Personality Disorders PDF

11/27/23, 3:36 AM Realizeit for Student Summary 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. Individuals have identity problems such as ego-centrism, or being self...

11/27/23, 3:36 AM Realizeit for Student Summary 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. Individuals have identity problems such as ego-centrism, 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. 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. Clients with personality disorders have a higher death rate, especially as a result of suicide; they also have higher rates of suicide attempts, accidents, and emergency department visits, and increased rates of separation, divorce, and involvement in legal proceedings regarding child custody. Personality disorders have been highly correlated with criminal behavior, alcoholism, and drug abuse. The difficulties associated with personality disorders persist throughout young and middle adulthood but tend to diminish in the 40s and 50s. Those with antisocial personality disorder are less likely to engage in criminal behavior, though problems with substance abuse and disregard for the feelings of others persist. The four temperament traits are harm avoidance, novelty seeking, reward dependence, and persistence. Each of these four genetically influenced traits affects a person’s automatic responses to certain situations. These response patterns are ingrained by 2 to 3 years of age. Combinations of medication and group and individual therapies are more likely to be effective than is any single treatment. Not all people with personality disorders seek treatment, however, even when significant others or family members urge them to do so. Typically, people with schizotypal, narcissistic, or obsessive–compulsive personality disorders are least likely to engage or remain in any treatment. Therapy helpful to clients with personality disorders varies according to the type and severity of symptoms and the particular disorder. People with personality disorders have traits that are inflexible and maladaptive and cause either significant functional impairment or subjective distress. Personality disorders are relatively common and diagnosed in early adulthood, though some behaviors are evident in childhood or adolescence. Rapid or substantial changes in personality are unlikely. This can be a primary source of frustration for family members, friends, and health care professionals. Schizotypal personality disorder is characterized by social and interpersonal deficits, cognitive and perceptual distortions, and eccentric behavior. People with antisocial personality disorder often appear glib and charming, but they are suspicious, insensitive, and uncaring and often exploit others for their own gain. People with BPD have markedly unstable mood, affect, self-image, interpersonal relationships, and impulsivity; they often engage in self-harm behavior. People with obsessive–compulsive personality disorder are preoccupied with orderliness, perfection, and interpersonal control at the expense of flexibility, openness, and efficiency. Narcissistic personality disorder is characterized by grandiosity, need for admiration, lack of empathy for others, and a sense of entitlement. Avoidant personality disorder is characterized by social discomfort and reticence in all situations, low self-esteem, and hypersensitivity to negative evaluation. The therapeutic relationship is crucial in caring for clients with personality disorders. Nurses can help clients identify their feelings and dysfunctional behaviors and develop appropriate coping skills and positive behaviors. Therapeutic communication and role modeling help promote appropriate social interactions, which help improve interpersonal relationships. Several therapeutic strategies are effective when working with clients with personality disorders. Cognitive restructuring techniques such as thought stopping, positive self-talk, and decatastrophizing are useful; self-help skills aid the client in functioning better in the community. Clients with BPD often have self-harm urges that they enact by cutting, burning, or punching themselves; this behavior sometimes causes permanent physical damage. The nurse can encourage the client to enter into a no-self-harm contract in which the client promises to try to keep from harming him or herself and to report to the nurse when he or she is having self-harm urges. Nurses must use self-awareness skills to minimize client manipulation and deal with feelings of frustration. Psychotropic medications are prescribed for clients with personality disorders based on the type and severity of symptoms the client experiences in aggression and impulsivity, mood dysregulation, anxiety, and psychotic symptoms. Lithium, anticonvulsant mood stabilizers, low dose neuroleptics, and benzodiazepines are used most often to treat aggression. Short-term therapy with antipsychotics may be useful for transient psychotic symptoms such as those seen in some clients specifically with borderline personality disorder. Mood dysregulation symptoms include emotional instability, emotional detachment, depression, and dysphoria. Emotional instability and mood swings respond favorably to lithium, carbamazepine (Tegretol), valproate (Depakote), or low-dose neuroleptics such as haloperidol (Haldol). Emotional detachment, cold and aloof emotions, and disinterest in social relations often respond to selective serotonin reuptake inhibitors (SSRIs) or atypical antipsychotics such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical depression is often treated with SSRIs, monoamine oxidase inhibitor (MAOI) antidepressants, or low-dose antipsychotic medications. Anxiety seen with personality disorders may be chronic cognitive anxiety, chronic somatic anxiety, or severe acute anxiety. Chronic cognitive anxiety responds to SSRIs and MAOIs, as does chronic somatic anxiety or anxiety manifested as multiple physical complaints. Episodes of https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 1/2 11/27/23, 3:36 AM Realizeit for Student severe acute anxiety are best treated with MAOIs or low-dose antipsychotic medications. Acute assessment and symptomatic management are essential for care of this client population. Personality Disorder Symptoms/Characteristics Paranoid Mistrust and suspicions of others; guarded, restricted affect Schizoid Schizotypal Antisocial Detached from social relationships; restricted affect; involved with things more than people Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior Disregard for rights of others, rules, and laws Nursing Interventions Serious, straightforward approach; teach client to valid involve client in treatment planning Improve client’s functioning in the community; assist c Develop self-care skills; improve community functionin Limit setting; confrontation; teach client to solve proble emotions of anger or frustration Unstable relationships, self-image, and affect; impulsivity; self- Promote safety; help client to cope and control emotio mutilation techniques; structure time; teach social skills Histrionic Excessive emotionality and attention seeking Teach social skills; provide factual feedback about beh Narcissistic Grandiose; lack of empathy; need for admiration Borderline Avoidant Dependent Obsessive– compulsive Social inhibitions; feelings of inadequacy; hypersensitive to negative evaluation Submissive and clinging behavior; excessive need to be taken care of Preoccupation with orderliness, perfectionism, and control Matter-of-fact approach; gain cooperation with needed needed self-care skills Support and reassurance; cognitive restructuring tech Foster client’s self-reliance and autonomy; teach probl skills; cognitive restructuring techniques Encourage negotiation with others; assist client in mak work; cognitive restructuring techniques https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IVtCtaoun4KMdegul%2fePt%2bh9MMaIFoYvxFjmrRvhyUR… 2/2