1. Personality Disorders
Chapter 24
Personality Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Introduction Personality defined Clinical disorders Paranoid Schizoid
Schizotypal
Narcissistic
Avoidant
Dependent
Obsessive-compulsive
Histrionic
Antisocial
Borderline
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3. Paranoid Personality Disorder
Prevalence
Characteristics
Treatment
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4. Schizoid Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Schizotypal Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Histrionic Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Narcissistic Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Avoidant Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Dependent Personality Disorder
Prevalence
Characteristics
Treatment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Obsessive-Compulsive Personality Disorder
Prevalence
Characteristics
Treatment
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11. Antisocial Personality Disorder (ASPD)
Antagonistic behaviors
Disinhibited behaviors
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12. Borderline Personality Disorder (BPD)
Negative effect
Impulsivity and antagonism
Splitting
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13. Etiology Biological factors Psychological factors
Genetic
Neurobiological
Psychological factors
Environmental factors
Diathesis-stress model
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14. Application of the Nursing Process
Assessment
Assessment tools
Patient history
Self assessment
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Case Study A patient admitted to your unit has a personality disorder.
What are some important areas to assess?
1. Assess for suicidal or homicidal thoughts. If these are present, the patient needs immediate attention.
2. Determine whether the patient has a medical disorder or another psychiatric disorder that may be responsible for the symptoms (especially a
substance use disorder).
3. View the assessment about personality functioning from within the person's ethnic, cultural, and social background.
4. Ascertain whether the patient experienced a recent important loss. Personality disorders are often exacerbated after the loss of significant
supporting people or in a disruptive social situation.
5. Evaluate for a change in personality in middle adulthood or later, which signals the need for a thorough medical workup or assessment for
unrecognized substance use disorder.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Nursing Process (Cont.)
Diagnosis (Table 24-2)
Outcomes identification (Table 24-3)
Implementation
Safety and teamwork
Pharmacological interventions
Case management
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17. Nursing Process (Cont.)
Advanced practice intervention
Psychotherapy
Evaluation
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18. Question 1
Which behavior indicates that a patient diagnosed with borderline personality disorder is improving?
The patient cries when her roommate refuses to go to the dining room with her.
The patient yells at the group facilitator when he points out that she is monopolizing the group.
The patient informs a staff member that she feels unsafe and is having thoughts of harming herself.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19. Question 1 (Cont.)
The patient tells the evening staff that the day staff excused her from group to smoke when she got upset.
Answer: C
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20. Audience Response Questions
Use of splitting is most associated with which personality disorder?
Antisocial
Borderline
Dependent
Schizotypal
ANS: B
Splitting, the primary defense or coping style used by persons with borderline personality disorder, is the inability to incorporate positive and negative aspects of oneself or others into a whole image.
REF: 7
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. Audience Response Questions
Perfectionism is a trait likely to be evident in a person with which personality disorder?
Obsessive-compulsive
Narcissistic
Antisocial
Avoidant
ANS: A
Persons with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness.
REF: 44
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22. Audience Response Questions
Antisocial, obsessive-compulsive, and schizotypal personality disorders occur most frequently in
adolescents.
children.
women.
men.
ANS: D
The prevalence rates for antisocial, obsessive-compulsive, and schizotypal personality disorders are highest in men.
REF: 36
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