Disorder
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 0
Chapter 22
Social Responses and
Personality Disorders
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 1
Figure 22-1 States of relatedness. (From Hagerty BMK et al: Image 25:291, 1993.)
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 2
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.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 3
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 obsessivecompulsive personality disorders)
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 4
Figure 22-4 The Stuart Stress Adaptation Model as related to social responses.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 5
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
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 6
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
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 7
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.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 8
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.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 9
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.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 10
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.
Copyright © 2005 Mosby, Inc. All rights reserved.
Slide 11
