Personality disorders

What is it? Personality Complex pattern of characteristics, largely outside of the person’s awareness Complex pattern of characteristics, largely outside of the person’s awareness Distinctive patterns of perceiving, feeling, thinking, coping and behaving Distinctive patterns of perceiving, feeling, thinking, coping and behaving Emerges within biopsychosocial framework Emerges within biopsychosocial framework Personality Disorder An enduring pattern of deviant inner experiences and behavior An enduring pattern of deviant inner experiences and behavior Differ from cultural expectations Differ from cultural expectations Pervasive, inflexible and stable Pervasive, inflexible and stable Leads to distress or impairment Leads to distress or impairment

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

Personality Trait vs. Personality Disorders Has to be inflexible and maladaptive and cause functional impairment Has to be inflexible and maladaptive and cause functional impairment Personality disorders are organized into three clusters: 1. CLUSTER A: odd & eccentric behaviors (e.g., paranoid, schizoid, schizotypal)

2. CLUSTER B: dramatic, emotional behavior ( antisocial, borderline, histrionic, narcissistic) 2. CLUSTER B: dramatic, emotional behavior ( antisocial, borderline, histrionic, narcissistic) 3. CLUSTER C: anxious, fearful behavior (avoidant, dependent, OCD, 3. CLUSTER C: anxious, fearful behavior (avoidant, dependent, OCD, NOT SPECIFIED: if not meeting criteria for any personality disorder NOT SPECIFIED: if not meeting criteria for any personality disorder

Epidemiology 10 – 20% 10 – 20% Borderline PD accounts for % of all diagnosed PD Borderline PD accounts for % of all diagnosed PD 75% of borderline PD are women 75% of borderline PD are women Antisocial PD has to be 18 year Antisocial PD has to be 18 year

Etiology 1. Developmental factors: Interruption of any task may lead to PD Interruption of any task may lead to PD 2. Environmental factors: Some attribution between developmental and environmental factors Some attribution between developmental and environmental factors 3. Biogenetic factors: Schizotypal ….. MAO Schizotypal ….. MAO Brian injury……. Borderline PD Brian injury……. Borderline PD

DIAGNISTIC CRITERIA

PARANOID PERSONALITY Difficult, Sarcastic, Hostile, and Suspicious view of the world Difficult, Sarcastic, Hostile, and Suspicious view of the world SCHIZOID PD: inability to perform relationship, low interest in establishing any relationship (marriage) inability to perform relationship, low interest in establishing any relationship (marriage) SCHIZOTYPAL PD cognitive and perceptual distortion cognitive and perceptual distortion

ANTISOCIAL PD Aggression in all manners Aggression in all manners Criminal records and multiple sexual relationship Criminal records and multiple sexual relationship BORDERLINE PD Fear of abandonment Fear of abandonment Broke away fearing failure Broke away fearing failure Acting out Acting out

HISTRIONIC PD Dramatic emotional expression, seeking attention, wants to impress others Dramatic emotional expression, seeking attention, wants to impress others NARCISSISTIC PD grandiose self-importance, talk about themselves and neglect others, overreaction for criticism grandiose self-importance, talk about themselves and neglect others, overreaction for criticism AVOIDANT PD Low self-esteem, and fear of rejection. Low self-esteem, and fear of rejection.

DEPENDENT PD DEPENDENT PD Excessive reliance on others for social support, fear separation and avoided responsibilities. Excessive reliance on others for social support, fear separation and avoided responsibilities.OCD perfectionism, detailed person, never throw anything, and workaholics.

Impulse Control Disorders Intermittent explosive disorder Intermittent explosive disorder Kleptomania Kleptomania Pyromania Pyromania Pathologic gambling Pathologic gambling Trichotillomania Trichotillomania

NURSING DAIGNOSIS Cluster A: Cluster A: 1. Anxiety 2. Ineffective coping 3. Social isolation 4. Disturbed thought process Cluster B: Cluster B: 1. Disburdened personal identity 2. Risk for suicide 3. Risk for violence toward self, others 4. Chronic low self esteem 5. Impaired social interaction

NURSING DAIGNOSIS Cluster C: Cluster C: 1. Chronic low self esteem 2. Impaired social interaction 3. Anxiety 4. Ineffective coping

Nursing intervention Assess for suicidal ideation Assess for suicidal ideation Establish “no harm” contract Establish “no harm” contract Encourage client to attend group therapy Encourage client to attend group therapy Teach client alternative ways to express anger and impulsive feelings Teach client alternative ways to express anger and impulsive feelings Discuss with the client self-mutilation Discuss with the client self-mutilation Encourage the client to have a journal of thought and feeling before self-mutilation Encourage the client to have a journal of thought and feeling before self-mutilation Assist client to recognize thought patterns that contribute to impulsive behaviors Assist client to recognize thought patterns that contribute to impulsive behaviors :

Suggest alternative behaviors to deal with intense feelings such as: Suggest alternative behaviors to deal with intense feelings such as: 1. Recognize the feeling and wrote it up 2. Talk about it 3. Identifying healthy options 4. Role playing 5. Using effective problem solving techniques 6. Self-rewarding Helping client to recognize community behaviors (e.g. driving) Helping client to recognize community behaviors (e.g. driving) Evaluation of family system and dynamic Evaluation of family system and dynamic Engage client in short social interactions Engage client in short social interactions Teaching assertiveness Teaching assertiveness Providing client with direct feedback in a nonjudgmental fashion. Providing client with direct feedback in a nonjudgmental fashion.