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 stem 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). PERSONALITY TRAITS: The most widely used system of personality trait is called Five- Factor Model. This includes, Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism. Each trait is further divided into several trait facets to analyse one’s personality clearly. Several theorists still argue that there are more traits which have not been captured by this five-factor model. Openness people loves adventure, appreciate art, imagination and learn new things throughout their life time. Meanwhile low openness people avoid new experiences, stick to their habits and not adventure lovers. Conscientiousness people are dependable, disciplined and achievement focused. Meanwhile low conscientiousness people are more spontaneous and careless, when extreme. Extraversion people/ Extroverts are cheerful, sociable and draw energy from crowds. Meanwhile introverts love to be alone. Commonly people think introversion and shyness are same. They both are different. Shyness people has fear of social interaction meanwhile introverts are cheerful but they prefer solo or small group activities. Agreeableness people are warmth, kind, helpful, compassionate and trust worthy. Meanwhile disagreeable people are cold and suspicious of others. High Neuroticism people experience lot of negative emotion. Meanwhile low neuroticism people will be emotionally stable. 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

1. PERSONALITY DISORDERS
JUHIN J
2ndYEAR MSC- NURSING

2. OBJECTIVES
 What is meant by personality
 Define- Personality disorders
 List down the epidemiology of personality disorders
 Explain the etiology of personality disorders
 What are the risk factors of personality disorders
 Classify- personality disorders
 Clinical manifestations of personality disorders
 Diagnostic evaluation of personality disorders
 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 stem 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. EPIDEMIOLOGY
 Around 5-10% of general population suffers from personality disorder.
 Incidence is even higher for people in lower socioeconomic groups.
 Borderline personality disorder is more common in psychiatric setups.
 Antisocial personality is more common among prison inmates.
 Mixed personality disorder is common than single type.
 Personality disorders are common in both male and female genders.

8. ETIOLOGY
Unknown
Genetic Factors
•Monozygotic, Cluster A- Schizo, Borderline- Mood disorders
Biological Factors
•Impulsivity & Aggressiveness- Borderline & Antisocial – H/o ADHD & Learning disability
Environmental factors
•60% borderline- childhood sexual abuse, Antisocial- childhood neglect & physical abuse
Psychological factors
• Freud- Psychosexual development,Wilhelm- PD- narrow range of defence mechanism

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

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. CLINICAL MANIFESTATION C-(A)
Paranoid PD
• Distrust & suspicion of others
• Others trying to harm, trustworthiness of others
Schizoid
• Lack of interest-relationship, discomfort-human interaction
• Inability to take pleasure - most activities, isolated
Schizotypal
• Flat/ inappropriate emotions
• Social anxiety & discomfort – close relationships

12. CLINICAL MANIFESTATION C-(B)
Antisocial
• Persistent lying, stealing, violation- other’s rights
• Recurring problems with the law
Borderline
• Impulsive/ risky behavior (unsafe sex, gambling)
• Suicidal behavior/ threats of self injury
Histrionic
• Constantly seeking attention, Easily influenced by others
• Inability – sincere, long lasting relationships
Narcissistic
• Belief- more special, more important
• Self esteem – Fragile & Vulnerable – minor criticism

13. CLINICAL MANIFESTATION C-(C)
Avoidant
• Too sensitive to criticism/ rejection , inferiority complex
• Extreme shyness – social & Personal relationships
Dependent
• Extreme dependence on others , clinging behavior
• Lack of self confidence, difficulty disagreeing, req. more advice
Obsessive -
Compulsive
• Extreme perfectionism, inflexibility, neglect- friends & enj. activities
• Stubborn, Inability to discard broken/ worthless objects

14. DIAGNOSTIC EVALUATION
 History Collection (In Depth)
 Physical examination
 International Personality Disorder Examination (IPDE)
(work, self, interpersonal relationships, affect, reality testing
and impulse control)
 Mental status examination

15. MANAGEMENT
Pharmacological management
• Antipsychotics (Paranoid, schizotypal, borderline)
• Antidepressants (SSRI, MAOI- Borderline; SSRI, Atypical AP- mood instability)
• Mood stabilizers (Lithium carbonate & propranolol- violent, antisocial PD)
• Anxiolytics (Avoidant PD)

16. MANAGEMENT
Non- Pharmacological management
• Interpersonal therapy
• Psychoanalytical therapy
• Milieu/ group therapy
• Cognitive- Behavior Therapy
• Dialectical behavior therapy

17. 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

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

19. 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:

20. 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:

21. 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:

22. 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:

23. ANY DOUBTS

24. SUMMARY

25. 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

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

27. THANKYOU EVERYONE