PERSONALITY DISORDERS

CHARACTERISTICS

Inflexible and maladaptive response to stress Disability in working and loving Ability to evoke interpersonal conflict Capacity to get “under the skin” of others

These clients usually do not recognize their symptoms as uncomfortable and will NOT seek help unless a severe crisis occurs.

PREVALENCE

10-15% in general population

Often “co-occur” with depression and anxiety

Onset usually occurs before onset of other psychiatric disorders

Various PD’s often co-exist

BIOLOGICAL FACTORS Genetic Component

Also to be considered… unfavorable environmental conditions

Personality Traits that are Inherited

Novelty seeking Introvert vs extrovert Reward dependence Closeness vs openness Neurotic vs stable Persistence Antagonistic vs agreeable Conscientious vs unreliable

PSYCHOSOCIAL FACTORS

Learning Theory

Cognitive Theory

Psychoanalytical Theory

Environmental Theory

ANALYSIS

There is probably a combination of biological and psychological factors that cause Personality Disorders to develop in people.

Would you agree with this statement???

WHY? Any examples?

ASSESSMENT OF PD’S

MMPI

Full medical historyPsychosocial History

Suicidal / aggressive thoughts Risk of harm to self or others Use of medications or illegal substances Ability to handle money Legal history Current or past abuse

EFFECTS OF PERSONALITY DISORDERS ON CAREGIVERS

Overwhelming needs of clients will usually be overwhelming for caregivers

Caregivers may feel: Confused Helpless Angry Frustrated

SPLITTING BEHAVIORS

Primary defense used by clients with borderline PD

Client labels one person “all good” and everyone else is “all bad”

Once all good person has not met clients needs they become ALL BAD! Then

Someone else is labeled “all good”.. And on it goes…

This creates conflict with staff!!!

THREE CLUSTERS OF PDS

CLUSTER A: Odd or eccentric

CLUSTER B: Dramatic, emotional, erratic

CLUSTER C: Anxious or fearful

CLUSTER A

Paranoid

Schizoid

Schizotypal

CLUSTER B

Dramatic, Erratic, Emotional

Anti social

Borderline

Narcissistic

Histrionic

CLUSTER C

Anxious or Fearful

Avoidant

Dependent

Obsessive- Compulsive

Passive- Aggressive

DIAGNOSIS

So what do you think would be some nursing diagnoses of concern?

Goals for Borderline? Short term? Long term?

INTERVENTIONS FOR MANIPULATIVE, AGGRESSIVE, OR IMPULSIVE BEHAVIOR

Manipulative: establish guidelines for accepted behavior ( Contract?), work on trust, can the patient identify their behaviors?

Aggressive : facilitate expression of anger in an adaptive, non-violent way (safety/ physical outlets), remove dangerous objects

Impulsive: assist with development of problem solving skills, keep stimuli low key, observe behavior for safety, encourage verbalization of hostile feelings

INTERVENTIONS

Basic Milieu Therapy

Psychobiological Interventions (meds)

Case management

Advanced Practice DBT

Skills oriented psychotherapy

Supportive psychotherapy

Group therapy