personality disorders Flashcards
Those who have them are
AWARE THEY HAVE A PROBLEM
And tend to be
DISTRESSED BY THEIR SYMPTOMS
ego-dystonic disorders
The Person Experiencing
A Personality Disorder
DOES NOT NECESSARILY THINK THEY HAVE A PROBLEM
ego-syntonic disorders
Consistent pattern of behavior, thought and emotion a person shows throughout their entire life.
How someone ACTS, THINKS & FEELS
personality
Early development and enduring through life
Influence perception of environment
OCEAN Model or dimensional traits
personality traits
Reliable through life, Valid with self assessment and collateral, and Universal around world.
five factor model
ocean 5 factor model
O- Openness:
Scoring high people are imaginative and novelty seeking new experiences
Scoring low people are conventional and practical and like consistency
C- Conscientiousness
Scoring high people follow rules, keep things orderly and planned behaviors but can be rigid
Scoring low people are spontaneous, free spirited and risk impulsivity and unreliability
E- Extroversion
Scoring high people get their energy from being around other people
Scoring low people are noted to have mental energy depleted by others and need space and time alone
A – Agreeableness
Scoring high people tend to prioritize getting along with others, helpful, kind and trustworthy but can be prone to peer pressure and group think
Scoring low people tend to be less interested in social harmony and will put less effort into helping others or be skeptical of motives of others
N – Neuroticism
Scoring high people tend to focus on negativity and worrying about bad outcomes
Scoring low people tend to be more optimistic and freedom from persistent negative moods. This does not mean they are always positive though.
TIDE for changes associated by personality disorder
Traits become Inflexible, Disabling, and Extreme
Pervasive pattern of maladaptive behaviors, cognition, mood and attitude
Impaired social, occupational, and functional living
Symptoms must be present for >1 year and with one exception, can be diagnosed as early as adolescence.
DSM-V
CLuster A DSM-V
paranoid
schizoid
schizotypal
CLuster B DSM-V
borderline
histrionic
narcissistic
antisocial
Cluster C DSM-V
obsessive-compulsive
dependent
avoidant
pervasive, persistent, and inappropriate mistrust of others
suspicious of others motives
assume that other intend to exploit, harm or deceive them
more common in men
estimated 1-4% of general population
paranoid personality disorder
predisposing factors of paranoid personality disorder
Possible hereditary link
Subject to early parental or peer antagonism and harassment
Possibly early trauma history
nursing considerations for paranoid personality disorder
gain trust
work on coping skills
acute setting: provide reassurance
Characterized primarily by a profound defect in the ability to form personal relationships
Failure to respond to others in a meaningful emotional way
Diagnosis occurs more frequently in men than in women
Prevalence within the general population has been estimated at 3-5%
schizoid personality disorder
predisposing factors for schizoid personality disorder
Possible hereditary factor
Childhood has been characterized as
-Bleak
-Cold
-Lacking empathy
-Notably lacking in nurturing
nursing considerations for schizoid personality disorder
respect need for space
work on coping skills
acute setting: dont force group activities
Behavior is odd and eccentric
Graver form of schizoid personality pattern
Affects approximately 3% of population
schizotypal personality disorder
symptoms of schizotypal personality disorder
Magical thinking
Ideas of reference
Illusions
Depersonalization
Superstitiousness
Withdrawal into self
predisposing factors for schizotypal personality disorder
Possible hereditary factor
Anatomic differences or neurochemical dysfunctions
Early family dynamics
Pattern of discomfort with personal affection and closeness
nursing considerations for schizotypal disorder
supportive therapy and medications as needed
work on coping skills
acute setting: dont force group activities
Pattern of socially irresponsible, exploitative, and guiltless behavior
-Disregard for rights of others
Behavior that is:
-Socially irresponsible
-Exploitative
-Without remorse
antisocial personality disorder
what does antisocial personality disorder look like
Fails to sustain consistent employment
Fails to conform to the law
Exploits and manipulates others for personal gain
Fails to develop stable relationships
Prevalence estimates in the U.S.:
2-4% in men
1% in women
Prior to age 18, this can not be diagnosed. Often Children with these symptoms are diagnosed with Conduct Disorder or Oppositional Defiant Disorder.
nursing considerations for antisocial personality disorder
dont try to convince or coax to do the “right thing”
risk to other-directed violence
chronic low self-esteem
impaired social interactions
unable to delay gratification
Pattern of intense, chaotic relationships
Fluctuating and extreme attitudes regarding others
Highly impulsive
Emotionally unstable
Directly and indirectly self-destructive
Lacks a clear sense of identity
Affects about 1-2% of population
More common in women than in men
borderline personality disorder
what does borderline personality disorder look like
Chronic depression and anxiety
Inability to be alone
Patterns of interaction
Clinging and distancing behaviors
Splitting
Manipulation
Self-destructive behaviors
Impulsivity often REACTING not responding with emotions leading their behaviors
predisposing factors for borderline personality disorder
Biological influences
-Biochemical
-Genetic
-Neurobiological
Psychosocial influences
-Childhood trauma and abuse
-Developmental factors
-Lack of autonomy
nursing considerations for borderline personality disorder
risk for self mutilation or self harm
impaired social interactions
work on developing coping skills
disturbed self image
anxiety severe panic attacks
diagnosing borderline personality disorder
The client with borderline personality disorder:
Has not harmed self
Can verbalize true source of anger
Expresses anger appropriately
Relates to more than one staff member
Completes activities of daily living independently
Does not manipulate one staff member against the other in order to fulfill own desires
treatment modalities for BPD
Interpersonal psychotherapy
Milieu or group therapy
Cognitive/behavioral therapy
Dialectical behavior therapy
Psychopharmacology
xfColorful, dramatic, and extroverted behavior in excitable, emotional people
Prevalence is estimated 2-3%
More common in women than in men
Histrionic Personality Disorder
Clinical Picture
Histrionic Personality Disorder
Attention-seeking
Overly gregarious
Seductive
Manipulative
Exhibitionistic
Highly distractible
Self-dramatizing
Difficulty paying attention to detail
Easily influenced by others
Difficulty forming close relationships
Strongly dependent
Somatic complaints are common
Predisposing factors
Histrionic Personality Disorder
Possible link to the noradrenergic and serotonergic systems
Possible hereditary factor
Learned behavior patterns – Attention for their conduct feeds their dopamine reward system.
nursing considerations for histrionic personality disorder
complicated grieving
work on coping skills
family therapy is often needed
Exaggerated sense of self-worth
Lack of empathy
Belief in an inalienable right to receive special consideration
Prevalence of the disorder is estimated at 6%
Diagnosed more often in men than in women
Narcissistic personality disorder
Clinical picture
Narcissistic Personality Disorder
Overly self-centered
Exploits others in effort to fulfill own desires
Mood is usually optimistic, relaxed, cheerful, and care-free
Grandiose mood
Mood can easily change if clients do not:
Meet self-expectations
Receive the positive feedback that they expect
Criticism from others may cause them to respond with rage, shame, and humiliation
Predisposing factors
Narcissistic Personality Disorder
As children, fears, failures, or dependency needs were responded to with criticism, disdain, or neglect
Parents were often narcissistic themselves
Parents may have overindulged the child and failed to set limits on inappropriate behavior
Extreme sensitivity to rejection
Social withdrawal
Prevalence is about 1%
Equally common in men and women
Low Openness, Low Extroversion, High Neuroticism with anxiety and prone to negative thoughts
They want relationships but are trapped by fear of rejection and abandonment
Avoidant Personality Disorder
Clinical picture
Avoidant Personality Disorder
Uncomfortable in social situations
Desire close relationships but avoid them because of fear of being rejected
Perceived as timid, withdrawn, or cold and strange
Often lonely and feel unwanted
View others as critical and betraying
Predisposing factors
Avoidant Personality Disorder
No clear cause is known
May be a combination of biological, genetic, and psychosocial influences
Primary psychosocial influence: parental rejection and censure
Low Self Esteem
Nursing Considerations
Avoidant Personality Disorder
NOT TYPICALLY SEEKING HELP
work on coping skills
therapy to improve self image and confidence
Pattern of relying on others for emotional support
Relatively common within the population
More common in women than in men
Stays in bad relationships to avoid being alone
Moves quickly to a new relationship if they are alone.
Dependent Personality Disorder
clinical picture
dependent personality disorder
Have a notable lack of self-confidence apparent in:
Posture, voice mannerisms
Overly generous and thoughtful, while underplaying own attractiveness and achievements
Low self-worth and easily hurt by criticism and disapproval
Avoid positions of responsibility and become anxious when forced into them
Assume passive and submissive roles in relationships
predisposing factors for dependent personality disorder
Possible hereditary influence
Stimulation and nurturance are experienced exclusively from one source
Singular attachment is made by infant to the exclusion of all others
Inflexibility about the way in which things must be done
Devotion to productivity at the exclusion of personal pleasure
Relatively common
Occurs more often in men than in women
Most common in oldest children
Low in Openness as things have to be done in a certain way.
Won’t delegate, get lost in detail and unable to throw out things.
OCD
Predisposing factors
OCD
Overcontrol by parents
Notable parental lack of positive reinforcement for acceptable behavior
Frequent punishment for undesirable behavior
clinical picture of OCD
Especially concerned with matters of organization and efficiency
Tend to be rigid and unbending
Socially polite and formal
Rank-conscious
EGO SYNTONIC! They do not see their behaviors as odd or maladaptive. They don’t feel distressed by them. The way they are doing things is the right way to do them.
OVERLY CONSCIENTIOUS PERSONALITY DISORDER
