Sie sind auf Seite 1von 8

5 - Personality Disorders

PERSONALITY DISORDERS

What does PERSONALITY mean?

persona– Greek term

a person’s charactersistic totality of emotional and behavioral traits apparent in ordinary life, a totality that is usually stable and predictable (Kaplan and Sadock – 1998)

Refers to a distinctive set of traits, behavior styles, and patterns that make up our character and inidividuality

It is the total of person’s internal and external patterns of adjustment to life, determined in part by the individual’s genetic make-up and by life experiences.

THEORIES OF PERSONALITY DEVELOPMENT

1.

Freud’s Psychoanalytic

a. Development of personality

b. Organization or structure

c. Dynamics of personality

2.

Erickson’s Psychosocial Development

a.

Concept of identity or an inner sense of sameness that preserves despite external changes. Identity crises and Identity confusion.

3.

Piaget’s Cognitive Developmental Theory

a. Sensory-motor

b. Pre-operational

c. Concrete-Operational

d. Formal-operational

PERSONALITY DISORDER

It is defined as a pervasive pattern of experience and behavior that is abnormal with respect to thinking, mood personal relations, and the control of impulses.

A personality disorder is described as a non-psychotic illness characterized by maladaptive behavior, which the person uses to fulfill his or her needs and bring satisfaction to him or herself.

ETIOLOGY

GENETIC FACTORS

BIOLOGIC FACTORS

PSYCHOANALYTIC FACTORS

CHILDHOOD EXPERIENCES

Biologic theories:

Personality develops through the interaction of hereditary dispositions and environmental influence.

TEMPERAMENT-refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion.

4 temperament traits:

1. Harm avoidance

5 - Personality Disorders

3. Reward dependence

4. Persistence

Psychodynamic Theories

Although temperament is largely inherited, social learning, culture, and random life events unique to each person influence character.

CHARACTER

consists of concepts about the self and the external world.

-

3 major

character traits:

1. self-directedness

2. Cooperativeness

3. Self-transcedence

Personality Disorder: CHARACTERISTICS

Inflexible, socially unacceptable behaviors

Self-centeredness

Manipulative and exploitative

Inability to tolerate minor stress, resulting in increased inability to cope with anxiety or depression

Lack of individual accountability for behavior, blaming others of their problems

Difficulty dealing with reality because of

a distorted or superficial understanding of self and the perception of others.

Vulnerbility to other mental disorders

Classification of Personality Disorder

A. Cluster A Personality Disorder

those considered to be marked by odd, eccentric behavior.

1. Paranoid

2. Schizoid

3. Schizotypal

PARANOID PERSONALITY DISORDER : SUSPECT

S: Spouse fidelity suspected

U: Unforgiving

S: Suspicious of others

P: Perceives attacks

E: Enemy or Friend

C: Confiding in others feared

T: Threats perceived in benign events

Paranoid Personality Disorder

psychologi cal personality disorder characterized by an extreme level of distrust and suspiciousness of others. Paranoid personalities are generally difficult to get along with, and their combative and

5 - Personality Disorders

distrustful nature often elicits hostility in others.

Symptoms

: paranoia, paranoid beliefs, suspiciousness, social withdrawal.

Treatment s: Psychotherapy, cognitive behavioural therapy, interpersonal psychotherapy & antidepressant

SCHIZOID PERSONALITY DISORDER : DISTANT

D: Dettached Affect

I: Indifferent to criticisms

S: Sexual interest of little interest

T: Tasks

A: Absence of close friends

N: Neither desires nor enjoys close relations

T: Takes pleasures in few activities

Schizoid Personality Disorder

are characteristically detached from social relationships and show a restricted range of expressed emotions. Their social skills, as would be expected, are weak, and they do not typically express a need for attention or approval. They may be perceived by others as somber and aloof, and often are referred to as "loners.

Symptoms

Prefer being alone and usually choose solitary activities

Prize independence and have few close friendships

Feel confused about how to respond to normal social cues and generally have little to say

Lack any desire for sexual relationships

Feel unable to experience pleasure

SCHIZOTYPAL PERSONALITY DISORDER : ME PECULIAR

M: Magical thinking or odd beliefs

E: Experiences unusual perceptions

P: Paranoid ideas

E: Eccentric behavior or appearance

C:Constricted or inappropriate affect

U:Unusual or odd thinking and speech

L:Lacks close friends

I: Ideas of reference

A: Anxiety in social situation

R: Rule out psychosis

B. Cluster B Personality Disorder

evidenced by dramatic, erratic behaviors and include

1.

Antisocial

5 - Personality Disorders

2. Borderline

3. Narcissistic

4. Histrionic

ANTISOCIAL PERSONALITY DISORDER :

CORRUPT

C: Conformity to law lacking

O: Obligations ignored

R: Reckless disregard for safety of self or others

R: Remorse lacking

U: Underhanded (deceitful, lies, cons others)

P: Planning insuficient (impulsive)

T: Temper (irritable and aggressive)

BORDERLINE PERSONALITY DISORDER : AM SUICIDE

A: Abandonment

M: Mood instability

S: Suicidal

U: Unstable and intense relationship

I: Impulsive

C: Control of anger

I: Identity disturbance

D: Dissociative or paranoid

E: Emptiness

NARCISSISTIC PERSONALITY DISORDER :

SPECIAL

P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty or ideal love)

E: Entitlement

C: Conceited

I: Interpersonal exploitation

A: Arrogant

L: Lacks empathy

HISTRIONIC PERSONALITY DISORDER :PRAISE ME

P: Provocative or sexuality seductive behavior

R: relationships (intimate)

A: Attention (uncomfortable)

I: Influence easily

S: Style of speech (lacks detai)

E: Emotions repidly shifting and shallow

M: Made up (physical appearance used to draw attention to self)

E: Emotions exaggerated

C. Cluster C Personality Disorder

distinguished by the anxious, fearful behavior commonly seen in

S: Special (believes he is unique)

1.

Obsessive-Compulsive

2.

Dependent

5 - Personality Disorders

3.

Avoidant

OBSESSIVE – COMPULSIVE : LAW FIRMS

L: Loses point of activity 9due to preoccupation with detail)

A: Ability to complete tasks (compromised by perfectionalism)

W: Worthless objects (unable to discard)

F: Friendships (excluded)

I: Inflexible and overconscientious

R: Reluctant to delegate

M: Miserly (towards self and others)

S: Stubborn

A pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency.

Refers to a group enduring characteristics in a person, including orderliness, meticulous,

preoccupation with detail, parsimony, obstinacy, neatness, difficulty handling uncertainty , and perfectionism

Incidence:

a. Difficulty showing emotions

b. Stubborn

c. Preoccupied with orderliness and try to maintain it in all areas of life

d. Strive for perfection

e. They become absorbed in their own belief, believe they are right

f. Do not listen to others

g. They have difficulty working collaboratively, preferring to “do it myself”

h. Poor judgment

i. Check and recheck any project or activities

j. Decision-making problem

Nursing Intervention:

1. Help client to view decision-making and completion of projects from a different perspectives.

2. Set a goal of completing a projective by giving a deadline

3. Tolerate less-than perfect work

4. Encouraging client to take risk

DEPENDENT PERSONALITY DISORDER :

RELIANCE

R: Reassurance required for decisions

More common to male

Oldest children

E: Expressing disagreement difficult due to fear of loss of support or approval

Professionals

L: Life responsibilities (needs to have these assumed by others)

SYMPTOMS:

I: Initiating projects difficult

5 - Personality Disorders

A: Alone

N: Nurturance go to excessive lengths

C: Companionship

E: Exaggerated fears of being left

Characterized by a pervasive and excessive need to be taken care of, which lead to submissive and clinging behavior and fears if separation.

Feelings of dependency and attachment are said to be universal, and perhaps defining, mammalian behaviors. (Fances, 1988)

Incidence:

1. Three times more common to women than men

2. It runs to the families

3. Common to youngest child

Symptoms:

1. Frequently anxious and mildly irritable

2. Pessimistic and self-critical

3. Report feeling of unhappy or depressed

4. Believe they would fail on their own

5. They believe they need someone else to assume responsibility

6. Tremendous difficulty making decisions

Motto: “Any relationship is better than none at all”

Nursing intervention:

1. Encourage verbalization of feelings

2. Help client to identify their strength

3. Assistance in daily functioning

4. Teach problem-solving

5. Psychotherapy- is the main method of treatment for DPD in a form of counseling.

6. GOAL: is to help the person to be become more active and independent

What are the complications of dependent personality disorder?

At risk for depression

Anxiety disorder

Phobias

Substance abuse

Can Dependent Personality Disorder can be prevented?

Prevention of the disorder might not be possible, treatment can sometimes allow a person who is prone to disorder learn more productive ways of dealing with situations.

AVOIDANT PERSONALITY DISORDER :

CRINGES

C: Certainty

R: rejection

I: Intimate relationship (restrained)

N: New interpersonal relationships(is inhibited in)

G: Gets around occupationa activity

5 - Personality Disorders

E: embarassment

S: Self viwed as unappealing

Is characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evalution.

Extremely sensitive to the opinions of others and therefore avoid most relationship

Incidence:

Occur in 0.5% to 1% of the general population

Equally common to both men and women

Causes:

Integrate biological and psychological influences

Limited support

Rejection

Symptoms:

1. Very low self-esteem

2. Shy, fearful, socially, awkward

3. Reluctant to do anything

4. Apathetic

5. Affectively flat

6. Uninterested in interpersonal relationship

Treatment:

Behavioral intervention technique for anxiety and social skill problems have had some success

Psychodynamic psychotherapy, which helps patients understand their thoughts and feelings, and cognitive behavioral therapy (CBT) can help. A combination of medication and talk therapy may be more effective than either treatment alone.

PASSIVE-AGGRESSIVE

It is characterize by negative attitude and passive resistance to demands for adequate social and occupational performance.

a. Sullen-passive resentful

b. Their mood fluctuates easily, rapidly, erratically

c. Easily upset/offended

d. May alternate between hostile and stubborn

e. Affect or feeling may be sad or angry

f. They view future negatively

g. Impaired judgment

h. Insight is limited

i. They tend to blame others

5 - Personality Disorders

Nursing Interventions

. Help client examine the relationship between feelings and actions

Help client to see what is annoying or troubling to others

Encourage client to express feelings

Possible Nursing diagnoses

Disturbed thought processes r/t auditory hallucinations

Anxiety r/t unsatisfactory interpersonal relationships

Hopelessness r/t low self-esteem

Ineffective coping r/t lack of impulse control

Nursing interventions: COGNITION

Reinforce reality if the client verbalizes illusions or feelings of depersonalization

Help the client select someone he/she trust to minimize suspicious or delusional thoughts

Encourage the client to validate perceptions before taking action that may precipitate difficulties

Nursing interventions: AFFECT

Encourage the client’s verbalization of feelings of anger, hostility, worthlessness or hopelessness

Give attention on and support when the client expresses feelings honestly and openly

Ecourage the client to share his feelings with others

Nursing interventions: INTERPERSONAL FUNCTIONING

Explore reasons the client has difficulty establishing interpersonal relationship

Exlpore the client’s self-concept and self-esteem

Nursing interventions: dysfunctional BEHAVIOR

State limits and behavior expected from the client

Enforce or llimits without apologizing

Be direct and confront the client when limits are not observed.

TREATMENT

Psychopharmacology

Lithium, anticonvulsant mood stablizers, and Bendiazepines are used most often to treat aggression.

Low dose of neropletics may be useful in modifying aggression, too.

Several treatment strategies are used with clients with personality disorder; these strategies are based on the disorder’s type and severity or the amount of distress or functional impairment the client experiences.

Combination of medication and group, and individual therapies are more likely to be effective than is any single treatment.