Personality Disorder

Personality
● an ingrained enduring pattern of behaving and relating to self, others, and the
environment
● includes perceptions, attitudes, and emotions.
● A person usually is not consciously aware of her or his personality
● factors influence personality:
● some stem from biologic and genetic makeup
● acquired as a person develops and interacts with the environment and other people.

Personality Disorder
● are diagnosed when there is impairment of personality functioning and personality traits
that are maladaptive.
● behavior often fails to conform to cultural, social or legal norms.
Relationships with others are dysfunctional and often characterized by:
● deceit
● Coercion
● Dintimidation
> not capable of mutual, intimate relationships and lack the capacity for empathy, remorse, or
concern for others (Cloninger & Svrakic,2017)

Maladaptive or dysfunctional personality traits (Skodol, 2018) exhibited by

individuals with a personality disorder may INCLUDE:
● Negative behaviors toward others, such as being mAnipulative, dishonest, deceitful, or
lying
● Anger and/or hostility
● Irritable, labile moods
● Lack of guilt or remorse, emotionally cold and uncaring
● Impulsivity, distractibility, poor judgment
● Irresponsible
● Risk-taking, thrill-seeking behaviors
● Mistrust
● Exhibitionism
● Entitlement
● Dependency, insecurity
● Eccentric perceptions
the traits that are present or that predominate for a given person are the basis for distinguishing
the disorders from each other.

Personality Disorder
● diagnosed until adulthood, that is, at age 18, when personality is more completely
formed.
● long-standing
● continue to behave in their same familiar ways even when these behaviors cause them
 ●

difficulties or distress.
● No specific medication alters personality, and therapy designed to help clients
● Some people with personality disorders believe their problems stem from others or the
world in general;
● they do not recognize their ow behavior as the source of difficulty.

Diagnosis is made when the person exhibits enduring behavioral patterns that
deviate from cultural expectations in two or more of the following areas:
● Ways of perceiving and interpreting self, other people, and events.
● Range, intensity, lability, and appropriateness of emotional response.
● Interpersonal functioning*
● Ability to control impulses or express behavior at the appropriate time and place
(impulse control)

Three Personality Clusters

Other Behaviors:
Other clusters of behavior related to maladaptive personality traits include:

Depressive behavior
● characterized by a pervasive pattern of depressive cognitions and behaviors in various
contexts.
● It occurs möre often in people with relatives who have major depressive disorders.
● often seek treatment for their distress.

Passive-aggressive behavior
● characterized by a negative attitude and a pervasive pattern of passive resistance to
demands for adequate social and occupational-performance.
● clients may appear cooperative, even ingratiating, or sullen and withdrawn, depending on
the circumstances.
● mood may fluctuate rapidly and erratically, and they may be easily upset or offended.

Onset and clinical course

● relatively common, occurring in 10% to 20% of the general population.
● Incidence is even higher for people in lower socioeconomic groups and unstable or
disadvantaged populations.
● 15%of all psychiatric inpatients have a primary diagnosis of a personality disorder.
● 40%to 45% of those with a primary diagnosis of major mental illness also have a
coexisting PD.
● Clients with personality disorders have a higher death rate, especially as a result of
suicide.
● they also have higher rates of suicide attempts, accidents, and emergency department
visits.
● increased rates of separation, divorce, and involvement in legal proceedings regarding
child custody.
● often are described as "treatment resistant."
● diminish in the 40's and 50's.
Barrier to treatment:
– do not perceive their dysfunctional or maladaptive behaviors as a problem;

Etiology
Biologic Theories
● Personality develops through the interaction of hereditary dispositions and environmental
influences.
Temperament- refers to the biologic processes of sensation, association, and motivation that
underlie the integration of skills and habits based on emotion

. High Harm avoidance

● exhibit fear of uncertainty, social inhibition
● shyness with strangers, rapid fatiguability
● pessimistic worry in anticipation of problems
 ● may result in maladaptive inhibition and excessive anxiety.
Low harm avoidance
● are carefree, energetic, outgoing, and optimistic.
● may result in unwarranted optimism and unresponsiveness to potential harm or danger.

. high novelty-seeking temperament

● results in someone who is quick tempered
● curious, easily bored, impulsive, extravagant, and disorderly.
● may be easily bored and distracted with daily life, prone to angry out-bursts, and fickle in
relationships.
low in novelty seeking
● slow tempered, stoic, reflective
● frugal, reserved, orderly, and tolerant of monotony
● may adhere to a routine of activities

. Reward dependance
● defines how a person responds to social cues.
high in reward dependence
● are tender- hearted, sensitive, sociable, and socially dependent.
● may become overly dependent on approval from others and readily assume the ideas or
wishes of others without regard for their own beliefs or desires.
low reward dependence
● practical, tough minded, cold, socially insensitive, irresolute, and indifferent to being
alone.
● Social withdrawal, detachment, aloofness, and disinterest in others

. Highly persistent people

● hardworking and ambitious overachievers who respond to fatigue or frustration as a
personal challenge.
● may persevere even when a situation dictates they should change or stop.
low persistent people
● inactive, indolent, unstable, and erratic.
● tend to give up easily when frustrated and rarely strive for higher accomplishments.

Psychodynamic Theories
…

3 major character traits have been distinguished:

. self-directedness
● people are realistic aral effective and can adapt their behavior to achieve goals
People low in self- directedness
● are blaming, helpless, irresponsible, and unreliable.
● cannot set and pursue meaningful goals.
 . cooperativeness
● refers to the extent to which a person sees himself or herself as an integral part of human
society.
Highly cooperative people -
● described as empathic, tolerant, compassionate, supportive, and principled.
low cooperativeness people
● are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic;
● look out for themselves without regard for the rights and feelings of others.

When fully developed, these character traits define a mature personality (Svrakic & Cloninger,
2005).

. Self-transcendence
● considers himself or herself to be an integral part of the universe.
● spiritual, unpretentious, humble, and fulfilled.
● These traits are helpful when dealing with suffering, illness, or death.
People low in self- transcendence
● practical, self-conscious, materialistic, and controlling.
● may have difficulty accepting suffering, loss of control, personal and material losses, and
death.

personality develops in response to inherited dispositions (temperament) and environmental

influences (character), which are experiences unique to each person.

PD result when the combination of temperament and character development produces

maladaptive, inflexible ways of viewing self, coping with the world and relating to others.

Treatment
Combinations of:
● medication
● group and individual therapies
Goals :
– focus on building trust
– Teaching basic living skills
– Providing support
– decrease distressing symptoms

Cognitive-Behavioral Therapy
● helpful for clients with PD
● focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating
and uprooting negative or irrational beliefs.

Psychopharmacology
Four symptom categories that underlie personality disorders are:
. cognitive-perceptual distortions
● including psychotic symptoms
. affective symptoms and mood dysregulation
. aggression and behavioral dysfunction
. anxiety
Nursing Interventions
● Be consistent and friendly despite client's hostility
● Avoid talking and laughing when client can see you but not hear you:
● If a client is very suspicious, use a one-to-one relationship, not a group situation.
● Avoid power struggles.
● Avoid any attempt to disagree with delusion