Personality Disorders

Paranoid Personality Disorder

Lacks trust and is suspicious of others and the reasons for their actions; believes others are trying to do harm with no reason; doubts loyalty of others; not willing to trust others; hesitates to confide in others for fear that information will be used against them; takes innocent remarks as personal insults; becomes angry or hostile to perceived slights; holds grudges; often suspects spouse/partner of infidelity.

Paranoid Personality Disorder Nursing Intervention

Use formal, business-like approach; involve client in care with validation before action.

Schizoid Personality Disorder

Appears cold or uninterested in others; almost always chooses to be alone; limited in emotional expression; cannot take pleasure in most activities; cannot pick up typical social cues; little to no interest in sexual activity.

Schizoid Personality Disorder Nursing Intervention

Promote improved functioning in the community.

Schizotypal Personality Disorder

Has unusual thinking, beliefs, speech, or behavior; experiences strange perceptions such as hearing voices; has flat or socially unusual emotions; socially anxious; difficulty forming close relationships; exhibits magical thinking; believes casual events have hidden messages.

Schizotypal Personality Disorder Nursing Intervention

Address self-care deficits; teach social skills for community functioning.

Group B Personality Disorders

(Dramatic/Emotional/Erratic)

Borderline Personality Disorder

Strong fear of abandonment; ongoing feelings of emptiness; sees self as unstable/weak; unstable deep relationships; mood swings with stress; threats of self-harm; often very angry; impulsive or risky behaviors; stress-related paranoia.

Borderline Personality Disorder Nursing Interventions

Ensure safety (No Harm contract); provide structure with limit-setting; strictly maintain boundaries and unit rules; teach social skills and role-play socially acceptable behaviors.

Histrionic Personality Disorder

Constantly seeks attention; overly emotional or dramatic; stirs sexual feelings for attention; speaks dramatically with few facts; easily influenced; shallow emotions; overly concerned with physical appearance; perceives relationships as closer than reality.

Histrionic Personality Disorder Nursing Interventions

Maintain professional boundaries; provide factual feedback on social interactions; role-play social skills; explore client strengths and assets.

Narcissistic Personality Disorder

Believes they are special or more important; fantasizes about power, success, or attractiveness; lacks empathy; exaggerates achievements; expects constant praise; feels superior and brags; expects favors; takes advantage of others; jealous or believes others are jealous.

Antisocial Personality Disorder

Little concern for others’ needs/feelings; lies, steals, cons others; repeated legal issues; violates others’ rights; aggressive/violent; impulsive and reckless; lacks remorse for harming others.

Group C Personality Disorders

(Anxious/Fearful)

Avoidant Personality Disorder

Very sensitive to criticism or rejection; feels inadequate; avoids work with social contact; isolated; avoids new activities and people; extremely shy; fears disapproval, embarrassment, or ridicule.

Avoidant Personality Disorder Nursing Interventions

Encourage expression of feelings; promote autonomy/self-reliance; use cognitive restructuring; teach problem-solving skills.

Dependent Personality Disorder

Overly reliant on others; submissive/clingy; fears self-care; lacks confidence; needs advice/comfort for decisions; difficulty starting projects; struggles to disagree; endures poor treatment; urgently seeks new relationships after loss.

Dependent Personality Disorder Nursing Intervention

Self-assess for countertransference; promote autonomy and decision-making.

Obsessive-Compulsive Personality Disorder

Focuses excessively on details, order, and rules; seeks perfection; cannot complete projects; needs control over tasks and people; ignores social activities; cannot discard worthless objects; rigid, stubborn; inflexible with morality/values; strict budgeting control.

Obsessive-Compulsive Personality Disorder Nursing Intervention

Encourage flexibility; support work-life balance; provide guidance on task delegation; promote social engagement.

General Nursing Considerations for Personality Disorders

Self-Assessment

Nurses must self-assess before caring for these clients due to potential intense emotional reactions.

Communication Strategies

Use firm but supportive approaches; anticipate client behaviors; offer realistic choices; maintain consistency; therapeutic communication is essential despite distrust or hostility.

Safety Considerations

Clients are at risk for self-injury or violence; limit-setting and consistency are critical, especially for Borderline and Antisocial Personality Disorders.

Skill-Building Interventions

Dependent and Histrionic clients benefit from assertiveness training, modeling, and psychotherapy.

Professional Interaction

Use matter-of-fact responses; ignore personal remarks; focus on social skill role-playing; maintain professional boundaries.

Dialectical Behavior Therapy

is a cognitive-behavioral therapy for clients exhibiting self-injurious behaviors. It focuses on gradual behavior changes and provides acceptance and validation for these clients.

Case management

benefits clients with persistent and severely impaired personality disorders.

In acute care facilities, case management focuses on

Obtaining pertinent history from current or previous providers. Supporting reintegration with the family and ensuring appropriate referrals to outpatient care.

In long-term outpatient facilities, case management goals include

Reducing hospitalizations by providing crisis services and enhancing social support services.