Chapter 24Personality
Development and Personality
Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Personality disorders are among the least
understood and recognized disorders in both
psychiatry and general medical care. They are
among the most common of the severe mental
disorders and occur frequently with other
illnesses (eg, substance use disorders, mood
disorders, anxiety disorders).
Personality Disorders Foundation, 2005
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Learning Objectives
After studying this chapter, you should be able to
• Define the terms personality and personality disorder
• Summarize the concepts of the following theories of
personality development: Freud’s psychoanalytic theory,
Erikson’s psychosocial theory, and Piaget’s cognitive
developmental theory
• Discuss the importance of a working knowledge of
personality growth and development in the mental health
setting
• Recognize factors that may contribute to the development
of behavioral disturbances in a client with paranoid
personality disorder
• Identify the characteristics of schizoid personality disorder
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Learning Objectives (cont.)
• Explain the importance of recognizing cultural
diversity in clients who exhibit disturbances in
cognition, affect, interpersonal relationships, and
impulse control
• Articulate four outcomes to reduce behavioral
disturbances in a client with the diagnosis of
borderline personality disorder
• Formulate a list of nonproductive reactions a nurse
may exhibit when working with clients who exhibit
clinical symptoms of antisocial personality disorder
• Develop an educational tool to use when interacting
with an elderly client who has clinical symptoms of
dependent personality disorder
• Construct a nursing plan of care for a client with the
diagnosis of histrionic personality disorder
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Theories of Personality Development
• Freud’s psychoanalytic theory of personality
development
• Erikson’s psychosocial theory of personality
development
• Piaget’s cognitive developmental theory
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Etiology of Personality Disorders
• Genetic factors
• Biologic factors
• Psychoanalytic factors
• Childhood experiences
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Characteristics of Personality Disorders
• Inflexible, socially unacceptable behaviors
• Self-centeredness
• Manipulative and exploitative behavior
• Inability to tolerate minor stress, resulting in increased
inability to cope with anxiety or depression
• Lack of individual accountability for behavior, blaming others
for their problems
• Difficulty dealing with reality due to a distorted or superficial
understanding of self and the perceptions of others
• Vulnerability to other mental disorders such as obsessive–
compulsive tendencies and panic attacks
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Clinical Symptoms and Diagnostic
Characteristics for Personality Disorders
• Cluster A disorders: odd, eccentric behavior
– Paranoid personality disorder
– Schizoid personality disorder
– Schizotypal personality disorder
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Clinical Symptoms and Diagnostic
Characteristics for Personality Disorders
(cont.)
• Cluster B disorders: emotional, erratic, or dramatic
behavior
– Antisocial personality disorder
– Borderline personality disorder
– Histrionic personality disorder
– Narcissistic personality disorder
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Clinical Symptoms and Diagnostic
Characteristics for Personality Disorders
(cont.)
• Cluster C disorders: anxious, fearful behavior
– Obsessive–compulsive personality disorder
– Dependent personality disorder
– Avoidant personality disorder
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Clinical Symptoms and Diagnostic
Characteristics for Personality Disorders
(cont.)
• Personality disorder, not otherwise specified
– Passive–aggressive personality disorder
– Depressive personality disorder
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The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
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Assessment
• Screening and assessment tools
• Disturbance of cognition
• Disturbance of affect
• Disturbance of interpersonal functioning
• Dysfunctional behavior (lack of impulse control)
• Transcultural considerations
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Nursing Diagnoses
• Disturbed thought
processes
• Disturbed thought
processes
• Anxiety
• Impaired verbal
communication
• Risk for other-directed
violence
• Disturbed sleep pattern
• Hopelessness
• Social isolation
• Ineffective coping
• Social isolation
• Ineffective coping
• Impaired social interaction
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Outcome Identification
Outcome identification for clients who exhibit personality
disorders generally focuses on the following:
• Improving their ability to differentiate reality from
fantasy
• Developing positive coping skills to reduce stress
• Improving impulse control and decreasing dysfunctional
behavior
• Developing skills to improve interpersonal relationships
• Developing insight into their illness
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Planning Interventions
When developing the plan of care, focus on the following:
• The client’s developmental needs that have not been
resolved
• Assisting the client in understanding identified problems
and anticipating possible future developmental stressors
• Direct nursing interventions at the specific behaviors,
characteristics, and symptoms that are common to an
identified disorder
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Implementation
• Assistance in meeting basic needs
• Symptom management
• Medication management
• Interactive therapies
• Client education
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Evaluation
• Evaluation of a client’s progress can be difficult.
• The client is able to manipulate or resist care, distort
perceptions, and transfer dependency needs to others.
• It may take several years to modify patterns of behavior
to meet stated outcomes.
• Clients may require repeated hospitalizations.
• Treatment of any personality disorder tends to be long
term and does not guarantee recovery.
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Key Terms
• Ego
• Projective identification
• Egocentrism
• Schemata
• Id
• Splitting
• Personality
• Superego
• Personality disorder
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Reflection
According to the chapter-opening quote by the
Personality Disorders Foundation, personality disorders
are among the least understood and recognized
disorders in both psychiatry and general medical care;
however, they are among the most common mental
disorders.
• Do you accept this statement to be true?
• If so, what can be done to increase awareness
of personality disorders?
• Explain your answers.
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?