Personality
Disorders (PD)
West Coast University
Psychiatric / Mental Health
Nursing
NURS 204
Personality
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The individual qualities, including habitual
behavior patterns, that make a person
unique
Personality traits is a persistent behavioral
patterns that do not significantly interfere
with one’s life, even though the behaviors
may be annoying or frustrating to others
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Definition of Personality
Disorder
Traits and habits that comprise the personality are
inflexible (rigid) and damaging
Pathology/impairment will affect the individual and those
who interact with the individual
Enduring pattern of inner experience and behavior that
deviates from the expectations of the person’s culture,
that is pervasive and inflexible. Manifested in two or more
of the following areas:
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Cognition
Affect
Interpersonal functioning
Impulse control
Social or occupational
Relationship
PD: Common Characteristics
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Onset in adolescence or early adulthood.
Tendency to foster vicious cycles (crisis
orientation)
Persists throughout the person’s life (chronicity)
Lack insight: not aware of their pathology
Intense transference/counter-transference
reaction
Failure to accept the consequences of behavior
Pattern of perceiving, thinking, and relating that
impairs social or occupational functioning
PD: Common Characteristics
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Manipulation
Narcissism
Impulsiveness
Biologic Factors
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Alterations in hormone & platelet monoamine
oxidase (MAO) levels
Neurotransmitter changes
Electroencephalographic (EEG) changes
Structural brain changes
Diminished blood flow and inflammation
Chronic inflammation, as evidenced by the
presence of elevated levels of C-reactive protein
Genetic Factors
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Familial tendencies
Cluster B correlated with mood disorders,
alcoholism, & somatization
Genetic variation
Psychosocial Factors
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Parent–child interactions
Intrapsychic theory
Enmeshment
Abandonment
Identity diffusion
Cluster A Personality
Disorder
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Odd or Eccentric
Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder
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Paranoid Personality Disorder
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A pervasive distrust and suspiciousness of
others such that their motives are
interpreted as malevolent, beginning by
early adulthood and present in a variety of
contexts.
E.g. Richard Nixon
 Film: “The Caine Mutiny” (1953)
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Paranoid PD Characteristics
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Suspiciousness and Mistrust
Rigidity
Hypervigilance
Distortions of reality
Restricted affect
Exclusion
Schema for Paranoid PD
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People will eventually try to hurt me
People can’t be trusted. They will always take
advantage of me
People will try to bother or annoy me
Don’t get mad, get even
Any insult, no matter how slight, directed at me
should be punished
Always be prepared for the worst
If I get close to people they can find out my
weaknesses
Nursing Guidelines
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Avoid being to nice or friendly
Give clear and straight forward explanations of
tests and procedures beforehand
Use simple, clear language; avoid ambiguity
Respect personal space and client’s preference
Provide client with a daily schedule of activities
and inform client of changes or reasons for
delays
Schizoid Personality Disorder
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A pervasive pattern of detachment from
social relationships and a restricted range
of expression interpersonal settings,
beginning by early adulthood and present
in a variety of contexts:
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Mr. Spock in the original Star Trek series
Schizoid PD Characteristics
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Detached
Aloof social style
Experience transient psychotic episodes
Experience anxiety, depression, and
dysphoric affect
Isolative
Deny interest in relationships
Humorless
Schema for Schizoid PD
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There are few reasons to be close to
people
I am my own best friend
Stay calm
Displays of emotions are unnecessary and
embarrassing
What others say is of little interest or
importance to me
Nursing Guidelines
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Avoid being too nice or friendly
Do not try to increase socialization
Perform thorough diagnostic assessment
as needed to identify symptoms of
disorders that the patient is reluctant to
discuss
Schizotypal Personality
Disorder
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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
eccentricities of behavior, beginning by early
adulthood and present in a variety of context:
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“Kramer” on “Seinfeld”
“Phoebe” on “Friends”
Film: “Psycho” (1960)
Schizotypal PD
Characteristics
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Ideas of reference
Odd beliefs or magical thinking (clairvoyance,
telepathy, or “sixth sense”)
Vague, circumstantial, metaphorical,
overelaborate, or stereotyped
Suspiciousness or paranoid ideation
Odd appearance, eccentric or peculiar
Lack close friends or confidants
Social anxiety
Nursing Guidelines
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Respect patient’s need for social isolation
Be aware of patient’s suspiciousness and
employ appropriate interventions
Nursing Process
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Nursing Diagnosis
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Ineffective Coping
Impaired social interaction
Outcome identification
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Participate in activity groups
Copes effectively with stressful situation
Approaches staff and other clients without
encouragement
Verbalizes thoughts and feelings that interfere with
socialization
Cluster B
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Dramatic, emotional, or erratic
Antisocial
 Borderline
 Narcissistic
 Histrionic
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Antisocial Personality
Disorder
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A pervasive pattern of disregard for and
violation of the rights of others occurring
since age 15, as indicated by the
following:
Career Criminals
 Film: “The God Father”
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Antisocial PD Characteristics
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Failure to conform to social norms
Deceitfulness
Impulsive
Irritability and aggressiveness
Reckless
Irresponsible
Lack of remorse
Schema for Antisocial PD
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Rules are meant for others
Only fools follow all of the rules
Rules are meant to be broken
My pleasure comes first
I will not allow myself to be frustrated
I will do whatever I must to get whatever I want
I am really smarter than most everybody else
Nursing Guidelines
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Be alert to manipulation such as flattery,
seductiveness, instilling of guilt or verbal attacks
Set clear and realistic limits of specific behavior
Ensure that all limits are adhered to by all staff
involved
Do not seek approval or coax, provide clear
boundaries and consequences
Do not argue, bargain, or rationalize
Confront inappropriate behaviors
Borderline Personality
Disorder
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A pervasive pattern of instability of
interpersonal relationship, self-image, and
affects, and marked impulsivity beginning
in early adulthood and present in a variety
of contexts:
Borderline PD
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Frantic efforts to avoid real or imagined
abandonment
Unstable and intense interpersonal relationships
Identity disturbance
Impulsivity
Recurrent suicidal behavior, gestures, or threats,
or self mutilation
Chronic feeling of emptiness
Intense anger or difficulty controlling anger
Schema for Borderline PD
I am not sure who I am
 I will eventually be abandoned
 My pain is so intense that I can’t bear it
 My anger controls me. I can’t modulate my
feelings
 When I am overwhelmed I must escape (by
flight or suicide
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Nursing Guidelines
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Set realistic goals, use clear action words
Be aware of manipulative behaviors, such as
flattery, seductiveness, instilling of guilt
Provide a clear and consistent boundaries and
limits
Avoid rejecting or rescuing
Assess for suicidal and self-mutilating behaviors,
especially during times of stress
Use a nonjudgmental attitude when client
discusses suicidal/self-destructive thoughts
Implement safety precautions
Narcissistic Personality
Disorder
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A pervasive pattern of grandiosity (in
fantasy and behavior), need for
admiration, and lack of empathy,
beginning in early adulthood and present
in a variety of contexts:
“Frazier Crane” on “Frazier”
 “Jerry Seinfeld” on “Seinfeld”
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Narcissistic PD
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Grandiose sense of self-importance
Preoccupied with fantasies or unlimited success,
power, brilliance, beauty, or ideal love
Believes that he or she is special and important
Require excessive admiration
Sense of entitlement
Exploitative
Lack empathy
Envious of others
Shows arrogant, haughty behavior or attitudes
Schema for Narcissistic PD
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I must have my way in every interaction
I am more special than anyone else
I should only have to relate to people like
me
I must be admired
No one should have more of anything that
I have
Nursing Guidelines
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Remain neutral; avoid engaging in power
struggles or becoming defensive in
response to the patient’s disparaging
remarks, no matter how provocative the
situation may be.
Histrionic Personality
Disorder
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A pervasive pattern of excessive
emotionality and attention seeking,
beginning in early adulthood and present
in a variety of contexts:
Judy Garland, Liza Minnelli, Robin Williams
 “Jack” and “Karen” on “Will” and “Grace”
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Histrionic PD
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Uncomfortable in situations in which he or she is
not the center of attention
Interaction are characterized by inappropriate
sexually seductive or provocative behavior
Rapid shifting and shallow expressions of
emotions
Use physical appearance to draw attention
Shows dramatization, exaggerated expressions
Easily influenced by others
Schema for Histrionic PD
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Appearances are important
People are judged on external appearance
I must be noticed
I must never be frustrated in life
I must get everything I think that I want
Beauty is the most important consideration
in judging someone
Nursing Guidelines
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Understand seductive behavior as a
response to distress
Keep communication and interactions
professional, despite temptation to
conspire with the patient in a flirtatious and
misleading manner
Cluster C
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Anxious and fearful
Dependent
 Obsessive-compulsive
 Avoidant
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Dependent
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A pervasive and excessive need to be
taken care of that leads to submissive and
clinging behavior and fear of separation,
beginning by early adulthood and present
in a variety of context
Dependent PD
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Difficulty making everyday decisions
Needs others to assume responsibility
Difficulty expressing disagreement with others
Difficulty initiating projects
Goes to excessive lengths to obtain support
from others
Feels helpless and uncomfortable when alone
Unrealistically preoccupied with fears or being
left to take care of him/herself
Urgently seeks another relationship as a source
of care and support
Schema of Dependent PD
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I can’t function without the support of others
Without the advice and reassurance of others I
can’t exist
In any situation, I am probably wrong
Anger expression, people will abandon me
If I am abandoned, I will be destroyed
I must keep people near me
If I am alone, I may be hurt
Nursing Guidelines
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Identify and help address current stressors
Be aware that strong counter-transference
often develops in clinicians because of
client’s excessive clinging.
Evaluate client’s ability for self-care.
Avoid doing things the client is capable of
doing
Help client identify assets and liabilities
Emphasize strengths and potential.
Point out when client negates own feelings or
opinions
Obsessive-compulsive
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A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency,
beginning by early adulthood and present
in a variety of context:
“Niles” on “Frasier”
 Martha Stewart
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Obsessive-Compulsive PD
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Preoccupied with details, rules, lists, order,
organization, or schedules
Shows perfectionism that interferes with task
completion
Excessively devoted to work and productivity
Overconscientious, scrupulous, inflexible
Unable to discard worn-out or worthless objects
Reluctant to delegate tasks or work with others
Adopts a miserly spending style
Rigid and stubborn
Schema for OCPD
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There are strict rules in life
By focusing on details of a situation, one will
reduce the chances of making errors
A person is defined by what they do
The better the job you do the better person you
are
Rules must be adhered to without alteration
Emotions must be controlled
Nursing Guidelines
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Guard against engaging in power
struggles with client. Need for control is
very high in these clients
Intellectualization, rationalization, and
reaction formation are the most common
defense mechanisms
Avoidant
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A pervasive pattern of social inhibition,
feelings of inadequacy, and
hypersensitivity to negative evaluation,
beginning by early adulthood and present
in a variety of context:
Avoidant PD
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Avoids occupational activity
Unwilling to get involve with people
Avoids intimate relationship
Afraid of being criticized or rejected in social
situation
Views self as socially inept, personally
unappealing, or inferior to others
Reluctant to take personal risks or to engage in
any new activities
Schema for Avoidant PD
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I must be liked
I must not look foolish to myself or others
at any time
The world is a dangerous place
I must depend on others to take care of
me
Isolation is preferable to being put at risk
of being hurt
Nursing Guidelines
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A friendly, gentle reassuring approach is
the best way to treat clients
Being pushed into social situations can
cause extreme and severe anxiety
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Application of the Nursing
Process
Safety
Consistency
Boundary setting
Appropriate self-disclosure
The Nurse’s Response
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Self-awareness
Countertransference
Labels and stigma
Supervision
Resources
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http://www.bpdcentral.com
Borderline Personality Disorder Central is an organization
with information and resources for people who care about
someone who may have borderline personality disorder
(BPD).
http://www.bpdresourcecenter.org
The Borderline Personality Disorder Resource Center
(BPDRC) at New York–Presbyterian Hospital has been set
up to help those impacted by the disorder find the most
current, accurate information on the nature of BPD and on
sources of treatment.
http://www.mentalhelp.net/poc/center_index.php?id=8
This Mental Help Net link contains information about
personality disorders: types, treatment, research, literature,
and resources.