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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

Chapter 20

Personality Disorders

Part I

  • Personality traits are enduring patterns of:
    • Perceiving
    • Relating to
    • Thinking about

the environment and oneself.

introduction cont
Introduction (cont.)
  • Personality disorders occur when these traits become
    • Inflexible
    • Maladaptive
    • The cause of significant functional impairment or subjective distress
introduction cont4
Introduction (cont.)
  • Personality development occurs in response to a number of biological and psychological influences, such as
    • Heredity
    • Temperament
    • Experiential learning
    • Social interaction
introduction cont5
Introduction (cont.)
  • People with personality disorders are not often treated in acute care settings, for which personality disorder is their primary psychiatric disorder.
introduction cont6
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.
personality disorders
Personality Disorders
  • Cluster A: Behaviors that are described as odd or eccentric
    • Paranoid personality disorder
    • Schizoid personality disorder
    • Schizotypal personality disorder
personality disorders cont
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
personality disorders cont9
Personality Disorders (cont.)
  • Cluster C: Behaviors that are described as anxious or fearful
    • Avoidant personality disorder
    • Dependent personality disorder
    • Obsessive-compulsive personality disorder
types of personality disorders
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
  • Disorder is more common in men than in women.
paranoid cont
Paranoid (cont.)
  • Clinical Picture
    • Constantly on guard
    • Hypervigilant
    • Ready for any real or imagined threat
    • Trusts no one
    • Constantly tests the honesty of others
paranoid cont13
Paranoid (cont.)
  • Clinical Picture (cont.)
    • Oversensitive
    • Tends to misinterpret minute cues
    • Magnifies and distorts cues in the environment
paranoid cont14
Paranoid (cont.)
  • Etiological Implications
    • Possible hereditary link
    • Subject to early parental antagonism and aggression
  • Definition
    • Characterized primarily by a profound defect in the ability to form personal relationships
    • Failure to respond to others in a meaningful emotional way
schizoid cont
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%.
schizoid cont17
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
schizoid cont18
Schizoid (cont.)
  • Etiological Implications
    • Possible hereditary factor
    • Childhood has been characterized as
      • Bleak
      • Cold
      • Unempathic
      • Notably lacking in nurturing
  • Definition
    • A graver form of the pathologically less severe schizoid personality pattern
schizotypal cont
Schizotypal (cont.)
  • Definition (cont.)
    • Recent studies indicate that approximately 3% of the population has this disorder.
schizotypal cont21
Schizotypal (cont.)
  • Clinical Picture
    • Clients aloof and isolated
    • Behave in a bland and apathetic manner
schizotypal cont22
Schizotypal (cont.)
  • Clinical Picture (cont.)
    • Everyday world manifests
      • Magical thinking
      • Ideas of reference
      • Illusions
      • Depersonalization
schizotypal cont23
Schizotypal (cont.)
  • Clinical Picture (cont.)
    • Exhibits bizarre speech pattern
    • When under stress, may decompensate and demonstrate psychotic symptoms
    • Demonstrates bland, inappropriate affect
schizotypal cont24
Schizotypal (cont.)
  • Etiological Implications
    • Possible hereditary factor
    • Possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain
schizotypal cont25
Schizotypal (cont.)
  • Etiological Implications (cont.)
    • Early family dynamics characterized by:
      • Indifference
      • Impassivity
      • Formality
      • Pattern of discomfort with personal affection and closeness
types of personality disorders26
Types of Personality Disorders
  • Antisocial
    • Definition
      • A pattern of
        • Socially irresponsible
        • Exploitative
        • Guiltless behavior

that reflects a disregard for the rights of others.

  • Clinical Picture
    • Fails to sustain consistent employment
    • Exploits and manipulates others for personal gain
    • Has a general disregard for the law
antisocial cont
Antisocial (cont.)
  • Definition
    • Prevalence estimates in the United States range from 3% in men to less than 1% in women.
types of personality disorders29
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
  • Definition (cont.)
    • Most common form of personality disorder
    • Emotionally unstable
    • Lacks a clear sense of identity
  • Definition (cont.)
    • Personality is
      • Excitable
      • Emotional
      • Colorful
      • Dramatic
      • Extroverted in behavior
histrionic cont
Histrionic (cont.)
  • Definition (cont.)
    • Prevalence thought to be about 2% to 3%
    • More common in women than men
histrionic cont33
Histrionic (cont.)
  • Clinical picture
    • Affected clients are
      • Self-dramatizing
      • Attention-seeking
      • Overly gregarious
      • Seductive
      • Manipulative
      • Exhibitionistic
histrionic cont34
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

histrionic cont35
Histrionic (cont.)
  • Etiological Implications
    • Possible link to the dopaminergic neurotransmitter system
    • Possible hereditary factor
    • Learned behavior patterns
  • Definition
    • Characterized by an exaggerated sense of self-worth
    • Lacks empathy
    • Believes has inalienable right to receive special consideration
narcissistic cont
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
narcissistic cont38
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
narcissistic cont39
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
narcissistic cont40
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.
  • 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.
avoidant cont
Avoidant (cont.)
  • Clinical Picture
    • Awkward and uncomfortable in social situations
    • Desires close relationships but avoid them because of fear of being rejected
avoidant cont43
Avoidant (cont.)
  • Etiological Implications
    • Possible hereditary influences
    • Parental rejection and criticism
  • Definition
    • Characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
dependent cont
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
dependent cont46
Dependent (cont.)
  • Clinical Picture
    • Client has a notable lack ofself-confidence that is often apparent in
      • Posture
      • Voice
      • Mannerisms
dependent cont47
Dependent (cont.)
  • Clinical Picture (cont.)
    • Typically passive and acquiescent to desires of others
    • Overly generous and thoughtful while underplaying own attractiveness and achievements
dependent cont48
Dependent (cont.)
  • Clinical Picture (cont.)
    • Assumes passive and submissive roles in relationships
    • Avoids positions of responsibility and becomes anxious when forced into them
dependent cont49
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
personality disorders50
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
  • 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
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
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
Obsessive-Compulsive (cont.)
  • Etiological Implications
    • Overcontrol by parents
    • Notable parental lack of positive reinforcement for acceptable behavior
    • Frequent punishment for undesirable behavior
passive aggressive
  • Definition
    • Exhibits a pervasive pattern of negativistic attitudes and passive resistance
    • Reacts badly to demands for adequate performance in social and occupational situations
passive aggressive cont
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


passive aggressive cont57
Passive-Aggressive (cont.)
  • Clinical Picture (cont.)
    • Able to vent anger and resentment subtly while gaining the attention, reassurance, and dependency that are craved
passive aggressive cont58
Passive-Aggressive (cont.)
  • Etiological Implications
    • Contradictory parental attitudes and behavior are implicated in predisposition to passive-aggressive personality disorder