Download Personality Disorders

Personality Disorders
Andrea Valdez
Cluster A:
The odd, eccentric Cluster.
Paranoid Personality Disorder:
Personality disorder in which a person has a long term of
distrust and suspicion of others.
Dale a 46 year old male with PPD, asks his therapist
repeatedly if he works for the CIA. He wouldn’t let the
therapist record their session and kept looking out the
blinds, he constantly says during the interview “there
are more secrets in people’s trash than in the CIA!” He
exclaims “You think that your academic degree makes
you more clever than I am or superior than me?” –At
the end of each session Dale wanted to check the
phone jacks and under the therapist’s desk…. “You can
never be too careful,” he half apologizes.
Schizoid Personality Disorder:
Lack of interest in social relationships, a tendency towards a solitary
lifestyle, emotional coldness and apathy, due to social anxiety
Tyler, 15 male, lives with his mom and sister, diagnosed
with SPD, spends most of his days playing games on
the computer and “talking” to people online. Tyler says
he only has one real life friend, but no one has ever met
his friend. He has a hard time carrying a conversation,
especially with people who are not his immediate family,
laughs at inappropriate situations. Tends to wear black
clothes all the time, he has severe social anxiety and
believes his teacher and classmates think negative things
about him as he believes they single him out.
Schizotypal Personality Disorder:
They experience acute discomfort in social settings and have a reduced capacity for
close relationships. They usually have voluntary social withdrawal similar to people
who are Schizoid. So you can think of Schizotypal as Schizoid plus magical thinking
and odd behavior.
George changed as a result of an epiphany he experienced at
the tender age of 9 when he encountered an alien spaceship
in his back yard and "in all probability" was abducted by its
crew. Ever since then, he has had numerous out of body
experiences and has developed psychic capabilities such as
remote viewing. "I can see that you don't believe a word of
it." - he declaims bitterly - "You probably can't wait to tell the
other therapists here about me and have a good laugh at my
expense." The Dr. reminds him that therapy sessions are
strictly confidential but he nods his head, "Yeah, sure,
whatever you say, Doc."
Cluster B:
The dramatic, emotional and erratic cluster.
Borderline Personality Disorder:
Experience intense, unstable emotions and moods swings that can shift fairly
quickly, generally have a hard time calming down once upset. They have
frequent anger outbursts and engage impulsive behaviors.
I never really feel 'happy and content' inside. I can feel
temporarily happy, angry, aggressive, depressed and empty,
extremely sad, jealous, hopeless, worthless and confused. Any
of these emotions are temporary. The main emotion that
stays with me most of the time is anxiety and I have trouble
relaxing and dealing with the smallest of things sometimes. I
can switch from one good emotion to another in a flash, and
no-one can understand why - even though I have reasons of
my own at the time. Everything is either black or white - I
can switch from liking someone a lot, to disliking them
completely, just through one individual incident. This hurts
those people if I confront them with it, but most of all, it
hurts me and my relationships.
Narcissistic Personality Disorder:
Problems with their sense of self-worth from a powerful sense of entitlement. Leads them
to believe they deserve special treatment, and assume they are uniquely talented. Their
sense of entitlement can lead them to act in ways that disregard and disrespect the worth
of those around them.
Sam complains of inability to tolerate people's stupidity
and selfishness in a variety of settings. He admits that
as a result of his "intellectual superiority" he is not well
placed to interact with others or even to understand
them and what they are going through. He is a recluse
and fears that he is being mocked as a misfit and a
freak. Throughout the first session, he frequently
compares himself to a machine, a computer, or a
member of an alien and advanced race. He even
describes being stalked by two or three vicious women
whom he had spurned, he claims, not without pride in
his own implied irresistibility.
Histrionic Personality Disorder:
Are characterized by a pattern of excessive emotionality and attention seeking.
Their lives are full of drama (so-called "drama queens"). They are uncomfortable
in situations where they are not the center of attention.
Marsha visibly resents the fact that the doctor has had
to pay attention to another patient (an emergency) "at
my expense" as she puts it. She pouts and bats
suspiciously long eyelashes as the male nurse explains
the doctor will be with her shortly, as there has been an
emergency. "Has any of your female patients fallen in
love with you?" - she suddenly changes tack. She laughs
throatily and shakes loose an acid blond mane: "You
may call it what you want nurse, but the simple truth is
that you are irresistibly cute” as she tries to get the male
staff ’s attention.
Antisocial Personality Disorder:
Is characterized by a pervasive pattern of disregard for the rights of other
people that often manifests as hostility and/or aggression. Deceit and
manipulation are also central features.
Mr. Ross was referred to therapy by the court, as part of a
rehabilitation program. He has served time in prison, having
been convicted of grand fraud. The scam perpetrated by him
involved hundreds of retired men and women in a dozen
states over a period of three years. All his victims lost their
life savings and suffered grievous and life-threatening stress
symptoms. When I ask him how does he feel about the fact
that three of his victims died of heart attacks as a direct
result of his misdeeds, he barely suppresses an urge to laugh
out loud and then denies any responsibility: his "clients" were
adults who knew what they were doing and had the deal he
was working on gone well, they would all have become "filthy
rich."
Cluster C:
The anxious, fearful cluster.
Avoidant Personality Disorder:
Is characterized by a pervasive pattern of social inhibition, feelings of inadequacy,
and a hypersensitivity to negative evaluation. People with this disorder are intensely
afraid that others will ridicule them, reject them, or criticize them.
"I would like to be normal" - says Gladys and blushes
purple. In which sense is she abnormal? She prefers
reading books and watching movies with her elderly
mother to going out with her colleagues to the
occasional office party. Maybe she doesn't feel close to
them? How long has she been working with these
people? Eight years in the same firm and "not one raise
in salary" - she blurts out, evidently hurt. Her boss
bullies her publicly and the searing shame of it all
prevents her from socializing with peers, suppliers, and
clients.
Dependent Personality Disorder:
Is a strong need to be taken care of by other people.
Tends to be clingy.
"I know I won't actually die, but it often feels like it." says Mona and nervously pats her auburn hair - "I can't
live without him, that's for sure. When he is gone, it's
like life switching from Technicolor to black and white.
There is no excitement, this electricity in the air that
seems to constantly surround him." She misses him so
much that it physically hurts. Sometimes she feels like
throwing up at the mere thought of separating or being
abandoned by him. I love him and he loves me, I know
it.
Obsessive Compulsive Personality Disorder:
Are preoccupied with rules, regulations, and orderliness. This
preoccupation with perfectionism and control is at the expense of
flexibility, openness, and efficiency.
Magda is distressed when I reschedule
our appointment. "But we always meet on
Wednesdays!" - she pleads, ignoring my
detailed explanations and my apologies.
She is evidently anxious and her voice
trembles. In small, precise movements
she rearranges the objects on my desk,
stacking stray papers and replacing pens
and pencils in their designated canisters.
Personality Disorders:
The Possible Causes
Karina Perez Reyes
Etiology
• Personality disorders are the result of complex biological and physiological
phenomena that are influenced by multifaceted variables involving genetics,
neurobiology, chemistry and environmental factors.
Biological Factors
• Genetic: Studies have led to a consensus that personality disorders represent
extreme variations of normal personality traits in four areas: anxious-dependency
traits, psychopathy-antisocial, social withdrawal, and compulsivity. These findings
support a genetic or inherited trait transmission in families.
• Neurobiological: The chemical neurotransmitter theory proposes that certain
neurotransmitters, including neurohormones, may regulate and influence
temperament. Research in brain imaging has also revealed some differences in the
size and function of specific structures of the brain in persons with some
personality disorders.
Psychological Factors
• Learning theory: The child develops maladaptive responses based on modeling or
reinforcement by important people in the child’s life.
• Cognitive Theory: The role of beliefs and assumptions in creating emotional and
behavioral responses that influence one’s experiences within the family
environment.
• Psychoanalytic Theory: The use of primitive defense mechanisms by individuals
with personality disorders. Defense mechanisms such as repression, suppression,
regression, undoing, and splitting have been identified as dominant.
Environmental Factors
• Behavioral genetics research has shown that about half of the variance
accounting for personality traits emerges from the environment. These
findings suggest that while the family environment is influential on
development, there are other environmental factors besides family
upbringing that shape an individual’s personality. For example, this can be
noted with siblings that are raised together yet have different personalities.
Diathesis-Stress Model
• Theory that explains psychopathology using a system approach. This theory explains how personality
disorders emerge from the multifaceted factors of biology and environment.
• Diathesis: Genetic and biological vulnerabilities and includes personality traits and temperament.
Temperament is our tendency to respond to challenges in predictable ways.
• Stress: Immediate influences on personality, such as the physical, social, psychological, and emotional
environment. Stress also includes what happened in the past, such as growing up in one’s family with
exposure to unique experiences and patterns of interaction.
• Under conditions of stress, the diathesis-stress model proposes that personality development becomes
maladaptive for some people, resulting in the emergence of a personality disorder.
• Genetic and biological traits are believed to influence the way an individual responds to the environment,
while at the same time, the environment is thought to influence the expression of inherited traits.
• Many studies have suggested a strong correlation between trauma, neglect , and other dysfunctional family or
social patterns of interaction on the development of the personality disorders among individuals with certain
personality traits and temperament.
Assessments
Jasmine Lopez
Cluster A
Paranoid (Distrustful/Suspicious), Schizoid (Social detachment,
emotionally restricted), Schizotypal (Odd beliefs, socially isolated)
Psychosocial Assessments
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Occupation
Education level
Medical history
Comorbidities
Current medications
Support systems
Cultural and/or spiritual beliefs
Cluster A
Paranoid (Distrustful/Suspicious), Schizoid (Social detachment,
emotionally restricted), Schizotypal (Odd beliefs, socially isolated)
Physical Assessments
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Level of anxiety
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Level of concentration
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Hallucinations
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Delusions
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Disorganized speech
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Dress and grooming
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Are they hearing voices?
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Signs of Depression
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Homicidal thoughts
Suicidal thoughts
1. Are you currently thinking about suicide?
2. Do you have a gun in your possession?
3. Do you have a plan to commit suicide?
4. Do you live alone?
5. Do you have local friends or family?
Cluster B
Antisocial (Disregard rights of others), Borderline (Instability in relationships,
impulsive), Histrionic (Excessive attention seeking), Narcissistic (Feelings of
grandiosity, need for admiration, lack of empathy)
Assessments
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Current relationships
History of trouble with the law
Violent or aggressive behavior
Cognitive dysfunctions
Thought process
Dishonest/manipulative statements
Impulse control
Self destructive behaviors
Suicidal thoughts
Isolation
Disturbed personal identity
Unstable mood/ mood swings
Ability to regulate emotions
Cluster C
Avoidant (Fear of rejection), Dependent (Need to be taken care of), Obsessive
compulsive (Preoccupation with orderliness, perfection, control)
Assessments
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Level of anxiety
Social isolation
Ability to be flexible
Ability to perform ADL’s
Self esteem
Interpersonal skills
Need to control
Fears of abandonment
Ability to control anger
Thought process
NANDA
Risk for harm to self r/t despair/hopelessness AEB swallowing foreign
objects.
Risk for social isolation r/t fear of rejection AEB inability to keep a job.
Diagnosis Outcomes
Eddy de la Torre
Cluster A
Paranoia
• The patient will consider alternate interpretations of situations without
becoming hostile or anxious.
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The patient will express fears and concerns.
The patient will demonstrate adapting coping techniques.
The patient will not harm others.
The patient will verbalize positive feelings about self.
Schizoid and Schizotypal
• The patient will increase attendance to group therapy.
• The client will identify proper coping techniques when around groups of
people.
• The patient will be able to identify the feeling of anxiety.
• The patient will verbalize feelings of anxiety or depression.
• The patient will finally be able to attend settings with groups of people.
Cluster B
Histrionic and Narcissistic
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Patient attends cognitive behavioral therapy to help with personal thinking
The patient will be able to discuss fantasies and rationalize them
Patient will increase self esteem
Patient will be able to properly set and work towards goals.
Borderline and Antisocial
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The patient will have established goals for self and asserts control over life.
The patient will attend cognitive behavioral therapy
The patient will be able to demonstrate appropriate coping factors
The patient will be able clarify certain feelings of negativity
Cluster C
Avoidant and Dependent
• Patent will have attended cognitive behavior therapies
• Patient will be able to express and verbalize feelings of anxiety or fears of
certain situations
• Patient will improve coping techniques in relation to anxiety or fear
• Patient will be able to identify situations which trigger anxiety or fears
Obsessive Compulsive Disorder
• Patient will be able to identify what triggers anxiety
• Patient will have learned alternate coping techniques relating to their anxiety
• Patient will consistently attend cognitive behavior therapy
Talk Therapy for
Personality Disorders
Rosa Pratt
Who ?
• PCPs may feel less comfortable treating severe depression with high suicidal
risk and direct patients to specialized care providers
• Advanced practice psychiatric nurses, psychiatrists, psychologists, social
workers, and nurse practitioners may focus solely on psychiatric care
• Psychotherapy may vary from formal to informal setting
• 21% of patients in primary care with major depression have an undiagnosed
bipolar disorder
What?
• Psychotherapy includes individual, couple, group, or family therapy that uses
evidenced based therapeutic frame-works and the nurse patient relationship
• Provides a safe environment where clients can receive feedback, share coping
skills, resources, and problem solving
• It stresses empathetic understanding, coping and anxiety reduction
• Helps patients manage strained interpersonal relationships, marriage and
family problems, academic and occupational problems and legal problems
Why?
• Talk therapy has been proven to be very effective treatment methodologies
for mood disorders
• Improves patient’s functioning between episodes and attempt to decrease the
frequency of future episodes
• Psychotherapy results in greater adherence to the lithium regimen
• Patients must deal with the consequences of their past episodes and their
vulnerability to experiencing future episodes
When?
• Pharmacotherapy and psychiatric management are essential in treatment of
acute manic attacks and during the continuation and maintenance phases of
bipolar disorder
• Patient an family need teaching of warning signs and symptoms of
impending episodes (changes in sleep patterns)
• Patient may be given a list of referrals for therapy and support groups like
the Depression and Bipolar Support Alliance (DBSA) or the ManicDepressive Association
Symptoms
Jennifer Lavery
Cluster A
Paranoid Personality Disorder
• distrusting, suspicious, hypersensitive, secretive, hypervigilant, jealous,
controlling
• believe others want to exploit, harm or deceive them without any evidence
of that
• difficult to interview as they are reluctant to share information about
themselves
• anticipates hostility
Schizoid Personality Disorder
• Indifferent, passive, emotionally detached, feelings of being an observer
• depersonalization (feelings of being detached from self and others)
Schizotypal Personality Disorder
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extreme anxiety in social situations, paranoia, odd beliefs, magical thinking
rambling/abstract/overly detailed conversations
misinterprets motivations of others and blame them for their social isolation
possible hallucinations and delusions
Cluster B
Histrionic Personality Disorder
• self-centered, low frustration tolerance, excessive emotionality
• impulsive, melodramatic, flirtatious, provocative, flamboyant, attention seeker
Narcissistic Personality Disorder
• egocentric, arrogant, inflated view of self, needs constant admiration, lack of
empathy for others,
• sense of personal entitlement, intense shame and fear of abandonment
Borderline Personality Disorder
• impulsive, self-mutilation, manipulative, self-image distortions, unstable
mood
• instability of emotional control, suicidal ideation
• hostility/anger/irritability in relationships, splitting
Antisocial Personality Disorder
• rule breaker, aggressive, abusive, deceitful, manipulative, disregard for
responsibility,
• impulsive, lack of empathy, unexpressive affect
• can be witty and charming when being manipulative
Cluster C
Avoidant Personality Disorder
• fears criticism, overly serious, withdrawn, low self-esteem, feelings of
inferiority
• reluctant to engage in new activities
Dependent Personality Disorder
• clingy, indecisive, submissive, fears of separation and abandonment
Obsessive-Compulsive Personality Disorder
• perfectionist, rigid, passive-aggressive, fearful of imminent catastrophe
Interventions, Communication
Techniques, & Medications
Gina Palacios
Cluster A- odd, eccentric thinking or behavior
• Paranoid-antianxiety and antipsychotic medication to improve relaxation and treat agitation
and delusions
• Schizoid-Psychotherapy and group therapy to improve sensitivity to others social cues, as
well as provide experiences in practicing interactions with others and feedback from others.
Wellbutrin (bupropion) is used to increase pleasure, as well as 2nd generation antipsychotics
(risperidone/risperdal & olanzapine/zyprexa) to improve a flattened mood.
• Schizotypal-therapy can help the person understand how perceptions can be faulty. Lowdose antipsychotic agents for psychotic-like symptoms and day-to-day functioning.
Depression and anxiety may be treated with antidepressants and antianxiety agents
Cluster B-dramatic, overly emotional or
unpredictable thinking or behavior
• Antisocial-Establishing the parameters of desirable and acceptable patient
behavior. Facilitation of the expression of anger in an adaptive, nonviolent
manner. Assisting the patient to mediate impulsive behavior through
application of problem-solving strategies to social and interpersonal
situations. No FDA specifically approved medications for treating antisocial
personality disorder. Prescribers are using medications “off label” until
evidence-based pharmacotherapies are proven to be safe and effective.
mood-stabilizing medications such as lithium to help with aggression and
impulsivity.
Cluster B-dramatic, overly emotional or
unpredictable thinking or behavior
• Borderline - maintain patient safety and to encourage verbalization of feelings and
impulses instead of action. Assist patient to identify situations and/or feelings that
may prompt self-harm. Instruct patient in coping strategies. Provide ongoing
surveillance of patient and environment. No medications specifically approved by
the FDA for treating personality disorders. prescribers are using the medications
“off label” until evidenced-based pharmacotherapies are proven to be safe and
effective. Persons with borderline personality disorder often respond to
anticonvulsant mood-stabilizing medications, low-dose antipsychotics, and omega-3
supplementation for mood and emotion dysregulation symptoms. Naltrexone, an
opioid receptor antagonist has been found to reduce self-injuring behaviors.
Cluster B-dramatic, overly emotional or
unpredictable thinking or behavior
• Histrionic-Psychotherapy is the treatment of choice for this disorder.
Medications such as antidepressants and antianxiety agents may be helpful in
treating associated symptoms.
• Narcissistic-no medication indicated for this disorder. Treatment includes
individual cognitive-behavioral therapy, family therapy, and group therapy.
Cluster C- anxious, fearful thinking or behavior.
• Avoidant- respond positively to antidepressant medications such as selective
serotonin reuptake inhibitors like citalopram and selective norepinephrine reuptake
inhibitors such as venlafaxine. Individual and group therapy is useful in processing
anxiety-provoking symptoms and in planning methods to approach and handle
anxiety-provoking situations.
• Dependent-no specific medications indicated for this disorder, but symptoms of
depression and anxiety may be treated with the appropriate medications.
Psychotherapy is the treatment of choice for this disorder. Cognitive behavioral
therapy can help in the development of new perspectives and attitudes about other
people.
Cluster C- anxious, fearful thinking or behavior.
• OCD-Selective serotonin reuptake inhibitors such as fluoxetine (Prozac) are
Food and Drug Administration (FDA) approved for the treatment of the
more severe version. Drugs such as Prozac may help reduce the obsessions,
anxiety, and depression associated with this disorder. Psychotherapy may
provide additional support. Group therapy and self-help groups have been
found to be especially helpful in sharing and learning from others.