Quality Management OfficerQuality Management OfficerBuraidah Mental Health HospitalBuraidah Mental Health Hospital

Prepared by :Prepared by :

Personality Disorder is an enduring Personality Disorder is an enduring pattern of inner experience & behaviour pattern of inner experience & behaviour

that differs markedly from the that differs markedly from the expectations of the individual’s culture.expectations of the individual’s culture.

Pervasive and inflexible, has an onset in Pervasive and inflexible, has an onset in adolescence or early adulthood, is stable adolescence or early adulthood, is stable overtime, & leads to distress or impairment .overtime, & leads to distress or impairment .

Personality Disorders are long standing and Personality Disorders are long standing and maladaptive pattern of perceiving & responding maladaptive pattern of perceiving & responding to other people and to stressful circumstances .to other people and to stressful circumstances .

CLUSTER ACLUSTER AOdd, eccentricOdd, eccentric

CLUSTER BCLUSTER B

• HistrionicHistrionic

Dramatic, erraticDramatic, erratic

CLUSTER CCLUSTER C• AvoidantAvoidant

fearfulfearful

• SchizoidSchizoid• SchizotypalSchizotypal

• NarcissisticNarcissistic

• AntisocialAntisocial

• DependentDependent

• Obsessive- Obsessive- CompulsiveCompulsive

• ParanoidParanoid

• BorderlineBorderline

A pervasive distrust and suspiciousness such A pervasive distrust and suspiciousness such that the motives of others are interpreted as that the motives of others are interpreted as malevolent (malicious) . malevolent (malicious) .

Constantly on guardConstantly on guardHypervigilantHypervigilantReady for any real or imagined threatReady for any real or imagined threat

Trusts no oneTrusts no oneConstantly tests the honesty of othersConstantly tests the honesty of others

Tends to misinterpret minute cuesTends to misinterpret minute cuesMagnifies OversensitiveMagnifies Oversensitive

Distorts cues in the environmentDistorts cues in the environment

Failure to respond to others in a meaningful Failure to respond to others in a meaningful emotional way . emotional way .

Characterized primarily by a profound defect inCharacterized primarily by a profound defect in the ability to form personal relationships .the ability to form personal relationships .

Indifferent to othersIndifferent to others

Client aloofClient aloof

Client emotionally coldClient emotionally cold

In presence of others, clientsIn presence of others, clientsappear shy, anxious, or uneasyappear shy, anxious, or uneasyInappropriately serious about Inappropriately serious about everything and have difficulty acting everything and have difficulty acting in a light-hearted manner in a light-hearted manner

Peculiarities of thinking , odd beliefs , & Peculiarities of thinking , odd beliefs , & eccentricities of appearance , behavior, eccentricities of appearance , behavior,

interpersonal style , and thoughts .interpersonal style , and thoughts .(e.g. belief in psychic phenomena (e.g. belief in psychic phenomena

& having magical powers . )& having magical powers . )

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Lack of regard for the moral or legal standards Lack of regard for the moral or legal standards in the local culture , marked inability to get in the local culture , marked inability to get along with others or abide by social rules . along with others or abide by social rules .

•Cruel and maliciousCruel and malicious•Inability to form lastingInability to form lasting monogamous relationship monogamous relationship

•Inconsistent work orInconsistent work or academic performanceacademic performance

•Cold, callous , intimidatingCold, callous , intimidating

•Failure to conform to societal normsFailure to conform to societal norms

Lack of one's own identity, with rapid changes Lack of one's own identity, with rapid changes in mood, intense unstable interpersonal in mood, intense unstable interpersonal relationships, marked impulsively , instability relationships, marked impulsively , instability in affect & in self image. in affect & in self image.

•Self-mutilation & suicidal gestures are common Self-mutilation & suicidal gestures are common

•Patterns of unstable moods & relationshipsPatterns of unstable moods & relationships

•Fear of abandonment , very poor self-imageFear of abandonment , very poor self-image

Pervasive attention-seeking behavior including Pervasive attention-seeking behavior including inappropriate sexual seductiveness & shallow inappropriate sexual seductiveness & shallow or exaggerated emotions . or exaggerated emotions .

• Common diagnosis in females flamboyant gayCommon diagnosis in females flamboyant gay “ “Drama Queen”Drama Queen”

• Overly dramatic , sensational, & sexual provocativeOverly dramatic , sensational, & sexual provocative

• Impulsive & need to be the center of attentionImpulsive & need to be the center of attention

• Thinking & emotions are perceived as shallowThinking & emotions are perceived as shallow

A pervasive pattern A pervasive pattern

of grandiosity , need of grandiosity , need

for admiration ,& a for admiration ,& a

lack of empathy. lack of empathy.

• Sensitive to criticism , envious & arrogantSensitive to criticism , envious & arrogant

• Exaggerated , unreasonable sense of selfExaggerated , unreasonable sense of self importance importance • Preoccupation with receiving attentionPreoccupation with receiving attention• Lack sensitivity and compassion for otherLack sensitivity and compassion for other peoplepeople

Marked social inhibition , feelings of inadequacy , Marked social inhibition , feelings of inadequacy , & extremely sensitive to criticism . & extremely sensitive to criticism .

•Interpersonally anxious & fearful of rejection Interpersonally anxious & fearful of rejection

•Extreme sensitivity to the opinion of othersExtreme sensitivity to the opinion of others•Highly avoidant of most interpersonal relationshipsHighly avoidant of most interpersonal relationships

Characterized by a pervasive and excessive need Characterized by a pervasive and excessive need to be taken care of ; that leads to submissive and to be taken care of ; that leads to submissive and clinging behavior and fears of separation clinging behavior and fears of separation

•Unreasonable fear of abandonment Unreasonable fear of abandonment

•Reliance on others to make major & minor life decisionsReliance on others to make major & minor life decisions•Assumes passive and submissive roles in relationshipsAssumes passive and submissive roles in relationships•Avoids positions of responsibility and becomes anxiousAvoids positions of responsibility and becomes anxious when forced into themwhen forced into them

Characterized by perfectionism & inflexibility, Characterized by perfectionism & inflexibility, preoccupation with uncontrollable patterns of preoccupation with uncontrollable patterns of thought & action thought & action

•Polite and formal Polite and formal

•Especially concerned with matters ofEspecially concerned with matters of organization and efficiencyorganization and efficiency•Tends to be rigid and unbendingTends to be rigid and unbending

Personality DisordersPersonality DisordersSUMMARY Descriptive BehaviorsSUMMARY Descriptive Behaviors

CLUSTER ACLUSTER A

Paranoid personality:Paranoid personality:Suspicious, distrustfulSuspicious, distrustful

Socially distant,Socially distant, detached detached

Schizoid personality: Schizoid personality:

Odd, eccentric Odd, eccentric Schizotypal personality: Schizotypal personality:

CLUSTER BCLUSTER B

* Antisocial personality: * Antisocial personality:

Impulsive, aggressive, manipulative

Impulsive, aggressive, manipulative

*Borderline personality:

*Borderline personality:

Impulsive, self-destructive, unstable

Impulsive, self-destructive, unstable

*Histrionic personality:

*Histrionic personality:

Emotional, dramatic, theatrical

Emotional, dramatic, theatrical

*Narcissistic personality:

*Narcissistic personality:

Boastful, egotistical,

Boastful, egotistical, ““superiority complex

superiority complex””

CLUSTER CCLUSTER C

•Avoidant personality: Avoidant personality:

Dependent,Dependent,submissive,

submissive,clingingclinging

Perfectionistic,

Perfectionistic, rigid,rigid,controllingcontrolling

Shy,Shy,timid,timid,

“inferiority complex”

“inferiority complex”

•Dependent personality:

Dependent personality:

•Obsessive–compulsive

Obsessive–compulsive

personality: personality:

Nursing Interventions :Nursing Interventions :

Nursing Interventions

Be patient with client’s extreme Be patient with client’s extreme emotional behaviors. Provide a emotional behaviors. Provide a consistent and structured milieu to consistent and structured milieu to decrease power struggles.decrease power struggles.

Encourage interaction (group), but do not Encourage interaction (group), but do not push .push .Be as neutral as possible as client perceives Be as neutral as possible as client perceives others as threatening .others as threatening .

Approach in a gentle, interested but non intrusive way . Respect client’s need for distance .

Nursing Interventions :

Nursing Interventions : Protect client from suicide and self mutilation .Set clear limits to maintain impulse control

Teach problem solving and assertiveness training.

Teach expression of feelings .

Help client to recognize distress related to the need for perfection and control .

Nursing Interventions : • Safety-suicide precautionsSafety-suicide precautions

• Anxiety Reduction• Focus on behavior, not the reasons for the behavior

• No changing of the rules-be consistent it creates a feeling of safety .

• Increase their sense of worth and competence by having them make their own decisions .