2. INTRODUCTION
– Personality traits are patterns of behavior that reflect how people
perceive and relate to others and themselves. Personality disorders
occur when these traits become rigid and maladaptive.
– Personality disorders include various inflexible maladaptive behavior
patterns or traits that may impair functioning and relationships
– The client usually remains in touch with reality and typically has a
lack of insight on his or her behavior. Stress exacerbates
manifestations of the personality disorder. In severe cases, the
personality disorder may deteriorate to a psychotic state.
3. DEFINITION
– According to WHO abnormal personality can be defined as “deeply
ingrained maladaptive pattern of behavior, continuing throughout the
most of adult life, although often becoming less obvious in middle or
old age
4. DEFINITION
– A personality disorder is an “enduring pattern of inner experiences
and behavior that deviates markedly from the expectations of the
individual’s culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to
distress or impairment”(APA)
5. CHARACTERISTIC OF
PERSONALITY DISORDER
– It is not a mental illness.
– It is a maladaptive behavior.
– It is long lasting, most of time lifelong problems.
– It causes significant impairment in social or occupational functioning.
– It produces distress to the individual and to others.
6. ETIOLOGY FACTORS:
Biological factors:
– Genetic
– Low level of serotonin.
– Those with family history of alcoholism or other psychiatric problems.
Especially among the people with a cluster A.
7. ETIOLOGY FACTORS
Developmental factors:
– Early traumatic experience
– Losses suffered by the attachment figure.
– Childhood abuse.
– Sexual abuse. Lack of parental care.
8. ETIOLOGY FACTORS:
Socio cultural factors:
– Isolation
– Long term psychiatric problems.
– Chronic institutionalization
– Immigration.
– Lack of close family ties which promotes loneliness.
14. Paranoid Personality Disorder
– Paranoid personality disorder as “a pervasive distrust and
suspiciousness of others such that their motives are interpreted as
malevolent, beginning by early adulthood and present in a variety of
contexts” (APA, 2000)
– Sadock and Sadock (2007) identify the characteristic feature as a
long-standing suspiciousness and mistrust of people in general
15. Clinical picture
– Individuals with paranoid personality disorder are constantly on
guard, hypervigilant, and ready for any real or imagined threat.
– They appear tense and irritable.
– They have developed a hard exterior and become immune or
insensitive to the feelings of others
– They always feel that others are there to take advantage of them.
16. Clinical picture………….
– They are extremely oversensitive and tend to misinterpret even minute cues
within the environment
– Because they trust no one, they are constantly “testing” the honesty of
others.
– Their behavior manner provokes exasperation and anger in almost everyone
with whom they come in contact.
– Individuals with paranoid personality disorder maintain their self-esteem by
attributing their shortcomings to others.
17. Clinical picture………….
– They do not accept responsibility for their own behaviors and feelings and
project this responsibility on to others.
– They are envious and hostile toward others who are highly successful and
believe the only reason they are not as successful is because they have been
treated unfairly.
– People who are paranoid are extremely vulnerable and constantly on the
defensive. Any real or imagined threat can leads to a possible loss of control
can result in aggression and violence. These outbursts are usually brief, and
the paranoid person soon regains the external control, rationalizes the
behavior, and reconstructs the defenses central to his or her personality
pattern.
18. PARANOID PERSONALITY DISORDER
Key signs and symptoms
• Feelings of being deceived
• Hostility
• Major distortions of reality
• Social isolation
• Suspiciousness, mistrusting friends and relatives
19. Diagnostic Criteria for Paranoid Personality
Disorder
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent,
beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the
following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used
maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to
react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
20. Diagnostic Criteria...............
B. Does not occur exclusively during the course of schizophrenia, a mood
disorder with psychotic features, or another psychotic disorder and is not
due to the direct effect of any drug
21. Predisposing Factors
– Studies have revealed a higher incidence of paranoid personality
disorder among relatives of clients with schizophrenia than among
control subjects (Sadock & Sadock, 2007).
– People with paranoid personality disorder may have been subjected to
parental antagonism and harassment. They likely served as
scapegoats for displaced parental aggression and gradually
relinquished all hope of affection and approval.
– They learned to perceive the world as harsh and unkind, a place
calling for protective vigilance and mistrust.
23. Schizoid Personality Disorder
Definition
– Schizoid personality disorder is characterized primarily by a profound defect
in the ability to form personal relationships or to respond to others in any
meaningful, emotional way (Skodol & Gunderson, 2008).
24. CLINICAL PICTURE
– These individuals display a lifelong pattern of social withdrawal, and their
discomfort with human interaction is apparent
– People with schizoid personality disorder appear cold, aloof, and indifferent to
others
– They prefer to work in isolation and are unsociable, with little need or desire for
emotional ties. They are able to invest enormous affective energy in intellectual
pursuits. In the presence of others they appear shy, anxious, or uneasy. They are
inappropriately serious about everything and have difficulty acting in a
lighthearted manner.
25. Key signs and symptoms
(1) Avoidance of meaningful interpersonal relationships; prefers solitaryactivities
(2) Use of autisticthinking, emotional detachment, and daydreaming
(3) Introverted since childhood but maintains fair contact with reality
(4) Asexual
26. Diagnostic Criteria for Schizoid Personality
Disorder
A. A pervasive pattern of detachment from social relationships and a restricted range
of expression of emotions in interpersonal settings, beginning by early adulthood
and present in a variety of contexts, as indicated by four (or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.
27. B. Does not occur exclusively during the course of schizophrenia, a mood disorder with
psychotic features, another psychotic disorder, or a pervasive development disorder and is not
due to the direct physiological effects of a general medical condition
29. schizotypal personality disorder
– Individuals with schizotypal personality disorder were once described
as “latent schizophrenics.” Their behavior is odd and eccentric but
does not decompensate to the level of schizophrenia.
30. Clinical picture
– Individuals with schizotypal personality disorder are aloof and
isolated and behave in a bland and apathetic manner. Magical
thinking, ideas of reference, illusions, and depersonalization are part
of their everyday world. Examples include superstitiousness, belief in
clairvoyance, telepathy, or “sixth sense;” and beliefs that “others can
feel my feelings” (APA, 2000).
– Under stress, these individuals may decompensate and demonstrate
psychotic symptoms, such as delusional thoughts, hallucinations, or
bizarre behaviors, but they are usually of brief duration (Sadock &
Sadock, 2007).
31. Key signs and symptoms
– This disorder is marked by odd thinking and behavior, a pervasive pattern of social
and interpersonal deficits and acute discomfort with others
– Inappropriate affect.
– Odd believes or magical thinking.
– Social withdrawal.
– Odd, eccentric or peculiar behavior.
– Lack of close relationship.
– Social isolation.
– Not fitting easily with others
32. Diagnostic Criteria of schizotypal personality
disorder
– A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with,
and reduced capacity for, close relationships as well as by cognitive or perceptual distortions
and eccentricities of behavior, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
– 1. Ideas of reference (excluding delusions of reference)
– 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (e.g., superstitiousness, telepathy, or “sixth sense;” in children and
adolescents or preoccupations)
– 3. Unusual perceptual experiences, including bodily illusions
– 4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or
stereotyped)
33. Diagnostic Criteria……………..
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric, or peculiar
8. Lack of close friends or confidants other than firstdegree relatives
9. Excessive social anxiety that does not diminish with familiarity and
tends to be associated with paranoid fears rather than negative
judgments about self
34. B. Does not occur exclusively during the course of schizophrenia, a mood disorder with
psychotic features, another psychotic disorder, or a pervasive developmental disorder.
36. Antisocial personality disorder
– Antisocial personality disorder is characterized by chronic antisocial
behavior that violates other rights or social norms which predisposes
the affected person to the criminal behavior
– Antisocial personality disorder is a pattern of socially irresponsible,
exploitative, and guiltless behavior that reflects a disregard for the
rights of others (Skodol & Gunderson, 2008).
37. Clinical picture
• Exploiting and manipulating others for personal gain and have a general disregard for the
law.
• They have difficulty sustaining consistent employment and in developing stable relationships.
• They appear cold and callous, often intimidating others with their brusque and belligerent
manner.
• They tend to be argumentative and, at times, cruel and malicious.
• They lack warmth and compassion and are often suspicious of these qualities in others.
Individuals with antisocial personality have a very low tolerance for frustration, act
impetuously, and are unable to delay gratification.
• They are restless and easily bored, often taking chances and seeking thrills, as if they were
immune to danger
38. Failure to sustain the relationship.
Impulsive actions.
Low tolerance to frustration.
Tendency to cause violence.
Lack of guilt
Inability to maintain close personal or sexual relationship
Key sign and symptoms
..
39. Diagnostic Criteria
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15
years, as indicated by three (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing
acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or
pleasure
3.Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor
financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen
from another.
40. Diagnostic criteria…………….
B. Individual is at least 18 years old.
C. There is evidence of conduct disorder with onset before age 15
years.
D. The occurrence of antisocial behavior is not exclusively during
the course of schizophrenia or a manic episode
41. Predisposing Factors
– Antisocial personality is more common among first-degree biological relatives of those
with the disorder than among the general population
– Attention deficit hyperactivity disorder and conduct disorder during childhood and
adolescence as predisposing factors to antisocial personality disorder.
– Parental deprivation during the first 5 years of life appears to be a critical
predisposing factor in the development of antisocial personality disorder.
– individuals with antisocial personality disorder often have been severely physically
abused in childhood.
42. Circumstances for predisposition to antisocial personality disorder
1. Absence of parental discipline
2. Extreme poverty
3. Removal from the home
4. Growing up without parental figures of both sexes
5. Erratic and inconsistent methods of discipline
6. Being “rescued” each time they are in trouble (never having to suffer the
consequences of one’s own behavior) 7. Maternal deprivation
44. Histrionic personality disorder.
– Patient with this disorder is characteristically have a pervasive pattern of
excessive emotionality and attention seeking behavior and are drawn to
momentary excitement and fleeting adventure.
45. Clinical Picture
– People with this disorder need to be the center of attention at all time
– They use manipulative and exhibitionistic behaviors in their demands to be the
center of attention
– Individuals with this disorder are highly distractible and flighty by nature. They
have difficulty paying attention to detail.
– They tend to be highly suggestible, impressionable, and easily influenced by others.
They are strongly dependent.
46. Key sign and symptoms
– Dramatic emotionality (emotional blackmail, angry scenes, demonstrative
suicide attempts.)
– Attention seeking behaviour.
– Lack of considerations for other
– Self-dramatization.
47. Diagnostic Criteria
A pervasive pattern of excessive emotionality and attention seeking, beginning by early
adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or
provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible, i.e., easily influenced by others or circumstances.
8. Considers relationships to be more intimate than they actually are.
48. Predisposing factors
– The root causes [of histrionic personality disorder] surround an
unbonded mother relationship and an abusive paternal relationship.
When a child is not the center of a parent’s attention, neglect, lack of
bonding, and deprivation leaves one starving for attention, approval,
praise, and reassurance.
50. Narcissistic Personality Disorder
– Patient with Narcissistic personality disorder is self-centered, self-
absorbed and lacking in empathy for others.
– He typically takes advantages of people to achieve his own ends, and
uses them without regards to their feelings.
– Being overly self-centered and exploiting others to fulfill their own
desires. They often do not conceive of their behavior as being
inappropriate or objectionable. Because they view themselves as
“superior” beings, they believe they are entitled to special rights and
privileges.
– The exploitation of others for self-gratification results in impaired
interpersonal relationships
51. KEY SIGN AND SYMPTOMS
Attention seeking
Dramatic behavior
Unable to face criticism.
Lack of empathy.
Arrogances.
Exploitative behavior
52. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack
of empathy, beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1.Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents,
expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
love.
3. Believes that he or she is “special” and unique and can only be understood by, or should
associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable
treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own
ends).
7. Lacks empathy: Is unwilling to recognize or identify with the feelings and needs of
others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.
54. Borderline personality disorder
– Borderline personality disorder is marked by a pattern of instability
in interpersonal relationship, mood, behavior, and self-image.
55. Borderline personality disorder
– Individuals with borderline personality always seem to be in a state of
crisis. Their affect is one of extreme intensity, and their behavior
reflects frequent changeability. These changes can occur within days,
hours, or even minutes. Often these individuals exhibit a single,
dominant affective tone, such as depression, which may give way
periodically to anxious agitation or inappropriate outbursts of anger.
56. Patterns of Interaction
– Clinging - they may exhibit helpless, dependent, or even childlike behaviors-and Distancing-
Distancing behaviors are characterized by hostility, anger, and devaluation of others, arising
from a feeling of discomfort with closeness
– Splitting-It arises from their lack of achievement of object constancy and is manifested by an
inability to integrate and accept both positive and negative feelings.
– Manipulation
– Self-Destructive Behaviors
– Impulsivity.
57. KEY SIGN AND SYMPTOMS
– Unstable relationship.
– Unstable self-image
– Unstable emotions
– Impulsivity
OTHERS
– Lack of control of anger.
– Recurrent suicidal threats or behavior.
– Uncertainty about personal identity.
– Chronic feeling of emptiness
58. Diagnostic Criteria
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and
marked impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. NOTE: Does not include suicidal or
self-mutilating behavior covered in criterion
2. A pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially selfdamaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). NOTE: Do not include suicidal or self-
mutilating behavior covered in criterion
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
59. Diagnostic Criteria………………
6. Affective instability due to marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety, usually lasting a few hours and
only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent
displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative
symptoms.
61. Avoidant personality disorder
– The individual with avoidant personality disorder is extremely
sensitive to rejection and because of this may lead a very socially
withdrawn life.
62. CLINICAL PICTURE
– Individuals with this disorder are awkward and uncomfortable in social
situations.
– Others may perceive them as timid, withdrawn, or perhaps cold and
strange.
– Those who have closer relationships with them, however, soon learn of
their sensitivities, touchiness, evasiveness, and mistrustful qualities.
– Their speech is usually slow and constrained, with frequent hesitations,
fragmentary thought sequences, and occasional confused and irrelevant
digressions.
– They are often lonely, and express feelings of being unwanted.
– They desire to have close relationships but avoid them because of their
fear of being rejected. Depression, anxiety, and anger at oneself for fail
63. Key sign and symptoms
– Fear of disapproval or rejection.
– Unwillingness to become involved with people.
– Shyness.
– Insecurity.
64. Diagnostic criteria
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative
evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by
four (or more) of the following:
1. Avoids occupational activities that involve significant interpersonal contact, because of fears
of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or
ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they
may prove embarrassing.
66. Dependent Personality Disorder
– Dependent personality disorder is characterized by “a pervasive and
excessive need to be taken care of that leads to submissive and
clinging behavior and fears of separation” (APA, 2000).
67. Clinical picture
– Individuals with dependent personality disorder have a notable lack
of self-confidence that is often apparent in their posture, voice, and
mannerisms.
– People with this disorder, let other make important discussion for
them and have a strong need for constant reassurance and support
68. Key sign and symptoms
– Feeling uncomfortable and helplessness.
– Inability to make decisions.
– Low self-esteem and lack of self-confidence.
– Clinging, demanding behavior
• Fear and anxiety about losing the people they’re dependent upon
• Hypersensitivity to potential rejection and decision making
• Low self-esteem
69. Diagnostic criteria
A. pervasive and excessive need to be taken care of that leads to submissive and clinging
behavior and fears of separation, beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or
approval: Do not include realistic fears of retribution.
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of
self-confidence in judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant.
70. Diagnostic criteria…………….
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being
unable to care for him- or herself.
7. Urgently seeks another relationship as a source of care and support when a close
relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of him- or
herself
71. Obsessive compulsive personality
disorder:
– Obsessive-compulsive personality disorder is characterized by
difficulty expressing warm and tender emotions, perfectionism,
stubbornness, the need to control others, and a devotion to work
72. Clinical picture
– The individual places a great deal of pressure on himself and other not to make
a mistake.
– Believes his way of doing something is the only correct way, may force himself
and others to follow right moral principles.
– Extremely devoted to work to the exclusion of leisure activities and friendships
73. Key sign and symptoms
– Feeling of excessive doubt and caution.
– Perfectionism.
– High standards
– Engages in rituals
74. Diagnostic Criteria
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal
control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present
in a variety of contexts, as indicated by four (or more) of the following:
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major
point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project
because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
(not accounted for by obvious economic necessity).
4. Is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not
accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of
doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be
hoarded for future catastrophes.
8. Shows rigidity and stubbornness.
76. TREATMENT
– serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors
(MAOIs) have been successful in decreasing impulsivity and self-destructive
acts (Borderline personality disorders).
– Antipsychotics have resulted in improvement in illusions, ideas of reference,
paranoid thinking, anxiety, and hostility in some clients It can be useful in
case of paranoid and schizotypal personality disorder
– Lithium carbonate and propranolol (Inderal) may be useful for the violent
episodes observed in clients with antisocial personality disorder
– Antidepressants, such as sertraline (Zoloft) and paroxetine (Paxil), may be
useful with these clients if panic disorder develops
77. Interpersonal Psychotherapy
– . Interpersonal psychotherapy may be particularly appropriate because
personality disorders largely reflect problems in interpersonal style.
– Long-term psychotherapy attempts to understand and modify the
maladjusted behaviors, cognition, and affects of clients with personality
disorders that dominate their personal lives and relationships.
– The core element of treatment is the establishment of an empathic
therapist–client relationship, based on collaboration and guided discovery
in which the therapist functions as a role model for the client.
78. Psychoanalytical Psychotherapy
– The treatment of choice for individuals with histrionic personality
disorder has been psychoanalytical psychotherapy (Skodol &
Gunderson, 2008). Treatment focuses on the unconscious motivation
for seeking total satisfaction from others and for being unable to
commit oneself to a stable, meaningful relationship
79. Milieu or Group Therapy
– This treatment is especially appropriate for individuals with
antisocial personality disorder, who respond more adaptively to
support and feedback from peers. In milieu or group therapy, feedback
from peers is more effective than in one-to-one interaction with a
therapist.
– Group therapy, particularly homogenous supportive groups that
emphasize the development of social skills may be helpful in
overcoming social anxiety and developing interpersonal trust and
rapport in clients with avoidant personality disorder.
80. Cognitive/Behavioral Therapy
– Behavioral strategies offer reinforcement for positive change. Social
skills training and assertiveness training teach alternative ways to
deal with frustration. This type of therapy may be useful for clients
with obsessive-compulsive, passive aggressive, antisocial, and
avoidant personality disorders
83. Nursing Diagnosis
– Social isolation
– Risk for other-directed violence
– Chronic low self-esteem
– Impaired social interaction
– Risk for self-directed violence
84. Interventions for Paranoia
– Assess for suicide risk.
– Diminish suspicious behavior.
– Avoid direct eye contact. Establish a trusting relationship
– Promote increased self-esteem.
– Remain calm, nonthreatening, and nonjudgmental.
– Provide continuity of care.
– Respond honestly to the client.
– Follow through on commitments made to the client.
– Acknowledge the client’s feelings, but tell the client that you do not share his or her
interpretation of an event. Provide a daily schedule of activities.
85. Interventions for Paranoia
– Assist the client to identify diversionary activities.
– Gradually introduce the client to groups.
– Refocus conversation to reality-based topics.
– Use roleplaying to help the client identify thoughts and feelings.
– Provide positive reinforcement for successes.
– Do not argue with delusions. Use concrete, specific words.
– Do not be secretive with the client.
– Do not whisper in the client’s presence.
86. Interventions for Paranoia
– Assure the client that he or she will be safe.
– Involve the client in noncompetitive tasks.
– Provide the client with the opportunity to complete small tasks.
– Monitor eating, drinking, sleeping, and elimination patterns.
– Limit physical contact. Monitor for agitation, and decrease stimuli as
needed
87. General interventions for a client
with a personality disorder
– Maintain safety against self-destructive behaviors.
– Allow the client to make choices and be as independent as possible.
– Encourage the client to discuss feelings rather than act them out.
– Provide consistency in response to the client’s acting-out behaviors.
– Discuss expectations and responsibilities with the client.
– Discuss the consequences that will follow certain behaviors.
– Inform the client that harm to self, others, and property is unacceptable.
88. General interventions for a client with a personality disorder
– Identify splitting behavior.
– Assist the client to deal directly with anger.
– Develop a written safety or behavioral contract with the client.
– Encourage the client to keep a journal recording daily feelings.
– Encourage the client to participate in group activities, and praise
nonmanipulative behavior.
– Set and maintain limits to decrease manipulative behavior.
– Remove the client from group situations in which attention-seeking behaviors
occur.
– Provide realistic praise for positive behaviors in social situations.
89. Conclusion
Clients with personality disorders are some of the most difficult ones
healthcare workers are likely to encounter. Personality characteristics
are formed very early in life and are difficult, if not impossible, to
change. In fact, some clinicians believe the therapeutic approach is not to
try to change the characteristics but rather to decrease the inflexibility
of the maladaptive traits and reduce their interference with everyday
functioning and meaningful relationships.
