PERSONALITY

DISORDERS
Personality
Personality is the way of thinking,
feeling and behaving that makes a
person different from other people. An
individual’s personality is influenced by
experiences, environment
(surroundings, life situations) and
inherited characteristics. A person’s
personality typically stays the same
over time.
Definition
A personality disorder is a way of
thinking, feeling and behaving that
deviates from the expectations of
the culture, causes distress or
problems functioning, and lasts over
time.
- American Psychiatric
Association
Classification of personality
disorders
I. Diagnostic and statistical manual of
mental disorder (DSM – IV)
I) Cluster – A(It contains odd-
eccentric behavior ) (Mad)

 Paranoid personality disorders.

 Schizoid personality disorders.
 Schizotypal personality disorders.
 II) Cluster – B (Bad)
It includes personality disorders with
dramatic and emotional behavior.
The disorders under cluster-B are:-
Antisocial personality disorder.
Border line personality disorder
Histrionic personality disorder
Narcissistic personality disorder.
III) Cluster – C (Sad)
In this cluster the patient have a sense of
anxiety and fearfulness. The disorder’s
are:-
Avoidant personality disorder.
Dependent personality disorder.
Obsessive compulsive personality
disorder.
Etiology of personality disorders
A) Biological factors
 Genetic factor play an important role in
development of personality disorders.
 Among monozygotic twins the concordance for
personality disorders are several times higher than
dizygotic twins.
 Cluster A personality disorder are more common in
the biological relatives of schizophrenia patients.
 Cluster B personality disorders have a genetic base.
 Person with personality disorder having the
alteration in brain structure and function.
B) Psychodynamics:-
 Parental rejection or indifference.
 Unmet need for satisfaction and security.
 A lack of ego strength, Id directed behavior.

C) Family Dynamics:-
 Absence of parental discipline.
 Extreme poverty.
 Removal from home.
 Lack of parental figures of both sex.
 Inadequate nurturing.
 Over protection
Cluster – A
A) Paranoid Personality
Disorder

Definition
Paranoid personality disorder
is a pattern of pervasive and
suspiciousness of other such that
their motives are interpreted as
malevolent.
Clinical Features
Suspicious
Is preoccupied with unjustified doubts
about the loyalty of friends (mistrustful).
Perceives attack on his character and is
quick to react angrily.
Has recurrent suspicious, without
justification.
Self –important
Jealous and irritable
Argumentative
B) Schizoid Personality
disorder
Schizoid personality disorder is
characterized primarily by a profound
defect in the ability to form personal
relationship or to respond others in any
meaningful, emotional way.

Or
It is characterized by detachment and
social withdrawal.
Clinical Features
 Neither desire nor enjoys close relationship
including being part of the family.
 Almost always chooses solitary activities.
 Has little interest in having sexual relationship
 Takes pleasure in few activities.
 Lacks close friends or confidents other than
first degree relatives.
 Appears in different to the praise or criticism.
 Shows emotional coldness,
 Detachment
 Humorless
 Inability to experience pleasure
C) Schizotypal Personality
disorders

Schizotypal personality
disorder described as latent
schizophrenics. Their behavior is odd
and eccentric but does not to the
level of schizophrenia.
Clinical features
 Ideas of reference
 Odd beliefs or magical thinking such as
believing in superstitions or telepathy
 Odd thinking and speech.
 Suspiciousness or paranoid ideation.
 Inappropriate affect.
 Odd and eccentric behavior.
 Lack of close friends and relationship.
 Excessive social anxiety.
 Not fitting easily with others
 Social isolation
Cluster – B
 A) Antisocial personality
disorder.
It is characterized by chronic antisocial
behavior that violates other rights or
social norms which predisposes the
affected person to criminal behavior.
Clinical Features
 Failure to conform to social norms with respect to
lawful behavior.
 Failure to plan ahead.
 Irritability and aggressiveness.
 Consistent irresponsibility as indicated by
repeated to failure to sustain consistent work.
 Low tolerance of frustration
 Impulsive action
 Lack of guilt
 Failure to sustain relationship
B) Borderline personality
disorder
Border line personality disorder as “A
pervasive pattern of instability of
interpersonal relationship, self image,
mood, affects, behavior and marked
impulsivity that begins by early
adulthood.
Clinical Features
A pattern of unstable and intense
interpersonal relationship.
Impulsivity that potentially self
damaging.
Recurrent suicidal behavior gestures or
threats.
Unstable emotions
Chronic feelings of emptiness.
Paranoid ideation.
Lack of control on anger
C) Histrionic personality
Disorder
Histrionic personality
disorder is characterized by self
dramatization, attention seeking
behavior, a craving for novelty and
excitement and self centered
approach to personal relationships.
Common in females.
People need to be the center of
attention at all times.
Clinical Features
In uncomfortable in situations in which he
or she is not the center of attention.
Display rapidly shifting and shallow
expression of emotions.
Consistently use appearances to draw
attention to self.
Attention seeking behavior
Over concern with physical attractiveness
Exaggerated and vague speech
Impulsivity
dramatic emotionality (emotional
blackmail, demonstrative suicide)
 D) Narcissistic
Personality Disorder
Narcissistic personality is defined as
“An exaggerated sense of self
worth (self-centered), they lack
empathy and are hyper sensitivity
to the evaluation of others.
Clinical Features
Has a grandiose sense of self importance.
Is preoccupied with fantasies of unlimited
success, power brilliance and beauty.
Believe that he/she is special and unique.
Lacks empathy, is unwilling to recognize or
identify with feelings and needs for others.
Exploitative behavior
Arrogance
Cluster – c
A) Avoidant Personality
Disorder:-

Avoidant personality disorder is

defined as extremely sensitivity to
rejection, feeling of inadequacy,
extreme social anxiety and
because of these may lead a very
socially withdrawn life.
Clinical features
Avoids occupational activities that
involve significant interpersonal contact
because of fear of criticism, disapproval
or rejection.
unwilling to get involved with people
Inferiority complex
Fear of criticism, disapproval or
rejection
B) Dependent
Personality Disorder
Dependent personality disorder is
characterized by a pervasive and
excessive need to be taken care of
that leads to submissive and
clinging behavior and fears of
separation.
Clinical Features
Has difficulty making everyday decisions
without an excessive amount of advice
and reassurance form others.
Needs others to assume responsibility for
most areas of his or her life.
Has difficulty expressing disagreement
with others because of fear of loss of
support or approval.
Feels uncomfortable or helpless when
alone because of exaggerated fears of
being unable to care for himself or herself
Low self – esteem and lack of confidence
Hypersensitivity to criticism
C) Obsessive – Compulsive
Personality disorder

Obsessive – Compulsive
Personality disorder is
characterized by a pervasive
pattern of pre-occupation with
orderliness, perfectionism, mental
and interpersonal control.
Clinical Features
 Is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the
major point of the activity is lost.
 Shows perfectionism that interferes with task
completion.
 Excessively devoted to work and productivity to the
exclusion of leisure activity.
 Feeling of excessive doubt
 Unable to discard worn out or worthless objects
even when they have no sentimental value.
 Shows rigidity and stubbornness.
Treatment
Psycho therapy
Occupational therapy
Group therapy
Pharmacotherapy
Anti anxiety agent such as
diazepam.
Anti psychotic to control severe
agitation.
Nursing care plan for personality
disorders
1. Nursing diagnosis
Social isolation related to
disturbed thought process that result in
delusional thinking.

Objective:-
Verbalize willingness to be
involved with others.
 Interventions
Assess degree of isolation by listening to
client’s comments about loneliness.
Spend time with client.
Plan appropriate time for activities.
Assist client to participate in diversion
activities.
Identify support system available to the
client.
Assess family relationships,
communication patterns, knowledge of
client condition.
Nursing diagnosis
High risk for violence directed at self /
others related to perceived threat of
danger.

Goal
To verbalize awareness of delusional
system.
Intervention
Note prior history of violent behavior
when under stress.
Assess client to identify situation that
trigger anxiety and aggressive behaviors.
Explore implications and consequences
of handling these situations with
aggression.
Encourage to engage in solitary activity
instead of group activities to begin with.
Assist client to define alternatives to
aggressive behavior. Engage in physical
activities.
Provide safe, quiet environment.
Be alert to signs of impending violent
behavior.
Nursing diagnosis
Anxiety related to inability to trust.

Goal
To reduce anxiety.
Intervention
Develop primary nurse patient relationship.
Assist client to identify sources of anxiety
and concerns.
Explore present patterns of coping with
anxiety and how effective they have been.
Discuss alternatives to current ineffective
behaviors.
Encourage implementation of new
strategies, giving feed back on effectiveness
Nursing diagnosis
Ineffective family process
related to temporary family
disorganization.

Goal
Express feelings freely and
appropriately.
Interventions
Identify individual factors that may
contribute to difficulty of family in
providing needed assistance the client.
Determine information available to
understand by family.
Discuss underlying reasons for client’s
behaviors.
Encourage and assist client to develop
problem solving skills.