PERSONALITY DISORDERS IN THE ELDERLY

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PERSONALITY DISORDERS IN THE ELDERLY

• OR..WORKING IN A SALT MINE IN SIBERIA HAS TO
  BE EASIER THAN THIS, OR ..HOW DOES ONE BECOME
  A MONK IN THE HIMALAYAS

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WHAT IS PERSONALITY?

• Personality refers to a distinctive set of
  traits, behavior styles, and patterns that make
  up our character or individuality. How we
  perceive the world, our attitudes, thoughts and
  feelings are all part of our personality. People
  with healthy personalities are able to cope with
  normal stresses and have no trouble forming
  relationships with family, friends, and
  co-workers.

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WHAT IS A PERSONALITY DISORDER?

• Those who struggle with a personality disorder
  have great difficulty dealing with other people.
  They tend to be inflexible, rigid, and unable to
  respond to the changes and demands of life.
  Although they feel that their behavior patterns
  are normal or right, people with personality
  disorders tend to have a narrow view of the world
  and find it difficult to participate in social
  activities.

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RECOGNIZING A PERSONALITY DISORDER

• Must fulfill several criteria
• A deeply ingrained, inflexible pattern of
  relating, perceiving, and thinking serious enough
  to cause distress or impaired functioning is a
  personality disorder
• Usually recognizable by adolescence or earlier,
  continue throughout adulthood, and become less
  obvious throughout middle age
• 
  DSM-IV

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PERSONALITY DISORDER CRITERIA

• AN ENDURING PATTERN OF INNER EXPERIENCE AND
  BEHAVIOR THAT DEVIATES MARKEDLY FROM THE
  EXPECTATIONS OF THE INDIVIDUALS CULTURE. THIS
  PATTERN IS MANIFESTED IN TWO OR MORE OF THE
  FOLLOWING AREAS

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PERSONALITY DISORDER/CRITERIA

• COGNITION, I.E., WAYS OF PERCEIVING AND
  INTERPRETING SELF, OTHER PEOPLE, AND EVENTS
• AFFECTIVITY, THEIR RANGE, INTENSITY, LABILITY,
  AND APPROPRIATENESS OF EMOTIONAL RESPONSE
• INTERPERSONAL FUNCTIONING
• IMPULSE CONTROL
• 
  DSM-IV

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CRITERIA/ CONTD

• The enduring pattern is inflexible and pervasive
  across a broad range of personal and social
  situations
• The enduring pattern leads to clinically
  significant distress or impairment in social,
  occupational, or other important areas of
  functioning
• Not better accounted for as a manifestation or
  consequence of another mental disorder
• Not due to direct physiological effects of a
  substance or a general medical condition
• Is stable and long duration, onset can be traced
  back at least to adolescence or early adulthood
  DSM-IV

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CAUSES OF PERSONALITY DISORDERS

• Some experts believe that events occurring in
  early childhood exert a powerful influence upon
  behavior later in life.
• Others indicate that people are genetically
  predisposed to personality disorders
• Environmental facts may cause a person who is
  already genetically vulnerable to develop a
  personality disorder

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TYPES OF PERSONALITY DISORDERS/FALL INTO THREE
DIFFERENT CATEGORIES OR CLUSTERS

• CLUSTSER A ODD OR ECCENTRIC BEHAVIOR
• CLUSTER B DRAMATIC, EMOTIONAL OR ERRATIC
  BEHAVIOR
• CLUSTER C ANXIOUS FEARFUL BEHAVIOR

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CLUSTER A

• SCHIZOID PERSONALITY DISORDER
• Neither desires nor enjoys close relationships,
  including being a part of a family
• Almost always chooses solitary activities
• Has little, if any, interest in having sexual
  experiences with another person
• Takes pleasure in few, if any, activities
• Lacks close friends or confidants other than
  first-degree relatives
• 
  DSM-IV

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SCHIZOID CONTD

• Shows emotional coldness, detachment, or
  flattened affectivity
• Appears indifferent to the praise or criticism of
  others
• Does not occur exclusively during the course of
  Schizophrenia, a Mood Disorder with Psychotic
  Features, another Psychotic Disorder, or a
  Pervasive Developmental Disorder, not due to the
  direct physiological effects of a general medical
  condition DSM-IV
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  DSM-IV

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PARANOID DISORDER (PERVASIVE DISTRUST AND
SUSPICIOUSNESS OF OTHERS SUCH THAT THEIR MOTIVES
ARE INTERPRETED AS MALEVOLENT, BEGINNING BY EARLY
ADULTHOOD )

• Suspects, without sufficient basis, that others
  are exploiting, harming, or deceiving him or her
• Is preoccupied with unjustified doubts about the
  loyalty or trustworthiness of friends and
  associates
• Perceives attacks on his or her character or
  reputation that are not apparent to others and
  is quick to react angrily or to counterattack
  DSM-IV

PARANOID PERSONALIT
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PARANOID, CONTD

• Reluctant to confide in others because of
  unwarranted fear that information will be used
  maliciously against him/her
• Reads hidden demeaning or threatening meanings
  into benign remarks or events
• Persistently bears grudges, i.e., is unforgiving
  of insult, injuries, or slights
• Has recurrent suspicions, without justification,
  regarding fidelity of spouse or sexual partner
• DSM-IV

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Schizotypal Personality Disorder (Pervasive

• Pattern of social and interpersonal deficits
  marked by acute discomfort with, and reduced
  capacity for, close relationships as well as by
  cognitive or perceptual distortions and
  eccentricities of behavior
• Odd beliefs or magical thinking that influences
  behavior is inconsistent with sub cultural norms
  (e.g., superstiousness, belief in clairvoyance,
  telepathy, or sixth sense in children and
  adolescents, bizarre fantasies or preoccupations)
• Ideas of reference (including delusions of
  reference)
• Unusual perceptual experiences, including bodily
  illusions
• 
  DSM-IV

At
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SCHIZOTYPAL , CONTD

• Excessive social anxiety that does not diminish
  with familiarity and tends to be associated with
  paranoid fears rather than negative judgments
  about self
• Odd thinking and speech
• Suspiciousness or paranoid ideation
• Inappropriate or constricted affect
• Behavior or appearance that is odd, eccentric, or
  peculiar
• 
  DSM-IV

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CLUSTER B/ DRAMATIC, EMOTIONAL OR ERRATIC
BEHAVIORANTISOCIAL PERSONALITY

• Failure to reform to conform to social norms with
  respect to lawful behaviors, repeatedly
  performing acts that are grounds for arrest
• Deceitfulness, repeated lying, use of aliases,
  conning others for personal profit or pleasure
• At least 18 years of age
• DSM-IV

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ANTISOCIAL, CONTD

• Impulsivity, failure to plan ahead
• Irritability or aggressiveness, repeated
  physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility, repeated failure to
  sustain consistent work or honor financial
  obligations
• Lack of remorse
• 
  DSM-IV
  

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Borderline Personality Disorder

• A pervasive pattern of instability of
  interpersonal relationships, self-image, and
  affects, marked impulsivity beginning in early
  adulthood, must have 5 of the following
• Frantic efforts to avoid real or imagined
  abandonment
• Pattern of unstable and intense interpersonal
  relationships characterized by idealization and
  devaluation
• Identity disturbance, markedly and persistently
  unstable image of self or sense of self
  DSM-IV

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BORDERLINE, CONTD

• Impulsivity in at least two areas that are
  self-damaging (e.g. spending, sex, substance
  abuse, binge eating, reckless driving
• Recurrent suicidal behavior, gesturing, threats,
  self-injury
• Affective instability, marked reactivity of
  mood, intense dysphoria, anxiety, irritability
• Chronic feelings of emptiness
• Inappropriate intense anger, or difficulty
  controlling anger, physical fights, constant
  anger
• Transient , stress-related paranoid ideation or
  severe dissociative symptoms DSM-IV

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HISTRIONIC PERSONALITY(5 OR MORE OF THE
FOLLOWING)

• Uncomfortable when not center of attention
• Interactive with others sexually inappropriate,
  seductive
• Displays rapidly shifting emotion, shallow
• Consistently uses physical appearance to draw
  attention to self
• Considers relationships to be more intimate than
  they really are
• Suggestible, easily influenced by others or
  circumstances
• Self-dramatization, theatricality, and
  exaggerated expression of emotion
• Style of speech that is excessively
  impressionistic and lacking in detail
  DSM-IV

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Narcissistic Personality Disorder

• Pervasive pattern of grandiosity, need for
  admiration, lack of empathy
• Preoccupied with fantasies of power, brilliance,
  beauty, or ideal love
• Believes he/she special and unique and can only
  be understood by, or should associate with
  high-status people
• Requires excessive admiration

• Interpersonally exploitative, i.e. takes
  advantage of others to achieve his/her own ends
• Lacks empathy is unwilling to recognize or
  identify with the feelings and needs of others
• Is often envious of others or believes that
  others are envious of him/her
• Shows arrogant, haughty behaviors or attitudes
• Sense of entitlement
• DSM-IV

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CLUSTER C DISORDERS/Avoidant Personality Disorder

• PERVASIVE PATTERN OF SOCIAL INHIBITION, FEELINGS
  OF INADEQUACY, AND HYPERSENSITIVITY TO NEGATIVE
  EVALUATION
• Views self as socially inept, personally
  unappealing, or inferior to others
• Avoids occupational activities that involve
  significant interpersonal contact, because of
  fears of criticism, disapproval, or rejection
• 
  DSM-IV

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AVOIDANT/CONTD

• Shows restraint within intimate relationships
  because of fear of being shamed or ridiculed
• Preoccupation with being criticized or rejected
  in social situations
• Inhibited in new relationships due to fear of
  inadequacy
• Views self as socially inept, inferior,
  personally unappealing
• Unusually reluctant to take personal risks or to
  engage in any new activities because they may
  prove embarrassing DSM-IV

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DEPENDENT PERSONALITY

• PERVASIVE NEED TO BE TAKEN CARE OF, LEADING TO
  SUBMISSIVE AND CLINGING BEHAVIORS , FEAR OF
  SEPARATION, BEGINNING EARLY ADULTHOOD
• Difficulty making everyday decisions without an
  excessive amount of assurance and advise from
  others
• Difficulty expressing disagreement with others
  due to fear of loss of support or approval
• Difficulty initiating projects or doing things on
  his/her own because of a lack of self-confidence
  in judgment or abilities rather than a lack of
  motivation or energy
  DSM-IV

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DEPENDENT, CONTD

• Excessive lengths to obtain nurturance and
  support from others, to the point of volunteering
  to do things that are unpleasant
• Feels uncomfortable or helpless when alone
  because of exaggerated fears of being unable to
  care for him/her self
• Urgently seeks another relationship as a source
  of care and support when a close relationship
  ends
• Is unrealistically preoccupied with fears of
  being left to take care of him/her self
• Needs others to assume responsibility for most
  areas of his/her life DSM-IV

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OBSESSIVE-COMPULSIVE DISORDER

• A PERVASIVE PATTERN OF PREOCCUPATION WITH
  ORDERLINESS, PERFECTIONISM, AND MENTAL AND
  INTERPERSONAL CONTROL, AT THE EXPENSE OF
  FLEXIBILITY, OPENNESS, AND EFFICIENCY, BEGINNING
  EARLY ADULTHOOD AND BY FOUR OF FOLLOWING
• Preoccupied with details, rules, lists, order,
  organization, or schedules to the extent that the
  major point of the activity is lost
• Perfectionism that interferes with task
  completion (unable to complete because of overly
  strict standards)
• Rigidity and stubbornness DSM-IV

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OCD DISORDER, CONTD

• Excessively devoted to work and productivity to
  the exclusion of leisure activities and
  friendships
• Over conscientious, scrupulous, and inflexible
  about matters of morality, ethics, or values (
  not accounted for by cultural or religious
  identification)
• Unable to discard worn-out /worthless objects
  even when they have no sentimental value
• Reluctant to delegate tasks or to work with
  others unless they submit to exactly his/her way
  of doing things
• Adopts a miserly spending style toward both self
  and others, money is viewed as something to be
  hoarded for future catastrophes
  DSM-IV

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STAFF BEHAVIORS

• BACKBITING
• TEAM SPLITTING
• I CAN DO IT BETTER THAN YOU
• NEGATIVITY REGARDING PATIENT
• INCREASED GOSSIPING, MISTRUST
• ENERGY SPENT OFF HOURS TALKING ABOUT
  YA-DA-YA-DA-YA-DA
• AWFULIZING, AINT IT AWFUL
• TALKING AT DESK ,PTS OVERHEARING

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SO WHAT TO DO??????????

• SELF-AWARENESS (OBSERVE BODY REACTION, FEELING IN
  GUT
• TIME OUT, DISTANCE
• FREQUENT STAFF MEETINGS (INFORMAL, BRING FOOD,
  HUMOR)
• SELF-CARE, TEAM-CARE
• PRACTICE VS, VALIDATE, VENT, VOLUNTEER,
  VIGILANCE

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WHAT TO DO, CONTD

• ASK FOR HELP!!
• EMPATHY WHEN YOU FEEL LIKE, EXPLETIVE, EXPLETIVE,
  EXPLETIVE!!!!!!!!!!!!!!
• NON-JUDGEMENTAL APPROACH, USE BUDDY SYSTEM
• VALIDATE YOURSELF AND RESIDENT, PATIENT, FAMILY

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WHAT TO DO CONTD

• SET LIMITS
• AS OFTEN AS POSSIBLE, USE SAME PRIMARY
• CHECK IT OUT
• TELL CLIENT/RESIDENT WHEN YOU WILL RETURN
• TIME OUT FOR SELF!

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DONT SHOULD ON YOURSELF!!!!
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HOW DO YOU EAT AN ELEPHANT,ONE BITE AT A TIME!