Dy, Myra Prizel C.

August19,2010
BSN111 Assignment

A. Personality Disorder
Personality- ingrained enduring pattern of behaving and relating to self, others, and the
environment; it includes perceptions, attitudes, and emotions. These behaviors and
characteristics are consistent across a broad range of situations and do not change easily. A
person usually is not consciously aware of her or his personality. It is affected by many factors
such as: some stem from biologic and genetic makeup, whereas some are acquired as a person
develops and interacts with the environment and other people.
Personality Disorders-are diagnosed when personality traits become inflexible and maladaptive
and significantly interfere with gow a person functions in society or cause the person emotional
distress. They usually are not diagnosed until adulthood, when personality is more completely
formed.
Diagnosis can be made if a person portrays behaviors that deviate to their cultural patterns in two
or more of the following areas such as cognition or how he/she perceives him/herself as a person,
and other people and situations also, if his/ her emotional response are appropriate in terms of
range, liability, and range, their interpersonal functioning and ability to control their wants and
expressing oneself in right time and place.

Category/ cluster

• Cluster A includes people whose behavior appears odd or eccentric and includes
paranoid, schizoid and schizotypal personality disorders.
• Cluster B includes people who appear dramatic, emotional, erratic and includes
antisocial, borderline, histrionic and narcissistic personality disorder.
• Cluster C includes people who appear anxious or fearful and includes avoidant,
dependent and obsessive- compulsive personality disorder.

Different Personality Disorders:

Cluster A Personality Disorders
Paranoid Personality Disorders
Manifestations:
-characterized by pervasive mistrust and suspiciousness of others;interpret others’ actions as
potentially harmful;appear aloof and withdrawn; may remain considerable physical distance
from the nurse;-appear guarded or hypervigilant;may survey rooms and its contents, look behind
furniture or doors; appear generally alert to any impending danger; choose to sit near the door
with backs against the wall;may have a restricted affect andmay be unable to demonstrate warm
or empathic emotional responses;mood may be labile, quickly changing from quietly suspicious
to angry and hostile;responses become sarcastic for no apparent reason;may spend
disproportinate time examining and analyzing the behavior and motives of others;often feel
attacked by others;uses defense mechanism of projection
Nursing Interventions:
Forming an effective working relationship with these clients is difficult. The nurse must
approach the client in a formal, business-like manner and refrain from social chitchat or jokes.
Being on time, keeping commitments, and being particularly straightforward are essential in to
the success of the nurse-client relationship.It is important for them to involve in them in
formulating their plans of care. The nurse asks what the client would like to accomplish in
concrete terms, such as minimizing problems at work or getting along with others. The nurse
should help the client to learn to validate ideas before taking action;
Schizoid Personality Disorders
Manifestations:
Characterized by pervasive pattern of detachment from social relationship and a restricted range
of emotional expression in interpersonal settings; display constricted affect and little if any,
emotion; are aloof and indifferent , appearing emotionally cold, uncaring or unfeeling. They
report no leisure;if under stress, their response appears passive and disinterested; marked
difficulty in expressing emotions, particularly aggression and anger.; do not report feeling
distressed about this lack of emotion; it is more distressing to family members; have a rich
fantasy and life, although they may be reluctant to reveal that information to the nurse or anyone.
;often involved in computers or electronics in hobbies or work; spend long hours in puzzles or
mathematical problems; may be indecisive and lack future goals or direction; have pervasive
lack of desire for involvement with others in all aspects of life;they do not have a desire friends,
rarely date or marry, and have little or no sexual contact
Nursing Interventions:
Interventions are focus on improved functioning in community. The nurse can make referrals to
social services or appropriate local agencies for assisstance to those who need housing or a
change in living circumstances.The nurse can help them find suitable housing that
accommodates the client’s desire and need for solitude.If the client has an identified family
member as his or her primary relationship, the nurse must ascertain whether that person can
continue in that role. If the person cannot, the client may need to establish at least a working
relationship with a case manager. The case manager can help the client to obtain services and
health care, manage finances, and so on. The client has a greater chance of success if he or she
can relate his or her needs to one person.
Schizotypal Personality Disorder
Manifestations:
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; have an odd appearance that causes others to notice
them; unkempt and disheveled, and their clothes are often ill-fitting, do not match and may be
stained or dirty; wander aimlessly and at times, become preoccupied with some environmental
detail; provides unsatisfactory answers; frequently use words incorrectly; cognitive distortions
include ideas of reference, magical thinking, odd or unfounded beliefs, and a preoccupation with
parapsychology; can experience great anxiety around other people, especially those who are
unfamiliar; do not view their anxiety as a problem; cannot respond to normal social cues and
hence cannot engage in superficial conversation; may have skills that could be useful in a
vocational setting, but they are not often successful in employment without support or assistance
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 as 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. The nurse must help
them function in the community with whom they must have contact, such as a landlord, store
clerk, or a pharmacist. The nurse can then role-play interactions that client would have with each
of these people, this allows clients to practice clear and logical requests to obtain services or to
conduct personal business,. Clients may be able to have written requests or to use the telephone
for business. Social skills training may help the client to talk clearly with others
Cluster B Personality Disorders
Antisocial Personality Disorder
Manifestations:
Charaterized 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 right of others, lack of
remorse for behavior, shallow emotions, lying, rationalization of own behavior, poor
jugdgement, impulsivity, irritability and aggressiveness, lack of insight,thrill-seeking behaviors,
exploitation of people in relationships, poor work history, consistent irresponsibility
Nursing Interventions:
The nurse must provide structure in the therapeutic relationship, identify acceptable and expected
behaviors and be consistent in those expections. He or she must minimize attempts by these
clients to manipulate and to control the relationship.
Limit the setting in three steps:
A. State the behavioral limit (describing the unacceptable behavior)
B. Identifying the consequences if the limit is exceeded
C. Identifying the expected or desired behavior
Consistent limit setting in a matter of fact nonjudgemental manner is crucial to success. The
nurse should not be angry or respond to the client harshly or punitively.
Confrontation is a way to focus on thegehavior itself rather than on attempts by clients to justify
it. The nurse can teach problem solving skills. The nurse can encourage them to identify sources
of frustration, how they respond to it, and the consequences. The nurse helps clients to identify
specific problems. Assessing use of alcohol and other drugs is essential when examining role
performance is nurse’s role in this disorder. The nurse must redirect the client to examine the
source of their problems realistically. Referrals to vocational or job programs may be indicated.
The nurse evaluates the effectiveness of treatment based on attainment of or progress toward
outcomes.
Borderline Personality Disorder
Manifestations:
Characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and
affect as well as marked impulsivity.; recurrent self-mutation 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; may cling and ask for help one minute and then become angry,
act out, and reject all offers of help in the next minute: may attempt to manipulate self to gain
immediate gratification of needs and times sabotage their own treatment plans by purposely
failing to do what they have agreed: have labile mood, unpredictable and diverse behavior:
experience wide range of dysfunction, pervasive mood is dysphoric involving unhappiness,
restlessness, and malaise; thinking about self and others is often polarized and extreme, which
is sometime referred to as spilliting, intellectual capacities are intact and are fully oriented to
reality, frequently report behaviors consistent with impaired judgment and lack of care and
concern for safety; are unstable view of themselves that shifts dramatically and suddenly
Interventions:
The nurse most likely to have contact with these clients during crises, when they are exhibiting
self –harm behaviors or transient psychotic symptoms. Brief hospitalization often are used to
manage these difficulties and to stabilized the clients condition. The nurse must always seriously
consider suicidal ideation with the presence of a plan, access to means for enacting the plan, and
self-harm behaviors and institute appropriate interventions. The nurse must provide the structure
and limit setting in the therapeutic relationship. The nurse must be quite clear about establishing
the boundaries of the therapeutic relationship. It is important to teach the basic communication
skills such as eye contact, active listening, taking turns talking, validating the meaning of
another’s communication,and using “I” statements. Keeping a journal often helps the clients
gain awareness of feelings. The nurse can review journal entries as a basis for discussion.
Reshape thinking patterns through Cognitive structure, thought stopping and decatastrophizing.

Histrionic Personality Disorder

 Manifestations: characterized by a pervasive pattern of excessive emotionality and attention
seeking; tendency to exaggerate the closeness of relationship or to dramatize relatively minor
occurances can result in unreliable data; speech is usually colorful and theatrical, full of
superlative adjectives’becomes appparent however, although colorful and entertaining,
descriptions are vague and lack detail; overall appearance is normal, although clients may be
overdress; uncomfortable when they are not the center of attention and go to great lengths to
gain that status.
Nursing Interventions:
The nurse gives clients feedback about their social interactions with others, including manner of
dress and nonverbal behavior. Feedback should not focus on appropriate alternatives not merely
criticisms. It may also be helpful disucuss social situations to explore client’s perceptions of
others’ reactions and behavior. Teaching social skills and role-playing skills in a safe,
nonthreatening environment can help clients to gain confidence in their ability to interact
socially. The nurse must convey genuine confidence in the client’s abilities.
Narcissistic Personality Disorder
Manifestations: characterized by a pervasive pattern of grandiosity, need for admiration , and
lack of empathy; may display an arrogant or haughty attitude; lack the ability to recognize or to
emphasize with the feelings to others; may express envy and begrudge others any recognition or
material success; thought processing is intact, but insight is limited; believe themselves to be
superior and special and are unlikely to consider that their behavior has any relation to their
problems; underlying self esteem is almost fragile and vulnerable; hypersensitive to criticism and
need constant attention and admiration; may experience some success because they are ambitious
and confident
Nursing interventions:
The nurse must use self-awareness skills to avoid the anger and frustration that the client’s
behavior and attitude can engender. The nurse must not internalize the criticism made by the
client or take it personally. The goal is gain cooperation of these clients with other treatment as
indicated. The nurse teaches about comorbid medical or psychiatric conditions, medication
regimen and needed self-care skills in a matter-of-fact manner.
Cluster C: Personality Disorders
Avoidant Personality Disorder:
Manifestations: characterized by a pervasive pattern of social discomfort and reticence, low self
esteem and hypersensitivity to negative evaluation; 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; clients have very low self-esteem; may report some
success in occupational roles because they are so eager to please or to win a supervisor’s
approval
Nursing Interventions:
These clients require much support and reassurance from the nurse. In the non threatening
context of 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. Reframing and
decatastrophizing can enhance selt worth. The nurse can teach social skills and help clients to
practice them in the safety of the nurse-client relationship.
Dependent Personality Disorder
Manifestations; characterized by a pervasive and excessive need to be taken care of which leads
to submissive and clinging behavior and fears of separatio; frequently anxious and be mildly
uncomomfortable; often pessimistic, and self-critical; other people hurt their feelings easily;
they commonly report feeling of unhappy and depressed; perceive themselves unable to function
outside a relationship with someone who can tell them what to do: uncomfortable and feel
helpless when alone
Nursing Interventions:
The nurse must help the client to express feelings of grief and loss over the end of relationship
while fostering autonomy and self-reliance. Helping the clients to identify their strenghts and
needs is more helpful than encouraging the overwhelming belief that “I can do anything
alone!”The nurse may need to teach problem solving skills and decision making and help client
apply them to daily life.

Obsessive-Compulsive Personality Disorder

Manifestations:
Characterized by a pervasive pattern of preoccupation with perfectionism, mental and
interpersonal control, and orderliness at the expense of flexibility, openness and efficiency;
demeanor of these clients is formal and serious and they answer questions with precision and
much detail; preoccupied with orderliness and try to maintain it in all areas of life; have low
self-esteem and are always harsh, critical and judgemental of themselve; have much difficulry in
relationshis, few friends and little social life
Nursing Interventions:
Nurses may be able to help clients to view decision making and completion of projects from
different perspective. Rather than striving for the goal of perfection, client can set a goal of
completing the project. Helping the client to accept or to tolerate less than perfect work or
decisions made on time may alleviate some difficulties at work or home. Encourage client to take
risks such as letting someone else plan a family activity may improve relationships.
Depressive Personality Disorder
Manifestations:
Characterized by pervasive pattern of depressive personality disorder may seem to have similar
behavior characteristics as clients with major depression; have sad, gloomy or dejected affect;
express unhappiness, cheerlessness and the inability to experience joy or pleasure in any
activity ; cannot relax, do not display sense of humor ; may repress or not express anger; self-
esteem is quite low with feelings of worthlessness, and inadequacy even when clients have been
successful
Nursing Interventions:
It is always important to assess whether there is a risk for self-harm. If express suicidal ideation
or has urges for self-injury, the nurse must provide interventions and plan care. The nurse
explains that client must take action rather than wait to feel better. Encourage client to become
involved in activities or engaged with others. Give factual feedback.

Passive aggressive Personality Disorder

Manifestations:
Characterized by negative attitude and pervasive pattern of passive resistance to demands for
adequate social and occupational performance; may appear cooperative, even ingratiating, or
sullen and withdrawn,depending on the circumstances,their mood fluctuate rapidly; experience
intense conflicet between dependence on others; often have various vagues or generalized
somatic complaints and may even adopt a sick role
Nursing Interventions:
The nurse can help them examine the relationship between feelings and subsequent actions. The
nurse can help the client to learn appropriate ways to express feelings directly, especially
negative feelings. Methods such as having the client write about the feelings or role play are
effective.

Describe your own personality? What is in you that differ from clients with personality disorder?
What personality disorder you are prone to? Justify your answer.

I am a type of person that do not try new things because I am afraid of failure. I am afraid of
what will be the consequences of my actions as a result I don’t try many things in life. Despite of
these, I am still happy with my life and I follow the flow of my life. I differ from clients with
personality disorder in such I way that I am not reluctant to ask questions, I maintain good eye
contact while in a conversation,I have self-confidence and I accept criticisms. I know how to act
at appropriate time and place. The personality disorder I am prone to is avoidant personality
disorder because there are times that I avoid unfamiliar situations and I am anxious many times.
I am also shy and easily devastated by criticisms. I am also fearful of avoiding mistakes and be
rejected. I also do not like rejection, criticisms or disapproval.
B. Anxiety
Anxiety- is a vague feeling of dread or apprehension; it is a response to internal or external
stimuli that can have behavioral, emotional, cognitive and physical symptoms. Anxiety is
distinguished from fear, identifiable, external stimulus that represents danger to the person.

Signs and Symptoms of Anxiety

Anxiety causes uncomfortable cognitive, psychomotor, and physiologic responses such

as difficulty with logical thought, increasingly agitated motor activity and elevated signs. To
reduce these uncomfortable feelings, the person tries to reduce the levels of discomforts by
implementing new adoptive behavior or defense mechanisms.

Level of Anxiety, indicators and management

• Mild Anxiety is a sensation that something is different and something is different and
warrants special attention. Sensory stimulation increases and helps the person focus
attention to learn, solve problems, think, act, feel and protect him or her.
Management:
People with anxiety canl learn and solve problem and are eager for information.
Teaching can be effective when they are mildly anxious.
• Moderate Anxiety is the disturbing feeling that something is wrong; the person becomes
nervous or agitated. In moderate anxiety, the person can still process information, solve
problems, and learn new assistance from others. He or she has difficulty concentrating
independently it can be directed to the topic.
Management:
Speaking in short time, simple and easy-to-understand sentences is effective. The nurse
must stop to ensure that the client is still taking in information correctly. The nurse may
need to redirect the client back to the topic. If the client goes off on an unrelated tangent.
• Severe Anxiety is when a person anxiety has trouble thinking and reasoning. Muscles
tightening and vital signs increase. The person paces; is restless, irritable, and angry; or
uses other similar emotional- psychomotor means to release tension. In panic, the
emotional- psychomotor realm predominates with accompanying fight, flight, or freeze
response.
Management:
It is essential to remain with the person because anxiety is likely to worsen if he or she is
left alone. Talking to the client in a low, calm , and soothing voice can help.
 Panic Anxiety –perceptual field reduced to focus on self, cannot process any
environmental stimuli, distorted perceptions, loss of rational thought, doesn’t recognize
potential danger, can’t communicate verbally ,possible delusions and hallucinations
Management:
The nurse must keep talking to the person in a comforting manner, even though the client
cannot process what the nurse is saying. Going to a small quiet and non stimulating
environment may help reduce anxiety. The nurse should remain with the client.

Anxiety Disorders
 • Agoraphobia- about or avoidance of places or situations from which escape might be
difficult or help might be unavailable., impaired ability to work, difficulty meeting daily
responsibilities
• Panic disorder- characterized by recurrent, unexpected panic attacks that causes constant
concern. Lasting for 15-30 minutes with four or more of the following: palpitations,
trembling, sweating, or shaking, shortness of breathe, choking, chest pain nausea, fear of
dying, or going crazy, paresthesias, chills or hot flashes
• Specific phobia- characterized by significant anxiety provoked by a specific feared object
or situation, which often leads to avoidance behavior; recognize fear as excessive or
unreasonable
• performance situation, which often leads to avoidance behavior; fear of embarassment,
avoidance of behavior or situation, recognition that response is irrational
• Obsessive-compulsive disorder- involves obsessions that cause marked anxiety and/ or
compulsions the attempt to neutralize anxiety, recurrent, persistent, unwanted, intrusive
thoughts impulses or images beyond worrying about realistic life problems
• Generalized anxiety disorder- characterized by at least 6 months of persistent and
excessive worry and anxiety; irritable, restless, easily fatigued, difficulty concentrating,
mind going , blank, tension, disturbed sleep
• Acute stress disorder- development of anxiety, dissociative and other symptoms within 1
month of exposure to extremely traumatic stressor.
• Post traumatic stress disorder- characterized by re-experiencing of an extremely traumatic
event, avoidance of stimuli associated with the event, numbing responsiveness and
persistent arousal.

Describe a situation when you become anxious? What trigger anxiety? What have you done to
resolve it?

I became anxious when my mother got sick. I am worried of the things that may happen to her
and our family in the future. I become afraid of the sufferings she may encounter in the future
and that we wont have money anymore to sustain her treatments.I prayed a lot to God to solve it
and tell my problem to my friends and they gave me strength to be strong enough and fight. They
told me that they are here for me and that if I need some help they will their best to help me. I
also did my part as a daughter to my mother and for our family.