16 PERSONALITYDISORDERS 379
ation or meditation techniques can help manage anx-
iety for clients with cluster C personality disorders.
Improvement in basic living skills through the rela-
tionship with a case manager or therapist can improve
the functional skills of people with schizotypal and
schizoid personality disorders. Assertiveness train-
ing groups can assist people with dependent and
passive-aggressive personality disorders to have more
satisfying relationships with others and to build self-
esteem.
Cognitive-behavioral therapy has been particu-
larly helpful for clients with personality disorders
(Harvard Mental Health Letter, 2002). Several cog-
nitive restructuring techniques are used to change
the way the client thinks about self and others: for
example, thought stopping in which the client stops
negative thought patterns; positive self-talk that is
designed to change negative self messages; and de-
catastrophizing that teaches the client to view life
events more realistically not as catastrophes. Exam-
ples of these techniques are presented later in this
chapter.
Dialectical behavior therapy (DBT) was de-
signed for clients with borderline personality disorder
(Lenihan, 1993). It focuses on distorted thinking and
behavior based on the assumption that poorly regu-
lated emotions are the underlying problem (Harvard
Mental Health Letter, 2002).
Table 16-2 summarizes the symptoms of and
nursing interventions for personality disorders.◗ CLUSTERAPERSONALITY
DISORDERS
PARANOID PERSONALITY DISORDER
Clinical Picture
Paranoid personality disorderis characterized by
pervasive mistrust and suspiciousness of others.
Clients with this disorder interpret others’ actions as
potentially harmful. During periods of stress, they
may develop transient psychotic symptoms. Incidence
is estimated to be 0.5% to 2.5% of the general popula-
tion; the disorder is more common in men than in
women. Data about prognosis and long-term out-
comes are limited, because most people with paranoid
personality disorder do not readily seek or remain in
treatment (APA, 2000).
Clients appear aloof and withdrawn and may re-
main a considerable physical distance from the nurse;
they view this as necessary for their protection.
Clients also may appear guarded or hypervigilant;
they may survey the room and its contents, look be-
hind furniture or doors, and generally appear alert to
any impending danger. They may choose to sit near
the door to have ready access to an exit or with their
backs against the wall to prevent anyone from sneak-
ing up behind them. They may have a restricted af-
fect and be unable to demonstrate warm or empathic
emotional responses such as “You look nice today” or
“I’m sorry you’re having a bad day.” Mood may be
labile, quickly changing from quietly suspicious to
angry or hostile. Responses may become sarcastic for
no apparent reason. The constant mistrust and sus-
picion that clients feel toward others and the envi-
ronment distorts thoughts, thought processing, and
content. Clients frequently see malevolence in the ac-
tions of others when none exists. They may spend dis-
proportionate time examining and analyzing the be-
havior and motives of others to discover hidden andTable 16-1
DRUGCHOICES FORSYMPTOMS OF
PERSONALITYDISORDERS
Target Symptom Drug of ChoiceAggression/impulsivity
Affective aggression Lithium
(normal) Anticonvulsants
Low-dose antipsychotics
Predatory Antipsychotics
(hostility/cruelty) Lithium
Organic-like Cholinergic agonists
aggression (donepezil)
Imipramine (Tofranil)
Ictal aggression Carbamazepine (Tegretol)
(abnormal) Diphenylhydantoin
(Dilantin)
Benzodiazepines
Mood dysregulation
Emotional lability Lithium
Carbamazepine (Tegretol)
Antipsychotics
Atypical depression/ MAOIs
dysphoria SSRIs
Antipsychotics
Emotional SSRIs
detachment Atypical antipsychotics
Anxiety
Chronic cognitive SSRIs
MAOIs
Benzodiazepines
Chronic somatic MAOIs
SSRIs
Severe anxiety MAOIs
Low-dose antipsychotics
Psychotic symptoms
Acute and psychosis Antipsychotics
Chronic and low- Low-dose antipsychotics
level psychotic-like
symptomsAdapted from Cloninger, C. R., & Svrakic, D. M. (2000). Personality dis-
orders. In B. J. Sadock & V. A. Sadock (Eds.). Comprehensive textbook of
psychiatry,Vol. 2 (7th ed., pp. 1723–1764). Philadelphia: Lippincott
Williams & Wilkins.