3. personality Disorder

PERSONALITY DISORDER
MENTAL HEALTH NURSING
MONAL PARMAR

1. Sub: MHN Topic: personality disorders Prepared by:- Parmar Monal .

2. The term personality refers to enduring qualities of an individual that are shown in his ways of behaving in a wide variety of circumstances

3. Personality Disorder

4. “An abnormal personality is one in which there are deeply ingrained maladaptive patterns of behavior recognizable by the time of adolescence or earlier and continuing through most of adult life. Because of this, the patient suffers or others have to suffer, and there is an adverse affect on the individual or on society.” Definition

5. Classification ICD10 DSMIV

6. ICD 10 CLASSIFICATION: F60-F69 Disorders of adult personality and behavior F60 Specific personality disorders F60.0 Paranoid personality disorder F60.1 Schizoid personality disorder F60.2 Dissocial personality disorder F60.3 Emotionally unstable personality disorder

7. CONTINU… F60.4 Histrionic personality disorder F60.5 Anankastic personality disorder F60.6 Anxious personality disorder F60.7 Dependent personality disorder F61 Mixed and other personality disorders

8. CONTI… F62 Enduring personality changes, not attributable to brain damage and Disease F63 Habit and impulse disorders F64 Gender identity disorders F65 Disorders of sexual preference

9. DSMIV Classification: Cluster A (odd and eccentric): paranoid schizoid, schizotypal personality disorder Cluster B (dramatic, emotional and erratic antisocial, boarderline , histrionic, narcissistic personality disorders Cluster C (anxious and fearful): avoidant, dependent and obsessive-compulsive personality disorders

10. DSMIV Classification Cluster A P aranoid S chizoid, S chizotypal (odd and eccentric ) Cluster B A ntisocial, B orderline, H istrionic, NA rcissistic ( dramatic, emotional and erratic) Cluster C A voidant, D ependent O bsessive- compulsive personality disorders (anxious and fearful)

11. Etiology :

12. Other Factors:

13. CONTI…

14. 1. Paranoid Personality Disorder

15. This disorder is marked by a distrust of other people and constant unwarranted suspicion that other have sinister motives .

16. The signs and symptoms are : Suspicious Mistrustful Sensitive Argumentative Stubborn Self-important Hypersensitive Jealous and irritable

17. 2. Schizoid Personality Disorder

18. Schizoid personality disorder is characterized by detachment social withdrawal. People with this disorder are commonly described as loners, with solitary interests and occupations and no close friends; typically they maintain a social distance even from family members and seem unconcerned about other’s praise or criticism.

19. The signs and symptoms are : Emotionally cold Aloof Detached Humorless Introspective : No desire for or enjoyment of close relationship Inability to experience pleasure

20. Emotionally cold : That person shows very little emotions They have been told and conditioned to hide their emotions

21. Introspective : self examination Analyzing yourself Looking at your own personality Ex when you meditate to try to understand your feelings

22. 3. Schizotypal Disorder

23. This disorder is marked by odd thinking and behaviour, a pervasive pattern of social and interpersonal deficit and acute discomfort with others.

24. The signs and symptoms are Inappropriate affect Odd beliefs or magical thinking Social withdrawal Odd, eccentric or peculiar behavior Lack of close relationships Social isolation Not fitting easily with others

25. 4. Antisocial (Dissocial) Personality Disorder (Sociopath, Psychopath):

26. Antisocial personality disorder is characterized by Chronic antisocial behaviour that violates other right’s or social norms which predisposes the affected person to criminal behaviour . The person is unable to maintain consistent, responsible functioning at work, school or as a parent.

27. The signs and symptoms are Failure to sustain relationships Disregard for the feelings of others Impulsive actions Low tolerance to frustration Tendency to cause violence Lack of guilt

28. CONTI… Failure to learn from experience Reckless disregard for own or others safety Impulsivity and failure to plan ahead Manipulative behavior for self-gratification Inability to maintain close personal or sexual relationship

29. Nursing intervention convey the message that it is not him but his behavior which is unacceptable. Maintain low level of stimuli Help the patient to identify the true objects of his hostility Explore with patient alternative ways of handling frustration Have sufficient staff available to present a show of strength to patient if necessary

30. Conti.. Administer tranquilizing medications Mechanical restraints may be necessary if the patient is not calmed by 'talking down ’ or by medication. Explain consequences if limits are violated Provide positive feedback for acceptable behavior He must understand that certain behaviors will not be tolerated within the society and that severe consequences will be imposed upon those individuals

31. 5.Borderline Personality Disorder

32. Borderline personality disorder is marked by a pattern of instability in interpersonal relationships, mood, behaviour and self-image.

33. The four main categories of signs and symptoms are Unstable relationships Unstable self image Unstable emotions Impulsivity

34. Nursing intervention Observe patient’s behavior frequently avoid appearing watchful and suspicious Secure a verbal contract from patient that he will seek out staff members for help when urge for self-mutilation is felt Encourage patient to talk about feelings he was having just prior to this behavior Rotate staff who works with the

35. 6. Histrionic Personality Disorder

36. Patients with this disorder characteristically have a pervasive pattern of excessive emotionality and attention seeking behaviour and are drawn to momentary excitements and fleeting adventures.

37. The signs and symptoms are Dramatic emotionality (Emotional blackmail, angry scenes, demonstrative suicide attempts, etc.) Craving for novelty and excitement Shallow and labile affectivity Attention-seeking behavior Over concern with physical attractiveness

38. CONTI.. Exaggerated, vague speech Self dramatization Impulsivity Suggestibility Ego-centricity, self-indulgence and lack of consideration for others

39. 7.Narcissistic Personality Disorder

40. Patient with narcissistic personality disorder is Self centred, self-absorbed and lacking in empathy for others. He typically takes advantage of people to achieve his own ends, and uses them without regard to their feelings.

41. The signs and symptoms are Attention-seeking, dramatic behavior Unable to face criticism Lack of empathy Exploitative behavior Arrogance Preoccupation with fantasies of success, power, beauty, brilliance or ideal love

42. 8. Anxious (Avoidant) Personality Disorder

43. Anxious (Avoidant) Personality Disorder is marked by feelings of inadequacy, extreme social anxiety, social withdrawal and hypersensitivity to others opinions. low self-esteem and poor self-confidence; have difficulty viewing situations and interactions objectively.

44. The signs and symptoms are Persistent feeling of tension and appre­hension Inferiority complex Fear of criticism, disapproval or rejection Unwillingness to become involved with people Excessive preoccupation with being criticized or rejected in social situations

45. 9.Dependent Personality

46. Dependent Personality disorder is characterized by an Extreme need to be taken care of, which leads to submissive, Clinging behaviour and fear of separation or rejection. People with this disorder let others make important decisions for them and have a strong need for constant reassurance and support.

47. The signs and symptoms are Subordination of one's own needs Unwillingness to make even reasonable demands on other people Inability to take decision Feeling uncomfortable or helpless when alone Low self-esteem and lack of self-confidence Hypersensitivity to criticism

48. 10.Obsessive- compulsive (Anankastic ) Personality Disorder

49. This disorder is marked by a pervasive desire for perfection and order at the expense of openness, flexibility and efficiency. The individual places a great deal of pressure on himself and others not to make mistakes.

50. The signs and symptoms are Feeling of excessive doubt and caution. Preoccupation with details, rules, lists, order or schedule Perfectionism Rigidity and stubbornness High standards

51. TREATMENT MODALITIES

52. Individual therapy Group therapy Therapeutic community Behaviour Occupational Recreational

53. NURSING INTERVENTIONS FOR PATIENTS WITH PERSONALITY DISORDERS Show acceptance of the person at all times by separating the person from the behaviors. Provide a safe environment Explain all unit rules and enforce them fairly and consistently. Explain all unit rules and enforce them fairly and consistently. Identify inappropriate behavior and discuss possible alternative behavior

54. Conti.. Encourage the patient to openly express feelings and thoughts Identify triggers of acting-out behaviors Communicate problems with manipulative patients to other team members Monitor medication. Assess for suicidal ideation Develop a no-harm contract with the patient with self-destructive tendencies Encourage the patient to keep a private journal of thoughts and feelings.

55. summary