Psychology Chapter on Personality and Self-Concept

Self-Awareness, Self-Esteem, and Self-Concept

• Self-awareness involves introspection and exploring thoughts, behaviors, emotions, and values.
• Self-esteem refers to an individual's self-regard and valuation.
• Self-concept encompasses body image, role performance, and personal identity.

Issues in Personality Disorders

• Ego-syntonic disorders: The individual doesn't perceive a problem with their personality traits. Typical of personality disorders.
• Ego-dystonic disorders: The individual is aware of the problem and distressed by their personality traits. Examples include obsessive-compulsive disorder.

Personality

• Personality combines your traits and how you act and think.
• Personality evolves over time.
• Harmful traits negatively impacting life, work, and social interactions may indicate a personality disorder.

When is a Personality Disorder Diagnosed?

• Traits become inflexible, disabling, and/or extreme.

5 Main Personality Traits

• Openness: Openness to new experiences.
• Conscientiousness: Impulse control and adherence to standards.
• Extroversion: Introversion versus extroversion.
• Agreeableness: How one interacts with others, generosity vs. aggression.
• Neuroticism: Emotional stability versus dysregulation, including anxiety, moodiness, and confidence.

Risk Factors for Personality Disorders (PD)

• Genetic factors: Tend to run in families, little data.
• Environmental factors: Exposure to trauma and abuse, and perception of events, particularly low socioeconomic status.
• Neurobiological factors: Certain neurotransmitters may influence temperament, potential brain size and functional differences.

What Do We Know About Personality Disorders?

• Personality Disorders represent a challenging and complex group of disorders.
• Difficulty with thoughts/emotions, managing impulses, participation in interpersonal relationships, distinguishes individual disorders with varying characteristics.

Cluster A Personality Disorders

• Behavior is characterized by odd, reclusive, and eccentric traits.
• Common in men, young age, and adolescence. Common risk factors include having a relative with schizophrenia.
• Subtypes, examples: Paranoid personality disorder.

Paranoid Personality Disorder

• Prevalence: 2-4% of the population.
• Defining Characteristics: Strong distrust of others, suspicion of others' motives, assumptions of disappointment. Often maintain superficial relationships, use projection, and hold grudges—hostile, and hypervigilant.
• Treatment: Therapy focused on developing trust, clear/straightforward communication, and boundary setting. Pharmacology (anti-anxiety/anti-psychotics).
• Nursing considerations: Be clear and direct.

Schizoid Personality Disorder

• Prevalence: 5% of the population.
• Defining Characteristics: Disinterest in social interactions, lifelong pattern of withdrawal, generally poor school performance, poor interpersonal relationships. May have imaginary friends/fantasies, and dislike physical contact along with flat affect or lack of expression of emotion. The person may feel like an observer.
• Treatment: Psychotherapy, addressing introspective needs and trust development.

Schizotypal Personality Disorder

• Prevalence: 0.6-4.6% of the population.
• Defining Characteristics: Withdrawn and socially detached, magical thinking, unusual/odd speech and behaviors, inappropriate affect, and self-centred speech, poor ability to relate/understand others. Extreme social anxiety, and suspiciousness. Also, symptoms of schizophrenia spectrum disorder.
• Treatment: Psychotherapy aimed at building trust and social skills. Pharmacology (anti-psychotics/anti-depressants).
• Nursing considerations: Respect social isolation needs/beliefs, awareness of behaviors.

Cluster B Personality Disorders

• Behavior is impulsive and dramatic.
• Subtypes: Antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder.

Antisocial Personality Disorder

• Prevalence: 0.2-3.3% of the population (overrepresented in prison population). Often underdiagnosed in women.
• Defining Characteristics: Impulsive, manipulative behavior for personal gain, often lacking remorse, superficial charm or manipulation, violence, disregard of others, and difficulty controlling impulses. Begins at a young age.
• Treatment: Psychotherapy (long and intense, sometimes anger management).

Borderline Personality Disorder

• Prevalence: 5.9% in general population, 20% in inpatient care, more common n women, childhood trauma(abuse), and abandonment.
• Defining Characteristics: Unstable moods (joy to extreme rage), impulsive behaviors, depression, splitting (seeing people as purely good or bad), substance abuse, self-harm, and suicidal thoughts/behaviors.
• Treatment: Dialectical Behavior Therapy (DBT) therapy, psycho/schema therapy, pharmacology(anti-depressants/anti-convulsants/mood stabilizers/anti-psychotics).

Histrionic Personality Disorder

• Prevalence: 2% of population, less common in Asian cultures.
• Defining Characteristics: Desire to be the center of attention, exaggerated/shallow emotions, seeks constant gratification, and manipulates for attention. Has a strong sense of inadequacy and helplessness, vague speech, and may have highly sexualized behavior.
• Treatment: Psychotherapy (e.g., individual therapy, clarification of inner feelings).

Narcissistic Personality Disorder

• Prevalence: 0.1-6% in the population, more common in men, childhood neglect.
• Defining Characteristics: Entitled, arrogant, believe they are perfect, grandiose, intense fear of abandonment, difficulties with relationships, poor self-esteem.
• Treatment: Psychotherapy (CBT), family therapy.

Avoidant Personality Disorder

• Prevalence: 2.4% of population, equal in men and women, childhood peer rejection/criticism.
• Defining Characteristics: Want close relationships but fear social interactions due to fear of ridicule or criticism, feelings of inadequacy, shyness and timidity, and hypersensitivity to negative feedback.
• Treatment: Psychotherapy (CBT, social skills training), pharmacology (anti-anxiety).

Obsessive-Compulsive Personality Disorder (OCPD)

• Prevalence: 2.1-7.9% of the population, more common in men, childhood criticism and control.
• Defining Characteristics: Strive for perfection, inflexible rules, perfectionistic, preoccupied with orderliness to the degree that it interferes with task completion.
• Treatment: Psychotherapy (CBT), pharmacology.

Dependent Personality Disorder

• Prevalence: 0.5% of the population (rare), risk of chronic physical illness or punishment for independence in childhood.
• Defining Characteristics: Extreme dependency on relationships, fear of separation, seeking out dominant personalities, see themselves as inadequate.
• Treatment: Psychotherapy (CBT), pharmacology (anti-depressants/anxiolytics).

Assessment

• Semi-structured interviews, often lacking insight and trust.
• Poor communication skills.
• Assess work/behavior problems, substance use, violence, etc.
• Open-ended questions, rule out other illnesses, and assure safety.

Typical Interview Highlights

• Safety assessment
• Physical and mental assessment
• Determine medical/psychiatric history (responsible), recent relevant changes in life.
• Recent or long-term personality changes.

Diagnosis

• Often goes underdiagnosed.
• Traits may develop early but aren't diagnosed until adulthood.
• Avoid diagnosing during crisis/active phase of another disorder.

Maintaining Boundaries

• Personal life: Focus on client, limited details about background.
• Confidentiality: Ensure confidentiality, discuss only relevant aspects with health care team.
• Professionalism: Interactions within clinical setting, scheduled duty hours.
• Respect: Respect institution, work policies, other team members.

Anger Control

• Determine expectations re expression of anger
• Limit frustrating situations
• Encourage coping mechanisms
• Keep safety a priority
• Use physical outlets for expressing anger

Impulse Control

• Identify problems requiring thoughtful action.
• Assess possible courses of action (costs and benefits).
• Teach “stop and think” skills.
• Evaluate outcomes and reinforce positive outcomes.
• Provide problem-solving opportunities.

Additional Notes for the Specific Case

• Client's history of abandonment, family problems, alcohol and drug use requires specific intervention.
• Assessment of suicide risk and need for immediate support was crucial.

This quiz explores key concepts related to personality, including self-awareness, self-esteem, and self-concept. It also delves into personality disorders, distinguishing between ego-syntonic and ego-dystonic disorders. Test your understanding of how personality traits evolve and when a personality disorder may be diagnosed.