Overview

Personality disorders are patterns of perceiving, reacting, and

relating to other people and events that are relatively inflexible and that impair a person's ability to function socially. Behavior may be odd or eccentric, dramatic or erratic, or anxious or inhibited. Doctors consider the diagnosis when inappropriate thinking or behavior is repeated despite negative consequences. Drugs do not change people's personality traits, but psychotherapy may help people recognize their problem and change their socially undesirable behaviors.

Overview
In contrast, people with a personality disorder are rigid

and tend to respond inappropriately to problems, to the point that relationships with family members, friends, and coworkers are affected. These maladaptive responses usually begin in adolescence or early adulthood and do not change over time. Personality disorders vary in severity. They are usually mild and rarely severe.

Overview
People with a personality disorder are unaware that their

thought or behavior patterns are inappropriate; thus, they tend not to seek help on their own. Instead, they may be referred by their friends, family members, or a social agency because their behavior is causing difficulty for others. When they seek help on their own, usually because of the life stresses created by their personality disorder, or troubling symptoms (for example, anxiety, depression, or substance abuse), they tend to believe their problems are caused by other people or by circumstances beyond their control.

Overview
Personality disorders are grouped into

three clusters.
Cluster A-- personality disorders involve

odd or eccentric behavior Cluster B-- dramatic or erratic behavior; and Cluster C-- anxious or inhibited behavior

Cluster A: Odd or Eccentric Behavior

Paranoid personality disorder
Schizoid personality disorder

Schizotypal personality disorder

Paranoid Personality
People with a paranoid personality are distrustful and

suspicious of others. Based on little or no evidence, they suspect that others are out to harm them and usually find hostile or malicious motives behind other people's actions. Thus, people with a paranoid personality may take actions that they feel are justifiable retaliation but that others find baffling. This behavior often leads to rejection by others, which seems to justify their original feelings. They are generally cold and distant in their relationships.

Paranoid Personality
People with a paranoid personality often take legal action

against others, especially if they feel righteously indignant. They are unable to see their own role in a conflict. They usually work in relative isolation and may be highly efficient and conscientious. Sometimes people who already feel alienated because of a defect or handicap (such as deafness) are more likely to suspect that other people have negative ideas or attitudes toward them. Such heightened suspicion, however, is not evidence of a paranoid personality unless it involves wrongly attributing malice to others.

Schizoid Personality
People with a schizoid personality are introverted, withdrawn, and solitary.
emotionally cold and socially distant

most often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others
They talk little, are given to daydreaming, and prefer theoretical speculation to practical action. Fantasizing is a common coping (defense) mechanism.

Schizotypal Personality
People with a schizotypal personality, like those with a schizoid personality, are socially and emotionally detached.
they display oddities of thinking, perceiving, and communicating similar to those of people with schizophrenia . Although schizotypal personality is sometimes present in people with schizophrenia before they become ill, most adults with a schizotypal personality do not develop schizophrenia.

Schizotypal Personality
Some people with a schizotypal personality

show signs of magical thinkingthat is, they believe that their thoughts or actions can control something or someone. For example, people may believe that they can harm others by thinking angry thoughts. People with a schizotypal personality may also have paranoid ideas.

Nursing Diagnoses: Cluster A disorders

Ineffective individual coping
Fear Social isolation Spiritual distress

Cluster B: Dramatic or Erratic Behavior

Antisocial personality disorder
Borderline personality disorder Narcissistic personality disorder Histrionic personality disorder

Antisocial Personality
People with an antisocial personality (previously called psychopathic or sociopathic personality), most of whom are male, show callous disregard for the rights and feelings of others.
Dishonesty and deceit permeate their relationships. They exploit others for material gain or personal gratification (unlike narcissistic people, who exploit others because they think their superiority justifies it).

Antisocial Personality
Characteristics:
act out their conflicts impulsively and

irresponsibly tolerate frustration poorly, and sometimes they are hostile or violent.

Antisocial Personality
Often they do not anticipate the negative consequences

of their antisocial behaviors and, despite the problems or harm they cause others, do not feel remorse or guilt. Rather, they glibly rationalize their behavior or blame it on others. Frustration and punishment do not motivate them to modify their behaviors or improve their judgment and foresight but, rather, usually confirm their harshly unsentimental view of the world.

Antisocial Personality
are prone to: alcoholism
drug addiction

sexual deviation
promiscuity imprisonment

They are likely to fail at their jobs and

move from one area to another.

Antisocial Personality
They often have a family history of antisocial behavior, substance abuse, divorce, and physical abuse.
As children, many were emotionally neglected and physically abused. have a shorter life expectancy than the general population. The disorder tends to diminish or stabilize with age.

Borderline Personality
People with a borderline personality, most of whom are

women, are unstable in their self-image, moods, behavior, and interpersonal relationships. Their thought processes are more disturbed than those of people with an antisocial personality, and their aggression is more often turned against the self. They are angrier, more impulsive, and more confused about their identity than are people with a histrionic personality. Borderline personality becomes evident in early adulthood but becomes less common in older age groups.

Borderline Personality
often report being neglected or abused as children
they feel empty, angry, and deserving of nurturing They have far more dramatic and intense interpersonal

relationships than people with cluster A personality disorders When they fear being abandoned by a caring person, they tend to express inappropriate and intense anger tend to see events and relationships as black or white, good or evil, but never neutral (splitting or dichotomous thinking)

Borderline Personality
When feel abandoned and alone, they may wonder whether they actually exist (that is, they do not feel real).
They can become desperately impulsive, engaging in reckless promiscuity , substance abuse, or selfmutilation. At times they are so out of touch with reality that they have brief episodes of psychotic thinking, paranoia, and hallucinations.

Borderline Personality
commonly visit primary care doctors.
The most common personality disorder treated by

therapists, because people with the disorder relentlessly seek someone to care for them. However, after repeated crises, vague unfounded complaints, and failures to comply with therapeutic recommendations, caretakers including doctorsoften become very frustrated with them and view them erroneously as people who prefer complaining to helping themselves.

Narcissistic Personality
People with a narcissistic personality have

a sense of superiority, a need for admiration, and a lack of empathy. They have an exaggerated belief in their own value or importance, which is what therapists call grandiosity.

Narcissistic Personality
May be extremely sensitive to failure, defeat, or criticism
When confronted by a failure to fulfill their high opinion

of themselves, they can easily become enraged or severely depressed. Because they believe themselves to be superior in their relationships with other people, they expect to be admired and often suspect that others envy them. They believe they are entitled to having their needs met without waiting, so they exploit others, whose needs or beliefs they deem to be less important.

Narcissistic Personality
Their behavior is usually offensive to

others, who view them as being selfcentered, arrogant, or selfish. This personality disorder typically occurs in high achievers, although it may also occur in people with few achievements.

Histrionic (Hysterical) Personality

People with a histrionic personality conspicuously seek attention, are dramatic and excessively emotional, and are overly concerned with appearance. Their lively, expressive manner results in easily established but often superficial and transient relationships. Their expression of emotions often seems exaggerated, childish, and contrived to evoke sympathy or attention (often erotic or sexual) from others.

Histrionic (Hysterical) Personality

Are prone to sexually provocative behavior or to

sexualizing nonsexual relationships. However, they may not really want a sexual relationship; rather, their seductive behavior often masks their wish to be dependent and protected. Some people with a histrionic personality also are hypochondriacal and exaggerate their physical problems to get the attention they need.

Nursing Diagnoses: Cluster B disorders

Impaired social interaction
High risk for violence, self-directed

(suicide or mutilation) High risk for violence, directed at others or objects Personal identity disturbance Fear

Cluster C: Anxious or Inhibited Behavior

Obsessive-Compulsive personality disorder
Dependent personality disorder Avoidant personality disorder

Obsessive-Compulsive Personality
preoccupied with orderliness, perfectionism, and control.
reliable, dependable, orderly, and methodical, but

their inflexibility makes them unable to adapt to change. Because they are cautious and weigh all aspects of a problem, they have difficulty making decisions.

Obsessive-Compulsive Personality
They take their responsibilities seriously, but

because they cannot tolerate mistakes or imperfection, they often have trouble completing tasks. Unlike the mental health disorder called obsessive-compulsive disorder, obsessivecompulsive personality does not involve repeated, unwanted obsessions and ritualistic behavior.

Obsessive-Compulsive Personality
are often high achievers, especially in the sciences and

other intellectually demanding fields that require order and attention to detail. However, their responsibilities make them so anxious that they can rarely enjoy their successes. They are uncomfortable with their feelings, with relationships, and with situations in which they lack control or must rely on others or in which events are unpredictable.

Dependent Personality
routinely surrender major decisions and

responsibilities to others and permit the needs of those they depend on to supersede their own. They lack self-confidence and feel intensely insecure about their ability to take care of themselves.

Dependent Personality
They often protest that they cannot make

decisions and do not know what to do or how to do it. This behavior is due partly to a reluctance to express their views for fear of offending the people they need and partly to a belief that others are more capable.

Dependent Personality
People with other personality disorders often

have traits of a dependent personality, but the dependent traits are usually hidden by the more dominant traits of the other disorder. Sometimes adults with a prolonged illness or physical handicap develop a dependent personality.

Avoidant Personality
are overly sensitive to rejection, and they

fear starting relationships or anything new. They have a strong desire for affection and acceptance but avoid intimate relationships and social situations for fear of disappointment and criticism.

Avoidant Personality
Unlike those with a schizoid personality, they

are openly distressed by their isolation and inability to relate comfortably to others. Unlike those with a borderline personality, they do not respond to rejection with anger; instead, they withdraw and appear shy and timid. Avoidant personality is similar to generalized social phobia.

Nursing Diagnoses: Cluster C disorders

Ineffective individual coping
Fear

Other Personality Type

Passive-Aggressive (Negativistic) Personality

Passive-Aggressive (Negativistic) Personality

behave in ways that appear inept or

passive these behaviors are actually ways to avoid responsibility or to control or punish others often procrastinate, perform tasks inefficiently, or claim an implausible disability

Passive-Aggressive (Negativistic) Personality

Frequently agree to perform tasks they

do not want to perform and then subtly undermine completion of the tasks Such behavior usually enables them to deny or conceal hostility or disagreements.

How is personality disorder diagnosis?

A doctor bases the diagnosis of a personality disorder on

a person's history, specifically, on repetition of maladaptive thought or behavior patterns. These patterns tend to become apparent because the person tenaciously resists changing them despite their negative consequences. In addition, a doctor is likely to notice the person's immature and maladaptive use of mental coping mechanisms, which interferes with their daily functioning. A doctor may also talk with people who interact with the person.