Personality disorders

Personality disorders DSM Criteria

MUST have 2 of the following

• Cognition

• Affect

• Interpersonal functioning

• Impulse control

Personality disorders: Cluster A

Eccentric/Odd

• Paranoid

• Schizoid

• Schizotypal

Personality disorders: Cluster B

Erratic/Dramatic

• Borderline

• Antisocial

• Narcissistic

• Histrionic

Personality disorders: Cluster C

Anxious/Fearful

• Avoidant

• Dependent

• Obsessive-complsive

Paranoid personality disorder

• Suspicion & mistrust

• Hesitant to confide in others

• Read into innocent comments & quick to become angry

• Hold grudges

• May be apparent in childhood

• Social anxiety in childhood

• Jealous, controlling as adults

• Often suspects partner of being unfaithful without basis

Paranoid personality disorder Tx

Counteract mistrust by:

• Adhering to schedules

• Avoiding being over friendly

• Projecting a neutral but kind affect

Individual therapy — Group therapy is threatening

Meds:

Antianxiety

• Diazepam - Valium

Antipsychotic

• Haloperidol - Haldol

• Pimozide - Orap

Schizoid personality disorder

• Symptoms appear in adolescence or early adulthood

• Loner’s poor academic performance

• Inc prevalence of disordered family life

• Avoid close relationships

• Detachement

• Emotional coldness

• Flat affect

Schizotypal personality disorder

• Severe social and interpersonal deficits

• Anxiety in social situations

• Rambling conversations

• Paranoia, sus, distrust

• Brief, intermittent episodes of hallucination or delusions

• Odd beliefs, fantasy or magical

• May be vulnerable to involvement with cults

• May be precursor to schizophrenia

Schizotypal Personality disorder Tx

Nursing care guidelines

• Respect pt need for social isolation

• Be aware of and intervene appropriately with pt suspiciousness

• Perform careful diagnositc assessment for symptoms that may need intervention

• Withhold judgement or ridicule

Tx

• Psychotherapy — Investigate possible involvement with cults

• Low dose antipsychotics

Histrionic personality disorder

• Excitable, dramatic

• Concerned with appearance

• Bold external behaviors

• Use impressionistic speech

• Excessive emotions — may be provocative, smothering

• Attention seeking, self centered, low frustration level

• Limited ability to develop meaningful relationships

• Often high functioning

• No insight into disorder or role in ruining relationships

Histrionic personality disorder Tx

Nursing guidelines

• Know that seductive behavior is a response to distress

• Keep interactions as professional - Ignore flirtations

• Model concrete language

• Help pt clarify inner-feelings

• Teach and role-model assertiveness

Meds

• Psychotherapy

Narcissistic personality disorder

• Feelings of entitlement exaggerated self importance

• Lack of empathy - tendency to exploit others

• Weak self esteem and hyper sensitivity to criticism

• Controlling/power struggles

• Constant need for administration

• Overcompensation for low esteem

• Less functional impairment than other personality disorders

Narcissistic personality disorder Tx

Guidelines for nursing

• Remain neutral

• Avoid power struggles or becoming defensive

• Role model empathy

Tx

• Difficult to treat — pt not likely to seek help

• CBT to deconstruct faulty thinking

• Group therapy

• Lithium for mood swings

Antisocial personality disorder

• Disinhibited behaviors

• Deceitful

• Irresponsible

• Profound lack of empathy

• Insensitive and disrespectful

• Sense of superiority and extremely opinionated

• Highly manipulative

• Absence of remorse or guilt

• Frequent run with the law

  • Stealing, lying,vandalism

  • Aggressive and violent

• Conduct disorder may be precursor

Antisocial personality disorder Tx

Guidelines for nursing care

• Aggression tends to present outwardly — watch for risk of harm

• Pt tend to not answer honestly

• Pt are manipulative and try to bend rules — Must be firm and consistent

• Focus on consequences of behavior

• Tx

  • Group therapy

  • Psychotherapy

  • CBT

Borderline personality disorder

• Severe impairments in functioning

• Emotional lability

• Marked impulsivity

• Self destructive behaviors

• Intense, unstable relationships

• Act out instead of expressing emotions

• Suicidal/self mutiliation in repsonse to rejection

• Splitting inability to view both positive and negative aspects as part of a whole

• ACE

Borderline personality disorder Tx

Guidelines for nursing

• Provide clear and consistent boundaries

• Clear, straightforward communication

• Calmly review therapeutic goals

• Aggresison tends to present toward self — watch for risk of self harm

  • Respond matter of factly to superficial self injuries

Tx

• Psychotherapy - CBT, DBT, Schema-focused therapy

• No meds

• Psychtotopics for symptom relief

Avoidant personality disorder

Avoidant personality disorder Tx

Dependent personality disorder

Dependent personality disorder Tx

OCD

OCD Tx

Pharm

NO MEDS

• But can treat s/s like mood swings, anxiety, aggression