Personality disorders
Personality is
that which permits a prediction of what a person will do in a given situation
Cattell
1970
Definition
Personality
disorders
An enduring
pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture is known as personality disorder.
Incidence
•
According
to a meta analysis done by Venkattaswamy M R et.al 1998
•
Incidence
of personality disorder in India is 0.6%
•
More
common in Urban population
•
Common
in males than females.
•
Multiple
personality disorders are common than single personality disorders
Classification
•
DSM
IV
- Clusters A-odd or eccentric
- Cluster B-dramatic, emotional, or erratic.
- Cluster C- anxious or fearful.
•
ICD
10 F60-F69 Disorders of adult personality and behaviour
§ Paranoid
§ Schizoid
§ Dissocial
§ Emotionally unstable
§ Histrionic
§ Anankastic
§ Anxious
§ Dependent
Etiological
factors
•
Genetic
v Twins
and siblings of people with personality disorders have a higher chance of
developing personality disorders
v Primary
degree relative of paranoid schizophrenia patients have higher chance in
developing paranoid type of personality disorder.
•
Biological
factors
v Neurochemical- Homovanillinic acid level increase in
Schizotypal
v Decreased serotonin
v Decrease of Opioid receptors in brain.
•
Psychodynamic
v Poor ego and superego development
v Unresponsiveness or over protecting mothers
v Early separation
v Maternal deprivation
v Physical and sexual abuse
v Excessive use of repression
v Fixation in the oral stage
v Rejection by parents
Classification
Cluster A
Paranoid personality
“a pervasive distrust and
suspiciousness of others such that their motives are interpreted as malevolent,
beginning by early adulthood and present in a variety of contexts” (APA, 2000).
Clinical features
•
Hyper vigilant
•
Ready for any real or imagined threat.
•
Tense and irritable.
•
Insensitive to the feelings of others.
•
They avoid interactions with other people
•
They always feel that others are there to take
advantage of them.
•
They trust no one.
•
Attributing their shortcomings to others.
•
They do not accept responsibility for
their own behaviors and feelings and project this responsibility on to others.
•
They are envious
Schizoid
It is
characterized primarily by a profound defect in the ability to form personal
relationships or to respond to others in any meaningful, emotional way
Clinical
features
•
Cold, aloof, and indifferent to others.
•
They prefer to work in isolation and are
unsociable, with little need or desire for emotional ties.
•
Affective energy is spend in intellectual
works.
•
Appear shy, anxious, or uneasy.
•
Inappropriately serious about everything
and have difficulty acting in a light hearted manner.
•
Their affect is commonly bland and
constricted.
Schizotypal
•
Persons with schizotypal personality
disorder are strikingly odd or strange, even to laypersons. Magical thinking,
peculiar notions, ideas of reference, illusions, and de realization are part of
a schizotypal person's everyday world.
Clinical features
•
Aloof and isolated
•
Behave in a bland and apathetic manner.
•
Magical thinking, ideas of reference,
illusions, and depersonalization are part of their everyday world.
Nursing management
•
Convey
accepting attitude
•
Low
level of stimuli
•
Encourage
to express feelings
•
Calm
attitude
•
Limit
setting
•
Reinforce
positive behaviour
•
Help
in gaining insight on his own behaviour
Cluster
B
Antisocial
personality:
Antisocial
personality disorder is a pattern of socially irresponsible, exploitative, and
guiltless behavior that reflects a disregard for the rights of others.
Clinical
features
•
These individuals exploit and manipulate
others for personal gain
•
A general disregard for the law.
•
Difficulty in sustaining consistent
employment and in developing stable relationships.
Histrionic
personality
Histrionic personality
disorder is characterized by colorful, dramatic, and extroverted behavior in
excitable, emotional people
Clinical features
•
Have difficulty maintaining long-lasting
relationships
•
They require constant affirmation of
approval and acceptance from others.
•
Manipulative and exhibitionistic behaviors
in their demands to be the center of attention.
•
Demonstrates
socially accepted behaviours
•
Failure to evoke the attention and
approval results in feelings of dejection and anxiety.
•
Interpersonal relationships are fleeting
and superficial.
Narcissistic
personality
Persons with narcissistic
personality disorder have an exaggerated sense of self-worth. They lack
empathy, and are hypersensitive to the evaluation of others.
Clinical features
•
Lack humility
•
Self-centered and exploiting others to
fulfil their own desires.
•
View themselves as “superior” beings; they
believe they are entitled to special rights and privileges.
•
Grounded in grandiose distortions
•
Impaired interpersonal relationships.
Nursing management
•
Observe
frequently
•
Encourage
to express feelings
•
Rotate
staff members to prevent dependence
•
Set
limits
•
Practice
giving and accepting positive criticisms
Cluster
C
Avoidant
personality
The individual with avoidant
personality disorder is extremely sensitive to rejection and because of this
may lead a very socially withdrawn life.
Clinical features
•
Timid, withdrawn, or perhaps cold and
strange.
•
Desire to have close relationships
•
Avoid relationship because of their fear
of being rejected.
Dependent
personality
Dependent personality
disorder is characterized by “a pervasive and excessive need to be taken care
of that leads to submissive and clinging behavior and fears of separation”
Clinical features
•
Lack of self-confidence
•
Passive and submissive role
•
Let others make their important decisions.
•
Avoids responsibility
•
Become anxious when forced to do.
Obsessive compulsive personality
Individuals with
obsessive–compulsive personality disorder are very serious and formal and have
difficulty in expressing emotions. They are overly disciplined, perfectionist,
and preoccupied with rules.
Clinical features
•
Intense fear of making mistakes
•
Accuracy and discipline
•
Polite and formal social behaviour
Nursing management
•
Involve
in decision making
•
Encourage
group activities
•
Avoid
dependence
•
Help
in rehearsing informal interactions with assistance.
Management
Medical
•
Antipsychotics
•
MAOIs
•
SSRIs
•
Lithium
•
Propranolol
•
Lorazepam
Psychological
•
Interpersonal
psychotherapy
•
Psychoanalytic
psychotherapy
•
Group
psychotherapy
•
CBT
COMMENTS