Personality Disorders Overview In order to understand disorders of personality is it necessary to have a clear understanding of what personality actually means. Every single person in the world has a unique personality different than everyone else. Our personalities are thought of as the way we act, think, believe, and feel that makes us different from each other (Nolen-Hoeksema, 2011). Personalities vary from person to person, and we all exhibit an intense, life long, pattern of behaviors, thoughts, and feelings known as traits. Personality traits are said to be stable throughout our life’s and the situations we are faced with in life. Personality traits can range from happy and outgoing to miserable, lonely, unstable, and unreliable. When personality becomes disruptive, and interferes with life in areas of social and occupational functions they are said to be a personality disorder (Nolen-Hoeksema, 2011). Persons with personality disorders have difficulty in their identities, pursuits in life, and relationships. Important to add at this point is the most common theories of personality disorders. One theory of personality is known as the five factor model (the Big 5). This theory uses five dimensions or factors with negative and positive opposites on a continuum to explain personality disorders from functional to dysfunctional. The Big 5 factors are negative emotionally, extraversion, openness to experience, agreeableness, and conscientiousness (Nolen-Hoeksema, 2011). Each of the Big 5 factors has facets such as anxiousness, warmth, fantasy, competency, and modesty to name a few. These facets help to pinpoint a disorder. Next, the DSM IV-TR currently deals with personality disorders very differently and consider personality disorders without any consideration to normal. The DSM IV- TR groups personality disorders into clusters. Cluster A includes odd or eccentric behaviors and thinking, Cluster B dramatic-emotional, and Cluster C with anxious-fearful personality disorders (Nolen-Hoeksema, 2011). Knowledge of these two currently used theories helps to explain diagnosis criteria and treatment for the personality disorders including in this report. This paper will report on three personality disorders known as Obsessive Compulsive, Borderline, and Substance abuse disorders.
Obsessive Compulsive Personality Disorder Obsessive compulsive personality disorder (OCD) falls in the DSM IV_TR classifications of Cluster C meaning anxious or fearful disorders (Nolen-Hoeksema, 2011). People with this disorder are constantly anxious or in fear and their behaviors are intended to ward off those fears. In addition, people with OCD have patterns of distorted thoughts (obsessions) and behaviors (compulsions). Some of the characteristics of OCD include pre-occupation with control, order, rigid behavior, inflexible, emotional blocked, perfectionism, and become highly anxious with changes in routines (Nolen-Hoeksema, 2011). People are with this disorder are identified as always on time, workaholics, rigid routines, perfectionist and they will take long times to produce a perfect paper no matter how long it takes ( making them less productive in their job performance).
U-Tube Video Review OCD According to a U-Tube video presentation by Koritzis, (2007) one of the most common symptoms of OCD is fear of contamination with germs, (Koritzis, 2007). The film interviews a woman with OCD, who fears on contamination, have led her to loose her job as well as her marriage, with difficulty in interpersonal relationships even with her daughter and close family members. Her onset with OCD began with the birth of her child and fear that her daughter would become ill if she was to become contaminated by germs. This led to a series of recurrent distressing thoughts and ideations (obsessions) and the feeling of being driven to perform ritualistic (compulsions) behaviors (Koritzis, 2007). She eventually set up her entire house separating items that she considers contaminated in a room and other rooms considered decontaminated after she properly cleanses each one. She washes her hands and kitchen sink from eight to two hundred times a day. She has manipulated her boyfriend and daughter into decontamination rituals before they can even be around her. The woman in this video is self-aware of her behaviors and has not lost the capacity to this insight, but becomes extremely anxious if she is unable to perform in this way. Koritzis, 2007, declares there is a biological predisposition to OCD involving the neurotransmitter serotonin being out of balance, (Koritzis, 2007). Finally, the video shows that treatment with antidepressants and behavior therapy can successfully treat the dysfunctional behaviors.
Questions of Interest OCD The questions I would wonder about this disorder are when a compulsion or behavior begins, what causes that particular behavior (such as hand washing, locking doors, not stepping on cracks in the sidewalk)? Was there an event that led to the obsession (thoughts) such as a rape, home invasion or break in, or illness as in cases of post-traumatic stress disorder? Have studies empirically proven this disorder genetic in origin in all cases? Are there any studies done to suggest how long a person lives with this disorder before an intervention and treatment plan activated? Does the television show Hoarding: Buried Alive show an accurate example of OCD? Who would be most likely to confront the person about their behaviors? Who would be most likely accepted by the person with OCD to believe they have a problem that has to be treated as it will only worsen with time? Are people with OCD more favorable to treatment in comparison with other personality disorders, for example dependent personality disorder?
Treatment Intervention OCD Lastly, treatment for OCD according to the National Institute for Mental Health (NIMH), (2012) first an exam with the medical doctor to rule out medical conditions. Medications recommended are anti-anxiety and anti-depressants with cognitive behavioral therapy (CBT), (NIMH, 2012). CBT can be exposure and response prevention, in which the person is expose to the obsessive thought and prevented from performing the compulsive behavior. CBT helps the person learn new ways to think, behave, and react to their obsessive-compulsive thoughts and behaviors. Each person responds to different treatment by only need medication, some therapy, and some will react positively with both. The treatment can be successful and restore a person to a functioning part of society.

Border Line Personality Disorder Borderline Personality Disorder (BPD) is a serious mental disorder with instability in self-image, moods, interpersonal relationships, and behavior that disrupts family, occupation, and the person’s sense of identity (Nolen-Hoeksema, 2011). It is easier to understand the symptoms of the disorder by looking at the possible causes. Biologically, there seems to be a genetic factor although unproven at present. Most people with this disorder have a history of sexual abuse, physical abuse, and neglect which can be thought of as environmental causes. This type of person’s instability leads to behaviors and thoughts on extreme sides of a spectrum. They vacillate between moods becoming depressed or anxious and angry with no reason. Their self-image swings from self-doubt to grandiosity, interpersonal relations are unstable because this person either idolizes or hates the other person (Nolen-Hoeksema,2011). They experience an emptiness (internal voids) which leads them to cling to people and if the person is not there for them, they interpret this as rejection and become depressed and angry. These feelings lead them to impulsive acts of self-damaging, self-mutilation, and even suicidal behavior. They can also have transient dissociative episodes where they feel out of touch with self, time, and reality (Nolen-Hoeksema, 2011). Another interesting aspect of the BPD is splitting which is when the person goes back and forth between good and bad of themselves and others. According to the DSM IV-TR criteria for BPD includes the above-mentioned symptoms beginning by early adulthood and include five or more of other symptoms. These symptoms include frantic efforts to avoid abandonment (real or imagined), pattern of unstable, personal relationships (alternating between idealization and devaluation), and identity disturbances (unstable self-image) (Nolen-Hoeksema, 2011). Impulsivity in two areas of self-damaging (spending money, substance abuse, reckless driving), recurrent suicidal behaviors or self-mutilation, intense episodes of dysphoria, irritability, or anxiety , long lasting feelings of emptiness, inappropriate anger, transient paranoid ideation or dissociative symptoms (Nolen-Hoeksema, 2011). BPD is usually always occurs comorbid with other disorders with anxiety, mood, disorders, eating disorders, and anti-social personality disorder, making it difficult for clinicians to diagnosis properly. In addition to the above mentioned symptoms BPD also engage in dangerous self-damaging or self-mutilating such as cutting, burning, hair pulling behaviors along with suicidal behaviors (Nolen-Hoeksema, 2011). These behaviors occur in response to the intense stress the person may be experiencing and very often, they will misjudge the destructiveness and kill either him or herself or end up in the hospital with severe damage to oneself.
U-Tube Video Review BPD The U-Tube video of BPD is a discussion of the disorder and treatment modalities by Dr. Hahn. She describes BPD as the above reporting of symptoms with some additional insight. Besides being unstable she emphasizes that people with BPD will do anything to avoid abandonment real or imagined. These people will use their self-destructive or self-mutilating behaviors to avoid abandonment by their spouses, or others they may cling. Further, they will display variable chronic dysphoria, emptiness, stormy relationships that are un-gratifying (Hahn, 2009). In addition, according to Hahn, 2009, they are dramatic, and describe a rising tension they are unable to tolerate so they will often self-mutilate as in cutting and when they see the blood and feel the cut they are relieved of the tension (Hahn, 2009). Other than possible biological (genetic) cause, Hahn sums the possible cause this way “the best way to become borderline is to be raised by one” (Hahn, 2009). This gives cause to believe there is an increased risk of this disorder if the family operates dysfunctional. Lastly, there is an increase in a possibility of developmental causes in parenting.
Questions of Interest BPD The questions would wonder about this disorder are based on my overall lack of knowledge of this disorder. This disorder is frightening and I wonder whether there is any way to educate the public about BPD? Is there a way to make diagnosis more clear for the clinicians? How can people with BPD experience dissociative episodes if there is not a biological component malfunctioning? Can people with BPD make it in society and function for long periods of time untreated? Can people who have undergone treatment successful is there a high re- occurrence rate? Do all people with this disorder raise their children to be doomed with this disorder, or can a child grow up and change (pull out of it) before it becomes full-blown BPD? Are studies being done to further understand this disorder? What types of diagnostic tools would help clinicians diagnosis this disorder with more efficiently? What would help a healthcare worker when engaged with a patient with this disorder? What does a physician do when they can no longer cope with a patient with BPD?
Treatment Intervention BPD Treatment for BPD according to NIMH include psychotherapy and medication (to treat symptoms not disorder) or both (NIMH, 2012). Psychotherapy can be used such as CBT to reduce range of mood and anxiety symptoms and reduce suicidal and self-harming behavior. Dialectical behavior therapy (DBT) focuses on the skills to control intense emotions seeking a balance in changing and accepting beliefs and behaviors (NIMN, 2012). Additionally there is schema-focused therapy that helps the person reframe schemas by changing the way they view themselves. Having the person’s family involved in therapy has also found to be helpful so they can better understand and support the person with BPD.

Substance Abuse Substance abuse related disorders involve long-standing inabilities to resist desires to drink alcohol or take drugs, and a substance is any natural or synthesized item that has psychoactive effects changing a person’s thoughts, emotions, perceptions, or behaviors (Nolen-Hoeksema, 2011). Substances are powerful biological agents affecting the brain by changing the way we see, perceive, feel, and behave. There are five groups of substances that mostly lead to substance disorder. They are central nervous system (CNS) depressants (alcohol, barbiturates, benzodiazepines, and inhalants), CNS stimulants (cocaine, amphetamines, nicotine, and caffeine), opioids, hallucinogens, and cannabis (Nolen-Hoeksema, 2011). Regarding the substances there are different types of abuse. Substance abuse is indicated when a person shows constant problems with home, school, and work, uses in places that are physically hazardous (like driving a car), legal problems with arrests for possession of or behaviors the substance is causing (walking through the middle of traffic), and finally continued use of substance despite the trouble it causes in social and personal relationships. Substance dependence is a maladaptive pattern of use with significant problems in persons’ life, tolerance to substance, withdrawal symptoms, and compulsive substance taking behavior (Nolen-Hoeksema, 2011). Furthermore, a substance intoxication results from physiological effects the substance has on the CNS, and substance withdrawal are the physiological and behavioral symptoms that occur when the substance is withdrawn (Nolen-Hoeksema, 2011). Substances (commonly known as drugs), and the people who use drugs are called drug addicts. The effects are the brain differ depending on what substance (stimulant, depressant, hallucinogenic, nicotine, caffeine) is used, how it is used (smoking, drank, inhaled, swallowed, or injected), how much (tolerance) of it is used, and how long has the person been using the substance. The brain has a pleasure pathway that will use the substance to reward us causing a euphoric, elated state such as with stimulants like cocaine, amphetamines, and nicotine. Psychoactive substances (used chronically) alter the reward centers in the brain leading to a craving desire for the cocaine, heroin, and amphetamines causing the brain to reduce production of dopamine, causing the need for more of the drug (Nolen-Hoeksema, 2011). If the body is unable to reproduce the usual amount of dopamine, withdrawal symptoms occur leaving the person sad, unmotivated, and craving more of the drug. There are biological theories of substance disorders with focus on genetics and neurotransmitters, a genetic vulnerability and a common underlying to use more than one type of substance (Nolen-Hoeksema, 2011). Psychological social learning theories suggest children learn from modeling parent’s behavior with substances (drinking coffee, smoking, or drug abuse), alcohol use is also modeled by males children by males in their families (Nolen-Hoeksema, 2011). Cognitive theory focuses on what people expect to gain with alcohol consumption such as an expectation that alcohol will relieve their stress, which will eventually lead to alcohol abuse and or dependence when adaptive coping mechanisms fail to be present. There is also a behavioral undercontrol condition which is a tendency to impulsively use drugs, seek sensation (being high), and antisocial behaviors (breaking the law) (Nolen-Hoeksema, 2011). These people take psychoactive drugs earlier in life, take larger amounts of the substance, and more likely to be diagnosed with abuse or dependence on drugs and this behavior is strong in families further suggestion genetic influence. Finally, people in chronic stress tend abuse and depend on substances for relief of the stressful life they lead. DSM-IV-TR criteria for substance dependence involves evidence of physiological dependence and repeated problems because of the use of the substance. Included in the criteria is maladaptive pattern of substance abuse leading to three or more of tolerance, withdrawal, substance taken in large amounts over long period of time, persistent attempts to cut down on abuse, social, family and work activates reduced because of use, and continued use of substance despite knowledge of damaging effects (Nolen-Hoeksema, 2011).
U-Tube Video Substance Abuse The U-Tube video “Teens share their drug abuse stories” involves two teens that share their downward spiral in their life’s as a result of substance abuse. The male describes being sixteen years old when he first tried smoking marijuana, which led to daily use, and eventually more drugs such as cocaine, meth amphetamines. He spent all his money on drugs to get high each day, began committing crimes such as felonies, and was in and out of jail. He further describes the psychological effects the drugs had on his life, leaving him overwhelmed with no purpose in life, his life ruined, with the drugs taking away his identity or sense of self. He turned to religion for help, went to rehabilitation and now believes Jesus gave him peace and took away the pain and anger the drugs caused. A young female then tells her story of growing up with a father who would drink alcohol, smoke pot, and do cocaine in front of her. She started to smoke pot and drink alcohol at age thirteen. This eventually led to stronger drugs, regular alcohol use on a regular basis. She stole money from her family to pay for the drugs, including prescription drugs, and alcohol to numb the pain of her childhood. She says she never felt in a right state of mind, hopeless, with only the drug dealers as friends. She too turned to religion to stop the abuse and set her life on a positive drug free life. The video further indicates that underage drinking cost the United States over $58 billion a year, forty percent of people that begin drinking alcohol before age thirteen become alcohol dependent later in life. In addition, alcohol kills more teenagers then all other drugs combined. Finally, children whose parents talk to them about the dangers of drug use are more likely refrain from drug use (urbanevangine, 2010).
Questions of Interest Substance Abuse

Treatment Intervention Substance Abuse According to the NIMH treatment for substance abuse varies. The treatment for alcohol treatment begins with a complete medical examination, including a through history, symptoms, medications, medical conditions, and alcohol abuse history (including current usage) and drug abuse history. The treatment choice is dependent on the diagnosis, severity of symptoms, and patient preference (NIMH, 2012). Again, as with other substance abuse treatments a variety of medications and psychotherapy is the preferred treatment. Medications such as anti-anxiety can decrease and ease withdrawal symptoms and cravings for other substances. Methadone is the drug of choice for opioid addiction including heroin. There are also antagonist drugs that block effects of addictive drug that can reduce the desire for the substance such as Naltrexone ( is also used in treating alcohol dependence) (Nolen-Hoeksema, 2011). Cognitive therapy, motivational interviewing (draw out persons motivations and commitments to change behavior), abstinence, self-help groups, prevention programs also with medication help the person overcome their addictions.

Reference
Hahn, R., (2009). Borderline personality disorder. Retrieved from: : http://www.youtube.com/watch?v=WgNqw25MAug&feature=related
Koritzis, (2007). Obsessive compulsive disorder. Retrieved from: http://www.youtube.com/watch?v=tPFQMRx2l3Y
Nolen-Hoekema, S., (2011). abnormal psychology, 5th edition [Vital Source digital version]. Retrieved from http://www. Myclassonline.com
Substance Abuse, (2010). Teens share their drug abuse stories, urbanevangine. Retrieved from: http://www.youtube.com/watch?v=jC5VC2-yNcE&feature=related