The document discusses personality and personality disorders. It defines personality as enduring patterns of perceiving, relating to, and thinking about oneself and the environment. Personality disorders are diagnosed when inflexible personality traits significantly impair functioning or cause distress. The document outlines several theories of personality development and classifies personality disorders into three clusters (A, B, and C) based on common characteristics.

1. Presenter: Ms Ritika Soni

4. oThe word PERSONALITY is derived from the Greek
term ‘persona’.
oIt was used originally to describe the theatrical mask
worn by some dramatic actors at the time of shooting.
o Over the years, it came to represent the person
behind the mask—the “real” person.
oPersonality psychology – Sigmund Freud, Alfred Adler, Gordon
Allport, Hans Eysenck, Abraham Maslow, Carl Rogers.
oTrait based personality theories- Raymond Cattell.

5. or
• Personality is often defined as an organized
combination of attributes, motives, value, and
behaviors unique to each individual.
• APA, 2000, defines personality traits as, “Enduring
patterns of perceiving, relating to, and thinking
about the environment and oneself, which are
exhibited in a wide range of important social and
personal contexts”.

7. • Personality disorders are “enduring
patterns of perceiving, relating to, and
thinking about the environment and
oneself” that “are exhibited in a wide
range of important social and personal
contexts,” and “are inflexible and
maladaptive, and cause either significant
functional impairment or subjective
distress”
(DSM-IV, p. 630)

8. Personality disorders
Personality disorders are diagnosed when
personality traits become inflexible and
maladaptive and significantly interfere with how
a person functions in society or cause the person
emotional distress.
• They usually are not diagnosed until adulthood,
when personality is more completely formed.
• No specific medication alters personality, and
therapy designed to help clients make changes is
often long-term with very slow progress.

9. Characteristics of P.D.
• Not a mental illness , it is a maladaptive behavior.
• Markedly disharmonious attitude and behavior in several areas of
functioning e.g.: affectivity, impulse control, ways of perceiving &
thinking etc.
• The person denies the maladaptive behaviors he exhibits, they have
become a way of life for him.
• The maladaptive behaviors are inflexible.
• Minor stress is poorly tolerated, resulting in
inability to cope with anxiety.
• Ego functioning is defective, therefore,
it may not control impulsive action of id.
• Disturbance of mood, such as anxiety or depression.

10. Statistics and Incidences
Personality disorders are relatively common, occurring in 10% to 13% of the
general population.
• 15% of all psychiatric inpatients have a primary diagnosis of a personality
disorder.
• 40% to 45% of those with a primary diagnosis of major mental illness also have a
coexisting personality disorder that significantly complicates the treatment.
• In mental health outpatient settings, the incidence of personality disorder is
30% to 50%.
• Clients with personality disorders have a higher death rate, especially as a
result of suicide; they also have higher rates of suicide attempts, accidents, and
emergency department visits and increased rates of separation, divorce, and
involvement in legal proceedings regarding child custody.
• Personality disorders have been correlated highly with criminal behavior (70%
to 85% of criminals have personality disorders), alcoholism (60% to 70%
alcoholics have personality disorders), and drug abuse (70% to 90% of those who
abuse drugs have personality disorders).

11. • Biological influences:
Genetics, neurologic deficit, low level of serotonin,
family h/o alcoholism & other P.D.
• Childhood Experiences- maladaptive behaviour,
Excessive pampering, lack of parental care
- Receiving reward for behaviour such as temper
tantrum encourages acting out(the parents gives in
to a child’s wishes rather than setting limits to stop
the behaviour).
- Creativity is not encouraged in the child; the child
doesn't have the opportunity to express himself .
- Rigid upbringing during childhood also has a –ve
effect on the development of child’s personality.
• Defective ego through which they are unable to
control their impulsive behaviour.
• Verbal abuse/physical abuse/Sexual abuse, any
traumatic experiences.
• A weak superego results in the incomplete
development or a lack of conscience
• High reactivity: Overly sensitive and
dissatisfaction of individual’s needs.

14. Cluster A: (odd or eccentric). P.D, Thought
to be on a ‘schizophrenic continuum’.
a) Paranoid P.D
b) Schizoid P.D
c) Schizotypal P.D.
Cluster B:(dramatic, emotional, or erratic)
P.D, thought to be on a ‘psychopathic
continuum’
a) Antisocial P.D
b) Histrionic P.D
c) Narcissistic P.D
d) Borderline (emotionally unstable) P.D
Cluster C: (anxious or fearful)
P.D, thought to be on a ‘introversion’.
a) Anxious (avoidant ) P.D
b) Dependent P.D
c) Obsessive- compulsive (Anankastic) P.D.
d) Passive-aggressive P.D

17.  Suspects, that others
are exploiting, harming, or
deceive her / him.
 Unjustified doubts about
a friend associates loyalty
or trustworthiness.
 Unwilling to discuss
personal matters to
others.
 Finds hidden demeaning
or threatening meanings.

18.  Unable to forgive and bears
grudges. He /she cannot
forgive insults, traumatisms
or underestimating him/ her.
 Perceives attacks against
his/her personality or
reputation and counteracts
with anger.
 Has recurrent groundless
suspicions, regarding the
faithfulness of his wife/ her
husband or sexual partner,
without justification..

20. • Few, if any, activities provide
pleasure.
• Emotional coldness, detachment or
flattened affectivity.
• Almost always chooses solitary
activities.
• Lack of close or trustful friends.
• Appears indifferent to praise or
criticism.
• Excessive preoccupation with
fantasy and introspection.
• Limited capacity to express either
warm, tender feelings or anger
towards others.

22. • Inappropriate or constricted affect.
• Poor rapport with others & a tendency to
social withdrawal.
• Ideas of reference
• Magical thinking or odd beliefs.
• Odd perceptual experiences.
• Odd thinking or speech.
• Suspiciousness or paranoid ideation.
• Unusual perceptual experiences including
somatosensory or other illusions,
depersonalization or derealization.

24. Cluster B: Behaviors described as
dramatic, emotional, or erratic.
Antisocial
Borderline
Histrionic
Narcissistic

27. • Callous unconcern for the feelings of others.
• Persistent attitude of irresponsibility and
disregard for social norms, rules& obligations.
• Inability to follow society rules according to
lawful behaviour.
• Repeated lying, use of false
names etc.
• Failure to plan ahead or being impulsive
Irritability and aggressiveness.
• Very low tolerance to frustration & a low
threshold for discharge of aggression,
including violence.
• Constant negligence & incapacity to
experience guilt.
• Marked proneness to blame others, or
to offer rationalizations for behavior.

28. • Acc. To ICD-10, emotionally unstable P.D. is
described as a disorder in which there is
marked tendency to act impulsively without
consideration of consequences, together
with affective instability.
• Further classified in to two :
- Impulsive type
- Borderline type

29. 1. Impulsive type:
• Emotional instability
• Lack of impulse control
• Outburst of violence, or
threatening behavior.
2. Borderline type:
• Instability in affect due to
intense reactivity of mood.
• Long lasting feelings of
emptiness, intense anger or
difficulty in controlling anger.
• Disturbed self image/identity of
self. e.g:who I am
• Series of suicidal threats or act
of self harm, suicidal gesture
OR accident proneness
• Unstable IPR pattern.

31. • Self- dramatization, exaggerated expression of emotions.
• Intense unstable interpersonal relationships
• Continual seeking for excitement, appreciation by others,
& activities in which the person is the center of attention.
• Shows inappropriate provocative or seductive manner.
• Shows shallow and rapid changing of emotion.

32. • Uses appearance to draw attention.
• Speech that lacks in detail and
excessively impressionistic.
• Suggestibility, easily influenced by others or
circumstances.

34. • Has grandiose sense of self-
importance.
• Is preoccupied by fantasies of
unlimited success, power,
brilliance, beauty or ideal love.
• Has a belief of being special and
unique.
• Demands excessive admiration.
• Has a sense of special rights.
• Attention seeking, dramatic
behavior, needs constant praise and
unable to face criticism.
• Lack of empathy with others with
exploitative behavior
• Shaky self esteem, sense of inferiority
and easily depressed by minor events.

35. Avoidant
Dependent
Obsessive–compulsive

36. • Persistent and pervasive feelings of tension and
apprehension.
• Avoids professional activities that involves
important interpersonal contact.
• Is unwilling to get involved due to a fear of not
being liked by others.
• Shows restraints in intimate relationships due to a
fear of shame.

37. • Has great worry
whether she/ he will be
criticized or rejected by
others.
• Keeps back from new
Interpersonal situations due
to feelings of inadequacies.
• Views oneself as
inferior, socially inept, or
personally unappealing.
• Is unwilling to takes part in
new activities, for a fear of
being embarrassed.

38. • Encouraging or allowing others to make most of one’s
important life decisions.
• Needs others to take the responsibility for the
major areas of his / her life.
• Difficulty in doing things on their own.
• Feeling uncomfortable /helpless when alone, because
of exaggerated fears of inability to care for oneself.

39. • Feels uncomfortable on its own as
he/she fears that cannot look after
himself/herself.
• When one close relationship is
over he/she is compelled to seek a new one.
• Limited capacity to make everyday
decisions without any excessive amount of
advice and reassurance from others.

41. • Has marked preoccupation with
details, lists, order, organization, rules,
or schedules.
• Has marked perfectionism that
interferes with the completion of the
task.
• Is exceedingly devoted to work and
productivity.

42. • Is over conscientiousness, meticulous
and inflexible in matters of morality,
ethics or values.
• Is unable to throw out worn-
out, useless, or worthless
objects, with no sentimental value.
• Feelings of excessive doubt and
caution.
• Is Stubborn and rigid.
• Pre-occupation with productivity

43. PASSIVE-AGGRESSIVE P.D
• Significant and persistent
passive resistance to
demands for adequate
social & occupational
performance.
• Stubbornness, intentional
inefficiency, forgetfulness
are used to achieve the
purpose.
• Secondary depression.

44. Clinical Manifestations
• Paranoid. Mistrusts and is suspicious of others; has guarded, restricted
affect.
• Schizoid. Detached from social relationships; has restricted affect;
involved with things more than people.
• Schizotypal. Acute discomfort in relationships; cognitive or perceptual
distortions; eccentric behavior.
• Antisocial. Disregard for rights of others, rule, and laws.
• Borderline. Unstable relationships, self-image, and affect; impulsivity;
self-mutilation.
• Histrionic. Excessive emotionality and attention-seeking.
• Narcissistic. Grandiose; lack of empathy; need for admiration.
• Avoidant. Social inhibitions; feelings of inadequacy; hypersensitive to
negative evaluation.
• Dependent. Submissive and clinging behavior; excessive need to be
taken care of.
• Obsessive-compulsive. Preoccupation with orderliness, perfectionism,
and control.
• Depressive. Pattern of depressive cognitions and behaviors in a variety
of contexts.
• Passive-aggressive. Pattern of negative attitudes and passive
resistance to demands for adequate performance in social and
occupational situations.

45. Avoidant
Antisocial
Schizotypal
Social withdrawal.
Awkward & uncomfortable in
social situations.
Breaks laws.
Appears friendly on surface.
No remorse or guilt.
Odd thinking or speech.
Aloof & isolated
Magical thinking.
Dependent
Borderline
Paranoid
Lack of self confidence.
Excessive reliance on others.
Self destructive “mutilation”
Always in crises.
Impulsive.
Suspicious
Humourless
cold
Obsessive compulsive
Histrionic
Schizoid
Perfectionist.
Preoccupied with:
Schedules
Rules. Details.
Impulsive.
False emotions.
Dramatic.
Center of attention.
Few friends.
Loner.
Indifferent to praise or
criticize.
Narcissistic
Can’t apologize.
Grandiose.

46. Assessment and Diagnostic Findings
The following tests can be used in the diagnosis of personality
disorders:
• Toxicology screen. Substance abuse is common in many
personality disorders, and intoxication can lead patients to
present with some features of personality disorders.
• Screening for HIV and other sexually transmitted
diseases. Patients with personality disorders often exhibit
impulse control, and may act without regard to risk; such
behavior can lead to infection with a sexually transmitted
disease.
• CT scanning. Computed tomography scanning with
appropriate blood work can be carried out if organic etiology is
suspected.
• Radiography. Radiography can be indicated for injuries from
fighting, motor vehicle accidents, or self-mutilation.

47. PERSONALITY TESTS

48. Personality disorders are
notoriously hard to treat.
But research suggests a
combination of
medications, dialectical
behavior therapy and
cognitive therapy can help
people with one of the
most common disorders.

49. • This treatment emphasizes
– personality structure and development
– to help people understand their feelings
and to find better coping mechanisms.

50. • Cognitive and behavioral therapies such as
cognitive therapy, dialectical behavior
therapy, interpersonal psychotherapy and
cognitive analytic therapy can also be
helpful.
• Most cognitive behavioral approaches
address specific aspects of thoughts,
feelings, behavior or attitude.

51. • dialectical behavior therapy (DBT) is a cognitive behavioral treatment
for clients with borderline personality disorder.
• Individual therapy utilizes validation and problem-solving strategies,
emphasizes the client s strengths, and applies the principles of
positive reinforcement to motivate behavioral changes.
• Coping skills are taught in group sessions and focus on identifying
and correcting skill deficits in all aspects of the client s life.
• Treatment goals include reducing suicidal gestures, regulating
emotions, and tolerating distress.

52. • There are no medications specifically approved by
the Food and Drug Administration to treat
personality disorders. However, several types of
psychiatric medications may help with various
personality disorder symptoms.
• Antidepressant medications. Antidepressants may
be useful if you have a depressed mood, anger,
impulsivity, irritability or hopelessness, which may
be associated with personality disorders.

53. • Mood-stabilizing medications. As their
name suggests, mood stabilizers can help
even out mood swings or reduce irritability,
impulsivity and aggression.
• Anti-anxiety medications. These may help
if you have anxiety, agitation or insomnia.
But in some cases, they can increase
impulsive behavior.
• Antipsychotic medications. Also called
neuroleptics, these may be helpful if your
symptoms include losing touch with reality
(psychosis) or in some cases if you have
anxiety or anger problems.

54. • Nursing interventions for clients
diagnosed with personality disorders
are directed at validating the clients
experience, ensuring client safety, and
teaching effective coping strategies.

55. Nursing Management of Personality
Disorders
The nursing management of a patient with personality disorder include the
following:
Nursing Assessment
Assessment of the patient include:
• History. Many of these clients report disturbed early relationships
with their parents that often begin at 18 to 30 months of age; 50% of
these clients have experienced childhood sexual abuse; others have
experienced physical and verbal abuse and parental alcoholism.
• Mood and affect. The pervasive mood is dysphoric, involving
unhappiness, restlessness, and malaise; clients often report intense
loneliness, boredom, frustration, and feeling “empty”.
• Thought process and content. Thinking about self and others is often
polarized and extreme, which is sometimes referred to as splitting;
clients tend to adore and idealize other people even after a brief
acquaintance but then quickly devalue them if these others do not meet
their expectations is some way.
• Sensorium and intellectual process. Intellectual capacities are intact,
and clients are fully oriented to reality.

56. Nursing Diagnosis
Nursing diagnoses for clients with personality disorder
include the following:
• Risk for suicide related to low frustration tolerance.
• Risk for self-mutilation related to impulsive behavior.
• Risk for other directed violence related to lack of
feelings of remorse.
• Ineffective coping related to failure to learn or change
behavior based on past experience or punishment.
• Social isolation related to ineffective interpersonal
relationships.

57. Nursing Care Planning and Goals
• The client will be safe and free of significant
injury.
• The client will not harm others or destroy
property.
• The client will demonstrate increased
control of impulsive behavior.
• The client will take appropriate steps to
meet his or her own needs.
• The client will demonstrate problem-solving
skills.
• The client will verbalize greater satisfaction
with relationships.

58. Nursing Interventions
Clients with personality disorder often are involved in long-
term psychotherapy to address issues of family
dysfunction and abuse.
• Promoting client’s safety. The nurse must always
seriously consider suicidal ideation with the presence of a
plan, access to means for enacting the plan, and self-harm
behaviors and institute appropriate interventions.
• Promoting therapeutic relationship. Regardless of the
clinical setting, the nurse must provide structure and limit
setting in the therapeutic relationship; in a clinic setting,
this may mean seeing the client for scheduled
appointments of a predetermined length rather than
whenever the client appears and demands the nurse’s
immediate attention.

59. • Establishing boundaries in relationships. The nurse must be quite clear
about establishing the boundaries of the therapeutic relationship to
ensure that neither the client’s nor the nurse’s boundaries are violated.
• Teaching effective communication skills. It is important to teach basic
communication skills such as eye contact, active listening, taking turns
talking, validating the meaning of another’s communication, and using “I”
statements.
• Helping clients to cope and to control emotions. The nurse can help the
clients to identify their feelings and learn to tolerate them without
exaggerated responses such as destruction of property or self-harm;
keeping a journal often helps clients gain awareness of feelings.
• Reshaping thinking patterns. Cognitive restructuring is a technique useful
in changing patterns of thinking by helping clients to recognize negative
thoughts and feelings and to replace them with positive patterns of
thinking; thought stopping is a technique to alter the process of negative
or self-critical thought patterns.
• Structuring the client’s daily activities. Minimizing unstructured time by
planning activities can help clients to manage time alone; clients can make
a written schedule that includes appointments, shopping, reading the
paper, and going for a walk.
• Evaluation

60. • For antisocial personality disorder:
• DEFENSIVE COPING related to dysfunctional family
system evidenced by disregard for societal norms and
laws; absence of guilty feelings; lack of family support,
inability to delay.
• Intervention:
– client should be made aware of which behaviors are
acceptable and which are not.
– Explain consequences of violation of the limits. A
consequence must involve something of value to the client.
– All staff must be consistent in enforcing these limits.
– Consequences should be administered in a matter-of-fact
manner immediately following the infraction.

61. • RISK FOR OTHER-DIRECTED VIOLENCE
related to rage reactions, negative role-modeling,
inability to tolerate frustration
• Intervention:
• Maintain low level of stimuli in client’s environment
(low lighting, few people, simple decor, low noise
level).
• Observe client’s behavior frequently during routine
activities and interactions; avoid appearing watchful
and suspicious.

62. For Borderline Personality
Disorder
• RISK FOR SELF-MUTILATION related to
Parental emotional deprivation (unresolved fears of
abandonment)
Interventions:
• Observe client’s behavior frequently. Do this through
routine activities and interactions; avoid appearing
watchful and suspicious
• Secure a verbal contract from client that he or she
will seek out staff member when urge for self-
mutilation is felt.

63. • Complicated grieving related to maternal deprivation
during reapprochement phase of development
(internalized as a loss, With fixation in anger stage of
grieving process) evidenced by depressed mood, acting-
out behaviors.
• Interventions:
• Convey an accepting attitude—one that creates a
nonthreatening environment for the client to express
feelings. Be honest and keep all promises.
• Identify the function that anger, frustration, and rage
serve for the client. Allow him or her to express these
feelings within reason.
• Encourage client to discharge pent-up anger through
participation in large motor activities (e.g., brisk walks,
jogging, physical exercises, volleyball, punching bag,
exercise bike).

64. summary
• Personality is :The totality of emotional and behavioral characteristics
that are particular to a specific person and that remain somewhat
stable and predictable over time.
• Personality disorders characterized by long-lasting rigid patterns
of thought and behavior. Because of the inflexibility and
pervasiveness of these patterns, they can cause serious
problems and impairment of functioning for the persons who are
afflicted with these disorders.
• Personality disorders are grouped into clusters each one has
certain characteristics.
• Treatment is a combination of a multidimensional therapies &
pharmacologic therapy is the least effective.

65. • Townsend, M. (2008). Essentials of
psychiatric mental health nursing. ( 4th
ed.) Philadelphia: F.A. Davis.
• websites
• http://wwwAdvances in Psychiatric
Treatment (2004), vol. 10.
http://apt.rcpsych.org/.rcpsych.ac.uk/