NCM105 5th Personality Disorders

5 - Personality Disorders

PERSONALITY DISORDERS

What does PERSONALITY mean?

� persona– Greek term

� …a person’s charactersistic totality of

emotional and behavioral traits

apparent in ordinary life, a totality that

is usually stable and predictable

(Kaplan and Sadock – 1998)

� Refers to a distinctive set of traits,

behavior styles, and patterns that

make up our character and

inidividuality

� It is the total of person’s internal and

external patterns of adjustment to life,

determined in part by the individual’s

genetic make-up and by life

experiences.

THEORIES OF PERSONALITY DEVELOPMENT

1. Freud’s Psychoanalytic

a. Development of personality

b. Organization or structure

c. Dynamics of personality

2. Erickson’s Psychosocial Development

a. Concept of identity or an inner

sense of sameness that

preserves despite external

changes. Identity crises and

Identity confusion.

3. Piaget’s Cognitive Developmental

Theory

a. Sensory-motor

b. Pre-operational

c. Concrete-Operational

d. Formal-operational

PERSONALITY DISORDER

• It is defined as a pervasive pattern of

experience and behavior that is

abnormal with respect to thinking,

mood personal relations, and the

control of impulses.

• A personality disorder is described as a

non-psychotic illness characterized by

maladaptive behavior, which the

person uses to fulfill his or her needs

and bring satisfaction to him or herself.

ETIOLOGY

• GENETIC FACTORS

• BIOLOGIC FACTORS

• PSYCHOANALYTIC FACTORS

• CHILDHOOD EXPERIENCES

Biologic theories:

� Personality develops through

the interaction of hereditary

dispositions and environmental

influence.

� TEMPERAMENT-refers to the

biologic processes of sensation,

association, and motivation that

underlie the integration of skills and

habits based on emotion.

� 4 temperament traits:

1. Harm avoidance

2. Novelty seeking


3. Reward dependence

4. Persistence

Psychodynamic Theories

� Although

temperament is largely inherited, social

learning, culture, and random life

events unique to each person influence

character.

� CHARACTER

- consists of concepts about the self

and the external world.

� 3 major

character traits:

1. self-directedness

2. Cooperativeness

3. Self-transcedence

Personality Disorder: CHARACTERISTICS

• Inflexible, socially unacceptable

behaviors

• Self-centeredness

• Manipulative and exploitative

• Inability to tolerate minor stress,

resulting in increased inability to cope

with anxiety or depression

• Lack of individual accountability for

behavior, blaming others of their

problems

• Difficulty dealing with reality because of

a distorted or superficial understanding

of self and the perception of others.

• Vulnerbility to other mental disorders

Classification of Personality Disorder

A. Cluster A Personality Disorder

those considered to be marked by odd,

eccentric behavior.

1. Paranoid

2. Schizoid

3. Schizotypal

PARANOID PERSONALITY DISORDER : SUSPECT

S: Spouse fidelity suspected

U: Unforgiving

S: Suspicious of others

P: Perceives attacks

E: Enemy or Friend

C: Confiding in others feared

T: Threats perceived in benign events

Paranoid Personality Disorder

� psychologi

cal personality disorder characterized

by an extreme level of distrust and

suspiciousness of others. Paranoid

personalities are generally difficult to

get along with, and their combative and


distrustful nature often elicits hostility

in others.

� Symptoms

: paranoia, paranoid beliefs,

suspiciousness, social withdrawal.

� Treatment

s: Psychotherapy, cognitive behavioural

therapy, interpersonal psychotherapy &

antidepressant

SCHIZOID PERSONALITY DISORDER : DISTANT

D: Dettached Affect

I: Indifferent to criticisms

S: Sexual interest of little interest

T: Tasks

A: Absence of close friends

N: Neither desires nor enjoys close relations

T: Takes pleasures in few activities

Schizoid Personality Disorder

� are

characteristically detached from

social relationships and show a

restricted range of expressed

emotions. Their social skills, as

would be expected, are weak, and

they do not typically express a need

for attention or approval. They may

be perceived by others as somber

and aloof, and often are referred to

as "loners.

Symptoms

• Prefer being alone and usually choose

solitary activities

• Prize independence and have few close

friendships

• Feel confused about how to respond to

normal social cues and generally have

little to say

• Lack any desire for sexual relationships

• Feel unable to experience pleasure

SCHIZOTYPAL PERSONALITY DISORDER : ME

PECULIAR

M: Magical thinking or odd beliefs

E: Experiences unusual perceptions

P: Paranoid ideas

E: Eccentric behavior or appearance

C:Constricted or inappropriate affect

U:Unusual or odd thinking and speech

L:Lacks close friends

I: Ideas of reference

A: Anxiety in social situation

R: Rule out psychosis

B. Cluster B Personality Disorder

evidenced by dramatic, erratic behaviors

and include

1. Antisocial


2. Borderline

3. Narcissistic

4. Histrionic

ANTISOCIAL PERSONALITY DISORDER :

CORRUPT

C: Conformity to law lacking

O: Obligations ignored

R: Reckless disregard for safety of self or

others

R: Remorse lacking

U: Underhanded (deceitful, lies, cons

others)

P: Planning insuficient (impulsive)

T: Temper (irritable and aggressive)

BORDERLINE PERSONALITY DISORDER : AM

SUICIDE

A: Abandonment

M: Mood instability

S: Suicidal

U: Unstable and intense relationship

I: Impulsive

C: Control of anger

I: Identity disturbance

D: Dissociative or paranoid

E: Emptiness

NARCISSISTIC PERSONALITY DISORDER :

SPECIAL

S: Special (believes he is unique)

P: Preoccupied with fantasies (of unlimited

success, power, brilliance, beauty or ideal

love)

E: Entitlement

C: Conceited

I: Interpersonal exploitation

A: Arrogant

L: Lacks empathy

HISTRIONIC PERSONALITY DISORDER :PRAISE

ME

P: Provocative or sexuality seductive

behavior

R: relationships (intimate)

A: Attention (uncomfortable)

I: Influence easily

S: Style of speech (lacks detai)

E: Emotions repidly shifting and shallow

M: Made up (physical appearance used to

draw attention to self)

E: Emotions exaggerated

C. Cluster C Personality Disorder

distinguished by the anxious, fearful

behavior commonly seen in

1. Obsessive-Compulsive

2. Dependent


3. Avoidant

OBSESSIVE – COMPULSIVE : LAW FIRMS

L: Loses point of activity 9due to

preoccupation with detail)

A: Ability to complete tasks (compromised

by perfectionalism)

W: Worthless objects (unable to discard)

F: Friendships (excluded)

I: Inflexible and overconscientious

R: Reluctant to delegate

M: Miserly (towards self and others)

S: Stubborn

� A pervasive pattern of preoccupation

with perfectionism, mental and

interpersonal control, and orderliness

at the expense of flexibility, openness,

and efficiency.

� Refers to a group enduring

characteristics in a person, including

orderliness, meticulous,

� preoccupation with detail, parsimony,

obstinacy, neatness, difficulty handling

uncertainty , and perfectionism

Incidence:

� More common to male

� Oldest children

� Professionals

SYMPTOMS:

a. Difficulty showing emotions

b. Stubborn

c. Preoccupied with orderliness and try to

maintain it in all areas of life

d. Strive for perfection

e. They become absorbed in their own

belief, believe they are right

f. Do not listen to others

g. They have difficulty working

collaboratively, preferring to “do it

myself”

h. Poor judgment

i. Check and recheck any project or

activities

j. Decision-making problem

Nursing Intervention:

1. Help client to view decision-making and

completion of projects from a different

perspectives.

2. Set a goal of completing a projective by

giving a deadline

3. Tolerate less-than perfect work

4. Encouraging client to take risk

DEPENDENT PERSONALITY DISORDER :

RELIANCE

R: Reassurance required for decisions

E: Expressing disagreement difficult due to

fear of loss of support or approval

L: Life responsibilities (needs to have these

assumed by others)

I: Initiating projects difficult


A: Alone

N: Nurturance go to excessive lengths

C: Companionship

E: Exaggerated fears of being left

� Characterized by a pervasive and

excessive need to be taken care of,

which lead to submissive and clinging

behavior and fears if separation.

� Feelings of dependency and attachment

are said to be universal, and perhaps

defining, mammalian behaviors.

(Fances, 1988)

Incidence:

1. Three times more common to women

than men

2. It runs to the families

3. Common to youngest child

Symptoms:

1. Frequently anxious and mildly irritable

2. Pessimistic and self-critical

3. Report feeling of unhappy or depressed

4. Believe they would fail on their own

5. They believe they need someone else to

assume responsibility

6. Tremendous difficulty making decisions

Motto: “Any relationship is better than

none at all”

Nursing intervention:

1. Encourage verbalization of feelings

2. Help client to identify their strength

3. Assistance in daily functioning

4. Teach problem-solving

5. Psychotherapy- is the main method of

treatment for DPD in a form of

counseling.

6. GOAL: is to help the person to be

become more active and independent

What are the complications of dependent

personality disorder?

� At risk for depression

� Anxiety disorder

� Phobias

� Substance abuse

Can Dependent Personality Disorder can

be prevented?

� Prevention of the disorder might not be

possible, treatment can sometimes

allow a person who is prone to disorder

learn more productive ways of dealing

with situations.

AVOIDANT PERSONALITY DISORDER :

CRINGES

C: Certainty

R: rejection

I: Intimate relationship (restrained)

N: New interpersonal relationships(is

inhibited in)

G: Gets around occupationa activity


E: embarassment

S: Self viwed as unappealing

• Is characterized by a pervasive pattern

of social discomfort and reticence, low

self-esteem, and hypersensitivity to

negative evalution.

• Extremely sensitive to the opinions of

others and therefore avoid most

relationship

Incidence:

� Occur in 0.5% to 1% of the general

population

� Equally common to both men and

women

Causes:

� Integrate biological and psychological

influences

� Limited support

� Rejection

Symptoms:

1. Very low self-esteem

2. Shy, fearful, socially, awkward

3. Reluctant to do anything

4. Apathetic

5. Affectively flat

6. Uninterested in interpersonal

relationship

Treatment:

� Behavioral intervention technique for

anxiety and social skill problems have

had some success

� Psychodynamic psychotherapy, which

helps patients understand their

thoughts and feelings, and cognitive

behavioral therapy (CBT) can help. A

combination of medication and talk

therapy may be more effective than

either treatment alone.

PASSIVE-AGGRESSIVE

• It is characterize by negative attitude

and passive resistance to demands for

adequate social and occupational

performance.

a. Sullen-passive resentful

b. Their mood fluctuates easily, rapidly,

erratically

c. Easily upset/offended

d. May alternate between hostile and

stubborn

e. Affect or feeling may be sad or angry

f. They view future negatively

g. Impaired judgment

h. Insight is limited

i. They tend to blame others


Nursing Interventions

• . Help client examine the relationship

between feelings and actions

• Help client to see what is annoying or

troubling to others

• Encourage client to express feelings

Possible Nursing diagnoses

� Disturbed thought processes r/t

auditory hallucinations

� Anxiety r/t unsatisfactory interpersonal

relationships

� Hopelessness r/t low self-esteem

� Ineffective coping r/t lack of impulse

control

Nursing interventions: COGNITION

� Reinforce reality if the client verbalizes

illusions or feelings of depersonalization

� Help the client select someone he/she

trust to minimize suspicious or

delusional thoughts

� Encourage the client to validate

perceptions before taking action that

may precipitate difficulties

Nursing interventions: AFFECT

� Encourage the client’s verbalization of

feelings of anger, hostility,

worthlessness or hopelessness

� Give attention on and support when the

client expresses feelings honestly and

openly

� Ecourage the client to share his feelings

with others

Nursing interventions: INTERPERSONAL

FUNCTIONING

� Explore reasons the client has difficulty

establishing interpersonal relationship

� Exlpore the client’s self-concept and

self-esteem

Nursing interventions: dysfunctional

BEHAVIOR

� State limits and behavior expected from

the client

� Enforce or llimits without apologizing

� Be direct and confront the client when

limits are not observed.

TREATMENT

� Psychopharmacology

� Lithium, anticonvulsant mood

stablizers, and Bendiazepines are used

most often to treat aggression.

� Low dose of neropletics may be useful

in modifying aggression, too.

� Several treatment strategies are used

with clients with personality disorder;

these strategies are based on the

disorder’s type and severity or the

amount of distress or functional

impairment the client experiences.

� Combination of medication and group,

and individual therapies are more likely

to be effective than is any single

treatment.

NCM105 5th Personality Disorders

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