A client who has a diagnosis of histrionic personality disorder has an established pattern of portraying herself as "the exception to the rule" in the course of her care and treatment
Today, the client has returned to the inpatient unit and has been confronted by the nurse with the fact that she neither got a pass nor told anyone that she was leaving. The client has responded, "But those rules are more for the schizophrenics and crazy people, right?" How should the nurse respond?
A) "Even though there's no real safety risk in your case, I'd appreciate it if you tried to remember next time."
B) "The rules apply to everybody equally and you're expected to follow them."
C) "If you want an exemption, I can ask the psychiatrist but there are no guarantees."
D) "What would make you think that? You're supposed to behave the same as anyone else here."
Ans: B
Direct, specific, and nonaggressive limit-setting is the most appropriate approach to managing the behaviors and manifestations of clients with personality disorders. Attempting to foster an exception to the rule or responding emotionally is inappropriate and likely ineffective.
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