The document discusses personality disorders, including their definition, classification, characteristics, types, treatment modalities, and the role of nurses. It defines personality disorders as long-term maladaptive patterns of behavior used to fulfill needs. They are classified into Clusters A, B and C based on behaviors. Common characteristics include self-centeredness and difficulty dealing with reality. The types include paranoid, schizoid, borderline, histrionic and narcissistic personality disorders. Treatment involves psychotherapy, group therapy, CBT and medication. Nurses help manage symptoms, provide education, and address disturbances in cognition, affect, and behavior.

1. Unit IX
Community Mental Health
Personality Disorders
Prepared By:
Sapana Dahal
M.Sc. Nursing 2nd Year
6/4/2023 1

2. Objective
At the end of the session , all the participants
will be able to explain about personality
disorders.
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3. Contents
Mental Illness
• Introduction
• Classification
Personality Disorders
• Introduction
• Characteristics
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4. Contents Contd…
• Types
• Treatments Modalities
• Role of Nurse
• Article
• References
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5. Mental Illness
A clinically significant behavioral or
psychological syndrome or pattern that occurs in
a person and that is associated with present
distress (e.g., a painful symptom) or disability
(i.e., impairment in one or more important areas
of functioning)
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6. Mental Illness
Contd…
or with a significantly increased risk of suffering
death, pain, disability, or an important loss of
freedom and is not merely an expectable and
culturally sanctioned response to a particular
event (e.g., the death of a loved one).
-DSM-IV-TR (American Psychiatric
Association [APA], 2000), the APA
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7. Classification of Mental Illness
Mental
Illness
Psychosis
Organic
Psychosis
Functional
Psychosis
Neurosis
Other
disorders
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8. Classification of Mental Illness
Contd
Organic psychosis
• Acute
• Chronic
Functional psychosis
• Schizophrenia (thought disorders)
• Mood disorders
1. Mania
2. Depression
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9. Classification of Mental Illness
Contd
Neurosis (minor mental illness)
• Anxiety neurosis
• Depressive neurosis
• Obsessive compulsive neurosis
• Hysterical neurosis
• Phobic neurosis
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10. Classification of Mental Illness
Contd
Other disorders
• Personality disorders
• Children and adolescent behavioral problems
• Transient situational disorders
• Mental retardation
• Alcohol and drug abuse
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11. Personality Disorders
• Personality disorder is defined as a long-term
maladaptive pattern of perception, emotional
regulation, anxiety, and impulse control.
• Described as a non psychotics illness
characterized by maladaptive behavior, which the
person uses to fulfill his or her needs and bring
satisfaction to self or herself.
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12. Personality Disorders
Contd…
• One of the least understood and recognized
disorders in both psychiatry and general medical
care.
• Among the most common of the severe mental
disorders and occur frequently with other
illnesses such as substance use or mood disorders.
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13. Prevalence
• Global rates of cluster A, B and C personality
disorders were 3.8% , 2.8% and 5.0%
(Winsper C, et al, 2020).
• Antisocial personality disorders are more
likely to be men, whereas borderline,
histrionic, and dependent are more often
women.
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14. Common Characteristics of Personality
Disorders
• Self-centeredness
• Inflexible, socially unacceptable behaviors
• Manipulative and exploitative behavior
• Inability to tolerate minor stress, resulting in
increased inability to cope with anxiety or
depression
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15. Common Characteristics of
Personality Disorders Contd…
• Lack of individual accountability for behavior,
blaming others for their problems
• Difficulty dealing with reality.
• Vulnerability to other mental disorders such as
obsessive-compulsive tendencies and panic
attacks
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16. Types of Personality Disorders
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17. Types of Personality Disorders
Contd…
Cluster A: Behaviors described as odd or
eccentric
a. Paranoid personality disorder
b. Schizoid personality disorder
c. Schizotypal personality disorder
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18. Types of Personality Disorders
Contd…
Paranoid personality
disorder:
• A long standing
suspiciousness and
mistrust of people in
general.
• Develops in childhood
as a result of poor
interpersonal family
relationships
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19. Paranoid personality disorder:
• Unemotional
• Lack a sense of humor
• Lack the ability to relax
• Poor interpersonal
relationships
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20. Types of Personality Disorders
Contd…
b. Schizoid personality disorder: a profound
defect in the ability to form personal
relationships or to respond to others in any
meaningful, emotional way.
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21. Types of Personality Disorders
Contd…
Schizoid Personality Disorder
• Appear cold, stile toward others aloof, and
indifferent to others.
• Work in isolation and are unsociable.
• Behavior and conversation exhibit little or no
spontaneity
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22. Types of Personality Disorders
Contd…
c. Schizotypal personality disorder:
• Latent schizophrenics
• Aloof and isolated and behave in a bland and
apathetic manner.
• Magical thinking, ideas of reference, illusions,
and depersonalization.
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23. Types of Personality Disorders
Contd…
Cluster B: Behaviors described as dramatic,
emotional, or erratic
a. Antisocial personality disorder
b. Borderline personality disorder
c. Histrionic personality disorder
d. Narcissistic personality disorder
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24. Types of Personality Disorders
Contd…
• Antisocial personality
disorder:
Socially irresponsible,
exploitative, and guiltless
behavior that reflects a
disregard for the rights of
others.
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25. Types of Personality Disorders
Contd…
Antisocial personality disorder:
• Survive in exciting, fast-paced environments in
which they are forced to live by their wits.
• Statistics show that 80% to 90% of all crime is
committed by individuals with antisocial
personality disorder
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26. Types of Personality Disorders
Contd…
b. Borderline personality disorder:
Exhibit impulsive, unpredictable behavior
related to gambling, shoplifting, sex, and sub-
stance abuse.
Feeling empty, lonely, unable to experience
pleasure, and unable to maintain employment.
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27. Types of Personality Disorders
Contd…
b. Borderline personality disorder
The defense mechanisms most commonly used
include denial, projection, regression, splitting,
and projective identification.
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28. 6/4/2023 28

29. Types of Personality Disorders
Contd…
c. Histrionic personality disorder: Act in a very
emotional and dramatic way that draws attention to
them.
Result of childhood factors such as the lack of
criticism or discipline, positive reinforcement for
certain behaviors, or unpredictable attention during
childhood.
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30. 6/4/2023 30

31. Types of Personality Disorders
Contd…
Narcissistic personality disorder: Inflated
sense of self importance and an extreme
preoccupation with themselves.
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32. Types of Personality Disorders
Contd…
Narcissistic personality disorder
• Contributing factors include a dysfunctional
childhood in which the child is subjected to
excessive pampering, extremely high parental
expectations, abuse, or neglect.
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33. Types of Personality Disorders
Contd…
Cluster C: Behaviors described as anxious or
fearful
• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder
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34. Types of Personality Disorders
Contd…
• Avoidant personality disorder:
A person has a lifelong patterns of feeling very
shy, inadequate and sensitive to rejection
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35. Types of Personality Disorders
Contd…
Avoidant personality disorder
Interferes with participation in occupational
activities, development of interpersonal
relationships, and the ability to take personal
risks or engage in new activities.
Social phobia may occur when withdrawal and
hypersensitivity persist over time.
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36. Types of Personality Disorders
Contd…
• Dependent personality disorder:
A person depends too much on others to meet
their emotional and physical needs.
Authoritarian or overprotective parenting style
can lead to the development of this disorder.
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37. Types of Personality Disorders
Contd…
• Dependent personality disorder
They urgently seek another relationship when a
close relationship ends.
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38. Types of Personality Disorders
Contd…
Obsessive-compulsive personality disorder:
• A person is preoccupied with rules, orderliness
and control
• Leisure activities and friendships are excluded
• Interpersonal relationships are affected
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39. Types of Personality Disorders
Contd…
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40. Treatment Modalities
• Interpersonal psychotherapy
• Psychoanalytic psychotherapy
• Milieu or group therapy
• Cognitive behavioral therapy
• Psychopharmacology
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41. Treatment Modalities Contd…
Interpersonal psychotherapy
Clients with paranoid, schizoid, schizotypal,
borderline, dependent, narcissistic and obsessive-
compulsive personality disorder
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42. Treatment Modalities
Contd…
Psychoanalytic psychotherapy
• Focuses on histrionic personality disorder.
• Treatment focuses on the unconscious
motivation for seeking total satisfaction from
others and for being unable to commit oneself
to a stable, meaningful relationship.
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43. Treatment Modalities
Contd…
Milieu or group therapy
• Appropriate for individuals with antisocial
personality disorder, who respond more
adaptively to support and feedback from peers
• Useful for avoidant personality disorder
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44. Treatment Modalities
Contd…
Cognitive behavioral therapy
Useful for clients with obsessive-compulsive,
passive- aggressive, antisocial, and avoidant
personality disorders.
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45. Treatment Modalities
Contd…
Psychopharmacology
Antipsychotic medications are helpful in the
treatment of psychotic decompensations
experienced by clients with paranoid,
schizotypal, and borderline personality disorders
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46. Role of Nurse in Managing Symptoms
• Focuses on the client's cognition, affect,
interpersonal functioning, and behavior, as
well as his or her ability to meet basic needs.
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47. Role of Nurse in Managing Symptoms
Contd…
Assistance in meeting basic needs, symptom
management, and medication management and
address the diagnostic criteria of disturbance in
cognition, disturbance in affect, disturbance in
interpersonal functioning, and dysfunctional
behavior including poor impulse control
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48. Role of Nurse in Managing Symptoms
Contd…
Client education focuses on the impact of
comorbid psychiatric disorders, problem-solving
techniques, medication compliance, and
participation in specific self-help or support
groups.
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49. Role of Nurse in Managing Symptoms
Contd…
For the client with a disturbance in cognition:
• Reinforcing reality if the client verbalizes
illusions or feelings of depersonalization.
• Helping the client select someone he or she
trusts to minimize suspicious or delusional
thoughts.
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50. Role of Nurse in Managing Symptoms
Contd…
• Exploring with the client present maladaptive
coping mechanisms and the purpose they serve.
• Exploring alternate coping mechanisms to
reduce stress.
• Assisting the client to develop insight regarding
the purpose of nursing interventions.
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51. Role of Nurse in Managing Symptoms
Contd…
For the client with a disturbance in affect
• Encourage the client to verbalize feelings of
anger, hostility, worthlessness, or
hopelessness.
• Give attention and support when the client
expresses feelings honestly and openly.
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52. Role of Nurse in Managing Symptoms
Contd…
• Encourage the client to share his or her
feelings with others.
• Provide a safe environment if the client
expresses suicidal ideation or exhibits self-
mutilation behavior.
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53. Role of Nurse in Managing Symptoms
Contd…
For the client with a disturbance in interpersonal
functioning:
• Exploring reasons the client has difficulty
establishing interpersonal relationships.
• Exploring the client's self-concept and self-
esteem .
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54. Role of Nurse in Managing Symptoms
Contd…
• Exploring the client's perception of how others
view him or her.
• Providing positive feedback regarding your
observations of the client's strengths.
• Encouraging the client to socialize with at least
one person daily.
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55. Role of Nurse in Managing Symptoms
Contd…
For the client with dysfunctional behavior
indicative of poor impulse control:
• Stating limits and behavior expected from the
client.
• Enforcing all limits without apologizing.
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56. Role of Nurse in Managing Symptoms
Contd…
• Being direct, confronting the client when
limits are not observed.
• Discussing consequences of the client's failure
to observe limits.
• Discussing behavior with the client in a non
judgmental manner.
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57. Related Articles
A case–control study conducted on “The impact
of a diagnosis of personality disorder on service
usage in an adult Community Mental Health
Team” in South London concluded that people
with PD have more severe symptomatology and
greater degrees of functional impairment when
compared to those without.
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58. Related Articles
Community clinicians should routinely screen
attenders to predict likely difficulties that might
arise and to make provision for these difficulties
in the treatment and management of clients.
(Byrne M, Henagulph S, McIvor RJ, Ramsey
J, Carson J,2014 )
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59. References
1. Townsend M. Psychiatric Mental Health
Nursing: Clients with Psychiatric Disorders.7th
Edition. New Delhi; Jaypee Brothers
Publishers;2012.
2. Stuart G. Principles and Practice of Psychiatric
Nursing.10th Edition. United States of America;
Elsevier Mosby Publishers.2014.
3. Shives L. Basic Concepts of Psychiatric- Mental
Health Nursing: Personality Development and
Personality Disorder. 8th Edition. New Delhi;
Wolters Kluwer Publishers.2012.
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60. References Contd…
4.Clement I. Basic Concepts of Community Health
Nursing.2nd Edition. New Delhi; Jaypee Brothers
Medical Publishers.2011.
5. Byrne M, Henagulph S, McIvor RJ, Ramsey J,
Carson J. The impact of a diagnosis of personality
disorder on service usage in an adult Community
Mental Health Team. Social psychiatry and
psychiatric epidemiology. 2014 Feb;49:307-16.
6/4/2023 60

61. References Contd…
6.Winsper C, Bilgin A, Thompson A, Marwaha
S, Chanen AM, Singh SP, Wang A, Furtado V.
The prevalence of personality disorders in the
community: a global systematic review and
meta-analysis. The British Journal of Psychiatry.
2020 Feb;216(2):69-78.
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62. THANK YOU
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