Personality Disorders - G. Manning 2025 - PDF

Objective 5 Personality Disorders G. Manning 2025 1 Objectives Define personality and personality disorders. Recall theories of personality development....

Objective 5 Personality Disorders G. Manning 2025 1 Objectives Define personality and personality disorders. Recall theories of personality development. Distinguish amongst the clusters of personality disorders. Discuss the nursing care, treatment modalities and collaborative management for clients experiencing personality disorder. (Ch. 19,33,34,and 35) 2 Personality An individual’s characteristic patterns of relatively permanent thought, feelings and behaviors that define the quality of experiences and relationships. Personality refers to an individual’s characteristic patterns of thoughts, feelings and behavior. (Review p.390) Key underlying concepts : Personality traits Personality type 3 1  *important * Characteristics of a Healthy Personality Maintaining a satisfactory role/relationships Positive self concept & self confidence Sense of self worth and contentment Overall ability to perform satisfactory Relate to others openly and honestly  Ability to learn, work, play & rest, have a purpose for living. 4 Personality Disorders * they all struggle with empathy intimacy in relationships. Inflexible, maladaptive behaviors, self centeredness, lack of tolerance for stressful situations, lack of accountability, and difficulty dealing with reality, that they have great difficulty recognizing problems that interferes with social or occupational functioning. Person is at an increased risk for other mental they are apart of and they believe the problems originate disorders Theories ( Recall) somewhere else Freud’s Psychoanalytic Theory of Personality Development Erikson’s Psychosocial Theory of Personality Development many live with mild symptoms, however when they become Piaget Cognitive Development Theory 5 stressed their symptoms exacerbate Etiology Biological result of complex biological and psychosocial phenomena that are influenced by multi-faceted variables involving genetic,  Genetics: may influence the development of PD neurobiological, neurochemical, and environmental factors.  Neurobiology/chemistry -brain structures may vary & neurotransmitters help regulate temperance Psychological factors:  Learning theory  Psychoanalytical theory: maladaptive responses, environment: half of the variance accounting for personality the use of defense mechanisms are dominant traits emerges from the environment  Environmental: family environment, childhood Childhood neglect and trauma have been experiences, trauma & abandonment established as risk factors for personality disorders Diathesis –Stress Model - multi-layered factors of biology & environment 6 2  Common Characteristics of Personality Disorders Inflexible socially unacceptable behaviors Challenges with self identity Self-centeredness Manipulative and exploitative behavior Difficulty recognizing that their difficulties are problems related to their personality. Inability to cope with minor stress Lack of individual accountability for behaviors, blames others for their problems Vulnerability to other mental disorders 7 cluster A: eccentric behaviours such as social isolation and detachment. displays unusual levels of suspiciousness, magical thinking, and Personality Disorders –pp.434-445 cognitive impairment Cluster A Paranoid Schizoid Odd /eccentric Schizotypal cluster B: responds to life demands with dramatic, emotional Cluster B Antisocial Borderline or erratic behaviour. Problems with impulse control, emotion Dramatic, Narcissistic erratic Histrionic processing, and regulation, and interpersonal difficulties Cluster C Avoidant Dependent characterize this cluster of disorder. Anxious , fearful Obsessive-compulsive 8 cluster C: consistent patterns of anxious ands fearful behaviours, rigid patterns of social shyness, hypersensitivity, need for orderliness and relationship dependency Cluster A- Odd, Eccentric Behavior Paranoid Personality Disorder cluster A= odd, eccentric behaviour Paranoid, suspicious behavior, irritable Distrustful of others, fears forming relationships Difficulty expressing emotions, lonely social isolation, odd behaviour Schizoid Personality Disorder -Social detachment (introvert) Restricted range of expressing emotions and forming relationships Schizotypal Personality Disorder May be difficult to distinguish from schizophrenia Magical thinking, ideas of reference, limited social contacts, and perceptual disturbances, superstitious All persons with Cluster A – social isolation, odd behaviors 9 3  Cluster B Dramatic , Erratic & Emotional Behavior cluster B= dramatic, erractic & emotional behaviour Antisocial Personality Disorder lack impulse control and insight Lack of respect for the rights of others and social norms; self indulgence; maladaptive behaviors such as stealing, lying, cheating; and a lack of remorse, common in males Borderline Personality Disorder Impulsive, unpredictable behavior; unstable, intense relationships; emotional lability; disassociation; paranoia; self mutilation; difficulty resolving conflict (in chaos) , prone to splitting “ All good or all bad”- more common in females Typically, persons with Cluster B traits lack impulse control and insight 10 Antisocial Personality Disorders Charles Manson Implicated in creating a cult (late 60’s) & orchestrated A # of murders Lengthy criminal history Died in prison 2017, age 83 David Russell Williams pleaded guilty to all 88 charges against him including two counts of first- degree murder, two counts each of sexual assault and forcible confinement, and 82 break-ins and attempted break-ins. 11 ASP Disorder David Russell Williams pleaded guilty to all 88 charges against him including two counts of first-degree murder, two counts each of sexual assault and forcible confinement, and 82 break-ins and attempted break-ins. Curiously, does not “fit” the pattern of a serial killer 12 ….. 4  Cluster B Emotional, Erratic, or Dramatic Behavior Histrionic Personality Disorder Pattern of theatrical or overly dramatic behavior; attention seeking; emotional lability, shallow Feelings of dependence and helplessness Narcissistic Personality Disorder Exaggerated, grandiose sense of self importance Envious of and wants to be envied by others “ It’s all about me” Rude & arrogant 13 cluster C= anxious, fearful behaviour Cluster C- Anxious, Fearful Behavior Obsessive-Compulsive Personality Disorder Preoccupation with rules and regulations, preoccupied with concern with organizational and trivial detail, excessive devotion to work and productivity that can interfere with daily functioning and social interactions OCD= is ruled by intrusive thoughts called obsessions that Dependent Personality Disorder Low self confidence, unable to function independent lye, cause anxiety and force the person to perform compulsions for relief clingy behaviors, preoccupied with fear of being alone Avoidant Personality Disorder Highly sensitive to rejection, criticism, humiliation, disapproval, or shame, resulting in impaired social functioning OCPD= ruled by perfectionism and detail, people with OCPD ; feel inadequate & insecure Avoid personal risks are not self-aware and can hurt the people around them * Difference between OCD and OCPD* 14 Personality Disorders- Assessment Assess : Insight into illness, mood , affect & risk for suicide Hx past behaviors, physical illnesses Cognition (assess for delusions, coping…) Affect( appropriate, labile) Interpersonal functioning( supports, decisions) Behavior- (impulse control, unpredictability, self harm , outbursts, lability, spending ) Meds, supports Screening Tools: International Personality Disorder Exam Minnesota Multiphasic Personality Inventory Assess :Transcultural considerations Review Assessment Guideline –p. 403 15 5  Nursing Interventions Assessing & promoting safety Maintaining Promoting self healthy awareness coping and being a &social skills team player Maintaining Setting a limits & therapeutic professional relationship boundaries 16 Interventions Provide safe environment (surveillance) ; trust Basic needs ( sleep, food , rest etc.) Explore maladaptive coping and their purpose. Help client develop insight into the purpose of interventions. Encourage client to verbalize & express feelings honestly /openly. Provide positive feedback regarding client’s strengths. Discuss limit setting; benefits/consequences (enforce limits with no apology). Boundaries Be firm, consistent, direct and non judgmental. Discuss alternate coping strategies , groups, DBT Review nursing care plan-19-1 p.453 Review Boxes 19-1, 19-2, 19-3 (Dealing with manipulation, impulsivity & anger) Tables: 19-2, 19-4, 19-5- Interventions 17 Nursing Diagnosis;-Table 19.2 Personality Disorders Type Nursing Interventions Schizotypal Brief talks focused on reality Schizoid Encourage brief encounters Paranoid Develop trust, not over friendly Borderline Trust, set consistent limits Don’t negotiate, set limits Antisocial Healthy coping and social skills ; Histrionic reassure Narcissistic Deal with limitations & setbacks Avoidant Promote self esteem Dependent Encourage decision making Obsessive Compulsive Simple, limited choices 18 6  Drugs used to treat PD Class Action Antianxiety Reduce stress/tension Antidepressants Increase feelings of well being Helps control mood Anticonvulsants & Helps control Lithium exaggerated thoughts Antipsychotics Control psychotic symptoms 19 What is the key to treatment? Rx-most require a combo of meds and psychotherapy/education Client /family education ( problem solving, med compliance, self help/support groups) Consistency, boundaries, consequences Nursing considerations -self awareness Nurses help clients make better choices and to develop healthier alternate coping mechanisms. 20 Consistent limit setting is vital in the care of clients diagnosed with personality disorders. A.True B. False 21 7  Study Note Limit setting should be consistent and achieved in an approach whereby the client recognizes that it is the behavior that is unacceptable, not the client. It is vital to work with the client to identify and address dysfunctional behaviors. 22 Summary Personality and personality disorders defined. Characteristics & symptoms of personality disorders Nursing care/process and treatment for clients diagnosed with personality disorder. 23 8