Personality Disorders

Definition
Personality disorder is defined as the totality of a person’s unique biopsychosocial and spiritual traits that consistently influence behavior.
The following traits are likely in individuals with a personality disorder:
  1. Interpersonal relations that ranges from distant to overprotective.
  2. Suspiciousness
  3. Social anxiety
  4. Failure to conform to social norms.
  5. Self-destructive behaviors
  6. Manipulation and splitting.
Prognosis is poor, and clients experience long term disability and may have other psychiatric disorders.
Diagnosis
A personality disorder is diagnosed when a person exhibits deviation on the following areas:
  1. Cognition – ways a person interprets and perceives him or herself, other people and events.
  2. Affect – ranges, lability and appropriateness of emotional response
  3. Impulse control – ability to control impulses or express behavior at the appropriate time and place.
Cluster A: Personality Disorders ( The Eccentric and Mad group)
1. Paranoid Personality disorder– People with a paranoid personality disorder are characterized by an overly suspicious and mistrustful behavior.
Clinical Manifestation
  1. Aloof and withdrawn
  2. Appear guarded and hypervigilant
  3. Have a restricted affect
  4. Unable to demonstrate a warm and empathetic emotional responses
  5. Shows constant mistrust and suspicion
  6. Frequently see malevolence in the actions when none exists
  7. Spends disproportionate time examining and analyzing the behavior and motive of others to discover hidden and threatening meanings
  8. Often feel attacked by others
  9. Devises plans or fantasies for protection
  10. Uses the defense mechanism of projection (blaming other people, institution or events for their own difficulties)
2. Schizoid Personality Disorder- People who are showing a pervasive pattern of social relationship detachment and a limited range of emotional expression in the interpersonal settings falls under this type of personality disorder.
Clinical Manifestations:
  1. Displays restricted affect
  2. Shows little emotion
  3. Aloof, emotionally cold and uncaring
  4. Have rich and extensive fantasy life
  5. Accomplished intellectually and often involved with computers or electronics in hobbies or job
  6. Spends long hours solving puzzles and mathematical problems
  7. Indecisive
  8. Lacks future goals or direction
  9. Impaired insight
  10. Self-absorbed and loners
  11. Lacks desire for involvement with others
  12. No disordered or delusional thought processes present
3. Schizotypal Personality Disorder– Schizoid and schizotypal personality disorder are both characterized by pervasive pattern of social and interpersonal deficits, however, the latter is noted with cognitive and perceptual distortions and behavioral eccentricities.
Clinical Manifestations:
  1. Odd appearance (stained or dirty clothes, unkempt and disheveled)
  2. Wander aimlessly
  3. Loose, bizarre or vague speech
  4. Restricted range of emotions
  5. Ideas or reference and magical thinking is noted
  6. Expresses ideas of suspicions regarding the motives of others
  7. Experiences anxiety with people
Cluster B: Personality Disorders ( The Erratic and Bad group)
1. Antisocial Personality Disorder– Antisocial Personality disorder is characterized by a persistent pattern of violation and disregard for the rights of others, deceit and manipulation
Clinical Manifestations:
  1. Violation of the rights of others
  2. Lack of remorse for behaviors
  3. Shallow emotions
  4. Lying
  5. Rationalization of own behavior
  6. Poor judgment
  7. Impulsivity
  8. Irritability and aggressiveness
  9. Lack of insight
  10. Thrill seeking behaviors
  11. Exploitation of people in relationships
  12. Poor work history
  13. Consistent irresponsibility
2. Borderline Personality Disorder– Borderline personality disorder is the most common personality disorder found in clinical settings. This disorder is characterized by a persistent pattern of unstable relationships, self image, affect and has marked impulsivity. It is more common in females than in males. Self-mutilation injuries such ascutting or burning are noted in this type of personality disorder.
Clinical manifestations:
  1. Fear of abandonment (real or perceived)
  2. Unstable and intense relationship
  3. Unstable self-image
  4. Impulsivity or recklessness
  5. Recurrent self-mutilating behavior or suicidal threats or gestures
  6. Chronic feelings of emptiness and boredom
  7. Labile mood
  8. Irritability
  9. Splitting
  10. Impaired judgment
  11. Lack of insight
  12. Transient psychotic symptoms such as hallucinations demanding self-harm
3. Narcissistic Personality Disorder– A person with a narcissistic personality disorder shows a persistent pattern of grandiosity either in fantasy or behavior, a need for admiration and a lack of empathy.
Clinical Manifestations:
  1. Arrogant and haughty attitude
  2. Lack the ability to recognize or to empathize with the feelings of others
  3. Express envy and begrudge others of any recognition of material success (they believe it rightfully should be theirs)
  4. Belittle or disparage other’s feelings
  5. Expresses grandiosity overtly
  6. Expect to be recognized for their perceived greatness
  7. Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
  8. Compares themselves with famous or privileged people
  9. Poor or limited insight
  10. Fragile and vulnerable self-esteem
  11. Ambitious and confident
  12. Exploit relationships to elevate their own status
4. Histrionic Personality disorder– Excessive emotionality and attention-seeking behaviors are pervasive patterns noted in people with a histrionic personality disorder.
Clinical manifestations:
  1. Exaggerate closeness of relationships or intimacy
  2. Uses colorful speech
  3. Tends to overdress
  4. Concerned with impressing others
  5. Emotionally expressive
  6. Experiences rapid mood and emotion shifts
  7. Self-absorbed
  8. Highly suggestible and will agree with almost anyone to gain attention
  9. Always want to be the center of attraction
Cluster C: Personality Disorders ( The anxious and Sad group)
1. Avoidant Personality Disorder
Avoidant personality disorder is characterized by a persistent pattern of:
  1. Social uneasiness and reticence
  2. Low self-esteem
  3. Hypersensitivity to negative reaction
Clinical Manifestations
  1. Shy
  2. Unusually fearful of rejection, criticism, shame or disapproval
  3. Socially awkward
  4. Easily devastated by real or perceived criticism
  5. Have a very low self-esteem
  6. Believes that they are inferior
2. Dependent Personality Disorder– People who are noted to excessively need someone to take care of them that lead to their persistent clingy and submissive behavior have a dependent personality disorder. These individuals have fear of being separated from the person whom they cling on to. The behavior elicits caretaking from others.
Clinical Manifestations
  1. Pessimistic
  2. Self-critical
  3. Can be easily be hurt by other people
  4. Frequently reports feeling unhappy or depressed ( due to actual or perceived loss of support from a person)
  5. Preoccupied with unrealistic fears of being alone and left alone to take care for themselves
  6. Has difficulty deciding on their own even how simple the problem is
  7. Constantly seeks advice from others and repeated assurances about all types of decisions
  8. Lacks confidence
  9. Uncomfortable and helpless when alone
  10. Has difficulty initiating  or completing simple daily tasks on their own
3. Obsessive Compulsive Personality Disorder– Individuals who are preoccupied with perfectionism, mental and interpersonal control and orderliness have an obsessive compulsive personality disorder. Persons with an obsessive compulsive personality are serious and formal and answer questions with precision and much detail. These people often seek treatment because of their recognition that life has no pleasure or because they are experiencing problems at work and in their relationships.
Clinical Manifestations
  1. Formal and serious
  2. Precise and detail-oriented
  3. Perfectionist
  4. Constricted emotional range (has difficulty expressing emotions)
  5. Stubborn and reluctant to relinquish control
  6. Restricted affect
  7. Preoccupation to orderliness
  8. Have low self-esteem
  9. Harsh
  10. Have difficulty in relationships
Signs and Symptoms
  1. Inappropriate response to stress and inflexible approach to problem solving.
  2. Long term difficulties in relating to others, in school and in work situations.
  3. Demanding and manipulative.
  4. Ability to cause others to react with extreme annoyance or irritability.
  5. Poor interpersonal skills.
  6. Anxiety
  7. Depression
  8. Anger and aggression
  9. Difficulty with adherence to treatment.
  10. Harm to self or others.
Nursing Diagnoses
  • Ineffective individual coping
  • Social isolation
  • Impaired social interaction
  • High risk for violence to self or others
  • Anxiety
Nursing Interventions
  1. Work with the client to increase coping skills and identify need for improvement coping.
  2. Respond to the client’s specific symptoms and needs.
  3. Keep communication clear and consistent.
  4. Client may require physical restraints, seclusion/observation room, one to one supervision.
  5. Keep the client involved in treatment planning.
  6. Avoid becoming victim to the client’s involvement in appropriate self-help groups.
  7. Require the client take responsibility for his/her own behavior and the consequences for actions.
  8. Discuss with the client and family the possible environment and situational causes, contributing factors, and triggers.

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