Personality Disorders PDF

11/27/23, 3:28 AM Realizeit for Student Introduction Personality can be defined as an ingrained, enduring pattern of behaving and relating to the self, others, and the environment; it includes perceptions, attitudes, and emotions. These behaviors and characteristics are consistent across a broad r...

11/27/23, 3:28 AM Realizeit for Student Introduction Personality can be defined as an ingrained, enduring pattern of behaving and relating to the self, others, and the environment; it includes perceptions, attitudes, and emotions. These behaviors and characteristics are consistent across a broad range of situations and do not change easily. A person is usually not consciously aware of his or her personality. Many factors influence personality; some stem from biologic and genetic makeup, while others are acquired as a person develops and interacts with the environment and other people. Personality disorders are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive. Individuals have identity problems such as egocentrism, or being self-centered, and their sense of self-esteem comes from gaining power or pleasure that is often at the expense of others. Their behavior often fails to conform to cultural, social, or legal norms, and they are motivated by personal gratification. Relationships with others are dysfunctional and often characterized by deceit, coercion, or intimidation by the individual with a personality disorder. They are not capable of mutual, intimate relationships and lack the capacity for empathy, remorse, or concern for others (Cloninger & Svrakic, 2017). Maladaptive or dysfunctional personality traits (Skodol, 2018) exhibited by individuals with a personality disorder may include: Negative behaviors toward others, such as being manipulative, dishonest, deceitful, or lying Anger and/or hostility Irritable, labile moods Lack of guilt or remorse, emotionally cold and uncaring Impulsivity, distractibility, poor judgment Irresponsible, not accountable for own actions Risk-taking, thrill-seeking behaviors Mistrust Exhibitionism Entitlement Dependency, insecurity Eccentric perceptions Certainly, not all these traits are a problem for each person diagnosed with a personality disorder. The traits that are present or that predominate for a given person are the basis for distinguishing the disorders from each other. Personality disorders are not diagnosed until adulthood, that is, at age 18, when personality is more completely formed. Nevertheless, maladaptive behavioral patterns can often be traced to early childhood or adolescence. Although there can be great variance among clients with personality disorders, many experience significant impairment in fulfilling family, academic, employment, and other functional roles. Personality disorders are long-standing because personality characteristics do not change easily. Thus, clients with personality disorders continue to behave in their same familiar ways even when these behaviors cause them difficulties or distress. No specific medication alters personality, and therapy designed to help clients make changes is often long term with slow progress. Some people with personality disorders believe their problems stem from others or the world in general; they do not recognize their own behavior as the source of difficulty. For these reasons, people with personality disorders are difficult to treat, which may be frustrating for the nurse and other caregivers as well as for family and friends. Many people with personality disorders also have coexisting mental illnesses. Personality Disorders During the revision and development process for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, much discussion surrounded the personality disorder diagnoses. In the end, a proposed hybrid model for personality disorders was not adopted but remains as an alternative section at the back of the manual (Morey, Benson, & Skodel, 2016). Box 18.1 summarizes the hybrid model alternative. BOX 18.1 Hybrid Model for Personality Disorders Personality disorder is a generalized pattern of behaviors, thoughts, and emotions that begins in adolescence, remains stable over time, and cause are characterized by: Impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) Pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism) The personality disorders included in this proposed model are antisocial, borderline, avoidant, narcissistic, obsessive–compulsive, and schizotypal. Adapted from Morey, L. C., Benson, K. T., & Skodel, A. E. (2016). Relating DSM-5 section III personality traits to section II personality disorder diagnoses. Psychological Medicine, 46(3), 647–655. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 1/2 11/27/23, 3:28 AM Realizeit for Student Personality disorder diagnoses are organized according to clusters around a predominant type of behavioral pattern. The clusters and the diagnoses in each are as follows: Cluster A—odd or eccentric behaviors Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder Cluster B—erratic or dramatic behaviors Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder Cluster C—anxious or fearful behaviors Avoidant personality disorder Dependent personality disorder Obsessive personality disorder In psychiatric settings, nurses most often encounter clients with antisocial and borderline personality disorders (BPDs). Clients with antisocial personality disorder may enter a psychiatric setting as part of a court-ordered evaluation or as an alternative to jail. Clients with BPD are often hospitalized because their emotional instability may lead to self-inflicted injuries. Most clients with these disorders are not treated in acute care settings for these personality disorders. Nurses may encounter these clients in any health care setting or in the psychiatric setting when a client is already hospitalized for another major mental illness. Other Behaviors Other clusters of behavior related to maladaptive personality traits include the following: Depressive behavior is characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have major depressive disorders. People with depressive personality disorders often seek treatment for their distress. Passive-aggressive behavior is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. These clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances. Their mood may fluctuate rapidly and erratically, and they may be easily upset or offended. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 2/2