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4 Personality Disorders Nursing Care Plans

Personality Disorders Nursing Care Plans|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

Risk For Self-Mutilation

Nursing Diagnosis

  • Risk For Self-Mutilation

Risk factors

  • Desperate need for attention.
  • Emotionally disturbed or battered children.
  • Feelings of depression, rejection, self-hatred, separation anxiety, guilt, and depersonalization.
  • History of self-injury.
  • History of physical, emotional, or sexual abuse.
  • High-risk populations (BPD, psychotic states).
  • Impulsive behavior.
  • Inability to verbally express feelings.
  • Ineffective coping skills.
  • Mentally retarded and autistic children.

Possibly evidenced by

  • Fresh superficial slashes on wrists or other parts of the body.
  • Intense rage focused inward.
  • Signs of old scars on wrists and other parts of the body (cigarette burns, superficial knife/razor marks).
  • Statements as to self-mutilation behaviors.

Desired Outcomes

  • Patient will be free of self-inflicted injury.
  • Patient will participate in impulse control training.
  • Patient will participate in coping skills training.
  • Patient will seek help when experiencing self-destructive impulses.
  • Patient will discuss alternative ways a client can meet demands of current situation.
  • Patient will express feelings related to stress and tension instead of acting-out behaviors.
  • Patient will sign a “no-harm” contract that identifies steps he or she will take when urges return.
  • Patient will respond to external limits.
  • Patient will participate in the therapeutic regimen.
  • Patient will demonstrate a decrease in frequency and intensity of self-inflicted injury.
  • Patient will demonstrate two new coping skills that work for the client for when tension mounts and impulse returns.
Nursing Interventions Rationale
Assess client’s history of self-mutilation:
  1. Types of mutilating behaviors.
  2. Frequency of behaviors.
  3. Stressors preceding behavior.
Identifying patterns and circumstances surrounding self-injury can help the nurse plan interventions and teaching strategies suitable to the client.
Identify feelings experienced before and around the act of self-mutilation. Feelings are a guideline for future intervention (e.g., rage at feeling left out or abandoned).
Explore with the client what these feelings might mean. Self-mutilation might also be:
  1. A way to gain control over others.
  2. A way to feel alive through pain.
  3. An expression of self-hate or guilt.
Secure a written or verbal no-harm contract with the client. Identify specific steps (e.g., persons to call upon when prompted to self-mutilate). Client is encouraged to take responsibility for healthier behavior. Talking to others and learning alternative coping skills can reduce frequency and severity until such behavior ceases.Personality Disorders Nursing Care Plans
Set and maintain limits on acceptable behavior and make clear client’s responsibilities. If the client is hospitalized at the time, be clear regarding the unit rules. Clear and nonpunitive limit setting is essential for decreasing negative behaviors.
Be consistent in maintaining and enforcing the limits, using a nonpunitive approach. Consistency can establish a sense of security.
Use a matter-of-fact approach when self-mutilation occurs. Avoid criticizing or giving sympathy. A neutral approach prevents blaming, which increases anxiety, giving special attention that encourages acting out.
After the treatment of the wound, discuss what happened right before, and the thoughts and feelings that the client had immediately before self-mutilating. identify dynamics for both client and clinician. Allows the identification of less harmful responses to help relieve intense tensions.
Work out a plan identifying alternatives to self-mutilating behaviors.
  1. Anticipate certain situations that might lead to increased stress (e.g., tension or rage).
  2. Identify actions that might modify the intensity of such situations.
  3. Identify two or three people whom the client can contact to discuss and examine intense feelings (rage,self hate) when ther arise.
Plan is periodically reviewed and evaluated. Offers a chance to deal with feelings and struggles that arise.
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