Glossary of Mental Health - Personality Disorders

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Created by daisy497

- Personality: complex traits
- determines how people cope
- how they respond to surroundings/others
- how they see themselves and others
- personalities: viewed on a continuum (normal abnormal)

Personality Disorder
- rigid, stereotyped behavioural pattern that persists throughout a person's life (long duration)
- inflexible/maladaptive responses to stress - impulse control
- impair social & occupational functioning
- lack insight

Diagnostic criteria of personality disorders:
2 or more:
1. COGNITION: ways of perceiving & interpreting oneself, other people and events
2. AFFECT: Range, intensity, lability, & appropriateness of emotional response
3. IMPAIRED SELF: Interpersonal functioning
4. IMPULSE CONTROL: Impulsivity & destructive behaviour - vicious circles of behaviour

Prevalence of Personality Disorders:
- Canada - difficult to determine
- General population 10-13%
- in Mental Health settings - incidence 30-50%
- highly correlated with criminal behaviour
- severity varies - mild/severe
- slightly more common in men
- [may end up in the hospital because of aggression of self-mutiliation; they will not come in on their own]
- [may outgrow in late 40s]
- [very high suicidal rates; highly aggressive and impulsive; many of them tend to marry nurses because they get a lot of attention]

Assessment of Personality Disorders:
- no simple technique
- interview [lengthy] reliable!!
- tools developed (MMPI - Minnesota Multiphasic Personality Disorder)
- International Personality Disorder Examination - comprehensive instrument

DSM-IV-TR Categories of Personality Disorders:
1. Cluster A - odd/eccentric (paranoid, schizoid, schizotypal)
2. Cluster B - Dramatic-Emotional [erratic] (borderline/antisocial - MOST COMMON)
3. Cluster C - Anxious/Fearful (avoidant, dependent, obsessive compulsive)

Personality Disorders:
- diagnosed or coded on axis: AXIS II
- high degree of overlap among personality disorders
- many individuals exhibit traits of several disorders
- become apparent before or during ADOLESCENCE/YOUNG ADULTHOOD
- most go undiagnosed
- enter health care system through ER
- crisis, courts
- suicidality or substance abuse
- many unmet needs related to current level of health care

Antisocial Personality Disorder
- history of antisocial behaviour (conduct)
- deceitfulness/manipulation
- consistent irresponsibility
- total lack of remorse (lying)
- charming/grandiose
- difficulty with interpersonal relationships
- forensic/prison populations (50%)

World of the Patient with Borderline Personality Disorder:
- "Everything looked and sounded unreal. Nothing was what it is. That's what I wanted - to be alone with myself in another world where truth is untrue and life can hide from itself"
- A Long Day's Journey Into Night by Eugene O'Neil
Borderline Personality Disorder:
- Relationships: Intense/Unstable
- Behaviours: Impulsive/self-damaing
- Suicidality: self-mutiliation is common
- Feelings of emptiness/boredom
- Inappropriate intense anger
- Affective instability
- Identity disturbance
- High prevalence of trauma as a child (abuse)
- Major Defence - SPLITTING

*split people against each other

IMPULSIVE clinical example of Borderline Personality Disorder:
Suzie, a 27 year old part-time secretary has been dating Tom for 2 weeks. She has told everyone he is absolutely "perfect" and they are 'madly in love'. One afternoon Tom can't meet her for dinner. Suzie files into a rage, picks up a stranger at a bar, has sex in her car. Returning home, she scratches her wrists with broken glass, calls Tom to tell him it's all his fault that she slashed her wrists and is going to die.
ANTISOCIAL clinical example of Borderline Personality Disorder:
- well you know, the only reason I'm here is because those cops made a mistake and thought I was the one assaulting that women. Actually, I stopped to help her and she told them I was trying to rape her. You know if she hadn't parked her car in the mall garage, then she wouldn't have been at risk in the first place."
Causes of Personality Disorder:
- little research on causes and treatment
- believed to be caused by multiple factors
- Developmental Theory: Separation-Individual (attachment)
- Projective Identification
*Environmental factors (very important to have a stable environment)
*Biological factors (need to let children explore their environment)

Personality Disorder "Label"
- system misfits - treatment resistant
- not sick
- Wastebasket diagnosis: a diagnosis which may be based on a fad, not proven to exist, not physiologically explained, or not described with specificity, and thus so broadly inclusive to the point of being scientifically useless
- psychological vampires
- manipulative, difficult, attention-seeking

Challenging Behaviours of Patients:
- demanding
- impulsive
- manipulation
- poor frustration tolerance
- splitting
- negativistic
- aggression
- acting out
- self-destructive (ex. laceration, incision, scratching)
- belief (attention-seeking)

Therapeutic Approaches to Care:
- treat as OUTPATIENT (they can get very dependent on the system)
- psychological interventions
- CBT (cognitive behavioural therapy)
- Dialectical Behavioural Therapy (DBT)
- Pharmaceutical interventions
- no cure for personality disorders

Nurses for Personality Disorders
- establish therapeutic relationship (boundaries) - they play one person against another
- understanding behaviours (flattery, seductiveness, guilt instilling)
- team approach
- realistic treatment plan - consistent
- setting clear limits
- remain calm, non-judgmental and consistent
- educate the family
- avoid rejecting or rescuing
- be specific when describing behaviour
- assess for suicidal/self-mutilating behaviours (SAFETY)
- use clear, straight forward communication - confrontation is necessary
- behavioural contract - antiharm contract
- avoid power struggles (nonjudgmental): this is what they are looking for
- anger management journal: express feelings
- anxiety reduction: teach relaxation techniques
- model respect, honesty, openness, & assertiveness

Clinical Interaction:
Client: "You're the sweetest nurse on the unit. I know you can help me get a pass for next Friday."

Nurse: "Darlene, when you compliment people because you want something from them, they are not likely to trust anything you say."

Impulse-Control Disorders:
- intermittent explosive disorder
- Kleptomania (steal): most women
- Pyromania (fire): set fire to things - Serotonin/Norepinephrine
- Pathologic gambling
- Trichotillomania: self-destructive hair pulling
- coexist with other disorders

Intermittent Explosive Disorder:
- Aggressiveness: assault/destruction of property
- Treatment: mulitfaceted
- Medication
- Psychotherapeutic interventions

Pathologic Gambling
- recurrent & disrupts interpersonal life
- preoccupied with gambling (arousal)
- 4 phases: winning, losing, desperation & hopelessness
- Canada: increase in legalized gambling
- associated with depression/substance use/violence/crime & unemployment

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