Personality disorders

1. Personality disorders

2. Definition • Enduring patterns • Deviated from expectations • Pervasive & inflexible • Onset in adolescent & early adulthood • Leads to distress and impairment

3. Personality Trait vs. Personality Disorders * Personality : may be described as a persons characteristics totality of emotional and behavioral traits apparent in ordinary life, a totality that is usually stable and predictable. * Personality disorders :are diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress. They usually are not diagnosed until adulthood, when personality is more completely formed.

4. Personality disorders are organized into three clusters: • 1. CLUSTER A: Individuals whose behavior appears odd or eccentric (paranoid, schizoid, and schizotypal personality disorders) • 2.CLUSTER B: Individuals who appear dramatic, emotional, or erratic (antisocial, borderline, histrionic, and narcissistic personality disorders) • 3. CLUSTER C: Individuals who appear anxious or fearful (avoidant, dependent, and obsessive compulsive personality disorders) • NOT SPECIFIED: if not meeting criteria for any personality disorder

5. Epidemiology • 10 – 20% • Borderline PD accounts for 30-60% of all diagnosed PD • 75% of borderline PD are women • Antisocial PD has to be 18 year

6. Etiology • Developmental factors: • Interruption of any task may lead to PD • Children's who are temperamentally fearful may later develop avoidant PD. • High anxiety levels --- avoidant PD 2. Environmental factors: • Some attribution between developmental and environmental factors

7. Etiology cont.. 3. Biogenetic factors: • Students with low MAO spent more time in social activity and sociability. • Low platelet mono amine oxidase levels associated with activity and sociability. • People who exhibit impulsive traits --- show increase levels of testosterone. • Schizotypal --- schizophrenia family • Antisocial personality --- alcohol use • Histrionic personality --- somatization • Borderline personality --- is common in the depressed family. • Brian injury……. Borderline PD

8. DIAGNISTIC CRITERIA

9. PARANOID PERSONALITY • Paranoid personality disorder is characterized by pervasive mistrust and suspiciousness of others. Clients with this disorder interpret others’ actions as potentially harmful. During periods of stress, they may develop transient psychotic symptoms. • Symptoms/Characteristics Mistrust and suspicions of others; guarded, restricted affect

10. Nursing Interventions • Forming an effective working relationship with paranoid or suspicious clients is difficult. The nurse must remember that these clients take everything seriously and are particularly sensitive to the reactions and • motivations of others. Therefore, the nurse must approach these clients in a formal, business-like manner and refrain from social chitchat or jokes. Being on time, keeping commitments, and being particularly • straightforward are essential to the success of the nurse–client relationship. • One of the most effective interventions is helping clients to learn • to validate ideas before taking action; however, this • requires the ability to trust and to listen to one person.

11. SCHIZOID PD: • inability to perform relationship, low interest in establishing any relationship (marriage) • is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. • Clients with schizoid personality disorder display a constricted affect and little, if any, emotion. • They are aloof and indifferent, appearing emotionally cold, uncaring, or unfeeling. They report no leisure or pleasurable activities, because they rarely experience enjoyment. Even under stress or adverse circumstances, their response appears passive and disinterested. • There is marked difficulty experiencing and expressing emotions, particularly anger or aggression. • Clients generally are accomplished intellectually and often involved with computers or electronics in hobbies or work. They may spend long hours solving puzzles or mathematical problems, although they see • these pursuits as useful or productive rather than fun.

12. Nursing intervention • focus on improved functioning in the community. • If a client needs housing or a change in living circumstances, the nurse can make referrals to social services or appropriate local agencies • for assistance. • The nurse can help agency personnel find suitable housing that will accommodate the client’s desire and need for solitude. • Facilities designed to promote socialization through group activities would be less desirable.

13. SCHIZOTYPAL PD • cognitive and perceptual distortion • is characterized by a pervasive pattern of social and interpersonal • deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities. • Clients often have an odd appearance that causes others to notice them. Clothes are ill fitting, do not match, and may be stained or dirty. Clients may be unkempt and disheveled. They may wander aimlessly and at times becosming preoccupied with some environmental detail. Speech is coherent but may be loose, digressive, or vague. • Clients often provide unsatisfactory answers to questions and may be unable to specify or to describe information clearly. They frequently • use words incorrectly, which makes their speech sound bizarre .

14. Nursing intervention • The focus of nursing care for clients with schizotypal personality disorder is development of self-care and social skills and improved functioning in the community. • The nurse encourages clients to establish a daily routine for hygiene and grooming. Such a routine is important rather than depending on the client to decide when hygiene and grooming tasks are necessary. • It is useful for clients to have an appearance that is not bizarre or disheveled, because stares or comments from others can increase discomfort

15. ANTISOCIAL PD • Aggression in all manners Criminal records and multiple sexual relationship

19. BORDERLINE PD • Fear of abandonment • Broke away fearing failure • Acting out

22. HISTRIONIC PD Dramatic emotional expression, seeking attention, wants to impress others • is characterized by a pervasive pattern of excessive emotionality and attention-seeking. • Clients are emotionally expressive, gregarious, • and effusive. They often exaggerate emotions inappropriately. The tendency of these clients to exaggerate the • closeness of relationships or to dramatize relatively • minor occurrences can result in unreliable data. • Speech is usually colorful and theatrical, full of superlative • Adjectives Clients are uncomfortable when they are not the • center of attention and go to great lengths to gain that • status. Clients tend to exaggerate the intimacy of relationships.

23. Nursing interventions • It also may help to discuss social situations to explore • the client’s perceptions of other’s reactions and • behavior. Teaching social skills and role-playing • The nurse must be specific in describing and • modeling social skills including establishing eye contact, • active listening, and respecting personal space. It • also helps to outline topics of discussion appropriate • for casual acquaintances, closer friends or family, and • the nurse only. • It is important to explore personal strengths and assets • and give specific feedback about positive characteristics. • Encouraging clients to use assertive communication, • such as “I” statements, may promote • self-esteem and help them to get their needs met • more appropriately. The nurse must convey genuine • confidence in the client’s abilities.

25. NARCISSISTIC PERSONALITY DISORDER • grandiose self-importance, talk about themselves and neglect others, overreaction for criticism • Clients may display an arrogant or haughty attitude. • They lack the ability to recognize or to empathize with the feelings of others. They may express envy and begrudge others any recognition or material success because they believe it rightfully should be theirs. Clients tend to disparage, belittle, or discount the feelings of others. They may express their grandiosity overtly, or they quietly may expect to be recognized for their perceived greatness. They often are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. These fantasies reinforce their sense of superiority. Clients may ruminate about long-overdue admiration and privilege and compare themselves favorably with famous or privileged people.

26. Nursing interventions • The nurse must use self-awareness skills to avoid the anger and frustration that their behavior and attitude can engender. • Clients may be rude and arrogant, unwilling to wait, and harsh and critical of the nurse. • The nurse must not internalize such criticism or take it personally. • The goal is to gain cooperation of these clients with other treatment as indicated.

27. AVOIDANT PD Low self-esteem, and fear of rejection. • is characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation. • Clients have very low self-esteem. They are hypersensitive to negative evaluation from others and readily believe themselves inferior. Clients are reluctant to do anything perceived as risky, which for them is almost anything. They are fearful and convinced that they will make a mistake, be humiliated, or embarrass themselves and others. Because they are unusually fearful of rejection, criticism, shame, or disapproval, they tend to avoid situations or relationships that may result in these feelings. They usually strongly desire social acceptance and human companionship: • they wish for closeness and intimacy but fear possible rejection and humiliation.

28. NURSING INTERVENTIONS • Nursing InterventionsThese clients require much support and reassurancefrom the nurse. In the non threatening context of therelationship, the nurse can help them to explore positiveself-aspects, positive responses from others, andpossible reasons for self-criticism. Helping clients topractice self-affirmations and positive self-talk maybe useful in promoting self-esteem. Other cognitiverestructuring techniques, such as reframing and decatastrophizing(described previously), can enhanceself-worth. The nurse can teach social skills and helpclients to practice them in the safety of the nurse–client relationship.

29. DEPENDENT PD Excessive reliance on others for social support, fear separation and avoided responsibilities. • is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. • These behaviors are designed to elicit caretaking from others. • Clients are frequently anxious and may be mildly uncomfortable. • They are often pessimistic and selfcritical; other people hurt their feelings easily. They commonly report feeling unhappy or depressed; this is associated most likely with the actual or threatened loss of support from another. • They are preoccupied excessively with unrealistic fears of being left alone to care for themselves. • They believe they would fail on their own, so keeping or finding a relationship occupies much of their time

30. NURSING INTERVENTIONS • The nurse must help clients to express feelings of grief and loss over the end of a relationship while fostering autonomy and self-reliance. • Helping clients to identify their strengths and needs is more helpful • than encouraging the overwhelming belief that “I can’t do anything alone!” Cognitive restructuring techniques such as reframing and decatastrophizing may be beneficial. • The nurse also may need to teach problem-solving • and decision-making and help clients apply them to • daily life • The nurse can help the client to explore problems, serve as a • sounding board for discussion of alternatives, and • provide support and positive feedback for the client’s • efforts in these areas.