Nursing Exam Preparation and Jobs Alerts(NEPJA)

Nursing Officer Exam Review Notes: Personality Disorders
Overview and General Concepts

• Definition: Deeply ingrained, inflexible, and maladaptive patterns of behavior that cause significant functional impairment or subjective distress.
• Key Characteristic: Most personality disorders are ego-syntonic (the patient believes their behavior is normal and correct), which makes treatment challenging and limits patient insight.
• General Nursing Approach: Do not attempt to “cure” the personality. Focus on improving functioning, reducing maladaptive behaviors (like self-harm), and setting strict boundaries.

Cluster A: Odd & Eccentric (The “Weird”)

Underlying trait: Social isolation, detachment, and cognitive/perceptual distortions.

• Paranoid Personality Disorder: Pervasive distrust and suspiciousness. Believes others are exploiting or deceiving them.
  • Nursing Action: Use clear, straightforward, and objective communication. Avoid being overly warm or friendly (which increases suspicion). Do not use humor or sarcasm. Show sealed medication packets if they suspect poisoning.
• Schizoid Personality Disorder: Profound detachment from social relationships. Does not desire or enjoy close relationships. Prefers solitary activities (e.g., night-shift jobs).
  • Nursing Action: Respect their need for distance. Do not force group therapy or socialization.
• Schizotypal Personality Disorder: Genetically linked to schizophrenia. Features magical thinking, ideas of reference, and eccentric appearance. May experience transient micro-psychotic episodes under stress.

Cluster B: Dramatic, Erratic & Emotional (The “Wild”)

Underlying trait: Impulsivity, boundary violations, and emotional dysregulation.

• Antisocial Personality Disorder (ASPD): Disregard for and violation of the rights of others. Characterized by manipulation, superficial charm, deceit, and a profound lack of remorse/empathy.
  • Diagnostic Criteria: Patient must be at least 18 years old with a documented history of Conduct Disorder before age 15. Highly comorbid with substance abuse.
  • Nursing Action: Absolute consistency among all staff members. Implement strict, clear limit-setting. Do not argue or negotiate rules. Hold them accountable for their actions.
• Borderline Personality Disorder (BPD): Severe instability in relationships, self-image, and mood. Driven by an intense fear of abandonment.
  • Key Features: Chronic feelings of emptiness, impulsive self-harm/mutilation (used to relieve emotional numbness, not usually a primary suicide attempt), and Splitting (viewing staff as “all good” or “all bad”).
  • Nursing Action: Safety is priority #1. Maintain a united staff front to prevent splitting. Avoid reacting emotionally to provocative behavior to manage your own countertransference.
  • Gold Standard Treatment: Dialectical Behavior Therapy (DBT) (focuses on mindfulness, distress tolerance, emotion regulation).
• Histrionic Personality Disorder: Excessive emotionality and attention-seeking. Often sexually seductive, provocative, and highly dramatic with shallow, rapidly shifting emotions.
  • Nursing Action: Set firm boundaries regarding inappropriate or seductive behavior. Keep interactions professional and objective.
• Narcissistic Personality Disorder: Grandiosity, need for admiration, and lack of empathy. Highly sensitive to criticism (which causes “narcissistic rage” or “narcissistic injury”).

Cluster C: Anxious & Fearful (The “Worried”)

Underlying trait: High anxiety, fear of rejection, and need for control.

• Avoidant Personality Disorder: Extreme social inhibition and hypersensitivity to negative evaluation. Unlike Schizoid, they deeply desire relationships but avoid them due to intense fear of rejection.
  • Nursing Action: Use a gentle, reassuring approach. Slowly integrate into group settings; do not push them into high-stress social situations immediately.
• Dependent Personality Disorder: Excessive need to be taken care of, leading to submissive and clinging behaviors. Terrified of separation and cannot make independent decisions.
  • Nursing Action: Support them but do not make decisions for them. Encourage autonomy and independent problem-solving (e.g., choosing their own clothes).
• Obsessive-Compulsive Personality Disorder (OCPD): Preoccupation with orderliness, perfectionism, and mental/interpersonal control. Highly rigid, miserly with money, and unable to delegate tasks.
  • OCPD vs. OCD: OCPD is a personality trait that is ego-syntonic (they like their perfectionism). OCD involves intrusive thoughts and compulsions that are ego-dystonic (causes them severe distress).
  • Nursing Action: Help the patient recognize that “good enough” is acceptable. Assist in setting time limits on tasks to prevent perfectionistic paralysis.
    High-Yield Exam Tips for Nursing Officers:

1. Manipulative Behavior: (ASPD, BPD) -> Requires united team, strict limits, and consistent consequences.
2. Safety: (BPD) -> Always assess suicide lethality and self-harm risk first.
3. Communication: (Paranoid) -> Be honest, objective, and neutral. (Schizoid) -> Respect boundaries.
4. Pharmacology: Medications do not cure personality disorders; they treat symptoms (e.g., SSRIs for BPD mood lability; low-dose antipsychotics for Schizotypal magical thinking).