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
