Chapter 24 personality disorder - ati 16

Question 1

Personality Disorders (PD) are?

Answer 1

defined as an enduring pattern of inner experience and behavior that is stable over time and leads to distress or impairment.

1. Deviates from the expectations of the person’s culture
2. Pervasive and inflexible
3. Begins in adolescence or early adulthood
4. Difficulty getting along with others
5. PD are descriptions of traits a person expresses that make up the whole of who the person is.

Question 2

Common characteristics PD:

Answer 2

1. Inflexible and maladaptive response to stress
2. Disability in working and loving (relationships)
3. Ability to evoke interpersonal conflict
4. Capacity to frustrate others
5. Approximately 10% of U.S. adults have at least one personality disorder

Question 3

Cluster A are?

Answer 3

Odd & Eccentric

1. Paranoid—pervasive distrust and suspiciousness of others and will interpret others’ motives as malevolent (Defense mechanism of Projection)
2. Schizoid—detachment from social relationships and a restricted emotional expression
3. Schizotypal—acute discomfort in close relationships, cognitive or perceptual distortions & eccentricities of behavior
   
   1. Magical Thinking/odd beliefs
   2. Does not lose contact with reality
   3. Can be made aware of their distorted thinking and reality
   4. DSM-5 also lists as first of schizophrenia spectrum disorders.

Question 4

Cluster B are?

Answer 4

Dramatic and emotional

1. Borderline –instability in interpersonal relationships, self-image, and marked impulsivity, emotional lability
2. Narcissistic-grandiosity, need for admiration, and lack of empathy
3. Antisocial—disregard for, and violation of the rights of others for personal gain.Callousness and lack of concern for others
4. Histrionic—excessive emotionality and attention seeking (seductiveness)

Question 5

Cluster C are?

Answer 5

Anxious or fearful

1. Obsessive Compulsive—preoccupation with orderliness, perfectionism and control, rigidity and inflexible standards
2. Avoidant—social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation (fears rejection and criticism)
3. Dependent—submissive and clinging behavior related to an excessive need to be taken care of (intense fear of separation)

Question 6

Nursing care of cluster A?

Answer 6

Odd and eccentric PD

1. Realize the client will probably not respond to efforts to build a relationship
2. Behaviors that cause the client difficulty can be addressed (i.e. grooming, social skills)
3. Focus on the behavior and not the personality
4. Be respectful and unobtrusive
5. Allow physical and emotional space (provides safety in the NPR)
6. Use clear, straightforward communication
7. Use humor cautiously (Paranoid Personality)

Question 7

Nursing care of Cluster B?

Answer 7

Dramatic & Emotional PD - most common

1. Nurses may become frustrated and angry because the person demands extreme amounts of attention (professional stigma)
2. Nurse needs to set limits, state clearly what s/he can and cannot do, and keep to the schedule. Refrain from arguing or bargaining
3. If the nurse is criticized, remember, it is part of the Cluster B dynamics. It is not about you
4. Work as a team with other care-givers. Avoid talking in a way that criticizes the person for being who s/he is

Question 8

Borderline Personality Disorder?

Answer 8

• Splitting—view others and themselves in “all or nothing” Leads to stormy relationships alternating between black and white view of others.
• High suicide rate with BPD (

Question 9

Dialectical Behavior Therapy (DBT)?

Answer 9

1. Created specifically to treat BPD
2. Build a life worth living
3. Focus on changing harmful behaviors by teaching behavioral skills, group therapy first.
4. DBT helps with accepting, finding meaning for, and tolerating distress.
   
   1. Emotional regulation
5. DBT is a structured program to learn ways to bear pain skillfully. For example, to learn to substitute feelings of distress with adaptive coping.

Question 10

Nursing Care of Cluster C?

Answer 10

– Anxious and fearful PD

1. OCPD, OCD is worse
2. Give as much control to the person as is safe and reasonable
3. Businesslike approach to OCPD—clear and non-confusing directions
4. CBT to help client reassess a situation and see alternative solutions
5. Avoidant PD
   1. Direct, involved approach to gain trust
   2. Realize the person may be become more dependent on the few staff s/he feels she can trust
   3. Provide positive feedback to help build self-esteem
6. Dependent PD
   
   1. Help client to assume age-appropriate tasks
   2. Set limits on what you will do and what the client is expected to do for self
   3. Attempt to engage client in risk-taking behaviors