Personality Disorders

-refers to a diagnostic category of psychiatric

disorders characterized by a chronic, inflexible, and
maladaptive pattern of relating to the world.
-a group of psychiatric conditions in which a person's
long-term (chronic) behaviors, emotions, and
thoughts are very different from their culture's
expectations and cause serious problems with
relationships and work.
Personality Disorders
-They suffer lifelong, inflexible and dysfunctional
patterns of relating and behaving
-The most noticeable and significant feature of
these disorders is their negative effect on
interpersonal relationships
“Ego Syntonic”
 Personality
-refers to a person's unique and enduring pattern
of thinking, feeling, and behaving.
-refers to the pattern of thoughts, feelings and
behavior that makes each of us the individuals
that we are
PERSONALITY DISORDERS
CLUSTERS
CLUSTER A (ODD and ECCENTRIC)
◦ PSS
CLUSTER B (DRAMATIC, EMOTIONAL, ERRATIC)
◦ BHAN
CLUSTER C (ANXIOUS, FEARFUL)
◦ ADO

“PSS BHAN ADO”

Paranoid Personality Disorder
(SUSPECT)
S: Spouse fidelity, suspected
U: Unforgiving (bears grudges)
S: Suspicious of others
P: Perceives attacks (and reacts quickly)
E: "Enemy or friend" (suspects associates, friends)
C: Confiding in others feared
T: Threats perceived in benign events
 Intervention:
1. Approach patient in a calm, formal, emphatic and business-like
manner.
2. Being on time, keeping commitments, and being particularly straight
forward.
3. Establish rapport
4. Avoid group therapies
some responds to low dose antipsychotics, benzodiazepines, and
antidepressants
Schizoid Personality Disorder
(DISTANT)
D: Detached (or flattened) affect
I: Indifferent to criticism and praise
S: Sexual experiences of little interest
T: Tasks (activities) done solitarily
A: Absence of close friends
N: Neither desires nor enjoys close relationships or
friends
T: Takes pleasure in few activities
The Secret Schizoid
-Ralph Klein
-Present themselves as socially available, interested,
engaged, and involved in interacting in the eyes of the
observer, while at the same time remaining
emotionally withdrawn and sequestered within the
safety of the internal world.
 Interventions:
1. Focus on improving functioning in the community
2. Socialization through group activities would be less
desirable
3. Approach patient in calm manner
4. Maintain a comfortable distance based on client’s verbal
and non verbal communication
5. Administer psychotropics ex. Risperidone(Risperdal)
 Schizotypal personality disorder
(ME PECULIAR )
M: Magical thinking or odd beliefs
E: Experiences unusual perceptions
P: Paranoid ideation
E: Eccentric behavior or appearance
C: Constricted (or inappropriate) affect
U: Unusual (odd) thinking and speech
L: Lacks close friends
I: Ideas of reference
A: Anxiety in social situations
R: Rule out psychotic disorders and pervasive developmental disorder
Interventions:
1. Approach patient in calm manner
2. Maintain a comfortable distance based on client’s
verbal and non verbal communication
3. Administer psychotropics ex.
Risperidone(Risperdal)
 Psychotherapeutic Management
most important—dealing with trust issues
A professional demeanor coupled with honesty and non
intrusiveness will assist in developing some trust
-clear, simple explanations and requests will reduce the patient’s
feelings of being threatened or controlled
-do not tolerate group therapies that expect or involve
confrontation or much emotional involvement
CLUSTER B (DRAMATIC,
EMOTIONAL, ERRATIC)
These people have intense emotional mood
swings and distorted perceptions of themselves
and impulsive behaviors.
 Borderline Personality Disorder
(AM SUICIDE)
A: Abandonment
M: Mood instability (marked reactivity of mood)
S: Suicidal (or self-mutilating) behavior
U: Unstable and intense relationships
I: Impulsivity (in two potentially self-damaging areas)
C: Control of anger
I: Identity disturbance
D: Dissociative (or paranoid) symptoms that are transient and stress-related
E: Emptiness (chronic feelings of)
Interventions
1. Use empathy while maintaining boundaries.
2. Long term psychotherapy to address issues of family
dysfunction and abuse
Short term: self harm and transient psychotic symptoms
3. Low dose of neuroleptics for 3 to 12 weeks
◦ Lithium valproic acid and carbamazepine
◦ Benzodiazepines SSRI
HELPING CLIENT COPE AND TO
CONTROL EMOTIONS
oKeeping a journal often helps the client gain
awareness of feelings
oDecreasing impulsivity and delay gratification
by using distraction techniques
Histrionic Personality Disorder (PRAISE
ME )
P: Provocative (or sexually seductive) behavior
R: Relationships (considered more intimate than they are)
A: Attention (uncomfortable when not the center of attention)
I: Influenced easily
S: Style of speech (impressionistic, lacks depth)
E: Emotions (rapidly shifting and shallow)
M: Made up (physical appearance used to draw attention to self)
E: Emotions exaggerated (theatrical)
Interventions
1. Focus on consistency, understanding, and
providing an environment that minimizes
maladaptive coping patterns
2. Provide support to facilitate independent problem
solving and daily functioning.
Antisocial Personality Disorder
(CORRUPT)
C: Conformity to law, lacking
O: Obligations ignored
R: Reckless disregard for safety of self or others
R: Remorse lacking
U: Underhanded (deceitful, lies, cons others)
P: Planning insufficient (impulsive)
T: Temper (irritable and aggressive)
Interventions:
1. LIMIT SETTING
3 steps in Limit setting
◦ stating the behavioral limit (stating the unacceptable behavior)
◦ Identifying the consequences if the limit is exceeded
◦ Identifying the expected or desired behavior
2. Confrontation
- The nurse points out the client’s problematic behavior while
remaining neutral, he or she avoids accusing the client
Narcissistic Personality Disorder
( EN SPECIAL )
E: Envious of others
N: Needs to be admired
S: Special (believes he or she is special and unique)
P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty,
or ideal love)
E: Entitlement
C: Conceited (grandiose sense of self-importance)
I: Interpersonal exploitation
A: Arrogant (haughty)
L: Lacks empathy
Interventions:
1. Use self-awareness skills to avoid anger and
frustration.
2. The nurse must not internalize client’s arrogance as
criticism
3. Sets limit on rude or verbally abusive behavior and
explains his or her expectations from the client
Avoidant Personality Disorder
(CRINGES)
C: Certainty (of being liked required before willing to get involved with others)
R: Rejection (or criticism) preoccupies one's thoughts in social situations
I: Intimate relationships (restraint in intimate relationships due to fear of being
shamed)
N: New interpersonal relationships (is inhibited in)
G: Gets around occupational activity (involving significant interpersonal
contact)
E: Embarrassment (potential) prevents new activity or taking personal risks
S: Self viewed as unappealing, inept, or inferior
Interventions:
1. Provide support and reassurance
2. In nonthreatening context of the relationship, help the
client to explore positive aspects, positive responses
from others and possible reasons for self-criticism
3. Help client practice self-affirmations and positive self-
talk
4. Reframing and decatastrophizing
Dependent Personality Disorder
(RELIANCE)
R: Reassurance required for decisions
E: Expressing disagreement difficult (due to fear of loss of support or
approval)
L: Life responsibilites (needs to have these assumed by others)
I: Initiating projects difficult (due to lack of self-confidence)
A: Alone (feels helpless & discomfort when alone)
N: Nurturance (goes to excessive lengths to obtain nurturance & support)
C: Companionship (another relationship) sought urgently when close
relationship ends
E: Exaggerated fears of being left to care for self
Interventions:
1. Help client express feeling of grief and loss
over the end of a relationship while fostering
autonomy and self-reliance.
2. Help client identify their strengths and needs.
3. Refrain from giving advice about problems or
making decisions for the client.
 Obsessive-Compulsive Personality
Disorder (LAW FIRMS)
L: Loses point of activity (due to preoccupation with detail)
A: Ability to complete tasks (compromised by perfectionism)
W: Worthless objects (unable to discard)
F: Friendships (and leisure activities)
I: Inflexible, scrupulous
R: Reluctant to spend
M: Make others do things his or her way in work or task-related
activity
S: Stubbornness (and rigidity)
Interventions:
1. Help client to view decision making and completion
of projects from a different perspective.
2. Encourage client to take risks to delegate activity.
3. Help clients to accept or to tolerate less-than-
perfect work or decisions
 Treatments
Psychotherapy
Psychotherapy is the main way to treat personality disorders. You learn about
your condition and your mood, feelings, thoughts and behavior. Using the insight
and knowledge you gain in psychotherapy, you can learn healthy ways to manage
your symptoms.
Types:
Cognitive behavioral therapy
Dialectical behavior therapy
Psychodynamic psychotherapy
Psychoeducation
 Medications
Antidepressant medications. Antidepressants may be useful if you have a
depressed mood, anger, impulsivity, irritability or hopelessness, which may be
associated with personality disorders.
Mood-stabilizing medications. As their name suggests, mood stabilizers can help
even out mood swings or reduce irritability, impulsivity and aggression.
Anti-anxiety medications. These may help if you have anxiety, agitation or
insomnia. But in some cases, they can increase impulsive behavior.
Antipsychotic medications. Also called neuroleptics, these may be helpful if your
symptoms include losing touch with reality (psychosis) or in some cases if you
have anxiety or anger problems.