Personality Disorders

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Personality Disorders

• Various inflexible maladaptive behavior
  patterns/traits that may impair functioning and
  relationships
• Usually remains in touch with reality
• Lacks insight into behaviors
• Stress exacerbates manifestations
• Severe cases may deteriorate into psychotic state

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CLUSTER AODD ECCENTRIC GROUP

• Schizoid personality
• Scizo-typal personality
• Paranoid personality

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Schizoid personality D/O

• C/B inability to form close relationships
• Social detachment/solitary life
• Aloof/indifferent
• Restricted expression of emotion
• Lacks interest in others

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Schizotypal personality D/O

• C/B exhibits abnormal /unusual thoughts,perception
  s,speech,behavior patterns
• Suspicious
• Paranoid
• Magical thinking
• Odd thinking/speech
• Relationship deficits

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Paranoid Personality D/O

• C/B suspiciousness, mistrust of others
• Argumentative
• Hostile aloofness
• Rigid, critical, controlling of others
• Grandiosity

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CLUSTERC Anxious Fearful Group

• Avoidant personality
• Dependent personality
• Obsessive Compulsive personality
• Passive- Aggressive personality

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Avoidant Personality Disorder

• C/B social withdrawal
• Hypersensitive to rejection,criticism
• Feels inadequate
• Social inhibition
• Lacks support system

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Obsessive Compulsive Personality D/O

• Need to control others
• Difficulty expressing warmth/tenderness
• Reflects perfectionism/devoted to work
• Overly conscientious/inflexible
• Preoccupied with details
• May hoard worthless objects

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Dependent Personality disorder

• C/B lack of self confidence
• Fears independence/lacks autonomy
• Passively allows others to make decisions and
  assume responsibility for major areas of their
  life
• Cannot tolerate being alone
• Needs others to make desicions

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CLUSTER B

• ERRATIC DRAMATIC GROUP
• HISTRIONIC
• NARCISSISTIC
• ANTISOCIAL
• BORDERLINE

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Histrionic Personality D/O

• C/B Overly dramatic, intensively expressive
• Enjoys being the center of attention
• Poor interpersonal relationships
• Romantic fantasies and control of partners
• Easily bored
• Displays dependency

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Narcissistic Personality D/O

• C/B increased sense of self importance
• Pre-occupied with fantasies /unlimited
  success/constant need for attention admiration
• Grandiosity/inflates accomplishments
• Lacks empathy/sensitivity to others needs

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Antisocial Personality Disorder

• C/B irresponsible and antisocial behavior
• Self-centered, inability to maintain
  relationships,irritability, unreliable
• Poor sexual adjustment/inability to delay
  gratification
• Aggressive, impulsive, manipulative
• Poor judgment
• Conflict with authority
• Poor work history
• Failure to handle responsibility

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Nursing Diagnosis

• Ineffective Coping-r/t inability to form valid
  appraisal of stressors,inability to use available
  resources

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EXPECTED OUTCOMESThe client will

• Immediate- Not harm self/others
• Identify behaviors leading to hospitalization
• Functions within limits of therapeutic mileu

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Outcomes continuedThe client will

• Stabilization-
• Demonstrate nondestructive ways to deal with
  stress and frustration.
• Identify ways to meet own needs that do not
  infringe on the rights of others
• Community-
• Achieve /maintain satisfactory work performance
• Meet own needs without exploiting or infringing
  on the rights of others

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Interventions

• Provide model for mature appropriate behavior
• Observe strict limit-setting by all staff
• Be consistent and firm with care plan essential
• Monitor own responses to clients
• Demonstrate concern/interest
• Reinforce positive behaviors(socialization.conform
  ing to limits)
• Avoid power struggles

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Personality D/O Scenario

• This is the 3rd in-patient hospitalization for
  Betty, a 21 y/o college student who was brought
  to the ER accompanied by her roommate after being
  found intoxicated and with multiple superficial
  cuts on both arms that followed a recent argument
  and break-up with a boyfriend of two months.
  While on the unit Betty is assigned to a nursing
  student. She tells the student that she is the
  best thing that happened to her since she is
  there, and that the rest of the staff is
  incompetent and cannot help her.
• 1. What data indicates that Betty may have a
  Borderline Personality D/O?
• 2. What other data might be found in her
  psycho-social history.?
• 3. Prioritize Two nursing diagnosis/goal/intervent
  ions.

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Borderline Personality Disorder

• C/B unstable interpersonal relationships
• Impulsive/unpredictable behaviors
• Chronic feelings of emptiness
• Extreme shifts in mood/depression
• Easily bored/argumentative
• Self-destructive behaviors
• Splitting, manipulative
• Inability to tolerate anxiety

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Nursing Diagnosis

• Risk for Self- Mutilation- r/t impulsive behavior
  Displays of temper Inability to express
  feelings verbally Physically self-damaging
  actsAttention seeking behaviors Ineffective
  coping skills
• Ineffective coping- r/t inability to form valid
  appraisal of stressors inability to use
  available resources
• Social Isolation- r/t chronic feelings of
  boredom/emptinessManipulation of
  othersalternate clinging/avoidance behaviors

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EXPECTED OUTCOMESThe client will

• Immediate-Be free from immediate injury Not harm
  others or destroy property Diminish efforts to
  manipulate staff or other clients(splitting-behavi
  ors)
• Stabilization- Eliminate acting-out
  behaviorsVerbalization of plans to moderate
  lifestyle
• Community-Demonstrate effective
  problem-solvingDevelop social support outside
  hospital

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Interventions

• Protect from self-mutilation
• Suicide assessment
• Establish therapeutic relationship
• Calm approach
• Set limits
• Consistent staff/planning
• Prevent client from manipulating other
  clients/visitors
• Teach relaxation techniques

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Passive-Aggressive personality

• C/B passively expresses covert aggression rather
  than dealing with it
• Procrastinates
• Stubborn
• Intentional inefficiency
• Forgetfulness
• Dependency

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REVIEW QUESTIONS

• The client with an antisocial personality d/o
  approaches various staff with numerous requests.
  The best response by the nurse would be
• a)Give the client a written list of permissible
  requests.
• b) Have the client make requests only to the
  assigned staff person
• c) Limit the client to the day room area
• d)Tell the client to remain in his or her room
  until approached by staff

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• The nurse assesses a client to be at risk for
  self-mutilation, and implements a no-self-harm
  contract. The safety contract would be effective
  when the client
• withdraws to her room when feeling overwhelmed.
• notifies staff when anxiety is increasing
• suppresses feelings of anger
• Talks to other clients about urges to hurt
  herself

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• When planning care for a client with Schizoid
  personality d/o, the most appropriate outcome
  would be for the client to
• Communicate effectively with his/her landlord
• Express interest in a new hobby
• Join a community group for socialization
• Verbalize thoughts and feelings to peers

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• Which of the following characteristics should the
  nurse consider before planning ongoing care for
  the client with a dependent personality disorder?
• A. They eagerly become involved in a therapeutic
  relationship because there is a sense of
  attachment.
• B. They are eager to tell their story and have
  others admire what they have accomplished.
• C. They view a therapeutic relationship as a
  waste of time because they dont see a problem
  with their behavior.
• D. They may vacillate between wanting the
  therapeutic relationship and pushing it away,
  depending on what threat is perceived.

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• Which symptom would the nurse expect to assess
  related to anger expression in a client diagnosed
  with borderline personality disorder?
• Controlled, subtle anger
• Inappropriate, intense anger
• Inability to recognize anger
• Substitution of physical symptoms for anger

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• A client with antisocial behavior flatters the
  nurse. This behavior can be interpreted as
• The client wanting something in return.
• The client wants the nurse to like him.
• The client needs attention.
• The client is trying to redirect the focus of the
  nurse-client relationship.

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• The nurse would formulate which of the following
  outcome criteria for a client with borderline
  personality disorder? The client
• Displays anger frequently
• Acts our her neediness.
• Experiences troubling thoughts without
  self-mutilation.
• Idolizes her nurse.

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• Which of the following indicates to the nurse
  that a client with antisocial personality
  disorder is improving? The client
• Compliments the nurse for having done an
  outstanding job on the unit.
• Tests the limits of his behavior.
• Acknowledges some manipulative behavior.
• Sleeps 8 hours per night.