Care and mobility considerations
The difficulties experienced by a person with a personality disorder (PD) depends upon the type of disorder and the degree to which it is exhibited.
There is a continuum of behaviour from the exhibition of a particular personality trait to the actual diagnosis of a personality disorder. Some of these traits may be desirable attributes in particular occupations e.g. obsessional traits in research or in the legal profession and histrionic characteristics in the performing arts.
The different features of the individual personality disorders can affect a person’s functional capacity in specific ways.
Coping with tasks involving contact with others may be affected by people with most of the diagnostic categories, but particularly avoidant, dependent and borderline PD. For example, anxiety and agitation may be so severe as to cause accidents, avoidance behaviour may cause inability to open letters or pay bills, and disturbed self-image may make productive working relationships impossible. People with obsessive compulsive PD may have difficulty in completing tasks within a reasonable period.
Daily living may be affected in schizoid, borderline, narcissistic, avoidant and dependent disorders; self-neglect can be extreme at times, and activities such as shopping or using public transport can cause considerable anxiety. There may be extreme emotional lability in borderline disorders or an abnormal fixation with appearance in narcissistic and histrionic disorders.
Social interaction is affected by all disorders to a greater or lesser extent. The conditions exerting the greatest effect are schizoid (where a person has no interest in relating to others) and avoidant (where he or she fears interaction with others). These people may lead solitary existences without any normal family or social contact. Those with paranoid, schizotypal, narcissistic, obsessive compulsive or histrionic PD may exhibit interactions with others characterised by bizarre behaviour or beliefs. Antisocial PD may or may not be manifest in day-to-day social interactions.
Mild Functional Restriction
| Category | Description |
|---|---|
Disabling Effects | People with a mild functional restriction are likely to have some of the following-:
|
Mobility | They should not have difficulty finding their way around unfamiliar places and should not require guidance or supervision. |
Care | They would not normally exhibit significant self-neglect and would not normally put themselves or others at risk of danger. They should not normally have any significant functional loss that will result in a reduction of their ability to carry out normal day-to-day activities. |
Moderate Functional Restriction
| Category | Description |
|---|---|
Disabling Effects | People with a moderate functional restriction are likely to have some of the following-:
|
Mobility | They are unlikely to have any physical difficulty with walking. They are unlikely to have difficulty finding their way around unfamiliar places and are unlikely to require guidance or supervision. They may be reluctant to go out but are unlikely to benefit from having a companion to encourage them to go out. |
Care | They may have intermittent episodes of self neglect but these are unlikely to last for more than a few weeks at a time. Because of their reluctance to go out, together with their inability to carry out day to day activities in a timely fashion, they may require help with activities such as shopping, preparing meals and management of housing and financial affairs. It should be noted that they may be unwilling to accept help in engaging in social activities. They may engage in risk taking behaviour, for example, unprotected sex or drug taking but presence of a companion is not likely to be able to prevent this. |
Severe Functional Restriction
| Category | Description |
|---|---|
Disabling Effects | People with a severe functional restriction are likely to have some of the following-:
|
Mobility | They are unlikely to have any physical difficulty with walking. They may have difficulty finding their way around unfamiliar places and may require guidance or supervision either because they may be considered a danger to themselves or others or because of overwhelming anxiety and lack of self confidence. |
Care | They may have persistent self neglect. Because of their unstable mental state they may require prompting for all activities of daily living such as maintaining hygiene, shopping, preparing meals and management of housing and financial affairs. They may be distressed at night and on occasion this may require someone to watch over them in order to provide reassurance and prevent injury or danger to themselves or others. |
Amended June 2008
