In this slides you will get to know about personality disorder and their types and management

Personality disorder

1. PERSONALITY DISORDER GARGI YADAV PG TUTOR NARAINA NURSING COLLEGE

2. INTRODUCTION The term personality refers to lasting qualities of an individual that are shown in his ways of behaving in a wide variety of circumstances. Personality disorder reflects adaptive failure involving impaired sense of self identity or failure to develop effective interpersonal functioning.

3. DEFINITION 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 effects on the individual or on society."

4. INCIDENCE The prevalence of personality disorders in the general population is 5 to 10%.

5. DSM Classification In DSMIV, personality disorders have been divided into three clusters: Cluster A (odd and eccentric): paranoid, schizoid, schizotypal personality disorders Cluster B (dramatic, emotional and erratic): antisocial, histrionic, narcissistic personality disorders. Cluster C (anxious and fearful): avoidant, dependent and obsessive-compulsive personality disorders.

6. ETIOLOGY Genetic Biological Social Psychological Developmental Environmental factors ETIOLOGICAL FACTORS

7. Genetic Factors Genetic factors influence the biological basis of brain function as well as basic personality structure. Biological Factors Some researchers suspect that poor regulation of the brain circuits that control emotion increases the risk for a personality disorder when combined with such factors as abuse, neglect or separation.

8. Psychodynamic Theories These theories propose that personality disorders stem from deficiencies in ego and superego development. These deficiencies may relate to mother-child relationships marked by unresponsiveness, over protectiveness or early separation. Other Factors Maternal deprivation, especially in antisocial personality Borderline personalities are more likely to report physical and sexual abuse in child-hood.

9. Histrionic personality is said to occur as a result of failure to resolve oedipal complex and excessive use of repression as a mechanism of defense. Dependent personality may be due to fixation in the oral stage of development Paranoid personality is due to absence of trust, which results from lack of parental affection in childhood and persistent rejection by parents leading to low self-esteem.

10. Clinical Features of Abnormal Personalities According to DSM V the four core features of all personality disorders are: 1. Distorted thinking patterns 2. Problematic emotional responses 3. Over or under regulated impulse control 4. Inter-personal difficulties

11. Paranoid Personality Disorder This disorder is marked by a distrust of other people and a constant unwarranted suspicion that others have sinister motives. Persons with paranoid personality disorder search for hidden meanings in everything others say and do. The signs and symptoms are: Suspicious Mistrustful Sensitive Argumentative Stubborn Self-important Hypersensitive Jealous and irritable

12. Schizoid Personality Disorder Schizoid personality disorder is characterized by detachment and 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. The signs and symptoms are: Emotionally cold Aloof Detached, Humorless Introspective No desire for or enjoyment of close relation-ship Inability to experience pleasure

13. Schizotypal Disorder This disorder is marked by odd thinking and behavior, a pervasive pattern of social and interpersonal deficits and acute discomfort with others. The signs and symptoms are: Inappropriate affect Odd beliefs or magical thinking Social withdrawal Odd, eccentric behavior Lack of close relationships Social isolation Not fitting easily with others

14. Antisocial (Dissocial) Personality Disorder (Sociopath, Psychopath) Antisocial personality disorder is characterized by chronic antisocial behavior that violates others rights or social norms which predisposes the affected person to criminal behavior. The person is unable to maintain consistent, responsible functioning at work, school or as a parent. 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

15. Lack of guilt 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

16. Histrionic Personality Disorder Patients with this disorder characteristically have a pervasive pattern of excessive emotionality and attention seeking behavior and are drawn to momentary excitements and fleeting adventures. This disorder is more common in females. People with disorder need to be the center of attention at all times. 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 behaviour Over concern with physical attractiveness

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

18. Narcissistic Personality Disorder Patient with narcissistic personality disorder is self-centered, 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. The signs and symptoms are: Inflated sense of self-importance 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

19. Borderline Personality Disorder Borderline personality disorder is marked by a pattern of instability in interpersonal relation-ships, mood, behavior and self-image. The four main categories of signs and symptoms are: Unstable relationships Unstable emotions Impulsivity Unstable self image Other symptoms include: Lack of control on anger Recurrent suicidal threats or behavior Uncertainty about personal identity Chronic feelings of emptiness Efforts to avoid abandonment Transient stress-related paranoid or dissociative symptoms Acting out of feelings instead of expressing them appropriately or verbally

20. Anxious (Avoidant) Personality Disorder Anxious personality disorder is marked by social withdrawal and hypersensitivity to others opinions. People with this disorder have low self-esteem and poor self-confidence; they dwell on the negative and have difficulty viewing situations and interactions objectively. 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 Many people with avoidant personality disorder have other psychiatric disorders like social phobia, anxiety disorder, obsessive compulsive disorder, depressive disorders, somatoform disorders, dissociative disorder and schizophrenia.

21. Dependent Personality This disorder is characterized by an extreme need to be taken care of, which leads to submissive, clinging behavior 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. 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

22. Obsessive-Compulsive ( Anankastic ) Personality Disorder This disorder is marked by a pervasive de-sire 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. May have a constant sense of righteous indigna-tion and feelings of anger and contempt for anyone who disagrees with him, believes his way of doing something is the only right way, may force himself and others to follow right moral principles and to conform to extremely high standards of performance and insist on literal compliance with authority and rules.

23. 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

24. TREATMENT Medications Antidepressants Anxiolytics Antipsychotics Mood Stablizers

25. Nursing Interventions for personality disorder patients Encourage the patient to openly express feelings and thoughts Identify triggers of acting-out behaviors Maintain alertness behaviors of patients to manipulative Provide positive feedback to patients who are making efforts to change behavior Approach patients from the front and speak clearly. This is especially true for the patient with paranoia Monitor medication Encourage the patient to participate in unit activities

26. Assess suicidal ideation Develop a no-harm contract with the patient with self-destructive tendencies Assist and educate the patient in the problem solving process Encourage the patient to keep a journal of thoughts and feelings

27. Self Assessment 1. Following are all core features of personality disorder, except: a. Interpersonal difficulties b. Distorted thinking c. Problematic emotional response d. Occupational impairment. Ans. d Occupational impairment

28. 2 . In which of the following personality disorders mistrust and suspiciousness are the main clinical features? a. Paranoid personality disorder b. Antisocial personality disorder c. Anxious personality disorder d. Histrionic personality disorder Ans. A. Paranoid personality disorder

29. 3. Ideas of reference, odd eccentric behavior and magical thinking are the main features in which of the following personality disorders? a. Paranoid personality disorder b. Antisocial personality disorder c. Schizotypal personality disorder d. Histrionic personality disorder Ans. C. Schizotypal personality disorder

30. 4. Which of the following is the most prominent characteristic of borderline personality disorder? a. Suspiciousness b. Magical thinking c. Instability in personal relationships d. Unlawful behavior Ans. C. Instability in personal relationships

31. 5. When assessing a patient with histrionic personality disorder, the nurse might identify which of the following characteristic behaviors? a. Odd eccentric and magical thinking b. Excessive emotionality and attention seeking behavior c. Self-centered and self-absorbed d. Preoccupation with orderliness and rigidity Ans. b. Excessive emotionality and attention seeking behavior

32. 6. Which of the following is a characteristic of antisocial personality disorder? a. Argumentative b. Loss of cognitive function c. Violates social norms d. Not capable of carrying on regular activities Ans. c Violates social norms

33. 7 . Anankastic personality is also known as: a. Obsessional personality b. Histrionic personality c. Narcissistic personality d. Borderline personality A ns. a. Obsessional personality

34. 8. The following features are characteristic of an antisocial (dissocial) personality, except: a. Pleasure seeking b. Inability to work under supervision c. Deep emotional relationship d. Drug abuse and alcohol dependence Ans. c. Deep emotional relationship