NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES(INI)

PRESENTATION ON PARANOID AND

SCHIZOID PERSONALITY DISORDERS
SUBJECT: MENTAL HEALTH NURSING
UNIT: XVII: PERSONALITY DISORDERS

SUBMITTED TO

SUBMITTED BY

DR. RAMACHANDRA

NEETHU ROSE JOHN

ADDL. PROFESSOR

MSc Nsg IInd YEAR

NIMHANS

NIMHANS

INTRODUCTION
The understanding of personality and its disorders is what distinguishes psychiatry
fundamentally from all other branches of medicine. A person is a self-aware human being, not a
machine-like object that lacks self-awareness. Personality refers to all of the characteristics that
distinguish a constantly developing, self-organizing human being from a predictable machinelike object. In other words, personality refers to all the ways in which someone shapes and adapts
in a unique way to ever-changing internal and external environments.
Knowledge of the personalities of people provides the psychobiological context in which their
behavior and relationships can be adequately understood as a complex adaptive process, which is
crucial for all diagnosis and treatment. As a result, no psychiatric assessment is adequate without
a description of the patient's personality and its development across the lifespan.
Even if a psychiatrist takes a reductive, rather than a holistic, view of psychological medicine,
the assessment of personality disorder (PD) is still essential in clinical practice because
personality disorders are such common conditions in contemporary society. PDs occur in 10 to
20 percent of the general population and in about half of psychiatric inpatients or outpatients.
People with PD have chronic impairments in their ability to work and love, tend to be less
educated, drug dependent, single, and unemployed, and have marital difficulties. They consume
a large portion of community services, social welfare benefits, and public health and prison
resources.
About one half of all psychiatric patients have PD, which is frequently comorbid with other
clinical syndromes. Personality disorders and associated traits, such as low self-directedness, are
predisposing influences on the full range of other psychiatric disorders (e.g., substance use,
suicide, affective disorders, schizophrenia and other psychotic disorders, impulse control
disorders, eating disorders, and anxiety disorders). Comorbid PDs interfere with treatment
outcomes of patients and increase personal incapacitation, morbidity, and mortality of these
patients.
On the other hand, recovery of a positive quality of life in people with mental disorders is most
strongly predicted by positive personality developments, such as increased self-directedness.
Positive personality traits, such as high self-directedness and cooperativeness, serve as protective
and recovery factors for many mental and other medical disorders and often improve the
treatment outcome of the co-morbid conditions, including psychoses. Both psychotherapy and
medication management benefit from the recognition and understanding of personality and its
disorders. Optimal psychiatric treatment requires that recovery address the needs of the person
for a positive quality of life in a hopeful and compassionate manner, rather than merely work to
reduce symptoms and risk of harm. A psychiatry for the person must be directed toward
improving positive mental health, as well as reducing negative symptoms of mental disorder.

HISTORICAL PERSPECTIVES
The concept of a personality disorder has been described for thousands of years (Skodol &
Gunderson, 2008). In the 4th century B.C., Hippocrates concluded that all disease stemmed from
an excess of or imbalance among four bodily humors: yellow bile, black bile, blood, and phlegm.
Hippocrates identified four fundamental personality styles that he concluded stemmed from
excesses in the four humors: the irritable and hostile choleric (yellow bile); the pessimistic
melancholic (black bile); the overly optimistic and extraverted sanguine (blood); and the
apathetic phlegmatic (phlegm). The medical profession first recognized that personality
disorders, apart from psychosis, were cause for their own special concern in 1801, with the
recognition that an individual can behave irrationally even when the powers of intellect are
intact. Nineteenth-century psychiatrists embraced the term moral insanity, the concept of which
defines what we know today as personality disorders. A major difficulty for psychiatrists has
been the establishment of a classification of personality disorders. The DSM-IV-TR provides
specific criteria for diagnosing these disorders. The DSM-IV-TR groups the personality disorders
into three clusters, which, together with the disorders classified under each, are described as
follows:
1. Cluster A: Behaviors described as odd or eccentric
a. Paranoid personality disorder
b. Schizoid personality disorder
c. Schizotypal personality disorder
2. Cluster B: Behaviors described as dramatic, emotional,
or erratic
a. Antisocial personality disorder
b. Borderline personality disorder
c. Histrionic personality disorder
d. Narcissistic personality disorder
3. Cluster C: Behaviors described as anxious or fearful
a. Avoidant personality disorder
b. Dependent personality disorder
c. Obsessivecompulsive personality disorder
Historically, individuals with personality disorders have been labeled as bad or immoral and
as deviants in the range of normal personality dimensions. The events and sequences that result
in pathology of the personality are complicated and difficult to unravel. Continued study is
needed to facilitate understanding of this complex behavioral phenomenon.
As per ICD 10 criteria
F60-69 Disorders of adult personality and behavior
F60 Specific personality disorders
F60.0 Paranoid personality disorder

F60.1 Schizoid personality disorder

F60.2 Dissocial personality disorder
F60.3 Emotionally unstable personality disorder
.30 Impulsive type
.31 Borderline type
F60.4 Histrionic personality disorder
F60.5 Anankastic personality disorder
F60.6 Anxious (avoidant) personality disorder
F60.7 Dependent personality disorder
F60.8 Other specific personality disorders
F60.9 Personality disorder, unspecified
F61 Mixed and other personality disorders
F62 Enduring personality changes, not attributable to brain damage and disease
F63 Habit and impulse disorders
F64 Gender identity disorders
F65 Disorders of sexual preference
F66 Psychological and behavioral disorders associated with sexual development and orientation
F68 Other disorders of adult personality and behavior
F69 Unspecified disorder of adult personality and behavior
SPECIFIC PERSONALITY DISORDERS
A specific personality disorder is a severe disturbance in the characterological constitution and
behavioural tendencies of the individual, usually involving several areas of the personality, and
nearly always associated with considerable personal and social disruption. Personality disorder
tends to appear in late childhood or adolescence and continues to be manifest into adulthood. It is
therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of
16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented
below; supplementary descriptions are provided with each of the subtypes.
Diagnostic guidelines
Conditions not directly attributable to gross brain damage or disease, or to another psychiatric
disorder, meeting the following criteria:
(a) Markedly disharmonious attitudes and behaviour, involving usually several areas of
functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style
of relating to others;
(b) The abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of
mental illness;

(c) The abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of
personal and social situations;
(d) The above manifestations always appear during childhood or adolescence and continue into
adulthood;
(e) The disorder leads to considerable personal distress but this may only become apparent late in
its course;
(f) The disorder is usually, but not invariably, associated with significant problems in
occupational and social performance.
For different cultures it may be necessary to develop specific sets of criteria with regard to social
norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is
usually required of the presence of at least three of the traits or behaviours given in the clinical
description
PARANOID PERSONALITY DISORDER
Definition and Epidemiological Statistics
The DSM-IV-TR defines paranoid personality disorder as a pervasive distrust and
suspiciousness of others such that their motives are interpreted as malevolent, beginning by early
adulthood and present in a variety of contexts (APA, 2000). Sadock and Sadock (2007) identify
the characteristic feature as a long-standing suspiciousness and mistrust of people in general.
Prevalence is difficult to establish because individuals with the disorder seldom seek assistance
for their problem or require hospitalization. When they present for treatment at the insistence of
others, they may be able to pull themselves together sufficiently so that their behavior does not
appear maladaptive. The disorder is more commonly diagnosed in men than in women.
Clinical Picture
Individuals with paranoid personality disorder are constantly on guard, hypervigilant, and ready
for any real or imagined threat. They appear tense and irritable. They have developed a hard
exterior and become immune or insensitive to the feelings of others. They avoid interactions with
other people, lest they be forced to relinquish some of their own power. They always feel that
others are there to take advantage of them. They are extremely oversensitive and tend to
misinterpret even minute cues within the environment, magnifying and distorting them into
thoughts of trickery and deception. Because they trust no one, they are constantly testing the
honesty of others. Their intimidating manner provokes exasperation and anger in almost
everyone with whom they come in contact. Individuals with paranoid personality disorder
maintain their self-esteem by attributing their shortcomings to others. They do not accept
responsibility for their own behaviors and feelings and project this responsibility on to others.

They are envious and hostile toward others who are highly successful and believe the only
reason they are not as successful is because they have been treated unfairly. People who are
paranoid are extremely vulnerable and constantly on the defensive. Any real or imagined threat
can release hostility and anger that is fueled by animosities from the past. The desire for reprisal
and vindication is so intense that a possible loss of control can result in aggression and violence.
These outbursts are usually brief, and the paranoid person soon regains the external control,
rationalizes the behavior, and reconstructs the defenses central to his or her personality pattern.
As per ICD 10,
(a) Excessive sensitiveness to setbacks and rebuffs
(b) Tendency to bear grudges persistently, e.g. refusal to forgive insults and injuries or slights;
(c) Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or
friendly actions of others as hostile or contemptuous;
(d) A combative and tenacious sense of personal rights out of keeping with the actual situation;
(e) Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual
partner;
(f) Tendency to experience excessive self-importance, manifest in a persistent self referential
attitude;
(g) Preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate
to the patient and in the world at large.
Includes: expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)
Excludes: delusional disorder (F22.-) schizophrenia (F20.-)

According to the DSM-5, there are two primary diagnostic criterion for Paranoid Personality
Disorder of which criterion A has seven sub features, four of which must be present to warrant a
diagnosis of PPD:
Criterion A is: Global mistrust and suspicion of others motives which commences in adulthood.
The seven sub features of criterion A are:
1.The person with PPD will believe others are using, lying to, or harming them, without apparent
evidence thereof.
2.They will have doubts about the loyalty and trustworthiness of others,
3.,They will not confide in others due to the belief that their confidence will be betrayed.
4.They will interpret ambiguous or benign remarks as hurtful or threatening, and

5. Hold grudges,
6. In the absence of objective evidence, believe their reputation or character are being assailed by
others, and will retaliate in some manner and
7. Will be jealous and suspicious without cause that intimate partners are being unfaithful.
Criterion B is that the above symptoms will not be during a psychotic episode in schizophrenia,
bipolar disorder, or depressive disorder with psychotic features,
A qualifier is that if the diagnostic criteria for PPD is met prior to the onset of Schizophrenia, it
should be noted Paranoid Personality Disorder was premorbid (American Psychiatric
Association, 2013).

Predisposing Factors
Research has indicated a possible hereditary link in paranoid personality disorder. Studies have
revealed a higher incidence of paranoid personality disorder among relatives of clients with
schizophrenia than among control subjects (Sadock & Sadock, 2007). Psychosocially, people
with paranoid personality disorder may have been subjected to parental antagonism and
harassment. They likely served as scapegoats for displaced parental aggression and gradually
relinquished all hope of affection and approval. They learned to perceive the world as harsh and
unkind, a place calling for protective vigilance and mistrust. They entered the world with a
chip-on-the-shoulder attitude and were met with many rebuffs and rejections from others.
Anticipating humiliation and betrayal by others, the paranoid person learned to attack first.
Diagnostic guidelines
At least three of the traits or behaviors listed in the diagnostic guidelines of the specific
personality disorders must be fulfilled.
Management
Psychotherapy
As with most personality disorders, psychotherapy is the treatment of choice. Individuals with
paranoid personality disorder, however, rarely present themselves for treatment. It should not be
surprising, then, that there has been little outcome research to suggest which types of treatment
are most effective with this disorder.
It is likely that a therapy which emphasizes a simple supportive, client-centered approach will be
most effective. Rapport-building with a person who has this disorder will be much more difficult

than usual because of the paranoia associated with the disorder. Early termination, therefore, is
common. As the therapy progresses, the patient will likely begin to trust the clinician more and
more. The client then will likely begin disclosing some of his or her more bizarre paranoid
ideation. The therapist must be careful to balance being objective in therapy and with regards to
these thoughts, and of raising the suspicions of the client that he or she is not trusted. It is a
difficult balance to maintain, even after a good working rapport has been established.
During times when the patient is acting upon his paranoid beliefs, the therapists loyalties and
trust may be called into question. Care must be used not to challenge the client too firmly or risk
the individual leaving therapy permanently. Control issues should be dealt with in much a similar
manner, with great care. Since the paranoid beliefs are delusion and not based in reality, arguing
them from a rational point of view is useless. Challenging the beliefs is also likely to result in
more frustration on both the part of the therapist and client, too.
All clinicians and mental health personnel who come into contact with the individual who suffers
from paranoid personality disorder should be more keenly aware of being straight-forward with
this individual. Subtle jokes are often lost on them and allusions to information about the client
not received directly from the clients mouth will raise a great deal of suspicion. Therapists
should typically avoid trying to have the patient sign a release of information for information not
essential to the current therapy. Items in life which usually wouldnt give most people a second
thought can easily become the focus of attention to this client, so care must be exercised in
discussions with the client. An honest, concrete approach will likely gain the most results,
focusing on current life difficulties which has brought the client into therapy at this time.
Clinicians should generally not inquire too deeply into the clients life or history, unless its
directly relevant to clinical treatment.
Medications
Medications are usually contraindicated for this disorder, since they can arouse unnecessary
suspicion that will usually result in noncompliance and treatment dropout. Medications which
are prescribed for specific conditions should be done so for the briefest time period possible to
bring the condition under management.
An anti-anxiety agent, such as diazepam, is appropriate to prescribe if the client suffers from
severe anxiety or agitation where it begins to interfere with normal, daily functioning. An antipsychotic medication, such as thioridazine or haloperidol, may be appropriate if a patient
decompensates into severe agitation or delusionsal thinking which may result in self-harm or
harm to others.

SCHIZOID PERSONALITY DISORDER

Definition and Epidemiological Statistics
Schizoid personality disorder is characterized primarily by a profound defect in the ability to
form personal relationships or to respond to others in any meaningful, emotional way (Skodol &
Gunderson, 2008). These individuals display a lifelong pattern of social withdrawal, and their
discomfort with human interaction is apparent. The prevalence of schizoid personality disorder
within the general population has been estimated at between 3 and 7.5 percent. Significant
numbers of people with the disorder are never observed in a clinical setting. Gender ratio of the
disorder is unknown, although it is diagnosed more frequently in men.
Clinical Picture
People with schizoid personality disorder appear cold, aloof, and indifferent to others. They
prefer to work in isolation and are unsociable, with little need or desire for emotional ties. They
are able to invest enormous affective energy in intellectual pursuits. In the presence of others
they appear shy, anxious, or uneasy. They are inappropriately serious about everything and have
difficulty acting in a lighthearted manner. Their behavior and conversation exhibit little or no
spontaneity. Typically they are unable to experience pleasure, and their affect is commonly bland
and constricted.
As per ICD 10, following features must be present:
(a)few, if any, activities, provide pleasure;
(b)emotional coldness, detachment or flattened affectivity;
(c)limited capacity to express either warm, tender feelings or anger towards others;
(d)apparent indifference to either praise or criticism;
(e)little interest in having sexual experiences with another person (taking into account age);
(f)almost invariable preference for solitary activities;
(g)excessive preoccupation with fantasy and introspection;
(h)lack of close friends or confiding relationships (or having only one) and of desire for such
relationships;
(i)marked insensitivity to prevailing social norms and conventions.
Excludes: Asperger's syndrome (F84.5)
delusional disorder (F22.0)
schizoid disorder of childhood (F84.5)
schizophrenia (F20.-)
schizotypal disorder (F21)

The criteria for SPD from the DSM-5 are as follows (American Psychiatric Association,
2013):
A persistent pattern of disinterest from social interactions and a limited variety of expression of
emotions in a close personal settings, starting in early adulthood and there in an array of
contexts, as shown by at least four (or more) of the subsequent:

neither wants nor likes close relationships, counting being part of a family

almost constantly picks introverted activities

has little if any, thought in engaging in any sexual experiences

seldom derives pleasure from any activities

has no close friends other than immediate relatives

appears apathetic to the admiration or disapproval of others

shows emotional coldness, detachment, or flattened affectivity

Predisposing Factors
Although the role of heredity in the etiology of schizoid personality disorder is unclear, the
feature of introversion appears to be a highly inheritable characteristic (Skodol & Gunderson,
2008). Further studies are required before definitive statements can be made. Psychosocially, the
development of schizoid personality is probably influenced by early interactional patterns
that the person found to be cold and unsatisfying. The childhoods of these individuals have often
been characterized as bleak, cold, and notably lacking empathy and nurturing. A child brought up
with this type of parenting may become a schizoid adult if that child possesses a temperamental
disposition that is shy, anxious, and introverted. Skodol and Gunderson (2008) state: Clinicians
have noted that schizoid personality disorder occurs in adults who experienced cold, neglectful,
and un-gratifying relationships in early childhood, which presumably had led these persons to
assume that relationships are not valuable or worth pursuing.
Diagnostic guidelines
At least three of the traits or behaviors listed in the diagnostic guidelines of the specific
personality disorders must be fulfilled.

Management for cluster A personality disorders

THERAPIES
It is unlikely that clients will pursue therapy because they are usually unaware of the features of
the personality disorder. If help is obtained, it's often sought only when the client experiences a
mood disorder, anxiety disorder, or dissociative symptoms as the result of a significant stressor,
such as divorce, bereavement trauma, and occupational loss. These clients don't usually remain
in therapy for long. The overall purpose of therapy is to establish a helping relationship that
provides support and guidance in social situations and relationships.
Individual Therapy

Work to establish a rapport with the client.

Establish a trust relationship.
Encourage the client to learn and practice decision making.
Provide support, and work to keep the client functioning comfortably.
Help the client develop appropriate interpersonal skills and break the rigid and inflexible
pattern of self-defeating behaviors.
Refer to social and occupational rehabilitation as necessary.

MEDICATIONS

Medications such as phenothiazines may be used for clients who are fearful or anxious.
Antidepressants, such as tricyclics, serotonin reuptake inhibitors, and monoamine oxidase
inhibitors, are used to treat depression.
Low-dose neuroleptic agents are used to treat delusions, ideas of reference, and anxiety and
cognitive symptoms in clients with schizotypal personality disorder. (See Appendix D for
medication information.)

FAMILY CARE

Explain to family members the characteristics of the personality disorder and how to manage
the eccentric behavior.
Encourage the family to help the client take care of physical needs because the client may not
focus on self-care.
Discuss how to facilitate the client's social needs because the client tends to restrict
interactions and daily activities.
Work with the family to aid the client with decision making.

Nursing Management
COMMUNICATION STRATEGIES - FOR CLIENTS WITH CLUSTER A PERSONALITY
DISORDERS

Make statements that reinforce reality.

Limit discussion to concrete, familiar topics.
Use clear, simple messages to prevent misinterpretation of words or phrases.
Resist trying to provide logic to counteract the client's inappropriate statements or behaviors
because a power struggle may ensue in which the client works vehemently to defend himself
Maintain a non-defensive position when the client verbalizes anger or makes hostile
comments.
Discuss non-controversial topics, avoiding such issues as religion and politics.
Don't use humor.
Acknowledge the practical difficulties, such as the occupational impairment and lack of
friendships that the client experiences as a result of the disorder.
Acknowledge the client's pain and fears.
Don't focus on the interaction of distorted perceptions because pointing out these perceptions
may generate paranoid fears.
Offer gentle reassurance when perceptions are frightening.
Don't touch the client. If touch is necessary, ask the client's permission because touch may be
misinterpreted as physical or sexual assault.
Accept the client's positive and negative feelings, and acknowledge that emotions can be
painful.
Help the client redirect energy in appropriate ways.

NURSING DIAGNOSIS: INEFFECTIVE INDIVIDUAL COPING

Probable Causes
Defining Characteristics

Situational or maturational crises

Eccentric behaviors

Lack of a support system

Anxiety

Unmet needs or expectations

Rigid adherence to known routines

Dysfunctional family of origin

Inability to make decisions

Long-Term Goal : The client will demonstrate behaviors that lead to resolution of identified
problems.
Short-Term Goal #1: The client will discuss problems with his current life situation.

Interventions and Rationales

Help the client identify problems and areas of concern. It's important that the client's
perspective be understood and what is perceived as stressful be clearly identified.
Encourage the client to identify problems without labeling himself or others as good or bad.
Clients must learn how to appraise problems realistically rather than taking a defensive
position.
Have the client talk about needs that aren't being met, and help the client decide which are
most important. When clients decide which of their needs are most important, they are more
likely to change their behavior to meet those needs.

Short-Term Goal #2: The client will explore coping skills and work to develop appropriate
solutions to problems.
Interventions and Rationales

Help the client identify behaviors that are helpful in handling problematic situations, such as
naming a problem correctly and refraining from labeling himself or others as good or bad.
Identification of strengths enhances self-esteem and allows the client to build on established
coping skills.
Help the client identify behaviors that are inappropriate for dealing with identified problems.
The client needs to identify behaviors that escalate problems and contribute to dysfunctional
coping.
Help the client identify the coping strategies that are normality used to handle problems.
These clients have a limited repertoire of coping skills.
Teach the client and provide opportunities to practice problem-solving, social, and
communication skills. Knowledge and comfort in the ability to use these skills increase the
likelihood that the client will use them.

NURSING DIAGNOSIS: IMPAIRED SOCIAL INTERACTION

Probable Causes

Defining Characteristics

Lack of relationship with early caretaker

Immature behaviors and feelings

Chaotic family relationships

Verbalization of inadequacy

Under developed ego

Disruptive speech

Absence of parental role

Odd behaviors, such as going models to

great lengths to prove a point and being

Probable Causes

Defining Characteristics
guarded or secretive around others

Long-Term Goal : The client will interact with people and become involved in both social and
therapeutic activities.
Short-Term Goal #1: The client will identify and discuss feelings that impede social
interactions.
Interventions and Rationales

Encourage the client to express thoughts and feelings about social interactions with others.
To control inappropriate social behaviors, the client needs to be aware of thoughts and
feelings that precede the behaviors.
Identify and discuss appropriate rules for behavior. By exploring rules for behavior, the client
can begin to compare personal behavior with what is considered socially acceptable and
identify areas of concern.
Have the client talk about feelings related to social rules. Examining feelings associated with
social rules enables the client to identify personal concerns about being accepted.
Help the client assess behavior that impairs socialization. Identifying inappropriate behavior
is the first step toward changing it.
Have the client discuss social situations that are uncomfortable. Discussions about
uncomfortable situations can facilitate understanding of the client's concerns, leading to
identification of strategies for handling these situations.
Help the client identify negative behaviors that interfere with the development of mutually
satisfying relationships. Clients need to develop an awareness of how their unacceptable
behaviors impact on others and prevent relationships from being established.
Short-Term Goal #2: The client will begin to participate in both social and therapeutic
activities.
Interventions and Rationales

Help the client develop a daily schedule that includes participating in activities and
interacting with others. The client benefits from a schedule because it prevents
procrastination and can decrease the anxiety about becoming involved in therapeutic and
social interactions and activities.
Instruct and help the client practice strategies that facilitate the development of social skills.
The client needs to learn and practice social skills to gain comfort with them.

Encourage the client to establish a schedule of group activities. such as support groups, group
therapy, games, sports, and volunteer work, in which interactions with others will occur.
Engaging in these activities can decrease isolation and provide opportunities for developing
social skills and other useful behaviors.
Provide the client with feedback about social skills, focusing or, reinforcing progress and
working on areas that need improvement. Feedback is essential for reinforcing positive
change.

CONCLUSION
Personality disorders are a diagnostic category of psychiatric disorders that affect approximately
10% of the population (Torgersen, 2005). Since everyone has a personality, but not everyone has
a personality disorder, these disorders are considered a variant form of normal, healthy
personality. This group of disorders is characterized by problematic thinking patterns; problems
with emotional regulation; and difficulty achieving a balance between spontaneity and impulse
control. However, the most significant and defining feature of personality disorders is the
negative effect these disorders have on interpersonal relationships. People with personality
disorders tend to respond to differing situations and demands with a characteristically rigid
constellation of thoughts, feelings, and behavior.
In conclusion, recent technological advancements and improvements to diagnostic
methodologies have enabled researchers to study personality and personality disorders as never
before. As a result, we now have a much greater understanding of these disorders. Furthermore,
this research has facilitated the development of several highly effective treatments for personality
disorders that are evidenced-based. As research continues, these treatment approaches will be
further refined. Therefore, we can state with confidence there is hope and relief for people
affected by these disorders, including their family members and loved ones.

REFERENCE
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and Wilkins

2. Townsend Mary,C.,(2004) A Concept of Evidenced Based Practice in Psychiatric,

Nursing.Philadelphia : F.A.Davis company.
3. http://psychcentral.com/disorders/paranoid-personality-disorder-treatment/
4. http://www.seforeningen.dk/files/articlefiles/Bibliotek/Offentligeartikler/SYMPTOMERDIAGNOSER/-%20ICD-10%20F60-62%20Personality%20Disorders%20%20F62.0%20chronic%20ptsd.pdf
5. http://www.communitycounselingservices.org/poc/view_doc.php?
type=doc&id=41589&cn=8
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