personality disorder.ppt nursing students

personality disorder

1. PERSONALITY DISORDERSPERSONALITY DISORDERS
By Eba Abdisa
(BSc, MSc in ICCMH, SPH)

2. PERSONALITY DISORDERSPERSONALITY DISORDERS
Learning objectives
After studying this unit, the student should
be able to:
1. Define personality and personality
disorder
2. List terms of psychological quality and
psychological process
3. List the characteristics of personality
disorders
10/15/24Gutema.A 2

3. Contd…………..Contd…………..
4. Identify the etiology of personality
disorder
5. Classify personality disorder in cluster
forms
6. Describe personality disorder in terms
of clinical types
7. Describe the nursing interventions
appropriate for personality disorders
10/15/24Gutema.A 3

4. Trait vs DisorderTrait vs Disorder
What is a personality??
All the ways in which someone shapes and adapts
in a unique way to ever-changing internal and
external environments.
Stable over time  allows some predictability
Types of traits are limited and dimensional
What is a disorder?
Functional impairment ,failure /Emotional distress
Maladaptive personality style
10/15/24Gutema.A 4

5. Personality DisordersPersonality Disorders
An enduring pattern of inner experience
and behavior that deviates markedly from
the expectations of the individual’s
culture. Manifested in two or more of
the following:
(1) Cognition
(2) Affectivity
(3) Interpersonal functioning
(4) Impulse control
10/15/24Gutema.A 5

6. EtiologyEtiology
Genetic predispositions + environmental influences
+ time = Personality formation
Bio psychosocial factors
Genetic Factors :-monozygotic twins, personality
disorders =xxx dizygotic twins.
Biological Factors
Hormones- impulsive traits show high levels of
testosterone, 17-estradiol, and estrone and
androgens increase the aggression and sexual
behavior.
Neurotransmitters -Raising serotonin levels and
dopamine levels
10/15/24Gutema.A 6

7. Etiology…Etiology…
Abuse-sexual, physical or emotional
Self-esteem, Neglection, Rejection
Defense Mechanisms
-Dissociation or denial is replacement of
unpleasant affects with pleasant ones.
-Projection- attribute their own
unacknowledged feelings to others.
-Splitting- All good and bad
•Loss, Financial restrain, Family alcohol or
substance use,
10/15/24Gutema.A 7

8. Cluster A Personality DisordersCluster A Personality Disorders
(‘odd & eccentric’)(‘odd & eccentric’)
Paranoid
Schizoid
Schizotypal
May be premorbid to schizophrenia in
some cases
10/15/24Gutema.A 8

9. Paranoid Personality DisorderParanoid Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Pervasive distrust and suspiciousness, sees motives
of others as malevolent. 4 or more.
(1) Suspects, without sufficient basis
(2) Unjustified doubts (loyalty or trustworthiness)
(3) Reluctant to confide in others b/c lack of trust
(4) Persistently bears grudges
(5) Reads threatening meanings into benign events
(6) Perceives attacks on character or reputation
(7) Suspicions regarding fidelity of spouse or partner
10/15/24Gutema.A 9

10. Characteristics of Paranoid PDCharacteristics of Paranoid PD
Unjustified suspiciousness, hostility ,Rigid
Hypersensitivity to slights, jealousy
litigious, lack odd behavior and Aloof.
Prevalence: 1-2%; M>F
Therapy:-Antipsychotic, Anxiolytic–
trusting relationship is key but hard to
come by because of ‘self-fulfilling prophecy’.
Psychotherapy (must deal sensitively)is
treatment of choice.
10/15/24Gutema.A 10

11. Schizoid Personality DisorderSchizoid Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Detachment from social relationships and a
restricted range of emotional expression.>4
(1) Neither desires nor enjoys close r/nships
(2) Almost always chooses solitary activities
(3) Little interest in having sexual experiences
(4) Takes pleasure in few, if any, activities
(5) Lacks close friends or confidants
(6) Appears indifferent to the praise or criticism
(7) Emotionally cold, detached
10/15/24Gutema.A 11

12. Characteristics of Schizoid PDCharacteristics of Schizoid PD
Solitary activities (computers, night watchman)
Limited emotional range, detached, daydream
NO increased risk for schizophrenia
No paranoid ideation and successful work history
“Loners” are not necessarily schizoid, unless
functioning impaired (traits vs. disorder)
Psychotherapy(must deal sensitively) +
antipsychotics, antidepressants, and psycho
stimulants
Prevalence 2%; M>F
10/15/24Gutema.A 12

13. Schizotypal Personality DisorderSchizotypal Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Little capacity for close relationships and cognitive or
perceptual disturbances and eccentric behavior
(1) Ideas of reference
(2) Odd beliefs or magical thinking
(3) Unusual perceptual experiences
(4) Odd thinking and speech
(5) Suspiciousness or paranoid ideation
(6) Inappropriate or constricted affect
(7) Odd, peculiar behavior or appearance
(8) Lack of close friends or confidants
(9) Excessive social anxiety
10/15/24Gutema.A 13

14. Characteristics of Schizotypal PDCharacteristics of Schizotypal PD
Isolated, anhedonic, aloof but also peculiar
Reason in odd ways (ideas of reference)
Anxious, detached
Increased incidence of schizophrenia in
family members
3% incidence; M=F
Psychotherapy +Antipsychotic(ideas of
reference, illusions) + Antidepressants
(when a depressive component pressent).
10/15/24Gutema.A 14

15. Cluster B Personality DisordersCluster B Personality Disorders
(‘emotional, dramatic, erratic’)(‘emotional, dramatic, erratic’)
Antisocial
Borderline
Histrionic
Narcissistic
10/15/24Gutema.A 15

16. Antisocial Personality DisorderAntisocial Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Pervasive pattern of disregard for and violation
of rights of others since age 15 .> 3 of f/f
(1) Repeatedly breaking the law
(2) Deceitfulness - repeated lying, use of aliases
(3) Impulsivity or failure to plan ahead
(4) Irritability and aggressiveness
(5) Reckless disregard for safety of self or others
(6) Consistent irresponsibility -doesn’t pay bill
(7) Lack of remorse
10/15/24Gutema.A 16

17. Characteristics of Antisocial Characteristics of Antisocial
Personality DisorderPersonality Disorder
The individual is at least age 18 years.
Conduct Disorder with onset before age 15 yrs
Aggressive, irresponsible, truant as teens. Get
into fights, abuse substances, run away, cruel to
animals, set fires, do poorly in school, lying.
As adults see criminality, assaultiveness,
impulsivity, substance abuse
More than 50% of prison population has ASPD,
3% of population, M:F 3-5:1
10/15/24Gutema.A 17

18. Borderline Personality Disorder Borderline Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Instability of relationships, self-image . > 5 f/f
(1) Efforts to avoid real or imagined abandonment.
(2) Intense and unstable relationships, alternating between
idealization and devaluation.
(3) Identity disturbance( unstable self-image )
(4) Impulsivity in at least two area(sex, spending,
substance abuse, reckless driving, binge eating)
(5) Self-mutilating or suicidal behavior, threat or gestures
(6) Affective instability lasting few hours to few days
(7) Chronic feelings of emptiness
(8) Inappropriate, intense anger
(9) Transient, stress-related paranoid ideation
10/15/24Gutema.A 18

19. Characteristics of Borderline PDCharacteristics of Borderline PD
2%-4% incidence, M:F 1:2
Tend to stabilize in their 40’s or 50’s
Increased prevalence of MDD and
substance abuse in first degree relatives.
The “borderland” between neurosis and
psychosis. Death by suicide is 8%.
Psychotherapy is treatment of choice
Antipsychotics +Antidepressants
+BDZ(particularly alprozalam )
+Anticonvulsants, such as carbamazepine.
10/15/24Gutema.A 19

20. Histrionic Personality DisorderHistrionic Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Excessive emotionality and attention seeking. >5
(1) Uncomfortable if not the center of attention
(2) Sexually seductive or provocative Interaction
(3)Display rapidly shifting and shallow emotions
(4) Uses physical appearance to draw attention
(5) Speech is impressionistic and lacking in detail
(6) Self-dramatization, theatricality
(7) Is suggestible, i.e., easily influenced by others
(8) Considers relationships to be more intimate
than they actually are.
10/15/24Gutema.A 20

21. Characteristics of Histrionic Characteristics of Histrionic
Personality DisorderPersonality Disorder
Prevalence 2-3%, F>>M
Exaggeration of thoughts and feelings -
everything is catastrophic or of extreme
importance
Antidepressants (for depression and
somatic complaints)+Antianxiety agents for
anxiety, and antipsychotics for derealization
and illusions.
10/15/24Gutema.A 21

22. Narcissistic Personality DisorderNarcissistic Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Grandiosity, need for admiration, lack of empathy. >5
(1) Grandiose sense of self-importance, superior.
(2) Fantasies of success, power, brilliance or beauty
(3) Believes he/she is “special,” unique
(4) Requires excessive admiration
(5) Sense of entitlement
(6) Takes advantage of others to achieve their own ends
(7) Lacks empathy: not recognize feelings of others
(8) Envious of others or believe others are envious of them
(9) Shows arrogant, haughty behaviors or attitudes
10/15/24Gutema.A 22

23. Characteristics of Narcissistic PDCharacteristics of Narcissistic PD
<1% of general population; M>F
Become enraged at criticism
Fragile self-esteem, prone to depression
Their behavior produces interpersonal and
occupational difficulties, rejection, loss.
Chronic, difficult to treat
Aging is handled poorly
Psychotherapy+ Lithium (mood swings)+
antidepressants(depression).
10/15/24Gutema.A 23

24. Cluster C Personality DisordersCluster C Personality Disorders
(‘fearful and anxious’)(‘fearful and anxious’)
Avoidant
Dependent
Obsessive-Compulsive
10/15/24Gutema.A 24

25. Avoidant Personality DisorderAvoidant Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Social inhibition, feelings of inadequacy. >4
(1) Avoids occupational activities involving others
b/c of fears of criticism, disapproval or rejection
(2) Unwilling being involved with people unless
certain of being liked
(3) Shows restraint within intimate relationships
(4) Preoccupied with being criticized or rejected
(5) Inhibited in new interpersonal situations
(6) Views self as socially inept or inferior to others
(7) Reluctant to take personal risks/ new activities
10/15/24Gutema.A 25

26. Characteristics of Avoidant PDCharacteristics of Avoidant PD
Extreme sensitivity to rejection leads to
socially withdrawn life
They have “an inferiority complex”
lack self-confidence, self-effacing, Uncertain.
Withdraw and feel hurt if a request is
refused or if they feel rejected or ridiculed.
0.5-1.0%; M=F
Treatment: Group or individual
psychotherapy, SSRIs
10/15/24Gutema.A 26

27. Dependent Personality DisorderDependent Personality Disorder
(diagnostic criteria)(diagnostic criteria)
Submissive and clinging behavior. Five or more:
(1)Difficulty in making decisions without advice
(2) Needs others to assume responsibility
(3) Has difficulty expressing disagreement
(4) Has difficulty initiating or doing things on own
(5) Goes to get nurturance or support from others
(6) Feels uncomfortable or helpless when alone
(7) Seeks another when a close relationship ends
(8) Is unrealistically preoccupied with fears of being
left to take care of himself or herself
10/15/24Gutema.A 27

28. Characteristics of Dependent PDCharacteristics of Dependent PD
Persons with chronic physical illness in
childhood may be more prone to the
disorder.
May stay with an abusive, unfaithful or
alcoholic partner rather than being alone.
Psychotherapy(Insight-oriented and
Behavioral therapy)+ BZD and
serotonergic agents.
Prevalence: very common; M=F
10/15/24Gutema.A 28

29. Obsessive Compulsive Personality Obsessive Compulsive Personality
DisorderDisorder
Orderliness, perfectionism, and mental and interpersonal control.
Four (or more) of the following:
(1) Preoccupied with details, rules, lists, order, to the extent that
the major point of the activity is lost.
(2) Shows perfectionism that interferes with task completion.
(3) Excessively devoted to work and productivity
(4) Scrupulous and inflexible about matters of morality
(5) Unable to discard worn-out or worthless objects
(6) Is reluctant to delegate tasks or to work with others
(7) Money is viewed as something to be hoarded for future
(8) Shows rigidity and stubbornness
10/15/24Gutema.A 29

30. Characteristics of Compulsive PDCharacteristics of Compulsive PD
Prevalence unknown and more common in oldest
children; M=F
Backgrounds: harsh discipline
Psychotherapy (Group therapy and behavior
therapy)+ BZD +Anticonvulsant + serotonergic
agents (fluoxetine).
10/15/24Gutema.A 30

31. Personality Disorder Not Personality Disorder Not
Otherwise SpecifiedOtherwise Specified
Don’t meet criteria for any specific
personality disorder, but traits cause
significant impairment in social or
occupational functioning
Very common diagnosis
10/15/24Gutema.A 31

32. Nursing management goalNursing management goal
To improve their interpersonal skills
To promote healthy interaction and
functioning.
To reduce or prevent violence to self or
others.
To develop the skills of self-
management ,how to tolerate and regulate
emotional distress until change occurs.
To promote healthy and appropriate
expression of feeling.  
10/15/24Gutema.A 32

33. Nursing diagnosis-exampleNursing diagnosis-example
Impaired social interaction
Self esteem, low
Risk for self mutilation
Anxiety
Disturbed thought process
Defensive coping
Social isolation
Risk of violence directed toward self or
others
10/15/24Gutema.A 33

34. Nursing interventionNursing intervention
Risk for other directed Violence
-Provide protective supervision for the patient(one
to one contact ,seclusion or medication).
-Be alert for signs of fear, anxiety, agitation
and intervene as early as possible.
-As agitation subside encourage the patient to
express his/her feeling, first in one to one contact,
then in small group and then in large group.
-Help the client identify and practice way to relieve
agitation, anxiety and fear.
10/15/24Gutema.A 34

35. Nursing interventionNursing intervention
Risk for self mutilation
-Assess any history of suicidal behavior and current
suicide ideation or plans
-Develop contract with client to notify staff when
anxiety is increasing
-Provide close 1:1 observation of the client
-Remove all potentially dangerous object
-Set and maintain limit regarding behavior,
responsibilities, unit rules and so forth.
-Provide prescribed medication
-
10/15/24Gutema.A 35

36. Nursing interventionNursing intervention
Impaired social interaction
-Develop mutual behavioral goal
-Maintain consistent behavior by all staff
-Encourage the development of appropriate
relationship with others.
-Communicate honest response to the client’s
behavior.
-Support for any interaction and attempts to
interact others.
-Provide honest, immediate feedback about
behavioral change.
-Maintain confidentiality
10/15/24Gutema.A 36

37. Nursing interventionNursing intervention
Disturbed thought process
-Be calm and non-threatening in all approaches to
the client.
-Observe the clients interaction with visitors
-Do not argue with client about delusions or idea
of reference
-Do not joke with the client about his belief
-Encourage the client to discuss topics other than
delusion such as home, life , family….
-Do not allow the client to ruminate or ramble
about delusion
10/15/24Gutema.A 37

38. Contd…Contd…
-Reassure the client that the origin of
his/her fears is internal and that the fears
are not based on external reality.
-Search for client’s belongings for weapons.
-If the delusion are religious, a referral to
the spiritual support may be indicated.
-Observe the client closely for agitation
and decrease stimuli.
-Do not enter into political, religious, or
other controversial discussions.
10/15/24Gutema.A 38