Topic 3: Personality Disorders

personality

a universal concept that everyone has; unique traits that begin to show when people are infants and are then shaped and formed by the environment, their response to it, the people who influence our lives, and the characteristics of how we respond and interact with the would around us

openness, conscientiousness, extraversion, agreeableness, neuroticism

what are the big 5 personality traits taht are used as a reference for many HCPs in the BH and psychology fields

healthy personality

exists when a person can adapt their preferred/usual way of interacting and responding to a situation where that response isn’t appropriate, socially acceptable, or won’t have the best outcomes; the flexibility is what helps protect/support us when times are difficult or when experiencing stressors/challenges

unhealthy personality

affects a person’s ability to function effectively in interpersonal relationships or when challenges arise, happens to most people on occasion; when this is consistently dysfunctional, dysphoric, or maladaptive, the person may be living with a personality disorder

Minnesota Multiphasic Personality Inventory (MMPR)

a personality assessment/inventory that provides results that can be aligned with the DSM for personality disorders

Myer-Briggs Type Indicator (MBTI)

personality assessment/inventory that provides four-letter personality types

DISC personality assessment

useful in employment and professional development

• trouble with self-identity/direction as they don’t understand how they fit in the world or what their purpose is

• difficulty feeling empathy for others and more focused on self

• struggles with intimacy in relationships due to fear, abandonment issues, lack of trust, or the belief that no one is worthy enough to be with them

• difficulty seeing the impact of the disorder on others

what are challenges for those with personality disorders

type A

3 personality disorders that are characterized by behaviors that are odd or eccentric → atypical and may precede schizophrenia

paranoid, schizoid, and schizotypal personality disorders

what are the type A personality disorders

paranoid personality disorder

type A personality disorder thats characteristics include disturbing, suspicious, jealous, unwilling to forgive others, increased anxiety in social situations

challenges: trusting others, anxiety while waiting for “the next thing to happen,” projection used as a defense mechanism, and attempting to lower their anxiety

adhere to the schedule, be genuine but neutral, use straightforward language and refrain but being overly friendly, set and enforce limits on behavior

What are the nursing guidelines for a patient with paranoid personality disorder

individual psychotherapy, medication to reduce anxiety, agitation, delusions, and paranoia; group therapy is not useful and is often threatening

what are the treatment options for paranoid personality disorders

schizoid personality disorder

type A personality disorders that characteristics include introverted, solitary lifestyle, little desire for relationships, imaginary companions, emotionally detached, restricted affect, difficulty interpreting social cues

Key challenges include social interactions, which should not be forced, detachment, and loneliness

RFs include a relative with schizophrenia and reduced brain cortical volume

do not force social interactions, avoid an overly friendly approach, and motivational interviewing should be used to determine willingness to discuss symptoms

what are the nursing guidelines for a patient with schizoid personality disorders

individual psychotherapy, supportive group therapy (after trust is established), medication to treat S/S like bupropion, risperidone, and olanzapine

what are the treatments for a patient with schizoid personality disorder

schizotypal personality disorder

type a personality disorder that is characterized by magical thinking, odd speech, strange behavior, eccentric dress, wanting meaningful relationships but severe social anxiety, interpersonal deficits, and paranoia

magical thinking and peculiarities of speech may be a barrier and result in omission

provide time and space for the client to isolate from a group environment socially, observe for suspiciousness or paranoia and intervene appropriately, address the client carefully to avoid missing any additional, unaddressed needs such as SI

what are the nursing guidelines for a client with schizotypal personality disorder

supportive care, usually uninterested in therapy, and trusting rapport is difficult to create, medication to reduce the severity and frequency of any delusions or hallucinations (low doses of antipsychotics like risperidone or olanzapine, anxiolytics or antidepressants to treat comorbid anxiety and depression)

what are the treatments for schizotypal personality disorder

type B

personality disorders that are characterized by behaviors that are dramatic, emotional, or erratic (unpredictable) that tend to have BIG responses to interactions and situations, regardless of what the expected/typical response would be

histrionic, narcissistic, borderline, and antisocial personality disorders

What are the type B personality disorders

histrionic personality disorders

type B personality disorder that is characterized by being the center of attention, feeling unworthy unless praised, having low self-esteem, and being highly suggestible

Key challenges: exaggeration, low self-esteem, impulsivity, highly suggestible, not effectively assertive, seductive, flirtatious, and casual in conversation

always maintain a completely professional approach to care, assess for SI, role model methods of being assertive and effectively encourage the client to use the method to express their needs and feelings

what are the nursing guidelines for a patient with histrionic personality disorders

individual psychotherapy that resolves around helping the client clarify their feelings and learn to express them to an appropriate degree, group therapy can be problematic due to disrupting for clients’ excessive displays of emotions and exaggerated behavior, medication to treat somatic or depressive symptoms (antidepressants) and to treat psychotic symptoms (anxiolytics or antipsychotics)

what are the treatments for histrionic personality disorder

narcissistic personality disorder

type B personality disorder that is characterized by grandiose sense of self, center of attention, aware of own “importance,” lack of empathy and remorse

key challenges: demanding, arrogant, power struggles, low self-esteem, fear of rejection, lack of empathy

do not challenge the client’s grandiose or incorrect/invalid statements, especially if the client has a history of violent behavior. avoid power struggles as they are likely to antagonize others, including the nurse (arguing or debating about rules/schedules), Demonstrate how to be empathetic to others when appropriate

what are the nursing guidelines for a patient with narcissistic personality disorder

individual CBT to reframe distorted thought patterns and beliefs, group therapy (may be useful), medication to stabilize mood if mood swings or lability is present like lithium or antidepressants if the client has depressive symptoms

what is the treatment for narcissistic personality disorder

borderline personality disorder

type B personality disorder is characterized by desiring a stable relationship, intense fear of abandonment, all-or-nothing, splitting, and emotional dysregulation

RF: genetics, if a parent has it, the child is 5x more likely to get it

Key Challenges: emotional lability, dysregulation, impulse aggression, impulsivity, comorbid condition, splitting, chronic suicidality, post stress-like neglect and abuse

borderline personality disorder

70% of those with this disorder attempt suicide in their lifetime and 10% complete suicide, so never minimize/ignore suicidal ideation or self-harm

do not take client statements personally, set and enforce limits and boundaries, make no “one time” exceptions to rules and remain consistent, recognize the client’s intense fear of abandonment and choose words carefully, assess all indications, statements and actions that may indicate suicidality or self-harm risk, collaborate with the other care providers, unit staff, and team members, frequently, and document completely and faithfully in a timely manner

what are the nursing guidelines for a patient with borderline personality disorder

the main goal is to gain insight and the ability to regulate their emotional response so it becomes more appropriate to the given situation, DBT is the most consistently effective treatment, individual therapies like STEPPS and CBT, medications like SSRIs, lithium, anticonvulsants, and antipsychotics

what are the treatments for borderline personality disorders

antisocial personality disorders

type B personality disorder that is characterized by being very social, superficially charming, disregard for rules, laws, and social norms, lack of empathy, and remorse

Key challenges: disinhibition, disregard for rules, lack of concern for others, substance use, history of violence, manipulation, impulsivity, aggression, often commit repeated criminal/unlawful activities, and are very manipulative

monitor for aggression and potential for violence, consistently set and maintain limits, rules and boundaries, enforce consequences when appropriate and make no exceptions to these, collaborate with others working with and around the client, assess your own responses to the client’s behavior and interactions (both observed and personally experienced), maintain neutrality and be aware of potential manipulative techniques or deceit

what are the nursing guidelines for a client with antisocial personality disorder

individual psychotherapy (CBT, DBT, or mentalization behavior therapy), group and family therapy, medication to stabilize mood or decrease anxiety/depressive symptoms

what are the treatments for antisocial personality disorders

type C

A type of personality disorder that can be described as anxious or fearful, those feel a significant level of anxiety under the surface, much of the time, and their “comfort zones” are the places/situations that have a significant impact on relationships

avoidant, dependent, and obsessive-compulsive personality disorders

what personality disorders are type C

avoidant personality disorder

type C personality disorder characterized by avoiding activities/interactions unless success is guaranteed, fear of rejection/embarrassment, socially inhibited, overly sensitive to negative feedback

Key challenges: social situations, trying new things, increased shyness over time, few close relationships

be reassuring and friendly, but not a social professional therapeutic approach, provide training and role modeling of assertive techniques and allow opportunities for the client to use these, be sure to consider the level of the client’s fear related to their challenging areas of interpersonal relating when providing and evaluating care

What are the nursing guidelines for avoidant personality disorders

avoidant personality disorder

the main goal of treatment is to improve the client’s ability to trust others and trust being “okay” if things do not go according to the best possible plan as well as building the client’s ability to be assertive

individual and group therapy to build trust and assertiveness, medication to reduce hyperactivity, reduce social anxiety, and reduce feelings of rejection

what are the treatments for avoidant personality disorder

dependent personality disorder

type C personality disorder that is characterized by allowing others to run their life for them, feels helpless to make decisions without advice, needs reassurance, fears being alone, is clingy, submissive, and agreeable

Key Challenges: making decisions, being alone, being independent, and a lack of confidence

evaluate the nurse-client relationship for the development of countertransference, help the client identify and address their own stressors, teach the client assertiveness skills and skills of independence, role model these, and provide opportunities for the client try them

what are the nursing guidelines for a client with dependent personality disorder

individual psychotherapy, specifically CBT, to correct faulty thought processess (cognitive distortions) related to taking responsibility, making decisions, and being alone, medication to treat anxiety, depressive, and panic attack symptoms that often appear comorbidly with this PD

what are the treatments for dependent personality disorders

obsessive-compulsive personality disorders

type C personality disorders that are characterized by the pervasive need for perfection that makes it difficult to complete tasks, devoted to rules, order, schedules, excessively devoted to work, inflexible, must do things “their way”

key challenges: preoccupation with perfection, missing out on activities/relationships, obsessed with structure, rules, older, and schedule

maintain structure but still allow an amount of control for clients to complete their personal activities that will fulfill their “typical schedule” or their own structure of the day, when possible, avoid power struggles and recognize the client’s intense need for control over what happens around them, help the client identify and use healthy, improved coping skills

what are the nursing guidelines for a client with obsessive-compulsive personality disorders

individual/group therapy to build healthy coping skills and improve the ability to relax and adjust to a non-perfect day, medication to reduce the severity of obsessive-compulsive symptoms, anxiety, or depressive symptoms like clomipramine or SSRIs (fluoxetine)

what are the treatments for obsessive-compulsive disorders