2040 personality
TRANSCRIPT
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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
Personal i ty Disorders
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
Personal i ty Disorders
NOC
Improved cop ing
Ef fect ive Fami ly Cop ing
Safety Behavior: Personal
Risk Detect ion
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Personal i ty Disorders
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
Personal i ty Disorders
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
Ine f fec t ive ind ividua l cop ing
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
Nurs ing Outc ome NOC
Nurs ing In t e rven t ion NIC
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
Nurs ing Outc ome NOC
Nurs ing In t e rven t ion NIC
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
Ine f fec t ive ind ividua l cop ing
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
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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
Ine f fec t ive ind ividua l cop ing
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
Nurs ing In t e rven t ion NIC
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
Nurs ing In t e rven t ion NIC
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
Nurs ing Outc ome NOC
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
Nurs ing In t e rven t ion NIC
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 .