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Personality Disorders Flashcards

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1
Q

personality

A

–complex pattern of characteristics largely outside the person’s awareness
–distinctive patterns of perceiving, feeling, thinking, coping, and behaving

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2
Q

personality disorder

A

–enduring pattern of deviant inner experiences and behavior
–pervasive, inflexible, and stable
–leads to distress or impairment

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3
Q

biological causes of personality disorders

A

–genetic and hereditary factors
–family hx
–alterations in neurotransmitters
–chemical substances

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4
Q

psychological causes of personality disorders

A

–childhood trauma
–parental rejection
–child neglect
–PTSD
–alcoholic parents
–excessive parenteral control
–upbringing
–fixation at any stage
–low self esteem

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5
Q

physical causes of personality disorder

A

–brain dysfunctions
–childhood pathology
–psych disorders

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6
Q

sociocultural causes of personality disorders

A

–involuntary isolation
–divorce
–broken homes and families
–prolonged separation
–deprivations
–internal conflicts
–assault
–experience to loss and death

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7
Q

most common symptoms of personality disorders

A

–impairment in interpersonal relationships
–dysfunction in cognition
–dysfunction in affect
–dysfunction in impulse control

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8
Q

overall treatment for personality disorders

A

–psychopharm
–individual therapy
–DBT
–group therapy
–family education and therapy
–social skills training groups

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9
Q

prognosis for personality disorders

A

depends on the degree of impairment and person’s motivation

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10
Q

Cluster A personality disorder

A

–odd or eccentric
–paranoid
–schizoid
–schizotypal

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11
Q

Cluster B personality disorders

A

–dramatic, emotional, and erratic
–antisocial
–borderline
–histrionic
–narcissistic

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12
Q

Cluster C personality disorders

A

–anxious or fearful
–avoidant
–dependent
–OCD

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13
Q

common features and diagnostic criteria of personality disorders

A

–enduring
–pervasive
–inner experience and external behavior
–differs significantly from expectations of individual’s culture
–involves two or more important areas of functioning: thinking, feeling, interpersonal functioning, impulse control
–leads to clinically significant distress or impairment in important areas: social, life skills
–not accounted for by another mental health condition
–not better accounted for by direct effects of a substance
–not accounted for by a medical condition

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14
Q

Schizotypal characteristics

A

–“distorted reality”
–odd ideas
–eccentricity
–unusual experiences
–superstition, religiosity
–suspiciousness
–reclusiveness

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15
Q

Paranoid characteristics

A

–“delusional/paranoid”
–paranoia
–distrustful nature
–doubts loyalty
–keeps grudges
–easily offended

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16
Q

Schizoid characteristics

A

–“social withdrawal”
–aloof
–uninterested in others
–solitary, socially withdrawn
–unaffected by praise and criticism

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17
Q

Cluster A/Paranoid Personality disorder specifics

A

–thinks others are exploiting, harming, or deceiving them
–doubts loyalty or trust-worthiness
–reluctant to confide
–suspicious of fidelity of spouse or partner
–reads “hidden” demeaning or threatening meanings in benign remarks or events
–bears grudges, unforgiving of slights, insults, or injury
–quick to anger or counter-attack

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18
Q

epidemiology and etiology of Cluster A

A

–slightly more men than women
–unclear, possible genetic predisposition

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19
Q

treatment of Cluster A

A

–tend to reject treatment due to underlying suspiciousness
–psychotherapy is first line
–antianxiety meds
–agitation = antipsychotics

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20
Q

nursing considerations for Cluster A patients

A

–appointments and schedules must be strictly adhered to
–being too nice and friendly may be met with suspicion; give clear, straightforward explanations
–use simple language and project neutral affect
–limit setting is essential

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21
Q

how others typically experience PPD

A

–take everything personally
–question every move or intention
–become angry and obsessed over small things
–blow small things out of proportion
–touchy or thin-skinned
–seem scary for no obvious reason
–have a “with me or against me” attitude
–blaming victim
–persist in endless angry storytelling
–“yes-butting”
–rigid in conclusions
–interpretations of other people’s motives
–chip on shoulder
–vindictive

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22
Q

Schizoid personality disorder specifics

A

–pervasive pattern of detachment from social relationships
–restricted range of expression of emotions with others
–lacking desire for intimacy (never marry)
–indifference to opportunities for close relationships
–little satisfaction from being part of family or social group
–preference for alone time
–little interest in sexual experiences with others
–no close friends or relatives
–indifference to approval or criticism from others
–emotional coldness, detachment, or flattened affect

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23
Q

epidemiology of schizoid

A

–rarely diagnosed
–least common Cluster A
–males more often
–symptoms appear in childhood and adolescence

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24
Q

treatment for schizoid

A

–psychotherapy
–group therapy
–antidepressants

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25
Q

guide for nurses for schizoid patients

A

–avoid being too “nice” or “friendly”
–do not try to increase socialization
–assess for symptoms the patient is reluctant to discuss
–protect against group’s ridicule

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26
Q

how others experience schizoid

A

–cold
–aloof
–blank
–zombie-like
–dead
–forgettable
–impossible to talk to or interview

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27
Q

Schizotypal personality disorder characteristics

A

–pattern of social and interpersonal deficits evidenced by acute discomfort
–reduced capacity for close relationships
–eccentric behavior
–ideals of reference
–odd beliefs or magical thinking that influences behavior
–perceptual alterations
–odd thinking and speech
–suspiciousness or paranoid ideation
–stiff, inappropriate, or constricted interactions
–odd or eccentric behavior or appearance
–few close friends
–anxiety in social situations

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28
Q

ideals of reference

A

incorrect interpretations of events as having special personal meaning

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29
Q

epidemiology and etiology of schizotypal

A

–more common in men
–abnormalities in brain structure, physiology, chemistry, and functioning like schizophrenia

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30
Q

interventions for schizotypal

A

–severe symptoms = treatment like schizophrenia with low-dose antipsychotics
–increase self worth
–social skills training
–reinforce socially appropriate behavior and dress
–enhance cognitive skills

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31
Q

guide for nurses for schizotypal patients

A

–respect the individual’s need for social isolation
–be aware of individual’s suspiciousness and employ appropriate interventions
–perform in-depth assessment to uncover underlying symptoms
–be aware of strange beliefs and activities

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32
Q

how others typically perceive schizotypal

A

–strange
–eccentric
–oddly anxious
–inside own head
–different
–crazy or a genius
–entertaining
–confusing
–full of odd incongruent statements
–good, kind people – just weird

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33
Q

Borderline personality disorder specifics

A

–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
–impulsivity in potentially self-damaging areas
–recurrent suicidal behavior, gestures, or threats
–affective instability
–chronic feelings of emptiness
–inappropriate, intense anger
–transient, stress-related paranoid ideation or severe dissociation
–starts by early adulthood
–view themselves as victims

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34
Q

splitting

A

–defense mechanism where the individual is unable to integrate and accept both positive and negative feelings
–people including themselves and life situations are either all good or all bad

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35
Q

BPD and manipulation

A

–masters at manipulation
–basically any behavior becomes an acceptable means of achieving the desired result: relief from separation anxiety

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36
Q

BPD and self-destructive behavior

A

–common among BPD patients
–about 1 in 10 die by suicide
–repetitive, self-mutilative behaviors, cutting, scratching, and burning
–most are manipulative gestures designed to elicit a rescue response from others
–suicide attempts are commonly the result of feeling abandoned

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37
Q

epidemiology and BPD

A

–85% of BPD patients have another mental illness (substance abuse, MDD, anxiety)

38
Q

biological factors of BPD

A

–CNS dysfunction
–possible structural anomalies associated with affective instability, transient psychotic episodes, and impulsive, aggressive, and suicidal behavior

39
Q

psychological factors of BPD

A

–psychoanalytic theory
–maladaptive cognitive processes

40
Q

psychoanalytic theory

A

–separation-individuation
–projective identification

41
Q

maladaptive cognitive processes

A

develop dysfunctional beliefs and maladaptive schemas leading to misinterpretation of environmental stimuli

42
Q

separation-individuation

A

can be viewed as the psychological birth of an infant, which occurs over a period when the child separates from the mother and begins to individuate

43
Q

affective instability

A

–rapid and extreme shifts in moods
–core characteristic
–erratic emotional responses to situations and intense sensitivity to criticism or perceived slights
–moody, irresponsible, or intense

44
Q

identity disturbance

A

–no sense of own identity and direction
–manifested by chronic feelings of emptiness and boredom
–direct actions in accord with wishes of others

45
Q

unstable interpersonal relationships

A

–extreme fear of abandonment as well as history of unstable insecure attachments
–idealize others, establish intense relationships that violate others’ interpersonal boundaries which then leads to rejection
–intense shame and self-hatred follow
–often result in self-injurious behaviors

46
Q

cognitive dysfunctions

A

–thinking in BPD patients is dichotomous
–evaluate things in mutually exclusive categories
–dissociation can occur

47
Q

dissociation

A

times when thinking, feeling, or behaviors occur outside of a person’s awareness

48
Q

impaired problem-solving

A

failure to engage in active problem solving

49
Q

impulsivity

A

act in the moment and clean up the mess later

50
Q

self-injurious behaviors

A

–compulsive hair pulling
–cutting wrist, arms or other body parts

51
Q

BPD treatment (meds)

A

–antidepressants (emotional deregulation)
–anticonvulsants (reducing impulsivity)
–antipsychotics (transient psych episodes)

52
Q

BPD treatment

A

–meds
–psychotherapy

53
Q

Dialectic Behavior Therapy

A

patients learn to understand their disorder by actively participating in establishing treatment goals, collecting data about own behavior, identifying treatment targets, and working with their therapists in changing problematic behaviors

54
Q

core interventions for DBT

A

–problem solving
–exposure techniques
–skill training
–contingency management
–cognitive modification
–emotional regulation skills
–interpersonal effectiveness
–distress tolerance skills
–self-management skills

55
Q

BPD and family dynamics

A

–chaotic families
–family is afraid to disagree with them or refuse to meet their needs fearing that self-destructive behavior will follow

56
Q

how others experience BPD

A

–unreasonable
–hostile while also dependent
–overly intense
–dramatic
–all or nothing
–thin-skinned
–vicious, spiteful, sharp-tongued
–never apologizes
–emotionally inconsistent
–extreme abandonment and separation fears

57
Q

antisocial personality disorder

A

–a pervasive pattern of disregard for, and violation of the rights of others
–psychopath or sociopath

58
Q

antisocial personality disorder specifics

A

–at least 18 years old
–evidence of conduct disorder with onset before 15 years old
–pattern of disregard for, and violation of, the rights of others
–driven by need to prove superiority and see themselves as center of universe
–failure to conform to social norms
–deceitfulness
–irritability and aggressiveness leading to physical fights or assaults
–consistent irresponsibility
–lack of remorse

59
Q

APD epidemiology and risk factors

A

–males over females
–must have exhibited one or more childhood behavioral characteristics of conduct disorder and ADHD (aggression to people or animals, serious violation of rules)
–co-morbid with mood, anxiety, other pers. disorders, and alcohol and drug abuse

60
Q

APD etiology

A

–genetics
–serotonin deficiency
–childhood maltreatment

61
Q

treatment of APD

A

–rarely seek
–if they do, for depression, substance abuse, uncontrolled anger, forensic evidence
–difficult and involves helping patient alter his/her cognitive schema
–prognosis is poor

62
Q

overall treatment goals for APD

A

develop a sense of attachment and empathy for other people and situations and to live within the norms of society

63
Q

APD nursing interventions

A

–blocks in development of therapeutic relationship
–identify dysfunctional thinking patterns, develop new problem-solving behaviors
–hold patient responsible for his/her behavior
–refrain from arguing or bargaining about rules
–give positive feedback
–self awareness enhancement

64
Q

how others typically experience APD

A

–charming (at first)
–untrustworthy (later)
–immature
–self-centered
–manipulative
–dangerous and rageful
–cognitively inflexible
–externally oriented
–arrogant and contemptuous

65
Q

Histrionic personality disorder specifics

A

–attention seeking, life of party
–insatiable need for attention and approval
–moody, experience helplessness
–sexually seductive to gain attention
–appearance is provocative and speech dramatic
–loyalty and fidelity are lacking

66
Q

histrionic epidemiology and etiology

A

–more frequent in women
–symptoms begin in early adulthood
–can co-occur with BPD, dependent and antisocial, anxiety disorders, substance abuse

67
Q

treatment for histrionic

A

psychotherapy is choice

68
Q

nursing interventions for histrionic

A

–seductive behavior is response to distress
–keep interactions professional; ignore flirtation
–model concrete language
–help patient clarify feelings
–teach and role-model assertiveness

69
Q

how others typically experience histrionic

A

–needy
–showy
–superficial
–overly emotional
–melodramatic
–seductive
–shallow
–childlike
–impulsive
–relentlessly demanding attention

70
Q

narcissistic personality disorder specifics

A

–pervasive pattern of grandiosity
–feelings of entitlement
–inexhaustible need for admiration
–lack of empathy
–suffer from low self-esteem
–exaggerates achievements and talents
–expects to be recognized as superior
–envious of others
–arrogant
–hypersensitive to criticism

71
Q

narcissistic epidemiology and etiology

A

–more common in men
–only children and first born have increased incidence
–co-exists with other personality disorders and with mood, anxiety, and substance abuse disorders
–etiology = overvaluation and overindulgence by parents

72
Q

treatment for narcissism

A

–difficult to treat patients not likely to seek help or confront shortcomings
–CBT to deconstruct faulty thinking
–group therapy
–lithium for mood swings

73
Q

nursing interventions for narcissists

A

–remain neutral
–avoid power struggles or becoming defensive
–role model empathy

74
Q

how other typically experience narcissists

A

–selfish
–presumptuous
–uncaring
–demeaning
–rageful
–power-mad
–insensitive
–manipulative
–arrogant

75
Q

avoidant personality disorder specifics

A

–avoid interpersonal contacts and social situations
–perceive themselves as socially inept
–avoids activities that involve interpersonal contact due to fears of criticism, disapproval, or rejection
–unwilling to get involved with people unless certain of being liked
–inhibited in intimate relationships
–feelings of inadequacy
–view of self is as inept, unappealing, or inferior

76
Q

avoidant epidemiology and etiology

A

–problem with epidemiology is that avoidant personality disorder overlaps with social phobia
–linked with parental and peer rejection and criticism

77
Q

avoidant treatment

A

–antianxiety and antidepressant meds
–individual and group therapy
–social skills training

78
Q

nursing interventions for avoidant personality

A

–friendly, accepting, reassuring approach
–acceptance of patient fears
–group therapy
–exercises to enhance new social skills
–design exercises to prevent failures
–assertiveness training

79
Q

how others typically experience avoidant patients

A

–inadequate
–anxious and fearful
–timid
–“wallflower”
–overly sensitive
–inhibited
–hypervigilant
–sad, lonely, tense
–daydreamer

80
Q

dependent personality disorder specifics

A

–difficulty making everyday decisions
–needs excessive advice and reassurance
–requires others to assume responsibility
–difficulty disagreeing with others due to fears of loss, support, or approval
–difficulty initiating projects or doing things on his/her own
–urgently seeks a new relationship for care and support whenever a relationship ends

81
Q

dependent etiology and epidemiology

A

–more frequent in women
–may be result of chronic physical illness or punishment for independent behavior in childhood

82
Q

treatment for dependent patients

A

psychotherapy

83
Q

nursing interventions for dependent patients

A

–help address current stressors
–set limits that don’t make the patient feel punished
–be aware of strong countertransference
–therapeutic relationship as testing ground for assertiveness training

84
Q

how others perceive dependent personalities

A

–clingy
–wishy washy
–generally fearful
–manipulative
–passive aggressive
–inviting exploitation
–desperate for caretaking
–naive

85
Q

OCD

A

pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness, and efficiency

86
Q

OCD specifics

A

–preoccupied with details, rules, lists, order, organization, or schedules that the major point of activity is lost
–perfectionism that interferes with task completion
–excessively devoted to work and productivity to exclusion of leisure activities and friendships
–over conscientious
–reluctant to delegate tasks

87
Q

OCD epidemiology and etiology

A

–more common in men
–risk factors include background of harsh discipline and having first-degree relative with this
–play is viewed as shameful, sinful, and irresponsible

88
Q

treatment for OCD

A

–patients tend to seek help
–group and behavioral therapy
–clomipramine and fluoxetine for obsessions, anxiety, and depression

89
Q

nursing interventions for OCD

A

–guard against power struggles
–remember that patient has difficulty dealing with unexpected changes

90
Q

how others experience OCD patients

A

–stingy
–perfectionist
–indecisive
–cold and unemotional
–hoarding
–anxious
–tangential
–controlling
–lacking sense of proportion
–workaholic
–demanding

Psych Exam 2 (6 decks)

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