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Nursing Care Plan for Personality Disorders

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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:

  • 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

  • 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.  

References

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  • Question 1 of 5

A client has been diagnosed with antisocial personality disorder and becomes very angry with the nurse and is starting to become aggressive. Which principle of management would most likely be implemented in this situation?

  • Question 2 of 5

A client with schizoaffective disorder has been admitted to the inpatient mental health center of the hospital. The client tells the nurse that he hears voices telling him to leave the hospital. Which response from the nurse is best?

  • Question 3 of 5

Which of the following is an example of a statement of making an observation that may be used with therapeutic communication?

  • Question 4 of 5

Which of the following are ways nurses create barriers to therapeutic communication? Select all that apply.

  • Question 5 of 5

A 23-year-old client is being seen for treatment after purposely cutting the skin on her arm. The client has impulsive behavior, is angry, and has been losing friends because of intense and needy behavior. Which type of personality disorder does this best describe?

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