cooperative, even ingratiating, or sullen and

PERSONALITY DISORDERS withdrawn, depending on the circumstances. Their

mood may fluctuate rapidly and erratically, and they
 A type of mental disorder in which you have a rigid
may be easily upset or offended.
and unhealthy pattern of thinking, functioning, and
behaving. ONSET AND CLINICAL COURSE 
 Features of these disorders usually become
Personality disorders are relatively common,
recognizable during adolescence or early adult life. It
occurring in 10% to 20% of the general population. Of all
is when personality is more completely formed.
psychiatric inpatients, 15% have a primary diagnosis of a
 Relationships with others are dysfunctional and often
personality disorder. Of those with a primary diagnosis of
characterized by deceit, coercion, or intimidation. major mental illness, 40% to 45% also have a coexisting
personality disorder that significantly complicates
THREE TYPES OF PERSONALITY DISORDERS treatment.
PERSONALITY ETIOLOGY 
CLUSTERS DISORDERS
Biologic Theories
Cluster A—odd  Paranoid personality
 Personality develops through the interaction of
or eccentric disorder
hereditary dispositions and environmental
behaviors  Schizoid personality
influences.
disorder
 Temperament refers to the biologic processes of
 Schizotypal
sensation, association, and motivation that underlie
personality disorder the integration of skills and habits based on emotion.
Cluster B—  Antisocial Genetic differences account for about 50% of the
erratic or personality disorder variances in temperament traits. 
dramatic  Borderline  The four temperament traits are harm avoidance,
behaviors personality disorder novelty seeking, reward dependence, and
 Histrionic persistence. Each of these four genetically influenced
personality disorder traits affects a person’s automatic responses to
 Narcissistic certain situations. These response patterns are
personality disorder ingrained by 2 to 3 years of age.
Cluster C—  Avoidant personality Psychodynamic Theories
anxious or fearful disorder
behaviors  Dependent  Character consists of concepts about the self and the
external world. It develops over time as a person
personality disorder
comes into contact with people and situations and
 Obsessive
confronts challenges. 
personality disorder
 Three major character traits have been
distinguished: self-directedness, cooperativeness,
Other clusters of behavior related to maladaptive
and self-transcendence.
personality traits include:

 DEPRESSIVE BEHAVIOR is characterized by a

CULTURAL CONSIDERATION
pervasive pattern of depressive cognitions and
behaviors in various contexts. It occurs more often in Certain personality disorders—for example, antisocial
people with relatives who have major depressive personality disorder —are diagnosed more often in men.
disorders. People with depressive personality BPD is diagnosed more often in women.  
disorders often seek treatment for their distress. TREATMENT
 PASSIVE-AGGRESSIVE BEHAVIOR is characterized by
a negative attitude and a pervasive pattern of passive PSYCHOPHARMACOLOGY 
resistance to demands for adequate social and
occupational performance. These clients may appear
 Pharmacologic treatment of clients with  Paranoid personality disorder is characterized by
personality disorders focuses on the client’s symptoms pervasive mistrust and suspiciousness of others.
rather than the particular subtype.  Clients with this disorder interpret others’ actions as
potentially harmful.
The four symptom categories that underlie personality
 Clients frequently see malevolence in the actions of
disorders are:
others where none exists.
 cognitive–perceptual distortions, including  These clients use the defense mechanism of
psychotic symptoms; projection
 affective symptoms and mood dysregulation;
 aggression and behavioral dysfunction; and b) SCHIZOID PERSONALITY DISORDER
 anxiety.   Schizoid personality disorder is characterized by a
pervasive pattern of detachment from social
These four symptom categories relate to the
relationships and a restricted range of emotional
underlying temperaments associated with personality
expression in interpersonal settings. 
disorders:
 Clients with schizoid personality disorder display a
 Low reward dependence corresponds to the constricted affect and little, if any, emotion.
categories of affective dysregulation, detachment,  Clients usually have a rich and extensive fantasy life,
and cognitive disturbances.  though they may be reluctant to reveal that
 High novelty seeking corresponds to the target information to the nurse or anyone else.
symptoms of impulsiveness and aggression.  Clients generally are accomplished intellectually and
 High harm avoidance corresponds to the categories often involved with computers or electronics for
of anxiety and depression symptoms.  work or to pass their time.
 Cognitive–perceptual disturbances include magical  Clients may be indecisive and lack future goals or
thinking, odd beliefs, illusions, suspiciousness, ideas direction.
of reference, and low-grade psychotic symptoms.  Clients have a pervasive lack of desire for
These chronic symptoms usually respond to low- involvement with others in all aspects of life.
dose antipsychotic medications.
c) SCHIZOTYPAL PERSONALITY
 Individual and Group DISORDER
Psychotherapy  Schizotypal personality disorder is characterized by a
pervasive pattern of social and interpersonal

 Individual and Group deficits marked by acute discomfort with and

reduced capacity for close relationships as well as by
Psychotherapy cognitive or perceptual distortions and behavioral
eccentricities.
 Individual and Group  Clients often have an odd appearance that causes
others to notice them.
Psychotherapy  Clients often provide unsatisfactory answers to
questions and may be unable to specify or to
INDIVIDUAL AND GROUP PSYCHOTHERAPY describe information clearly.
 Clients experience great anxiety around other
Individual and group psychotherapy goals for people, especially those who are unfamiliar.
clients with personality disorders focus on:
 building trust,
 teaching basic living skills,
 providing support,
 decreasing distressing symptoms such as anxiety,
and
 improving interpersonal relationships

a) PARANOID PERSONALITY DISORDER

 NURSING INTERVENTIONS
PARANOID PERSONALITY SCHIZOID PERSONALITY SCHIZOTYPAL PERSONALITY
DISORDER DISORDER DISORDER
1. Nurse must approach 1. Improved functioning in 1. Development of self-care
these clients in a formal, the community. and social skills and
businesslike manner and 2. If the client has an improved functioning in
refrain from social chit- identified family member the community.
chat or jokes. as his or her primary 2. The nurse can then role-
2. Develop a nurse-client relationship, the nurse play interactions that
relationship. must ascertain whether clients would have with
3. Help clients validate ideas that person can continue each of these people.
before taking action. in that role.

d) ANTISOCIAL PERSONALITY DISORDER Clients often display false emotions chosen to

 is characterized by a pervasive pattern of disregard suit the occasion or to work to their advantage. 
for and violation of the rights of others—and by the d) Thought Process and Content 
central characteristics of deceit and manipulation. Clients do not experience disordered thoughts,
This pattern has also been referred to as but their views of the world are narrow and distorted. 
psychopathy, sociopathy, or dissocial personality They view the world as cold and hostile and
disorder. therefore rationalize their behavior. 
 It occurs in about 3% of the general population, up to e) Sensorium and Intellectual Processes
30% in clinical settings, and is three to four times Clients are oriented, have no sensory–perceptual
more common in men than in women. In prison alterations, and have average or above-average IQs. 
populations, about 75% are diagnosed with antisocial f) Judgment and Insight 
personality disorder. These clients generally exercise poor judgment
 Antisocial behaviors tend to peak in the 20s and for various reasons. They pay no attention to the legality
diminish significantly after 45 years of age in many of their actions and do not consider morals or ethics
individuals. when making decisions. 
Their behavior is determined primarily by what
APPLICATION OF THE NURSING PROCESS: they want, and they perceive their needs as immediate. 
g) Self-Concept 
ANTISOCIAL PERSONALITY DISORDER
Superficially, clients appear confident, self-
Assessment  assured, and accomplished, perhaps even flip or
arrogant. 
Clients are skillful at deceiving others, so during They may be described as egocentric, but
assessment, it helps to check and validate information actually the self is quite shallow and empty; these clients
from other sources.  are devoid of personal emotions.
a) History h) Roles and Relationships
Onset is in childhood or adolescence, though Clients manipulate and exploit those around
formal diagnosis is not made until the client is 18 years them. They view relationships as serving their needs and
old.  pursue others only for personal gain. They never think
Families have high rates of depression, substance about the repercussions of their actions to others.
abuse, antisocial personality disorder, poverty, and
divorce. Erratic, neglectful, harsh, or even abusive Data Analysis 
parenting frequently marks the childhoods of these
People with antisocial personality disorder
clients (Stevens, 2018). 
generally do not seek treatment voluntarily unless they
b) General Appearance and Motor Behavior  perceive some personal gain from doing so. Nursing
Appearance is usually normal; these clients may diagnoses commonly used when working with these
be quite engaging and even charming.  clients include: 
c) Mood and Affect 
  Ineffective coping   Promoting responsible behavior 
 Ineffective role performance   Limit setting 
 Risk for other-directed violence   State the limit. 
 Identify the consequences of exceeding the limit. 
Outcome Identification   Identify the expected or acceptable behavior. 
The treatment focus is often behavioral change.  Consistent adherence to rules and treatment plan
Although treatment is unlikely to affect the client’s  Confrontation 
insight or view of the world and others, it is possible to  Point out the problem behavior. 
make changes in behavior.   Keep the client focused on him or herself. 
 Help clients solve problems and control emotions. 
Treatment outcomes may include:  Effective problem-solving skills 
1. The client will demonstrate nondestructive ways to  Decreased impulsivity 
express feelings and frustration.   Expressing negative emotions such as anger or
2. The client will identify ways to meet his or her own frustration 
needs that do not infringe on the rights of others.   Taking a time-out from stressful situations 
3. The client will achieve or maintain satisfactory role  Enhancing role performance 
performance (e.g., at work or as a parent).   Identifying barriers to role fulfillment
 Decreasing or eliminating use of drugs and alcohol
Intervention
Forming a Therapeutic Relationship and Promoting e) BORDERLINE PERSONALITY DISORDER
Responsible Behavior   BPD is characterized by a pervasive pattern of
unstable interpersonal relationships, self-image,
Limit setting is an effective technique that involves three and affect as well as marked impulsivity.
steps:  BPD is the most common personality disorder found
1. Stating the behavioral limit (describing the in clinical settings. It is three times more common in
unacceptable behavior)  women than in men. 
2. Identifying the consequences if the limit is exceeded   Up to three-quarters of clients with BPD engage in
3. Identifying the expected or desired behavior  deliberate self-harm, sometimes called nonsuicidal
self-injury (Merza, Papp, Molnar, & Szabo, 2017).
Confrontation is another technique designed to manage  Typically, recurrent self-mutilation is a cry for help,
manipulative or deceptive behavior. The nurse points out an expression of intense anger or helplessness, or a
a client’s problematic behavior while remaining neutral form of self-punishment.
and matter-of-fact; he or she avoids accusing the client. 
APPLICATION OF THE NURSING PROCESS:
Helping Clients Solve Problems and Control Emotions 
BORDERLINE PERSONALITY DISORDER
Clients with antisocial personality disorder have Assessment
an established pattern of reacting impulsively when
confronted with problems. The nurse can teach problem- a) History
solving skills and help clients practice them. Problem- Many of these clients report disturbed early
solving skills include identifying the problem, exploring relationships with their parents that often begin at 18 to
alternative solutions and related consequences, 30 months of age.
choosing and implementing an alternative, and Commonly, early attempts by these clients to
evaluating the results.  achieve developmental independence were met with
punitive responses from parents or threats of withdrawal
  Taking a time-out or leaving the area and going
of parental support and approval.
to a neutral place to regain internal control is often a
Fifty percent of these clients have experienced
helpful strategy. Time-outs help clients to avoid
childhood sexual abuse; others have experienced
impulsive reactions and angry outbursts in emotionally
physical and verbal abuse and parental alcoholism
charged situations, regain control of emotions, and
(Meissner, 2005).
engage in constructive problem-solving.

NURSING INTERVENTIONS b) General Appearance and Motor Behavior 

ANTISOCIAL DISORDER
 Clients experience a wide range of dysfunction— Data Analysis
from severe to mild. Initial behavior and presentation Nursing diagnoses for clients with Borderline
may vary widely depending on a client’s present status. Personality Disorder may include the following:
c) Mood and Affect   Risk for Suicide
The pervasive mood is dysphoric, involving  Risk for Self-Mutilation
unhappiness, restlessness, and malaise. Clients often  Risk for Other-Directed Violence
report intense loneliness, boredom, frustration, and  Ineffective Coping
feeling “empty.” They rarely experience periods of  Social Isolation
satisfaction or well-being. 
d) Thought Process and Content  Outcome Identification
Thinking about self and others is often polarized
Treatment outcomes may include the following:
and extreme, which is sometime referred to as splitting.
Clients tend to adore and idealize other people even 1. The client will be safe and free of significant injury.
after a brief acquaintance but then quickly devalue them 2. The client will not harm others or destroy property.
if these others do not meet their expectations in some 3. The client will demonstrate increased control of
way.  impulsive behavior.
e) Sensorium and Intellectual Processes 4. The client will take appropriate steps to meet his or
Intellectual capacities are intact, and clients are her own needs.
fully oriented to reality. The exception is transient 5. The client will demonstrate problem-solving skills.
psychotic symptoms; during such episodes, reports of 6. The client will verbalize greater satisfaction with
auditory hallucinations encouraging or demanding self- relationships.
harm are most common. 
Interventions
f) Judgment and Insight  Clients with borderline personality disorder often
Clients frequently report behaviors consistent are involved in long-term psychotherapy to address
with impaired judgment and lack of care and concern for issues of family dysfunction and abuse. The nurse is most
safety, such as gambling, shoplifting, and reckless driving. likely to have contact with these clients during crises,
They make decisions impulsively based on emotions when they are exhibiting self-harm behaviors or
rather than facts.  transient psychotic symptoms.
g) Self-Concept  Brief hospitalizations often are used to manage
Clients have an unstable view of themselves that these difficulties and to stabilize the client’s condition.
shifts dramatically and suddenly. They may appear needy
and dependent one moment and angry, hostile, and Promoting client's safety
rejecting the next.
1. Clients’ physical safety is always a priority. The nurse
Suicidal threats, gestures, and attempts are
must always seriously consider suicidal ideation with
common. Self-harm and mutilation, such as cutting,
the presence of a plan, access to means for enacting
punching, or burning, are common.
the plan, and self-harm behaviors and institute
h) Roles and Relationships
appropriate interventions.
Clients hate being alone, but their erratic, labile,
2. Helping clients to avoid self-injury can be difficult
and sometimes dangerous behaviors often isolate them.
when antecedent conditions vary greatly.
Relationships are unstable, stormy, and intense; the
Sometimes, clients may discuss self-harm urges with
cycle repeats itself continually. These clients have
the nurse if they feel comfortable doing so. The
extreme fears of abandonment and difficulty believing a
nurse must remain nonjudgmental when discussing
relationship still exists once the person is away from
this topic
them.
3. It has been common practice in many settings to
i) Physiologic and Self-Care Considerations
encourage clients to enter a no-self-harm contract, in
In addition to suicidal and self-harm behavior,
which a client promises to not engage in self-harm
clients also may engage in binging (excessive overeating)
and to report to the nurse when he or she is losing
and purging (self-induced vomiting), substance abuse,
control.
unprotected sex, or reckless behavior such as driving
while intoxicated. They usually have difficulty sleeping. Promoting Therapeutic Relationship
 Regardless of the clinical setting, the nurse must recognize negative thoughts and feelings and to
provide structure and limit setting in the therapeutic replace them with positive patterns of thinking.
relationship. 2. THOUGHT STOPPING - is a technique to alter the
In a clinic setting, this may mean seeing the client process of negative or self-critical thought patterns
for scheduled appointments of a predetermined length such as “I’m dumb, I’m stupid, I can’t do anything
rather than whenever the client appears and demands right.” When the thoughts begin, the client may
the nurse’s immediate attention. actually say “Stop!” in a loud voice to stop the
In the hospital setting, the nurse would plan to negative thoughts.
spend a specific amount of time with the client working 3. DECATASTROPHIZING - is a technique that involves
on issues or coping strategies rather than giving the learning to assess situations realistically rather than
client exclusive access when he or she has had an always assuming a catastrophe will happen. The
outburst. nurse asks, “So what is the worst thing that could
happen?” or “How do you suppose other people
Establishing Boundaries in Relationship
might deal with that?”
Clients have difficulty maintaining satisfying
Structuring
interpersonal relationships. Personal boundaries are
unclear, and clients often have unrealistic expectations. CLIENT'S DAILY ACTIVITIES
Erratic patterns of thinking and behaving often alienate
Feelings of chronic boredom and emptiness, fear
them from others.
of abandonment, and intolerance of being alone are
The nurse must be quite clear about establishing
common problems. Minimizing unstructured time by
the boundaries of the therapeutic relationship to ensure
planning activities can help clients to manage time alone.
that neither the client’s nor the nurse’s boundaries are
violated.

Teaching Effective Communication Skills Evaluation

It is important to teach basic communication As with any personality disorder, changes may be
skills such as eye contact, active listening, taking turns small and slow. The degree of functional impairment of
talking, validating the meaning of another’s clients with borderline personality disorder may vary
communication, and using “I” statements (“I think …, ” “I widely. Clients with severe impairment may be evaluated
feel …, ” “I need …”). in terms of their ability to be safe and to refrain from
The nurse can model these techniques and self-injury.
engage in role-playing with clients. The nurse asks how Generally, when clients experience fewer crises
clients feel when interacting and gives feedback about less frequently over time, treatment is effective.
nonverbal behavior, such as “I noticed you were looking
at the floor when discussing your feelings.
f) HISTRIONIC PERSONALITY DISORDER
Helping Clients to Cope and to Control Emotions  Is characterized by a pervasive pattern of excessive
1. The nurse can help clients to identify their feelings emotionality and attention seeking. It occurs in 2%
and learn to tolerate them without exaggerated to 3% of the general population and in 10% to 15% of
responses such as destruction of property or self- the clinical population. It is seen more often in
harm. Keeping a journal often helps clients gain women than in men. Clients usually seek treatment
awareness of feelings. The nurse can review journal for depression, unexplained physical problems, and
entries as a basis for discussion. difficulties in relationships.
2. Another aspect of emotional regulation is decreasing  Clients are emotionally expressive, gregarious, and
impulsivity and learning to delay gratification. When effusive. They often exaggerate emotions
clients have an immediate desire or request, they inappropriately.
must learn that it is unreasonable to expect it to be  Expressed emotions, although colorful, are insincere
granted without delay. and shallow; this is readily apparent to others but
not to clients. They experience rapid shifts in moods
Reshaping Thinking Patterns and emotions and may be laughing uproariously one
moment and sobbing the next.
1. COGNITIVE RESTRUCTURING - is a technique useful
in changing patterns of thinking by helping clients to
 Clients are self-absorbed and focus most of their NURSING RESPONSIBIBILITIES
thinking on themselves, with little or no thought
about the needs of others. 1. The nurse must use self-awareness skills to avoid the
 They may even faint, become ill, or fall to the floor. anger and frustration that these clients’ behavior and
They brighten considerably when given attention attitude can engender. Clients may be rude and
after some of these behaviors; this leaves others arrogant, unwilling to wait, and harsh and critical of
feeling that they have been used. the nurse.
2. The nurse must not internalize such criticism or take
NURSING RESPONSIBILITIES it personally. The goal is to gain cooperation of these
clients with other treatment as indicated.
1. The nurse gives clients feedback about their social
3. The nurse teaches about comorbid medical or
interactions with others, including manner of dress
psychiatric conditions, medication regimen, and any
and non-verbal behavior. Feedback should focus on
needed self-care skills in a matter-of-fact manner. He
appropriate alternatives, not merely criticism.
or she sets limits on rude or verbally abusive
2. It also may help to discuss social situations to explore
behavior and explains his or her expectations of the
clients’ perceptions of others’ reactions and
client.
behavior.
3. Teaching social skills and role-playing those skills in a
safe, nonthreatening environment can help clients to h) AVOIDANT PERSONALITY DISORDER
gain confidence in their ability to interact socially.  Avoidant personality disorder is one of a group of
The nurse must be specific in describing and conditions known as personality disorders. These
modeling social skills, including establishing eye disorders, in general, are enduring patterns of
contact, engaging in active listening, and respecting behavior out of keeping with cultural norms that
personal space. cause emotional pain for an individual or those
around them.
 Avoidant personality disorder is grouped with other
g) NARCISSISTIC PERSONALITY DISORDER
personality disorders marked by feelings of
 Is characterized by a pervasive pattern of
nervousness and fear.
grandiosity (in fantasy or behavior), need for
 People with avoidant personality disorder have
admiration, and lack of empathy. It occurs in 1% to
chronic feelings of inadequacy and are highly
2% of the general population and in 2% to 16% of the
sensitive to being negatively judged by others.
clinical population. Fifty percent to 75% of people
Though they would like to interact with others, they
with this diagnosis are men.
tend to avoid social interaction due to the intense
fear of being rejected by others.
SIGNS AND SYMPTOMS
SIGNS AND SYMPTOMS
 Clients may display an arrogant or haughty attitude.
 Clients tend to disparage, belittle, or discount the  They’re oversensitive and easily hurt by criticism or
feelings of others. disapproval
 Clients may ruminate about long-overdue admiration  They have few, if any, close friends and are reluctant
 Clients may ruminate about long-overdue admiration to become involved with others unless certain of
and privilege and compare themselves favorably being liked
with famous or privileged people.  They experience extreme anxiety (nervousness) and
 Clients believe themselves to be superior and special fear in social settings and relationships, leading them
and are unlikely to consider that their behavior has to avoid activities or jobs that involve being with
any relation to their problems: they view their others
problems as the fault of others.  They tend to be shy, awkward, and self-conscious in
social situations due to a fear of doing something
TREATMENT wrong or being embarrassed
 They tend to exaggerate potential problems
Individual psychotherapy is the most effective
treatment, and hospitalization is rare unless comorbid
conditions exist for which the client requires inpatient CAUSES
treatment. The exact cause of avoidant personality disorder
isn’t known. However, it’s believed that both genetics
and environment play a role. It’s also believed that a) Abusive relationships: People who have a history of
avoidant personality disorder may be passed down in abusive relationships have a higher risk of a DPD
families through genes, but this hasn’t yet been proven. diagnosis.
Environmental factors, particularly in childhood, do play b) Childhood trauma: Children who have experienced
an important role. child abuse (including verbal abuse) or neglect may
develop DPD.
TREATMENT
TREATMENT
Psychotherapy is the main treatment for avoidant
personality disorder. A type of individual counseling that Psychotherapy (a type of counseling) is the main method
focuses on changing a person ' s thinking (cognitive of treatment for DPD. The goal of therapy is to help the
therapy) and behavior (behavioral therapy). person with DPD become more active and independent,
and to learn to form healthy relationships.
NURSING RESPONSIBIBILITIES
NURSING RESPONSIBIBILITIES
1. Promoting client’s safety
2. Teaching effective communication skills 1. The nurse must help clients to express feelings of
3. Helping clients to cope and to control emotions grief and loss over the end of a relationship while
4. Reshaping thinking patterns fostering autonomy and self-reliance.
2. Helping clients to identify their strengths and needs
i) DEPENDENT PERSONALITY DISORDER is more helpful than encouraging the overwhelming
 Dependent personality disorder (DPD) is a type of belief that “I can’t do anything alone!” Cognitive
anxious personality disorder. People with DPD often restructuring techniques such as reframing and
feel helpless, submissive or incapable of taking care decatastrophizing may be beneficial.
of themselves. They may have trouble making simple 3. Clients may need assistance in daily functioning if
decisions. they have little or no past success in this area.
 Dependent personality disorder is characterized by a Included are such things as planning menus, doing
pervasive and excessive need to be taken care of, the weekly shopping, budgeting money, balancing a
which leads to submissive and clinging behavior checkbook, and paying bills.
and fears of separation. These behaviors are 4. Careful assessment to determine areas of need is
designed to elicit caretaking from others. essential. Depending on the client’s abilities and
 The disorder occurs in as much as 15% of the limitations, referral to agencies for services or
population and is seen three times more often in assistance may be indicated.
women than in men. It runs in families and is most 5. The nurse also may need to teach problem-solving
common in the youngest child. People with and decision-making and help clients apply them to
dependent personality disorder often seek treatment daily life. He or she must refrain from giving advice
for anxious, depressed, or somatic symptoms (APA, about problems or making decisions for clients even
2000). though clients may ask the nurse to do so.
6. The nurse can help the client to explore problems,
SIGNS AND SYMPTOMS serve as a sounding board for discussion of
alternatives, and provide support and positive
 Avoidance of personal responsibility
feedback for the client’s efforts in these areas.
 Difficulty being alone
 Fear of abandonment and a sense of helplessness
when relationships end
 Oversensitivity to criticism j) OBSESSIVE COMPULSIVE
 Pessimism and lack of self-confidence PERSONALITY DISORER
 Trouble making everyday decisions  Is characterized by a pervasive pattern of
preoccupation with perfectionism, mental and
CAUSES
interpersonal control, and orderliness at the
Experts have found DPD is more likely in people with expense of flexibility, openness, and efficiency.
particular life experiences, including:
What is the difference between OCD AND OCPD?

a. OBSESSIVE COMPULSIVE DISORDER (OCD)

 Have two main parts: - Obsession - Compulsion disorders often seek treatment for their distress and
 Anxiety Disorder generally have a favorable response to
 Ruled by constant distress antidepressant medications.
 Self-aware
 Anxiety leads to compulsion SIGNS AND SYMPTOMS
 Constant cycle  Typical mood dominated by sadness and joylessness
 Pessimistic outlook
b. OBSESSIVE COMPULSIVE PERSONALITY  Prone to guilt or remorse
DISORDER (OCPD)  Self-critical and self derogatory
 Ruled by Perfectionism  Low self-esteem, or a self-concept that centers on
 Personality Disorder beliefs of worthlessness
 Not self-aware  Brooding or given to worry
 Perfectionism = Good  Critical and judgmental toward others
 More problems at workplace
CAUSES
SIGNS AND SYMPTOMS
a) Biological differences
 Excessive doubt and indecisiveness b) Brain chemistry
 Being unwilling to throw out broken or worthless c) Inherited traits
objects d) Life events
 Becoming overly fixated on a single idea, task, or
belief
 Being unwilling to compromise
RISK FACTORS
 Perfectionism that interferes with completing tasks
 Difficulty coping with criticism a) Having a first-degree blood relative
b) Traumatic or stressful life events
CAUSES c) Personality traits that include negativity
a) Genetics d) History of other mental health disorders
b) Childhood trauma
COMPLICATIONS
TREATMENT a) Lower quality of life
1. Cognitive behavioral therapy (CBT) b) Major depression, anxiety disorders and other mood
2. Selective serotonin reuptake inhibitor (SSRI) disorders
3. Relaxation training - Breathing and Relaxation c) Substance misuse
techniques. d) Relationship difficulties and family conflicts
e) School or work problems and trouble getting things
NURSING RESPONSIBIBILITIES done
1. Help clients to view decision making and completion f) Continuing pain and general medical illnesses
of projects from a different perspective. g) Suicidal thoughts or behavior
2. Helping clients to accept or to tolerate less-than- h) Personality disorders or other mental health
perfect work or decisions made on time may disorders
alleviate some difficulties at work or home. PREVENTION
3. Encouraging clients to take risks, such as letting
someone else plan a family activity, may improve 1. Take steps to control stress
relationships. 2. Reach out to family and friends
3. Continuing pain and general medical illnesses
k) DEPRESSIVE PERSONALITY DISORDER 4. Consider getting long-term treatment
 Depressive personality disorder is characterized by a TREATMENT OPTIONS
pervasive pattern of depressive cognitions and
behaviors in various contexts. 1. Cognitive Behavioral Therapy (CBT) and
 It occurs equally in men and women and more often Interpersonal Therapy (IPT) are the two most
in people with relatives who have major depressive evidence-based forms of psychotherapy for treating
disorders, People with depressive personality people with depression:
  CBT helps you identify dysfunctional thinking CONTRIBUTING FACTORS
patterns and behaviors that are contributing to
your depression a) Genetics
 IPT helps you address any unhealthy b) Growing up in an abusive environment
interpersonal relationships and social skills c) Not having learned how to assert oneself during
2. A newer type of treatment, Cognitive-Behavioral childhood
Analysis System of Psychotherapy (CBASP) trusted d) Disruptions in a child’s relationship to authority
source, is the only psychotherapy specifically figures, such as parents, caretakers, or teachers
developed for treating chronic depression. It’s an Researchers also link passive-aggressive behavior to:
integrative treatment that combines various aspects
of other therapies including the following 1. Anxiety disorders
approaches: 2. ADHD
 cognitive 3. Depression
 behavioral 4. Substance abuse
 interpersonal (relationships and social factors) 5. Personality disorder
 psychodynamic (the psychological roots of TREATMENT
mental health difficulties)
There is no specific treatment for PAPD.
CBASP helps you develop a feeling of personal
However, a psychologist or counselor may often help
safety in your relationships, heal interpersonal trauma,
people learn ways to identify, address, and stop engaging
and improve any interpersonal avoidance patterns.
in these contradictory behaviors and actions
3. Your doctor might also suggest medication if
NURSING RESPONSIBIBILITIES
appropriate. Modern antidepressant medications fall
into two main categories: 1. The nurse can help them examine the relationship
 selective serotonin reuptake inhibitors (SSRIs) between feelings and subsequent actions.
 serotonin-norepinephrine reuptake inhibitors 2. The nurse also can help the client to learn
(SNRIs) appropriate ways to express feelings directly,
especially negative feelings such as anger.
NURSING RESPONSIBIBILITIES 3. Methods such as having the client write about their
1. Promoting client' s safety feelings or roleplay.
2. Promoting therapeutic relationship
3. Helping clients to cope and to control emotions
ELDER CONSIDERATION
4. Reshaping thinking patterns  Abrams and Sadavoy (2004) wrote that personality
disorders from Cluster A and C are more prevalent in
older age and are closely correlated with depression.
l) PASSIVE – AGGRESSIVE PERSONALITY  According to geropsychologist Erlene Rosowsky,
DISORDER PsyD. Personality disorders may appear to worsen
with age, although the prevalence remains stable
 Is a pattern of indirectly expressing negative
with 10%–20% of people age 65 or older having a
feelings instead of openly addressing them.
personality disorder.
 People to express negative feelings and emotions
 In general, personality disorders do not appear for
subtly or passively rather than directly.
the first time in old age.
SIGNS AND SYMPTOMS
COMMUNITY BASED CARE
 Resentment and opposition to the demands of
Caring for clients with personality disorders
others, especially the demands of people in positions
occurs primarily in community-based settings.
of authority
The nurse uses skills to deal with clients who
 Resistance to cooperation, procrastination and
have personality disorders in clinics, outpatient settings,
intentional mistakes in response to others' demands
doctors’ offices, and many medical settings. Often, the
 Cynical, sullen or hostile attitude
personality disorder is not the focus of attention; rather,
 Frequent complaints about feeling underappreciated
the client may be seeking treatment for a physical
or cheated
condition.
 Most people with personality disorders are 3. Do not take undue flattery or harsh criticism
treated in group or individual therapy settings, personally; it is a result of the client’s personality
community support programs, or self-help group. disorder.
4. Set realistic goals and remember that behavior
MENTAL HEALTH PROMOTION changes in clients with personality disorders take a
PERSONALITY DISORDERS long time. Progress can be very slow.

Treatment of individuals with a personality disorder

often focuses on:

1. Mood stabilization
2. Developing social and relationship skills
3. Decreasing impulsivity

Hayward, Slade, and Moran (2006) study found that

client with personality disorders perceived unmet needs
in five areas:

 Self-care
 Sexual Expression
 Budgeting
 Psychotic symptoms
 Psychological distress

There are “Protective Factors” that help children to be

less likely to develop antisocial behavior as adults
(Cohen, Chen, Gordon, Johnson, Brook, & Kasen, 2008).
This includes the following:

 School commitment or importance of school

 Parent or peer disapproval of antisocial behavior,
and
 Being involved in a religious community

Moreover, here are the points to consider for nurses

when working with clients with personality disorders.

1. Talking to colleagues about feelings of frustrations

will help you to deal with your emotional responses
so you can be more effective with clients.
2. Clear, frequent communication with other health-
care providers can help to diminish the client’s
manipulation.