Personality disorders

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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


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notes.nursium.com: Personality disorders
Personality disorders
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