Personality Disorders on the NCLEX
Clusters A, B, C, borderline splitting, staff consistency, boundary setting.
Enduring, inflexible patterns of relating. The NCLEX tests the clusters and how to handle splitting.
Cluster A: odd, eccentric
Paranoid: pervasive distrust, reads hidden meaning into remarks. Schizoid: detached loner, prefers solitude, flat affect, does not want relationships. Schizotypal: odd beliefs, magical thinking, eccentric appearance, social anxiety. Approach: respect distance, be straightforward, do not push socialization.
Cluster B: dramatic, erratic
Antisocial: disregard for others' rights, deceit, lack of remorse, history of conduct disorder. Firm limits, consistent consequences. Borderline: unstable relationships, fear of abandonment, identity disturbance, impulsivity, self-harm, splitting. DBT is the evidence-based therapy. Histrionic: attention-seeking, dramatic, seductive. Narcissistic: grandiosity, need for admiration, lack of empathy.
Cluster C: anxious, fearful
Avoidant: wants relationships but fears rejection, hypersensitive to criticism. Dependent: cannot make decisions alone, submissive, fears being left to care for self. Obsessive-compulsive personality: perfectionism and control (ego-syntonic, unlike OCD, which has intrusive rituals the person finds distressing).
Splitting and staff consistency
Splitting: seeing people as all good or all bad. On a unit it looks like 'you're the only nurse who understands me, the others are terrible'. The countermeasure is a single consistent care plan communicated to the whole team. Frequent team huddles, everyone enforces the same limits, no side deals, no exceptions. Splitting only works when staff respond inconsistently.
Boundaries
State limits clearly, in advance, with matter-of-fact tone: the behavior, the limit, the consequence. Enforce every time. Do not argue, punish, or take manipulation personally. Consistent assignment of staff helps. Document objectively.
Frequently asked
Patient praises you and trashes the night nurse. Best response?
Neutral and team-oriented: 'Your care plan is the same with every nurse on this unit.' Do not accept the compliment at the other nurse's expense.
Self-harm in borderline personality: attention-seeking?
Treat every self-harm act and threat seriously and assess suicide risk. Self-harm often regulates emotion, and this population has a real completed-suicide rate.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free