Chapter 19: Personality Disorders Flashcards
A person complains that most staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her “mixed-up feelings” about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it “makes the numbness stop.” Given this presentation, you would deduce that this person most likely has which personality disorder?
a. Obsessive-compulsive personality disorder is characterized by rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or harmful to their relationships.
b. People with BPD have an unstable sense of self (identity); tend to “split” their view of others into black or white, good or bad (rather than being able to see the person as something in between or as having both good and bad features); have difficulty coping with perceived rejection or strong emotions; cope by “numbing” and relieve numbing (or self-sooth) via self-injurious behaviour; and tend to be highly sensitive to perceived rejection or abandonment (here, the nurse’s leaving was perceived as abandonment).
c. People with ASPD are primarily concerned with gaining personal power or pleasure, and in their relationships they focus on their own gratification to an extreme that defies conforming to ethical or community standards consistent with their culture. They have difficulty with intimacy and will exploit others if it benefits them in relationships.
d. People with STPD manifest oddities of behaviour and thinking such as eccentric speech, social awkwardness or inappropriateness, derealization, and magical thinking; they could be said to share some of the less disabling and less dramatic symptoms of schizophrenia.
b. People with BPD have an unstable sense of self (identity); tend to “split” their view of others into black or white, good or bad (rather than being able to see the person as something in between or as having both good and bad features); have difficulty coping with perceived rejection or strong emotions; cope by “numbing” and relieve numbing (or self-sooth) via self-injurious behaviour; and tend to be highly sensitive to perceived rejection or abandonment (here, the nurse’s leaving was perceived as abandonment).
Which statement about people with personality disorders is accurate?
a. Although some personality disorders are not associated with an increased risk of suicide, several, particularly those involving mood instability and an impaired ability to cope with strong emotions (such as BPD and ASPD) are associated with a significantly greater risk of suicide.
b. Most people with personality disorders tend not to see themselves as being in a position to benefit from changing. Instead, they tend to attribute their distress to the behaviour of others and as a result may not seek treatment for themselves (and instead tend to enter treatment at the request or order of a family member, friend, employer, or court).
c. Although the early focus in theories about personality disorders emphasized intrapersonal and interpersonal responses to early life events, more recent research also addresses genetic and biological factors as playing a role in the etiology of these disorders.
d. People with BPDs, the group most likely to be found in inpatient treatment settings, tend to be very demanding of staff, often idealizing some staff at the expense of others, leading to discord among colleagues and strife about how to best care for the person.
b. Most people with personality disorders tend not to see themselves as being in a position to benefit from changing. Instead, they tend to attribute their distress to the behaviour of others and as a result may not seek treatment for themselves (and instead tend to enter treatment at the request or order of a family member, friend, employer, or court).
A person shows the nurse multiple fresh, serious (but non–life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic?
a. Although conveying empathy and support would often be therapeutic in other situations, in this case it is withheld until after the person has made an independent effort, via the written assignment, to assume responsibility for understanding and controlling her own behaviour.
b. As a result, as a general rule, the focus is instead on promoting the person’s own internal controls (rather than relying on external controls that might inadvertently reinforce or aggravate the maladaptive behaviour).
c. It is important not to assume that self-injurious behaviour is simply a plea for attention because it is usually much more complicated than that. Further, withholding all attention (i.e., responsiveness) would tend to make the person even more desperate for attention and in turn would increase the likelihood of the person acting out her distress rather than decrease it. In some cases, the dangerousness of a person’s behaviour might leave the staff with little other choice, but placing the person in seclusion would likely increase the person’s desperation and subsequent acting out as well, and placing her on one-to-one observation would increase her dependence on staff for coping and remaining safe, rather than promoting independence and coping.
d. Self-injurious behaviour is often a response to overwhelming emotions or to “numbing,” in itself a response to such emotions (but one that, as it continues, also becomes intolerable to the person). The goal in responding to such behaviour is to provide for the person’s safety and increase the person’s ability to recognize and intervene in its causes, while at the same time avoiding inadvertent reinforcement of the behaviour by providing undue attention or support in response to it. In practice, the nurse would provide first aid in a neutral manner and, instead of processing the causes at that moment, first assign the person to contemplate and write about events leading up to the self-injury. This approach is intended to help the person become more independent in being able to recognize and manage her own emotional responses.
d. Self-injurious behaviour is often a response to overwhelming emotions or to “numbing,” in itself a response to such emotions (but one that, as it continues, also becomes intolerable to the person). The goal in responding to such behaviour is to provide for the person’s safety and increase the person’s ability to recognize and intervene in its causes, while at the same time avoiding inadvertent reinforcement of the behaviour by providing undue attention or support in response to it. In practice, the nurse would provide first aid in a neutral manner and, instead of processing the causes at that moment, first assign the person to contemplate and write about events leading up to the self-injury. This approach is intended to help the person become more independent in being able to recognize and manage her own emotional responses.
A patient is flirting with a peer and is overheard asking him to intercede with staff so that she will be given privileges to leave the inpatient mental health unit. Later, she offers a back rub to a nurse if that nurse will give her the prn sedation (sedation as needed early, although it has been ordered for 1000 hrs. Which response to such behaviours would be most therapeutic?
a. The patient is demonstrating manipulative behaviour. The goal is for her to replace maladaptive responses with approaches that are both more effective and more socially acceptable. The process for doing this involves increasing the patient’s self-awareness, identifying and encouraging alternate ways of meeting her needs, and setting limits (with predicable and clear consequences). Labelling the behaviour helps identify it as maladaptive, building insight.
b. Advising other patients of this person’s manipulative behaviour and seeking their assistance would represent a degree of violation of this patient’s confidentiality.
c. Bargaining with the patient would tend to reinforce the manipulative behaviour by rewarding her with partial success in response to the manipulation.
d. Ignoring the behaviour, whether it be the staff or the patient’s peers who ignore it, is a passive response that would not be likely to result in either the development of insight or a change in the person’s behaviour.
a. The patient is demonstrating manipulative behaviour. The goal is for her to replace maladaptive responses with approaches that are both more effective and more socially acceptable. The process for doing this involves increasing the patient’s self-awareness, identifying and encouraging alternate ways of meeting her needs, and setting limits (with predicable and clear consequences). Labelling the behaviour helps identify it as maladaptive, building insight.
A person becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic?
a. The person demonstrated impaired frustration tolerance and a maladaptive response to anger. He was acting out his anger by throwing the music player. Most acting out occurs in response to desperation and an impaired ability to communicate intense feelings via more acceptable means. Placing the person in seclusion or threatening to remove his privileges, especially if done in the absence of other interventions, would likely increase his desperation and lead to more acting out rather than less.
b. Similarly, simply pointing out that his behaviour is intolerable without offering alternatives or helping him change his behaviour would only increase his desperation and acting out.
c. Offering to help him learn to operate the music player might enhance the therapeutic relationship and reduce his distress with the music player, but it would not help him learn better ways to manage his anger and frustration.
d. However, exploring with the person how he was feeling would help the person learn to identify the cues that his feelings were intensifying.
d. However, exploring with the person how he was feeling would help the person learn to identify the cues that his feelings were intensifying.
