CHARACTERISTICS Inflexible and maladaptive response to stress Disability in working and loving Ability to evoke interpersonal conflict Capacity to get “under the skin” of others These clients usually do not recognize their symptoms as uncomfortable and will NOT seek help unless a severe crisis occurs.
PREVALENCE 10-15% in general population Often “co-occur” with depression and anxiety Onset usually occurs before onset of other psychiatric disorders Various PD’s often co-exist
BIOLOGICAL FACTORS Genetic Component Alsoto be considered… unfavorable environmental conditions Personality Traits that are Inherited Novelty seeking Introvert vs extrovert Reward dependence Closeness vs openness Neurotic vs stable Persistence Antagonistic vs agreeable Conscientious vs unreliable
ANALYSIS There is probably a combination of biological and psychological factors that cause Personality Disorders to develop in people. Would you agree with this statement??? WHY? Any examples?
ASSESSMENT OF PD’S MMPI Fullmedical history Psychosocial History Suicidal / aggressive thoughts Risk of harm to self or others Use of medications or illegal substances Ability to handle money Legal history Current or past abuse
EFFECTS OF PERSONALITY DISORDERS ON CAREGIVERS Overwhelming needs of clients will usually be overwhelming for caregivers Caregivers may feel: Confused Helpless Angry Frustrated
SPLITTING BEHAVIORS Primary defense used by clients with borderline PD Client labels one person “all good” and everyone else is “all bad” Once all good person has not met clients needs they become ALL BAD! Then Someone else is labeled “all good”.. And on it goes… This creates conflict with staff!!!
THREE CLUSTERS OF PDS CLUSTER A: Odd or eccentric CLUSTER B: Dramatic, emotional, erratic CLUSTER C: Anxious or fearful
DIAGNOSIS So what do you think would be some nursing diagnoses of concern? Goals for Borderline? Short term? Long term?
INTERVENTIONS FOR MANIPULATIVE, AGGRESSIVE, OR IMPULSIVE BEHAVIOR Manipulative: establish guidelines for accepted behavior ( Contract?), work on trust, can the patient identify their behaviors? Aggressive : facilitate expression of anger in an adaptive, non-violent way (safety/ physical outlets), remove dangerous objects Impulsive: assist with development of problem solving skills, keep stimuli low key, observe behavior for safety, encourage verbalization of hostile feelings
INTERVENTIONS Basic Advanced Practice Milieu Therapy DBT Psychobiological Skillsoriented Interventions (meds) psychotherapy Case management Supportive psychotherapy Group therapy