personality disorder

Presenter: Professor Justine Abram, MSN, RN, CNRN
Overview of personality disorder types under three clusters:
  - Cluster A: Odd or Eccentric
  - Cluster B: Dramatic, Emotional or Erratic
  - Cluster C: Anxious or Fearful

Types:
  - Paranoid Personality Disorder:
    - Characterized by global mistrust and suspicion of others.
  - Schizoid Personality Disorder:
    - Individuals exhibit expressively emotionless and disengaged behavior.
  - Schizotypal Personality Disorder:
    - Features odd thinking and behavior.

Characteristics:
  - Ideas of reference
  - Odd beliefs or magical thinking
  - Unusual perceptual experiences
  - Suspiciousness or paranoid ideation
  - Inappropriate affect
  - Odd behavior or appearance
  - Lack of friends
  - Excessive social anxiety that does not diminish with familiarity

Description of Behavior:
  - Aloof and apathetic
  - Superstitious
  - Demonstrates bizarre speech patterns
  - Communicates in a tangential manner
  - Under stress, may show:
    - Possible decompensation
    - Psychotic symptoms
    - Inappropriate affect

Patient Profile: A 35-year-old man named Mario
  - Dresses in a space suit every Tuesday and Thursday
  - Claims to have computers that detect the precise time of an alien invasion
  - Troubled by the "negative forces" in his house impacting his "psychic soul-spot"
  - Exhibits severe stress responses including stopping eating and showering
Case Questions:
1. What patterns of behavior, beliefs, or thoughts may disrupt the patient's functioning?
2. What are the appropriate nursing interventions?

Types:
  - Antisocial Personality Disorder:
    - Disregard for and violation of the rights of others.
  - Borderline Personality Disorder:
    - Involves unstable self-identity, relationships, and affect.
  - Histrionic Personality Disorder:
    - Characterized by colorful, dramatic, and flirtatious behavior.
  - Narcissistic Personality Disorder:
    - Exhibits an exaggerated sense of superiority.

Key Features:
  - Failure to obey laws
  - Deceitfulness and impulsivity
  - Irritability and aggression
  - Disregard for personal and others' safety
  - Irresponsibility and lack of remorse
  - History of childhood conduct disorder

Behavioral Patterns:
  - Exploits others and breaks the law
  - Difficulty sustaining employment
  - Few stable relationships
  - Displays a cheerful demeanor when things go well but can be argumentative and cold
  - Exhibits reckless and impulsive behavior
  - Does not accept responsibility for actions

Patient Profile: Joey, age 32
  - Oldest of five children raised by a single mother
  - Experienced physical abuse and chronic school absenteeism, ultimately dropping out in 10th grade
  - History of violence and carries a weapon, threatening its use
  - Arrest record includes shoplifting, auto theft, and armed robbery
  - Displays aggressive behavior during admission, claiming he doesn't belong in a psychiatric unit
Case Questions:
1. What behaviors, beliefs, or thoughts may disrupt the patient's functioning?
2. What are appropriate nursing interventions?

Defining Traits:
  - Frantic efforts to avoid abandonment
  - Unstable and intense relationships
  - Unstable sense of self
  - Self-damaging impulsivity
  - Recurrent suicidal or self-mutilating behavior
  - Markedly reactive mood with chronic feelings of emptiness
  - Inappropriate intense anger and transient paranoia or dissociative symptoms

Behavioral Patterns:
  - Frequently in crisis with emotional volatility
  - Intense affect and chaotic relationships, marked by clinging and distancing
  - Engages in manipulative and self-destructive behavior
  - Commonly faces stigma and often has a history of childhood abuse

Patient Profile: Tina, age 37
  - Diagnosed with borderline personality disorder at 22 and has maintained the same therapist since then
  - Reacts hysterically when informed her therapist is moving, fearing abandonment
  - Engages in self-harm by slicing her calves with a razor blade, leading to hospitalization
  - Expresses dependence on the nursing staff for support during admission
Case Questions:
1. What behaviors, beliefs, or thoughts may disrupt the patient's functioning?
2. What are the appropriate nursing interventions?

Types:
  - Dependent Personality Disorder:
    - Characterized by pervasive dependence on others.
  - Obsessive-Compulsive Personality Disorder:
    - Exhibits rigid conformity to rules and order.
  - Avoidant Personality Disorder:
    - Features extreme shyness and fear of rejection.

Defining Traits:
  - Preoccupation with details, order, and perfectionism
  - Excessively devoted to productivity and overconscientiousness about morality and values
  - Inability to discard worthless objects and reluctance to delegate
  - Hoards money and demonstrates rigid and stubborn behavior

Behavioral Patterns:
  - No recurrent obsessions and compulsions
  - Appears serious, lacking spontaneity, and has difficulty making decisions
  - Meticulous and diligent, often appearing controlled and dependable
  - Internally experiences feelings of anger and defiance

Anticipated patient behaviors in a psychiatric unit:
  - At their best
    - What behaviors may demonstrate improvement and stability?
  - At their worst
    - What behaviors may indicate regression or crisis?
Which patient will require the most time and why?
Which patient presents as the highest priority and why?

Challenges:
  - Use of reality-based thinking if delusions are present
  - Support in completing activities of daily living (ADLs) if severe decompensation occurs
  - Prevent social isolation and promote socialization
  - Coping with stress and improving low self-esteem
Common Traits:
- Bizarre behaviors, peculiar thoughts, introversion, social anxiety, suspicion towards others

Challenges:
  - Establishing a safe environment and reinforcing unit rules
  - Improving interpersonal communication and anger management skills
  - Addressing specific problems with short-term outcomes and identifying dysfunctional thought patterns
  - Promoting self-responsibility and providing alternatives to dysfunctional thinking
Common Traits:
- Impulsivity, interpersonal problems, aggression, lack of empathy

Challenges:
  - Management of anxiety
  - Development of interpersonal relationship skills
  - Addressing loneliness and sleep-related issues
  - Utilizing a therapeutic approach to convey acceptance of rigidity
Common Traits:
- Perfectionism, inflexibility, difficulty expressing emotions, controlling behavior in relationships

Acknowledgment of the American Psychiatric Association (2013) and DSM-V references
Additional resources: www.apna.org