Lec _11-Personality Disorders-narrated

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By: RogerK (139 month(s) ago)

The personality disorder is basically a set of traits that combine to negatively affect your life. They have a wide range of causes and some are easier to treat than others. This test is set up to look for the ten recognized personality disorders which are Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, and Obsessive compulsive. http://www.disorderscentral.com/

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Personality Disorders:

Personality Disorders

Definition of Personality Disorders:

Definition of Personality Disorders Kernberg (1984) defined personality disorders as a spectrum of maladaptive traits that produce or influence considerable psychological and emotional disturbance and impaired relationships. The DSM-IV-TR delineates clinical features of personality disorders as an enduring pattern of feeling (emotions), thinking (cognitive distortions), and behaving (maladaptive in nature) that become rigid and stable over time.

Behavioral Features of Personality Disorders:

Behavioral Features of Personality Disorders Behavioral features of personality disorders tend to be rigid & inflexible , resulting in distress or maladaptive coping skills . Such maladaptive responses often lead to personal problems that induce extreme anxiety , distress and depression in patients , and the ability to perform at optimum level is constantly compromised. Some patients experience lifelong difficulty adapting to change, tolerating frustration and crises and forming healthy relationships.

Behavioral Features (cont):

Behavioral Features (cont) Patients will deny their existing problems, and usually lack insight into their maladaptive behaviors. These behaviors are symptoms that are described as ego syntonic (comfortable for the individual but usually not comfortable for others). Their behaviors are acceptable to them because they represent aspects of their personality that have become typical and gratifying for them . Patients with PDs differ from other patients experiencing anxiety, depression, or other emotional disorders because the latter experience an uncomfortable and unacceptable ego dystonic state that forces them to seek therapeutic assistance to change. Patients with PDs do not recognize or accept the need for a change in the way they behave, they tend to use displacement and/or projection to aid in their coping. These patients usually tax the mental and physical resources of the health care team. They often display an uncanny ability to create crisis and uproar. Nurses and other members of the team are challenged in developing innovative treatment strategies to meet the needs of these patients.

Recognition of Special Needs in Patients with PDs:

Recognition of Special Needs in Patients with PDs Understand factors associated with personality development Recognize the impact of early traumas on coping styles Deal with intense reactions that occur when working with these patients Work with other MH professionals to develop consistency and prevent splitting of staff Recognize the need to maintain boundaries that are extremely clear.

Splitting, Boundaries & Countertransference:

Splitting, Boundaries & Countertransference Splitting is a behavior that involves setting up conflict between others, almost as if saying, “Let’s you and he/she fight.” It’s not uncommon for patients with PDs to create splitting situations among staff members such that the staff become engaged in serious conflicts concerning the appropriate management of the patient. Such behaviors arouse intense feelings and negative reactions (countertransference) in nurses and other caregivers. Clear boundaries in these settings are essential. Boundary means rules defining who and how members participate in a subsystem or a relationship. For example, it is important for the nurse to maintain a professional boundary between self and the patient.

Understanding the Origins of Personality Disorders:

Understanding the Origins of Personality Disorders Understanding the origins of these behaviors can play a key role in minimizing negative reactions. Working with these patients must be perceived as a challenge rather than a burden. Nurses are challenged to sharpen their skills in patience, self-awareness, creativity and a nonjudgmental approach. Staff needs to develop treatment plans that do not allow for splitting staff. To accomplish this they must confer frequently.

Understanding (cont):

Understanding (cont) Most personality theories emphasize the significance of primary caregivers in child growth and development. The child must master the initial demands for the socialization within family , where the foundation is laid for the future emergence of interpersonal relationships with all others. These early interactions mediate the infant’s perception of the world. Understanding key concepts in personality formation such as ego development and organization is crucial for nurses who must asses the meaning of their own, as well as the patient’s maladaptive behaviors, facilitation of adaptive coping behaviors and evaluation of patient responses.

Psychodynamic Theories :

Psychodynamic Theories Object Relations Concept Object relations , defined in simple terms, are internalized relationships recollected from early primary caregivers. This relationship is considered the core of the person’s existence, “all other human behavior and experiences….are relational derivatives” Mahler postulated that internalization of the primary caregiver allows the child to maintain an image of the caregiver when absent. Kernberg concurred with other object relations’ theorists noting that the basis of severe personality disorders was related to inadequate or impaired object relations that are ingrained in the personality.

Neurobiological Theories:

Neurobiological Theories Neurotransmitters such as Serotonin and Dopamine have been implicated in impulsivity, aggression and suicidal gestures manifested in disordered personalities, especially Borderline and Antisocial Types.

Cluster A Personality Disorders:

Cluster A Personality Disorders The first cluster of personality disorders comprises those in which patients are considered withdrawn, odd, or eccentric. These Personality Disorders include: Paranoid Schizoid Schizotypal

Therapeutic Interventions:

Therapeutic Interventions Paranoid Personality Disorder Nursing Interventions Establish Rapport Minimize potential for aggressive behaviors Support adaptive behaviors Schizoid & Schizotypal Personality Disorder Nursing Interventions Approach the patient in a calm manner Maintain a comfortable distance based on the patient’s verbal and nonverbal communication Administer Psychotropics (antipsychotics) and observe the patient’s responses- both desired and adverse effects Provide structured social interactions

Cluster B Personality Disorders:

Cluster B Personality Disorders The second cluster of personality disorders consists of those in which patients seek attention and engage in erratic behaviors. These Personality Disorders include: Antisocial Borderline Histrionic Narcissistic

Therapeutic Interventions:

Therapeutic Interventions Antisocial Personality Disorder Respond to patients maladaptive behavior with firm and consistent limit setting. Approach patients in a sensitive and nonjudgmental manner to facilitate trust and rapport because they fear and mistrust intimacy and closeness. Borderline Personality Disorder Form a nurse-patient relationship based on clearly stated, realistic expectations Assist in reduction of self-destructive behavior and intent Acknowledge problem behaviors Assist the patient to develop adaptive coping patterns Encourage verbalization of feelings about self Dialectical Behavior Therapy Psychopharmacologic Therapy: Antipsychotics, Mood Stabilizers, Antidepressants

Therapeutic Interventions:

Therapeutic Interventions Histrionic Personality Disorder Nursing Interventions: Treatment is similar to that of other personality disorders and e.g. BPD Consistency Understanding Managing Countertransference Issues Providing an environment that minimizes maladaptive coping patterns Psychopharmacologic approaches center on depression, anxiety and psychosis

Therapeutic Interventions:

Therapeutic Interventions Narcissistic Personality Disorder Hospitalization is usually precipitated by depression, suicidal behaviors and mood swings that often follow failure and rejection. Group Therapy may be avoided by the patient because it would require them to to balance the desire for a special patient-therapist relationship and because they may fear confrontation by group members.

Cluster C Personality Disorders:

Cluster C Personality Disorders The third cluster of personality disorders comprises conditions in which the symptoms are anxiety and fear. Personality Disorders in this cluster include: Avoidant Dependent Obsessive-Compulsive

Therapeutic Interventions:

Therapeutic Interventions Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Nursing Interventions: Establish Trust to minimize anxiety Once anxiety is minimized, the nurse-patient relationship focuses on exploration of old behaviors with consideration for individual change, improved insight, improved sense of self and overall improved quality of life/rfelationships.