C7 NUR1212C Module 2

Eating Disorders, Personality Disorders, Dependency (Substance Related Disorders), Interpersonal Violence, Crisis, Abuse, Suicide Prevention, Palliative care, Hospice, End-of-Life care, Grief & Bereavement

Personality Disorder

An enduring, inflexible pattern of thinking, feeling, behaving, & relating to others

-usually lack insight

-blame others (genuinely unaware that their personality traits are causing the problem)

-believe everyone else is the problem

-rarely seek treatment unless another condition exists

-results in: impaired relationships, poor coping, distress, functional impairment

Characteristics of Personality Disorder

Difficulty trusting others

Poor impulse control

Manipulation

Emotional instability

Primitive defense mechanisms

Poor interpersonal relationships

Lack accountability

Splitting

Projection

Passive-aggressive behaviors

Splitting

a defense mechanism commonly seen is BPD where a person views people, events, or themselves in extreme "all good” or “all bad”

-can pin nurses against each other using splitting

Example:

"My morning nurse is wonderful."

"My afternoon nurse is terrible."

Projection

Blaming other for one’s own beliefs

Example:

Patient cheats spouse.

Accuses spouse of cheating.

-Patient projects feelings onto another person until that person begins reacting accordingly

Personality disorder Cluster A

Odd/Eccentric, Socially isolated

-Paranoid Personality Disorder (PPD)

-Schizoid Personality

-Schizotypal Personality Disorder

Paranoid Personality Disorder

-Cluster A

Distrusts everyone

Suspicious

Hostile

Believes others intend harm

-Priority nursing intervention:

Build trust

Avoid whispering

Be honest

Schizoid Personality

-Cluster A

Prefers isolation

No desire for relationships

Flat affect

Emotionally detached

Schizotypal Personality Disorder

-Cluster A

Odd & magical thinking

Peculiar speech

Social anxiety

Ideas of reference- false belief that external events have a direct personal meaning (hearing a song on the radio and firmly feeling that the lyrics were written to or about you)

Resembles schizophrenia without psychosis

Personality disorder Cluster B

Manipulation, dramatic, emotional

-Antisocial personality disorder

-Borderline personality disorder

-Narcissistic personality disorder

-Histrionic personality disorder

Antisocial personality disorder

-Cluster B

Violates rights of others

No remorse

Lies & Manipulates

Aggressive

Criminal behavior

Poor impulse control

-Nursing interventions:

Safety first

Firm limits

Avoid power struggles

Remain objective

Avoid emotional reactions

Borderline Personality Disorder (BPD)

Fear of abandonment

Mood instability

Impulsivity

Self-harm

Suicide attempts

Splitting

Unstable relationships

Identity disturbance

-Nursing assessment:

Suicide risk (Safety FIRST)

Self-mutilation

Impulsive behaviors

Narcissistic Personality Disorder

-Cluster B

Grandiosity

Sense of entitlement

Requires admiration

Lacks empathy

Exploits others

Arrogant

Histrionic Personality Disorder

Attention seeking

Seductive

Theatrical

Emotionally exaggerated

Needs to be center of attention

Personality disorder Cluster C

Anxiety/Fear

-Avoidant personality disorder

-Obsessive-compulsive personality disorder

-Dependent personality disorder

Avoidant personality disorder

-Cluster C

Fear of rejection

Social withdrawal

Low self-esteem

Hypersensitive to criticism

Obsessive-compulsive personality disorder

-Cluster C

-Not OCD!

Perfectionism

Rigid

Need for control

Orderliness

Difficulty delegating (others cannot meet your exact standards)

Dependent personality disorder

Excessive need to be taken care of

Needs others to make decisions

Fear of abandonment

Submissive (in order to maintain closeness)

Clingy

Cannot function independently

OCPD vs. OCD

OCPD: No obsessions, No compulsions, Personality disorder

OCD: Obsessions, Compulsions, Anxiety disorder

Manipulation behaviors

Flattery

Begging

Power struggles

Attention seeking

Rule breaking

Splitting

Seductiveness

-Nurse interventions:

Remain consistent

Avoid bargaining

Avoid arguing

Avoid favoritism

Document behaviors objectively

Milieu therapy

Using the patient's living or group environment as a therapeutic community

-Promotes:

Problem solving

Coping skills

Appropriate interactions

Behavior modification

Dialectical Behavior Therapy (DBT)

Evidence-based talk therapy- teaching you to accept yourself while simultaneously making the positive behavioral changes needed to build a "life worth living"

Gold standard for Borderline Personality Disorder

Teaches:

Mindfulness

Emotional regulation

Distress tolerance

Interpersonal effectiveness

Personality Disorders Medications

-Medications do not treat personality disorder itself but treats symptoms

SSRIs (treat comorbid depression & anxiety, minimize aggression)

Mood Stabilizers/anticonvulsants- Lithium, Carbamazepine, Lamotrigine (regulate mood & minimize aggression & impulsivity)

Second-generation (atypical) antipsychotics- Olanzapine & Quetiapine (help with psychotic features of BPD/ mood stability)

Trazodone (Serotonin antagonist reuptake inhibitor-SARI) and Venlafaxine (SNRI) - have low toxicity in overdose

-Benzodiazepines not appropriate (especially with borderline and antisocial PD) because of potential for abuse and overdose; only emergency situations

Overall Nurse Priorities for Personality Disorders

✔ Safety before therapy.

✔ Suicide assessment first in Borderline Personality Disorder.

✔ Consistent staff communication prevents splitting.

✔ Set limits without arguing.

✔ Validate feelings—not maladaptive behaviors.

✔ Personality disorders are chronic patterns—not temporary illnesses.

✔ Medications treat symptoms, not the disorder itself.

✔ Team consistency is essential.