Personality disorders
Prepared by:
Asma Ali
Lecturer FIN&HS
PERSONALITY
Personality is a consistent (constant) way of
thinking and feeling which results from the
interaction of a person’s genetic make-up his
level of education and past experiences.
Largely unconscious.
Cannot be changed easily.
PERSONALITY
DISORDERS
• Personality disorders occur when traits become
inflexible and maladaptive but stable over time.
• Cause either significant functional impairment or
subjective distress. However they stay in the
main stream of society.
• Present with symptoms more subtle than other
disorders.
• Onset in adolescence or early adulthood.
• Personality traits are consistent and stable
characteristics that define an individual's
patterns of thoughts, feelings, and behaviors
DSM-IV-TR CRITERIA
• DSM-IV-TR stands for, Diagnostic and Statistical Manual
of Mental Disorders, fourth edition, text revision.
• The list of personality disorders are also known as Axis II
disorders.
• Enduring pattern of inner experience and behavior that
deviates markedly from an individual’s culture
manifesting in two or more of the following areas:
– Cognition
– Affect (mood)
– Inter-personal functioning
– Impulse control
Prevalence and Co-morbidity
• 10% to 15% in general populations
• Often co-occur with depression and anxiety
• Onset usually occurs before onset of other
psychiatric disorders
• Various PDs often co-exist
Biological Determinants
• Certain inherited traits may
be present at birth.
• Genetic alterations may result
in an extreme variation.
• Unfavorable environmental
conditions may affect the
development of the disorder.
Assessment
• Minnesota Multiphasic Personality Inventory
(MMPI) to evaluate personality
• Full medical history
• Psychosocial history
– Suicidal or aggressive thoughts
– Risk of harm from self or others
– Use of medications or illegal substances
– Ability to handle money
– Legal history
– Current or past abuse
Impact of Personality Disorder
Client’s Behaviors on Caregivers
• Overwhelming needs of clients may also
be overwhelming for caregivers
• Caregivers may feel
– Confused
– Helpless
– Angry
– Frustrated
Splitting Behaviors of Clients
• Primary defense used by clients with borderline PD
• Client labels individuals either “all good” or “all bad”
• When all-good person does not met client's needs,
that person becomes all bad
• Someone else then labeled all good, others all bad
• Creates conflict in staff members
• To decrease conflict among staff
– Open communication in staff meetings
– Ongoing clinical supervision
Clusters (DSM-IV)
• Cluster A: “ Eccentric”(Unconventional) Personality Disorders
– Paranoid
– Schizoid
– Schizotypal
• Cluster B: “Dramatic” Personality Disorders
– Antisocial
– Borderline
– Histrionic
– Narcissistic
• Cluster C: “Anxious” Personality Disorders
– Avoidant
– Dependent
– Obsessive Compulsive
Signs and symptoms of Cluster A
(eccentric)
• Paranoid personality disorder
– General suspiciousness
– Inability to work collaboratively with others
– Emotional detachment
– Hostility(agression) toward others
Nursing intervention
• Few seek professional help on their own.
• bussniess like manners approch.
• no social chitchat.
• keep stright forward with this client.
• Treatment focuses on development of trust.
• Cognitive therapy to overcome negative thinking.
• Give specific feedback about positive characteristics.
• helpng client to learn validate any idea then take action.
Schizoid personality disorder
– Fantasizing (daydreaming)
– Extreme introversion(self-absorption)
– Emotional distance, even from family members
– Fixation on your own thoughts and feelings
Nursing Intervention
– Few seek professional help on their own.
–socialization through group actvities is less desirable
– Focus on the value of interpersonal relationships,
empathy, and social skills.
– Treatment prognosis is generally poor.
– Give specific feedback about positive thoughts.
Cont……..
Schizotypal personality disorder
– Indifference to and withdrawal from others
– "Magical thinking" — the idea that you can
influence people and events with your thoughts.
– Elaborate style of dressing, speaking and
interacting with others
– Belief that messages are hidden for you in public
speeches and displays
– Suspicious or paranoid ideas
Nursing Intervention
– Main focus is on developing social skills
– development of self care, grooming , routine
should not be depending on client.
– Treatment also addresses comorbid depression
– Medical treatment is similar to that used for
schizophrenia
Signs and Symptoms of Cluster B
(Dramatic)
Histrionic personality disorder
– Excessive sensitivity to others' approval
– Attention-grabbing, often sexually provocative
clothing and behavior
– Excessive concern with your physical appearance
– False sense of intimacy with others
– Constant, sudden emotional shifts
Nursing Interventions
• The nurse gives clients feedback about their social
interactions with others including manner of dress and
nonverbal behavior.
• Teaching social skills and role-playing those skills in a safe,
nonthreatening environment can help clients to gain
confidence in their ability to interact socially.
• The nurse must be specific in describing and modeling
social skills including establishing eye contact, active
listening, and respecting personal space.
• Give specific feedback about positive characteristics.
• teach active listining , respect persnal space .
Cont……
Narcissistic personality disorder
– Constant attention-grabbing and admiration-
seeking behavior
– Inability to empathize with others
– Excessive anger or shame in response to criticism
– Manipulation of others to further your own
desires
Nursing Interventions
• The nurse must use self awareness skills to avoid the
anger and frustration.
• Clients may be rude and arrogant, unwilling to wait, and
harsh and critical of the nurse. The nurse must not
internalize such criticism or take it personally.
• The nurse teaches about comorbid medical or psychiatric
conditions, medication regimen, and any needed self-care
skills in a matter-of-fact manner.
• He or she sets limits on rude or verbally abusive behavior
and explains his or her expectations from the client.
Cont….
• Antisocial personality disorder
– Chronic irresponsibility and unreliability .
– Lack of regard for the law and for others' rights.
– Persistent lying and stealing .
– Aggressive, often violent behavior.
– Lack of remorse for hurting others .
– Lack of concern for the safety of self and others .
Cont……
• Borderline personality disorder
– Difficulty controlling emotions or impulses .
– Frequent, dramatic changes in mood, opinions and
plans .
– Stormy relationships involving frequent, intense
anger and possibly physical fights .
– Fear of being alone despite a tendency to push
people away .
– Feeling of emptiness inside .
Nursing Interventions.
Promoting client’s safety
No self-harm contract: in which a client promises to not engage
in self-harm and to report to the nurse when he or she is losing
control.
Safe expression of feelings and emotions.
Helping client to cope and control emotions
Identifying feelings.
Moderating emotional responses.
journaling
Decreasing impulsivity.
Establishing boundaries.
conti…
Cognitive restructuring techniques
• Thought-stopping
• Positive self talk
• Decatastrophizing
• Structuring time
• Teaching social skills
• Teaching effective communication skills
• Therapeutic relationship
• Assertiveness techniques such as “I” statements
• Use of distraction such as walking or listening to music
Sign and symptoms Cluster C
(Anxious or Fearful)
Avoidant personality disorder
• Over-riding sense of social
discomfort
• Easily hurt by criticism
• Always need emotional support
• Occasionally try to socialize
– so distressing they retreat into
loneliness
Cont….
Dependent Personality Disorder
• Submissive, clingy behavior
• Fear of separation
• Easily hurt by criticism
Cont…..
Obsessive-Compulsive
Personality Disorder
• Excessive control and
perfectionism
• Inflexible
• Preoccupied with trivial
details
• Judgmental/moralistic
• Often humorless
out comes
• the patient will be able :
• use adaptive coping strategies to deal with
conflict
• accept reponsibilities for own
actions/beaviours.
• communicates needs appropiately.
• demonstrates self-restrain of compulsive or
impulsive behavior.
NURSING DIAGNOSIS
• ineffective coping
• severe/ panic levels of anxiety
• self mutilation
• risk for other directed violance
• impaired parenting
• social isolation
• defensive coping
• chronic low self-esteem
Intervention for Manipulative , Aggressive
Or Impulsive Behavior
• Manipulative Behavior
• Aggressive Behavior
• Impulsive Behavior
• BASIC LEVEL INTERVENSION
• milieu therapy
• psychobiological interventions
• case management
• ADVANCED PRACTICE INTERVENTION
• dielectical behavioral therapy
• skill oriented psychotherapy
• supportive psychotherapy
• group therapy
NURSING CARE
• prevent self harm . no harm contract
• set limits on inappropriate or manipulative
behavior.
• provide clear consistent boundries.
• assist in examing concequences of behavior
• consistent approach by staff
• do not recure or reject.
• give recognition of goal achievement.
THANK YOU
