objective 5 Flashcards
Distinctive set of traits, behavior styles, and patterns that
make up our character and individuality
personality
Individuals display significant challenges in self-identity or
self-direction and have problems with empathy or
intimacy within their relationships
personality disorder’s
paranoid, schizoid, and schizotypal
cluster A
antisocial, borderline, histrionic, narcissistic
cluster B
avoidant, dependent and obsessive-compulsive
cluster C
Every developmental stage has a series of conflicts a
person must handle
erikson
Each person has certain amount of psychic energy to
cope with everyday problems
Freud
what are clinical symptoms of personality disorders?
Changes in cognition
Fluctuation in emotional responses (affect)
Changes in interpersonal functioning
Fluctuating impulse control
what are the diagnostic characteristics of personality disorders?
Evidence of an enduring pattern of behavior and inner
experience in at least two of the areas above (clinical
symptoms)
Stable, long lasting pattern exhibited as a marked deviation
from which is expected in the individual’s culture
Onset most likely traceable to adolescence or early adulthood
Pattern widespread, occurring over personal and social
situations
Resultant distress in important areas of functioning
Pattern not associated with or due to a medical condition or
another mental disorder
what are the characteristics of cluster A PD’s?
Suspicious/mistrust of others
Fear others will exploit, harm, or deceive them
Fear of confiding in others (fear personal information
will be used against them)
Misread compliments as manipulation
Hypervigilant
Prone to counterattack
Hostile and aloof
what are the nursing guidelines for cluster A PD’s
To counteract patient fear, nurses should give
straightforward explanations of tests, history taking,
procedures, adverse effects of drugs, changes in
treatment plan, and possible further procedures
what are the characteristics of schizoid PD?
Ideas of reference
Anxiety
Cognitive and perceptual distortions
Avoids close relationships, is socially isolated
Social ineptness
Social awareness is lacking, and relationships generate
fear and confusion in the patient
Has poor occupational functioning, and appears cold,
aloof, and detached
what are the nursing guidelines for schizoid PD?
Respect patient’s need for social isolation
Be aware of patient’s suspiciousness
Perform careful diagnostic assessment as needed to
uncover any other medical or psychological symptoms
that may need intervention (i.e. suicidal thoughts)
what are the characteristics of schizotypal PD?
A lifelong pattern of social isolation
Ideas of reference
Magical thinking or odd beliefs
Perceptual distortions; vague, stereotyped speech;
Blunted or inappropriate affect; distant and strained
Social relationships - patients tend to be frightened
what are the characteristics of cluster B PD’s?
Unstable, intense relationships
Identity disturbances; impulsivity; self-mutilation
rapid mood shifts; chronic emptiness
Intense fear of abandonment & anger
Major defense – splitting (alternating between idealizing &
devaluing)
Self-mutilation and suicide-prone behaviour
Anger is intense and pervasive
what are the nursing guidelines for cluster B PD’s?
Set realistic goals; use clear action words
Be aware of manipulative behaviors
Provide clear and consistent boundaries and limits
Use clear and straightforward communication
Behavioral problems - calmly review the therapeutic goals and
boundaries of the treatment
Avoid rejecting or rescuing
Assess for suicidal and self-mutilating behaviours
Relationship building, safety, & limit setting are other foci
what are the characteristics of histrionic PD?
Centre of attention; flamboyant
Seductive or provocative behaviours
Shallow, rapidly shifting emotion
Dramatic expression of emotions
Overly concerned with impressing others
Exaggerates degree of intimacy with others
Self-aggrandizing; preoccupied with own appearance
what are the characteristics of narcissistic PD?
Grandiosity, fantasies of power or brilliance
Disparaging (judgmental)
Need to be admired, sense of entitlement, arrogant,
patronizing, rude, overestimates self and underestimates
others
Patient demands the best of everything
Sensitive to rejection, criticism
Filled with rage
what are the nursing guidelines for narcissistic PD?
Remain neutral
Avoid engaging in power struggles or becoming
defensive in response to the patients disparaging
remarks
Convey unassuming self-confidence
what are the characteristics of antisocial PD?
Ability to seem normal
No anxiety or depression
Manipulative
Exploitive of others
Aggressive
Seductive
Callous toward others
Expects immediate gratification
what are the nursing guidelines for antisocial PD?
Try to prevent or reduce untoward effects of
manipulation
Set clear and realistic limits on behavior; provide clear
boundaries and consequences
Ensure limits are adhered to by all staff
Document signs of manipulation or aggression (times,
dates, and circumstances)
Be aware that antisocial patients can instill guilt when
they are not getting what they want (manipulation)
Substance abuse is best handled through well-organized
treatment program before any other form of therapy
starts
what are the characteristics of cluster B PD’s?
Excessively anxious in social situations
Hypersensitive to negative evaluation
Desiring of social interaction
what are the nursing guidelines for cluster C PD’s?
Friendly, accepting, reassuring approach
Being pushed into social situations can cause extreme
and severe anxiety
what are the characteristics of dependent PD
Inability to make daily decisions without advice and
reassurance
Need of others to be responsible for important areas of
life
Anxious and helpless when alone
Submissive (passive, obedient)
Solicit caretaking by clinging
Fear abandonment if they are too competent
Experience anxiety and may have coexisting
depression
what are the characteristics of obsessive-compulsive PD?
Perfectionistic
Has need for control
Inflexible, rigid
Preoccupied with details
Highly critical of self and others
what are the nursing guidelines for Obsessive-compulsive PD?
Guard against power struggles with patient
Most common defense mechanisms are
intellectualization, rationalization, reaction
formation, isolation, and undoing
Exhibit covert (hidden) obstructionism through
manipulation, procrastination (finds excuses for delays),
stubbornness
Inefficiency due to dependence on others
Lacks self confidence
Pessimistic about the future
passive-aggressive or negativistic PD
Exhibit life-long depressive symptoms
Chronically unhappy
Low self esteem
Self critical
Characteristics include, poor posture, raspy or hoarse
voice, flat or blunted affect, psychomotor
retardation/delay
depressive personality disorder
Assessment tools
Semi-structured interview by clinicians
Patient history
suicidal or homicidal ideation
current use of medications & other substances, food,
and money
involvement with the courts
current or past physical, sexual, or emotional abuse
Self-assessment
assessment
Ineffective coping
Anxiety
Risk for other-directed violence
Risk for self-directed violence
Impaired social interaction
Social isolation; Fear
Disturbed thought processes
Defensive coping
Self-mutilation
Chronic low self-esteem
Ineffective therapeutic regimen management
diagnosis
Patients with personality disorders are usually admitted
to psychiatric institutions for reasons other than their
PD
Most often seen - borderline & antisocial PD’s
BPD - impulsive, suicidal, self-mutilating, aggressive,
manipulative, and even psychotic under stress.
ASPD - manipulative, aggressive, and impulsive
planning
Safety and teamwork
* Pharmacological interventions
* Case management
implementation
Establishing parameters of desirable and acceptable
personal behavior
limit setting
Facilitation of expression of anger in adaptive, nonviolent
manner
anger control assistance
Assisting the person to mediate impulsive behavior through
the application of problem-solving strategies to social and
interpersonal situations
impulse-control training
The goal of milieu therapy is affect management within
a group context
Nurses must help patients verbalize feelings rather than
act them out
See Table 19.5: Dialogue with a person with
manipulative, aggressive, and impulsive traits
Milieu management
Broad array of psychotropic agents, all geared toward
maintaining cognitive function and relieving symptoms.
Antipsychotics may be useful for brief periods to control
agitation, rage, and brief psychotic episodes
Compliance is usually an important issue
Patients with PD are fearful about taking something over
which they have no control
pharmacological interventions
ow dose atypical antipsychotic agents
schizotypal personality disorders
Mood-Stabilizing Meds
ASPD
Anticonvulsant Mood-Stabilizing Meds, low-dose
antipsychotic meds, and omega-3 supplements (mood
and emotion)
BPD
SSRI (Celexa), SNRI’s (Cymbalta)
avoidant PD
