Chapter 12  Personality Disorders

1. Chapter 12Personality Disorders

2. Characteristics of Personality Disorders • Deeply ingrained, inflexible, maladaptive patterns of behavior • Most apparent in interpersonal and social relationships • Capacity to cause extreme irritation and annoyance in others • Consistent and constant symptoms

3. Descriptive Adjectives • Egocentric • Self-indulgent • Manipulative • Impulsive • Lacks awareness of problem • Dependent • Passive-aggressive tendency

4. Cluster A Personality Disorders • Tend to demonstrate odd or eccentric behavior • Paranoid disorder • Schizoid disorder • Schizotypal disorder

5. Paranoid Personality Disorder • Persistent pattern of suspicion or mistrust • Signs and symptoms • Suspicious nature • Angry or hostile outbursts • Rigid, inflexible nature • Self-mutilating acts • Inability to achieve closeness in interpersonal relationships • Unable to take constructive criticism, but critical of others

6. Paranoid Personality Disorder • Exact cause is unknown • No-harm contracts, journals, and behavior logs can help clients who self-mutilate or engage in cutting to track their thoughts and behavior patterns.

7. Schizoid Personality Disorder • Self-absorbed in own feelings; emotional indifference • Loners, avoid close relationships and intimacy • Bland facial expression • Avoid positive emotion in others • Characteristics seen in most aspects of life by adult years

8. Schizotypal Personality Disorder • Strange and unusual patterns of thinking and communicating • Withdrawn from social situations • Magical thinking • Ideas of reference • Little ability to respond to feelings of others • Psychotic behavior may occur in brief episodes

9. Cluster B Personality Disorders • Dramatic, emotional, erratic behavior • Antisocial disorder • Borderline disorder • Narcissistic disorder • Histrionic disorder

10. Antisocial Personality Disorder • Persistent pattern of disregard and infringement on the rights of others • Indifference to laws of society and humanity • Sociopath • Chronic disorder • Difficult to treat

11. Antisocial Personality Disorder (cont.) • Suspicious, feels betrayed • Violates rights of others without remorse • Hostile, punitive scheming • Easily bored, restless • Impulsive • Sexually aggressive • Compulsive self-indulgence

12. Borderline Personality Disorder • Persistent pattern of unstable relationships, insecurity, mood swings • Insecure, irritable, dependent • Mood swings (self-admiration/self-dislike) • Chronic sense of emptiness and abandonment, anxiety • Quick change from clingy behavior to angry outbursts (Jekyll and Hyde) • Splitting • Self-mutilation

13. Narcissistic Personality Disorder • Narcissism: excessive love and attention given to one’s own self-image • Grandiose sense of self-importance, with underlying feelings of inferiority • Exploitation of others for own needs • Little regard for feelings of others • Fantasies of power, beauty, success (p. 178)

14. Narcissistic Personality Disorder • Arrogance • Claims of Entitlement • Demand for the best of everything • Hypersensitivity to criticism • Poor insight into behavior

15. Histrionic Personality Disorder • Overly dramatic emotional behavior to attract the attention of others • Extreme egocentricity • Unmet dependency needs • Melodramatic, vague speech • Manipulative • Attention-seeking behavior • Shallow, superficial relationships • Provocative sexual behavior

16. Cluster C Personality Disorders • Anxious and fearful types of behavior • Avoidant disorder • Dependent disorder • Obsessive-compulsive disorder

17. Avoidant Personality Disorder • Sensitive to rejection • Social inadequacy with intense anxiety • Lack of trust • Fear of criticism • Embarrassment in intimate relationships • Self-doubt, low self-esteem • Extreme shyness, social withdrawal

18. Dependent Personality Disorder • Insecurity, self-doubt • Extreme fear of being alone • Extreme reliance on others • Inability to make decisions • Constant need for reassurance • Feelings of incompetence • Self-sacrificing, submissive • Extremely anxious

19. Obsessive-Compulsive Personality Disorder • Unrealistic expectations • Excessive attention to orderliness, details • Inability to relax • Rigid and controlling • Missed deadlines • Rigid morals and ethics • Hoarding • Shallow

20. Treatment of Personality Disorders • Clients must gain perspective about underlying problem • Difficult to form therapeutic relationships • Most lack insight, resist attempts to impose change • Most have trouble trusting others

21. Treatment of Personality Disorders (cont.) • No-harm contracts, journals, behavior logs • Psychotherapy • Cognitive-behavioral therapy • Occupational therapy • Preferred methodcombination of psychotherapy and medication

22. Nursing Process Applied • Assessment • What events or behaviors led to admission • Nonverbal behaviors and symptoms • Thought processes • Inconsistencies between words and behavior • Anxiety level, emotional state • Coping mechanisms

23. Nursing Process Applied (cont.) • Nursing diagnoses • Expected outcomes

24. Nursing Process Applied (cont.) • Interventions • Identify personal feelings about the client’s behavior • Separate the person from the behavior

25. Nursing Process Applied (cont.) • Evaluation • Your ability to set boundaries and maintain therapeutic approach • Interaction with other clients • Impulse control • The client’s behavior following discharge

26. Question • Tell whether the following statement is true or false. Three cluster groups of personality traits have been identified.

27. Answer • True • Rationale: According to the DSM-IV-TR, there are three clusters of personality disorders. Commonalities exist between the groups.

28. Question • Which personality disorder involves a continued need for lavish attention and admiration? A. Avoidant personality disorder B. Obsessive-compulsive personality disorder C. Narcissistic personality disorder D. Paranoid personality disorder

29. Answer • C. Narcissistic personality disorder • Rationale: A person with narcissistic personality disorder has a grandiose sense of self-importance with little care for the feelings of others.

30. Question • Which personality disorder involves extreme shyness and social withdrawal? A. Obsessive-compulsive personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Schizotypal personality disorder

31. Answer • B. Avoidant personality disorder • Rationale: A person with avoidant personality disorder is sensitive to rejection, intensely anxious, and extremely shy in social situations.