NCM 117 Lec - Personality Disorders

Friday, 4 February 2022 9:03 pm
NCM 117 LEC - PERSONALITY DISORDERS

PERSONALITY
- It is the totality of a person's unique biopsychosocial and spiritual traits that consistently influence
behavior
- Individual differences in characteristic, patterns of thinking, feelings, and behavior
- Focus on 2 broad areas:
○ Understanding of the individual differences in particular personality characteristics such as sociability
or irritability
Personality Disorder
• Inflexible maladaptive pattern of behavior that impairs functioning
• Diagnosis when personality traits become inflexible, maladaptive, and significantly interfere with how a
person functions in society and causes emotional distress
• Can only be diagnosed when the person reaches adulthood when his/her personality is completely formed
• Long standing treatment because you cannot change the character easily
• They cannot recognize their own behavior as a source of difficulty
• Inflexible maladaptive pattern of behavior that impair functioning
Cause of PD
- Maladaptive social behavior exhibited by individuals are reinforced and maintained by rewards
Characteristics of Patients with PD

1. Still in touch with reality
a. The person may have the awareness existing
2. Stress exacerbates PD
a. Stress is the most common precipitating factor of all kinds of diseases
3. Recognizable by adolescence or earlier and continue throughout adult life
a. It may depend on the triggering factors and timing of PD
4. Have troubles with working and loving
a. Big concern on adaptation and socialization
Traits of Individuals with Personality Disorder

1. Interpersonal relations that range from distant to overprotective
2. Suspiciousness
3. Social anxiety
4. Failure to conform to social norm
5. Self-destructive behavior
6. Manipulation and Splitting
Clusters of Personality Disorders

• Cluster A—odd or eccentric behaviors
○ Paranoid personality disorder → suspicious, jealous, short tempered
○ Schizoid personality disorder → doesn't want to socialize, prefers to be alone, detached
○ Schizotypal personality disorder → superstitious, believes in magic, ideas of reference
• Cluster B—erratic or dramatic behaviors
○ Antisocial personality disorder → irresponsible, display lack of guilt, good at manipulation
○ Borderline personality disorder → intense relationship, self- mutilation, impulsiveness
○ Histrionic personality disorder → attention-seeking, self-centered, seductive, dramatic
Narcissistic personality disorder → grandiose view of self, lacks empathy for others
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○ Narcissistic personality disorder → grandiose view of self, lacks empathy for others
• Cluster C—anxious or fearful behaviors
○ Avoidant personality disorder → preoccupied with perfection, conscious of rules, self-critical
○ Dependent personality disorder → fearful of criticism and rejection, negative self-esteem, few social
interactions
○ Obsessive personality disorder → submissive, clinging to others, unable to make decision by self
PD Prevalence
- 6-9% of population have one or more PD
- ASPD & OCPD more common in men
- Borderline, dependent, histrionic for women
- Most people with PD never seek professional help
A. Cluster A
1. Paranoid Personality Disorder
Diagnostic Criteria (4 or more of the ff.)

• Suspicious of other people
• Doubts loyalty and trustworthiness of friends and associates
• Reluctant to confide to others
• Conscious of hidden meanings behind remarks of others
• Persistently bears grudges
• Suspicious of fidelity of spouse or sexual partner
• Blames others for problems
Clinical Picture
• Constantly on guard, hypervigilant & ready for any real or imaginative threat
• Look tense & irritable
• Insensitive to the feeling of others
• Avoid interactions with others
• Always feel that others are taking advantage of them
• Extremely oversensitive
• Do not accept responsibility for their own behaviors
Treatment (Paranoid PD)

• Engage in a collaborative working relationship based on trust
• Individual Psychotherapy
□ is the process of examining thoughts, feelings, bodily experience, and relationships, as well as
looking at personal and/or family patterns to gain greater understanding about oneself
• Pharmacologic Therapy
□ Antipsychotic drugs :
 Zyprexa
 Risperdal
 Prozac
 Antianxiety drugs
Nursing Interventions
• Use straightforward, honest, professional approach rather than casual or friendly approach
• Offer persistent, consistent, and flexible care
• Provide a supportive, non-judgmental environment in which a pt. can safely explore his feelings.
• Establish a therapeutic relationship by actively listening and responding.
PPD: DON’T GET TOO PERSONAL

• Avoid inquiring too deeply into his life or history unless it’s relevant to clinical treatment.
• Avoid inquiring too deeply into his life or history unless it’s relevant to clinical treatment.
• Don’t challenge the pt’s paranoid beliefs
• Avoid situations that threaten the pt’s autonomy
• Use humor cautiously
• Help identify negative behaviors that interfere with his relationships so he can see how his behavior
affects others
2. Schizoid Personality Disorder

• Does not enjoy close relationships
• Always chooses solitary activities
• Has little interest in having sexual experiences
• Takes pleasure in few activities
• Lacks close friends or confidants
• Appears cold & aloof
◊ Hallmark: detachment, social withdrawal, indifference to others’ feelings
◊ Prevalence: affects 0.7% of general population; more on males
◊ Causes: UNKNOWN; grossly deficient early parenting
Clinical Picture
• Appear cold, aloof & indifferent to others
• They prefer to work in isolation & are unsociable with little need or desire for emotional ties.
• In the presence of other they appear shy, anxious or uneasy.
• They are inappropriately serious about everything and have difficulty acting in a lighthearted manner
• They are unable to experience pleasure and their affect is commonly bland and constricted
• Focusing on immediate concerns/problems
• Developing rapport & trust in slow gradual process, help feel secure & acknowledge boundaries
• Bring feelings into proper focus (esp. fears, fantasies, imaginations, dependency, withdrawn)
• Respect the need for privacy, & slowly build a trusting relationship to find pleasure than fear
• Avoid defensiveness & arguing
3. Schizotypal Personality Disorder

• Ideas of references
• Odd beliefs or magical thinking
• Unusual perceptual experiences
• Inappropriate affect
• Appears strange or odd
• Lack of close friends or confidants
• Excessive social anxiety
Clinical Picture
• Aloof & isolated & behave in a bland and apathetic manner
• Magical thinking
• Ideas of reference
• Illusions

• Illusions
• Depersonalization
• Bizarre speech pattern
• They cannot orient their thoughts logically and become lost in personal irrelevancies
• Under stress they may decompensate and demonstrate psychotic symptoms
• Affect is bland or inappropriate
Nursing Management
• Set limits on manipulative behavior
• All staff must be consistent and follow through with consequences in a matter of fact manner
• Provide positive feedback for nonmanipulative behavior
• Offer recognition and praise for accomplishment
• Develop consistent relationship
• Encourage patient to examine behaviors and discuss feelings
• Give positive reinforcement for successful interaction with others
• Rotate staff who work with the patient
B. Cluster B
1. Borderline PD
Diagnostic Criteria ( 5 or more of the ff. )

• Unstable yet intense relationship
• Identity disturbance
• Impulsivity of at least two (spending, sex, substance abuse, reckless driving, binge eating)
• Tends to have self-detrimental behavior
• Affective instability
• Chronic feelings of emptiness
• Difficulty controlling anger
• Transient paranoid ideation
◊ Borderline Personality Disorder: INTENSE, UNSTABLE, EXTREME
◊ Instability of Mood, Identity, Relationships, Impulses, & Self-image
◊ Family hx: Probable childhood sexual abuse
• Encourage to take responsibility for herself, don’t rescue except suicidal or self-mutilating behavior
• Convey empathy & support but don’t try to solve problems, let pt solve him/herself
• Maintain consistency
2. Histrionic Personality Disorder
Diagnostic Criteria (5 or more of the ff. )

• Uncomfortable in situations in which he or she is not the center of attention
• Inappropriate sexually seductive or provocative behavior
• Rapid shifting of emotions
• Uses physical appearance to draw attention to self
• Shows self-dramatization
Treatment
• Patients rarely seeks tx unless it causes functional impairment & ineffective coping

• Patients rarely seeks tx unless it causes functional impairment & ineffective coping
• Goal of tx not to cure but relieve worst elements of behavior
• Psychotherapy – tx of choice, focus on solving problems in life; Individual psychotherapy is preferred
(not family since it may trigger dramatic, attention seeking behavior)
• Pharmacologic: no meds
3. Antisocial Personality Disorder

• Failure to conform to social norms
• Deceitfulness
• Impulsivity
• Irritability or aggressiveness
• Reckless disregard for safety of self or others
• Consistent irresponsibility
• Lack of remorse
ANTISOCIAL as an acronym
A – Abuses substances (some pts)
N – No satisfying IPR’s
T – Tends to manipulate others
I – Irresponsible & exploitative
S – Social norms are disregarded
O – Obnoxious toward others (no guilt, shame, or remorse)
C – Cold & callous
I – Intimidates others
A – Argumentative
L – Legal problems
Treatment
• Psychotherapy= tx of choice
• Individual Psychotherapy jailhouse talk (what to pursue after release, improvement of social or family
relationships, & learning new coping skills)
• Pharmacologic Therapy – not recommended but be given to treat disorganized thinking, stabilize mood
swings

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Friday, 4 February 2022 9:03 pm

NCM 117 LEC - PERSONALITY DISORDERS

Characteristics of Patients with PD

Traits of Individuals with Personality Disorder

Clusters of Personality Disorders

Diagnostic Criteria (4 or more of the ff.)

Treatment (Paranoid PD)

PPD: DON’T GET TOO PERSONAL

2. Schizoid Personality Disorder

Diagnostic Criteria (4 or more of the ff.)

◊ Hallmark: detachment, social withdrawal, indifference to others’ feelings

◊ Prevalence: affects 0.7% of general population; more on males

◊ Causes: UNKNOWN; grossly deficient early parenting

Diagnostic Criteria (5 or more of the ff.)

New Section 3 Page 3

Diagnostic Criteria ( 5 or more of the ff. )

◊ Borderline Personality Disorder: INTENSE, UNSTABLE, EXTREME

◊ Instability of Mood, Identity, Relationships, Impulses, & Self-image

◊ Family hx: Probable childhood sexual abuse

2. Histrionic Personality Disorder

Diagnostic Criteria (5 or more of the ff. )

New Section 3 Page 4

3. Antisocial Personality Disorder

Diagnostic Criteria (3 or more of the ff.)

New Section 3 Page 5

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