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
person’s 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
2. Poor impulse control, Rigid and
inflexible
3. Mood characteristics
4. Impaired judgment
5. Impaired reality testing
6. Impaired object relations
7. Impaired thought process
8. Impaired self-perception
9. 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 Paranoid Clients are
and ECCENTRIC Schizoid withdrawn and
engage in odd
Schizotypal
behavior
Cluster II- Antisocial Clients seek
ERRATIC, Borderline attention
DRAMATIC and Histrionic
EMOTIONAL
Narcissistic
Custer III- Avoidant Clients seek to
AVOIDANT, Dependent avoid or minimize
ANXIOUS and experience
Obsessive-
FEARFUL anxiety
compulsive
PD not otherwise Passive-Aggressive Clients are
specified Masochistic covertly
aggressive
against self and
 Types of PD
Classification Personality

ODD or Paranoid, Schizoid,

Eccentric Schizotypal
Dramatic/Erra Borderline, Antisocial,
tic Histrionic, Narcissistic
Anxious/ Dependent, Avoidant ,
Fearful 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
Assessment
Marlon’s 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

2. Consistency in approach

3. Behavioral therapy
 Implementation for PD

Nursing Interventions
2. Maintain safe environment

3. Develop a written contract with

patient
4. Establish therapeutic relationship

5. Maintain objectivity and consistency

6. 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