Cluster C: Anxious or fearful behaviors (Avoidant, dependent, obsessive-compulsive)
Describe the odd/eccentric personality disorder (Cluster A)
Paranoid: people suspicious of others (more men than women)
Schizoid: people who do not enjoy social relationships and usually have no close friends. (more men than women)
Schizotypal: the same as schizoid, but they also show eccentric thoughts and behaviors which can be considered a milder version of the symptoms of schizophrenia. Often aloof, bizarre, superstitious, magical thinking
What criteria does the DSM-5 give for Paranoid Personality Disorders (cluster A)?
Four of the following:
questions loyalty and trustworthiness of friends
reads hidden meaning into innocuous events
reluctant to confide
easily slighted, quickly responds with anger
questions spouses fidelity
You may also see: constantly on guard, overly sensitive, testing honest of others, hyper vigilant, tense, irritable
What traits may be displayed by a client with Paranoid personality disorder? Describe treatment
Intense insecurity r/t real or perceived inferiority
lack of maternal bonding
chip on their shoulder
often used as scapegoats as children
The rarely seek treatment due to their mistrust, view everyone else as the problem
Psychotherapy most often used
Medications often not used because it can arouse suspicion, but anti-anxiety meds may be used for those with high anxiety
What is the DSM-5 criteria for Schizoid Personality Disorder (cluster A)?
inappropriately serious about everything, shy, aloof, no spontaneity
What is the DSM 5 criteria for Schizotypal PD?
5 of the following:
ideas of reference (excluding delusions of reference)
odd beliefs/magical thinking that influences behavior and is inconsistent with norms
Unusual perceptual experience - body illusions
Odd thinking and speech
suspicious or paranoid ideation
(often superstitious with social anxiety)
What is the schizophrenia continuum?
Common among first degree relatives of individuals with schizophrenia
Close link between schizotypal and schizophrenia
Lack of bonding, families were indifferent, formal, lead to discomfort with affection and closeness
Lack of social skills: shunner, overlooked, rejected, humiliated by others...begin to tune out reality because fantasy is better. Low self-esteem, distrust of interpersonal relations
What interventions can be done for Cluster A personality disorders?
Be aware of client isolation, suspiciousness
Avoid being too nice, overly friendly
Use neutral, kind approach
Clear, straight forward explanations
Simple, clear language
Give warning about changes, reasons for delay, medication side effects
Describe Cluster B disorders
Borderline (most common PD): intense emotionality, unstable identity and impulsivity. Typically, attitudes and feelings about other people considerably vary for no apparent reason
Histrionic (formerly hysterical): the key feature of histrionic PD is overy dramatic and attention-seeking behavior
Narcissistic: people that have a grandiose view of their abilities and are preoccupied with fantasies of great success. They want to be admired. Self centered
Antisocial (psychopathy) (oldest recognized disorder): disregard for the rights of others. Show irresponsible and antisocial behavior. irritable and aggressive. Absence of empathy and a lack of feelings of guilt after a transgression.
For anti-social personality disorder, what are the s/s?
Often a history of conduct prior to age 15
At least 4 of the following:
unstable work history
fails to conform to social norms (illegal actions)
irritable and aggressive
fails to honor financial obligations
fails to plan ahead (homeless)
no regard for the truth
irresponsible parenting style
not able to sustain monogamous relationships
lacks remorse (charming and intelligent on surface)
What the DSM-5 criteria for Antisocial PD?
Since the age of 15 there has been a disregard for and violation of the right's of others, those right's considered normal by the local culture, as indicated by at least 3 of the following:
-repeated acts that could lead to arrest
-conning for the pleasure of profit, repeated lying, or the use of aliases
-failure to plan ahead or being impulsive
-repeated assaults on others
-reckless when it comes to their or other's safety
-Poor work behavior or failure to honor financial obligations
-Rationalizing the pain they inflict on others
Must be at least 18 yrs of age
Evidence of conduct disorder with its onset before the age of 15
Symptoms not due to another mental disorder
What factors predispose someone to antisocial PD?
Often physical abuse
Absence of parental discipline/erratic discipline
Removal from the home
Growing up without parental figures of both sexes
Being rescued every time they were in trouble-no consequences
More men than women
What interventions can be done for antisocial PD?
set clear, realistic limits on specific behaviors
all limits adhere to by all staff
use of many staff for appearance of strength and control
document objective physical signs of manipulation or aggression
provide clear boundaries, consequences
guard against letting client make you feel guilty
guard against being manipulated
Screen for dangerous objects
Group therapy is best option, but no therapy is truly successful
What is the DSM-5 criteria for Borderline PD?
5 of the following:
intense fear of abandonment
unstable, intense personal relationships
chronic suicidal ideation, self mutilation
What are the s/s of Borderline PD?
intense, unstable mood
chronic, underlying depression
anger- directed at staff or others
Fear of abandonment
Clinging and distancing
What are the biological and psychodynamic components of borderline PD?
Biological: genetic predisposition. Relationship with affective disorder. Serotonin disturbance. More women than men
Psychodynamic: border between neurosis/psychosis
Mahler's theory of object relations- a child is rewarded for dependent behaviors and punished for independent ones
What is the most common defense mechanism for clients with borderline PD?
Dichotomous thinking or splitting*
What interventions can be done for borderline PD?
Set clear, realistic goals
be aware of manipulative behaviors
clear, consistent boundaries/limits
for behavioral problems, review therapeutic goals and treatment boundaries
avoid rejecting, rescuing
assess for suicidal, self mutilating behaviors (suicide precautions)
Long term family, cognitive therapy
What is the DSM-5 criteria for Histrionic PD?
4 of the following:
constantly seeks attention
inappropriately sexually seductive
over concerned with appearance
expresses emotion with exaggeration
uncomfortable when NOT the center of attentions
shifting and shallow emotions (easily angered)
What is the mnemonic PRAISE ME for histrionic PD?
P rovacative or seductive behavior
R elationships considered more intimate than they are
A ttention, must be the center of attention
I nfluenced easily
S peech that impressive, lacks detail
E motionally labile, shallowness
M ake-up that puts draws attention to the physical appearance
E exaggerated emotions, theatrical
What is the DSM-5 criteria for Narcissistic PD?
5 of the following:
reacts to criticism with rage and humiliation
exploitative in relationships
believes their problems are unique
preoccupied with fantasies of greatness
sense of entitlement
What interventions can be done for narcissistic PD?
Stay neutral, avoid power struggles
Don't be defensive when disparaged
Convey unassuming self-confidence
Group and cognitive therapy
What interventions can be done for Cluster B personality disorders?
Focus on SAFETY, maintaining a stable mood, and effective social interactions
NO primary nursing
openly discuss manipulation
MUST communicate between shifts
limit setting- clear, consistent, enforceable
avoid power struggle
Describe Cluster C personality disorders
Avoidant personality disorder: fear of rejection of criticism
Dependent personality disorder: excessive reliance on others