Personality Disorders

Introduction to Personality Disorders

• Definition of Personality:

  • Ingrained, enduring pattern of behaving and relating to self, others, and the environment.

  • Encompasses perceptions, attitudes, and emotions.

  • Individuals are usually not consciously aware of their own personality.

• Personality Disorders:

  • Characterized by impairment in personality functioning.

  • Manifest through maladaptive personality traits.

  • Often include identity problems and dysfunctional relationships.

Maladaptive or Dysfunctional Personality Traits

• Negative Behaviors Toward Others:

  • Includes expressions of anger and/or hostility.

• Emotional Characteristics:

  • Exhibits irritable, labile moods.

  • Displays lack of guilt or remorse, often feeling emotionally cold and uncaring.

• Behavioral Traits:

  • Displays impulsivity and poor judgment.

  • Shows irresponsibility with a lack of accountability for actions.

  • Engages in risk-taking and thrill-seeking behaviors.

  • Tendencies of mistrust, exhibitionism, and entitlement.

  • Exhibits dependency, insecurity, and eccentric perceptions.

Classification of Personality Disorders

• Cluster A (Odd or Eccentric Behaviors):

  • Paranoid Personality Disorder

  • Schizoid Personality Disorder

  • Schizotypal Personality Disorder

• Cluster B (Erratic or Dramatic Behaviors):

  • Antisocial Personality Disorder

  • Borderline Personality Disorder

  • Histrionic Personality Disorder

  • Narcissistic Personality Disorder

• Cluster C (Anxious or Fearful Behaviors):

  • Avoidant Personality Disorder

  • Dependent Personality Disorder

  • Obsessive Personality Disorder

  • Note: Focus of class will be on specific highlighted diagnoses.

Related Maladaptive Behaviors

• Depressive Behavior

• Passive-Aggressive Behavior

Prevalence of Personality Disorders

• Commonality:

  • Affect approximately 10%–20% of the general population.

  • Higher incidence noted in lower socioeconomic groups.

• Co-morbidity

  • 40% to 45% of individuals with a primary diagnosis of major mental illness also have a coexisting personality disorder, complicating treatment.

  • Often termed "treatment resistant" due to complexities in changing personality traits.

  • Patients may not perceive their behavior as problematic and sometimes take pride in it.

Onset and Diagnosis

• Onset:

  • Personality disorders can often be traced back to early childhood or adolescence.

• Diagnosis:

  • Typically not diagnosed until early adulthood (Age 18).

  • Diagnosis can vary among clients, with severe impairments in fulfilling roles in academics, family, employment, etc.

Etiology of Personality Disorders

• Development:

  • Personality develops from the interaction of hereditary dispositions and environmental influences.

• Biological Theories:

  • Temperament: Traits include harm avoidance, novelty seeking, reward dependence, and persistence.

• Psychodynamic Theories:

  • Characteristics include:

  • Self-directedness: Responsible and goal-oriented.

  • Cooperativeness: Integral part of society.

  • Self-transcendence: Integral part of the universe.

Cultural Considerations

• Cultural Context:

  • Judgments about personality must take ethnic, cultural, and social backgrounds into account.

  • Factors include:

  • Guarded behavior due to language barriers.

  • Religious or spiritual beliefs affecting behavior.

  • Different cultural perspectives on avoidant and dependent behaviors.

  • Cultural values pertaining to work, productivity, and gender roles.

Characteristics of Personality Disorders

• Long-Standing Nature:

  • The characteristics of personality disorders do not change easily.

• Medication:

  • No specific medication exists to change personality.

• Therapy:

  • Therapy aims to help clients make changes but is a long-term process often resulting in slow progress.

  • Many clients with personality disorders may blame others for their problems.

  • Complications in relationships with caregivers, family members, and friends may arise.

Treatment of Personality Disorders

• Psychopharmacology:

  • Targeting cognitive–perceptual distortions, affective symptoms, mood dysregulation, aggression, behavioral dysfunction, and anxiety.

• Psychotherapy:

  • Individual and group therapy practices:

  • Cognitive–Behavioral Therapy: Incorporates cognitive restructuring techniques like thought stopping and positive self-talk.

  • Dialectical Behavior Therapy: Specifically for borderline personality disorder.

Specific Personality Disorders

Paranoid Personality Disorder

• Characteristics:

  • Clients perceive others' actions as potentially harmful.

  • During stress, may develop transient psychotic symptoms.

  • More prevalent in males.

  • Lifelong difficulties in working and living with others.

• Clinical Picture:

  • Pervasive mistrust and suspiciousness, projection, conflict with authority figures.

• Nursing Actions:

  • Adopt a formal, business-like approach, involve clients in care planning, validate ideas before action.

Antisocial Personality Disorder

• Characteristics:

  • Marked by a disregard for others' rights, deceit, and manipulation.

• Assessment Measures:

  • History of aggressive acts or abusive parenting experience.

  • General appearance and motor behavior usually appear normal.

  • Mood and affect can display false emotions.

  • Judgment and insight are lacking regarding morals or ethics.

  • Self-concept appears confident yet is shallow and empty.

• Nursing Actions:

  • Promote responsible behavior through limit setting and confrontation, problem-solving, and controlling emotions.

Borderline Personality Disorder

• Characteristics:

  • Presents with unstable interpersonal relationships, self-image, and affect; marked impulsivity.

• Assessment Details:

  • History indicates disturbed early relationships with parents.

  • General appearance varies widely.

  • Mood is often dysphoric.

  • Thought processes may include splitting and dissociative episodes.

• Nursing Actions:

  • Address self-harm behaviors, maintain a structured therapeutic relationship with limit setting, reshape thinking patterns via cognitive restructuring techniques.

Narcissistic Personality Disorder

• Characteristics:

  • Pervasive pattern of grandiosity, need for admiration, lack of empathy, and arrogance.

• Nursing Actions:

  • Develop self-awareness to avoid frustrations, maintain a matter-of-fact approach, and enforce behavior limits.

• Treatment Overview:

  • Individual psychotherapy is most effective; hospitalization is rare unless comorbid conditions present.

Obsessive-Compulsive Personality Disorder

• Characteristics:

  • Pervasive preoccupation with perfectionism, formal demeanor, constricted emotion, orderliness, and harsh self-evaluation.

• Nursing Actions:

  • Encourage different perspectives on decision-making and risk-taking.

Age-Related Considerations

• Important Notes:

  • Personality disorders are usually not diagnosed until age 18 but show observable traits throughout childhood and adolescence.

  • Older adults can experience either stabilization or aggravation of symptoms, often facing increased risks of depression, suicide, and dementia.

Mental Health Promotion

• Focus Areas:

  • Treatment aims at mood stabilization, reducing impulsivity, and enhancing social skills.

  • Importance of addressing unmet needs in self-care, sexual expression, budgeting, and psychological distress.

• Protective Factors:

  • Strong school commitment, positive peer relationships, disapproval of antisocial behaviors, functional family relationships, and effective parenting skills significantly reduce risks of developing antisocial behaviors in children.

Self-Awareness Issues for Nurses

• Considerations:

  • Discuss feelings of anger or frustration with colleagues to avoid misinterpretation of client motivation.

  • Be vigilant against manipulation by clients; do not take flattery or criticism personally.

  • Set realistic goals when working with clients to enhance therapeutic efficacy.