This personality disorder is according to DSM 5

1. PERSONALITY DISORDERS
 The term personality refers to enduring qualities of an
individual that are shown in his ways of behaving in a wide
variety of circumstances. Personality disorders result when
personality traits become abnormal, i.e. become inflexible
and maladaptive and cause significant social or occupational
impairment or significant subjective distress

2. DEFINITION
 An abnormal personality is one in which there are "deeply
ingrained maladaptive patterns of behavior recognizable by
the time of adolescence or earlier and continuing through
most of adult life. Because of this, the patient suffers or
others have to suffer, and there is an adverse affect on the
individual or on society."

3. TYPES OF PERSONALITY DISORDERS
• Paranoid personality disorder
• Schizoid (schizotypal) personality disorder
• Dissocial personality disorder
• Emotionally unstable (impulsive and borderline type) personality disorder
• Histrionic personality disorder
• Anankastic (obsessive-compulsive personality disorder)
• Anxious (avoidant) personality disorder
• Dependent personality disorder
• Other disorders

4. OVERALL MANAGEMENT STRATEGIES
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 The objective of management is to offer support to people with personality
disorder and allow them to express their concerns and emotions in a safe
environment. This supportive approach would allow the treatment team and
patient to develop trust and lead to stabilization. The specific treatment strategies
include crisis intervention, short term hospitalization, psychotherapy and
pharmacotherapy

5. CLASSIFICATION
a. Cluster A (odd and eccentric): paranoid, schizoid, schizotypal personality disorders
b. Cluster B (dramatic, emotional and erratic): antisocial, histrionic, narcissistic
personality disorders
c. Cluster C (anxious and fearful): avoidant, dependent and obsessive-compulsive
personality disorder

6. PARANOID PERSONALITY (clinical
manifestation )
• Suspicious
• Mistrustful
• Sensitive
• Argumentative
• Stubborn
• Self-important

7. SCHIZOID PERSONALITY DISORDER
• Emotionally cold
• Aloof
• Detached
• Humorless
• Introspective

8. SCHIZOTYPAL PERSONALITY DISORDER
• Inappropriate affect
• Odd beliefs or magical thinking
• Social withdrawal
• Odd, eccentric or peculiar behavior

9. ANTISOCIAL PERSONALITY DISORDER
• Failure to sustain relationships
• Disregard for the feelings of others
• Impulsive actions
• Low tolerance to frustration
• Tendency to cause violence
• Lack of guilt
• Failure to learn from experience

10. HISTRIONIC PERSONALITY DISORDERS
This disorder is more common in females
• Dramatic emotionality (Emotional blackmail, angry scenes, demonstrative suicide
attempts, etc.)
• Craving for novelty and excitement
• Shallow and labile affectivity
• Attention-seeking behavior
• Over concern with physical attractiveness

11. NARCISSTIC PERSONALITY DISORDERS
• Inflated sense of self-importance
• Attention-seeking, dramatic behavior
• Unable to face criticism
• Lack of empathy
• Exploitative behavior

12. BORDERLINE PERSONALITY DISORDER
• Unstable relationships
• Impulsive behavior
• Variable moods
• Lack of control on anger
• Recurrent suicidal threats or behavior
• Uncertainty about personal identity
• Chronic feelings of emptiness
• Efforts to avoid abandonment
• Transient stress-related paranoid or dissociative symptoms

13. AVOIDANT PERSONALITY DISORDER
• Persistent feeling of tension and apprehension
• Inferiority complex
• Fear of criticism, disapproval or rejection
• Unwillingness to become involved with people
• Excessive preoccupation with being criticized or rejected in social situations

14. DEPENDENT PERSONALITY DISORDER
• Subordination of one's own needs
• Unwillingness to make even reasonable demands on other people
• Inability to take decision
• Feeling uncomfortable or helpless when alone

15. OBSESSIVE COMPULSIVE PERSONALITY
DISORDER
• Feeling of excessive doubt and caution
• Preoccupation with details, rules, lists, order or schedule
• Perfectionism
• Rigidity and stubbornness
• High standards.

16. ETIOLOGY
 A Hereditary factors: Chromosomal abnormality or genetic predisposition can be
responsible for a psychopathic personality.
 B. Relation of personality disorder to mental disorder: For example, schizoid
personalities are considered to be partial expressions of schizophrenia.
 C. Personality disorder and upbringing: e.g. disturbed parent-child
relationships.

17. D. Other causes:
• Maternal deprivation, especially in antisocial personality.
• Borderline personalities are more likely to report physical and sexual abuse in
childhood.
• Histrionic personality is said to occur as a result of failure to resolve oedipal complex
complex and excessive use of repression as a mechanism of defense.
• Dependent personality may be due to fixation in the oral stage of development.
• Paranoid personality is due to absence of trust, which results from lack of parental
affection in childhood and persistent rejection by parents leading to low self-esteem.

18. Paranoid personality disorder
 The most prominent features of paranoid personality disorder are mistrust of
others and the desire to avoid relationships in which one is not in control or loses
power. These individuals are suspicious, guarded, and hostile. They are
consistently mistrustful of others’ motives, even relatives and close friends. Actions
of others are often misinterpreted as deception, deprecation, and betrayal,
especially regarding fidelity or trustworthiness of a spouse or friend . Minor
innocuous incidents are often misinterpreted as having sinister or hidden
meaning, and suspicions are magnified into major distortions of reality. People
with paranoid personalities are unforgiving and hold grudges; their typical
emotional responses are anger and hostility. They distance themselves from others
and are outwardly argumentative and abrasive; internally, they feel powerlessness,
fearful, and vulnerable. Other hallmark features of paranoid personality disorder
are persistent ideas of self-importance and the tendency to be rigid and
controlled.

19. Schizoid personality disorder
 People with schizoid personality disorder are expressively impassive and
interpersonally unengaged. They tend to be unable to experience the joyful and
pleasurable aspects of life. They are introverted and reclusive, and clinically appear
distant, aloof, apathetic, and emotionally detached. They have difficulties making
friends, seem uninterested in social activities, and appear to gain little satisfaction
in personal relationships. In fact, they appear to be incapable of forming social
relationships. Interests are directed at objects, things, and abstractions. As
children, they engage primarily in solitary activities, such as stamp collecting,
computer games, electronic equipment, or academic pursuits such as
mathematics or engineering. In addition, there seems to be a cognitive deficit
characterized by obscure thought processes, particularly about social matters.
Communication with others is confused and lacks focus. These individuals reveal
minimum introspection and self-awareness, and interpersonal experiences are
described in a very mechanical way

20. Schizotypal personality disorder
 Persons with the schizotypal personality disorder are characterized by a
pattern of social and interpersonal deficits. They are void of any close
friends other than first-degree relatives. They have odd beliefs about their
world that are inconsistent with their cultural norms. Ideas of reference
(incorrect interpretations of events as having special, personal meaning)
are often present, as are unusual perceptual delusions and odd,
circumstantial, and metaphorical thinking and speech. Their mood is
constricted or inappropriate, and they have excessive social anxieties of a
paranoid character that do not diminish with familiarity. Their appearance
and behavior are characterized as odd, eccentric, or peculiar. They usually
exhibit an avoidant behavior pattern

21. Borderline personality disorder
 People with BPD have problems in regulating their moods, developing a
sense of self, maintaining interpersonal relationships, maintaining reality-
based cognitive processes, and avoiding impulsive or destructive
behavior. They appear more competent than they actually are and often
set unrealistically high expectations for themselves. When these
expectations are not met, they experience intense shame, self-hate, and
self-directed anger. Their lives are like soap operas—one crisis after
another. Some of the crises are caused by the individual’s dysfunctional
lifestyle or inadequate social milieu, but many are caused by fate—the
death of a spouse or a diagnosis of an illness. They react emotionally with
minimal coping skills. The intensity of their dysregulation often frightens
themselves and others

22. Anti social personality disorder
 APA, 2000. The term psychopathy, which originated in Germany in the late 19th
century, initially referred to all personality disorders (Dolan, 1994) but has gradually
became equated with only APD. People with this disorder are behaviorally impulsive
and interpersonally irresponsible. They fail to adapt to the ethical and social standards
of the community. They act hastily and spontaneously, are shortsighted, and fail to plan
ahead or consider alternatives. They lack a sense of personal obligation to fulfill social
and financial responsibilities, including those involved with being a spouse, a parent,
an employee, a friend, or member of the community social norms and values.
 They enjoy a sense of freedom and relish being unencumbered and unconfined by
people, places, or responsibilities. They can be interpersonally engaging, which is often
mistaken for a genuine sense of concern for other people. In reality, they lack empathy,
are unable to express human compassion, and tend to be insensitive, callous, and
contemptuous of others. Easily irritated, they often become aggressive, disregarding
the safety of themselves or others. They lack remorse for transgressions. No matter
what the consequences, they are rarely able to delay gratification

23. Histrionic personality disorders
 “Attention seeking” and “emotional” describe people with histrionic personality
disorders. These individuals are lively and dramatic and draw attention to
themselves by their enthusiasm, dress, and apparent openness. They are the “life
of the party” and, on the surface, seem interested in others. Their insatiable need
for attention and approval quickly becomes obvious. These needs are inflexible
and persistent, even after others attempt to meet them. They are moody and often
experience a sense of helplessness when others are disinterested in them. They are
sexually seductive in their attempts to gain attention and often are uncomfortable
within a single relationship. They are highly suggestible and have a tendency to
change opinions often. Their appearance is provocative and their speech dramatic.
They express strong opinions without supporting facts. Loyalty and fidelity are
lacking

24. Narcissist personality disorder
 People with a narcissistic personality disorder are grandiose, have an inexhaustible
need for admiration, and lack empathy. Beginning in childhood, these individuals
believe that they are superior, special, or unique and that others should recognize
them in this way . They are often preoccupied with fantasies of unlimited success,
power, beauty, or ideal love. They overvalue their personal worth, direct their
affections toward themselves, and expect others to hold them in high esteem.
They define the world through their own self-centered view.
 People with narcissistic personality disorder are benignly arrogant and feel
themselves above the conventions of their cultural group. They believe they are
entitled to be served and that it is their inalienable right to receive special
considerations. These individuals are often successful in their jobs but may
alienate their significant others, who grow tired of their narcissism . Clinically,
those with narcissistic personality disorder show overlapping characteristics of
BPD.

25. Avoidant personality disorder
 Avoidant personality disorder is characterized by avoiding social
situations in which there is interpersonal contact with others. This
avoidance is purposeful and deliberate because of fears of criticism and
feelings of inadequacy. These individuals are extremely sensitive to
negative comments and disapproval. They engage in interpersonal
relationships only when they receive unconditional approval.
 The behavior becomes problematic when they restrict their social
activities and work opportunities because of their extreme fear of
rejection. They appear timid, shy, and hesitant. In childhood, they are shy,
but instead of growing out of the shyness, it becomes worse in
adulthood. They distance themselves from activities that involve personal
contact with others. They perceive themselves as socially inept,
inadequate, and inferior, which in turn justifies their isolation and
rejection by others. They rely on fantasy for gratification of needs,
confidence, and conflict resolution.

26. Obsessive compulsive personality disorder
 . These people are not fun. They may be completely devoted to work, which typically
has a rigid character, such as maintaining financial records or tracking inventory. They
are uncomfortable with unstructured leisure time, especially vacations. Leisure activities
are likely to be formalized (season tickets to sports, organized tour groups). Hobbies
are approached seriously.
 Behaviorally, individuals with OCD are perfectionists, maintaining a regulated, highly
structured, strictly organized life. A need to control others and situations is common in
personal and in work life. They are prone to repetition and have difficulty making
decisions and completing tasks because they become so involved in the details. They
can be overly conscientious about morality and ethics and value polite, formal, and
correct interpersonal relationships. They also tend to be rigid, stubborn, and indecisive
and are unable to accept new ideas and customs. Their mood is tense and joyless.
Warm feelings are restrained, and they tightly control the expression of emotions

27. TREATMENT
 Personality disorder is often difficult to treat. Drug treatment has a very
limited role and may be used if associated mental illness like depression
or psychosis is present. Individual and group psychotherapy, therapeutic
community and behavioral therapy may be beneficial. Manipulation of
the social environment can be tried.

28. NURSING INTERVENTION
 CLUSTER A
• Convey an accepting attitude towards the patient. Be honest, keep all promises and
convey the message that it is not him but his behavior which is unacceptable.
• Maintain low level of stimuli in the environment to decrease agitation and
aggressive behavior; remove all dangerous objects from the environment.
• Help the patient to identify the true object of his hostility and encourage him to
gradually verbalize hostile feelings. This may help him to come to terms with
unresolved issues.

29. CLUSTER B
• Observe patient's behavior frequently. Do this during routine activities and
interaction; avoid appearing watchful and suspicious.
• Secure a verbal contract from patient that he will seek out staff members for help
when urge for self-mutilation is felt.
• If self-mutilation occurs, care for patient's wounds in matter-of-fact manner. Do not
give positive reinforcement to this behavior by offering sympathy or additional
attention. Assignation a one-to-one basis if need arises.
• Encourage patient to talk about feelings he was having just prior to this behavior.
Act as a role model for appropriate expression of angry feelings. Give positive
reinforcement when attempts to conform are made

30. CLUSTER C
• These individuals seek mental health care when they have attacks of anxiety, spells
of immobilization, sexual impotence, and excessive fatigue. To change the
compulsive pattern, psychotherapy is needed. There may be short-term
pharmacologic intervention with an antidepressant or anxiolytic as an adjunct.
• A supportive nurse–patient relationship based on acceptance of the patient’s
need for order and rigidity will help the person have enough confidence to try
new behaviors.
• Examining the patient’s belief that underlies the dysfunctional behaviors can set
the stage for challenging the childhood thinking. Because the compulsive pattern
was established in childhood, it will take a long time to modify the behavior