Chapter 14:
Personality Disorders
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Personality Disorders
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Maladaptive patterns of behavior relating to
others
Not caused by Axis I disorders
Onset during adolescence or early adulthood
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Cluster A: Odd, Eccentric
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Paranoid
Schizoid
Schizotypal
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Cluster B: Dramatic, Emotional
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Antisocial
Borderline
Histrionic
Narcissistic
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Cluster C: Anxious, Fearful


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Avoidant
Dependent
Obsessive-compulsive
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Theoretic Perspectives

Freud
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Antisocial, borderline, histrionic, narcissistic
personality disorders associated with phallic stage
Object relations
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
Stability and depth of individual’s relations with
significant others
Manifested by warmth, dedication, concern,
tactfulness
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Object Relations Theories
Margaret Mahler
Separation-Individuation
 Differentiation
 Practicing
 Rapprochement
 Object constancy
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Object Relations Theories
Otto Kernberg
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Tasks:

Distinguish between self and others

Integration of good and bad (self images, objects)
Splitting: Inability to synthesize positive and negative
aspects of self and others
Idealization: Idealizes person when needs are met
Devaluation: Devalues person when needs are unmet
Lack of object constancy leads to feelings of
abandonment
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Masterson
Defenses blocking growth to autonomy:
 Projection
 Clinging
 Denial
 Avoidance
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Discharge Criteria



Consider risk factor of safety for client
and others.
Have plan for follow-up.
Provide psychoeducation.
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Assessment Domains
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Emotional
Cognitive
Social
Spiritual
Physical
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11
Useful Nursing Diagnoses
Cluster A


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
Anxiety
Ineffective coping
Social isolation
Disturbed thought processes
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Useful Nursing Diagnoses
Cluster B
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Ineffective coping
Disturbed personal identity
Chronic low self-esteem
Risk for self-mutilation
Risk for suicide
Impaired social interaction
Risk for other-directed violence
Risk for self-directed violence
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Useful Nursing Diagnoses
Cluster C




Anxiety
Ineffective coping
Chronic low self-esteem
Impaired social interaction
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Example Outcomes
Client will:
 Refrain from self-mutilation.
 Recognize occurrence of cognitive
distortions.
 Identify one new method of problem solving.
 Identify positive role models.
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Planning
Recognize that behavioral changes occur
slowly.
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Interventions

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Assess suicidality.
Encourage attendance at group.
Assess escalation of anger.
Assess impulsivity, self-mutilation.
Contract concerning threatening behavior.
Encourage journal writing.
Teach:



Anger/impulse management.
Recognition of faulty thought patterns.
Alternative behaviors.
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