Anti-Social Personality Disorder Flashcards
Personality
the totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time
Factors that influence personality
- biologic make-up
- genetic make-up
- acquired as a person develops and interacts with the environment and other people
- these behaviors and characteristics are consistent across a broad rage of situations that do not change easily
Definition of Personality Disorders
occur when these traits deviate markedly from expectations of an individuals culture
-become rigid and inflexible, contribute to maladaptive behavior or impairment in functioning and lead to distress
Definition of Anti-Social Personality Disorder
persistent pattern of disregard for and violation of the rights of others– and by the central characteristics of deceit and manipulation
When does Anti-Social Personality Disorder Begin?
In childhood (Conduct Disorder) or early adolescence and remains consistent up to adulthood
Anti-social Personality Disorder: Central Features
Deceit and Manipulation
- also lack empathy as they have a tendency to disregard the feelings, rights, and suffering of others
- history of pathological lying
Anti-Social Personality Disorder: Sense of Self
- inflated sense of self that appears confident and assured but is often to the determent of others, as they tend to be opinionated, coarse , and verbose, rambling about topics to impress others
- seeks special privileges
- gets involved in social activities, more often then not when asked not to do so
Anti-Social Personality Disorder: Etiology
- also known as sociopathic or psychopathic
- whether it is due to nature or nurture
- no known genetic risk factors for personality disorders
- do not have episodes of personality disorder; rather they have these traits as life-long behavioral pattern
Risk Factors
- usually begins in childhood or adolescence
- linked to head injuries in childhood
- recent research has been on the development of the hypothalamus of the brain responsible for impulse control
- psychoanalytic theory–> under developed super ego
Diagnostic Work-Up
- complete history and physical exam with consideration of previous neurological trauma
- no laboratory tests
- focus on personal and social history
- consider their underlying beliefs as a way to validate diagnosis –> “people will get to me if I don’t get to them first”
History
- onset in childhood, or adolescence
- childhood history enuresis, sleep-walking, and syntactic acts of cruelty are characteristic predictors
- in adolescence, engage in lying, truancy, sexual promiscuity, cigarette smoking, substance abuse, and illegal activities that bought them in contact with police
- erratic, neglectful, harsh, or even abusive parenting marks the childhoods of these clients
Clinical Presentation
failure to conform to rules in society so that often behaviors are in direct violation of the law
- deceitful, tells lies, and distortions to the pleasure and advantage of the self-pathological lying
- lack of empathy and disregard for others
- shallow emotions
- may be initially pleasant and cooperative but then becomes nasty and difficult
General Appearance and Motor Behavior
- usually normal
- may be engaging and even charming
- depending on circumstances of interview, might exhibit signs of mild or moderate anxiety, especially if another person or agency arranged it
- aggressive physically as well as verbally
- thrill-seeking behavior
Mood and Affect
- false emotions; chosen to suit the occasion or to work to their advantage
- cannot emphasize with the feelings of others, enables them to exploit others without guilt
- feel remorse only when they are caught breaking the law or exploiting someone
- impulsive, irritable
Thought Process and Content
- views of the world are narrowed and distorted
- because coercion and personal profit motivate them, believe others are governed the same way
- view the world as cold and hostile and therefore rationalize their behavior
- “its a dog-eats-dog world”
- believe they are only taking care of themselves because no one else will
Sensorium and Intellectual Process
- oriented
- no sensory-perceptual alterations
- average or above average IQ
Judgment and Insight
- exercise poor judgment
- consistently irresponsible and has lack of remorse for deviant activities and behaviors
- pay no attention to legality of their actions
- do not consider morals or ethics in decisions
- behavior determined by what they want; perceive needs as immediate
- impulsive
- lack insight; never see their actions as the cause of their problems; someone else’s fault
Self- Concept
- appear confident, self-assured, accomplished or arrogant
- feeling fearless, disregard their own vulnerability, and believe they cannot be caught in lies, deceit or illegal actions
- self is shallow and empty; devoid of personal emotions
- appraise their own strengths and weaknesses
Roles and Relationships
- manipulative and exploit those around them
- view relationship as serving their needs and pursue others only for personal gain
- never think about the repercussions of their actions to others
- involved in many relationships simultaneously
- not sustain long-term commitment
- poor work history; absenteeism, theft, embezzlement, or quit out of boredom)
Acute Nursing Interventions/ Treatment Goal; Goal of the milieu
Goal of milieu:
help the patient learn how to socialize appropriately
Acute Nursing Interventions
> Promote responsible behavior
-limit setting
Consistent adherence to rules and treatment plan
-confrontation
-helping solve problems and control emotions
-decrease impulsivity
-enhancing role performance
-identifying barriers to role fulfillment
-taking a time-out from stressful situations
-decreasing or eliminating use of drugs and alcohol
-effective problem-solving skills
Acute Nursing Interventions/ Treatment: Promote Responsible Behavior
nurse must provide structure in relationship, identify acceptable and expected behaviors, and be consistent in those expectations
-limit setting
Limit Setting
promote responsible behavior
- Technique that involves 3 steps:
1. State the limit (describe the unacceptable behavior)
2. Identify the consequences if the limit is exceeded
3. Identify expected or desired behavior
Acute Nursing Interventions/ Treatment: Consistent adherence to rules and treatment plan; Confrontation
technique designed to manage manipulation or deceptive behavior
- points out the problem behavior while remaining neutral and matter-of-fact; avoids accusing client
- keep patient focused on self and the topic
- nurse can focus on the behavior itself rather than on attempts by client to justify it
Confrontation example
(technique designed to manage manipulative or deceptive behavior)
-points out problem behavior
-keep patient focused on self
NURSE: “you’ve said you’re interested in learning to manage angry outbursts, but you’ve missed the last 3 group meetings”
CLIENT: Well ,I can tell no one in the group likes me, why should I bother?
NURSE: “The group meetings are designed to help you and the others, but you cant work on issues if you are not there”.
Acute Nursing Interventions/ Treatment: Helping Patients Solve Problems and Control Emotions
clients have a pattern of reacting impulsively when confronted with problems
- effective problem-solving skills
- decreased impulsivity
- taking time out from stressful situations
Problem Solving Skills
- identifying the problem
- exploring alternative solutions and related consequences
- choosing and implementing on alternatives, and evaluating the results
- these patients need a step-by step approach to be able to solve problems
Chronic Treatment
- no psycho-pharmacologic treatment
- manage symptoms such as anger, hostility and aggression
- behavior therapy can be implemented to focus on or improving moral and social behaviors through enhancement of cognitive functioning
- we don’t attempt to change moral structure
Medical/ Legal Pitfalls
- can fool even most experienced clinician
- ASPD’s seek pleasure in injuring others, most patient and violent situations associated with clinicians involved comorbid conditions (substance abuse), violence and violence risk are often associated with intoxication
- consider forensic evaluation or consultation with a forensic specialist
Outcomes: Patient will….
- demonstrate non-destructive ways to express feelings and frustration
- identify ways to meet needs that do not infringe on the right of others
- achieve or maintain satisfactory role performance (work, parent, partner)
- refrain from manipulating others to fulfill own desires
- fulfill ADL’s willingly and independently
Client and Family Education
- avoiding use of alcohol and other drugs
- appropriate social skills
- effective problem-solving skills
- managing emotions such as anger and frustration
- taking a time-out to avoid stressful situations
