Module Components

• Overview
• Learning Activities

Topics

• Epidemiology
• Diagnoses
• Differential Diagnoses
• Treatment
• Pediatric Considerations

NDNP 870 - Diagnosis and Management 1: Differential Diagnosis of Mental Disorders Across the Lifespan

Module 9: Personality Disorders, Oppositional and Conduct Disorders

Diagnoses

Be careful when you are considering personality disorder diagnoses due to stigma. They are diagnoses to make over time with multiple observations and assessment of functional barriers.

Ask about problematic behaviors. Do they have a history of multiple suicide attempts? Is there a history of sexual abuse? Are there problems working with others? Is there a lack of friends and close relationships?

When individuals present with symptoms, always look for the main diagnoses first. Sometimes the personality disorder is the primary diagnosis. Behaviors to observe over time include a show of enhanced vigilance, repeated episodes of self-harm, excessive dependence, demanding something, then rejecting it, failure to respond to therapeutic treatments, impulsivity, extreme responses, consistently faulty judgment, and more focus on appearance than relationship.

The PMHNP must take into consideration cultural, ethnic, and social background before diagnosing personality disorders. Do not confuse expression of cultural customs, habits, religious or political values and problems with acculturation as personality disorders. That is a criterion of exclusion for the diagnoses of personality disorders. It would be important to speak with family members and friends to see if these are problematic behaviors.

Screening Questions for Personality Disorders:

• In general, do you have difficulty making and keeping friends?
• Would you normally describe yourself as a loner?
• In general, do you trust other people?
• Do you normally lose your temper easily?
• Are you normally an impulsive sort of person?
• Are you normally a worrier?
• In general, do you depend on others a lot?
• In general, are you a perfectionist?

General Personality Disorder - 2 or more:

• Cognition (ways of perceiving and interpreting self, other people and events)
• Affectivity (the range, intensity, labiality, and appropriateness of emotional response)
• Interpersonal functioning
• Impulse control

Paranoid Personality Disorder—Suspiciousness

Schizoid Personality Disorder—Withdrawal

Schizotypal Personality Disorder—Odd

Antisocial Personality Disorder—Dishonesty

Borderline Personality Disorder—Labiality

• Accounts for about 25% hospital admissions (worsens afterward)
• Symptoms worse in 30-40 year old age group
• 40% have history of sexual abuse

Histrionic Personality Disorder— Attention Seeking

Narcissistic Personality Disorder — Grandiosity

Avoidant Personality Disorder — Hypersensitivity

Dependent Personality Disorder — Submissiveness

Obsessive-Compulsive Personality Disorder — Perfectionism