Nursing Care Plan for Personality Disorders

Pathophysiology

Personality disorder is a term that covers several different types of mental disorders that cause an unhealthy pattern of thinking, functioning and behaving. Most clients with personality disorders believe that their thought processes are normal, and everyone else is the problem; therefore, many may never seek counseling or therapy and go untreated. Personality disorders may develop from a history of childhood abuse or neglect, negative or traumatic experiences, or dysfunctional family life.  Personality disorders are categorized into three clusters according to behavior: Cluster A disorders (Schizoid, Schizotypal) exhibit odd, or eccentric thinking and behavior, Cluster B disorders (Antisocial, Borderline, Narcissistic) exhibit dramatic, unpredictable and overly emotional behaviors, and Cluster C disorders (Obsessive-Compulsive, Avoidant) exhibit anxiety and fear.

Etiology

Diagnostic Criteria:

The primary features of a personality disorder are self and interpersonal function and specific personality traits. For each disorder, there must be stability in the expression of the personality traits across a consistent period of time and situations. The client’s developmental stage, socioeconomic status or culture do not explain the difficulty in functioning and the impairments are not related to another mental or medical condition or substance use.

Schizotypal

  • Confused between self and others; views other people’s experiences as their own
  • Difficulty understanding impact of own behaviors
  • Psychoticism – odd, unusual behavior or thought processes
  • Detachment – little reaction to emotional situations and wants to be alone

 

Antisocial

  • Egocentric
  • Lack of empathy or remorse for hurting or mistreating another, callousness
  • Lack of mutually intimate relationships; exploitation, deceit and coercion used to intimidate and control
  • Frequently angry or irritable
  • Disinhibition; irresponsible, impulsive and high risk taker

 

Borderline

  • Poor, unstable self-image, self-criticism, feelings of emptiness, often feels insulted
  • Unstable goals or career plans
  • Unstable and conflicted close relationships with mistrust and neediness
  • Frequent mood changes, highly emotional, intense nervousness or panic; hostility
  • Fear of rejection or separation from others
  • Impulsivity with risky, self-damaging activities

 

Narcissistic

  • Compares self to others for self-definition with an exaggerated self-appraisal
  • Goals are set based on gaining approval from others
  • Recognizes others’ needs or feelings only if relevant to self
  • Superficial relationships, need for personal gain
  • Feelings of entitlement or self-centeredness, condescending toward others
  • Excessive attempts to attract attention and admiration of others

 

Avoidant

  • Low self-esteem, sensitivity to criticism or rejection
  • Reluctant to pursue goals, take risks, or develop relationships for fear of shame or ridicule
  • Withdrawal from social contacts and activity, avoids intimacy
  • Anhedonia; unable to feel pleasure or take interest in things

 

Obsessive- Compulsive

  • Self identity derived from productivity, relationships are secondary to work
  • Difficulty completing tasks due to unreasonably high standards
  • Difficulty understanding others’ feelings
  • Rigid perfectionism – persists at tasks or continues behavior despite repeated failures

Desired Outcome

Client will develop ability to set realistic goals. Client will identify realistic personal strengths. Client will demonstrate a reduction in violent or manipulative behaviors. Client will demonstrate coping skills for anxiety.

Personality Disorders Nursing Care Plan

Subjective Data:

  • Lack of interest in social activities or relationships
  • Anxiety
  • Feelings of emptiness
  • Easily influenced by others
  • Envy of others
  • Low self-esteem or lack of self-confidence
  • Difficulty disagreeing with others
  • Desire to be in control of people

Objective Data:

  • Odd or eccentric behavior
  • Hostility, aggressive behavior
  • Lying or stealing
  • Lack of remorse
  • Arrogance
  • Shyness
  • Clingy or submissive behavior
  • Inability to discard broken or worthless objects / hoarding
  • Poor control of money

Nursing Interventions and Rationales

  1. Assess client’s neurological status

  2. Determine if there are other conditions present and get baseline

  3. Observe and identify behaviors and set clear limits with consequences

  4. Helps to set and maintain structure and limits that develop feelings of security and safety

  5. Be consistent when interacting with the client and in routine care

  6. Changes in consistency threaten the structure of care and open up the opportunity for the client to use manipulative behaviors or tactics. Client may be resistant to change, so consistency helps encourage new thought processes.

  7. Approach and interact with a calm, respectful,  supportive and stable attitude

  8. Personal insecurities or emotions can cause tension or power struggles with client. Professionalism helps improve client’s treatment and therapy and avoid negative behaviors.

  9. Discuss with the client their plans and goals; help distinguish between positive, realistic goals and unrealistic goals

  10. Help the client regain control of reality and become more focused. Helps the client understand their personal capabilities

  11. Set realistic, short term goals for client and offer recognition for attaining those goals

  12. Helps client realize their abilities and limitations. Encouragement improves self-esteem and cooperation.

  13. Provide realistic feedback and evaluations

  14. Manipulative behavior may ensue without honest, realistic interpretations of behavior or therapy progress and may negatively impact treatment.

    Helps discern areas of improvement and areas that still need work

  15. Enforce limits and consequences, and discourage hostile or aggressive behaviors

  16. Helps reinforce structure and discourage inappropriate behaviors. Maintains safety of client and others.

  17. Discuss alternative ideas or ways of thinking

  18. Helps client develop coping skills for emotions or feelings

  19. Monitor and encourage positive social interaction with others in a safe environment

  20. Help clients develop positive social skills and healthy interactions. Offers an opportunity to learn new ways of dealing with social situations.

  21. Teach clients relaxation techniques and deep breathing exercises

  22. Help clients control anxiety and manage situations independently to reduce symptoms.

  23. Provide resources and support for family members

  24. Help family members learn to cope with effects of client’s disorder and develop effective communication skills.


References

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