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Slide 0
Chapter 22
Social Responses and
Personality Disorders
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 1
Figure 22-1 States of relatedness. (From Hagerty BMK et al: Image 25:291, 1993.)
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 2
Features of Personality Disorders
• The individual has acquired few strategies for relating,
and his or her approach to relationships and to the
environment is inflexible and maladaptive.
• The individual’s needs, perceptions, and behavior tend
to foster vicious circles that continue unhelpful patterns
and provoke negative reactions from others.
• The individual’s adaptation skills are characterized by
tenuous stability, fragility, and lack of resilience when
faced with stressful situations.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 3
DSM-IV-TR Clusters of Personality
Disorders
• Cluster A includes personality disorders of an odd or
eccentric nature (paranoid, schizoid, and schizotypal
personality disorders)
• Cluster B includes disorders of an erratic, dramatic, or
emotional nature (antisocial, borderline, histrionic, and
narcissistic personality disorders)
• Cluster C includes disorders of an anxious or fearful
nature (avoidant, dependent, and obsessivecompulsive personality disorders)
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 4
Figure 22-4 The Stuart Stress Adaptation Model as related to social responses.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 5
Primary Nursing Diagnoses Related to
Maladaptive Social Responses
• Defensive coping
• Chronic low self-esteem
• Risk for self-mutilation
• Impaired social interaction
• Risk for self-directed violence
• Risk for other-directed violence
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Slide 6
Primary Medical Diagnoses Related to
Maladaptive Social Responses
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder
• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 7
Evidence-Based Treatments for Personality
Disorders
Disorder: Avoidant personality disorder
Treatment:
• Group-administered behavioral interventions are
effective in improving social skills.
• Antidepressants may be helpful as well.
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Slide 8
Evidence-Based Treatments for Personality
Disorders (Cont.)
Disorder: Borderline personality disorder
Treatment:
• Dialectical behavioral therapy (DBT) produces lower
attrition, fewer and less severe episodes of parasuicidal
behavior, and fewer days of hospitalization.
• Partial hospitalization involving group and individual
psychotherapy for 18 months reduces the number of
suicide attempts, acts of self-harm, psychiatric
symptoms, and inpatient days, and increases the quality
of social and interpersonal functioning.
• Noradrenergic agents tend to improve mood but not
irritability or dyscontrol.
• Serotonergic agents may act to reduce impulsivity.
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Slide 9
Evidence-Based Treatments for Personality
Disorders (Cont.)
Disorder: Mixed personality disorder (excluding
cluster A disorders)
Treatment:
• An average of 40 weeks of brief dynamic therapy
yields substantial symptomatic improvement at both
the end of treatment and after 1.5 years.
• Medications may be useful for several of these
disorders, although many methodological problems
remain to be worked out.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 10
Evidence-Based Treatments for Personality
Disorders (Cont.)
Disorder: Schizotypal personality disorder (and other
cluster A disorders)
Treatment:
• Antipsychotic medications may be useful in reducing
some of the symptoms of these disorders.
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