Personality Disorders

By: Senior Nursing Instructor

Nomana Mehmood

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 Objectives
At the end of this session, the students will be able to:

• Discuss the history and development of personality

disorders.
• Explain some common features exhibited by individuals
with different personality disorder.
• Utilize nursing process based on an understanding of the
psychodynamics‟ of clients exhibiting various
maladaptive behaviors in selected situations.

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 Personality
• The word personality is derived from the
Greek term persona. It was originally used to
describe the theatrical mask worn by some
dramatic actors at the time.
• Personality essentially, refers to who a person
is and how that person behaves. It influences
an individual’s thoughts, feelings, attitudes,
values, motivations, and behaviors.

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 PERSONALITY TRAITS
Personality traits can be defined as a distinct set
of qualities demonstrated over an extended
period of time that characterize an individual.

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 Historical Aspect
• The concept of a personality disorder has been described
for thousands of years (Skodal & Gunderson, 2008). In
the 4th century B.C., Hippocrates concluded that all
disease stemmed from an excess of or imbalance among
four bodily humors: yellow bile, black bile, blood, and
phlegm. Hippocrates identified four fundamental
personality styles that he concluded stemmed from
excesses in the four humors:
• the irritable and bad tempered (yellow bile);
• the pessimistic melancholic (black bile);
• the overly optimistic and extraverted sanguine (blood);
• the apathetic phlegmatic –stable temperament (phlegm). 5
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 PERSONALITY
DISORDERS
• A personality disorder refers to a long-term
maladaptive way of thinking and behaving that is
ingrained and inflexible.
• Personality traits can be considered personality
disorders when the following criteria are met: The
traits are maladaptive, rigid, and enduring, and
produce impairment in functioning or individual
distress.
• Onset in adolescence or early adulthood.

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 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
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 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

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 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
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 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 11
 Signs and symptoms of Cluster A
(eccentric)
• Paranoid personality disorder
– Generally mistrust and suspicious to others
– Inability to work collaboratively with others
– Emotional detachment and cold, not sharing their
feeling
– Hostility (agression) toward others
– Suspicions that others are exploiting, harming, or
deceiving person

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 Nursing intervention

• Few seek professional help on their own.

• Treatment focuses on development of trust.
• Cognitive therapy to overcome negative thinking.
• Give specific feedback about positive
characteristics.

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 Schizoid personality disorder

– Schizoid Personality Disorder Pervasive pattern of detachment

from social relationships and restricted emotional expression as
indicated by four or more of the following:
– Lack of desire or enjoyment of close relationships Solitary
activities as consistent choice
– Little or no sexual desire
– Little pleasure in activities
– Emotional coldness, detachment
– Extreme introversion (self-absorption)
– Fixation on your own thoughts and feelings

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 Nursing Intervention

– Few seek professional help on their own.

– Focus on the value of interpersonal relationships,
empathy, and social skills.
– Give specific feedback about positive thoughts.

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Schizotypal personality disorder
– Pervasive pattern of social and interpersonal deficits;
acute discomfort with close relationships accompanied
by cognitive or perceptual distortions ,as indicated by
five or more of the following: Ideas of reference
– Odd beliefs or magical thinking
– Unusual perceptual experiences
– Odd thinking or speech
– Suspiciousness or paranoia
– Lack of close friends or confidants
– Excessive social anxiety

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 Nursing Intervention

– Main focus is on developing social skills

– Medical treatment is similar to that used for
schizophrenia
– Treatment prognosis is generally poor

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 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, but some times sudden emotional shifts
– impressionistic style of speech that lacks detail
– Easily suggestible
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 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.
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Narcissistic personality disorder
– Grandiose fantasy or behavior with need for admiration
and lack of empathy, as indicated by five or more of the
following:
– Constant attention-grabbing and admiration-seeking
behavior
– Grandiose sense of self-importance
– Belief that person is special and unique
– Need for excessive admiration
– Lacking of empathy
– Jealous of others or belief that others are envious of person
– Proud behaviors or attitudes

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 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.
• He or she sets limits on rude or verbally abusive behavior
and explains his or her expectations from the client.
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Antisocial personality disorder
– Chronic irresponsibility and unreliability Unlawful
behaviors.
– Lack of regard for the law and for others' rights.
– Persistent lying and stealing .
– Aggressive, often violent behavior.
– Lack of concern for the safety of self and others .
– lake of remorse

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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 .
– Transient stress-related paranoid ideation
– Recurrent suicidal behavior/thoughts/threats
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 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.
 Establishing boundaries.

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 con…
 Cognitive restructuring techniques
• Thought-stopping
• Positive self talk
• Decatastrophizing (a technique, used in treating people with
irrational or exaggerated fears, that explores the reality of a feared
stimulus as a way of diminishing its imagined or anticipated danger)
• Teaching social skills
• Teaching effective communication skills
• Therapeutic relationship
• Use of distraction such as walking or listening to music

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 Sign and symptoms Cluster C
(Anxious or Fearful)

Avoidant personality disorder

• Social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation.
• Unwillingness to get involved with others unless
certainty of being liked
• Over-riding sense of social discomfort
• Easily hurt by criticism
• Always need emotional support
• Occasionally try to socialize
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 Dependent Personality Disorder

Need to be taken care of leading to clinging behavior and fears of separation,

Difficulty in making everyday decisions
• Need for others to assume responsibility for person’s life in most major
areas
• Difficulty in expressing disagreement
• Difficulty in initiating projects or doing things on own
• Excessive attempts to get nurturance and support from others
• Feelings of discomfort or helplessness when alone
• Urgent seeking out of another care and supportive relationship when one
ends
• Unrealistic fears of being left to provide self-car

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 Obsessive-Compulsive
Personality Disorder

• Excessive control and

perfectionism
• Inflexible
• Judgmental/moralistic
• Often humorless

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• Preoccupation with perfection, and mental and interpersonal
control, as indicated by four or more of the following:
• Preoccupation with details, rules, lists, order, organization, or
schedules
• Perfectionism interfering with task completion
• Excessive devotion to work and productivity leading to
exclusion of leisure activities
• Inability to discard worn-out or worthless objects Reluctance
to delegate tasks or work with others
• Rigidity and stubbornness
• friendships Over conscientiousness
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THANK YOU

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