Psych Semis Exam

• Personality


  An enduring pattern of behavior, thoughts, and emotions
• Personality Disorders


  • Impairment in personality functioning and maladaptive traits
• Maladaptive Traits Associated with Personality Disorders


  • Manipulativeness, dishonesty, deceit, and lying
  • Anger, hostility, and irritable, labile moods
  • Lack of guilt or remorse, emotional coldness
  • Impulsivity, distractibility, and poor judgment
  • Irresponsibility and lack of accountability
  • Risk-taking and thrill-seeking behaviors
  • Mistrust and exhibitionism
  • Feelings of entitlement and dependency or insecurity
  • Eccentric perceptions
• Diagnosis of Personality Disorders

  Typically diagnosed in adulthood (age 18 or older), but maladaptive behaviors often trace back to early childhood or adolescence
• Personality Disorders can cause significant impairment in various life domains, including family, academic, and employment
• Treatment and Management of Personality Disorders

  • Long-standing and difficult to change
  • No specific medication targets personality traits directly
  • Therapy is often long-term and focuses on helping clients make gradual changes
  • Many individuals with personality disorders lack insight into their own behavior, making treatment challenging
  • Coexisting mental illnesses are common among individuals with personality disorders
• Clusters of Personality Disorders in the DSM-5

  • Cluster A: Odd or Eccentric Behaviors
  • Cluster B: Erratic or Dramatic Behaviors
  • Cluster C: Anxious or Fearful Behaviors
• Cluster A: Odd or Eccentric Behaviors

  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
• Cluster B: Erratic or Dramatic Behaviors

  • Antisocial Personality Disorder
  • Borderline Personality Disorder (BPD)
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
• Cluster C: Anxious or Fearful Behaviors

  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder (OCPD)
• Other Maladaptive Behaviors


  • Depressive Personality Disorder
  • Passive-Aggressive Behavior
• Epidemiology and Clinical Course of Personality Disorders

  • Affect 10% to 20% of the general population, with higher rates in lower socioeconomic groups
  • Approximately 15% of psychiatric inpatients have a primary diagnosis of a personality disorder
  • Individuals with personality disorders often have coexisting mental health issues, substance abuse problems, and involvement in legal issues
  • Treatment Resistance is common due to deeply ingrained personality characteristics and lack of insight into maladaptive behaviors
  • The clinical course varies, with some improvements seen in middle adulthood, particularly in borderline personality disorder
• Etiology of Personality Disorders

  • Biologic Theories: Personality develops from the interplay of genetic predispositions and environmental factors
  • Psychodynamic Theories: Temperament is inherited but shaped by social learning, culture, and life experiences
• Pharmacological Treatment of Personality Disorders

  • Low-dose Antipsychotics for cognitive-perceptual disturbances
  • Lithium, mood stabilizers, and benzodiazepines for aggression
  • Mood stabilizers, neuroleptics, and SSRIs for mood dysregulation symptoms
  • SSRIs, MAOIs, and low-dose antipsychotics for anxiety
• Psychotherapy for Personality Disorders

  • Inpatient Hospitalization for safety concerns
  • Building trust, teaching living skills, providing support, reducing distressing symptoms, and improving interpersonal relationships
  • Relaxation Techniques and basic living skills training
  • Cognitive-Behavioral Therapy (CBT) to change negative thought patterns
  • Dialectical Behavior Therapy (DBT) for emotion regulation and distorted thinking
• Paranoid Personality Disorder


  Characterized by pervasive mistrust and suspicion of others, interpreting their actions as potentially harmful
• Incidence of Paranoid Personality Disorder is estimated at 2% to 4% of the general population, more common in males
• Clients with Paranoid Personality Disorder may develop transient psychotic symptoms during periods of stress
• Lifelong difficulties living and working with others are common in Paranoid Personality Disorder
• Presentation of Paranoid Personality Disorder

  • Aloof and withdrawn demeanor
  • Guarded or hypervigilant behavior
  • Restricted affect
  • Labile mood
  • Seeing malevolence in others' actions
  • Use of projection defense mechanism
  • Conflict with authority figures
• Nursing Interventions for Paranoid Personality Disorder

  • Approach clients in a formal, businesslike manner
  • Avoid social chit-chat or jokes
  • Be straightforward, punctual, and keep commitments
  • Involve clients in formulating their care plan
  • Help clients validate ideas before taking action
  • Encourage basing decisions and actions on reality
• Schizoid Personality Disorder


  Characterized by detachment from social relationships and a restricted range of emotional expression
• Incidence of Schizoid Personality Disorder is estimated at 5% of the general population, more common in males
• Clients with Schizoid Personality Disorder often avoid treatment and social interactions
• Presentation of Schizoid Personality Disorder

  • Constricted affect and emotional coldness
  • Difficulty experiencing and expressing emotions
  • Rich fantasy life
  • Engages in intellectual pursuits
  • Pervasive lack of desire for involvement with others
  • Few social skills
  • Indecisive and lacks future goals or aspirations
  • Impaired insight regarding their lack of emotion or social involvement
• Nursing Interventions for Schizoid Personality Disorder

  • Focus on improving functioning in the community
  • Help find suitable housing that accommodates the client's desire for solitude
  • Establish a working relationship with a case manager
  • Ensure continuity of care if a family member serves as the primary relationship
  • Encourage relating needs to one person
• Schizotypal Personality Disorder


  Characterized by social and interpersonal deficits, cognitive or perceptual distortions, and behavioral eccentricities
• Incidence of Schizotypal Personality Disorder is about 3% of the population, slightly more common in men than women
• Clients with Schizotypal Personality Disorder may experience transient psychotic episodes under extreme stress and may develop schizophrenia
• Presentation of Schizotypal Personality Disorder

  • Odd appearance, unkempt, disheveled, with ill-fitting or stained clothes
  • Coherent speech but may be loose, digressive, or vague, with incorrect word usage
  • Restricted range of emotions, flat affect, sometimes silly or inappropriate
  • Cognitive distortions include ideas of reference, magical thinking, and odd or unfounded beliefs
  • Great anxiety around unfamiliar people, difficulty in trusting others
  • Limited capacity for close relationships, usually having only one significant relationship
  • Difficulty responding to normal social cues, limited success in employment
• Nursing Interventions for Schizotypal Personality Disorder

  • Focus on developing self-care and social skills and improving functioning in the community
  • Encourage establishing a daily routine for hygiene and grooming
  • Help clients prepare lists of people in the community they need to interact with and role-play interactions
  • Provide social skills training to improve communication and reduce bizarre conversations
  • Identify one person with whom clients can discuss unusual beliefs
  • Assist clients in finding acceptable ways to express themselves
• Antisocial Personality Disorder


  Characterized by a pervasive pattern of disregard for and violation of the rights of others, central features include deceit and manipulation
• Antisocial Personality Disorder, also known as psychopathy, sociopathy, or dyssocial personality disorder, occurs in about 3% of the general population, up to 30% in clinical settings, and is more common in men than women
• Peak antisocial behaviors typically occur in the 20s and diminish significantly after age 45
• Therapeutic Relationship and Promoting Responsible Behavior for Antisocial Personality Disorder

  • Minimize attempts by clients to manipulate and control the relationship
  • Use Limit Setting: 1) State the behavioral limit, 2) Identify consequences if the limit is exceeded, 3) Identify the expected or desired behavior
  • Use confrontation to manage manipulative or deceptive behavior: Point out problematic behavior neutrally and matter-of-factly, keep clients focused on the topic and in the present
• Borderline Personality Disorder (BPD)

  Characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect, along with marked impulsivity
• Borderline Personality Disorder has a prevalence of approximately 2-3% of the general population, five times more common in those with a first-degree relative with the diagnosis
• Borderline Personality Disorder is the most common personality disorder in clinical settings, and is more common in women (three times)
• Under stress, transient psychotic symptoms may occur in Borderline Personality Disorder
• 1. 10% of individuals with Borderline Personality Disorder commit suicide, and many more suffer permanent damage from self-mutilation injuries