Chapter 24: Personality Disorders

what are common challenges in treating personality disorders?

difficulties with self-identity, self-direction, empathy, and intimacy

why might people with personality disorders not seek help?

they may not recognize their behavior as problematic or think the issue lies with others

what factors must be considered to avoid misdiagnosis of personality disorders?

ethnic, cultural, and social background

How many personality disorders are recognized by the APA (2013)

10 personality disorders

what are the personality disorders in cluster A?

Paranoid, Schizoid, Schizotypal

what are the personality disorders in Cluster B?

Boderline, Narcissistic, Histrionic, Antisocial

what are the personality disorder in Cluster C?

avoidant, dependent, obsessive-compulsive

what is the hallmark trait of paranoid personality disorder?

a pervasive distrust and suspicion of others’s motives

what defense mechanism is most commonly used in paranoid personality disorder?

projection

why is group therapy used cautiously in paranoid personality disorder?

patients are suspicious and may perceive group settings as threatening

what is a key feature of schizoid personality disorder?

lifelong social withdrawal and emotional detachment

what type of employment suits individuals with schizoid personality disorder?

solitary jobs (ex: night security guard)

what medication might be used to improve emotional expressiveness in schizoid personality disorder?

risperidone or olanzapine

what distinguishes schizotypal personality disorder from schizophrenia?

schizotypal individuals have brief psychotic symptoms and are aware of their odd beliefs

what symptom is shared between schizotypal and paranoid personality disorders?

paranoia or suspiciousness

why might someone with schizotypal personality disorder join occult or religious groups?

their medical thinking and odd beliefs align with those groups

what type of therapy is initially recommended for schizotypal personality disorder?

supportive therapy with focus on cognitive disortions

what is the core belief in Paranoid Personality Disorder?

that others are trying to exploit, harm, or deceive them

what defense mechanism is dominant in Paranoid PD?

projection

what is a key nursing strategy when caring for someone with paranoid PD?

be straightforward, stick to schedules, avoid being overly friendly

what medications may be used to treat agitation in Paranoid PD?

diazepam and haloperidol in small doses

what are hallmark traits of Schizotypal Personality Disorder?

magical thinking, odd beliefs, eccentric behavior, paranoia

how does Schizotypal PD differ from schizophrenia?

symptoms are milder and patients can recognize odd beliefs

what the best initial treatment for Schizotypal PD?

supportive care and possible low-dose antipsychotics

what are sings of Histrionic Personality Disorder?

attention seeking, dramatic, emotionally expressive, impulsive

what is a nursing consideration when working with histrionic PD?

maintain professional boundaries and assess for suicidal gestures

what core emotion dominates Avoidant personality disorder?

fear of rejection and criticism

what nursing strategy is most helpful for Avoidant PD?

provide acceptance, don’t push into social situations too quickly

which medications may reduce social anxiety in Avoidant PD?

SSRI (citalopram), beta blockers (atenolol)

what defines Dependent Personality Disorder?

a pervasive need to be cared for, leading to clingy and submissive behavior

what therapy is most effective for Dependent PD?

Cognitive Behavioral Therapy (CBT)

what medication is sometimes used for panic attacks in Dependent PD?

Imipramine (Torfranil)

how does Obsessive-compulsive personality disorder differ from OCD?

OCPD involves perfectionism the person believes is correct, OCD involves unwanted intrusive thoughts

what are common traits in OCPD?

perfectionism, stubbornness, control, inflexibility

what should nurses avoid in caring for OCPD patients?

power struggles; instead offer structure and encourage adaptive coping

what medication may reduce symptoms of OCPD?

Clomipramine (Anafranil) or fluoxetine (Prozac)

what are common signs and symptoms associated with Risk for Suicide in Borderline Personality Disorder?

history of suicide attempts, family history of self-destructive behavior, disturbed interpersonal relationships, isolation, impulsivity, manipulation to obtain nurturing relationships

what is the nursing diagnosis related to a patient with a history of suicide attempts and impulsivity?

risk for suicide

what are the desired outcomes for a patient with Risk for Suicide?

no suicide attempts, patient remains free from harm, maintains healthy connections, controls impulses without supervision, uses social support groups, plans for the future

what signs indicate Self-Mutilation in a patient with Boderline PD?

history of self-mutilation, impulsivity, biting, cuts, ingestion, or inhalation of harmful substances, insertion of objects into body offices, picking at wounds, self-inflicted burns

what is the nursing diagnosis for patients exhibiting self-harm behaviors?

self-mutilation

what outcomes should be expected for a patient diagnosed with Self-Mutilation?

patient refrains from intentional self-injury, maintains self-control without supervision, obtains assistance as needed, participates in support groups, follows treatment regimen

what behaviors are signs of Risk for Violence in Borderline PD?

impulsivity, history of other-directed violence, threats

what is the nursing diagnosis for impulsivity combined with threats or aggression?

risk for violence

what outcomes are associated with Risk for Violence?

patient expresses needs constructively, monitor anger, maintains self-control without supervision

what signs are seen with Social Isolation/ Impaired Socialization in Borderline PD?

behavior unaccepted by dominant culture, hypersensitivity to negative evaluation, unstable and intense relationships, feeling rejected or indifferent, inability to engage socially

what outcomes correspond with Social Isolation / Impaired Socialization

patient exhibits sensitivity and receptiveness to others, cooperates, uses assertive behaviors appropriately, interacts effectively with others

what symptoms indicate Disturbed Personal Identity in Borderline PD?

dependency, excessive emotional responses, attention-seeking, feelings of emptiness, uncertainty about goals, unclear personal boundaries

what outcomes define improvement in Disturbed Personal Identity?

patient verbalizes clear sense of identity, performs social roles, challenges negative self-images, establishes personal boundaries, maintains awareness of thoughts and feelings

what behaviors indicate Difficulty Coping in Borderline PD?

difficulty in relationships, manipulation, detructive behaviors toward self and others, failure to meet role expectation, inadequate problem solving, self-mutilation used to calm or gain nurturing

what are the expected outcomes for Difficulty Coping?

uses effective coping strategies, expresses emotions, seeks support, promotes safety, takes responsibility for actions, identifies community resources, initiates goal-directed behavior

what are signs and symptoms associated with Risk for Violence in Antisocial PD?

rigid posture, hyperactivity, pacing, history of child abuse, history of violence, violating others’ rights, anger, aggression, impulsivity, substance misuse, negative role models

what is the nursing diagnosis for a patient exhibiting anger, aggression, impulsivity, and a history of violence?

risk for violence

what are the expected outcomes for the nursing diagnosis Risk for Violence?

patient will not harm others, uses conflict resolution, controls impulses, expresses needs nondestructively, refrains from verbal outbursts, respects others’ personal space

what signs indicated Impaired Impulse Control in patient with Antisocial PD?

illegal behaviors, reckless actions, acting without planning, repeated behaviors, failure to honor obligations

what is the nursing diagnosis for reckless behavior and repeated fights?

Impaired Impulse Control

What outcomes are desired for Impaired Impulse Control?

patient recognizes emotional cues to impulsivity, develops alternate coping strategies, takes responsibility, obtains support, self-initiates goal-directed behavior

what signs are associated with Impaired Social Interaction in Antisocial PD?

unstable relationships, lack of empathy, projecting hostility, behaviors unaccepted by culture, grandiosity, dysfunctional social interactions

what is the nursing diagnosis related to lack of empathy and unstable relationships?

Impaired Social Interaction

what are the expected outcomes for Impaired social interaction?

patient exhibits receptiveness and sensitivity to others, cooperates, interacts considerately with others

what cluster is Borderline Personality Disorder (BPD) classified under?

Cluster B- dramatic, emotional, or erratic personality disorders

what are the major features of Borderline Personality Disorder?

marked instability, impulsivity, indentity/ self-image distortions, unstable mood, unstable interpersonal relationships, and emotional dysregulation

define emotional dysregulation in the context of Borderline PD?

poorly modulated mood characterized by rapid mood swings and difficulty managing painful emotions healthily

what is emotional lability?

rapid shifts from one emotional extreme to another, often out of proportion to the situation

what are common impulse behaviors seen in Borderline PD?

reckless driving, unsafe sex. substance use, binge eating, gambling, overspending, self-harm, and suicial attempts

what defense mechanism is characteristic of borderline PD?

splitting- viewing others as all good or all bad with no middle ground

how do individuals with Borderline PD typically view relationships?

they idealize others quickly, then devaluate them after disappointment or frustration

what percentage of individuals with borderline PD attempt suicide?

about 70%

what biological factors contribute to Borderline personality?

genetic vulnerability (about 46%), serotonergic dysfunction, and abnormalities in prefrontal cortex and limbic regions

What childhood developmental theory helps explain Borderline PD?

Margaret Mahler’s separation-individual theory- disruptions in normal emotional separation from the primary caregiver

how does disrupted separation- individualization affect Borderline PD development?

leads to fear or abandonment, anger, and unstable interpersonal relationships in adulthood

what is a common comorbidity with Borderline PD?

major depressive disorder, bipolar disorder, anxiety disorders, sleep disorders, and substance use disorders

how do symptoms of Borderline personality disorder tend to change with age?

symptoms, especially suicidal and self-harm thoughts, tend to decrease over time