Personality Disorders ppt Flashcards
Personality Disorder in general are:
Impairment of personality functioning
Personality traits that are maladaptive
Identity problems
Relationships are dysfunctional.
Cluster A personality Disorders:
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Cluster B Personality Disorders
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Cluster C Personality Disorders
Avoidant personality disorder
Dependent personality disorder
Obsessive personality disorder
How common are Personality Disorders? What percent of the population have it?
Relatively common (10%–20% of general population)
What percent of people with a primary diagnosis of major mental illness also have personality disorder?
40% to 45% of people with primary diagnosis of major mental illness also have coexisting personality disorder that significantly complicates treatment.
Cluster A: Paranoid Personality Disorder - what is the clinical picture
Pervasive mistrust/suspiciousness*
Conflict with authority figures
What is the nursing interventions for Paranoid Personality Disorder?
Formal, business-like approach
Client involvement in plan of care
Validate idea before action
Cluster A Personality Disorder Schizoid Personalty Disorder- What is the clinical picture?
Clinical picture
Prefer being alone and choose to do activities alone*
Cluster A Personality Disorder Schizoid Personalty Disorder- Nursing Interventions
Focus on improved functioning in community
Client has greater chance of success if he or she can relate his or her needs to one person.
Cluster A Personality Disorder Schizotypical Personality Disorder - What is the clinical picture?
Belief in special powers, such as mental telepathy or superstitions*
Cluster A Personality Disorder Schizotypical Personality Disorder -Nursing Interventions
Focus on self-care and social skills
Encouragement of daily routines
Identifying appropriate outlets for discussing unusual beliefs
Cluster B: Antisocial personality disorder
Characterized by disregard for rights of others, deceit, and manipulation
Cluster B: Antisocial personality disorder assessment
Assessment
History (acts of cruelty, abusive parenting)
General appearance and motor behavior (usually normal)
Mood and affect (display of false emotions)
Thought process and content (narrowed view of world)
Sensorium and intellectual processes (oriented, average or above average IQ)
Judgment and insight (do not consider morals or ethics)
Self-concept (appear confident, but the self is shallow and empty)
Roles and relationships (manipulate and exploit those around them)
Cluster B: Antisocial personality disorder Intervention
Therapeutic relationship; promoting responsible behavior ( firm limit setting, straightforward approach matter of fact approach, enforce consequences)
Clearly convey your expectations of the client, as well as the consequences for failure to meet them.
Avoid power struggles and confrontations.
For Antisocial personality Disorder, what are medications used for?
Treat disorganized thinking.
Stabilize mood swings.
Ease the acute symptoms of concurrent psychiatric disorders.
What is used to treat controlling aggressive outbursts?
Lithium or a beta-adrenergic blocker (e.g., propranolol ) may be useful in controlling aggressive outbursts.
For pts with Antisocial Personality Disorder, as a nursing intervention, what should you encourage the client to do?
Encourage the client to:
Express feelings.
Analyze own behavior.
Be accountable for own actions.
What are other treatments used for Antisocial personality disorder?
Psychotherapy, focused on the individual and family.
Group therapy may also be useful.
What else fits under Antisocial Personality Disorder?
Sociopath
Sociopath is NOT an official DSM-V diagnosis; fits under Antisocial Personality
Sociopath
A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three or more of the certain symptoms.
Sociopath is diagnosed by three or more symptoms of the following:
Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest.
Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.
Impulsivity or failure to plan.
Irritability and aggressiveness, often with physical fights or assaults.
Reckless disregard for the safety of self or others.
Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations.
Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.
Cluster B: Borderline Personality Disorder
Characterized by pervasive pattern of unstable interpersonal relationships, self-image, marked impulsivity
Borderline Personality Disorder Assessment
History (disturbed early relationships with parents)
General appearance and motor behavior (wide range of dysfunction)
Mood and affect (dysphoric)
Thought process and content (polarized and extreme thinking about self and others)
Sensorium and intellectual processes (fully oriented to reality)
Judgment and insight (impaired judgment and lack of concern for safety)
Self-concept (unstable view of self, self-harm)
Roles and relationships (hate being alone but experience social isolation, chronic feeling of emptiness)
Physiological and self-care considerations (impulsive behavior)
Borderline Personality Disorder Interventions
Safety (no-self-harm contract)
Therapeutic relationship (structured, with limit setting)
Strict adherence to boundaries
Communication skills
Coping, emotion control
Reshaping thinking patterns (cognitive restructuring, thought stopping, positive self-talk, decatastrophizing)
Structuring of daily activities
Histrionic Personality Disorder Clinical Picture
Excessive emotionality and attention seeking; exaggeration of closeness of relationships; insincere and shallow emotions
Histrionic Personality Disorder Nursing Interventions
Feedback about social interactions; social skills training through role-playing; exploration of strengths and assets
Narcissistic Personality Disorder Clinical Picture
Pervasive pattern of grandiosity; need for admiration; lack of empathy; arrogant or haughty attitude; superior view; fragile, vulnerable self-esteem; ambitious; “Narcissistic Injury”
Narcissistic Personality Disorder Nursing Interventions
Self-awareness skills to avoid anger and frustration; matter-of-fact approach; limit setting
Teach that mistakes are acceptable.
Avoidant Personality Disorder Clinical Picture
Social discomfort; low self-esteem; hypersensitive to negative evaluation
Avoidant Personality Disorder Nursing Interventions
Self-affirmations; positive self-talk; reframing and decatastrophizing; social skills training
Dependent Personality Disorder Clinical Picture
Need to be taken care of; submissive and clinging behavior; frequently anxious
Dependent Personality Disorder Nursing Interventions
Emphasize decision making to increase self-responsibility.
Praise decision making and independent actions.
Teach assertiveness.
Assist to clarify feelings, needs, and desires.
Increase self-esteem.
Obsessive–Compulsive Personality Disorder Clinical Picture
Preoccupation with perfectionism; formal and serious demeanor; constricted emotional range; preoccupied with orderliness; low self-esteem; harsh self-evaluations
Obsessive–Compulsive Personality Disorder Nursing Interventions
Difficulties with decision-making; cognitive restructuring; risk-taking
Elder Considerations for Personality Disorders
Disorders persist into older age.
Some may stabilize, while others “age badly.”
-Chronically angry, unhappy, or dissatisfied
Older adults with personality disorders are at higher risk for depression & suicide
Treatment for Personality Disorder- Psychopharmacology
Cognitive–perceptual distortions
Affective symptoms and mood dysregulation
Depression
Anxiety
Treatment for Personality Disorder Individual and Group psychotherapy
Cognitive–behavioral therapy (cognitive restructuring techniques)
Thought stopping
Positive self-talk
Dialectical behavior therapy (borderline personality disorder)
Self awareness issues and how to deal as nurses
Discuss feelings of anger or frustration with colleagues.
Nurse can easily mistakenly believe client simply lacks motivation.
Be mindful of manipulation of staff members.
Don’t take flattery or criticism personally.
