Personality Disorders

• - suspicious, mistrust, interpret actions of others as a personal threat
• - hypersensitive to other people motives and often act in defense of a fragile self-concept, unable to laugh at themselves-very serious
• - always think someone is out to get them
• - can have irrational thinking- this is what will hospitilize them- become violent because of a perceived threat
• - diagnosed more often in men than
• women
• - they will have a blunted affect

- characterized by distrust and suspiousness towards others based on unfounded beliefs that others want to harm, exploit, or deceive the person (ATI)

*Cluster A- Odd or Eccentric traits

• - want emotional distance, do not want relationships with others
• - rarely have close friends and apprear uncomfortable interacting with others
• - do not care what others think
• - will have success in work if it does not involve social interaction
• - daydreamers- more gratifying than interacting for real
• - nurse-patient relationship will focus on building trust and initiating acceptance of group therapy

- characterized by emotional detatchment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative (ATI)

*Cluster A- Odd or Eccentric traits

• - similar to schizophrenia but psychotic symptoms are less severe and occur infrequently
• - problems in thinking, perceiving, and communicating
• - behavior odd, hard time fitting in, don't do well with rejection or anger
• - paranoid ideation and odd beliefs very prevalent
• - fantasies about imaginary relationships are substituted for real relationships

- Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations (ATI)

*Cluster A- Odd or Eccentric traits

*paranoid personality disorder, schizoid personality disorder, & schizotypal personality disorder

• - trust issues
• - professional demeanor
• - honesty
• - clear, concise explanations and requests
• - don't do well with groups that involve confrontation or emotional involvement

• - prior conduct disorder
• - total disregaurd for the law
• - promiscuous, feel no guilt about hurting others
• - most of time in prison system instead of mental health system
• - LIE, CHEAT, STEAL
• - can be charming, social, and intellectual
• - cause: genetics and enviroment, parents, bonding and weak response to autonomic nervous system, low heart rate, insensitive to the connotations of language, inability to learn from reward and punishment

• Nurse-Patient Relationship:
• - setting firm limits: they will try to manipulate the situation
• - need to be consistent with enforcing rules and behaviors
• - need to show accountability and identify how their behavior is affecting others

- characterized by disregaurd for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibilty (ATI)

- groups with other antisocial personality disorder patients are effective for them

*Cluster B- Dramatic, Emotional, or Erratic traits

• - emotional dysregulation
• - anger, impulsivity, intense psychological pain, impairment of interpersonal or occupational functioning
• - abandonment issues, self injurious behavior
• - has problems with identity- cannot appreciate mixed bag of qualities that others become
• - great problem with being alone, seeks short terms intimate relationships
• - displace anger on others
• - mimic bipolar qualitites,
• - mood swings, euphoria, rage
• self mutilate, and suicidal ideation
• - can appear as though they suffer from PTSD
• - 75% of BPD are women who have had sexual abuse as a child

- characterized by instability of affect, identity, and relationships; fear of abandonment, splitting behaviors, manipulation, and impulsiveness; often tries self mutilation and may be suicidal (ATI)

• Causes:
• - temperament, childhood experiences, neurologic and bichemical dysfunction
• - ineffective serotonin system and increased levels of norepinephrine, increased levels of anxiety and mood instability

• Treatment:
• - psychopharmacology: SSRI's
• - group therapy, problem solving, stress management, anger management

• Nurse-Patient Relationship:
• - use empathy while maintaining clear boundardies
• - must have limit setting

*Cluster B- Dramatic, Emotional, or Erratic traits

• - grandiose displays of their own self importance
• - reality based but embellished
• - needs to be admired, arrogant, self absorbed and self centered
• - indifferent to criticism of others- sense of entitlement
• - cannot emphasize with others, will use others to meet own needs; makes excuses and uses rationales why it is not their fault

• Nurse-Patient Relationship:
• - limit setting
• - realistic short term goals
• - group therapy

- characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensative to criticism

*Cluster B- Dramatic, Emotional, or Erratic traits

• - draws attention to themselves, dramatizes events
• - extroverted- silly, colorful, temper tantrums
• - uses somatic complaints to avoid responsibility and support dependency
• - views relationships with others as special and possessing greater intamacy than is real

• Nurse-Patient Relationship:
• - attention given for other centered behaviors
• - facilitate independence
• - problem solving
• - clarify true feelings and help clarify appropriate ways to express them

- characterized by emotional attention-seeking behavior in which the person needs to be the center of attention; often seductive and flirtatious (ATI)

*Cluster B- Dramatic, Emotional, or Erratic traits

• - excessive need to be taken care of that leads to submissive and clinging behaviors
• - fear of separation
• - need ot have direction and constant reassurance
• - feel inferior, avoid responsibility and express helplessness, maintain the need to rely on others

- characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends; the most frequently-seen personality disorder inthe clinical setting

• Nurse-Patient Relationship:
• - decision making
• - increase responsibility
• - become more assertive

*Cluster C- Anxious or Fearful traits; Insecurity and Inadequacy

• - timid
• - socially withdrawn, feel inadequate
• - fearful and shy-desire relationships but need to feel certain about being liked before making social contacts

**nurse needs to give positive feedback for any atttempt at interactoins with others to promote self-esteem

- characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations

• *Cluster C- Anxious or Fearful traits; Insecurity and Inadequacy

• - perfectionist
• - inflexible
• - afraid of making mistakes

- characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task

*Cluster C- Anxious or Fearful traits; Insecurity and Inadequacy