Personality

 It is the habitual patterns and qualities of behavior of an individual as expressed by physical and
mental activities and attitudes.
 It is the distinctive individual qualities of a person.
 It is the total of the person’s internal and external patterns of adjustment to life, determined in
part by genetically transmitted organic endowment and by life’s experience.

Personality Traits
 These are qualities of behavior that make a person unique.
 It reflects the person's characteristic patterns of thoughts, feelings, and behaviors.

Personality Disorders
 Described as non-psychotic illness characterized by maladaptive behavior, which the person
uses to fulfill his or her needs and brings satisfaction to self.
 Pervasive and inflexible pattern of behavior demonstrating unhealthy characteristics that limit
the individual’s ability to function in society.
 A personality disorder is a type of mental disorder in which you have a rigid and unhealthy
pattern of thinking, functioning and behaving.
 A person with a personality disorder has trouble perceiving and relating to situations and
people.
 This causes significant problems and limitations in relationships, social activities, work and
school.

Characteristics of P.D.
 The person denies the maladaptive behaviors he or she exhibits; they have become a way of life.
 The maladaptive behaviors are inflexible.
 Minor stress is poorly tolerated, resulting in increased inability to cope with anxiety.
 The person is in contact with reality, although he or she has difficulty dealing with it.
 Disturbance of mood, such as anxiety or depression, may be present.
 Psychiatric help is rarely sought because the person is unaware or denies that his or her
behavior is maladaptive.

Causes of Personality disorders

 Personality disorders are thought to be caused by a combination of these genetic and
environmental influences.
 Genes may make an individual vulnerable to developing a personality disorder, and a life
situation may trigger the actual development.
1. Psychoanalytic and development theories
o There is the unsuccessful mastery of tasks in early developmental stages.
o Failure to establish trust in infancy as a result of inconsistent or neglectful care can be
correlated with later
o Negative childhood experiences
o Borderline P.D. is believed to be associated with the failure to work through the
separation- individuation process in early toddler hood.
a. the child may have been unable to separate from the mother without the
significant fear and anxiety (parents reward clinging behavior and prevents
autonomy
b. the mother may have been perceived by the child as both strongly nurturing at
times and hateful and punishing at unpredictable times
2. Socio-Cultural Theory
o Emotional and physical abuse in childhood by caretakers as well as sexual abuse by non-
caretakers can lead to the development of borderline personality disorder.
3. Psychobiologic theory
o Some genetic transmission and presence of specific neurologic deficits in individuals
with antisocial P.D.
o Inadequate regulation of serotonin and dopamine levels in clients with borderline P.D.
4. Behavioral theory
 o In anti-social P.D., the child learns socially undesirable behavior from parents, who
reward acting-out behavior by giving in rather than setting limits.
o The child with borderline P.D. is rewarded for clinging, dependent behavior
5. Family Theory
o Significant parental deprivation during the years of the child’s life, with chaotic home
environment and inconsistent, impulsive parents can cause antisocial P.D.
o An unstable family system leads to unstable personality and borderline P.D.

Risk Factors
Although the precise cause of personality disorders is not known, certain factors seem to increase the risk
of developing or triggering personality disorders, including:
 Family history of personality disorders or other mental illness.
 Abusive, unstable or chaotic family life during childhood.
 Being diagnosed with childhood conduct disorder.
 Variations in brain chemistry and structure

Types of Personality Disorders

Cluster A Personality Disorders

Characterized by odd, eccentric thinking or behavior

1. Paranoid Personality Disorder

o Pervasive distrust and suspicion of others and their motives.
o Unjustified belief that others are trying to harm or deceive you.
o Unjustified suspicion of the loyalty or trustworthiness of others.
o Hesitancy to confide in others due to unreasonable fear that others will use the
information against you.
o Perception of innocent remarks or nonthreatening situations as personal insults or
attacks.
o Angry or hostile reaction to perceived slights or insults
o Tendency to hold grudges.
o Unjustified, recurrent suspicion that spouse or sexual partner is unfaithful
o Cold and aloof manner
o Rigid and inflexible
o Resentful, accusing and argumentative
o Inability to tolerate criticisms
o Controlling relationships
o Extreme jealousy
o Projection of faults to others
o Inability to perceive self as a problem
o Angry or hostile outbursts
o No friends
o No sense of humor

2. Schizoid Personality Disorder

o Lack of interest in social or personal relationships, preferring to be alone
o Limited range of emotional expression
o Inability to take pleasure in most activities
o Inability to pick up normal social cues
o Appearance of being cold or indifferent to others.
o Little or no interest in having sex with another person.
o Withdrawal and seclusion
o Emotional indifference
o Self-absorbed attitude
o Avoidance of close relationships and intimacy
o Loners
o Preference in solitary activities
o Decreased pleasure experience
 o Bland facial expression
o Daydreaming
o Social avoidance
o Functions well in vocation that requires them to work alone

3. Schizotypal Personality Disorder

o Peculiar dress, thinking, beliefs, speech or behavior.
o Odd perceptual experiences, such as hearing a voice whisper your name.
o Flat emotions or inappropriate emotional responses.
o Social anxiety and a lack of or discomfort with close relationships
o Indifferent, inappropriate or suspicious response to others.
o "Magical thinking" — believing you can influence people and events with your thoughts.
o Belief that certain casual incidents or events have hidden messages meant only for you
o Social isolation
o Common in childhood and adolescence
o 1% develops psychotic disorders or schizophrenia
o Suspiciousness or paranoid ideation
o Ideas of reference

Cluster B Personality Disorders

Characterized by dramatic, overly emotional or unpredictable thinking or behavior

1. Antisocial Personality Disorder

o impulsive, aggressive, manipulative
o A pervasive pattern of disregard for and violation of the rights of others.
o Common in men
o Patients with these disorders are those with conduct disorders in childhood.
o 80% to 90% of all crimes are committed by these people.
o Fails to follow rules and regulations
o Desire for pleasure and need gratification
o Repeated acts that are grounds for arrest.
o Repeated lying, use of aliases, or conning others.
o Impulsivity or failure to plan ahead
o Repeated physical fights or assaults
o Reckless disregard for safety of self and others
o Failure to sustain consistent work behavior or honor financial obligations.
o Lack of remorse at having hurt, mistreated or stolen from another
o Poor work history
o Lack of concern about right and wrong, socially accepted morals and values, sexual
promiscuity
o Aggressive, often violent behavior
o Charming and scheming

2. Borderline Personality Disorder

o Impulsive and risky behavior, such as having unsafe sex, gambling or binge eating
o Unstable or fragile self-image
o Unstable and intense relationships
o Up and down moods, often as a reaction to interpersonal stress
o Suicidal behavior or threats of self-injury
o Intense fear of being alone or abandoned
o Ongoing feelings of emptiness
o Frequent, intense displays of anger
o Stress-related paranoia that comes and goes
o Frantic effort to avoid real or imagined abandonment
o Pattern of unstable interpersonal relationships
o Unstable self-image or sense of self.
o Chronic feelings of emptiness and boredom
o Inappropriate anger or difficulty controlling anger.
 o Unable to experience pleasure and unable to maintain employment.
o Prone to commit suicide
o Coexistence of depression
o People with this disorder are prone to constant mood swings and bouts of anger.
o “Jekyll and Hyde” characteristic
o Clingy, dependent and manipulative behavior

3. Histrionic Personality Disorder

o Constantly seeking attention.
o Excessively emotional, dramatic or sexually provocative to gain attention.
o Speaks dramatically with strong opinions, but few facts or details to back them up
o Easily influenced by others
o Shallow, rapidly changing emotions
o Excessive concern with physical appearance
o Thinks relationships with others are closer than they really are
o Is uncomfortable in situation where he or she is not the center of attention.
o Displays inappropriate sexually seductive or provocative behavior
o Shows dramatization or exaggerated expression of emotion
o Is suggestible
o Pre-occupied with fantasies of unlimited success and beauty.
o Envious of others and believes that others are envious of her.
o Common in women
o Considers relationship to be more intimate than they really are.
o They need to be the center of attention all the time, often interrupting others in order
to dominate the conversation.
o They use grandiose language to describe everyday events and seek constant praise.
o Histrionics also tend to exaggerate friendships and relationships, believing that
everyone loves them.

4. Narcissistic Personality Disorder

o Belief that you're special and more important than others.
o Fantasies about power, success and attractiveness.
o Failure to recognize others' needs and feelings.
o Exaggeration of achievements or talents
o Expectation of constant praise and admiration
o Arrogance
o Unreasonable expectations of favors and advantages, often taking advantage of others
o Envious of others or believes that others are envious of them
o boastful, egotistical, “superiority complex”
o Has a grandiose sense of self- importance and uniqueness
o Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
love.
o Believes he or she is unique and special and should only associate with others who are
special or high-status people
o Has sense of entitlement
o Is interpersonally exploitative/ exploits other people/ takes advantage
o Lacks empathy
o Shows arrogance
o Excessive drive for success and power
 Obsessively Taking Selfies is Now a Real Mental Disorder Called ‘Selfitis’
 “Selfitis” is a term coined to describe the cultural habit of taking an
overabundance of photos of oneself and posting them on Instagram, Facebook,
Snapchat, and other social media sites.
Cluster C Personality Disorders
Characterized by anxious, fearful thinking or behavior.

1. Avoidant Personality Disorder

o Too sensitive to criticism or rejection
o Feeling inadequate, inferior or unattractive
o Avoidance of work activities that require interpersonal contact.
o Socially inhibited, timid and isolated, avoiding new activities or meeting strangers
o Extreme shyness in social situations and personal relationships.
o Fear of disapproval, embarrassment or ridicule
o Shy, timid, “inferiority complex
o Is willing to get involved with people unless certain of being liked.
o Overly serious, blunted emotional expression.
o Shows restraint in intimate relationships for fear of being shamed or ridiculed
o Is inhibited in interpersonal relationships because of feelings of inadequacy.
o Views self as socially inept and inferior to others.
o Is unusually reluctant to take personal risks.
o Devaluation of personal abilities and achievements.

2. Dependent Personality Disorder

o Excessive dependence on others and feeling the need to be taken cared of.
o Submissive or clingy behavior toward others.
o Fear of having to provide self-care or fend for yourself if left alone.
o Lack of self-confidence, requiring excessive advice and reassurance from others to make
even small decisions
o Difficulty starting or doing projects on your own due to lack of self-confidence.
o Difficulty disagreeing with others, fearing disapproval.
o Tolerance of poor or abusive treatment, even when other options are available.
o Urgent need to start a new relationship when a close one has ended
o Submissive, clinging
o Has difficulty making everyday decisions.
o Needs others to assume responsibility for major areas of his life.
o Has difficulty expressing disagreement
o Has difficulty initiating projects.
o Seldom disagrees for fear of loss of support and approval
o Lack of self- confidence, poor self- esteem, indecisiveness.
o Goes to excessive lengths to obtain nurturance from others.
o Feels uncomfortable or helpless when alone.
o Urgently seeks relationships as source of care and support.
o Is unrealistically preoccupied with fears of being left to take care of self.

3. Obsessive-Compulsive Personality Disorder

o Obsessive-compulsive personality disorder (OCPD), as defined by the current versions of
the DSM IV-TR and DSM-5, and termed anankastic personality disorder in the ICD-10, is
a disorder characterized by preoccupation with orderliness, perfectionism, and mental
and interpersonal control, at the expense of flexibility.
o Preoccupation with details, orderliness and rules.
o Extreme perfectionism, resulting in dysfunction and distress when perfection is not
achieved, such as feeling unable to finish a project because you don't meet your own
strict standards
o Desire to be in control of people, tasks and situations, and inability to delegate tasks.
o Neglect of friends and enjoyable activities because of excessive commitment to work or
a project.
o Inability to discard broken or worthless objects
o Rigid and stubborn
o Inflexible about morality, ethics or values.
o Tight, miserly control over budgeting and spending money
o Adopts a miserly spending style/ reluctant to spend/ hoards money.
 o Is preoccupied with details, lists, rules, organization or schedules.
o Excessive dedication to work/ too busy to have friends and leisure activities.
o Aspires to perfectionism that interferes with task completion.
o Is excessively devoted to work and productivity.
o Is over conscientious, scrupulous, and flexible about matters of morality, ethics or
values.
o Moralistic judgmental attitude toward others.

Managing Personality Disorders

Psychotherapy
 The treatment of choice for P.D. is short term psychotherapy focusing on solutions for specific
life problems.
 Group therapy may be appropriate if the client agrees to attend to sufficient number of
sessions.
Medications
 Antidepressants may be useful if clients have a depressed mood, anger, impulsivity, irritability
or hopelessness, which may be associated with personality disorders.
 Mood stabilizers. As their name suggests, mood stabilizers can help even out mood swings or
reduce irritability, impulsivity and aggression.
 Antipsychotic medications. Also called neuroleptics, these may be helpful if clients’ symptoms
include losing touch with reality (psychosis) or in some cases if clients have anxiety or anger
problems.
 Anti-anxiety medications. These may help if clients have anxiety, agitation or insomnia. But in
some cases, they can increase impulsive behavior, so they're avoided in certain types of
personality disorders.
Nursing Interventions

For client with an odd, eccentric P.D.

 Adopt an objective, matter-of-fact manner when interacting with the client and maintain clear,
consistent verbal and non-verbal communication.
 Provide daily structure for activities of daily living.
 Maintain focus on reality and reality-based topics.
 Help the client to clearly identify feelings that are implied.
 Help the client with problem solving for life issues identified as sources of stress.
 Gradually involve the client in group situations, providing support when necessary, and provide
positive feedback for socially appropriate behavior.
For the client with dramatic, emotional, erratic personality disorder
 Prevent self-harm by observing the client frequently and developing a no harm contract.
 Give immediate feedback when confronting inappropriate or manipulative behavior, and help
the client to examine the consequences of appropriate and inappropriate behavior.
 Act as a role model for appropriate expression of feelings and negative emotions.
 Work with the treatment team in maintaining consistent feedback for the client, reinforcing
specific treatment objectives, and avoid manipulations of staff by the client.
 Avoid rescuing or rejecting the client.
 Set limits, reinforce consequences or manipulative behavior or disregard for rights of others.
 Give positive feedback for achieving goals and independent behavior
 Explore the client’s feelings regarding rejection, being alone, and fear of abandonment.
 Use a problem-solving approach to help the client explore necessary changes.
 Encourage the client’s participation in follow-up treatment.

For the client with anxious, fearful P.D.

 Establish a caring, consistent therapeutic relationship and clear expectations for responsible
behavior.
 Expect the client to make decisions, and teach him how to be assertive (or refer to a training
program for his behavior).
 Encourage the client to identify positive self- attributes.
 Provide positive feedback when the client interacts in social situations appropriately.
  Teach the client to use stress-management and relaxation techniques to cope with anxiety.

For the family of the client with a personality disorder

 Help family members to define and maintain generational boundaries.
 Provide positive feedback for efforts to define self- functioning.
 Encourage clear definitions of acceptable behavior for the client within the family.
 Encourage parents to work on areas of conflict in their own relationship.
 Teach family members to use stress reduction measures to handle anxiety.