Learning Objectives:

■ Recognize characteristics of each personality

disorder.
■ Describe behaviors of individual with
personality disorders.
■ Describe nursing interventions for patients
with personality disorders.
Personality can be defined as an ingrained,
enduring pattern of behaving and relating to self,
others and environment; personality includes
perceptions, attitudes and emotions.
Personality disorders are diagnosed when
personality traits become inflexible and maladaptive
and significantly interfere with how a person functions
in society or cause the person emotional distress.
They usually are not diagnosed until adulthood, when
personality is more completely formed.
Personality Disorder
■ They are not capable of mutual, intimate relationship,
and lack the capacity for empathy, remorse or concern
for others
■ They usually are not diagnosed until adulthood, when
personality is more completely formed at age 18
■ Are long standing because personality characteristics
do not change easily.
■ Client may continue to behave in their same familiar
ways even when these behaviors cause them
difficulties or distress
■ They do not recognize their own behavior as the
source of difficulty
■ Thus they are difficult to treat
■ Many of them have coexisting mental illness
■ Maladaptive dysfunctional personality traits
exhibited by individuals with personality
disorders
■ Negative behavior towards others such as being
manipulative, dishonest, deceitful, or lying
■ Anger and/or hostility
■ Irritable, labile moods
■ Lack of guilt or remorse, emotionally cold and
uncaring
■ Impulsivity, poor judgement
■ Irresponsible, not accountable for own actions
■ Impulsivity , poor judgment
■ Risk taking, thrills seeking behaviors
■ Mistrust
■ Exhibitionism
■ Entitlement
■ Dependency
■ Eccentric perception
 is made when the person exhibits enduring
Diagnosis
behavioral patterns that deviate from cultural
expectations in two or more of the following areas:

• Ways of perceiving and interpreting self, other

people, and events (cognition)
• Range, intensity, lability, and appropriateness of
emotional response (affect)
•Interpersonal functioning
•Ability to control impulses or express behavior at the
appropriate time and place (impulse control)
 Personality Disorder Clusters

DSM-V-TR

Cluster A- Odd, eccentric behavior

•Paranoid personality disorder
•Schizoid personality disorder
•Schizotypal personality disorder

Cluster B- Dramatic, Emotional, Erratic Behaviors

•Antisocial personality disorder
•Borderline personality disorder
•Histrionic personality disorder
•Narcissistic personality disorder

Cluster C- Anxious, fearful behavior

•Avoidant personality disorder
•Dependent personality disorder
•Obsessive-compulsive disorder
DSM-V-TR Criteria for Personality Disorder

■ Disturbances in two or more of the following must be present:

A. Cognition ( thinking about self, people, and events)

B. Affectivity ( range, intensity, lability and appropriateness of
emotional response)
C. Interpersonal functioning
D. Impulse control
Cluster A: Odd-Eccentric Behaviors

I. Criteria for Paranoid personality disorder

A. Suspicious of others.
B. Doubts trustworthiness or loyalty of friends and
others.
C. Fear of confiding in others.
D. Suspicious, without justification, of spouse’s or
sexual partner’s fidelity.
E. Interprets remarks as demeaning or
threatening
F. Holds grudges toward others
G. Becomes angry and threatening when he or she
perceives being attacked by others.
II. Criteria for Schizoid Personality Disorder

A. Lacks desire for close relationships or

friends
B. Chooses solitary activities
C. Little interest in sexual experiences
D. Avoids activities
E. Appears cold and detached
F. Lacks close friends
G. Appears indifferent to praise or criticism
III. Criteria for Schizotypal Personality Disorder

A.Ideas of reference
B. Magical thinking or odd beliefs
C. Unusual perceptual experiences, including
bodily illusions
D.Odd thinking and vague, stereotypical, over
elaborate speech
E.Suspicious
F. Blunted or inappropriate affect
G.Odd or eccentric appearance or behavior/
H. Few close relationships
I. Excessive social anxiety.
Cluster B: Dramatic, Emotional, Erratic Behaviors

I. Criteria for Antisocial Personality Disorder

A.Deceitfulness, as seen in lying

B. Engages in illegal activities
C.Aggressive behavior
D. Lack of guilt or remorse
E. Irresponsible in work and with finances
F. Impulsiveness
G. Reckless disregard of safety for self and
others.
II. Criteria for Borderline Personality Disorder

A. Frantic avoidance of abandonment, real or

imagined.
B. Unstable and intense interpersonal relationships
C. Identity disturbances
D. Impulsivity
E. Affective instability
F. Recurrent suicidal behavior or self-mutilating
behavior
G. Rapid mood shifts
H. Chronic feelings of emptiness
I. Problems with anger
J. Transient dissociative and paranoid symptoms
III. Criteria for Narcissistic Personality Disorder

A. Grandiose self-importance
B. Fantasies of unlimited power, success, or
briillance
C. Believes that he or she is special or unique
D. Needs to be admired
E. Sense of entitlement ( given special treatment)
F. Takes advantage of others for own benefit
G. Lacks empathy
H. Envious of others or others are envious of him
or her
I. Arrogant or haughty
 IV. Criteria for Histrionic Personality Disorder
A.Needs to be center of attention
B. Displays sexually seductive or provocative
behaviors
C. Uses physical appearance to draw attention
D. Uses speech to impress others but is lacking
in depth
E. Dramatic expression of emotion
F. Shallow, rapidly shifting emotions
G. Easily influenced by others
H. Exaggerates degree of intimacy with others
 Cluster C: Anxious – Fearful Behaviors
I. Criteria for Dependent Personality Disorder

A. Unable to make daily decisions without much advice

and reassurance.
B. Needs others to be responsible for important areas of
life.
C. Seldom disagrees with others because of fear of loss
of support or approval.
D. Problem with initiating projects or doing things on own
because of little self- confidence.
E. Performs unpleasant tasks to obtain support from
others
F. Anxious or helpless when alone because of fear of
being unable to take care for self.
G. Urgently seeks another relationship for support and
care after close relationship ends.
H. Preoccupied with fear of being alone to care for self.
II. Criteria for Avoidant Personality Disorder

A. Avoids occupations involving interpersonal contact

because of fears of disapproval or rejection.
B. Uninvolved with others unless certain of being
liked.
C. Fears intimate relationships because of fear of
shame or ridicule.
D. Preoccupied with being criticized or rejected in
social situations.
E. Inhibited and feels inadequate in new interpersonal
situations.
F. Believes self to be socially inept, unappealing or
inferior to others.
G. Very reluctant to take risks or engage in new
activities because of possibility of being
embarrassed.
III. Criteria for Obsessive-Compulsive Personality
Disorder

A. Preoccupied with details, rules, lists, organization

B. Perfectionism that interferes with task completion
C. Too busy working to have friends or leisure
activities
D. Overconscientious and inflexible
E. Unable to discard worthless or worn-out objects
F. Others must do things his or her way in work or
task related activity
G. Reluctant to spend and hoards money
H. Rigid and stubborn
PARANOID PERSONALITY
DISODERS
■ Paranoid personality disorder is
characterized by pervasive mistrust and
suspiciousness of others. Clients with
this disorder interpret others’ actions as
potentially harmful.
Manifestation
■ Clients appear aloof and withdrawn and may remain a
considerable physical distance from the nurse; (protection).
■ Clients also may appear guarded or hypervigilant; they may
survey the room and its contents, look behind furniture or
doors, and generally appear alert to any impending danger.
■ They may choose to sit near the door to have ready access to
an exit or with their backs against the wall to prevent anyone
from sneaking up behind them.
■ They may have a restricted affect and may be
unable to demonstrate warm or empathic
emotional responses such as “You look nice
today” or “I’m sorry you’re having a bad day.”
Mood may be labile, quickly changing from
quietly suspicious to angry or hostile.
■ These clients use the defense mechanism of
projection, which is blaming other people,
institutions, or events for their own difficulties.
■ It is common for such clients to blame the government
for personal problems. For example, a client who gets a
parking ticket may say it is part of a plot by the police to
drive him out of the neighborhood.
■ Conflict with authority figures on the job is common;
Nursing Interventions
■ Forming an effective working relationship with paranoid or suspicious
clients is difficult.
■ The nurse must remember that these clients take everything seriously
and are particularly sensitive to the reactions and motivations of others
■ The nurse must approach these clients in a formal, business-like manner
and refrain from social chitchat or jokes.
■ Being on time, keeping commitments, and being particularly
straightforward are essential to the success of the nurse–client
relationship.
■ One of the most effective interventions is helping clients
to learn to validate ideas before taking action; however, this
requires the ability to trust and to listen to one person.
■ The rationale for this intervention is that clients can avoid
problems if they can refrain from taking action until they
have validated their ideas with another person.
■ This helps prevent clients from acting on paranoid ideas or
beliefs.
■ It also assists them to start basing decisions and actions on
reality.
 SCHIZOID PERSONALITY
DISORDER
■ Schizoid personality disorder is characterized by a
pervasive pattern of detachment from social relationships
and a restricted range of emotional expression in
interpersonal settings
■ People with schizoid personality disorder avoid treatment
as much as they avoid other relationships, unless their life
circumstances change significantly
Manifestation:
■ display a constricted affect and little, if any, emotion.
■ They are aloof and indifferent, appearing emotionally cold,
uncaring, or unfeeling.
■ They report no leisure or pleasurable activities because they rarely
experience enjoyment.
■ Even under stress or adverse circumstances, their response appears
passive and disinterested.
■ There is marked difficulty experiencing and expressing emotions,
particularly anger or aggression.
■ clients do not report feeling distressed about this lack of emotion;
it is more distressing to family members.
■ Clients usually have a rich and extensive fantasy life, although
they may be reluctant to reveal that information to the nurse or
anyone else.
■ The ideal relationships that occur in the client’s fantasies
are rewarding and gratifying; these fantasies, though, are
in stark contrast to real-life experiences.
■ The fantasy relationship often includes someone the client
has met only briefly. Nevertheless, these clients can
distinguish fantasies from reality, and no disordered or
delusional thought processes are evident
■ Clients generally are accomplished intellectually and
often involved with computers or electronics in
hobbies or work.
■ Clients may be indecisive and lack future goals or
direction.
■ Clients have a pervasive lack of desire for involvement
with others in all aspects of life
Nursing Interventions

■ Nursing interventions focus on improved

functioning in the community.
■ If a client needs housing or a change in living
circumstances, the nurse can make referrals to
social services or appropriate local agencies for
assistance.
■ The nurse can help agency personnel find suitable housing that
accommodates the client’s desire and need for solitude.
■ For example, the client with a schizoid personality disorder
would function best in a board and care facility, which provides
meals and laundry service but requires little social interaction.
■ Facilities designed to promote socialization through group
activities would be less desirable
SCHIZOTYPAL PERSONALITY DISORDER
■ Schizotypal personality disorder is characterized by 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 behavioral eccentricities
■ Clients may experience transient psychotic episodes in
response to extreme stress.
Manifestation:
■ Clients often have an odd appearance that causes
others to notice them.
■ They may be unkempt and disheveled, and their
clothes are often ill-fitting, do not match, and may be
stained or dirty.
■ They may wander aimlessly and, at times, become
preoccupied with some environmental detail.
■ Speech is coherent but may be loose, digressive, or vague. Clients often
provide unsatisfactory answers to questions and may be unable to
specify or to describe information clearly.
■ They frequently use words incorrectly, which makes their speech sound
bizarre.
■ For example, in response to a question about sleeping habits, the
clientmight respond, “Sleep is slow, the REMs don’t flow.”
■ These clients have a restricted range of emotions; that is, they lack the
ability to experience and to express a full range of emotions such as
anger, happiness, and pleasure.
■ Affect is often flat and sometimes is silly or inappropriate
■ Cognitive distortions include ideas of reference,
magical thinking, odd or unfounded beliefs, and a
preoccupation with parapsychology, including
extrasensory perception and clairvoyance
■ Clients experience great anxiety around other people,
especially those who are unfamiliar
■ Clients experience great anxiety around other people,
especially those who are unfamiliar
 Nursing Interventions
■ The focus of nursing care for clients with schizotypal personality
disorder is development of self-care and social skills and improved
functioning in the community.
■ The nurse encourages clients to establish a daily routine for hygiene
and grooming. Such a routine is important because it does not depend
on the client to decide when hygiene and grooming tasks are necessary.
■ It is useful for clients to have an appearance that is not bizarre or
disheveled because stares or comments from others can increase
discomfort
■ The focus of nursing care is development of self-
care and social skills and improved functioning in
the community.
■ The nurse encourages clients to establish a daily
routine for hygiene and grooming. Such a routine is
important because it does not depend on the client to
decide when hygiene and grooming tasks are
necessary.
■ It is useful for clients to have an appearance that is
not bizarre or disheveled because stares or
comments from others can increase discomfort
■ Social skills training may help clients to talk clearly
with others and to reduce bizarre conversations.
■ It helps to identify one person with whom clients can
discuss unusual or bizarre beliefs, such as a social
worker or a family member.
■ Given an acceptable outlet for these topics, clients may
be able to refrain from these conversations with people
who might react negatively
CLUSTER B: PERSONALITY
DISORDERS
ANTISOCIAL PERSONALITY
DISORDER
■ Antisocial personality disorder is
characterized by a pervasive pattern of
disregard for and violation of the rights of
others—and with the central characteristics
of deceit and manipulation
■ Violation of the rights of others
■ Lack of remorse for behavior
■ Shallow emotions
■ Lying
■ Rationalization of own behavior
■ Poor judgment
■ Impulsivity
■Irritability and aggressiveness
■Lack of insight
■Thrill-seeking behaviors
■ Exploitation of people in relationships
■ Poor work history
■Consistent irresponsibility
Intervention
■ Forming a Therapeutic Relationship and Promoting
Responsible Behavior
-The nurse must provide structure in the therapeutic
relationship, identify acceptable and expected behaviors,
and focus on the behavior itself rather than on attempts by
clients to justify it.
For example:
Nurse: “You’ve said you’re interested in learning to
manage angry outbursts, but you’ve missed the last three
group meetings.”
Client: “Well, I can tell no one in the group likes me.
Why should I bother?”
Nurse: “The group meetings are designed to help you and
the others, but you can’t work on issues if you’re not
there.”
■ Helping Clients Solve Problems and Control
Emotions
-The nurse can teach problem-solving skills and help
clients to practice them.
-Problem-solving skills include identifying the problem,
exploring alternative solutions and related
consequences, choosing and implementing an
alternative, and evaluating the results.
■ Limit setting is an effective technique that involves three steps:
1. Stating the behavioral limit (describing the unacceptable behavior)
2. Identifying the consequences if the limit is exceeded
3. Identifying the expected or desired behavior
■ Example:
“It is not acceptable for you to ask personal questions. If you continue, I
will terminate our interaction.
We need to use this time to work on solving your job-related problems.”
■ Confrontation is another technique designed
to manage manipulative or deceptive behavior.
■ The nurse points out a client’s problematic
behavior while remaining neutral and matter-of-
fact; he or she avoids accusing the client.
■ The nurse also can use confrontation to keep
clients focused on the topic and in the present.
BLACK

■ People who love the black color are cool person and
don’t want to think what people think about them. As
long they were comfortable, they will do whatever
they like.
■ In friendship, they are pretty fun to be made as friends
because they usually can provide solutions to problem
of their friends.
 BORDERLINE PERSONALITY DISORDER

■Borderline personality disorder is

characterized by a pervasive pattern of
unstable interpersonal relationships,
self-image, and affect as well as
marked impulsivity.
■ Borderline personality disorder is the most
common personality disorder found in
clinical settings.
■ It is three times more common in women than
in men. Under stress, transient psychotic
symptoms are common
■ Many more suffer permanent damage from
self-mutilation injuries, such as cutting or
burning
■ Typically, recurrent self- mutilation is a cry for
help, an expression of intense anger or
helplessness, or a form of self-punishment.
■ The resulting physical pain is also a means to
block emotional pain.
■ Clients who engage in self-mutilation do so to
reinforce that they are still alive; they seek to
experience physical pain in the face of emotional
numbing
■Working with clients who have borderline
personality disorder can be frustrating.
■They may cling and ask for help one
minute and then become angry, act out,
and reject all offers of help in the next
minute.
■ They may attempt to manipulate staff to gain
immediate gratification of needs and at times
sabotage their own treatment plans by purposely
failing to do what they have agreed.
■ Their labile mood, unpredictability, and diverse
behaviors can make it seem as if the staff is
always “back to square one” with them.
 Interventions
■ Clients with borderline personality disorder often
are involved in long-term psychotherapy to
address issues of family dysfunction and abuse.
■ When clients are relatively calm and thinking
clearly, it is helpful for the nurse to explore self-
harm behavior.
■ The nurse avoids sensational aspects of the injury; the focus is
on identifying mood and affect, level of agitation and distress,
and circumstances surrounding the incident.
■ In this way, clients can begin to identify trigger situations,
moods, or emotions that precede self-harm and to use more
effective coping skills to deal with the trigger issues.
■ If clients do injure themselves, the nurse assesses the injury
and need for treatment in a calm, matter-of-fact manner
■ Promoting the Therapeutic Relationship
■ Promoting Clients’ Safety
■ Establishing Boundaries in Relationships
-Client: “You’re better than my family and the doctors.
You understand me more than anyone else.”
Nurse: “I’m interested in helping you get better, just as
the other staff members are.”
■Teaching Effective
Communication Skills
■Helping Clients to Cope and to
Control Emotions
 Reshaping Thinking Patterns
■ Cognitive restructuring is a technique
useful in changing patterns of thinking by
helping clients to recognize negative
thoughts and feelings and to replace them
with positive patterns of thinking.
■ Thought stopping is a technique to alter the
process of negative or self-critical thought
patterns such as “I’m dumb, I’m stupid, I can’t
do anything right.”
■ When the thoughts begin, the client may
actually say “Stop!” in a loud voice to stop the
negative thoughts
■ Decatastrophizing is a technique that involves
learning to assess situations realistically rather than
always assuming a catastrophe will happen.
■ The nurse asks, “So what is the worst thing that
could happen?” or “How likely do you think that
is?” or “How do you suppose other people might
deal with that?” or “Can you think of any
exceptions to that?”
■ Structuring the Clients’ Daily
Activities
- Feelings of chronic boredom and
emptiness, fear of abandonment, and
intolerance of being alone are common
problems
WHITE

■ Color white lovers are the type of person who are

sincere in everything and they at least do not like being
lied.
■ For them, honesty is most important thing. In addition,
they are usually a bit closed, they only had a few close
friends they can confide in, but they would be good
place to vent for all their friends.
HISTRIONIC PERSONALITY
DISORDER
■ Histrionic personality disorder is
characterized by a pervasive pattern of excessive
emotionality and attention seeking
■ Histrionic personality disorder is characterized
by a pervasive pattern of excessive emotionality
and attention seeking
■ They experience rapid shifts in moods
and emotions and may be laughing
uproariously one moment and sobbing
the next
■ They are highly suggestible and will
agree with almost anyone to gain
attention
■ Clients are emotionally expressive, gregarious, and
effusive.
■ They often exaggerate emotions inappropriately.
■ For example, a client says, “He is the most wonderful
doctor! He is so fantastic! He has changed my life!” to
describe a physician she has seen once or twice.
■ In such a case, the client cannot specify why she views
the doctor so highly
■ Clients are uncomfortable when they are not the center
of attention and go to great lengths to gain that status.
■ They use their physical appearance and dress to gain
attention.
■ At times, they may fish for compliments in unsubtle
ways, fabricate unbelievable stories, or create public
scenes to attract attention.
■ They may even faint, become ill, or fall to the floor.
■ Clients are uncomfortable when they are not the center
of attention and go to great lengths to gain that status.
■ They use their physical appearance and dress to gain
attention.
■ At times, they may fish for compliments in unsubtle
ways, fabricate unbelievable stories, or create public
scenes to attract attention.
■ They may even faint, become ill, or fall to the floor.
■ Clients tend to exaggerate the intimacy
of relationships.
■ They refer to almost all acquaintances as
“dear, dear friends.”
■ They may embarrass family members or friends by
flamboyant and inappropriate public behavior such as
hugging and kissing someone who has just been
introduced or sobbing uncontrollably over a minor
incident.
■ Clients may ignore old friends if someone new and
interesting has been introduced
 Nursing Interventions
■ The nurse gives clients feedback about their social
interactions with others, including manner of dress and
nonverbal behavior. Feedback should focus on appropriate
alternatives, not merely criticism.
■ For example, the nurse might say, “When you embrace and
kiss other people on first meeting them, they may interpret
your behavior in a sexual manner. It would be more
acceptable to stand at least 2 feet away from them and to
shake hands.”
■ It also may help to discuss social situations to
explore clients’ perceptions of others’ reactions
and behavior.
■ Teaching social skills and role-playing those
skills in a safe, nonthreatening environment can
help clients to gain confidence in their ability to
interact socially
■ Clients may be quite sensitive to discussing self-
esteem and may respond with exaggerated
emotions.
■ It is important to explore personal strengths and
assets and to give specific feedback about
positive characteristics.
YELLOW

■ Peoples who love yellow color are open, dynamic, and

fun person to be around.
■ Naturally, they have flamboyant and exciting
personality.
■ So it’s no problem for them to appear different than
others. They also have good taste in life and food.
NARCISSISTIC PERSONALITY
DISORDER
■ Narcissistic personality disorder is
characterized by a pervasive pattern of
grandiosity (in fantasy or behavior), need
for admiration, and lack of empathy
■ Narcissistic traits are common in adolescence and
do not necessarily indicate that a personality
disorder will develop in adulthood.
■ Clients may display an arrogant or haughty attitude.
They lack the ability to recognize or to empathize
with the feelings of others.
■ They may express envy and begrudge others any
recognition or material success because they believe it
rightfully should be theirs.
■ Clients tend to disparage, belittle, or discount the
feelings of others.
■ They may express their grandiosity overtly, or they
quietly may expect to be recognized for their perceived
greatness
■ Thought processing is intact, but insight is limited
or poor.
■ Clients believe themselves to be superior and
special and are unlikely to consider that their
behavior has any relation to their problems: they
view their problems as the fault of others.
■ Underlying self-esteem is almost always fragile and
vulnerable.
■ These clients are hypersensitive to criticism and need
constant attention and admiration.
■ At work, these clients may experience some success
because they are ambitious and confident.
■ Difficulties are common, however, because they have
trouble working with others (whom they consider to be
inferior) and have limited ability to accept criticism or
feedback.
 Nursing Intervention
■ Clients with narcissistic personality disorder can present one of the
greatest challenges to the nurse
■ The nurse must use self-awareness skills to avoid the anger and
frustration that these clients’ behavior and attitude can engender
■ Clients may be rude and arrogant, unwilling to wait, and harsh and
critical of the nurse.
■ The nurse must not internalize such criticism or take it personally.
■ The goal is to gain cooperation of these clients with other treatment as
indicated
PURPLE

■ Purple color lovers are negotiators who have

strong desire to please themselves and others.
Although these type of person generally well
liked, they are not easy to be open and like to
enjoy as a bit mysterious person.
CLUSTER C: PERSONALITY
DISORDERS
 AVOIDANT PERSONALITY DISORDER
■ Avoidant personality disorder is characterized by a
pervasive pattern of social discomfort and reticence, low
self-esteem, and hypersensitivity to negative evaluation
■ These clients are likely to report being overly inhibited
as children and that they often avoid unfamiliar
situations and people with an intensity beyond that
expected for their developmental stage.
■ This inhibition, which may have continued throughout
upbringing, contributes to low self-esteem and social alienation
■ Clients are apt to be anxious and may fidget in chairs and make
poor eye contact with the nurse.
■ They may be reluctant to ask questions or to make requests.
■ They may appear sad as well as anxious.
■ They describe being shy, fearful, socially awkward, and easily
devastated by real or perceived criticism.
■ Clients have very low self-esteem.
■ They are hypersensitive to negative
evaluation from others and readily believe
themselves to be inferior.
■ Clients may report some success in occupational roles
because they are so eager to please or to win a
supervisor’s approval.
■ Shyness, awkwardness, or fear of failure, however,
may prevent them from seeking jobs that might be
more suitable, challenging, or rewarding.
■ For example, a client may reject a promotion and
continue to remain in an entry-level position for years
even though he or she is well qualified to advance.
Nursing Interventions
■ These clients require much support and reassurance from the
nurse. In the nonthreatening context of the relationship, the
nurse can help them to explore positive self-aspects, positive
responses from others, and possible reasons for self-
criticism.
■ Helping clients to practice self-affirmations and positive self-
talk may be useful in promoting self-esteem
■ The nurse can teach social skills and help clients to practice
them in the safety of the nurse–client relationship
BROWN
Brown color lovers has ‘grounded’ or not made-up
personality. They are loyal and friend that can be
relied. Home and family are important to them,
and of course comfort is the major factor in their
life.
DEPENDENT PERSONALITY DISORDER

■ Dependent personality disorder is characterized by a

pervasive and excessive need to be taken care of,
which leads to submissive and clinging behavior and
fears of separation.
■ These behaviors are designed to elicit caretaking from
others.
■ Clients are frequently anxious and may be mildly
uncomfortable. They are often pessimistic and
self-critical; other people hurt their feelings easily.
■ They commonly report feeling unhappy or
depressed; this is associated most likely with the
actual or threatened loss of support from another.
■ They are preoccupied excessively with unrealistic
fears of being left alone to care for themselves.
■ They believe they would fail on their own, so
keeping or finding a relationship occupies much
of their time.
■ They have tremendous difficulty making
decisions, no matter how minor.
■ They seek advice and repeated reassurances about
all types of decisions, from what to wear to what
type of job to pursue.
■ Clients perceive themselves as unable to function
outside a relationship with someone who can tell
them what to do.
■ They are very uncomfortable and feel helpless
when alone, even if the current relationship is
intact.
■ They have difficulty initiating projects or
completing simple daily tasks independently.
■ When these clients do experience the end of a
relationship, they urgently and desperately seek
another.
■ The unspoken motto seems to be “Any
relationship is better than none at all.”
Nursing Interventions

■ The nurse must help clients to express

feelings of grief and loss over the end of a
relationship while fostering autonomy and
self-reliance.
■ Clients may need assistance in daily functioning if they have
little or no past success in this area.
■ Included are such things as planning menus, doing the weekly
shopping, budgeting money, balancing a checkbook, and paying
bills.
■ The nurse also may need to teach problem-solving and decision-
making and help clients apply them to daily life.
■ He or she must refrain from giving advice about problems or
making decisions for clients even though clients may ask the
nurse to do so.
GREEN

■ Fans of green color are a type of people who

always feel comfortable with security. They also
always want to create a better world for others.
Green color lovers are wise and manage their
time and life goals. But when it comes to
important things, they could be rigid.
OBSESSIVE–COMPULSIVE
PERSONALITY DISORDER
■ Obsessive–compulsive personality disorder is
characterized by a pervasive pattern of
preoccupation with perfectionism, mental and
interpersonal control, and orderliness at the
expense of flexibility, openness, and efficiency.
■ The demeanor of these clients is formal and
serious, and they answer questions with
precision and much detail.
■ They often report feeling the need to be perfect
beginning in childhood.
■ They were expected to be good and to do the
right thing to win parental approval.
■Clients are preoccupied with
orderliness and try to
maintain it in all areas of life
.
■ They become absorbed in their own perspective, believe
they are right, and do not listen carefully to others
because they have already dismissed what is being said.
■ Clients check and recheck the details of any project or
activity; often, they never complete the project because
of “trying to get it right.”
■ They have problems with judgment and decision-making
—specifically actually reaching a decision.
■ They consider and reconsider alternatives, and the desire
for perfection prevents reaching a decision.
■ These clients have low self-esteem and are
always harsh, critical, and judgmental of
themselves; they believe that they “could
have done better” regardless of how well
the job has been done
■ These clients have much difficulty in relationships, few
friends, and little social life.
■ They do not express warm or tender feelings to others;
attempts to do so are very stiff and formal and may sound
insincere.
■ For example, if a significant other expresses love and
affection, a client’s response might be “The feeling is mutual .”
■ Marital and parent–child relationships are often
difficult because these clients can be harsh and
unrelenting.
■ For example, most clients are frugal, do not give gifts
or want to discard old items, and insist that those
around them do the same.
■ At work, clients may experience some success,
particularly in fields when precision and attention to
detail are desirable
■ They fail to make timely decisions because of
continually striving for perfection
Nursing Interventions

■ Nurses may be able to help clients to view decision

making and completion of projects from a different
perspective.
■ Helping clients to accept or to tolerate less-than-perfect
work or decisions made on time may alleviate some
difficulties at work or home
■ Clients may benefit from cognitive restructuring
techniques.
■ The nurse can ask, “What is the worst that could
happen?” or “How might your boss (or your wife) see
this situation?”
■ These questions may challenge some rigid and
inflexible thinking.
■ Encouraging clients to take risks, such as letting
someone else plan a family activity, may improve
relationship
GRAY

■ People who love gray color are the type of persons

who tends to pull away from the attention of people.
They usually do not like direct activities.
■ Because they often hesitate to decide, so they often
decide anything until the last moment.
Other Behaviors
Depressive Behavior
■ Is characterized by a pervasive pattern of depressive
cognitions and behaviors in various context.
■ It occurs more often in people with relatives who have
major depressive disorders.
■ People with depressive personality disorders often
seek treatment for their distress
Passive-aggressive behavior

■ Is characterized by negative attitude and a pervasive pattern

of passive resistance to demands for adequate social and
occupational performance.
■ These clients may appear cooperative, even ingratiating, or
sullen and withdrawn, depending on the circumstances.
■ Their mood may fluctuate rapidly and erratically, and they
may be easily upset or offended
BLUE
■ Fans of blue color are quiet organized and trustworthy
type of person. They are also very appreciative of the
loyalty of others. Some types of blue color has
different character. Blue sky represents the type of
person who likes fun and relaxed life, while the navy
blue represents more serious and conservatives
personality.
 BIOLOGIC THEORIES

•Personality develops through the

interaction of hereditary dispositions and
environmental influences.

• Temperament refers to the biologic

processes of sensation, association and
motivation that underlie the integration
of skills and habits based on emotion.

• 50% of genetic differences account for

variances in temperament traits.
4 Temperaments Traits

1. Harm avoidance

• People with high harm avoidance exhibit fear of uncertainty, social

inhibition, shyness with strangers, rapid fatigability, and pessimistic worry
in anticipation of problems.

• Those with low harm avoidance are carefree, energetic, outgoing, and
optimistic.

• High harm-avoidance behaviors may result in maladaptive inhibition and

excessive anxiety.

• Low harm-avoidance behaviors may result in unwarranted optimism and

unresponsiveness to potential harm or danger.
2. Novelty seeking

•A high novelty-seeking temperament results in

someone who is quick tempered, curious, easily
bored, impulsive, extravagant, and disorderly.
He or she may be easily bored and distracted
with daily life, prone to angry outbursts, and
fickle in relationships.

• The person low in novelty seeking is slow

tempered, stoic, reflective, frugal, reserved,
orderly, and tolerant of monotony; he or she
may adhere to a routine of activities.
3. Reward Dependence

•Reward dependence defines how a person responds to social cues.

•People high in reward dependence are tenderhearted,

•sensitive, sociable, and socially dependent. They may become
overly dependent on approval from others and readily assume the
ideas or wishes of others without regard for their own beliefs or
desires.

•People with low reward dependence are practical, tough minded,

cold, socially insensitive, irresolute, and indifferent to being alone.
Social withdrawal, detachment, aloofness, and disinterest in others
can result.
4. Persistence

•Highly persistent people are hardworking and

ambitious overachievers who respond to fatigue or
frustration as a personal challenge. They may
persevere even when a situation dictates they should
change or stop.

•People with low persistence are inactive, indolent,

unstable, and erratic. They tend to give up easily
when frustrated and rarely strive for higher
accomplishments.
 Basically, peoples who love bright
colors like yellow usually are a cheerful,
optimistic and cheerful person. If there’s
something wrong, they will try to
change it as soon as possible. They
usually very spontaneous and always
curious about everything.
 PSYCHODYNAMIC THEORIES

Although temperament is largely inherited, social learning, culture, and

random life events unique to each person influence character.

Character consists of concepts about the self and the external

world. It develops over time as a person comes into contact with people
and situations and confronts challenges.

Three major character traits:

•self-directedness
•cooperativeness
•self-transcendence

When fully developed, these character traits define a mature personality

1. Self-directedness is the extent to which a person is
responsible, reliable, resourceful, goal oriented, and self
confident.

•Self-directed people are realistic and effective and can

adapt their behavior to achieve goals.

•People low in self directedness are blaming, helpless,

irresponsible, and unreliable. They cannot set and pursue
meaningful goals.
2. Cooperativeness refers to the extent
to which a person sees himself or herself as an
integral part of human society.

•Highly cooperative people are described as

empathic, tolerant, compassionate, supportive,
and principled.

•People with low cooperativeness are self-

absorbed, intolerant, critical, unhelpful,
revengeful, and opportunistic; that is, they look
out for themselves without regard for the rights
and feelings of others.
3. Self-transcendence describes the extent to
which a person considers himself or herself to be
an integral part of the universe.

•Self-transcendent people are spiritual,

unpretentious, humble, and fulfilled. These traits
are helpful when dealing with suffering, illness,
or death.

•People low in self transcendence are practical,

self conscious, materialistic, and controlling.
They may have difficulty accepting suffering,
loss of control, personal and material losses, and
death.
 Pink
Fans of pink color are a
sensitive and friendly people
who usually has a sweet
personality. They really like
their pleasant childhood and
love something romantic.
• Psychodynamic factors –
Freud believed that enduring
personality traits are a result
of fixation at one
psychosexual stage of
development.

• Environmental factors- life

experiences particularly
childhood and adolescence
influence the formation of
one’s personality.
Any persons with personality
disorder show history of:

a.Negative childhood
experiences
b.Separation and
abandonment
c. Emotional and/or physical
abuse
d. Significant loss of parenting
In summary, personality develops in
response to inherited
dispositions (temperament) and
environmental influences
(character), which are experiences
unique to each
person.
Personality disorders result when the
combination
of temperament and character
development produces maladaptive,
inflexible ways of viewing self, coping
with the
world, and relating to others.
Treatment:

• Psychotherapy – transference
based psychotherapy, the goal
is to end destructive behavior
by focusing on the way a
person experiences self, others
and the environment
• Eye movement desensitization
and reprocessing (EMDR)

- Help heal and resolve the

psychological trauma from the past

- During this procedure, patient is

made to remember past traumatic
events while simultaneously focusing
on external stimulus. The resultant
rapid eye movement causes the
traumatic event to dissipate from the
brain.
• Cognitive Behavioral
therapy
• Social skills training
• Relaxation and
meditation techniques
• Psychopharmacology
RED

■ Red color lovers are enthusiasts and love to have

fun to enjoy this life. On the other hand, they
easily feel bored because people who love red
color most likely always do everything quickly.
In essence, peoples who love red color have high
enthusiasm and motivation.