Self Personality Disorders Presentation PDF

Self Personality Disorders Self 0 0 0 1 Self-Awareness 2 Self-Esteem 3 Self Conce...

Self Personality Disorders Self 0 0 0 1 Self-Awareness 2 Self-Esteem 3 Self Concept Introspection The degree to which an Body image, role individual likes or values performance, personal Exploration of thoughts, themselves identity behaviours, emotions, and values Issues may be: Ego Syntonic Ego Dystonic The person experiencing The person experiencing the problem doesn’t think the problem is aware of they have a problem and distressed about their (typical of personality problems (ex: Obsessive disorders) Compulsive Disorder) Personality Your personality summarizes your personality traits; how you think and act. Your personality evolves over time. Is your personality the same as it was 5 years ago? When those traits are harmful and negatively impact life, work, and social interactions, it is indicative of a personality disorder. How would you describe your personality? Describe yourself to the When is a personality disorder diagnosed? Think TIDE Traits become Inflexible, Disabling, and/or Extreme  5 main personality traits Openness Are you open or closed to new experiences? Conscientiousness Antagonism vs adherence. Can you control impulses? Extroversion Extrovert vs. introvert Agreeableness Generosity/amiability vs. aggressiveness/temper. How do you interact with others? Neuroticism Emotional stability vs dysregulation. May encompass anxiety, moodiness, confidence, security, etc. Risk Factors for PD Genetic Environmental Neurobiological factors factors factors Tend to run in families Exposure to trauma and Certain neurotransmitters Little data abuse may regulate or influence Perception of events temperament Low socioeconomic status Some brain size and functional differences in some PD cases  Thoughts What do we know? and emotions Personality disorders are a challenging and complex group of disorders Managing impulses Although each disorder is unique, they all have difficulty with: Participation in interpersonal relationships Cluster A Behaviour is characterized as Odd Reclusive Eccentric Most at risk for Cluster A Men Having a Young age relative with and schizophrenia adolescence  Paranoid Personality Disorder (accusatory) Prevalence Defining Characteristics 2-4% of population Strong distrust and suspicion Assume others will disappoint them; often a self-fulfilling prophecy Only able to maintain superficial relationships Use projection as a defense mechanism Severe reaction to being lied to; hold intense grudges Very hostile and hypervigilant  of Paranoid PD Nursing Considerations Unlikely to accept treatment Be clear and straightforward Stick to promises, appointments, and schedules Set limits on threatening behaviours Deal with accusations in a realistic manner without humiliation Therapy Psychotherapy is the first line treatment; focus on development of trust Pharmacology Antianxiety(valium) and antipsychotic (haloperidol) medications may help with delusional thinking or severe agitation. Schizoid Personality Disorder (aloof) Prevalence Defining Characteristics 5% of the population Disinterest in social interactions Lifelong pattern of social withdrawal Loners, generally poor school performance, victims of bullying Have imaginary friends or fantasies Don’t enjoy physical contact Flat affect May feel like an ‘observer’ in life  Treatment Nursing Considerations Avoid being overly friendly and do not force socialization Protect from ridicule from group members Therapy Treatment with psychotherapy; very introspective and often do well in therapy Open up as trust develops Therapy may improve sensitivity to social clues Schizotypal Personality Disorder (awkward) Prevalence Defining Characteristics 0.6-4.6% of population Withdrawn and alone Socially detached Use magical thinking Strikingly unusual; odd speech patterns, inappropriate affect Overconfidence and self-centred speech; poor at gauging other’s perspectives WANT social relationships, but unable to maintain them (different from schizoid) Both a PD and a schizophrenia spectrum disorder Extreme social anxiety and suspicions of others  Treatment of Schizotypal PD Nursing Considerations Respect their need for social isolation Be aware of suspicions Be respectful that they may have odd beliefs and activities as a part of everyday life Therapy Psychotherapy; may be involved in cults or unusual religious groups so interview cautiously Pharmacology Antipsychotic medications help with symptom management Antidepressants and antianxiety medications help with comorbid symptoms Cluster B Behaviour is characterized as Impulsive Dramatic Antisocial Personality Disorder (Psycho/Sociopathy) Prevalence Defining 0.2-3.3% of the population Characteristics Impulsive, manipulative for personal gain Overrepresented in the prison Disregard for rights of others population No remorse Women are likely May be verbally charming, but can quickly underdiagnosed turn violent Cannot be diagnosed until 18 Poor impulse control years of age AND a history of Often begins with excessive lying, fighting, conduct disorder stealing, violence, and manipulation from Risk with caregiver with ASPD or young age alcoholism and victim of child abuse Treatment for Antisocial PD Nursing Considerations Conduct an assessment of life stressors, history of violent thoughts, behaviours, and substance abuse be aware of distrust, hostility, and inability to connect and its effect on therapeutic relationships. Actively listen. provide consistency, support, boundaries, and limits; we can’t allow manipulation be aware admission is often involuntary Therapy Often long and intense therapy; reluctant to participate Anger-management therapy Pharmacology None approved but some evidence to support mood stabilizers, and antipsychotics Table of contents 01 02 03 The disease and its People at risk Risk factors symptoms 04 05 06 Available Disease prevention Conclusion treatments and control Borderline Personality Disorder Prevalence Defining 5.9% in general population Characteristics High mortality rate 20% in inpatient psychiatric care Unstable moods; intense joy to rage More common in women Impulsive 5x more likely to develop if a first Depression degree relative has BPD Splitting Higher incidence of childhood sexual Men more likely experience substance trauma abuse, women more likely to self harm and Higher rate in those who suffer verbal lead to hospitalization abuse from a parent Physical violence, hostility, irritability Risk with early abandonment Maladaptive coping strategies Associated with self-mutilation Seek out help for anxiety, depression, suicidality, self-harming  Splitting 100% good 100% bad Treatment of BorderlineNursing PD Considerations Therapeutic relationship is essential Beware of splitting; may try to pit staff against one another Thorough assessment of risk of harm Set realistic outcomes Clear, consistent boundaries and limits Change nursing assignment often to avoid attachment Therapy Dialectical Behaviour Therapy helpful with a healthy therapeutic relationship Schema-focused Pharmacology Anti-depressants, lithium, and anticonvulsants for mood and emotional dysregulation Naltrexone may help with self-injury behaviours Schema Therapy Combination of CBT with other psychotherapy to change self- perception Aims to help clients view themselves differently so they can create new and more effective interactions with their environment and others Histrionic Personality Disorder Prevalence Defining 2% of the population Characteristics Want to be the centre of attention Less common in Asian cultures Big, dramatic personality Difficulty developing meaningful relationships Exaggerated or shallow emotional expression Seek constant gratification Manipulate for attention Strong sense of inadequacy and helplessness May have highly sexualized behaviour Speech vague Treatment of Histrionic PD Nursing Considerations Understand that seductive behaviour may be in response to distress Keep communication professional Encourage concrete language Assess for suicidal ideation or self-harm Therapy Individual psychotherapy to promote clarification of inner feelings and expressions Group therapy unlikely to be appropriate Pharmacology Antidepressants of antianxiety medications helpful for comorbid symptoms Antipsychotics if suffering from derealization Narcissistic Personality Disorder Prevalence Defining 0.1-6% of the population Characteristics Believe they are perfect Familial tendency Act entitled, arrogant, and grandiose More common in men Have an intense fear of abandonment Risk with childhood neglect and Antagonistic criticism Tolerate rejection poorly Common in conjunction with Attempt to maintain self-esteem through substance abuse disorders, admiration feeding and eating disorders, and Lack empathy depression Fragile and low self-esteem  Treatment of Narcissistic PD Nursing Considerations Remain neutral; recognize behaviour stems from shame and fear of abandonment Avoid power struggles or becoming defensive Role model empathy; allow them to practice interactions without your nurse/patient relationship Therapy Unlikely to participate as they do not see themselves as the issue. More likely to be involved in couples or family therapy Cognitive behavioural therapy most helpful with faulty thinking Family therapy to help family cope with stress Cognitive Behavioural Therapy CBT combines cognitive aspects to change negative/distorted thoughts and beliefs with behavioural aspects to alter problematic action patterns Focus on skill training and problem solving Therapist guides to assist recognition of harmful ways of thinking and analyzing and reinterpreting past and current experiences to adopt positive behaviours and interactions Provides a supportive setting to explore anxieties or fears Family Therapy Family therapy helps to educate about the disorder and how to improve interactions and support the client Cluster C Behaviour is characterized as Anxious Fearful Avoidant Personality Disorder (cowardly) Prevalence Defining 2.4% of the population Characteristics Avoid social interactions Equal in men and women Fear ridicule Risk with parental and peer Overly concerned about looking foolish rejection and criticism Shy, timid, socially inhibited May have early symptoms in They want close relationships childhood that increase during Intense fear of social situations adolescence and early adulthood Hypersensitive to rejection/negative feedback Feel inferior to peers Few relationships that aren’t familial Treatment of Avoidant PD Nursing Considerations Be friendly but do not push into social situations Convey acceptance of fears Provide with opportunities to advance social skills but do so with caution; failure can increase feelings of worthlessness Therapy CBT is helpful with processing anxiety- provoking symptoms and assertiveness Social skills training Pharmacology None approved, but may have some relief with antianxiety and antidepressant medication for comorbidities Obsessive Compulsive Personality Disorder (Compulsive) Prevalence Defining 2.1-7.9% of population Characteristics Strive for perfection More common in men Inflexible rule followers Oldest siblings more likely Preoccupation with orderliness, Risk with excessive parental Perfectionism, control, rules, details, criticism and control and schedules First degree relative Inefficient as so much time on planning Limited emotional expression Controlling in relationships Extreme fear of mistakes Different from OCD  Treatment of OCPD Nursing Considerations Guard against power struggles; the need for control is high Have difficulty with unexpected changes Provide structure Help them accept less than perfect and relinquish control Therapy Focus on coping skills and anxiety with CBT Pharmacology Clomipramine is helpful is reducing obsessions, anxiety and depression Fluoxetine also proven to be helpful Dependent Personality Disorder (clingy) Prevalence Defining 0.5% of population (rare) Characteristics Extreme dependency in relationships and Risk with chronic physical illness fear of separation or punishment for independence Seek out dominant personalities in childhood See themselves as “dumb” or “inadequate” Cling to relationships Often trapped in a cycle of abuse Submissive  Treatment of Dependent PD Nursing Considerations Identify stressors Beware of counter-transference Role model assertiveness Therapy Psychotherapy is first choice of treatment. CBT helps with healthy, accurate thinking and attitudes Pharmacology Antidepressants and antianxiety medications for symptom management Tricyclic antidepressants (imipramine) helpful for panic attacks Monitor for medication dependence  “When was the last time you were Assessment upset? What upset you? How did you handle it? Semi-structured interviews Often lack insight and trust “How do others describe you?” May possess poor communication skills Ask how others might describe them “How would you describe yourself?” Assess work history, behaviour problems, violence history, drug use “What do you like about yourself? What Use open-ended questions would you like to change?” Rule out non-psychiatric illness Assure safety “How do you usually relate to others?” Typical Interview Highlights Assure safety! Assessment Determine medical Take background into (physical and or psychiatric history consideration mental) that may be responsible Determine if recent Evaluate for recent changes in life or late changes to personality Diagnosis Often go underdiagnosed Traits may develop early but are unlikely to be diagnosed before adulthood. Personality is still developing in childhood, but early intervention may help. Do not try to diagnose during an active phase of another illness; traits are amplified during crisis or illness Maintaining Boundaries Personal life Confidentiality Focus on client needs Ensure confidentiality Share limited details about Discuss only relevant background information aspects of client condition with health care team Professionalism Respect Keep interactions within Respect the institution, the clinical setting work policies, and other Interact during scheduled members of the HC team duty hours for professional purposes  Anger Control Determine expectations for expression of anger Limit frustrating situations until able to better cope Encourage assistance if increasing frustration Keep safety a priority Provide physical outlets for expression of anger (punching bag, sports, writing, journaling) Assist in identifying triggers for anger Identify function of anger, frustration, and rage Identify consequences of inappropriate expression of anger Impulse Control Identify the problem or situation requiring thoughtful action Assess in identifying course of possible action with costs and benefits Teach to “stop and think” Assist in evaluating outcomes Use positive reinforcement for positive outcomes Provide opportunities for problem solving in therapeutic environment and beyond  The nurse is reviewing the chart to prepare a plan of care. Progress Notes May 26: Client attended outpatient community mental health program and reveals a complicated past. He was abandoned by his mother at the age of 8 years and fell into the foster system never being adopted or having a family of his own. He said, “I did not realize what love was until I became a parent five years ago. I try to be happy but I cannot seem to find it. I get angry at my partner quickly for silly things. When I come home from work the house is a mess and she does not work. I take my frustration out on her. I see that after the fight but at the time, I explode at her. I have hit her in the past. Several times. She does not deserve that. I scare her. I scare my son. I want to be a better father. I am trying but it doesn’t seem to be helping. That is why I am here. It is court ordered to attend these sessions because of my anger. I cannot keep a job. I bounce from one job to another. I know I need to support my family. I will not do what my mother did to me. I feel helpless most times.” Client states that he uses cannabis recreationally approximately 3-5 times per week and drinks approximately 26 ounces of whiskey on the weekend. They have used the food bank several times a month for the last six months. Client was overheard commenting on the clothing of the unit clerk and said, “She flirted with him when he walked in and he would have no problem getting her into bed.” Client was reprimanded immediately for that type of inappropriate language and he denied saying anything to the other group member despite being heard by writer. Actions to Take Parameters to Monitor Assess risk for suicide Potential Conditions Family group therapy Administer valium Borderline personality progress (anticonvulsant) disorder Effectiveness of Avoid being “too nice” to Avoidant personality mindfulness and relaxation patient disorder techniques Initiate peripheral Schizotypal Regulation of limits in life intravenous personality disorder Improvement to emotional Initiate therapeutic Narcissistic expressiveness relationship with patient personality disorder Depression The nurse is caring for a client with Cluster B personality disorder. The nurse expects to note which client behaviors specifically associated with this diagnosis? Select all that apply. A. Marked impulsivity B. Submissive behaviour C. Excessive need to be taken care of D. Instability of personal relationships E. Detachment from social relationships F. Restricted range of emotional expression Activity (~30 minutes) Open up your moodle and see the personality trait document. Determine which personality disorder each party guest is most likely to have based on their traits and what interventions may be appropriate. Discuss in small groups of (~4) and then we will discuss as a larger group.