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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withdrawn, guarded or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.
Nursing Intervention:
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
Nursing Intervention:
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

Nursing Intervention:
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 selfharm
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, believes relationships to be intimate than they
are
Clinical Picture: speech is usually colorful and theatrical,
full of superlatives, emotionally aggressive and gregarious
Nursing Intervention:
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
Nursing Intervention:
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
they believe others hate them
or that they will embarrass themselves.
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
Nursing Intervention:
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 selfcritical, preoccupied excessively with
unrealistic fears of being left alone, report
feeling of unhappy or depressed, seek
advice and repeated reassurance.
Nursing Intervention:
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,
has trouble discarding 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

Nursing Intervention:
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
Nursing Intervention:
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
Nursing Intervention:

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
1. Impulsive and Unpredictable ; he/she engages

Column B
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 selfconfidence 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

disorder
h. paranoid personality
disorder
i. schizoid personality
disorder
j. schizotypal personality
disorder

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
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 nonthreatening context of the relationship, the nurse can help them explore positive selfaspects, 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