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PERSONALITY DISORDERS
CHARACTERISTICS Inflexible and maladaptive response to stress Disability in working and loving Ability to evoke interpe...
PREVALENCE   10-15% in general population   Often “co-occur” with depression and anxiety   Onset usually occurs before ...
BIOLOGICAL FACTORS   Genetic Component     Alsoto be considered… unfavorable environmental      conditions     Personal...
PSYCHOSOCIAL FACTORS   Learning Theory   Cognitive Theory   Psychoanalytical Theory   Environmental Theory
ANALYSIS   There is probably a combination of biological and    psychological factors that cause Personality    Disorders...
ASSESSMENT OF PD’S   MMPI    Fullmedical history    Psychosocial History       Suicidal / aggressive thoughts       R...
EFFECTS OF PERSONALITY       DISORDERS ON CAREGIVERS   Overwhelming needs of clients will usually be    overwhelming for ...
SPLITTING BEHAVIORS Primary defense used by clients with borderline  PD Client labels one person “all good” and everyone...
THREE CLUSTERS OF PDS   CLUSTER A: Odd or eccentric   CLUSTER B: Dramatic, emotional, erratic   CLUSTER C: Anxious or f...
CLUSTER A Paranoid Schizoid Schizotypal
CLUSTER B   Dramatic, Erratic, Emotional     Anti   social     Borderline     Narcissistic     Histrionic
CLUSTER C   Anxious or Fearful     Avoidant     Dependent     Obsessive-   Compulsive     Passive-   Aggressive
DIAGNOSIS   So what do you think would be some nursing    diagnoses of concern?   Goals for Borderline? Short term? Long...
INTERVENTIONS FOR MANIPULATIVE,     AGGRESSIVE, OR IMPULSIVE BEHAVIOR   Manipulative: establish guidelines for accepted  ...
INTERVENTIONS   Basic                       Advanced Practice     Milieu   Therapy            DBT     Psychobiologica...
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Personality disorders order 9

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Mental Health Fall '12

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Personality disorders order 9

  1. 1. PERSONALITY DISORDERS
  2. 2. 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.
  3. 3. 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
  4. 4. 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
  5. 5. PSYCHOSOCIAL FACTORS Learning Theory Cognitive Theory Psychoanalytical Theory Environmental Theory
  6. 6. 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?
  7. 7. 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
  8. 8. EFFECTS OF PERSONALITY DISORDERS ON CAREGIVERS Overwhelming needs of clients will usually be overwhelming for caregivers Caregivers may feel:  Confused  Helpless  Angry  Frustrated
  9. 9. 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!!!
  10. 10. THREE CLUSTERS OF PDS CLUSTER A: Odd or eccentric CLUSTER B: Dramatic, emotional, erratic CLUSTER C: Anxious or fearful
  11. 11. CLUSTER A Paranoid Schizoid Schizotypal
  12. 12. CLUSTER B Dramatic, Erratic, Emotional  Anti social  Borderline  Narcissistic  Histrionic
  13. 13. CLUSTER C Anxious or Fearful  Avoidant  Dependent  Obsessive- Compulsive  Passive- Aggressive
  14. 14. DIAGNOSIS So what do you think would be some nursing diagnoses of concern? Goals for Borderline? Short term? Long term?
  15. 15. 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
  16. 16. INTERVENTIONS Basic  Advanced Practice  Milieu Therapy  DBT  Psychobiological  Skillsoriented Interventions (meds) psychotherapy  Case management  Supportive psychotherapy  Group therapy

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