Cluster A (odd/eccentric)
Paranoid
Characterized by Distrust And
Suspiciousness Towards Others, based on
the belief (unsupported by evidence) that
others want to exploit, harm, or deceive the
person. These individuals are:
-Hypervigilant
-Anticipate hostility
-May provoke hostile responses by initiating a
“counterattack”
-Demonstrate jealousy, controlling behaviors,
and unwillingness to forgive.
**Paranoid people are difficult to interview b/c
they are reluctant to share information about
themselves
Nursing Interventions:
• Objective, matter-of-fact approach
• Avoid being too “nice or friendly”
• Clear, simple, consistent verbal-non-verbal
communication
• Give clear straightforward explanations
• Warn about changes, side effects etc
Schizoid Schizotypal
Characterized Emotional Detachment, Characterized by Odd Beliefs, leading to
disinterest in close relationships, and interpersonal difficulties, an eccentric
indifference to praise or criticism; often appearance, and magical thinking or
uncooperative. perceptual distortions that are not clear
delusions or hallucinations.
The person with this disorder does not seek
out or enjoy close relationships. These
individuals may be able to function in a solitary
occupation.
Schizoid PD can be a precursor to
schizophrenia or delusional disorder. There is
increased prevalence of the disorder in
families with schizophrenia or schizotypal PD.
MANIPULATIVE BEHAVIOR
SET LIMITS!!
-Discuss concerns about behavior with patient
-identify undesirable behavior, and discuss with patient what is
desirable behavior in a give situation or setting
-Establish consequences for occurrence or nonoccurrence of
desired behavior in a non punitive ad easily understood way
-Refrain from arguing or bargaining with patient about
 • Help identify feelings established behavioral expectations and consequences

• Assist with problem-solving -Modify behavioral expectations as needed based on reasonable

changes in patient’s situations
• Gradually involve in group situations but do not insist.
Respect need for social isolation.

Cluster B (Dramatic/Emotional/Erratic)

Antisocial Borderline Histrionic Narcissistic

Characterized by consistent Characterized by Instability of Characterized by Emotional Characterized by Arrogance,

Disregard for Others with
exploitation and repeated unlawful
actions, deceit and failure to
accept personal responsibility.
Previously called Psychopaths or
Sociopaths. There is a clear
history of conduct disorder in
childhood, and the individual show
no remorse for hurting others.
They repeatedly:
-Neglect responsibilities
-Tell lies
-Perform destructive or illegal
acts, without developing any
insight into predictable
Affect, identity and Relationships;
fear of abandonment, splitting
behavior, manipulation, and
impulsiveness; often tries self-
mutilation and may be suicidal.
Individuals w/ Borderline PD
desperately seek relationships to
avoid feelings of abandoned, but
often drive others away b/c of their
excessive demands, impulsive
behavior, and their frequent use of
splitting.
Attention-Seeking Behavior, in
which the person needs to be the
center of attention; often seductive
and flirtatious, the histrionic
person is impulsive and
melodramatic. Relationships do
not last b/c their partner often
feels smothered or reacts to the
insensitivity of the histrionic
person. The individual with
histrionic PD has no insight into
his role in breaking up
relationships. In the treatment
setting, the person demands “the
best of everything” and can be
very critical
Grandiose Views of Self-
Importance, the need for constant
admiration along with a lack of
empathy for others that strains
most relationships; often sensitive
to criticism. Underneath the
surface of arrogance, narcissistics
feel intense shame and fear that if
they are “bad” they will be
abandoned. They are afraid of
their own mistakes, as well as the
mistakes of others. May seek
help, feeling that loved ones do
not show enough appreciation of
their special qualities
consequences.

Nursing Interventions IMPULSIVE BEHAVIOR

• Prevent self-harm. No harm contract. IMPULSE CONTROL TRAINING!!

• Set limits on inappropriate or manipulative behaviors
• Provide clear, consistent boundaries
• Assist examining consequences of behavior.
• Consistent approach by staff
• Do not rescue or reject
• Remain neutral, avoid engaging in power struggles or be coming
defensive to patient’s comments
• Give recognition for goal achievement
-Assist pt to: Identify problem or situation that requires thoughtful action,
and courses of possible actions, their costs or benefits
-Teach pt to cue himself to “stop and think” before acting impulsively
-Assist pt to evaluate the outcome of the chosen course or action
-Provide positive reinforcement for successful outcomes (e.g. praise and
rewards)
-Provide opportunities for pt to practice problem solving in social and
interpersonal situations outside the therapeutic environment

• Explore feelings

• Teach problem solving and role model assertiveness

• Encourage and model concrete and descriptive communication

• Document behaviors and incidents objectively

• Encourage follow up treatment

Cluster C (Anxious/Fearful/Insecure/Inadequate)
Avoidant Dependant Obsessive Compulsive

Characterized by Social Inhibition and Avoidance

of all situations that require interpersonal contact,
despite wanting close relationships, due to extreme
fear of rejection; often very anxious in social
situations.
Because in their social presentation they appear
timid and with low self-esteem and poor self-care,
they are often mistreated in groups. If they do
develop relationships, they cling to their partners in
a dependent way. They are seen in Tx for symptoms
of anxiety.
Characterized by Extreme Dependency in a close
Relationship with an urgent search to find a
replacement when one relationship ends; the most
frequently-seen personality disorder in the clinical
setting. Individuals with Dependent PD have
difficulty making independent decisions and are
constantly seeking reassurance. Their
submissiveness makes them vulnerable to abusive
relationships. The have a deeply held conviction of
personal incompetence that they cannot survive on
their own.
Characterized by Perfectionism with a focus on
orderliness and control .They become so
preoccupied with details and rules that they may not
be able to accomplish a given task. Persons with
Obsessive-Compulsive PD feel genuine affection for
friends and family, and don’t have insight about their
own difficult behavior creating tension in their close
relationships, in which the person tries to control the
partner.

Nursing Interventions: AGGRESSIVE BEHAVIOR

• Caring consistent approach ANGER CONTROL ASSISTANCE!!

• Clear expectations for behavior -Determine appropriate behavioral expectations for expressions of
anger, given pt’s level of cognitive and physical functioning
• Expect patient to make decisions
-Limit access to frustrating situations until pt is able to express anger in
• Teach assertiveness an adaptive manner
• Encourage to identify positive attributes -Encourage pt to seek assistance from nursing staff during periods of
increasing tension
• Provide positive feedback for increased interactions in social
situations -Monitor potential for inappropriate aggression and intervene before its
expression
• Teach stress management and relaxation techniques
-Assist pt in identifying source of anger

-Prevent physical harm if anger is directed towards self or others

-Provide physical outlets for expressions of anger or tension (e.g.

pushing bag, sports, clay, journal writing)