Kim Maryniak, PhD, RNC-NIC, NEA-BC
Nurses in any setting may care for patients who have a mental disorder. Patients with behavioral health needs may seek out healthcare for their disorder, or it may be a co-morbidity for a patient who has a physical illness. Patients with personality disorders may be encountered by nurses along the continuum of healthcare. It is important that nurses have an understanding of personality disorder to effectively care for their patients.
Personality disorders, defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), is a persistent pattern of internal experience and behavior which manifests in two or more of the areas of thinking, feeling, interpersonal relationships, and impulse control. This pattern greatly differs from the expectations of the individual's culture, is insidious and uncompromising, has an onset in adolescence or early adulthood, stabilizes over time, and can cause disturbance or affliction to the affected individual (American Psychiatric Association [APA], 2013).
In the United States, approximately 10-15% of the population has been diagnosed with a personality disorder (Bienenfeld, 2016 & National Institute of Mental Health, 2017). On a global level, it is estimated that 4-15% of the population has a personality disorder (Tyrer, Reed, & Crawford, 2015).
The fundamental characteristics of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. Four core features of personality disorders include inflexible, extreme and distorted thinking patterns (thoughts), problematic emotional response patterns (feelings), problems with impulse control (behavior), and substantial interpersonal problems (behavior) (APA, 2013).
Although there are many theories that have been studied, there is no definitive cause that has been identified for the development of personality disorders. Many believe it is multi-factorial in nature. Development of personality disorders involves numerous predisposing factors that occur over a period of time.
In the current edition of the APA manual (DSM-V), the disorders are provided as ten categories for personality types, divided into three clusters, based on descriptive similarities, such as symptoms and risk factors.
• The cluster A group of personality disorders contains those in which individuals demonstrate behaviors described as odd or eccentric (Bienenfeld, 2016 & Parekh, 2016).
o Cluster A includes paranoid, schizoid, and schizotypal personalities.
• The cluster B group of personality disorders contains those in which individuals demonstrate behaviors described as emotional or dramatic (Bienenfeld, 2016 & Parekh, 2016).
o Cluster B includes antisocial, histrionic, narcissistic, and borderline personalities.
• The cluster C group of personality disorders contains those in which individuals demonstrate behaviors described as fearful or anxious (Bienenfeld, 2016; Parekh, 2016).
o Cluster C includes avoidant, dependent, and obsessive/compulsive personalities, as well as personality disorder not otherwise specified (APA, 2013).
Nursing assessment and monitoring is important in identifying personality disorders. Interventions include ensuring the safety of the patient and others, developing therapeutic relationships, consistency amongst healthcare team members, assisting the patient with anxiety reduction, encouraging appropriate expression of emotions, and patient and family teaching, among others. The treatment of these disorders is a lengthy process that requires intense psychotherapy and may involve medications.
For more information regarding this topic, refer to the RN.com course Caring for Patients with Mental Health Disorders.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bienenfeld, D. (2016). Personality disorders. Retrieved from: http://emedicine.medscape.com/article/294307-overview
National Institute of Mental Health. (2017). Prevalence of personality disorders in adults. Retrieved from: http://www.nimh.nih.gov/health/statistics/prevalence/any-personality-disorder.shtml
Parekh, R. (2016). What are personality disorders? Retrieved from: https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
Tyrer, P., Reed, G. M., & Crawford, M. J. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), 717-726.
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