personality disorders

4 common characteristics of those with PD

inflexible and maladaptive responses to stress/ lack resilience, disability in working with and loving others, ability to evoke interpersonal conflict and provoke negative reactions, difficulty recognizing that problems with others are due to their own personality

DSM5 criteria of personality disorders

an enduring deviation of inner experience and behavior of at least 2 of the following: cognition, affect, interpersonal functioning, impulse control

cluster A

type of cluster where behaviors are odd or eccentric

cluster B

type of cluster where behaviors are dramatic, emotional, erratic

cluster C

type of cluster where behaviors are anxious and fearful

paranoid, schizoid, schizotypal

cluster A personality disorders

antisocial, borderline, histrionic, narcissistic,

cluster B personality disorders

dependent, obsessive compulsive, avoidant

cluster C personality disorders

suspicious, hold grudges, unforgiving, very critical but have difficulty accepting criticism, cold, unemotional, no sense of humor

paranoid PD characteristics

avoid being overly friendly, be neutrally kind, establish trust, be clear and straightforward, get it in writing

nursing considerations for paranoid PD

no desire for relationships, loners, cold, flat affect

schizoid PD characteristics

don’t try to re-socialize, avoid being overly friendly, need thorough assessment questioning

nursing considerations for schizoid PD

withdrawn, aloof, have odd beliefs, magical thinking, superstitious, social anxiety, have few close relationships, can be precursor to schizophrenia

schizotypal PD characteristics

respect need for isolation, avoid being overly friendly, be clear and straightforward

nursing considerations for schizotypal PD

steal, lie, deceitful, irresponsible, lack of remorse/ have no empathy, can be charming, interact with others using manipulation and/ or aggression, substance abuse (#1 comorbid illness)

antisocial PD characteristics

avoid being manipulated as pt. may use flattery or guilt, set clear expectations to be followed by all staff

nursing considerations for antisocial PD

intense and unstable relationships, tension between dependence and rejection, impulsive and damaging behaviors, emotional dysregulation, suicidal or self-mutilating in response to perceived rejection, emotional emptiness, splitting, black and white thinking, outburst of emotion

characteristics of borderline PD

avoid manipulation, avoid rejecting or rescuing client, be straightforward with clear and consistent boundaries, must be physically present, assess for safety, nurse must be self-aware of emotions

nursing considerations for borderline PD

draw attention to themselves, concerned about appearance, excessive emotionality, rapidly shifting emotion from person to person, shallow, superficial, no empathy, only care about themselves, instant gratification with affection

histrionic PD characteristics

remain professional, reinforce personal qualities (rather than just focusing on physical appearance)

nursing considerations for histrionic PD

uses others to meet their needs, persistent entitlement, belittles others, grandiose, self-absorbed, lacks empathy, controlling, overcompensation for low self esteem

narcissistic PD characteristics

convey self-confidence, avoid power struggles, reinforce social appropriateness

nursing considerations for narcissistic PD

overly agreeable, passive, unable to be without relationship, clingy, lacks own interests, difficulty making decisions

dependent PD characteristics

identify real vs perceived needs, meet needs with limits, teach assertiveness

nursing considerations for dependent PD

inflexible, rigid, need to be in control, perfectionistic, prioritize work over leisure or relationships, decreased decisions due to preoccupation with details, highly moral and ethical, have lists/ rules/ schedules/ “should”

obsessive compulsive PD characteristics

avoid power struggles, look for intellectualization, rationalization, and rxn formations

nursing considerations for obsessive compulsive PD

social phobia, feel inadequate, fears criticism and rejection, feel inferior and unappealing, avoid new situations

avoidant PD characteristics

be friendly and reassuring, gradually introduce to social situations

nursing considerations for avoidant PD

interventions for personality disorders

treat symptoms (anxiety, mood swings, aggression, etc.), teaching, protect from harm of self and others, milieu therapy, role play, journaling, mood monitoring, cognitive behavioral approaches, social skills training