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Chapter 20. Personality Disorders Part I. Introduction. Personality traits are enduring patterns of: Perceiving Relating to Thinking about the environment and oneself. Introduction (cont.). Personality disorders occur when these traits become Inflexible Maladaptive
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Chapter 20 Personality Disorders Part I
Introduction • Personality traits are enduring patterns of: • Perceiving • Relating to • Thinking about the environment and oneself.
Introduction (cont.) • Personality disorders occur when these traits become • Inflexible • Maladaptive • The cause of significant functional impairment or subjective distress
Introduction (cont.) • Personality development occurs in response to a number of biological and psychological influences, such as • Heredity • Temperament • Experiential learning • Social interaction
Introduction (cont.) • People with personality disorders are not often treated in acute care settings, for which personality disorder is their primary psychiatric disorder.
Introduction (cont.) • Many clients with other psychiatric and medical diagnoses manifest symptoms of personality disorders. • Nurses are likely to frequently encounter clients with these personality characteristics in all healthcare settings.
Personality Disorders • Cluster A: Behaviors that are described as odd or eccentric • Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder
Personality Disorders (cont.) • Cluster B: Behaviors that are described as dramatic, emotional, or erratic • Antisocial personality disorder • Borderline personality disorder • Histrionic personality disorder • Narcissistic personality disorder
Personality Disorders (cont.) • Cluster C: Behaviors that are described as anxious or fearful • Avoidant personality disorder • Dependent personality disorder • Obsessive-compulsive personality disorder
Types of Personality Disorders • Paranoid • Definition: A pervasive distrust and suspiciousness such that the motives of others are interpreted as malevolent; condition begins by early adulthood and presents in a variety of contexts
Paranoid • Disorder is more common in men than in women.
Paranoid (cont.) • Clinical Picture • Constantly on guard • Hypervigilant • Ready for any real or imagined threat • Trusts no one • Constantly tests the honesty of others
Paranoid (cont.) • Clinical Picture (cont.) • Oversensitive • Tends to misinterpret minute cues • Magnifies and distorts cues in the environment
Paranoid (cont.) • Etiological Implications • Possible hereditary link • Subject to early parental antagonism and aggression
Schizoid • Definition • Characterized primarily by a profound defect in the ability to form personal relationships • Failure to respond to others in a meaningful emotional way
Schizoid (cont.) • Definition (cont.) • Diagnosis occurs more frequently in men than in women. • Prevalence within the general population has been estimated at 3% to 7.5%.
Schizoid (cont.) • Clinical Picture • Indifferent to others • Client aloof • Client emotionally cold • In presence of others, clients appear shy, anxious, or uneasy • Inappropriately serious about everything and have difficulty acting in a light-hearted manner
Schizoid (cont.) • Etiological Implications • Possible hereditary factor • Childhood has been characterized as • Bleak • Cold • Unempathic • Notably lacking in nurturing
Schizotypal • Definition • A graver form of the pathologically less severe schizoid personality pattern
Schizotypal (cont.) • Definition (cont.) • Recent studies indicate that approximately 3% of the population has this disorder.
Schizotypal (cont.) • Clinical Picture • Clients aloof and isolated • Behave in a bland and apathetic manner
Schizotypal (cont.) • Clinical Picture (cont.) • Everyday world manifests • Magical thinking • Ideas of reference • Illusions • Depersonalization
Schizotypal (cont.) • Clinical Picture (cont.) • Exhibits bizarre speech pattern • When under stress, may decompensate and demonstrate psychotic symptoms • Demonstrates bland, inappropriate affect
Schizotypal (cont.) • Etiological Implications • Possible hereditary factor • Possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain
Schizotypal (cont.) • Etiological Implications (cont.) • Early family dynamics characterized by: • Indifference • Impassivity • Formality • Pattern of discomfort with personal affection and closeness
Types of Personality Disorders • Antisocial • Definition • A pattern of • Socially irresponsible • Exploitative • Guiltless behavior that reflects a disregard for the rights of others.
Antisocial • Clinical Picture • Fails to sustain consistent employment • Exploits and manipulates others for personal gain • Has a general disregard for the law
Antisocial (cont.) • Definition • Prevalence estimates in the United States range from 3% in men to less than 1% in women.
Types of Personality Disorders • Borderline • Definition • Characterized by a pattern of intense and chaotic relationships with affective instability • Clients have fluctuating and extreme attitudes regarding other people • Clients highly impulsive
Borderline • Definition (cont.) • Most common form of personality disorder • Emotionally unstable • Lacks a clear sense of identity
Histrionic • Definition (cont.) • Personality is • Excitable • Emotional • Colorful • Dramatic • Extroverted in behavior
Histrionic (cont.) • Definition (cont.) • Prevalence thought to be about 2% to 3% • More common in women than men
Histrionic (cont.) • Clinical picture • Affected clients are • Self-dramatizing • Attention-seeking • Overly gregarious • Seductive • Manipulative • Exhibitionistic
Histrionic (cont.) • Clinical picture (cont.) • Affected clients (cont.) • Are highly distractible • Have difficulty paying attention to detail • Are easily influenced by others • Have difficulty forming close relationships
Histrionic (cont.) • Etiological Implications • Possible link to the dopaminergic neurotransmitter system • Possible hereditary factor • Learned behavior patterns
Narcissistic • Definition • Characterized by an exaggerated sense of self-worth • Lacks empathy • Believes has inalienable right to receive special consideration
Narcissistic (cont.) • Definition • Prevalence of the disorder from 2% to 16% in the clinical population • Less than 1% in the general population is narcissistic • Disorder more common in men than women
Narcissistic (cont.) • Clinical Picture • Client overly self-centered • Exploits others in an effort to fulfill own desires • Mood, which is often grounded in grandiosity, is usually optimistic • Client relaxed, cheerful,and care-free
Narcissistic (cont.) • Clinical picture (cont.) • Mood can easily change because of fragile self-esteem if client does not • Meet self-expectations • Receive positive feedback expected from others • Responds to negative feedback from others with rage, shame, and humiliation
Narcissistic (cont.) • Etiological Implications • As children, these people have had their fears, failures, or dependency needs responded to with criticism, disdain, or neglect. • Parents were often narcissistic themselves.
Avoidant • Definition • Characterized by • Extreme sensitivity to rejection • Social withdrawal • Prevalence is between 0.5% and 1% and is equally common in both men and women.
Avoidant (cont.) • Clinical Picture • Awkward and uncomfortable in social situations • Desires close relationships but avoid them because of fear of being rejected
Avoidant (cont.) • Etiological Implications • Possible hereditary influences • Parental rejection and criticism
Dependent • Definition • Characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
Dependent (cont.) • Definition (cont.) • Relatively common within the population • More common among women than men • More common in the youngest children of a family than in the oldest ones
Dependent (cont.) • Clinical Picture • Client has a notable lack ofself-confidence that is often apparent in • Posture • Voice • Mannerisms
Dependent (cont.) • Clinical Picture (cont.) • Typically passive and acquiescent to desires of others • Overly generous and thoughtful while underplaying own attractiveness and achievements
Dependent (cont.) • Clinical Picture (cont.) • Assumes passive and submissive roles in relationships • Avoids positions of responsibility and becomes anxious when forced into them
Dependent (cont.) • Etiological Implications • Possible hereditary influence • Stimulation and nurturance are experienced exclusively from one source • A singular attachment is made by the infant to the exclusion of all others
Personality Disorders • Obsessive/Compulsive • Definition • Characterized by inflexibilityabout the way in which things must be done • Devotion to productivity at the exclusion of personal pleasure