Personality-Disorder-and-Anxiety

• Individual with mental health condition and/or risk

  Nurse will assess: 1.Health (physical, mental, social) 2. Mental health (ability to cope with stress and realize abilities)
• Nurse will assist the individual


  Seek consultation, or treatment
• Mental health condition or disorders like personality disorder should be diagnosed by Psychiatrist, or Clinical Psychologist
• Personality Disorder


  • The trait or personality becomes a disorder if it is already maladaptive or inflexible
  • People with personality disorder believe they don't have a problem with their traits even it is inappropriate, and causing inconvenience to others or in society
  • Personality disorders are clustered because they share most of the traits
• Cluster I: withdrawn, odd and eccentric behavior


  • Paranoid
  • Schizoid
  • Schizotypal
• Paranoid


  • Suspicious
  • Secretive
  • Jealous
  • Key approach: Trust and rapport
• Schizoid


  • Poor social relationship
  • Aloof
  • Loner
  • Passive
  • Key approach: Distance, Initiate social interaction
• Schizotypal


  • Bizarre fantasy, language and thoughts
  • Magical fantasy
  • Isolated
  • Sensitive
  • Key approach: Presenting reality, Distance, May need medication
• Cluster II: seeks attention, erratic, emotional, dramatic


  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
• Antisocial


  • Violates the law
  • Impulsive
  • Lack of loyalty, honesty and fidelity
  • Key approach: Safety, Set a limit, Myth: not being friendly equates antisocial personality
• Borderline


  • Self-damaging
  • Emptiness
  • Lack of control-anger management
  • Key approach: Expression of feelings, Suicide precaution
• Histrionic


  • Flamboyant (dramatization)
  • Seductive and intimate
  • "Positive or negative" attention seeker
  • Key approach: Self-worth
• Narcissistic


  • Grandiosity-beauty, power, brilliance
  • Excessive self-admiration
  • "Positive" attention seeker
  • Key approach: Realistic expectation, Self-worth
• Cluster III: avoids the experience of anxiety or fear


  • Avoidant
  • Dependent
  • Obsessive Compulsive
• Avoidant

  • Fear of criticism
  • Avoids social event, relationship, new activities
  • Key approach: Expression of feelings, Assist if necessary
• Dependent


  • Low self-confidence
  • Dependent to others
  • Key approach: Expression of feelings, Promote independence
• Obsessive Compulsive


  • Perfectionist
  • Fear of losing control
  • Key approach: Alternative activity, Assist in coping
  • Note: Obsessive Compulsive Personality Disorder is different from OCD
• Anxiety


  Fear of the unknown
• Anxiety Level


  • Mild (+1)
  • Moderate (+2)
  • Severe (+3)
  • Panic (+4)
• Mild (+1) Anxiety


  • Physical: Fidgeting (small movements), GI problems, Sleeping difficulty
  • Psychological: Perceptual field (Awareness): wide, Attentive and Alert, Good problem-solving
  • Management: Awareness, Divert
• Moderate (+2) Anxiety


  • Physical: Diaphoresis, Muscle tension, Bounding pulse, Urinary frequency, GI problems, Headache
  • Psychological: Perceptual field: narrow, Selective attention
  • Management: Assist if necessary, May need medication
• Severe (+3) Anxiety


  • Physical: Tachycardia, Chest pain, Vertigo, NV, Diarrhea, Severe Headache, Pallor, Trembling, Rigidity
  • Psychological: Perceptual field: Scattered focus, Does not reply to instruction or direction, Fails to finish a task, Cries
  • Management: Safety, May need medication
• Panic (+4) Anxiety


  • Physical: Increased BP/ RR, Immobile, Mute, Run, Dilated pupils
  • Psychological: Perceptual field: distorted: delusion and hallucination, "nandilim bigla paningin ko", Irrational thought, No precaution, Could not communicate
  • Management: Safety: Stay with the client, Simple instruction, Nurse should stay calm
• Anxiety Disorders


  • Agoraphobia
  • Acute Stress Disorder
  • Post Traumatic Stress Disorder
  • Social Phobia
  • Specific Phobia
  • Obsessive Compulsive Disorder
  • Generalized Anxiety Disorder
  • Panic Disorder
• Agoraphobia


  Avoidance of places or situations where escape is deemed to be difficult, e.g. "Paano kaya ako bababa dito, baka di marinig boses at nahihiya ako kasi titingin sila lahat sa akin."
• Acute Stress Disorder


  2 days to 4 weeks of anxiety after a traumatic or stressful event, e.g. Your teacher shouted on you.
• Post Traumatic Stress Disorder


  Anxiety related to prolonged and persistent flashbacks of distress or traumatic experience, e.g. War, abuse, loss, calamities
• Social Phobia


  Fear of being exposed to social situation, e.g. "Ayaw ko pumunta sa palengke, feelking ko lahat sila pinag uusapan ako or nakatingil sila sa akin."
• Specific Phobia


  Avoiding certain object or situation
• Obsessive Compulsive Disorder


  Obsession (recurrent thought), Compulsion (ritualistic repetitive behavior), e.g. Checking the door or alarm clock several times before sleeping
• Generalized Anxiety Disorder


  Frequent (almost every day) uncontrollable or excessive worrying, without exact cause, e.g. Sleepless nights with various thoughts
• Panic Disorder


  Recurrent and unexpected panic attack, intense anxiety, impending doom
• Anxiety Interventions


  • Cognitive Behavior Therapy
  • Systematic Desensitization
  • Imagery
  • Medication
• Cognitive Behavior Therapy


  • By psychiatrist, or psychologist
  • Cognitive (thought)
  • Behavior (action)
  • The individual will try to have awareness and reflect on the result
• Systematic Desensitization


  • Slowly exposing the individuals to the trigger and training them to maintain relaxed response
  • Flooding is also a form of desensitization but it may not be effective as it immediately exposes the client to the trigger
• Imagery


  Imagining positive or relaxing things or places like rivers and gardens
• Medication will be discussed
• Anorexia Nervosa


  • Eating small amounts/ plays with food/ refusal to eat
  • "sobrang taba ko na" even though he or she is thin
  • BMI less than 17.5 kg/m2; denial of underweight concern
  • Ammenorhea r/t malnutrition
  • V/S: hypotension, bradycardia, hypothermia
  • Fine downy body hairs r/t malnutrition
• Bulimia Nervosa


  • Binge eating- discretely eating large amount of food for at least 2 hours; loss of self-control during this episode, at least twice a week for three months
  • Normal or above BMI
  • Purging- "ilabas yung kinain" to minimize guilt - to prevent weight gain: self-induced vomiting, excessive exercise, fasting, laxative, diuretics, enemas
  • Binge- Purge cycle: "lamon then labas"
• Binge-Purge Cycle Signs


  • Teeth- enamel loss r/t stomach acid from frequent vomiting
  • Russel's sign: Calluses or scars on dorsum fingers r/t frequent contact of incisor teeth during the self-induced vomiting
  • Parotitis- inflammation of parotid glands r/t frequent self-induced vomiting