Pass the Shift

Psych / Mental Health · Personality Disorders

Personality Disorders: Borderline, Antisocial & More

Last reviewed October 15, 2026 by Pending RN review

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On this page
  1. 1. Overview
  2. 2. Borderline Personality Disorder (BPD)
  3. 3. Antisocial Personality Disorder (ASPD)
  4. 4. Priority Nursing Actions
  5. 5. Treatment & Medications
  6. 6. Emergencies
  7. 7. Patient Education
  8. 8. Memory Aids
  9. 9. NCLEX-Style Practice Questions
  10. References

Prepared for Pass the Shift (owner: Kristina, RN). Always follow your facility’s protocols, provider orders, and current references.

If you or someone you know is in crisis: call or text 988 (Suicide & Crisis Lifeline, U.S.) or call 911 for immediate danger. This guide is for exam study, not for diagnosing or treating anyone.

1. Overview

Personality disorders are long-standing, inflexible patterns of thinking, feeling, and relating that differ markedly from cultural expectations, begin by adolescence or early adulthood, and cause distress or impaired functioning. Patients often see their traits as “normal” (ego-syntonic), so insight is limited. Causes include genetics, temperament, and early adversity/trauma.

ClusterThemeTypes (conceptual)
A — “Odd/eccentric”Social withdrawal, unusual thinkingParanoid (mistrust), schizoid (detached), schizotypal (odd beliefs, magical thinking)
B — “Dramatic/erratic”Emotional, impulsiveAntisocial, borderline, histrionic (attention-seeking), narcissistic (grandiose, needs admiration)
C — “Anxious/fearful”Anxiety, fearAvoidant (fear of rejection), dependent (needs care), obsessive-compulsive PD (perfectionism, control — differs from OCD)

Memory aid: A = Weird, B = Wild, C = Worried.

2. Borderline Personality Disorder (BPD)

  • Unstable relationships, self-image, and emotions; intense fear of abandonment
  • — idealizing then devaluing (“You’re the only nurse who understands me… you’re the worst”)
  • Impulsivity (spending, substances, sex, binge eating), chronic emptiness, intense anger
  • Self-harm (cutting, burning) and recurrent suicidal behavior — always take seriously; lifetime suicide risk is elevated
  • Transient stress-related paranoia or dissociation

3. Antisocial Personality Disorder (ASPD)

  • Pervasive disregard for and violation of others’ rights since adolescence (history of conduct problems before 15); diagnosed at ≥ 18
  • Deceitful, manipulative, superficially charming, impulsive, irritable/aggressive, reckless, lack of remorse, irresponsible
  • High co-occurrence with substance use

4. Priority Nursing Actions

  1. Safety: assess for suicidal ideation and self-harm; treat wounds matter-of-factly without excessive attention; remove means
  2. Consistent limit setting: clear, enforceable rules with stated consequences, applied by all staff the same way — reduces manipulation and splitting
  3. Team communication: regular team meetings; one primary nurse; don’t take sides or talk about other staff
  4. Maintain professional boundaries: no special favors, secrets, or personal disclosures; avoid power struggles
  5. Help the patient name feelings and connect them to behavior; teach coping (distress tolerance, emotion regulation)
  6. For ASPD: hold the patient accountable; firm, matter-of-fact approach; monitor for aggression; first
  7. Be aware of your own feelings (frustration, anger) — seek supervision

5. Treatment & Medications

  • Psychotherapy is primary: Dialectical behavior therapy (DBT) is the best-studied for BPD (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness); also mentalization-based therapy, schema therapy, CBT
  • No medication is FDA-approved for personality disorders. Meds target co-occurring symptoms: SSRIs (mood/anxiety), mood stabilizers (impulsivity/anger), low-dose antipsychotics (transient psychosis). Be cautious with benzodiazepines (disinhibition, misuse) and dispense limited quantities when overdose risk is high

6. Emergencies

  • Self-harm with serious injury or overdose — ABCs, medical care first
  • Escalating aggression — de-escalation; restraint/seclusion only as a last resort per order and policy

7. Patient Education

  • Learn and practice DBT skills; use a written safety plan and crisis line 988
  • Avoid alcohol/drugs that increase impulsivity
  • Family education about boundaries and validation

8. Memory Aids

  • “Consistency kills splitting”
  • BPD = “Fear of abandonment, swing of emotion”; ASPD = “Rules are for others”
  • Limits: Clear, Consistent, Consequences (3 Cs)

9. NCLEX-Style Practice Questions

1. A patient with BPD tells the nurse, “You’re the only one who really cares; the night nurse is horrible.” What is the best response?

A. “Thank you, I try harder than the others.”
B. “I’ll talk to the night nurse about her attitude.”
C. “All of the staff follow the same plan of care. What happened last night?”
D. “You shouldn’t say that about other people.”

Answer: C. This addresses splitting by reinforcing team consistency and exploring the concern without taking sides.

2. Which intervention is most effective for a patient with antisocial personality disorder who repeatedly breaks unit rules?

A. Allow exceptions to build rapport
B. Set clear limits with consistent consequences enforced by all staff
C. Ignore the behavior to avoid power struggles
D. Let the patient set their own rules

Answer: B. Consistent, enforceable limits reduce manipulation.

3. A patient with BPD has superficial cuts on the forearm. What should the nurse do first?

A. Lecture the patient about self-harm
B. Assess and treat the wounds in a calm, matter-of-fact way and assess suicide risk
C. Place the patient in seclusion
D. Ignore the wounds to avoid reinforcing behavior

Answer: B. Provide physical care and assess safety without excessive attention or punishment.

4. Which therapy has the strongest evidence for borderline personality disorder?

A. Electroconvulsive therapy
B. Dialectical behavior therapy
C. Aversion therapy
D. Psychoanalysis alone

Answer: B.

5. A patient asks the nurse to keep a “secret” about planning to leave the unit. The nurse’s best response:

A. “I promise not to tell anyone.”
B. “I can’t keep information that affects your safety secret; I’ll need to share it with the team.”
C. “Tell me and I’ll decide later.”
D. “Secrets are fine between us.”

Answer: B. Nurses cannot promise secrecy about safety-related information.

References

Torrico, T. J., Jamil, R. T., Fleisher, C., & Gillespie, E. (2024). Borderline personality disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430883/

Torrico, T. J., & Hany, M. (2024). Antisocial personality disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546673/

National Institute of Mental Health. (n.d.). Borderline personality disorder. Retrieved October 15, 2026, from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). (Concepts summarized in original words; no DSM text reproduced.)

National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/test-plans.page