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Personality Disorders

Personality Disorders

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Published by nursekatie

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Published by: nursekatie on Oct 12, 2009
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09/12/2010

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Cluster A (odd/eccentric)
Paranoid
Characterized by
Distrust AndSuspiciousness Towards Others
, based onthe belief (unsupported by evidence) thatothers want to exploit, harm, or deceive theperson. These individuals are:-Hypervigilant-Anticipate hostility-May provoke hostile responses by initiating a“counterattack”-Demonstrate jealousy, controlling behaviors,and unwillingness to forgive.**Paranoid people are difficult to interview b/cthey are reluctant to share information aboutthemselves
Schizoid
Characterized Emotional Detachment,disinterest in close relationships, andindifference to praise or criticism; oftenuncooperative.The person with this disorder does not seekout or enjoy close relationships. Theseindividuals may be able to function in a solitaryoccupation.Schizoid PD can be a precursor toschizophrenia or delusional disorder. There isincreased prevalence of the disorder infamilies with schizophrenia or schizotypal PD.
Schizotypal
Characterized by Odd Beliefs, leading tointerpersonal difficulties, an eccentricappearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations.
Nursing Interventions:
Objective, matter-of-fact approach
Avoid being too “nice or friendly”
Clear, simple, consistent verbal-non-verbalcommunication
Give clear straightforward explanations
Warn about changes, side effects etcMANIPULATIVE BEHAVIORSET LIMITS!!-Discuss concerns about behavior with patient-identify undesirable behavior, and discuss with patient what isdesirable behavior in a give situation or setting-Establish consequences for occurrence or nonoccurrence of desired behavior in a non punitive ad easily understood way-Refrain from arguing or bargaining with patient about
 
Help identify feelings
Assist with problem-solving
Gradually involve in group situations but do not insist.Respect need for social isolation.established behavioral expectations and consequences-Modify behavioral expectations as needed based on reasonablechanges in patient’s situations
Cluster B (Dramatic/Emotional/Erratic)Antisocial
Characterized by consistentDisregard for Others withexploitation and repeated unlawfulactions, deceit and failure toaccept personal responsibility.Previously called Psychopaths or Sociopaths. There is a clear history of conduct disorder inchildhood, and the individual showno remorse for hurting others.They repeatedly:-Neglect responsibilities-Tell lies-Perform destructive or illegalacts, without developing anyinsight into predictable
Borderline
Characterized by Instability of Affect, identity and Relationships;fear of abandonment, splittingbehavior, manipulation, andimpulsiveness; often tries self-mutilation and may be suicidal.Individuals w/ Borderline PDdesperately seek relationships toavoid feelings of abandoned, butoften drive others away b/c of their excessive demands, impulsivebehavior, and their frequent use of splitting.
Histrionic
Characterized by EmotionalAttention-Seeking Behavior, inwhich the person needs to be thecenter of attention; often seductiveand flirtatious, the histrionicperson is impulsive andmelodramatic. Relationships donot last b/c their partner oftenfeels smothered or reacts to theinsensitivity of the histrionicperson. The individual withhistrionic PD has no insight intohis role in breaking uprelationships. In the treatmentsetting, the person demands “thebest of everything” and can bevery critical
Narcissistic
Characterized by Arrogance,Grandiose Views of Self-Importance, the need for constantadmiration along with a lack of empathy for others that strainsmost relationships; often sensitiveto criticism. Underneath thesurface of arrogance, narcissisticsfeel intense shame and fear that if they are “bad” they will beabandoned. They are afraid of their own mistakes, as well as themistakes of others. May seekhelp, feeling that loved ones donot show enough appreciation of their special qualities
 
consequences.
Nursing Interventions
Prevent self-harm. No harm contract.
Set limits on inappropriate or manipulative behaviors
Provide clear, consistent boundaries
Assist examining consequences of behavior.
Consistent approach by staff 
Do not rescue or reject
Remain neutral, avoid engaging in power struggles or be comingdefensive to patient’s comments
Give recognition for goal achievement
Explore feelings
Teach problem solving and role model assertiveness
Encourage and model concrete and descriptive communication
Document behaviors and incidents objectively
Encourage follow up treatmentIMPULSIVE BEHAVIORIMPULSE CONTROL TRAINING!!-Assist pt to: Identify problem or situation that requires thoughtful action,and courses of possible actions, their costs or benefits-Teach pt to cue himself to “stop and think” before acting impulsively-Assist pt to evaluate the outcome of the chosen course or action-Provide positive reinforcement for successful outcomes (e.g. praise andrewards)-Provide opportunities for pt to practice problem solving in social andinterpersonal situations outside the therapeutic environment
Cluster C (Anxious/Fearful/Insecure/Inadequate)Avoidant
Characterized by
Social Inhibition
and Avoidance
DependantObsessive Compulsive

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