Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River,...

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Personality Disorders Spring 2011

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Personality The individual qualities, including habitual behavior patterns, that make a person unique

Transcript of Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River,...

Page 1: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

PersonalityDisorders

Spring 2011

Page 2: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Contemporary Psychiatric-Mental Health Nursing, Second EditionCarol R. Kneisl and Eileen Trigoboff

Contemporary Psychiatric-Mental Health Nursing

Chapter 22Personality Disorders

Page 3: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Personality

• The individual qualities, including habitual behavior patterns, that make a person unique

Page 4: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Personality Traits

• Persistent behavioral patterns that do not significantly interfere with one’s life, even though the behaviors may be annoying or frustrating to others

Page 5: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Personality Disorders

• Rigid, stereotyped behavior pattern• Persists throughout the person’s life• Pattern of perceiving, thinking, and relating

that impairs social or occupational functioning• Axis II diagnoses

Page 6: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Common Characteristics

• Failure to accept the consequences of behavior

• Lack of insight• External response to stress

Page 7: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Essential Characteristics

• Chronicity• Pervasiveness• Maladaptation

Page 8: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Biologic Factors

• Alterations in hormone & platelet monoamine oxidase (MAO) levels

• Smooth-pursuit eye movements• Neurotransmitter changes

Page 9: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Biologic Factors - continued

• Electroencephalographic (EEG) changes• Structural brain changes• Diminished blood flow and inflammation

Page 10: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Genetic Factors

• Familial tendencies• Cluster B correlated with mood disorders,

alcoholism, & somatization• Genetic variation

Page 11: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Psychosocial Factors

• Parent–child interactions• Intrapsychic theory• Enmeshment• Abandonment• Identity diffusion

Page 12: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Humanistic Theory

• Personality disorders are a combination of multiple factors.

Page 13: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Diagnostic Clusters

• Cluster A: Odd–Eccentric– Paranoid– Schizoid– Schizotypal

Page 14: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Diagnostic Clusters - continued

• Cluster B: Dramatic–Emotional– Borderline– Histrionic– Narcissistic– Antisocial

Page 15: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interview with Elizabeth

Click here to view a video interview with Elizabeth

Page 16: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Diagnostic Clusters - continued

• Cluster C: Anxious–Fearful– Avoidant– Dependent– Obsessive-compulsive

Page 17: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Application of the Nursing Process

• Safety• Consistency• Boundary setting• Appropriate self-disclosure

Page 18: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Difficult Behaviors

• Manipulation• Narcissism• Impulsiveness

Page 19: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Paranoid Personality Disorder

• Respect personal space.• Respect client’s preference.• Give feedback based on nonverbal cues.• Provide client with a daily schedule of

activities and inform client of changes.

Page 20: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Paranoid Personality Disorder - continued

• Help client identify adaptive diversionary activities.

• Use role-playing.• Use an objective, matter-of-fact approach

with client.• Use concrete, specific words rather than

global abstractions.

Page 21: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for the Angry Client

• Use a calm, unhurried approach.• Do not touch client indiscriminately.• Respect personal space.• Use active listening skills.• Remain aware of personal feelings.

Page 22: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Antisocial Personality Disorder

• Use a concerned, matter-of-fact approach.• Set, communicate, and maintain consistent

rules and regulations.• Do not argue, bargain, or rationalize.

Page 23: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for the Antisocial Personality Disorder - continued

• Confront inappropriate behaviors.• Do not seek approval or coax; use choices and

consequences.• Be alert for flattery or verbal attacks.

Page 24: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Manipulative Behavior

• Assign one primary staff member.• Maintain realistic limits with enforceable

consequences.• Give a rationale for limits and consequences.

Page 25: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Manipulative Behavior - continued

• Model respect, honesty, openness, and assertiveness.

• Confront client each time manipulation occurs.

Page 26: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Dependent Personality Disorder

• Evaluate client’s ability for self-care.• Avoid doing things the client is capable of

doing.• Help client identify assets and liabilities.

Page 27: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Interventions for Dependent Personality Disorder - continued

• Emphasize strengths and potential.• Encourage client to take responsibility for own

opinions.• Point out when client negates own feelings or

opinions.

Page 28: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

The Nurse’s Response

• Self-awareness• Countertransference• Labels and stigma• Supervision

Page 29: Personality Disorders Spring 2011. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Contemporary Psychiatric-Mental.

Resources• http://www.bpdcentral.com

Borderline Personality Disorder Central is an organization with information and resources for people who care about someone who may have borderline personality disorder (BPD).

• http://www.bpdresourcecenter.orgThe Borderline Personality Disorder Resource Center (BPDRC) at New York–Presbyterian Hospital has been set up to help those impacted by the disorder find the most current, accurate information on the nature of BPD and on sources of treatment.

• http://www.mentalhelp.net/poc/center_index.php?id=8This Mental Help Net link contains information about personality disorders: types, treatment, research, literature, and resources.