Personality Disorders Chapter 24 Personality Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Introduction Personality defined Clinical disorders Paranoid Schizoid Schizotypal Narcissistic Avoidant Dependent Obsessive-compulsive Histrionic Antisocial Borderline Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Paranoid Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Schizoid Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Schizotypal Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Histrionic Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Narcissistic Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Avoidant Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dependent Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Obsessive-Compulsive Personality Disorder Prevalence Characteristics Treatment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Antisocial Personality Disorder (ASPD) Antagonistic behaviors Disinhibited behaviors Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Borderline Personality Disorder (BPD) Negative effect Impulsivity and antagonism Splitting Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Etiology Biological factors Psychological factors Genetic Neurobiological Psychological factors Environmental factors Diathesis-stress model Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Application of the Nursing Process Assessment Assessment tools Patient history Self assessment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study A patient admitted to your unit has a personality disorder. What are some important areas to assess? 1. Assess for suicidal or homicidal thoughts. If these are present, the patient needs immediate attention. 2. Determine whether the patient has a medical disorder or another psychiatric disorder that may be responsible for the symptoms (especially a substance use disorder). 3. View the assessment about personality functioning from within the person's ethnic, cultural, and social background. 4. Ascertain whether the patient experienced a recent important loss. Personality disorders are often exacerbated after the loss of significant supporting people or in a disruptive social situation. 5. Evaluate for a change in personality in middle adulthood or later, which signals the need for a thorough medical workup or assessment for unrecognized substance use disorder. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Process (Cont.) Diagnosis (Table 24-2) Outcomes identification (Table 24-3) Implementation Safety and teamwork Pharmacological interventions Case management Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nursing Process (Cont.) Advanced practice intervention Psychotherapy Evaluation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Question 1 Which behavior indicates that a patient diagnosed with borderline personality disorder is improving? The patient cries when her roommate refuses to go to the dining room with her. The patient yells at the group facilitator when he points out that she is monopolizing the group. The patient informs a staff member that she feels unsafe and is having thoughts of harming herself. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Question 1 (Cont.) The patient tells the evening staff that the day staff excused her from group to smoke when she got upset. Answer: C Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions Use of splitting is most associated with which personality disorder? Antisocial Borderline Dependent Schizotypal ANS: B   Splitting, the primary defense or coping style used by persons with borderline personality disorder, is the inability to incorporate positive and negative aspects of oneself or others into a whole image. REF: 7 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions Perfectionism is a trait likely to be evident in a person with which personality disorder? Obsessive-compulsive Narcissistic Antisocial Avoidant ANS: A   Persons with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. REF: 44 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions Antisocial, obsessive-compulsive, and schizotypal personality disorders occur most frequently in adolescents. children. women. men. ANS: D   The prevalence rates for antisocial, obsessive-compulsive, and schizotypal personality disorders are highest in men. REF: 36 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.