Personality Disorders

Personality Disorders

Nikki Pinney, MSN, RN
DSC School of Nursing

Introduction

• Personality Traits:
  • Enduring patterns of
  • Perceiving
  • Relating to
  • Thinking about the environment and oneself

What is a Personality Disorder?

• Definition:
  • Occur when personality traits become:
  • Inflexible or maladaptive responses to stress
  • Cause significant functional impairment
  • Impairments:
  • Self-identity
  • Self-direction
  • Interpersonal functioning
  • Often exhibit lack of insight into the illness

Clusters of Personality Disorders (DSM V)

• Cluster A: Weird

  • Behaviors that are odd or eccentric:
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder

• Cluster B: Wild

  • Behaviors that are dramatic, emotional, or erratic:
  • Antisocial Personality Disorder
  • Histrionic Personality Disorder
  • Borderline Personality Disorder
  • Narcissistic Personality Disorder

• Cluster C: Worried

  • Behaviors that are anxious or fearful:
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Also includes: Passive-Aggressive Personality Disorder (not specified)

Borderline Personality Disorder

Assessment

• Characteristics:
  • Unstable relationships
  • Frequent crises
  • Extreme intensity of affect
  • Frequent changeability in behavior
  • Presence of self-destructive behaviors
  • Impulsivity
  • High incidence of trauma/abuse

Key Concepts

• Intense Emotions:
  • Periods of joy, rage and crisis
  • Splitting as a defense mechanism:
  • Categorizing people/things as all good or all bad
  • Relationships often become dramatic and sour over time
  • Extreme fear of abandonment may lead to drastic actions

Outcomes

• Successful management includes:
  • No self-harm incidents
  • Appropriate expression of anger
  • Seeking staff support instead of resorting to self-harm
  • Connecting behaviors to others' responses
  • Improved self-care practices

Planning and Implementation

• Challenges:
  • Building a therapeutic relationship can be difficult
• Strategies:
  • Create a safe environment
  • Establish behavioral limits and teach anger management
  • Empower client by putting them in charge of decisions
  • Anticipate needs to reduce impulsive behaviors
  • Provide honest praise for positive relationship behaviors
  • Implement behavior contracts to outline expectations
  • Enforce boundaries in the client/nurse relationship
  • Maintain consistent and frequent communication among staff

Treatment Modalities for Personality Disorders

• Therapeutic Approaches:
  • Dialectical Behavior Therapy (DBT)
  • Focuses on relaxation skills, meditation, and emotional regulation
  • Cognitive Behavioral Therapy (CBT)
  • Interpersonal Psychotherapy
  • Milieu or Group Therapy
  • Psychopharmacology (medication management)

Communication Techniques

• Effective Strategies:
  • Be firm and direct in communication
  • Offer clients clear choices (3 options)
  • Ensure consistency and limit setting with no exceptions
  • Encourage assertiveness in dependent and histrionic personalities
  • Allow introverted features in clients with schizoid or schizotypal disorders
  • Remain professional and avoid staff splitting

Differences from Other Mental Illnesses

• Understanding personality disorders requires different assessment techniques and interventions compared to traditional mental illnesses.
• Key Distinctions for Assessment:
  • Personality disorders involve deeper-rooted behaviors with functional impairments, whereas other mental illnesses may focus more on acute symptoms.

Key Questions for Reflection

• How does the assessment of personality disorders differ from other mental illnesses?
• What are effective interventions for treating patients with personality disorders?
• What is the difference between CBT and DBT?
• What communication techniques work best with clients exhibiting personality disorders?