Personality disorders are characterized by inflexible and maladaptive responses to stress that cause disability in relationships and work. They affect 10-15% of the population and often co-occur with other disorders. Personality disorders have both biological and psychosocial factors, including genetics and learned behaviors. They are assessed through history and testing, and can overwhelm caregivers with clients' needs. The disorders are grouped into three clusters based on characteristics: odd/eccentric, dramatic/emotional, or anxious/fearful. Treatment focuses on milieu therapy, medications, case management, and advanced therapies like dialectical behavior therapy.

1. PERSONALITY DISORDERS

2. CHARACTERISTICS
 Inflexible and maladaptive response to stress
 Disability in working and loving
 Ability to evoke interpersonal conflict
 Capacity to get “under the skin” of others
 These clients usually do not recognize their
symptoms as uncomfortable and will NOT seek
help unless a severe crisis occurs.

3. PREVALENCE
 10-15% in general population
 Often “co-occur” with depression and anxiety
 Onset usually occurs before onset of other
psychiatric disorders
 Various PD’s often co-exist

4. BIOLOGICAL FACTORS
 Genetic Component
 Alsoto be considered… unfavorable environmental
conditions
 Personality Traits that are Inherited
 Novelty seeking
 Introvert vs extrovert
 Reward dependence
 Closeness vs openness
 Neurotic vs stable
 Persistence
 Antagonistic vs agreeable
 Conscientious vs unreliable

5. PSYCHOSOCIAL FACTORS
 Learning Theory
 Cognitive Theory
 Psychoanalytical Theory
 Environmental Theory

6. ANALYSIS
 There is probably a combination of biological and
psychological factors that cause Personality
Disorders to develop in people.
 Would you agree with this statement???
 WHY? Any examples?

7. ASSESSMENT OF PD’S
 MMPI
Fullmedical history
Psychosocial History
 Suicidal / aggressive thoughts
 Risk of harm to self or others
 Use of medications or illegal substances
 Ability to handle money
 Legal history
 Current or past abuse

8. EFFECTS OF PERSONALITY
DISORDERS ON CAREGIVERS
 Overwhelming needs of clients will usually be
overwhelming for caregivers
 Caregivers may feel:
 Confused
 Helpless
 Angry
 Frustrated

9. SPLITTING BEHAVIORS
 Primary defense used by clients with borderline
PD
 Client labels one person “all good” and everyone
else is “all bad”
 Once all good person has not met clients needs
they become ALL BAD! Then
 Someone else is labeled “all good”.. And on it
goes…
 This creates conflict with staff!!!

10. THREE CLUSTERS OF PDS
 CLUSTER A: Odd or eccentric
 CLUSTER B: Dramatic, emotional, erratic
 CLUSTER C: Anxious or fearful

11. CLUSTER A
 Paranoid
 Schizoid
 Schizotypal

12. CLUSTER B
 Dramatic, Erratic, Emotional
 Anti social
 Borderline
 Narcissistic
 Histrionic

13. CLUSTER C
 Anxious or Fearful
 Avoidant
 Dependent
 Obsessive- Compulsive
 Passive- Aggressive

14. DIAGNOSIS
 So what do you think would be some nursing
diagnoses of concern?
 Goals for Borderline? Short term? Long term?

15. INTERVENTIONS FOR MANIPULATIVE,
AGGRESSIVE, OR IMPULSIVE BEHAVIOR
 Manipulative: establish guidelines for accepted
behavior ( Contract?), work on trust, can the
patient identify their behaviors?
 Aggressive : facilitate expression of anger in an
adaptive, non-violent way (safety/ physical
outlets), remove dangerous objects
 Impulsive: assist with development of problem
solving skills, keep stimuli low key, observe
behavior for safety, encourage verbalization of
hostile feelings

16. INTERVENTIONS
 Basic  Advanced Practice
 Milieu Therapy  DBT
 Psychobiological  Skillsoriented
Interventions (meds) psychotherapy
 Case management  Supportive
psychotherapy
 Group therapy