sleep.
- Diet – Be careful with sugary foods and caffeinated drinks, but especially not within 6 hours of bedtime. Also avoid large meals close to bedtime.
- Watch Your Naps – Naps can be a great way to provide a quick break and restore your energy, especially in the afternoon. But keep them limited to 30 minutes or less. Any longer, and you risk falling into a deeper sleep, then staying up later, and then limiting how much sleep you get that night. If you have insomnia, it’s recommended that you cut out naps entirely.
Sometimes, sleep problems don’t resolve easily. If you’re still struggling to sleep after you follow the guidelines above, it may be an indication of a more serious problem. Consult with your physician if you or a loved one observe any of the following:
- Breathing “pauses” while asleep
- Can’t sleep through the night
- Can’t stay awake during the day
- Unexplained drop in academic/work performance
- Unusual events during sleep:
- Sleep walking/li>
- Talking in sleep
The source of the problem may be medical, or it may be psychological. If your physician determines that the source of the problem is more psychological, then there are ways that I can help. Contact one of our clinicians to schedule an assessment.
Schizophrenia and other Psychotic Disorders
Psychotic disorders refer to a group of disorders that are characterized by a loss of contact with reality. People who are psychotic may exhibit some of the following symptoms*:
|
Hallucinations |
Seeing (hearing, tasting, smelling, feeling) something that is not there |
|
Delusions |
Believes in something with absolute conviction, despite no supporting evidence |
|
Disorganized Speech |
Nonsensical speech , or loosely associated speech patterns |
|
Catatonic Behavior |
Loss of motor skills, or the opposite, hyperactive motor activity |
|
Paranoia |
Believes that others intend to harm, deceive, or exploit the patient |
|
Avolition |
Lack of motivation or drive to achieve |
|
Blunted Affect |
Difficulty (or inability) to express emotion, either verbally or non-verbally |
|
Alogia |
Minimally responds, or doesn’t respond, to questions |
* In order to be considered psychotic symptoms, the above symptoms must not be due to effects of a substance or due to a general medical condition.
Psychotic disorders are generally considered to be neuro-developmental conditions, meaning that contributing factors to psychosis can be found in both nature (genetics) and nurture (environment). It is rare to see psychotic disorders occur in people prior to their late teens, although some cases have been reported in children as young as 5 or 6 years old. A growing body of research is also showing that marijuana use in adolescence can increase one’s likelihood of developing a psychotic disorder in their late teens or early adulthood.
The challenges for the psychotic patient and his/her family are great. Without adequate treatment, psychotic patients have tremendous difficulty functioning on a daily basis. They often become quite isolated and withdrawn, which only adds to their difficulties. This also increases the burden on parents, who have to continue supporting their child past the age at which his peers are moving on to independence. The goals of treatment are to keep the person stable (i.e., not in active psychosis), and to keep the person engaged in his or her life. Active engagement in one’s life can stave off the cognitive deterioration that otherwise occurs when psychotic patients disengage and become stagnant.
People with psychotic disorders need a lot of support from the family and the community. Regular contact and monitoring of functioning are important.
- Psychological Evaluation: Psychological evaluation is a critical step in treatment, as it can determine the nature and severity of the psychotic symptoms. In doing so, the evaluation can guide treatment.
- Medication Evaluation: Medical intervention plays an important role in treatment of psychosis. Medications help to regulate the biochemical imbalances that cause psychosis. The best intervention is a combination of medicine and psychotherapy.
- Family Therapy: Psychotic Disorders affect the entire family, as many psychotic patients are unable to live independently. Parents can feel powerless to help their child, and even the most patient siblings can become aggravated with the symptoms. The psychotic patient benefits the most when family members learn to develop a therapeutic and supportive environment that helps the patient achieve consistent progress.
- Group Therapy: Groups can be highly effective once the patient is stabilized on medication. Groups work by educating the clients in a supportive atmosphere, while also working out a goal-oriented curriculum.
Sleep Disorders and Sleep Problems in Children
Sleep problems are pretty clear: If you’re not sleeping, you’ve got a problem. A healthy night’s sleep is crucial to help children recover from one day’s activities and prepare for the next day’s pursuits. For children and adolescents, “healthy” means at least 9 hours of sleep per night. Studies show that having a regular bedtime and a good night’s sleep is the most consistent predictor of healthy development in childhood. As a matter of fact, sleep is one of the first things that we look at when we first meet a child with behavioral or academic problems. Consider the following:
A tired child looks….
- Depressed
- Irritable
- Anxious
- Distracted
- Slooooow
A rested child looks…
- Energetic
- Happy
- Calm
- Focused
- On point
It’s easy to see how a child who looks depressed, anxious, or ADHD, may just need a good night’s sleep. Yet the National Sleep Foundation reports that nearly 70% of children under the age of 10 have some type of sleep problem. Many times, making some adjustments to the evening routine can make a world of change in a child’s sleep hygiene. Some tips include:
- Plan Your Evenings – Create a realistic timeline for the evening. Think about all of the activities that must be done, and set goals to complete each in a certain amount of time. But make sure and include time to...
- Relax and Read – Just like adults, children need time to unwind at the end of a day. A great way to do this is to spend time reading with parents. Reading makes a great transition to sleep: lying in bed prepares the body for sleep, and following a story helps a child to let go of the day’s events. Most importantly, it provides special time with you.
- Share Something – Offering your child a special time helps to support a growing child-parent bond. Your child is more likely to share feelings, fears, conflicts, and love when they know they have your full attention.
- Unplug! – Kids have access to so many gadgets that stimulate the brain and are so much more exciting than sleep. Television, iPod, iPad, computer, DS, smart phone. All have the ability to get your child’s brain humming, which moves them farther and farther away from the relaxation required to sleep. Set a time by which all screens need to be turned off (and turned in) so your kids get ample time to let their brains unwind.
- Diet – Be careful with sugary foods and caffeinated drinks, but especially not within 6 hours of the child’s bedtime. Also avoid large meals close to bedtime.
Sometimes, however, sleep problems don’t resolve easily. If your child is still struggling to sleep after you follow the guidelines above, it may be an indication of a more serious problem. Consult with your pediatrician if you observe any of the following:
- Breathing “pauses” while asleep
- Can’t sleep through the night
- Can’t stay awake during the day
- Unexplained drop in school performance
- Unusual events during sleep:
- Sleep walking
- Talking in sleep
- Night Terrors (differentfrom nightmares in that child will not be alert to your presence)
The source of the problem may be medical, or it may be psychological. If your pediatrician determines that the source of the problem is more psychological, then there are ways that I can help.