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Introduction
- personality is defined as the totality of emotional and behavioral charasteristics that are particular to a specific person and that remain somewhat stable and predictable over time
- personality traits are characteristics with which an individual is born or develops early in life
- seen developing during the adolescent yrs but are not dx'ed until 18 until that time they are listed under Axis II as traits
- they influence the way in which he or she perceives and relates to the environment and are quite stable over time
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Historial Aspect
- the first recognition that personality disorder, apart from psychosis, were caused for their own special concern was in 1801, with the recognition that an individual can behave irrationally even when the powers of intellect are intact
- The pathology of personality is complex, but DSM attempt to classify trait specific diagnostic criteria to allow for identification of impairment and possible intervention strategies.
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Intro
biological and psychological
- Personality development occurs in response to a number of biological and psychological influences
- - heredity
- - temperament
- - experiential learning
- - social interaction
- - patient who experienced childhood trauma or abuse or any development factors that have a direct link to parenting are at risk for developing a personality disorder.
- rigid maladapative- effect jobs, social relationships, use substance (use as a defense mechanism constantly)
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Intro 2
- personality disorders occur when these traits become rigid and inflexible and contribute to maladaptive patterns of behaviors or impairment in functioning (loss of job, social relationships, SUD)
- a patient who has a personality disorder exhibits impairment in self-identity and self direction and these maladaptive behavioral are not always perceived by the pt as dysfunctional
- the often co-occur with other mental health diagnoses. such as depression, anxiety, eating disorders and SUD
- they are defense mechanism such as repression, regression, undoing and splitting
- (usually not hospital, you will find them SUD, self harm, getting arrested)
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Introduction 3
- people with personality disorders are not often treated in acute care settings in cases in which personality disorder is their primary psychiatric disorder
- many clients with other psychiatric and medical diagnoses manifest symptoms of personality disorders
- nurses are likely to encounter clients with these personality characteristics frequently in all health-care settings.
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Risk Factors 1
- Pt with personality disorders are at high risk for developing
- - self injury
- - suicide
- - drug and alcohol use
- - legal issue
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risk factor 2
- progression of psychiatric disorders such as OCD & depression
- interferes with tx of Axis I ie schizo
- inability to form relationships, hold steady job, control impulses, and aggression
- hard to dx, need to be observed over time and in multiple social and academic setting
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Tx Modalities for PD
- harder to understand bc not clear
- interpersonal psychotherapy
- psychoanalytical psycho therapy
- group therapy
- cognitive/behavioral therapy (thoughts to feelings)
- dialectical behavior therapy (psychosocial, arousal states/intrapersonal interactions)
- pychopharmacology- rarely
- tx is depending on type, age, safety, factors and co-morbidity
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Types of personality disorders
- ten specific types of personality disorders are identified in the DSM-5. they are classified into three american classification clusters
- - Cluster A Behaviors- odd, eccentric, suspicious, detached, (Paranoid PD, Schizoid PD, Schizotypal PD)
- - Cluster B Behavior- impulsive, dramatic, emotional, erratic (antisocial PD, borderline PD, historionic PD, Narcisstic PD)
- - Cluster C Behavior- submissive, anxious, fearful, controlling (Avoidant PD, dependent PD, OCD PD,
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Cluster A
Paranoid PD
- characterized as a pervasive, persistene and inapproriate mistrust of others
- individuals with this disorder are suspicious of others motive and assume that others intended to exploit, harm or deceive them
- the disorder is more common in men than in women with occurence of 1 in 4 percent of general population
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Cluster A
Paranoid PD
Clinical picture
- constantly on guard- on defensive
- hyperviligant
- ready for any real or imagined threat- will fight
- constantly test the honesty of others
- insensitive to the feelings of others
- attributes shortcomings to others
- in touch with reality in other areas.
- go to work.school but hard with relationships
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Cluster A Paranoid PD
clinical picture 2
- oversensitive
- trust no one
- tends to misinterupt minute cues
- magnifies and distorts cues in the environment
- does not accept responsibility for his/her own behavior
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Cluster A Paranoid PD
predisposing factors
- possible hereditary link with higher incident of among relatives of pt w/schizo
- subjected to early parental antagonism and harassment
- probable scapegoat of parent hostility and gave up all hope of affection and approval
- perceived the world as harsh and unkind and always have a chip on their shoulder
- they avoid humilitation and betrayl by attacking first
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Cluster A Paranoid PD
treatment
- avoid being overly warm and friendly or humorous with pt as they may misinterpret your intentions
- cannot tolerate group work and will often provoke intrapersonal conflict with others- watch this interaction
- provide consistent daily schedules and rules but respect privacy & provide access to CBT/DBT (don't like rules)
- be aware of your personal response to pt, gentle and unintrusive and be sure to avoid whispering around pt
- may also benefit of label use of antipsychotic, or antidepressants or anxiolytics to treat underlying co-morbid mental illness
- Primary care or er- see them for other reasons not this
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Cluster A Schizoid PD
- characterized primarily by a profound defect in the ability to form relationships
- failure to respond to other in a meaningful emotional way
- more than painfully shy
- dx occurs more frequently in men than in women
- prevalence within the general population has been estimated at 3 to 7.5 percent
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Cluster A Schizoid PD
clinical picture
- aloof and indifferent to others
- emotionally cold detached
- often no cooperative with direction, tx
- no close friends, perfers to be alone
- indifferent to praise or criticism
- appears shy, anxious, or uneasy in the pressence of others
- inapproriately serious about everything and difficulty acting in a light-hearted manner
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Cluster A Schizoid PD
predisposing factors
- possible hereditary factor
- childhood has been characterized as
- - bleak
- - cold
- - unempathetic
- - notably lacking in nurturing
- - ungratifying relationships that lead to assume that they are not worth pursuing
- not alot of love why bother with relationship
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Cluster A Schizotypal PD
most serious
- a graver form of the pathologically
- affects approx. 1 to 2 percent of the population
- a portion of these cases are linked to clinical precursors of schizo and were once described as 'latent schizo'
- no hallucination no negative symptoms
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Cluster A Schizotypal PD
clinical picture
- pts are aloof and isolated
- behave in a bland and apathetic manner
- strong perference to be alone
- little to no interest in sex or sexual relationships
- ideas of reference
- suspicious
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Cluster A Schizotypal PD
clinical picture- 2
- symptoms-
- magical thinkers- different from others- think about it and it happens I did that
- behavior appear odd or eccentric
- illusions
- depersonalization
- withdrawal into the self
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Cluster A Schizotypal PD
clinical picture 3
- exhibits bizarre speech patterns, tangential, vague and non pertinent to conservation
- when under stress, may decompensate and demostrate psychotic symptoms
- aggression may occur when psychotic and fearful
- demonstrates bland, inapproriate affect
- maybe creative- willy wonkers, bizarre, flamboyent
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Cluster A Schizotypal PD
predisposing factors
- possible hereditary factor
- possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain (dopamine mechanism)
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Cluster A Schizotypal PD
early family dynamics
- Indifference
- Impassivity
- formality
- leading to a pattern of discomfort with personal affection and closeness, especially if shunned or humilitated. new inner world provides more rewards that external one
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Cluster A Schizotypal PD
Treatment
- reality testing to help with their unusual thinking (add doubt)
- avoid becoming overly involved in pt inner world or personal life
- give clear direction, expectations, and explanation
- help inc social skills by modeling
- respect need for distance
- atypical antipsych, anxiolytics
- off label use of stimulants to left mood or inc social alertness (have also been used in depression)
- remember they don't want to connect with you.
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