Personality• is essentially the “style” of how a person deals with the world. Personality traits then are stylistic peculiarities that all people bring to social relationships, including traits such as shyness, seductiveness, rigidity, or suspiciousness (Groves, 2004). In people with a personality disorder (PD), these traits are exaggerated to the point that they cause dysfunction in their relationships (Groves, 2004).• The DSM-IV-TR classifies personality disorders as Axis II diagnoses (along with mental retardation). It also defines a PD as: An enduring pattern of inner experience and behavior that deviates markedly form the expectations of the individuals culture, is pervasive and inflexible, has an onset in adolescent or early adulthood, is stable over time and leads to distress or impairment.
Clinical Picture• Personality disorders (PDs) involve long-term and repetitive use of maladaptive and often self- defeating behaviors.• Do not recognize their symptoms as uncomfortable; thus they do not seek treatment unless a severe crisis occurs.
Clinical Picture• All PDs have four characteristics in common: (1) inflexible and maladaptive response to stress; (2) disability in working and loving; (3) ability to evoke interpersonal conflict; (4) capacity to frustrate others.• Tend to be perceived as aggravating and demanding by health care workers, so the potential for value judgments is high, and effective care is at risk.
Personality disorders• DSM-IV-TR Cluster A Disorders—Odd or Eccentric Behavior
Epidemiology and Comorbidity• In the general population, is 10% to 15%, depending on severity.• Personality disorders are predisposing factors for many other psychiatric disorders• Etiology
Assessment• Patient History o Suicidal or homicidal ideation o Current use of medications and other substances, food, and money o Involvement with the courts; and current or past physical, sexual, or emotional abuse. o Information about the patient’s current level of crisis and dysfunctional coping styles• Self-Assessment
Diagnosis• Ineffective coping• Anxiety• Risk for other-directed violence• Risk for self-directed violence• Impaired social interaction, Social isolation• Fear, Disturbed thought processes• Defensive coping• Self-mutilation
Outcomes Identification• Realistic goal setting (change occurs so slowly)• Small steps are necessary• Minimizing self-destructive or aggressive behavior• Reducing the effect of manipulative behaviors• linking consequences to both functional and dysfunctional behaviors• Initiating functional alternatives to prevent a crisis• Ongoing management of anger, anxiety, shame, and happiness
Planning• Patients with personality disorder are usually admitted to the hospital for reasons other than their personality disorder (borderline, antisocial).• Plan for the following Behaviors:• impulsive, suicidal, self-mutilating, aggressive, manipulative• Possibly psychotic under stress• manipulative, aggressive, and impulsive.
Borderline Personality Disorder
Ineffective Coping/ Self- mutilation
Implementation/Evaluation• Management of behaviors/limit setting• Milieu Management• Pharmacological Interventions• Case Management• Psychotherapy• Evaluation
Summary• People with PD present complex behavioral challenges for people around them• People with PD have (1) inflexible and maladaptive responses to stress (2) disability in working and loving• (3) ability to evoke strong intense personal conflict (4) capacity to “get under the skin”• PDs often occur with axis 1 comorbidities• Do not believe there is anything wrong with them• Use more primitive defenses in response to stress• Self assessment when working with PD patients