personality disorders
define the following : personality, unhealthy personality, maladaptive behaviors, and dysphoric
personality : a set of unique, stable patterns of thoughts, feeling, and behaviors that make an individual distinct from others
unhealthy personality : when an individual's interpersonal and social relationships and functioning are consistently maladaptive, complicated or dysphoric
maladaptive behaviors : actions or patterns of behavior that a perosn uses to cope with stress or difficult emotions, these lead to negative consequences, hinder personal growth, and cause harm to self or others
dysphoric : persistent state of low mood, feeling of sadness, hopelessness, and apathy
how do we describe cluster A personality disorders and what are they ?
behaviors are odd or eccentric
paranoid, schizoid, schizotypal
how do we describe cluster B personality disorders and what are they ?
behaviors are dramatic, emotional, or erratic
borderline, narcissistic, histrionic, antisocial
how do we describe cluster C personality disorders and what are they ?
behaviors are anxious or fearful
avoidant, dependent, and obsessive compulsive
what are personality disorders ?
- long term patterns of behavior and inner experiences that differ significantly from what is expected
- most often in late adolescents to early adulthood
- behaviors may be odd, dramatic, or anxious (perceived as mentally ill)
- not usually diagnosed in children
explain Paranoid personality disorder
prevalence : 2%-4% of population, men>women, higher Dx with family Hx
characteristics :
- Long-standing distrust and suspiciousness of others
- Hypervigilant, anticipate hostility
- May be seen in childhood or adolescence
- Social anxiety in childhood (May be teased for odd behavior)
- Adults have trouble with relationships due to: jealous, controlling, unwillingness to forgive
- Projection is dominant defense mechanism
nursing care : all prearranged promises, appointments, and schedules should be adhered to, clear and straight forward explanation, simple language, and set limits
treatments : individuals often reject treatment, difficult to interview due to fear info will be used against them
- psychotherapy is the 1st line
- meds = antianxiety (valium) and antipsychotics (haldol and orap)
explain histrionic personality disorder
prevalence : 2%, women
characteristics : excitable and dramatic/high functioning, extroversion, flamboyance, colorful personality, limited ability to develop meaningful relationships, attention seeking, selfish, low frustration tolerance, excessive emotions, impulsive, flirty, provocative, no insight to disorder or role in ruining relationships
nursing care : professional communication and interactions, may exaggerate symptoms/ difficulty functioning, use concrete and descriptive language, help clarify feelings, teach/role model assertiveness, assess for SI
treatments : psychotherapy and no specific medications
explain avoidant personality disorder
prevalence : 2.4%, men and women =
characteristics : sensitive to rejection, shyness increases with age, low self-esteem, feelings of inferior compared to peers, reluctant to engage in unfamiliar activities, depression, anxiety, and anger, preoccupied with rejection, humiliation, and failure
nursing care : be friendly, accepting, and reassuring, social situations will cause severe anxiety, provide ways to enhance new social skills and help them learn to express their needs
treatments : psychotherapy, antianxiety, BARA, antidepressants, serotonergic agents
what is included in cluster A of personality disorders ?
paranoid, schizoid, schizotypal
explain schizoid personality disorder
prevalence : 5 %, men
characteristics : appear in childhood/adolescents, lifelong pattern of social withdrawal, expressionless, depersonalization, detachment from self and world
nursing care : avoid being too nice and socialization, individual may discuss topics like coping and anxiety, protect against ridicule from group members
treatments : psychotherapy and medications (antidepressants like wellbutrin and antipsychotics like risperdal and zyprexa)
explain narcissistic personality disorder
prevalence : 0-6%, men
characteristics : feelings of entitlement, exaggerated self importance, lack of empathy, weak self esteem and hypersensitivity to criticism, arrogant and have inflated view of their importance, need for constant admiration, feel intense shame and fear of abandonment, do not tolerate rejection
nursing care : remain neutral, recognize behaviors, help identify goals/develop stronger self identity, avoid engaging in power struggles/becoming defensive, do not challenge grandiose statements, show empathy
treatments : psychotherapy and medications like mood stabilizers
explain dependent personality disorder
prevalence : 0.5%
characteristics : submissive, clinigy, overwhelming need to be cared for, intense fear of separation, lack of confidence in own ability or judgement, manipulate others to assume responsibility, intense anxiety when left alone even for brief periods of time
nursing care : help identify and address stressors, strong countertransference may develop due to patients demands for extra time and crisis state, therapeutic relationship can provide testing ground for increased assertiveness
treatments : psychotherapy (CBT), no meds
what is included in cluster B of personality disorders ?
borderline, narcissistic, histrionic, antisocial
explain schizotypal personality disorder
prevalence : 0.6-4.6%, men, younger people, greater when 1st degree has schiz
characteristics : magical thinking, odd beliefs, starnge speech patterns, inappropriate affect, severe social/interpersonal deficits, anxiety in social situations, rambling, paranoia, suspicious, anxious, brief intermittent episodes of hallucinations/ delusions, can be made aware of their own belief
nursing care : respect their need for social isolation, be aware of their suspiciousness, perform careful assessment to uncover any other medical or psych symptoms, be aware of strange beliefs and activities
treatments : tend to avoid treatment ; goal is provide supportive care
explain borderline personality disorder
prevalence : 1.6% of population
epidemiology : 70% will commit Suicide, 10% will complete
co-mo : MDD, bipolar, anxiety, sleep disorder, substance abuse, DM, HTN, fibromyalgia, arthritis
cognitive factors : disruption of normal seperation ; individuation between child and mother
characteristics : severe impairments in functioning, instability, impulsivity, emotional dysreg, emotional lability, self destructive behaviors, antagonism, splitting
nursing care : assessment is a semistructured interview with use of the MMPI
treatments : biological is psychotropics geared toward symptom relief, along with psychosocial therapy like CBT, dialectial behavior therapy, and schema focused therapy
explain obsessive compulsive personality disorder
prevalence : 2-8%
characteristics : rigid and inflexible standards for self and others, constant rehearsal of social responses, excessive goal seeking even if self-defeating or harms relationships, strict standards interfere with project completion, unhealthy focus on perfection
nursing care : guard against power struggles, they have difficulty dealing with unexpected changes, provide structure yet allow for time to complete habitual behavior, help identify ineffective coping and develop better skills
treatments : need to be aware of own suffering and seek Tx for anxiety and depression, grou and behavioral therapy, med = anofranil, prozac
what is included in cluster C of personality disorders ?
avoidant, dependent, and obsessive compulsive
explain antisocial personality disorder
prevalence : 0.2-3.3%
epidemiology : most researched, men with substance use disorders and the incarcerated
RF : genetic (aggressive disregard and trait of disinhibition), alteration in serotonin transmission, inconsistent parenting/disciple, abuse, neglect, less common in black people and other minorities
characteristics : Antagonist behaviors (Deceitful, manipulative, hostile), Disregard for responsibility, Disinherited behaviors (Risk taking/impulsive, disregard for responsibility), Callousness (Profound lack of empathy), Criminal misconduct and substance abuse, Symptoms peak in mid teens to 20s; by 40s symptoms may abate and improve without treatment
nursing care : assess current stressors, criminal history, SI/HI or violent thoughts, anxiety, aggression, anger, motivation for maintaining control, and substance use
treatments : pharm : no meds for specific disorder, mood stabilizers, SSRIs, benzos, and methylphenidate all for symptoms
- psychotherapists, CBT, metallization behavioral therapy, and dialectical behavior therapy