Editing Mental Health and Psychosocial Nursing (section)

== Personality Disorders ==
Enduring, inflexible patterns of inner experience and behavior deviating from cultural expectation, beginning by adolescence or early adulthood, causing distress or impairment.

'''Cluster A (odd, eccentric)''': paranoid (pervasive distrust), schizoid (detachment, no desire for relationships), schizotypal (odd beliefs, magical thinking, eccentric behavior without frank psychosis).

'''Cluster B (dramatic, erratic)''': antisocial (disregard for the rights of others, deceit, impulsivity, lack of remorse; requires age 18 and evidence of conduct disorder before age 15), borderline (instability of relationships, self-image, and affect; splitting; frantic efforts to avoid abandonment; recurrent self-harm and suicidal behavior), histrionic (excessive emotionality and attention seeking), narcissistic (grandiosity, need for admiration, lack of empathy).

'''Cluster C (anxious, fearful)''': avoidant (social inhibition from fear of rejection), dependent (excessive need to be cared for, difficulty making decisions), obsessive-compulsive personality disorder (preoccupation with order, perfectionism, and control; ego-syntonic, unlike OCD).

Nursing management principles:
* '''Consistency across the entire team''' is the single most important intervention. Document limits and communicate them in report.
* '''Set clear limits with stated consequences''', then enforce them without anger or negotiation.
* Address '''splitting''' by staff meeting together and presenting a unified plan; avoid taking flattery personally.
* For self-harm: assess intent, ensure safety, treat wounds matter-of-factly without excessive attention, and explore the feeling that preceded the act. Dialectical behavior therapy is the evidence-based treatment for borderline personality disorder.
* Expect manipulation with antisocial presentations; do not accept gifts or favors, and confront behavior factually.