Chapter 24: Personality Disorders – Traits & Treatment

The ten disorders are categorized into three clusters: Cluster A encompasses odd and eccentric behaviors (Paranoid, Schizoid, and Schizotypal); Cluster B features dramatic, emotional, or erratic behaviors (Antisocial, Borderline, Histrionic, and Narcissistic); and Cluster C describes anxious or fearful behaviors (Avoidant, Dependent, and Obsessive-Compulsive). Essential nursing guidelines and treatment modalities, emphasizing the need for professional neutrality, limit setting, and cultural considerations during assessment, are discussed for each disorder. The text offers in-depth coverage of Borderline Personality Disorder (BPD), highlighting core pathological features like emotional dysregulation, chronic impulsivity, self-destructive tendencies, and the reliance on splitting as a primary defense mechanism. Etiological factors for BPD include genetic predisposition, neurobiological abnormalities such as limbic hyperreactivity, and psychological theories centered on the disruption of the separation-individuation process. The chapter also details Antisocial Personality Disorder (ASPD), characterized by callousness, profound lack of empathy, deceitfulness, and disregard for the rights of others, noting that symptoms often abate after age 40. Treatment for severe personality disorders emphasizes structured psychological approaches, notably Dialectical Behavior Therapy (DBT) for BPD and Cognitive Behavioral Therapy (CBT) for both BPD and ASPD, often supplemented by pharmacotherapy to manage specific symptoms like aggression, depression, or anxiety. Nurses are advised to monitor their own emotional responses, particularly countertransference, and maintain consistent team approaches to ensure patient safety and therapeutic success.