Nursing Care Plan (NCP) for Personality Disorders

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Outline

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 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 the impact of their 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; an 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

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

Personality Disorders Nursing Care Plan

Subjective Data:

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

Objective Data:

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

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess the client’s neurological status Determine if there are other conditions present and get a baseline 
Observe and identify behaviors and set clear limits with consequences Helps to set and maintain structure and limits that develop feelings of security and safety
Be consistent when interacting with the client and in routine care Changes in consistency threaten the structure of care and open up the opportunity for the client to use manipulative behaviors or tactics. The client may be resistant to change, so consistency helps encourage new thought processes.
Approach and interact with a calm, respectful,  supportive and stable attitude Personal insecurities or emotions can cause tension or power struggles with the client. Professionalism helps improve the client’s treatment and therapy and avoid negative behaviors. 
Discuss with the client their plans and goals; help distinguish between positive, realistic goals and unrealistic goals Help the client regain control of reality and become more focused.

Helps the client understand their capabilities .Set realistic, short term goals for the client and offer recognition for attaining those goals

  

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

Provide realistic feedback and evaluations Manipulative behavior may ensue without honest, realistic interpretations of behavior or therapy progress and may negatively impact the treatment. Helps discern areas of improvement and areas that still need work 
Enforce limits and consequences, and discourage hostile or aggressive behaviors Helps reinforce the structure and discourage inappropriate behaviors. Maintains the safety of clients and others.
Discuss alternative ideas or ways of thinking Helps the client develop coping skills for emotions or feelings  
Monitor and encourage positive social interaction with others in a safe environment Help clients develop positive social skills and healthy interactions. Offers an opportunity to learn new ways of dealing with social situations. 
Teach clients relaxation techniques and deep breathing exercises Help clients control anxiety and manage situations independently to reduce symptoms. 
Provide resources and support for family members Help family members learn to cope with the effects of the client’s disorder and develop effective communication skills. 

Writing a Nursing Care Plan (NCP) for Personality Disorders

A Nursing Care Plan (NCP) for Personality Disorders starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

References

https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463

https://my.clevelandclinic.org/health/diseases/9636-personality-disorders-overview

https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

https://www.hopkinsmedicine.org/health/conditions-and-diseases/personality-disorders

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Transcript

Hey everyone. Today, we’re going to be creating a nursing care plan for personality disorders. So let’s get started. All right, we’re going to get started with the pathophysiology. So personality disorder is a term that covers several different types of mental disorders that cause unhealthy patterns of thinking, functioning and behaving. These are categorized into three clusters. According to the behavior cluster of disorders, schizoid and schizotypal exhibit odd or eccentric thinking. Behavior cluster B disorders, antisocial, borderline, and narcissistic exhibit dramatic, unpredictable, and overly emotional behaviors. Cluster C disorders, obsessive compulsive and avoidant, exhibit anxiety and fear. Nursing considerations: going to assess neurological function, monitor behaviors, set clear boundaries, and encourage positive interaction. Desired outcomes: the client will develop the ability to set realistic goals, identify realistic personal strengths, demonstrate a reduction in violent or manipulative behaviors, and demonstrate coping skills for anxiety.

So we’re going to go ahead and get into our care plan. We have some subjective data and we have some objective data. So things that we’re going to see in these patients, one of the things is going to be low self-esteem and anxiety. Some other things you may see with these patients: they may be arrogant, poorly control of money, and have a lack of remorse. Some others that you’ll see are the desire to be in control of other people, difficulty disagreeing with low self-esteem, lack of confidence, envy of others, easily influenced, and feelings of emptiness. Some other objectives being the inability to discard worthless or broken objects or possible hoarding, shyness, hostility, and that odd or eccentric behavior. 

So interventions, we want to make sure we’re going to first assess the client’s neurological status. So we’re going to do a neuro assessment. We want to determine if there are any other conditions present and get a baseline for this patient. Another invention we’re going to be doing is observe and identify behaviors and set clear limits with consequences. This helps set and maintain the structure and limits that develop feelings of security and safety for the patient. We want to make sure that we’re being consistent when we’re interacting with the client and routine care; so making sure we’re consistent with the patient. Changes in the consistency will threaten the structure of the care and open up the opportunity for the client to use manipulative behaviors or tactics. The client may be resistant to change, so consistency helps encourage new thought processes. Another intervention we want to discuss with the client are their plans and goals, and help distinguish between some positive, realistic goals and unrealistic goals. So we’re going to talk about goals; this is going to help the client regain control of reality and become more focused. It’s also going to help the client understand their capabilities. Set realistic, short-term goals for the client and offer and recognition for obtaining these goals. It’s also going to help the client realize their abilities and maybe some of their limitations, offer encouragement, and improve their self-esteem and cooperation in the process. Another invention we’re going to be doing is making sure we’re enforcing limits and consequences. And we want to make sure we’re discouraging hostile or aggressive behaviors; this is going to help reinforce the structure and discourage inappropriate behaviors by the patient. It’s also going to maintain the safety of the clients as well as others around you. Another intervention, we want to make sure we discuss alternative ideas or ways of thinking. This is going to help the client develop coping skills for emotions or feelings that they have. We’re also going to monitor and encourage positive social interaction with others in a safe environment. This is going to help the clients develop positive social skills and healthy interactions. It’s going to offer an opportunity to learn new ways of dealing with social situations. 

So we’re going to go over some key points. So this covers several different types of mental disorders that cause an unhealthy pattern of thinking, functioning and behaving. The cause is unknown, but it’s believed to be triggered by genetic and environmental influences. So some subjective and objective data. What you’ll see in these patients is they may have some low self-esteem, anxiety, lack of interest, desire to be in control, odd eccentric behavior, lack of remorse, arrogance, lying, or stealing. We’re going to make sure we’re assessing their neurological function at baseline. Observe any behaviors, making sure we’re setting those boundaries with those patients. And we want to discuss their plans and their goals. We’re going to set those boundaries, discuss alternative ways of thinking, encouraging positive, social interactions with others. And there you have a completed care plan. 

We love you guys. Go out, be your best self today and, as always, happy nursing.

 

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