Personality Disorders Flashcards
Paranoid
Cognitive Manifestation:
- hypersensitive to setbacks, rebuffs; easily insulted; inner humiliation; feel treated unfairly; don’t trust people (suspicious); refuse to forgive; vengeful; believe gossip, insecure
Pathological trait:
- Paranoid/suspiciousness
Most important deficiency:
- trust
Risk for Harm:
- Moderate-high to others; low to self
Treatment goals:
- Help them develop trust, decrease aggression, improve/develop relationships
Nursing interventions:
- Straightforward, honest, professional approach
- Consistent and flexible care, Supportive, nonjudgmental environment, Active listening
Medications:
- Antipsychotics (May be prescribed on a short-term basis to alleviate psychotic symptoms)
- Antidepressants (May be prescribed for short-term use)
Schizoid
Cognitive Manifestation:
- feel suffocated when people violate personal space; can be indifferent towards others (may have hidden sense of superiority); like objective facts; refuses emotional intimacy, prefer being alone and private; observe life from afar (“being on the outside”), can feel like a robot
Pathological trait:
- indifference
Most important deficiency:
- Attachment
Risk for Harm:
- generally low; may have extreme anger
Treatment goals:
- Address issues of concern (e.g., depression)
Nursing Interventions:
- Allow physical and emotional distance, slowly build a trusting therapeutic relationship
- Provide flexible care (Pushing them to talk too soon may cause them to withdraw)
- Teach social skills
- Encourage expression of feelings and accountability for actions
Medications:
- Antipsychotics (May be prescribed on a short-term basis to alleviate psychotic symptoms)
Schizotypal
Cognitive Manifestation:
- subjective experience) think others think negatively about them, extremely uncomfortable with close relationships, situations have unusual meanings for them, believe in paranormal phenomenon and superstitions
Pathological trait:
- Eccentricity
Most important deficiency:
- Ability to Fit
Risk for harm:
- Difficult to predict toward others, due to impulsiveness
Treatment:
- Slowly help them become involved with others
Nursing interventions:
- Provide consistent, flexible care
- Be direct and involved, to promote trust
- Allow time to make difficult decisions
- Know they are easily overwhelmed
Medications:
- Antipsychotics (May be prescribed on a short-term basis to alleviate psychotic symptoms)
- Antidepressants (May be prescribed for short-term use)
Antisocial
Cognitive Manifestation:
- lack of remorse
- Disregard for and the violation of others’ rights
Pathological trait:
- exploitation
Most important deficiency:
- Integrity
Risk for harm:
- High to others; low to self
Treatment:
- Teach them to interact in collaborative (vs. manipulative) ways
Nursing interventions:
- Charming/convincing
- Be straightforward/matter-of-fact set limits on unacceptable behavior
- Encourage/reinforce social skills, positive behavior
- Convey expectations, consequences, hold them accountable
- Expect refusal to cooperate, anticipate manipulation, help them recognize manipulation
- Avoid confrontation, defensive behavior, power struggles
- Engage in discussions, Avoid lecturing, Watch for signs of agitation, Help with anger management
Medications:
- SSRIs (May be prescribed to diminish rapid mood swings, impulsive, aggressive, and self-destructive behavior)
Borderline
Cognitive Manifestation:
- sensitive to minor rejection and criticism; unsure of personal identity, morals, values; (when stressed) feel paranoid, experience depersonalization (a state in which one’s thoughts and feelings seem unreal or not to belong to oneself); may experience derealization (mental state where you feel detached from your surroundings–>psychotic episodes)
Pathological trait:
- Instability
Most important deficiency:
- Consistency
Risk for harm:
- High
Treatment:
- Promote mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness
Nursing Interventions:
- Encourage expression of feelings & accountability for actions
- Convey empathy and support; avoid sympathy and nurturing, Foster problem-solving skills
- Recognize manipulation; avoid reinforcing it
- Avoid defensiveness, arguing, Staff use the same approach, May idealize some & devalue others,
- Limit interactions to assigned staff, Set expectations for social behavior; provide positive reinforcement, Respect their personal space
- Monitor for “cheeking” or hoarding
- Encourage relaxation & exercise
Medications:
- Antipsychotics (May be prescribed on a short-term basis to alleviate psychotic symptoms)
- SSRIs (May be prescribed to diminish rapid mood swings, impulsive, aggressive, and self-destructive behavior)
Histrionic
Cognitive Manifestation:
- crave novelty, excitement; excessively sensitive to criticism, disapproval; have pride; low tolerance for frustration; smooth over trouble; high strung, dramatic, enthusiastic
Pathological trait:
- expressiveness
Most important deficiency:
- Shame
Risk for harm:
- Not known
Treatment goals:
- Encourage them to use a more rational approach to problem-solving
Nursing interventions:
- Incorporate their choices, Increase their sense of control; may lower their anxiety
- They will want to “win you over”, Initially responsive and cooperative
- Teach social skills, reinforce appropriate behavior
- Encourage warmth, genuineness, empathy
- Help them base reactions on reality, promote expression of feelings, accountability for actions, Help them manage crises and feelings,
- Encourage stress-reduction (e.g., deep breathing, exercise)
- Monitor for suicidal thoughts, behaviors
Medications:
- Antidepressants (May be prescribed for short-term use)
Narcissistic
Cognitive Manifestation:
- impatient and disdainful when others talk about themselves; intolerant of contradictory views and opinions; do not care about other people’s emotional, mental, psychological needs; prone to feeling shamed, humiliated, worthless (but never show it); ambitious (do not take risks/do not want to fail)
Pathological trait:
- self-aggrandizement
Most important deficiency:
- Equality
Risk for harm:
- Relatively low; can become violent
Treatment:
- Help them find appropriate ways to meet their needs
- Help them make emotional connection and tolerate distress
Nursing Interventions:
- Convey respect; acknowledge their sense of self-importance
- Don’t reinforce grandiosity or weakness, Focus on positive traits, pain, loss, rejection
- Avoid defensive behavior/arguments
- Provide consistent, flexible care
- Be nonjudgmental, Direct and involved
- Teach social skills; reinforce appropriate behaviors If unreasonable expectations or demands, matter-of-factly say they are being unreasonable, Avoiding them could ↑ attention-seeking
Avoidant
Cognitive Manifestation:
- strong desire for intimacy (avoid being involved with others); Severely anxious in social situations; feel inadequate, inferior, socially inept, unappealing; fear of ridicule, humiliation, rejection, being disliked; extremely sensitive to rejection
Pathological trait:
- timidity
Most important deficiency:
- resilience
Risk for harm:
- Moderate
Treatment goals:
- Help them decrease avoidance and increase social interaction and tolerance for negative emotions
Nursing interventions:
- Consistent, flexible care, Be direct; involved, They may be dependent on staff, Avoid fostering dependency
- Encourage self-care, Assess for depression
- Tell them about procedures early, Initially, give explicit directives, Gradually encourage them to make decisions; provide support, Tell them if you will not be there
- Encourage expression of feelings
- Encourage accountability for actions
- Stress management, relaxation
Dependent
Cognitive Manifestation:
- cannot stand being alone (feel isolated, uncomfortable, helpless, lonely); sensitive to criticism (fear of disapproval, loss of support, rejection, abandonment)
- expect the worst out of situation, dread, fearful; feel ineffective compared to others; fear being left to take care of themselves; lack of self-confidence; difficulty making decisions
Pathological trait:
- Submissiveness
Most important deficiency:
- Thinking/Doing for themselves
Risk for harm:
- Moderate-High
Treatment Goals:
- Help them establish identity outside their relationship to others, Help them become more “OK” alone
Nursing Interventions:
- Offer consistent, flexible care, Be direct & involved; develop trust, Allow treatment choices, Limit caregivers to increase security, Promote autonomy, Help establish & work toward goals, Help express ideas/feelings assertively, Compliance usually superficial, Be matter-of-fact re: physical complaints, Teach them about their medications, Emphasize no magical drugs, Watch for medication dependence
Obsessive-Compulsive
Cognitive Manifestation:
- preoccupied with trivial details, lists, procedures, rules, schedules; reluctant to delegate (frustrated when others suggest other methods; have high self-standards, self-critical, harsh about mistakes; so much work–> no time to relax; work needs to be perfect; hard to appreciate other’s ideas, beliefs and values
Pathological trait:
- Rigidity
Most important deficiency:
- Flexibility
Risk for harm:
- lowest of all personality disorders
Treatment goals:
- Encourage them to decrease rigidity, increase flexibility/spontaneity, and develop compassion
Nursing Interventions:
- Consistent, flexible, direct, involved
- Give them choices (e.g., treatment)
- Maintain a professional attitude
- Pay attention to detail
- Know they need distance, be attentive
- Expect long monologues
- Be tolerant and kind, don’t brush aside what’s important
- Don’t focus on emotions too early
- Have them keep a feelings journal
- Know their defensiveness is a cover for vulnerability
- Encourage therapy for best results, Reinforce appropriate social skills
