Personality Disorders - BPS

Personality Disorders

Enduring patterns of inner experience and behavior that deviate markedly from the expectations of cultural norms, causing significant distress or impairment in social, occupational, or other important areas of functioning. These patterns are ingrained and inflexible, typically emerging in adolescence or early adulthood. They are not consciously aware of the problem.

Onset/Clinical course

40-50% with major mental illness also have coexisting personality disorder, complicating treatment.

Often labeled “treatment resistant” b/c client lacks insight and may view traits as normal or point of pride.

Cognitive-behavior therapy (CBT)

A type of psychotherapy that helps individuals identify and change negative thought patterns and behaviors.

Dialectical behavior therapy (DBT)

A form of cognitive-behavioral therapy specifically designed for individuals with borderline personality disorder, focusing on teaching skills in mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

Paranoid Personality Disorder

• Pervasive mistrust/suspiciousness

• Use of projection (ego defense mechanism)

• Conflict with authority figures

• Usually begins in early adulthood

• More common in men

Paranoid personality disorder nursing interventions

• Formal, business-like approach

• Client involvement in plan of care

• Validate idea before action

Schizoid Personality Disorder

• Pervasive pattern of social detachment

• Constricted affect

• Little emotion

• Usually have rich and extensive fantasy life but are reluctant to reveal

Schizoid Nursing interventions

• Improve functioning in community

• Client has greater chance of success if they can relate their needs to one person

Schizotypal Personality Disorder

• Pervasive pattern of social and interpersonal deficits

• Cognitive or perceptual distortions

• Behavioral eccentricities

• Odd appearance - speech, dress, or mannerisms

• Restricted range of emotions

• A lot of anxiety around other people, esp. unfamiliar

Schizotypal Nursing Interventions

• Focus on self-care and social skilss

• Encouragement of daily routines

• Identifying appropriate outlets for discussing unusual beliefs

Antisocial Personality Disorder

• Pattern of disregard for and violation of the rights of others

• Often involves deceit, impulsivity, and lack of remorse

• Individuals may engage in criminal behavior and have difficulty maintaining long-term relationships.

• Hx of acts of cruelty, abusive parents

• Usually normal appearance

• Mood and affect - display false emotions

• Narrowed view of world

• Oriented, average or above average IQ

• Do not consider morals or ethics

• Appear confident, but the self is shallow and empty

• Manipulate and exploit others

Antisocial PD Nursing Interventions

• Enhance awareness of behaviors and consequences

• Promote adherence to treatment

• Set clear boundaries and limits

• Keep them focused on themselves (tend to blame others)

• Give outlet to express negative emotions

• Enhance role performance and accountability

• Prone to substance abuse - address if needed

Borderline Personality Disorder

• Characterized by pervasive pattern of unstable interpersonal relationships, self-image, affect; marked impulsivity.

• Hx of disturbed early relationships with parents

• Dysphoric mood/affect

• Polarized and extreme thinking about self and others (splitting; all good or all bad)

• Dissociative episodes

• Fully oriented to reality (exception is transient psychotic symptoms)

• Impaired judgement and lack of concern for safety

• Unstable view of self, self-harm

• Hate being alone, but experience social isolation

• Reckless behavior

• Impulsive and reactive

• Struggle with suicide or self-harm

Borderline PD Nursing Interventions

• Safety (no self-harm contract)

• Therapeutic relationship (structured, limit-setting)

• Strict adherence to boundaries

• Communication skills

• Coping, emotional control

• Reshaping thinking patterns (DBT)

• Encourage emotional regulation and mindfulness

• Promote consistency and clear boundaries

• Structuring of daily activities

Histrionic Personality Disorder

• Characterized by excessive emotionality and attention-seeking behavior, often leading to shallow relationships; individuals may be overly concerned with physical appearance and seek approval from others.

• Flirtatious, provocative, very extraverted

• Center of attention

• Exaggeration of closeness of relationships

• Insincere and shallow emotions

• Concerned with outward appearance

• Use of regression (defense mechanism)

Histrionic PD Nursing Interventions

• Give feedback about social interactions

• Social skills training through role-playing

• Exploration of strengths and assets

Narcissistic Personality Disorder

• Pervasive pattern of grandiosity

• Need for admiration

• Lack of empathy

• Arrogant and superior attitude

• Superior view

• Fragile, vulnerable self-esteem

• Ambitious

Narcissistic PD Nursing Interventions

• Nurse should maintain self-awareness, avoid frustration

• Use matter-of-fact speech

• Limit-setting to prevent manipulation or abuse

Avoidant Personality Disorder

• Social discomfort

• Low self-esteem

• Hypersensitivity to criticism

• They do desire relationships but are often fearful of rejection and criticism, leading to avoidance of social situations.

Avoidant PD Nursing Interventions

• Encourage self-affirmations and positive self-talk

• Use reframing and decatastrophizing

• Train in social skills and gradual exposure

Dependent Personality Disorder

• Excessive need to be taken care of

• Submissive, clinging behavior

• Let others make decisions for them

• Fear of separation

• Frequently anxious

Dependent PD Nursing Interventions

• Expression of feelings of grief and loss

• Assistance in daily functioning

• Teaching problem-solving

• Want clients to learn to make decisions for themselves and see themselves as able to make those decisions

Obsessive-Compulsive Personality Disorder (OCPD)

• Preoccupation with order, perfectionism, control

• Formal and serious demeanor

  • Emotionally constricted, harsh self-criticism, low self-esteem

OCPD Nursing Interventions

• Teach flexibility and alternative perspectives in decision-making

• Cognitive restructuring for rigid thinking

• Encourage risk-taking to reduce over-control

• Focus on completion of projects instead of perfectionism

Elder Considerations

• Personality disorders persist into older age.

• Higher risk of depression, suicide, and dementia