Personality Disorders PDF

Personality disorders By: Mohamed Mustafa Abdullah Personality disorders Definition : Disorders characterized by an enduring, deeply ingrained pervasive and inflexible pattern of inner experience and behavior, which are maladaptive in the individual’s culture and lead to di...

Personality disorders By: Mohamed Mustafa Abdullah Personality disorders Definition : Disorders characterized by an enduring, deeply ingrained pervasive and inflexible pattern of inner experience and behavior, which are maladaptive in the individual’s culture and lead to distress or impairment of work or social functioning.  Etiology Exact unknown – may vary between types. Biological: – genetics (e.g. D4DR gene related to novelty-seeking behaviour) – abnormal brain maturation during early years in life – underactive autonomic nervous system Risk factors: General: – social reinforcement of abnormal behaviours – low social class – poor parenting – disrupted/arrested psychic development Borderline personality disorder – dysfunctional families, sexual abuse.  Epidimiology 3–5% of adult population have a PD. Age of onset: adolescence/early adulthood.  :History Maladaptions may manifest as: Cognitions Affectivity control over impulses and gratification of needs manner of relating to others handling of interpersonal situations manner of handling stress  :Clusters PDs are divided into 3 clusters. A: Odd/Eccentric 1. Paranoid – sensitivity, suspicious, self-reference, bears grudges, jealous. 2. Schizoid – cold, aloof, lacks social norms, withdrawn and detached, little interest in sexual experience. 3. Schizo-typal Personality Disorder: Odd beliefs, and eccentricities of appearance, behavior, interpersonal style, and thought (e.g., belief in psychic phenomena and having magical powers).  B: Dramatic/Emotional 1. Histrionic – egocentric, shallow mood, self-dramatisation – likes to be centre of attention. 2. Dissocial –(antisocial) No tolerance. Blames others. No guilt, callous unconcern for others, irritability, tendency to violence (also known as psychopathic disorder, psychopathy, sociopathy). 3. Emotionally unstable: (A) impulsive – inability to plan ahead, unstable mood etc. (B) borderline –  4. Narcissistic Personality Disorder: Behavior or a fantasy of grandiosity, a lack of empathy, a need to be admired by others, an inability to see the viewpoints of others, and hypersensitive to the opinions of others.  C: Fearful/Anxious 1. Anankastic – obsessional, pedantic, perfectionist, cautious, needs to plan ahead with meticulous detail. 2. Dependent – needs reassurance, will not take responsibility, feels inadequacy, fear of abandonment. 3. Anxious – feeling of tension and apprehension, fear of criticism or rejection, self-conscious.  :Investigations Personality Diagnostic Questionnaire (PDQ), Structured Clinical Interview for PD (SCIPD), Standardised Assessment of Personality (SAP), International Personality Disorder Examination (IPDE). MRI to exclude organic causes of personality change, e.g. frontal lobe tumour, subdural haematoma.  :Management (1) Careful assessment should be conducted – need collateral history. (2) Treatment of comorbid psychiatric disorders, e.g. depression. (3) Psychotherapies: dynamic/CBT; individual/group therapy. (4) Drug therapies: low-dose antipsychotics for ideas of reference, impulsivity and intensely angry affect. Antidepressants may be useful in borderline personality disorder. Carbamazepine lithium may be used for episodic behavioural dyscontrol and aggression. (5) May require detention under MHA if Complications: Subjective distress. Adverse effects on relationships/society. Alcohol and substance abuse. Increased suicide risk. Prognosis: There is evidence that cluster B mature with time. Likely to impair social or work functioning. NURSING PROCESS Assessment : some of the techniques may include: Use direct questions to find out what events or behavior led to the admission. Assess thought processes for content and clarity. Determine social habits and relationships. Note any scars and cuts, ask about suicidal thoughts. Ask about usual coping methods and note any resistance to questioning or indication of impulsive reaction to requested information.  Nursing diagnoses: Social isolation R/T suspicious view of others. Anxiety R/T unconscious conflicts. Disturbed personal identity R/T social withdrawal. Self directed violence R/T self mutilating behaviors. Powerlessness R/T extreme feelings of dependency. EXPECTED OUTCOMES Increases interaction with others. Exhibits relaxed posture. Expresses thoughts and feelings appropriately. Refrains from harming self or others. Makes independent decisions about self care.  INTERVENTIONS Show acceptance of the person at all times by separating the person from behaviors. Provide a safe environment. Require client to take responsibility for their actions. Encourage client to openly express feelings. Identify triggers of acting out behaviour. Provide positive feedback to clients who are making efforts to change behaviour. Approach clients from the front and speak clearly.