1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 24Personality Development and Personality Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Personality disorders are among the least understood and recognized disorders in both psychiatry and general medical care. They are among the most common of the severe mental disorders and occur frequently with other illnesses (eg, substance use disorders, mood disorders, anxiety disorders). Personality Disorders Foundation, 2005

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Define the terms personality and personality disorder Summarize the concepts of the following theories of personality development: Freud’s psychoanalytic theory, Erikson’s psychosocial theory, and Piaget’s cognitive developmental theory Discuss the importance of a working knowledge of personality growth and development in the mental health setting Recognize factors that may contribute to the development of behavioral disturbances in a client with paranoid personality disorder Identify the characteristics of schizoid personality disorder

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Explain the importance of recognizing cultural diversity in clients who exhibit disturbances in cognition, affect, interpersonal relationships, and impulse control Articulate four outcomes to reduce behavioral disturbances in a client with the diagnosis of borderline personality disorder Formulate a list of nonproductive reactions a nurse may exhibit when working with clients who exhibit clinical symptoms of antisocial personality disorder Develop an educational tool to use when interacting with an elderly client who has clinical symptoms of dependent personality disorder Construct a nursing plan of care for a client with the diagnosis of histrionic personality disorder

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Theories of Personality Development Freud’s psychoanalytic theory of personality development Erikson’s psychosocial theory of personality development Piaget’s cognitive developmental theory

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Personality Disorders Genetic factors Biologic factors Psychoanalytic factors Childhood experiences

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Personality Disorders Inflexible, socially unacceptable behaviors Self-centeredness Manipulative and exploitative behavior Inability to tolerate minor stress, resulting in increased inability to cope with anxiety or depression Lack of individual accountability for behavior, blaming others for their problems Difficulty dealing with reality due to a distorted or superficial understanding of self and the perceptions of others Vulnerability to other mental disorders such as obsessive– compulsive tendencies and panic attacks

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics for Personality Disorders Cluster A disorders: odd, eccentric behavior –Paranoid personality disorder –Schizoid personality disorder –Schizotypal personality disorder

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics for Personality Disorders (cont.) Cluster B disorders: emotional, erratic, or dramatic behavior –Antisocial personality disorder –Borderline personality disorder –Histrionic personality disorder –Narcissistic personality disorder

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics for Personality Disorders (cont.) Cluster C disorders: anxious, fearful behavior –Obsessive–compulsive personality disorder –Dependent personality disorder –Avoidant personality disorder

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics for Personality Disorders (cont.) Personality disorder, not otherwise specified –Passive–aggressive personality disorder –Depressive personality disorder

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Screening and assessment tools Disturbance of cognition Disturbance of affect Disturbance of interpersonal functioning Dysfunctional behavior (lack of impulse control) Transcultural considerations

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Disturbed thought processes Anxiety Hopelessness Ineffective coping Impaired social interaction Impaired verbal communication Risk for other-directed violence Disturbed sleep pattern Social isolation

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcome identification for clients who exhibit personality disorders generally focuses on the following: Improving their ability to differentiate reality from fantasy Developing positive coping skills to reduce stress Improving impulse control and decreasing dysfunctional behavior Developing skills to improve interpersonal relationships Developing insight into their illness

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions When developing the plan of care, focus on the following: The client’s developmental needs that have not been resolved Assisting the client in understanding identified problems and anticipating possible future developmental stressors Direct nursing interventions at the specific behaviors, characteristics, and symptoms that are common to an identified disorder

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance in meeting basic needs Symptom management Medication management Interactive therapies Client education

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Evaluation of a client’s progress can be difficult. The client is able to manipulate or resist care, distort perceptions, and transfer dependency needs to others. It may take several years to modify patterns of behavior to meet stated outcomes. Clients may require repeated hospitalizations. Treatment of any personality disorder tends to be long term and does not guarantee recovery.

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Ego Egocentrism Id Personality Personality disorder Projective identification Schemata Splitting Superego

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the chapter-opening quote by the Personality Disorders Foundation, personality disorders are among the least understood and recognized disorders in both psychiatry and general medical care; however, they are among the most common mental disorders. Do you accept this statement to be true? If so, what can be done to increase awareness of personality disorders? Explain your answers. ?