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Chapter 32

Personality Disorders

Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

Learning Objectives
Recognize characteristics of each personality disorder. Describe behaviors of individuals with personality disorders. Describe nursing interventions for patients with personality disorders. Recognize issues related to the care of patients with personality disorders.

Keltners Psychiatric Nursing Philippine edition

Cluster A: Odd-Centric
Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder

Keltners Psychiatric Nursing Philippine edition

Clinical Example
Jessica saw that her friend and colleague, Cathy, whom she confided her feelings that their supervisor reprimanded her when she had another outburst with one of her co-employees, was talking to the supervisor. She thought that her co-workers are talking behind her back, discussing ways how to get her fired. She discussed it with her supervisor but was told that there is no such thing. Since then she started distancing herself from her colleagues, and during coffee break, she goes to cafeteria and feels that her colleagues would look at her and laugh behind her back. This had not only affected her work but also her relationship with her family and neighbors.
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Clinical Example
Pedro is a loner. He prefers solitary activities, such as listening to music, watching DVDs, and reading books. He was not able to finish his studies but settled on working in menial jobs. He jumped from job to job until he was able to find a job where there is minimal interaction with others. He had no friends, acquaintances, or lover and he was contented with this.

Keltners Psychiatric Nursing Philippine edition

Cluster B: Dramatic-Erratic
Antisocial personality disorder Borderline personality disorder Narcissistic personality disorder Histrionic personality disorder

Keltners Psychiatric Nursing Philippine edition

Clinical Example
Andre has an unhappy childhood. During his teenage, he used to kill animals in the most gruesome ways. He had also uploaded the video of the killing to the Internet and was sentenced for a community service of a year. Now, in his mid-20s, he was convicted of trespassing and rape. While he served his sentence, he was able to make his mark that he was feared by others. After several years, he was given a parole because, according to his papers, he showed exemplary good conduct during his sentence. Unknowingly to the public, he manipulated the people inside the prison so that he can be given parole. As soon as he was out, he started planning his revenge. He initially projected a good ex-con image but began his murderous activities, starting with the woman who testified against him during his trial.

Keltners Psychiatric Nursing Philippine edition

Cluster C: Anxious-Fearful
Dependent personality disorder Avoidant personality disorder Obsessive-compulsive personality disorder

Keltners Psychiatric Nursing Philippine edition

Clinical Example
John experienced being unloved by his own father. He has been often called stupid. He grew up fearful of his father. Like a typical student, he would immediately go home after school and stay in his room reading books, writing stories, or solving difficult math problems. Although he was able to go to college through a scholarship, he studies online to avoid being criticized by others. He works inside a stockroom where he feels safe. He buys his groceries at times when there would be very few people in the grocery store to see him. He finds solitude and safety inside his small apartment. He would not go beyond his comfort zone again.
Keltners Psychiatric Nursing Philippine edition

Clinical Example
Monk maintains a rigid set of standards or rules, values, ethics, and morality. He has an everyday routine that has never been broken. He rides the same bus every day at the same time. He arrives at work on time and leaves on time. He reacts negatively to those who do the opposite of his work. He is inflexible and has difficulty building relationships with people whose values are different from him.

Keltners Psychiatric Nursing Philippine edition

Useful NANDA Diagnoses


Anxiety Communication, impaired verbal Family processes, interrupted Hopelessness Loneliness, risk for Powerlessness Self-esteem, chronic low, situational low, situational low, risk for situational low Self-mutilation, risk for Social isolation Violence, risk for selfdirected or risk for otherdirected

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Nursing Interventions
Help the patient recognize specific behaviors distressing to self, others, or both Manage feelings Develop coping behaviors that are less dysfunctional

Keltners Psychiatric Nursing Philippine edition