Antisocial Personality Disorder Nursing Diagnosis and Nursing Care Plan

Antisocial Personality Disorder Nursing Care Plans Diagnosis and Interventions

Antisocial Personality Disorder NCLEX Review and Nursing Care Plans

Antisocial personality disorder is defined as a type of mental illness wherein an individual is characterized by having blatant disregard for the rights and feelings of others. Otherwise known as sociopathy.

People with antisocial personality disorder also habitually ignore the concept of right and wrong. They tend to manipulate and antagonize others, ignoring social contracts with zero expression of guilt or remorse.

Individuals suffering from antisocial personality disorder habitually break laws and consequently, becoming criminals themselves.

They exhibit irrational behavior such as being involved in the use of illegal drugs, acting and behaving violently against others, and having a high degree of dishonesty. Because of this, people with this personality disorder find it difficult to fulfill life responsibilities (i.e., family).

Causes of Antisocial Personality Disorder

Personality is defined as the totality of a combination of a person’s thoughts and emotions that is unique to every individual. It is both the perception and understanding of an individual of the outside world as well as their own understanding of ones self. Personality develops early on, starting during childhood and is honed all throughout by environmental and genetic factors.

While causes of antisocial personality disorder is unknown, there are prominent factors in play for its development.:

  • Genetic predisposition can make someone vulnerable to develop antisocial personality disorder. These are oftentimes can be due to life encounters that can add stress to a person.
  • Problems during the development of the brain, resulting to changes in brain physiology.

Risk Factors of Antisocial Personality Disorder

Certain factors predisposes a person to develop sociopathy and they are listed below:

  • Childhood diagnosis of conduct disorder
  • Familial history of personality disorder, especially antisocial personality disorder
  • History of abuse of neglect during the childhood years
  • Unstable and traumatic life during childhood.
  • Men are at a greater risk than women for developing sociopathy

Signs and Symptoms of Antisocial Personality Disorder

Enumerated below are some signs and symptoms of antisocial personality disorder:

  • Disregard between right or wrong
  • Habitual lying or deception towards others
  •  Marked disrespect for the feelings of others
  • Manipulates others by using wit or charms in order to gain the advantage
  • Arrogance, sense of superiority
  • Recurring problem with the law
  • Use of intimidation and dishonesty to violate others
  • Impulsiveness, reckless behavior
  • Marked hostility, aggression, use of violence directed to others
  • Lack of empathy and remorse about hurting others
  • Risky behavior, ignoring the safety of others
  • Abusive relationships
  • Insensitivity to the consequences of reckless or irresponsible behavior
  • Habitual irresponsibility to complete financial expectations at work or obligations.

In adults, sociopathic behavior starts to occur before the age of 15. Manifestations of antisocial personality disorders include grave and habitual instances that can be summed up with the following:

  • Marked aggression to others, especially those they view as weak (i.e., animals, old people)
  • Property destruction
  • Theft
  • Blatant rule-breaking

Even though sociopathy is a chronic condition, in some people certain symptoms, (i.e., destructive behavior) decreases over time. It is not clear if these warnings of unruly behaviors is due to old age or due to an increased awareness of the impacts of these behaviors and actions.

Antisocial Personality Disorder Nursing Diagnosis

Antisocial Personality Disorder Nursing Plan 1

Nursing Diagnosis: Risk for Suicide related to impulsive behavior secondary to antisocial personality disorder

Desired Outcome: The patient will be able to be free from self-inflicted injury and participate in impulse control training.

 Antisocial Personality Disorder Nursing InterventionsRationale
Ensure that the patient has close and sustained supervision at all times.Suicide is impulsive behavior and can happen with little to no warning. Close supervision by a competent watcher should be ensured all the time.
Ensure in providing a safe environment. Remove items that could be used for suicide such as pills or weapons. This also includes common items that can be potentially used for self-harm such as metal spoons or telephone cords.Removing items that can be used dangerously ensures patient safety, thereby preventing the patient from acting out on these impulses.
Allow the patient opportunities to express themselves freely and without judgment, including verbalizations of thoughts and concerns.It is necessary for suicidal thoughts to be openly discussed for the following reasons: It limits and reduces suicidal urges to be acted out when verbalized. It establishes the patient’s trust in the health workers by signaling to the patient that the staff is open for these discussions.
Educate the patient on the proper use of the prescribed regiment to ensure his coping.Medications may help with the patient’s self-harm urges, especially when the patient is also suffering from other health conditions like depression.
Instruct the patient on cognitive-behavioral techniques to address suicidal ideations and urges.Giving appropriate instructions ensures and helps the patient in recognizing and separating negative and positive thoughts. It helps the patient to approach these negative thoughts with positive counterparts.
Orient the patient of other self-expression methods to address and manage self-harm urges.Letting the patient be informed of ways to manage, such as suicide programs and hotlines, ensures that the patient safely handles these urges.

Antisocial Personality Disorder Nursing Plan 2

Nursing Diagnosis: Risk for Self-mutilation related to ineffective coping skills secondary to antisocial personality disorder

Desired Outcome: The patient will be able to remain free from self-inflicted injury and participate in impulse control training.

Antisocial Personality Disorder Nursing InterventionsRationale
Assess the patient’s pattern of self-mutilating behavior focusing on:
Types
Frequency
Stressors
Triggering the behavior
Careful assessment and identification of the factors surrounding the patient’s tendency to self-harm ensure the healthcare provider of a comprehensive care plan suitable for the patient’s needs.
Help the client explore the feelings and urges and their meaningSelf-harm may usually mean: Utilized to control others Utilized to feel alive through pain and suffering Utilized to express self-hate or guilt
Set limits with the patient on what behavior is acceptable. These include orienting the patient of his responsibilities and expectations from him.Clear and non-punishing rules and environment ensure that the patient’s unruly behavior is controlled and decreased.
Address a patient’s self-mutilation event as objectively as possible, neither criticizing nor soothing the patient.A neutral attitude when approaching these events limits blaming that may otherwise increase the patient’s anxiety and therefore compound self-harm urges.
Formulate plans with the client for alternatives on self-mutilating behaviors. Anticipate stressors that may trigger the urges.

Recognize factors that may increase the urges.Identify point persons that may help the patient effectively divert strong urges of rage and unhealthy behavior.
Formulating a plan ensures that the care and support rendered follow an orderly framework that can be reviewed periodically as the patient’s condition changes.
Practice consistency in enforcing the patient’s set boundaries to be as objective as possible.Consistency ensures order and balance is achieved in the implementation of care. It can also give the patient a sense of security of the care provided.

Antisocial Personality Disorder Nursing Plan 3

Nursing Diagnosis: Chronic Low Self-Esteem related to lack of realistic ego boundaries secondary to antisocial personality disorder as evidenced by the rejection of positive feedback and exaggeration of negative criticisms towards self.

Desired Outcome: The patient will be able to reframe and dispute distorted perceptions in order to meet future goals.

Antisocial Personality Disorder Nursing InterventionsRationale
Assess the patient’s perception of self. Focus on the following:
Strengths and weaknesses in doing activities of daily living.
Strengths and weaknesses in relation to appearance, sexuality, and personality.
Partnering and working with the client encourages the evaluation of the aspects of his life regarding realistic measures of his strengths and weaknesses.
Maintain objectivity as much as possible when working with the patient. Ensure to approach the patient calmly and respectfully.Doing this ensures that the patient comprehends that he is still respected despite unruly and inappropriate behavior.
Be aware that clients with personality disorders will react negatively against feelings of low self-esteem such as projection, anger, blaming, etc.The majority of the observed behaviors in this type of patient usually protect their fragile sense of self. Usually, these behaviors are the reasons for the interpersonal hardships that they encounter in relationships with others.
Provide accurate and honest feedback to the patient, particularly observations on his strengths or areas for improvement.Accurate and honest feedback ensures that the patient is given an objective view of self and his strengths and weaknesses. It also reinforces to the patient that someone is trying to relate with them.
Do not give flattery or dishonest observations to the patient.Dishonesty and unnecessary flattery can compromise the already established trust with the patient. This can gravely affect the therapeutic contract with the client.
Establish realistic goals with the patient. Take note that the patient’s negative perception took years to develop.Unrealistic goals may lead the patient to hopelessness. In addition, it can lead to frustration for the nurse. Statements that blame the nurse “for not helping” the patient and the nurse blaming the patient “is not getting better” may arise.

Antisocial Personality Disorder Nursing Plan 4

Nursing Diagnosis: Impaired Social Interaction related to unacceptable social behaviors secondary to antisocial personality disorder as evidenced by destructive behavior toward self and others.

Desired Outcome: The patient will be able to demonstrate a decrease in reports of violent outbursts as an indicator of improving behavior patterns.

Antisocial Personality Disorder Nursing InterventionsRationale
Practice limit setting of manipulative behaviors: Arguing or begging
Flattery
Instilling guilt
Attention-seeking behavior
Riling others against others
Habitual disregard of rules
Consistent attempts to seize control and power
Angry
Self-entitlement behavior
The limit setting at the beginning ensures that order and structure are inculcated to the patient. Referring to these limits frequently is necessary for it is expected that the client will challenge these.
In a respectful manner, address patient concerns, issues, limits, responsibilities and behavior as objectively as possible. State the rule and regulations of the institution and its corresponding consequences for any deviations.Orienting the patient head-on of his boundaries and rules for acceptable behavior ensures that both he and the nurse are expected to abide by it. Patients should be made aware of the repercussions of rule-breaking.
Assess the patient’s need for skills enhancement and training.Improvement workshops allow the client to work around unruly behavior through demonstration and practice of appropriate conduct. With this, it may act as a motivating factor for the patient to continuously receive positive feedback for improvement.
Comprehend that the patient would be resistant to changes. This is factual, especially for those starting therapy.Objectively addressing the patient’s episodes of resistance to change is part of establishing trust. With this, the nurse is reminded that the focus is to assist the patient in addressing his needs and issues, avoiding vested interest for client improvement.
Intervene in manipulative conduct. All staff should adhere to set boundaries.
Observed clinical signs should be documented objectively. (Including time, date, other circumstances of the behavior).
Provide set limits, boundaries, and framework
Enforce repercussions of broken rules and regulations.
The patient has a high probability of testing and challenging these limits continuously. Once he understands that these limits cannot be broken, they will realize to employ other ways on how to healthily address and meet their needs.

Antisocial Personality Disorder Nursing Plan 5

Nursing Diagnosis: Ineffective Coping related to lack of motivation to change behaviors secondary to antisocial personality disorder as evidenced by intense emotional dysregulation

Desired Outcome: The patient will be able to demonstrate an increase in controlling negative impulses and reduction of manipulative behaviors.

Antisocial Personality Disorder Nursing InterventionsRationale
Highlight acceptable behaviors and expected limits for the patient.Ensuring limit setting is in place keeps the patient from acting out uncontrollably. It gives the patient a sense of structure, therefore increasing the patient’s sense of security.
Approach the patient as objectively as possible. Maintain a neutral disposition when addressing the patient from all aspects.This assures the patient of a sense of security and provides order for the patient. Any exceptions given out may lead to manipulative tendencies.
Be conscious of the flattery that the patient may give in order to manipulate the nurse.Indulging flattery statements and the behavior of the client may cause the care provider to be riled against other members of the health care team.
If the client uses seduction, reiterate and reorient the patient to the therapeutic regimen and goals.Reorientation to the treatment goals reinforces the idea that the patient is in need of professional help. Indulging on these instances will render the therapeutic regimen useless.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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