This document discusses personality disorders in nursing home residents. It defines personality disorders as inflexible patterns of thinking, feeling and behaving that are at odds with social expectations. It lists 10 specific personality disorder types and common characteristics. It then provides more details on paranoid, schizoid, obsessive-compulsive, dependent, histrionic and borderline personality disorders. The document notes that personality disorders are more common in institutionalized elderly and can worsen management challenges. It provides tips for staff internal reactions, institutional management strategies, and responding to and reacting to residents with personality disorders.

1. Personality DisordersPersonality Disorders
in the nursing home
Dr. Drew
Chenelly

2. What is a PersonalityWhat is a Personality
Disorder?Disorder?
An enduring, inflexible, maladaptive,
pattern of thinking, feeling, perceiving
and behavior which is at odds with
social expectations and leads to
impairment in important areas of the
individuals functioning.

3. Personality Disorder Types:Personality Disorder Types:
 Paranoid
 Schizoid
 Schizotypal
 Antisocial
 Avoidant
 Dependent
 Obsessive-Compulsive
 Borderline
 Histrionic
 Narcissistic

4. Common characteristics of PD:
 Other people seen as cause of problems.
 Apparent from adolescence.
 Exaggerated normal character traits.
 Relationships are shallow.
 Emotions are unstable.
 Continuum of severity.
 Not a mental illness.

5. Paranoid PersonalityParanoid Personality
 Mistrustful & suspicious.
 Bears grudges.
 Loner with few close relationships.
 Angry, argumentative & quarrelsome.
 Preoccupied with fairness.
 Looks for hidden meanings, insults & slights.
 Expects exploitation, harm & deception.

6. Schizoid & SchizotypalSchizoid & Schizotypal
 Emotionally cold, detached or flat.
 Isolated loner who is indifferent to praise or
criticism from others.
 Eccentric or peculiar beliefs and behavior.
 Odd thinking and speech (e.g. vague,
metaphorical, circumstantial).
 Often suspicious.

7. Obsessive-CompulsiveObsessive-Compulsive
 Preoccupied with details, rules, lists & order.
 Perfectionism that interferes with task completion.
 Rigid, stubborn, moralistic.
 Overconscientious & overcontroling.
 Suppressed anger.
 Others must be in exact agreement.

8. Dependent PersonalityDependent Personality
 Pervasive & excessive need to be taken care of.
 Submissive, clinging behavior & fear of separation.
 Can’t make decisions without much advice &
reassurance from others.
 Intense discomfort when alone.
 Great need for nurturance & fear of abandonment.

9. Histrionic personalityHistrionic personality
 Must be center of attention.
 Seductive or provocative behavior.
 Rapidly shifting & shallow but exaggerated
expression of emotion.
 Dramatically described but vague symptoms.
 When needs are not met becomes angry,
demanding & coercive.

10. Borderline PersonalityBorderline Personality
 Unstable & intense relationships alternating
between over-idealization & devaluation.
 Inappropriate intense intense anger &
unstable emotions.
 Impulsiveness, feelings of emptiness, dramatic
shifts in self-image & lack of empathy.
 Maipulativeness & fear of abandonment.
 Need for constant external approval & special
treatment.

11. Personality Disorders & ElderlyPersonality Disorders & Elderly
 Most frequent PD in elderly = Paranoid,
Histrionic & Schizoid.
 Borderline most prominent in younger groups.
 Personality Disorders = greater co-morbidities.
 Estimates up to 20% in institutionalized elderly.
 May moderate in middle-age & worsen again in
old-age.

12. Your internal reactionYour internal reaction
(or never complain never explain)
 Stay calm…Do not respond with anger.
 Think of the behavior as a clinical problem
which needs to be managed.
 Do not take the hostility personally.
 Do not be drawn into an argument or be
forced into defending yourself.
 Do not be lured into agreeing with criticism of
another staff member.

13. Institutional ManagementInstitutional Management
 One person should be designated to hear all c/o.
 All staff and resident expectations should be
made explicit.
 Present a unified front.
 Do not attempt to satisfy unreasonable demands
or apologize.
 Avoid confrontation.
 Place appropriate responsibility in the resident's
hands.

14. Responding & Reacting:Responding & Reacting:
 Allow face-saving alternatives.
 Do not feel responsible for immediately solving
problems.
 Minimize attention to the problem behaviors
and respond to healthy aspects of personality.
 Terminate contact when resident is abusive.
 Respond to the underlying rather than the
overt content of angry remarks.