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Chapter 10
Personality Disorders
Personality disorders
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Personality Definition
-Style of how a person deals with the world
-Traits are stylistic peculiarities that all people bring to social relationships
(shyness, seductiveness, etc)
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Personality Disorder Definition
-Personality traits exaggerated to the point that they cause dysfunction in their
relationships
-DSM IV classified as Axis II
-They do not believe there is anything wrong with them, but rather their
problems occur by other people or events
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Common characteristics
-Inflexible and maladaptive responses to stress
-Disability in working and living
-Tendency to evoke intense personal conflict
-Capacity to “get under the skin” of others
Prevalence and comorbidity
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Prevalence
-14.8% met the standard diagnostic criteria
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Comorbidity
-Often co-occur with substance abuse, somatization,
eating disorders, PTSD, depression and anxiety
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Theory
-Genetics: significant role in the development
-Neurobiological Factors: brain imaging suggest
abnormalities in prefrontal, corticostriatal and limbic
networks related to decreased serotonin
neurotransmission and behavioral disinhibition
-Psychological Influences: childhood abuse & trauma
-Cultural Considerations: Certain subgroups high risk
DSM IV: Cluster A The odd and
eccentric personality disorders
Often referred to as “odd” or “eccentric”
 Most strongly related to schizophrenia
 Common features: avoid interpersonal
relationships, have unusual beliefs,
indifferent to reactions of others
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-Paranoid Personality Disorder
-Schizoid Personality Disorder
-Schizotypal Personality Disorder
DSM IV Cluster B: the dramatic,
emotional, erratic personality
Characteristics: Dramatic, erratic or
flamboyant behavior
 Overlap with Axis I Comorbidity
 Manipulation is common defensive
mechanism
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-Antisocial Personality Disorder
-Borderline Personality Disorder
-Histrionic Personality Disorder
-Narcissistic Personality Disorder
DSM IV: Cluster C the anxious and
fearful disorders
Common features: high levels of anxiety
and outward signs of fear
 Show social inhibitions in a sexual sphere
 Often fearful & reluctant to show irritation
and anger even when justified
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-Avoidant Personality Disorder
-Obsessive-Compulsive Personality Disorder
-Dependent Personality Disorder
Application of the nursing process
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Assessment
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Diagnosis
Outcomes Identification
Planning
Implementation
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Primitive Defenses
Assessment Tools: Assessment of history & self assessment
Assessment Guidelines
Communication Guidelines
Milieu Therapy
Psychotherapy: Psychodynamic, CBT, Dialectical Behavior Therapy
No medications for treatment of these disorders but treating the symptoms
is helpful
Evaluation
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Evaluating treatment effectiveness in the population- difficult