Personality disorders are conditions where an individual's thoughts, feelings and behaviors differ significantly from societal norms. About 5-15% of adults have at least one personality disorder. They are grouped into three clusters based on characteristics: Cluster A includes paranoid, schizoid and schizotypal disorders; Cluster B includes antisocial, borderline, histrionic and narcissistic disorders; and Cluster C includes avoidant, dependent and obsessive-compulsive disorders. Borderline personality disorder is characterized by unstable moods and relationships, impulsivity and difficulty regulating emotions. Treatment involves therapy such as dialectical behavior therapy and medication management. Nursing care focuses on safety, support, consistency and helping patients develop coping skills.

1. PSY344 – Week 2

2. 
 Personality refers to individual differences in
characteristic patterns of thinking, feeling and behaving.
 If there is any disturbance in maintaining in your
personality more than few weeks than it leads to
personality disorder.
 Personality disorders are conditions in which an
individual differs significantly from an average person, in
terms of how they think, perceive, feel or relate to others.
 Changes in how a person feels and distorted beliefs about
other people can lead to odd behaviour, which can be
distressing and may upset others.
Defining Personality

3. 
 5-15 % of adults have one or more personality
disorder.
 Hospitalization of personality disorders isn’t
necessarily common and most people diagnosed
with the symptom lead unhindered lives with the
aid of antipsychotics and therapy programs
especially anger management programs.
Incidence

4. 
 Cluster A Personality Disorders:
 Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder
 Cluster B Personality Disorders:
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
 Cluster C Personality Disorders:
 Avoidant personality disorder
 Dependent personality disorder
 Obsessive-compulsive personality disorder
Types of Personality
Disorders

5. 
 Borderline personality disorder (BPD) is a serious
mental illness marked by unstable moods,
behaviour, and relationships.
 Causes:
 Genetic
 Traumatic childhood
 Vulnerable temperament
 Stressful maturational events in adolescence and
childhood
 Childhood abuse or trauma or neglect
Borderline Personality
Disorder

6. 
 Abuse (emotional, sexual, physical) by the care takers
 Chronic stress
 Unresolved life events
 Over involvement and under involvement of parents
 Defective family environment
 Alteration in level of neurotransmitters, e.g. serotonin,
acetylcholine, GABA and norepinephrine
 Affective disorders
 Substance abuse disorder
 Post-traumatic stress disorder
Causes Cont.

7. 
 You feel very worried about people abandoning you, and
would do anything to stop that happening.
 You have very intense emotions that last from a few
hours to a few days and can change quickly (for example,
from feeling very happy and confident in the morning to
feeling low and sad in the afternoon).
 You don't have a strong sense of who you are, and it can
change depending on who you're with.
 You find it very hard to make and keep stable
relationships.
Symptoms

8. 
 You act impulsively and do things that could harm you
(such as binge eating, unsafe sex, using drugs or driving
dangerously).
 You have suicidal thoughts or self- harming behaviour
such as cutting.
 You feel empty and lonely a lot of the time.
 You get very angry, and struggle to control your anger.
 When very stressed, sometimes you might:
 Feel paranoid
 Have psychotic experiences, such as seeing or hearing
things other people don't
 Feel numb or 'checked out' and not remember things
properly after they've happened.
Symptoms

9. 
 Self- reported experiences of the client
 A comprehensive personal and family history
 A physical examination
 Blood test to exclude HIV or Syphilis
 EEG, CT scan to exclude epilepsy and brain lesions
 Mental state examination
Diagnosis

10. 
 To be diagnosed with BPD, a person must experience at
least five of the following symptoms:
 Fear of abandonment
 Unstable or changing relationships
 Unstable self-image; struggles with identity or sense of
self
 Impulsive or self-damaging behaviours (e.g., excessive
spending, unsafe sex, substance abuse, reckless driving,
binge eating).
Diagnosis (Simplified)

11. 
 Suicidal behaviour or self-injury
 Varied or random mood swings
 Constant feelings of worthlessness or sadness
 Problems with anger, including frequent loss of
temper or physical fights
 Stress-related paranoia or loss of contact with reality
Diagnosis (Simplified)

12. 
 Counselling and therapy
 Medications
 Usually treatments include a combination of therapy and
medications especially in cases that are schizoaffective /
Schizotypical and delusions or in rarer cases
hallucinations are present.
 Long-term CBT has proven to be the key choice towards
BPD patients however an improvised version known as
DBT (dialectical behavioural therapy) has proven even
more effective due to its schizophrenic treatment
capabilities as well.
Treatment

13. 
 This type of therapy focuses on the concept of mindfulness, or being aware
of and attentive to the current situation.
 DBT teaches skills to control intense emotions, reduces self-destructive
behaviours, and improves relationships.
 This therapy differs from CBT in that it seeks a balance between changing
and accepting beliefs and behaviours.
 Individual, Family and marital counselling may be require according to
needs.
 DBT is known to be a high risk method and has certain rules, for example
medication and DBT being used together is frowned upon due to suicidal
risks.
 Some methods involve tactics such as the ‘’Devil’s Advocate’’ where we
agree, test and push the patients mindset posing risky techniques.
Dialectical Behavioural
Therapy

14. 
 Typical antipsychotics :- Haloperidol
 Atypical antipsychotic:- Aripiprazole
 Mood stabilizers:- valproate sodium
 Antidepressants:- Amitriptyline
 Omega-3 fatty acid
Medication

15. 
 Healthy Habits:
 Such as getting enough sleep
 Eating healthy foods
 Getting regular exercise
 Avoiding alcohol and drugs
 These habits can help reduce stress and anxiety. And
they can help make your symptoms less severe and
less frequent.
Alternatives

16. 
 Place the client near to the nurses’ station.
 Have a keen insight into client’s in all the means
e.g. communication, performing activities.
 If the client is developing behaviour destructive behavioural
tendency, observe closely, never allow the client to keep
potentially dangerous objects like knife, blade, etc.
 Based on client’s need one-to-one relationship has to be
maintained.
 Identify the stressors which promote undesirable behaviour of
the client, try to avoid them.
Nursing Management and
Clinical Management

17. 
 Remove sharp and dangerous objects in the client’s
environment.
 Encourage the client to interact and share his past
experiences, review the events, explore the feelings
related to these episodes.
 Allow the client to participate in small group discussions,
where he can exchange his feelings.
 Set clear and realistic goals for client activities.
Nursing Management and
Clinical Management

18. 
 Set limitations for client’s inappropriate behaviour like
destructive behaviour .e.g .mutilation behaviour, fears
related leaving alone or verbal or physical threats.
 Rotate the staff for client’s care, so that he will not
develop any dependency.
 Motivate the client to establish and maintain effective
communication skills and relationship with significant
members.
Nursing Management and
Clinical Management

19. 
 Avoid labelling the client by his activities.
 Never show sympathy or empathy to the client’s humiliation
attitude or activities.
 Give positive reinforcement for client’s appropriate behaviour.
 Promote consistency.
 A written contract has to be established for acceptable and
appropriate behaviour.
 Encourage the client to participate actively in assertiveness
techniques, problem solving techniques.
 Never do arguments or criticisms for client’s activities.
Nursing Management and
Clinical Management