Persons with histrionic personality disorder are excitable and emotional and behave in a colorful, dramatic, extroverted fashion. Inability to maintain sincere, long-lasting attachments. They are unaware of their true feelings and cannot explain their motivations. With age, the symptoms of histrionic personality disorder will come down. But patients will feel hard to handle it because they lack the energy they had earlier. Individuals with narcissistic personality disorder have a heightened sense of self-importance, lack of empathy and grandiose feelings of uniqueness. Underneath, however, their self-esteem is fragile and vulnerable to even minor criticism. Narcissistic symptoms diminish after 40 years of age. Persons with avoidant personality disorder show extreme sensitivity to rejection and may lead socially withdrawn lives. Although shy, they are not asocial and show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance. We often describe this group as having an inferiority complex. Some marry, have children, and live their lives surrounded only by family members. If their support system fails, however, they are subject to depression, anxiety, and anger.

1. HISTRIONIC, NARCISSISTIC &
AVOIDANCE PERSONALITY DISORDER
JUHIN J
2ndYEAR MSC- NURSING

2. OBJECTIVES
 What is meant by personality
 Define- Personality disorders
 What are the risk factors of personality disorders
 Classify- personality disorders
 Histrionic personality disorder
 Narcissistic personality disorder
 Avoidance Personality Disorder
 Management of personality disorders
 Nursing diagnosis of personality disorders

3. PERSONALITY DISORDERS
JUHIN J
2ndYEAR MSC- NURSING
CON, CMC,VELLORE

4. INTRODUCTION
 Personality means enduring qualities of a person in many circumstances.
 It includes perceptions, attitudes and emotions.
 These behaviors and characteristics are consistent across a broad range of
situations and do not change easily.
 A person usually is not consciously aware of his/ her personality.
 Many factors influence personality; some from biologic and genetic
makeup, whereas some are acquired as a person develops and interacts
with the environment and other people.
 These qualities develop into personality traits(Characters).

5. PERSONALITYTRAITS
“Five Factor Model”

6. PERSONALITY DISORDER
Personality disorder is defined as,
“characteristic and enduring pattern of
inner experience (or) behavior as a whole
marked deviation for a level of exception
and acceptable range of individuals’
culture”. - ICD 10

7. RISK FACTORS
 School dropouts
 Unemployment
 Divorced/ separated
 Unmarried
 History of child abuse
 Neglect from parents

8. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 International Personality Disorder Examination (IPDE)
 Mental status examination

9. CLASSIFICATION (ICD 10)
F 60: Specific personality D
 F60.0 Paranoid personality disorder
 F60.1 Schizoid personality disorder
 F60.2 Dissocial personality disorder
 F60.3 Emotionally Unstable
personality disorder
 F60.4 Histrionic personality disorder
 F60.5 Anankastic personality disorder
 F60.6 Anxious personality disorder
 F60.7 Dependent personality disorder
 F60.8 Other specific personality
disorder
 F60.9 Unspecified personality disorder
F 61: Mixed and other PD
 F61.0 Mixed personality disorder
 F61.1 Troublesome personality
changes
 F61.2 Enduring personality changes,
not attribute
F 62:
 F62.0 Enduring personality change
after catastrophic experience
 F62.1 Enduring personality change
after psychiatric illness
 F62.8 Other enduring personality
changes
 F62.9 Enduring personality change,
unspecified
F 68: Other disorders of
adult psychiatry and
behavior
F 69: Unspecified
disorders of adult
psychiatry and behavior
ICD 11:
It focuses on core personality
dysfunction, while allowing the
classification on three levels as mild,
moderate and severe personality
disorders.

10. CLASSIFICATION (DSMV)
Cluster A: Suspicious, Odd
nature
 Paranoid personality
disorder
 Schizoid personality
disorder
 Schizotypal personality
disorder
Cluster B: Dramatic,
emotional nature
 Antisocial personality
disorder
 Borderline personality
disorder
 Histrionic personality
disorder
 Narcissistic personality
disorder
Cluster C: Anxious or fearful
nature
 Avoidant personality
disorder
 Dependent personality
disorder
 Obsessive-Compulsive
personality disorder

11. HISTRIONIC PERSONALITY DISORDER
 Persons with histrionic personality disorder
are excitable and emotional and behave in a
colorful, dramatic, extroverted fashion.
 Inability to maintain sincere, long-lasting
attachments.
 They are unaware of their true feelings and
cannot explain their motivations.
 With age, the symptoms of histrionic
personality disorder will come down. But
patients will feel hard to handle it because
they lack the energy they had earlier.

12. EPIDEMIOLOGY
 Prevalence of histrionic personality disorder is about 2%.
 Occurs frequently in women.
 There is a genetic link between histrionic - antisocial personality
disorder & alcohol use disorder.
 Patients with histrionic personality disorder are at increased risk
for major depression, somatic symptom disorder, and conversion
disorder.
 Narcissistic, borderline, antisocial, and dependent are the most
common co-occurring personality disorders.
EPIDEMIOLOGY
COMORBIDITY

13. CLINICAL MANIFESTATION - H
 High level of attention seeking
 Uncomfortable when they are not the center of attention.
 Flirtatious, provocatively sexual
 Speech and emotions are exaggerated
 Ego centric
 Not concerned with others
 Overestimates the intimacy of relationships
 Easily offended or hurt

14. DIFFERENTIAL DIAGNOSIS - H
 In Borderline personality disorder- suicide attempts, identity
diffusion and brief psychotic episodes
 Somatic symptom disorder
 Brief psychotic disorder
 Dissociative disorders

15. MANAGEMENT - H
Pharmacological management
• Antipsychotics (derealization, illusions)
• Antidepressants (depression, somatic complaints)
• Antianxiety (anxiety)
Non- Pharmacological management
• Psychotherapy

16. COMPLICATIONS - H
 Frequent suicidal gestures and threats to get better caregiving
 Interpersonal relations that are unstable
 Frequent marital problems
 Tendency to neglect long-term relationships for the excitement
of new relationships.

17. NARCISSISTIC PERSONALITY DISORDER
 Individuals with narcissistic personality
disorder have a heightened sense of self-
importance, lack of empathy and
grandiose feelings of uniqueness.
 Underneath, however, their self-esteem
is fragile and vulnerable to even minor
criticism.
 Narcissistic symptoms diminish after 40
years of age.

18. EPIDEMIOLOGY
 The prevalence of narcissistic personality disorder is <1% in general
population and 2% -16% in clinical population.
 More common in men.
 These patients are at increased risk for major depression and
substance use disorders (especially cocaine use).
 The most common co-occurring personality disorders are
borderline, antisocial, histrionic, and paranoid.
EPIDEMIOLOGY
COMORBIDITY

19. CLINICAL MANIFESTATION - N
 Grandiose sense of self importance
 Exploiting others, Arrogance
 Poor handling of criticism, gets enraged
 Fragile self-esteem, susceptible to depression
 Needing others to admire them
 Jealous of others’ success
 Assuming others are jealous of them
 Interpersonal difficulties, occupational problems, rejection and
loss

20. DIFFERENTIAL DIAGNOSIS - N
• Borderline personality disorder(>anxiety, >chaotic, suicide attempt)
• Histrionic personality disorder (exhibitionism, interpersonal manipulativeness)
• Antisocial personality disorder(impulsive behavior, alcohol/ substance use- law violation)
• Grandiosity of mania(euphoria, hypomanic episode)

21. MANAGEMENT - N
Pharmacological management
• Lithium (mood swings)
• Antidepressants (depression)
Non- Pharmacological management
• Psychotherapy
• Group therapy

22. COMPLICATIONS - N
 Social withdrawal
 Depressed mood
 Dysthymic/ major depressive disorder

23. AVOIDANT PERSONALITY DISORDER
 Persons with avoidant personality disorder show
extreme sensitivity to rejection and may lead
socially withdrawn lives.
 Although shy, they are not asocial and show a
great desire for companionship, but they need
unusually strong guarantees of uncritical
acceptance.
 We often describe this group as having an
inferiority complex.
 Some marry, have children, and live their lives
surrounded only by family members. If their
support system fails, however, they are subject
to depression, anxiety, and anger.

24. EPIDEMIOLOGY
 Prevalence of this disorder is about 0.5% to 2% in general
population.
 It occurs in men and women equally.
 Increased risk for mood and anxiety disorders
 Most common cooccurring personality disorders are schizotypal,
schizoid, paranoid, dependent, and borderline. Somatic symptom
disorder may be comorbid.
EPIDEMIOLOGY
COMORBIDITY

25. CLINICAL MANIFESTATION - A
 Hypersensitivity to rejection
 Lack of confidence, insecure
 Fear being disliked
 Feels inferior
 Fear of responsibility and leadership
 Craves acceptance
 Avoids relationships for fear of shame
 Fear or sensitive to rejection/ criticism
 Avoids activities/ situations perceived as risky

26. DIFFERENTIAL DIAGNOSIS - A
• Social anxiety disorder(specific situations, IPR - avoided)
• Panic disorder (agoraphobia also manifest avoidance)
• Schizoid and schizotypal Personality D(wish to be alone)
• Borderline & Histrionic PD(demanding, irritable, unpredictable)
• Dependent PD(fear of being abandoned, unloved)

27. MANAGEMENT - A
Pharmacological management
• Antidepressants (depression)
• Antianxiety (anxiety)
• Beta adrenergic receptor(hyperactivity)
Non- Pharmacological management
• Psychotherapy
• Group therapy
• Assertiveness training

28. NURSING MANAGEMENT
For manipulative patients
• Effective communication strategies
• Ways to promote healthy interaction and functioning
• Patient and family education
• Ways to reduce/ prevent violence to self or others
For dependent patients
• Effective communication strategies
• Ways to encourage more independent functioning
• Ways to promote healthy and appropriate expression of feelings
• Ways to prevent aggression
• Patient and family education
For angry patients

29. NURSING PROCESS
• Risk for injury
• Impaired Social interaction
• Low self esteem
• Maladaptive social behavior
• Ineffective therapeutic regimen
• Ineffective individual coping
• Ineffective family coping

30. RISK FOR INJURY EVIDENCED BY LOW SELF-ESTEEM, KEEPING
SHARP OBJECTS AND THREATENING TO HARM HIMSELF.
• Initiate a nurse patient relationship
• Inform the patient to notify staff when anxiety is increasing
• Vigilant observation is needed
• Remove all potentially dangerous objects from the patient
and environment
• Administer medications as per order
Nursing Interventions:

31. IMPAIRED SOCIAL INTERACTION EVIDENCED BY INCONSISTENT
BEHAVIOR, FRAGILE RELATIONSHIP, ANGER OUT BURSTS.
• Develop mutual behavioral goals
• Communicate honest responses to the patient’s behavior
• Provide honest, immediate feedback about the behavioral
change
• Maintain confidentiality
Nursing Interventions:

32. LOW SELF-ESTEEM EVIDENCED BY LACK OF INITIATION,
PESSIMISTIC THINKING, FEELING OF SHAME AND GUILT.
• Describe interpersonal strength and weakness
• Provide opportunities to demonstrate strengths such as
helping other patients, assuming leadership roles.
• Help to analyse experiences that are perceived as failures.
• Communicate acceptance of the patient as a person while
not accepting maladaptive social behavior.
Nursing Interventions:

33. INEFFECTIVE THERAPEUTIC REGIMEN EVIDENCED BY RELUCTANCE OR
REFUSAL TO TAKE MEDICATION, INADEQUATE ATTENTION TO MEET
REST AND SLEEP, INABILITY TO CARRYOUT DAILY ACTIVITIES.
• Tell the patient to take medications as prescribed.
• Check the patient’s mouth, if necessary, after giving oral
medications.
• Explain the patient that medications are part of treatment plan
and that he/she is expected to take them.
• Be straight forward and specific with patients, when giving
information about medications.
• Observe the patient’s eating, drinking and elimination patterns
and assist the patient as necessary.
Nursing Interventions:

34. A study was conducted among employees and students. 230
participants(176- employed/ retired; 54- university students) were selected as
samples and data was collected using self-made questionnaire prepared with
the help of Oldham & Morris personality style. There was a tendency for people
to believe that people with OCD are suitable for Accountancy; Narcissism and
Paranoia are suitable for General Management; Histrionic is suitable for Acting
and Schizotypal is suitable in making Art. But the results revealed that Paranoid
and Sadistic people were good managers whereas Histrionic, Passive Aggressive
and Schizotypal were the worst. (Adrin, Kelly, 2019)
JOURNAL DISCUSSION
Journal of Mental Health, Mental health literacy, sub-clinical personality disorders and job fit,Vol 28(3), 2019, P. 249-254

35. A study was conducted among young adult women with an aim to
examine the relationship between narcissism and sexual coercion. 101 young
adult females (who were in a romantic relationship belonging the age group of
18- 29) were selected as samples. Data was collected using Narcissistic
Personality Inventory(NPI) and Sexual Coercion in Intimate Relationships
Scale(SCIRS). The results revealed that sexual coercion was influenced by
narcissism.
JOURNAL DISCUSSION
The International Journal of Indian Psychology, Impact of Narcissism on Sexual Coercion inYoung AdultWomen,
Vol 9(2),2021

36. ANY DOUBTS

37. SUMMARY

38. REFERENCE
Books:
Kaplan and Sadock’s.(2022). Synopsis of Psychiatry (12th ed.). P. 1778-1780
Lalitha.(2015). Mental Health and Psychiatric Nursing- An Indian Perspective. P. 430-456
Mary C. Towsend.(2015). Psychiatric Mental Health Nursing (8th ed.). P. 674 -698
Prakash.(2020). Mental Health and Psychiatric Nursing. P. 274-279
Sheila L. Videbeck.(2015). Psychiatric - Mental Health Nursing (5th ed.). P. 319-343
Subash Indra Kumar.(2014). Psychiatry and Mental Health Nursing. P. 624
Internet:
https://www.livescience.com/41313-personality-traits.html

39. PERSONALITY DISORDERS
JUHIN J
2ndYEAR MSC- NURSING
CON, CMC,VELLORE

40. THANKYOU