psych week 9: personality disorders

personality disorders clusters

• Cluster A:

• Cluster B:

• Cluster C:

things that might bring a P.D’ed client into treatment

• lossess

• major affective disorder

• aniety disorder

• interpersonal conflicts

• somatic issues

• referred

• alcoholism/chemical dependency

assessment

• history

• physical eam

• family assessment

• mental status eam/psychological tests

  • suicidal ideation and/or vuolence towards others

• legal history

managing personality disorders

• acute care

  • hospitilization is innapropriate unless there is an acute coeisting disorder or the client ehibits a suicide risk, self mutilating behaviors, etc

outpatient care of PD

• empathize client, facilitate the development of a therapeutic relationship

• address the presenting problems

• assist client in realizing that their behaviors are not working for them, but rather against them

• find appropriate behaviors to replace their current maladaptive behaviors

• encourage the client to try out new patterns of thinking and behaving, therapist acts as a coach

psychopharmacology of PD

• aniolytics and SSRIs may be used to reduce aniety and depression

• lithium/anticonvulsants to help regulate moods and control aggresion and impulsivity and predatory behaviors

• short term, low dose antipsychotics may be used for transient psychotic states caused by overwhelming stress

goals of treatment for personality disorders

• risk control

• adherence behavior

• symptoms control/decreased use of maladaptive coping patterns

family support

• assist fam members in defining and maintaining boundaries

• encourage the family to set clear definitions of acceptable behaviors for the client within the faily

• assist family members with coping skills in dealing with the client

• teach family members to use stress management techniques

self care for the nurse

• self awareness is crucial, analyze your own feelings and reactions to a client with personality disorder

• seek assitance from a peer to prevent feelings from interfering with therapeutic performance

• maintain ongoing team communication regarding epectations for these clients

definition of personality

• enduring and consistent attitudes, beliefs, desires, values and patterns of behavior

personality disorders

• a personality disorder is “an enduring pattern of inner eperience and behavior that deviates markedldy from the epectations of an individuals culutre, is pervasive and infleible, has an onset in adolescnece or early adulthood, is stable over time, and leads to significant distress or imapirment

symptoms of perosnality disorders are found in:

• cognition

• affectivity

• interpersonal behavior

• impulse control

common characteristics of all personality disorders are

• patterns of behavior are not a result of another mental illness or due to the direct effects of a substance o general medical condition

• infleible, rigid and maladaptive responses to stressors and life events

• distress and impairment in social, occupaional, and/or other areas of functioning

• inability to see themselves objectively, tend to merge personal boundaries with others

etiology theoriess related personality disorders

• psychodynamic/developmental

• cognitive/behavioral

• biological/neurochemical

what is cluster A PD

• aranoid PD

• Schizotypal PD

• Schizoid PD

what is Cluster B

• Antisocial PD

• Histrionic PD

• Borderline PD

• Narcissistic PD

What is Cluster C

• Avoidant PD

• Dependent PD

• Obsessive-Compulsive PD

Cluster A Paranoid PD SYmptoms

• Distrusting, suspicious

• argumentative, short tempered

• difficulty adjusting to change

• unwarranted jealously of a significant other regarding fidelity, attention, etc

• unforgicing, insensitive, vengeful

Cluster A Schizoid PD symptoms

• prefers solitude, low stress, routines and repetition

• indifferent to feedback from others

• anhedonia, flattened affect, restructed range of emotions

• difficulty epressing anger

• brief psychotic episodes in response to stressful events

• higher incidence in families with shchizophrenia

cluster A: schizotypical PD symptoms

• belief that all events refer to self

• odd beliefs that influence bheaviors (superstitiious, telepathy, etc)

• odd speech and appearance (metaphorical, overelaborate, etc)

• inappropriate or constircted affect

• ecessive aniety in socia situations related to paranoid fears

• higher incidence in families with schizophrenia

Cluster B: antisocial PD symptoms

• failure to conform to social norms

• involvement in illegal activities

• high incidence of substance abuse

• lack of guilt and empathy

• lack of impulse control

• irresponsibility

• dishonest, manipulative

• aggresivw

cluster b: borderline PD symptoms

• history of abuse, neglect, and/or early parental loss or separation

• frantic efforts to avoid real or imagined abandonment, intense, stormy relationships

• recurreny suicidal ideations and self mutilation

• markedly and persistently unstable self image

• impulsive (bingeing, spending, unsafe se)

• negative or angry affect

PRAISE (borderline personality traits)

Cluster B: histrionic PD symptoms

• attention seeking, self centered attitude

• seually seductive or provocative behavior

• rapidly shifting, shallow emotions, easily influenced

• use of suicidal gestures and threats for attention

• attentiveness to phtsical appearance

• considers relationships to be more intimate than they actually are

• complaints of physical illness

CLuster B: narcissistic PD symptoms

• grandiose view of self, requiring ecessive admiration

• lack of empathy towards other interperosnally eploitative, envious

• preoccupied with fantasies of self importance, beauty, brilliance etc

• arroagnt behaviors and attitude

• sense of entitlement

Cluster C: avoidant PD symptoms

• Avoidance of social situations due to fear of criticism or rejection

• tendency to withhold thoughts/feelings

• negative sense of self, low self esteem

• very critical of themselves

• reluctant to take risks or engage in new activities

• shy and anious

cluster c: dependent PD symptoms

• needs others to assume major responsibility for them

• unable to make decisions independelty

• clingy and submissive

• preoccupied with fears of being left to take care of self

• goes to ecessive lengths to obtain support and nurturing from others

Cluster C: Obsessive-Compulsice PD symptoms

• very rigid, perfectionist

• preoccupied with rules, details, lists

• difficulty in relaing, self criticism

• insistent on others, conforming to their methods, reluctant to delegate tasks

• discarding or hoarding issues

• fear of losing control over siutations, objects or people