Personality Disorders PDF

**Chapter 22: Personality disorders (when studying, know how the clusters and within the clusters know how each present and criteria for them)** **Introduction:** - Personality: The totality of emotional and behavioral characteristics that are particular to a specific person and that rem...

**Chapter 22: Personality disorders (when studying, know how the clusters and within the clusters know how each present and criteria for them)** **Introduction:** - Personality: The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time. - Personality Traits: Characteristics born with or develop early in life - Personality development occurs in response to a number influences: - Heredity, Temperament, Experiential learning, Social interaction - Majority of individuals exhibit some behaviors seen with PDs every so often - Personality disorders occur when traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning Historical aspects: - Ten specific types of personality disorders are identified in the DSM 5 - **CLUSTER A:** Behaviors described as odd or eccentric - **Ex: paranoid personality disorder, schizoid, schizotypal** - **CLUSTER B:**Behaviors described as dramatic, emotional, or erratic - **KNOW Ex: Antisocial, borderline, histrionic, narcissistic** - **Most complicated to treat and manage** - **CLUSTER C:** Behaviors described as anxious or fearful - **Ex: avoidant, dependent, obsessive compulsive personality disorder** **CLUSTER A: Behaviors described as odd or eccentric \[SPS\]** **Paranoid personality disorder:** - **Defined as a patterned of pervasive mistrust and suspicion of others and misinterpretation of others' motives as hostile** - Those who suffer from this disorder are not choosing not to trust; their perception of the world is just skewed toward suspicion (notebookLM, i loved this) - Little resemblance w/ the s/s of schizophrenia - **Suspicious of others' motives and assume that others intend to exploit, harm, or deceive them** - More common in men than in women - Clinical picture - Constantly on guard, hypervigilant - Ready for any real or imagined threat - **Trusts no one;** constantly tests the honesty of others - Tends to misinterpret minute cues - Magnifies and distorts cues in the environment - Oversensitive; **often asks lots of questions & is suspicious of others** - **Insensitive to the feelings of others** - **Does not accept responsibility for their own behavior** - **Attributes shortcomings to others** - Predisposing factors - Possible hereditary link - Subject to early parental antagonism/hostility and harassment, raised by abusive parent **Schizoid personality disorder: (know difference in schizoid AND schizotypal)** - Characterized primarily by a profound defect in the ability to form personal relationships - **Failure to respond to others in a meaningful, emotional way; Don't enjoy close relationships** - **They can't form relationships b/c detachment from social relationship & can't express their emotions** - Hyperfocused on subject/topic they enjoy \[math, science, sports, etc\] - Diagnosis occurs more frequently in men than in women. - Prevalence within the general population has been estimated at 3% to 5%. - **Clinical picture** - **Emotionally cold, eccentric, aloof, lonely/isolated, and indifferent to others** - No close friends; prefers to be alone - Appears shy, anxious, or uneasy in the presence of others - Inappropriately serious about everything and has difficulty acting in a lighthearted manner - **Predisposing factors** - Possible hereditary factor - More common among first-degree relatives of people with schizophrenia - Early family dynamics characterized by: Indifference, Impassivity, Formality - Leading to a pattern of discomfort with personal affection and closeness - Childhood has been characterized as Bleak, Cold, Unemphatic, Notably lacking in nurturing - **KNOW Dx criteria for schizoid personality disorder:** **detachment from social relationships, does not enjoy close relationships, chooses solitary activities, and emotionally coldness** **Schizotypal personality disorder:** - Behavior is odd and eccentric; **most clearly mimics schizophrenia** - Affects approximately 4% of the population - When under great deal of stress, may demonstrate psychotic symptoms \[hallucinations & delusions\] - This PD has strong desire for social connections but have trouble maintaining them due to their unusual thoughts and actions - s/s: Aloof and isolated; withdrawal into self, Bland, inappropriate affect - **Bizarre speech patterns, Superstitiousness; magical thinking**; ideas of reference, Illusions, Depersonalization - They go grocery shopping @ night to avoid people; when in public, their heads are down w/ hood on - Their affect is bland or inappropriate (such as laughing at their own problems or at a situation most people would consider sad) **CLUSTER B: Behaviors described as dramatic, emotional, or erratic \[BAN\]** **Antisocial personality disorder:** previously categorized as "sociopathic or psychopathic" - A pattern of behavior that is **socially irresponsible, exploitative, and without remorse** - Behavior reflects a disregard for the rights of others - **Individuals that LACK the ability to have remorse/guilt** - **Deceitfulness** - **Most frequently encountered in prisons, jails, and rehabilitation services** - When clients are seen, it is commonly a way to avoid legal consequences or b/c it's court-ordered. They believe they're above the law - Sometimes they are admitted to the health-care system by court order for psychological evaluation - Clinical picture (box 22-3) - **Belligerent and argumentative** - **Do not accept responsibility for the consequences of their behavior** - Fails to sustain consistent employment - Fails to conform to the law - Exploits and manipulates others for personal gain, lacks remorse - Fails to develop stable relationships - Unable to delay gratification; Low frustration tolerance - Impulsive and reckless - Inconsistent work or academic performance - Failure to conform to societal norms - Inability to function as a responsible parent - More common in men than in women - Predisposing factors - Possible genetic influence, Having a disruptive behavior disorder as a child - History of severe physical abuse, Absent or inconsistent parental discipline - Extreme poverty, Removal from the home **ADPIE** - **Safety is a priority** - **Nursing Diagnoses:** - Risk for other-directed violence - Defensive coping - Chronic low self-esteem - Impaired social interaction - Ineffective health maintenance - **Outcomes:** - The client - Discusses angry feelings with staff and in group sessions - Has not harmed self or others - Can rechannel hostility into socially acceptable behaviors - Follows rules and regulations of the therapy environment - Can verbalize which of their behaviors are not acceptable - Shows regard for the rights of others by delaying gratification of own desires when appropriate - Does not manipulate others in an attempt to increase feeling of self-worth - Verbalizes understanding of knowledge required to maintain basic health needs - **Planning/intervention:** - Risk for violence directed at others - Convey accepting attitude. - Observe client's behavior frequently. - Maintain and convey a calm attitude. - Defensive coping - Do not attempt to coax or convince the client to do the "right thing." - Use words like "you will be expected to..." instead of "you should.. Or shouldn't..." - Provide positive feedback. - Talk about past behaviors - **Evaluation:** - Evaluation of care for the client with antisocial personality disorder is based on accomplishment of previously established outcome criteria. **Borderline personality disorder:** - Characterized by a pattern of intense and **chaotic relationships with affective instability \[constant shift in mood\]** and fluctuating attitudes toward other people - **Difficult to maintain relationship b/c they view everything as "all good" or "all bad" in a person** - **Clinical picture KNOW** - **Inability to be alone but push people out @ times \[clingy but can be distanced\]** - **Frantic efforts to avoid real or imagined abandonment** - **Clinging:** they exhibit helpless, dependent, or even childlike behaviors. They over idealize a single individual with whom they want to spend all their time with. - **Distancing:** characterized by hostility, anger, and devaluation of others that arise from feeling of discomfort with closeness. - **Highly impulsive, emotionally unstable** - **Directly and indirectly self-destructive (ex: cutting, burning)** - **Splitting: people, including themselves, and life situations are either all good or all bad** - **Use of manipulation** - Ex: "no one else in the world can help me the way you do" - Lacks a clear sense of identity - Fluctuating and extreme attitudes regarding other people - Affects about 1% to 2% of the population - More common in women than in men - Predisposing factors - Biological influences - Biochemical: Possible serotonergic defect \[serotonin & epinephrine play a role in this\] - Genetic: Possible familial connection with depression - PTSD is often co-diagnosed w/ this - Psychosocial influences: Childhood trauma and abuse - Developmental factors: Fails to achieve task of autonomy in early childhood **ADPIE** - **Safety is a MAJOR priority** - **Nursing Diagnoses:** - Risk for self-mutilation; Risk for suicide - Risk for other-directed violence - Complicated grieving - Impaired social interaction - Disturbed personal identity - Anxiety (severe to panic) - Chronic low self-esteem - **Outcomes:** - The client - Has not harmed self - Seeks out staff when desire for self-mutilation is strong - Is able to identify true source of anger - **Expresses anger appropriately** - Relates to more than one staff member - Completes activities of daily living independently - **Does not manipulate one staff member against the other to fulfill own desires** - **Planning/implementation:** - Risk for self-mutilation/risk for self-directed or other-directed violence - Observe client's behavior frequently. - Try to redirect violent behavior with physical outlets for the client's anxiety. - **They may have to be one-on-one for their safety** - Complicated grieving - Convey an accepting attitude. - Explore with the client the true source of anger. - Impaired social interaction - Help the client understand that you will be available. - Explore feelings that are related to fears of abandonment and engulfment. - **Evaluation**: - Evaluation of care for the client with borderline personality disorder is based on accomplishment of previously established outcome criteria. **Histrionic personality disorder:** - **Acts like a "drama queen OR drama king" and constantly seeks out attention (lecture)** - Behavior is: Excitable, Emotional, Colorful, Dramatic, Extroverted - Prevalence is thought to be about 2% - **Clinical picture/characteristics** - **KNOW drama queen (wants to be center of attention), flirty/seductive, uses physical appearance for attention, shallow expressions of emotions, and speech lacking detail** - **Attention-seeking** - **Use physical appearance for attention** - **Shallow expression of emotion** - **Strongly dependent, Manipulative** - **Very flirty** - Self-dramatizing; exhibitionistic - Highly distractible - Difficulty paying attention to detail, Easily influenced by others - Difficulty forming close relationships (typically **only superficial relationships**) - Somatic complaints are common - Predisposing factors: Possible hereditary factor, Biogenetically determined temperament, Learned behavior patterns \[from childhood if their parents constantly gave them rewards for achievements\] **Narcissistic personality disorder** - Characterized by an exaggerated sense of self-worth: **Believes they are better than everyone else** - Lack of empathy - Belief in an inalienable right to receive special consideration - Prevalence of the disorder is estimated between 1% to 6%. - Diagnosed more often in men than in women - Clinical picture - Lack humility; overly self-centered - Exploits others in an effort to fulfill own desires - Mood, **which is often grounded in grandiosity**, is usually optimistic, relaxed, cheerful, and carefree - This mood can easily change b/c of their fragile self-esteem - Criticism from others may cause them to respond with rage, shame, and humiliation - Predisposing factors - Narcissistic personality disorder may have been evolved from a parent-child dynamic of excessive adoration or excessive criticism that is poorly attuned with the child's experience - Parents were often narcissistic themselves - Parents may have overindulged the child and failed to set limits on inappropriate behavior **CLUSTER C: Behaviors described as anxious or fearful \[DAO/"bow"\]** **Avoidant personality disorder:** - **Characterized by extreme sensitivity to rejection which can lead to a very socially withdrawal life** - **They don't try to make friends or have relationships b/c they're constantly fearful they'll say the wrong thing or are afraid of rejection** - Prevalence is about 2% to 3% and is equally common in men and women - **KNOW Clinical picture/characteristics:** - **Awkward and uncomfortable in social situations** - **Desire close relationships but avoid them because of fear of being rejected** - **Feel inadequate** - **Speech is typically slow and constrained with frequent hesitations** - Perceived as timid, withdrawn, or cold and strange - Often lonely and feel unwanted, View others as critical and betraying - Predisposing factors - No clear cause is known - May be a combination of biological, genetic, and psychosocial influences - Psychosocial influences may include childhood trauma or neglect, leading to fears of abandonment or to viewing the world as a hostile and dangerous place **Dependent personality disorder:** - **Characterized by a lack of self-confidence and extreme reliance on others** - Tendency: to allow others to make decisions, to **feel helpless when they are alone, to act submissively**, to subordinate needs to others, to tolerate mistreatment by others, to demean oneself, and to fail to function in situations requiring assertive behavior - **Clinical picture/characteristics** - **KNOW passive/submissive, feels helpless when alone, lack of self-confidence, and do anything to earn acceptance** - Overly generous and thoughtful, while underplaying own attractiveness and achievements - Low self-worth and easily hurt by criticism and disapproval - Avoid positions of leadership/responsibility and become anxious when forced into them - Predisposing factors - Possible hereditary influence - Psychosocially, dependency is fostered in infancy when stimulation and nurturance are experienced exclusively from one source. - A singular attachment is made by the infant to the exclusion of all others. **Obsessive-compulsive personality disorder: NOT OCD; cluster C** - **Individuals are very serious & formal & have difficulty expressing emotions; have an intense fear of making mistakes leading to difficulty w/ decision making** - **They're hyper-aware of people & their roles/ranks** - Overly disciplined, perfectionist, and preoccupied with rules - **KNOW Characterized by:** - **Preoccupied w/ details, rules and order** - **Reluctant to delegate** - **Shows rigidity and stubbornness** - **Perfectionism interfere with task completion** - **Excessive devotion to work/productivity** - **They commonly lack a social life** - Characterized by inflexibility about the way in which things must be done - Devotion to productivity at the exclusion of personal pleasure - Occurs more often in men than in women - Within the family constellation, it appears to be most common in oldest children. - Clinical picture - Especially concerned with matters of organization and efficiency - **Tend to be rigid and unbending** - Socially polite and formal - On the surface, appear to be very calm and controlled-underneath there is a great deal of: - Ambivalence, conflict, hostility - **Rank conscious** - Predisposing factors - Genetic vulnerability is possible - Overcontrol by parents - Notable parental lack of positive reinforcement for acceptable behavior - Frequent punishment for undesirable behavior **Treatment modalities for personality disorders:** - **Management is focused on THERAPY and not medications** - Interpersonal psychotherapy - Psychoanalytical psychotherapy - Milieu or group therapy - Cognitive/behavioral therapy - **Dialectical behavior therapy** - **Looks at emotional regulation, looks at social skills** - **Four primary modes:** group skills, individual psychotherapy, telephone contact, and therapist consultation and tema meeting - Psychopharmacology \[**DON'T USE BENZOS FOR THIS**\] - Schizotypal PD: antipsychotic meds - Borderline PD: antipsychotic and mood-stabilizing agents - Narcissistic PD: lithium