PERSONALITY

DISORDER
• refers to individual differences in
characteristic patterns of thinking, feeling
and behaving.
Personality trait
• is a broad behavioral element that
describes your personality, such as kind,
outgoing, or impatient.
 Personality Disorder

• are diagnosed when personality traits

become inflexible and maladaptive and
significantly interfere with how a person
• functions in society or cause the person
emotional distress.
 Personality Disorder Clusters
Cluster A: Individuals whose behavior
appears odd or eccentric
•paranoid, schizoid, and schizotypal
personality disorders
Cluster B: Individuals who appear dramatic,
emotional, or erratic
•antisocial, borderline, histrionic, and
narcissistic personality disorders
 Cluster C: Individuals who appear anxious
or fearful
•avoidant, dependent, and
obsessive–compulsive personality disorders
 Etiological Factors
• Genetic factors- due to inherited traits
• Temperamental factors- due to emotional
climate at home
• Biologic factors- due to imbalance in
hormones and neurotransmitters
• Psychoanalytic factors- due to fixation at
certain psychosexual stage of
development
 CULTURAL
CONSIDERATIONS
TREATMENT
Strategies are based on:
✔disorder’s type and severity or
✔the amount of distress or
✔ functional impairment the client
experiences.
•Combinations of medication and group and
individual therapies are more likely to be
effective than single treatment
 Psychopharmacology
•Table 16.1
•DRUG CHOICES FOR SYMPTOMS OF
PERSONALITY DISORDERS
 Individual and Group Psychotherapy
•focus on building trust, teaching basic living
skills, providing support, decreasing
distressing symptoms such as anxiety, and
improving interpersonal relationships.
CLUSTER A: PERSONALITY
DISORDERS
 Paranoid Personality Disorder
• a relentless mistrust and suspicion of
others without adequate reason to be
suspicious.
• This disorder often begins in childhood or
early adolescence and appears to be more
common in men than in women.
• Studies estimate that PPD affects between
2.3% and 4.4% of the general population.
 Essential Features
• Suspect, without sufficient basis, that
others are exploiting, harming, or
deceiving them
• Preoccupied with unjustified doubts about
the loyalty or trustworthiness of friends or
associates
• Be reluctant to confide in others because
of unwarranted fears that the information
will be used maliciously against them.
• Read hidden or demeaning or threatening
meanings into benign remarks or events
• Persistently bear grudges
• Perceive attacks on their character or
reputation that are not apparent to others
• Have recurrent suspicions, without
justification, regarding fidelity of spouse or
sexual partner
 Symptoms
✔ believing that others have hidden motives
or are out to harm them
✔ doubting the loyalty of others
✔ being hypersensitive to criticism
✔ having trouble working with others
✔ being quick to become angry and hostile
✔ becoming detached or socially isolated
✔ being argumentative and defensive
✔ having trouble seeing their own problems
✔ having trouble relaxing
 Nursing Intervention
• the nurse must approach these clients in a
formal, business-like manner and refrain
from social chitchat or jokes.*
• Teach client to validate ideas before taking
• action;
• involve client in treatment planning
• the best nursing approach will be
straightforward, respectful, and
unobtrusive
SCHIZOID PERSONALITY
DISORDER
• is characterized by a pervasive pattern of
detachment from social relationships and
a restricted range of emotional expression
in interpersonal settings
• avoid treatment as much as they avod
other relationships
 Essential Features
• Demonstrates pervasive pattern of
detachment from social relationships
• Exhibits restricted range of emotions
• Must have four or more of the following:
✔ Neither desires nor enjoys close relationships,
including being part of a family
✔ Chooses solitary activities
✔ Has little (if any) interest in sexual
experiences
✔ Takes pleasure in few (if any) activities
✔ Lacks close friends
✔ Appears indifferent to praise or criticism
✔ Shows emotional coldness
 Nursing Intervention
1. Focus on improved functioning in the
community
2. establish at least a working relationship
with a case manager in the community
SCHIZOTYPAL PERSONALITY
DISORDER
 Essential Features
• Demonstrates pervasive pattern of acute
discomfort with social and interpersonal
relationships
• Exhibits cognitive or perceptual distortions
and eccentricities of behavior
• Must exhibit five of the following:
✔ Ideas of reference
✔ Odd beliefs or magical thinking
✔ Unusual perceptual experiences
✔ Odd thinking and speech
✔ Suspiciousness or paranoid ideation
✔ Behavior or appearance that is odd, eccentric,
or peculiar
✔ Lack of close friends
✔ Excessive social anxiety
 Nursing Intervention
1. Develop self-care skills;
✔ nurse encourages clients to establish a daily
routine for hygiene and grooming
2. improve community functioning;
✔ role-play interactions that clients would have
with family members or friends
3. Social skills training
✔ may help clients to talk clearly with others and
to reduce bizarre conversations.
CLUSTER B: PERSONALITY
DISORDERS
ANTISOCIAL PERSONALITY
DISORDER
 Essential Features
• A pervasive pattern of disregard for and
violation of the rights of others
• Repeated acts that are grounds for arrest
• Repeated lying, use of aliases, or conning
others
• Impulsivity or failure to plan ahead
• Repeated physical fights or assaults
• Reckless disregard for safety of self or
others
• Failure to sustain consistent work behavior
or honor financial obligations
• Lack of remorse (at) having hurt,
mistreated, or stolen from another
 APPLICATION OF THE
NURSING PROCESS
Assessment
✔Clients are skillful at deceiving, so check
and validate information from other sources.
History
✔Childhood histories of enuresis,
sleepwalking, and syntonic acts of cruelty
are characteristic predictors
✔ In adolescence, clients may have engaged
in lying, truancy, sexual promiscuity,
cigarette smoking, substance use, and
illegal activities that brought them into
contact with police.
✔ Families have high rates of depression,
substance abuse, poverty, and divorce.
✔ Erratic, neglectful, harsh, or even abusive
parenting
 General Appearance and Motor Behavior
✔Appearance usually is normal; these clients
may be quite engaging and even charming.
Mood and Affect
✔Clients often display false emotions chosen
to suit the occasion or to work to their
advantage.
✔ clients cannot empathize with the feelings
of others, which enables them to exploit
others without guilt.
Thought Process and Content
• Clients do not experience disordered
thoughts, but their view of the world is
narrow and distorted
✔ view the world as cold and hostile and
therefore rationalize their behavior.
 Sensorium and Intellectual Processes
•Clients are oriented, have no
sensory–perceptual alterations, and have
average or above-average IQs.
Judgment and Insight
✔They pay no attention to the legality of their
actions and do not consider morals or ethics
when making decisions*
✔ Clients lack insight and almost never see
their actions as the cause of their
problems.
Self-Concept
✔ Superficially, clients appear confident,
self-assured, and accomplished, perhaps
even flip or arrogant, but actually the self
is quite shallow and empty;
 Roles and Relationships
✔Clients manipulate and exploit those around
them.
✔They view relationships as serving their
needs and pursue others only for personal
gain.
✔involved in many relationships
o cannot sustain long-term commitments
o unsuccessful as spouses and parents and
leave others abandoned and disappointed.
 Nursing Diagnosis
• Ineffective Coping
• Ineffective Role Performance
• Risk for Other-Directed Violence
 Nursing Intervention
Promoting responsible behavior
1.Limit Settings
✔State the limit
✔Identify consequences of exceeding the
limit.
✔Identify expected or acceptable behavior.
2. Consistent adherence to rules and
treatment plan
 3. Confrontation
✔Point out problem behavior.
✔Keep client focused on self.
 4. Helping clients solve problems and
control emotions
✔Effective problem-solving skills
✔ Decreased impulsivity
✔ Expressing negative emotions such as
anger or frustration
✔Taking a time-out from stressful situations
 5. Enhancing role performance
✔Identifying barriers to role fulfillment
✔Decreasing or eliminating use of drugs and
alcohol
BORDERLINE PERSONALITY
DISORDER
 Essential Features
✔ Frantic efforts to avoid real or imagined
abandonment
✔ Pattern of unstable interpersonal
relationships
✔ Unstable self-image or sense
Spending
of self
Sex
✔ Impulsivity in at least Substance
two areasabuse
that are
potentially self-damaging
Reckless driving
Binge eating
✔ Recurrent suicidal behaviors, gestures, or
threats or self-mutilating behavior
✔ Chronic feelings of emptiness
✔ Inappropriate anger or difficulty controlling
anger
✔ Transient, stress-related paranoid ideation
 APPLICATION OF THE
NURSING PROCESS
ASSESSMENT
•History
✔Fifty percent of these clients have
experienced childhood sexual abuse
✔others experienced physical and verbal
abuse and parental alcoholism
✔tend to use transitional objects*
 General Appearance and Motor Behavior
✔Severe - clients may appear disheveled
✔unable to sit still, or
✔display very labile emotions.
 Mood and Affect
✔pervasive mood is dysphoric, involving
unhappiness, restlessness, and malaise.
✔Clients may become irritable, even hostile or
sarcastic, and complain of episodes of panic
anxiety.
✔They experience intense emotions such as
anger and rage
 Thought Process and Content
✔Clients tend to adore and idealize other
people but then quickly devalue them if they
do not meet their expectations in some way
✔have excessive and chronic fears of
abandonment
✔experience dissociative episodes
✔under extreme stress, clients may develop
transient psychotic symptoms such as
delusions or hallucinations.
 Sensorium and Intellectual Processes
✔Intellectual capacities are intact, and clients
are fully oriented to reality.
✔clients also report flashbacks of previous
abuse or trauma.
 Judgment and Insight
✔Impaired judgment and lack of care and
concern for safety*
✔Clients have difficulty accepting
responsibility for meeting needs outside a
relationship
✔see life’s problems and failures as a result of
others’ shortcomings
 Self-Concept
✔appear needy and dependent one moment
and angry, hostile, and rejecting the next
✔Sudden changes in opinions and plans*
✔Suicidal threats, gestures, and attempts;
Self-harm and mutilation are common*
 Roles and Relationships
✔Clients hate being alone, but their erratic,
labile
✔Relationships are unstable, stormy, and
intense; the cycle repeats itself continually.
✔clients have extreme
✔fears of abandonment and difficulty believing
a relationship still exists once the person is
away from them*
✔ Feelings for others are often distorted,
erratic, and inappropriate.*
✔ Clients usually have a history of poor
school and work performance*
 Physiologic and Self-Care
Considerations
✔clients also may engage in binging
(excessive overeating) and purging
(self-induced vomiting),
✔substance abuse,
✔Unprotected sex, or reckless behavior such
as driving while intoxicated.
 Nursing Diagnosis
• Risk for Suicide
• Risk for Self-Mutilation
• Risk for Other-Directed Violence
• Ineffective Coping
• Social Isolation
 NURSING INTERVENTIONS
1. Promoting client’s safety
✔ No-self-harm contract
✔ Safe expression of feelings and emotions
2. Helping client to cope and control
emotions
✔ Identifying feelings
✔ Journal entries
✔ Moderating emotional responses
✔ Decreasing impulsivity
✔ Delaying gratification
 The technique consists of
confronting the worst-case
scenario of a feared event
or object, using mental
imagery to examine
whether the effects of the
3. Cognitive restructuring techniques
event or object have been

✔Thought stopping overestimated (magnified

or exaggerated)

✔Decatastrophizing
4. Structuring time
5. Teaching social skills
6. Teaching effective communication skills
 7. Entering therapeutic relationship
✔Limit setting
✔Confrontation
HISTRIONIC PERSONALITY
DISORDER
• is characterized by a pervasive pattern of
excessive emotionality and attention
seeking.
• It occurs in 2% to 3% of the general
population and in 10% to 15% of the
clinical population.
• It is seen more often in women than in
men.
 Essential Features
✔ Is uncomfortable in situations in which he
or she is not the center of attention
✔ Displays inappropriate sexually seductive
or provocative behavior
✔ Has rapid shifts of emotion
✔ Uses physical appearance to draw
attention to self
✔ Shows dramatization or exaggerated
expression of emotion
✔ Is suggestible
✔ Considers relationships to be more
intimate than they really are
 Nursing Intervention
✔ nurse gives clients feedback about their
social interactions with others, including
manner of dress and nonverbal behavior.*
✔ The nurse must be specific in describing
and modeling social skills, including
establishing eye contact, engaging in
active listening, and respecting personal
space
✔ Encouraging clients to use assertive
communication*
 NARCISSISTIC
PERSONALITY DISORDER
• is characterized by a pervasive pattern of
grandiosity (in fantasy or behavior), need
for admiration, and lack of empathy.
• It occurs in 1% to 2%of the general
population and in 2% to 16% of the clinical
• population.
• 50% to 75% of people with this diagnosis
are men.
• Narcissistic traits are common in
adolescence
 Essential Features
✔ Has a grandiose sense of self-importance
✔ Is preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal
love
✔ Believes he or she is unique and special
and should only associate with others who
are special or high-status people
✔ Requires admiration of others
✔ Has a sense of entitlement
✔ Is interpersonally exploitive
✔ Lacks empathy
✔ Shows arrogance
 Nursing Intervention
✔ The nurse must use self-awareness skills
to avoid the anger and frustration that
these clients’ behavior and attitude can
engender
✔ The nurse must not internalize such
criticism or take it personally*
✔ He or she sets limits on rude or verbally
abusive behavior and explains his or her
expectations of the client.
CLUSTER C: PERSONALITY
DISORDERS
AVOIDANT PERSONALITY
DISORDER
• is characterized by a pervasive pattern of
social discomfort and reticence, low
self-esteem, and hypersensitivity to
negative evaluation
• It occurs in 0.5% to 1% of the general
population and in 10% of the clinical
population.
• It is equally common in men and women.
 Essential Features
• Is unwilling to get involved with people
unless certain of being liked
• Shows restraint in intimate relationships
for fear of being shamed or ridiculed
• Is inhibited in interpersonal relationships
because of feelings of inadequacy
• Views self as socially inept and inferior to
others
• Is usually reluctant to take personal risks
 Nursing Intervention
✔ nurse can help them explore positive
self-aspects, positive responses from
others, and possible reasons for
self-criticism
✔ nurse can teach social skills and help
clients to practice them in the safety of the
nurse–client relationship
DEPENDENT PERSONALITY
DISORDER
• is characterized by a pervasive and
excessive need to be taken care of, which
leads to submissive and clinging behavior
and fears of separation.
• occurs in as much as 15% of the
population and is seen three times more
often in women than in men.
• It runs in families and is most common in
the youngest child
 Essential Features
✔ Has difficulty making everyday decisions
✔ Needs others to assume responsibility for
major areas of his or her life
✔ Has difficulty expressing disagreement
✔ Has difficulty initiating projects
✔ Goes to excessive lengths to obtain
nurturance from others
✔ Feels uncomfortable or helpless when
alone
✔ Urgently seeks relationships as a source
of care or support
✔ Is unrealistically preoccupied with fears of
being left to take care of
 Nursing Intervention
✔ help clients to express feelings of grief and
loss over the end of a relationship while
fostering autonomy and self-reliance.
✔ Helping clients to identify their strengths
and needs is more helpful than
encouraging the overwhelming belief that
“I can’t do anything alone!”*
✔ teach problem-solving and
decision-making and help clients apply
them to daily life*
OBSESSIVE–COMPULSIVE
PERSONALITY
DISORDER
• is characterized by a pervasive pattern of
preoccupation with perfectionism, mental
and interpersonal control, and orderliness
• at the expense of flexibility, openness, and
efficiency
• occurs in about 1% to 2% of the
population, affecting twice as many men
as women
 Essential Features
✔ Is preoccupied with details, lists, rules,
organization, or schedules
✔ Aspires to perfectionism that interferes
with task completion
✔ Is excessively devoted to work and
productivity
✔ Is overconscientious, scrupulous, and
inflexible about matters of morality, ethics
or values
✔ Is unable to discard worn-out and
worthless objects
✔ Is reluctant to delegate tasks
✔ Adopts a miserly spending style
✔ Is rigid and stubborn
 Nursing Intervention
✔ Limit, but do not interrupt, the compulsive
acts.
✔ Teach the client to use alternate coping
methods to decrease anxiety.
✔ Client’s behavior maybe frustrating to staff
and family. Power struggles often result.*
✔ Assess the client’s needs carefully.
✔ Provide an environment that has structure
and predictability as a strategy to
decrease anxiety.
✔ Risk associated with the use of alcohol
and drug abuse.