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BNKN Mental Health WB > Personality Disorder > Flashcards

Personality Disorder Flashcards

1
Q

What is personality? What are the factors identified which shape our personality?

A

enduring and recognising characteristics that make us unique and shape our responses to live events
Factors- genetics, family, life events, culture and society

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2
Q

What are personality traits ?

A

aspects of maladaptive personality behaviours that not meet the diagnosis for disorder emerges when an individual is under stress

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3
Q

When is someone’s personality considered to be a disorder

A

when behaviour manifestations interfere significantly with a person’s life or those close to them

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4
Q

List some reasons for self-harming

A
  • self-control
  • emotional tension build up
  • alleviating empty feeling
  • escaping flashbacks
  • expressing anger
  • releasing self-hatred
  • decreasing alienation from others
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5
Q

DSM 5 “cluster B’

A
  • Dramatic, emotional, erratic, labile mood, involvement in several intense interpersonal conflicts throughtout their lifetime
    At least 18 years old
    expressed conduct disorder before 15 years
    disregard for the law
    reckless, aggressive, deceitful and impulsive behaviour
    so not show remorse, difficulty sustaining job/study
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6
Q

DSM 5 “cluster B’ Borderline personality disorder summarisation

A

terrified of abandonment active attempts to avoid it
experiences intense and unstable moods
forms intense and unstable relationships
experiences disturbances of identify
angages n impulsive self-directed destructive behaviours
exhibits recurrent suicidal behaviours chronic feeling of emptiness and transit paranoia

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7
Q

DSM 5 “cluster B’ Histrionic personality disorder summarisation

A

the person

  • craves the centre of attention and engages in self-dramatisation and/or uses physical appearance to attain this
  • displays inappropriate seuxal seductive behaviour
  • uses speech to impress other but it lacks in depth
  • is prone to exaggeration and dramatic expression of emotion
  • tends to exaggerate the degree of intimacy that they share with others
  • tends to be easily led by others
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8
Q

DSM 5 “cluster B’ Narcissistic personality disorder summarisation

A
  • filled with self-importance and grandiosity
  • preoccupied with fantasies of success and power, genius and beauty- profound belief of being special and entilied
  • displays arrogance
  • lacks empathy
  • not exploit other for own benefit
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9
Q

Problems with diagnosing personality disorders

A
  • subjective data
  • negative stereotyping
  • checklist (what is someone meets 4/5 criteria)
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10
Q

What is a personality

A

Unique combination of traits that make you an individual, including characteristic behaviours, attitudes, feelings, and the way of thinking
Our personality manifests on our mood, attitudes and opinions and is clearly expressed when we interact with others

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11
Q

Personality disorder

A

A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

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12
Q

Personality disorder development

A
  • should a person develop inflexible, maladaptive behaviours; e.g. manipulation, hostility, lying, poor judgement, and alienation that interfere with social or occupational functioning, the person exhibits signs and symptoms of personality disorder
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13
Q

Causes of personality disorder

A
  • becomes noticeable from an early age

- research suggests negative influences in our lives from a young age cause PD (evolution base theory)

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14
Q

Main influencing factors of PD

A
  • poor parenting (inconsistent discipline/ supervision)
  • rejection
  • lack of love (attachment)
  • abuse, conflict
  • family history of PD, drugs and alcohol use
  • PTSD, early exposure of trauma (not later in life)
  • some possible genetic component, esp BPD
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15
Q

Childhood experience related to PD

A
  • parental rewarding of behaviour such as temper tantrums (ineffective boundary setting)
  • creativity is not encouraged (leads to a sense of poor self worth)
  • ridgid upbringing (discourages experimentation and promotes poor self-esteem)
  • parental fostering of dependence (apron strings) discourages positive self concepts
  • socially undesirable behaviours by parents or significant others
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16
Q

Cluster A PD

A

Odd, eccentric, cold, withdrawn, suspicious, irritable traits

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17
Q

DSM 5 “Cluster A” Paranoid PD summarisation

A
  • person has expectations of being harmed or exploited without reason
  • preoccupation with unjustified doubts unwillingness to confide in others
  • perceives hidden, demeaning or threatening remarks from others. perceives attacks on their character or reputation
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18
Q

DSM 5 “Cluster A” Schiziod PD summarisation

A
  • neither enjoys nor desires close relationships. preference for solitary activities
  • little interest in sexual activity. indifference to praise or criticism. emotional frigidity.
19
Q

DSM 5 “Cluster A” Schizotypal PD summarisation

A
  • exhibits evidence they are experiencing ideas of reference. expressed odd beliefs and thinking in their speech, odd appearance
  • some paranoid ideation. social anxiety. lack of social network/friends
20
Q

Cluster C PD

A

Anxious, tense, over controlled

21
Q

DSM 5 “Cluster C” Avoidant PD summarisation

A
  • fears disapproval, rejection and ridicule, avoids occupations and social settings where this may occur
  • avoidance of intimate relationships, preoccupation with fear of shame, rejection and ridicule
  • embarrassment and/or anxiety experienced in social situations, feelings of inferiority, reluctance to take risk
22
Q

DSM 5 “Cluster C” Dependent PD summarisation

A
  • unable to make decisions or initiate projects without considerable advice, reassurance and direction
  • difficulty expressing disapproval, experiences discomfort when alone and fears isolation
  • confidence is lacking and the person will go to the extraordinary lengths to obtain support from others’- urgent needs to establish a new relationship for support and care when an existing relationship ends.
23
Q

DSM 5 “Cluster C” obsessive compulsive PD summarisation

A
  • preoccupation with details, rules, schedules and organisation; perfectionism interferes with the completion of tasks
  • displays over- conscientiousness, inflexibility, rigidity and stubbornness.
  • tends to hoard possessions and is reluctant to spend, tendency to prefer work rather than to socialise
24
Q

DSM 5 “Cluster C” summarisation NOS (not otherwise specified) PD

A
  • displays features of more than one disorder, without meeting the full criteria in one or more areas of functioning
  • specific disorder that is not included in DSM-IV -5,, passive aggressive or depressive disorder
25
Q

Aetiology

A

Based upon gathering and evaluating the histories and experiences of sufferers.
BP stemming from past environmental experiences as opposed to a specific biological cause.
factors associated with possibly birth trauma, substance misuse by the mother and family temperament.
- sufferers are often exposed to substance misuse
- sufferers often have histories of sexual and/or physical abuse
- early life experiences
- emotional dysregulation arises from biologically vulnerable patients being exposed at an early age to invalidating environments
- invalidating environments during childhood fail to teach children how to label and regulate emotions, how to

26
Q

Assumptions about BPD

A
  • its permanent
  • problems with personality; ergo person is flawed
  • always cause by abuse
  • relatives need to take more responsibility
  • medications will not help
  • professionals all agree on treatment
  • a person has to exhibit self-harm to be diagnosed
  • people with BPD are manipulative
  • cannot attain genuine relationships
  • all people with BPD’s are the same
27
Q

DSM 5 diagnosis

A

pervasive pattern of instability of personal relationships, self-image and affects and marked impulsivity beginning by early adulthood and present in a variety of contexts

1) frantic efforts to avoid real or imagined abandonment
2) a pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation (splitting)
3) identity disturbance: markedly and persistently unstable self-image or sense of self
4) impulsivity in at least 2 areas that are potentially self-damaging
5) recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6) affective instability due to a marked reactivity of mood
7) chronic feelings of emptiness
8) inappropriate, intense ager or difficulty controlling anger
9) transient, stress related paranoid ideation or severe dissociative symptoms

28
Q

Crisis assessment

A

determine current level of risk to self and others

  • client and family need to be clear about risk management and crisis plans
  • clear concise and precise documentation
  • a long term perspective needs to be held
  • comprehensive holistic assessment
  • identification of stressors, contect and protective factors
  • MHA can be legally used by ideally avoided
  • find out strategies and supports they have used to deal with previous crises
  • ask about alcohol and other drug use
  • help the person manage their anxiety and distress by focusing on the current problem
  • encourage them to work with staff to identify short-term changes they can make
29
Q

Interventions Crisis intervention: and stabilization

A
  • need to actively invoke the person in all decision making so that the decisions are based on explicit, joint understanding and the person is encouraged to consider various treatment options and consider consequences of the choices they make.
30
Q

Interventions Crisis intervention: limit setting

A
  • as people with BPD have under-developed self control they need to know what behaviours are acceptable, what are not, and the consequences of breaking these rules. firm, fair and consistent minit setting by all members of the team should be strived for
31
Q

Interventions Crisis intervention: self-management

A
  • nurses managing their own responses to working with people with BPD. need to acknowledge, reflect on and manage these carefully
32
Q

Interventions Crisis intervention: CBT

A

cognitive behaviour therapy

33
Q

Interventions Crisis intervention: Mentalisation

A

incorporates cognitive behaviour therapy and aims to teach people how to recognise, understand and name emotional states in themselves in order to address their difficulties with affect, interpersonal functioning and impulse control

34
Q

Interventions Crisis intervention: team approach

A

important as PD patients can try “spitting” staff members

35
Q

Self harm

A

a compulsion or impulse to inflict wounds on one’s own body, motivated by a need to cope with unbearable psychological distress or regain a sense of emotional balance. The act is usually carried out without suicidal, sexual or decorative intent
Acute: serious imminent and realistic plans to suicide/ self harm
Chronic: suicide/ self harm as repetitive attempts to deal with life stressors and difficulties

36
Q

processes if self harm

A
  • is often the only solution they have for releasing tensions is not an attention seeking device
  • triggers, most common the perception of interpersonal loss threat of rejection, abandonment, relationship break up, conflict, flashback/ memory
  • reactions, intense, emotional, angerm anxious, fearful
  • thinking no one loves me, alone, can’t do this this is to much
  • response, self harm often people report no pain during act. sometimes experience guilt, grief or disgust but usually calm with a sense of relief, satisfaction and control. this is rapid but temporary
37
Q

psychological characteristics associated with PD and self harm

A
  • hugely associated with BPD
  • strongly dislike/ invalidate themselves
  • hypersensitive to rejection
  • chronic anger, usually aimed at themselves, irritable
  • suppression of anger and aggression
  • depressed, self destructive
  • chronic anxiety
  • do not see themselves skilled at coping
  • poor control over their lives
  • avoidant
  • disempowered
38
Q

Reinforcing self harming behaviour

A

negative reinforcement : punishment, humiliation or treating in ways that increase pain e.g. using seclusion./ restraints
positive reinforcement: rewarding, extra time and special treatment; secondary gain seeking restitution for precious loss of affection. Attention needs to be professional rather than nurturing

39
Q

nursing intervention

A
  • collaborative planning
  • encourage identification of thoughts that precede injurious acts and link them with past (abuse) experiences
  • observe for wounds/ scars
  • encourage verbal communication of feelings
  • development of coping skills
  • working with self-esteem, identify and set achievable goals
  • consider behaviour contracts for sense of safety
  • reduce social isolation
  • cultural considerations
40
Q

Nursing considerations

A
  • responses to self harm
  • expectation of co-operation
  • feelings of failure/ incompetence
  • debrief/ supervision
  • boundaries
  • therapeutic alliances
  • staff splitting (attitudes)
41
Q

problems with diagnosis

A
  • cultural differences
  • comorbidity with MMI
  • organic disorders
42
Q

nursing diagnosis

A
  • is the behaviour of the individual that is of concern, not the medical diagnosis
  • nursing diagnosis needs to examine the behaviours in most need of addressing
  • risk assessment, suicide, vulnerability, substance use
  • coping strategies
  • emotional stability
43
Q

interventions

A
  • pharmacological - limited use
  • talking therapy (psychotherapy)
  • group therapy
  • counselling
  • CBT
  • DBT
  • therapeutic communication
  • managing self harm
  • communication
44
Q

therapeutic communication

A
  • minimisation of hierarchy
  • community rules and protocols
  • MDT involvement
  • safe environment
  • crisis management
  • be aware of burnout in families, family need support too

BNKN Mental Health WB (15 decks)

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