Personality Disorders

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To become intimately involved with another person, an individual must

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risk revealing private thoughts and feelings

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indicates that the person is actively involved in satisfying relationships. It involves high levels of belonging, mutuality, reciprocity, and interdependence

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connectedness

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relates to a lack of involvement that is comfortable and acceptable to the individual

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parallelism

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occurs when the person is involved in relationships but is unable to maintain unique sense of self and ego boundaries

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enmeshment

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adaptive social responses include

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the ability to tolerate solitude and the expression of autonomy, mutuality, and interdependence

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personality is shaped by

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biology and social learning

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the symbiotic stage of development

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3 to 18 mos; infant completely dependent on others

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the separation-individuation of development

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18 months to 3 years

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the development of the child's internal psychological structure and growing sense of separateness, wholeness, and capabilitiy

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individualization

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the development of morality and empath feelings occurs between the ages of

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6 to 10 years

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ends when the person is self-sufficient and maintains interdependent relationships with parents and peers

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adolescence

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a set of deeply ingrained, enduring patterns of thinking, feeling, and behaving

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personality

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a set of patterns or traits that hinder a person's ability to maintain meaningful relationships, feel fulfilled, and enjoy life.

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personality disorder

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begins in adolescence or early adulthood, is stable over time, and leads to distress or impairment

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personality disorder

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Individuals with personality disorders have a significant and persistent impairment in their

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interpersonal relationships and other aspects of functioning

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Three key features of personality disorders

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1. The individual has an inflexible and maladaptive approach to relationships and the environment
2. The individual's needs, perceptions, and behavior tend to foster cycles that promote unhelpful patterns and provoke negative reactions from others.
3. The individual's coping skills are unstable and fragile, and there is a lack of resilience when faced with stressful situations

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Personality disorders of an odd or eccentric nature

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Cluster A

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Paranoid, schizoid, and schizotypal personality disorders

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Cluster A

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personality of an erratic, dramatic, or emotional nature

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Cluster B

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antisocial, borderline, histrionic, and narcissistic personality disorders

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cluster B

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personality disorders of an anxious or fearful nature

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avoidant, dependent, and OCD

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a behavior in which people treat others as objects and form relationships that center around control issues, with their behavior easily misunderstood

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manipulative behavior

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Manipulative patients have little motivation to

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change because it often has rewards for them: they are getting what they want.

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Manipulators are

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goal oriented or self oriented, not other oriented.

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Manipulators are skilled at giving the impression

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they care about others

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Manipulative persons is unaware of the lack of relatedness and assumes that

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interpersonal relationships are formed to take advantage of others

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A manipulative person cannot imagine an

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intimate, sharing relationship

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A difficult personality disorder to diagnose and treat; must be at least 18 y/o, and demonstrate a pattern of breaking rules since the age of 15.

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antisocial behavior

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This diagnosis is only applied when an individual consistently ignores social rules; in manipulative, exploitative, or dishonest; lacks remorse for actions; and is involved in criminal activity

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antisocial behavior

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Most prevalent personality disorder

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borderline personality disorder

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Characteristics of borderline personality disorder

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Women; did not achieve object constancy during the separation-individuation stage; fail to complete separation from primary caretaker and fail to complete autonomy in childhood

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Behavior characteristics of borderline personality disorder

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Clinging
Depression accompanied by rage and defended by acting out
Detachment and withdrawal

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____ is the hallmark of borderline personality disorder

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impulsive rage

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Seen in a borderline person's self-mutilation, unstable relationships, violence, and completed suicides

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impulsive aggression

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Problems with this personality disorder occur when people do not gain the status they think is deserved or lose status.

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narcissism

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Frustration caused by lack or loss of recognition may be expressed as

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anger, depression, substance abuse, or other maladaptive behaviors

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people with narcissistic personality disorders have

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fragile self-esteem

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Narcissistic people are constantly searching for

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praise, appreciation, and admiration

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extravagence, inability to establish and follow a life plan, failure to learn by experience, poor judgment, and unreliability

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impulsiveness

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Manipulative people may withdraw when

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confronted about their manipulations and may be rejected by those they have been trying to manipulate

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composed of temperament, which is inherited, and character, which is learned

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personality

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People with antisocial personality disorder have reduced _____ volume and lower than average activity in ____

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prefrontal gray matter; frontal lobes

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Borderline and antisocial disorders are associated with

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a wide variety of substance abuse disorders

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Amygdalas

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the brain region that governs learned fear and emotion

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The four childhood conditions that were found preceding a personality disorder diagnosis were:

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conduct problems, depressive symptoms, anxiety or fear, and immaturity

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Marriage, birth of a child, employment, going away to camp, job promotion brings about a great deal of anxiety to

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borderline personality disorder persons

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A characteristic of people with borderline personality disorder in which they have an inability to integrate the good and bad aspects of oneself and objects

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splitting

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A borderline patient projects onto a nurse the cruel, punishing parts of him and the nurse begins to react to the patient in a cruel, punishing way.

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projective identification

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expected outcome for the patient with maladaptive social responses will

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obtain maximum interpersonal satisfaction by establishing and maintaining self-enhancing relationships with others.

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a psychiatric condition in which a person has a long-term distrust and suspicion of others, but does not have a full-blown psychotic disorder such as schizophrenia

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paranoid personality disorder

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a psychiatric condition in which a person has a lifelong pattern of indifference to other and social isolation

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schizoid personality disorder

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a mental health condition in which a person has trouble with relationships and disturbances in thought patterns, appearance, and behavior

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schizotypal personality disorder

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A mental health condition in which a person has a long-term pattern of manipulation, exploiting, or violating the rights of others. This behavior is often criminal.

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antisocial personality disorder

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a condition in which people have long-term patterns of unstable, turbulent emotions, such as feelings about themselves and others. These inner experiences often cause them to take impulsive actions and have chaotic relationships.

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borderline personality disorder

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A condition in which people act in a very emotional and dramatic way that draws attention to themselves

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histrionic personality disorders

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A condition in which people have an inflated sense of self-importance and an extreme preoccupation with themselves

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narcissistic personality disorder

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A mental health condition in which a person has a lifelong pattern of feeling very shy, inadequate, and sensitive to rejection

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avoidant personality disorder

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a long-term (chronic) condition in which people depend too much on others to meet their emotional and physical needs

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dependent personality disorder

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a condition in which a person is preoccupied with rules, orderliness, and control

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OCD

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intense emotional attachment or rejection derived rom feelings about earlier personal relationships

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transference

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the nurse's strong reaction to the patient, such as feelings of excessive sympathy, impatience, anger, or contempt

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countertransference

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-establish control with no option to escape involvement
-provide an experienced, consistent staff
-implement clear structure with rules that are fair, firm, and consistently enforced
-provide support while the patient learns to experience painful feelings and try out new behavioral responses

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principles of milieu treatment for patients with cluster B personality disorders

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manipulative patients should be

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held responsible for their behaviors

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____ is a nursing intervention that can be helpful to patients who have difficulty with close relationships

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journal writing

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an empirically validated treatment approach for patients with borderline personality disorder

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dialectical behavior therapy

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DBT uses

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behavioral and cognitive techniques