Ch. 13 - Personality Disorders

Question 1

The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time - predict how react going to react
Tend be born with it

Answer 1

Personality Defined

Question 2

Personality traits are characteristics with which an individual is born or develops early in life
They influence the way in which he or she perceives and relates to the environment and are quite stable over time
Personality: How we perceive and interact with the world.
Personality disorder traits:

Answer 2

Personality traits

Question 3

Personality traits: Stylistic peculiarities that all people bring to social relationships

Answer 3

Personality: How we perceive and interact with the world.

Question 4

Difficulty accurately perceiving and interpreting the world around them
Never in treatment: adjust: disorder that stops them then get treatment; impacts people around them and those with it
Stop being able go to work effectively or impact life
Difficulty with impulse control
Inappropriate emotional responses
Indivs not aware is a prob
Blaming:

Answer 4

Personality disorder traits:

Question 5

Genuinely unaware that their personality traits are causing the problems
Blame others not themselves

Answer 5

Blaming:

Question 6

Personality disorders occur when these traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning
Causing probs in daily functioning
Make life diff for self and others around them
Cannot cope
Causes chaos

Answer 6

The traits create difficulties

Question 7

Tends do things need do without probs
A pattern of perceiving, relating, thinking
Can relate to others without expecting others to meet all their needs
Balance work and play
Identify goals accomplished through discipline and creativity - carry through to accomplish goals
Identify self as total of strengths and weaknesses

Answer 7

Healthy personality

Question 8

Prob
Long standing pxs. in behavior, mood, perceptions, relationships
Generally do not perceive a px. - esp if have disorder
Become distressed b/c of other people’s rxs. or behavior towards them-Use projection
Inflexible (maladaptive response to stress)
Poor working and loving relationships
Ability to evoke interpersonal conflict
Capacity to frustrate others
Blame others (often springs from feeling threatened) - not their prob but your prob; not see or know how personality affecting others; defense mechanism

Answer 8

Characteristics of personality disorders

Question 9

Many clients with other psychiatric and medical diagnoses manifest symptoms of personality disorders - not hospitalized with personality illnesses; come in with other issues; seen in oupat in therapy because probs causing in daily life
Nurses are frequently likely to encounter clients with these personality characteristics in all health-care settings

Answer 9

Considerations

Question 10

Cluster A: Odd Eccentric (Weird)
Cluster B: Dramatic Erratic (Wild)
Cluster C: Anxious Fearful (Worried)

Answer 10

Types of personality disorders - DSM-5

Question 11

Paranoid, Schizoid, Schizotypal

Answer 11

Cluster A: Odd Eccentric (Weird)

Question 12

Histrionic, Narcissistic, Borderline, Antisocial
Difficulties in relationships with other people
Create probs for people and those around them

Answer 12

Cluster B: Dramatic Erratic (Wild)

Question 13

Dependent, Avoidant, Obsessive-Compulsive
Common diagnosis

Answer 13

Cluster C: Anxious Fearful (Worried)

Question 14

More common in men
Suspicious of others, misread cues
hypervigilent
Deliver the patient education (i.e. medications, plan of care, or treatment) in a non confrontation or non- threatening manner.
Change tell them up front because suspicious
Misread cue and feel directed/attacking them - paranoid thought
When giving meds, txs, give the same information: Have you heard this before? - if diff med, dose, time - say diff - not take med esp if paranoid

Answer 14

Paranoid Personality Disorder - Cluster A (Odd/Eccentric)

Question 15

avoids close relationships, socially isolated
social awareness lacking and relationships generate fear and confusion
Flat affect, appearing indifferent to both praise and criticism
Invest little energy in human relationships; conversely, may invest enormous energy in nonhuman interests (e.g., mathematics, astronomy, etc.); often connect more with animals
Often creative, original thinkers
Strive for simplification and clarity to decrease anxiety - when working with this indiv
Explanations in directions can ease anxiety

Answer 15

Schizoid Personality Disorder - Cluster A (Odd/Eccentric)

Question 16

Resembles symptom of schizophrenia but with no psychosis with it (no psychotic features)
Odd, eccentric behavior and speech patterns
Cognitive perceptual distortions without psychosis
May display magical thinking and rituals
Give-and-take conversations difficult
Genuinely unhappy about lack of relationships
Social anxiety and unhappiness may increase over time

Answer 16

Schizotypal Personality Disorder - Cluster A (Odd/Eccentric)

Question 17

Manipulative, insensitive
Very dramatic; shift in emotional liability; lack insight in why people think not as funny as they think as they are
Dramatic, rapidly shifting, charming, flamboyant, and sexually seductive behaviors/seductive
Really giggly; shallow, superficial in relationships
Need to become and remain the center of attention, love, and admiration
Constant, sudden emotional shifts and lability
Superficial, shallow, short-lived relationships
Lack insight into cause of relationship failures

Answer 17

Histrionic Personality Disorder - Cluster B - dramatic/erractic - emotional - difficulty for self and others

Question 18

Grandiose sense of personal achievement
Center around themself - all about them; cannot be happy for someone else
Cannot change these people - figure out how respond to them differently because then they respond differently
Haughty sense of entitlement
Lack of empathy; exploiting others to meet own needs
Increasing attention seeking over time
Envious of others
Use of splitting, tantrums
Can be sadistic, with paranoid tendencies - need be best and think others out to take them down and be on them
Change in how you respond

Answer 18

Narcissistic Personality Disorder - Cluster B - dramatic/erractic - emotional - difficulty for self and others

Question 19

Most havoc for people
No meds to help
Definition
Traits
Common behaviors

Answer 19

Borderline Personality Disorder - Cluster B - dramatic/erractic - emotional - difficulty for self and others

Question 20

Characterized by a pattern of intense and chaotic relationships with affective instability - affect unstable
Stir the pot; get chaos going then step back and see what happens; chaos around these people often; you are all good/bad
Fluctuating and extreme attitudes regarding other people
Highly/pretty impulsive - dangerous; suicidal/cutting; phys safety issue
Deal in world of black and white
Can happen instantly

Answer 20

Definition - Borderline Personality Disorder

Question 21

Emotionally unstable - all over board
Directly and indirectly self-destructive - impulsiveness; cutting to relieve anxiety and to feel to bring back to reality
Lacks a clear sense of identity
Affects about 1 to 2 percent of the population
More common in women than in men - young girls of teenagers

Answer 21

Traits - Borderline Personality Disorder

Question 22

Chronic depression - meds: anxiety/depression meds
Inability to be alone - fear being alone; get close and then push people away - very diff for fams or friends; not like be alone: come close to me then as step to be with them push you away; want people but push them away; exhausting
Clinging and distancing behaviors
Splitting - master manipulators; like stir the pot and split the group in half; need to address it; be consistent in how respond and be together in how approach
Manipulation
Self-destructive behaviors
Impulsivity

Answer 22

Common behaviors - Borderline Personality Disorder

Question 23

All good—all bad
Unstable, intense relationships
Chronic emptiness - feel like this; so cut
Intense fear of abandonment-biggest fears
Splitting (alternating between idealizing and devaluing): master get people fighting with each other; will cause tension and fighting
Self-mutilation—Cutting
Impulsivity
Create turmoil and then step back to watch; stir the pot then step back

Answer 23

Cluster B - borderline personality

Question 24

Feeling Abandoned
Getting into very negative relationships - relationships not last and very healthy
Lack of a healthy support system
Lack of appropriate self soothing skills - cutting can be way of soothing self or decrease anxiety; goal be help understand what to do when feeling abdonament - know support sys; healthy ways to cope

Answer 24

Cluster B - borderline personality common triggers

Question 25

Emotional instability
Separation insecurity
Depression (chronic)
Fear feelings of abandonment
Excessive demands, impulsive behavior, uncontrolled anger
Stormy relationships
Idealization and devaluation
Self-mutilation and prone to suicide
Splitting

Answer 25

Borderline

Question 26

Attention seeking
Antagonism
Grandiosity
Expectation of special treatment
Arrogant and haughty
Lack of empathy
Exploit, blame, and envy others
Shallow, superficial, and tantrums
Manipulation
Splitting

Answer 26

Narcissistic

Question 27

Definition
has superficial charm - conartists
violates the rights of others
lying/conning
lack of remorse
motivated by power and control - VERY IMP
life is a game and the object is to win in the most exciting grandiose way

Answer 27

Antisocial Personality Disorder - cluster B

Question 28

A pattern of behavior that is:
Not feel Socially irresponsible - rules not apply to them
Exploitative - exploit others
Without remorse - others issue not theirs
Behavior reflects a disregard for the rights of others

Answer 28

Antisocial Personality Disorder

Question 29

motivated by power and control - IMP
they reorganize their external world to fit their world view
risk of substance abuse - co-diagnosis
Lack remorse
For dx.:
must be at least 18 years of age; same things will have this diagnosis
have some sx. of conduct disorder before age 15 - child diagnosis
often in correctional system
Must establish and adhere to plan of care and maintain clear boundaries to minimize manipulation and acting out
THREE C’S to deal with them: Corral, Confront, Consequences (need to be immediate): look about with this; corral them: boundaries, confront them - same page - and consequences should be immediate

Answer 29

Antisocial personality - cluster B

Question 30

Fails to sustain consistent employment. - difficulty with employment
Fails to conform to the law - probs with law
Exploits and manipulates others for personal gain
Fails to develop stable relationships
Low frustration tolerance

Answer 30

Clinical Picture: antisocial traits

Question 31

Not often seen in most clinical settings - unless other diagnoses; not think have prob
Most frequently encountered in prisons, jails, and rehabilitation services - incarcerated; police encounter them
When clients are seen, it is commonly a way to avoid legal consequences
Sometimes they are admitted to the health-care system by court order for psychological evaluation - court ordered treatment for eval; be there because ordered by law

Answer 31

Nursing process: assessment: antisocial Personality Disorder

Question 32

An individual, with a history of antisocial personality disorder, was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected?
A.“It’s not my fault.”
B.“I’m too ashamed to talk about it.”
C.“I just don’t remember doing it.”
D.“I’m really sorry about all the people I’ve hurt.”

Answer 32

Correct answer: A
Individuals diagnosed with antisocial personality disorder lack remorse about their actions and view themselves as victims. This individual would most likely refuse to acknowledge responsibility for the accident

Question 33

A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe?
A.Social isolation
B.Suspiciousness of others
C.Bizarre speech patterns
D.Generates conflict among the staff

Answer 33

Correct answer: D
Clients diagnosed with borderline personality disorder, having little empathy toward others, are unable to accept both positive and negative feelings, and view others as all good or all bad. They tend to split staff, generating conflict

Question 34

In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?
A.Predictability
B.Controlled anger
C.Little tolerance for being alone
D.Stable and satisfactory relationships

Answer 34

Correct answer: C
Clients diagnosed with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship no matter how unsatisfactory rather than experience feelings of loneliness, emptiness, and boredom

Question 35

Personality disorder
hypersensitive to criticism
Social anxiety disorders
preoccupied with fear of rejection
unwilling to get involved with people unless certain of being liked
Help them: Teach: socialization skills, give positive feedback (hypersensitive to what people saying), build self-esteem (saying + things about self)

Answer 35

Avoidant - Cluster C - anxious/fearful: chronic trauma roots

Question 36

Inability to make decisions without advice and reassurance - paralyzes to make decisions
Anxious and helpless when alone
Submissive
Experience anxiety and may have co-existing depression

Answer 36

Cluster C - dependent personality

Question 37

Preoccupies with rules
Perfectionist
Too busy to have really good or cultivate good friends
Very Rigid control
More common in oldest children
Cannot get obsessive-compulsive action out of head

Answer 37

Cluster C: obsessive-compulsive personality

Question 38

Pervasive pattern of negativistic attitude and passive resistance to demands
Passively resistant to authority, demands, obligations, and responsibilities by such behaviors as dawdling, procrastination, being late and “forgetting”
Not want to have conflict - avoid conflict
Not learned how to say no; take on things cannot do

Answer 38

Cluster C: passive aggressive

Question 39

Normally admitted to inpt. for reasons other than their personality disorder. Most often see borderline and antisocial dx. due to safety issues - gen management of personality disorders - hospitalized other things going on; borderline for safety issues; or may court ordered
Not gen admitted of personality disorders - not admitted for personality disorders - still as HCP have borderline disorder - can split staff
Not motivated for long-term tx.—they often don’t see anything wrong with self - not recognize it in themself - not understand me - you have prob
Tx. of choice: short-term psychotherapy focusing on solutions for specific life pxs. (outpat - identified causing them probs) - see probs in work then go get help; what causing pxs in life; focus on the solutions so responsibility on them

Answer 39

Gen management of personality disorders

Question 40

What current pxs. in life causing distress - start there; pxs causing stress
Who is your support person(s) - do you have one
What changes would you make in your life
How do you handle anxious feelings
Have you done anything to hurt yourself
Have you had trouble with legal system
Attempt keep focus on them; keep bringing questions back to them

Answer 40

Gen considerations: identify current/presenting pxs - questions to start with for psychiatric disorder - assessment

Question 41

Be consistent-all staff talk, set limits, set boundaries - consistent
No harm contract - come to someone if thinking of harm
Have them identify someone to contact when thoughts of self-mutilation
Grounding techniques - brings them back to the present; do things wherever are - decrease anxiety
Plan alternative to self-mutilating behaviors - help self-soothe self: grounding techniques; identify ways decrease anxiety
Be consistent - IMPORTANT

Answer 41

Dealing with manipulation and splitting

Question 42

PD is persistent/consistent
Change how react to them; change how they respond and relationship
Indiv May lack motivation to change aspects of self, but may respond to px.-solving approach to specific issues; not feel they px
Useful for each family member to improve self-functioning rather than focus on changing another person; how respond differently
Maintain clear expectations for each family member’s role

Answer 42

Working with fam

Question 43

Outcomes should be realistic, modest, and obtainable.
Criteria might include the following:
Minimizing self-destructive behaviors - SAFETY
Reducing manipulating behaviors
Linking consequences to behaviors
Initiating alternatives to prevent crisis
Ongoing management of emotions
Creating lifestyle that prevents regression

Answer 43

Gen outcomes

Question 44

Medications generally not recommended for PD - not for antipersonality disorder
If coexisting psychiatric disorders, medications for the specific sxs. may be used
Antipsychotic may be helpful for control or agitation, rage, or psychotic episodes; all age spectrum
Antidepressants may be useful for Borderline Personality - underlying MDD

Answer 44

Pharm

Question 45

Constant awareness of your own rxs. to pts. Behavior - self-awareness; how react to diff personalities - how react to indivs in diff situations
Model appropriate px-solving, interpersonal skills - watching you always
Avoid being too nice-remain neutral (watch for splitting; obj and neural - firm in boundaries)
Be consistent and on same page
Stress responsibility and accountability for self

Answer 45

Nursing guidelines