PERSONALITY

DISORDER

A.K
DEFINITIONS
• Personality - Is habitual patterns and
qualities of behaviour of any individual
expressed by physical and mental activities
and attitudes, distinct by individual qualities
of a person.
• Personality Disorder – Is an enduring
pattern of inner experience and behaviour
that deviates markedly from the expectations
of the individual’s culture.
• Personality disorders are deeply ingrained,
rigid ways of thinking and behaving that
result in impaired relationships with others
and often cause distress for the individual
who experiences them.
 Etiology

• Gene: certain personality traits may be

passed on to us by our parents through
inherited genes
• Environment: this involves the
surrounding one grew up in, events that
occurred and relationships with family
members and others
 Risk factors
• Family history of personality disorders
• Low levels of education and lower social
and economic status
• Verbal, physical or sexual abuse during
childhood
• Neglect or an unstable or chaotic family
life during childhood
• Variations in brain chemistry and structure
 EPIDEMIOLOGY

• Rate of 6-15% in the general population.

Increase in urban areas. Male=Female.
Some disorders more in males eg.
Antisocial.
• Decrease with age. Eg. Antisocial may
commit less crime and yet increase in
domestic violence as age increases.
• Rate in psychiatric services higher, even
up to 30%.
PERSONALITY TYPES

In DSM4, they are grouped into 3 clusters

based on similarities:
1. Cluster A: Behaviors described as odd or eccentric
a. Paranoid personality disorder
b. Schizoid personality disorder
c. Schizotypal personality disorder
2. Cluster B: Behaviors described as dramatic, emotional,
or erratic
a. Antisocial personality disorder
b. Borderline personality disorder
c. Histrionic personality disorder
d. Narcissistic personality disorder
3. Cluster C: Behaviors described as anxious or fearful
a. Avoidant personality disorder
b. Dependent personality disorder
c. Obsessive–compulsive personality disorder
 Cluster A: Paranoid Personality
Disorder
• A pervasive distrust and suspiciousness of
others such that their motives are interpreted as
malevolent.
– Suspects others are exploiting or deceiving him
– Preoccupied with unjustified doubts of loyalty
– Is reluctant to confide in others because he believes they will
use the information against him
– Reads hidden demeaning meanings into benign remarks
– Persistently bears a grudge
– Perceives attacks on his character
– Recurrent suspicions regarding fidelity of spouse or sexual
partner
 Cluster A: Schizoid Personality
Disorder
• Pervasive pattern of detachment from social
relationships and restricted expression of
emotion with 4 or more the following:
– Neither desires nor enjoys close relationships
– Almost always chooses solitary activities
– Little if any interest in sexual experiences with another
person
– Takes pleasure in few in any activities
– Lacks close friends other than first-degree relatives
– Appears indifferent to the praise or criticism of others
– Shows emotional coldness or flattened affect
 Cluster A: Schizotypal
Personality Disorder
• A general pattern of social and interpersonal deficits marked by acute
discomfort with and reduced capacity for close relationships as well as by
cognitive or perceptual alterations and abnormality of behaviour
1. Ideas of reference
2. Magical thinking or odd beliefs (claiming that they tell the future, read the
thoughts of others, and so on)
3. Odd perceptual experiences, such as hearing a voice whisper your
name
4. Odd thinking or speech
5. Suspiciousness or paranoid ideation
6. Narrowed or unappropriated affect
7. Unusual appearance or behaviour
8. Few close relationships
9. Unconfortable in social situations
 Cluster B: Antisocial
Personality Disorder
• Characterized by dishonesty, handling, revenge and harm to
others with an absence of guilt or anxiety
1. Violates rights of others
2. Engages in illegal activities
3. Aggressive behaviour
4. Lack of guilt or shame
5. Irresponsible in work and with finances
6. Impulsiveness
7. Irresponsibility
8. manipulative
 Cluster B: Borderline
Personality Disorder
• This disorder is characterized by a persistent
pattern of unstable relationships, self image, affect
and has marked impulsivity. It is the most common
personality disorder found in clinical settings.
– Patterns of unstable moods and relationships
– Impulsivity,
– fear of abandonment (real or perceived), coupled
with a very poor self-image
– Recurrent self mutilating behaviour or suicidal
threats or gesture
– Transient psychotic symptoms such as
hallucinations demanding Self harm
Cluster B: Histrionic Personality
Disorder
• An insidious pattern of excessive emotionality and attentive seeking
• Always want to be the centre of attraction
• Excessively emotional, dramatic or sexually provocative to gain
attention
• Speaks dramatically with strong opinions, but few facts or details to
back them up
• Concerned with impressing others
• Highly suggestible and will agree with almost anyone to gain
attention
• Excessive concern with physical appearance
• Thinks relationships with others are closer than they really are.
 Cluster B: Narcissistic
Personality Disorder
• The essential feature of narcissistic personality disorder is
a grandiose of self-importance, often combined with
interrupted feelings of inferiority.
1. Belief that you're special and more important than others
2. Fantasies about power, success and attractiveness
3. Exaggeration of achievements or talents
4. Takes advantage of others for own benefit
5. Jealous of others or others are jealous of him or her
6. Expectation of constant praise and admiration
7. Overconfidence
8. Arrogance
Cluster C: Avoidant Personality
Disorder
• Avoidant personality disorder is characterized by
a persistent pattern of social uneasiness, low
esteem and hypersensitivity to negative reaction.
• Extreme shyness in social situations and
personal relationships
• Unusually fearful of rejection, criticism, shame or
disapproval
• Easily devasted by real or perceived criticism
• Believes that they are inferior or unattractive
 Cluster C: Dependent
Personality Disorder
• A general and excessive need to be taken care of that
leads to obedient and clinging behaviour and fears of
separation.
• Excessive dependence on others and feeling the need
to be taken care of
• Submissive or clingy behaviour toward others
• Fear of having to provide self-care or fend for yourself if
left alone
• Lack of self-confidence, requiring excessive advice and
reassurance from others to make even small decisions
• Difficulty starting or doing projects on your own due to
lack of self-confidence
• Difficulty disagreeing with others, fearing
disapproval
• Tolerance of poor or abusive treatment,
even when other options are available
• Urgent need to start a new relationship
when a close one has ended
 Cluster C: Obsessive-Compulsive
Personality D.
• Preoccupation with details, orderliness and rules
• Extreme perfectionism, resulting in dysfunction and
distress when perfection is not achieved, such as
feeling unable to finish a project because you don't
meet your own strict standards
• Desire to be in control of people, tasks and
situations, and inability to delegate tasks
• Neglect of friends and enjoyable activities because
of excessive commitment to work or a project
• Inability to discard broken or worthless objects
• Rigid and stubborn
• Inflexible about morality, ethics or values
• Tight, miserly control over budgeting and
spending money
• Harsh
• Obsessive-compulsive personality disorder
is not the same as obsessive-compulsive
disorder, a type of anxiety disorder.
 Treatment
• Psychotherapy
• Medications, e.g. antipsychotics, mood
stabilizers
• Coping skills for family members
• Hospitalization in severe cases
 Interpersonal psychotherapy
• Interpersonal psychotherapy may be particularly
appropriate because personality disorder largely reflect
problems in interpersonal style. Long term
psychotherapy attempts to understand and modify the
maladjusted behaviors, cognition and affects of clients
with personality disorders that dominate their personal
lives and relationships
• The core treatment is the establishment of an empathic
therapist-client relationship, based on collaboration and
guided discovery in which the therapist functions as a
role model for the client.
Psychoanalytical psychotherapy

• The treatment of choice for individuals with

histrionic personality disorder has been
Psychoanalytical psychotherapy.
Treatment focuses on the unconscious
motivation for seeking total satisfaction
from others and for being unable to
commit oneself to a stable, meaningful
relationship.
 Cognitive/ behaviour therapy
• Behavioural strategies offer reinforcement for
positive change. Social skills training &
assertiveness training teach alternative ways to
deal with frustration
• Cognitive strategies help the client recognize &
correct inaccurate internal mental schemata.
• This type of therapy may be useful for clients
with obsessive-compulsive, antisocial &
avoidant personality disorders.
 NURSING MANAGEMENT
• Its important to note that the nursing
management for personality disorders
is problem based.
 Nursing diagnosis and intervention

1. Risk for other-directed violence R/T rage reactions, negative

role-modeling, and inability to tolerate frustration.
Intervention:
• Convey an accepting attitude towards this client. Work on
development of trust, keep all promises & convey the message
that it is not him or her but the behaviour that is unacceptable.
• maintain low level of stimuli in clients environment (low lighting,
few people, simple décor, low noise level)
• Observe clients behaviour frequently during routine activities &
interactions, avoid appearing watchful & suspicious.
• Remove all dangerous objects from clients environment.
• Help client identify the true object of his hostility
• Encourage client to verbalize hostile feelings
gradually.
• Explore with client alternative ways of handling
frustration
• Staff should maintain & convey a calm attitude
• If client is not calmed by “talking down” or by
medication, use of mechanical restraints maybe
necessary.
2. Chronic Low Self-Esteem related to avoidant and
dependent patterns evidenced by dependent on
others’ opinions, indecisive.
3. Impaired social interactions R/T negative role
modeling & low self esteem, evidenced by inability to
develop a satisfactory, enduring intimate relationship
with another.
4. Ineffective Coping related to negative attitudes
toward health behaviour evidenced by superficial
relationship with others.
5. Risk For Self-Mutilation
THE END

QUESTIONS !