Chapter 12 Personality Disorders. Characteristics of Personality Disorders. Deeply ingrained, inflexible, maladaptive patterns of behavior Most apparent in interpersonal and social relationships Capacity to cause extreme irritation and annoyance in others Consistent and constant symptoms.
Characteristics of Personality Disorders • Deeply ingrained, inflexible, maladaptive patterns of behavior • Most apparent in interpersonal and social relationships • Capacity to cause extreme irritation and annoyance in others • Consistent and constant symptoms
Descriptive Adjectives • Egocentric • Self-indulgent • Manipulative • Impulsive • Lacks awareness of problem • Dependent • Passive-aggressive tendency
Cluster A Personality Disorders • Tend to demonstrate odd or eccentric behavior • Paranoid disorder • Schizoid disorder • Schizotypal disorder
Paranoid Personality Disorder • Persistent pattern of suspicion or mistrust • Signs and symptoms • Suspicious nature • Angry or hostile outbursts • Rigid, inflexible nature • Self-mutilating acts • Inability to achieve closeness in interpersonal relationships • Unable to take constructive criticism, but critical of others
Paranoid Personality Disorder • Exact cause is unknown • No-harm contracts, journals, and behavior logs can help clients who self-mutilate or engage in cutting to track their thoughts and behavior patterns.
Schizoid Personality Disorder • Self-absorbed in own feelings; emotional indifference • Loners, avoid close relationships and intimacy • Bland facial expression • Avoid positive emotion in others • Characteristics seen in most aspects of life by adult years
Schizotypal Personality Disorder • Strange and unusual patterns of thinking and communicating • Withdrawn from social situations • Magical thinking • Ideas of reference • Little ability to respond to feelings of others • Psychotic behavior may occur in brief episodes
Cluster B Personality Disorders • Dramatic, emotional, erratic behavior • Antisocial disorder • Borderline disorder • Narcissistic disorder • Histrionic disorder
Antisocial Personality Disorder • Persistent pattern of disregard and infringement on the rights of others • Indifference to laws of society and humanity • Sociopath • Chronic disorder • Difficult to treat
Antisocial Personality Disorder (cont.) • Suspicious, feels betrayed • Violates rights of others without remorse • Hostile, punitive scheming • Easily bored, restless • Impulsive • Sexually aggressive • Compulsive self-indulgence
Borderline Personality Disorder • Persistent pattern of unstable relationships, insecurity, mood swings • Insecure, irritable, dependent • Mood swings (self-admiration/self-dislike) • Chronic sense of emptiness and abandonment, anxiety • Quick change from clingy behavior to angry outbursts (Jekyll and Hyde) • Splitting • Self-mutilation
Narcissistic Personality Disorder • Narcissism: excessive love and attention given to one’s own self-image • Grandiose sense of self-importance, with underlying feelings of inferiority • Exploitation of others for own needs • Little regard for feelings of others • Fantasies of power, beauty, success (p. 178)
Narcissistic Personality Disorder • Arrogance • Claims of Entitlement • Demand for the best of everything • Hypersensitivity to criticism • Poor insight into behavior
Histrionic Personality Disorder • Overly dramatic emotional behavior to attract the attention of others • Extreme egocentricity • Unmet dependency needs • Melodramatic, vague speech • Manipulative • Attention-seeking behavior • Shallow, superficial relationships • Provocative sexual behavior
Cluster C Personality Disorders • Anxious and fearful types of behavior • Avoidant disorder • Dependent disorder • Obsessive-compulsive disorder
Avoidant Personality Disorder • Sensitive to rejection • Social inadequacy with intense anxiety • Lack of trust • Fear of criticism • Embarrassment in intimate relationships • Self-doubt, low self-esteem • Extreme shyness, social withdrawal
Dependent Personality Disorder • Insecurity, self-doubt • Extreme fear of being alone • Extreme reliance on others • Inability to make decisions • Constant need for reassurance • Feelings of incompetence • Self-sacrificing, submissive • Extremely anxious
Obsessive-Compulsive Personality Disorder • Unrealistic expectations • Excessive attention to orderliness, details • Inability to relax • Rigid and controlling • Missed deadlines • Rigid morals and ethics • Hoarding • Shallow
Treatment of Personality Disorders • Clients must gain perspective about underlying problem • Difficult to form therapeutic relationships • Most lack insight, resist attempts to impose change • Most have trouble trusting others
Treatment of Personality Disorders (cont.) • No-harm contracts, journals, behavior logs • Psychotherapy • Cognitive-behavioral therapy • Occupational therapy • Preferred methodcombination of psychotherapy and medication
Nursing Process Applied • Assessment • What events or behaviors led to admission • Nonverbal behaviors and symptoms • Thought processes • Inconsistencies between words and behavior • Anxiety level, emotional state • Coping mechanisms
Nursing Process Applied (cont.) • Nursing diagnoses • Expected outcomes
Nursing Process Applied (cont.) • Interventions • Identify personal feelings about the client’s behavior • Separate the person from the behavior
Nursing Process Applied (cont.) • Evaluation • Your ability to set boundaries and maintain therapeutic approach • Interaction with other clients • Impulse control • The client’s behavior following discharge
Question • Tell whether the following statement is true or false. Three cluster groups of personality traits have been identified.
Answer • True • Rationale: According to the DSM-IV-TR, there are three clusters of personality disorders. Commonalities exist between the groups.
Question • Which personality disorder involves a continued need for lavish attention and admiration? A. Avoidant personality disorder B. Obsessive-compulsive personality disorder C. Narcissistic personality disorder D. Paranoid personality disorder
Answer • C. Narcissistic personality disorder • Rationale: A person with narcissistic personality disorder has a grandiose sense of self-importance with little care for the feelings of others.
Question • Which personality disorder involves extreme shyness and social withdrawal? A. Obsessive-compulsive personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Schizotypal personality disorder
Answer • B. Avoidant personality disorder • Rationale: A person with avoidant personality disorder is sensitive to rejection, intensely anxious, and extremely shy in social situations.