Personality Disorders

Cluster A (odd/eccentric) Paranoid

Schizoid

Schizotypal

Characterized by Distrust And Suspiciousness Towards Others, based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive the person. These individuals are:

Characterized Emotional Detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative.

Characterized by Odd Beliefs, leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations.

-Hypervigilant -Anticipate hostility -May provoke hostile responses by initiating a “counterattack” -Demonstrate jealousy, controlling behaviors, and unwillingness to forgive.

**Paranoid people are difficult to interview b/c they are reluctant to share information about themselves

The person with this disorder does not seek out or enjoy close relationships. These individuals may be able to function in a solitary occupation.

Schizoid PD can be a precursor to schizophrenia or delusional disorder. There is increased prevalence of the disorder in families with schizophrenia or schizotypal PD.

Nursing Interventions:

MANIPULATIVE BEHAVIOR SET LIMITS!!

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Objective, matter-of-fact approach

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Avoid being too “nice or friendly”

-Discuss concerns about behavior with patient

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Clear, simple, consistent verbal-non-verbal communication

-identify undesirable behavior, and discuss with patient what is desirable behavior in a give situation or setting

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Give clear straightforward explanations

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Warn about changes, side effects etc

-Establish consequences for occurrence or nonoccurrence of desired behavior in a non punitive ad easily understood way -Refrain from arguing or bargaining with patient about

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Help identify feelings

established behavioral expectations and consequences

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Assist with problem-solving

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Gradually involve in group situations but do not insist. Respect need for social isolation.

-Modify behavioral expectations as needed based on reasonable changes in patient’s situations

Cluster B (Dramatic/Emotional/Erratic) Antisocial

Borderline

Histrionic

Narcissistic

Characterized by consistent Disregard for Others with exploitation and repeated unlawful actions, deceit and failure to accept personal responsibility.

Characterized by Instability of Affect, identity and Relationships; fear of abandonment, splitting behavior, manipulation, and impulsiveness; often tries selfmutilation and may be suicidal.

Characterized by Emotional Attention-Seeking Behavior, in which the person needs to be the center of attention; often seductive and flirtatious, the histrionic person is impulsive and melodramatic. Relationships do not last b/c their partner often feels smothered or reacts to the insensitivity of the histrionic person. The individual with histrionic PD has no insight into his role in breaking up relationships. In the treatment setting, the person demands “the best of everything” and can be very critical

Characterized by Arrogance, Grandiose Views of SelfImportance, the need for constant admiration along with a lack of empathy for others that strains most relationships; often sensitive to criticism. Underneath the surface of arrogance, narcissistics feel intense shame and fear that if they are “bad” they will be abandoned. They are afraid of their own mistakes, as well as the mistakes of others. May seek help, feeling that loved ones do not show enough appreciation of their special qualities

Previously called Psychopaths or Sociopaths. There is a clear history of conduct disorder in childhood, and the individual show no remorse for hurting others. They repeatedly: -Neglect responsibilities -Tell lies -Perform destructive or illegal acts, without developing any insight into predictable

Individuals w/ Borderline PD desperately seek relationships to avoid feelings of abandoned, but often drive others away b/c of their excessive demands, impulsive behavior, and their frequent use of splitting.

consequences.

Nursing Interventions

IMPULSIVE BEHAVIOR IMPULSE CONTROL TRAINING!!

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Prevent self-harm. No harm contract.

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Set limits on inappropriate or manipulative behaviors

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Provide clear, consistent boundaries

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Assist examining consequences of behavior.

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Consistent approach by staff

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Do not rescue or reject

-Provide positive reinforcement for successful outcomes (e.g. praise and rewards)

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Remain neutral, avoid engaging in power struggles or be coming defensive to patient’s comments

-Provide opportunities for pt to practice problem solving in social and interpersonal situations outside the therapeutic environment

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Give recognition for goal achievement

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Explore feelings

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Teach problem solving and role model assertiveness

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Encourage and model concrete and descriptive communication

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Document behaviors and incidents objectively

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Encourage follow up treatment

Avoidant

Characterized by Social Inhibition and Avoidance

-Assist pt to: Identify problem or situation that requires thoughtful action, and courses of possible actions, their costs or benefits -Teach pt to cue himself to “stop and think” before acting impulsively -Assist pt to evaluate the outcome of the chosen course or action

Cluster C (Anxious/Fearful/Insecure/Inadequate) Dependant Obsessive Compulsive

of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations. Because in their social presentation they appear timid and with low self-esteem and poor self-care, they are often mistreated in groups. If they do develop relationships, they cling to their partners in a dependent way. They are seen in Tx for symptoms of anxiety.

Characterized by Extreme Dependency in a close Relationship with an urgent search to find a replacement when one relationship ends; the most frequently-seen personality disorder in the clinical setting. Individuals with Dependent PD have difficulty making independent decisions and are constantly seeking reassurance. Their submissiveness makes them vulnerable to abusive relationships. The have a deeply held conviction of personal incompetence that they cannot survive on their own.

Nursing Interventions: •

Caring consistent approach

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Clear expectations for behavior

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Expect patient to make decisions

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Teach assertiveness

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Encourage to identify positive attributes

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Provide positive feedback for increased interactions in social situations

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Teach stress management and relaxation techniques

Characterized by Perfectionism with a focus on orderliness and control .They become so preoccupied with details and rules that they may not be able to accomplish a given task. Persons with Obsessive-Compulsive PD feel genuine affection for friends and family, and don’t have insight about their own difficult behavior creating tension in their close relationships, in which the person tries to control the partner.

AGGRESSIVE BEHAVIOR ANGER CONTROL ASSISTANCE!! -Determine appropriate behavioral expectations for expressions of anger, given pt’s level of cognitive and physical functioning -Limit access to frustrating situations until pt is able to express anger in an adaptive manner -Encourage pt to seek assistance from nursing staff during periods of increasing tension -Monitor potential for inappropriate aggression and intervene before its expression -Assist pt in identifying source of anger -Prevent physical harm if anger is directed towards self or others -Provide physical outlets for expressions of anger or tension (e.g. pushing bag, sports, clay, journal writing)