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PERSONALITY DISORDERS IN THE ELDERLY

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Personality refers to a distinctive set of traits, ... ANXIOUS FEARFUL BEHAVIOR CLUSTER A SCHIZOID PERSONALITY DISORDER Neither desires nor enjoys close ... – PowerPoint PPT presentation

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Title: PERSONALITY DISORDERS IN THE ELDERLY


1
PERSONALITY DISORDERS IN THE ELDERLY
  • OR..WORKING IN A SALT MINE IN SIBERIA HAS TO
    BE EASIER THAN THIS, OR ..HOW DOES ONE BECOME
    A MONK IN THE HIMALAYAS

2
WHAT IS PERSONALITY?
  • Personality refers to a distinctive set of
    traits, behavior styles, and patterns that make
    up our character or individuality. How we
    perceive the world, our attitudes, thoughts and
    feelings are all part of our personality. People
    with healthy personalities are able to cope with
    normal stresses and have no trouble forming
    relationships with family, friends, and
    co-workers.

3
WHAT IS A PERSONALITY DISORDER?
  • Those who struggle with a personality disorder
    have great difficulty dealing with other people.
    They tend to be inflexible, rigid, and unable to
    respond to the changes and demands of life.
    Although they feel that their behavior patterns
    are normal or right, people with personality
    disorders tend to have a narrow view of the world
    and find it difficult to participate in social
    activities.

4
RECOGNIZING A PERSONALITY DISORDER
  • Must fulfill several criteria
  • A deeply ingrained, inflexible pattern of
    relating, perceiving, and thinking serious enough
    to cause distress or impaired functioning is a
    personality disorder
  • Usually recognizable by adolescence or earlier,
    continue throughout adulthood, and become less
    obvious throughout middle age

  • DSM-IV

5
PERSONALITY DISORDER CRITERIA
  • AN ENDURING PATTERN OF INNER EXPERIENCE AND
    BEHAVIOR THAT DEVIATES MARKEDLY FROM THE
    EXPECTATIONS OF THE INDIVIDUALS CULTURE. THIS
    PATTERN IS MANIFESTED IN TWO OR MORE OF THE
    FOLLOWING AREAS

6
PERSONALITY DISORDER/CRITERIA
  • COGNITION, I.E., WAYS OF PERCEIVING AND
    INTERPRETING SELF, OTHER PEOPLE, AND EVENTS
  • AFFECTIVITY, THEIR RANGE, INTENSITY, LABILITY,
    AND APPROPRIATENESS OF EMOTIONAL RESPONSE
  • INTERPERSONAL FUNCTIONING
  • IMPULSE CONTROL

  • DSM-IV

7
CRITERIA/ CONTD
  • The enduring pattern is inflexible and pervasive
    across a broad range of personal and social
    situations
  • The enduring pattern leads to clinically
    significant distress or impairment in social,
    occupational, or other important areas of
    functioning
  • Not better accounted for as a manifestation or
    consequence of another mental disorder
  • Not due to direct physiological effects of a
    substance or a general medical condition
  • Is stable and long duration, onset can be traced
    back at least to adolescence or early adulthood
    DSM-IV

8
CAUSES OF PERSONALITY DISORDERS
  • Some experts believe that events occurring in
    early childhood exert a powerful influence upon
    behavior later in life.
  • Others indicate that people are genetically
    predisposed to personality disorders
  • Environmental facts may cause a person who is
    already genetically vulnerable to develop a
    personality disorder

9
TYPES OF PERSONALITY DISORDERS/FALL INTO THREE
DIFFERENT CATEGORIES OR CLUSTERS
  • CLUSTSER A ODD OR ECCENTRIC BEHAVIOR
  • CLUSTER B DRAMATIC, EMOTIONAL OR ERRATIC
    BEHAVIOR
  • CLUSTER C ANXIOUS FEARFUL BEHAVIOR

10
CLUSTER A
  • SCHIZOID PERSONALITY DISORDER
  • Neither desires nor enjoys close relationships,
    including being a part of a family
  • Almost always chooses solitary activities
  • Has little, if any, interest in having sexual
    experiences with another person
  • Takes pleasure in few, if any, activities
  • Lacks close friends or confidants other than
    first-degree relatives

  • DSM-IV

11
SCHIZOID CONTD
  • Shows emotional coldness, detachment, or
    flattened affectivity
  • Appears indifferent to the praise or criticism of
    others
  • Does not occur exclusively during the course of
    Schizophrenia, a Mood Disorder with Psychotic
    Features, another Psychotic Disorder, or a
    Pervasive Developmental Disorder, not due to the
    direct physiological effects of a general medical
    condition DSM-IV









  • DSM-IV

12
PARANOID DISORDER (PERVASIVE DISTRUST AND
SUSPICIOUSNESS OF OTHERS SUCH THAT THEIR MOTIVES
ARE INTERPRETED AS MALEVOLENT, BEGINNING BY EARLY
ADULTHOOD )
  • Suspects, without sufficient basis, that others
    are exploiting, harming, or deceiving him or her
  • Is preoccupied with unjustified doubts about the
    loyalty or trustworthiness of friends and
    associates
  • Perceives attacks on his or her character or
    reputation that are not apparent to others and
    is quick to react angrily or to counterattack
    DSM-IV

PARANOID PERSONALIT
13
PARANOID, CONTD
  • Reluctant to confide in others because of
    unwarranted fear that information will be used
    maliciously against him/her
  • Reads hidden demeaning or threatening meanings
    into benign remarks or events
  • Persistently bears grudges, i.e., is unforgiving
    of insult, injuries, or slights
  • Has recurrent suspicions, without justification,
    regarding fidelity of spouse or sexual partner
  • DSM-IV

14
Schizotypal Personality Disorder (Pervasive
  • Pattern of social and interpersonal deficits
    marked by acute discomfort with, and reduced
    capacity for, close relationships as well as by
    cognitive or perceptual distortions and
    eccentricities of behavior
  • Odd beliefs or magical thinking that influences
    behavior is inconsistent with sub cultural norms
    (e.g., superstiousness, belief in clairvoyance,
    telepathy, or sixth sense in children and
    adolescents, bizarre fantasies or preoccupations)
  • Ideas of reference (including delusions of
    reference)
  • Unusual perceptual experiences, including bodily
    illusions

  • DSM-IV

At
15
SCHIZOTYPAL , CONTD
  • Excessive social anxiety that does not diminish
    with familiarity and tends to be associated with
    paranoid fears rather than negative judgments
    about self
  • Odd thinking and speech
  • Suspiciousness or paranoid ideation
  • Inappropriate or constricted affect
  • Behavior or appearance that is odd, eccentric, or
    peculiar

  • DSM-IV

16
CLUSTER B/ DRAMATIC, EMOTIONAL OR ERRATIC
BEHAVIOR ANTISOCIAL PERSONALITY
  • Failure to reform to conform to social norms with
    respect to lawful behaviors, repeatedly
    performing acts that are grounds for arrest
  • Deceitfulness, repeated lying, use of aliases,
    conning others for personal profit or pleasure
  • At least 18 years of age
  • DSM-IV

17
ANTISOCIAL, CONTD
  • Impulsivity, failure to plan ahead
  • Irritability or aggressiveness, repeated
    physical fights or assaults
  • Reckless disregard for safety of self or others
  • Consistent irresponsibility, repeated failure to
    sustain consistent work or honor financial
    obligations
  • Lack of remorse

  • DSM-IV

18
Borderline Personality Disorder
  • A pervasive pattern of instability of
    interpersonal relationships, self-image, and
    affects, marked impulsivity beginning in early
    adulthood, must have 5 of the following
  • Frantic efforts to avoid real or imagined
    abandonment
  • Pattern of unstable and intense interpersonal
    relationships characterized by idealization and
    devaluation
  • Identity disturbance, markedly and persistently
    unstable image of self or sense of self
    DSM-IV

19
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20
BORDERLINE, CONTD
  1. Impulsivity in at least two areas that are
    self-damaging (e.g. spending, sex, substance
    abuse, binge eating, reckless driving
  2. Recurrent suicidal behavior, gesturing, threats,
    self-injury
  3. Affective instability, marked reactivity of
    mood, intense dysphoria, anxiety, irritability
  4. Chronic feelings of emptiness
  5. Inappropriate intense anger, or difficulty
    controlling anger, physical fights, constant
    anger
  6. Transient , stress-related paranoid ideation or
    severe dissociative symptoms DSM-IV

21
HISTRIONIC PERSONALITY (5 OR MORE OF THE
FOLLOWING)
  • Uncomfortable when not center of attention
  • Interactive with others sexually inappropriate,
    seductive
  • Displays rapidly shifting emotion, shallow
  • Consistently uses physical appearance to draw
    attention to self
  • Considers relationships to be more intimate than
    they really are
  • Suggestible, easily influenced by others or
    circumstances
  • Self-dramatization, theatricality, and
    exaggerated expression of emotion
  • Style of speech that is excessively
    impressionistic and lacking in detail
    DSM-IV

22
Narcissistic Personality Disorder
  • Pervasive pattern of grandiosity, need for
    admiration, lack of empathy
  • Preoccupied with fantasies of power, brilliance,
    beauty, or ideal love
  • Believes he/she special and unique and can only
    be understood by, or should associate with
    high-status people
  • Requires excessive admiration
  • Interpersonally exploitative, i.e. takes
    advantage of others to achieve his/her own ends
  • Lacks empathy is unwilling to recognize or
    identify with the feelings and needs of others
  • Is often envious of others or believes that
    others are envious of him/her
  • Shows arrogant, haughty behaviors or attitudes
  • Sense of entitlement
  • DSM-IV

23
CLUSTER C DISORDERS/Avoidant Personality Disorder
  • PERVASIVE PATTERN OF SOCIAL INHIBITION, FEELINGS
    OF INADEQUACY, AND HYPERSENSITIVITY TO NEGATIVE
    EVALUATION
  • Views self as socially inept, personally
    unappealing, or inferior to others
  • Avoids occupational activities that involve
    significant interpersonal contact, because of
    fears of criticism, disapproval, or rejection

  • DSM-IV

24
AVOIDANT/CONTD
  • Shows restraint within intimate relationships
    because of fear of being shamed or ridiculed
  • Preoccupation with being criticized or rejected
    in social situations
  • Inhibited in new relationships due to fear of
    inadequacy
  • Views self as socially inept, inferior,
    personally unappealing
  • Unusually reluctant to take personal risks or to
    engage in any new activities because they may
    prove embarrassing DSM-IV

25
DEPENDENT PERSONALITY
  • PERVASIVE NEED TO BE TAKEN CARE OF, LEADING TO
    SUBMISSIVE AND CLINGING BEHAVIORS , FEAR OF
    SEPARATION, BEGINNING EARLY ADULTHOOD
  • Difficulty making everyday decisions without an
    excessive amount of assurance and advise from
    others
  • Difficulty expressing disagreement with others
    due to fear of loss of support or approval
  • Difficulty initiating projects or doing things on
    his/her own because of a lack of self-confidence
    in judgment or abilities rather than a lack of
    motivation or energy
    DSM-IV

26
DEPENDENT, CONTD
  • Excessive lengths to obtain nurturance and
    support from others, to the point of volunteering
    to do things that are unpleasant
  • Feels uncomfortable or helpless when alone
    because of exaggerated fears of being unable to
    care for him/her self
  • Urgently seeks another relationship as a source
    of care and support when a close relationship
    ends
  • Is unrealistically preoccupied with fears of
    being left to take care of him/her self
  • Needs others to assume responsibility for most
    areas of his/her life DSM-IV

27
OBSESSIVE-COMPULSIVE DISORDER
  • A PERVASIVE PATTERN OF PREOCCUPATION WITH
    ORDERLINESS, PERFECTIONISM, AND MENTAL AND
    INTERPERSONAL CONTROL, AT THE EXPENSE OF
    FLEXIBILITY, OPENNESS, AND EFFICIENCY, BEGINNING
    EARLY ADULTHOOD AND BY FOUR OF FOLLOWING
  • Preoccupied with details, rules, lists, order,
    organization, or schedules to the extent that the
    major point of the activity is lost
  • Perfectionism that interferes with task
    completion (unable to complete because of overly
    strict standards)
  • Rigidity and stubbornness DSM-IV

28
OCD DISORDER, CONTD
  • Excessively devoted to work and productivity to
    the exclusion of leisure activities and
    friendships
  • Over conscientious, scrupulous, and inflexible
    about matters of morality, ethics, or values (
    not accounted for by cultural or religious
    identification)
  • Unable to discard worn-out /worthless objects
    even when they have no sentimental value
  • Reluctant to delegate tasks or to work with
    others unless they submit to exactly his/her way
    of doing things
  • Adopts a miserly spending style toward both self
    and others, money is viewed as something to be
    hoarded for future catastrophes
    DSM-IV

29
STAFF BEHAVIORS
  • BACKBITING
  • TEAM SPLITTING
  • I CAN DO IT BETTER THAN YOU
  • NEGATIVITY REGARDING PATIENT
  • INCREASED GOSSIPING, MISTRUST
  • ENERGY SPENT OFF HOURS TALKING ABOUT
    YA-DA-YA-DA-YA-DA
  • AWFULIZING, AINT IT AWFUL
  • TALKING AT DESK ,PTS OVERHEARING

30
SO WHAT TO DO??????????
  • SELF-AWARENESS (OBSERVE BODY REACTION, FEELING IN
    GUT
  • TIME OUT, DISTANCE
  • FREQUENT STAFF MEETINGS (INFORMAL, BRING FOOD,
    HUMOR)
  • SELF-CARE, TEAM-CARE
  • PRACTICE VS, VALIDATE, VENT, VOLUNTEER,
    VIGILANCE

31
WHAT TO DO, CONTD
  • ASK FOR HELP!!
  • EMPATHY WHEN YOU FEEL LIKE, EXPLETIVE, EXPLETIVE,
    EXPLETIVE!!!!!!!!!!!!!!
  • NON-JUDGEMENTAL APPROACH, USE BUDDY SYSTEM
  • VALIDATE YOURSELF AND RESIDENT, PATIENT, FAMILY

32
WHAT TO DO CONTD
  • SET LIMITS
  • AS OFTEN AS POSSIBLE, USE SAME PRIMARY
  • CHECK IT OUT
  • TELL CLIENT/RESIDENT WHEN YOU WILL RETURN
  • TIME OUT FOR SELF!

33
DONT SHOULD ON YOURSELF!!!!
34
HOW DO YOU EAT AN ELEPHANT,ONE BITE AT A TIME!
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