Personality Disorders Flashcards
Personality
The characteristics and behavior that comprise a person’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns. Personality helps determine behavior
Personality Disorder
- An enduring pattern of deviant inner experiences and behavior
- Differ from cultural expectations
- Pervasive, inflexible, and stable
- Leads to distress or impairment
- Dysfunctions in cognition, impulse control, relationships, and affect
Epidemiology and Etiology
Prevalence: About 8% of global population
About 1 in 10 American adults
Emotional dysregulation is amplified
Risk factors
-Genetic & Neurobiological
-Psychosocial & Environmental
-Diathesis-stress model
Most Common Symptoms in Personality Disorders
Impairment in interpersonal relationships
Dysfunction in cognition
Dysfunction in affect
Dysfunction in impulse control
Overall Tx for Personality Disorders
- Psychopharmacology
- Individual therapy
- Dialectical behavioral therapy (DBT)
- Family education and therapy
- Social Skills Training groups
- Group therapy
Prognosis for Personality Disorders
- Treatable
- Prognosis is dependent on degree of impairment and person’s motivation
Features and Diagnostic Criteria
A specific and notable pattern of thinking, feeling, and behaving that has the following characteristics:
* Persistent
* Pervasive: across a broad range of situations
* Involves both inner experience and external behavior
* Differs significantly from individual’s culture
* Involves two or more areas of functioning: thinking, feeling, interpersonal functioning, impulse control
* Leads to significant distress/impairment in social, legal,occupational, financial, safety, etc.
* Not better accounted for by another mental health condition
* Not better accounted for by the direct physiological effects of a substance
* Not accounted for by a medical condition
Cluster A: Eccentric
Paranoid
Schizoid
Schizotypal
Cluster B: Erratic
Borderline
Narcissistic
Histrionic
Antisocial
Cluster C: Anxious
Avoidant
Dependent
Obsessive-compulsive
Cluster A mnemonic
PaSS on the party
Cluster A Personality Disorders all have…
Negative symptoms of Schizophrenia
Paranoid
Delusional/Paranoid
Paranoia
Disruptful Nature
Double loyalty
Keeps grudges
easily offended
Cluster A: Paranoid Personality Disorder
- Longstanding intense distrust and suspicion
- Reluctant to confide in others, anxious
- Jealous, controlling as adults
- Unwillingness to forgive & vindictive
- Hypervigilant, quick to anger, provoke others
Paranoid Personality Disorder Guidelines for nurses
Counteracting mistrust
Adhere to schedules & boundaries (esp. when threatening)
Avoid being overly friendly but acknowledge feelings
Use simple, direct language
Project a neutral but kind affect
Schizoid
Social Withdrawal
Aloof
Uninterested in others
Socially withdrawn
Unaffected by praise and criticism
Cluster A: Schizoid Personality Disorder
Loners, poor academic performance
Increased prevalence of disordered family life
Avoid close relationships
Depersonalization, detachment
Cold, detached, distant
Schizoid Personality Disorder Guidelines for nurses
Avoid being too “nice” or “friendly”
Do not try to increase socialization
Assess for symptoms the patient is reluctant to discuss
Protect against group’s ridicule
Respect personal space while encouraging participation
Schizotypal
Distorted Reality
Odd ideas
Eccentric
Unusual experiences
Superstition
Suspicious
Reclusiveness
Cluster A: Schizotypal Personality Disorder
Severe social and interpersonal deficits
Rambling conversation
Paranoia, suspiciousness, anxiety, distrust, odd and eccentric
Brief episodes of hallucination or delusion
Can be made aware of their odd beliefs and magical thinking
Schizotypal Personality Disorder Guideline for nurses
Respect patient’s need for social isolation.
Be aware of and intervene appropriately with patient’s suspiciousness.
Reinforce socially appropriate behavior and dress
Perform careful diagnostic assessment for symptoms that may need intervention (e.g., suicidal thoughts).
Cluster B mnemonic
BAHNed from the party
Cluster B: Borderline Personality Disorder
- Suicidal behavior, gestures, or threats; or self-mutilating behavior
- Affective instability, mood swings
- Identity disturbance: Feelings of emptiness, dysphoria, & boredom
- Intense anger or difficulty controlling anger
- Paranoid ideation or severe dissociation
- Efforts to avoid real or imagined abandonment
- Unstable interpersonal relationships
- Identity disturbances
- Impulsivity in at least two areas that are self-damaging (spending, sex, substance abuse…)
- View themselves as victims
Splitting
- A defense mechanism in which they are unable to integrate and accept both positive and negative feelings.
- People (including themselves) and life situations are either all good or all bad.
Borderline Personality Disorder Guidelines for nurses
- Comprehensive assessment: risk assessment and emotional triggers
- Building trust and therapeutic relationships with consistency, empathy, and validation
- Teaching coping strategies for emotional regulation
- Setting boundaries and conflict resolution
- Safety!
Cluster B: Antisocial Personality Disorder
- Antagonistic behaviors
- Disinhibited behaviors
- Lack of empathy, remorse or guilt
- Violation others’ rights
- Evidence of conduct disorder with onset before age 15
- Need to prove superiority
- Center of the universe
- Irritability and aggressiveness
- Superficially charming but deceitful
Think Criminal
Antisocial Personality Disorder Nursing care guidelines
- Identify blocks therapeutic relationship
- Identify dysfunctional thinking, develop new problem-solving behaviors
- Self-responsibility facilitation
- Anger control assistance
- Help build a new support system
- Self-awareness enhancement
Cluster B: Histrionic Personality Disorder
- Excitable, dramatic, high functioning
- Bold; attention-seeking, provocative
- Self-centered; low-frustration level
- Excessive emotions; smothering
- No insight: Limited relationships
- Considers relationships more intimate than they are
Histrionic Personality Disorder Guidelines for nursing care
- Know seductive behavior is a response to distress
- Keep interactions professional; ignore flirtations
- Help patient clarify feelings
- Teach and role-model assertiveness
- Assess for suicidal ideation
- Set firm boundaries
Cluster B: Narcissistic Personality Disorder
- Feelings of entitlement, self importance
- Lack of empathy; exploit others
- Low self-esteem and hypersensitivity
- Constant need for admiration
Narcissistic Personality Disorder Guidelines for Nursing Care
Remain neutral
Promote a stronger patient self-identity
Avoid power struggles or becoming defensive
Role-model empathy
Cluster C mnemonic
Party is DOA
Dependent
Insecure
indecision
clinginess
passivity
requires reassurance
fear of aloneness
Cluster C: Dependent Personality Disorder
- High need to be taken care of, clinging behavior
- Fears of separation and abandonment
- Manipulating others to take responsibilities; Submissiveness
- Intense anxiety when left alone even briefly
Dependent Personality Disorder Guidelines for nursing care
Help address current stressors
Set limits
Be aware of strong countertransference
Use therapeutic relationship for assertiveness training
Encourage independence and self-efficacy
Cluster C: Obsessive-Compulsive Personality Disorder
- Rigidity; inflexible standards
- Excessive goal-seeking that is self-defeating or relationship-defeating
- Strict standards interfere with project completion
- Unhealthy focus on perfection
- Does not interfere greatly with daily functioning as does the Obsessive-Compulsive disorder
Obsessive-compulsive Personality Disorder Guidelines for nursing care
- Guard against power struggles
- Remember the patient has difficulty with unexpected changes
- Provide structure, but with time to complete habitual behaviors
- Promote calm, supportive environment
Obessive Compulsive
Rigid Requiring Order
Needs, rules, organization
perfectionistic
Excessively moral
constantly productive
Rigid
Avoidant
Inhibited
Inferiority
Social withdrawal
shyness
avoidance
Embarrassement
Low self-esteem
Cluster C: Avoidant Personality Disorder
- Low self-esteem
- Shyness that increases with age
- Feelings of inferiority
- Reluctance to engage with new people
- Subject to depression, anxiety, and anger
- Preoccupied with rejection, humiliation, and failure
Avoidant Personality Disorder Guidelines for nursing care
- Friendly, accepting, reassuring approach
- Acceptance of patient fears
- Exercises to enhance new social skills
- Design exercises to prevent failures
- Assertiveness training
