PERSONALITY DISORDERS

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PERSONALITY DISORDERS

• Mercedes A Perez-Millan MSN, ARNP

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PERSONALITY

• Personality is a consistent way of thinking and
  feeling which results from the interaction of a
  persons genetic
• make-up his level of education
• and past experiences.
• Largely unconscious
• Cannot be changed easily

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PERSONALITY TRAITS

• A characteristic mode of behavior or any
  mannerism that distinguishes one individual from
  another. Example shy, outspoken, etc
• Exhibited in a wide range of important social and
  personal contexts

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PERSONALITY DISORDERS

• Occur when traits become inflexible and
  maladaptive but stable over time.
• Cause either significant functional impairment or
  subjective distress. However they stay in the
  main stream of society.
• Present with symptoms more subtle than other
  disorders.
• Onset in adolescence or early adulthood.

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DSM-IV-TR CRITERIA

• Axis II disorder
• Enduring pattern of inner experience and behavior
  that deviates markedly from an individuals
  culture manifesting in two or more of the
  following areas
• Cognition
• Affect
• Interpersonal functioning
• Impulse control

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DSM-IV-TR CRITERIA Continued

• Enduring pattern is
• Inflexible/pervasive personal/social situations
• Significant distress in social, occupational,
  other areas of functioning
• Of stable and long duration
• Not due to physiological effects of substance or
  medical condition

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ETIOLOGY

• Psychoanalytical/Developmental Theories
• Biological Theories, e.g. genetic
• Socio-Cultural Theories
• Behavioral Theories

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COMMON BEHAVIORS IN PERSONALITY DISORDERS

• Manipulation
• Self-Centeredness
• Power Struggles
• Rigidity
• Inflexibility
• Poor ability to self-regulate

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DSM IV- CATEGORIES

• CLUSTER A Behaviors that are described as odd
  or eccentric
• Paranoid
• Schizoid
• Schizotypal

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DSM IV- CATEGORIES

• CLUSTER B Behaviors that are described as
  dramatic, emotional, or erratic
• Antisocial
• Borderline
• Histrionic
• Narcissistic

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DSM IV- CATEGORIES

• CLUSTER C Behaviors that are described as
  anxious or fearful
• Avoidant
• Dependent
• Obsessive compulsive

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NURSING CARE

• Usually not admitted for P.D.
• Axis I psychiatric diagnosis needed for admitting
  disorder P.D.
• Realistic goals behavior will probably not
  change significantly

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NURSING CARE ODD, ECCENTRIC

• Objective, matter of fact
• Clear, consistent verbal-non-verbal
• Structure for ADLs
• Maintain focus on reality
• Help identify feelings
• Assist with problem solving
• Gradually involve in group situations

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NURSING CAREDAMATIC, ERRATIC

• Prevent self-harm
• No-harm contract
• Set limits on inappropriate or manipulative
  behavior
• Assist in examining consequences of beh.
• Consistent approach by staff
• Do not rescue or reject
• Give () feedback for goal acheivement

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NURSING CAREDAMATIC, ERRATIC (Cont)

• Explore feelings
• Teach problem solving to change behavior
• Encourage follow up treatment

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NURSING CAREANXIOUS, FEARFUL

• Caring consistent approach
• Clear expectations for behavior
• Expect patient to make decisions
• Teach assertiveness
• Encourage to identify () attributes
• Provide () feedback for increased interactions
  in social situations
• Teach stress management and relaxation techniques

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NURSING CARE OF A MANIPULATIVE CLIENT

• Help patient identify manipulative behaviors
• Set clear, consistent, enforceable limits
• Consistent team approach
• Be clear with consequences
• Follow through with consequences
• Avoid power struggles with client