personality disorders

personality

complex pattern of characteristics largely outside of the persons awareness which comprise the individuals distinctive pattern of perceiving, feeling, thinking, coping behavior

personality traits

prominent aspects of personality that are exhibited in a wide range of social and personal contexts

personality traits are enduring patterns of

perceiving, realting to, thinking about environment and oneself

personality involves

cognition, affectivity, interpersonal behavior and impulse control

cognition

ways of perceiving and assigning meaning to self others and events

affectivity

the range intensity and appropriateness of emotionality

personality development

response to a number of biological and psychological influences. heredity, temperament, experiential learning, social interaction

prevalence and comorbidity of personality disorders

personality disorder manifest in adolescence and early childhood. often co occur with depression and anxiety, onset usually occurs before other psychiatric disorders, varying personality disorders coexist, many people dont seek help so its hard to know how many people are affected by it

gender

gender is a major risk factor for certain personality disorders. women are more at risk for avoidant dependent and paranoid personality disorders. men are at risk for antisocial personality disorder. 

personality disorder definiton

a rigid stereotyped behavioral pattern that persists throughout a persons life. chronic maladaptive pattern of perceiving, thinking and relating that impairs social or occupational functioning causing inner distress. deviates from the expectations of a persons culture. is serious and at risk for psychiatric or comorbidity mood disorders, anxiety, substance abuse and injuries to self and others

personality disorders occur when personality traits become

inflexible and rigid, maladaptive, cause significant dysfunction or severe impairment and subjective distress, a lifelong behavior pattern that negatively affects many areas of life causes problems and is not produced by another disorder or illness

individuals with personality disorders

lack insight, lack understanding of the impact of their behavior on their environment, fail to accept consequences for their own behaviors, when threatened attempt to manipulate or change their environment to decrease stress instead of changing behavior, many individuals with other psychiatric and medical diagnoses manifest symptoms of personality disorders

psychoanalytic theory

emphasize the importance of nurturing from immediate caregivers and loved ones for fostering positive personality traits

biologic theory

stress influence of genetic transmission combined with environmental exposures for the formation of personality

social learning and cognitive perspectives

people acquire personality characteristics through thought and interaction with their environment

risk for problems

when development is stalled disrupted or becomes negative

a personality disorder must meet these criteria:

significant impairment in self or interpersonal functions, one or more pathological personality trait, impairments are stable overtime and across situations, personality traits or trait expressions are not normative for developmental stage or cultural environment. not due to use of a substance or medical condition

cluster a

represent behaviors that are described as odd or eccentric. paranoid pd, schizoid pd, schizotypal pd

cluster b

represent behaviors that are described as dramatic, emotional or erratic. antisocial pd, borderline pd, histrionic pd, narcissistic pd

cluster c

represent behaviors that are described as anxious or fearful. avoidant pd, dependent pd, obsessive compulsive disorder

paranoid personality disorder

a pervasive distrust and suspiciousness of others such that others motives are interpreted as malevolent. quick to take offense. do not acknowledge their negative feelings, project negative feelings on others and look for hidden meanings in conversations, begins by early adulthood

clinical observation of paranoid pd

constantly on guard, hypervigilant, guarded, oversensitive to surroundings and interactions, ready for any real or imagined threat mistrusts and misinterpreted cues, magnifies and distorts environmental cues, trusts no one, has few friends if ant, constantly tests the honesty of others, do not lose contact with reality

predisposing factors of paranoid personality disorder

possibly hereditary link. subjected to early parental antagonism and harassment

schizoid pd

show indifference to social relationships, characterized by a profound defect in the ability to form personal relationships, failure to response to others in a meaningful emotional way, flattened affectivity, cold, unsociable, seclusive demeanor

clinical observation of schizoid pd

indifferent to others and environment, client is aloof, withdraws from social events, client is emotionally cold, flat affect, in the presence of others the client appears shy anxious or uneasy. inappropriately serious about everything and has difficulty acting in a light hearted manner

predisposing factors of schizoid pd

possible hereditary factor. childhood has been characterized as bleak, cold, unempathetic, notably lacking in nurturing

schizotypal pd

displays an enduring and pervasive pattern and interpersonal deficits with extreme discomfort and intolerance for close relationships. thought patterns are disturbed, odd behaviors. a graver form of the pathologically of the less severe schizoid personality pattern

clinical observations of schizotypal pd

exhibits bizarre speech pattern, aloof, isolative, inappropriate affect, social anxiety, when under stress may decompensate and demonstrate psychotic symptoms, demonstrates bland and apathetic manners, everyday world manifests with magical thinking and ideas of reference, delusions, depersonalization

predisposing factors of schizotypal

possible hereditary factor and or possible physiological influence such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain (dysregulation of dopaminergic pathways), early family dynamics of  indifference, impassivity (void of emotion) parental patterns of discomfort with personal affection and closeness

cluster b disorders recapped

dramatic, emotional, attention seeking behaviors. moods are labile and shallow, become involved in intense interpersonal conflicts, antisocial traits more common in men, borderline and histrionic traits more common in females

antisocial personality disorder

aggressive and irresponsible behaviors, superficially cahrming, lack genuine wrmth

antisocial pd is a pattern of

socially irresponsible, domestic violence, fights, stealing, substance abuse, exploitive and manipulative, guiltless behavior that reflects a disregard for the rights of others. failure to conform to society laws and norms

antisocial pd predisposing factors

genetics, sociopathic or alcohol mother, aggressive child temperament, parental deprivation in first 5 years of life, history of adhd or conduct disorder, absence of parental discipline, extreme poverty, removal from the home, being rescued each time they are in trouble which means never having to suffer consequences for their behavior, maternal or paternal deprivation

clinical observations of antisocial pd

fails to sustain employment, exploits and manipulates others for personal gain, cold callous intimidating, inconsistent work or academic performance, failure to conform to societal norms, cruel and malicious, inability to form lasting monogamous relationship, low levels of behavioral inhibitions, very difficult to diagnose and treat, lack fear and decision making

borderline pd

characterized by a pattern of intense and chaotic relationships with affective instability. have fluctuating and extreme attitudes and moods regarding other people. view life experiences and relationships to the extremes of either very good or very bad. this tendency is known as splitting. view themselves as victims. highly impulsive, mood swings, depression, anger, anxiety, if feelings of being ignored can self mutilate, harm self, become aggressive for attention or numb emotions

predisposing influences of borderline pd

possible history of childhood abuse, neglect and separation from caregivers or loved ones, others with psychiatric disorders in the home

biochemical factors of borderline pd

changes in certain areas of the brain involved in emotion regulation impulsivity and aggression. in addition certain brain chemicals that hep regulate mood such as serotonin may not function properly. 

most common form of personality disorder

borderline pd. emotionally unstable. extreme affective instability usually lasting a few hours and usually no longer than a day

people with borderline pd always seems to be…

in a state of crisis. affect is one of extreme intensity, behavior reflects frequent changeability, self destructive behaviors present

borderline clients are most identified by

the intensity and instability of their affect and behavior

common behaviors of borderline pd

depression, inability to be alone, attention seeking behavior, clinging and distancing behaviors, splitting, manipulation

histrionic pd

long lasting pattern of excessive emotionally charged interactions and attention seeking behaviors, strive to be center of attention, speech is superficial, lacks detail. seductive, insecure, dependent on approval of others, naive, easily influenced, low tolerance to frustration, blame disappointments on others, suppress feelings related to past events and lack insight

predisposing factors of histrionic pd

link to nonadrenergic and serotonergic systems , possible hereditary factor, learned behavior patterns

histrionic clinical observations

highly distractible, difficulty paying attention to detail, flamboyant in dress and speech, exhibitionistic, easily influenced by others, difficulty forming close relationships, excitable, emotional, colorful, dramatic, attention seeking, manipulative, extroverted in behavior, seductive

narcissistic pd

lifelong pattern of self centeredness, self absorption, inability to empathize, insensitive to others, grandiose, extreme desires for admiration, feel special and important and have the rights for special treatment, exaggerate successes, self esteem is fragile, oversensitive to comments, envious of others and believe others envy them

predisposing factors of narcisssistic

they tend to be overly pampered and indulged. learn to view themselves as special and grow to expect special treatment from others. parents often narcissistic themselves

narcissistic clinical observations

mood can easily change because of fragile self esteem if they do not meet self expectations or receive positive feedback from others, criticism from others may cause them to respond with rage shame and humiliation, clients are overly self centered, overly sensitive to what others think, insensitive to other needs, lack empathy, exploit others in an effort to fulfill their own desires, mood which is often grounded in grandiosity is usually optimistic relaxed cheerful and care free

avoidant personality disorder

pattern in early adulthood of social discomfort timid fear of rejection and negative feedback will only form relationships if acceptance is guaranteed, self perception of unattractiveness, inferior, socially inept, avoid social demands, feelings of shame, embarrassment, ridicule trying new activities. involves all social activities not just specific ones

predisposing factors of avoidant pd

possible hereditary influences, parental rejection and criticism

clinical observations of avoidant pd

awkward and uncomfortable in social situations, desire close relationships but avoid them because of their fear of being rejected, inappropriate displays of anger dissociative paranoid ideation preoccupied being criticized or rejected

dependent pd

excessive need to be taken care of, pervasive, submissive and clinging behaviors, fears of separation, difficulty in making independent decisions and starting projects, lack trust in ones judgments, helpless, hopeless, relationships are based on being cared for. will stay in relationship even if abused

predisposing factors of dependent pd

possible hereditary influence, stimulation and nurturance are experienced exclusively from one source, a singular attachment is made by the infant to the exclusion of all others

dependent personality clinical manifestations

they have a noticeable lack of self confidence that is often apparent in their posture, voice, mannerisms, typically passive and acquiescent to desires of others, overly generous and thoughtful while underplaying their own attractiveness and achievements, assume passive and submissive roles in relationship, avoid positions of responsibility and become anxious when forced into them

treatments for personality disorders

interpersonal psychotherapy, psychoanalytical psychotherapy, milieu or group therapy, cBT, DBT for borderline pd, case management, psychopharmacology

symptoms of cluster A disorders

suspicious, paranoid, preoccupied, reluctant, isolate, flat affect, limited emotional response, no meaningful relationships, detached from activities, off thinking and speech, social anxiety, negative self judgments

goal of cluster A

solve immediate crisis or problem and complete social skills training

symtpoms of cluster B

disregards safety of others, failure to conform to social norms. unstable relationships, reckless disregard, aggressive, manipulative, unstable self image, exaggerated speech and manners, impulsive, attention seeking

goals of cluster B

prevent suicide and harm, gain insight, improve coping, gain insight into feelings and behaviors and unrealistic expectations/ fears

symptoms of cluster C

avoidant of social activities, disapproval, fear of being shamed, needs to be taken care of, lack of self confidence, helplessness and insecure

goals for cluster c

enhance social functioning, solve immediate crisis, assertiveness training, cognitive reconstruction

guarded suspicious argumentative

Acknowledge their perception without debate or agreement. Focus attention on treatment. Be respectful, maintain professional distance and approach

aloof, uninvolved

Demonstrate understanding and respect privacy. Explain rationale for personal questioning. Do not push for social interaction

idiosyncratic, eccentric

Consistent approach addressing complaints and beliefs, do not challenge or reinforce perspectives

demanding

SET LIMITS- minimize excessive or realistic demands

dramatic, emotionally involved, seductive

Supportive attitude. Maintain professional boundaries to prevent unprovoked responses

superior clients

Recognize and support strengths. Show interest in opinions, demonstrate competence.

sociopathic

Set realistic limits on visits. Do not tolerate aggressive behaviors, develop treatment plan to address aggressive behavior.

orderly, controlled, controlling

Clearly state treatment approaches, options, rationales, give as much details as possible, avoid struggle of who is in charge.

Anxiously avoidant, Clinging, dependent

Demonstrate patience, empathy towards fears, frequent brief encounters, forewarn of any milieu changes

Controlling, avoidant, dependent

Directly address concerns about behaviors, identifying underlying feelings about their illness and treatment, avoid feeling resentful about “acting out” behaviors

nursing considerations

trust, safety protection of the vulnerable, hygiene, nutrition, communication, social skills, normal communication skills are compromised by emotions