Personality disorders

Prepared by:

Miss Sehrish Naz

oRN, Post RN, MSN
oLecturer Institute of nursing sciences, Khyber Medical University,
Hayatabad, Peshawar.
 PERSONALITY
Personality is a consistent (constant) way of
thinking and feeling which results from the
interaction of a person’s genetic make-up his
level of education and past experiences.

 Largely unconscious.
 Cannot be changed easily.
 PERSONALITY
DISORDERS
• Personality disorders occur when traits become
inflexible and maladaptive but stable over time.
• Cause either significant functional impairment or
subjective distress. However they stay in the
main stream of society.
• Present with symptoms more subtle than other
disorders.
• Onset in adolescence or early adulthood.
 DSM-IV-TR CRITERIA
• DSM-IV-TR stands for, Diagnostic and Statistical Manual
of Mental Disorders, fourth edition, text revision.
• The list of personality disorders are also known as Axis II
disorders.
• Enduring pattern of inner experience and behavior that
deviates markedly from an individual’s culture
manifesting in two or more of the following areas:
– Cognition
– Affect (mood)
– Inter-personal functioning
– Impulse control
 Prevalence and Co-morbidity

• 10% to 15% in general populations

• Often co-occur with depression and anxiety
• Onset usually occurs before onset of other
psychiatric disorders
• Various PDs often co-exist
 Biological Determinants
• Certain inherited traits may
be present at birth.
• Genetic alterations may result
in an extreme variation.
• Unfavorable environmental
conditions may affect the
development of the disorder.
 Assessment

• Minnesota Multiphasic Personality Inventory

(MMPI) to evaluate personality

• Full medical history

• Psychosocial history
– Suicidal or aggressive thoughts
– Risk of harm from self or others
– Use of medications or illegal substances
– Ability to handle money
– Legal history
– Current or past abuse
 Impact of Personality Disorder
Client’s Behaviors on Caregivers
• Overwhelming needs of clients may also
be overwhelming for caregivers
• Caregivers may feel
– Confused
– Helpless
– Angry
– Frustrated
 Splitting Behaviors of Clients
• Primary defense used by clients with borderline PD
• Client labels individuals either “all good” or “all bad”
• When all-good person does not met client's needs,
that person becomes all bad
• Someone else then labeled all good, others all bad
• Creates conflict in staff members
• To decrease conflict among staff
– Open communication in staff meetings
– Ongoing clinical supervision
 Clusters (DSM-IV)
• Cluster A: “ Eccentric”(Unconventional) Personality Disorders
– Paranoid
– Schizoid
– Schizotypal
• Cluster B: “Dramatic” Personality Disorders
– Antisocial
– Borderline
– Histrionic
– Narcissistic
• Cluster C: “Anxious” Personality Disorders
– Avoidant
– Dependent
– Obsessive Compulsive
 Signs and symptoms of Cluster A
(eccentric)
• Paranoid personality disorder
– General suspiciousness
– Inability to work collaboratively with others
– Emotional detachment
– Hostility(agression) toward others
 Nursing intervention

• Few seek professional help on their own.

• Treatment focuses on development of trust.
• Cognitive therapy to overcome negative thinking.
• Give specific feedback about positive
characteristics.
 Schizoid personality disorder

– Fantasizing (daydreaming)
– Extreme introversion(self-absorption)
– Emotional distance, even from family members
– Fixation on your own thoughts and feelings
 Nursing Intervention

– Few seek professional help on their own.

– Focus on the value of interpersonal relationships,
empathy, and social skills.
– Treatment prognosis is generally poor.
– Give specific feedback about positive thoughts.
 Cont……..
Schizotypal personality disorder
– Indifference to and withdrawal from others
– "Magical thinking" — the idea that you can
influence people and events with your thoughts.
– Elaborate style of dressing, speaking and
interacting with others
– Belief that messages are hidden for you in public
speeches and displays
– Suspicious or paranoid ideas
 Nursing Intervention

– Main focus is on developing social skills

– Treatment also addresses comorbid depression
– Medical treatment is similar to that used for
schizophrenia
– Treatment prognosis is generally poor
 Signs and Symptoms of Cluster B
(Dramatic)
Histrionic personality disorder
– Excessive sensitivity to others' approval
– Attention-grabbing, often sexually provocative
clothing and behavior
– Excessive concern with your physical appearance
– False sense of intimacy with others
– Constant, sudden emotional shifts
 Nursing Interventions
• The nurse gives clients feedback about their social
interactions with others including manner of dress
and nonverbal behavior.
• Teaching social skills and role-playing those skills in a
safe, nonthreatening environment can help clients to
gain confidence in their ability to interact socially.
• The nurse must be specific in describing and modeling
social skills including establishing eye contact, active
listening, and respecting personal space.
• Give specific feedback about positive characteristics.
 Cont……

Narcissistic personality disorder

– Constant attention-grabbing and admiration-
seeking behavior
– Inability to empathize with others
– Excessive anger or shame in response to criticism
– Manipulation of others to further your own
desires
 Nursing Interventions

• The nurse must use self awareness skills to avoid the

anger and frustration.
• Clients may be rude and arrogant, unwilling to wait, and
harsh and critical of the nurse. The nurse must not
internalize such criticism or take it personally.
• The nurse teaches about comorbid medical or psychiatric
conditions, medication regimen, and any needed self-care
skills in a matter-of-fact manner.
• He or she sets limits on rude or verbally abusive behavior
and explains his or her expectations from the client.
 Cont….
• Antisocial personality disorder
– Chronic irresponsibility and unreliability .
– Lack of regard for the law and for others' rights.
– Persistent lying and stealing .
– Aggressive, often violent behavior.
– Lack of remorse for hurting others .
– Lack of concern for the safety of self and others .
 Cont……
• Borderline personality disorder
– Difficulty controlling emotions or impulses .
– Frequent, dramatic changes in mood, opinions and
plans .
– Stormy relationships involving frequent, intense
anger and possibly physical fights .
– Fear of being alone despite a tendency to push
people away .
– Feeling of emptiness inside .
 Nursing Interventions.
 Promoting client’s safety
 No self-harm contract: in which a client promises to not
engage in self-harm and to report to the nurse when he or she
is losing control.
 Safe expression of feelings and emotions.
 Helping client to cope and control emotions
 Identifying feelings.
 Moderating emotional responses.
 Decreasing impulsivity.
 Establishing boundaries.
 conti…
 Cognitive restructuring techniques
• Thought-stopping
• Positive self talk
• Decatastrophizing
• Structuring time
• Teaching social skills
• Teaching effective communication skills
• Therapeutic relationship
• Assertiveness techniques such as “I” statements
• Use of distraction such as walking or listening to music
 Sign and symptoms Cluster C
(Anxious or Fearful)

Avoidant personality disorder

• Over-riding sense of social

discomfort
• Easily hurt by criticism
• Always need emotional support
• Occasionally try to socialize
– so distressing they retreat into
loneliness
 Cont….
Dependent Personality Disorder

• Submissive, clingy behavior

• Fear of separation
• Easily hurt by criticism
 Cont…..
Obsessive-Compulsive
Personality Disorder

• Excessive control and

perfectionism
• Inflexible
• Preoccupied with trivial
details
• Judgmental/moralistic
• Often humorless
THANK YOU