Antisocial and Other Personality Disorders Flashcards
Personality Disorders: Cluster B
Dramatic, emotional erratic characteristics – Borderline – Antisocial – Histrionic – Narcissistic
Antisocial Personality Disorder: Dx criteria
Marked pattern of disregard for and violation of the rights of others since age 15, & 3 or more of the following:
– Failure to conform to social norms as indicated by repeatedly performing acts that are grounds for arrest
– Deceitfulness, lying, conning, using aliases
– Impulsivity, failure to plan ahead
– Irritability, aggressiveness, fights assaults
– Reckless disregard for safety of self and others
– Consistent irresponsibility as in work, finances
– Lack of remorse for actions
APD: onset/actions
- Must be at least age 18
- Conduct Disorder onset before age 15
- Differentiate from actions while abusing substances, & schizophrenia & bipolar diagnoses
APD: Associated Findings
– Lack empathy
– Callous, cynical of rights of others
– Inflated arrogant self-appraisal
– Excessively opinionated, self assured or cocky
– Glib superficial charm, impressive verbal ability
– Irresponsible exploitive in sexual relationships, multiple partners & lack of sustained monogamy
– Possible dysphoria, complaints of tension, boredom, depressed mood
- Psychopath, sociopath
- Chronic course- improves after age 40
- Not always in legal trouble can be in business, politics military (competition rewarded rather than cooperation)
- More men- there are gender differences in expression- see page 516, Box 28.2
APD: Epidemiology/Risk Factors
- 0.2 – 3.3% of the population
- Men more often diagnosed
- 12 month prevalence rates greater among Native Americans and lower among Asians compared with whites
- Comorbid with mood, anxiety, and other personality disorders; alcohol and drug abuse
APD: Etiology (Biologic)
– Emotional distancing, aggression, impulsivity from neural dysfunction
– Moral judgment impairment - dysfunction of prefrontal cortex
– Fearlessness- lack of activation of limbic prefrontal circuit during fearful situations
– Psychological
– Unsatisfactory attachments; difficult temperament
– Social
– Chaotic families
– Abuse or neglect, domestic violence
APD: Nursing Assessment
- Initial Nursing Assessment
- Mental Status Exam including suicidality (10% completion rate)
- Physical effects of chronic use of addictive substances
- Determine the quality of relationships, impulsivity, and the extent of aggression
- Legal issues
APD: Nursing Dx
- Dysfunctional family processes, alcoholism
- Disturbed thought processes
- Risk for other-directed violence
- Risk for self-directed violence
- Ineffective role performance
- Impaired social interactions
APD: Nursing Interventions
• Help develop positive interaction skills – Problem-solving groups – Communication techniques – Address distorted cognitive schema – Teach empathy
• Milieu interventions-experience consistency
– Refrain from arguing or bargaining about rules
– Give positive feedback for accepting additional responsibility
• Help build a new support system
Psychoeducation Checklist
- Positive health care practices including appropriate use of substances
- Effective communication & interaction skills
- Impulse control
- Anger management
- Group experience to help develop self-awareness & impact of behavior on others
- Analyzing an issue from another persons’ point of view
- Maintenance of employment
- Interpersonal relationships & social interactions
APD: Outcomes
• Evaluate in terms of specific problems
– (ex. maintaining employment, adherence to treatment recommendations, interpersonal relationship stabilization)
• Often will need to establish a new social network as the previous ones are gone.
Histrionic Personality Disorder
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, in 5 (or more) of the following:
- Is uncomfortable in situations in which he or she is not the center of attention.
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
- Displays rapidly shifting & shallow emotions.
- Consistently uses physical appearance to draw attention to self.
- Has a style of speech that is excessively impressionistic and lacking in detail
- Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible (i.e., easily influenced by others or circumstances).
- Considers relationships to be more intimate than they actually are.
Histrionic Personality Disorder: Etiology
minimal research on biological or genetic factors, parental role model, irregular reinforcement in childhood from multiple caregivers
Histrionic Personality Disorder: Treatment
goal is to correct the expectation that others are needed to fulfill all their needs
Histrionic Personality Disorder: Assessment
childhood social disapproval or deprivation; quality of the individual’s interpersonal relationships, self esteem
Histrionic Personality Disorder: Nursing Dx
chronic low self-esteem, ineffective coping, ineffective sexual patterns
Histrionic Personality Disorder: Interventions
therapeutic relationship, independent decision making, express confidence in ability to handle situations, reinforcement of personal strengths, support autonomous action, assertiveness groups
Histrionic Personality Disorder: Outcomes
Improved confidence & interpersonal relationships, ability to solve own problems and handle own needs
Narcissistic Personality Disorder
Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Has a grandiose sense of self-importance
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Narcissistic Personality Disorder: Epidemiology
men 7.7% > women 4.8%
Narcissistic Personality Disorder: Etiology
little evidence of biologic factors; possible result of parents’ overvaluation and overindulgence of a child vs. cannot function independently due to lack of emotional separation from primary caregiver vs. strategy to reduce intense feelings of shame
• Found more often in celebrities & highly respected professions such as law, medicine and science, only children, first born males in cultures where males get special privileges, children of narcissistic people
Narcissistic Personality Disorder: Nursing Management
- Seen in medical settings more than mental health
- World defined through their self-centered view
- Use self-awareness skills & supervision when interacting
- Difficult to establish therapeutic relationship
- Work with their goals
- Focus on responses to other health care problems
Personality Disorders: Cluster A
- Odd or eccentric behavior
- Paranoid
- Schizoid
- Schizotypal
Paranoid Personality Disorder
Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following:
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
- Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Does not occur exclusively during the course of a psychotic disorder and is not from the physiological effects of another medical condition.
- Want to appear in control & objective but negative emotions show (nervousness, anger, envy, jealousy)
- Often have job problems
- Uses projection to attribute own feelings to others
- Won’t seek help unless decompensates into psychosis
–>its not usually seen for mental health problems initially
Paranoid Personality Disorder: Prevalence
2.2-4.4%
Paranoid Personality Disorder: Etiology Theories
- Possible neurochemical transmission acceleration
- Genetic predisposition
- Excess limbic & sympathetic nervous system reactivity
Paranoid Personality Disorder: Assessment
Disturbed or illogical thoughts reflecting misinterpretation of environmental stimuli
Paranoid Personality Disorder: Nursing Dx
- Disturbed thought processes
- Social isolation not a relevant nursing diagnosis since they do not meet the defining characteristics of feelings of aloneness rejection desire for contact with people
Paranoid Personality Disorder: Nursing Interventions
- Therapeutic relationship - hard to establish trust
- Identification of problem areas like getting along with others, keeping a job, or other health issues
- Work on a different view of the problem area
- Techniques: acceptance, develop discrepancy (help them deal with their medical issue before their mental health issue), reflection
Paranoid Personality Disorder: Outcomes
- Change occurs over time
- Thought patterns will be less paranoid
Schizoid Personality Disorder
A pervasive pattern of DETACHMENT from social relationships and a restricted range of expression of emotions in interpersonal settings, begins in early adulthood and present in a variety of contexts, as indicated by 4 (or more) of the following:
- Neither desires nor enjoys close relationships, including being part of a family.
- Almost always chooses solitary activities.
- Has little, if any, interest in having sex with another person.
- Takes pleasure in few, if any, activities.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to the praise or criticism of others.
- Shows emotional coldness, detachment, or flat affect.
* schizoiD = Detachment