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N363: Practice of Nursing IV > Exam 2: Personality Disorders > Flashcards

Exam 2: Personality Disorders Flashcards

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1
Q

Personality

A

Complex pattern of characteristics largely outside of the person’s awareness, which compromise the individual’s distinctive pattern of perceiving, feeling, thinking, coping and behavior

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2
Q

Personality Traits

A

Prominent aspects of personality that are exhibited in a wide range of social and personal contexts

The are the lower level - the behaviors that are exhibited as a part of personality basically

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3
Q

Personality and Personality Traits tend to do be what

A

Stable over time (minor differences based on mood but generally consistent)

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4
Q

Personality Traits are enduring patterns of what 3 things?

A
  1. Perceiving
  2. Relating To
  3. Thinking about environment and oneself
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5
Q

Personality involves what 4 aspects?

A
  1. Cognition
  2. Affectivity
  3. Interpersonal Behavior
  4. Impulse Control
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6
Q

Cognition

A

Ways of perceiving and assigning meaning to self, others, and events

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7
Q

Affectivity

A

The range, intensity, and appropriateness of emotionality

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8
Q

Personality development develops as a response to what things?

A

Biological and Psychological Influences:

  1. Heredity
  2. Temperament
  3. Experiential Learning
  4. Social Interaction
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9
Q

When do Personality Disorders often manifest?

A

Adolescence and early adulthood

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10
Q

Prevalence of personality disorders is estimated to be about ___%

A

9.6

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11
Q

Personality disorders often co-occur with ___ and ___

A

Depression and Anxiety

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12
Q

It is important to know what regarding when personality disorders appear?

A

They will appear BEFORE other psychiatric disorders

ex: Someone with BPD will develop the depression and anxiety over time

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13
Q

Why is it so difficult to have accurate numbers about personality disorders?

A

Difficult to verify number of population affected due to significant numbers of individuals not seeking professional help

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14
Q

___ can be a major risk factor for the development of certain personality disorders

A

Gender

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15
Q

Women are at an increased risk for what personality disorders?

A

Avoidant PD

Dependent PD

Paranoid PD

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16
Q

Men are at higher risk for what personality disorder?

A

Antisocial PD

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17
Q

What groups have a higher prevalence and occurrence of personality disorders?

A

African American and Native American Groups

Young Adults

Low SES

Divorced, Separated, Widowed, Never Married

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18
Q

Personality Disorder (Definition)

A

A RIGID, stereotyped behavioral pattern that persists throughout a person’s life.

CHRONIC maladaptive pattern of perceiving, thinking, and relating that impairs social or occupational functioning causing inner distress

Rigid, throughout life, consistent, and chronic

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19
Q

Personality disorders deviate markedly from what?

A

The expectations of a person’s culture

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20
Q

Personality disorders are ___ and put people are risk for ___ ___ like…

A

SERIOUS

PSYCHIATRIC CO-MORBIDITIES

Mood disorders, anxiety, substance abuse, injuries to self/others

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21
Q

Personality disorders occur when personality traits become what?

A
  1. Inflexible and Rigid (change very hard to make)
  2. Maladaptive
  3. Cause significant dysfunction (in roles, etc) or severe impairment and SUBJECTIVE distress
  4. A lifelong behavioral pattern that negatively affects many areas of life, causes problems, and is not produced by another disorder or illness
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22
Q

Individuals with personality disorders lack…

A

INSIGHT

Understanding of the impact of their behavior on their environment

Fail to accept consequences of their own behavior

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23
Q

Individuals with personality disorders when threatened may attempt to do what?

A

Manipulate or change their environment to decrease stress instead of actually changing the behavior

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24
Q

Many individuals with other psychiatric and medical diagnoses manifest symptoms of…

A

Personality Disorders

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25
Q

Psychoanalytic Theory of PD

A

Empathize importance of nurturing from immediate caregivers and loved ones for fostering positive personality traits

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26
Q

Biologic Theory of PD

A

Stress influence of genetic transmission combined with environmental exposures for the formation of personality can lead to PD

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27
Q

Social Learning and Cognitive Perspectives Theory of Personality Disorders

A

People acquire personality characteristics through thought and interaction with their environment

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28
Q

When development is stalled, disrupted, or becomes negative…

A

There is a risk for problems - like personality disorders

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29
Q

According to the DSM V, Personality Disorders must meet what overarching criteria

A
  1. Significant impairment in self or interpersonal functions
  2. One or more pathological personality trait
  3. Impairments are stable over time / across situations
  4. Personality traits or trait expressions are not normative for developmental stage or cultural environment
  5. Not due to the use of a substance or medical condition
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30
Q

3 Cluster Types of Personality Disorders

A

A
B
C

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31
Q

Cluster A PD’s represent behaviors described as what

A

Odd or Eccentric

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32
Q

Cluster B PD’s represent behaviors that are described as what

A

Dramatic, Emotional, or Erratic

High emotion and high charged interactions; lack of consistency in behavior - needs consistent treatment

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33
Q

Cluster C PD’s represent behaviors that are described as

A

Anxious and Fearful

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34
Q

What PDs are in Cluster A

A

Paranoid PD

Schizoid PD

Schizotypal PD

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35
Q

What PDs are in Cluster B

A

Antisocial PD

Borderline PD

Histrionic PD

Narcissistic PD

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36
Q

Paranoid Personality Disorder

A

Cluster A - Odd or Eccentric

A pervasive DISTRUST and SUSPICIOUSNESS of others such that others’ motives are interpreted as malevolent and Quick to take Offence

Do not acknowledge their negative feelings and will Project negative feelings on others while looking for hidden meanings in conversations

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37
Q

When does Paranoid Personality Disorder develop?

A

Begins by early adulthood and presents in a variety of contexts

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38
Q

Clinical Observations/Characteristics of Paranoid PD

A

Constantly on guard

Hypervigilant, guarded, oversensitive to surroundings and interactions

Ready for any real or imagined threat, mistrusts, and misinterprets cues

Magnifies and distorts environmental cues

Trusts NO ONE - has few if any friends

Constantly tests the honesty of others

DOES NOT LOSE CONTACT WITH REALITY

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39
Q

What is the major characteristic setting paranoid PD apart from schizophrenia?

A

There is no loss of contact with reality in Paranoid PD

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40
Q

Predisposing factors for Paranoid PD

A

Possible hereditary link

Being subject to early parental antagonism and harassment

4.4% of population estimated to have Paranoid PD

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41
Q

Schizoid Personality Disorder

A

Cluster A = Odd or Eccentric

Shows indifference to social relationships and is characterized primarily by a profound defect in the ability to form personal relationships

Fails to respond to others in a meaningful and emotional way

Affect: Flat, cold, unsociable, seclusive demeanor

42
Q

Clinical Observations/Characteristics of Schizoid PD

A

Indifferent to others and the environment

Aloof, withdraws from social events

Emotionally cold, flat affect

In the presence of others, client at first appears shy anxious or uneasy

Inappropriately serious about EVERYTHING and has difficulty acting in a light hearted manner/humor

43
Q

Predisposing Factors for Schizoid PD

A

Possible hereditary factor

Childhood characterized as Bleak, Cold, Unemphatic, Notably lacking in nurturing

3.1% estimated general population

44
Q

Schizotypal Personality Disorder

A

Cluster A = Odd or Eccentric

Displays an enduring and pervasive pattern of interpersonal deficits with extreme discomfort and intolerance for close relationships

Can be described as a more serious form of Schizoid PD in a way - but what makes it different is that the thought patterns are disturbed and there are odd behaviors

45
Q

What sets Schizotypal apart from Schizoid PD

A

Schizotypal has thought patterns that are more odd with behaviors and are disturbed

46
Q

Clinical Observations/Characteristics of Schizotypal PD

A

Exhibits bizarre speech patterns

Aloof, isolative, inappropriate affect, social anxiety

When under stress - may decompensate and demonstrate psychotic symptoms–> less safety issues than schizophrenia but still has safety concerns

Everyday world manifests with magical thinking and ideas of reference believing they control things they do not actually control

Delusions and Depersonalization

47
Q

Predisposing Factors for Schizotypal PD

A

Possible Hereditary Link or other possible physiological influence such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain (dysregulation of dopaminergic pathways)

Early family dynamics of indifference, impassivity (void of emotions)

Parental patterns of discomfort with personal affection and closeness

48
Q

How do the delusions of Schizotypal PD differ from the delusions of Schizophrenia

A

There are no EXTREME safety risks in SPD (but that does not mean safety is not a concern)

49
Q

What do Cluster B PD’s typically act like?

A

Dramatic, Emotional, Attention Seeking Behaviors

Moods are labile (constantly changing, fluctuating, unstable) and shallow

Become involved in intense interpersonal conflicts

Antisocial and Narcissistic = more common in men; Borderline and Histrionic more common in women

50
Q

Antisocial Personality Disorder (Anti-social, A-social, Psychopathy, Sociopathy)

A

Cluster B = Dramatic, Emotional, Erratic

Aggressive and irresponsible behaviors

Superficially charming

Lack genuine warmth

51
Q

What is the prevalence of Antisocial PD

A

In the US:

3% of men, 1% of women 18 +

52
Q

What is Antisocial PD if it is caught in someone 15 years old or younger

A

Conduct Disorder

53
Q

Antisocial behavior is a pattern of what

A
  1. Being socially irresponsible, domestic violence, fighting, stealing, substance abuse
  2. Being exploitative and manipulative
  3. Having guiltless behavior that reflects a disregard for the rights of others
  4. Failure to conform to society laws and norms
54
Q

Predisposing factors for Antisocial Personality Disorder

A

Possible genetic influence

Sociopathic mother/father

Aggressive temperament as a child

Parental deprivation during the 1st 5 YEARS OF LIFE

History of ADHD or CD during childhood or adolescence

Absence of parental discipline or influence, Erratic and inconsistent methods of parenting

Extreme poverty

Removal from the home

Being “rescued” each time they are in trouble - never suffering consequences of their own behavior

Maternal/Paternal Deprivation

55
Q

Antisocial PD is often in correlation with ___ and ___

A

ADHD and CD

56
Q

Clinical Observations/Characteristics of Antisocial PD

A

Fails to sustain consistent employment

Exploits and manipulates others for personal gain

Cold, Callous, intimidating

inconsistent work or academic performance

failure to conform to societal norms

cruel and malicious

inability to form lasting monogamous relationships

low levels of behavioral inhibitions

very difficult to diagnose and treat

lack of fear

poor decisions making/ lack thereof

difficult to diagnose and treat - non compliant and hard to engage

57
Q

Borderline Personality Disorder

A

Cluster B = Dramatic, Emotional, Erratic

Characterized by a pattern of intense and chaotic relationships with affective instability

Have fluctuating and extreme attitudes and moods regarding other people

Splitting

58
Q

Splitting (definition)

A

Act of viewing life experiences and relationships to extremes of either VERY good or VERY bad

Common in BPD

59
Q

What sort of characteristics may describe someone with BPD

A

View themselves as victims

Highly impulsive

Mood swings

Depression, anger, anxiety

Potential for self mutilation, harming themselves

Aggression for attention or numb emotions

60
Q

When it comes to BPD what is a big concern

A

Safety - they can impulsively hurt themselves

61
Q

Predisposing factors for BPD

A

Possible hx of child abuse, neglect, and separation from caregivers or loved ones

Others with psychiatric disorders in the home

Genetic - possible hereditary factor

Biochemical - some research has shown changes in certain areas of the brain are involved in emotion regulation, impulsivity and aggression - also some brain chemicals that help regulate mood like serotonin may not function properly

62
Q

What is the most common personality disorder?

A

Borderline Personality Disorder

63
Q

__% of the general population has BPD and 75% of that group is ____

A

2; female

64
Q

Someone with BPD appears as ____ ____

A

Emotionally Unstable

65
Q

Clinical Observations and Characteristics of BPD

A

Emotionally unstable

Identity disturbances in body image, sexuality, long term goals and careers

Extreme affective instability usually lasting a few hours and usually no longer than a day

Always seems to be in a state of crisis!!!! - extreme affect, behavior reflects frequent changeability, self destructive behavior present

Patients are most strikingly identified by the intensity and instability of affect and behavior

66
Q

BPD patients are most strikingly identified by the ___ and ___ of their affect and behavior

A

instability and intensity

67
Q

How long does the extreme affective instability of BPD episodes usually last?

A

Usually lasts a few hours, usually no longer than a day

68
Q

Common Behaviors in BPD

A

Depression

Inability to be alone and attention seeking behaviors

Clinging and distancing behaviors

Splitting

Manipulation

69
Q

Histrionic Personality Disorder

A

Cluster B = Emotional, Erratic, Dramatic

Long standing pattern of excessive emotionally charged interactions and attention seeking behaviors

Strives to be the center of attention, speech superficial, lacks detail

Seductive, insecure, dependent on approval of others, naive, easily influenced

low tolerance to frustration, blame disappointments on others, suppresses feelings r/t past events and lacks insight

70
Q

In Histrionic PD they lack ___

A

Insight (unaware of their behaviors, unlike BPD)

71
Q

___% of the general population has Histrionic PD and most are ___

A

1.8; female

72
Q

Predisposing Factors for Histrionic PD

A

Possible link to noradrenergic and serotonergic systems

Possible hereditary factor

Learned behavior patterns

73
Q

Clinical Observations/Characteristics of Histrionic PD

A

Highly distractible

Difficulty paying attention to detail

Flamboyant in dress and speech - exhibitionistic

Easily influenced by others

Difficulty forming close relationships: excitable, emotional, colorful, dramatic, manipulative, attention seeking

Extroverted in behavior, seductive

74
Q

Cluster A tends to be more _____ while Cluster B is more ____

A

Introverted; Extroverted

75
Q

Narcissistic Personality Disorder

A

Cluster B - Dramatic, Emotional, Erratic

Lifelong pattern of self centeredness, self absorption, inability to empathize, insensitivity of others, grandiosity, extreme desires for admiration, feeling special and important with rights for special treatment, exaggeration of successes, fragile self esteem, oversensitivity to comments/criticism, envy for others and belief people envy them

76
Q

_____% of the population has Narcissistic PD and most are ____

A

6%; male (75%; Women 25%)

77
Q

Despite what you may think, what is a Narcissistic PD self esteem usually like?

A

Very fragile and quickly is oversensitive to comments to criticism

78
Q

Predisposing Factors for Narcissistic PD

A

Tendency to be overpampered and Indulged - Learned to view themselves as special and grow to expect special treatment from others

Parents often were narcissistic themselves

79
Q

Clinical Observations/Characteristics of Narcissistic PD

A

Mood can easily change because of fragile self esteem if they do NOT: meet self expectations or receive positive feedback from others

Criticism from others may cause them to respond with rage, shame, and humiliation

Clients are overly self centered, overly sensitive to what others think, insensitive to others needs, lack empathy

Exploit others in an effort to fulfill their own desires

Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and care-free

80
Q

Avoidant Personality Disorders

A

Cluster C = Anxious or Fearful

Pattern in early adulthood of social discomfort, timid, fear of rejection and negative feedback

Will only form relationships if acceptance is guaranteed, self perception of unattractiveness, inferior, socially inept

Avoids social demands, feelings of shame, embarrassment, ridicules trying new things

81
Q

What makes Avoidant PD different from a social phobia

A

Avoidant personality disorder involves ALL SOCIAL ACTIVITIES whereas social phobia involves specific situations

82
Q

What is the prevalence of Avoidant PD

A

2-4% of the general population

Equally common in both sexes

83
Q

Predisposing Factors for Avoidant Personality Disorder

A

Possible hereditary influences

Parental rejection and criticism

84
Q

Clinical Observations/Characteristics of Avoidant PD

A

Awkward and uncomfortable in social situations

Easily embarrassed

DOES DESIRE CLOSE RELATIONSHIPS but avoids them because of their fear of being rejected

Inappropriate displays of anger, dissociative, paranoid ideation, preoccupied being criticized or rejected

85
Q

Dependent Personality Disorder

A

Cluster C = Anxious or Fearful

Excessive need to be taken care of, pervasive, submissive and clinging behaviors

Fears of separation, Difficulty in Making Independent decisions and starting projects, lack trust in their own judgments

Helpless, Hopeless, Relationships are based on being cared for - will even stay in abusive relationships

86
Q

___% of the population has dependent PD and it is most common in the ____ child of a family

A

0.5%; youngest child of a family

87
Q

Predisposing Factors for Dependent Personality Disorder

A

Possible Hereditary influence

Stimulation and nurturance are experienced exclusively from a single source

A singular attachment is made by the infant to the exclusion of all others

88
Q

Clinical Observations/Characteristics of Dependent PD

A

They have a notable LACK OF SELF CONFIDENCE that is often apparent in their: POSTURE, VOICE, MANNERISMS

Typically passive and acquiescent to the desires of others

Overly generous and thoughtful, while underplaying their own attractiveness and achievements

Assume passive and submissive roles in relationships

Avoid positions of responsibility and become anxious when forced into them

89
Q

Across the board, the most common group of treatments for PD’s is ___

A

Therapies

90
Q

Treatments for Personality Disorders

A

Interpersonal Psychotherapy

Psychoanalytical Psychotherapy

Milieu or Group Therapy (Practice social skills in a safe place)

Cognitive Behavioral therapy

DBT (Dialectical Behavior Therapy) for BPD

Case Management - lots of support in community and for BPD safety issues

Psychopharmacology

91
Q

Why is DBT (Dialectical Behavior Therapy) good for BPD

A

it dives into behaviors and changes thought processes

92
Q

Overall what are some Symptoms of Cluster A PD’s

A

Suspiciousness

Paranoia

Distrustfulness

Preoccupation

Reluctance or inability to trust

Reads into interactions as having hidden agendas

Isolative

Flat affect

Blunted or limited emotional response

Limited to no meaningful relationships

Detached from activities

Socially detached

Odd thinking. speech and behaviors

Social anxiety

Negative self judgments

93
Q

Goals for Cluster A PD’s

A

Solve immediate crisis or problem - since they will not focus on anything else until its solved - and complete social skills training!!! (milieu or group therapy maybe)

94
Q

Symptoms of Cluster B PD’s

A

Disregards and violates rights and safety of others

Failure to conform to social norms

Deceitful

Erratic work patterns if any

Instability in relationships

Reckless disregard

Irresponsible

Aggressive toward self and/or others

Manipulative

Mood swings

Instability of emotions (Labile)

Unstable self image

Theatrical

Exaggerated speech and manners

Impulsive

Attention seeking

Must be center of attention

Feelings of emptiness

95
Q

Goals for Cluster B PD’s

A

1. PREVENT SUICIDE AND HARM

Gain insight

Improve coping

Gain insight into feelings and behaviors and unrealistic expectations and fears

96
Q

Symptoms of Cluster C PD’s

A

Avoidant of social activities due to fears of criticism, disapproval or rejection

Feelings of inadequacies

Fear of being shamed or ridiculed in intimate relationships

Difficult decision making

Inappropriate anger with displays of temper

Excessive needs to be taken care of

Difficult with expressive disagreements with others

Lack of self confidence

Lack of initiating projects or relationships

Goes to any length to be nurtured and cared for

Helplessness and insecure when alone

97
Q

Goals for Cluster C PD’s

A

Enhance social functioning

Solve immediate crisis

Assertiveness training

Cognitive reconstruction

98
Q

Approaches for Nurses to use with Cluster A Clients (Odd or Eccentric)

A
  1. When Guarded, Suspicious, Argumentative ==> acknowledge their perception without debate or agreement. Focus attn on treatment and be respectful while maintaining professional distance
  2. When aloof or uninvolved ==> demonstrate understanding and respect privacy. Explain rationale for personal questioning and do not push for social interaction
  3. When idiosyncratic or eccentric ==> consistent approach addressing complaints and beliefs, do not challenge or reinforce perspectives
99
Q

Approaches for nurses to use with Cluster B clients (Dramatic, Emotional, Erratic)

A
  1. Demanding ==> SET LIMITS - minimize excessive or realistic demands
  2. Dramatic, Emotionally involved, Seductive ==> Supportive attitude, maintain professional boundaries to prevent unprovoked responses
  3. Superior Client ==> recognize and support strengths, show interest in opinions, demonstrate competence
  4. Sociopath ==> set realistic limits on visits, do not tolerate aggression, develop treatment plan to address aggressive behavior
100
Q

Approaches for nurses to use with Cluster C clients (Anxious or Fearful)

A
  1. Orderly, Controlled, controlling ==> Clearly state treatment approaches, options, rationales, give as much detail as possible, avoid struggle of who is in charge
  2. Anxiously avoidant, clining, dependent ==> Demonstrate patience, empathy to fears, frequent brief encounters, forewarn of any milieu changes
  3. Controlling, avoidant, dependent ==> directly address concerns about behaviors, ID underlying feelings about their illness and treatment, avoid being resentful about “acting out” behaviors
101
Q

Nursing Considerations for Personality Disorders

A

SAFETY

Trust

Protection and Vulnerable Population

hygiene and nutrition

Communication and social skills

Normal communication skills compromised by emotion - appropriate communication skills will be needed for successful relationships

102
Q

Nursing Diagnoses for Personality Disorders

A

Risk for self or other direct violence

Risk for self mutilation

Ineffective coping

Disturbed thought process

Anxiety

Fear

Impaired social interaction

Chronic low self esteem

Ineffective therapeutic regimen management

Ineffective family coping

N363: Practice of Nursing IV (16 decks)

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