Ch. 13 - Personality Disorders Flashcards by Kelsey Klipfel

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

Personality Defined

How well did you know this?

Not at all

Perfectly

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:

Personality traits

How well did you know this?

Not at all

Perfectly

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

Personality: How we perceive and interact with the world.

How well did you know this?

Not at all

Perfectly

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:

Personality disorder traits:

How well did you know this?

Not at all

Perfectly

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

Blaming:

How well did you know this?

Not at all

Perfectly

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

The traits create difficulties

How well did you know this?

Not at all

Perfectly

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

Healthy personality

How well did you know this?

Not at all

Perfectly

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

Characteristics of personality disorders

How well did you know this?

Not at all

Perfectly

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

Considerations

How well did you know this?

Not at all

Perfectly

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

Types of personality disorders - DSM-5

How well did you know this?

Not at all

Perfectly

Paranoid, Schizoid, Schizotypal

Cluster A: Odd Eccentric (Weird)

How well did you know this?

Not at all

Perfectly

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

Cluster B: Dramatic Erratic (Wild)

How well did you know this?

Not at all

Perfectly

Dependent, Avoidant, Obsessive-Compulsive
Common diagnosis

Cluster C: Anxious Fearful (Worried)

How well did you know this?

Not at all

Perfectly

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

Paranoid Personality Disorder - Cluster A (Odd/Eccentric)

How well did you know this?

Not at all

Perfectly

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

Schizoid Personality Disorder - Cluster A (Odd/Eccentric)

How well did you know this?

Not at all

Perfectly

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

Schizotypal Personality Disorder - Cluster A (Odd/Eccentric)

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

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

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

Definition - Borderline Personality Disorder

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

Traits - Borderline Personality Disorder

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

Common behaviors - Borderline Personality Disorder

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

Cluster B - borderline personality

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

Cluster B - borderline personality common triggers

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

Borderline

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

Narcissistic

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

Antisocial Personality Disorder - cluster B

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

Antisocial Personality Disorder

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

Antisocial personality - cluster B

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

Clinical Picture: antisocial traits

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

Nursing process: assessment: antisocial Personality Disorder

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.”

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

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

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

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

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

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)

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

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

Cluster C - dependent personality

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

Cluster C: obsessive-compulsive personality

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

Cluster C: passive aggressive

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

Gen management of personality disorders

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

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

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

Dealing with manipulation and splitting

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

Working with fam

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

Gen outcomes

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

Pharm

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

Nursing guidelines