personality disorders

what is personality?

the sum of emotional and behavioral characteristics particular to a specific person remaining relatively stable over time

what are personality traits?

characteristics one is born with and develops early → shapes perception and relation to environment; these are influenced by hereditary, temperament, learning experiences, and social interactions

what is the five factor model/the big five?

openness, conscientiousness, extraversion, agreeableness, neuroticism → these traits are each estimated to be about 50% heritable and predict important life outcomes like education and health

when do personality disorders arise?

when traits become rigid, inflexible, and contribute to maladaptive behaviors that impair functioning or cause distress → most evident in adolescence and early adulthood

what are the three clusters of personality disorders?

A: odd/eccentric, B: dramatic/emotional/erratic, C: anxious/fearful

what are some disorders that fall into cluster A: odd/eccentric?

paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder

characteristics of paranoid personality disorder?

cluster A: paranoia, mistrust, suspicion without adequate reason → having relatives with schizophrenia or delusional disorder and childhood trauma increases risk

characteristics of schizoid personality disorder?

cluster A: lifelong indifference, social isolation, absent paranoia/hallucinations → heritability estimated at ~30%

characteristics of schizotypal personality disorder?

cluster A: distanced relationships, odd speech/behavior, mild emotional range → diagnosed in early adulthood; on the spectrum between schizoid and schizophrenia

what are some disorders that fall into cluster B: dramatic/emotional/erratic?

histrionic, narcissistic, borderline personality disorder, antisocial personality disorder

characteristics of histrionic disorder?

cluster B: overly dramatic, seeks attention, inappropriately provocative, rapid emotion shifts, highly suggestible → more often diagnosed in women

characteristics of narcissistic disorder?

cluster B: grandiosity, preoccupation with self, exaggerated achievement, entitlement, lack of empathy, physical/mental health co-morbities → often linked to early trauma/adverse childhood events

characteristics of borderline personality disorder?

cluster B: unstable relationships, mood swings, inpulsivity, affective instability, frequent crises, self-harm, internalized feelings, rapid changeability → can use SAPAS screening (> or equal to 3 suggests personality disorder); also associated with unhealthy lifestyle, difficulties accessing health care, incr risk for poor physical health

characteristics of antisocial personality disorder?

cluster B: exploitative, guiltless, disregard for others’ rights, manipulative for personal gain, law-breaking, difficulty maintaining employment/relationships, cruelty, lack of empathy → more common in men, strongly associated with prison populations; only 1/3 of those with this disorder meet criterial for psychopathy (greater emotional deficits, egotism)

what are some disorders that fall under cluster C anxious/fearful?

avoidant personality disorder, dependent personality disorder, obsessive compulsive personality disorder

characteristics of avoidant personality disorder?

cluster C: extreme social inhibition, fear of rejection, feelings of inadequacy, impacts function → symptoms seen in childhood and increase in adolescence

characteristics of dependent personality disorder?

cluster C: helplessness, submissiveness, difficulty making decisions, urgent need for new relationships, unresolved fears of abandonment

characteristics of obsessive-compulsive personality disorder?

cluster C: preoccupation with order, perfectionism, rules, excessive devotion to work, black and white thinking, rigidness → diagnosis requires >= 4 symptoms

when is diagnosis and management done for those with antisocial personality disorder?

usually after harm occurs → pts are frequently non-compliant with therapy and are difficult to tx; best outcomes are with interprofessional teams

what are some general nursing interventions?

observe patient behavior frequently, encourage reaching out to staff when urges occur, promote discharge of anger via large motor activities like exercise, teach patients to recognize and examine maladaptive behaviors, rotate staff to prevent dependency on specific caregivers

what disorders are best treated with cognitive behavioral therapy CBT?

depression, anxiety, OCD, phobias, PTSD

what disorders are best treated with dialectical behavioral therapy DBT?

borderline personality disorder and chronic suicidal behavior

what meds to use for personality disorders?

no meds are FDA approved for personality disorders but associated symptoms like depression or aggression can be tx with antidepressants, mood stabilizers, antipsychotics