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Personality Disorders: Traits, Dysfunction, and Treatment

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  1. Chapter 10 Personality Disorders

  2. Personality disorders • Personality Definition -Style of how a person deals with the world -Traits are stylistic peculiarities that all people bring to social relationships (shyness, seductiveness, etc) • Personality Disorder Definition -Personality traits exaggerated to the point that they cause dysfunction in their relationships -DSM IV classified as Axis II -They do not believe there is anything wrong with them, but rather their problems occur by other people or events • Common characteristics -Inflexible and maladaptive responses to stress -Disability in working and living -Tendency to evoke intense personal conflict -Capacity to “get under the skin” of others

  3. Prevalence and comorbidity • Prevalence -14.8% met the standard diagnostic criteria • Comorbidity -Often co-occur with substance abuse, somatization, eating disorders, PTSD, depression and anxiety • Theory -Genetics: significant role in the development -Neurobiological Factors: brain imaging suggest abnormalities in prefrontal, corticostriatal and limbic networks related to decreased serotonin neurotransmission and behavioral disinhibition -Psychological Influences: childhood abuse & trauma -Cultural Considerations: Certain subgroups high risk

  4. DSM IV: Cluster A The odd and eccentric personality disorders • Often referred to as “odd” or “eccentric” • Most strongly related to schizophrenia • Common features: avoid interpersonal relationships, have unusual beliefs, indifferent to reactions of others -Paranoid Personality Disorder -Schizoid Personality Disorder -Schizotypal Personality Disorder

  5. DSM IV Cluster B: the dramatic, emotional, erratic personality • Characteristics: Dramatic, erratic or flamboyant behavior • Overlap with Axis I Comorbidity • Manipulation is common defensive mechanism -Antisocial Personality Disorder -Borderline Personality Disorder -Histrionic Personality Disorder -Narcissistic Personality Disorder

  6. DSM IV: Cluster C the anxious and fearful disorders • Common features: high levels of anxiety and outward signs of fear • Show social inhibitions in a sexual sphere • Often fearful & reluctant to show irritation and anger even when justified -Avoidant Personality Disorder -Obsessive-Compulsive Personality Disorder -Dependent Personality Disorder

  7. Application of the nursing process • Assessment • Primitive Defenses • Assessment Tools: Assessment of history & self assessment • Assessment Guidelines • Diagnosis • Outcomes Identification • Planning • Implementation • Communication Guidelines • Milieu Therapy • Psychotherapy: Psychodynamic, CBT, Dialectical Behavior Therapy • No medications for treatment of these disorders but treating the symptoms is helpful • Evaluation • Evaluating treatment effectiveness in the population- difficult

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