9 Nursing Care Plan for Personality Disorders

Personality is the traits and attitudes that can be suspected in someone and affect the patterns of cognitive, affective and behavioral. The patterns in a long time, consciously or unconsciously, and affect people's response and adaptation to the environment. Adaptation is the center of personality theory.


Definition of Personality Disorders

Kerberg (1984): maladaptive attitudes that produce or influence the psychological considerations, causing emotional disturbance and damage relations with others.

Maladaptive responses such as inflexible, rigid, is a pathological condition that causes the client stress, anxiety and depression.


1. Paranoid Personality Disorder

Pervasive suspicion and unwarranted and not trust to others.

• Often feel like to be kept others from feeling threatened or attacks from others.
• Mood them sensitive and hostile, aloof.
• Difficult to build a trusting relationship
• Be careful in dealing with other people.
• Pathological jealousy.
• Inability to relax, lacking a sense of humor.
• Critical to the others, but it is difficult to accept criticism.

Interventions:

• Approach calm manner, empathy and avoid things that make jealous.
• Due to suspicious clients will harm everyone, then the nurse must consider verbal and non-verbal signs to determine if the client is being aggressive or hostile.
• All actions will be discussed first so he understands the reason and purpose, so as not suspicious.
• Try to act according to the agreements made​​.
• Support adaptive behaviors such as trust others are not always going to threaten, that self safe. Able to adapt to stressors.

2. Schizotypal and Schizoid Personality Disorder

The inability to form close personal relationships

• This person is difficult to relate to others, and difficult to maintain intimate relationships.
• Tend could develop into schizophrenia, and there is a genetic element.
• The signs are: isolation, limited interaction with peers, social anxiety, school performance is not good, hypersensitivity, limitations in speech and thought process, no warmth / softness.
• Do not care about the praise / criticism of others.
• Affect blunt, flat, pulled away and looked cool.

Intervention:

• Approach client calmly.
• Adjust the level of talks with the relationship with the client, observe the verbal and nonverbal.
• Include in group therapy.
• Arrange level client relationships, for example, starting from the nurse-client relationship, the client - the client, the client with another group and finally group therapy.

3. Antisocial Personality Disorder

The person does not behave according to social norms.
Characteristics: failure to learn from experience, often acting risky and impulsive, no guilt and recurrent, exploit others, does not respect the rights of others, there is no loyalty and honesty.

• Tend to be drug addicts.
• They are manipulative and are happy to argue
• Teams often fail to address the health because they often do unlawful acts and norms, cheat, do not have a plan as impulsive, there is a history of fighting, insulting and aggressive, could endanger themselves and others, failed to manage finances.

Interventions:

• Be an example of how to interact with sound.
• Do not get stuck client behaviors such as arguing, make sure the rules and sanctions that will be earned if not obedient, discuss the impact of his behavior over the years.
• Include in group therapy, family and health care team work together so that all the same rules and be consistent.
• Encourage clients to get along with others so that good self-esteem.

4. Borderline Personality Disorder

An instability in interpersonal relationships, self-image and feeling natural.

• This guy has an ego that is not integrated and fragile.

Characteristics: do not have a clear identity, tend to use coping children, it is difficult to accept the fact.

• When stressed, he will regression, spliting (looking at the world as a dichotomous, good - bad, positive-negative), deny and projections.
• Tend to feel lonely, hurting himself.

Interventions:

• Soothing at a critical time.
• Because nurses often refer to either (when his will be obeyed) or bitchy sisters, it is often a conflict. So the nurse to avoid and resolve conflicts.
• Create a list of daily activities, regulations, responsibility and a clear agreement.
• Avoid self-harm acts directly or indirectly because he felt himself evil.
• If necessary collaborative physician for appropriate medication symptoms.
• Include in group therapy.

5. Histrionic Personality Disorder

The behavior of clients ranging from high ego functions (attention-seeking) to the lower ego functions (want to have intercourse with anyone, impulsivity, and psychosis).
Behavior seen:

• Feeling uncomfortable in a situation where he is not the center of attention.
• Having sexual intercourse with many people.
• Perform physical attractiveness to seek attention.
• Diction made as attractive as possible.
• Behave dramatic, as in the theater at the time of expressing his emotions.
• Easy on the suggestion.
• Like intimate relationship with anyone, even if other people do not feel it.
• Overreaction to minor events
• Arrogant and demanding behavior

This disorder in women, relationships with others are usually superficial, flamboyant, and prefer to rely on therapists

• His ego makes him fantasize, fall in love with the therapist.
• Coping: dissociation, repression.
• Other maladaptive behavior: temper tantrums, manipulative, relentless demand.

Interventions:

• Consistent, understanding, overcoming feelings of love or hate the therapist
• Making the environment do not cause maladaptive behavior.
• Discuss about fantasy, brought to reality
• Teach healthy behaviors in achieving goals, teach constructive coping.
• Taught the principles and healthy behaviors.

6. Narcissism Personality Disorder

People who are enjoying themselves and are always acting to please him.

• The person is able to work but are often asked for help because of difficulty in dealing closely with other people, no neurotic symptoms, sexual difficulties, and there is a chronic feeling of emptiness.

Characteristics:

• Want to be considered superior.
• There is a fantasy of self; successful, beautiful, clever, powerful and worthy of love.
• Self confident; special, unique, and can only be understood by the party whose status is "similar" to themselves.
• Want to be admired
• Take advantage of other people's interests.
• No empathy, like jealous / envious of others and consider others as well as against him.
• Feeling cocky mask feelings of inferiority, insecurity and inadequacy.

Interventions:

• The nurse must be aware of the client's reaction face egocentric and love for attention.
• Increase self esteem clients.
• Involve the client in any event nearby so he started paying attention to other people and the environment.
• Client must view themselves from another viewpoint.
• Other interventions together with the borderline personality.

7. Avoidant Personality Disorder

Always avoid participating in activities because of fear of being criticized, belittled or rejected.

• Refuse to participate unless there is a guarantee not to be denied.
• Can not relate to other people for fear of being rejected.
• Felt stupid, incapable, shy.
• Always look for signs of rejection, although the positive relationship.

Interventions:

• Develop a relationship of trust with clear rules that he felt he received
• Always try to be honest and relaxed
• Emphasizing that it is a valuable client to be friends.

8. Dependent Personality Disorder

• Clients always depend and feel inferior.
• Always ask for support and advice, not to make a decision.
• Acting like a child, refused responsibility as adults.
• Always fear, relying on the people who take care of him.

Interventions:

• Learn each client request will not depend.
• Try the client makes the decisions, the nurse simply pave the way or insight.

9. Obsessive-Compulsive Personality

• Rigid in living standards that have been set.
• The client is very anxious, very fear of losing control of her ability.
• He gave very little material, feelings and concerns.

Interventions:

• Relieve anxiety and increase self-esteem.
• The use of medication to calm.
• Adjust the signs and symptoms.
• Give cognitive therapy that they are safe.

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Nursing Concept of Personality Disorders

General Concept of Personality Disorders

1. Personality disorder primarily involves problems with interpersonal relationships.
2. Personality disorders are generally chronic, pervasive (affecting all areas of the client's life), and maladaptive (eg, personality disorders cause significant difficulty in life, work and family life).
3. Personality disorder involves a pattern of excessive or oddly normal personality.
4. Personality disorders can occur together with other severe psychiatric problems.
5. Personality disorders may be difficult to be treated or diagnosed.

Common Symptoms of Personality Disorders

1. Suspicious or do not believe.
2. Rigid thinking.
3. Distortion of reality.
4. Projection.
5. Afec limited or excessive.
6. Isolation.
7. Unstable interpersonal ties.
8. Limited or excesses of moral development.
9. Self-care deficit.
10. Somatic symptoms.
11. Thinking delusions.
12. Bad identity or excesses sense of self importance.
13. Potentially damaging to self or others.

Type of Pervasive Personality Disorder


Group A

1. Paranoid Personality Disorder: do not believe the total on others begins in young adulthood, indicated by at least four of the following conditions:

• Suspiciously, without cause, that people exploit or cheat.
• Busy with vague doubts about the loyalty or honesty of a friend or colleague.
• Finding hidden harassment or threatening meaning of a comment or trivial events.
• Always hurt or complain.
• Attacks (not visible to others) on the character or reputation of a person, followed by a fast reaction of anger or counterattack.
• Suspicious relapse.

2. Schizoid Personality Disorder: Patterns of separation settling of social relations and also the limited range of emotional expression in interpersonal relationships begins in young adulthood, indicated by at least four of the following symptoms:

• Lack of desire or inability to enjoy intimate relationships, including with his own family.
• The choices are almost always exclusive to a solitary activity.
• Few, if any, attention to sexual experience with another person.
• Experience the pleasure of little, if any, activity.
• Lack of good friends.
• Indifferent to praise or criticism.
• Cold emotion and flat affect.

3. Schizotypal Personality Disorder: Patterns of social and interpersonal deficits persist (acute discomfort, and reduced capacity for close relationships, cognitive or perceptual distortions and behavioral egocentricity) begins in young adulthood, indicated by at least five of the following symptoms:

• Ideas of reference (excluding delusions of reference).
• Odd beliefs or magical thinking that influences behavior.
• Unusual perceptual experience (Illusions body).
• Thinking and talking weird (not clear, circumstantial, metaphorical, excessive elaboration, stereotyped / repetitive)
• Suspicious or paranoid thinking).
• Afek Improper or restricted.
• Behavior or strange or eccentric appearance.
• Lack of good friends.
• Of excessive social anxiety that does not diminish with familiarity and usually including paranoid thoughts.

Group B


1. Antisocial Personality Disorder

• Evidence of conduct disorder before the age of 15 on the client at least 18 years old.
• The pattern is not settled appreciate and violate the rights of others since age 15, as indicated by three of the following conditions:

• Failed to comply with social norms or law-abiding behavior.
• Irritability or aggressiveness.
• Is not responsible for the employment history and financial obligations.
• Impulsive and fail to plan ahead.
• Traitor.
• Not respect the safety of self and others.
• Lack of feeling regret.

2. Borderline Personality Disorder: patterns persist instability in interpersonal relationships, self-image, affective, and impulse control begins in young adulthood, indicated by:

• Enterprises like crazy / hysterical to avoid waiver (not including suicide attempts and acts of self-harm).
• Unstable personal relationships and stiff.
• Settled identity disorder.
• Impulsive behavior, reckless, at least 2 of the following areas: spending, sex, substance abuse, driving, overeating.
• Behavior or signs or threats of suicide or self-harm relapse / recurrence.
• Manifestation of mood reactivity, usually for short periods rarely exceed a few days.
• Chronic feelings of emptiness and boredom.
• Angry stiff, Improper, lack of control of anger.
• Stress-related paranoid thoughts, temporary or disosiataif severe symptoms.

3. Histrionic Personality Disorder: patterns of emotional and behavioral excesses settled attention-seeking, beginning in young adulthood is indicated by at least 5 of the following symptoms:

• Feel uncomfortable when not the center of attention.
• Behavior or sexual seducing unnatural appearance.
• Emotional instability.
• Very concerned (excessive) to the physical appearance, using it to draw attention to themselves.
• Talk excessively impressionistic style and lack of detail.
• Self-dramatization, exaggerated expression of emotions and theatrical.
• Forcing.
• The mistaken belief that the relationship with other people is more intimate than a reality.

4. Narcissistic Personality Disorder: patterns of settling pretense, need for admiration and lack of empathy, beginning in young adulthood is indicated by five of the following symptoms:

• Strong sense of self importance.
• Preoccupied with thoughts of success, beauty, intelligence, power and infinite love.
• Convinced that he superrior (great) and just want to connect with people or institutions that great.
• Need admired and considered excessive.
• Strong feelings that are entitled to preferential treatment / special.
• Exploit others.
• Lack of empathy.
• Envious of others or believes others envy him.

Group C

1. Shy Personality Disorder: patterns of social barriers persist, and hypersensitive to criticism, beginning in adulthood, indicated by at least four of the following symptoms:

• Avoid work activities including significant interpersonal contact.
• Not willing to risk engaging in intercourse without certainty of success to be liked.
• Limiting intimate relationship.
• Busy with the fear of being rejected or criticized in social situations.
• Shame in a new relationship.
• Sure that could not socially, personally or lower unattractive to others.
• Not willing to risk personal or engage in new activities.

2. Dependency Personality Disorder: The need for excessive settling and treated / untreated, leads to submissive and dependent behavior and fear of separation. Starting in young adults is indicated by at least 5 of the following symptoms:

• Inability to make decisions every day without excessive advice from others.
• Need someone else to take over responsibility in life.
• Reluctant to disagree with others because of fear of rejection.
• Difficult to start a project and do everything yourself.
• Highly sought to gain emotional support from others (voluntary does not unpleasant).
• Feel uncomfortable or no expectations when alone.
• Trying to find a new dependency relationship when a close relationship ends.
• Busy with fear sendirri left to care for themselves.

3. Obsessive-Compulsive Personality Disorder: Patterns settled busy with regularity, perfection and mental and interpersonal control will cost flexibility, openness and efficiency, beginning in young adulthood is indicated by at least four of the following symptoms:

• Busy on the details, rules, lists, scheduling organization, causing inability to focus on the main point of an activity.
• Perfectionists who disrupt the completion of a task.
• Excessive loyal towards work and productivity by eliminating the activity fun and friendship.
• Very careful, meticulous and unusual klentur about morality, ethics and values​​.
• The inability to throw useless things.
• Reluctant to delegate tasks except the task will be done in accordance with the doing.
• Stingy with money.
• Rigid and stubborn.

4. Agresig-Passive Personality Disorder

• Registered as a non-specific personality disorder who have behavior more than 1 personality disorder but no full criteria for a single personality disorder.
• Common symptoms of passive aggressive behavior affect social interaction and work.
• Procrastination / Likes to procrastinate.
• Failed to perform a task or a bad job when do not want doing.
• Will hurt suggestions on how to improve performance.
• Failure to do part of the job fair yag.
• Excessive deride and criticize superiors.
• Improper claims that her demands and irritable and arguing when asked to perform a task.

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