Week 5: Personality Disorders Flashcards
Personality
complex pattern of characteristics largely outside of the person’s awareness, which compromise the individual’s distinctive pattern of perceiving, feeling, thinking, coping and behavior
it is a higher level than the traits themselves -
Personality Traits
prominent aspects of personality that are exhibited in a wide range of social and personal contexts
The are the lower level - the behaviors that are exhibited as a part of personality basically
Personality and Personality Traits tend to do be what
stable over time (minor differences based on mood but generally consistent)
Personality Traits are enduring patterns of what 3 things
- Perceiving
- Relating To
- Thinking about environment and oneself
Personality involves what 4 aspects
- Cognition
- Affectivity
- Interpersonal Behavior
- Impulse Control
Cognition
ways of perceiving and assigning meaning to self, others, and events
Affectivity
the range intensity and appropriateness of emotionality
Personality development develops as a response to what things?
A number of Biological and Psychological Influences:
- Heredity
- Temperament
- Experiential Learning
- Social Interaction
Personality Disorders often manifest when
in adolescence and early adulthood
Prevalence of personality disorders is estimated to be about ___%
9.6
Personality disorders often co-occur with ___ and ___
depression and anxiety
It is important to know what regarding when personality disorders appear?
They will appear BEFORE other psychiatric disorders
ex: Someone with BPD will develop the depression and anxiety over time
Why is it so difficult to have accurate numbers about personality disorders
difficult to verify number of population affected due to significant numbers of individuals not seeking professional help
___ can be a major risk factor for the development of certain personality disorders
Gender
Women are at an increased risk for what personality disorders
Avoidant PD
Dependent PD
Paranoid PD
Men are at higher risk for what personality disorder
antisocial personality disorder
What groups have a higher prevalence and occurrence of personality disorders
African American and Native American Groups
Young Adults
Low SES
Divorced, Separated, Widowed, Never Married
Personality Disorder (Definition)
a RIGID, stereotyped behavioral pattern that persists throughout a person’s life.
a CHRONIC maladaptive pattern of perceiving, thinking, and relating that impairs social or occupational functioning causing inner distress
Rigid, throughout life, consistent, and chronic
Personality disorders deviate markedly from what
the expectations of a person’s culture
Personality disorders are ___ and put people are risk for ___ ___ like..;.
personality disorders are SERIOUS and put people at risk for PSYCHIATRIC CO-MORBIDITIES like Mood disorders, anxiety, substance abuse, injuries to self/others
Personality disorders occur when personality traits become what?
- Inflexible and Rigid (change very hard to make)
- Maladaptive
- Cause significant dysfunction (in roles, etc) or severe impairment and SUBJECTIVE distress
- A lifelong behavioral pattern that negatively affects many areas of life, causes problems, and is not produced by another disorder or illness
Individuals with personality disorders lack…
INSIGHT
Understanding of the impact of their behavior on their environment
Fail to accept consequences of their own behavior
Individuals with personality disorders when threatened may attempt to do what
manipulate or change their environment to decrease stress instead of actually changing the behavior
Many individuals with other psychiatric and medical diagnoses manifest symptoms of…
personality disorders
Psychoanalytic Theory of PD
Empathize importance of nurturing from immediate caregivers and loved ones for fostering positive personality traits
Biologic Theory of PD
stress influence of genetic transmission combined with environmental exposures for the formation of personality can lead to PD
Social Learning and Cognitive Perspectives Theory of Personality Disorders
People acquire personality characteristics through thought and interaction with their environment
When development is stalled, disrupted, or becomes negative…
there is a risk for problems - like personality disorders
According to the DSM V, Personality Disorders must meet what overarching criteria
- Significant impairment in self or interpersonal functions
- One or more pathological personality trait
- Impairments are stable over time / across situations
- Personality traits or trait expressions are not normative for developmental stage or cultural environment
- Not due to the use of a substance or medical condition
3 Cluster Types of Personality Disorders
A
B
C
Cluster A PDs represent behaviors described as what
A = ODD or ECCENTRIC
Cluster B PDs represent behaviors that are described as …
B = DRAMATIC, EMOTIONAL, or ERRATIC
High emotion and high charged interactions; lack of consistency in behavior - needs consistent treatment
Cluster C PDs represent behaviors that are described as …
C = ANXIOUS or FEARFUL
What PDs are in Cluster A
Paranoid PD
Schizoid PD
Schizotypal PD
What PDs are in Cluster B
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Paranoid Personality Disorder
Cluster A - Odd or Eccentric
A pervasive DISTRUST and SUSPICIOUSNESS of others such that others’ motives are interpreted as malevolent and Quick to take Offence
Do not acknowledge their negative feelings and will Project negative feelings on others while looking for hidden meanings in conversations
When does Paranoid Personality Disorder develop
conditions begins by early adulthood and presents in a variety of contexts
Clinical Observations/Characteristics of Paranoid PD
Constantly on guard
Hypervigilant, guarded, oversensitive to surroundings and interactions
Ready for any real or imagined threat, mistrusts, and misinterprets cues
Magnifies and distorts environmental cues
Trusts NO ONE - has few if any friends
Constantly tests the honesty of others
DOES NOT LOSE CONTACT WITH REALITY
What is the major characteristic setting paranoid PD apart from schizophrenia
there is no loss of contact with reality in paranoid PD
Predisposing factors for paranoid PD
possible hereditary link
being subject to early parental antagonism and harassment
4.4% of population estimated to have paranoid PD
Schizoid Personality Disorder
Cluster A = Odd or Eccentric
Shows indifference to social relationships and is characterized primarily by a profound defect in the ability to form personal relationships
Fails to respond to others in a meaningful and emotional way
Affect: Flat, cold, unsociable, seclusive demeanor
Clinical Observations/Characteristics of Schizoid PD
Indifferent to others and the environment
Aloof, withdraws from social events
Emotionally cold, flat affect
In the presence of others, client at first appears shy anxious or uneasy
Inappropriately serious about EVERYTHING and has difficulty acting in a light hearted manner/humor
Predisposing Factors for Schizoid PD
Possible hereditary factor
Childhood characterized as Bleak, Cold, Unemphatic, Notably lacking in nurturing
3.1% estimated general population
Schizotypal Personality Disorder
Cluster A = Odd or Eccentric
Displays an enduring and pervasive pattern of interpersonal deficits with extreme discomfort and intolerance for close relationships
Can be described as a more serious form of Schizoid PD in a way - but what makes it different is that the though patterns are disturbed and there are odd behaviors
What sets Schizotypal apart from Schizoid PD
Schizotypal has thought patterns that are more odd with behaviors and are disturbed
Clinical Observations/Characteristics of Schizotypal PD
Exhibits bizarre speech patterns
Aloof, isolative, inappropriate affect, social anxiety
When under stress - may decompensate and demonstrate psychotic symptoms–> less safety issues than schizophrenia but still has safety concerns
Everyday world manifests with magical thinking and ideas of reference believing they control things they do not actually control
Delusions and Depersonalization
Predisposing Factors for Schizotypal PD
Possible Hereditary Link or other possible physiological influence such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain (dysregulation of dopaminergic pathways)
Early family dynamics of indifference, impassivity (void of emotions)
Parental patterns of discomfort with personal affection and closeness
How do the delusions of schizotypal PD differ from the delusions of schizophrenia
there are no EXTREME safety risks in SPD (but that does not mean safety is not a concern)
What do Cluster B PDs typically act like
(Dramatic, Emotional, Attn Seeking Behaviors)
Moods are labile (constantly changing, fluctuating, unstable) and shallow
Become involved in intense interpersonal conflicts
Antisocial = more common in men; BPD and Histrionic more common in women
Antisocial Personality Disorder (Anti-social, A-social, Psychopathy, Sociopathy)
Cluster B = Dramatic, Emotional, Erratic
Aggressive and irresponsible behaviors
Superficially charming
Lack genuine warmth
What is the prevalence of Antisocial PD
in the US:
3% of men, 1% of women 18 +
What is antisocial PD if it is caught in someone 15 years old or younger
Conduct Disorder
Antisocial behavior is a pattern of what
- being socially irresponsible, domestic violence, fighting, stealing, substance abuse
- being exploitative and manipulative
- having guiltless behavior that reflects a disregard for the rights of others
- Failure to conform to society laws and norms
Predisposing factors for Antisocial Personality Disorder
Possible genetic influence
Sociopathic mother/father
Aggressive temperament as a child
Parental deprivation during the 1st 5 YEARS OF LIFE
History of ADHD or CD during childhood or adolescence
Absence of parental discipline or influence, Erratic and inconsistent methods of parenting
Extreme poverty
Removal from the home
Being “rescued” each time they are in trouble - never suffering consequences of their own behavior
Maternal/Paternal Deprivation
Antisocial PD is often in correlation with ___ and ___
ADHD and CD
Clinical Observations/Characteristics of Antisocial PD
Fails to sustain consistent employment
Exploits and manipulates others for personal gain
Cold, Callous, intimidating
inconsistent work or academic performance
failure to conform to societal norms
cruel and malicious
inability to form lasting monogamous relationships
low levels of behavioral inhibitions
very difficult to diagnose and treat
lack of fear
poor decisions making/ lack thereof
difficult to diagnose and treat - non compliant and hard to engage
Borderline Personality Disorder
Cluster B = Dramatic, Emotional, Erratic
Characterized by a pattern of intense and chaotic relationships with affective instability
Have fluctuating and extreme attitudes and moods regarding other people
Splitting
Splitting
Act of viewing life experiences and relationships to extremes of either VERY good or VERY bad
common in BPD
What sort of characteristics may describe someone with BPD
View themselves as victims
highly impulsive
mood swings
depression, anger, anxiety
potential for self mutilation, harming themselves
aggression for attention or numb emotions
When it comes to BPD what is a big concern
safety - they can impulsively hurt themselves
Predisposing factors for BPD
possible hx of child abuse, neglect, and separation from caregivers or loved ones
others with psychiatric disorders in the home
genetic - possible hereditary factor
biochemical - some research has shown changes in certain areas of the brain are involved in emotion regulation, impulsivity and aggression - also some brain chemicals that help regulate mood like serotonin may not function properly
What is the most common personality disorder
Borderline Personality Disorder
__% of the general population has BPD and 75% of that group is ____
2; female
Someone with BPD appears as ____ ____
emotionally unstable
Clinical Observations and Characteristics of BPD
emotionally unstable
identity disturbances in body image, sexuality, long term goals and careers
extreme affective instability usually lasting a few hours and usually no longer than a day
always seems to be in a state of crisis!!!! - extreme affect, behavior reflects frequent changeability, self destructive behavior present
Clients are most strikingly identified by the intensity and instability of affect and behavior
BPD patients are most strikingly identified by the ___ and ___ of their affect and behavior
instability and intensity
How long does the extreme affective instability of BPD episodes usually last
usually lasts a few hours and usually no longer than a day
Common Behaviors in BPD
depression
inability to be alone and attention seeking behaviors
clinging and distancing behaviors
splitting
manipulation
Histrionic Personality Disorder
Cluster B = Emotional, Erratic, Dramatic
Long standing pattern of excessive emotionally charged interactions and attention seeking behaviors
Strives to be the center of attention, speech superficial, lacks detail
Seductive, insecure, dependent on approval of others, naive, easily influenced
low tolerance to frustration, blame disappointments on others, suppresses feelings r/t past events and lacks insight
In Histrionic PD they lack ___
insight (unaware of their behaviors, unlike BPD)
___% of the general population has Histrionic PD and most are ___
1.8; female
Predisposing Factors for Histrionic PD
Possible link to noradrenergic and serotonergic systems
Possible hereditary factor
Learned behavior patterns
Clinical Observations/Characteristics of Histrionic PD
Highly distractible
Difficulty paying attention to detail
Flamboyant in dress and speech - exhibitionistic
Easily influenced by others
Difficulty forming close relationships: excitable, emotional, colorful, dramatic, manipulative, attention seeking
Extroverted in behavior, seductive
Cluster A tends to be more _____ while Cluster B is more ____
introverted; extroverted
Narcissistic Personality Disorder
Cluster B - Dramatic, Emotional, Erratic
Lifelong pattern of self centeredness, self absorption, inability to empathize, insensitivity of others, grandiosity, extreme desires for admiration, feeling special and important with rights for special treatment, exaggeration of successes, fragile self esteem, oversensitivity to comments/criticism, envy for others and belief people envy them
_____% of the population has Narcissistic PD and most are ____
6%; male (75%; Women 25%)
Despite what you may think, what is a Narcissistic PD self esteem usually like
very fragile and quickly is oversensitive to comments to criticism
Predisposing Factors for Narcissistic PD
Tendency to be overpampered and Indulged - Learned to view themselves as special and grow to expect special treatment from others
Parents often were narcissistic themselves
Clinical Observations/Characteristics of Narcissistic PD
Mood can easily change because of fragile self esteem if they do NOT: meet self expectations or receive positive feedback from others
Criticism from others may cause them to respond with rage, shame, and humiliation
Clients are overly self centered, overly sensitive to what others think, insensitive to others needs, lack empathy
Exploit others in an effort to fulfill their own desires
Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and care-free
Avoidant Personality Disorders
Cluster C =Anxious or Fearful
Pattern in early adulthood of social discomfort, timid, fear of rejection and negative feedback
Will only form relationships if acceptance is guaranteed, self perception of unattractiveness, inferior, socially inept
Avoids social demands, feelings of shame, embarrassment, ridicules trying new things
What makes Avoidant PD different from a social phobia
Avoidant personality disorder involves ALL SOCIAL ACTIVITIES whereas social phobia involves specific situations
What is the prevalence of Avoidant PD
2-4% of the general population
Equally common in both sexes
Predisposing Factors for Avoidant Personality Disorder
Possible hereditary influences
Parental rejection and criticism
Clinical Observations/Characteristics of Avoidant PD
Awkward and uncomfortable in social situations
Easily embarrassed
DOES DESIRE CLOSE RELATIONSHIPS but avoids them because of their fear of being rejected
Inappropriate displays of anger, dissociative, paranoid ideation, preoccupied being criticized or rejected
Dependent Personality Disorder
Cluster C = Anxious or Fearful
Excessive need to be taken care of, pervasive, submissive and clinging behaviors
Fears of separation, Difficulty in Making Independent decisions and starting projects, lack trust in their own judgments
Helpless, Hopeless, Relationships are based on being cared for - will even stay in abusive relationships
___% of the population has dependent PD and it is most common in the ____ child of a family
0.5%; youngest child of a family
Predisposing Factors for Dependent Personality Disorder
Possible Hereditary influence
Stimulation and nurturance are experienced exclusively from a single source
A singular attachment is made by the infant to the exclusion of all others
Clinical Observations/Characteristics of Dependent PD
They have a notable LACK OF SELF CONFIDENCE that is often apparent in their: POSTURE, VOICE, MANNERISMS
Typically passive and acquiescent to the desires of others
Overly generous and thoughtful, while underplaying their own attractiveness and achievements
Assume passive and submissive roles in relationships
Avoid positions of responsibility and become anxious when forced into them
Across the board, the most common group of treatments for PDs is ___
therapies
Treatments for Personality Disorders
Interpersonal Psychotherapy
Psychoanalytical Psychotherapy
Milieu or Group Therapy (Practice social skills in a safe place)
Cognitive Behavioral therapy
DBT (Dialectical Behavior Therapy) for BPD
Case Management - lots of support in community and for BPD safety issues
Psychopharmacology
Why is DBT (Dialectical Behavior Therapy) good for BPD
it dives into behaviors and changes thought processes
Overall what are some Symptoms of Cluster A PDs
suspiciousness
paranoia
distrustfulness
preoccupation
reluctance or inability to trust
reads into interactions as having hidden agendas
isolative
flat affect
blunted or limited emotional response
limited to no meaningful relationships
detached from activities
socially detached
odd thinking. speech and behaviors
social anxiety
negative self judgments
Goals for Cluster A PDs
solve immediate crisis or problem - since they will not focus on anything else until its solved - and complete social skills training!!! (milieu or group therapy maybe)
Symptoms of Cluster B PDs
disregards and violates rights and safety of others
failure to conform to social norms
deceitful
erratic work patterns if any
instability in relationships
reckless disregard
irresponsible
aggressive toward self and/or others
manipulative
mood swings
instability of emotions (Labile)
unstable self image
theatrical
exaggerated speech and manners
impulsive
attention seeking
must be center of attention
feelings of emptiness
Goals for Cluster B PDs
1. PREVENT SUICIDE AND HARM
gain insight
improve coping
gain insight into feelings and behaviors and unrealistic expectations and fears
Symptoms of Cluster C PDs
avoidant of social activities due to fears of criticism, disapproval or rejection
feelings of inadequacies
fear of being shamed or ridiculed in intimate relationships
difficult decision making
inappropriate anger with displays of temper
excessive needs to be taken care of
difficult with expressive disagreements with others
lack of self confidence
lack of initiating projects or relationships
goes to any length to be nurtured and cared for
helplessness and insecure when alone
Goals for Cluster C PDs
enhance social functioning
solve immediate crisis
assertiveness training
cognitive reconstruction
Approaches for Nurses to use with Cluster A Clients (Odd or Eccentric)
- When Guarded, Suspicious, Argumentative ==> acknowledge their perception without debate or agreement. Focus attn on treatment and be respectful while maintaining professional distance
- When aloof or uninvolved ==> demonstrate understanding and respect privacy. Explain rationale for personal questioning and do not push for social interaction
- When idiosyncratic or eccentric ==> consistent approach addressing complaints and beliefs, do not challenge or reinforce perspectives
Approaches for nurses to use with Cluster B clients (Dramatic, Emotional, Erratic)
- Demanding ==> SET LIMITS - minimize excessive or realistic demands
- Dramatic, Emotionally involved, Seductive ==> Supportive attitude, maintain professional boundaries to prevent unprovoked responses
- Superior Client ==> recognize and support strengths, show interest in opinions, demonstrate competence
- Sociopath ==> set realistic limits on visits, do not tolerate aggression, develop treatment plan to address aggressive behavior
Approaches for nurses to use with Cluster C clients (Anxious or Fearful)
- Orderly, Controlled, controlling ==> Clearly state treatment approaches, options, rationales, give as much detail as possible, avoid struggle of who is in charge
- Anxiously avoidant, clining, dependent ==> Demonstrate patience, empathy to fears, frequent brief encounters, forewarn of any milieu changes
- Controlling, avoidant, dependent ==> directly address concerns about behaviors, ID underlying feelings about their illness and treatment, avoid being resentful about “acting out” behaviors
Nursing Considerations for Personality Disorders
SAFETY
Trust
Protection and Vulnerable Population
hygiene and nutrition
Communication and social skills
Normal communication skills compromised by emotion - appropriate communication skills will be needed for successful relationships
Nursing Diagnoses for Personality Disorders
Risk for self or other direct violence
Risk for self mutilation
ineffective coping
Disturbed thought process
Anxiety
Fear
impaired social interaction
chronic low self esteem
ineffective therapeutic regimen management
ineffective family coping
