Personality and Sexual Disorders: Comprehensive Nursing Notes
Focus Keyword: Personality Disorder
These structured, personality disorder notes are crafted for nursing students seeking deep, focused knowledge akin resources. All classifications, definitions, types, symptoms, and management protocols are comprehensively covered, interspersed with colorful visuals, mnemonics, tables, and diagrams. Optimized for learning, active recall, and PDF export.
Introduction
The human personality comprises enduring patterns of thoughts, feelings, and behaviors that distinguish individuals from one another. Alterations, extremes, or maladaptive traits in these patterns may give rise to personality disorder. Additionally, sexual health—an essential aspect of holistic nursing care—encompasses sexual functioning, identity, and preferences, which may be affected in sexual disorders. As a nurse, understanding the breadth of personality disorder and sexual disorders is vital for patient-centered care, early recognition, and health promotion.
What is a Personality Disorder?
Personality disorder refers to enduring, rigid patterns of inner experience and behavior that deviate markedly from the expectations of the individual’s culture, are pervasive and inflexible, begin in adolescence or early adulthood, are stable over time, and lead to distress or impairment.
Key characteristics of personality disorder:
- Early onset and chronic course
- Pervasiveness across situations
- Disturbances in cognition, affectivity, interpersonal functioning, and/or impulse control
- Associated with significant distress or social/occupational impairment
Classification of Personality Disorders
Personality disorder is classified by the DSM-5 into three main clusters (Cluster A, B, & C). Each cluster groups disorders with similar characteristics.
| Cluster | Mnemonic | Description | Disorders |
|---|---|---|---|
| A | “Weird” | Odd or eccentric behaviors | Paranoid, Schizoid, Schizotypal |
| B | “Wild” | Dramatic, emotional, erratic behaviors | Antisocial, Borderline, Histrionic, Narcissistic |
| C | “Worried” | Anxious or fearful behaviors | Avoidant, Dependent, Obsessive-Compulsive |
Clinical Features of Personality Disorder
- Disturbance in thought/perception: e.g., suspiciousness, odd beliefs, perceptual distortions
- Disturbance in affect: e.g., inappropriate emotional responses, lability, constriction
- Interpersonal dysfunction: e.g., difficulty forming/maintaining relationships, maladaptive coping
- Impulse control problems: e.g., poor frustration tolerance, risk-taking, aggression or harm to self/others
- Cognitive distortions: e.g., paranoia, magical thinking, egocentrism
Personality disorder patients often lack insight into their condition and tend to externalize blame.
Etiology of Personality Disorders
- Genetic Factors: Hereditary predisposition and family history contribute.
- Biological Factors: Neurochemical imbalances, abnormal brain structure, and neurotransmitter alterations (serotonin, dopamine).
- Psychosocial Factors: Early childhood trauma, neglect, abuse, dysfunctional family/attachment issues.
- Cultural & Environmental: Societal influences, cultural expectations, and chronic stressors.
Cluster A Personality Disorders
Cluster A includes disorders characterized by odd, eccentric thinking or behavior.
Paranoid Personality Disorder
- Pervasive distrust and suspiciousness of others
- Believes others are exploiting, harming, or deceiving them
- Questions loyalty/trustworthiness
- Reluctant to confide in others
- Reads hidden, threatening meanings into benign events
- Holds grudges; quick to react with anger
Schizoid Personality Disorder
- Detachment from social relationships
- Chooses solitary activities
- Lacks desire for close relationships
- Little interest in sexual experiences
- Emotionally cold, detached, or flattened affect
Schizotypal Personality Disorder
- Acute discomfort in close relationships
- Cognitive or perceptual distortions (ideas of reference, magical thinking)
- Eccentric behaviors or appearance
- Odd thinking, speech, or beliefs (telepathy, superstitions)
Cluster B Personality Disorders
Cluster B includes disorders characterized by dramatic, emotional, or erratic behaviors.
Antisocial Personality Disorder
- Disregard for others’ rights, laws, or social norms
- Deceitfulness, lying, impulsivity
- Irritability, aggressiveness
- Lack of remorse after harming others
- Manipulative—may appear charming superficially
- Only diagnosed in those ≥18 y/o (with conduct disorder before age 15)
Borderline Personality Disorder
- Instability of interpersonal relationships, self-image, and affect
- Intense, rapidly shifting moods
- Chronic feelings of emptiness
- Impulsivity (self-harm, substance misuse)
- Fear of abandonment
- Recurrent suicidal behaviors, gestures, or threats
Histrionic Personality Disorder
- Excessive emotionality and attention-seeking
- Uncomfortable when not center of attention
- Inappropriate sexually provocative behaviors
- Shallow, rapidly shifting emotions
- Uses appearance to draw attention
- Easily influenced by others or circumstances
Narcissistic Personality Disorder
- Grandiose sense of self-importance
- Preoccupied with fantasies of unlimited success, power, or beauty
- Believes they are “special” and unique
- Lack of empathy, exploitative
- Sensitive to criticism; arrogant or haughty attitudes
Cluster C Personality Disorders
Cluster C includes disorders marked by anxious or fearful behaviors.
Avoidant Personality Disorder
- Social inhibition; feelings of inadequacy
- Hypersensitivity to negative evaluation or criticism
- Reluctance to get involved unless certain of being liked
- Views self as socially inept or inferior
Dependent Personality Disorder
- Excessive need to be taken care of
- Difficulty making everyday decisions without reassurance
- Fears of being left to care for self
- Difficulty expressing disagreement
- Goes to excessive lengths to obtain nurturance/support
Obsessive-Compulsive Personality Disorder (OCPD)
- Preoccupation with orderliness, perfectionism, and control
- Inflexible about morals, ethics, or values
- Stubbornness, rigidity, and reluctant to delegate tasks
- Over-dedicated to work/productivity at the expense of leisure/relationships
- Note: Not the same as OCD (no intrusive obsessions/compulsions)
Diagnosis of Personality Disorder
- Clinical interview and detailed history (early onset, pervasiveness, functional impairment)
- Collateral information (family, friends)
- DSM-5 diagnostic criteria (must not be attributable to other medical/psychiatric/substance causes)
- Standardized assessment tools (e.g., Structured Clinical Interview for DSM, Personality Diagnostic Questionnaire)
Always rule out substance use, major mental illnesses, and medical conditions before diagnosing a personality disorder.
Management of Personality Disorder
- Psychoeducation: Educate patient/family about the nature & course
- Psychotherapy (mainstay): Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT, for Borderline PD), Psychodynamic Therapy, Group/Family Therapy
- Pharmacotherapy: Symptom-targeted (antidepressants, mood stabilizers, antipsychotics)
- Risk management: Suicidal/self-injurious risk assessment and mitigation
- Supportive approaches: Building a therapeutic alliance, enhancing coping, structured environments
Key Mnemonics
Cluster A: “PASS” = Paranoid, Schizoid, Schizotypal
Cluster B: “BAHN” = Borderline, Antisocial, Histrionic, Narcissistic
Cluster C: “ADO” = Avoidant, Dependent, Obsessive-compulsive
Borderline Personality Disorder – “IMPULSIVE”
Instability
Mood swings
Paranoia under stress
Unstable relationships
Lacks sense of self
Suicidal/self-harm tendencies
Impulsivity
Values (shifts quickly)
Emptiness feelings
Cluster B: “BAHN” = Borderline, Antisocial, Histrionic, Narcissistic
Cluster C: “ADO” = Avoidant, Dependent, Obsessive-compulsive
Borderline Personality Disorder – “IMPULSIVE”
Instability
Mood swings
Paranoia under stress
Unstable relationships
Lacks sense of self
Suicidal/self-harm tendencies
Impulsivity
Values (shifts quickly)
Emptiness feelings
Tables & Diagrams
Personality Disorder Clusters at a Glance
Comparison Table: OCPD vs OCD
| Feature | Obsessive-Compulsive Personality Disorder (OCPD) | Obsessive-Compulsive Disorder (OCD) |
|---|---|---|
| Ego | Ego-syntonic (behaviors aligned with own beliefs) | Ego-dystonic (behaviors unwanted/distressing) |
| Symptoms | Rigid perfectionism, orderliness, need for control | Intrusive obsessions & ritualistic compulsions |
| Insight | Limited | Usually good |
Sexual Disorders
Sexual disorders refer to disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle. They are classified as sexual dysfunctions, paraphilic disorders, and gender dysphoria.
Classification of Sexual Disorders
| Type | Description | Examples |
|---|---|---|
| Sexual Dysfunctions | Disturbances in sexual desire/response | Erectile Disorder, Female Sexual Interest/Arousal Disorder, Premature Ejaculation, etc. |
| Paraphilic Disorders | Atypical sexual interests with distress/harm | Exhibitionistic Disorder, Fetishistic Disorder, Pedophilic Disorder, etc. |
| Gender Dysphoria | Distress from incongruence between gender identity and assigned gender | Gender Dysphoria in Children, Adolescents, Adults |
Paraphilic Disorders
- Exhibitionistic Disorder: Urges/fantasies of exposing genitals to unsuspecting strangers
- Voyeuristic Disorder: Sexual arousal from observing unsuspecting persons naked or engaged in sexual activity
- Fetishistic Disorder: Use of nonliving objects for sexual excitement
- Frotteuristic Disorder: Touching or rubbing against a nonconsenting person
- Pedophilic Disorder: Sexual activity/fantasies involving prepubescent children
- Sexual Masochism Disorder: Sexual arousal from being humiliated/beaten/etc.
- Sexual Sadism Disorder: Sexual arousal from inflicting humiliation/suffering on others
Sexual Dysfunctions
| Disorder | Description | Additional Notes |
|---|---|---|
| Erectile Disorder | Difficulty attaining/maintaining an erection | Not due to medical/medicamentous causes |
| Female Sexual Interest/Arousal Disorder | Absent/reduced interest in sexual activity | Affects desire & arousal stages |
| Premature (Early) Ejaculation | Persistent early ejaculation with minimal stimulation | Impacts self-esteem, relationships |
| Female Orgasmic Disorder | Delay/absence of orgasm after sexual excitement | Not explained by relationship difficulties/other disorder |
| Genito-Pelvic Pain/Penetration Disorder | Difficulty with vaginal penetration, pain, anxiety, tensing | Encompasses vaginismus and dyspareunia |
Gender Dysphoria
Persistent distress due to incongruence between one’s experienced/expressed gender and assigned gender at birth. Recognizing and respecting those with gender dysphoria is vital for holistic, sensitive care.
- Insistence that one is another gender
- Prefers clothing/toys typically associated with other gender
- Strong dislike of one’s sexual anatomy
- Clinically significant distress or impairment
References & Suggested Further Reading
Further Practice & Suggestions
- Use flashcards and mnemonics to reinforce personality disorder types and criteria.
- Practice clinical scenarios with simulated patients focusing on communication skills and empathy.
- Review latest DSM-5 updates for evolving diagnostic criteria.
- Integrate knowledge with case-based learning to relate symptoms with real-world practice.
Personality Disorders: Comprehensive Nursing Notes
Welcome, future nursing leaders! As someone who has taught psychiatric nursing for over 20 years, I’m excited to guide you through the fascinating—and crucial—topic of personality disorders. These disorders are often misunderstood, yet they are prevalent and deeply impactful on patient care. In this guide, you’ll find everything you need: clear overviews, mnemonics, visual aids, clinical tips, and all the science you need to master the nursing care of individuals with personality disorders.
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- Colorful Visual Aids
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Prevalence of Personality Disorders
Personality disorders are common, yet frequently underdiagnosed. Studies estimate a worldwide prevalence of 10–15% of the general population. These rates vary by diagnostic criteria, cultural setting, and population studied.
- Borderline personality disorder: 1–2% (general), 20% (psychiatric inpatients)
- Antisocial personality disorder: 3% in males, 1% in females
- Obsessive-compulsive personality disorder: Up to 8%
- Paranoid, schizoid, schizotypal: ~5% combined
Comorbidity is high: many individuals meet criteria for more than one personality disorder, and often have mood, anxiety, or substance use disorders.
Etiology: What Causes Personality Disorders?
Personality disorder etiology is multifactorial—resulting from complex interactions of:
| Factor | Examples/Notes |
|---|---|
| Genetic | Family history, twin studies, temperamental traits inherited (e.g. impulsivity, affect regulation) |
| Biological | Neurobiological differences (serotonin, dopamine); childhood temperament; perinatal complications |
| Psychological | Attachment disruptions, childhood maltreatment (abuse, neglect), learned maladaptive coping |
| Social/Cultural | Dysfunctional family patterns, adverse childhood environment, cultural frameworks, trauma |
Mnemonic: “GENES Provide Safety”
Genetic Environmental NEurobiological Social factors → cause personality disorder
Psychopathology of Personality Disorders
Personality disorder is characterized by enduring, inflexible, and maladaptive patterns of thinking, feeling, and behaving. These patterns deviate markedly from the societal expectations and lead to significant functional impairment or distress.
- Onset in adolescence or early adulthood
- Pervasive across a range of situations
- Stable and long duration (not an episodic illness)
- Impair social, occupational, or academic functioning
- Often ego-syntonic (patients view their traits as normal)
DSM-5 Diagnostic Criteria
- An enduring pattern of inner experience and behavior deviating markedly from expectations of the individual’s culture
- Pattern is inflexible, pervasive, and leads to distress or functional impairment
- Pattern is stable, long in duration, and onset can be traced back to adolescence/early adulthood
- Not better explained by another mental disorder, a medical condition, or substances
Domains Affected
- Cognition: How people perceive/interpret self, others, and environment
- Affectivity: Range, intensity, lability, appropriateness of emotion
- Interpersonal Functioning: Capacity for relationships
- Impulse Control: Ability to modulate impulses
Classification of Personality Disorders
DSM-5 classifies personality disorders into three clusters based on descriptive similarities:
| Cluster | Personality Disorder Types | Mnemonic | Traits |
|---|---|---|---|
| A | Paranoid, Schizoid, Schizotypal | “AWKWARD” | Odd, eccentric (“weird”) |
| B | Antisocial, Borderline, Histrionic, Narcissistic | “BAD” | Dramatic, emotional, erratic |
| C | Avoidant, Dependent, Obsessive-Compulsive | “CLINGY” | Anxious, fearful |
Mnemonic: “A is AWKWARD (weird), B is BAD (wild), C is CLINGY (worried)”
Cluster A: Odd or Eccentric Disorders (“Weird”)
Paranoid Personality Disorder
- Prevalence: ~2–4%
- Core Feature: Distrust, suspicion toward others’ motives
- Presents as: Hypervigilance, reads hidden demeaning/threatening meanings into benign remarks
- Nursing Cues: Patient may appear guarded, defensive, hostile
P for “Paranoid” = Persecutory thoughts
| Assessment Tips |
|---|
| Maintain a neutral, empathetic demeanor |
| Be honest; avoid jokes or ambiguous statements |
| Respect need for personal space |
Schizoid Personality Disorder
- Prevalence: <1%
- Core Feature: Social detachment, restricted emotional expression
- Presents as: Chooses solitary activities, indifferent to praise/criticism, few friends
- Nursing Cues: Flat affect, may seem indifferent and aloof
“Schizoid → avoid” (social interaction)
| Therapeutic Approach |
|---|
| Respect preference for solitary activities |
| Do not force socialization |
| Encourage skills at patient’s pace |
Schizotypal Personality Disorder
- Prevalence: ~3%
- Core Feature: Social and interpersonal deficits, cognitive/perceptual distortions, eccentricity
- Presents as: Odd beliefs or magical thinking, unusual speech, excessive social anxiety
- Nursing Cues: Patient may appear eccentric or “odd,” anxious around others
“Schizo-type-al” = odd types of behavior
| Supportive Care |
|---|
| Communicate clearly and concretely |
| Educate about reality testing if safe to do so |
| Allow eccentricities if not harmful |
Cluster B: Dramatic, Emotional, or Erratic Disorders (“Wild”)
Antisocial Personality Disorder
- Prevalence: 3% M; 1% F
- Core Feature: Disregard/violation of others’ rights since age 15
- Presents as: Deceit, impulsivity, lack of remorse, criminality
- Nursing Cues: Patient appears charming, manipulative, “rules don’t apply”
“Anti-social = Antagonistic to society”
Risk: Prone to violence, legal difficulties, substance use
| Nursing Tips |
|---|
| Set firm, consistent limits |
| Hold accountable for actions |
| Protect staff and peers |
Borderline Personality Disorder
- Prevalence: 1–2% (high in clinical settings)
- Core Feature: Instability of relationships, self-image, and affect; marked impulsivity
- Presents as: Frantic efforts to avoid abandonment, mood swings, chronic emptiness, recurrent self-harm
- Nursing Cues: Rapidly shifting emotions (“splitting”), idealization to devaluation
“BORDERline = BORDERS between extremes”
| Assessment Priorities |
|---|
| Monitor for self-harm or suicidal risk |
| Maintain clear boundaries & consistency |
| Use team approach to avoid staff splitting |
Mnemonic for BPD Diagnostic Criteria: “AM SUICIDE”
- Abandonment fears
- Mood instability
- Suicidal/self-harm
- Unstable relationships
- Identity disturbance
- Chronic emptiness
- Inappropriate anger
- Dissociative symptoms
- Efforts to avoid abandonment
Histrionic Personality Disorder
- Prevalence: ~2%
- Core Feature: Excessive emotionality, attention seeking behavior
- Presents as: Inappropriately seductive, dramatic, easily influenced, rapidly shifting emotions
- Nursing Cues: Patient may be flirtatious, easily bored, dramatic in expression
“Histrionic = History of drama”
| Nursing Care |
|---|
| Give attention when appropriate, but avoid reinforcing exaggerated symptoms |
| Encourage more appropriate expression of feelings |
Narcissistic Personality Disorder
- Prevalence: <1%
- Core Feature: Grandiosity, need for admiration, lack of empathy
- Presents as: Exaggerated sense of self-importance, entitlement, sensitive to criticism
- Nursing Cues: May act arrogant, expect special treatment, belittle others
“Narcissist = ‘I am the best!'”
| Nursing Notes |
|---|
| Remain neutral; do not engage in power struggles |
| Avoid criticizing; set limits to manage entitlement |
| Acknowledge strengths when appropriate |
Cluster C: Anxious or Fearful Disorders (“Worried”)
Avoidant Personality Disorder
- Prevalence: ~2.4%
- Core Feature: Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
- Presents as: Avoids occupational activities involving significant interpersonal contact; fears criticism/rejection
- Nursing Cues: Shy, timid, easily wounded by criticism
“Avoidant = Avoids social situations”
| Supportive Strategies |
|---|
| Be patient and reassuring |
| Encourage gradual social interaction |
| Acknowledge strengths |
Dependent Personality Disorder
- Prevalence: ~0.5%
- Core Feature: Excessive need to be taken care of, submissive and clingy behavior, fears separation
- Presents as: Difficulty making decisions, passive, fears disagreement or disapproval
- Nursing Cues: Overly needy, fears being left alone
“Dependent = Depends on others”
| Facilitate Growth |
|---|
| Assist with gradual decision-making |
| Reinforce assertiveness |
| Encourage autonomy in self-care |
Obsessive-Compulsive Personality Disorder
- Prevalence: 2–8% (most common PD)
- Core Feature: Preoccupation with orderliness, perfectionism, and control
- Presents as: Inflexibility, stubborn, preoccupied with details/rules, reluctant to delegate
- Nursing Cues: Overly rigid, difficulty relaxing, stubborn about routines
“OCPD = Order, Control, Perfection, Duty-bound”
| Flexible Care |
|---|
| Give choices when possible |
| Encourage gradual change in routines |
| Reinforce healthy perfectionism |
Nursing Assessment of Personality Disorders
- Establish rapport: Build trust—especially challenging in personality disorders
- Comprehensive history: Developmental, psychosocial, family, trauma background, medical, and psychiatric history
- Assess patterns: Consistency of behavior across situations and time
- Screen for: Suicidality, aggression, self-harm, substance use, co-morbid psychiatric disorders
- Mental Status Exam: Appearance, attitude, emotion, thought content, risk behaviors
- Functionality: Social, occupational, and interpersonal function
Mnemonic: “TRUST”
Trust-building, Rapport, Underlying patterns, Social/functional impact, Threat to safety
Trust-building, Rapport, Underlying patterns, Social/functional impact, Threat to safety
Treatment Approaches
1. Psychotherapy (First-Line Treatment)
- Cognitive-Behavioral Therapy (CBT): Restructures distorted thoughts; develops adaptive coping
- Dialectical Behavior Therapy (DBT): Borderline PD; focuses on emotion regulation, tolerance, and mindfulness
- Group Therapy: Social skills (avoid power struggles for cluster B)
2. Pharmacotherapy (Adjunct)
Drugs are NOT primary; used to target severe symptoms (mood lability, depression, anxiety, psychosis):
- SSRIs: For impulsivity, depression, anxiety (borderline, avoidant)
- Low-dose antipsychotics: Severe disorganization, psychotic features (schizotypal, borderline)
- Mood stabilizers: Impulse control (borderline, antisocial)
3. Nursing Interventions
- Set clear boundaries and expectations
- Promote adaptive social skills and impulse control
- Monitor for risk (self-harm, aggression)
- Involve family/support, as appropriate
“Personality Disorders need PEP Talk”: Psychotherapy, Education, Pharmacotherapy (if severe)
Consideration of Special Populations
| Population | Considerations |
|---|---|
| Adolescents | Diagnose with caution (traits may be transient). Family-based approaches help. Early intervention is key. |
| Older Adults | Personality traits may mellow, but comorbid medical illness can exacerbate maladaptive behaviors. |
| LGBTQIA+ | Sensitivity to stigma, minority stress. Culturally competent, individualized care important. |
| Forensic/Legal Settings | High prevalence of Cluster B (esp. antisocial PD); multidisciplinary risk assessment required. |
- Account for culture, background, and life stage in assessment/planning
- Assess for trauma/PTSD and socioeconomic stressors
Follow-Up and Home Care
- Continuity of care: Essential for stability and progress
- Regular follow-up: Assess symptom progression, coping skills, medication adherence, family stress
- Role of community nurses: Support, monitor risk behaviors, facilitate access to resources (housing, employment)
Discharge/transition planning: Focus on safety and realistic goals. Involve family or support network when possible.
Mnemonic: “CARE”
Continuity, Adherence, Resource linkage, Engagement for recovery
Continuity, Adherence, Resource linkage, Engagement for recovery
Key Points & Study Tools
- Personality disorder is an enduring, inflexible way of thinking/relating, causing distress or impairment.
- Classify as Cluster A (odd), B (dramatic), or C (anxious) with “AWKWARD, BAD, CLINGY” mnemonics.
- Psychotherapy is first-line; medications are adjunct only for severe or target symptoms.
- Boundaries, patience, safety checks are cornerstone nursing interventions.
Visual: Personality Disorder Clusters
Summary Table: Clusters at a Glance
| Cluster | Major Disorders | Quick Mnemonic |
|---|---|---|
| A | Paranoid, Schizoid, Schizotypal | “AWKWARD” |
| B | Antisocial, Borderline, Histrionic, Narcissistic | “BAD” |
| C | Avoidant, Dependent, OCPD | “CLINGY” |
References & Further Reading
Nursing Management of Personality & Sexual Disorders
Welcome, students! In your journey as future nursing professionals, you will care for individuals struggling with personality disorders and sexual disorders. Mastery of nursing management in these scenarios is essential for providing safe, evidence-based, compassionate care. Let’s dive into practical frameworks, actionable interventions, and real-world scenarios that set you up for success on the floor and in your exams.
- Focus on evidence-based nursing interventions
- Emphasis on therapeutic communication & patient safety
- Includes mnemonic aids, tables, and clinical examples
- Optimized for clinical application, exams, and lifelong learning
The Nursing Process
- Assessment: gathering subjective & objective data.
- Diagnosis: identifying patient problems.
- Planning: creating SMART goals & strategies.
- Implementation: carrying out interventions.
- Evaluation: assessing outcomes, modifying care.
Priority-Setting Mnemonics
A-B-C’s Airway, Breathing, Circulation
MASLOW Physiological → Safety → Love/Belonging → Esteem → Self-actualization
SAFETY FIRST If patient is at risk for harm to self/others, address immediately!
MASLOW Physiological → Safety → Love/Belonging → Esteem → Self-actualization
SAFETY FIRST If patient is at risk for harm to self/others, address immediately!
In psychiatric-mental health nursing, safety and risk mitigation are always your initial priorities, especially in acute decompensation.
Personality disorders are enduring patterns of inner experience and behavior, differing markedly from cultural expectations and causing distress or impairment. The DSM-5 clusters them into:
Cluster A: Odd or Eccentric (Paranoid, Schizoid, Schizotypal)
Cluster B: Dramatic, Emotional, Erratic (Antisocial, Borderline, Histrionic, Narcissistic)
Cluster C: Anxious/Fearful (Avoidant, Dependent, Obsessive-Compulsive)
Cluster A: Odd or Eccentric Disorders
Nursing Pearls: Approach with calm, matter-of-fact, consistent demeanor; respect boundaries.
- Paranoid Personality Disorder: Distrust/suspicion of others.
- Schizoid Personality Disorder: Detachment from social relationships; limited emotional range.
- Schizotypal Personality Disorder: Acute social discomfort, eccentric behavior, cognitive distortions.
Key Nursing Interventions:
- Establish trust: Be honest and nonjudgmental, follow through with promises and routines.
- Use clear, direct communication; avoid overstimulation and ambiguous language.
- Do not force socialization, but encourage participation in structured activities at patient’s own pace.
- Avoid jokes, metaphors, or sarcasm; use concrete instructions.
- Monitor for signs of escalating isolation, suspiciousness, or risk of self-neglect.
- Promote activities of daily living; assess for nutrition/hygiene deficits.
- Document observations and patient’s patterns of interaction.
THINK: “Suspicious Solitude”
“Trust is earned slowly; routine = reassurance.”
Cluster B: Dramatic, Emotional, Erratic Disorders
High Risk: Self-harm, manipulation, impulsivity—maintain safety vigilance.
- Antisocial Personality Disorder: Violation of others’ rights, manipulativeness, lack of remorse.
- Borderline Personality Disorder: Instability in relationships, self-image, affects. Marked impulsivity, risk of self-harm.
- Histrionic Personality Disorder: Excessive emotion, attention-seeking, suggestibility.
- Narcissistic Personality Disorder: Grandiosity, need for admiration, lack of empathy.
Key Nursing Interventions:
- Maintain firm, consistent, neutral limits. Clearly outline rules and consequences; avoid power struggles.
- Give safe outlets for emotions (journaling, art, walking, non-judgmental conversation).
- Monitor for suicidal/self-harm behaviors; intervene promptly. Use 1:1 observation if indicated.
- Support adaptive coping; discourage splitting (viewing staff as all good/all bad).
- Manage manipulation: Rotate staff, share info in team, document all interactions.
- Reinforce positive behavior; avoid reinforcing crisis-driven attention-seeking.
- Use matter-of-fact, nondefensive tone; validate feelings but set behavioral limits.
- Teach impulse-control and anger management skills.
- Encourage group therapy, DBT (dialectical behavior therapy) for BPD.
Mnemonic: “SEAL the Chaos”
Set Expectations, Assess Safety, Encourage Alternatives, Limit manipulation.
Cluster C: Anxious, Fearful Disorders
Nursing Pearls: Support self-efficacy, reduce anxiety, promote gradual exposure to feared situations.
- Avoidant Personality Disorder: Social inhibition, feeling of inadequacy, hypersensitivity.
- Dependent Personality Disorder: Excessive need to be cared for, submissive and clinging behavior.
- Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, control, perfectionism (not the same as OCD).
Key Nursing Interventions:
- Encourage independence within ability; reinforce decision-making, praise small steps.
- Use positive reinforcement to build self-esteem.
- Teach and model relaxation/coping strategies.
- Provide structure, but allow some patient control over routine.
- Gradually introduce group activities/social exposure.
- Offer choices when possible; avoid making demands or fostering dependency.
- Avoid power struggles over routines (esp. with OCPD); set clear, achievable expectations.
- Monitor for comorbid depression and anxiety symptoms.
- Document progress and challenges objectively.
Mnemonic: “ACE Anxiety”
Advocate, Challenge gently, Empower.
Unspecified or Mixed Personality Disorders
When patients have mixed features or do not fit classic clusters, use individualized, holistic nursing care plans:
- Thoroughly assess symptoms, coping skills, triggers, and supports.
- Prioritize safety and risk reduction first.
- Build collaborative care plans involving the patient and interdisciplinary team.
- Utilize skills from all clusters as appropriate (e.g., setting limits and building efficacy).
- Document all unique interventions and patient responses.
- Engage family/support networks, respecting confidentiality boundaries.
These include sexual dysfunctions, paraphilic disorders, and gender dysphoria. Culturally sensitive, ethical, and nonjudgmental nursing care is essential.
Sexual Dysfunction
Includes disorders of sexual desire, arousal, orgasm, and pain (e.g., erectile disorder, female orgasmic disorder).
Key Nursing Interventions:
- Create private, supportive environment; assure confidentiality.
- Use therapeutic, nonjudgmental communication—normalize these topics.
- Assess for medical (medications, comorbidities) and psychological factors (stress, trauma).
- Encourage involvement of sexual partner when appropriate (esp. in education/counseling).
- Provide factual information about physiology, myths, and medical impacts.
- Collaborate with sexual health clinics or sex therapists for specialized counseling.
- Monitor for anxiety, depression, or relationship distress; refer if indicated.
- Support development of realistic, individualized goals for sexual health.
- Document history, findings, and education provided.
Paraphilic Disorders
Includes sexual interests/behaviors involving non-consenting persons, suffering, or non-human objects (e.g., exhibitionistic, voyeuristic, pedophilic disorders).
Mandated reporting: Legally required to report if children/vulnerable adults are involved or in danger.
Key Nursing Interventions:
- Maintain patient and community safety as the top priority.
- Be nonjudgmental, avoid shaming, but reinforce harm reduction and boundaries.
- Assess for risk to self/others using validated screening tools.
- Implement supervision/monitoring if needed; follow legal/ethical reporting requirements.
- Support engagement in specialized therapy (CBT, group therapy targeting impulse control).
- Work collaboratively with interdisciplinary/forensic teams.
- Document verbatim statements, all risks, and actions taken.
Gender Dysphoria
Distress from incongruence between experienced/expressed gender and assigned gender. Stigma, discrimination, and suicide risk are high.
Key Nursing Interventions:
- Create a gender-affirming environment; use patient’s chosen name/pronouns.
- Validate feelings and experiences; avoid making assumptions about identity or goals (not all desire hormone/surgical therapy).
- Screen for depression, anxiety, PTSD, substance use, and suicidal ideation.
- Refer for specialized counseling/support groups as indicated.
- Promote informed consent for hormone/surgical therapies; provide education re: risks, benefits, options.
- Support family education/interventions if desired by patient.
- Advocate for protection against discrimination and access to care.
- Document patient wishes, care preferences, and all counseling provided.
- Adolescents: Early onset may require family therapy, careful school collaboration, creative engagement (art, play, peer group) vs. adult-centric models.
- Older Adults: Personality changes may reflect underlying dementia or delirium; screen thoroughly and avoid ageist assumptions.
- Culturally Diverse Patients: Recognize how cultural context shapes personality expression, coping, and beliefs around sexuality/gender. Use interpreters as needed.
- LGBTQIA+ Patients: Increased risk for discrimination, mental health issues, and barriers to care. Use gender-neutral language and affirm patient’s identity and orientation.
- Care Continuity: Arrange seamless referrals to outpatient therapy, support groups, home health, or social workers.
- Medication Adherence: Teach about side effects, the importance of routine, use blister packs or reminders.
- Family/Caregiver Education: Offer psychoeducation, address stigma, clarify realistic expectations, discuss crisis plans.
- Relapse Signs: Teach patient/family subtle warning signs (sleep, eating, mood, hygiene changes) and when to seek help.
- Safety Plans: Develop plans for suicidal/homicidal risk or aggressive outburst triggers. Keep hotlines visible at home.
- Promote Independence: Encourage stepwise achievement of self-management skills. Celebrate positive steps, however small.
- Documentation: Maintain thorough, objective, and timely home visit notes, including progress, teaching, and all safety assessments.
| Disorder | Priority Risks | Sample Interventions | Helpful Mnemonic |
|---|---|---|---|
| Borderline Personality | Self-harm, impulsivity | Safety observation, limit-setting, teach coping, validate feelings, promote DBT | SEAL |
| Paranoid Personality | Suspicion, isolation | Consistent staff, avoid jokes, clear/firm language, gradual participation | Suspicious Solitude |
| Antisocial | Law violation, aggression | Set firm rules, avoid power struggles, reward positive, involve social services | Rules & Results |
| Obsessive-Compulsive Pers. | Rigidity, anger with change | Allow control when possible, avoid rushing, gradual routine changes | Structure Softly |
| Sexual Dysfunction | Distress, relationship strain | Normalize, support education and therapy referral, involve partner | SHARE |
| Paraphilic Disorders | Violation, legal risk | Mandated reporting, harm reduction, referral to specialized therapy | SAFEGUARD |
| Gender Dysphoria | Stigma, suicide risk | Affirming care, screen for comorbidities, connect to LGBTQ resources | AFFIRM |
Nursing Process Application Example
Scenario: You have a patient with Borderline Personality Disorder admitted after a suicide attempt.- Assessment: Suicidal ideation, self-harm scars, sudden mood shifts
- Diagnosis: Risk for self-directed violence
- Planning: Patient will remain safe and contract to seek help for urges
- Implementation: 1:1 observation, reinforce use of crisis card, teach emotion regulation
- Evaluation: Patient communicates urges for help, no further self-harm during shift
Communication Pearls
- Adopt neutral, accepting, and direct language
- Use active listening–avoid invalidating feelings even when maladaptive
- Set clear boundaries on time, topics, and physical space
- Document exactly what is said and done–”If it’s not charted, it’s not done!”
- American Psychiatric Nurses Association. https://www.apna.org/
- Townsend, M. C. (2023). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. Elsevier.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association.
- SAMHSA Resources on Trauma, Sexual and Gender Minorities Care: https://www.samhsa.gov/