personality disorders Flashcards
personality disorder
influence the way they perceive and relate to the environment
occur when traits deviate markedly from the expectations of the individuals culture, become rigid and inflexible, contribute to maladaptive patterns of behavior or impairment in functioning, and lead to distress
Cluster A: eccentric
paranoid
schizoid
schizotypal
Cluster B: Erratic
Borderline
Narcissistic
histrionic
antisocial
Cluster C: Anxious
Avoidant
Dependent
Obessive-compulsive
paranoid personality disorder (A)
paranoia
distrustful nature
doubts loyalty
keeps grudges
easily offended
suspects that others are exploiting, harming, or deceiving them
pre-occupied with loyalty or trustworthiness
reluctant to confide
suspicious of fidelity of spouse or sexual partner
sees hidden or threatening meanings in benign remarks or events
bears grudges, unforgiving of slights, insults, or injury
quick to become angry or to counter-attack
treatment of paranoid personality disorder (A)
reject treatment
psychotherapy is 1st line of treatment
antianxiety meds (diazepam)
antipsychotics for agitation
tips for nurses working with cluster A paranoid personality (A)
appointments and schedules are strictly adhered to
do not be to nice and friendly can cause suspicion
instead give clear and straightforward explanations
use simple language and neutral affect
limit setting is essential for threatening behaviors
schizoid personality disorder characteristics (A)
symptoms appear in childhood and adolescence
loners, poor academic performance
increased prevalence of disordered family life
avoid close relationships
depersonalization, detachment
guidelines for nurses for schizoid PD (A)
avoid being to nice or friendly
do not try to increase socialization
assess for symptoms the patient is reluctant to discuss
protect against group’s ridicule
treatment for schizoid personality disorder (A)
psychotherapy
group therapy
antidepressants, 2nd generation antipsychotics
schizotypal personality disorder characteristics (A)
severe social and interpersonal deficits
anxiety in social situations
rambling conversation
paranoia, suspiciousness, anxiety, distrust
brief intermittent episodes of hallucination or delusion
can be made aware of their own odd beliefs
may be vulnerable to involvement with cults or unusual religious/occult groups
nursing guidelines for schizotypal personality disorder
respect patients need for social isolation
be aware of and intervene appropriately with patient’s suspiciousness
perform careful diagnostic assessment for symptoms that may need intervention (SI)
withhold judgement or ridicule
treatment of schizotypal personality disorder
supportive psychological care
investigate possible involvement with cults
low-dose antipsychotics
Histrionic personality disorder (B) characteristics
excitable, dramatic, often high functioning
bold external behaviors
limited ability to develop meaningful relationships
attention seeking, self centered, low frustration level
excessive emotions; may be provocative; smothering
no insight into disorder or role in ruining relationships
guidelines for nursing care of histrionic (B)
know that seductive behavior is a response to distress
keep interactions professional
ignore flirtations
model concrete language
help patient clarify inner feelings
teach and role-mode; assertiveness
assess for suicidal ideation
treatment of histrionic (B)
psychotherapy
Narcissistic personality disorder (B) characteristics
feelings of entitlement, exaggerated self importance
lack of empathy; tendency to exploit others
weak self-esteem and hypersensitivity to criticism
constant need for admiration
less functional impairment than other personality disorders
guidelines for nurse care histrionic (B)
remain neutral
promote a stronger patient self-identity
avoid power struggles or becoming defensive
role-model empathy
treatment of narcissistic (B)
difficult to treat: patients not likely to seek help or confront shortcomings
CBT to deconstruct fault thinking
group therapy; lithium for mood swings
borderline personality disorder (B)
pervasive patterns of instability of interpersonal relationships, self image and affect
frantic efforts to avoid real or imagined abandonment
pattern of unstable and intense interpersonal relationships
identity disturbances (unstable self image)
impulsivity that is potentially self-damaging (spending, sex, substance abuse)
recurrent SI, gestures, or threats; or self mutilating behaviors
affective instability due to a marked reactivity of mood
chronic feelings of emptiness
inappropriate, intense anger or difficulty controlling anger
transient, stress-related paranoid ideation or sever dissociation
beginning by early adulthood
view themselves as a victim
risk factors of borderline personality disorder
high genetic association
neurobiological
cognitive: separation-individuation
treatments of borderline personality disorder
biological treatment- psychotropics geared toward symptom relief
psychological therapies- CBT, DBT, schema-focused therapy
antisocial personality disorder (B) characteristics
antagonistic behaviors
disinhibited behaviors
profound lack of empathy
absence of remorse or guilt
symptoms peak mid-teens to 20’s; symptoms may abate and improve on their own aby age 40
treatment for antisocial personality disorders (B)
no specific meds
mood-stabilizers
also possible: SSRIs, benzos, ritalin
psychological therapies for antisocial personality disorders (B)
some evidence that this patient population may bond with psychotherapists
CBT
MBT
DBT
Avoidant personality disorder (C) characteristics
low self-esteem
shyness that increases with age
feelings of inferiority
reluctance to engage with new people subject to depression, anxiety, humiliation, and failure
guidelines for care with avoidant personality disorder (C)
friendly, accepting, reassuring approach
dont push
acceptance of patient fears
group therapy
exercises to enhance new social skills
design exercises to prevent failures
assertiveness training
treatment for avoidant personality disorder (C)
individual therapy
trust building
assertiveness training
group therapy
anti-anxiety agents
anti-depressants
dependent personality disorder (C) characteristics
high need to be taken care of
submissiveness
fears of separation and abandonment
manipulating others to take responsibilities
intense anxiety when left alone even briefly
guidelines for dependent personality disorder (C)
help address current stressors
set limits that dont make the patient feel punished
be aware of strong countertransference
use therapeutic relationship as a testing ground for assertiveness training
treatment of dependent personality disorder (C)
psychotherapy is treatment of choice
obsessive-compulsive personality disorder characteristics
rigidity, inflexible standards for others and self
constant rehearsal of social responses
excessive goal-seeking that is self-defeating or relationship-defeating
strict standards interfere with project completion
unhealthy focus on perfection
guidelines for nursing care for OCD
guard against power struggles
remember that the patient has a difficult dealing with unexpected changes
provide structure, but with time to complete habitual behaviors
treatment of OCD
group and behavioral therapy
clomipramine or fluoxetine for obsession’s, anxiety, and depression
