Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Mental Health
Chapter 24 Personality Disorders
| Question | Answer |
|---|---|
| Personality Disorders | Personality comes from the Latin word persona, which means “mask,” and it may refer to what other people see. Personality disorders are among the most challenging and complex group of disorders to treat. Individuals who meet the criteria for these disorders display significant challenges in self-identity or self-direction, and they have problems with empathy or intimacy within their relationships. |
| Cluster A: Eccentric (Behaviors described as odd or eccentric) | Paranoid Schizoid Schizotypal |
| Cluster B: Erratic (Behaviors described as dramatic, emotional or erratic) | Borderline Narcissistic Histrionic Antisocial |
| Cluster C: Behaviors describe as avoidant, dependent or obsessive-compulsive) | Avoidant Dependent Obsessive-compulsive |
| Cluster A Personality Disorders : Paranoid Personality Disorder | Paranoid personality disorder is characterized by a long-standing distrust and suspiciousness of others based on the belief, unsupported by evidence, that others want to exploit, harm, or deceive the person. These individuals are hypervigilant, anticipate hostility, and may provoke hostile responses by initiating a counterattack. ** Relatives of patients with schizophrenia are more frequently affected with it. A diagnosis of paranoid personality disorder often precedes a schizophrenia diagnosis.** |
| Paranoid Personality Disorder Characteristics | Longstanding distrust and suspicion of others May be apparent in childhood Social anxiety in childhood Jealous, controlling as adults Unwillingness to forgive and projection of feelings As adults, people with paranoid personality disorder tend to have difficult relationships due to their jealousy, controlling behaviors, and unwillingness to forgive. Projection, whereby people attribute their own unacknowledged feelings to others, is the dominant defense mechanism. For example, they may accus |
| Guidelines for Nursing Care For Paranoid Personality Disorder | Counteracting mistrust • Adhere to schedules • Avoid being overly friendly • Use simple, direct language • Project a neutral but kind affect • Set limits Individual therapy focuses on the development of a professional and trusting relationship Group therapy is threatening to people with paranoid personality disorder. However, the group setting may be useful for improving Social skills. Role playing and group feedback can help reduce suspiciousness |
| Medications that may be used for Paranoid Personality Disorder | Antianxiety agents (Diazepam) – used to reduce anxiety and agitation. Antipsychotics for more severe delusions • Haloperidol (Haldol) – brief period to manage mildly delusional thinking or sever agitation. • Pimozide (Orap) – Maybe useful in reducing paranoid ideations. |
| Cluster A Personality Disorders : Schizoid Personality Disorder | People with schizoid personality disorder exhibit a lifelong pattern of social withdrawal. They are somewhat expressionless and have a restricted range of emotional expression. Others tend to view them as odd or eccentric because of their discomfort with social interaction. |
| Schizoid Personality Disorder Characteristics | Symptoms appear in childhood and adolescence Loners, poor academic performance Increased prevalence of disordered family life Avoid close relationships Depersonalization, detachment -Difficult time connecting with others -Social withdrawal -Long-term pattern of social withdrawal -No real relationships -Classic loner |
| Guidelines for Nursing Care For Schizoid Personality Disorder | Avoid being too “nice” or “friendly” Do not try to increase socialization Assess for symptoms the patient is reluctant to discuss Protect against group’s ridicule Treatment Psychotherapy – 1st treatment choice Group therapy – not a good first treatment choice |
| Medications that may be used For Schizoid Personality Disorder | Antidepressants, 2nd-generation antipsychotics -Depressive symptoms may be treated with antidepressants such as bupropion (Wellbutrin), which can help increase the patient’s pleasure in life. -Second-generation antipsychotics, such as risperidone (Risperdal) or olanzapine (Zyprexa), are used to improve emotional expressiveness. |
| Cluster A Personality Disorders : Schizotypal Personality Disorder | People with schizotypal personality disorder do not blend in with the crowd. Their symptoms are strikingly strange and unusual. Magical thinking, odd beliefs, strange speech patterns, and inappropriate affect are hallmarks of this disorder. |
| Schizotypal Personality Disorder Characteristic | Severe social and interpersonal deficits Anxiety in social situations Rambling conversation Paranoia, suspiciousness, anxiety, distrust Brief, intermittent episodes of hallucination or delusion Can be made aware of their own odd beliefs May be vulnerable to involvement with cults or unusual religious/occult groups -Most common disorder out of all three. -Extreme social deficit -Rambling conversations -Paranoia -Brief intermittent episodes of hallucination or delusion. (Different from schi |
| Guidelines for Nursing Care For Schizotypal Personality Disorder | Respect patient’s need for social isolation. Be aware of and intervene appropriately with patient’s suspiciousness. Perform careful diagnostic assessment for symptoms that may need intervention (e.g., suicidal thoughts). Withhold judgment or ridicule Treatment Supportive psychological care (investigate possible involvement with cults) |
| Medications that may be used For Schizotypal Personality Disorder | Low-dose antipsychotics -Benefit from low-dose antipsychotic agents such as risperidone (Risperdal) or olanzapine (Zyprexa) for psychotic-like symptoms and day-to-day functioning. These agents help with symptoms such as ideas of reference or illusions. -Major depressive disorder and anxiety disorders may be treated with antidepressants and antianxiety agents. |
| Cluster B Personality Disorder: Histrionic | People with histrionic personality disorder are excitable and dramatic yet are often also high functioning. They may be referred to as “drama queens” or “drama majors.” Classic characteristics of this population include extroversion, flamboyance, and colorful personalities. Despite this bold exterior, they tend to have limited abilities to develop meaningful relationships. |
| Histrionic Characteristics | Excitable, dramatic; often high functioning Bold external behaviors Limited ability to develop meaningful relationships Attention-seeking, self-centered; low-frustration level Excessive emotions; may be provocative; smothering No insight into disorder or role in ruining relationships -Dramatic -All about them -High functioning -Very bold, sexualize, flirtatious -Attention seeker -Limited ability to develop a meaningful relationship -Could not go that deep emotionally |
| Guidelines for Nursing Care For Histrionic Personality Disorder | Guidelines for nursing care Know that seductive behavior is a response to distress. Keep interactions professional; ignore flirtations. Model concrete language. Help patient clarify inner feelings Teach and role-model assertiveness. Assess for suicidal ideation |
| Cluster B Personality Disorder: Narcissistic Personality Disorder | Narcissistic personality disorder is characterized by feelings of entitlement, an exaggerated belief in one’s own importance, and a lack of empathy. In reality, people with this disorder suffer from weak self-esteem and hypersensitivity to criticism. Narcissistic personality disorder is associated with less impairment in individual functioning and quality of life than the other personality-based disorders. |
| Narcissistic Personality Disorder Characteristics: | Feelings of entitlement, exaggerated self-importance Lack of empathy; tendency to exploit others Weak self-esteem and hypersensitivity to criticism Constant need for admiration Less functional impairment than other personality disorders -Think very highly about themselves -Think they are better than everyone else -Feelings of entitlement - “I deserve this” - “I am better” -Exaggerated self-important -Not really emotional, just think they are better than others. |
| Guidelines for Nursing Care For Narcissistic Personality Disorder | Remain neutral. Promote a stronger patient self-identity Avoid power struggles or becoming defensive. Role-model empathy. Treatment Difficult to treat: patients not likely to seek help or confront shortcomings Cognitive-behavioral therapy (CBT) to deconstruct faulty thinking Group therapy; |
| Medications that may be used For Narcissistic Personality Disorder | lithium for mood swings |
| Cluster B Personality Disorder: Borderline Personality Disorder | Most Challenging Personality Disorders: -This disorder is the best-known and most dramatic of the personality disorders. Borderline personality disorder is characterized by severe impairments in functioning. Its major features are patterns of marked instability, impulsivity, identity or self-image distortions, unstable mood, and unstable interpersonal relationships. -It is marked by emotional dysregulation, a term that describes poorly modulated mood characterized by mood swings. |
| Cluster B Personality Disorder: Borderline Personality Disorder cont. | - One of the primary features of borderline personality disorder is emotional lability, which is, rapidly moving from one emotional extreme to another. - Another disruptive trait common in people with borderline personality disorder is impulsivity, or acting quickly in response to emotions without considering the consequences. This results in damaged relationships and even in suicide attempts |
| Borderline Personality Disorder Characteristics: | Severe impairments in functioning Emotional lability Impulsivity Self-destructive behaviors Antagonism Splitting (Primary defense mechanism): Inability to view both positive and negative aspects of others as part of a whole -The most common one -Challenging to work with -They see a person as either good or bad -Split personality -One day they love you and the next day they hate you. -In childhood – may develop around the age of 3, learn not to trust for example if a parent leaves. - |
| Treatment Modalities | Dialectical behavior therapy (DBT) 2. Dialectical behavior therapy (DBT): DBT is an evidence-based therapy developed by Linehan (1993) to treat chronically suicidal individuals with borderline personality disorder. -DBT combines cognitive and behavioral techniques with mindfulness, which emphasizes being aware of one’s thoughts and actively shaping them. -The goals of DBT are to increase the patient’s ability to manage distress and improve interpersonal effectiveness skills. Treatment focuses on behavio |
| Medications that may be used For Borderline Personality Disorder | Psychotropic geared toward symptom relief -Psychotropic medications geared toward maintaining patients’ cognitive function, symptom relief, and improved quality of life are available. -People with borderline personality disorder often respond to antidepressants such as SSRIs, anticonvulsants, and lithium for symptoms of mood and emotional dysregulation. |
| Nursing Process: Diagnoses for Borderline Personality Disorder | Risk for self-mutilation (most often used) Risk for suicide Risk for violence Social isolation Impaired socialization Disturbed personal identity Difficulty coping |
| Nursing Process: Outcomes and Planning for Borderline Personality Disorder | Importance of the therapeutic relationship Avoid manipulative behaviors |
| Nursing Process: Implementation for Borderline Personality Disorder | Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries -Acting in accordance with unit policies, the nurse remains neutral and dresses the patient’s self-inflicted wounds in a matter-of-fact manner. Then the patient is instructed to write down the sequence of events leading up to the injuries, as well as the consequences, before staff will discuss the event. |
| Medications that may be used For Borderline Personality Disorder cont. | -Naltrexone (Revia, Vivitrol), an opioid receptor antagonist, has been found to reduce self-injurious behaviors. -Second-generation antipsychotics may control anger and brief episodes of psychosis |
| Cluster B Personality Disorder: Antisocial Personality Disorder | Most Challenging Personality Disorders: -People with this disorder may be more commonly referred to as sociopaths. This diagnosis is reserved for adults, but symptoms are evident by the midteens. --Symptoms tend to peak during the late teenage years and into the mid-20s. By around 40 years of age, the symptoms may abate and improve even without treatment. |
| Cluster B Personality Disorder: Antisocial Personality Disorder cont. | - The main pathological traits that characterize antisocial personality disorder are antagonistic behaviors such as being deceitful and manipulative for personal gain or hostile if one’s needs are blocked. The disorder is also characterized by disinhibited behaviors such as risk taking, disregard for responsibility, and impulsivity. Criminal misconduct and substance misuse are common in this population. |
| Cluster B Personality Disorder: Antisocial Personality Disorder cont. | - People with this disorder are mostly concerned with gaining personal power or pleasure; in relationships they focus on their own gratification to an extreme. They have little to no capacity for intimacy and, in relationships, will exploit others if it benefits them. |
| Cluster B Personality Disorder: Antisocial Personality Disorder cont. | -One of the most disturbing qualities associated with antisocial personality disorder is a profound lack of empathy, also known as callousness. This results in a lack of concern about the feelings of others, the absence of remorse or guilt except in the face of punishment, and a disregard for meeting school, family, and other obligations. |
| Antisocial Personality Disorder Characteristics: | Antagonistic behaviors Disinhibited behaviors Profound lack of empathy Absence of remorse or guilt Symptoms peak mid-teens to 20s; symptoms may abate and improve on their own by age 40 Sociopath -Wants to have their needs met, as long as they get their needs met – they do not care what anyone thinks they still want their needs met. -They know they are not supposed to do something, and they do it anyway with no remorse. -Have been abused, a lot of traumas occurred in their life |
| Nursing Process: Diagnoses for Antisocial Personality Disorder | Risk for violence Impaired impulse control Impaired social interaction |
| Nursing Process: Outcomes for Antisocial Personality Disorder | Abusive behavior self-restraint Aggression self-restraint Coping, social interaction, social isolation knowledge Health promotion knowledge Health promoting behavior These will be difficult to accomplishment. Maintaining safety is the priority. |
| Nursing Process: Planning and Implementation for Antisocial Personality Disorder | Boundaries, consistency, support, and limits Realistic choices Therapeutic communication vs. manipulation Teamwork and safety (prime) Pharmacological interventions (mood stabilizers) |
| Nursing Process: Evaluation for Antisocial Personality Disorder | is difficult and may be unknowable Motivation patients may learn to change behaviors |
| Treatment Modalities: Meds for Antisocial Personality Disorder | No specific medications Mood-stabilizers may help with aggression Also possible: SSRIs, benzodiazepines, or Ritalin -People with antisocial personality disorder respond to: -Mood-stabilizing medications such as lithium or valproic acid (Depakote) to help with aggression, depression, and impulsivity. |
| Treatment Modalities: Meds for Antisocial Personality Disorder cont | -SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) may be used to decrease irritability and help with anxiety and depression. – -Benzodiazepines may help with anxiety but should be used with caution because they are addictive. -Methylphenidate (Ritalin) may help if there is a comorbidity of attention-deficit/hyperactivity disorder. |
| Cluster C Personality Disorder: Avoidant Personality Disorder | People with avoidant personality disorder are extremely sensitive to rejection, feel inadequate, and are socially inhibited. They avoid interpersonal contact owing to fears of rejection or criticism. |
| Avoidant Personality Disorder Characteristic | Low self-esteem Shyness that increases with age Feelings of inferiority Reluctance to engage with new people Subject to depression, anxiety, and anger Preoccupied with rejection, humiliation, and failure -Less common -Low self-esteem -Very shy -Feelings of inferiority -Someone who wants to work in a library (Avoid people, very quiet, do not have a lot of friends, avoid the risk of rejection) -In children – may have social anxiety |
| Guidelines for nursing care : Avoidant Personality Disorder | Friendly, accepting, and reassuring approach Don ‘t push! Acceptance of patient fears Group therapy Exercises to enhance new social skills Design exercises to prevent failures Assertiveness training |
| Treatment Modalities for Avoidant Personality Disorder | Treatment Modalities Individual therapy • Trust building • Assertiveness training Group therapy |
| Treatment Modalities: MEDS for Avoidant Personality Disorder | Antidepressants -Antidepressant medications: Including selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa) and Serotonin norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor) — may reduce social anxiety. -Antianxiety agents can be helpful. Beta-adrenergic receptor antagonists (e.g., atenolol) help reduce autonomic nervous system hyperactivity. -Serotonergic agents may help individuals with avoidant personalities feel less sensitive to rejection. |
| Cluster C Personality Disorder: Dependent Personality Disorder | Dependent personality disorder is characterized by a pattern of submissive and clinging behavior related to an overwhelming need to be cared for. This need results in intense fears of separation. |
| Dependent Personality Disorder Characteristics: | High need to be taken care of Submissiveness Fears of separation and abandonment Manipulating others to take responsibilities Intense anxiety when left alone even briefly -Needs to be taken care of -Dependent -Someone who is 35, lives with family, and still, needs parents to take care of them. - |
| Guidelines for nursing care for Dependent Personality Disorder | Help address current stressors Set limits that don’t make the patient feel punished Be aware of strong countertransference Use therapeutic relationship as a testing ground for assertiveness training |
| Treatment Modality: Meds for Dependent Personality Disorder | -Panic attacks can be helped with the tricyclic antidepressant imipramine (Tofranil). |
| Cluster C Personality Disorder: Obsessive-Compulsive Personality Disorder | Obsessive-compulsive personality disorder is characterized by limited emotional expression, stubbornness, perseverance, and indecisiveness. Preoccupation with orderliness, perfectionism, and control are the hallmarks of this disorder. **Obsessive-compulsive personality disorder is one of the most prevalent personality disorders.** |
| Obsessive-Compulsive Personality Disorder Characteristics: | Rigidity; inflexible standards for others and self Constant rehearsal of social responses Excessive goal-seeking that is self-defeating or relationship-defeating Strict standards interfere with project completion Unhealthy focus on perfection People with obsessive-compulsive personality disorder often do feel genuine affection for friends and family. Yet leisure activities and friendships are dropped in favor of excessive devotion to work and productivity. |
| Guidelines for nursing care for Obsessive-Compulsive Personality Disorder | Guard against power struggles Remember that the patient has difficulty dealing with unexpected changes Provide structure, but with time to complete habitual behaviors |
| Treatment Modality: Meds Obsessive-Compulsive Personality Disorder | Clomipramine or fluoxetine for obsessions, anxiety, and depression |
Created by:
bonitasoul
Popular Nursing sets