2040 Personality

8/7/2019 2040 Personality

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THE PERSONALITY

DISORDERS

Presented by Professor

Chr is t ine DelNero

Lect ure Overv iew

C lus te r A Odd or Eccen t r ic Paranoid Persona l i ty Disorder

Schzo id Personal i ty Disorder

Sch izo typa l Persona l i ty Disorder

Lect u re Overv iew con t .

Cluste r B Drama t i c and

Emot ional

Ant isoc ia l Personal i ty Disorder

Border l ine Persona l i ty Disorder

Narc iss is t ic Persona l i ty Disorder

His t r ion ic Persona l i ty Disorder

Lect u re Overv iew con t .

C lus te r C Anx ious o r Fear ful

Dependent Persona l i ty Disorder

Obsess ive Compuls ive Persona l i ty

Disorder

Avo idant Persona l i ty Disorder

DEFINITIONS

Personal i ty - --an evolv ing

pat t ern of th ink ing, perce iv ing

and exper ienc ing. I tencom passes ones endur ing

at t i tudes and be l ie fs . These

patt erns are acquired in ear ly

ch i ldhood and become l i fe long

patt erns of behav ior .

Def in i t ions con t .

Personal i ty D iso rder

Personal i ty t r a i ts a re in f lex ib le and

maladapt ive and cause s ign i f icantfunct i ona l impa irment . The pat ien t

w i th a persona l i ty d isorder is no t

ab le to accomp l ish the

developmen ta l t asks o f t rus t ,

au tonomy and meaningfu l

re la t ionsh ips.


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Def in i t ions con t .

Long-te rm ma ladap t ive andrepet i t ive behav iorscharacter ize the personal i tyd isorders . These behaviors arenot cons idered uncomfort ab le or maladapt i ve by the pat ient asare symptom s tha t a reexper ienced in o ther psychdisorders .

Comm on Charac te r is t i cs

In f lex ib le and ma ladap t iveresponse to s t ress.

Ma ladap t ive behav io rs in

occupa t iona l and soc ia l

re la t ionships

Ab il i t y t o evok e and c reate

in terpersonal conf l ic t

Common Char. cont

Lack o f respec t fo r boundar ies .

Capac i ty t o ge t under the sk in

o f o thers. I f you a re feel ing

cons is ten t ly i r r i ta ted and

anx ious when deal ing w i t h a

pat ient , suspect a personal i ty

d isorder.

Personal i ty Disorders

DSM IV TR

Devia t i on f rom t he ex pec ta t i ons

of ones cu l ture in t hese areas

Cogn i t ion

Af fect

In terpersona l funct ion ing

Impu lse con t ro l

Theor ies

B io log ica l inher i tab le t ra i ts

Nove l ty seek ing

Harm avo idance

Reward dependence

Pers is tence

Theories con t .

Ch ron i c Trauma

A s ing le t raumat ic event c auses us

to fear a recurrence. Chron ic t rauma repeats cyc le over

and over and as a resu l t t he bra in s

cor t ica l map, the ind iv idua l s

behavior and cor t ica l deve lopment

is reorganized.


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Chron ic Trauma con t .

Pa t i ents w i th a PD ac t ou t aforgot t en h is tory , a past thathas gone unquest ioned.

Pr oj ec t i o n

Exper ience of an everydaycon t inu ing te r ro r tha t a l l t he i r percept ions and se l f -es teem arebu i l t .

Chron ic Trauma c on t .

Unconsc ious disconnec t ion o f t he i r

emo t ions .

I n ab i li t y t o a t t a c h a d ap t i v el y t o

o thers

Inab il i t y t o lea rn f rom hea l thy

re la t ionsh ips

Man ipu la t ion and power s t ruggles

present in a l l re la t ionsh ips

Theor ies con t .

Ps y c hodynamic I s s ues

Defense Mechan isms

Repress ion and suppress ion

U nd o in g

Regress ion

Spl i t t ing (Border l ine PD)

Genera l Assessm ent

Medic a l H i sto ry .

Ps yc h ia t r ic H i s to ry.

So c io c ul t u ra l B ac k g ro un d.

Suic ide o r Homic ida l idea t ion o r

in ten t .

Where in deve lopmenta l cyc le

has PD present ed


N AN DA

Ine f fect ive Ind iv idua l Coping

Inef fect ive Fami ly Cop ing

Risk fo r se l f -d i rected V io lenc e

Risk fo r V io lence Towards Others

Risk fo r In ju ry


NOC

Improved cop ing

Ef fect ive Fami ly Cop ing

Safety Behavior: Personal

Risk Detect ion


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NIC Se l f -aw areness enhancement

Se l f -esteem enhancement

Se l f -responsib i l i ty Fac i l i t a t ion

Risk Ident i f ica t ion


c o n t .

Eva lua t ion of NOC Outcom es

Cluste r A Odd or

Eccen t r ic

Paranoid Personal i ty Disorder

A pervas ive , pers is tent d is t rust

and susp ic ious o f o thers .

Peop le wi t h PPD be l ieve tha t t hey

have been done i r revers ib le harm

by o thers .

Unw i l l ing to conf ide or share in fo

w i th o thers

Assessment PPD cont .

Canno t ac c ep t c omp l imen ts ;these are misread asman ipu la t ion

They a re hyperv ig i lant , jea lous ,a rgumenta t ive , sa rcas t ic ,comp la in ing and an t ic ipa tehos t i l i t y .

Unab le to t rust any one .

Assessment PPD c ont .

Pers isten t ly bear g rudges

Reac t qu ick ly and angr il y to any

perce ived c r i t i c ism Ex t reme ly poor IPR and in t imate

re la t ionships. Ext remely jea lousand suspic ious w i thou t ev idenceespec ia l ly w i th spouse or sexualpartner.

Assessment PPD cont .

Psycho t ic ep isodes can occur

espec ia l ly dur ing t imes of

ex t reme s t ress Ra rel y i n it i a te c ontac t w i th

med ica l sys tem.

Are most o f ten seen in ER

Of ten sign ou t AMA


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Nurs ing Diagnosis

NANDA

Power less nes s Soc ia l i s ola t i on

An xi et y

Risk fo r o ther -d i rec ted v io lence

Dis tu rbed though t processes

Dis tu rbed sensory percep t ion

Ris k for s ui c ide

Nurs ing Diagnosis cont .

Chron ic low se l f -es teem Dis tu rbed persona l iden t i ty

Impa ired ad jus tmen t

Ine f fec t ive ind ividua l cop ing

Nurs ing Outc ome NOC

Ou tc ome c r i t e ri a rela te to thepr ior i ty nurs ing d iagnos is

Peop le w i th PPD have a poor prognos is for changing behavior .

Most des i red outc ome i s t o g i v eperson w i th PPD a sense of greater cont ro l in a g ivens i tua t ion

Nurs ing Int ervent ion NIC

Clear c ommun ic a t i on

Avo id being over ly f r iend ly o r

personable. Cal l by form al name

St ra igh t fo rward , c lea r br ie f

comm un ica t ion . Show respec t .

Keep pa t i ent i n fo rmed o f

changes in t rea tment

Schizoid PD Cluste r A

A ss es sm e nt

A pervas ive pat te rn o f de tachm ent

and avo idance o f soc ia lre la t ionsh ips

A rest r ic ted range o f verba l and

non-verbal expression

Does not des i re IPR

Chooses so l i ta ry act iv i t ies

Sc hizo id assess c ont

Sexua l re la t ionsh ips impa i red or

non-ex is tent

A nh ed on ia

Fla t tened a f fec t , de tac hed

May be prec u rs o r t o

schizophrenia


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Nurs ing Diagnosis

NANDA

Soc ia l i s ola t i on Ris k for s ui c ide

Se l f c a re de fi c i t s


Impa ired v erbal c ommun ic a t i on

Nurs ing ou tc ome NOC

Nurs ing In t e rven t ion NIC

Clear c ommun ic a t i on

Task o r ien ted i nte rv en t i ons

Clear s ta temen t o f ex pec ta t i ons

Avo id touch and over ly fr iendly

approach.

Es tab li s h a wa rm, non

threaten ing env i ronment

Sch izo typa l PD Clus . A

A ss es sm e nt

Eccen t r i c behav io r and ex t reme

socia l and in terpersona l

re la t ionsh ip def ic i ts .

Cogn i t ive and perceptua l

d is to r t ions

Odd be l ie fs and magica l th ink i ng

Ideas o f re ference

Sch izo typal PD

assessment con t .

Unus ual pe rc eptua l

d is turbances inc lud ing somat ic

i l lus ions Excess ive soc ia l anx ie ty . Want

soc ia l re la t ionships. Do not

respond to in terpersonal cues.

Rig id and inappropr ia te a f fec t

Sch izo typa l PD

assessment con t .

Sel f -ca re de f ic i ts . Unkempt and

bizarre dress.

Parano id idea t ion andsuspic iousness of o thers

Mos t p reva lent in f i rst degree

re la t ive o f peop le w i t h

schizophrenia


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Nurs ing Diagnosis

NANDA

Soc ia l i s ola t i on Se l f -ca re de f ic i ts

Impa ired v erbal c ommun ic a t i on

An xi et y

A l te red sensory percep t ion

A l te red though t p roc es s es



Dec reas e anx iet y

Goa l or i en ted task s

In te rpe rs ona l t eac h ing

Se l f -ca re teach ing

Low dos e an t i ps y c ho t i c s

Clust er B PD Dramat ic ,

Emot iona l , Erra t ic

An t isoc ia l PD Assessment

A pervas ive pat te rn o f d isregard fo r

and v io la t ion o f the r igh ts o f o thers

Sense o f en t i t lem ent , lack o f

boundar ies.

Often en te r MHSys tem as a resu lt

o f cour t o rder

Ant isoc ia l PD assess

c o n t .

Neg lec t fu l o f respons ib il i t ies

Co-morb id o f ten w i th subs tance

abuse

Ex t reme lac k o f empa thy fo r

o thers

H ighly man ipu la t ive , can be

charming

Ant isoc ia l PD

a se ss m en t c o nt .

Can be aggress ive and v io lent

L ac k o f r em o r se

Ex t reme ine f fec t ive ind ividua l

cop ing . Very low f rus t ra t ion

to le rance


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Nurs ing Diagnosis

NANDA

Risk fo r o ther di rec ted v io lence Inef fec t i v e c op ing

Inef fec t i v e fam i l y c op ing



Clear , c onsi s tent t rea tment p lan

Clear , c ons i sten t l im i t s e t t i ng

Av oid man ipu la t i on

Clear boundar ies

Clear doc umen ta t i on

Behav io ral approach

NIC con t .

Ps y c hopha rmac ology

Be aw are o f d rug seek ing behavior

Medica t ion fo r aggress ion, an t i -

convu lsants , l i th ium and se lect ed

SSRIs

Border l ine Personal i t y

Disorder Cluster B

A ss es sm e nt

Ext rem e instab i l i ty IPR,

impuls iv i t y , d is turbed se l f conceptand impaired body image.

Major de fense o f sp l i t t ing

Fear o f abandonment

Se l f -mut i la t ion

BPD assessment c ont

I r r it ab i li t y and anx ie t y

Dep res sion

M an ip ul at i o n

Aggress ive and v io len t behav ior

Perhaps mos t d i f f i cu l t o f a l l PDs

to t rea t


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Nurs ing Diagnosis

NANDA

Ri s k fo r se l f- d i rec ted v io lenc e Risk for se l f -mut i la t ion

Risk fo r o ther di rec ted v io lence

An xi et y

Power less nes s

Risk fo r ca regive r ro le st ra in


Nurs ing Outc omes NOC

Nurs ing In tervent ions

NIC

Rea li s t i c goa ls

Clear boundar ies and lim i ts

Team approac h w i th a l l

mem bers on same page. Be

aw are of BPD pat ient be ing ab le

to be ex t reme ly m an ipu la t ive .

They f requent ly ins t i l l gu i l t

NIC con t .

Av oid re jec t i on

Be a ler t fo r su ic ida l and se l f

mut i la t ing behav iors

Cont ro l aggress ion

Above a l l avo id sp l i t t ing by

adher ing to a c lear ly def ined

t rea tm ent p lan

NIC con t .

Ps y c hopharmac o logy

SSRIs

Ant ic onvu lsants fo r moodstab i l iza t ion

Low -dose ant ipsychot ics

N ar c i ss t ic PD

Hist r ion ic PD

Sim i l ar d i so rde rs

D if fe r in tha t H is t r ionic PD

exh ib i t s t rong ly seduc t ivebehaviors and dress. Both

requ i re exc ess ive a t t en t ion ,

have in f la ted sense of se l f -

impor tance


10/13

NPD and HPD c ont

A person w i th NPD is moreexp lo i t i ve o f o thers where

people wi t h HPD are exc ess ive ly

d ramat ic bu t ve ry sha l low in

the i r range of emot ions

Nurs ing Diagnosis

NANDA

Di s tu rbed s el f c onc ep t Power less nes s

R isk fo r se l f di rec ted v iolence


Nurs ing Out c om e (NOC) Nurs ing Int ervent ion NIC

NPD

Avo id power s t rugg les

Do not become defens ive wi t h

negat ive c r i t i c i sm

Set l im i t s c lea r ly

Avo id non-judgmenta l s ta t ements


NPD Main ta in h igh ly pro fess iona l

demeanor Recogn ize seduct ive behavior as a

means o f express ing anx ie ty andd is t ress

Set c lea r l im i t s

Avo id respond ing to dramat ics ta temen ts

HPD NIC c ont

Ro le m o de l

Asser t iveness t ra in ing

Psychopharmaco logy possib le

use of SSRI or MA OI


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Cluste r C PD Anxious or

Fearfu l

Dependen t PD Obsess ive-Compuls ive PD

Av oidan t PD

Clus te r C con t .

Obsess ive-Compuls ive PDassessement

Pervas ive pat te rn o f p reocc upat ion

w i th order l iness, per fect ion ism and

ment a l and in terpersona l cont ro l

Preoccup ied w i th ru le , de ta i ls and

order

Rig id , d i f f icu l t IPR, s tubborn

OCD PD assess m ent

c o n t .

Miserly , unable to delega te

task s, c r i t ica l o f o thers , unable

to accep t any k ind of c r i t i c ism

themselves.

Unable to enjoy le isure ac t iv i ty

Wo rk a ho li c s

Pa c k -r at s

OCD PD co nt .

Unab le to mak e a dec i sion

Fea r l os ing c on t ro l

Lac k o f ab i li t y t o c ompromis e

Ex t reme ly poo r IPR


A v oid po w e r s t r ug gle s

P rese rve sense o f con t ro l

Ps y c h op ha rma c olo gy : Clomipramine (Anafran i l ) and SSRIS

P rov ide c lea r , conc ise exp lana t ions .

Do not engage in excess verba l

conversat ion . Ci rcu lar th ink ing

Dependent PD Clust er C

A ss es sm e nt

A pervas ive need to be taken care

of Submiss ive and c l ing ing behavior

Fear o f separa t ion

Needs o thers to assume

responsib i l i ty fo r major a reas o f

l i fe


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Dependent PD cont .

Unable to ini t ia te independentac t ion

Unable to be asser t i ve in IPR

Unable to to le rate be ing a lone


Ine f fec t ive ind ividua l cop ing Power less nes s

R isk fo r sexua l abuse

Ris k for s ui c ide


Av oid man ipu la t i on

A l low pa t i ent t o pe rfo rm task s

tha t a re accompl ishable

Teac h and role model

assert iveness and independence

Observe fo r s igns o f su ic ide and

abuse

Avoidant PD Cluster C

Pervas ive pat t e rn of soc ia linh ib i t ion, fee l ings of inadequacy and extremeshyness and wi t hdraw n behavior

V iews se l f as inadequa te ,in fer ior

Unable to engage in news i tua t ions

Nurs ing Out c om e NOC Nurs ing Int ervent ion NIC

Warm, f r iendly engag ing manner

G ive reassurance , espec ia l l y

w hen encourag ing pa t ien t t oengage in new or chal lengings i tua t ions

Trea t soc ia l phob ias w i th SSRI sor benzodiazepines to t reatpani c a t t ac k s


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Lect u re Summ ary

A ss es sm e nt I f the nurse is fee l ing pers is tent ly

anx ious, angry , i r r i ta t ed and

f rust ra ted w i th a pat ien t , suspect

the pat ien t has a persona l i ty

d isorder .

Care fu l assessment is necessary .

Ho l i s t i c assessment i s key .

Lect u re Summ ary

Nu rs ing ou tc omes NOC Ef fect ive cop ing

Suic ide r isk decreased

Anxie ty , anger, aggress ion

managed

L imi t se t t ing ach ieved

Lect u re Summ ary con t

Nursing In te rvent ions con t .

A l l d iscussed in lec ture . Outc omes

and in tervent ions are main ly based

on pat ien t s behavior , w i th pr io r i ty

nurs ing d iagnos is (unmet needs)

gu id ing outcomes and

in tervent ions. L imi t se t t ing shou ld

be fo remos t in the t rea tm en t p lan .

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