Personality Disorders

Psychiatric Nursing
What is personality?
The aggregate of the physical and mental
qualities of the individual as these interact
in characteristic fashion with his
environment
- Taylor, Cecilia
What is personality trait?
Those characteristics of an individual which
make him unique and form the basis for
the way he perceives the world and how
he relates to others
- Taylor, Cecilia
Personality disorders
Personality disturbances that come
together to create a pervasive pattern of
behavior and inner experience that is quite
different from the norms of the culture
They have disturbances in self-image
Decreased ability to have successful
relationships

Characteristic of personality
disorders
Maladaptive traits often prevent the
persons interpersonal relationships and
they increase the level of anxiety or
internal stress

MALADAPTIVE BEHAVIORAL patterns are
the hallmark of personality disorders
Characteristic of personality
disorders
Maladaptive traits are often RIGID and
INFLEXIBLE that exist in attitudes and
behavior of the person
Once a personality trait is established, it is
extremely resistant but NOT IMPOSSIBLE
to change
Personality Disorders
Personality disorders
Inflexible mal-adaptive behavior pattern or
traits that may impair social, intellectual
functioning and relationships
Personality Disorders
Personality disorders
A spectrum of mal-adaptive traits that
produce or influence considerable
psychological and emotional
disturbances and impair relationships
Personality Disorders
Personality disorders
Inflexible mal-adaptive behavior
pattern or traits that may impair
social, intellectual functioning and
relationships
Features of PD
The Onset begins during
adolescence and young adulthood
Features of PD
Features of personality disorders
1. Poor impulse control, Rigid and inflexible
2. Mood characteristics
3. Impaired judgment
4. Impaired reality testing
5. Impaired object relations
6. Impaired thought process
7. Impaired self-perception
8. Impaired stimulus barrier

Features
Characteristics
Poor impulse control
Acting out to manage internal pain
Forms of acting out include physical and
verbal attacks, manipulation, substance
abuse, promiscuous sexual behaviors, and
suicide attempts
Features
Mood characteristics
Experiences abandonment and
depression
Moods include rage, guilt, fear, and
emptiness
Impaired judgment
Has difficulty with problem solving
Unable to perceive the consequences
of behavior
Features
Impaired reality testing: Distorts reality
and often projects own feelings onto
others.
Impaired object relations: Rigid reality and
inflexible and has difficulty in intimate
relationships.
Impaired self-perception: Distorted self-
perception and experiences self-hate or
self-idealization
Impaired thought processes
Features
Concrete or diffuse thinking
Difficulty concentrating
Impaired memory
Impaired stimulus barrier
Unable to regulate incoming sensory stimuli
Increased excitability
Excessive response to noise and light
Poor attention span
Agitated
Insomnia
Features of PD
Clients may deny their existing
problems and lack insight into their
mal-adaptive behavior
Types of Personality Disorders
Cluster Disorders Descriptions
Cluster 1- ODD and
ECCENTRIC
Paranoid
Schizoid
Schizotypal
Clients are
withdrawn and
engage in odd
behavior
Cluster II-
ERRATIC,
DRAMATIC and
EMOTIONAL
Antisocial
Borderline
Histrionic
Narcissistic
Clients seek
attention
Custer III-
AVOIDANT,
ANXIOUS and
FEARFUL
Avoidant
Dependent
Obsessive-compulsive
Clients seek to avoid
or minimize
experience anxiety
PD not otherwise
specified
Passive-Aggressive
Masochistic
Clients are covertly
aggressive against
self and others
Types of PD
Classification Personality
ODD or
Eccentric
Paranoid, Schizoid, Schizotypal
Dramatic/Erratic Borderline, Antisocial,
Histrionic, Narcissistic
Anxious/ Fearful Dependent, Avoidant , OCPD
Others Passive-aggressive,
cyclothymic and depressive
Prevalence of Personality Disorders
13.4 % prevalence rate
Most common of which are the avoidant,
schizoid and paranoid personality
disorders
Etiologies of Personality Disorders
There exists NO clear-cut single cause for
Personality disorders, largely UNKNOWN
Multi-causation, genetic and
environmental factors may all play roles
TEMPERAMENT may also play a role
Schizoid personality disorder

Description:
Characterized by an inability to form warm,
close social relationships
Schizoid personality disorder

Assessment
Social detachment and lack of close
relationships
Interest in solitary activities
Aloof and indifferent
Restricted expression of emotions
Lack of interest in others
Schizotypal personality disorder
Description: Exhibits abnormal or highly
unusual thoughts, perceptions, speech,
and behavior patterns
Schizotypal personality disorder
Assessments
Magical thinking
Odd thinking and speech
Relationship deficits
Paranoid personality disorder
Description:
Characterized by suspiciousness and
mistrust of others
Paranoid personality disorder
Assessment
Suspicious and distrusting
Argumentative
Hostile aloofness
Rigid, critical, and controlling of others
Grandiosity
Histrionic personality disorder
Description
Characterized by overly dramatic and
intensely expressive behavior
The client is lively and dramatic and
enjoys being the center of attention
Interpersonal relations may be poor
Histrionic personality disorder
Assessment
Marlons Syndrome
Attention seeking
Needs to be the center of attention
Sexually seductive or provocative
Self-dramatizing and theatrical
Overly concerned with appearance
Has romantic fantasies and controls partners
Bores easily
Displays dependency
Narcissistic personality disorders
Description
Characterized by an increased sense of
self-importance
The client is preoccupied with fantasies
and unlimited success and has a constant
need attention and admiration
Narcissistic personality disorders
Assessment
Grandiosity
Requires admiration and inflated
accomplishments
Overestimates abilities and
underestimates contributions of others
Lacks empathy and sensitivity to needs of
others
Avoidant personality disorder

Description:
Characterized by social withdrawal and
extreme sensitivity to potential rejection
Avoidant personality disorder

Assessment
Feelings of inadequacy
Hypersensitive to reactions of others and
reacts poorly to criticism
Social inhibition
Lack of support system
Dependent personality disorder
Description
The individual lacks self-confidence and
the ability to function independently
Passively allows others to make decisions
and assume responsibility for major areas
in his or her life
Dependent personality disorder
Assessment
Difficulty making decisions
Lacks autonomy
Cannot tolerate being alone and must
always have a close relationship
Needs others to assume responsibility and
make decisions
Obsessive-compulsive personality
disorder

Description
The client has difficulty expressing warm
and tender emotions and reflects
perfectionism, stubbornness, the need to
control others, and a devotion to work
Obsessive-compulsive personality
disorder

Assessment
Orderliness and perfectionism
Overly conscientious
Inflexible and preoccupied with details and rules
Devoted to work and lacks leisure activities and
friendships
Miserly and stubborn
Hoards worthless objects
Antisocial personality disorder

Description
A pattern of irresponsible and antisocial
behavior
Characterized by selfishness, inability to
maintain lasting relationships, poor sexual
adjustment, and failure to accept social
norms, irritability, and aggressiveness

Antisocial personality disorder

Assessment
Perceives the world as hostile
Superficial charm and hostility
No shame or guilt
Self-centered
Unreliable
Easily bored
Poor work history
Unable to tolerate frustration
Views others as objects to be manipulated
Poor judgment
Impulsive
Borderline personality disorder

Description
Characterized by instability in
interpersonal relationships, mood, and
self-image
Behavior may be impulsive and
unpredictable
Borderline personality disorder

Assessment
Unclear identity
Unstable and intense
Extreme shifts in mood
Easily angered
Easily bored
Argumentative
Depression
Self-destructive behavior
Manipulation
Unable to tolerate anxiety
Chronic feelings of emptiness and fear of being
alone
Splitting
Passive-aggressive personality
disorder
Description
Characterized by passively expressing
covert aggression rather than dealing with
it directly
The behavior can interfere with both social
and work activities

Passive-aggressive personality
disorder
Assessment
Procrastination
Stubbornness
Intentional inefficiency
Forgetfulness
Dependency
Implementation
Therapies for Personality disorders
1. Consistency in approach
2. Behavioral therapy



Implementation for PD
Nursing Interventions
1. Maintain safe environment
2. Develop a written contract with patient
3. Establish therapeutic relationship
4. Maintain objectivity and consistency
5. Set limits to behavior


Interventions for PD
Treatment is a long tiring process
Help the patient learn ways to reduce
anxiety
Limit setting
Develop a written contract
Encourage to keep journal
Recognize and deal with manipulative
behavior
General implementation for
personality disorders
Maintain safety against self-destructive
behaviors
Allow the client to make choices and be as
independent as possible
Encourage the client to discuss feelings rather
than act them out
Provide consistency in response to the client's
acting-out behaviors
Discuss expectations and responsibilities with
the client
General implementation for
personality disorders
Discuss the consequences that will follow
certain behaviors
Inform the client that harm to self, others,
and property is unacceptable
Identify splitting behavior
Assist the client to deal directly with anger
Develop a written contract with the client
General implementation for
personality disorders
Encourage the client to keep a journal recording
daily feelings
Encourage the client to participate in-group
activities, and praise non-manipulative behavior
Set and maintain limits to decrease manipulative
behavior
Remove the client from group situations in
which attention-seeking behaviors occur
Provide realistic praise for positive behaviors in
social situations
Ways to handle manipulative
behavior
Set clear realistic limits
CONFRONT client about manipulative
behavior
Clearly and consistently communicate care
plans and client behaviors to other nurses
Accept no gifts or flattery
Form therapeutic Nurse-patient
relationship