PSYCHIATRIC NURSING

PERSONALITY DISORDER

Personality Disorder

Personality Disorder
• Assessment:
– – Inflexible & maladaptive responses to stress. Distress & impairment in social, occupational, & other areas of functioning. – Stable & long duration – Ability to evoke interpersonal conflict .

Personality Disorder : Clusters
A: Odd or Eccentric
– Paranoid P.D – Schizoid P.D. – Schizotypal P.D

• C : Anxious , fearful
– Dependent P.D – Obsessive – Compulsive P.D – Avoidant P.D.

• B:Dramatic, emotional, erratic
– – – – Antisocial P.D Borderline P.D. Histrionic P.D. Narcissistic P.D.

Personality Disorder : Cluster-A
A. Paranoid P.D. Vigilant & suspicious Bear grudges, unforgiving Diff. close relationship/work alone Cold, lack of sense of humor Very critical • Interventions: – Avoid being too friendly/nice – Give clear simple explanation, language. – Maintain neutral & kind affect. – Make a written plan of treatment – cooperation. – Antipsychotic medications

Personality Disorder : Cluster-A
A. Schizoid P.D.
Neither desire nor close relationships. Prefer solitary/loners. Cold, detachment, flattened affect. Occupation involves little interpersonal contacts.

• Interventions:
– Avoid being too nice & friendly – Do not try to re-socialize – Supportive psychotherapy – Behavioral-cognitive ty – Group therapy – Atypical AntiPsychotic

Personality Disorder : Cluster-A
A. Schizotypal P.D.
Similar to schizoid. Ideas of reference, odd beliefs, magical thinking, illusions. Paranoid fears Lack of interpersonal relationships. Inappropriate affect Odd, eccentric or peculiar.

• Interventions:
– Respect C. need for social isolation. – Appropriate intervention for suspiciousness. – Same with schizoid.

Personality Disorder : Cluster-B
B. ANTISOCIAL Personality P.D. • Interventions: – Prevent manipulative behavior Stealing, lying,cruelty to – set clear & realistic limits. animals, vandalism, sunbstance abuse. ( known to all) Deceitful – Document behaviors, physical signs. Consistent irresponsibility – Provide clear boundaries & Impassivity & repeated aggressiveness. consequences Total lack of remorse – Be aware of guilt & Manipulative, aggressive, manipulations. exploiting. – Treatment for substance abuse Substance abuse – Lithium; carbamazipine, SSRI

– Behavior therapy

Personality Disorder : Cluster-B
B. Borderline P.D.

Intense and unstable relationshipsdependence vs. rejections. Impulsive, self damaging behaviors. Recurrent suicidal/self mutilating behaviors/sarcasm Chronic feeling of emptiness or boredom, absence of satisfaction Frantic efforts to avoid abandonment. Splitting personality-good vs. bad.

• Interventions: o Set clear/realistic goals. o Be aware of manipulative behaviors o Provide clear and consistent boundaries & limits. o Avoid rejecting and rescuing. o Assess suicidal, aggressive behaviors. o Hospitalization possible. o Behavior- cognitive therapy o Group therapy. o SSRI

Personality Disorder : Cluster-B
B. Histrionic P.D. Consistently draw attention to themselves. Attractive & use physical appearance. Show excessive emotionality and attention getting behavior. Shallow personality. Are suggestible Without instant gratification or admiration from others – depression or suicidal

• Interventions: – Understand seductive behavior – distress – Keep professional communication and interactions. – Use concrete and descriptive language. – Teach and model assertiveness.

Personality Disorder : Cluster-B
B. Narcissistic P.D. Exploit others to meet their own needs & desires Arrogant, persistent entitlement. Demeanor of grandiosity, need for admiration, lack of empathy Begrudge others their success or possessions. Relationships are characterized by disruption or control.

• Interventions: – Remain neutral & avoid power struggles or becoming defensive. – Convey anassuming self-confidence.

Personality Disorder : Cluster-C
C. Dependent P.D. Unusual degree of agreeableness & friendliness. Clinging behavior Difficulty decision making Often mistreated, abused, self sacrifice. Have difficulty expressing disagreements

• Interventions: – Try to satisfy c’s need, set limits. – Teach and role model assertiveness

Personality Disorder : Cluster-C
C. Obsessive-Compulsive P.D. Inflexible, rigid& need to be in control Perfectionists Overemphasis on work. Preoccupied with details Highly critical of self & othersmorality, ethics, values. Intimacy in relationships is superficial.

• Interventions: – Guard against engaging in power struggles. – Need for control is very high. – Defense Mech: Intellectualization,r ationalization, reaction formation.

Personality Disorder : Cluster-C
C. Avoidant P.D. Social inhibition- social phobias Strong feelings of inadequacies. Avoid interpersonal activities. Views- socially inept, personally un appealing

• Interventions: – A friendly. Gentle reassuring approach. – Cognitive-behavioral, desensitization, social skills – May involve in small group activities. – MAOI, benzodiazepines

The end

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