1. Personality Disorders
Chapter 14:
Personality Disorders
Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. Personality Disorders
Maladaptive patterns of behavior relating to others
Not caused by Axis I disorders
Onset during adolescence or early adulthood

3. Cluster A: Odd, Eccentric
Paranoid
Schizoid
Schizotypal

4. Cluster B: Dramatic, Emotional
Antisocial
Borderline
Histrionic
Narcissistic

5. Cluster C: Anxious, Fearful
Avoidant
Dependent
Obsessive-compulsive

6. Theoretic Perspectives
Freud
Antisocial, borderline, histrionic, narcissistic personality disorders associated with phallic stage
Object relations
Stability and depth of individual’s relations with significant others
Manifested by warmth, dedication, concern, tactfulness

7. Object Relations Theories Margaret Mahler
Separation-Individuation
Differentiation
Practicing
Rapprochement
Object constancy

8. Object Relations Theories Otto Kernberg
Tasks:
Distinguish between self and others
Integration of good and bad (self images, objects)
Splitting: Inability to synthesize positive and negative aspects of self and others
Idealization: Idealizes person when needs are met
Devaluation: Devalues person when needs are unmet
Lack of object constancy leads to feelings of abandonment

9. Masterson Defenses blocking growth to autonomy: Projection Clinging
Denial
Avoidance

10. Discharge Criteria
Consider risk factor of safety for client and others.
Have plan for follow-up.
Provide psychoeducation.

11. Assessment Domains
Emotional
Cognitive
Social
Spiritual
Physical

12. Useful Nursing Diagnoses Cluster A
Anxiety
Ineffective coping
Social isolation
Disturbed thought processes

13. Useful Nursing Diagnoses Cluster B
Ineffective coping
Disturbed personal identity
Chronic low self-esteem
Risk for self-mutilation
Risk for suicide
Impaired social interaction
Risk for other-directed violence
Risk for self-directed violence

14. Useful Nursing Diagnoses Cluster C
Anxiety
Ineffective coping
Chronic low self-esteem
Impaired social interaction

15. Example Outcomes Client will: Refrain from self-mutilation.
Recognize occurrence of cognitive distortions.
Identify one new method of problem solving.
Identify positive role models.

16. Planning
Recognize that behavioral changes occur slowly……

17. Interventions Assess suicidality. Encourage attendance at group.
Assess escalation of anger.
Assess impulsivity, self-mutilation.
Contract concerning threatening behavior.
Encourage journal writing.
Teach:
Anger/impulse management.
Recognition of faulty thought patterns.
Alternative behaviors.