Table of Contents:

1. Personality Disorders
2. Nursing Interventions

Personality Disorders
1. Personality Disorders (PD)
Personality disorders involve long-standing patterns of y Personality traits are rigid and difficult to change.
thinking and behaving in ways that cause problems with y Clients often do not perceive their behavior as
interpersonal relationships and impair daily functioning. problematic and tend to blame others for their
Personality disorders are grouped into clusters based on difficulties.
their common traits (TABLE 1 & TABLE 2).
Psychotherapy is the primary treatment for PDs.
y Individual therapy
TABLE 1. PERSONALITY DISORDERS y Builds insight, accountability, and coping
strategies
Clusters Diagnoses y Group therapy
y Helps clients practice social skills and
Cluster A y Paranoid
isolation
Odd, eccentric y Schizoid
y Cognitive-behavioral therapy (CBT)
y Schizotypal y Teaches clients to recognize and reframe
unhelpful thought patterns
y Dialectical behavior therapy (DBT)
y Teaches emotion regulation, distress
tolerance, and interpersonal skills
y Especially effective for borderline PD
Cluster B y Antisocial y Medications may be used to manage comorbid
Dramatic, erratic y Borderline conditions such as depression or anxiety.
y Histrionic
y Narcissistic

Cluster C y Avoidant
Anxious, fearful y Dependent
y Obsessive-compulsive

Mental Health

 PD treatment: Psychotherapy is the primary treatment for clients with personality disorders.

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1. Personality Disorders (PD), Continued 2. Nursing Interventions
Nursing priorities include:
TABLE 2. TOP 5 PERSONALITY DISORDERS 1. Ensuring safety
2. Setting boundaries
Disorder Key Traits
3. Building a therapeutic relationship
Paranoid: y Distrusts others 4. Supporting healthy coping skills
Suspicious of
Reads hidden meaning into 1. Ensure safety:
others remarks

Assess for suicidal ideation.
y Easily offended, hypervigilant
y Monitor for self-injurious behaviors (especially
Antisocial: y Lies, manipulates with borderline personality disorder).
Disregards y Disregards the rights of others
If self-injurious behaviors do occur (cutting,
societal norms y Lacks guilt or remorse burning self): Maintain a nonreactive attitude
when providing wound care to avoid
Borderline:
High risk for self injury (cutting) reinforcing self-injurious behavior with
Unstable and suicide attention or emotion.
moods and y Fears abandonment y Don’t: React with alarm, “Oh no, why did
relationships y Impulsive you do this?! That looks so painful!”
Narcissistic: y Needs praise and admiration y Do: Calmly clean wound. “Let’s talk later
Exaggerated y Lacks empathy about what led to this.”
self-importance y Provide safe outlets for intense emotions
(exercise, journaling).
Dependent: y Fears abandonment y Helps release tension andrisk of aggression
Struggles y Clings to others or self-injury
to function y Lacks confidence
2. Set boundaries:
independently y Needs constant reassurance
y Clients with PD often challenge rules and
test limits.

Establish clear boundaries and consequences
as a team to prevent manipulation, acting out, and
staff splitting.
y Staff splitting occurs when a client views some
staff as “all good” and others as “all bad” 
Conflict and manipulation within the care team.
y Emphasize accountability for the client’s actions
toblaming others and help form insight into
behaviors.
y Example: “What choices did you make in that
situation?”

Mental Health

 Borderline personality disorder: Clients with  Boundary setting: Clients with personality
borderline PD are at high risk for suicide and disorders often challenge rules and test
self-injurious behaviors. Prioritize safety and limits. Nurses must establish clear boundaries
maintain a nonreactive attitude when providing and consistent consequences as a team to
wound care to avoid reinforcing self-injurious prevent manipulation and acting out.
behavior.

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2. Nursing Interventions, Continued
3. Build a therapeutic relationship: 4. Support healthy coping skills:
y Remain calm, nonjudgmental, and consistent to
Teach emotional regulation and impulse-control
build trust andemotional reactivity. strategies (journaling, deep breathing).

For clients with paranoid PD, avoid small y This helps clients manage intense emotions
talk, joking, or being overly friendly, as it may andimpulsive behavior.
suspicion and mistrust. y Validate feelings and encourage accountability.

Avoid arguing with clients, rescuing, or y Example: “It sounds like you are feeling really
reinforcing dependent behaviors: Engaging in frustrated. What is another way you can
emotional reactions or over-accommodation express that feeling without yelling?”
reinforces inappropriate behaviors. y This helps clients build self-awareness and
y Example: A client refuses to go to group improve emotional regulation.
therapy.
y Don’t say: “That’s okay; I’ll tell them you’re
not feeling well.”
y This response reinforces avoidance and
undermines the care plan.
y Say: “Group therapy is part of your
treatment plan. I’ll walk with you to the
door.”
y This response maintains consistent
boundaries and expectations while
offering support.

Mental Health

 Paranoid personality disorder: For clients  Coping skills: Teach emotional regulation and
with paranoid personality disorder, the nurse impulse-control strategies, such as journaling
should avoid small talk, joking, or being or deep breathing, to help the client manage
overly friendly, as it may increase suspicion intense emotions and reduce impulsive
and mistrust. behaviors.

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  What is the first-line treatment for personality  When caring for a client with paranoid personality
disorders? disorder, the nurse should not make small talk,
joke, or be overly friendly towards the client (True
 Clients with borderline personality disorder are or False?).
at high risk for _____ and _____ behaviors. Nurses
should maintain a/an _____ attitude when providing  To help the client manage intense emotions
wound care to avoid reinforcing the behavior. and reduce impulsive behaviors, the nurse
should teach the client _____ regulation and
 When caring for a client with a personality _____-control strategies, such as _____ and _____.
disorder, nurses must establish clear _____
and consistent _____ as a team to prevent
manipulation and acting out.

5. emotional regulation, impulse-control, journaling, deep breathing

Mental Health

References:

Halter, M. J. (2022). Varcarolis’ foundations of psychiatric-mental health Pollard, C. L. & Jakubec, S. L. (2023). Varcarolis’s Canadian psychiatric
nursing: A clinical approach (9th ed.). Elsevier. mental health nursing: A clinical approach (3rd ed.). Elsevier.
Morgan, K. I. (2024). Davis Advantage for Townsend’s psychiatric Videbeck, S. L. (2023). Psychiatric-mental health nursing (9th ed.).
mental health nursing (11th ed.). F. A. Davis Company. Wolters Kluwer.

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