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Chapter 20. Personality Disorders Part I. Introduction. Personality traits are enduring patterns of: Perceiving Relating to Thinking about the environment and oneself. Introduction (cont.). Personality disorders occur when these traits become Inflexible Maladaptive

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Chapter 20 l.jpg

Chapter 20

Personality Disorders

Part I

Introduction l.jpg

  • Personality traits are enduring patterns of:

    • Perceiving

    • Relating to

    • Thinking about

      the environment and oneself.

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Introduction (cont.)

  • Personality disorders occur when these traits become

    • Inflexible

    • Maladaptive

    • The cause of significant functional impairment or subjective distress

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Introduction (cont.)

  • Personality development occurs in response to a number of biological and psychological influences, such as

    • Heredity

    • Temperament

    • Experiential learning

    • Social interaction

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Introduction (cont.)

  • People with personality disorders are not often treated in acute care settings, for which personality disorder is their primary psychiatric disorder.

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Introduction (cont.)

  • Many clients with other psychiatric and medical diagnoses manifest symptoms of personality disorders.

  • Nurses are likely to frequently encounter clients with these personality characteristics in all healthcare settings.

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Personality Disorders

  • Cluster A: Behaviors that are described as odd or eccentric

    • Paranoid personality disorder

    • Schizoid personality disorder

    • Schizotypal personality disorder

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Personality Disorders (cont.)

  • Cluster B: Behaviors that are described as dramatic, emotional, or erratic

    • Antisocial personality disorder

    • Borderline personality disorder

    • Histrionic personality disorder

    • Narcissistic personality disorder

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Personality Disorders (cont.)

  • Cluster C: Behaviors that are described as anxious or fearful

    • Avoidant personality disorder

    • Dependent personality disorder

    • Obsessive-compulsive personality disorder

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Types of Personality Disorders

  • Paranoid

    • Definition: A pervasive distrust and suspiciousness such that the motives of others are interpreted as malevolent; condition begins by early adulthood and presents in a variety of contexts

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  • Disorder is more common in men than in women.

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Paranoid (cont.)

  • Clinical Picture

    • Constantly on guard

    • Hypervigilant

    • Ready for any real or imagined threat

    • Trusts no one

    • Constantly tests the honesty of others

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Paranoid (cont.)

  • Clinical Picture (cont.)

    • Oversensitive

    • Tends to misinterpret minute cues

    • Magnifies and distorts cues in the environment

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Paranoid (cont.)

  • Etiological Implications

    • Possible hereditary link

    • Subject to early parental antagonism and aggression

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  • Definition

    • Characterized primarily by a profound defect in the ability to form personal relationships

    • Failure to respond to others in a meaningful emotional way

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Schizoid (cont.)

  • Definition (cont.)

    • Diagnosis occurs more frequently in men than in women.

    • Prevalence within the general population has been estimated at 3% to 7.5%.

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Schizoid (cont.)

  • Clinical Picture

    • Indifferent to others

    • Client aloof

    • Client emotionally cold

    • In presence of others, clients appear shy, anxious, or uneasy

    • Inappropriately serious about everything and have difficulty acting in a light-hearted manner

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Schizoid (cont.)

  • Etiological Implications

    • Possible hereditary factor

    • Childhood has been characterized as

      • Bleak

      • Cold

      • Unempathic

      • Notably lacking in nurturing

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  • Definition

    • A graver form of the pathologically less severe schizoid personality pattern

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Schizotypal (cont.)

  • Definition (cont.)

    • Recent studies indicate that approximately 3% of the population has this disorder.

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Schizotypal (cont.)

  • Clinical Picture

    • Clients aloof and isolated

    • Behave in a bland and apathetic manner

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Schizotypal (cont.)

  • Clinical Picture (cont.)

    • Everyday world manifests

      • Magical thinking

      • Ideas of reference

      • Illusions

      • Depersonalization

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Schizotypal (cont.)

  • Clinical Picture (cont.)

    • Exhibits bizarre speech pattern

    • When under stress, may decompensate and demonstrate psychotic symptoms

    • Demonstrates bland, inappropriate affect

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Schizotypal (cont.)

  • Etiological Implications

    • Possible hereditary factor

    • Possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain

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Schizotypal (cont.)

  • Etiological Implications (cont.)

    • Early family dynamics characterized by:

      • Indifference

      • Impassivity

      • Formality

      • Pattern of discomfort with personal affection and closeness

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Types of Personality Disorders

  • Antisocial

    • Definition

      • A pattern of

        • Socially irresponsible

        • Exploitative

        • Guiltless behavior

          that reflects a disregard for the rights of others.

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  • Clinical Picture

    • Fails to sustain consistent employment

    • Exploits and manipulates others for personal gain

    • Has a general disregard for the law

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Antisocial (cont.)

  • Definition

    • Prevalence estimates in the United States range from 3% in men to less than 1% in women.

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Types of Personality Disorders

  • Borderline

    • Definition

      • Characterized by a pattern of intense and chaotic relationships with affective instability

      • Clients have fluctuating and extreme attitudes regarding other people

      • Clients highly impulsive

Borderline l.jpg

  • Definition (cont.)

    • Most common form of personality disorder

    • Emotionally unstable

    • Lacks a clear sense of identity

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  • Definition (cont.)

    • Personality is

      • Excitable

      • Emotional

      • Colorful

      • Dramatic

      • Extroverted in behavior

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Histrionic (cont.)

  • Definition (cont.)

    • Prevalence thought to be about 2% to 3%

    • More common in women than men

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Histrionic (cont.)

  • Clinical picture

    • Affected clients are

      • Self-dramatizing

      • Attention-seeking

      • Overly gregarious

      • Seductive

      • Manipulative

      • Exhibitionistic

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Histrionic (cont.)

  • Clinical picture (cont.)

    • Affected clients (cont.)

      • Are highly distractible

      • Have difficulty paying attention to detail

      • Are easily influenced by others

      • Have difficulty forming

        close relationships

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Histrionic (cont.)

  • Etiological Implications

    • Possible link to the dopaminergic neurotransmitter system

    • Possible hereditary factor

    • Learned behavior patterns

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  • Definition

    • Characterized by an exaggerated sense of self-worth

    • Lacks empathy

    • Believes has inalienable right to receive special consideration

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Narcissistic (cont.)

  • Definition

    • Prevalence of the disorder from 2% to 16% in the clinical population

    • Less than 1% in the general population is narcissistic

    • Disorder more common in men than women

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Narcissistic (cont.)

  • Clinical Picture

    • Client overly self-centered

    • Exploits others in an effort to fulfill own desires

    • Mood, which is often grounded in grandiosity, is usually optimistic

    • Client relaxed, cheerful,and care-free

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Narcissistic (cont.)

  • Clinical picture (cont.)

    • Mood can easily change because of fragile self-esteem if client does not

      • Meet self-expectations

      • Receive positive feedback expected from others

    • Responds to negative feedback from others with rage, shame, and humiliation

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Narcissistic (cont.)

  • Etiological Implications

    • As children, these people have had their fears, failures, or dependency needs responded to with criticism, disdain, or neglect.

    • Parents were often narcissistic themselves.

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  • Definition

    • Characterized by

      • Extreme sensitivity to rejection

      • Social withdrawal

    • Prevalence is between 0.5% and 1% and is equally common in both men and women.

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Avoidant (cont.)

  • Clinical Picture

    • Awkward and uncomfortable in social situations

    • Desires close relationships but avoid them because of fear of being rejected

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Avoidant (cont.)

  • Etiological Implications

    • Possible hereditary influences

    • Parental rejection and criticism

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  • Definition

    • Characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

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Dependent (cont.)

  • Definition (cont.)

    • Relatively common within the population

    • More common among women than men

    • More common in the youngest children of a family than in the oldest ones

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Dependent (cont.)

  • Clinical Picture

    • Client has a notable lack ofself-confidence that is often apparent in

      • Posture

      • Voice

      • Mannerisms

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Dependent (cont.)

  • Clinical Picture (cont.)

    • Typically passive and acquiescent to desires of others

    • Overly generous and thoughtful while underplaying own attractiveness and achievements

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Dependent (cont.)

  • Clinical Picture (cont.)

    • Assumes passive and submissive roles in relationships

    • Avoids positions of responsibility and becomes anxious when forced into them

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Dependent (cont.)

  • Etiological Implications

    • Possible hereditary influence

    • Stimulation and nurturance are experienced exclusively from one source

    • A singular attachment is made by the infant to the exclusion of all others

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Personality Disorders

  • Obsessive/Compulsive

    • Definition

      • Characterized by inflexibilityabout the way in which things must be done

      • Devotion to productivity at the exclusion of personal pleasure

Obsessive compulsive l.jpg

  • Definition

    • Relatively common and occurs more often in men than women

    • Within family constellation, appears to be most common in the oldest children

Obsessive compulsive cont l.jpg
Obsessive-Compulsive (cont.)

  • Clinical Picture

    • Especially concerned with matters of organization and efficiency

    • Tends to be rigid and unbending

    • Client polite and formal

    • Client rank-conscious (ingratiating with authority figures)

Obsessive compulsive cont53 l.jpg
Obsessive-Compulsive (cont.)

  • Clinical Picture (cont.)

    • Appears to be very calm and controlled

    • Underneath there is a great deal of

      • Ambivalence

      • Conflict

      • Hostility

Obsessive compulsive cont54 l.jpg
Obsessive-Compulsive (cont.)

  • Etiological Implications

    • Overcontrol by parents

    • Notable parental lack of positive reinforcement for acceptable behavior

    • Frequent punishment for undesirable behavior

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  • Definition

    • Exhibits a pervasive pattern of negativistic attitudes and passive resistance

    • Reacts badly to demands for adequate performance in social and occupational situations

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Passive-Aggressive (cont.)

  • Clinical Picture

    • Exhibits passive resistance

    • Exhibits general obstructiveness

    • Commonly switches among the roles of the martyr, the affronted, the aggrieved,

      the misunderstood, the contrite,

      the guilt-ridden, the sickly, and the


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Passive-Aggressive (cont.)

  • Clinical Picture (cont.)

    • Able to vent anger and resentment subtly while gaining the attention, reassurance, and dependency that are craved

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Passive-Aggressive (cont.)

  • Etiological Implications

    • Contradictory parental attitudes and behavior are implicated in predisposition to passive-aggressive personality disorder