PERSONALITY DISORDERS

This module aligns with key elements of APNA’s “Growth & Development” and “Clinical Decision Making” (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Assessment of Personality Disorders
• Problems Associated with Personality Disorders
• Treatment of Personality Disorders

Module Learning Outcomes

• Describe the signs and symptoms of Personality Disorders
• Identify the common nursing problems associated with Personality Disorders
• Summarize the treatment of Personality Disorders.

Concepts

• Self
• Behavior
• Coping

Overview

In this module, we will cover matters related to personality disorders including their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include Clusters A, B, and C.

Personality disorders have four defining features, which include distorted thinking patterns, problematic emotional responses, over- or under-regulated impulse control, and interpersonal difficulties. While these four core features are universal among all ten personality disorders, the DSM-5 divides the personality disorders into three different clusters based on symptom similarities.

To meet the criteria for any personality disorder, the individual must display a pattern of behaviors in adulthood. Children cannot be diagnosed with a personality disorder. Some children may present with similar symptoms, such as poor peer relationships, odd or eccentric behaviors, or peculiar thoughts and language; however, a formal personality disorder diagnosis cannot be made until the age of 18. Nurses most often come across Antisocial and Borderline personality disorders in the psychiatric setting (Videbeck, 2020). Individuals diagnosed with a personality disorder may continue to have difficulties related to the personality disorder in young and middle adulthood but typically decline as age increases to forties and fifties (Videbeck, 2020). It is common for those diagnosed with a personality disorder to have another coexisting mental health diagnosis (Videbeck, 2020).

Memorable Psychiatry and Neurology. (2022). Personality disorder mnemonics (memorable psychiatry lecture) [Video]. YouTube. https://youtube.com/watch?v=U6Y9WTyPgG0&si=EnSIkaIECMiOmarE

Assessment

Personality disorders are typically associated with traits that are inflexible and maladaptive and are related to significant functional impairment or subjective distress (Videbeck, 2020). There is a wide range of maladaptive and/or dysfunctional behavior or personality characteristics associated with a personality disorder. Some of these behaviors and characteristics coupled with each personality disorder are summarized below from the Fariba et al. (2022) resource. 

• Paranoid – suspicious and distrustful
• Schizoid – reclusive, difficulty in forming personal relationships, blunted affect
• Schizotypal – bizarre behavior/speech/thought content, inappropriate affect, abnormal visual experiences
• Antisocial – violates social norms and others’ rights, impulsive, volatile, reckless, aggressive, manipulative
• Borderline – labile mood, unstable intense relationships, fear abandonment, self-harm
• Histrionic – attention-seeking, increased concern of physical appearance, come across sexually promiscuous
• Narcissistic – self-centered, egotistical grandiosity, lack empathy, overly sensitive to criticism, sense of entitlement
• Avoidant – low self-esteem, may desire social connection, but avoid social relationships
• Dependent – dependent on others for emotional validation
• Obsessive – perfectionists, inflexible, overly conscientious, mildly constricted affect

Problems

The problems that may be associated with a personality disorder diagnosis include:

• Ineffective coping
• Risk for non-suicidal self-injury
• Social isolation
• Risk for suicide

Treatment

Videbeck (2020) explained treatment of personality disorders may be difficult. Treatment difficulties are explained by several reasons, including:

1. One’s personality and associated behaviors are deeply ingrained
2. When change occurs, it is slow
3. Many do not recognize their behaviors as dysfunctional or maladaptive
4. There is no specific medication to change personality.

Videbeck (2020) identified a few general interventions for nurses to help patients diagnosed with a personality disorder:

1. Cultivate a therapeutic relationship and use therapeutic communication techniques to help role model appropriate social interactions.
2. Help clients identify inappropriate or dysfunctional thoughts and/or behaviors and encourage replacement with positive behaviors and adaptive coping mechanisms.
3. Use cognitive restructuring (e.g., thought-stopping and positive self-talk).

Specific signs and symptoms may warrant psychotropic medication treatment. For example, a patient diagnosed with a Cluster C personality disorder may benefit from an SSRI to treat underlying anxiety (Fariba et al., 2022). Additional treatment options for an individual diagnosed with a personality disorder may include psychotherapy, cognitive-behavioral therapy (CBT), social skills training, and group therapy (Fariba et al., 2022).

Adapted from Fundamentals of Psychological Disorders 2nd Edition- Module 13 by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow .