PERSONALITY DISORDERS

DEFINITIONS:
It is also known as Character Disorder. a type of mental illness in which you have trouble perceiving and relating to situations

and to people including yourself having disturbances in self-image resulting for them to have decreased ability to have successful relationships. Generally means having a rigid and unhealthy pattern of thinking and behaving no matter what the situation. in some cases this is not realize because the way of thinking and behaving seems natural, and they may blame others for the challenges theyd face.
This leads to significant problems and limitations in relationships, social encounters,

work and school.

IMPORTANT KEY TERMS: Personality = is the combination of thoughts, emotions and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality Traits = 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. Character = an individual's set of emotional, cognitive, and behavioral patterns learned and accumulated over time.

CHARACTERISTICS: Symptoms vary widely depending on the type of personality disorder. In general, personality disorders involve feelings, thoughts, and behaviors that do not adapt to a wide range of settings. These patterns usually begin in adolescence and may lead to problems in social and work situations.

The severity of these conditions ranges from mild to severe.

ETIOLOGY: The causes of personality disorders are unknown. However, many genetic and environmental factors are thought to play a role. The roots of personality disorder lie in both early life experiences and genetic (ie, inherited) factors. However, severe changes in personality may develop during later life because of the unique stresses experienced by older adults. Many older adults become overwhelmed by losses (eg, deaths among friends and loved ones), medical problems, and stresses that build up over time. This is especially true for people who are not able to cope well or do not have the personal, social, or financial resources to act as a cushion or buffer against these stresses.
Personality forms during childhood, shaped through an interaction of two factors:

1. Inherited tendencies, or your genes: = are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. = sometimes called your temperament. = the "nature" part of the nature vs. nurture debate. 2. Environment, or your life situations: = the surroundings you grew up in, events that occurred, and relationships with family members and others. = includes such things as the type of parenting you had, whether loving or abusive. = the "nurture" part of the nature vs. nurture debate.

TYPES OF PERSONALITY DISORDERS: There are many formally identified personality disorders, each with their own set of behaviors and symptoms. Many of these fall into different categories or clusters: Cluster Disorders Descriptions Possible Psychiatric Illness that may developed

Cluster 1- ODD and ECCENTRIC Cluster II- ERRATIC, DRAMATIC and EMOTIONAL Custer IIIAVOIDANT, ANXIOUS and FEARFUL PD not otherwise specified

Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive Passive-aggressive Depressive Sadomasochistic Cyclothymic

Clients are withdrawn and engage in odd behavior Clients seek attention

schizoprenia depression

Clients seek to avoid or minimize experience anxiety

Anxiety disorder

Clients are covertly Either anxiety or aggressive against self depression and others

1. Cluster A: a. Schizoid Personality Disorder - is a psychiatric condition in which a person has a lifelong pattern of indifference to others and social isolation. Symptoms: A person with schizoid personality disorder: Appears aloof and detached Avoids social activities that involve emotional intimacy with other people Does not want or enjoy close relationships, even with family members Lack of interest in social relationships Limited range of emotional expression Inability to pick up normal social cues Appearing dull or indifferent to others

b. Paranoid Personality Disorder - is a psychiatric condition in which a person has a long-term distrust and suspicion of others, but does not have a full-blown psychotic disorder such as schizophrenia. Symptoms: Concern that other people have hidden motives Expectation that they will be exploited by others

Inability to work together with others Social isolation Detachment Hostility Distrust and suspicion of others

Believing that others are trying to harm you Emotional detachment

c. Schizotypal Personality Disorder - is a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior.

Symptoms: People with schizotypal personality disorder:

May be very disturbed. People with schizotypal personality disorder feel upset by their difficulty in forming and keeping close relationships. Peculiar dress, thinking, beliefs(such as aliens). or behavior (fears of being monitored by government agencies) Perceptual alterations, such as those affecting touch Discomfort in close relationships Flat emotions or inappropriate emotional responses Indifference to others "Magical thinking" believing you can influence people and events with your thoughts Believing that messages are hidden for you in public speeches or displays

2. Cluster B:

a. Antisocial Personality Disorder - is a type of chronic mental illness in which a person's ways of thinking, perceiving situations and relating to others are abnormal and destructive. Antisocialis sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder.

Symptoms: Disregard for right and wrong Persistent lying or deceit Using charm or wit to manipulate others Recurring difficulties with the law Repeatedly violating the rights of others Child abuse or neglect Intimidation of others Aggressive or violent behavior Lack of remorse about harming others Impulsive behavior Agitation Poor or abusive relationships Irresponsible work behavior Have problems with substance abuse

c. Narcissistic Personality Disorder - is a condition in which people have an inflated sense of self-importance and an extreme preoccupation with themselves. Symptoms: A person with narcissistic personality disorder may: React to criticism with rage, shame, or humiliation Take advantage of other people to achieve his or her own goals Have excessive feelings of self-importance Exaggerate achievements and talents Be preoccupied with fantasies of success, power, beauty, intelligence, or ideal love Have unreasonable expectations of favorable treatment Need constant attention and admiration Disregard the feelings of others, and have little ability to feel empathy Have obsessive self-interest Pursue mainly selfish goals

b. Borderline Personality Disorder - is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others. These inner experiences often cause them to take impulsive actions and have chaotic relationships. Symptoms:

Fear of being abandoned Feelings of emptiness and boredom Frequent displays of inappropriate anger Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting Intolerance of being alone Repeated crises and acts of self-injury, such as wrist cutting or overdosing Tend to see things in terms of extremes, such as either all good or all bad

d. Histrionic Personality Disorder - is a condition in which people act in a very emotional and dramatic way that draws attention to themselve. Symptoms: People with this disorder are usually able to function at a high level and can be successful socially and at work. Acting or looking overly seductive Being easily influenced by other people Being overly concerned with their looks Being overly dramatic and emotional Being overly sensitive to criticism or disapproval Believing that relationships are more intimate than they actually are Blaming failure or disappointment on others Constantly seeking reassurance or approval Having a low tolerance for frustration or delayed gratification Needing to be the center of attention (self-centeredness) Quickly changing emotions, which may seem shallow to others

3. Cluster C: a. Avoidant Personality Disorder - is a mental health condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection. Symptoms: People with avoidant personality disorder are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. Loss and rejection are so painful that these individuals will choose to be lonely rather than risk trying to connect with others. Hypersensitivity to rejection/criticism Self-imposed social isolation

Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships Avoids physical contact because it has been associated with an unpleasant or painful stimulus Avoids interpersonal relationships Feelings of inadequacy Severe low self-esteem Mistrust of others Highly self-conscious Feeling inferior to others Utilizes fantasy as a form of escapism and to interrupt painful thoughts

b. Dependent Personality Disorder - is a long-term (chronic) condition in which people depend too much on others to meet their emotional and physical needs. Symptoms: People with this disorder do not trust their own ability to make decisions. They may be very upset by separation and loss. They may go to great lengths, even suffering abuse, to stay in a relationship. Symptoms of dependent personality disorder may include: Avoiding being alone Avoiding personal responsibility Becoming easily hurt by criticism or disapproval Becoming overly focused on fears of being abandoned Becoming very passive in relationships Feeling very upset or helpless when relationships end Having difficulty making decisions without support from others Having problems expressing disagreements with others

c. Obsessive-Compulsive Personality Disorder (OCPD) - is a condition in which a person is preoccupied with rules, orderliness, and control. Symptoms: OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.

A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person's ability to complete tasks, because their standards are so rigid. People with this disorder may emotionally withdraw when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships. Some of the other signs of obsessive-compulsive personality disorder include: Excess devotion to work Inability to throw things away, even when the objects have no value Lack of flexibility Lack of generosity Not wanting to allow other people to do things Not willing to show affection Preoccupation with details, rules, and lists Preoccupation with orderliness and rules Extreme perfectionism Desire to be in control of situations Inability to discard broken or worthless objects Inflexibility

4. Other Personality Disorder a. Passive- aggressive Personality Disorder (Negativistic) - is a chronic condition, meaning that it lasts throughout life where they appear to comply or act appropriately, but actually behave negatively and passively resist. Symptoms: Contradictory and inconsistent behavior. An individual with passive-aggressive personality disorder may appear enthusiastic to carry out others requests, but he or she purposely performs in a manner that is not useful and sometimes even damaging. Intentional avoidance of responsibility. Some behaviors that may be used to avoid responsibility include: o Procrastination to delay or postpone needlessly and intentionally o Deliberate inefficiency purposefully performing in an incompetent manner o Forgetfulness Feelings of resentment toward others Stubbornness Argumentative, sulky, and hostile, especially toward authority figures

Easily offended Resentful of useful suggestions from others Blames others Chronically impatient Unexpressed anger or hostility

b. Depressive- Personality Disorder - (also known as melancholic personality disorder) is a controversial psychiatric diagnosis that denotes apersonality disorder with depressive features. Symptoms:

Usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, and Self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem Is critical, blaming, and derogatory towards the self Is brooding and given to worry Is negativistic, critical, and judgmental toward others Is pessimistic Is prone to feeling guilty or remorseful

unhappiness

c. Masochistic Personality Disorder also called self defeating personality disorder can be defined as a pattern of self defeating and self distructing behaviour which generally begins in the early stages of adulthood and is present in various stages. Symptoms: They tend to avoid pleasurable experiences. Respond to positive events with depression, and a feeling of guilt. They reject people who treat them well. Find love, care and other affections unattractive. Reject great opportunities for pleasure. They refuse to be helped. They provoke anger and reject responses from others and then feel rejected and hurt. d. Cyclothymic Personality Disorder - A personality disorder in which a person experiences regularly alternating periods of elation and depression, usually not related to external circumstances or situation Symptoms:

has depressive periods: depressed mood or loss of interest or pleasure in all, or almost all, activities and pastimes alternating with hypomanic periods: elevated, expansive, or irritable mood becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences alternating with restriction of involvement in pleasurable activities and guilt over past activities alternates between over-optimism or exaggeration of past achievement and a pessimistic attitude toward the future, or brooding about past events is more talkative than usual, with inappropriate laughing, joking, and punning: and, then, less talkative, with tearfulness or crying has a decreased need for sleep alternating with hypersomnia has shaky self-esteem: naive grandiose overconfidence alternating with lack of selfconfidence has periods of sharpened and creative thinking alternating with periods of mental confusion and apathy displays marked unevenness in the quantity and quality of productivity, often associated with unusual working hours engages in uninhibited people-seeking (that may lead to hyper-sexuality) alternating with introverted self-absorption frequently shifts line of work, study, interest, or future plans engages in occasional financial extravagance has a tendency toward promiscuity, with repeated conjugal or romantic failure may use alcohol or drugs to control moods or to augment excitement has irritable-angry-explosive outbursts that alienate loved ones makes frequent changes in residence or geographical location

Management: Therapies for Personality disorders 1. Consistency in approach 2. Behavioral therapy Nursing Interventions 1. Maintain safe environment 2. Develop a written contract with patient 3. Establish therapeutic relationship 4. Maintain objectivity and consistency 5. Set limits to behavior 6. Treatment is a long tiring process 7. Help the patient learn ways to reduce anxiety

8. Limit setting 9. Develop a written contract 10. Encourage to keep journal 11. Recognize and deal with manipulative behavior 12. Discuss the consequences that will follow certain behaviors 13. Inform the client that harm to self, others, and property is unacceptable 14. Identify splitting behavior 15. Assist the client to deal directly with anger 16. Develop a written contract with the client 17. Encourage the client to keep a journal recording daily feelings 18. Encourage the client to participate in-group activities, and praise non-manipulative behavior 19. Set and maintain limits to decrease manipulative behavior 20. Remove the client from group situations in which attention-seeking behaviors occur 21. Provide realistic praise for positive behaviors in social situations Ways to handle manipulative behavior: 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

Health care team roles Nursing staff and allied health professionals can assist in the treatment of personality disorders by being aware of the symptoms of each cluster. Since personality disorders often present as relationship difficulties, nursing staff and allied health professionals may recognize personality disorders in particularly problematic patients. During the treatment phase, nursing staff and allied health professionals can help patients by providing them with appropriate educational materials and referrals for ongoing psychotherapy or group therapy, if applicable.

Medications Medications may be prescribed for patients with specific personality disorders. The type of medication depends on the disorder. ANTIPSYCHOTIC DRUGS. Antipsychotic drugs, such as haloperidol (Haldol), may be given to patients with paranoid personality disorder if they are having brief psychotic episodes. Patients with borderline or schizotypal personality disorder are sometimes given antipsychotic drugs in low doses; however, the efficacy of these drugs in treating personality disorder is less clear than in schizophrenia. MOOD STABILIZERS. Carbamazepine (Tegretol) is a drug that is commonly used to treat seizures, but is also helpful for borderline patients with rage outbursts and similar behavioral problems. Lithium and valproate may also be used as mood stabilizers, especially among people with borderline personality disorder. ANTIDEPRESSANTS AND ANTI-ANXIETY MEDICATIONS. Medications in these categories are sometimes prescribed for patients with schizoid personality disorder to help them manage anxietysymptoms while they are in psychotherapy. Antidepressants are also commonly used to treat people with borderline personality disorder. Treatment with medications is not recommended for patients with avoidant, histrionic, dependent, or narcissistic personality disorders. The use of potentially addictive medications should be avoided in people with borderline or antisocial personality disorders. However, some avoidant patients who also have social phobia may benefit from monoamine oxidase inhibitors (MAO inhibitors), a particular class of antidepressant. Psychotherapy Psychoanalytic psychotherapy is suggested for patients who can benefit from insight-oriented treatment. These patients typically include those with dependent, obsessive-compulsive, and avoidant personality disorders. Doctors usually recommend individual psychotherapy for narcissistic and borderline patients, but often refer these patients to therapists with specialized training in these disorders. Psychotherapeutic treatment for personality disorders may take as long as three to five years. Insight-oriented approaches are not recommended for patients with paranoid or antisocial personality disorders. These patients are likely to resent the therapist and see him or her as trying to control or dominate them. Supportive therapy is regarded as the most helpful form of psychotherapy for patients with schizoid personality disorder. Cognitive-behavioral therapy Cognitive-behavioral approaches are often recommended for patients with avoidant or dependent personality disorders. Patients in these groups typically have mistaken beliefs about their

competence or likableness. These assumptions can be successfully challenged by cognitivebehavioral methods. Group therapy Group therapy is frequently useful for patients with schizoid or avoidant personality disorders because it helps them to break out of their social isolation. It has also been recommended for patients with histrionic and antisocial personality disorders. These patients tend to act out, and pressure from peers in group treatment can motivate them to change. Because patients with antisocial personality disorder can destabilize groups that include people with other disorders, it is usually best if these people meet exclusively with others with the same disorder (in "homogeneous" groups). Family therapy Family therapy may be suggested for patients whose personality disorders cause serious problems for members of their families. It is also sometimes recommended for borderline patients from overinvolved or possessive families. Xxxxxxxxxxxxdsdaqwwaaww23ewwewws