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Personality
Disorders
Ncm 117 lecture
 OBJECTIVES:
1. Describe personality disorders in terms of
client’s difficulty in perceiving, relating to, and
thinking about self, others and the environment
2. Discuss factors thought to influence the
development of personality disorders
3. Apply the nursing process to the care of
clients with personality disorder
4. Evaluate personal feelings, attitude, and
responses to clients with personality disorders
 Personality
❑ As an ingrained, enduring pattern of behaving and
relating to self, others and the environment.
❑These behaviors and characteristics are
consistent across a broad range of situations
and do not change easily.
 Personality
❑It is the habitual patterns and qualities of behavior of
any individual as expressed by physical and mental
❑
activities and attitudes.
Individuals who have developed personality styles
that demonstrate unhealthy.
 Personality
❑Diagnosed when personality traits become
inflexible and maladaptive and significantly
interfere with how a person functions in society of
cause a person emotional distress.
❑Higher in lower socioeconomic groups and
unstable or disadvantaged population.
 Personality
❑Have higher death rate due to suicide.
❑Have higher rates of suicide attempts
accidents and emergency department
visit.
 Personality
❑•Highly correlated with criminal behavior.
❑•Clients with such disorder are describe as
“treatment – resistant” because personality
characteristics and behavioral patterns are
deeply ingrained.
❑Increase rates of separation, divorce and
involvement in legal proceedings regarding
child custody.
 Personality
❑Clients do not perceive their dysfunctional
or maladaptive behavior as a problem, but
rather a source of pride; changing their
behavior is viewed to be threat to them.
PERSONALITY DISORDERS
❑are diagnosed when there is
impairment of personality functioning
and personality traits that are
maladaptive.
❑Individuals have identity problems
such as egocentrism, or being self-
centered, and their sense of self-
esteem comes from gaining power or
pleasure that is often at the expense
of others.
PERSONALITY DISORDERS
✔ Their behavior often fails to conform to
cultural, social, or legal norms, and they
are motivated by personal gratification.
✔ Relationships with others are
dysfunctional and often characterized by
deceit, coercion, or intimidation by the
individual with a personality disorder.
PERSONALITY DISORDERS
✔ They are not capable of mutual,
intimate relationships and lack the
capacity for empathy, remorse, or
concern for others (Cloninger &
Svrakic, 2017).
Characteristic
• Unaware that they have problems; lack of insight concerning usual component
: of own behavior.
• Poor interpersonal relationship.
• Defensive behavior against real or perceived threat to self; are impulsive and
unreliable.
• Exaggerated or restricted moral development.
• Limited or unusual problem-solving skill
• Potential for mastery is limited.
• Very little change in behavior after interventions.
• In contact with reality but have difficulty dealing with it have poor judgment.
• Claiming but non-impulsive.
PERSONALITY DISORDERS
❑are not diagnosed until adulthood, that is,
at age 18, when personality is more
completely formed.
❑Maladaptive behavioral patterns can
often be traced to early childhood or
adolescence.
PERSONALITY DISORDERS
❑Many experience significant impairment in
fulfilling family, academic, employment,
and other functional roles.
❑are long-standing; clients with personality
disorders continue to behave in their
same familiar ways even when these
behaviors cause them difficulties or
distress.
PERSONALITY DISORDERS
❑No specific medication alters personality,
and therapy designed to help clients make
changes is often long term with slow
progress.
❑For these reasons, people with personality
disorders are difficult to treat, which may be
frustrating for the nurse and other
caregivers as well as for family and friends.
PERSONALITY DISORDERS
❑Many people with personality disorders also
have coexisting mental illnesses.
 TYPES OF PERSONALITY DISORDERS
CLUSTER A – “Odd or Eccentric” and includes PARANOID,
SCHIZOID and SCHIZOTYPAL personality disorders.
Add a main topic

CLUSTER B – “the Dramatic, emotional” and includes ANTI SOCIAL,

BORDERLINE, HISTRIONIC, and NARCISSISTIC personality disorder.

CLUSTER C – “the anxious or fearful” and includes AVOIDANT,

DEPENDENT and OBSESSIVE-COMPULSIVE personality
disorders
Cluster A
1. PARANOID PERSONALITY
DISORDER
- Is characterized by pervasive mistrust and
suspicious of others,
- interpret other’s actions as potentially
harmful.
- Is common in men than in a women
- preoccupied with unjustified doubts of
other’s loyalty
- Reluctance to confide in others
- persistently bears grudges
- quick to react angrily
1. PARANOID PERSONALITY
❑ DISORDER
use the defense mechanism of projection,
which is blaming other people, institutions, or
events for their own difficulties.
❑ Conflict with authority figures on the job is
common;
❑ Paranoia may extend to feelings of being
singled out for menial tasks, treated as
stupid, or more closely monitored than other
employees.
1. PARANOID PERSONALITY
❑ DISORDER
Incidence is estimated at 2% to 4% of the
general population; the disorder is more
common in males than females.
❑ Data about prognosis are limited because
most people do not readily seek or remain in
treatment.
❑ Generally, they tend to have lifelong
problems living and working with others (Lee,
2017).
NURSING MANAGEMENT:
✔ The nurse must approach these clients in a
formal, businesslike manner and refrain from
social chit-chat or jokes.
✔ Being on time, keeping commitments, and
being especially straightforward are essential
to the success of the nurse–client relationship.
✔ These clients need to feel in control, it is
important to involve them in formulating their
care plan.
NURSING MANAGEMENT:
• Avoid competitive games/aggressive
activities requiring physical contact
(Appropriate activities include solitary
games such as drawing, typing
photography)
• Avoid anxiety producing situation
• Avoid taking sides when talking to patient
2. SCHIZOID PERSONALITY
DISORDER
❑ is characterized by a pervasive pattern of
detachment from social relationships and
a restricted range of emotional expression
in interpersonal settings.
❑ It may affect 5% of the general
population and is more common in males
than females (Cloninger & Svrakic, 2017).
❑ Avoid treatment as much as they avoid
other relationships, unless their life
circumstances change significantly.
2. SCHIZOID PERSONALITY
DISORDER
❑ a pervasive lack of desire for involvement
with others in all aspects of life.
❑ They do not have or desire friends, rarely
date or marry, and have little or no sexual
contact.
❑ They have few social skills, are oblivious to
the social cues or overtures of others, and
do not engage in social conversation.
NURSING MANAGEMENT:
❑ focus on improved functioning in the
community.
❑ If a client needs housing or a change in living
circumstances, the nurse can make referrals
to social services or appropriate local
agencies for assistance
3. SCHIZOTYPAL PERSONALITY
DISORDER
❑ is characterized by a pervasive pattern of
social and interpersonal deficits marked
by acute discomfort with and reduced
capacity for close relationships as well as
by cognitive or perceptual distortions
and behavioral eccentricities.
❑ Clients may experience transient
psychotic episodes in response to
extreme stress.
3. SCHIZOTYPAL PERSONALITY
DISORDER
❑ Incidence is about 3% of the population; the
disorder is slightly more common in men
than in women.
❑ Persons with schizotypal personality
disorder may develop schizophrenia
(Racioppi et al., 2018).
NURSING MANAGEMENT:
❑ FOCUS : development of self-care and
social skills and improved functioning in the
community.
❑ The nurse encourages clients to establish a
daily routine for hygiene and grooming
Cluster B
4. ANTISOCIAL PERSONALITY
DISORDER
❑is characterized by a pervasive pattern of
disregard for and violation of the rights of
others—and by the central characteristics of
deceit and manipulation.
❑It occurs in about 3% of the general
population, up to 30% in clinical settings, and
is three to four times more common in men
than in women
NURSING MANAGEMENT:
✔ Promote responsible behavior
✔ Limit setting
-State the limit
-Identify consequences of exceeding the
limit
-Identify expected or acceptable
behavior
✔ Consistent adherence to rules and treatment
plan
✔ Confrontation
NURSING MANAGEMENT:
✔ Point our problem behavior
✔ Keep client focus on self
✔ Help clients solve problems and control
emotions
✔ Effective problem-solving skills
✔ Decreased impulsivity
✔ Expressing negative emotions such as anger or
frustrations
✔ Taking time out from stressful situation
NURSING MANAGEMENT:
✔ Enhancing role performance
✔ Identifying barriers to role fulfillment
✔ Decreasing or eliminating use of drugs and
alcohol
5. BORDERLINE PERSONALITY
❑ is characterized by a pervasive pattern of
DISORDER
unstable interpersonal relationships, self-
image, and affect as well as marked
impulsivity.
❑ About 2% to 3% of the general population
has BPD; it is five times more common in
those with a first-degree relative with the
diagnosis.
❑ BPD is the most common personality
disorder found in clinical settings.
5. BORDERLINE PERSONALITY
DISORDER
❑ 8-10% commit suicide, many suffers
from self- mutilation injuries such as
cutting or burning
❑ recurrent mutilation is a cry for help,
an expression of intense anger, or
helplessness or form of self-
punishment.
5. BORDERLINE PERSONALITY
DISORDER
❑ physical pain means blocking emotional
pain for them
❑ do self-mutilation to enforce that they are
still alive
❑ seek to experience physical pain
❑ dealing with this type of personality is very
frustrating
NURSING MANAGEMENT:
• Promoting client’s safety
✔ No-self-harm contract
✔ Safe expression of feelings and emotions
• Helping client to cope and control emotions
✔ Identifying feelings
✔ Journal entries
✔ Moderating emotional responses
✔ Decreasing impulsivity
✔ Delaying gratification
NURSING MANAGEMENT:
• Cognitive restructuring techniques
✔ Thought stopping
✔ Decatastrophizing
• Structuring time
•Teaching social skills
• Teaching effective communication skills
• Entering therapeutic relationship
✔ Limit setting
✔ Confrontation
6. HISTRIONIC PERSONALITY
❑is characterized by a pervasive pattern of
DISORDER
excessive emotionality and attention
seeking. They get uncomfortable when they
are not the center of attention and go to
great lengths to gain that status
❑emotionally expressive, gregarious, and
effusive. They often exaggerate emotions
and closeness of relationships
inappropriately.
6. HISTRIONIC PERSONALITY
❑Speech is usually colorful and theatrical, full
DISORDER
of superlative adjectives but vague and lack
detail.
❑ Example: “He is the most wonderful
doctor!, He is so fantastic!, He has changed
my life!”
6. HISTRIONIC PERSONALITY
❑It is found in 1% to 3% of the general
DISORDER
population but in as much as 10% to 15% of
inpatient populations.
❑Clients often seek assistance for depression,
unexplained physical problems, and
difficulties with relationships. However,
clients do not see how their own behavior
has an impact on their current difficulties.
❑This disorder is diagnosed more frequently
in females than in males (Cloninger &
Svrakic, 2017).
NURSING MANAGEMENT:
✔Give client feedback about their social
interactions with others, including manner of
dress and nonverbal behavior. Feedback should
focus on appropriate alternatives, not merely
criticism.
✔Discuss social situations to explore clients’
perceptions of others’ reactions and behavior.
NURSING MANAGEMENT:
✔Teaching social skills and role-playing those skills
in a safe, nonthreatening environment can help
clients gain confidence in their ability to interact
socially.
✔The nurse must be specific in describing and
modeling social skills, including establishing eye
contact, engaging in active listening, and
respecting personal space.
NURSING MANAGEMENT:
✔It also helps to outline topics of discussion
appropriate for casual acquaintances, closer
friends or family, and the nurse only.
✔Explore personal strengths and assets and to
give specific feedback about positive
characteristics.
7. NARCISSISTIC PERSONALITY
DISORDER
❑May display an arrogant or haughty
attitude. They lack the ability to recognize or
empathize with the feelings of others.
❑They may express envy and begrudge
others any recognition or material success
because they believe it rightfully should be
theirs. Clients tend to disparage, belittle, or
discount the feelings of others.
7. NARCISSISTIC PERSONALITY
DISORDER
❑is characterized by a pervasive pattern of
grandiosity (in fantasy or behavior), need
for admiration, and lack of empathy.
❑Often preoccupied with fantasies of
unlimited success, power, brilliance, beauty,
or ideal love. These fantasies reinforce their
sense of superiority.
❑They are hypersensitive to criticism and
need constant attention and admiration.
display a sense of entitlement
7. NARCISSISTIC PERSONALITY
DISORDER
❑It occurs in 1% to 6% of the general
population.
❑Of people with this diagnosis, 50% to 75%
are men.
❑Narcissistic traits are common in
adolescence and do not necessarily indicate
that a personality disorder will develop in
adulthood.
NURSING MANAGEMENT:
✔The nurse must use self-awareness skills to
avoid the anger and frustration that these
clients’ behavior and attitude can engender.
✔Clients may be rude and arrogant, unwilling
to wait, and harsh and critical of the nurse.
The nurse must not internalize such criticism
or take it personally.
NURSING MANAGEMENT:
✔The goal is to gain the cooperation of these
clients with other treatment as indicated. The
nurse teaches about comorbid medical or
psychiatric conditions, medication regimen,
and any needed self-care skills in a matter-of
fact manner.
✔He or she sets limits on rude or verbally
abusive behavior and explains his or her
expectations of the client.
Cluster C
8. AVOIDANT PERSONALITY
DISORDER
❑is characterized by a pervasive pattern of
social discomfort and reticence, low self-
esteem, and hypersensitivity to negative
evaluation.
❑Clients with avoidant personality disorder
have low self-esteem. They are
hypersensitive to negative evaluation from
others and readily believe themselves to be
inferior.
8. AVOIDANT PERSONALITY
DISORDER
❑It occurs in 2% to 3% of the general
population. It is equally common in men and
women. Clients are good candidates for
individual psychotherapy (Cloninger &
Svrakic, 2017).
NURSING MANAGEMENT:
✔The nurse can help them explore positive self-
aspects, positive responses from others, and
possible reasons for self-criticism.
✔Helping clients practice self-affirmations and
positive self-talk may be useful in promoting self-
esteem. Other cognitive restructuring techniques
such as reframing and decatastrophizing can
enhance self-worth.
NURSING MANAGEMENT:
✔The nurse can teach social skills and
help clients practice them in the safety
of the nurse–client relationship.
9. DEPENDENT PERSONALITY
DISORDER
❑is characterized by a pervasive and
excessive need to be taken care of, which
leads to submissive and clinging behavior
and fears of separation. These behaviors
are designed to elicit caretaking from
others.
9. DEPENDENT PERSONALITY
DISORDER
❑They are excessively preoccupied with
unrealistic fears of being left alone to care
for themselves. They believe they would fail
on their own, so keeping or finding a
relationship occupies much of their time.
❑They have tremendous difficulty making
decisions, no matter how minor.
9. DEPENDENT PERSONALITY
DISORDER
❑Clients perceive themselves as unable to
function outside a relationship with someone
who can tell them what to do.
❑When these clients do experience the end of
a relationship, they urgently and desperately
seek another. The unspoken motto seems
to be “Any relationship is better than no
relationship at all.”
9. DEPENDENT PERSONALITY
DISORDER
❑This disorder occurs in about 1% of the
population and is three times more common
in females than males. It runs in families and
is more common in the youngest child.
❑People with dependent personality disorder
may seek treatment for anxious, depressed,
or somatic symptoms (Cloninger & Svrakic,
2017).
NURSING MANAGEMENT:
✔Helping clients identify their strengths and
needs is more helpful than encouraging the
overwhelming belief that “I can’t do
anything alone!”
✔Cognitive restructuring techniques such as
reframing and decatastrophizing may be
beneficial.
NURSING MANAGEMENT:
✔Clients may need assistance in daily
functioning if they have little or no past
success in this area.
✔Depending on the client’s abilities and
limitations, referral to agencies for services
or assistance may be indicated.
NURSING MANAGEMENT:
✔The nurse may also need to teach problem-
solving and decision-making and help clients
apply them to daily life. He or she must refrain
from giving advice about problems or making
decisions for clients, even though clients may ask
the nurse to do so.
✔The nurse can help the client explore problems,
serve as a sounding board for discussion of
alternatives, and provide support and positive
feedback for the client’s efforts in these areas.
10. OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
❑is characterized by a pervasive pattern of
preoccupation with perfectionism, mental
and interpersonal control, and orderliness at
the expense of flexibility, openness, and
efficiency.
10. OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
❑preoccupied with orderliness and try to
maintain it in all areas of life. They strive for
perfection as though it were attainable and
are preoccupied with details, rules, lists, and
schedules to the point of often missing “the
big picture.”
❑They become absorbed in their own
perspective, believe they are right, and do
not listen carefully to others because they
have already dismissed what is being said.
10. OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
❑Clients check and recheck the details of any
project or activity; often, they never
complete the project because of “trying to
get it right.”
10. OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
❑It is one of the most prevalent personality
disorders, occurring in about 2% to 8% of the
population, affecting twice as many men as
women.
❑Incidence is higher in oldest children and
people in professions involving facts, figures,
or methodical focus on detail.
10. OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
❑These people often seek treatment because
they recognize that their life is pleasureless
or they are experiencing problems with
work or relationships. Clients frequently
benefit from individual therapy.
NURSING MANAGEMENT:
✔Rather than striving for the goal of perfection,
clients can set a goal of completing the project or
making the decision by a specified deadline.
Helping clients accept or tolerate less-than
perfect work or decisions made on time may
alleviate some difficulties at work or home.
NURSING MANAGEMENT:
✔Clients may benefit from cognitive restructuring
techniques.
✔The nurse can ask, “What is the worst that could
happen?” or “How might your boss (or your wife)
see this situation?”.
NURSING MANAGEMENT:
✔Encouraging clients to take risks, such as letting
someone else plan a family activity, may improve
relationships.
✔Practicing negotiation with family or friends may
also help clients relinquish some of their need for
control.