PERSONALITY

DISORDERS
 WHAT IS “PERSONALITY?”

Can be defined as an ingrained,

enduring pattern of behaving and
relating to self, others, and the
environment; it includes perceptions,
attitudes, and emotions.
 WHAT IS A PERSONALITY DISORDER?
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 other.
Relationship with others are dysfunctional and often
characterized by deceit, coercion, or intimidation by the
individual personality disorder. There are not capable of
mutual, intimate relationship, and lack the capacity for
empathy, remorse, or concern for other
 DYSFUNCTIONAL PERSONALITY TRAITS
EXHIBITED WITH A PERSONALITY
DISORDERS
Negative behaviours towards others, such as being
manipulative, dishonest, deceitful, or lying
Anger and / or hostility
Irritable, labile moods
Lack of guilt or remorse, emotionally cold and
uncaring
Impulsivity, poor judgement

Irresponsible, not accountable for own actions

CLASSIFYING
PERSONALITY
DISORDERS
 CLUSTER A: ODD OR ECCENTRIC
BEHAVIOR

Paranoid personality disorder

Schizoid personality disorder
Schizotypal personality disorder
CLUSTER B: DRAMATIC, EMOTIONAL OR
ERRATIC BEHAVIOR

Antisocial personality disorder

Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
 CLUSTER C: ANXIOUS FEARFUL
BEHAVIORS

Avoidant personality disorder

Dependent personality disorder
Obsessive-compulsive personality
disorder
 OTHER BEHAVIORS

Depressive behavior
Is characterized by a pervasive pattern of depressive
cognitions and behaviors in various contexts. It occurs
more often in people with relatives who have major
depressive disorders. People with depressive personality
disorders often seek treatment for their distress.
Passive- Aggressive Behavior
Is characterized by a negative attitude and a pervasive
pattern of passive resistance to demand for adequate
social and occupational performance. This clients may
appear cooperative, even ingratiating, or sullen and
withdrawn, depending on the circumstances. There mood
may fluctuate rapidly and erratically, and they may be
easily upset or offended.
ETIOLOGY
 BIOLOGICAL THEORIES
Personality develop through the interaction of hereditary
disposition 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.
Genetic differences account for about 50% of the variances in
temperament traits.
The four temperament traits are harm avoidance, Novelty
seeking, Reward dependence and Persistence. Each of this
four genetically influence traits affects a person’s automatic
responses to a certain situation. This response pattern are
ingrained by 2-3 years of age.
 People with high-harm avoidance exhibit fear of uncertain thing, social inhibition,
shyness with strangers, rapid fatigability, and pessimistic worry and anticipation of
problems, those with low-harm avoidance are carefree, energetic, outgoing, and
optimistic. High-harm avoidance behaviors may result in maladaptive inhabitation and
excessive anxiety. Low-harm avoidance behaviors' may result in unwarranted optimistic
and unresponsiveness to potential harm or danger.
 A high-novelty seeking temperament result in someone who is quick tempered,
curious, easily bored, impulsive, extravagance and disorderly. He/she maybe easily
bored and distracted with daily life, prone to angry outburst, and fickle and relationship.
The person low in novelty seeking is slow tempered. Stoic, reflective, frugal, reserve,
orderly, and tolerant of monotony. He/she may adhere to a routine of activities.
 Reward dependence defines how the person responds to social cues. People high
in reward dependence are tendered haltered, sensitive, sociable, and socially
dependence, they may become overly dependent on approval from others and readily
assumes the ideas and wishes of others without regard for their own belief or desires.
People with low-reward dependence are practical, tough-minded, cold, socially
insensitive, irresolute, and indifferent to being alone. Social withdrawal, detachment,
aloofness and disinterest in others can result.
 Highly persistent people are hardworking and ambitious over achievers who
responds to fatigue or frustration as a personal challenge .
 PSYCHODYNAMIC THEORIES

Character consist of concepts about the

self and the external world. It develops over
time as a person comes into contact with
people and situations and confronts
challenges.
Three major character traits have been
distinguished; self-directed,
cooperativeness, and self-transcendence
 SELF-DIRECTEDNESS

Reliable
Responsible
Resourceful
Goal oriented
Self confident
They are realistic and effective, can adapt their
behavior to achieve goals

Blaming
 COOPERATIVENESS

Emphatic
Tolerant
Compassionate
Supportive
Principled

Self-absorbed
 SELF-TRASCENDENCE
Spiritual
Unpretentious
Humble
Fulfilled
This traits are helpful when dealing with suffering,
illness or death

Practical
Self-conscious
Materialistic
 Personality develops in response to inherited
disposition(temperament) and environmental
influences (character) , which are experiences
unique to each person.
Personality disorders result when the
combination of temperament and character
development produces maladaptive, inflexible
ways of viewing self, coping with the world, and
relating to other.
 CULTURAL CONSIDERATIONS

Person’s ethnic
Cultural background
Social background
Minority group, political refugees, ethnic group
Religious and spiritual beliefs
 TREATMENT
Psychopharmacological
Focuses on the symptoms rather than the particular
subtype
The four symptom categories that underlie personality
disorders are cognitive-perceptual distortion,
including psychotic symptoms; affective symptoms
and mood dysregulation; aggression and behaviorial
dysfunction ; and anxiety
Individual and Group Psychotherapy
Cognitive-behavioral therapy
Dialectical behavior therapy
 Drug choices for Symptoms of Personality Disorders
Target Symptom Drug of Choice
 Aggression/impulsivity

 Affective aggression (normal)  lithuim

 Anticonvulsants
 Low-dose antipsychotics

 Predatory (hostility/cruelty)  Antipsychotics

 Lithuim
 Organic-like aggression  Cholinergic agonist(donepezil)
 Imipramine (tofranil)

 Ictal aggression (abnormal)  Carbamezepine (tegretol)

 Antipsychotics
 Mood dysregulation
 Emotional lability  Lithuim
 Carbamezephine (tegretol)
 Atypical depression/dysphoria  MAOIs
 SSRIs
 Antipsychotics
 Emotional detachment  SSRIs
 Atypical antipsychotics
 Anxiety
 Chronis cognitive  MAOIs
 SSRIs
 Benzodiazepines
 Chronic somatic  MAOIs
 SSRIs
 Severe anxiety  MAOIs
 Low-dose antipsychotics
 Psychotic symptoms
 Acute and psychosis  Antipsychotic
 Chronic and low-level psychotic-  Low-dose antipsychotics
like symptoms
 MAOIs- monoamine oxidase inhibitors; SSRIs- selective serotonin reuptake
CLUSTER A PERSONALITY DISORDERS:
PARANOID PERSONALITY DISORDER
Pervasive distrust and suspicion of others and their motives
Unjustified belief that others are trying to harm or deceive
you
Unjustified suspicion of the loyalty or trustworthiness of
others
Hesitancy to confide in others due to unreasonable fear that
others will use the information against you
Perception of innocent remarks or nonthreatening situations
as personal insults or attacks
Angry or hostile reaction to perceived slights or insults
Tendency to hold grudges
Unjustified, recurrent suspicion that spouse or sexual partner
is unfaithful
NURSING INTERVENTIONS

 serious, straightforward approach

 teach client to validate ideas before taking
actions
 involve client treatment planning
must approach this client in a formal, business-like
manner and refrain from social chitchat or jokes
 SCHIZOID PERSONALITY DISORDER

 Lack of interest in social or personal relationships,

preferring to be alone
 Involved with things more than people
 Limited range of emotional expression
 Inability to take pleasure in most activities
 Inability to pick up normal social cues
 Appearance of being cold or indifferent to others,
uncaring, unfeeling
 Little or no interest in having sex with another
person
NURSING INTERVENTIONS
Focus on improve functioning the community, if the
client needs housing or a change in living
circumstances the nurse can make referrals to social
services or appropriate local agencies for assistance
Facility design to promote socialization through
group activities and would be less desirable.
SCHIZOTYPAL PERSONALITY
DISORDER
 Peculiar dress, thinking, beliefs, speech or behavior
 Odd perceptual experiences, such as hearing a
voice whisper your name
 Flat emotions or inappropriate emotional responses
 Social anxiety and a lack of or discomfort with close
relationships
 Indifferent, inappropriate or suspicious response to
others
 "Magical thinking" — believing you can influence
people and events with your thoughts
 Belief that certain casual incidents or events have
NURSING INTERVENTIONS

Develop self-care skills

Improve community functioning
Social skills training
 CLUSTER B: DRAMATIC, EMOTIONAL OR
ERRATIC BEHAVIOR

Antisocial personality disorder

Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
ANTISOCIAL PERSONALITY
DISORDERS
 Disregard for others' needs or feelings
 Persistent lying, stealing, using aliases, conning others
 Recurring problems with the law
 Repeated violation of the rights of others
 Aggressive, often violent behavior
 Disregard for the safety of self or others
 Impulsive behavior
 Consistently irresponsible
 Lack of remorse for behaviour
 Have average or above average IQs
 Manipulate and exploit those around them
 they view relationships as serving their needs and pursue others
only for personal gain
 Often involved in many relationships, sometimes simultaneously.
Marry and have children, but cant sustain long-term commitment
NURSING INTERVENTIONS

• limit setting
• State the limit
• Identify the consequences of exceeding the limit
• Identify expected or acceptable behavior
• Confrontation
• Point out problem behavior
• Keep client focused on self
• Help clients solve problems and control emotions
• Teach client to solve problems effectively and manage
emotions of anger and frustrations
• Effective problem solving skills
BORDERLINE PERSONALITY
DISORDERS
 Impulsive and risky behavior, such as having unsafe sex,
gambling or binge eating
 Unstable or fragile self-image
 Unstable and intense relationships
 Up and down moods, often as a reaction to interpersonal stress
 Suicidal behavior or threats of self-injury
 Intense fear of being alone or abandoned
 The pervasive mood is dysphoric, involving unhappy,
restlessness, and malaise
 Ongoing feelings of emptiness
 Frequent, intense displays of anger
 Stress-related paranoia that comes and goes
NURSING INTERVENTIONS
 Promoting clients safety
o No-self-harm contract
o Safe expression of feelings and emotions
 Helping client to cope and control emotions
o Identifying feeling
o Journal entries
o Moderating emotional response
o Decreasing impulsivity
o Delaying gratification
 Cognitive restructuring techniques
o Thought stopping
o Decatastropizing
HISTRIONIC PERSONALITY DISORDER
 Constantly seeking attention
 Excessively emotional, dramatic or sexually
provocative to gain attention
 Speaks dramatically with strong opinions, but few
facts or details to back them up
 Easily influenced by others
 Shallow, rapidly changing emotions
 Excessive concern with physical appearance
 Thinks relationships with others are closer than they
really are
NURSING INTERVENTIONS

• Teach social skills

• Provide factual feedback about behavior
• Promote self-esteem
• Nurse must convey genuine confidence in the
clients ability
 NARCISSISTIC PERSONALITY DISORDER
 Characterized by pervasive pattern of grandiosity (Fantasies about power,
success and attractiveness)
 Common in adolescence and do not necessarily indicate that a personality
disorders will develop in adulthood
 Belief that you're special and more important than others
 Failure to recognize others' needs and feelings
 Exaggeration of achievements or talents
 Expectation of constant praise and admiration
 Arrogance
 Unreasonable expectations of favors and advantages, often taking advantage of
others
 Hypersensitive to criticism and need constant attention and admiration
 At work, these clients may experience some success because they are ambitious
and confident
NURSING INTERVENTIONS

• Matter-of-fact approach
• Gain cooperation with needed treatment
• Teach client any needed self-care skills
CLUSTER C: ANXIOUS FEARFUL
BEHAVIORS

Avoidant personality disorder

Dependent personality disorder
Obsessive-compulsive personality
disorder
AVOIDANT PERSONALITY DISORDER
 Too sensitive to criticism or rejection
 Feeling inadequate, inferior or unattractive
 Avoidance of work activities that require
interpersonal contact
 Socially inhibited, timid and isolated, avoiding new
activities or meeting strangers
 Extreme shyness in social situations and personal
relationships
 Very low self-esteem
 Fear of disapproval, embarrassment or ridicule
 Clients may report some success in occupational
roles because they are eager to please or to win a
supervisors approval.
NURSING INTERVENTIONS

• Support and reassurance

• Promote self-esteem
• Cognitive reassuring techniques
DEPENDENT PERSONALITY DISORDER
 Excessive dependence on others and feeling the
need to be taken care of
 Submissive or clingy behavior toward others
 Fear of having to provide self-care or fend for yourself
if left alone
 Lack of self-confidence, requiring excessive advice
and reassurance from others to make even small
decisions
 Difficulty starting or doing projects on your own due
to lack of self-confidence
 Difficulty disagreeing with others, fearing disapproval
 Tolerance of poor or abusive treatment, even when
NURSING INTERVENTIONS

• Foster client’s self-reliance and autonomy

• Teach problem solving and decision making
skills
• Cognitive restructuring techniques
 OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

 Preoccupation with details, orderliness and rules

 Extreme perfectionism, resulting in dysfunction and distress
when perfection is not achieved, such as feeling unable to
finish a project because you don't meet your own strict
standards
 Desire to be in control of people, tasks and situations, and
inability to delegate tasks
 Neglect of friends and enjoyable activities because of
excessive commitment to work or a project
 Inability to discard broken or worthless objects
 Rigid and stubborn
 Inflexible about morality, ethics or values
 Tight, miserly control over budgeting and spending money
NURSING INTERVENTIONS
• Encourage negotiation with others
• Assist client to make timely decisions and
complete work
• Cognitive restructuring techniques
• Encourage clients to take risk, such as letting
someone else plan a family activity
ELDER CONSIDERATIONS
Personality disorders are not first diagnosed in elder
persons, but may persist from young adulthood into
older age.
Others are described as ‘aging badly”
Unwilling to acknowledge limitations that come with
aging
Refuse accept need when needed
Unhappy ,dissatisfied
Increased risk for depression, suicide, and dementia
 CASE STUDY
MARY (BORDERLINE PERSONALITY DISORDER)
CASE STUDY DETAILS

Mary is a 26-year-old African-American woman who presents with a history of non-suicidal

self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two
suicide attempts by overdosing on prescribed medications, one as a teenager and one six
months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to
think about suicide as a “way out.”

When she is stressed, Mary says that she often “zones out,” even in the middle of
conversations or while at work. She states, “I don’t know who Mary really is,” and describes a
longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job
based on who is in her social group. At times, she thinks that her partner is “the best thing
that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text
messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and
will ignore or lash out at him, including yelling or throwing things. Immediately after doing so,
she reports feeling regret and panic at the thought of him leaving her. Mary reports that before
she began dating her current partner she sometimes engaged in sexual activity with multiple
people per week, often with partners whom she did not know.
SYMPTOMS
Anger
Anxiety
Concentration Difficulties
Emotion Dysregulation
Impulsivity
Mood Cycles
Risky Behaviors
Self-Injury
Suicidal thoughts
DIAGNOSES AND RELATED TREATMENTS

BORDERLINE PERSONALITY DISORDER

The following treatments have empirical support for

individuals with Borderline Personality Disorder:
Dialectical Behavior Therapy for Borderline Personality
Disorder
Mentalization-Based Treatment for Borderline Personality
Disorder
GROUP III
Manzano, Alexandra T.
Lumanog, Noel A.
Mara, Jeaneth O.
Ginez, Glenn Donn
Ignacio, Eduardo III
Macaraeg, Jimbo Jake V