PERSONALITY DISORDER 2.

Stress exacerbates PD
➢ Stress is the most common precipating factors
Personality 3. Recognizable by adolescence or earlier and continue throughout
- The totality of a person’s unique biopsychosocial and spiritual traits adult life
that consistently influence behavior ➢ It may depend on the triggering factors and timing of PD
- Individual differences in characteristics, pattern of thinking, feelings 4. Have troubles with working and loving
and behaving ➢ A big concern on adaptation and socialization
- 2 broad areas: TRAITS OF INDIVIDUALS WITH PD
➢ Understanding of individual differences in particular personality
characteristics such as: - Enduring pattern of perceiving, relating and thinking about the
environment
• Sociability
- One self that are exhibited in a wide range of social and personal
• Irritability
context
Personality disorders 1. Interpersonal relations that range from distant to overprotective
➢ It may be gauge the values and virtues of an individual
- are diagnoses when personality traits become inflexible,
2. Suspiciousness
maladaptive and significantly interfere with how a person function
➢ A quality of distrust or disbelief
in society
3. Social anxiety
- cause a person an emotional distress
➢ The stress of this situation is too much to handle
- can be only diagnosed when the person reaches adulthood and
4. Failure to conform to social norm
personality is more completely formed
➢ They become deviant in the society
- a long-standing treatment because characters are cannot change
5. Self-destructive behavior
easily
➢ Hurt and inflect pain of satisfaction
- they can’t recognize their own behavior as a source of difficulty
6. Manipulation and splitting
- INFLEXIBLE maladaptive pattern of behavior that impair functioning
CLUSTERS OF PD
CAUSE
a. Cluster A = odd and eccentric
- Maladaptive social behavior exhibited by individuals are reinforced
1. Paranoid
and maintained by rewards
o Suspicious, jealous and short tempered
CHARACTERISTICS: 2. Schizoid
o Doesn’t want to socialize and prefers to be alone and
1. Still in touch with reality
detached
➢ Still has an awareness

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 3. Schizotypal CA: PARANOID PD
o Superstitious, believes in magic and ideas of reference
- Pervasive distress and suspiciousness of others such that their
motives are interpreted as malevolent
b. Cluster B = dramatic, emotional or erratic
- Beginning at early adulthood
1. Antisocial
- More common in men than women
o Irresponsible, display lack of guilt and good at
Diagnostic criteria (4 or more of the following)
manipulation
a. Suspicious of other people
2. Borderline
b. Doubts loyalty and trustworthiness of friends and associates
o Intense relationship, self-mutilation and impulsiveness
c. Reluctant to confide to others
3. Histrionic
d. Conscious of hidden meanings behind remarks of others
o Attention-seeking, self-centered, seductive and dramatic
e. Persistently bears grudges
4. Narcissistic
f. Suspicious of fidelity of spouse or sexual partner
o Grandiose view of self and lacks empathy for others
g. Blames others for problems
c. Cluster C = anxious and fearful Clinical features:
1. Obsessive-compulsive
➢ Constantly on guard, hypervigilant and ready for any real or
o Preoccupied with perfection, conscious of rules and self-
imaginative threat
critical
➢ Look tense and irritable
2. Avoidant
➢ Insensitive to the feelings of others
o Fearful of criticism and rejection, negative self-esteem
➢ Avoid interactions with others
and few social interactions
➢ Always feel that others are taking advantage of them
3. Dependent
➢ Extremely oversensitive
o Submissive, clinging to others and unable to make
➢ Do not accept responsibility for their own behaviors
decisions by self
Treatment
PD PREVALENCE
- Engage in a collaborative working relationship based on trust
- 6-9% of population have one or more PD
- Individual psychotherapy
- ASPD & OCPD are more common in men
➢ The process of examining thoughts, feelings, bodily experience
- Borderline, dependent and histrionic for women
and relationships as well as looking at personal and family
- Most people with PD never seek for professional help
patterns to gain greater understanding about oneself
- Pharmacologic therapy

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 ➢ Antipsychotic drugs: Zyprexa, Risperdal, Prozac and antianxiety Diagnostic Criteria (4 or more)
drugs
a. Does not enjoy close relationships
Nursing interventions b. Always chooses solitary activities
c. Has little interest in having sexual experiences
➢ Use straightforward, honest, professional approach rather than
d. Takes pleasure in few activities
casual or friendly approach
e. Lacks close friends or confidants
➢ Offer persistent, consistent and flexible care
f. Appears cold and aloof
➢ Provide a supportive non-judgemental environment in which a
pt ca safely explore his feelings Clinical features:
➢ Establish a therapeutic relationship by actively listening and
➢ Appear cold, aloof and indifferent to others
responding
➢ They prefer to work in isolation and are unsociable with little
➢ DON’T GET TOO PERSONAL
need or desire for emotional ties
• Avoid inquiring too deeply into his life or history unless
➢ In the presence of other they appear shy, anxious or uneasy
it’s relevant to clinical treatment
➢ They are inappropriately serious about everything and have
• Don’t challenge the pt’s paranoid beliefs because it is not
difficulty acting in a lighthearted manner
therapeutic
➢ They are unable to experience pleasure and their affect is
• Avoids situations that threaten the pt’s autonomy commonly bland and constricted
• Use humor cautiously
• Help identify negative behaviors that interfere with his Nursing interventions
relationships so he can see how his behavior affects ➢ Focus on immediate concerns/problems
others ➢ Develop rapport and trust in slow gradual process and help feel
secure and acknowledge boundaries
CA: SCHIZOID PD ➢ Bring feelings into proper focus (especially fears, fantasies,
imaginations, dependency and withdrawn)
- Lack of interest in social relationships ➢ Respect the need for privacy and slowly build a trusting
- Solitary or sheltered lifestyle relationship to find pleasure than fear
- Secretiveness, emotional coldness, detachment and apathy ➢ Avoid defensiveness and arguing
- Hallmark: detachment, social withdrawal and indifference to others’
feelings
- Prevalence: affects 0.7% of general population and more on males
- Causes: unknown and grossly deficient early parenting

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 CA: SCHIZOTYPAL PD ➢ Develop consistent relationship
➢ Encourage patient to examine behaviors and discuss feelings
- Thought disorder, paranoia and social anxiety, derealization,
➢ Give positive reinforcement for successful interaction with
transient psychosis and unconventional beliefs
others
Diagnostic criteria (5 or more) ➢ Rotate staff who work with the patient

a. Ideas of references
b. Odd beliefs or magical thinking
CB: BORDERLINE PD
c. Unusual perceptual experiences
d. Inappropriate affect - Mental illness characterized by long term pattern of unstable
e. Appears strange or odd relationship
f. Lack of close friends or confidants - Distorted sense of self and strong emotional reaction
g. Excessive social anxiety - Intense, unstable and extremes
- Instability of mood, identity, relationships, impulses and self-image
Clinical features:
- Family hx: probable childhood sexual abuse
➢ Aloof and isolated and behave in a bland and apathetic manner
Diagnostic criteria (5 or more)
➢ Magical thinking
➢ Ideas of reference a. Unstable yet intense relationship
➢ Illusions b. Identity disturbance
➢ Depersonalization c. Impulsivity of at least two (spending, sex, substance abuse, reckless
➢ Bizarre speech pattern driving, binge eating)
➢ Cannot orient their thoughts logically and become lost in d. Tends to have self-detrimental behavior
personal irrelevancies e. Affective instability
➢ Under stress they may decompensate and demonstrate f. Chronic feelings of emptiness
psychotic symptoms g. Difficulty controlling anger
➢ Affect is bland or inappropriate h. Transient paranoid ideation
Nursing Interventions Nursing interventions
➢ Set limits on manipulative behavior ➢ Encourage to take responsibility for herself, don’t rescue except
➢ All staff must be consistent and follow through with suicidal or self-mutilating behavior
consequences in a matter-of-fact manner ➢ Convey empathy and support but don’t try to solve problems and
➢ Provide positive feedback for non-manipulative behavior let pt solve herself
➢ Offer recognition and praise accomplishment ➢ Maintain consistency

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 CB: HISTRIONIC PD Clinical features:
Diagnostic criteria (5 or more) ➢ A-bsuses substances
➢ N-o satisfying IPR’s
a. Uncomfortable in situations in which e or she is not the center of
➢ T-end to manipulate others
attention
➢ I-rresponsible and exploitative
b. Inappropriate sexually seductive or provocative behaviour
➢ S-ocial norms are disregarded
c. Rapid shifting of emotions
➢ O-bnoxios toward others (no guilt, shame or remorse)
d. Uses physical appearance to draw attention to self
➢ C-old and callous
e. Shows self dramatization
➢ I-ntimidates others
Treatments: ➢ A-rgumentative
➢ L-egal problems
- Patients rarely seeks treatment unless it causes functional
impairment and ineffective coping Treatment
- Goal of treatment is not to cure but relieve worst elements of
➢ Individual Psychotherapy
behavior
- Jailhouse talk
- Psychotherapy
- What to pursue after release, improvement of social or family
• Treatment of choice, focus on solving problems in life and
relationships and learning new coping skills
individual psychotherapy is preferred (not family since it may
➢ Pharmacologic therapy are not recommended but be given to
trigger dramatic attention seeking behavior)
treat to disorganized thinking and stabilize mood swings

CB: ANTISOCIAL PD
Diagnostic criteria (3 or more):
a. Failure to conform social norms
b. Deceitfulness
c. Impulsivity
d. Irritability or aggressiveness
e. Reckless disregard for safety of self or others
f. Consistent irresponsibility
g. Lack of remorse

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