the type and severity of symptoms the client
experiences in aggression and impulsivity,
mood dysregulation, anxiety, and psychotic
symptoms.- Clients with borderline personality disorder
often have self-harm urges that they enact
by cutting, burning, or punching themselves;
this behavior sometimes causes permanent
physical damage. The nurse can encourage
the client to enter into a no self-harm con-
tract in which the client promises to try to
keep from harming himself or herself and to
report to the nurse when he or she is having
self-harm urges. - Nurses must use self-awareness skills to
minimize client manipulation and deal with
feelings of frustration.
For further learning, visit http://connection.lww.com.
REFERENCES
Alper, G., & Peterson, S. J. (2001). Dialectical behavior
therapy for patient with borderline personality dis-
order. Journal of Psychosocial Nursing, 39(10), 38–45.
American Psychiatric Association. (2000). DSM-IV-TR:
Diagnostic and statistical manual of mental disorders-
Text revision(4th ed.). Washington DC: Author.
Bleiberg, E. (2002). How to help children at risk of devel-
oping a borderline or narcissistic personality disorder.
Brown University Child and Adolescent Behavior
Letter, 18(6), 1, 3–4.
Brown, M. Z., Comtois, K. A., & Linehan, M. M. (2002).
Reasons for suicide attempts and nonsuicidal self-
injury in women with borderline personality disorder.
Journal of Abnormal Psychology, 111(1), 198–202.
Cloninger, C. R., & Svrakic, D. M. (2000). Personality
disorders. In B. J. Sadock & V. A. Sadock (Eds.),
Comprehensive textbook of psychiatry,Vol. 2 (7th ed.,
pp. 1723–1764). Philadelphia: Lippincott Williams &
Wilkins.
Divalproex may help women with bipolar/borderline dis-
order. (2002). Pharmacology Update, 13(7), 6–7.
Gabbard, G. O. (2000). Psychoanalysis. In B. J. Sadock &
V. A. Sadock (Eds.), Comprehensive textbook of psy-
chiatry,Vol. 1 (7th ed., pp. 563–607). Philadelphia:
Lippincott Williams & Wilkins.
Harvard Medical School Health. (2002). Borderline per-
sonality disorder: New recommendations. Harvard
Mental Health Letter, 18(9), 4–6.
Johnson, J. G., Cohen, P., Smailes, E., Kasen, S.,
Oldham, J. M., Skodol, A. E., & Brook, J. S. (2000).
Adolescent personality disorders associates with vio-
lence and criminal behavior during adolescence and
early adulthood. American Journal of Psychiatry,
157 (9), 1406–1412.
Linehan, M. M. (1993). Cognitive-behavioral treatment
of borderline personality disorder.New York: The
Guilford Press.
McMurran, M., Fyffe, S., McCarthy, L., Duggan, C., &
Lathem, A. (2001). ‘Stop & think’: A social problem-
solving therapy with personality-disordered offend-
ers. Criminal Behavior & Mental Health, 11(4),
273–285.402 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
attention-seeking, and seductive or provoca-
tive behavior.- Narcissistic personality disorder is charac-
terized by grandiosity, need for admiration,
lack of empathy for others, and a sense of
entitlement. - Avoidant personality disorder is character-
ized by social discomfort and reticence in all
situations, low self-esteem, and hypersensi-
tivity to negative evaluation. - Dependent personality disorder is character-
ized by a pervasive and excessive need to be
taken care of, which leads to submissive and
clinging behaviors and fears of separation
and abandonment. - People with passive-aggressive personality
disorder demonstrate passive resistance to
demands for adequate social and occupa-
tional performance and negativity; they often
play the role of a martyr. - The therapeutic relationship is crucial in
caring for clients with personality disorders.
Nurses can help clients identify their feelings
and dysfunctional behaviors and to develop
appropriate coping skills and positive behav-
iors. Therapeutic communication and role-
modeling help to promote appropriate social
interactions, which help to improve
interpersonal relationships. - Several therapeutic strategies are effective
when working with clients with personality
disorders. Cognitive restructuring tech-
niques such as thought-stopping, positive
self-talk, and decatastrophizing are useful;
self-help skills and skills help the client to
function better in the community. - Psychotropic medications are prescribed for
clients with personality disorders based on
Critical Thinking Questions
1.Where do you see yourself in relation to the
four types of temperament (harm avoidance,
novelty seeking, reward dependence, and
persistence)?
2.What has been the most significant influence
on your development as a person?
3.There is a significant correlation between the
diagnosis of antisocial personality disorder
and criminal behavior. The DSM-IV-TR in-
cludes “violation of the rights of others” in the
definition of this disorder. Is this personality
disorder more a social than a mental health
problem? Why?