1. The Client with a Personality Disorder
Chapter 18
The Client with a Personality Disorder

2. Personality Traits that make a person unique
Typically stable over time
Influences how a person looks, behaves, and reacts to life’s events

3. Personality Disorder Enduring pattern of inner experience and behavior
Deviates markedly from expectations of individual’s culture
Pervasive and inflexible
Onset in adolescence or early adulthood
Stable over time
Leads to distress or impairment
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4. Personality Disorder Clusters
Dramatic and emotional:
Borderline, Narcissistic, Histrionic, Antisocial
Odd and eccentric:
Schizoid, Schizotypal, Paranoid
Anxiety- and fear-based
Obsessive-compulsive, Avoidant, Dependent, Passive-aggressive or negativistic

5. Borderline Personality Disorder
Patterns of unstable relationships
Unstable self-image
Efforts to avoid being abandoned
Impulsive actions
Recurrent self-mutilating behavior
Frequent anger. Depression
Etiology: Precise cause unknown

6. Narcissistic Personality Disorder
Self-centeredness. Inflated self-esteem
Begins by early adulthood
Overestimates abilities. Feels superior
Demands admiration and special treatment
Lacks empathy toward others
Etiology: Development shows pattern of selfless love and adoration from significant adult. Escapes reality-based experiences. Fears criticism for not being perfect

7. Histrionic Personality Disorder
Must be center of attention
Uses physical appearance to draw attention to self
Experiences rapid emotional swings
Behaves in seductive manner
Unable to form close interpersonal relationships
Rapidly shifts feelings towards others

8. Histrionic Personality Disorder: Etiology
Raised with emphasis on good looks and ability to entertain others
More common among females
Men need to be center of attention
Women seek power and domination over others

9. Antisocial Personality Disorder
Pervasive pattern of disregard for others
Lying. Impulsivity. History of violence
Reckless disregard for safety of self or others. Lack remorse.
Etiology: Family history of violence, neglect, or alcoholism. Bullying-Cruelty to people and animals. Stealing, vandalism, truancy, or running away from home. Patterns of coercion begin early

10. Schizoid Personality Disorder
Marked detachment. Shows little emotion. Has few close friendships
Spends time by self
Does not care about others’ opinions
Does not respond appropriately to social cues
Etiology: Learns to expect nothing and give nothing. Quite uncommon. Personality remains constant. More common among males

11. Schizotypal Personality Disorder
Diagnosis requires pattern of cognitive and perceptual distortions and eccentricities
Traceable to early adulthood
Distinctly odd personality
Lack of close personal relationships
Magical thinking, paranoia, odd speech, or distorted beliefs

12. Schizotypal Personality Disorder
Unknown cause, common
More common among men
Deficits in social interactions similar to schizophrenia
Etiology: Learns to expect nothing and give nothing. Quite uncommon. Personality remains constant. More common among males

13. Paranoid Personality Disorder
Suspicious of others. Doubts loyalty
Reluctant to confide in others
Reads hidden, demeaning, threatening meanings into benign remarks
Bears grudges
Etiology: May have had abusive, cruel, or sadistic parent. Learns to be fearful and mistrusting. Learns to be independent, not to ask for help. Affects up to 2.5 percent of population

14. Obsessive-Compulsive Personality Disorder
Preoccupied with order, cleanliness, control, and perfectionism
Likes to maintain control
Loyal to work
Avoids leisure or pleasurable pursuits
Highly inflexible
Tends to hoard money

15. Obsessive-Compulsive Personality Disorder: Etiology
Childhood emphasis on perfection and attention to rules
Little personal warmth in home
Praise rarely received
Significant impairment in functioning
Affects 1 percent of population
More common among males

16. Avoidant Personality Disorder
Social inhibition. Feelings of inadequacy
Avoids situations that could lead to criticism or rejection
Shy and inhibited. Perceives self to be inferior
Etiology: History of not being noticed -public exposure can result in humiliation. Would like to be social, but fears rejection. Family is critical and rejecting, but only source of support. Equally common among males and females

17. Dependent Personality Disorder
Needs to be taken care of
Clingy and submissive
Fears the unknown
Has trouble making decisions
Has trouble disagreeing with others
Unable to function alone
Willing to do what others want

18. Dependent Personality Disorder: Etiology
May result from too much nurturing or parental control
Cultural/social factors may contribute
More common among females
One of the most frequently reported personality disorders
May develop Axis I somatoform disorders
Uses illness for support and attention

19. Passive-Aggressive or Negativistic Personality Disorder
Not actual diagnosis
Requires more study
Pervasive negativity
Passive resistance to social/occupational demands
Procrastinates
Stubborn
Intentional inefficiency

20. Passive-Aggressive or Negativistic Personality Disorder: Etiology
Abrupt loss of infantile and child nurturance
Unfair developmental demands
Learns to take long time to complete tasks
Performs tasks with obvious flaws

21. Nursing Care Most nurses encounter personality disorders
May have difficulty establishing nurse-client relationship
Extremely difficult with which to work
Teams need to support each other

22. Assessment Observe client’s behaviors
History: Can be augmented by reports from family members, teachers, etc.
Nursing Diagnosis
Many, including:
Ineffective coping
Impaired social interaction
Fear
Anxiety
Chronic low self-esteem
Risk for violence

23. Planning/Interventions
Set clear boundaries
Be professional, supportive, and nonjudgmental
Expect manipulative behavior
Provide structure and support
Use clear communication
Have patience

24. Evaluation Should be based on identified outcomes
Care will require time