Chapter III

BASIC CONCEPTS OF PERSONALITY

A. Definition of personality
 The sum total of all the inherited and acquired physical, mental, and emotional traits of
a person as this interacts with the environment in a unique and distinct way. Expressed
through behavior.

B. Theories of Personality Development

A. Theory of Humours (Body Fluids)
 This is one of the earliest theories of personality and it has the idea that personality
depended on the balance of fluids in the body. •There were four basic body fluids:
 The Sanguine (Blood)
 Personality Characteristic
o Cheerful
o Energetic
o Personable
o Talkative
o Out-going
o Enthusiasm
o Friendly
o Compassionate
o Care-free
o Optimistic
o Happy
o Hopeful
o Accommodating
o Light-hearted
However, they may have the following weaknesses: •
o Weak-willed
o Unstable
o Undisciplined
o Egocentric
o Loud
o Exaggerates
o Fearful
o Restless
o Undependable
B. The Phlegmatic (Phlegm)
 Personality Characteristics
o Calm
o Placid (not easily irritated)
o Easy-going

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 o Dependent
o Efficient
o Conservative
o Practical
o Leader
o Diplomat
o Humorous
o Slow
o Indifferent
o Cold
However, they may have the following weaknesses:
o Stingy
o Fearful
o Indecisive
o Spectator
o Self-protective
o Selfish
o Unmotivated
C. The Melancholic (Black bile)
 Personality Characteristics
o Gloomy
o Moody
o Sad
o Self-centered
o Negative
o Pessimistic
o Theoretical
o Impractical
o Unsociable
o Critical
o Revengeful
o Rigid
o Depressed
o Dejected
o Deplorable
o Self-involved
However, they may have the following strengths:
o Gifted
o Analytical
o Sensitive
o Perfectionist
o Aesthetic

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 o Idealistic
o Loyal
o Self-sacrificing
D. The Choleric (Yellow bile)
 Personality Characteristics
o Hot-tempered
o Cruel
o Sarcastic
o Domineering
o Inconsiderate
o Proud
o Intolerant – ‘choleric’
o Self-sufficient
o Unemotional
o Hasty
o Crafty
o Irritable
o Passionate
o Strong
o Active
o Imaginative
E. Somatotypes (Bodily Shapes)
 These theories of personality were based on bodily shape or physical structure.
 Key figures of these theories were Kretschmer (1925) and Sheldon (1954).
 According to Kretschmer, specific mental illnesses tended to be associated with
specific body shapes. He classified the body shapes as:
a) Asthenic (Leptosomatic) type
b) Pyknic type
c) Athletic type
 Sheldon (1954), on the other hand, grouped the somatotype into three as:
a. Ectomorphs: —Weak somatic structure as well as undeveloped viscera—
thin, long, fragile (like leptosomatic type) —Pessimistic, unsociable,
reserved, brainy, artistic and introvert
b. Mesomorphs: ―Balanced development of viscera and strong somatic
structure—muscular (like athletic type) ―Craving for muscular activity,
self- assertive, loves risk and adventure, energetic, assertive and bold
tempered
c. Endomorphs: - Person having highly developed viscera, but weak somatic
structure— fat, soft, round (like pyknic type). —Easy-going, sociable,
affectionate and fond of eating.
 Kretschmer’s Classification of Personality Body Type (Characteristics Social
Relations Mental Illness

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  ASTHENIC (lean and thin) Long limbs; Slender- long neck; Narrow
chest; Adam’s apple; Frail; Thin Shy; Introvert; Reclusive; Self-
centered; Introspect Schizophrenia
 PYKNIC (having fat bodies) Short limbs; Round head; Short, fat neck;
Large trunk; Plumpy; Rounded Outgoing; Frank; Cheerful; Sociable;
Jolly; Easy going; Good natures; Extravert; Mood changes Manic-
depressive psychosis
 ATHLETIC (balanced body) Broad shoulders; Narrow hips; Strong
bones; Muscular Shy; Reclusive; Self- centered; Energetic; Optimistic;
Adjustable Rare
 Sheldon’s Classification of Personality Body Type (Characteristics Social
Relations)
 ECTOMORPH Frail Thin Introspective Restrained character
 MESOMORPH Robust Muscular Hearty Insensitive
 ENDOMORPH Plump Rounded Jolly Easy-going
C. Eysenck’s Theory of Personality
b. Eysenck proposed a theory of personality based on biological factors, arguing that
individuals inherit a type of nervous system that affects their ability to learn and adapt to the
environment.
c. Eysenck behavior could be represented by two dimensions:
a) Introversion / Extroversion
 The typical introvert is a quiet, retiring sort of person, introspective, fond of
books rather than people; he is reserved and distant except to intimate friends.
•He tends to plan ahead, ‘looks before he leaps’ and distrusts the impulse of the
moment
 He does not like excitement, takes matters of everyday life with proper
seriousness, and likes a well- ordered mode of life. •He keeps his feelings under
close control, seldom behaves in an aggressive manner, and does not lose his
temper easily.
 He is reliable, somewhat pessimistic and places great importance on ethical
standards.
 The typical extrovert is sociable, likes parties, has many friends, needs to have
people to talk to, and does not like reading or studying by himself.
 He likes practical jokes, always has a ready answer, and generally likes change;
he is carefree, easy-going, optimistic and likes to ‘laugh and be merry’. •He
prefers to keep moving and doing things, tends to be aggressive and lose his
temper quickly; altogether his feelings are not kept under tight control and he’s
not always a reliable person.
 He craves excitement, takes chances, often sticks his neck out, acts on the spur
of the moment and is generally an impulsive individual
b) Neuroticism / Stability (N).
 Eysenck called these second-order personality traits.

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  A person’s level of neuroticism is determined by the reactivity of their sympathetic
nervous system. •A stable person’s nervous system will generally be less reactive to
stressful situations, remaining calm and level headed.
 Someone high in neuroticism on the other hand will be much more unstable, and
prone to overreacting to stimuli and may be quick to worry, anger or fear. •They are
overly emotional and find it difficult to calm down once upset. Neurotic individuals
have an Autonomic Nervous System that responds quickly to stress.
c) Psychoticism/Normality
 Eysenck (1966) later added a third trait/dimension - Psychoticism – e.g., lacking in
empathy, cruel, a loner, aggressive and troublesome. •This has been related to high
levels of testosterone.
 The higher the testosterone, the higher the level of psychoticism, with low levels
related to more normal balanced behavior. •He was especially interested in the
characteristics of people whom he considered to have achieved their potential as
individuals
 According to Eysenck, the two dimensions of neuroticism (stable vs. unstable) and
introversion-extroversion combine to form a variety of personality characteristics.
D. Narrow-Band Theories of Personality
 The narrow-band theories of personality are theories which do not attempt to provide overall
accounts of human functioning, but rather are concerned with just one or two distinctive
features about people, and how they differ from one another.
 They leave other aspects of personality open, and concentrate on just one particular area of
individual difference.
 Characteristics of Type A and Type B Personalities
o Type A persons are hard-driving and competitive Type B persons are quite the
opposite.
o Type B persons are easy going, non- competitive, placid and unflappable They live
under constant pressure, largely of their own making. They seek recognition and
advancement and take on multiple activities with deadlines to meet. Much of the time
they may function well as alert, competent, efficient people who get things done.
When put under stressful conditions they cannot control, however, they are likely to
become hostile, impatient, anxious and disorganized They bear stress easily. They are
likely to live longer than Type A persons Given a task/work to do.
o Type As’ tend to perform any task near their maximum capacity no matter what the
situation calls for. They work hard at arithmetic problems whether or not a deadline is
imposed Type Bs’ work harder when given a deadline.

C. Therapeutic Models
I. Psychoanalytic – unconscious thoughts; psychosexual development
 Psychoanalysis to learn unconscious thoughts; the therapist is nondirective and
interprets meaning
II. Interpersonal – relationships are the basis for mental health or illness

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  Therapy focuses on the here and now and emphasizes relationships; the therapist is
an active participant
III. Behavioral – behavior is learned through conditioning
 Behavioral modification addresses maladaptive behaviors by rewarding adaptive
behavior
IV. Cognitive – negative and self-critical thinking cause depression
 Cognitive-behavioral therapists assist in identifying negative thought patterns and
replacing them with rational ones; therapy often involves homework
V. Biological – psychiatric disorders are heavily influenced by and/or cause changes to
the brain and/or neurotransmitter(s), resulting in changes in thinking and behavior
 Neurochemical imbalances are corrected through medication and talk therapy (e.g.,
cognitive-behavioral therapy)
VI. Psychotherapy – various forms of talk therapy, formally known as psychotherapy,
focused on the complexity and inner workings of the mind
 Emphasized environmental influences on mental health and illness

A. Psychoanalytic Theory - Freud

 Three layers of mental activity: the conscious mind is influenced by the preconscious
and the unconscious mind
 The conscious mind: is current awareness—thoughts, beliefs, and feelings
 The preconscious: lies immediately below the surface. although its content is not
currently the subject of our attention, it is accessible with the conscious effort
 To the unconscious mind: the deepest and the biggest chunk of the iceberg. Where
our most primitive feelings, drives, and memories reside, especially those that are
unbearable and traumatic
 Interactive agents in the brain:
o id: primitive, pleasure-seeking, and impulsive part (predominately sexual
pleasure) of our personalities that lurks in the unconscious mind
o ego: problem solver and reality tester that navigates in the outside world. Acts as
an intermediary between the id and reality by using ego defense mechanisms, such
as repression, denial, and rationalization
o superego: the moral component of the personality that Freud referred to as our
conscience (our sense of what is right or wrong). Greatly influenced by parents’ or
caregivers’ moral and ethical stances.

According to Freud, suspicion and manipulation of others develop as the result of

attitudes formed during the oral stage, when an infant first learns to relate to the
environment. Anal stage traits include stinginess, stubbornness, orderliness, or their
opposites. Phallic stage traits include flirtatiousness, pride, vanity, difficulty with

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 authority figures, and difficulties with sexual identity. Genital stage traits include the
ability to form satisfying sexual and emotional relationships with members of the
opposite sex, emancipation from parents, and a strong sense of personal identity.

According to Freud, fixation at the oral stage sometimes produces dependent

infantile behaviors in adults. Latency fixations often result in difficulty identifying
with others and developing social skills, resulting in a sense of inadequacy and
inferiority. Phallic fixations result in having difficulty with authority figures and
poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity,
messiness, destructiveness, and cruelty.
o Therapeutic model: Psychoanalytic therapy
o Freud’s answer for a scientific method to relieve emotional disturbances
o Time-consuming (three to five times a week for many years), expensive, and
emotionally painful process
o The goal of this therapy is to know and understand what is happening at the
unconscious level to uncover the truth
o Free association: used to search for forgotten and repressed memories – the patient
is encouraged to say anything that comes to mind in response to a word or phrase
o Psychodynamic therapy: theoretically related to psychoanalytic therapy and views
the mind in essentially the same way o Tends to be shorter, about 10 to 12 sessions
 The therapist takes a more active role because the therapeutic relationship is part
of the healing process
o Transference: occurs as the patient projects intense feelings onto the therapist
related to unfinished work from previous relationships o Safe expression of these
feelings is crucial to successful therapy
o Example: a patient acts more immature when in the presence of a therapist who
reminds the patient of his or her mother
o Psychodynamic Therapists are taught to recognize that they, too, have unconscious
emotional responses to the patient o This countertransference must be scrutinized
to prevent damage to the therapeutic relationship
B. Interpersonal Theory
 Focuses on what occurs between people, as opposed to psychoanalytic therapy, which is
rooted in what occurs in the mind
 Herbert “Harry” Stack Sullivan believed that social forces and interpersonal problems
were the cause of psychiatric alterations
 According to Sullivan, human beings are driven by the need for interaction
 Loneliness is considered the most painful human experience
 Emphasized the early relationship with the significant other (primary parenting figure) as
crucial for personality development and believed that healthy relationships are necessary
for a healthy personality

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  Despite the need for human interaction, Sullivan believed that interaction is the source of
anxiety
 In the earliest relationship, anxiety is transmitted from the significant other to the child
 A child's anxiety is also based on perceived degrees of approval or disapproval of the
primary caregiver
 All behavior is aimed at avoiding anxiety and threats to self-esteem o One way of avoiding
anxiety is by focusing on positive attributes, or the good me (“I’m a good skier”), and
hiding the negative aspects, or the bad me (“I failed an exam”), of ourselves from others
and maybe even from ourselves
The, not me is used to separate us from parts of ourselves that we cannot bear to
acknowledge that are pushed deep into the unconscious and disassociated from
our sense of self
▪ Example: a female adolescent from a strict and conservative family who
begins to have stirrings of attraction towards girls, yet firmly maintains
(and beliefs) that she has feelings for and interest in boys
 Theory of development – personalities are influenced by the social environment as
children, particularly as adolescents
 Personality is most influenced by the mother but that personality can be molded even in
adulthood
o Therapeutic Model: Interpersonal therapy (IPT)
o Hands-on system in which therapists actively guide and challenge maladaptive
behaviors and distorted views
o The premise of this work is that if people are aware of their dysfunctional patterns
and unrealistic expectations, they can modify them
o The focus is on the here and now, with an emphasis on the patient’s life and
relationships at home, at work, and socially
o The therapist becomes a “participant observer” and reflects the patient’s
interpersonal behavior, including responses to the therapist
C. Behavioral theory
 Therapeutic Model: Behavioral Therapy or behavior modification
o Attempts to correct or eliminate maladaptive behaviors or responses by rewarding
and reinforcing adaptive behavior
 Systematic desensitization based on classical conditioning
o The premise is that learned responses can be reversed by first promoting relaxation and
then gradually facing a particular anxiety-provoking stimulus \
o Particularly successful in extinguishing extreme fears, or phobias
o Agoraphobia, the fear of open places, can be treated by initially visualizing trips
outdoors while using relaxation techniques. Later the individual can practice actual

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 excursions that gradually increase in length, thereby eliminating or reducing
agoraphobia
 Aversion therapy based on both classical and operant conditioning o Used to eradicate
unwanted habits by associating unpleasant consequences with them
o Pharmacologically based aversion therapy is disulfiram (Antabuse) – people who take
this medication and then ingest alcohol become extremely ill, with nausea, vomiting,
and dizziness
o Also has been used with sex offenders, who may, for example, receive electric shocks
in response to arousal from child pornography
 Biofeedback – a technique in which individuals learn to control physiological responses
such as breathing rates, heart rates, blood pressure, brain waves, and skin temperature
o Control is achieved by providing visual or auditory biofeedback of the physiological
response and then using relaxation techniques such as slow, deep breathing, or
meditation
o The recent emergency of smartphone apps and wearable devices that provide this
immediate physiological feedback
D. Therapeutic Model: person-centered therapy
 Carl Rogers saw people as basically healthy and good and identified people and all living
organisms as having innate self-actualizing tendencies to grow, develop, and realize their
full potential
 Believed that clients were in the best position to explore, understand, and identify
solutions to their problems
 Uses the analogy of teaching a child to ride a bicycle – it is not enough to tell the child
how to ride; the child must try to ride the bike
 Existentially based therapy – the emphasis is on self-awareness and the present because
the past has already happened, and the future has not yet occurred
 The role of the therapist is that of a nondirective facilitator who seeks clarification and
provides encouragement in this process
 Three essential qualities in the therapist are congruence (genuineness), empathy, and
respect
o If these three are present, the patient will improve; without them, there is little chance
the therapy will be successful
E. Therapeutic Model: Cognitive-behavioral therapy (CBT)
 Aaron T. Beck believed that depressed people generally have standard patterns of
negative and self-critical thinking
 Popular, effective, and well-researched therapeutic tool
 Based on both cognitive and behavioral theory and seeks to modify negative thoughts that
lead to dysfunctional emotions and actions
 Several concepts underlie this therapy:

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o We all have schemata, or unique assumptions about ourselves, others, and the
world around us
▪ For example, if someone has a schema that no one can be trusted,
this person will question everyone’s motives and expect deception in
relationships
▪ Other dominant forms of negative schemata include incompetence,
abandonment, evilness, and vulnerability
o People are unaware of their basic assumptions, but their beliefs and attitudes will
make the assumptions apparent
o Rapid, unthinking responses based on these schemata are known as automatic
thoughts
▪ These responses are particularly intense and frequent in psychiatric
disorders such as depression and anxiety
▪ These automatic thoughts, or cognitive distortions, are irrational
because people make false assumptions and misinterpretations

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Common cognitive distortions

Distortion Definition Example

All-or-nothing thinking Thinking in black and white, Cheryl got the

reducing complex outcomes secondhighest score in the
into absolutes cheerleading competition.
She considers herself a loser.

Overgeneralization Using a bad outcome (or a Marty had a traffic accident.

few bad outcomes) as She refuses to drive and says
evidence that nothing will
ever go right again “I shouldn’t be allowed on the
road”

Labeling A form of generalization “Because I failed the advanced

where a characteristic or event statistics exam, I am a failure. I
becomes definitive and results might as well give up”
in an overly harsh label for
self and others

Mental filter Focusing on a negative detail Anne’s boss evaluated her

or bad event and allowing it work as exemplary and gave
to taint everything else her a few suggestions for
improvement. Anne obsessed
with the suggestions and
ignored the rest

Disqualifying the positive Maintaining a negative view “I’ve just been offered the
by rejecting information that job I’ve always wanted. No
supports a positive view as one else must have applied”
being irrelevant, inaccurate,
or accidental

Jumping to conclusions Making a negative “My fiancé, Mike, didn’t call

interpretation even though me for 3 hours; therefore, he
doesn’t love me”
there is little or no supporting
evidence

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 a. Mind reading inferring negative thoughts, The grocery store clerk was
responses, and motives of grouchy and barely made eye
others contact. “I must have done
something wrong”

b. Fortune-telling error Anticipating that things will “I’ll ask her out, but I know
turn out badly as an fact she won’t have a good time”

Magnification or Exaggerating the importance of “I’m alone on a Saturday night

minimization something (e.g., a personal because no one likes
failure or the success of me. When other people are
others) or reducing the alone, it’s because they want
importance of something to be”
(e.g., personal success or the
failure of others)

a. Catastrophizing An extreme form of “If I don’t make a good

magnification in which the impression on the boss at the
very worst is assumed to be a
company picnic, she will fire
probable outcome
me”
Emotional reasoning Drawing a conclusion based “I’m nervous about the exam.
on an emotional state I must not be prepared. If I
were, I wouldn’t be afraid”

“Should” and “must” Rigid self-directives “My patient is worse today.

statements that presume an I should give better care so
unrealistic amount of that she will get better”
control over external
events

Personalization assuming responsibility for “I’m sorry that your party

an external event or situation wasn’t fun anymore. It’s
that was likely out of probably because I was there”
personal control

o The goal of CBT is to identify the negative patterns of thought that lead to negative
emotions

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 o Once the maladaptive patterns are identified, they can be replaced with rational
thoughts
o A useful technique is to use a four-column format to record the precipitating event or
situation, the resulting automatic thought, the ensuing feeling(s) and behavior(s), and
finally, a challenge to the negative thoughts based on rational evidence and thoughts
o Referred to as the ABCs of irrational beliefs:
 Examples of ABCs of Irrational Beliefs
 Activating Event
o Jack has been in counseling for depression. His therapist’s administrative
assistant called and canceled this week’s appointment.
 Belief
o My therapist is disgusted with me and wants to avoid me.
 Consequence
o Sadness, rejection, and hopelessness. Decides to call off work and just go
back to bed.
 Reframing
o There is no evidence to believe the therapist finds me disgusting. Would the
therapist have called to reschedule if he didn’t want to see me again?
F. Biological Therapy
 Psychopharmacology is the primary biological treatment for mental disorders
 Major classifications of medications are antidepressants, antipsychotics, antianxiety
agents, mood stabilizers, and psychostimulants
 Clinicians recognize the importance of optimizing other biological variables, such as
correcting hormone levels (as in hyperthyroidism), regulating nutritionally deficient
diets, and balancing inadequate sleep patterns
 Electroconvulsive therapy (ECT) has proven to be an effective treatment for severe
depression and other psychiatric conditions o A procedure that uses electrical current
to induce a seizure and is thought to work by affecting neurotransmitters and
neuroreceptors
 Other brain-stimulation therapies are increasingly being used in psychiatry o
Repetitive transcranial magnetic stimulation (rTMS) uses an electromagnetic device to
deliver a rapidly pulsed magnetic field to the cerebral cortex to activate neurons
o Magnetic seizure therapy (MST) uses higher-frequency electronic pulses instead
of electricity to induce a seizure
o Vagus nerve stimulation (VNS) works by stimulating the vagus nerve, which
results in improved levels of neurotransmitters
o Deep-brain stimulation (DBS) relies on surgically implanted electrodes
stimulating a specific area of the brain

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  Most mental health professionals combine biological approaches with talk therapy
 The use of medication and CBT is an extremely effective treatment for many
psychiatric disorders, especially major depression
G. Psychotherapy changes the brain
 Karlsson found positive treatment responses with various psychotherapies resulting
in brain changes for the following disorders: major depressive disorder (MDD),
anxiety disorders (panic disorder, social anxiety disorder, specific phobias),
posttraumatic stress disorder (PTSD), borderline personality disorder, and
obsessive-compulsive disorder (OCD)
 The most effective therapies for treating these disorders resulting in brain changes
are cognitive behavioral therapy (CBT), dialectic behavior therapy (DBT),
psychodynamic psychotherapy, and interpersonal psychotherapy (IP)
H. Nursing Models
 Interpersonal relations in nursing
o Hildegard Peplau’s seminal work Interpersonal Relations in Nursing was first
published in 1952 and has served as a foundation for understanding and
conducting therapeutic nursing relationships since
o Based her work on Sullivan’s interpersonal theory and emphasizing the nature of
the nurse-patient relationship strongly influenced the outcome for the patient
o Conceptualized the four levels of anxiety:
1. Mild anxiety is day-to-day alertness (e.g., "I'm awake and taking care of
business”). Stimuli in the environment are perceived and understood, and
learning can easily take place
2. Moderate anxiety is felt as a heightened sense of awareness, such as when
you are about to take an exam. The perceptual field is narrowed, and an
individual hears, sees, and understands less. Learning can still take place,
although it may require more direction
3. Severe anxiety interferes with clear thinking, and the perceptual field is
greatly diminished. Nearly all behavior is directed at reducing anxiety. An
example of this is your response to your car skidding on wet pavement.
4. Panic anxiety is overwhelming and results in either paralysis or dangerous
hyperactivity. An individual cannot communicate, function, or follow
directions. This is the sort of anxiety that is associated with the terror of
panic attacks.

 Influence of Theories and Therapies on Nursing Care

o Behavioral: promoting adaptive behaviors through reinforcement can be valuable
and important in working with patients, especially when working with a pediatric

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 population. These patients look forward to positive reinforcement for good
behavior and will work hard for gold stars or other privileges
o Cognitive: helping patients identify negative thought patterns is a worthwhile
intervention in promoting healthy functioning and improving neurochemistry.
Workbooks are available to aid in the process of identifying these cognitive
disorders.
o Psychosocial development: Erikson’s theory provides a structure for
understanding critical junctures in development. The older adult who has suffered
a stroke may be depressed and despairing because he can no longer take care of
his house. In this case, the nurse and the patient could explore ways of optimizing
the patient’s remaining strengths and talents, such as by nurturing and tutoring
young people or by developing attainable goals such as getting the mail, taking out
the trash, and so forth
o Hierarchy of needs: Maslow’s theory is useful in prioritizing nursing care. When
working with actively suicidal patients, students sometimes think it is rude to ask
if the patients are thinking about killing themselves. However, safety supersedes
this potential threat to self-esteem. Although the “must dos” in nursing begin with
physical care (e.g., providing medication and hydration through intravenous [IV]
fluids), the goal should also include higher-level needs, which can be obtained by
listening, observing, and collaborating with the patient in the development of the
plan of care
 Mental Health Recovery Model in Psychiatric Nursing
o Not a focus on a cure, but instead emphasizes living adaptively with chronic
mental illness
o Viewed as both an overarching philosophy of life for people with mental illness
and an approach to care for use by those who treat, finance, and support mental
health care
o Also an effective approach to dealing with substance abuse
o Shifts the responsibility for care from the provider to the individual
o Emphasizes hope, social connection, empowerment, coping strategies, and
meaning in life
o Moves the relationship from a nurse-patient relationship to a nurse-patient
partnership

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