These clients have low self-esteem and are al-
ways harsh, critical, and judgmental of themselves;
they believe that they “could have done better” re-
gardless of how well the job has been done. Praise and
reassurance do not change this belief. Clients are bur-
dened by extremely high and unattainable standards
and expectations. Although no one could live up to
these expectations, they feel guilty and worthless for
being unable to achieve them. They tend to evaluate
self and others solely on deeds or actions without re-
gard for personal qualities.
These clients have much difficulty in relation-
ships, few friends, and little social life. They do not
express warm or tender feelings to others; attempts
to do so are very stiff and formal and may sound in-
sincere. For example, if a significant other expresses
love and affection, a client’s response might be, “The
feeling is mutual.”
Marital and parental-child relationships are
often difficult because these clients can be harsh and
unrelenting. For example, most clients are frugal, do
not give gifts or want to discard old items, and insist
that those around them do the same. Shopping for
something new to wear may seem frivolous and
wasteful. Clients cannot tolerate lack of control and,
hence, may organize family outings to the point that
no one enjoys them. These behaviors can cause daily
strife and discord in family life.
At work, clients may experience some success,
particularly in fields when precision and attention to
detail are desirable. They may miss deadlines, how-
ever, while trying to achieve perfection or may fail to
make needed decisions while searching for more
data. They fail to make timely decisions because of
continually striving for perfection. They have diffi-
culty working collaboratively, preferring to “do it my-
self” so it is done correctly. If clients do accept help
from others, they may give such detailed instructions
and watch the other person so closely that coworkers
are insulted, annoyed, and refuse to work with them.
Given this excessive need for routine and control,
new situations and compromise are also difficult.
Nursing Interventions
Nurses may be able to help clients to view decision-
making and completion of projects from a different
perspective. Rather than striving for the goal of per-
fection, clients can set a goal of completing the project
or making the decision by a specified deadline. Help-
ing clients to accept or to tolerate less-than-perfect
work or decisions made on time may alleviate some
difficulties at work or home. Clients may benefit from
cognitive restructuring techniques. The nurse can
ask, “What is the worst that could happen?” or “How
might your boss (or your wife) see this situation?”
These questions may challenge some rigid and inflex-
ible thinking.
Encouraging clients to take risks, such as letting
someone else plan a family activity, may improve
relationships. Practicing negotiation with family or
friends also may help clients to relinquish some of
their need for control.◗ OTHERRELATEDDISORDERS
Researchers are studying the following two dis-
orders, depressive personality disorder and passive-
aggressive disorder, for inclusion as personality dis-
orders. The DSM-IV-TR currently lists and describes
these conditions.DEPRESSIVE PERSONALITY
DISORDER
Clinical Picture
Depressive personality disorderis characterized
by a pervasive pattern of depressive cognitions and
behaviors in various contexts. It occurs equally in men
and women and more often in people with relatives
who have major depressive disorders. People with de-
pressive personality disorders often seek treatment
for their distress and generally have a favorable re-
sponse to antidepressant medications (APA, 2000).
Although clients with depressive personality dis-
order may seem to have similar behavior characteris-
tics as clients with major depression (e.g., moodiness,
brooding, joylessness, pessimism), the personality dis-
order is much less severe. Clients with depressive per-
sonality disorder usually do not experience the sever-
ity and long duration of major depression nor the
hallmark symptoms of sleep disturbances, loss of ap-
petite, recurrent thoughts of death, and total dis-
interest in all activities. Major depressive episode is
discussed in Chapter 15.
These clients have a sad, gloomy, or dejected af-
fect. They express persistent unhappiness, cheerless-
ness, and hopelessness, regardless of the situation.
They often report the inability to experience joy or
pleasure in any activity; they cannot relax and do not
display a sense of humor. Clients may repress or not
express anger. They brood and worry over all aspects
of daily life. Thinking is negative and pessimistic;
these clients rarely see any hope for future improve-
ment. They view this pessimism as “being realistic.”
Regardless of positive outcomes in a given situation,
negative thinking continues. Judgment or decision-
making skills are usually intact but dominated by
pessimistic thinking; clients often blame themselves
or others unjustly for situations beyond anyone’s
control.398 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS