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Ch 34

Mr. D's Personality Disorders

QuestionAnswer
DSM The Diagnostic and Statistical Manual of Mental Disorders
DSM V has ____ most of the PDs as recognized in DSM IV retained
The DSM is a categorical classification
The DSM is produced by the American Psychiatric Association
PDs are categorized under which axis? Axis II
PDs occur when personality traits become fixed, rigid, (inflexible, and maladaptive)
PDs cause either significant functional impairment or subjective distress
Those with PDs have difficulty dealing with other people
PDs are usually recognized by early adulthood or earlier and continue throughout life
What is the difference between a PD and an Axis 1dx like schizophrenia? FDA med approval for Axis 1 schizo', but NOT for PD (except for symptoms if danger to self or others)
People with PDs do not seek treatment because they do not understand their behavior and consequences of their behavior.
Nature vs Nurture Environment may affect change in personality
All PDs have manipulation, self-destructive bahavior, functional impairment
Splitting Primitive ego defense mechanism that is common in people with borderline PD
When does manipulation become pathological? When it is the primary method to get needs met, and when others are dehumanized and treated as objects whose purpose is to fulfill the needs of the manipulator.
Manipulation techniques: anger, praise, seduction, threats, self-serving
Interventions for manipulative behavior: Identify the behavior, examine what's happening, be assertive, do not accept any gifts, create a boundary (say no and be ok with it)
Cluster A behaviors are described as Odd or Eccentric
Cluster A PDs: paranoid, schizoid, schizotypal. Treated with Interpersonal Psychotherapy
Signs of Paranoid PD suspicion that others are out to get him, preoccupation with doubts of loyalty of friends
Predisposing factors of Paranoid PD possibly hereditary
Treatment of Paranoid PD Interpersonal Psychotherapy
Treatment of Schizoid PD Interpersonal Psychotherapy
Clinical picture of Schizotypal PD aloof and isolated and behave in a bland and apathetic manner. MAGICAL THINKING, ideas of reference, illusions, and depersonalization. Superstitious, clairvoyant, telepathy, 6th sense, belief that "others can feel my feelings."
Diagnostic Criteria of Schizotypal PD Unusual perceptual experiences, including bodily illusions. Lack of close friends other than 1st degree relatives.
Treatment of Schizotypal PD Interpersonal Psychotherapy
Cluster B behaviors are described as Dramatic, Emotional, (or Erratic)
Cluster B PDs: antisocial, borderline, histrionic, narcissistic
Definition of Histrionic PD colorful, dramatic, and extroverted, emotional, shallow, flighty, flirtatious, NEED TO BE CENTER OF ATTENTION. More common in women than men.
Clinical picture of Histrionic PD tend to be self-dramatizing, attention seeking, overly gregarious, need for approval, SEDUCTIVE
Clinical picture of Borderline PD chronic depression, inability to be alone, clinging and distancing, splitting, manipulation
Predisposing factors of Borderline PD 75% female.
Treatment of Borderline PD DBT
DBT Dialectical Behavior Therapy
What is the 1st psychotherapy shown to be effective in treating borderline PD? DBT
DBT states that the core problem in borderline PD is emotional dysregulation (ED)
Dysregulation in Borderline PD is mainly due to biological risk factors and emotionally unstable childhood environments
The focus of DBT is to help the client develop and maintain skills that will decrease emotional dysregulation
Most Borderline PD patients are female and have been sexually molested
Clinical picture of Narcissistic PD lack humility, self-centered, arrogant, entitled, special, deserving, grandiose, exploits others. View themselves as SUPERIOR. Spoiled brat. More common in men than women.
Treatment of Narcissistic PD Interpersonal Psychotherapy
Clinical picture of Antisocial PD pattern of socially irresponsible, exploitative, and GUILTLESS behavior that reflects a general disregard for the rights of others. LOW TOLERANCE for frustration, impulsive, unable to delay gratification.
Some adults with Antisocial PD have been diagnosed with conduct disorder as youth
Antisocial spectrum: Mild minor trouble with the law
Antisocial spectrum: Severe psychopath
Psychopath % of general population 1-2%
Psychopath % of prison population 10%
Possible biological explanations revolve around the Amygdala
The amygdala is linked with fear
Damage to the frontal cortex is speculated as a cause for psychopathic behaviors
The frontal cortex plays a part in decision making
Many ______collar criminals are psychopaths. white
Robert Hare says that psychopaths flourish because many characteristics that define this disorder are actually valued in the business world.
Some valued business psychopath characteristics are quick thinking, no remorse, manipulative
Robert Hare's shock timer countdown experiment. Normal people sweat. Psychopaths did NOT sweat.
Some experts believe that there is no cure for psychopaths
Notorious psychopaths of the past Charles Manson, Ted Bundy, Albert Hamilton Fish
The Gray man, werewolf of wysteria, brooklyn vampire, Hannibal Lechter Albert Hamilton Fish
Cluster C behaviors are described as Anxious or Fearful
Cluster C PD: avoidant, dependant, obsessive-compulsive (, passive-aggressive in DSM IV)
Signs of Avoidant PD timid(shy), cold, withdrawn, see others as critical/betraying/condescending. May be caused by parental rejection.
Signs of Dependent PD lack self confidence, passive, clingy, difficulty with decision making, sees others superior
Predisposing factors of Dependent PD More common in women. Youngest in family
Treatment of Dependent PD Interpersonal Psychotherapy
Signs of Obsessive-Compulsive PD Preoccupied with details, rules, and order. Shows perfectionism that interferes with task completion. Excessively devoted to work. Serious and inflexible.
Treatment of Obsessive-Compulsive PD Interpersonal Psychotherapy
passive-aggressive PD does not really fit into any cluster
Which antidepressant medications have been successful in decreasing impulsivity and self-destructive acts in borderline patients? SSRI (Prozac) and MAOI
Milieu Group Therapy
Milieu therapy has been found to be useful with which type of PD? antisocial
Personality a pattern of relatively permanent traits, dispositions, or characteristics within an individual that gives some measure of consistency to that person
Schizophrenia is in axis 1
Drugs are only given to treat the ______ of PD symptoms (danger to self or others)
Medication for PD is considered not that effective
What type of people do antisocial people seek to manipulate dependant needy people
Individuals with paranoid PD are extremely oversensitive and tend to misinterpret minute cues within the environment, magnifying, and distorting them into thoughts of trickery and deception
Nsg Dx: Risk for self-mutilation. S & Sx: Unresolved fears of abandonment
Nsg Dx: Risk for self-mutilation. Nsg Actions: Observe client's behavior frequently. Secure verbal no-harm cantract from client. Care for wounds matter-of-factly. Encourage verbalization of feelings. Make environment safe. Act as role model.
Nsg Dx: Risk for self-mutilation. Outcomes: Client has not harmed self. Seeks out staff when desire for self-mutilation occurs.
Nsg Dx: Complacted Grieving. S & Sx: Depressed mood. Acting-out behaviors.
Nsg Dx: Complacted Grieving. Nursing Actions: Create trusting relationship. Encourage appropriate expression of anger. Explore true source of anger. Teach stages of grief. Set limits on acting-out behavior. Give positive feedback.
Nsg Dx: Complacted Grieving. Outcomes: Client expresses anger appropriately. Understands stages of grief and the need for personal progression through this process.
Nsg Dx: Impaired Social Interaction. S & Sx: Clinging and distancing behaviors. Staff splitting.
Nsg Dx: Impaired Social Interaction. Nursing Actions: Examine inappropriate behaviors. Encourage independence and give positive reinforcement. Explore fears. Explain inappropriateness of these behaviors. Rotate staff.
Nsg Dx: Impaired Social Interaction. Outcomes: Relates to more than one staff member. Completestes ADL's indepedently. Does not manipulate staff against each other.
Most antisocial people are men
Most antisocial people start out with conduct disorder
Definition of Schizoid PD profound defect in the ability to form personal relationships or to respond to others in a meaningful, emotional way.
People with Schizoid PD appear cold, aloof, and indifferent to others
What is the best form of therapy for antisocial people? Milieu therapy (group). Set boundaries; don't let them take over interview; keep focus on them.
75% of all borderline PD patients female
Most borderline PD patients have been sexually molested
Main feature of borderline PD is emotional dysfunction
Borderline PD use ____ as a threat self harm (cutting is common)
Is there a cure for psychopaths? No
Individuals with paranoid PD are constantly on guard, hypervigilant, and readyfor any real or imagined threat.
Interpersonal psychotherapy is suggested for clients with paranoid, schizoid, schizotypal, borderline, dependent, narcissist, and obsessive-compulsive PD's.
Diagnostic criteria for Paranoid PD Suspects that others are exploiting, harming, or deciving. Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends. Reluctant to confide in others because of fear that the information will be used against him.
Passive aggresive people may not do good work, have to be reminded, hard time with conflict, sloppy job
OCD med class SSRI
Matching: Paranoid Snowden. Suspicious of everyone.
Matching: Schizoid Sniper. Has a lifelong pattern of social withdrawal.
Matching: Schizotypal Gandalf. Believes he has 6th sense and can know what others are thinking.
Matching: Antisocial Pimp. Shows no remorse for the exploitation and manipulation of others.
Matching: Borderline Experimental drug test subject. Swallows a bottle of pills after the therapist leaves on vacation.
Matching: Histrionic Drama queen. Demonstrates highly emotional and overly dramatic behaviors.
Matching: Narcissistic Fashion model. Believes she is entitled to special privileges.
Matching: Avoidant Artist. Refuses to enter into a relationship because of the fear of rejection.
Matching: Dependent Ho. Allows others to make all her important decisions for her.
Matching: Obsessive-Compulsive CHP. Believe everyone must follow the rules and that the rules can be bent for no one.
Matching: Passive-Aggressive Navy. Accepts a job he does not want to do, then does a poor job and delays past the deadline.
Kim has a diagnosis of Borderline PD. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to: Rotate staff members who work with Kim so that she will learn to relate to more than one.
All of the following may be examples of manipulative behaviors in the borderline client except: a. Refusal to stay in room alone. b. Asking for cigarettes. c. “You're the best nurse here.” d. Cutting. Asking for cigarettes. It's an addiction.
“Splitting” by the client with borderline PD denotes: A primitive defense mechanism in which the client sees objects as all good or all bad.
According to Margaret Mahler, predisposition to borderline PD occurs when development tasks go unfulfilled in which of the following phases? Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence.
Jack is a new client on the psychiatric unit with a diagnosis of Antisocial PD. Which of the following characteristics would you expect to assess in Jack? Lack of guilt for wrongdoing.
Milieu therapy is a good choice for clients with antisocial PD because it: Emulates a social community in which the client may learn to live harmoniously with others.
In evaluating the progress of Jack, a client diagnosed with Antisocial PD, which of the following behaviors would be considered the most significant indication of positive change? On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight.
30 min's to end shift. Supervisr gives K-T 1 hr job. Needs b done b4 she go. K-T says to Dona, “Do this job for me!” Dona agrees. Dona b furious at K-T. “This is crazy. I'm not doing this for her.” Dona leaves without finishing. This is an example of? Passive-aggressive
Carol, a new nurse being oriented by head nurse Carey. Carol describes a new technique she has learned. Head nurse Corey says, “WTF r u doing! R U telling me how to do my job? We always do it like this!” This b an example of? Obsessive-compulsive
Which of the following behavioral patterns is characteristics of individuals with histrionic PD? Overreacting to minor stimuli
Interpersonal Psychotherapy Empathetic therapist client relationship based on collaboration and guided discovery in which the therapist functions as a role model for the client.
Asocial rather be alone, NOT a disorder
Antisocial rule breaker, manipulative
Psychopath no care for others
PD Personality Disorder
Created by: Sanctus Verus