CHILDHOOD

PERSONALITY
DISORDER
By: Felmark Ross D. Labrador
BSN 302
PERSONALITY DISORDER
A personality disorder is a term for behavior patterns that
make it difficult for people to get along with others,
regardless of their environment or circumstances.
Children and teens who suffer from a personality
disorder have problems maintaining healthy
relationships and often blame circumstances or people
around them for problems they have created. This
behavior leads to a feeling of loneliness and isolation as
they fail to conform to cultural, social, or legal norms, and
they are motivated by personal gratification.
 10-20%
Personality disorders are
relatively common, occurring in
10% to 20% of the general
population

Incidence is even higher for people in lower

socioeconomic groups and unstable or disadvantaged
populations. Clients with personality disorders have a
higher death rate, especially as a result of suicide; they
also have higher rates of suicide attempts, accidents,
and emergency department visits, and increased rates
of separation, divorce, and involvement in legal
proceedings regarding child custody.
Biological Theory
The four temperament traits are harm avoidance, novelty seeking,
reward dependence, and persistence.
Each of these four genetically influenced traits affects a person’s
automatic responses to certain situations.
These response patterns are ingrained by 2 to 3 years of age.
People with high harm avoidance exhibit fear of uncertainty, social
inhibition, shyness with strangers, rapid fatigability, and pessimistic
worry in anticipation of problems.
Those with low harm avoidance are carefree, energetic, outgoing,
and optimistic.
 TYPES OF PERSONALITY DISORDER

Cluster A Cluster B Cluster C

The Odd, The Dramatic, The Anxious,
Eccentric cluster Unpredictable cluster Fearful cluster

Includes: Includes: Includes:

Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality
Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality
Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-compulsive
Personality Disorder
DIAGNOSIS
Personality disorders are not diagnosed until adulthood,
that is, at age 18, when personality is more completely
formed. Nevertheless, maladaptive behavioral patterns
can often be traced to early childhood or adolescence. The
Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5), is a reference doctors and mental
health professionals use to help diagnose mental health
conditions. Each personality disorder has criteria that
must be met for a diagnosis.
TREATMENT
People with personality disorders are often described as “treatment
resistant.” This is not surprising, considering that personality
characteristics and behavioral patterns are deeply ingrained. It is
difficult to change one’s personality; if such changes occur, they
evolve slowly. The slow course of treatment can be frustrating for
family, friends, and health care providers.

Individual and group psychotherapy

Individual and group psychotherapy goals for clients with personality
disorders focus on building trust, teaching basic living skills, providing
support, decreasing distressing symptoms such as anxiety, and
improving interpersonal relationships. Relaxation or meditation
techniques can help manage anxiety for clients.
INTERMITTENT
EXPLOSIVE
DISORDER
By: Felmark Ross D. Labrador
BSN 302
INTERMITTENT EXPLOSIVE DISORDER
It involves repeated episodes of impulsive, aggressive, violent
behavior, and angry verbal outbursts, usually lasting less than
30 minutes.
During these episodes, there may be physical injury to others,
destruction of property, and injury to the individual as well. The
intensity of the emotional outburst is grossly out of proportion
to the stressor or situation. In other words, a minor issue or
occurrence may result in rage, aggression, and assault of
others.
The episode may occur with seemingly no warning. Afterward,
the individual may be embarrassed and feel guilty or
remorseful for his or her actions. But that does not prevent
future impulsive, aggressive outbursts.
The onset of IED can occur at any time in life but is most
common in adolescence and young adulthood. It is more
common in males than in females.
ROOT CAUSE

BIOLOGICAL
Brain chemistry (varying levels of serotonin) can contribute to the
disorder
neurotransmitter imbalances, especially serotonin; plasma
tryptophan depletion; and frontal lobe dysfunction

GENETICS
Close family member with mental, mood, anxiety disorders
A history of mental health disorders, including attention deficit hyperactivity disorder
(ADHD), antisocial personality disorder, borderline personality disorder

ENVIRONMENTAL Childhood exposure to trauma, neglect, or maltreatment

DIAGNOSIS
To be diagnosed with intermittent explosive disorder, an
individual must display a failure to control aggressive impulses as
defined by either of the following:
Verbal aggression (temper tantrums, verbal arguments or
fights) or physical aggression toward property, animals or
individuals, occurring twice weekly, on average, for a period
of 3 months. The aggression does not result in physical harm
to individuals or animals or destruction of property. Or
Three episodes involving damage or destruction of property
and/or physical assault involving physical injury against
animals or other individuals occurring within a 12-month
period.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), is a reference doctors and mental health
professionals use to help diagnose mental health conditions.
TREATMENT
Treatment for IED includes medications, such as fluoxetine
(Prozac); lithium; and anticonvulsant mood stabilizers such as
valproic acid (Depakote), phenytoin (Dilantin), topiramate
(Topamax), and oxcarbazepine (Trileptal).
Selective serotonin reuptake inhibitor antidepressants
particularly seem to reduce aggressive tendencies because
serotonin deficiencies are often linked to causation (Kim &
Boylan, 2016). Although these medications reduce aggressive
impulses and irritability in many people, they do not eliminate
the outbursts of IED.
Additional interventions can improve outcomes, such as
cognitive behavioral therapy, anger management strategies,
avoidance of alcohol and other substances, and relaxation
techniques. The best outcomes involve a combination of
these interventions and treatment.
 CONDUCT
DISORDER
By: Felmark Ross D. Labrador
BSN 302
CONDUCT DISORDER
Characterized by persistent behavior that violates societal norms,
rules, laws, and the rights of others. These children and adolescents
have significantly impaired abilities to function in social, academic,
or occupational areas.
Symptoms are clustered in four areas: aggression to people and
animals, destruction of property, deceitfulness and theft, and serious
violation of rules.
Children with conduct disorder often exhibit callous and
unemotional traits.
They have little empathy for others, do not feel “bad” or guilty or
show remorse for their behavior, have shallow or superficial
emotions, and are unconcerned about poor performance at school or
home.
These children have low self-esteem, poor frustration tolerance, and
temper outbursts.
Frequently associated with early onset of sexual behavior, drinking,
smoking, use of illegal substances.
ROOT CAUSE
BIOLOGICAL Brain damage
Prenatal exposure to alcohol causes an increased risk for conduct
disorder

GENETICS Close family member with mental, mood, anxiety disorders

Poor family functioning; marital discord, poor parenting (parental

ENVIRONMENTAL rejection), and a family history of substance abuse and psychiatric

problems.
Child abuse is an especially significant risk factor

SOCIAL Low socioeconomic status

Not being accepted by peers
Two subtypes of conduct disorder are based on
age at onset:
1. The childhood-onset type involves symptoms before 10
years of age, including physical aggression toward others
and disturbed peer relationships. These children are more
likely to have persistent conduct disorder and develop
antisocial personality disorder as adults.
2. Adolescent-onset type is defined by no behaviors of
conduct disorder until after 10 years of age. These
adolescents are less likely to be aggressive, and they have
more normal peer relationships. They are less likely to
have persistent conduct disorder or antisocial personality
disorder as adults.
DIAGNOSIS
Behaviors associated with conduct disorders fall into categories of aggression, destruction, deceit/theft,
and rule violation, but they can vary in intensity. They are often described as mild, moderate, or severe.

The child has some conduct problems that cause

MILD relatively minor harm to others. Examples include

repeated lying, truancy, minor shoplifting, and
staying out late without permission.

MODERATE
The number of conduct problems increases as does the
amount of harm to others. Examples include vandalism,
conning others, running away from home, verbal
bullying and intimidation, drinking alcohol, and sexual
promiscuity.

SEVERE
The person has many conduct problems that cause considerable harm to
others. Examples include forced sex, cruelty to animals, physical fights,
cruelty to peers, use of a weapon, burglary, robbery, and violation of
previous parole or probation requirements.
TREATMENT
Psychotherapy (a type of counseling) is aimed at
helping the child learn to express and control
anger in more appropriate ways. A type of therapy
called cognitive-behavioral therapy aims to
reshape the child's thinking (cognition) to improve
problem solving skills, anger management, moral
reasoning skills, and impulse control.
Family therapy may be used to help improve
family interactions and communication among
family members. A specialized therapy technique
called parent management training (PMT) teaches
parents ways to positively alter their child's
behavior in the home.
NURSING INTERVENTIONS
Decreasing violence and increasing compliance with treatment
1. Protect others from client’s aggression and manipulation.
2. Set limits for unacceptable behavior.
3. Provide consistency with the client’s treatment plan.
4. Use behavioral contracts.
5. Institute time-out.
6. Provide a routine schedule of daily activities.
Improving coping skills and self-esteem
1. Show acceptance of the person, not necessarily the behavior.
2. Encourage the client to keep a diary.
3. Teach and practice problem-solving skills.
4. Promoting social interaction
5. Teach age-appropriate social skills.
6. Role model and practice social skills.
7. Provide positive feedback for acceptable behavior.
8. Providing client and family education
 OPPOSITIONAL
DEFIANT DISORDER
By: Felmark Ross D. Labrador
BSN 302
Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is a childhood
mental disorder which consists of an enduring pattern
of uncooperative, defiant, disobedient, and hostile
behavior toward authority figures without major
antisocial violations. A certain level of oppositional
behavior is common in children and adolescents;
indeed, it is almost expected at some phases such as
2 to 3 years of age and in early adolescence. The
prevalence rates of ODD vary from 2% up to 15% of
the adolescent population, which highlights the
difficulty of distinguishing negative behaviour from
ODD and conduct disorder–type behaviors.
DIAGNOSIS
ODD is diagnosed only when behaviors are more frequent and intense
than in unaffected peers and cause dysfunction in social, academic, or
work situations. The disruptive, defiant behaviors usually begin at home
with parents or parental figures and are more intense in this setting than
settings outside the home.
Early onset is also associated with an increased risk for developing
conduct disorder. Children with this disorder can develop conduct
disorder; some will be diagnosed with antisocial personality disorder as
adults.
For a child to be diagnosed with an oppositional defiant disorder, they
must exhibit at least four out of eight symptoms found in the diagnostic
criteria of DSM-5.
 TREATMENT
Treatment for ODD is based on
parent management training
models of behavioral
interventions. These programs are
based on the idea that ODD
problem behaviors are learned
and inadvertently reinforced in
the home and school.
 CONDUCT DISORDER VS OPPOSITIONAL DEFIANT DISORDER

Characterized by aggression, destruction, Characterized by angry or irritable mood,

deceitfulness or theft, and serious violations argumentative or defiant, and vindictiveness

MORE symptoms related with PHYSICAL LESS symptoms related with PHYSICAL
VIOLENCE VIOLENCE

Duration of symptoms is at least 12 MONTHS Duration of sypmtoms is at least 6 MONTHS

Severity is based on frequency and extent of Severity is according to number of settings

misconduct where the behavior is manifested

Has THREE SUBTYPES NO SPECIFIED SUBTYPE

Affective-oriented risk factors Both Affective and Cognitive-oriented

risk factors
REFERENCES

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