1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 12Personality Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Personality Disorders Deeply ingrained, inflexible, maladaptive patterns of behavior Most apparent in interpersonal and social relationships Cause extreme irritation and annoyance in others Consistent and constant symptoms

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Descriptive Adjectives Egocentric Self-indulgent Manipulative Impulsive Lacks awareness of problem Dependent Passive-aggressive tendency

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cluster A Personality Disorders Tend to demonstrate odd or eccentric behavior –Paranoid disorder –Schizoid disorder –Schizotypal disorder

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Paranoid Personality Disorder Persistent pattern of suspicion or mistrust Signs and symptoms –Suspicious nature –Angry or hostile outbursts –Rigid, inflexible nature –Often quite efficient –Inability to achieve closeness in interpersonal relationships –Unable to take constructive criticism, but critical of others Signs and Symptoms Box 12.1 Page 173

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizoid Personality Disorder Withdrawn and secluded and demonstrate an emotional indifference toward social relationships Self-absorbed in own feelings; emotional indifference Loners, avoid close relationships and intimacy Bland facial expression Avoid positive emotion in others Characteristics seen in most aspects of life by adult years Signs and Symptoms of Schizoid Personality Disorder Box 12.2 Page 174

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizotypal Personality Disorder Strange and unusual patterns of thinking and communicating Withdrawn from social situations Magical thinking Ideas of reference Little ability to respond to feelings of others Psychotic behavior may occur in brief episodes Signs and Symptoms of Schizotypal Personality Disorder Box 12.3 Page 174

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 12.1 “Uneasy Predictions” How should the nurse approach this situation? What characteristics of schizotypal personality does Margie demonstrate? How could the nurse help Margie continue a therapeutic type of interaction with other clients on the unit?

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cluster B Personality Disorders Dramatic, emotional, erratic behavior –Antisocial disorder –Borderline disorder –Narcissistic disorder –Histrionic disorder

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antisocial Personality Disorder Persistent pattern of disregard and infringement on the rights of others Indifference to laws of society and humanity Often referred to as a Sociopath Chronic disorder Difficult to treat Selfish and seemingly has not conscience; often lie and steal

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Antisocial Personality Disorder (cont.) Suspicious, feels betrayed Violates rights of others without remorse Hostile, punitive scheming Easily bored, restless Impulsive Sexually aggressive Compulsive self-indulgence Signs and Symptoms of Antisocial Personality Disorder Box 12.4 Page 174

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Borderline Personality Disorder Persistent pattern of unstable relationships, insecurity, mood swings Insecure, irritable, dependent Mood swings (self-admiration/self-dislike) Chronic sense of emptiness and abandonment, anxiety Quick change from clingy behavior to angry outbursts (Jekyll and Hyde) Splitting Self-mutilation (Cutting: Box 12.5) Signs and Symptoms of Borderline Personality Disorder Box 12.6 Page 178

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 12.3 “Hidden Ambivalence” How does Sherry’s behavior demonstrate her underlying sense of insecurity? How is “splitting” evident in her behavior? How should the nurse respond to Sherry’s last statement?

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 12.2 “Smooth Character” How should you respond to this situation? Why is limit setting so important in dealing with Ed’s behavior? What are the chances that Ed will benefit from the treatment process?

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Narcissistic Personality Disorder Narcissism – Greek word meaning – excessive love and attention given to one’s own self-image Continuous need for lavish attention and admiration with little regard for the feelings of others Grandiose sense of self-importance, with underlying feelings of inferiority Entitlement (others owe them bc they are superior) Little regard for feelings of others Fantasies Arrogant Signs and Symptoms Box 12.7 Page 179

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Histrionic Personality Disorder Extreme egocentricity and excessive emotion in a demanding manner to gain personal attention. Uncomfortable in situations where the center stage is not afforded to them Unmet dependency needs Melodramatic, vague speech Manipulative Attention-seeking behavior Shallow, superficial relationships Provocative sexual behavior Signs and Symptoms of Histrionic Personality Disorder Box 12.8 Page 180

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cluster C Personality Disorders Anxious and fearful types of behavior –Avoidant disorder –Dependent disorder –Obsessive-compulsive disorder

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Avoidant Personality Disorder Shy and very sensitive to negative comments from others Sensitive to rejection, ridicule, and disapproval Social inadequacy with intense anxiety Lack of trust Fear of criticism Embarrassment in intimate relationships Self-doubt, low self-esteem Extreme shyness, social withdrawal Signs and Symptoms of Avoidant Personality Disorder Box 12.9 Page 180

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dependent Personality Disorder Consistent and extreme need to be cared for that leads to reliance on others – Perceive themselves as helpless and incompetent Insecurity, self-doubt Extreme fear of being alone Extreme reliance on others Inability to make decisions Constant need for reassurance Feelings of incompetence Self-sacrificing, submissive Extremely anxious Signs and Symptoms of Dependent Personality Disorder Box 12.10 Page 181

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Obsessive-Compulsive Personality Disorder Conscientious, highly organized, and preoccupied with order and perfection – want rigid control and lack flexibility to allow for compromise Unrealistic expectations Excessive attention to orderliness, details Inability to relax Rigid and controlling Missed deadlines Rigid morals and ethics Hoarding Shallow Signs and Symptoms of OC Personality Disorder Box 12.11 Page 182

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Personality Disorders Clients must gain perspective about underlying problem Difficult to form therapeutic relationships –Most lack insight, resist attempts to impose change –Most have trouble trusting others

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Personality Disorders cont.) No-harm contracts (cutting), journals, behavior logs Psychotherapy Cognitive-behavioral therapy Occupational therapy Preferred method  combination of psychotherapy and medication

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPg. 182 –What events or behaviors led to admission –Nonverbal behaviors and symptoms –Thought processes –Inconsistencies between words and behavior –Anxiety level, emotional state –Coping mechanisms

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Nursing diagnosesPage 184 Expected outcomesPage 184

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) InterventionsPage 184 –Identify personal feelings about the client’s behavior –Separate the person from the behavior

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) EvaluationPage 185 –Your ability to set boundaries and maintain therapeutic approach –Interaction with other clients –Impulse control –The client’s behavior following discharge

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Three cluster groups of personality traits have been identified.

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: According to the DSM-IV-TR, there are three clusters of personality disorders. Commonalities exist between the groups.

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which personality disorder involves a continued need for lavish attention and admiration? A. Avoidant personality disorder B. Obsessive-compulsive personality disorder C. Narcissistic personality disorder D. Paranoid personality disorder

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Narcissistic personality disorder Rationale: A person with narcissistic personality disorder has a grandiose sense of self-importance with little care for the feelings of others.

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which personality disorder involves extreme shyness and social withdrawal? A. Obsessive-compulsive personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Schizotypal personality disorder

33. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Avoidant personality disorder Rationale: A person with avoidant personality disorder is sensitive to rejection, intensely anxious, and extremely shy in social situations.