Causes & Behaviors:

• Difficulties with emotional regulation
• Lack of empathy for others
• Poor impulse control
• Disruptive or abusive early family background
• Rigid and inflexible thinking patterns
• Immature interests
• Unacceptable social behavior or values
• Alienating others through angry, clinging, demeaning, and/or manipulative behavior or ridicule toward others
• Destructive behavior toward self or others
• Dysfunctional interaction with peers, family, and/or others
• Observed use of unsuccessful social interaction behaviors

Interventions:

• Monitor your own thoughts and feelings constantly regarding your response to the client. Supervision is strongly recommended for new and seasoned clinicians alike when working with clients with personality disorders. Strong and intense countertransference reactions are bound to occur. When the nurse is enmeshed in his or her own strong reactions toward the client (either positive or negative), nurse effectiveness suffers, and the therapeutic alliance might be threatened.
• Set limits on any manipulative behaviors such as arguing or begging, angry, demanding behaviors, flattery or seductiveness, instilling guilt, clinging, constantly seeking attention, pitting one person, staff, or group against another, frequently disregarding the rules, and constant engagement in power struggles. From the beginning, limits need to be clear. It will be necessary to refer to these limits frequently because it is to be expected that the client will test these limits repeatedly.
  • All limits should be adhered by all staff involved
  • Objective physical signs in managing clinical problems should be carefully documented
  • Provide clear boundaries and consequences
  • Enforce the consequences
• Understand that PD clients in particular will be resistant to change and that this is symptomatic of PDs. This is particularly true in the beginning phases of therapy. Responding to the client’s resistance and seeming lack of change in a neutral manner is part of the foundation for trust. In other words, the nurse does not have a vested interest in the client “getting better.”. The nurse remains focused on the client’s needs and issues in any event.