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

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

3. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cluster A: Odd, Eccentric  Paranoid  Schizoid  Schizotypal

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cluster B: Dramatic, Emotional  Antisocial  Borderline  Histrionic  Narcissistic

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cluster C: Anxious, Fearful  Avoidant  Dependent  Obsessive-compulsive

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Object Relations Theories Margaret Mahler Separation-Individuation  Differentiation  Practicing  Rapprochement  Object constancy

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Masterson Defenses blocking growth to autonomy:  Projection  Clinging  Denial  Avoidance

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Discharge Criteria  Consider risk factor of safety for client and others.  Have plan for follow-up.  Provide psychoeducation.

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Assessment Domains  Emotional  Cognitive  Social  Spiritual  Physical

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Useful Nursing Diagnoses Cluster A  Anxiety  Ineffective coping  Social isolation  Disturbed thought processes

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Useful Nursing Diagnoses Cluster C  Anxiety  Ineffective coping  Chronic low self-esteem  Impaired social interaction

15. 15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Planning Recognize that behavioral changes occur slowly.

17. 17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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.