Personality Disorders

Diagnostic Features for Personality Disorder?

• Abnormal, inflexible behavior patterns traced back to adolescence/early adulthood

• Deviate in: cognition, emotional stability, interpersonal functional, impulse control/destructive behavior

Cluster A Personality Disorders

• Odd or eccentric behavior

• Paranoid, schizoid, schizotypal (pattern of acute discomfort in relationships)

Diagnostic Features for Personality Disorder?

• Abnormal, inflexible behavior patterns traced back to adolescence/early adulthood

• Deviate in: cognition, emotional stability, interpersonal functional, impulse control/destructive behavior

Cluster A Personality Disorders

• Odd or eccentric behavior

• Paranoid, schizoid, schizotypal (pattern of acute discomfort in relationships)

Cluster B Personality Disorders

• Dramatic, emotional, erratic behavior

• MOST COMMON

• Borderline, Antisocial, Histrionic, Narcisstic

Cluster C Personality Disorders

• Anxious or fearful behavior

• Avoidant, dependent, obsessive-compulsive

S/s of Borderline Personality Disorder (BPD)

• Frantic to avoid abandonment

• Unstable relationships

• Unstable self-image

• Recurrent suicidal behavior/self-injury

• Intense anger/reactivity of mood

• Feelings of emptiness

• Severe dissociative s/s

Clinical Course of BPD

• s/s begin in adolescence/early adulthood

• Appear “high functioning” between periods of crisis (unlike bipolar)

• Tend to have more stability, better relationships, and less impulsivity as they age

Etiology of BPD

• Bio: dysfunction of limbic system and frontal lobe

• Psychoanalytic: have not achieved healthy separation from caregivers

• Cognitive: rigid, inflexible, dichotomous thinking

• Social: emotionally vulnerable, environment causes emotional reaction

Nursing Assessment for BPD

• SAFETY!!

• Hygiene/nutrition/sleep

• Prescribed meds?

• Substance Use hx

• Family psych hx

• Trauma hx

• MSE: some have good insight, some don’t want to accept diagnosis

Nursing Interventions BPD

• Interdisciplinary tx

• Establish personal boundaries

• Manage dissociative state

• Change thoughts: challenge dysfunctional thinking/feelings of abandonment

• Change behaviors: positive reinforcement, but consequences for undesired behavior

Medication Tx for BPD

• SSRIs

• Mood stabilities to reduce impulsivity → Depakote, Lamictal

• Anti-epileptics

• Antipsychotics (if they have psychotic s/s)

Dialectical Behavior Therapy (DBT)

Combines CBT approaches:

• Mindfulness

• Interpersonal effectiveness

• Emotion regulation

• Distress tolerance skills

• Self-management

What is Antisocial Personality Disorder?

• Pervasive pattern of disregard for the well-being of others

• Highly comorbid w/ alcohol + drug abuse

• Can start seeing at 15yo

Antisocial Personality Disorder s/s

• Failure to conform to norms

• Deceitful and impulsive

• Irritable/aggressive

• Reckless/disregard for safety

• Lack of remorse

Etiology of Antisocial

• Neurobio changes!

• Difficult temperament (even as a child)

• Unsatisfactory attachments

• Chaotic families

Nursing Assessment of Antisocial

• SAFETY!! → HIGHEST RISK FOR VIOLENCE

• Legal/probation issues?

• Family dysfunction?

• Employment status

• Incarceration?

• Substance use hx

Nursing Interventions

• Set clear, realistic limits on behavior

• Set clear boundaries/consequences

• Interdisciplinary tx

• Document physical signs of aggression

• Tx substance use/withdrawal