5 - Personality Disorders PERSONALITY DISORDERS What does PERSONALITY mean?

persona Greek term a persons charactersistic totality of emotional and behavioral traits apparent in ordinary life, a totality that is usually stable and predictable (Kaplan and Sadock 1998) Refers to a distinctive set of traits, behavior styles, and patterns that make up our character and inidividuality It is the total of persons internal and external patterns of adjustment to life, determined in part by the individuals genetic make-up and by life experiences. THEORIES OF PERSONALITY DEVELOPMENT 1. Freuds Psychoanalytic a. Development of personality b. Organization or structure c. Dynamics of personality 2. Ericksons Psychosocial Development a. Concept of identity or an inner sense of sameness that preserves despite external changes. Identity crises and Identity confusion. 3. Piagets Cognitive Developmental Theory a. Sensory-motor b. Pre-operational 2. Novelty seeking PERSONALITY DISORDER It is defined as a pervasive pattern of experience and behavior that is abnormal with respect to thinking, mood personal relations, and the control of impulses. A personality disorder is described as a non-psychotic illness characterized by maladaptive behavior, which the person uses to fulfill his or her needs and bring satisfaction to him or herself. c. Concrete-Operational d. Formal-operational

ETIOLOGY GENETIC FACTORS BIOLOGIC FACTORS PSYCHOANALYTIC FACTORS CHILDHOOD EXPERIENCES Biologic theories: Personality develops through the interaction of hereditary dispositions and environmental influence. TEMPERAMENT-refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion. 4 temperament traits: 1. Harm avoidance

5 - Personality Disorders 3. Reward dependence 4. Persistence Psychodynamic Theories Although temperament is largely inherited, social learning, culture, and random life events unique to each person influence character. CHARACTER - consists of concepts about the self and the external world. 3 major character traits: 1. self-directedness 2. Cooperativeness 3. Self-transcedence PARANOID PERSONALITY DISORDER : SUSPECT S: Spouse fidelity suspected Personality Disorder: CHARACTERISTICS Inflexible, socially unacceptable behaviors Self-centeredness E: Enemy or Friend Manipulative and exploitative Inability to tolerate minor stress, resulting in increased inability to cope with anxiety or depression Lack of individual accountability for behavior, blaming others of their problems Difficulty dealing with reality because of a distorted or superficial understanding of self and the perception of others. C: Confiding in others feared T: Threats perceived in benign events Paranoid Personality Disorder psychologi cal personality disorder characterized by an extreme level of distrust and suspiciousness of others. Paranoid personalities are generally difficult to get along with, and their combative and U: Unforgiving S: Suspicious of others P: Perceives attacks Vulnerbility to other mental disorders

Classification of Personality Disorder A. Cluster A Personality Disorder those considered to be marked by odd, eccentric behavior. 1. Paranoid 2. Schizoid 3. Schizotypal

5 - Personality Disorders distrustful nature often elicits hostility in others. Symptoms : paranoia, paranoid beliefs, suspiciousness, social withdrawal. Treatment s: Psychotherapy, cognitive behavioural therapy, interpersonal psychotherapy & antidepressant Prefer being alone and usually choose solitary activities Prize independence and have few close friendships Feel confused about how to respond to normal social cues and generally have little to say Lack any desire for sexual relationships Feel unable to experience pleasure

SCHIZOID PERSONALITY DISORDER : DISTANT D: Dettached Affect I: Indifferent to criticisms M: Magical thinking or odd beliefs S: Sexual interest of little interest E: Experiences unusual perceptions T: Tasks P: Paranoid ideas A: Absence of close friends E: Eccentric behavior or appearance N: Neither desires nor enjoys close relations C:Constricted or inappropriate affect T: Takes pleasures in few activities U:Unusual or odd thinking and speech Schizoid Personality Disorder L:Lacks close friends are characteristically detached from social relationships and show a restricted range of expressed emotions. Their social skills, as would be expected, are weak, and they do not typically express a need for attention or approval. They may be perceived by others as somber and aloof, and often are referred to as "loners. Symptoms I: Ideas of reference A: Anxiety in social situation R: Rule out psychosis SCHIZOTYPAL PERSONALITY DISORDER : ME PECULIAR

B. Cluster B Personality Disorder evidenced by dramatic, erratic behaviors and include 1. Antisocial

5 - Personality Disorders 2. Borderline 3. Narcissistic 4. Histrionic ANTISOCIAL PERSONALITY DISORDER : CORRUPT C: Conformity to law lacking O: Obligations ignored R: Reckless disregard for safety of self or others R: Remorse lacking U: Underhanded (deceitful, lies, cons others) P: Planning insuficient (impulsive) T: Temper (irritable and aggressive) HISTRIONIC PERSONALITY DISORDER :PRAISE ME P: Provocative or sexuality seductive behavior R: relationships (intimate) A: Attention (uncomfortable) I: Influence easily S: Style of speech (lacks detai) E: Emotions repidly shifting and shallow M: Made up (physical appearance used to draw attention to self) E: Emotions exaggerated P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty or ideal love) E: Entitlement C: Conceited I: Interpersonal exploitation A: Arrogant L: Lacks empathy

BORDERLINE PERSONALITY DISORDER : AM SUICIDE A: Abandonment M: Mood instability S: Suicidal U: Unstable and intense relationship I: Impulsive C: Control of anger I: Identity disturbance D: Dissociative or paranoid E: Emptiness NARCISSISTIC PERSONALITY DISORDER : SPECIAL S: Special (believes he is unique)

C. Cluster C Personality Disorder distinguished by the anxious, fearful behavior commonly seen in 1. Obsessive-Compulsive 2. Dependent

5 - Personality Disorders 3. Avoidant a. Difficulty showing emotions b. Stubborn OBSESSIVE COMPULSIVE : LAW FIRMS L: Loses point of activity 9due to preoccupation with detail) A: Ability to complete tasks (compromised by perfectionalism) W: Worthless objects (unable to discard) F: Friendships (excluded) I: Inflexible and overconscientious R: Reluctant to delegate M: Miserly (towards self and others) S: Stubborn A pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency. Refers to a group enduring characteristics in a person, including orderliness, meticulous, preoccupation with detail, parsimony, obstinacy, neatness, difficulty handling uncertainty , and perfectionism Incidence: R: Reassurance required for decisions More common to male Oldest children Professionals SYMPTOMS: E: Expressing disagreement difficult due to fear of loss of support or approval L: Life responsibilities (needs to have these assumed by others) I: Initiating projects difficult j. c. Preoccupied with orderliness and try to maintain it in all areas of life d. Strive for perfection e. They become absorbed in their own belief, believe they are right f. Do not listen to others

g. They have difficulty working collaboratively, preferring to do it myself h. Poor judgment i. Check and recheck any project or activities Decision-making problem

Nursing Intervention: 1. Help client to view decision-making and completion of projects from a different perspectives. 2. Set a goal of completing a projective by giving a deadline 3. Tolerate less-than perfect work 4. Encouraging client to take risk

DEPENDENT PERSONALITY DISORDER : RELIANCE

5 - Personality Disorders A: Alone N: Nurturance go to excessive lengths C: Companionship E: Exaggerated fears of being left Characterized by a pervasive and excessive need to be taken care of, which lead to submissive and clinging behavior and fears if separation. Feelings of dependency and attachment are said to be universal, and perhaps defining, mammalian behaviors. (Fances, 1988) Incidence: 1. Three times more common to women than men 2. It runs to the families 3. Common to youngest child Symptoms: 1. Frequently anxious and mildly irritable 2. Pessimistic and self-critical 3. Report feeling of unhappy or depressed 4. Believe they would fail on their own 5. They believe they need someone else to assume responsibility 6. Tremendous difficulty making decisions Motto: Any relationship is better than none at all Nursing intervention: 1. Encourage verbalization of feelings AVOIDANT PERSONALITY DISORDER : CRINGES C: Certainty R: rejection I: Intimate relationship (restrained) N: New interpersonal relationships(is inhibited in) G: Gets around occupationa activity 2. Help client to identify their strength 3. Assistance in daily functioning 4. Teach problem-solving 5. Psychotherapy- is the main method of treatment for DPD in a form of counseling. 6. GOAL: is to help the person to be become more active and independent What are the complications of dependent personality disorder? At risk for depression Anxiety disorder Phobias Substance abuse Can Dependent Personality Disorder can be prevented? Prevention of the disorder might not be possible, treatment can sometimes allow a person who is prone to disorder learn more productive ways of dealing with situations.

5 - Personality Disorders E: embarassment S: Self viwed as unappealing Is characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evalution. Extremely sensitive to the opinions of others and therefore avoid most relationship Behavioral intervention technique for anxiety and social skill problems have had some success Psychodynamic psychotherapy, which helps patients understand their thoughts and feelings, and cognitive behavioral therapy (CBT) can help. A combination of medication and talk therapy may be more effective than either treatment alone.

Incidence: Occur in 0.5% to 1% of the general population Equally common to both men and women PASSIVE-AGGRESSIVE Causes: Integrate biological and psychological influences Limited support Rejection Symptoms: 1. Very low self-esteem c. Easily upset/offended 2. Shy, fearful, socially, awkward 3. Reluctant to do anything 4. Apathetic 5. Affectively flat 6. Uninterested in interpersonal relationship Treatment: i. They tend to blame others d. May alternate between hostile and stubborn e. Affect or feeling may be sad or angry f. They view future negatively It is characterize by negative attitude and passive resistance to demands for adequate social and occupational performance.

a. Sullen-passive resentful b. Their mood fluctuates easily, rapidly, erratically

g. Impaired judgment h. Insight is limited

5 - Personality Disorders Nursing Interventions . Help client examine the relationship between feelings and actions Help client to see what is annoying or troubling to others Encourage client to express feelings Exlpore the clients self-concept and self-esteem Nursing interventions: dysfunctional BEHAVIOR State limits and behavior expected from the client Enforce or llimits without apologizing Be direct and confront the client when limits are not observed. TREATMENT Nursing interventions: COGNITION Reinforce reality if the client verbalizes illusions or feelings of depersonalization Help the client select someone he/she trust to minimize suspicious or delusional thoughts Encourage the client to validate perceptions before taking action that may precipitate difficulties Nursing interventions: AFFECT Encourage the clients verbalization of feelings of anger, hostility, worthlessness or hopelessness Give attention on and support when the client expresses feelings honestly and openly Psychopharmacology Lithium, anticonvulsant mood stablizers, and Bendiazepines are used most often to treat aggression. Low dose of neropletics may be useful in modifying aggression, too. Several treatment strategies are used with clients with personality disorder; these strategies are based on the disorders type and severity or the amount of distress or functional impairment the client experiences. Combination of medication and group, and individual therapies are more likely to be effective than is any single treatment. Ecourage the client to share his feelings with others Nursing interventions: INTERPERSONAL FUNCTIONING Explore reasons the client has difficulty establishing interpersonal relationship

Possible Nursing diagnoses Disturbed thought processes r/t auditory hallucinations Anxiety r/t unsatisfactory interpersonal relationships Hopelessness r/t low self-esteem Ineffective coping r/t lack of impulse control