1. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 0

2. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 1 Chapter 22 Social Responses and Personality Disorders

3. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 2 Figure 22-1 States of relatedness. (From Hagerty BMK et al: Image 25:291, 1993.)

4. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 3 Features of Personality Disorders The individual has acquired few strategies for relating, and his or her approach to relationships and to the environment is inflexible and maladaptive. The individual’s needs, perceptions, and behavior tend to foster vicious circles that continue unhelpful patterns and provoke negative reactions from others. The individual’s adaptation skills are characterized by tenuous stability, fragility, and lack of resilience when faced with stressful situations.

5. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 4 DSM-IV-TR Clusters of Personality Disorders Cluster A includes personality disorders of an odd or eccentric nature (paranoid, schizoid, and schizotypal personality disorders) Cluster B includes disorders of an erratic, dramatic, or emotional nature (antisocial, borderline, histrionic, and narcissistic personality disorders) Cluster C includes disorders of an anxious or fearful nature (avoidant, dependent, and obsessive- compulsive personality disorders)

6. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 5 Figure 22-4 The Stuart Stress Adaptation Model as related to social responses.

7. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 6 Primary Nursing Diagnoses Related to Maladaptive Social Responses Defensive coping Chronic low self-esteem Risk for self-mutilation Impaired social interaction Risk for self-directed violence Risk for other-directed violence

8. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 7 Primary Medical Diagnoses Related to Maladaptive Social Responses Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder Avoidant personality disorder Dependent personality disorder Obsessive-compulsive personality disorder

9. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 8 Evidence-Based Treatments for Personality Disorders Disorder: Avoidant personality disorder Treatment: Group-administered behavioral interventions are effective in improving social skills. Antidepressants may be helpful as well.

10. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 9 Evidence-Based Treatments for Personality Disorders (Cont.) Disorder: Borderline personality disorder Treatment: Dialectical behavioral therapy (DBT) produces lower attrition, fewer and less severe episodes of parasuicidal behavior, and fewer days of hospitalization. Partial hospitalization involving group and individual psychotherapy for 18 months reduces the number of suicide attempts, acts of self-harm, psychiatric symptoms, and inpatient days, and increases the quality of social and interpersonal functioning. Noradrenergic agents tend to improve mood but not irritability or dyscontrol. Serotonergic agents may act to reduce impulsivity.

11. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 10 Evidence-Based Treatments for Personality Disorders (Cont.) Disorder: Mixed personality disorder (excluding cluster A disorders) Treatment: An average of 40 weeks of brief dynamic therapy yields substantial symptomatic improvement at both the end of treatment and after 1.5 years. Medications may be useful for several of these disorders, although many methodological problems remain to be worked out.

12. Copyright © 2005 Mosby, Inc. All rights reserved. Slide 11 Evidence-Based Treatments for Personality Disorders (Cont.) Disorder: Schizotypal personality disorder (and other cluster A disorders) Treatment: Antipsychotic medications may be useful in reducing some of the symptoms of these disorders.