A.

Definition of Personality Disorders

Understanding Personality Disorders According to several experts :

1. Koswara (1991) in the everyday sense of personality is how individuals present and impress others.

2. Maramis (1999) personality is the overall pattern of thoughts, feelings, and behaviors that are often
used by someone in an effort to adapt continuously to his life.

3. Rusdi Malim (1998) which refers to PPGDJ-III (Guidelines for Classification of Diagnosis of Mental
Disorders III) is paranoid, schizoid, emotionally unstable, implusive type and threshold, historic,
anecastic, anxious (avoiding), dependent, other characteristics that are not classified. Personality
Disorder is a general term for a type of mental illness in which the way of thinking, understanding
situations, and dealing with other people does not function.

4. Kaplan and Saddock are a variant of the character traits that are beyond the range found in most
people. Kaplan and Saddock define personality as the totality of emotional and behavioral traits that
mark a person's life from day to day under the usual conditions, personality is relatively stable and
predictable

Personality disorder is a severe disorder in character and behavioral tendencies in individuals. The
disorder involves several areas of personality and is associated with personal and social disorder. The
disorder can be caused by heredity and life experiences in early childhood.

The diagnosis of a personality disorder in someone who is based on the form of behavior, mood, social
interaction, impulsiveness, can be a controversial thing and detrimental to the individual concerned,
most lay people give a label or various stigma to them. As a result, these individuals are increasingly
reluctant to seek treatment and self-isolation.

The appearance of personality disorder begins with the emergence of distress, which is followed by
suppressing those feelings and behaving in a certain way as people experience distress in general. The
low function of social interaction in the neighborhood and work environment contributes to worsening
conditions and emotional atmosphere by dramatizing, keeping tight, repeating or recalling the mood
(obsessive), and antisocial.

Some of these behaviors disturb individuals and their daily activities, in general individuals who
experience personality disorders find it difficult to maintain or continue relationships with others. This is
caused by chronic interpersonal problems, or difficulties in recognizing the feelings (emotions) that arise
in themselves.

People with personality disorders have the characteristics of rigid behavior that is difficult to adjust so
that other people such as being impulsive, irritable, many requests, fear, hostility, manipulative, or even
acting rude. Problems of dependence on alcohol, mood disorders, anxiety and eating disorders, doing
things that are dangerous to yourself, suicidal ideation, sexual disorders often become part of the
problem of personality disorders.
B. Factors That Cause Personality Disorders

1. Genetic Factors
Satu buktinya berasal dari penelitian gangguan psikiatrik pada 15.000 pasangan kembar di
Amerika Serikat. Diantara kembar monozigotik, angka kesesuaian untuk gangguan kepribadian
adalah beberapa kali lebih tinggi dibandingkan kembar dizigotik. Selain itu menurut suatu
penelitian, tentang penilaian multiple kepribadian dan temperamen, minat okupasional dan waktu
luang, dan sikap social, kembar monozigotikyang dibesarkan terpisah adalah kira-kira sama
dengan kembar monozigotik yang dibesarkan bersama-sama.
2. Temperamental Factors
The temperamental factors identified in childhood may be related to personality disorders in
adulthood. For example, children who are temperamentally afraid may experience avoidance.
3. Biological Factors
a. Hormones, people who show impulsive nature often also show increased levels of testosterone,
17-estradiol and estrone
b. Neurotransmitter, the assessment of personality traits and dopaminergic and serotonergic
systems, states a function that activates the awareness of the neurotransmitter. Increasing cadaar
serotonin with certain seretonergic drugs such as fluoxetine can produce dramatic changes in some
personality characteristics. Serotonin decreases depression, impulsivity.
c. Electrophysiology, changes in electrical conductance on electroencephalograms have been found
in some patients with personality disorders, most often in the antisocial type and threshold, where slow
wave activity is found.
4. Psychoanalytic Factors
Sigmund Freud states that personality traits are related to fixation at one stage of psychosexual
development. Anal fixation, which is excessive or lacking in anal gratification, can lead to stubbornness,
stinginess and extreme precision
C. Common Symptoms of Personality Disorders
Individuals with personality disorders are filled with various experiences of conflict and instability in
several aspects of their lives. Symptoms are generally personality disorders based on criteria in each of
the available categories. In general, this disorder is classified based on:
1. Individual experiences and behaviors that deviate from social expectation. The pattern deviations
in one or more:
 a. Way of thinking (cognition) includes changes in perception and interpretation of himself, others
and time.
b. Affection (emotional response to self, labile, intensity and scope)
c. Interpersonal functions
d. Control of impulses
2. These disturbances are permanent in the individual person and affect the social situation.
3. Personality disorders that form are closely related to the formation of distress or worsening social
relations, work problems or other important social functions.
4. The pattern of the disorder is stable with a long duration and the disorder can appear and peak before
approaching adulthood and is not limited to episodes of mental illness.
5. Personality pattern disorders are not caused by psychological effects that arise due to medical
conditions such as head injuries.

D. Risk of Personality Disorders

Individuals who do not immediately take medication, personality disorders can have an impact on:
1. Social isolation, loss of closest friends caused by the inability to have a healthy relationship, shame
due to broken relationships with the community.
2. Suicide, self-injury often occurs in individuals who experience threshold personality disorder and
cluster B.
3. Dependence on alcohol and drugs
4. Depression, anxiety and eating disorders. For all clusters there is a risk of developing other
psychological problems
5. Harmful behavior that can damage yourself. People with threshold personality disorder have the
potential to carry out dangerous actions, without calculations such as engaging in risky free sex or
engaging in gambling. In dependent personality disorder, there is a risk of experiencing sexual,
emotional, or physical abuse because this individual only prioritizes surviving the relationship (depends
on the person)
6. Violence or even murder. Aggressive behavior in paranoid and antisocial personality disorders
7. Criminal acts. Antisocial personality disorder has a greater risk of committing criminal acts. This can
result in the prison person himself being imprisoned
8. Symptom disorders that exist can be worse in the future if they are not properly treated.
E. Various Personality Disorders
Group A (tends to think or behave strangely and eccentricly / seems strange):
1. Paranoid
Paranoid personality disorder is characterized by mistrust of others and excessive suspicion that people
around him have evil motives.People with this disorder tend to have excessive trust in their own
knowledge and abilities and usually avoid close relationships. They look for hidden meanings in
everything and read hostile intentions into the actions of others. They like to test the loyalty of friends
and loved ones and often seem cold and distant. They usually like to blame others and tend to carry old
grudges.
2. Schizoid
People with Schizoid personality disorder avoid relationships with others and don't show much emotion.
Unlike avoidants, schizoids really prefer to be alone and don't secretly want popularity. They tend to look
for work that requires a little social contact. their social skills are weak and they do not show the need
for attention or acceptance. They are considered to have no sense of humor and are far away and are
often referred to as "loners."
3. Schizotypal
Many believe that schizotypal personality disorder represents mild schizophrenia. This disorder is
characterized by strange forms of thinking and understanding, and individuals with this disorder often
seek isolation from others. They sometimes believe in having extra sensory abilities or unrelated
activities related to them in several important ways. They generally behave eccentrically and have
difficulty concentrating for a long time. their speech is often more complicated and difficult to follow.

Group B (tend to be emotional in thinking and behaving):

1. Antisocial
Many people misunderstand that antisocial personality disorder refers to people who have poor social
skills. Conversely, antisocial personality disorder is characterized by a lack of conscience.
People with this disorder are vulnerable to criminal behavior, believing that their victims are weak and
deserve to be exploited. Antisocials tend to lie and steal. Often, they are not careful about money and
take action without thinking about the consequences. They are often aggressive and far more concerned
with their own needs than those of others.
2. Threshold / Borderline
 It is a personality disorder that causes sufferers to not have a clear and consistent sense of self and
never have certainty in their values, loyalty, and career choices. They cannot stand being alone, have a
fear of being ignored, and demand attention. Easily experiencing chronic feelings of depression and
empty feelings, they often try to kill themselves and take self-mutilation actions (Davidson, Neale, Kring,
2004).
3. Histrionic
People with Histrionic personality disorder are constant attention seekers. They need to be the center of
attention all the time, often bothering others to dominate the conversation. They use grandiose
language to describe everyday events and seek constant praise. They like to dress "who provokes" or
exaggerate their weaknesses to get attention. They also tend to exaggerate friendships and relationships,
believing that everyone likes them. They are often manipulative
4.  Narcissistic

Gangguan kepribadian Narcissistic dicirikan oleh keterpusatan diri. Seperti gangguan Histrionic, orang-
orang dengan gangguan ini senang mencari perhatian dan pujian. Mereka membesar-besarkan prestasi
mereka, mengharapkan orang lain untuk mengakui mereka sebagai superior. Mereka cenderung teman,
karena mereka percaya bahwa tidak sembarang orang yang layak menjadi teman mereka. Narsisis
cenderung membuat kesan pertama yang baik, namun mengalami kesulitan menjaga hubungan jangka
panjang. Mereka umumnya tidak tertarik pada perasaan orang lain dan dapat mengambil keuntungan
dari mereka.

Kelompok C (cenderung tampak cemas dan ketakutan) :

1. Avoidant
Personality disorder characterized by extreme social anxiety. People with this disorder often feel "not
enough", avoid social situations, and find work with little contact with others. Avoidants are afraid of
being rejected and are worried if they embarrass themselves in front of others. They exaggerate the
potential difficulties in new situations to make people think about avoiding the situation. Often, they will
create a fantasy world to replace the original. Unlike schizophrenic personality disorder, avoidants miss
social relationships, but don't feel they can get them yet. They often experience depression and have low
self-confidence.
2. Dependent
This personality disorder is characterized by the need to be looked after. People with this disorder tend
to depend on people and feel afraid of losing them. They may become suicidal when separated from
loved ones. They tend to let others make important decisions for them and often jump from one
relationship to another. they often persist in a relationship, even though they are often abused or hurt.
excessive sensitivity to general rejection. They often feel helpless and depressed
3.;Obsessive-Compulsive Disorder
The name obsessive-compulsive personality disorder (OCDP) is similar to obsessive-compulsive anxiety,
but the two are very different. People with obsessive-compulsive personality disorder focus too much on
order and perfection. They must do everything "right" often to disrupt their productivity. They tend to
get caught up in details, but lose the bigger picture. They set high standards that make no sense for
themselves and others, and tend to be very critical of others when they do not live up to this high
standard. They avoid working in teams, believing others to be too careless or incompetent. They avoid
making decisions because they are afraid of making mistakes and are rarely generous with time or
money. They often have difficulty expressing emotions.

F. Treatment for People with Personality Disorders

Specific treatment, according to the personality disorder description:
Group A
A. Paranoid
Psychotherapy - Paranoid patients do not work well in group psychotherapy, therefore therapists must
deal directly in dealing with patients and it must be remembered that honesty is very important for
patients.
Pharmacotherapy - Pharmacotherapy is useful in dealing with agitation and anxiety. In most cases, anti-
anxiety drugs such as aliazepam can be used.
B. Schizoid
Psychotherapy - In a group therapy environment, patients with schizoid personality disorder may be
silent for a long period of time, but one day, they will get involved.
Patients must be protected from aggressive attacks by other group members given their propensity for
calm. With the passage of time, group members become important for schizoid patients and can provide
social contact.
Pharmacotherapy - With small doses of antipsychotics, antidepressants and psychostimulants can be
used and are effective in some patients.
C. Skizotipal
Psychotherapy - Strange and strange thoughts in patients with schizotipal personality disorder must be
treated with caution. Some patients engage in worship, strange religious practices. Therapists may not
laugh at these activities or try their beliefs or activities.
Pharmacotherapy - Antipsychotic medication may be useful in dealing with the idea of self, patient and
other symptoms of the disorder and can be used together with psychotherapy. The use of haloperidol is
reported to give positive results on.

Group B
A. Antisocial
Psychotherapy - If a patient feels among his peers, their lack of motivation to change can disappear,
possibly because of that the group that helps themselves will be more useful than in prison in
eliminating interference.
But therapists must find a way to deal with destructive behavior in patients. And to overcome the
patient's fear of intimacy, the therapist must fail the patient's efforts to escape from meeting others.
Pharmacotherapy - Pharmacotherapy is used to deal with symptoms that are expected to arise such as
anxiety, attacks and depression.

B. Threshold / Borderline
Psychotherapy - A reality-oriented approach is more effective than deep unconscious interpretation.
Behavioral therapy is used in patients with threshold personality disorder to control impulses and angry
outbursts and to reduce sensitivity to criticism and rejection.
Social skills training, especially with video tape, helps patients to see how their actions affect others, this
is to improve their interpersonal behavior.
Pharmacotherapy - Antipsychotics can be used to control anger, hostility and brief psychotic episodes.
Antidepressants improve depressed mood that is often found in patients.
Dialectical behavior therapy is one type of CBT focusing on coping skills, in this therapy individuals learn
to control behavior and emotions with full awareness techniques, patients are helped to recognize
various emotional content without reacting (controlling behavior) This therapy is effective for healing
threshold personality disorders .
C. Historinic Personality Disorders
Psychotherapy - Patients with histrionic personality disorder often do not realize their true feelings.
Psychotherapy is psychoanalysis oriented, both in groups or individually.
Pharmacotherapy - Pharmacotherapy can be added if symptoms are targeted, such as the use of
aantidepressants for depression and somatic complaints, anti anxiety drugs for anxiety and
antipsychotics for derealization and illusion.
D. Narcissistic Personality Disorders
Psychotherapy - Treats naaristic personality disorder of a person because he has to leave his narcissism if
he wants to make progress.
Pharmacotherapy - Lithium (escalith) is used in patients who have mood swings as part of the clinical
picture. And because it is prone to depression, antidepressants can also be used

Group C
A. Avoid
Psychotherapy - Therapists encourage patients to go out into the world to do what they feel they have a
high risk of humiliation, rejection and failure.
But therapists must be careful when giving assignments to practice new social skills outside of therapy,
because failure can aggravate a patient's self-esteem that has been bad.
But groups can help patients understand the effects of their sensitivity to rejection on themselves and
others. Practicing assertiveness is a form of behavioral therapy that can teach patients to express their
needs openly and to increase their self-esteem.
Pharmacotherapy - Some patients are helped by beta blockers, such as atenolol (Tenormin), to overcome
hyperactivity of the autonomic nervous system, which tends to be high in patients with avoiding
personality disorders, especially if they encounter a scary situation.
B. Dependent
Psychotherapy - The therapy used is through cognitive behavioral processes, by creating independence
in patients, exercising assertiveness and fostering self-confidence.
Pharmacotherapy - Benzodiazepines and serotonergic drugs can be useful.
C. Obsessive Compulsive Disorder
Psychotherapy - Patients with obsessive compulsive personality disorder often know that they are sick
and seek treatment or self-will. Free association and less directive therapy are highly valued by patients
with this disorder.
Pharmacotherapy - Clonazepam (clonopine) is a benzodiazepine with anti-convulsants, the use of this
drug to reduce symptoms in patients with severe obsessive compulsive personality disorder.
nursing care in personality disorders
1. Assesment
patient identification
main complaint
history of disease now
personal history
family history
mental status check
general appearance
awareness
attention
orientation
2. nursing diagnoses
a. Low self-esteem is related to pulling away
b. risk of violent behavior towards yourself or others related to violent behavior
3. nursing intervention
a. Low self-esteem is related to pulling away
b. risk of violent behavior towards yourself or others related to violent behavior
A. Conclusion
Personality Disorder is a general term for a type of mental illness in which the way of thinking,
understanding situations, and dealing with other people does not function. People with personality
disorders have the characteristics of rigid behavior that is difficult to adjust so that other people such as
being impulsive, irritable, many requests, fear, hostility, manipulative, or even acting rude.
In the form of psychological disorders that greatly affect a person's life. Having a personality disorder
can negatively affect one's work, family, and social life. Those who have personality disorders have
several different features including psychological disorders in themselves: the ability to have successful
interpersonal relationships, the suitability of emotional reach, how to understand themselves, others,
and the world, and the difficulty of having proper impulse control.
Personality disorders create a pattern of pervasive behavior and inner experiences that are very different
from cultural and individual norms that exist in society. Sometimes in the form of deviant behavior that
appears dramatically without realizing it. Therefore, those who have personality disorders often
experience conflicts with themselves personally, family, and the surrounding environment.
Personality disorders are grouped into 3: tend to think or behave strangely and eccentric / seem strange,
tend to be emotional in thinking and behaving, and tend to be afraid and anxious.
However, from all forms of personality disorders, several treatments have been carried out for the
treatment of people with personality disorders. So that, over time these behaviors can be minimized