personality disorder

Personality Disorder

Are diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in the society or cause the person emotional distress.

Personality disorder begins in childhood and persist throughout adulthood

Clusters of Personality Disorder according to DSM-IV-TR

Cluster A- odd, eccentric cluster

1. Paranoid

2. Schizoid

3. Schizotypal personality

Paranoid

Pervasive mistrust and suspiciousness of others.

Clinical picture: Aloof and withdrawn, guarded or hypervigilant, restricted affect

Defense Mechanism of Projection

Nursing Intervention:

Approach in a formal business-like manner

Refrain from social chit chat or jokes

Keeping commitments and being particularly straight forward

Help them validate ideas before taking action

Schizoid

Pervasive pattern of detachment from social relationships and restricted range of emotional expression in interpersonal settings.

People with this disorder tend to be socially isolated

Clinical picture: Socially detached and does not enjoy social contact, Lacks close friends or confidants other than first degree relatives, marked difficulty expressing emotions particularly anger or aggression, Often daydream, dissociation from or no bodily or sensory pleasures.


Improve functioning in the community

Provide care that accommodates the desire to solitude

Schizotypal

Pervasive pattern of social and interpersonal limitations.

experience acute discomfort in social settings and have a reduced capacity for close relationships

Clinical Picture: they may wander aimlessly and at times become preoccupied with some detail, eccentric behavior, bizarre speech, flat affect

Cognitive distortion of Ideas of Reference


Development of self-care and social skills

Help function in the community with minimal discomfort

Cluster B- dramatic, emotional or erratic

1. Antisocial

2. Borderline

3. Histrionic

4. Narcissistic

Antisocial

Pervasive pattern of disregard for and violation of the rights of others.

The type of person you'd expect to see in jail. Lack of empathy, trouble with the law,violent

Tend to peak in 20s and diminish significantly after 45 years old

Assessment:

Violation of the right of others

Lack of remorse for behavior

Shallow emotions

Lying

Rationalization of own behavior

Poor judgment

Impulsivity

Irritability and aggressiveness

Lack of insight

Thrill seeking behavior

Exploitation of people in relationship

Poor work history

Consistent irresponsibility


Limit setting

Behavior- state the acceptable and unacceptable

Exceed= Consequence

Confrontation- points out a clients problematic behavior while remaining neutral and matter-of-fact

Helping client solve problems and control emotions

Enhancing role performance

Borderline Personality Disorder

Pervasive pattern of unstable interpersonal relationships, self0image and affect as well as marked impulsivity

Black and white thinking, identity disturbance, fear of abandonment, may have a history of self harm and suicide attempts.

Assessment:

Fear of abandonment

Unstable and intense relationship

Unstable self-image

Impulsivity and restlessness

Recurrent self-mutilating behavior or suicidal threats or gestures

Chronic feelings of emptiness and boredom

Labile emotion

Irritability

Polarized thinking about self and others (splitting)

Impaired judgment

Lack of insight

Transient psychotic symptoms such as hallucinations demanding self-harm

Nursing Intervention

Clients safety- is ALWAYS PRIORITY

Seriously consider suicidal ideation (plan, access to means, self-harm behaviors)

Establishing Boundaries in relationship

Teach effective communication skills- I Statement (eg. I feel...I think)

Help clients cope and control emotions (eg. Use distractions, Keeping journal)

Reshaping thinking pattern

Cognitive restructuring- replace negative thoughts and feelings into

positive thinking

Thought stopping- say STOP! aloud when thinking negative thoughts

like Im dump or Im stupid

Positive self-talk

Decatastrophizing- what if that happen? What would I do?helps

patients assess situations realistically rather

always assuming that catastrophe will happen.

Histrionic Personality Disorder

Pervasive pattern of excessive emotionality and attention seeking.

Sexual, wants to be the center of attention,believesrelationships to be intimate than they are

Clinical Picture: speech is usually colorful and theatrical, full of superlatives, emotionally aggressive and gregarious


Give client feedback about their social interaction with others.

Focus on Alternatives not on Criticism

Narcissistic Personality Disorder

Characterized by pervasive pattern of grandiosity, need for admiration and lack of empathy

Thinks highly of self, only relates to other "high class people", entitled, manipulative.

Clinical Picture: arrogant, belittle or discount the feelings of others, often preoccupied with fantasies, view problems as a fault of others, hypersensitive to criticism


Nurse must use self-awareness skills to avoid anger and frustration

Set on limits in rude or verbally abusive behavior

Cluster C- anxious or fearful

1. Avoidant personality disorder

2. Dependent personality disorder

3. Obsessive compulsive disorder

Avoidant personality disorder

Pervasive pattern of social discomfort and reticence, low self-esteem and hypersensitivity to negative evaluation

Avoids social situations because theybelieveothers hate them or that they willembarrassthemselves.

They usually strongly desire social acceptance and human companionship

Clinical Picture: social inhibitions, readily believe themselves as inferior, avoid situation that may result in rejection


Help client practice self- affirmation and positive self-talk

Teach social skills- Decatastrophizing

Dependent Personality Disorder

Pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.

Wants to be taken care of, has trouble making decisions without guidance, has a hard time disagreeing with others.

Clinical Picture: pessimistic and self-critical, preoccupied excessively with unrealistic fears of being left alone, report feeling of unhappy or depressed, seek advice and repeated reassurance.


Help client to identify their strengths, cognitive restructuring

Teach problem solving and decision making- refrain ADVICE

Obsessive Compulsive Disorder

Pattern of pre-occupation with perfectionism, mental and interpersonal control and orderliness at the expense of flexibility, openness and efficiency

Enjoys lists, schedules, organization, might be a workaholic, hastroublediscarding things when they are no longer useful.

Clinical Picture: difficulty expressing emotions and emotions they express are rigid and lack spontaneity, stubborn, believe they are right


Completion of projects or decision making by specific deadline

View decision making completion of projects from different perspective.

Help client accept or tolerate less than perfect work

Related Disorders

1. Depressive personality disorder

2. Passive-aggressive personality disorder

Depressive Personality Disorder

Pervasive pattern of depressive cognitions and behaviors in various contexts

Depressive personality disorder occurs before, during, and after major depressive episodes

Clinical Picture: sad, gloomy, persistent unhappiness, cheerlessness, hopelessness regardless of the situation, cannot relax, dont display sense of humor, feelings of worthlessness and inadequacy even when clients have been successful, pessimistic outlook in life


Encourage client to involve in activities- social skills

Give factual feedback rather than general praise

Cognitive restructuring

Passive Aggressive Personality disorder

Negative attitude and pervasive pattern of passive resistance to demands for adequate social and occupational performance.

Clinical Picture: negative attitude, oppose and resist demands expected by others, express resistance through procrastination, intentional inefficiency, stuborness


examine relationship between feelings and subsequent actions

teach client appropriate ways on how to express feelings directly

Who am I?

Directions : Match column A with column B. write the letter before the number

Column A Column B

1. Impulsive and Unpredictable ; he/she engages a. antisocial personality

in acting out and self-mutilation

2. Overly dramatic and intensely expressive

disorder

b. avoidant personality

disorder

3. Exaggerated sense of self-importance and exhibitionistic and pre-occupied with fantasies

4. Passive and helpless and has low self-confidence and self-esteem

c. borderline personality

disorder

d. dependent personality

disorder

5. Perfectionist, rigid, stubborn; indecisive and anxious

e. histrionic personality

disorder

6. Suspicious and distrustful to others, hostile, cold and defensive

7. Aloof, indifferent and reclusive; engages in excessive daydreaming

8. Odd, eccentric and interested in unusual beliefs and habits

9. Deceitful attitude, display lack of remorse, exploits others and exhibits con artist behavior

10. Hypersensitive to rejection and socially withdrawn, despite a desire for affection and interaction

Test II: Identification

1-3.Identify the 3 personality disorder under Cluster A

1.

2.

3

4-5. Give 2 characteristic of Anti-social Personality disorder

4.

5.

f. narcissistic personality

disorder

g. obsessive compulsive

disorder

h. paranoid personality

disorder

i. schizoid personality

disorder

j. schizotypal personality

disorder

Test II: Situational Problems

1. Antisocial personality disorder is identified with patterns of disrespect for and abuse of the rights of others. Destructive behavior towards the self and other is commonly displayed. Upon assessment, the nurse should also observe for which of the following characteristics associated with this disorder?

a. failure to establish relationship

b. manipulative behavior

c. disordered thoughts

d. low self-esteem

2. Common characteristic of borderline personality disorder is self-mutilating behavior. This reflects the patients:

a. despair

b. anxiety

c. anger

d. impulsivity

3. The following traits are included in Narcissistic personality disorder except:

a. arrogance

b. hypersensitivity

c. grandiosity

d. dysphoria

4. Which of the following nursing intervention is appropriate with avoidant personality disorder?

a. provide opportunities for exploration

b. help identify patients strengths

c. encourage to lead a group therapy

d. do limit-setting for manipulative behavior

5. A client is hospitalized with obsessive compulsive disorder. The nurse notes the client is vigorously washing his/her hands. Which response by the nurse would be most appropriate?

a. Your hands look clean. Why are you still washing them?

b. You should stop washing your hands because they will get chapped

c. Its time to go to the dining room. Ill walk with you

d. Ill go get some lotion for your hands so they wont get chapped

Answer Key

Matching type:

1. c

2. e

3. f

4. d

5. g

6. h

7. i

8. j

9. a

10. b

Test II: Identification

1. Paranoid

2. Schizoid

3. Schizotypal personality

4. Violation of the right of others

5. Impulsivity

Test III: Situational Problem

1. Antisocial personality disorder is identified with patterns of disrespect for and abuse of the rights of others. Destructive behavior towards the self and other is commonly displayed. Upon assessment, the nurse should also observe for which of the following characteristics associated with this disorder?

a. failure to establish relationship

b. manipulative behavior

c. disordered thoughts

d. low self-esteem

Answer: B

Though low self-esteem is present, antisocial personality disorders central characteristics are deceit and manipulation. Clients with this personality disorder are in fact involved in many relationships, but they experience difficulty sustaining them. They do not experience disordered thoughts

2. Common characteristic of borderline personality disorder is self-mutilating behavior. This reflects the patients:

a. despair

b. anxiety

c. anger

d. impulsivity

Answer: C

Typically, recurrent self-mutilation is cry for help, an expression of intense anger, helplessness or guilt; or a form of self-punishment. It is also means to block psychological pain, which is a means to validate that the person is still alive and can feel physical pain when experiencing emotional numbness an unreality

3. The following traits are included in Narcissistic personality disorder except:

a. arrogance

b. hypersensitivity

c. grandiosity

d. dysphoria

Answer: D

Dysphoria is a disorder of affect characterized by depression, malaise and anguish is associated with mood disorders. Narcissistic personality disorder is characterized by pervasive grandiosity, need for admiration, and lack of empathy

4. Which of the following nursing intervention is appropriate with avoidant personality disorder?

a. provide opportunities for exploration

b. help identify patients strengths

c. encourage to lead a group therapy

d. do limit-setting for manipulative behavior

Answer: B

These clients require much support and reassurance from the nurse. In the non-threatening context of the relationship, the nurse can help them explore positive self- aspects, positive responses from others and possible reasons for self-criticism

5. A client is hospitalized with obsessive compulsive disorder. The nurse notes the client is vigorously washing his/her hands. Which response by the nurse would be most appropriate?

a. Your hands look clean. Why are you still washing them?

b. You should stop washing your hands because they will get chapped

c. Its time to go to the dining room. Ill walk with you

d. Ill go get some lotion for your hands so they wont get chapped

Answer: C

This would distract the client by offering alternative activity. Nurse should never ask questions WHY. Response in choice B is threatening and implies misbehavior by the client. Response in choice D does not distract the client from the behavior.

Far Eastern University

Institute of Nursing

Personality Disorders

SUBMITTED BY:

Rosas, Frederick T.

BSN504- Group 14

SUBMITTED TO:

Prof. Ma. Olivia Molina, RN, MAN

personality disorder

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