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Nursing 1111
Personality Disorders Chapter 16
| Question | Answer |
|---|---|
| Cluster A | Odd or eccentric |
| Cluster B | Dramatic, emotional, erratic |
| Cluster C | Anxious or fearful |
| What is personality? | Enduring pattern of behavior |
| Reflects a means of adapting to a particular environment and its cultural, thnic, and community standard | Personality |
| Healthy personality | Sees own strengths and weaknesses |
| PD | Inflexibel and maladaptive response to stress |
| Healthy personality | Recognizes own boundaries |
| PD | Disability in working and loving |
| Healthy personality | Interacts with other without expecting to meet all needs |
| PD | Abitlity to evoke interpersonal conflict |
| Healthy | Seeks balance of work and play |
| PD | Capacity to frustrate or "get under the skin" of others |
| Healthy | Defines and expresses spirituality |
| Axis II Disorders | Personality Disorders and Retardation |
| Antisocial Personality Disorder | Main features of consistent disregard for others with exploitation ad repeated unlawful actions |
| Antisocial Personality Disorder | Be careful; High dangerous; No concious; Take chances; Take what they want |
| Personality Disorder | PD |
| PD | 10% to 15% in general populations; Often co-occur with depression, panic disorder, substance abuse, eating disorder, anxiety disorder, PTSD and impulse control disorder; Onset usually occurs before onset of other psychiatrric disorders; Others coexist |
| True | T/F It is unlikesly that there is a single cause for a discrete personality disorder. |
| T/F Interaction of biological determinants and psychological factors in the etiology of personality disorders. | True |
| Biological Determinants | Certain inherited tratis present at birth; Genetic alterations may result in an extreme variation; Repeated trauma physcological abuse, and physcial abuse. |
| Antisocial behavior | Is more related to genetic factors than environment |
| The nine personality traits that have bee identified as potentially inherited are? | Novelty seeking; Harm avoidance; Reward dependence; persistence; Neuroticism (negative affect) vs emotional stability; Introversion vs extraversion; Conscientiousness vs undependabitility; Antagonism vd agreeableness; Closeness vs openess to experience |
| Psychological Factors: | Learning theory; Cognitive theory; Psychoanalytic theory |
| Learning theory | Modeling or reinforcement |
| Cognitive theory | Distortion of thinking |
| Psychoanalytic theory | Primitve defense mechanisms |
| Assessment of PDs | Minnesota Multiphasi Personality Inventory (MMPI) to evalute personality; Full medical history; Psychosocial history |
| Psychosocial history | Suicidal or aggressive thoughts; Risk of harm from self or others; Use of medications or illegal subastances; Ability to handle money; Legal history; Current or pas abuse |
| Cluster A | Paranoid |
| Cluster A | Schizoid |
| Cluster A | Schizotypal |
| Cluster B | Antisocial |
| Cluster B | Borderline |
| Cluster B | Histrionic |
| Clustter B | Narcissistic |
| Cluster C | Avoidant |
| Cluster C | Dependent |
| Cluster C | Obessive-compulsive |
| What defense mechanisms are used by people with PDs are? | Repression, Suppresion, Regression, undoing, and Splitting |
| Splitting | Is the inabitility to incorporate positive and negative aspects of oneself or others into a whole image. |
| The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship, hoping that this person will meet all of his or her needs. | Splitting |
| Splitting | Primary defense used by individusals with borderline PD. |
| Labels one person "all good" and the other "all bad" | splitting |
| Splitting | Creates conflict in staff members |
| To decrease conflict among staff | Open communication in stafff meetings; Ongoing clincial supervision |
| Paranoid PD Disorder | Suspicious of others; Fear of others will exploit, harm or deceive; Fear of confiding in others; Misread compliments as manipulation; Hyperviagilant; Prone to counterattack; Hostile; Aloof |
| Schizoid Personality Disorder | Primary feature of emotional detachment |
| Able to function in a solitary occupation but shows indifference to praise or criticism form others | Schizoid PD |
| Characteristics: Avoids close relationship; Socially isolated; Poor occupational functioning; Cold, aloof and detached; Social awareness is lacking; Relationships generate fear and confusion in the client | Schizoid PD |
| Nurses need to give clear & precise explanations of tests, history taking and procedure, side effects of drugs, changes in treatment plan and possible further procedures to counteract client fear of harm. | Paranoid PD |
| Nurses should strive for a sense of acceptance & trust to help decrease client's fear. | Schizoid PD |
| Nurses dont't push self on client's with this PD and respect we are all unique. No groups | Schizoid |
| Central Characteristic of odd beliefs leading to interpersonal difficulties. | Schizotypal PD |
| Schizotypal PD | Characteristics: Ideas of reference; Magical thinking; Odd beliefs; Perceptual distortions |
| Vague, sterotyped speech; Freightened; Suspicious; Blunted affect; Distatnt and strained social relationships | Schizotypal PD |
| Sixth Sense | Schizotypal PD |
| An individual with this PD may seek help because of the intense anxiety felt in social relationships | Schizotypal |
| Cluster A | Seldom seek psychiatric treatment, believing firmly in their interpretation of the world. May also be seen in acute care setting s oif they develop brief psychotic symptoms under stress or require treatment of a comorbid psychiatric disorder |
| Cluster B | Seek out interpersonal relationships but can not maintain them because of excessive demands and emotional instability |
| Manipulative | Demonstrate charm and superficial warmth for other, their main goal is to use others to meet their own needs |
| Entitlement | Unconsciously feel that their needs are more important than the needs of others, the y deny the negative effects of hurting others |
| Cluster B | Recieve psychiatric care, either voluntarily because of affective distress, or involuntarily because of illegal behavior. |
| Antisocial PD | Main features of consistent disregard for others with exploitation and repeated unlawful actions |
| Antisocial PD | Superficial charm; Violates rights of others; Exploits others; Lies; Cheats; Lacks guilt remorse; Impulsive; Acts out; Lack empathy; Extremely manipulative; Aggressive |
| Antisocial PD | High dangerous; No concious; Must be careful around; Take chances and take what they want |
| Persons with antisocial PD were previously called: | Psychopaths or Sociopaths |
| Antisocial PD | These individuals do not voluntarly seek psychiatric care, but they often seek court-referred evaluation or treatment. |
| Borderline PD | Central characteristic are instability in affect, identity, and relationships |
| Borderline PD | Impulsivity; Self-mutilation self destructive behaviors; Rapid mood shifts; Chronic emptiness; Intense fear of abandonment;Clingy relationships |
| Borderline PD | Splitting is the major defense; Uses sexual behaviors as a bargaining tool;suicidial behavior |
| Borderline PD | Intese and pervasive anger |
| Borderline PD | Is the one of the most common PDs seen in psychiatric treatment settings |
| Client's with borderline PD may have a history of multiple or dramtic: | Suicidal gestures |
| How many clients can be expected to complete that have borderline PD? | One in ten |
| Histrionic PD | The key ingredient of emotional attention-seeking behavior, in which the person needs to the center of attention |
| Histrionic PD | Center of attention; Flamboyant; Seductive or provoative; Shallow, rapidly shifting emotions; Dramatic expression of emotions; Overly concerned with impressing others |
| Histrionic PD | Exaggerates degree of intimacy with others; Self-aggrandizing; Proccupied with own appearance; Fells depressed when admiration of others is not given; Suicide gestures may result entry into the health care system |
| Narcissistic PD | The primary feature of arrogance, with a grandiose view of self importance |
| Narcissistic PD | Overestimates self and underestimates others; Feels humiliated, degraded and empty when client is corrected, when boundaries are defined and when limits are set on client's behavior |
| Narcissistic PD | Constant admiration along with a lack of empathy for others that strains most relationships |
| Narcissistic PD | Intense shame and fear that if they are "bad" they would be abandoned |
| Narcissistic PD | Grandiosity; Fantasies of power or brilliance; Need to be admired; Sense of entitlement; Arrogant; Patronizing; Rude; Covers fragile ego;To lower anxiety, maylaunch a counterattack |
| Narcissistic PD | May seek help for depression, feeling that loved ones do not show enough appreciation of the special qualities |
| Narcissistic PD | Selfish |
| Avoidant PD | The central characteristic of social inhibintion and avoidance of all situations that require interpersonal contact |
| Avoidant PD | Seen in treatment for symptoms of anxiety, especially social anxiety disorder |
| Avoidant PD | Lacking ability to relax to let guard down; Has to have approval from others before going out; Has low self-esteem |
| Avoidant PD | Social inhibition; Feelings of inadequacy; Hypersensitivity to criticism; Preoccupation with fear of rejection and criticism; Self perceived to be socially inept; Has low self esteem |
| Dependent PD | The primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends |
| Dependent PD | Hard for them to take on an assertive role |
| Dependent PD | Inability to make daily decisisons without advice and reassurance; Need of others to be responsible for important areas of life; Anxious; Submissive; Helpless when alone |
| Dependent PD | Solicit care taking by clinging; Fear of abandonment if they are too competent; Co existing depression |
| Obsessive-Compulsive PD | The primary feature is perfectionism with a focus on orlderliness and control |
| Obessive-Complusive PD | Preoccupied with rules; Perfectionistic (don't finish the work because of being preoccupied with the details and rules |
| Obessive-Complusive PD | Too busy to have friends; Rigid Control; Superficial Relationships; Complains about others' efficiences & gives others directions |
| Personality disorder NOS | Do not meet criteria for any specific personality disorder |
| Personality disorder NOS | Mixed Personality; Passive-aggressive disorder; Depressive Personality disorder |
| Mixed Personality | More than one specific personality |
| Passive-aggressive disorder | Wants others to see what they've done |
| Passive-aggressive disorder | Exhibit passive rsistance; Exhibit general obstructiveness; Commonly switch among the roles of the martyr, the affronted, the aggrieved, the misunderstood, the contrite, the guilt ridden, the sicly, and the overworked |
| Passive-Aggressive disorder | Able to vent anger and resentment subtly while gaining the attention, reassurance, and dependency they crave |
| Social Interaction Skills: | Personal behaviors that promote effective relationships |
| Social Interaction Skills: | Uses conflict resolution methods |
| Social Interaction Skills: | Short term indicators: Exhibits receptiveness; Ehibits sensitivity to others; Cooperates with others; Uses assertive behaviors as appropriate; Uses confrontation as appropriate |
| Motivation: | Inner urge that moves or prompts an individual to positive actions |
| Motivation: | Accepts responsibility for actions |
| Motivation: | Develops an action plan; Obtains needed support; Self-initiates goal0directed behavior; Expresses belief in ability ro perform action; Expresses that performance will lead to desired outcome |
| Aggression Self-Control: | Self-restraint of assaultive, combative, or destructive behaviors toward others |
| Aggression Self-Control: | Communicates needs appropriately |
| Aggression Self-Control: | Indentifies when frustated, when angry; Indentifies responsiblity to maintain control; Identifies alternatives to ggression, to verbal outbursts; Vent negative feelings appropriately; Refrains from striking and harming others |
| Impulse Self-Control: | Self-restraint of compulsive or impulsive behaviors |
| Schizotypal | Manifests ideas of reference; Shows cognitive and perceptual distortions; Socially inept; Anxious |
| Schizotypal | Respect client's need for social isolation; Be aware of client's suspiciousness and employ appropriate interventions; As with schizoid clinet, perform careful diagnostic assess ment as needed to uncover any other medical or psycho symptoms of interview |
| Schizotypal | Skills-oriented psycholtherapy; Cognitive and behavioral measures; Highly structured group therapy; Low-dose antipsychotics |
| Paranoid | Projects blame; Suspicious; Hostile and violent; Shows cognitive and perceptual distortions |
| Paranoid | Avoid being too "nice or friendly"; Give clear and straightforward explanations of tests and procedures beforehand; Use simple, clear languare ; avoid ambiguity |
| Schizoid | Reclusive; Avoidant; Uncooperative |
| Schizoid | Avoid being too "nice or friendly"; Do not try to increase socialization; Perform thorough diagnostic assessment as needed to identify symptoms or disorders that the client is reluctant to discuss |
| Schizoid | Suggested Therapies: Supportive psychotherapy; Group therapy; Antipsychotics, antidepressants, anxiolyics as needed |
| Borderline | Shows separation anxiety ; Mainfests ideas of reference; Impulsive (suicide, self-mutilation); Engages in splitting |
| Borderline | Set realistic goals, use clear action words; Be aware of manipulative behaviors(flattery, seductiveness, instilling of guilt); Use clear and straighforward communication; When behavioral problems emerge, calmly review the therapeutic goals and boundaries; |
| Borderline | Suggested Therapies: Dialectical behavior therapy; SSRIs for anger and depression; Carbamazepine for lack of control and self-harm; low dose antipsychotics; Low-dose antipsychotics for cognitive disturbance. |
| Antisocial | Manipulative; Exploitive of others; Aggressive; Callous towards others |
| Antisocial | Try to prevent or reduce untoward effects of manipulation(flattery, seductiveness, instilling guilt): Set clear and realistic limits on specifeic behavior; Ensure all limits are adhered to by all staff involved ; Carefully document objectively |
| Antisocial | Cognitive approach, Structured community residential program; Pharmacologic agent for aggression (Lithium, anticonvulsants, SSRIs) |
| Narcissistic | Exploitive; Grandiose; Disparaging; Rageful; Very sensitvie to rejection, criticism |
| Narcissistic | Remain neutral; avoid engaging inpower struggles or becoming defensive in response to the client's disparaging remarks, no matter how provocative the situation maybe; Convey unassumming self-confidence |
| Narcissistic | Cognitive and behavioral measures; Group therapy; No specific medication |
| Histrionic | Seductive; Flamboyant; Attention seeking; Shallow; Depressive and suicidal when admiration is withdrawn |
| Histrionic | Understand seductive behavior as a a response to distress; Keep communication and interactions professional, despite temptation to collude with the client in a flirtatious and misleading manner; Encourage and model the use of concrete and descriptive |
| Histrionic | Group therapy; Treatment of comorbid personality disorders; Antidepressants as needed |
| Histrionic | Teach and role-model assertiveness |
| Dependent | Excessively clinging; Self-sacrificing, submissive; Needy, get others to care for him or her |
| Dependent | Idenity and help address current stresses; Try to satisfy client's needs at the same time that limits are set up in such a manner that client does not feel punished and withdraw |
| Dependent | Be aware that strong countertransference often develops in clinicians because of client's excessive clinging; therefore, supervision is well advised |
| Dependent | Supportive therapy or cognitive-behavioral therapy; Group therapy |
| Obsessive-compulsive | Perfectionistic; Has need for control; Inflexible, rigid; Preoccupied with details; Highly critical of self and others |
| OC | Guard against engaging in power struggles with client. Need for control is very high in these clients; Intellecutalization, rationalization, and reaction formation are the most common defense mechanisms |
| OC | Supportive or insightful psychotherapy, also cognitive-behavioral therapy; Clomipramind for obsessional thinking and depression |
| Avoidant | Excessively anxious in social situations; Hypersensitive to negative to negative evaluation |
| Avoidant | A friendly, gentle, reassuring approach is the best way to treat clients; Being pushed into social situations can cause extreme and sever anxiety |
| Avoidant | Desensitization, social skill training, or other cognitive-behavioral techniques to treat social phobia; Group therapy; MAOIs and anxiolytics |
| Signs & Symptoms: Crisis, high levels of anxiety | Nursing Diagnoses: Ineffective coping; Anxiety; Self-mutilation |
| Signs & Symptoms: Anger and aggression; child, elder, or spouse abuse | Nursing Diagnoses: Risk for other-directed violence; Inefffective coping; Impaired Parenting; Disabled family coping |
| Signs & Symptoms: Withdrawal | Social isolation |
| Signs & Symptoms: Paranoia | Nursing Diagnoses: Fear, Disturbed sensory perception; Disturbed thought processes; Defensive coping |
| Signs & Symptoms: Depression | Nursing Diagnoses:Hopelessness; Risk of suicide; Self-mutilation; Chronic low self-esteem; Spiritual distress |
| Signs & Symptoms: Difficulty in relationships, manipulation | Nursing Diagnoses: Ineffective coping; Impaired social interaction; Defensive coping; Interrupted family processes; Risk for loneliness |
| Signs & Symptoms: Failure to keep medical appointments, failure to follow prescribed medical procedure or medication regimen | Ineffective therapeutic regimen management; Noncomplicance |
Created by:
keystudent
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