Personality Disorders

Personality

• Personality: Totality of emotions and behaviors, usually stable and predictable.
• Personality Traits: Characteristics developed over time, influencing perception and relating to the environment; usually stable.
• Disorders: Occur when there's a disruption or dysfunction impacting relationships, career, and academia.
• Common symptom: Interpersonal relationship issues.
• Cognitive Disturbances: Affecting reasoning and perception.
• Affective Disturbances: Mood and emotional dysregulation.
• Personality Disorder (PD): Diagnosed when traits cause major disruption and functional impairment.

Contributing Factors

• Genetics/Hereditary: Increased incidence in families with PD traits.
• Biological Factors:
  • Brain changes (decreased areas relating to empathy and compassion).
  • Neurotransmitter disregulation (serotonin).
• Personal/Environmental Experiences:
  • Adverse Childhood Experiences (ACEs): Trauma during personality development increases risk.

Personality Disorder Clusters

Cluster A: Odd and Eccentric

• Unconventional behaviors, difficulty relating, perceived as odd or eccentric.
• Traits include:
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder

Paranoid Personality Disorder

• Suspicious, distrustful of others, feels exploited.
• On guard, defensive, intimidating.
• Hypervigilant, ready for perceived threats.
• Bears grudges, reacts angrily to perceived attacks.
• May result in aggressive behavior and violence.

Schizoid Personality Disorder

• Indifferent to others, inability to form relationships.
• Not interested in relationships.
• Emotional coldness, flat affect.
• Prefers solitary activities, intellectual pursuits.

Schizotypal Personality Disorder

• Very bizarre and odd
• Inappropriate social interactions.
• Magical thinking (superstitions, clairvoyance, telepathy).
• Unusual perceptual experiences.
• Lacks close friends.

Cluster B: Dramatic, Emotional, Erratic

• Dramatic, unpredictable, emotional, difficulty controlling emotions.
• Traits include:
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder

Antisocial Personality Disorder

• Difficulty maintaining stable relationships and consistent employment.
• Manipulative, exploits others.
• No remorse or guilt.
• No regard for authority or law.
• Engages in criminal behavior.
• Sociopath is a personality trait, can have antisocial traits.

Borderline Personality Disorder

• Poor self-concept, impulsive.
• Pattern of self-injurious behavior (NSSIs) for attention.
• Manipulative, intense, chaotic, unstable relationships.
• Alternating extremes of idealization and devaluation.
• Splitting behaviors, chronic fear of abandonment.
• Lacks remorse.
• Treatment: Treat the wound, not the behavior.
• Consistency in nursing care is important.

Histrionic Personality Disorder

• Very dramatic, seductive, attention-seeking.
• Superficial, transient relationships.
• Wants to be the center of attention.
• Sexually preoccupied, constant affirmation-seeking.

Narcissistic Personality Disorder

• Exaggerated sense of self-importance.
• Exploits others, constant need for admiration.
• Feels superior to others.

Cluster C: Anxious and Fearful

• Experience fearful and anxious signs and symptoms.
• Traits include:
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder

Avoidant Personality Disorder

• Avoids others due to insecurity and fear of rejection.
• Wants relationships but fears rejection.
• Experiences depression, anxiety, and anger at self.
• Poor self-concept, views self as socially inept.
• Avoids jobs with interpersonal contact.

Dependent Personality Disorder

• Difficulty making decisions, needs excessive reassurance.
• Relies on others, longs to be taken care of.
• Submissive, clingy, fear of separation.
• Uncomfortable when alone.
• Difficulty expressing disagreement.

Obsessive-Compulsive Personality Disorder

• Perfectionist, inflexible.
• Reluctant to delegate tasks.
• Perfectionism interferes with tasks.
• Overconscientious, inflexible about morality.

Nursing Implications

• Complete mental and physical health assessment.
• Body scan to map out any injuries and track insurance behavior.
• Assess substance use/abuse, risk for self-harm/suicide, aggression/violence.
• Directly ask about suicidal risk, aviation, urges, or attacks.
• Follow-up on self-injurious behavior.
• Search for access to recessional objects.
• Obtain a list of current medications and over-the-counter medication.
• Address escalating behaviors and high emotions.
• Consistent nurse assignment: Increases trust, provides consistency, allows observation of subtle changes.

Interventions

• Ensure a safe environment (free from harmful objects).
• Follow-up on patient reports of symptoms.
• Explore emotions, even anger, using emotional intelligence.
• Role model appropriate behavior, establish trust.
• Encourage talking about feelings.
• Cognitive Behavioral Therapy (CBT) and Dialectal Behavioral Therapy (DBT)
• Maintain firm limit setting from the start.
• No specific pharmacological treatment; medications may be used for anxiety or depression.
• Antisocial PD is difficult to treat due to lack of motivation to change.

Evaluation and Outcome Goals

• Socialization.
• Better Judgment
• Engaging in groups.
• Self-awareness of triggers and actions.
• Realizing expressed exhibited behaviors toward others.

Key Considerations

• Self-reflection:
  • Recognize potential emotional triggers (e.g., anger).
  • Prepare for manipulative behaviors.
  • Do not engage at the same level as the patient.
  • The nurse should not personalize insults or manipulative behaviors.
• Communication:
  • Prioritize therapeutic relationships.
  • Always provide information to patients.