Personality Disorders

PERSONALITY DISORDERS

Personality

Prevalence of Personality Disorders

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an ingrained, enduring pattern of
behaving and relating to oneself and
others
includes perceptions, attitudes, and
emotions regarding oneself and the
world
It is consistent over time and does
not change easily or rapidly

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A spectrum of maladaptive traits
that
produce
or
influence
considerable psychological and
emotional disturbances and impair
relationships. (Kernberg)
Enduring pattern of feeling, thinking
& behaving that become rigid,
pervasive over time. (APA)
Symptoms are described as ego
syntonic, which means comfortable
for the individual but uncomfortable
for others.

Characteristic
Disorders
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Etiologies of Personality Disorders
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Personality Disorders

13.4 % prevalence rate
Most common of which are the
avoidant, schizoid & paranoid
personality disorders

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There exists NO clear-cut single
cause for Personality disorders,
largely UNKNOWN
Multi-causation,
genetic
&
environmental factors may all play
roles
TEMPERAMENT may also play a
role

Types of Personality Disorders
Cluster

Disorders

Descriptions

Cluster 1- ODD
& ECCENTRIC

Paranoid

Clients
are
withdrawn and
engage in odd
behavior

Schizoid

Personality

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
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

Schizotypal
Cluster IIERRATIC,
DRAMATIC &
EMOTIONAL

Clients
seek
attention

Borderline
Histrionic
Narcissistic

Custer IIIAVOIDANT,
ANXIOUS &
FEARFUL

Avoidant
Dependent
Obsessivecompulsive

Features of PD
1. The Onset begins during adolescence
and young adulthood
2. Poor impulse control, Rigid and
inflexible
3. Clients may deny their existing
problems and lack insight into their maladaptive behavior
4. Impaired judgment
5. Impaired reality testing
6. Impaired object relations
7. Impaired thought process
8. Impaired self-perception
9. Impaired stimulus barrier

Antisocial

Clients seek to
avoid
or
minimize
experience
anxiety

CLUSTER I
A. Schizoid Personality Disorder
- Characterized by an inability to
form
warm,
close
social
relationships
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Assessment
Social detachment and lack of close
relationships
Interest in solitary activities
Aloof and indifferent
Restricted expression of emotions
Lack of interest in others

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Nursing Interventions
Maintain comfortable distance
Initiate structured social interactions
Positive nurse client relationship

RCdelaPeña, RN, RM//

B. Schizotypal Personality Disorder
- Exhibits abnormal or highly unusual
thoughts, perceptions, speech, and
behavior patterns
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Assessments
Magical thinking
Odd thinking and speech
Relationship deficits
Nursing Interventions
Maintain comfortable distance & be
calm
Administer
psychotropics,
as
ordered
Start structured social interactions

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C. Paranoid Personality Disorder
Characterized by suspiciousness and
mistrust of others
Assessment
Suspicious and distrusting
Argumentative
Hostile aloofness
Rigid, critical, and controlling of
others
Grandiosity
Nursing Interventions
Establish rapport
Minimize risk of aggression
Support adaptation
Maintain
an
unambiguous
environment

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CLUSTER II
A. Histrionic
personality
disorder
Characterized by overly dramatic
and intensely expressive behavior

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Assessment
Keep self the center of attention
Self dramatization (flamboyant)
Pose seduction & intimacy

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Nursing Interventions
Consistency,
understanding,
supportive
environment,
help
develop adaptive coping
Increase self worth
Assist patient assume a mature adult
role

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B. Narcissistic
Personality
Disorder
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
Assessment
Sense of grandiose self importance
Excessive self admiration
Lacks empathy but arrogant
Fantasies of unlimited power,
beauty or brilliance
C. Antisocial
personality
disorder
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
Assessment
Exploitation of others
Violate laws & rights of others
Impulsive risky behaviors
Lack of loyalty, honesty & fidelity
Nursing Interventions
Use firm & consistent limits to
maladaptive behaviors *CBQ!*
Facilitate trust & rapport in a
structured environment
D. Borderline
Personality
Disorder
Characterized by instability in
interpersonal relationships, mood,
and self-image
Behavior may be impulsive and
unpredictable
Assessment
Chronic feelings of emptiness
Lack of control
Impulsive & self-damaging
Neurotic
Gestures, threats self maturation
Nursing Interventions
Set clear realistic expectations in the
nurse-client relationship (they tend
to CLING)
Reduce self destructive behavior
Encourage verbalization
CLUSTER III

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A. Avoidant Personality Disorder
Characterized by social withdrawal
and extreme sensitivity to potential
rejection

RCdelaPeña, RN, RM//
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Assessment
Fears criticism & rejection
Escapes intimate relationship
Avoidance of positive social events
Reluctant to engage in new
activities
Nursing Intervention
Facilitate
TRUST
through
RELIABLE & DEPENDABLE
nurse client relationship

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Assist in coping with compulsive
behavior
(accept
rituals
as
interruption will increase anxiety)
Reduce anxiety
Set limits to destructive acts
Encourage alternate activity

Therapies for Personality Disorders
1. Consistency in approach
2. Behavioral therapy
General Nursing Interventions for PD
1. Maintain safe environment
2. Develop a written contract with patient

B. Dependent
Personality
Disorder
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

3. Establish therapeutic relationship

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

7. Limit setting

Nursing Interventions
Reduce anxiety
Facilitate expression of ideas &
feelings
Offer assistance only when needed
C. Obsessive-compulsive
Personality Disorder
The client has difficulty expressing
warm and tender emotions and
reflects perfectionism, stubbornness,
the need to control others, and a
devotion to work
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
Nursing Interventions

4. Maintain objectivity and consistency
5. Set limits to behavior
6. Help the patient learn ways to reduce
anxiety

8. Develop a written contract
9. Encourage to keep journal
10. Recognize and deal with manipulative
behavior
11. General implementation for personality
disorders
12. Maintain safety against self-destructive
behaviors
13. Allow the client to make choices and be
as independent as possible
14. Encourage the client to discuss feelings
rather than act them out
15. Provide consistency in response to the
client's acting-out behaviors
16. Discuss expectations and responsibilities
with the client
17. General implementation for personality
disorders
18. Discuss the consequences that will
follow certain behaviors
19. Inform the client that harm to self,
others, and property is unacceptable
20. Identify splitting behavior

21. Assist the client to deal directly with
anger

5. Provide realistic praise for positive
behaviors in social situations
6. Ways to handle manipulative behavior
7. Set clear realistic limits

RCdelaPeña, RN, RM//
General
Implementation
Personality Disorders

for

1. Encourage the client to keep a journal
recording daily feelings
2. Encourage the client to participate ingroup activities, and praise nonmanipulative behavior
3. Set and maintain limits to decrease
manipulative behavior
4. Remove the client from group situations
in which attention-seeking behaviors
occur

8. CONFRONT client about manipulative
behavior
9. Clearly and consistently communicate
care plans and client behaviors to other
nurses
10. Accept no gifts or flattery
11. Form
therapeutic
relationship

Nurse-patient

RCdelaPeña, RN, RM//