Chapter 22

2. Chapter 22 Social Responses and Personality Disorders

3. Figure 22-1 States of relatedness. (From Hagerty BMK et al: Image 25:291, 1993.)

4. 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.

5. 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 obsessive-compulsive personality disorders)

6. Figure 22-4 The Stuart Stress Adaptation Model as related to social responses.

7. 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

8. 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

9. 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.

10. 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.

11. 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.

12. 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.