Personality Disorders

Chapter 12: Personality Disorders

Introduction to Personality Disorders

Personality Traits

  • Definition: Persistent ways in which an individual views and relates to other people and to society.

  • Components: Include how an individual controls their behavior, their emotional responses to situations, how they think about themselves or others, and how they relate to other people.

Personality Disorders

  • Definition: Deeply ingrained, persistent, inflexible, and maladaptive patterns of behavior that conflict with cultural norms.

  • Characteristics:

    • Manifested in thought processes, emotional reactivity, interpersonal relationships, and self-control.

    • Symptoms are consistent and constant.

    • Treatment is rarely sought; nonadherence is a significant issue when treatment is pursued.

    • Individuals tend to view life in extremes, often as 'all good' or 'all bad' (splitting).

    • Exhibit arrogant and self-indulgent behaviors.

    • Unable to delay the satisfaction of their needs to accommodate others' wishes.

    • May display passive-aggressive tendencies.

    • Demonstrate emotional ambivalence.

    • Frequently project their faults onto others.

  • There are 10 generally recognized personality disorders, which are grouped into 3 categories or cluster groups based on their characteristics.

Personality Disorders Characterized by Aloof or Eccentric Behaviors (Cluster A)

Paranoid Personality Disorder

  • Signs and Symptoms:

    • A persistent pattern of suspicion or mistrust towards others.

    • Exhibits a suspicious nature, often leading to angry or hostile outbursts.

    • Possesses a rigid, inflexible nature, yet can be quite efficient.

    • Inability to achieve closeness in interpersonal relationships.

    • Unable to accept constructive criticism, yet is highly critical of others.

Schizoid Personality Disorder

  • Signs and Symptoms:

    • Reclusive and socially withdrawn.

    • Derives less pleasure from soothing, sensual activities.

    • Displays a bland affect, appearing unresponsive to positive emotions in others.

    • These characteristics are observed in most aspects of life by adulthood.

    • Oblivious to how their behaviors are perceived by others.

Schizotypal Personality Disorder

  • Signs and Symptoms:

    • Socially secluded and withdrawn.

    • Exhibits unusual patterns of thinking and communicating.

    • Prone to magical thinking and ideas of reference (the belief that unrelated events have a special meaning for them).

    • Commonly experiences perceptual distortions and illusions.

    • Emotions are rigid and inflexible, with little ability to respond to the feelings of others.

    • Brief episodes of psychotic behavior may occur.

Personality Disorders Characterized by Dramatic, Emotional, or Erratic Behaviors (Cluster B)

Antisocial Personality Disorder

  • Signs and Symptoms:

    • A persistent pattern of disregard for and infringement on the rights of others.

    • Demonstrates cold indifference to the laws of society and humanity, seemingly without a conscience.

    • Considered a chronic disorder that is difficult to treat.

    • Impulsive individuals who victimize others for materialistic self-gain.

    • Often have continual involvement with law enforcement.

    • Rarely benefit from incarceration or traditional treatment.

Borderline Personality Disorder

  • Signs and Symptoms:

    • A persistent pattern of unstable relationships, insecurity, and rapid mood swings.

    • Impulsive, prone to angry outbursts, and emotionally labile (rapidly shifting emotions).

    • Experiences a chronic sense of emptiness, fear of abandonment, and intense anxiety.

    • Engages in splitting (viewing others as 'all good' or 'all bad').

    • May experience brief episodes of paranoia and hallucinations.

    • Frequently makes suicide threats and engages in self-mutilation (self-injury, which may provide perceived 'benefits' such as emotional regulation or a release of tension).

    • Exhibits other self-destructive impulsive behaviors.

    • Experiences of happiness and well-being are rare.

Narcissistic Personality Disorder

  • Signs and Symptoms:

    • Possesses an exaggerated, grandiose sense of self-importance.

    • Displays arrogance and a sense of entitlement.

    • An underlying feature is often feelings of inferiority and envy of others.

    • Over-exaggerates personal achievements.

    • Has little regard for others' feelings.

    • Lacks insight into their behaviors and engages in unrealistic thinking.

Histrionic Personality Disorder

  • Signs and Symptoms:

    • Characterized by extreme egocentricity and emotionalism.

    • Has a demanding need for personal attention.

    • Behaves melodramatically, often with fake or exaggerated expressions.

    • Develops superficial relationships.

    • May use provocative dress and mannerisms to attract attention.

    • Easily influenced and overly trusting.

Personality Disorders Characterized by Anxious or Fearful Behaviors (Cluster C)

Avoidant Personality Disorder

  • Signs and Symptoms:

    • Is shy and highly sensitive to negative comments from others.

    • Avoids interactions with others due to an extreme fear of ridicule or disapproval.

    • Experiences social inadequacy and intense anxiety in group settings.

    • Perceives rejection even when it is nonexistent.

    • Suffers from self-doubt and low self-esteem.

Dependent Personality Disorder

  • Signs and Symptoms:

    • Exhibits consistent, extreme dependence on others.

    • Perceives self as helpless and incompetent.

    • Insecurity and self-doubt lead to avoidance of self-care decisions.

    • Experiences an extreme fear of being alone and an inability to make independent decisions.

    • Independent activities are not considered an option.

    • Has an increased involvement in abusive relationships due to their dependence.

Obsessive-Compulsive Personality Disorder

  • Signs and Symptoms:

    • Conscientious and highly organized.

    • Preoccupied with order, rules, and perfection.

    • Rigid, controlling, and highly critical of both self and others.

    • Finds it difficult to feel satisfaction from accomplishments.

    • Deadlines provoke high anxiety.

    • Adheres to rigid morals and ethics.

    • Relationships tend to be serious and shallow.

Treatment of Personality Disorders

  • Client Perspective: Clients must gain perspective regarding their underlying problems, which is often challenging.

  • Therapeutic Relationships: Difficult to form due to lack of insight, resistance to change, and mistrust inherent in personality disorders.

  • Psychotherapies Used:

    • Individual Psychotherapy: Often has limited benefit due to the client's mistrust.

    • Group Therapy/Behavior Modification: Aimed at improving interaction skills and increasing understanding of how behaviors are perceived by others.

    • Family Therapy: Can be utilized to address family dynamics.

  • Preferred Approach: A combination of psychotherapy and medication is generally preferred.

Nursing Process

Nursing Assessment

  • Identify events or behaviors that led to admission.

  • Observe nonverbal behaviors and symptoms.

  • Assess thought processes for characteristic patterns.

  • Note inconsistencies between words and behavior.

  • Evaluate anxiety level and emotional state.

  • Identify coping mechanisms, both adaptive and maladaptive.

  • Assess for suicidal thoughts or a specific plan.

Selected Nursing Care Focus

  • Goal: Attained from the review of assessment data.

  • Expected Outcomes: Should be revised as needed if not occurring within a given timeframe.

  • Interventions: Nurses must continually identify their personal feelings when providing care, as it can be very challenging.

  • Evaluation: Efficacy of treatment is difficult to measure, though the primary goal is to do no harm.

    • Changes in personality disorders do not occur quickly.

    • Improvements are often not recognizable during brief treatment periods.

    • There is limited potential for significant improvement within typical treatment durations.

Questions and Answers

Question #1

Statement: Three categories or cluster groups of personality traits have been identified.

Answer: True.

Rationale: There are 3 categories or cluster groups of personality disorders. They are categorized according to their range of characteristics (Cluster A: Aloof/Eccentric; Cluster B: Dramatic/Emotional/Erratic; Cluster C: Anxious/Fearful).

Question #2

Which personality disorder involves a continued need for lavish attention and admiration?

  • Avoidant personality disorder

  • Obsessive-compulsive personality disorder

  • Narcissistic personality disorder

  • Paranoid personality disorder

Answer: C. Narcissistic personality disorder.

Rationale: A person with narcissistic personality disorder has a grandiose sense of self-importance with little care for the feelings of others, driven by a need for admiration.

Question #3

Which personality disorder involves extreme shyness and social withdrawal?

  • Obsessive-compulsive personality disorder

  • Avoidant personality disorder

  • Histrionic personality disorder

  • Schizotypal personality disorder

Answer: B. Avoidant personality disorder.

Rationale: A person with avoidant personality disorder is sensitive to rejection, intensely anxious, and extremely shy in social situations, leading to social withdrawal.