Personality- an ingrained, enduring pattern of behaving and relating to self, others, and the environment. - personality includes perceptions, attitudes, and emotions. - biologic, genetic, environment and other people influence personality. personality. Personality disorder Diagnosed when the person caused emotional distress. - when the p erson exhibits enduring behavioral patterns. Ways of perceiving and interpreting self, other people, and events (cognition) Range, intensity, lability, and appropriateness of emotional r esponse (affect) Interpersonal functioning Ability to control impulses or express behavior at the appropriate time and place (impulse control).
- antisocial personality disorder are less likely to engage in criminal behavior, although problems with substance abuse and disregard for the feelings. - borderline personality disorder tend to demonstrate decreased impulsive behavior, increased adaptive behavior.
ETIOLOGY Biologic Theories Temperament- biologic
processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion.
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CATEGORIES OF PERSONALITY DISORDERS A includes people whose behavior appears odd or eccentric and includes paranoid, schizoid, and schizotypal personality disorders. Cluster B includes people who appear dramatic, emotional, or erratic and includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C includes people who appear anxious or fearful and in cludes avoidant, dependent, and obsessive-compulsive obsessive-compulsive personality disorders y
Cluster
4 temperament traits: 1. harm avoidance - Maladaptive inhibition and excessive anxiety. - High-uncertainty, social inhibition, shyness with strangers,rapid fatigability, and pessimistic worry in anticipation of problems - Low- carefree, energetic, outgoing, and optimistic. - unwarranted optimism and unresponsiveness to potential harm or danger. 2. novelty seeking -High-who is quick-tempered, curious, easily bored, impulsive, extravagant, and disorderly. -Low- slow-tempered, stoical, reflective, frugal, reserved, orderly, and tolerant of monotony
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Proposed personality disorder categories: depressive and passive-aggressive personality disorders.
ONSET AND CLINICAL COURSE -
Clients with personality disorders have a
higher death rate especially as a r esult of suicide. People with personality disorders often are described as ³treatment-resistant.´ ³treatment-resistant.´ Clients with personality disorders do not perceive their dysfunctional or maladaptive behaviors as a problem; indeed, sometimes these behaviors are a source of pr ide.
3. reward dependence - defines how a person responds responds to social cues. - High-tenderhearted, sensitive, sociable, socially dependent. - Low- practical, tough-minded, cold, socially insensitive, irresolute, and indifferent to being alone. Social withdrawal, withdrawal, detachment, aloofness, and disinterest. 4. persistence -High- hardworking and ambitious overachievers who respond to fatigue or frustration as a personal challenge. -Low- inactive, indolent, unstable, and erratic. They tend to give up easily when frustrated and rarely strive for h igher accomplishments.
Psychodynamic Theories consists of concepts about the self and the external world.
Character
3 major character traits 1. self-directedness - responsible, reliable, resourceful, goal-oriented, and self-confident. - realistic and effective and can adapt their behavior to achieve goals.
4. anxiety a. chronic cognitive anxiety (SSRIs and MAOIs) b. somatic anxiety c. severe acute anxiety(MAOIs or lowdose antipsychotic)
- low in self-directedness are blaming, helpless, irresponsible, and unreliable.
The DSM-IV-TR clusters of personality disorders: Low reward dependence and cluster A disorders correspond to the categories of affective dysregulation, detachment, and cognitive disturbances High novelty seeking and cluster B disorders correspond to the target symptoms of impulsiveness and aggression. High harm avoidance and cluster C disorders correspond to the categories of anxiety and depression symptoms.
2. cooperativeness - a person sees himself or herself as an integral part of human society. -High-empathic, tolerant, compassionate, supportive, and principled. -Low- they look out for themselves without regard for the rights and feelings of others. 3. self-transcendence - a person considers himself or herself to be an integral part of the universe. - spiritual, unpretentious, humble, and fulfilled. - Low-self-transcendence are practical, self-conscious, materialistic, and controlling.
Psychopharmacology 4 symptom categories 1. cognitive perceptual distortions - Magical thinking, odd beliefs, illusions, suspiciousness, ideas of reference, and low-grade psychotic symptoms (low-dose antipsychotic medications) 2. affective symptoms and mood dysregulation - symptoms include emotional instability, emotional detachment, depression, and dysphoria. - Emotional instability and mood swings respond favorably to lithium, carbamazepine (Tegretol), valproate (Depakote), or low-dose neuroleptics such as haloperidol (Haldol). 3. aggression and behavioral dysfunction - Lithium, anticonvulsant mood stabilizers, and benzodiazepines are used most often to treat aggression. - Low-dose neuroleptics may be useful in modifying predatory aggression
Individual and Group Psychotherapy -
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focus on building trust, teaching basic living skills, providing support, decreasing distressing symptoms such as anxiety, and improving interpersonal r elationships. can improve the functional skills of people with schizotypal and schizoid personality disorders. to have more satisfying relationships with others and to build selfesteem.
Cognitive-behavioral
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therapy stops negative thought p atterns; positive self talk decatastrophizing that teaches the client to view life events more realistically ( to lower anxiety)
Dialectical behavior therapy (DBT) for clients with borderline personality disorder focuses on distorted thinking and behavior based on the assumption that poorly regulated emotions are the underlying problem
CLUSTER APERSONALITY
DISOR DERS A. PARANOID PERSONALITY DISORDER -
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characterized by pervasive mistrust and suspiciousness of others. Harmful (malevolence) develop transient psychotic symptoms when stressed out ( sumpong ) appear aloof and withdrawn and may remain a considerable physical distance from the nurse; they view this as necessary for their protection. appear guarded or hypervigilant have a restricted affect and be unable to demonstrate warm or empathic emotional responses Mood is labile, quickly changing from quietly suspicious to angry or h ostile use the defense mechanism of projection which is blaming other.
C. SCHIZOTYPAL PERSONALITY DISORDER - odd or eccentric severe anxiety -
experience transient psychotic episodes in response to extreme stress. Clients may be unkempt and disheveled. ( messed-up hair or clothes) coherent speech but vague restricted range of emotions illusion ( clairvoyance )
Nursing Interventions -
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development of self-care and social skills and improved functioning in the community. ( daily hygiene ) The nurse can then r ole-play interactions that clients would have with each of these people ( to practice clear and logical of patient )
Nursing Interventions
CLUSTER B PERSONALITY
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DISOR DERS
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approach these clients in a formal, businesslike manner. Being on time, keeping commitments, and being particularly straightforward helping clients to learn to validate ideas before taking action to avoid further problems ( to reorient client to reality )
D. ANTISOCIAL PERSONALITY DISORDER - pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation. Onset is in childhood or adolescence
B. SCHIZOID PERSONALITY DISORDER - detachment from social relationships and a restricted range of emotional expression - aloof and indifferent, appearing emotionally cold, uncaring, or unfeeling. no leisure difficulty experiencing and expressing emotions, particularly anger or aggression. have a rich and extensive fantasy life but do not shows it. (rewarding and gratifying) They may spend long hours solving puzzles or mathematical problems lack future goals or direction. self-absorbed and loners
Nursing Interventions -
referrals to social services for assistance promote socialization through group activities
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false emotions they view the world narrow, distorted, cold, hostile oriented, average or above IQ ³ gusting makuha kaagad kung anung gusto´ Impulsive Manipulative
Intervention FORMING
A THER APEUT IC AND PROMOTING RESPONSIBLE BEHAVIOR - Confrontation is another technique designed to manage manipulative or deceptive behavior. ( to keep clients focused on the topic ) RELATIONSHIP
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E. BORDERLINE PERSONALITY DISORDER - a prolonged disturbance of personality function most common type of personality dysphoric involving unhappiness, restlessness, and malaise
restructuring helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking. Thought-stopping is a technique to alter the process of negative or self critical thought patterns positive self-talk, the client reframes negative thoughts into positive ones - Decatastrophizing is a technique that involves learning to assess situations r ealistically rather than always assuming a catastrophe will happen Cognitive
F. HISTRIONIC PERSONALITY DISORDER -
excessive emotionality and attentionseeking. dramatize relatively minor occurrences can result in unreliable data. emotionally expressive, gregarious, and effusive. uncomfortable when they are not th e center of attention
G. NAR CISSISTI C PERSONALITY DISORDER - pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy - pretentious display an arrogant or hau ghty attitude. ( being superior ) Thought-processing is intact, but insight is limited or poor.
Nursing Interventions - use self-awareness skills to avoid the anger and frustration that their behavior and attitude can engender. The goal is to gain cooperation of these clients with other treatment as indicated
CLUSTER C PERSONALITY
DISOR DERS AVOIDANT PERSONALITY DISORDER (AvPD) - pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation.
- pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction.
DEPENDENT PERSONALITY DISORDER ( DPD ) - psychological dependence on other people -
characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER - a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control and orderliness at the expense of flexibility, openn ess and efficiency.
OTHER R ELATED DISOR DERS
DEPRESSIVE PERSONALITY DISORDER - pattern of depressive cognitions and behaviors in various contexts. have a sad, gloomy, or dejected affect Self-esteem is quite low
PASSIVE-AGGRESSIVE PERSONALITY DISORDER - resistance to demands for adequate social and occupational performance. - appear cooperative, even ingratiating, or sullen and withdrawn, depending on the circumstances.
Points to Consider When Working With Clients With Personality Disorders Talking to colleagues about feelings of frustration will help you to deal with your emotional responses so you can be more effective with clients. Clear, frequent communication with other health care providers can help to diminish the client¶s manipulation. Do not take undue flattery or harsh criticism personally; it is a result of the client¶s personality disorder. Set realistic goals and r emember that behavior changes in clients with personality disorders take a long time. Progress can be very slow.
