Personality disorders are enduring patterns of inner experiences and behaviors that deviate from cultural expectations, cause distress, and impair functioning. Unlike acute psychiatric illnesses, personality disorders are chronic, inflexible, and pervasive across different areas of life.
For healthcare professionals, especially nurses, managing personality disorders requires therapeutic communication, boundary setting, crisis intervention, and consistent care approaches.
This article explores seven major personality disorders, integrating clinical features, nursing interventions, and exam-focused insights (NCLEX, HESI, ATI, Kaplan).
Narcissistic Personality Disorder (NPD)
Key Features
- Believes they are superior and perfect.
- Exhibits grandiose, arrogant, and egotistical behavior.
- Relies on constant reinforcement and admiration from others.
- Lacks empathy; often exploits others for personal gain.
Nursing Considerations
- Maintain professional boundaries.
- Avoid feeding into excessive praise or criticism.
- Reinforce reality-based feedback.
Exam Insight (HESI/ATI):
- Traits: Exploitation of others, rage when criticized, entitlement.
- Nursing expectation: Lack of empathy.
Paranoid Personality Disorder (PPD)
Key Features
- Extreme distrust and suspicion of others.
- Constant need to control the environment.
- Often misinterprets benign remarks as threatening.
Nursing Considerations
- Approach with calm, consistent communication.
- Avoid confrontations.
- Encourage expression of feelings.
Exam Insight (HESI):
- Improvement is seen when a client discusses feelings of anxiety with the nurse.
Histrionic Personality Disorder (HPD)
Key Features
- Center of attention in all situations.
- Overly dramatic, exaggerated emotional expression.
- Low frustration tolerance and demands immediate gratification.
- Often overly friendly, flirtatious, or seductive.
Nursing Considerations
- Encourage more genuine expression of emotions.
- Set firm boundaries in interactions.
- Provide feedback about inappropriate behavior.
Exam Insight (ATI/HESI):
- Traits: Shallow emotions, attention-seeking.
- Nurse should expect lack of insight into their behavior.
Dependent Personality Disorder (DPD)
Key Features
- Extreme dependence on others in relationships.
- Intense fear of abandonment or separation.
- Difficulty making decisions without reassurance.
Nursing Considerations
- Promote independent decision-making.
- Encourage journaling and assertiveness training.
- Give positive reinforcement for autonomous actions.
Exam Insight (ATI):
- Nursing action: Give positive feedback when client is assertive.
- Progress signs: Client makes independent statements like, “I am planning which plants I want to cultivate this spring.”
Borderline Personality Disorder (BPD)
Key Features
- Intense fear of abandonment.
- Uses manipulative behavior to maintain relationships.
- Emotional instability, impulsivity.
- Engages in self-harm or suicidal gestures for attention.
Nursing Considerations
- Priority: Ensure safety — monitor for self-harm.
- Assign different staff members to prevent staff-splitting.
- Remain consistent, firm, and neutral.
- Encourage journaling and mindfulness.
Exam Insight (HESI/ATI):
- Clients may engage in superficial cuts → immediate safety assessment needed.
- Borderline clients may attempt to pit staff against each other (splitting).
Antisocial Personality Disorder (ASPD)
Key Features
- Impulsive, manipulative, aggressive behavior.
- Lacks remorse for actions.
- Disregards the rights of others for personal gain.
- Criminal history often present.
Nursing Considerations
- Maintain clear boundaries and consequences.
- Avoid arguing — stick to facts.
- Focus on safety of others.
Exam Insight (Kaplan/ATI):
- Traits: Lack of guilt, manipulative behavior, disregard for laws.
- Nursing care: Focus on consistent enforcement of rules.
Schizotypal Personality Disorder (STPD)
Key Features
- Withdrawn, socially isolated.
- Belief in special powers or magical thinking.
- Speech may be vague, eccentric, or metaphorical.
Nursing Considerations
- Build trust gradually.
- Encourage reality-based thinking.
- Avoid challenging magical beliefs directly.
Exam Insight (HESI):
A client who says, “I believe people can read and control my thoughts” → indicates Schizotypal Personality Disorder.Quick Comparison Table
| Disorder | Key Features | Nursing Focus | Exam Tip |
|---|---|---|---|
| Narcissistic | Grandiose, arrogant, entitled | Maintain boundaries | Lack of empathy |
| Paranoid | Distrustful, suspicious | Encourage expression | Progress = expresses anxiety |
| Histrionic | Attention-seeking, dramatic | Set boundaries | Expect shallow emotions |
| Dependent | Extreme dependency | Encourage independence | Positive feedback for assertiveness |
| Borderline | Fear of abandonment, self-harm | Ensure safety, consistency | Splitting & self-injury risk |
| Antisocial | Manipulative, lacks remorse | Enforce rules | Lack of guilt/remorse |
| Schizotypal | Withdrawn, magical thinking | Encourage reality | Delusional-like thoughts |
FAQs on Personality Disorders
Q1. What is the biggest challenge in treating personality disorders?
The biggest challenge is that these behaviors are deeply ingrained and often ego-syntonic (clients do not see them as a problem).
Q2. Which personality disorder is most associated with self-harm?
Borderline Personality Disorder is strongly linked with suicidal behavior and self-injury.
Q3. How do you build trust with a paranoid client?
By maintaining consistency, being honest, and allowing them to express feelings without confrontation.
Q4. Which personality disorder is linked with criminal behavior?
Antisocial Personality Disorder is often associated with disregard for laws and manipulative behavior.
Q5. What indicates successful treatment in Dependent Personality Disorder?
The ability to make independent decisions and assertive statements without seeking constant reassurance.
