Personality Disorders Flashcards
What are the cluster A d/o
(APSS) Paranoid, Schizoid, Schizotypal - Odd or eccentric
What is Paranoid PD
(Cluster A) Distrust, suspicion, short temper, argumentative, jealous, unable to forgive or adjust to change. Lack of tender feelings for others
What is Schizoid PD
(Cluster A) Brief psychotic episodes in response to stress, loner, passive, detached, self absorbed, lack of strong emotions, lack of trust, difficulty expressing anger
What is Schizotypal PD
(Cluster A) Magical thinking, incorrect interpretation of external events and belief that all events refer to self, constricted/inappropriate affect, social anxiety (poor/moderate functioning)
What are the cluster B d/o
(NAHB) Narcissistic, Antisocial, Histrionic, Borderline - Dramatic, emotional, erratic
What is Antisocial PD
(Cluster B) charming at first, lack of conscience, empathy or responsibility, manipulative, involved in criminal acts or substance abuse
What is Borderline PD
(Cluster B) Anger, suicidal thoughts, self mutilation, cutting intense stormy relationships, impulsive acts, people as all good or all bad, feel abandoned, difficulty identifying self
Intervention for Borderline PD
Dialect behavioral therapy - dialogue to rework destructive ways to deal with crisis, teaches there are choices to decrease suicidal thoughts, learn new patterns of thinking and behaving
What is Narcissistic PD
(Cluster B) Grandiose view of self, lack of empthty for others, needs admiration, preoccupation with fantasies of success, brilliance, beauty, perfect love, conceded
What is Histrionic PD
(Cluster B) Fluctuations of emotions, suicidal threats when feeling abandoned, attention seeker, sexual seduction, flamboyance, somatization, dramatic speech, attentive to physical appearance, shallow, DRAMA QUEEN
What are cluster C d/o
(ADOC) Avoidant, Dependent, Obsessive Compulsive
What is Avoidant PD
(Cluster C) Fears criticism, disapproval or rejection, avoid social interactions, hold in thoughts and feelings, low self-esteem - intermediate functioning
What is Dependent PD
(Cluster C) Submissive, clingy, can’t make decisions on own, cant follow through on tasks, cant express negative feelings
What is Obsessive Compulsive PD
(Cluster C) Preoccupied with structure/organization/perfection/control, workaholics, cant relax, self critical, rule conscious, insistence that others go with their methods, cant get rid of things, cant delegate, procrastination, wont spend money
Freud’s perspective of PD
Comes from unresolved conflicts
1) Oral- probs trusting others, self centered, dependent, jealous (Paranoid,borderline, histrionic)
2) Anal- probs making decisions, cannot share, full of rage (antisocial,borderline, histrionic dependent)
3) Phallic- probs with superego, guilt (antisocial/borderline, histrionic, narcissistic)
4) Latency- probs with too little (borderline) or too much (OCD) control
5) Genital- probs with sense of self (various PD)
Separation - Individuation (Margaret Mahler)
Childhood process of developing sense of self separate from mother (4 stages) Differentiation Practicing Rapprochement Beginning of object constancy
Otto Kernberg
2 tasks of object relations - child can distinguish between self and another, can integrate good and bad images of self and of others
Borderline PD - splitting (cant integrate good and bad of self and others), idealization of those who meet needs, devaluation of those who don’t meet needs, lack of object constancy (cant hold memory of another, love one is absent is viewed as abandonment) ALWAYS AT NURSES STATION
Masterson - Object Relations
4 defenses block growth and autonomy (Projection, Denial, Clinging, Avoidance)
Borderline PD develops when person is ‘stuck’ (frustration in every day living, cant maintain relationships, anger and rage when ignored, inability to have images of another when absent, cannot mourn) CENTER OF ATTENTION
What is splitting of staff, and how can we reduce it
No equality of the staff, always the ‘good nurse’ and others are ‘bad nurse’ images
Open communication in staff meetings, ongoing clinical supervision
Splitting behaviors of patients
Primary defense with borderline PD, labels people as ‘all good’ or ‘all bad’, creates conflict with staff members
Therapies for PD
Milieu - recreation of a community setting
Movement - learning relaxation
Music/art - helps express feelings
Occupational - helps development of life skills
Group - problem solving
Family - family dynamics
Medication- control symptoms
Medications of PD
Benzos - short term
Antipsychotics to treat aggressiveness and impulsivity
Mood stabilizers to treat rage, violence, impulsivity, feelings of losing control
Antidepressants
Antianxiety agents
Nursing Diagnosis for Cluster A
Anxiety
Ineffective Coping
Social Isolation
Disturbed thought process
Nursing Diagnosis for Cluster B
Ineffective Coping Disturbed personal identity Chronic low self-esteem Risk for self mutilation Risk for suicide Impaired social interaction Risk for self.other directed violence
Nursing Diagnosis for Cluster C
Anxiety
Ineffective Coping
Chronic low self-esteem
Impaired social interaction
Interventions for manipulative, aggressive, or impulse behaviors
Calm nonjudgmental approach
Communication with tx team to prevent splitting
Teach alternative ways to manage feelings
Frequent short interactions
Encourage journaling
Encourage group participation
Close watch for escalation in anger
Redirection
Time out
Seclusion/restraint per protocol - LAST RESORT
Discharge Criteria for PD
Consider risk factor of safety for client and others
Have follow-up plan
Provide psycho-education
