Personality Disorders Flashcards
Personality
how we perceive and interact with the world
Manipulation
responds as manipulating others
Splitting
driving wedges in between staff
Stable personality
enduring patterns that are flexible and adaptive
- roll with the puches
Pathologic personality
enduring patterns that are inflexible and maladaptive
- brittle
Stable personality what type of sense of self
stable and realistic
- accurate interpretation of social situations and understanding of relational motives and actions of others
- capacity to serve self and others
- flexible and adaptive states
- find genuine joy in life and relationships
UNStable personality what type of sense of self
unstable and unrealistic
- Misinterpret social situations and lack understanding of relational motives & actions of others
- lacks capacity to serve self and others
- inflexible and maladaptive states
- suffer due to disorder
PATHO of Personality Disorders
Nature vs Nurture: 1st-degree relatives
Genetic
- paranoid personality disorder
- schizoid
- schizotypical
- OCD
- Antisocial personality disorder
- borderline personality
Neuro
- disturbances of 5-HT and GABA
- Abnormal brain structures (amygdala)
- irritability and hypersensitivity
CHILDHOOD TRAUMA
- maladaptive coping and does not change as an adult
Personality Patterns
- Cognition
- Affective
- Social
- Behaviors
Cognition - perception and thinking
Affective - emotional responses
Social/Interpersonal - relate to others
Behaviors - how we respond to a situation (stress)
Thoughts w/o PD
Accurate perception & interpretation of events
Thoughts with PD
Inaccurate perception & interpretation of events
Affectivity w/o PD
Ability to modulate; fits with situation
Affectivity w/ PD
Inability to modulate; extreme & inappropriate
Behaviors without PD
Socially appropriate
Within control
Behaviors with PD
Lack of impulse control; unable to delay gratification
Social w/o PD
Other directed; empathetic
Social w/ PD
Ego-syntonic
- intoned to one’s self
- they see it as appropriate
PD is treatment-resistant due to
little insight and improvement slow
high in divorce, criminal activity, and suicide
Distorted Personality onset
early adolescent or early adulthood
A distorted Personality is a distorted sense of
self
Distorted Personality has what type of patterns
pervasive and inflexible - maladaptive
Distorted Personality leads to
distress or impairment
Risk Factors of PD
Family hx mental illnesses
low socioeconomic
verbal, physical, or sexual abuse during childhood
neglect, unstable, or chaotic family life during childhood
being dx with childhood conduct disorder
loss of parents through death or traumatic divorce during childhood
What is a key feature of all PD?
impaired social interaction
Complications of PD
depression/anxiety
child abuse/neglect
alcohol or sybstance abuse
education and employment problems
eating disorder (BPD)
suicidal and self-injury (BPD)
reckless or risky driving or sex (BPD/ASPD)
aggression/ violence and incarceration (ASPD)
What s/s are more common in BPD?
eating disorder
suicidal and self-injury
reckless and risky behavior
more inward
What s/s are more common in ASPD?
reckless or risky driving or sex
aggression/ violence
incarceration
more outward
PD Assessments
General appearance & motor behavior
- speed up or slow down
Mood & affect
Thought processes & content
Sensorium & intellectual processes
Judgment & insight
Self-concept and self-conception = communication needs
Roles & Relationships
Physiologic considerations
Use of defense mechanisms
Cluster A of PD
paranoid
schizoid
schizotypical
Cluster A of PD traits
weird
odd
eccentric
- suspicious
- cold and remote
- irrational thoughts
- withdrawn
Cluster B of PD
antisocial
borderline
histrionic
narcissistic
Cluster B of PD traits
wild
dramatic
emotional
erratic
- attention-seeking behavior
- labile
- shallow and insincere
-increase rates of substance abuse and suicide
Cluster C of PD
avoidant
dependent
OCPD
Cluster C of PD traits
wimpy
anxious and fearful
insecure and inadequacy
- tense
- overcontrolled
- depressed
Affective domain
emotional expression
- how big and appropriate
- ability to empathize to what extent
Cognitive domain
thought and perceptions
- motivation for actions of self and others
Social Domain
interactions with others
- relationships style
Paranoid PD
- affective domain
Hostile
Irritable
angry mood/affect
Paranoid PD
- cognitive domain
pervasive, persistent & inappropriate distrust/suspiciousness**
Paranoid PD
- social domain
Difficulty with intimacy
Pathological jealousy
Unforgiving
Paranoid PD
accusatory and assumes others will disappoint, manipulate, talk behind back
genuine distrustful and suspicious
PPD wants to ensure
loyalty of family and friends
- no cheating
PPD reacts severely to
being lied to and slighted
Interventions for PPD
Serious & straightforward approach
Honor commitments w/ patient
Involve patient in treatment plan
Teach the patient to validate ideas with a trusted person before acting on an idea
- act inappropriately if distrusts them
Present information in a concrete manner
Schizoid
- affective domain
Often blunted or flat
Restricted
Schizoid
- cognitive domain
“Poverty of thought”
vague communication
Schizoid
- social domain
Present as aloof
Rarely date or marry
“loners”
don’t connect with others
Schizoid mnemonic
-ziod in schizoid = droid in Star Wars
Schizoid
physical contact is less pleasurable (sex and holding hands)
- less likely to seek relationships
avoid social interaction
not interested
- isolate distinct from paranoid and social anxiety
flat affect and emotionally blunted
- will play with machinery or pets
Schizoid Nursing Interventions
Understand that the patient will not benefit from forced social interaction
May need case mgmt services; cannot plan for future needs
Patients may be difficult to include in developing POC-indifference
does not care about the treatment plan
need a lot of lead time and need time to prepare
- written schedule
Schizotypal PD
lack of close friends or confidants but wants friends
superstitious beliefs due to response of their odd behavior
bizarre behavior
suspicious attitude toward others
excessive social anxiety does not improve with familiarity
Schizotypal mnemnonic
they want a -pal
Schizotypal PD
- affective domain
Inappropriate
Constricted
Schizotypal PD
- cognitive domain
Paranoid ideation
Magical thinking -
Ideas of reference -
Schizotypal PD
- social domain
Often avoided by others r/t odd behavior & appearance
indifference to others
Schizotypal PD Interventions
Improve self-care skills
Work towards improved function in the community (appearance, dialogue)
Include in groups to work towards improved social skills
Antisocial PD
- affective domain
Expressive but not genuine
Antisocial PD
- cognitive domain
Egocentric
grandiose
Impulsive
hostile towards society and others
- shamelessly exploit others
Antisocial PD
- social domain
3-4 times more common in men <18 y/o
- conduct disorder in adolescents with trouble in school
Exploitive of others
Sense of entitlement
- can envolve into aggression and violent behavior
Antisocial PD
Interventions
Limit setting and do not be flexible
Confrontation w/o shame
- be neutral and not manipulative
Consistency within the treatment team
- safety from threats and verbal abuse
Work on problem-solving
- work on impulsiveness
Borderline PD
fear of abandonment
extreme mood swings
unstable relationships
impulsive, self-destructive, tendencies
unstable self-image
self-harm = 8/10 die by suicide
paranoia, dissociation
chronic feelings of emptiness
BPD
- affective domain
Intense, labile emotions
anxious
empty (affective instability)
BPD
- cognitive domain
Identity disturbance
dichotomous thinking
May have psychotic episodes under stress
BPD
- social domain
Manipulative relationships
fear abandonment and being alone
3 x more common in women than men
they either love you or hate you
Borderline PD Interventions
Ensure safety: Eating disorders, self-mutilation, risk-taking, suicidal ideation
- No-self-harm contracts when indicated
Establish firm boundaries
Establish a therapeutic relationship; non-judgmental & professional
Provide a safe environment for expression of feelings/emotions (no “tough love”)
Do not be reactive - stay in control of the medication and situations
- official and
Teach to recognize and tolerate feelings; decatastrophizing
- come to nurses when you are having self-harm thoughts instead of acting on them
Histrionic PD background
display exaggerated emotional and attention-seeking
- dramatic
Histrionic PD s/s
discomfort when not the center of attention
seductive
emotional unpredictability
attention-seeking appearance
affected and shallow speech
dramatic/exaggerated emotions
easily influenced
overfamiliarity with acquaintances
Histrionic PD Dx
H&P
referral for symptom questionnaires and structured dx interviews
Histrionic PD
- affective domain
Dramatic & extroverted
Histrionic PD
- cognitive domain
Self-centered
Guided by feelings more than thinking
Histrionic PD
- social domain
Sexual, seductive
Attention-seeking
Manipulative
Histrionic PD interventions
Offer feedback on behavior while offering appropriate alternatives
Model appropriate social skills
Teach the use of “I” messages to express needs in a socially appropriate way
Narcissistic PD
- affective domain
Labile
Narcissistic PD
- cognitive domain
Arrogant, egotistical, grandiose thinking
- only about them will step on others to get where they want to go
Narcissistic PD
- social domain
Lack of empathy for others
“What’s in it for me?”
Sense of entitlement
Narcissistic PD Interventions
Limit setting
Be self-aware (don’t internalize)
State expectations clearly
Reality orientation
Avoidant PD
- affective domain
Fearful & shy
- hypersensitivity to rejection and failure
- low self-esteem and inadequate
Avoidant PD
- cognitive domain
Exaggerated need for acceptance
Avoidant PD
- social domain
Strong fear of rejection, few close friends, reticent & withdrawn (but want relationships)
Feelings of inferiority
Avoidant PD nursing interventions
Work on positive self-affirmations
- bullet journaling
Promote self-esteem
Reframing
Decatastrophizing
Dependent PD
- affective domain
Helplessness
Dependent PD
- cognitive domain
Lack of self confidence
Dependent PD
- social domain
Excessive dependence on others
- desire to be taken care of and will tolerant abuse rather than be alone
- don’t trust own decision-making
- perfect victims for human traffickers
Cling to others
Dependent PD nursing interventions
Explore problems & solutions w/o solving for them
Promote independence
- set up accounts
- get a job
- personal finances
- read legal documents
OCPD
obsessed with order, perfectionism, complete control, rules, details, schedules
- inflexible
- easily stressed
- surprisingly inefficient (spends extra time planning and worrying)
- rigid with beliefs and moral issues
- perceived as stubborn
OCPD
- affective domain
Unable to express emotions
OCPD
- cognitive domain
Perfectionism, procrastination, & indecision (would rather not try, than try and fail)
- paralysied by perfectionims
- anxious and irritable if not in control
- like rules and schedules (rigid)
OCPD
- social domain
Omnipotent (all powerful)
Omniscient (all knowing)
Need for control
OCPD nursing interventions
Practice negotiation
Decatastrophizing
Have the patient set realistic goals
- completion rather than perfection
Common Therapies for PD
Cognitive Behavioral Therapy - healthy positive replacement of negative thoughts
Dialectical Behavior Therapy - tolerate skills that everything does not need to be perfect
Psychodynamic psychotherapy - unconscious thoughts and behaviors for impulse control
Psychoeducation - coping strategies
Meds for PD
Antidepressants (SSRIs)
Mood-stabilizers - GABA (not lithium)
Anti-anxiety medications
Antipsychotic medications for psychosis or delusions
- relisten to 50 minutes for medications
Focus on symptom relief
The nurse should do what for all PD patients (key takeaways)
Lead with EMPATHY
Be self-aware of self-harm and help them though it
Understand that progress is slow
Be realistic in goal-setting
Focus on behavioral change rather than “healing” the disorder
Understand that patients have limited insight
