4 Personality Disorders Nursing Care Plans

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Personality is defined as the differences in the characteristic patterns of behaving, feeling and thinking of an individual.

A personality disorder is a type of mental illness in which a person’s personality traits have become rigid, inflexible, maladaptive and can hinder the person’s perception and association to situations and people. This can cause significant problems and restriction in the family, social activities, school, employment and other functional roles.

Nursing Care Plans

The nursing care plan varies according to the kind of personality disorder, its severity, and life situation. A collaborative intervention is needed to make sure all of the clients social, medical and psychiatric needs are met.

The goals of the nurse for clients with personality disorders focus on establishing trust, providing safety and comfort, teaching basic living skills and promoting a responsible behavior.

Here are four (4) nursing care plans (NCP) and nursing diagnosis for personality disorders:

  1. Risk For Self-Mutilation
  2. Chronic Low Self-Esteem
  3. Impaired Social Interaction
  4. Ineffective Coping
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Chronic Low Self-Esteem

Nursing Diagnosis

  • Chronic Low Self-Esteem

May be related to

  • Avoidant and dependent patterns.
  • Childhood physical, sexual, psychological abuse and/ or neglect.
  • Dysfunctional family of origin.
  • Lack of realistic ego boundaries.
  • Persistent lack of integrated self-view, with splitting as a defense.
  • Shame and guilt.
  • Substance abuse.

Possibly evidenced by

  • Evaluates self as unable to deal with events.
  • Excessively seeks reassurance.
  • Expresses longstanding shame/guilt.
  • Hesitant to try new things/situations.
  • Longstanding or chronic self-negting verbalizations; expressions of shame and guilt.
  • Overly conforming, dependent on others’ opinions, indecisive.
  • Rationalizes away/ rejects positive feedback and exaggerates negative feedback about self.

Desired Outcomes

  • Patient will identify one skill he or she will work on to meet future goals.
  • Patient will identify two cognitive distortions that affect self-image.
  • Patient will identify three strengths in work/school life.
  • Patient will reframe and dispute one cognitive distortion with nurse.
  • Patient will set one realistic goal with nurse that he or she wishes to pursue.
  • Patient will state a willingness to work on two realistic future goals.
  • Patient will identify one new skills he or she has learned to help meet personal goals.
  • Patient will demonstrate ability to reframe and dispute cognitive distortions with assistance of a nurse/clinician.
Nursing Interventions Rationale
Assess with clients their self perception. Target different areas of the client’s life:

  1. Strengths and weaknesses in performance at work/school.daily-life tasks.
  2. Strengths and weaknesses as to physical appearance, sexuality, personality.
Identify with client with realistic areas of strength and weaknesses. Client and nurse can work on the realities of the self-appraisal, and target those areas of assessment that do not appear accurate.
Maintain a neutral, calm, and respectful manner, although with some clients this is easier said than done. Helps client see himself or herself as respected as a person even when behavior might not be appropriate.
Review with the client the types of cognitive distortions that affect self-esteem (e.g., self-blame, mind reading, overgeneralization, selective inattention, all-or-none thinking). These are the most common cognitive distortions people use. Identifying them is the first step to correcting distortions that form one’s self-view.
Teach client to reframe and dispute cognitive distortions. Disputes need to be strong, specific, and nonjudgmental. Practice and belief in the disputes over time help clients gain a more realistic appraisal of events, the world, and themselves.
Work with client to recognize cognitive distortions. Encourage client to keep a log. Cognitive distortions are automatic. Keeping a log helps make automatic, unconscious thinking clear.
Keep in mind clients with personality disorders might defend against feeling of low-self-esteem through blaming, projection, anger, passivity, and demanding behaviors. Many behaviors seen in PD clients cover a fragile sense of self. Often these behaviors are the crux of clients’ interpersonal difficulties in all their relationships.
Discourage client from making repetitive self-blaming and negative remarks. Unacceptable behavior does not make the client a bad person, it means that the client made some poor choices in the past.
Discourage client from dwelling on and “relieving” past mistakes. The past cannot be changed. Dwelling on past mistakes prevents the client from appraising the present and planning for the future.
Discuss with client his or her plans for the future. Work with client to set realistic short-term goals. Identify skills to be learned to help client reach his or her goals. Looking toward the future minimizes dwelling on the past and negative self-rumination. When realistic short-term goals are met, client can gain a sense of accomplishment, direction, and purpose in life. Accomplishing goals can bolster a sense of control and enhance self-perception.
Focus questions in a positive and active light; helps client refocus on the present and look to the future. For example. “What can you do differently now?” or “What have you learned from that experience?”. Allows client to look at past behaviors differently, and gives the client a sense that he or she has choices in the future.
Give the client honest and genuine feedback regarding your observations as to his or her strengths, and areas that could use additional skills. Feedback helps give clients a more accurate view of self, strengths, areas to work on, as well as a sense that someone is trying to understand them.
Do not flatter or be dishonest in your appraisals. Dishonesty and insincerity undermine trust and negatively affect any therapeutic alliance.
Set goals realistically, and renegotiate goals frequently. Remember that client’s negative self-view and distrust of the world took years to develop. Unrealistic goals can set up hopelessness in clients and frustrations in nurse clinicians. Clients might blame the nurse for not “helping them,” and nurses might blame the client for not “getting better”.
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See Also

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Mental Health and Psychiatric Care Plans

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2 COMMENTS

  1. As a healthcare provider with a diagnosis of BPD, these care plans seem well written and well researched. I think there is a lot of stigma around personality disorders. But this was broken down well to manage many chronic symptoms.

    Thank you!

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