Ch. 15: Personality Disorders Flashcards
A client who has a personality disorder demonstrates ______ personality characteristics
Pathological
A client who has a personality disorder exhibits impairments in _____ or _______ and _____
Self-identity or self-direction and interpersonal functioning
Are the maladaptive behaviors of a personality disorder always perceived by the individual as dysfunctional?
No, sometimes some areas of personal functioning may be adequate
What are some other mental health diagnsosis that co-occur with personality disorders?
Depression
Anxiety
Eating and substance use disorders
What are some defense mechanisms that are used by clients who have personality disorders?
Repression Regression Suppression Undoing Splitting
What is splitting?
The inability to incorporate positive and negative aspects of oneself or others into a whole image
What personality disorder is splitting commonly associated with?
Personality disorders
In splitting, how does the client tend to characterize people or things?
All good or all bad at any particular moment
EX: “You are the worse person in the world. later that day”… “You are the best, but the nurse from the last shift is absolutely terrible”
Clients who have a personality disorder will exhibit one or more of the following common pathological personality characteristics…what are they? (5)
- Inflexibility/maladaptive response to stress
- Compulsiveness and lack of social restraint
- Inability to emotionally connect in social and professional relationships
- Tendency to provoke interpersonal conflict
- Ability to merge personal boundaries with others
What are the 10 personality disorders?
Paranoid Schizoid Schizotypal Antisocial Borderline Narcissistic Histrionic Avoidant Dependent Obsessive compulsive
What characterizes cluster A and what 3 are part of this?
Cluster A: Odd, eccentric traits
- Paranoid
- Schizoid
- Schizotypal
What characterizes cluster B and what 4 are part of this?
Cluster B: Emotional, dramatic, erratic traits
- Antisocial
- Borderline
- Histrionic
- Narcissistic
What characterizes cluster C and what 3 are part of this?
Cluster C: Anxious or fearful; insecure and inadequacy
- Avoidant
- Dependent
- Obsessive-compulsive
What cluster and what disorder is this:
Disregard for others with exploitations, repeated unlawful actions, deceit, and failure to accept personal responsibility
Cluster B–Anitsocial
What cluster and what disorder is this:
Emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative
Cluster A–Schizoid
What cluster and disorder is this:
Emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious
Cluster B–Histrionic
What cluster and disorder is this:
Extreme dependency in close relationships with an urgent search to find a replacement when one relationship ends
Cluster C–Dependent
What cluster and disorder is this:
Distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person
Cluster A–Paranoid
What cluster and disorder is this:
Perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task
Cluster C–Obsessive-compulsive
What cluster and disorder is this:
Instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal
Cluster B–Suicidal
What cluster and disorder is this:
Odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations
Cluster A–Schizotypical
What cluster and disorder is this:
Social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations
Cluster C–Avoidant
What cluster and disorder is this:
Arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism
Cluster B–Narcissistic
____ is always a priority concern because some clients who have a personality disorder are at risk for self-injury or violence
Safety
Why is developing a therapeutic relationship often challenging with clients with personality disorders?
Due to the clients distrust or hostility toward others
What will help build a therapeutic nurse-client relationship with a pt with personality disorder?
A firm, yet supportive approach and consistent care
For clients who are manipulative, like those with borderline or antisocial personality disorder, what is essential?
Limit-setting and consistency
Clients who have dependent and histrionic personality disorders often benefit from _____ & ____
Assertiveness training and modeling
What PD tend to isolate themselves…what should we do as nurses if this happens?
Schizoid or schizotypical personality disorders isolate theselves; we should respect this need
Clients who have histrionic personality disorder, who may be flirtatious…what is it important the nurse do?
Maintain professional boundaries and communication at all times
When caring for clients who exhibit dependent behavior, self-assess frequently for ______
Countertransference reactions
What are effective treatment modalities for clients who have PD?
Psychotherapy
Group therapy
Cognitive and behavior therapy
What is a type of cognitive-behavioral therapy that is used for clients who exhibit self-injurious behavior?
Dialectical behavior therapy
What does dialectical behavior focus on?
Gradual behavior changes and provides acceptance and validation for these clients
A nurse manager is discussing the care of a client who has a PD with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?
A. I can promote my clients sense of control by establishing a schedule.
B. Self-assessment will help me cope with emotional reactions to client care.
C. I should practice limit-setting to help prevent client manipulation.
D. Maintaining professional boundaries is a priority of client care.
A
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of PD?
A. I’m scared that you’re going to leave me
B. I’ll go to group therapy if you let me smoke
C. I need to feel that everyone admires me
D. I sometimes feel better if I cut myself
A. Clients who have avoidant have a fear of abandonment-this statement is expected
B= avoidant PD C= Narcissistic PD D= Borderline
A charge nurse is preparing a staff education session on PD. Which of the following should be included as personality characteristics associated with all of the personality disorders? (SATA)
A. Difficult in getting along with other members of a group
B. Belief in the ability to become invisible during times of stress
C. Display of defense mechanisms when routines are changed
D. Claiming to be more important than other persons
E. Difficulty understanding why is it inappropriate to have a personal relationship with staff
A, C, E
A nurse is caring for a client who has borderline PD. The client says, “The nurse on the evening shift is always nice! You are the meanest nurse ever!” The nurse should recognize the clients statement as an example of which of the following defense mechanisms?
A. Regression
B. Splitting
C. Undoing
D. Identification
B
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (SATA)
A. Demonstrates extreme anxiety when placed in a social situation
B. Has difficulty making even simple decisions
C. Attempts to convince other clients to give him their belongings
D. Becomes agitates if his personal area is not neat and orderly
E. Blames others for his past and current problems
C, E
A= avoidant B= Narcissistic D= Obsessive-compulsive
