Personality disorders
Personality disorders: Excerpt from Professional Guide to Diseases (Eighth Edition)
Defined as individual traits that reflect chronic, inflexible, and maladaptive patterns of behavior, personality disorders cause social discomfort and impair social and occupational functioning. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, groups personality disorders into three clusters:
❑ Cluster A — paranoid, schizoid, and schizotypal personality disorders. These disorders share odd or eccentric behavior.
❑ Cluster B — antisocial, borderline, histrionic, and narcissistic personality disorders. Dramatic, emotional, or erratic behavior highlights these disorders.
❑ Cluster C — avoidant, dependent, and obsessive-compulsive personality disorders. These disorders are marked by anxious or fearful behavior.
Each disorder produces characteristic signs and symptoms, which may vary among patients and even with the same patient at different times.
Personality disorders are lifelong conditions with an onset in adolescence or early adulthood. Cluster A and B disorders tend to grow less intense in middle age and late life, whereas cluster C disorders tend to become exaggerated. Patients with cluster B disorders are susceptible to substance abuse, poor impulse control, and suicidal behavior, which may shorten lives.
Personality disorders overlap with other psychiatric disorders, such as substance abuse disorders, mood disorders, and anxiety disorders.
Causes and incidence
Various theories attempt to explain the origin of personality disorders. Genetic factors influence the biological basis of brain function as well as basic personality structure. In turn, personality structure affects how a person responds to life experiences and interacts with the social environment. Over time, each person develops distinctive ways of perceiving the world and of feeling, thinking, and behaving.
Some researchers suspect that poor regulation of the areas controlling emotion within the brain increases the risk of a personality disorder, especially when combined with such factors as abuse, neglect, or separation. For a biologically predisposed person, the major developmental challenges of adolescence and early adulthood may trigger a personality disorder.
Social theories hold that disorders reflect learned responses, having much to do with reinforcement, modeling, and aversive stimuli as contributing factors. According to psychodynamic theories, personality disorders reflect deficiencies in ego and superego development and are related to poor mother-child relationships characterized by unresponsiveness, overprotectiveness, or early separation.
Personality disorders are common and affect 10% to 15% of the population in the United States. Gender influences presence; for example, antisocial and obsessive-compulsive personality disorders are more common in men, whereas borderline, dependent, and histrionic personality disorders are more prevalent in women.
Signs and symptoms
Each specific personality disorder produces characteristic signs and symptoms, which may vary among patients and within the same patient at different times. In general, the history of the patient with a personality disorder will reveal long-standing difficulties in interpersonal relationships, ranging from dependency to withdrawal, and in occupational functioning, with effects ranging from compulsive perfectionism to intentional sabotage.
The patient with a personality disorder may show any degree of self-confidence, ranging from no self-esteem to arrogance. Convinced that his behavior is normal, he avoids responsibility for its consequences, commonly resorting to projections and blame.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing personality disorders.
Treatment
Personality disorders are difficult to treat. Successful therapy requires a trusting relationship in which the therapist can use a direct approach. The type of therapy chosen depends on the patient’s symptoms. Family and group therapies are usually effective. Cognitive and self-help groups have also been beneficial.
Drug therapy is effective in some types of personality disorders; for example, pimozide has been successfully used to reduce paranoia ideation in some patients with paranoid personality disorder. Antipsychotic drugs (olanzapine or risperidone) may be used to treat severe agitation or delusional thinking. Selective serotonin reuptake inhibitors, such as fluoxetine, may be used to treat irritability, anger, and obsessional thinking. Antianxiety drugs may be used to treat severe anxiety that interferes with normal thinking.
Hospital inpatient milieu therapy can be effective in crisis situations and possibly for long-term treatment of some disorders. Inpatient treatment is controversial, however, because most patients with personality disorders don’t comply with extended therapeutic regimens; for such patients, outpatient therapy may be more helpful.
Special considerations
❑ Provide consistent care. Take a direct, involved approach to ensure trust. Keep in mind that many of these patients don’t respond well to interviews, whereas others are charming and convincing.
❑ Teach the patient social skills, and reinforce appropriate behavior.
❑ Encourage expression of feelings, self-analysis of behavior, and accountability for actions.
Specific care measures vary with the particular personality disorder.
For antisocial personality disorder:
❑ Be clear about your expectations and the consequences of failing to meet them.
❑ Use a straightforward, matter-of-fact approach to set limits on unacceptable behavior. Encourage and reinforce positive behavior.
❑ Expect the patient to refuse to cooperate so that he can gain control.
❑ Avoid power struggles and confrontations to maintain the opportunity for therapeutic communication.
❑ Avoid defensiveness and arguing.
❑ Observe for physical and verbal signs of agitation.
❑ Help the patient manage anger.
❑ Teach the patient social skills and reinforce appropriate behavior.
For avoidant personality disorder:
❑ Assess for signs of depression. Impaired social interaction increases the risk of affective disorders.
❑ Establish a trusting relationship with the patient. Be aware that he may become dependent on the few staff members whom he believes he can trust.
❑ Make sure that the patient has plenty of time to prepare for all upcoming procedures. This patient can’t handle surprises well.
❑ Inform the patient when you will and won’t be available if he needs assistance.
For borderline personality disorder:
❑ Encourage the patient to take responsibility for himself. Don’t attempt to rescue him from the consequences of his actions (except for suicidal and self-mutilating behaviors).
❑ Don’t try to solve problems that the patient can solve himself.
❑ Maintain a consistent approach in all interactions with the patient, and ensure that other staff members do so as well.
❑ Recognize behaviors that the patient uses to manipulate people so that you can avoid unconsciously reinforcing them.
❑ Set appropriate expectations for social interactions, and praise the patient when expectations are met.
❑ To promote trust, respect the patient’s personal space.
❑ Recognize that the patient may idolize some staff members and devalue others.
❑ Don’t take sides in the patient’s disputes with other staff members.
For dependent personality disorder:
❑ Encourage the patient to make decisions. Continue to provide support and reassurance as his decision-making ability improves.
❑ Give the patient as much opportunity to control treatment as possible. Offer options and allow choice, even if all are chosen.
❑ Encourage activities that require decision-making to promote autonomy.
For histrionic personality disorder:
❑ Give the patient choices in care strategies, and incorporate his wishes into the plan of treatment as much as possible. By increasing his sense of self-control, you’ll reduce his anxiety.
❑ Be aware that the patient will want to “win over” caregivers and, at least initially, will be responsive and cooperative.
For narcissistic personality disorder:
❑ Convey respect and acknowledge the patient’s sense of self-importance so that a coherent sense of self can be reestablished. Don’t reinforce either pathologic grandiosity or weakness.
❑ If the patient makes unreasonable demands or has unreasonable expectations, tell him in a matter-of-fact way that he’s being unreasonable. Remain nonjudgmental because a critical attitude may make the patient more demanding and difficult. Don’t avoid him as this could increase maladaptive attention-seeking behavior.
❑ Focus on positive traits, or on feelings of pain, loss, or rejection.
For obsessive-compulsive personality disorder:
❑ Allow the patient to participate in his own treatment plan by offering choices whenever possible.
❑ Adopt a professional approach in your interactions with the patient. Avoid informality; this patient expects strict attention to detail.
For paranoid personality disorder:
❑ Avoid situations that threaten the patient’s autonomy or challenge his beliefs.
❑ Approach the patient in a straightforward and candid manner, adopting a professional, rather than a casual or friendly, attitude. Remember that the paranoid patient easily misinterprets remarks intended to be humorous.
❑ Encourage the patient to take part in social interactions to expose him to others’perceptions and realities and to promote social skills development.
❑ Help the patient identify negative behaviors that interfere with his relationships so that he can see how his behavior affects others.
❑ Provide a supportive and nonjudgmental environment in which the patient can safely explore and verbalize his feelings.
For schizoid personality disorder:
❑ Remember that the schizoid patient needs close human contact but is easily overwhelmed. Respect the patient’s need for privacy, and slowly build a trusting, therapeutic relationship, so that he finds more pleasure than fear in relating to you.
❑ Give the patient plenty of time to express his feelings. Keep in mind that, if you push him to do so before he’s ready, he may retreat.
❑ Recognize the patient’s need for physical and emotional distance.
❑ Remember that the patient needs close human contact but is easily overwhelmed.
For schizotypal personality disorder:
❑ Recognize that the patient with this disorder is easily overwhelmed by stress. Allow him plenty of time to make difficult decisions.
❑ Avoid defensiveness and arguing.
❑ Recognize the patient’s need for physical and emotional distance.
❑ Be aware that the patient may relate unusually well to certain staff members and not at all to others.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Personality disorders
More Medical Textbooks Online about Personality disorders
Review other book chapters online related to Personality disorders:
Medical Books Excerpts
- ANXIETY
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Anxiety
- "In a Page: Signs and Symptoms" (2004)
- [ read ]
- Agitation
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Anxiety
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Agitation
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Anxiety
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Anxiety
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Anxiety
- "Field Guide to Bedside Diagnosis" (2007)
- [ read ]
- Agitation
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Anxiety
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Agitation
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Anxiety
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Generalized anxiety disorder (Professional Guide to Diseases (Eighth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
