Personality Disorder1 Essay

Personality Disorder1 Essay Personality Disorder1 Essay Personality Disorders Bonnie Ramos, RN, M.S. Common Characteristics of Personality Disorders (PDs) Inflexible and maladaptive response to stress Disability in working and loving Ability to evoke interpersonal conflict Capacity to "get under the skin" of others PD Commonalities Thinks problem is someone else’s, project own problems onto others Manipulative and controlling Hx failed relationships & lost jobs Emotional immaturity Tx Come to Tx for help with depression, anxiety, alcoholism or difficulties in work or personal relationships not to have their personalities changed Come as result of other’s insistence Avoid hospitalization (if possible) Pharmacology less useful (than in Axis I disorders) Therapy not usually sought by cluster A & C Set limits with cluster B Prevalence and Comorbidity 10% to 15% in general populations Often co-occur with depression and anxiety Onset usually occurs before onset of other psychiatric disorders Various PDs often coexist Biological Determinants Certain inherited traits present at birth Genetic alterations may result in an extreme variation Unfavorable environmental conditions may affect development of disorder Potentially Inherited Traits Novelty seeking Harm avoidance Reward dependence Persistence Neuroticism (negative affect) versus emotional stability Introversion versus extraversion Conscientiousness versus undependability Antagonism versus agreeableness Closeness versus openness to experiences Psychosocial Factors Learning theory Cognitive theory Environmental factors Assessment of PDs Minnesota Multiphasic Personality Inventory (MMPI) to evaluate personality Full medical history Psychosocial history Suicidal or aggressive thoughts Risk of harm from self or others Use of medications or illegal substances Ability to handle money Legal history Current or past abuse Effect of Clients with Personality Disorders on Caregivers Overwhelming needs of clients may also be overwhelming for caregivers Caregivers may feel Confused Helpless Angry Frustrated Three Clusters of PDs Characterized by similar behavior patterns Cluster A: Odd or eccentric Cluster B: Dramatic, emotional, erratic Cluster C: Anxious or fearful Personality Disorders Cluster A: Interventions Be aware of client isolation, suspiciousness Avoid being â€Å"too nice,† overly friendly Use neutral, kind approach Clear, straightforward explanations Simple, clear language Give warning about changes, reasons for delay, medication side effects Cluster B: Borderline Personality Disorder Interventions Set clear, realistic goals Be aware of manipulative behaviors Clear, consistent boundaries/limits For behavioral problems, review therapeutic goals and treatment boundaries Avoid rejecting, rescuing Assess for suicidal, self-mutilating behavior Cluster B: Splitting Behaviors Primary defense used by clients with borderline PD Client labels one person â€Å"all good† and the others â€Å"all bad† When all-good person has not met client's needs, that person becomes all bad Someone else then labeled all good, others all bad Creates conflict in staff members To decrease conflict among staff Open communication in staff meetings Ongoing clinical supervision Cluster B: Antisocial Personality Disorder Interventions Set clear, realistic limits on specific behavior All limits adhered to by all staff Document objective physical signs of manipulation or aggression Provide clear boundaries, consequences Guard against letting client make you feel guilty Guard against being manipulated Cluster B: Narcissistic Personality Disorder Interventions Stay neutral, avoid power struggles Don’t be defensive when disparaged Convey unassuming self-confidence Cluster B: Histrionic Personality Disorder Interventions Understand seductive behavior as a response to stress Keep relationship professional Encourage/model use of concrete descriptive language Teach and model assertiveness Cluster C: Avoidant, Dependent, or OCPD Presents as primarily anxious or fearful