Personality Disorders Psychiatric Nursing

Personality Disorders Psychiatric Nursing

What is personality? “The aggregate of the physical and mental qualities of the individual as these interact in characteristic fashion with his environment” - Taylor, Cecilia

What is personality trait? “Those characteristics of an individual which make him unique and form the basis for the way he perceives the world and how he relates to others” - Taylor, Cecilia

Personality disorders 

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Personality disturbances that come together to create a pervasive pattern of behavior and inner experience that is quite different from the norms of the culture They have disturbances in self-image Decreased ability to have successful relationships

Characteristic of personality disorders 

Maladaptive traits often prevent the person’s interpersonal relationships and they increase the level of anxiety or internal stress

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MALADAPTIVE BEHAVIORAL patterns are the hallmark of personality disorders

Characteristic of personality disorders 

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Maladaptive traits are often RIGID and INFLEXIBLE that exist in attitudes and behavior of the person Once a personality trait is established, it is extremely resistant but NOT IMPOSSIBLE to change

Personality Disorders 

Personality disorders 

Inflexible mal-adaptive behavior pattern or traits that may impair social, intellectual functioning and relationships

Personality Disorders 

Personality disorders 

A spectrum of mal-adaptive traits that produce or influence considerable psychological and emotional disturbances and impair relationships

Personality Disorders 

Personality disorders 

Inflexible mal-adaptive behavior pattern or traits that may impair social, intellectual functioning and relationships

Features of PD •

The Onset begins during adolescence and young adulthood

Features of PD Features of personality disorders 2. Poor impulse control, Rigid and inflexible 3. Mood characteristics 4. Impaired judgment 5. Impaired reality testing 6. Impaired object relations 7. Impaired thought process 8. Impaired self-perception 9. Impaired stimulus barrier

Features    

Characteristics Poor impulse control Acting out to manage internal pain Forms of acting out include physical and verbal attacks, manipulation, substance abuse, promiscuous sexual behaviors, and suicide attempts

Features Mood characteristics  Experiences abandonment and depression  Moods include rage, guilt, fear, and emptiness  Impaired judgment  Has difficulty with problem solving  Unable to perceive the consequences of behavior

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Impaired reality testing: Distorts reality and often projects own feelings onto others. Impaired object relations: Rigid reality and inflexible and has difficulty in intimate relationships. Impaired self-perception: Distorted self-perception and experiences selfhate or self-idealization Impaired thought processes

Features          

Concrete or diffuse thinking Difficulty concentrating Impaired memory Impaired stimulus barrier Unable to regulate incoming sensory stimuli Increased excitability Excessive response to noise and light Poor attention span Agitated Insomnia

Features of PD •

Clients may deny their existing problems and lack insight into their mal-adaptive behavior

Types of Personality Disorders Cluster

Disorders

Descriptions

Cluster 1- ODD and ECCENTRIC

Paranoid Schizoid Schizotypal

Clients are withdrawn and engage in odd behavior

Cluster IIERRATIC, DRAMATIC and EMOTIONAL

Antisocial Borderline Histrionic Narcissistic

Clients seek attention

Custer IIIAVOIDANT, ANXIOUS and FEARFUL

Avoidant Dependent Obsessivecompulsive PD not otherwise Passive-Aggressive specified Masochistic

Clients seek to avoid or minimize experience anxiety Clients are covertly aggressive against self and

Types of PD Classification

Personality

ODD or Eccentric Dramatic/Erra tic Anxious/ Fearful Others

Paranoid, Schizoid, Schizotypal Borderline, Antisocial, Histrionic, Narcissistic Dependent, Avoidant , OCPD Passive-aggressive, cyclothymic and depressive

Prevalence of Personality Disorders  

13.4 % prevalence rate Most common of which are the avoidant, schizoid and paranoid personality disorders

Etiologies of Personality Disorders 

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There exists NO clear-cut single cause for Personality disorders, largely UNKNOWN Multi-causation, genetic and environmental factors may all play roles TEMPERAMENT may also play a role

Schizoid personality disorder Description: Characterized by an inability to form warm, close social relationships

Schizoid personality disorder Assessment  Social detachment and lack of close relationships  Interest in solitary activities  Aloof and indifferent  Restricted expression of emotions  Lack of interest in others

Schizotypal personality disorder Description: Exhibits abnormal or highly unusual thoughts, perceptions, speech, and behavior patterns

Schizotypal personality disorder Assessments  Magical thinking  Odd thinking and speech  Relationship deficits

Paranoid personality disorder Description: Characterized by suspiciousness and mistrust of others 

Paranoid personality disorder Assessment  Suspicious and distrusting  Argumentative  Hostile aloofness  Rigid, critical, and controlling of others  Grandiosity

Histrionic personality disorder  

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Description Characterized by overly dramatic and intensely expressive behavior The client is lively and dramatic and enjoys being the center of attention Interpersonal relations may be poor

Histrionic personality disorder Assessment Assessment Marlon’s Syndrome  Attention seeking  Needs to be the center of attention  Sexually seductive or provocative  Self-dramatizing and theatrical  Overly concerned with appearance  Has romantic fantasies and controls partners  Bores easily  Displays dependency

Narcissistic personality disorders Description  Characterized by an increased sense of self-importance  The client is preoccupied with fantasies and unlimited success and has a constant need attention and admiration

Narcissistic personality disorders Assessment  Grandiosity  Requires admiration and inflated accomplishments  Overestimates abilities and underestimates contributions of others  Lacks empathy and sensitivity to needs of others

Avoidant personality disorder Description:  Characterized by social withdrawal and extreme sensitivity to potential rejection

Avoidant personality disorder Assessment  Feelings of inadequacy  Hypersensitive to reactions of others and reacts poorly to criticism  Social inhibition  Lack of support system

Dependent personality disorder Description  The individual lacks self-confidence and the ability to function independently  Passively allows others to make decisions and assume responsibility for major areas in his or her life

Dependent personality disorder Assessment  Difficulty making decisions  Lacks autonomy  Cannot tolerate being alone and must always have a close relationship  Needs others to assume responsibility and make decisions

Obsessive-compulsive personality disorder Description  The client has difficulty expressing warm and tender emotions and reflects perfectionism, stubbornness, the need to control others, and a devotion to work

Obsessive-compulsive personality disorder Assessment  Orderliness and perfectionism  Overly conscientious  Inflexible and preoccupied with details and rules  Devoted to work and lacks leisure activities and friendships  Miserly and stubborn  Hoards worthless objects

Antisocial personality disorder Description  A pattern of irresponsible and antisocial behavior  Characterized by selfishness, inability to maintain lasting relationships, poor sexual adjustment, and failure to accept social norms, irritability, and aggressiveness

Antisocial personality disorder Assessment  Perceives the world as hostile  Superficial charm and hostility  No shame or guilt  Self-centered  Unreliable  Easily bored  Poor work history  Unable to tolerate frustration  Views others as objects to be manipulated  Poor judgment  Impulsive

Borderline personality disorder Description  Characterized by instability in interpersonal relationships, mood, and self-image  Behavior may be impulsive and unpredictable

Borderline personality disorder Assessment  Unclear identity  Unstable and intense  Extreme shifts in mood  Easily angered  Easily bored  Argumentative  Depression  Self-destructive behavior  Manipulation  Unable to tolerate anxiety  Chronic feelings of emptiness and fear of being alone  Splitting

Passive-aggressive personality disorder Description  Characterized by passively expressing covert aggression rather than dealing with it directly  The behavior can interfere with both social and work activities

Passive-aggressive personality disorder Assessment  Procrastination  Stubbornness  Intentional inefficiency  Forgetfulness  Dependency

Implementation Therapies for Personality disorders 2. Consistency in approach 3. Behavioral therapy

Implementation for PD Nursing Interventions 2. Maintain safe environment 3. Develop a written contract with patient 4. Establish therapeutic relationship 5. Maintain objectivity and consistency 6. Set limits to behavior

Interventions for PD  

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Treatment is a long tiring process Help the patient learn ways to reduce anxiety Limit setting Develop a written contract Encourage to keep journal Recognize and deal with manipulative behavior

General implementation for personality disorders 

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Maintain safety against self-destructive behaviors Allow the client to make choices and be as independent as possible Encourage the client to discuss feelings rather than act them out Provide consistency in response to the client's acting-out behaviors Discuss expectations and responsibilities with the client

General implementation for personality disorders 

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Discuss the consequences that will follow certain behaviors Inform the client that harm to self, others, and property is unacceptable Identify splitting behavior Assist the client to deal directly with anger Develop a written contract with the client

General implementation for personality disorders 

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Encourage the client to keep a journal recording daily feelings Encourage the client to participate ingroup activities, and praise nonmanipulative behavior Set and maintain limits to decrease manipulative behavior Remove the client from group situations in which attention-seeking behaviors occur Provide realistic praise for positive behaviors in social situations

Ways to handle manipulative behavior  

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Set clear realistic limits CONFRONT client about manipulative behavior Clearly and consistently communicate care plans and client behaviors to other nurses Accept no gifts or flattery Form therapeutic Nurse-patient relationship