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1. Personality disorders.
Vilimaina Takayawa
NK 712 Lecture Notes

2. Learning outcomes
At the end of this unit, the student is able to:
1. Determine personality and personality disorders
2. discuss the etiologies of personality and its
disorders
3. Describe the clusters of personality disorders
under DSM IV
4. Elaborate on the causative theories of personality
disorders
5. Strategize the management and treatment of
personality disorders.

3. What is Personality?
• is derived from the Greek term persona.
• It is what distinguishes an individual.
• Individual qualities include: habitual behavior
patterns, that make a person unique.
• is an ingrained enduring pattern of behaving
and relating to self, others and the
environment

4. Cont..
• Behaviors and characteristics are consistent
across a broad range of situations and do not
change easily.
• A person is usually not aware of his/her
personality.
• Some re acquired as they develop and
interact with the environment and other
people.

5. Personality Traits (
• Enduring patterns of perceiving,
relating and thinking about oneself
and the environment.
• Exhibited in a wide range of social and
personal contexts (APA, 2000)

6. The ‘Big 5’ of Personality Traits
• Openness to experience
• Conscientiousness
• Extraversion
• Agreeableness
• Neuroticism
*personality disorders represent extreme
variations of OCEAN

7. What is personality disorder?
 Is diagnosed when personality traits become
inflexible and maladaptive.
 It significantly interferes with how a person
functions in society or cause the person
emotional distress.
 Not diagnosed until adulthood-when
personality is more completely formed.
 Inability to fulfil family, academic,
employment and other functional roles.

8. Cont’d
 They are and do not change easily and
neither by medications
 They continue to behave in their same
familiar ways, even when these behaviors
cause them difficulties or distress.
 Therapy often take long term with slow
progress

9. Etiology
1.Biological theories.
• Personality develops through the
interaction of hereditary dispositions and
environmental factors.
• Has four Temperament/Behavioural
Traits.
• Genetic differences account for about 50%
of the variances in temperament traits.

10. Cont.- Temperament/Behavioral Traits
• There are four:
1. Harm avoidance
2. Novelty seeking
3. Reward dependence
4. Persistence
• affects a person’s automatic responses to
certain situations
• ingrained by 2-3 years of age (Svrakic &
Cloninger,2005).

11. Cont. Behavioral traits
1. High harm avoidance – exhibit fear of
uncertainty, social inhibition, shyness with
strangers, rapid fatigue, and pessimistic worry
in anticipation of problems.
Low harm avoidance - care free, energetic
outgoing and optimistic –may result in
unwarranted optimism and unresponsiveness
to potential harm or danger.

12. Cont. Biological theory
2. High novelty seeking – someone who is
quick tempered, curious, easily bored,
impulsive, extravagant and disorderly-person
who is easily distracted, are prone to anger
outbursts and fickle in relationships.
Low novelty seeking - is slow tempered,
reflective, frugal, reserved ,orderly, tolerant of
monotony, he or she may adhere to a routine
of activities.

13. Cont. Biological theory
3.High Reward dependence – tenderhearted,
sensitive, sociable and socially dependent-may
become overly dependent on approval from
others and readily assume the ideas or wishes
of other people without considering their own.
Low reward dependence – people who are
practical, tough minded, cold, socially,
irresolute and indifferent to being alone-
resulting in socialwithrawal, aloofness and
disinterest in others.

14. Cont’d. Biological theory
4.High persistent - hardworking and ambitious
overachievers who respond to fatigue or frustration
as a personal challenge-may persevere even when
a situation dictates they change or stop.
Low persistence - inactive,indolent,unstable and
erratic.
Tend to give up easily when frustrated and rarely
strive for higher accomplishments.

15. 2. Psychodynamic Theories
• Character are concepts about the self and the
external world.
• It develops over time as a person comes in contact
with people, situations and confronting challenges.
• Three major character traits :
1.Self directedness
2.Cooperativeness
3.Self-transcendence
(Svrakic & Cloninger,2005).

16. Cont. Psychodynamic Theory
1. High Self-directedness – is responsible, reliable,
resourceful ,goal-directed and self confident.
Realistic and effective and can adapt their behavior
to achieve goals.
Low self-directedness - are
blaming,helpless,irresponsible and unreliable-they
cannot pursue meaningful goals.

17. Cont.. Psychodynamic
2.High Cooperativeness – people are empathic,
tolerant, compassionate, supportive and principled.
Low cooperativeness - people are self absorbed,
intolerant, critical, unhelpful, revengeful and
opportunistic
They look out for themselves without regard for the
rights and feelings of others.

18. Cont’d…Psychodynamic
3.High Self transcendence - spiritual
people,unpretentious,humble and fulfilled
• Helpful in dealing with sufferings, illness or death.
Low self-transcendence-are people who are
practical, self conscious, materialistic and controlling
They have difficulty accepting suffereing,loss of
control, personal & material losses and death.

19. Summary-Psychodynamic
• Character matures in stepwise stages from
infancy through late adulthood.
• Psychological development analyzed by Freud
and Erickson
• Each stage have an associated developmental
task that the person must perform for mature
personality development.
• Failure to complete a developmental task
jeopardizes the person’s ability to achieve
future developmental tasks.

20. Summary of the 2 theories.
• Personality develops in response to inherited
dispositions(Temperament) and
environmental influences(Character) which
are experiences unique to each person.
• Personality disorders result when the
combination of temperament and character
development produces maladaptive,
inflexible ways of viewing self, coping with
the world and relating to others.

21. Classification under DSM IV
• There are 10 personality disorders
• are grouped into three clusters on the basis of
descriptive features.
• They are cluster A, B & C.
Cluster A – people with odd/eccentric behavior.
Cluster B:- dramatic, impulsive, and erratic
behavior
Cluster C: - those who are Anxious or fearful

22. Cluster A
1.Paranoid
2.Schizoid
3.Schizotypical

23. 1. Paranoid personality disorder.
(mistrust)
• Is pervasively, unjustifiably suspicious, bear
grudges and quick to counterattack,
mistrustful, as evidenced by jealousy,
accusations of infidelity and guardedness.
• Hereditary – parental antagonism and
harassment (learn to perceive the world as
harsh and unkind
• Restricts feelings, as evidenced by lack of
humor, absence of sentimental or tender
feelings, pride in being cold and unemotional.

24. 2. Schizoid personality disorder
(nonreactive)
• Is introvert, emotionally cold, aloof and
notably lacking nurturing.
• Shows indifference to the praise or criticism of
others.
• Has little or no desire for social or sexual
involvement.
• Does not desire or enjoy close relationship
• Common in males.

25. 3. Schizotypal personality disorder
(fantasy)
• Manifest various oddities of thought,
perception, speech, affect & behavior.
• Such as ideas of reference, bizarre
fantasies & preoccupation.
• Is suspicious & hypersensitive to real or
imagined criticism.
• Isolates self from society because of acute
discomfort.

26. Cluster B
1. Borderline
2. Histrionic
3. Narcissistic
4. Antisocial

27. 1.Borderline personality disorder
(unstable)
• Is impulsive, unpredictable in areas of life that
are self damaging. inflict physical self-harm.
• Has unstable mood; is uncertain about identity,
may experience severe dissociative symptoms.
• Patients can be argumentative at one moment,
depressed the next, and later complain of
having no feelings.
• Poor interpersonal relationships

29. 2. Histrionic Personality disorder
• Is overly dramatic, needs to be center of
attention, express self in theatrical fashion
• Very self-centered, attention seeker, irrational
outburst of emotions.
• Very seductive/flirtatious - uses appearance ,
style of speech to draw attention to self.
• Relationship –viewed as more serious/intimate
than they actually are.
• Repression and dissociation are used as defense
mechanism

30. Cont..
• Tend to exaggerate their thoughts and
feelings and make everything sound more
important than it really is.
• Display temper tantrums, tears, and
accusations when they are not the center
of attention or are not receiving praise or
approval.
• Is suggestible and overrates the intimacy of
relationships.

32. 3. Narcissistic personality disorder
(strive for power)
• Has grandiose sense of self importance.
• Is preoccupied with fantasies of unlimited
success, power, beauty, brilliance etc.
• Shows an arrogant attitude based on
feeling of entitlement.
• In relationships with others, expect special
favors.
• Take advantage of others, lacks ability for
empathy.
• Below surface is a fragile self-esteem

33. Cont..
• Grandiose sense of self-importance and
they consider themselves special and
expect special treatment.
• Handle criticism poorly
• Relationships are fragile
• Interpersonal difficulties, occupational
problems, rejection are common.

34. 4.Antisocial personality disorder
(antisocial)
• Engages in behaviors that causes conflict
with society, such as theft, vandalism,
fighting, delinquency, truancy, lying,
substance abuse, and illegal activities
• unable to sustain consistent work or
function as a responsible parent or spouse.
• Cannot maintain an enduring attachment to
a sex partner.
• Lacks guilt, respect, loyalty, blames others,
irritable, aggressive.

35. Cont’d.
• Child abuse, and drunk driving are common events
in their lives.
• Manipulate others for personal gain, don't plan
ahead or learn from past experiences.

36. Cluster C
1.Avoidant
2.Dependent
3.Obsessive-compulsive

37. 1. Avoidant personality disorder
(shy)
• Clients who are shy, introverted, lacking
self confidence, extremely sensitive to
rejection.
• Is unwilling to become others unless given
a guarantee of acceptance.
• Withdraws socially in interpersonal, work
roles; avoid new situations.
• Desires affection, acceptance yet shows.
• Afraid to speak up in public(timidity)

39. 2. Dependent personality disorder
(dependent)
• Passively allows others to assume
responsibility for major areas of life.
(Avoid positions of responsibility and become
anxious if asked to assume a leadership role)
• Lacks self confidence and initiative.
• Submissive , clingy behaviour
• Fears being alone so urgently seeks a close
relationship(Sense of attachment).
• Easily hurt by criticism

40. Cont...
• Cannot make decisions without advice
• Pessimism, self-doubt, passivity, and
fears of expression sexual and
aggressive feelings.

41. 3.Obsessive-compulsive personality
• Preoccupied with rules, regulations,
orderliness, neatness, details, and the
achievement of perfection.
• Excessive doubt and caution.
• Perfectionism
• Rigidity
• stubbornness
• High standards

42. Treatment
• Despite the prevalence of PD they are
notoriously frustrating to treat.
• Although people usually improve in terms of
clinical and statistical significance, they might
not reach normalcy.
• Principles of care are;
Monitor signs of self-harm& suicidality.
Ensure consistency of care among treatment
team.
Enact firm, fair and consistent limit setting on
client.

43. Cont’d…
Involve client in setting limits &
determining consequences.
Interactive therapies.
• Cognitive behavioral therapies aim to help
people to develop more efficient coping
mechanism.
• Dialectical behavioral therapies similar to
CBT but it also actively incorporates social
skill training.
Pharmacological interventions.
• Medication has been of limited use.

44. Cont…
• Antipsychotics are used for cluster-A PD.
• Mood stabilizers such as lithium and
anticonvulsants are may help in cluster-B PD.
Therapeutic community.
• To create a social environment conducive to
personal development.
• Mainly this style is to seek minimal hierarchical
power, so as to maintain equality between
staff and clients.

45. Client teaching/ care.
• Approach people with Cluster A disorders
in a gentle, interested, and nonintrusive
manner that is respectful of the client’s need
for distance and privacy.
• Clients with Cluster B disorders require
much more patience and structure on your
part. The milieu must be consistent to avoid
manipulation and power struggles.
• In client with Cluster C disorders, it is
helpful to point out their avoidance
behaviours and secondary gains. Problem
solving and assertiveness training help them
become more independent.

46. Cont…
• The three fundamental beliefs guiding
nursing practice are self-determination, role
functioning, and maintaining hope.
• The first priority of care is safety from
suicide and self-mutilation. Clients must be
protected until they can protect themselves.
Anti-harm contracts may help maintain
safety.
• The problem solving process is used to
determine positive coping alternatives in
response to thoughts of self-harm.

47. Cont…
• Manipulative clients need a highly
structured approach. Nurses may need
frequent staff reports and supervision to
counteract the client’s ability to play one
staff member against the other.
• Helpless and dependent clients need
interventions to increase their coping skills
and develop a more independent style of
functioning. Problem solving, social skills
training, and assertiveness training are
effective interventions.

48. Cont…
• Group therapy helps client’s focus on
interpersonal issues as they get feedback
from more than one person and have the
opportunity to be therapeutic with other
group members.
• Clients need to learn how to make their own
decision to reinforce an internal locus of
control. Using the problem solving process
helps them see the variety of choices that
can be made, tested, and evaluated.
• Provide enough distance and privacy to
prevent escalation of anxiety.

49. Cont…
• Promote clients’ realistic self-appraisal
through discussion of abilities and
limitations.
• Help clients acknowledge that an anxiety-
free life is impossible, which may help
them give up striving for perfection.
• Avoid power struggles and help client’s
accept responsibility for their own
behaviour.
• Discuss how fear of rejection may interfere
with seeking help from others when
appropriate .

50. Reference
Elder, R., Evans., & Nizette., (2013) Psychiatric and Mental Health
Nursing. (3rd Edition). Mosby, Elsevier
Evans J. & Brown P(2012),Mental Health Nursing-First Australian
Edition, Lippincott Williams & Wilkins, Philadelphia.
Fortinash.H Worret (2012),Psychiatric Mental Health Nursing,(5th
ed),Elsevier, Mosby.
Townsend, M. C. (2015) Psychiatric Nursing: Assessment, Care
Plan and Medications. (9th Ed). Philadelphia: F. A Davis
Company.
Varcarolis, E.M. (2015) Manual of Psychiatric Nursing Care
Planning-Assessment Guides Diagnoses Psychopharmacology. (5th

51. The End!
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