Personality Disorders

Various inflexible maladaptive behavior patterns/traits that may impair functioning and relationships

Usually remains in touch with realityLacks insight into behaviorsStress exacerbates manifestationsSevere cases may deteriorate into

psychotic state

CLUSTER “A”ODD – ECCENTRIC GROUP

Schizoid personalityScizo-typal personalityParanoid personality

Schizoid personality D/O

C/B inability to form close relationshipsSocial detachment/solitary lifeAloof/indifferentRestricted expression of emotionLacks interest in others

Schizotypal personality D/O

C/B exhibits abnormal /unusual thoughts,perceptions,speech,behavior patterns

SuspiciousParanoidMagical thinkingOdd thinking/speechRelationship deficits

Paranoid Personality D/O

C/B suspiciousness, mistrust of othersArgumentativeHostile aloofnessRigid, critical, controlling of othersGrandiosity

CLUSTER”C” Anxious – Fearful Group

Avoidant personalityDependent personality

Obsessive Compulsive personalityPassive- Aggressive personality

Avoidant Personality Disorder

C/B social withdrawalHypersensitive to rejection,criticismFeels inadequateSocial inhibitionLacks support system

Obsessive Compulsive Personality D/O

Need to control othersDifficulty expressing warmth/tendernessReflects perfectionism/devoted to workOverly conscientious/inflexiblePreoccupied with detailsMay hoard worthless objects

Dependent Personality disorder

C/B lack of self confidenceFears independence/lacks autonomyPassively allows others to make decisions

and assume responsibility for major areas of their life

Cannot tolerate being aloneNeeds others to make desicions

“CLUSTER B”

ERRATIC DRAMATIC GROUP

HISTRIONIC

NARCISSISTIC

ANTISOCIAL

BORDERLINE

Histrionic Personality D/O

C/B Overly dramatic, intensively expressive

Enjoys being the center of attentionPoor interpersonal relationshipsRomantic fantasies and control of

partnersEasily boredDisplays dependency

Narcissistic Personality D/O

C/B increased sense of self –importancePre-occupied with fantasies /unlimited

success/constant need for attention & admiration

Grandiosity/inflates accomplishmentsLacks empathy/sensitivity to others needs

Antisocial Personality Disorder

C/B irresponsible and antisocial behaviorSelf-centered, inability to maintain

relationships,irritability, unreliablePoor sexual adjustment/inability to delay

gratificationAggressive, impulsive, manipulativePoor judgmentConflict with authorityPoor work historyFailure to handle responsibility

Nursing Diagnosis

Ineffective Coping-r/t inability to form valid appraisal of stressors,inability to use available resources

EXPECTED OUTCOMESThe client will:

• Immediate- * Not harm self/others

• Identify behaviors leading to hospitalization

• Functions within limits of therapeutic mileu

Outcomes continuedThe client will:

• Stabilization-Demonstrate nondestructive ways to deal with

stress and frustration.Identify ways to meet own needs that do not

infringe on the rights of others• Community- Achieve /maintain satisfactory work performanceMeet own needs without exploiting or infringing

on the rights of others

Interventions

Provide model for mature appropriate behaviorObserve strict limit-setting by all staffBe consistent and firm with care plan –essential Monitor own responses to clientsDemonstrate concern/interestReinforce positive

behaviors(socialization.conforming to limits)Avoid power struggles

Borderline Personality Disorder

C/B unstable interpersonal relationshipsImpulsive/unpredictable behaviorsChronic feelings of emptinessExtreme shifts in mood/depressionEasily bored/argumentativeSelf-destructive behaviorsSplitting, manipulativeInability to tolerate anxiety

Nursing Diagnosis

Risk for Self- Mutilation- r/t impulsive behavior ; Displays of temper Inability to express feelings verbally; Physically self-damaging acts;Attention seeking behaviors; Ineffective coping skills

Ineffective coping- r/t inability to form valid appraisal of stressors; inability to use available resources

Social Isolation- r/t chronic feelings of boredom/emptiness;Manipulation of others;alternate clinging/avoidance behaviors

EXPECTED OUTCOMESThe client will:

Immediate-Be free from immediate injury; Not harm others or destroy property; Diminish efforts to manipulate staff or other clients(splitting-behaviors)

Stabilization- Eliminate acting-out behaviors;Verbalization of plans to moderate lifestyle

Community-Demonstrate effective problem-solving:Develop social support outside hospital

Interventions

Protect from self-mutilationSuicide assessmentEstablish therapeutic relationshipCalm approachSet limitsConsistent staff/planningPrevent client from manipulating other

clients/visitorsTeach relaxation techniques

Passive-Aggressive personality

C/B passively expresses covert aggression rather than dealing with it

ProcrastinatesStubbornIntentional inefficiencyForgetfulnessDependency

REVIEW QUESTIONS

The client with an antisocial personality d/o approaches various staff with numerous requests. The best response by the nurse would be:

a)Give the client a written list of permissible requests.

b) Have the client make requests only to the assigned staff person

c) Limit the client to the day room aread)Tell the client to remain in his or her room until

approached by staff

The nurse assesses a client to be at risk for self-mutilation, and implements a no-self-harm contract. The safety contract would be effective when the client:

a) withdraws to her room when feeling overwhelmed.

b) notifies staff when anxiety is increasingc) suppresses feelings of angerd) Talks to other clients about urges to hurt

herself

A 31 year old client with dependent personality d/o has been living at home with very supportive parents. He is making plans for Independent Living in the community. He tells the nurse “ I don’t know if I can make it on my without my parents.” The nurse responds therapeutically by saying:

a) “You are a 31 year old adult now, not a child who needs his parents to care for him.”

b) “ You and your parents need a break from each other; it will be good for both of you.”

c) “Your parents have been supportive and can continue to be even if you live apart.

d) “ Your parents won’t be around forever.”

When planning care for a client with Schizoid personality d/o, the most appropriate outcome would be for the client to:

a) Communicate effectively with his/her landlord

b) Express interest in a new hobby

c) Join a community group for socialization

d) Verbalize thoughts and feelings to peers