Defined as an ingrained, enduring pattern of behaving and relating to self.

Personality includes perceptions, attitudes and emotions May factors influence personality such as:

Biologic and genetic make-up Interaction with the environment and other

people

Diagnosed when the personality traits become inflexible and maladaptive and significantly interfere with how a person functions in a society Maladaptive patterns can be traced to early childhood or adolescence

Diagnosis is made when the person exhibits enduring 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 Interpersonal functioning Ability to control impulses or express behavior at the appropriate time and place (impulse control)

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 or 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 disorders

Personality disorders are relatively common occurring in 10% to 13% of the general population Incidence is even higher for people in lower socioeconomic groups and unstable or disadvantaged populations Personality disorders have been correlated highly with criminal behavior, alcoholism and drug abuse.

Biologic Theories Psychodynamic 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.

The four temperament traits are: Harm avoidance Novelty seeking Reward dependence Persistence Each of these four genetically influenced traits affects a persons automatic responses to certain situations. These response patterns are ingrained by 2 to 3 years.

People with high harm avoidance exhibit fear and uncertainty, social inhibition, shyness with strangers, rapid fatigability and pessimistic worry in anticipation of problems High harm avoidance behaviors may result in maladaptive inhibition and excessive anxiety

People with low harm avoidance are carefree, energetic, outgoing and optimistic. Low harm avoidance behaviors may result in unwarranted optimism and unresponsiveness to potential harm or danger

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 with low novelty seeking behavior is slow tempered, stoical, reflective, frugal, reserved, orderly and tolerant of monotony; he or she may adhere to a routine of activities.

Reward dependence defines how a person responds to social cues People in high 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.

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 that 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.

Character consists of concepts about the self and the external world. It develops over time as a person comes into contact with other people and situations and confronts challenges. Three major character traits have been distinguished: self-directedness, cooperativeness, and self-transcendence. When fully developed, these character traits define a mature personality.

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 with low self-directedness are blaming, helpless, irresponsible and unreliable. They cannot set and pursue meaningful goals.

Cooperativeness refers to the extent to which a person sees himself as an integral part of human society Highly cooperative people are described as empathetic, tolerant, compassionate, supportive and principled.

People with low cooperativeness are self-absorbed, intolerant, critical, unhelpful, revengeful and opportunistic. They look out for themselves without regard for the rights and feelings of others.

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 and 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.

In summary, personality develops in response to inherited dispositions (temperaments) and environmental influences (character). Personality disorders result when the combination of temperament and character development produces maladaptive, inflexible ways of viewing self, coping with the world and relating with the world

Paranoid personality is characterized by pervasive mistrust and suspiciousness of others Clients with this disorder interprets others actions as potentially harmful.

aloof, withdrawn may remain a considerable physical distance from the nurse guarded or hypervigilant, they may survey the room and its contents, look behind furniture or doors, and generally appear alert to impending danger. They may have a restricted affect and be unable to demonstrate warm or empathetic emotional responses.

They may choose to sit near the door to have ready access to an access or with their back against the wall to prevent anyone from speaking behind of them. Mood may be labile, quickly changing from quietly suspicious to angry or hostile. They may spend disproportionate time examining and analyzing the behavior and motives of others to discover hidden and threatening meanings. The client uses the defense mechanism projection.

Approach the client in a formal, business-like manner and refrain from social chitchat or jokes. Be on time and keep commitments Involve the client in formulating their plan of care. Help the client validate ideas before taking action to prevent acting out paranoid thoughts or beliefs.

Is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression.

Aloof and indifferent, appearing emotionally cold, uncaring or unfeeling Report no leisure or pleasurable activities, because they rarely experience enjoyment. (anhedonia) Client may have a rich and extensive fantasy; however, the client can distinguish fantasy from reality. Clients are accomplished intellectually and often involved with computers or electronics. They do not have or desire friends, rarely date or marry and have little or no sexual contact.

Intervention focuses on improved functioning in the community. Develop sensitivity in interpersonal cues and social skills Teach the client appropriate ways in reacting to common social situations.

Is characterized by the pervasive pattern of social and interpersonal deficits marked by cognitive and perceptual distortions and behavioral eccentricity.

Clients often have an odd appearance that causes others to notice them Clothes are ill fitting, do not match, may be stained or dirty. Speech may be loose, digressive or vague. Clients often provide unsatisfactory answers to questions They frequently use words incorrectly, which makes their words sound bizarre.

Cognitive distortions include ideas of reference, magical thinking, and a preoccupation with parapsychology such as ESP and Clairvoyance.

Development of self-care and social skills Improved functioning in the community Establish a daily routine for hygiene and grooming Help the client develop a relationship with people who can discuss the unusual or bizarre situations.

Is characterized by disregard for and violation of the rights of others and with the characteristics of deceit and manipulation. This pattern has also been described as psychopathy or sociopathy.

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 behavior Exploitation of people in relationships Poor work history Consistent irresponsibility

Limit-setting
Stating the behavioral limit (describing the

unacceptable behavior) Identifying the consequences if the limit is exceeded Identifying the expected or desired behavior Consistent limit setting in a matter-of-fact, non-judgmental manner is crucial to success.

Keep client focused on self Effective problem-solving skills Decreased impulsivity Expressing negative emotions such as anger or frustration Identifying barriers to role performance Decreasing or eliminating the use of drugs and alcohol.

Characterized by a pattern of unstable interpersonal relationships, selfimage and affect as well as marked impulsivity.

Fear of abandonment, real or perceived Unstable and intense relationships Unstable self-image Impulsivity or recklessness Recurrent self-mutilating behavior or suicidal threats or gestures Chronic feeling of emptiness or boredom Labile mood

Irritability Polarized thinking about self and others (Splitting) Impaired judgment Lack of insight Transient psychotic symptoms such as hallucinations demanding self-harm

Promoting the clients safety

No self-harm contract Safe expression of feelings and emotions

Helping client to control and cope with emotions

Identifying feelings Journal entries Moderating emotional responses Decreasing impulsivity

Delaying gratification

Cognitive restructuring techniques

Decatastrophizing Thought-stopping

Therapeutic relationship
Limit-setting Confrontation

Characterized by a pattern of excessive emotionality and attention-seeking

Tendency to exaggerate the closeness of relationships Speech is usually colorful and theatrical, full of superlative adjectives Appearance is normal although clients may overdress Clients are uncomfortable when they are not the center of attention and go to great lengths to get that status Clients may have a variety of vague physical complaints or exaggerated versions of physical illness.

Feedback should focus on appropriate alternatives, not merely criticism Be specific in modeling and describing social skills. Teach the client to develop appropriate ways of developing self-esteem

Characterized by a pattern of grandiosity, need for admiration and a lack of empathy.

May be arrogant or display haughty behavior Lack the ability to empathize or recognize the feelings of others Clients believe themselves to be superior and special Hypersensitive to criticism and need constant admiration and attention. Expect special treatment from others Display a sense of entitlement

Matter-of-fact approach Gain cooperation with needed treatment Teach client any needed self-care skills

Characterized by 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 would often avoid unfamiliar situations and people with an intensity beyond that expected of developmental stage.

Clients may fidget in chair and make poor eye contact with the nurse May describe being shy, fearful, socially awkward Easily devastated by real or perceived criticism Have very low self-esteem Hypersensitive to negative evaluation from others and readily believe themselves inferior. They usually desire closeness and intimacy but fear possible rejection and humiliation.

Explore positive self-aspects, positive responses from others and positive selfcriticism Promote self-esteem by practicing selfaffirmation Reframing and decatastrophizing Teach the client social skills.

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 often pessimistic and selfcritical Other people hurt their feelings easily Commonly report being unhappy or depressed associated most likely with actual or threatened loss of support from another

They are preoccupied excessively with fears of being left alone to care for themselves The believe they would fail on their own, so keeping and finding a relationship occupies much of their time They seek advice and repeated assurances about all type of decisions.

Foster self-reliance and autonomy Teach problem-solving and decisionmaking skills Cognitive restructuring techniques

Is characterized by a pattern of preoccupation with perfectionism, mental and interpersonal control and orderliness at the expense of flexibility, openness and efficiency.

Preoccupied with orderliness and try to maintain it in all areas of life They often strive for perfection Check and recheck the details of any project or activity Consider and reconsider alternatives, which often prevents the reaching of a decision. Clients have low self-esteem, and are always harsh, critical and judgmental of themselves. Have much difficulty in relationships, few friends and little social life.

Encourage negotiation with others Assist the client to make timely decisions and complete work Cognitive restructuring techniques Encourage the client to take risks and relinquish some of their need for control.

Characterized by a negative attitude and a pattern of passive resistance to demands for adequate social and occupational performance

May appear cooperative, ingratiating or sullen and withdrawn Mood may fluctuate rapidly and erratically Clients are frequently ambivalent and indecisive Habitually resent, oppose and resist demands to function at a level expected by others Expresses resistance through procrastination, forgetfulness, stubbornness and intentional inefficiency especially to tasks assigned by authority figures.

Help the client to identify feelings and express them directly Assist client to examine own feelings and behavior realistically