02.11 Personality Disorders

All right in this lesson we're going to talk about personality disorders.

Let's just start with the definition. Personality disorders are a group of maladaptive Behavior earns of behavior cognition and inner culture that make maintaining relationships and functioning very difficult. So what the heck does that mean? Basically the behaviors and thought processes that make up our personality and make us who we are become distorted. So we can't interact with others in a way that is functional and manageable.

There are three clusters of personality disorders. Cluster a is odd and eccentric which includes schizoid, schizotypical, and paranoid personality disorders. Cluster B is over-emotional and erratic and it includes histrionic, narcissistic, antisocial, and borderline personality disorders. And cluster C is anxious and fearful and It involves obsessive-compulsive, avoidant, and dependent personality disorders. For the purposes of this lesson we aren't going to go into too much detail about the specific personality disorders, but we will talk about the general characteristics of all personality disorders. If you check out the care plan attached to this lesson, it defines a few of these in more specifics.

The first thing to know about personality disorders is that it involves a distortion of reality. Remember that patients with schizophrenia tend to have breaks with reality. They will go in and out based on their hallucinations and delusions and what specific type of schizophrenia they have. But with personality disorder distort reality but they never actually fully break from it. The biggest issue we have with personality disorders is that they cannot see or predict the consequences of their actions and they can't see the impact of their actions on others. So in a normal situation... if this is me, and this is you. I recognize that everything I do has the potential to impact you and your life especially if you're someone who is close to me. Now, let's say this is someone with personality disorder, and this is someone close to them. Clients with personality disorder tend to believe that their actions only impact themselves. There is a disconnect between their actions and the possible impact on other people. It is very difficult and in some cases next to impossible for them to make the connection that there is even any kind of impact on the other person. This is especially true in narcissistic personality disorder. Everything is about them and they cannot possibly understand why you would be upset about something they did because in their minds it doesn’t affect you.

So, some defining characteristics - clients with personality disorders tend to have a preoccupation with sex, religion, or themselves and a distorted view of themselves, whether excessively high or excessively low. All of this makes it very difficult to maintain relationships, and many of these clients become expert manipulators. They also tend to be very excitable, making it hard to focus or having jumpy or excessive responses to light or sound, as well as poor impulse control. We also see that many clients with personality disorders tend to deal with their emotions with a physical response, like becoming agitated or violent.

So, that being said - safety is ALWAYS our #1 priority. We assess for self-harm and possibly create a written contract with them stating that they won’t harm themselves or anyone else while they’re in our care. We do want to promote Independence whenever appropriate but we still need to be consistent with our limits and boundaries. We also need to make sure we communicate our expectations and manage theirs - they need to know what we expect them to do, and they need to know what we will and won’t be doing for them. You should be genuine in all of your interactions with these clients. And we need to acknowledge splitting when it occurs. Splitting is when the client will try to turn one staff member against the other or split them, or will categorize some as better or worse than others. They may even say these are the good nurses and these are the bad nurses. So the client may say “well Susie was my nurse yesterday and she said that I could go outside whenever I want”. Or even “I like Joe better than you”. We need to acknowledge that when it happens by saying something like “I am hearing that you are frustrated, let’s talk about that instead of trying to compare staff members”. We want them to discuss how they are feeling and the emotions behind it, not the behaviors or manipulations.

Priority nursing concepts for a patient with personality disorder is safety, of course, mood / affect, and interpersonal relationships. Again, you can imagine that someone who is manipulative and doesn't see the consequences of their actions would have difficulty maintaining healthy relationships.

So let's recap. Remember that there are three clusters of personality disorders based on key characteristics. Clients with personality disorder tend to have distorted views of reality and can't see the consequences of their behavior. It's very common for these clients to use manipulation as a coping mechanism so we want to acknowledge splitting when it occurs and promote discussion of their feelings. Remember that consistency is key so set boundaries limits and communicate expectations and then hold to them. This is often a reason for splitting because some staff members hold to these boundaries and some don’t, so as a staff we need to make sure we’re doing this, as well. And of course safety is always first.

That's it for personality disorders. Make sure you check out all of the resources attached to this lesson, including the care plan and patient story. Now go out and be your best self today. And, as always, happy nursing!