Personality Disorders

ingrained, enduring pattern of behaving and relation to self, others, and environment
perceptions, attitudes, emotions
usually not consciously aware of own personality
can't medicate personality -> can give things for their side effects
personality disorders develop early in childhood

impairment of personality functioning
traits that are maladaptive
identity problens
dysfunctional relationships

anxiety, depression, bipolar disorder

negative behaviors toward others
anger and/or hostility
irritable, labile moods
lack of guilt or remorse, emotionally cold or uncaring
impulsivity, poor judgment
irresponisbility, lack of accountability for own actions
risk-taking, thrill-seeking behaviors
mistrust
exhibitionism
entitlement
dependency, insecurity
eccentric perceptions

odd or eccentric behaviors - WEIRD
paranoid
schizoid
schizotypal

erratic or dramatic behaviors - WACKY
antisocial
borderline
histrionic
narcissistic

anxious or fearful behaviors - WORRIED
avoidant
dependent
obsessive-compulsive personality disorder (different than OCD)

realtively common (10%-20% of general population)
often described as being "treatment resistant" = not aware they have a problem and don't want treatment
lack of perception by person that behavior is problem = behavior is a point of pride

not formally diagnosed until 18 years of age = still developing brain
are observable throughout childhood, adolescence
not first diagnosed in older adults but may persist into older age
may or may not stabilize in older adults
seem chronically angry, unhappy or dissatisfied
higher risk for depression, suicide, dementia

personality develops through the interaction of hereditary dispositions and environmental influences
biological theories = temperament (traits: harm avoidance, novelty seeking, reward dependence, persistence_

judgements of personality must be viewed with consideration of ethnic, cultural and social background
gaurded or defensive behavior due to language bariers
religious or spiritual beliefs
different views of avoidant and dependent behavior = dependent behavior is normal for certain religions
cultural value of work and productivity
gender roles and behaviors

targets symptoms
aggression/impulsivity
mood dysregulation (lithiun)
anxiety (SSRI)
psychotic symptoms

CBT - #1 treatment
thought stopping
positive self-talk
dialectical behavior therapy (borderline personality disorder)

pervasive mistrust/suspiciousness
use of projection
conflict with authority figures
can function in society, don't typically come in just for paranoia

forma;, business-like approach - caring approach can make them think you want something from them
client involvement in plan of care
validate idea before actions

pervasive pattern of social detachment
constricted affect
little emotion
usually have rich and extensive fantasy life but are reluctant to reveal
"loners" = want to be alone

focus on improved functioning in community
respect need for solitude

can be made aware of their own odd belieefs = what makes different than schizophrenia
pervasive pattern of social and interpersonal deficits
cognitive or perceptual distortions
behavioral eccentricities
odd appearance
restricted rage of emotions

history (acts of cruelty, abusive parenting
general appearance and motor behavior (usually normal)
mood and affect (display of false emotions)
thought process and content (narrowed view of world)
sensorium and intellectual processes (oriented, average or above-average intelligence quotient)
judgement and insight (do not consider morals or ethics)
self-concept (appear confident, but the self is shallow and empty)
roles and relationships (manipulate and exploit those around them)
complete lack of regard for the rights of others, they do not see others as worthy of dignity of respect
may harm animals at young age or have conduct issues

therapeutic relationship; promoting responsible behavior (limit setting, confrontation)
problem-solving; control of emotions (taking a time-out)
improving role performance
do not receive treatment voluntarily unless they see gain from it
need to speak to them matter of fact
problem risks: risk of violence, inaffective coping

history (disturbed early relationships with parents)
general appearance and motor behavior (wide range of dysfunction)
mood and affect (dysphoric)
thought process and content (splitting = inability to see all parts of a person as whole, dissociative episodes)
sensorium and intellectual processes (fully oriented to reality, exception is transient psychotic symptoms
judgment and insight (impaired judgment and lack of concern for afety)
self-concept (unstable view of self = feel very empty and get value from others, self-harm)
roles and relationships (hate being alone but experience social isolation)
physiological and self-care considerations (reckless behavior)
very impulsive
typically have extreme childhood abuse
wide range of emotions = characterized by labile emotions

safety (explore self-harm behavior) - very high risk
therapeutic relationships (structured, with limit setting)
strict adherence to boundaries
communication skills (they lack them)
coping, emotion control
reshaping thinking patterns (cognitive restructuring, thought stopping, positive self-talk, decatastrophizing)
structuring of daily activities
speak matter of fact and set limits and boundaries

excessive emotionality and attention seeking; exaggeration if closeness of relationships; insincere and shallow emotions

feedback about social interactions; social skills training through role-playing; exploration of strengths and assests

pervasive pattern of grandiosity
need for admiration
lack of empathy
arrogant or haughty attitude
sense of superiority
fragile, vulnerable self-esteem
ambition

self-awareness skills to avoid anger and frustration
matter-of-fact approach (business-like)
limit setting

social discomfort
low self-esteem
hypersensitivity to negative evaluate

self-affirmations
positive self-talk
reframing and decatastriphizing
social skills training (how to interact with people)

pathological need to be taken care of (don't want to be left alone)
submissive and clinging behavior
frequently anxious

assistance in expressing grief and loss (being alone is a loss to them)
assistance in daily functioning
teaching problem-solving (teach how totake care of themself - like getting groceries for themself
only do what they cannot do for themself

"the perfectionist"
preoccupation with perfectionsim
formal and serious demeanor
constricted emotional range
preoccupied with orderliness
low self-esteem
harsh self-evaluations (call themself bad names when they do something wrong)

different persepctive on decision-making
cognitive restructuring (is it really that bad to load the dishwasher like that?)
risk-taking
offer different perspective
what would happen if you let someone else take control

treatment focuses on moodstabilization, decreasing impulsivity, and developing social and relationship skills
unmet needs: self-care, sexual expression, budgeting, psychotic symptoms, psycholgoical distress
children with greater number of "protective factors" less likely to develop antisocial behavior as adults
school commitment or importance of school
positive peer relationships
parent or peer disapproval of antisocial behavior
functional family relationship
effectie parenting skills

discuss feelings of angeror frustration with colleagues
nurse can mistakenly believe client lacks motivation (their thoughts interfere with functioning)
be mindful of clients' manupulation of staff
don't take flattery or criticism personally
set realistic goals (part of their personality cannot change that on treat symptoms)