Exam 3 Chapter 23 Flashcards
when traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning
personality disorder
separation anxiety resolves between 24-36 mos
Mahler
Yellow bile
irritable and hostile
pessimistic and melancholic
black bile
overly optimistic and extraverted
blood
apathetic phlegmatic
phlegm
moral insanity of old
became personality d/o
3 Clusters of PD
A: odd or eccentric
B: draumatic, emotional or irratic
C: anxious or fearful
Paranoid
Schizoid
Schizotypal
Cluster A: odd or eccentric
Antisocial
Borderline PD
Histrionic
Narcisistic
Cluster B: draumatic, emotional or erratic
Avoidant
Dependent
OCD
Cluster C: anxious or fearful
pervasive, persistent and inappropriate mistrust of others
1:4 in population
men>women
Paranoid
profound defect in relationships
unable to experience pleasure
bland and constricted affect
shy, anxious, introverted kid with bleak, cold childhood lacking empathy and learning
Schizoid
alouf and isolated
living in own world
odd, eccentric behavior that does not decompensate into schizophrenia
magical thinking, ideas of reference, illusions, depersonalization
Schizotypal
socially irresponsible, exploitative, guiltless behaviors that reflect a disregard for the rights of others
antisocial
pattern of intense and chaotic relationships with affective instability and fluctuating attitudes toward other people.
Impulsive, self-destructive, lack a clear sense of identity
women (4) > men (1)
borderline pd
colorful, dramatic, extroverted behavior in excitable, emotional ppl
woemn > men
self dramatizing, attention seeking overly agregarious and seductive
histrionic
demonstrate what our society tends to foster and admire in its members: to be well-liked, successful, popular, extroverted, attractive, and sociable. However, beneath these surface characteristics is a driven quality-an all-consuming need for approval and a desperate striving to be conspicuous and to evoke affection or attract attention at all costs. Failure to evoke the attention and approval they seek often results in feelings of dejection and anxiety
histrionic
highly distractible and flighty by nature
display themselves as carefree and sophisticated on one hand, and inhibited and naive on the other. Tend to be highly suggestible, impressionable, and easily influenced by others.
histrionic
Nothing they do works consistently, such children experience frustration in getting their parents’ attention and exaggerate behaviors basic to their gender stereotype to secure compliments and affection. Otherwise, they are ignored. Such children enter adolescence with a nearly insatiable thirst for attention and love
Histrionic PD
exaggerated sense of self-worth
lack empathy
believe they have the inalienable right to receive special consideration, and that their desire is sufficient justification for possessing whatever they seek.
6% population and men>women
Narcissistic
lack humility, being overly self-centered, and exploiting others to fulfill their own desires
Narcissistic
optimistic mood, relaxed, cheerful and carefree
fragile self-esteem
if they do not gain the approval they persued: rage, shame, humiliation, or dejection
narcissistic
as children, fears, failures, or dependency needs responded to with criticism, disdain, or neglect.
Unable to view others as sources of comfort and support
project an image of invulnerability and self-sufficiency to conceals true sense of emptiness and contributes to inability to feel deeply.
Narcissistic
extremely sensitive to rejection which may lead to a socially withdrawn life. There may be a strong demand for companionship, but are too fearful of rejection.
Extreme shyness and fear of rejection create needs for unusually strong assurances of unconditional acceptance. 2%, men=women
avoidance pd
timid, withdrawn, cold, strange
avoidance pd
speech is slow and constrained with frequent hesitations, fragmentary thought sequences, and occasional confused and irrelevant digressions. Depression, anxiety, and anger at oneself for failing to develop social relations are commonly experienced
avoidance pd
primary psychosocial predisposing influence to _____ disorder is parental rejection and censure, which is often reinforced by peers.
avoidance
a pattern of relying on others excessively for emotional support
dependent d/o
more common in women than men and in the youngest child of the family
dependent d/o
a notable lack of self-confidence that is apparant in posture, voice, and mannerisms
dependent d/o
see the world through rose colored glasses
dependent d/o
pessimistic, discouraged, rejected; suffering is done in silence
dependent d/o
avoid positions of responsibility and become anxious when forced into them
dependent d/o
psychosocially, ________ is fostered in infancy when stimulation and nurturance are experienced exclusively from one source.
dependent d/o
child may come to fear a loss of love or attachment from the parental figure if independent behaviors are attempted
dependent d/o
serious, formal, and have difficulty expressing emotions
overly disciplined, perfectionistic, and preoccupied with rules
have a devotion to productivity to the exclusion of personal pleasure
more common in men>women, oldest child in family
OCD
intense fear of making mistakes leads to difficulty making decisions
OCD
are contemptuos of people whose behavior they view as frivolous or impulsive
OCD
commonly use reaction formation
OCD
praise for positive behaviors in childhood is bestowed much less frequently than punishment for undesirable behaviors; learn what they must NOT do to avoid punishment instead of what they CAN do to receive award
OCD
ambulatory schizophrenia, pseudoneurotic schizophrenia, and emotionally unstable personaltiy
borderline pd
prefer a frantic search for companionship, no matter how unsatisfactory, to sitting with feelings of lonliness, emptiness, and boredom; possess a chronic fear of abandonment
borderline PD
people and life situations are either all good or all bad
splitting-primitive ego defense mechansim assoc with borderline pd
splitting arises from lack of
object constancy and is manifested by an inability to integrate and accept both positive and negative feelings (borderline pd)
Manipulation
to avoid or achieve relief from separation anxiety in borderline PD
What is the neurotransmitter assoc with borderline pd
decreased serotonin (like depression)
Which phase of Mahler’s theory of object relations do ppl with borderline pd get stuck in?
reapprochement phase (16-24mos): awareness of separateness of self becomes acute; this is frightening to the child, who wants to regain some lost closeness but not return to symbiosis. The child wants the mother there as needed for emotional refueling, and to maintain feelings of security. In the case of borderline pd, mom gets threatened when baby becomes more independent-and withdraws emotional support-no more “refueling”; mom rewards clinging, dependent behaviors, and punishes independent ones
unresolved grief for the nurturing they failed to receive results in internalized rage that manifests itself in the _____so common in ppl with borderline pd
depression
risk for self-mutilation risk for self-directed violence risk for suicide risk for other-directed violence complicated grieving impaired social interaction disturbed personal identity anxiety (severe to panic) chronic low self esteem
nursing diagnoses for borderline pd
The Client: has not harmed self seeks out staff when desire for self-mutilation is strong is able to identify true source of anger expresses anger appropriately relates to more than one staff member completes ADLs independently does not manipulate one staff member against the other in order to fulfill own desires
outcomes for borderline pd
seldom seen in clinical settings, when they are, it is commonly a way to avoid legal consequences
antisocial pd
possess a low tolerance for frustration, at impetuously, and are unable to delay gratification
antisocial pd
tend to be argumentative, cruel, and malicious. Appear cold, callous, often intimidating others with brusque and belligerent manner
antisocial pd
first inclination is to demean and dominate
antisocial pd
believe “good guys come in last”
antisocial pd
Use PROJECTION as primary ego defense mechanism; they do not accept responsibility for the consequences of their behavior
antisocial pd
One of the most distinctive characteristics of these individuals is their tendency to ignore conventional authority and rules; they are flagrant in their disrespect for the law and for the rights of others
antisocial pd
as a child, this patient displayed tantrums since infancy and would become furious when awaiting a bottle or diaper change. As they mature, they become bullies of other children. They are undaunted by punishment. They are daring and foolhardy in their willingness to change physical harm, and they seem unaffected by pain
antisocial pd
ADHD and conduct disorders in childhood and adolescence are predisposing factors to which personality d/o?
antisocial pd
Which is most damaging? presence or intermittent appearance of inconsistent impulsive parents or loss of a consistent parent
inconsistent impulsive parents is most damaging
risk for other-directed violence defensive coping chronic low self esteem impaired social interaction ineffective health maintenance
nursing diagnoses for antisocial pd
absence of parental discipline
extreme poverty
removal from the home
growing up without parental figures of both sexes
erratic and inconsistent methods of discipline
being “rescued” each time they are in trouble (never have to suffer the consequences of their own behavior)
maternal deprivation
predisposing factors to antisocial pd
psychoanalytical psychotherapy
treatment of choice for histrionic pd
treatment focuses on the unconscious motivation for seeking total satisfaction from others and for being unable to commit oneself to a stable, meaningful relationship
Milieu or group therapy
appropriate for antisocial pd
Cognitive/behavioral therapy
useful for ocd, antisocial, and avoidant personality
dialectical behavior therapy
a treatment for the chronic self-injurious and parasuicidal behavior of clients with borderline pd. combines concepts of cognitive, behavioral, and interpersonal therapies with eastern mindfulness practices
due to its success with borderline pd pts, DBT is now used with substance use disorders, eating disorders, schizophrenia, nd ptsd.
antipsychotic meds
helpful in treating psychotic decompensations experienced by paranoid, schizotypal, and borderline pd’s
how to treat violent episodes observed in clients with antisocial pd?
lithium and propranolol
what med do we give to pts with avoidant pd
anxiolytics, antidepressants like Zoloft and Paxil if panic d/o develops
Drugs for borderline do
SSRIs and MAOIs
