Personality Disorder

NCM 117/ PSYCHIATRIC NURSING/ LECTURE

PERSONALITY • Losses suffered from attached
figure
• Is the way of thinking, feeling and
• Childhood abuse
behaving that makes a person different
• Sexual abuse
from other people.
• Lack of parental care
DISORER 3. Social Cultural Factors
• Isolation
• Is an illness that disrupts normal physical
• Long term psychiatric problem
or mental functions.
• Chronic institutionalization
PERSONALITY DISORDER • Immigration, lack of close family
4. Psychodynamic Factors
• Is a way of thinking, feeling and behaving • Anxiety
that deviates from the expectation of the
• Autonomy
culture, causes distress or problems
• Separation/Abandonment
functioning, and lasts over time.
• Dependency
• Are described in the ICD-10 as deeply
ingrained and enduring behavior • Lack of Coping
patterns, manifesting themselves as Types/Classification of Personality Disorder
inflexible responses to a broad range of
personal and social situations. It is divided into 3 Clusters:

DIAGNOSIS OF PERSONALITY DISORDER 1. Cluster A – the odd and eccentric.

“Weird”
Diagnosis of personality disorder is typically 2. Cluster B – the erratic and dramatic.
made in individuals 18 or older. People under “Wild”
18 are typically not diagnosed with personality 3. Cluster C – the fearful and anxious.
disorder because their personalities are still “Worried”
developing.
Cluster A – the odd and eccentric “Weird“
• Physical Exam
• Psychiatric Evaluation 1. Paranoid Personality Disorder:
• Diagnostic Criteria in DSM 5 • Difficulty trusting others, even
without any reasonable suspicion.
Diagnostic Criteria: • They may hold grudges for long
Personality disorder affects at least two of these times, refuse to confide in others,
areas: and perceive mundane remarks
as slights against them.
• Way of thinking about oneself and others.
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one’s behavior.
Characteristics of Personality Disorder
• It is NOT a mental illness
• It is a maladaptive disorder
• It is a long lasting, most of the time
lifelong problems.
• It causes a significant impairment in
social and occupational functioning.
• Prevalence: Males > Females, 0.5 –
• It produces stress to family and others.
2.5% population
• His/her behavior deviates from what is
• Course: Lifelong
normal.
• Treatment: Psychotherapy such as
• The behavior is consistent over time.
Cognitive-behavioral and group therapy.
• It is the possession of abnormal
• Medication: antidepressant, anti-anxiety,
personality traits.
short term benzodiazepines and
Factors Causing Personality Disorder antipsychotics are recommended
together with psychotherapy.
1. Biological:
• Genetics Nursing Management:
• Hereditary/ Family History • Rapport
• Alterations in neurotransmitters – • Clear and consistent verbal and
low in serotonin nonverbal messages
• Psychoanalytic factors • Regular routine
2. Development Factors
• Low stress topic of conversation
• Early traumatic experiences
Personality Disorder
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
• Support the patient to take prescribed • Encourage social interactions
drugs.
Cluster B – the erratic and dramatic “Wild“
• Monitor for alcohol or drug misuse
• Observe for paranoid delusion. 1. Antisocial Personality Disorder
2. Schizotypal Personality Disorder • Little to no regard for the needs and
• Hear voices, believe everyday emotions of others.
occurrences are really hidden • Do not think much about the safety of
messages for them, and believe that themselves or others
their thoughts can influence people • Often lie, cheat, steal, and con others in
and events in their lives. They may order to get their ways.
also feel uncomfortable with close • Violate the rights of others and can even
personal relationships. turn aggressive.
• Do not feel remorse

• Prevalence: 3%, males > females,

• Treatment: supportive therapy with • Prevalence: 3% male and <1% females -
social skills training common in first degree relatives
• Pharmacotherapy: haloperidol, - 75% on poor urban prisons
thiothixene, olanzapine • Very difficult to treat
• Confined settings with external constraint
Nursing Management the string emphasis on legal suncions,
• Increase self-worth • Pharmacology for dangerous behaviors
• Provide social skills training Nursing Management
• Reinforce socially appropriate dress and
behavior • Protect others from client’s aggression,
• Focus on enhancing cognitive skills. manipulation, and hostility
3. Schizoid Personality Disorder • Assist clients to delay gratification by
• This disorder makes people reluctant setting limits on unacceptable behaviors.
to be around others, making them 2. Borderline Personality Disorder
seem cold and unapproachable to • Fragile egos and believe that the people
others. People with schizoid they love will abandon them.
personality disorder cannot pick up on • Unstable relationships, both with
social cues, find happiness in romantic partners and others
everyday activities or express • May act out with threats of self-harm,
emotion. anger outbursts, and paranoia. They may
also resort to risky behaviors from their
impulsivity.

• Prevalence: 1 – 7.5%; Males>

Females 2:1
• Treatment: supportive, insight –
oriented and group therapy.
• No pharmacotherapy
• Treatment prognosis is usually poor.
• 2 – 3 % of population: 2:1 ration female
Nursing Management
to male
• Provide social skills training
Personality Disorder
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
• Mothers of patients has also borderline
personality disorder
• Diagnosed before 40 years old
• Treatment: psychotherapy – exploration,
insight oriented, supportive, dialectical
behavior therapy.
• Medication for impulsivity, lability,
psychosis mood symptoms.
• Be aware of countertransference
Nursing Management
• Safety is the priority care (Risk for self- Causes
mutilation)
• Environment
• Check for physical indicator of self-
injuries • Genetics
• Check nutrition, sleep, and physical Treatments
response and emotion.
3. Histrionic Personality Disorder • Psychotherapy as primary form of
• About 1.8% of the population treatment
• Have good social skills In severe cases:
• Manipulates others to obtain attention
• They may have alexithymia – a deficit in • Mood stabilizers
recognizing one’s own emotion. • Antidepressant
• Antipsychotic drugs
Nursing Management
• Must use therapeutic communication
• Develop a relationship with the patient
based on empathy and trust
• Promote patient’s development and
engagement with their support network.
Cluster C – the Anxious and Fearful “Worried“
1. Avoidant Personality Disorder
• It appears to affect men and women
equally.
Possible Causes:
• Symptoms may be noticed in childhood
• Genes; personality traits called and often begin to create discomfort in
temperament adolescence or early adulthood.
• Childhood trauma • Fear of rejection is so strong
• Isolation is the key
Treatment:
• Psychotherapy
• Holistic therapy
• Group/Family therapy is not
recommended.
Nursing Management
• Monitor for signs of growing agitation
• Assist patients to control impulsiveness
(recognize feelings)
Causes
• Monitor and treat patient for suicidal
ideation (remove dangerous objects) • Genes
4. Narcissistic Personality Disorder • Parental/Peer Rejection
• Affects more males than females, and it
often begins in the teens or early Treatment
adulthood. • Individual counseling (psychotherapy)
• Sense of entitlement • Anti-depressant and anti-anxiety drugs
• Doing so avoids deep feeling of • Supportive family members
insecurity 2. Dependent Personality Disorder
• Prevalence of Dependent PD is about
1%
Personality Disorder
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
• Occurs more commonly in women than Nursing Management
men
• Approached the patient calmly and
• Must be distinguished from BPD because
slowly
they share common symptoms
• If the patient needs to act out their
compulsion allow them to do so as
long as it is safe.
• Encouraging the patient to talk about
why they have to do the behavior and
what it means, can also help them to
relieve anxiety
• Monitor the patient’s eating habits
and drinking habits.
• Help the patient set limits for
themselves and suggesting alternate
activities or expression of feelings.
OCD NOT OCD
Causes
A man who washes A woman who
• Particular life experiences: his hands 100 times a unfailingly washes
- abusive relationships day until they are red her hands before
- certain cultural/religious or family and raw every meal
behaviors A woman who locks A woman who double
- Early disruptions in learning and relocks her door – checks that her
independence before going to work apartment door and
every day – for half an windows are locked
hour each night before she
Treatment Options: goes to bed.
• Cognitive Behavioral Therapy (CBT) A college student who A musician who
• Include skills that foster independence must tap on the door practices a difficult
frame of every passage over and
Nursing Management classroom 14 times over again until its
before entering perfect
• The provider must guide the patient to
A woman who stores A woman who
improve self confidence
18 years of dedicates all her
• Conduct activities that will build self- newspapers “just in spare time and
reliance case” – with no money to building her
• The provider will talk about finding a system for filling or record collection.
positive and meaningful relationship retrieving
3. Obsessive Compulsive Disorder
• Usually begins in the teen or young adult
years.
• Considered a lifelong disorder
• Interferes with daily activities
• Obsession are recurring and irrational
ideas or image
• Compulsions are recurring and irrational
acts or behavior
Causes:
• Biology
• Genetics
• Learning
Risk Factors
• Family history
• Stressful life events
Treatment
• Cognitive behavioral therapy
- exposure prevention (habituation)
- response prevention
• Selective serotonin reuptake inhibitors
(SSRIs) for 3 months
• 2010 studies, noted Seromycin