Personality disorders are characterized by enduring maladaptive patterns of behavior, cognition and inner experience that deviate significantly from the expectations of one's culture. There are several personality disorders classified in the ICD-10 and DSM-IV systems including paranoid, schizoid, borderline, histrionic and narcissistic disorders. Nursing interventions focus on providing a safe environment, explaining rules consistently, identifying triggers, monitoring for suicidal ideation and developing alternative coping strategies to dysfunctional behaviors.

1. Sub: MHN
Topic: personality
disorders
Prepared by:-
Parmar Monal.

2. • The term personality refers to
enduring qualities of an individual
that are shown in his ways of
behaving in a wide variety of
circumstances

4. • “An abnormal personality is one in
which there are deeply ingrained
maladaptive patterns of behavior
recognizable by the time of
adolescence or earlier and continuing
through most of adult life. Because of
this, the patient suffers or others have
to suffer, and there is an adverse
affect on the individual or on society.”
Definition

6. Classification
ICD10 DSMIV

7. ICD 10 CLASSIFICATION:
• F60-F69 Disorders of adult personality and
behavior
• F60 Specific personality disorders
• F60.0 Paranoid personality disorder
• F60.1 Schizoid personality disorder
• F60.2 Dissocial personality disorder
• F60.3 Emotionally unstable personality
disorder

8. CONTINU…
• F60.4 Histrionic personality disorder
• F60.5 Anankastic personality disorder
• F60.6 Anxious personality disorder
• F60.7 Dependent personality disorder
• F61 Mixed and other personality
disorders

9. CONTI…
• F62 Enduring personality changes, not
attributable to brain damage and
Disease
• F63 Habit and impulse disorders
• F64 Gender identity disorders
• F65 Disorders of sexual preference

10. DSMIV Classification:
• Cluster A (odd and eccentric): paranoid
schizoid, schizotypal personality disorder
• Cluster B (dramatic, emotional and erratic
antisocial, boarderline, histrionic, narcissistic
personality disorders
• Cluster C (anxious and fearful): avoidant,
dependent and obsessive-compulsive
personality disorders

11. DSMIV Classification
Cluster A
• Paranoid
• Schizoid,
• Schizotypal
(odd and
eccentric)
Cluster B
Antisocial,
Borderline,
Histrionic,
NArcissistic
(dramatic,
emotional and
erratic)
Cluster C
Avoidant,
Dependent
Obsessive-
compulsive
personality
disorders
(anxious
and
fearful)

12. Etiology:

13. Genetic
factor :
Biological
factors
Psychodynamic

14. Other Factors:
Maternal
deprivation
antisocial
personality
abuse in
childhood.
Borderline
personalities

15. CONTI…
failure to
resolve oedipal
complex
Histrionic
personality
fixation in the
oral stage of
development.
Dependent
personality

16. 1. Paranoid Personality Disorder

17. This disorder is marked by a distrust of
other people and constant
unwarranted suspicion that other
have sinister motives.

18. The signs and symptoms are:
• Suspicious
• Mistrustful
• Sensitive
• Argumentative
• Stubborn
• Self-important
• Hypersensitive
• Jealous and irritable

19. 2. Schizoid Personality Disorder

20. Schizoid personality disorder is characterized by
• detachment
• social withdrawal.
People with this disorder are commonly
described as
• loners,
• with solitary interests and occupations and
• no close friends;
• typically they maintain a social distance even
from family members and seem unconcerned
about other’s praise or criticism.

21. The signs and symptoms are:
• Emotionally cold
• Aloof
• Detached
• Humorless
• Introspective :
• No desire for or enjoyment of close
relationship
• Inability to experience pleasure

22. • Emotionally cold :
That person shows very little emotions
They have been told and conditioned to hide
their emotions

23. • Introspective :
self examination
Analyzing yourself
Looking at your own personality
Ex when you meditate to try to understand
your feelings

24. 3. Schizotypal Disorder

25. This disorder is marked by odd thinking and
behaviour, a pervasive pattern of social and
interpersonal deficit and acute discomfort with
others.

26. The signs and symptoms are
• Inappropriate affect
• Odd beliefs or magical thinking
• Social withdrawal
• Odd, eccentric or peculiar behavior
• Lack of close relationships
• Social isolation
• Not fitting easily with others

27. 4. Antisocial (Dissocial) Personality
Disorder (Sociopath, Psychopath):

28. Antisocial personality disorder is
characterized by
Chronic antisocial behaviour that violates
other right’s or social norms
which predisposes the affected person to
criminal behaviour.
The person is unable to maintain
consistent, responsible functioning at
work, school or as a parent.

29. The signs and symptoms are
• Failure to sustain relationships
• Disregard for the feelings of others
• Impulsive actions
• Low tolerance to frustration
• Tendency to cause violence
• Lack of guilt

30. CONTI…
• Failure to learn from experience
• Reckless disregard for own or others safety
• Impulsivity and failure to plan ahead
• Manipulative behavior for self-gratification
• Inability to maintain close personal or sexual
relationship

31. Nursing intervention
• convey the message that it is not him but his
behavior which is unacceptable.
• Maintain low level of stimuli
• Help the patient to identify the true objects
of his hostility
• Explore with patient alternative ways of
handling frustration
• Have sufficient staff available to present a
show of strength to patient if necessary

32. Conti..
• Administer tranquilizing medications
• Mechanical restraints may be necessary if the
patient is not calmed by 'talking down’ or by
medication.
• Explain consequences if limits are violated
• Provide positive feedback for acceptable behavior
• He must understand that certain behaviors will
not be tolerated within the society and that
severe consequences will be imposed upon those
individuals

33. 5.Borderline Personality
Disorder

34. • Borderline personality disorder is marked by
• a pattern of instability in interpersonal
relationships, mood, behaviour and self-
image.

35. The four main categories of
signs and symptoms are
• Unstable relationships
• Unstable self image
• Unstable emotions
• Impulsivity

36. Nursing intervention
• Observe patient’s behavior frequently
• avoid appearing watchful and suspicious
• Secure a verbal contract from patient that
he will seek out staff members for help when
urge for self-mutilation is felt
• Encourage patient to talk about feelings he
was having just prior to this behavior
• Rotate staff who works with the

37. 6. Histrionic Personality
Disorder

38. Patients with this disorder characteristically
have a
pervasive pattern of excessive emotionality and
attention seeking behaviour
and are drawn to momentary excitements and
fleeting adventures.

39. The signs and symptoms are
• Dramatic emotionality (Emotional blackmail,
angry scenes, demonstrative suicide
attempts, etc.)
• Craving for novelty and excitement
• Shallow and labile affectivity
• Attention-seeking behavior
• Over concern with physical attractiveness

40. CONTI..
• Exaggerated, vague speech
• Self dramatization
• Impulsivity
• Suggestibility
• Ego-centricity, self-indulgence and lack of
consideration for others

41. 7.Narcissistic Personality
Disorder

42. Patient with narcissistic personality
disorder is
• Self centred,
• self-absorbed and
• lacking in empathy for others.
• He typically takes advantage of people
to achieve his own ends, and uses
them without regard to their feelings.

43. The signs and symptoms are
• Attention-seeking, dramatic behavior
• Unable to face criticism
• Lack of empathy
• Exploitative behavior
• Arrogance
• Preoccupation with fantasies of success,
power, beauty, brilliance or ideal love

44. 8. Anxious (Avoidant)
Personality Disorder

45. Anxious (Avoidant) Personality Disorder is
marked by
• feelings of inadequacy,
• extreme social anxiety,
• social withdrawal and
• hypersensitivity to others opinions.
• low self-esteem and
• poor self-confidence;
• have difficulty viewing situations and
interactions
objectively.

46. The signs and symptoms are
• Persistent feeling of tension and appre-
hension
• Inferiority complex
• Fear of criticism, disapproval or rejection
• Unwillingness to become involved with people
• Excessive preoccupation with being criticized
or rejected in social situations

47. 9.Dependent Personality

48. Dependent Personality disorder is characterized
by an
• Extreme need to be taken care of,
• which leads to submissive,
• Clinging behaviour and
• fear of separation or rejection.
• People with this disorder let others make
important decisions for them and have a
• strong need for constant reassurance and
support.

49. The signs and symptoms are
• Subordination of one's own needs
• Unwillingness to make even reasonable
demands on other people
• Inability to take decision
• Feeling uncomfortable or helpless when alone
• Low self-esteem and lack of self-confidence
• Hypersensitivity to criticism

50. 10.Obsessive- compulsive
(Anankastic ) Personality Disorder

51. • This disorder is marked by a pervasive desire
for perfection and order at the expense of
openness,
• flexibility and efficiency.
• The individual places a great deal of pressure
on himself and others not to make mistakes.

52. The signs and symptoms are
• Feeling of excessive doubt and caution.
• Preoccupation with details, rules, lists, order
or schedule
• Perfectionism
• Rigidity and stubbornness
• High standards

53. TREATMENT MODALITIES

54. • Individual therapy
• Group therapy
• Therapeutic community
• Behaviour
• Occupational
• Recreational

55. NURSING INTERVENTIONS FOR
PATIENTS WITH PERSONALITY
DISORDERS
• Show acceptance of the person at all times
by separating the person from the behaviors.
• Provide a safe environment
• Explain all unit rules and enforce them fairly
and consistently.
• Explain all unit rules and enforce them fairly
and consistently.
• Identify inappropriate behavior and discuss
possible alternative behavior

56. Conti..
• Encourage the patient to openly express feelings
and thoughts
• Identify triggers of acting-out behaviors
• Communicate problems with manipulative
patients to other team members
• Monitor medication.
• Assess for suicidal ideation
• Develop a no-harm contract with the patient
with self-destructive tendencies
• Encourage the patient to keep a private journal
of thoughts and feelings.

57. summary