1. Personality Disorders Various inflexible maladaptive behavior patterns/traits that may impair functioning and relationships Usually remains in touch with reality Lacks insight into behaviors Stress exacerbates manifestations Severe cases may deteriorate into psychotic state

2. CLUSTER “A” ODD – ECCENTRIC GROUP Schizoid personality Scizo-typal personality Paranoid personality

3. Schizoid personality D/O C/B inability to form close relationships Social detachment/solitary life Aloof/indifferent Restricted expression of emotion Lacks interest in others

4. Schizotypal personality D/O C/B exhibits abnormal /unusual thoughts,perceptions,speech,behavior patterns Suspicious Paranoid Magical thinking Odd thinking/speech Relationship deficits

5. Paranoid Personality D/O C/B suspiciousness, mistrust of others Argumentative Hostile aloofness Rigid, critical, controlling of others Grandiosity

6. CLUSTER”C” Anxious – Fearful Group Avoidant personality Dependent personality Obsessive Compulsive personality Passive- Aggressive personality

7. Avoidant Personality Disorder C/B social withdrawal Hypersensitive to rejection,criticism Feels inadequate Social inhibition Lacks support system

8. Obsessive Compulsive Personality D/O Need to control others Difficulty expressing warmth/tenderness Reflects perfectionism/devoted to work Overly conscientious/inflexible Preoccupied with details May hoard worthless objects

9. Dependent Personality disorder C/B lack of self confidence Fears independence/lacks autonomy Passively allows others to make decisions and assume responsibility for major areas of their life Cannot tolerate being alone Needs others to make desicions

10. “CLUSTER B” ERRATIC DRAMATIC GROUP HISTRIONIC NARCISSISTIC ANTISOCIAL BORDERLINE

11. Histrionic Personality D/O C/B Overly dramatic, intensively expressive Enjoys being the center of attention Poor interpersonal relationships Romantic fantasies and control of partners Easily bored Displays dependency

12. Narcissistic Personality D/O C/B increased sense of self –importance Pre-occupied with fantasies /unlimited success/constant need for attention & admiration Grandiosity/inflates accomplishments Lacks empathy/sensitivity to others needs

13. Antisocial Personality Disorder C/B irresponsible and antisocial behavior Self-centered, inability to maintain relationships,irritability, unreliable Poor sexual adjustment/inability to delay gratification Aggressive, impulsive, manipulative Poor judgment Conflict with authority Poor work history Failure to handle responsibility

14. Nursing Diagnosis Ineffective Coping-r/t inability to form valid appraisal of stressors,inability to use available resources

15. EXPECTED OUTCOMES The client will: Immediate- * Not harm self/others Identify behaviors leading to hospitalization Functions within limits of therapeutic mileu

16. Outcomes continued The client will: Stabilization- Demonstrate nondestructive ways to deal with stress and frustration. Identify ways to meet own needs that do not infringe on the rights of others Community- Achieve /maintain satisfactory work performance Meet own needs without exploiting or infringing on the rights of others

17. Interventions Provide model for mature appropriate behavior Observe strict limit-setting by all staff Be consistent and firm with care plan –essential Monitor own responses to clients Demonstrate concern/interest Reinforce positive behaviors(socialization.conforming to limits) Avoid power struggles

18. Borderline Personality Disorder C/B unstable interpersonal relationships Impulsive/unpredictable behaviors Chronic feelings of emptiness Extreme shifts in mood/depression Easily bored/argumentative Self-destructive behaviors Splitting, manipulative Inability to tolerate anxiety

19. Nursing Diagnosis Risk for Self- Mutilation- r/t impulsive behavior ; Displays of temper Inability to express feelings verbally; Physically self- damaging acts;Attention seeking behaviors; Ineffective coping skills Ineffective coping- r/t inability to form valid appraisal of stressors; inability to use available resources Social Isolation- r/t chronic feelings of boredom/emptiness;Manipulation of others;alternate clinging/avoidance behaviors

20. EXPECTED OUTCOMES The client will:  Immediate-Be free from immediate injury; Not harm others or destroy property; Diminish efforts to manipulate staff or other clients(splitting-behaviors)  Stabilization- Eliminate acting-out behaviors;Verbalization of plans to moderate lifestyle  Community-Demonstrate effective problem- solving:Develop social support outside hospital

21. Interventions Protect from self-mutilation Suicide assessment Establish therapeutic relationship Calm approach Set limits Consistent staff/planning Prevent client from manipulating other clients/visitors Teach relaxation techniques

22. Passive-Aggressive personality C/B passively expresses covert aggression rather than dealing with it Procrastinates Stubborn Intentional inefficiency Forgetfulness Dependency

23. REVIEW QUESTIONS The client with an antisocial personality d/o approaches various staff with numerous requests. The best response by the nurse would be: a)Give the client a written list of permissible requests. b) Have the client make requests only to the assigned staff person c) Limit the client to the day room area d)Tell the client to remain in his or her room until approached by staff

24. The nurse assesses a client to be at risk for self- mutilation, and implements a no-self-harm contract. The safety contract would be effective when the client: a)withdraws to her room when feeling overwhelmed. b)notifies staff when anxiety is increasing c)suppresses feelings of anger d)Talks to other clients about urges to hurt herself

25. A 31 year old client with dependent personality d/o has been living at home with very supportive parents. He is making plans for Independent Living in the community. He tells the nurse “ I don’t know if I can make it on my without my parents.” The nurse responds therapeutically by saying:

26. a)“You are a 31 year old adult now, not a child who needs his parents to care for him.” b)“ You and your parents need a break from each other; it will be good for both of you.” c)“Your parents have been supportive and can continue to be even if you live apart. d)“ Your parents won’t be around forever.”

27. When planning care for a client with Schizoid personality d/o, the most appropriate outcome would be for the client to: a)Communicate effectively with his/her landlord b)Express interest in a new hobby c)Join a community group for socialization d)Verbalize thoughts and feelings to peers