Personality Disorders Flashcards
Personality Disorders are
A set of patterns or traits that hinder a person’s ability to interact and maintain meaningful relationships.
-The patterns deviate from cultural expectations and leads to distress and impairment in functioning
Personality Disorder Traits
- Behavior pattern deviates from cultural norm
-
Use of ineffective coping mechanisms
* Impaired social and occupational functioning - Approach to relationships
* Inflexible and maladaptive
* Elicit a strong response from others* - Rigid, stereotyped behavior pattern
- Stability is tenuous, fragile and they lack resilience
Personality disorders - Etiology
- History of abuse
- Lack of boundaries
Personality disorders - common characteristics
- Failure to accept the consequence of behavior
- Lack of insight
- External response to stress
- Significant impairment in fulfilling family, academic, employment and other functional roles
- Often have the ability to evoke interpersonal conflict
- Involve reliance on maladaptive coping skills
Diagnostic Clusters (3)
Cluster A - Odd- Eccentric
Cluster B - Dramatic - Emotional
Cluster C - Anxious - Fearful
Cluster A : Odd - Eccentric
- Paranoid (suspicious, guarded)
- Schizoid (emotional coldness, detachment, flat affect)
- Schizotypal (superstitious, clairvoyance, telepathy, bizarre fantasies) - lack of close friends and confidants except 1st degree relative)
Cluster B : Dramatic - Emotional
- Borderline (unstable, abandonment, Impulsive, anger)
- Histrionic (center of attention, seductive, shallow, drama)
- Narcissistic (Grandiose, pompous ass, entitled)
- Antisocial (lack of remorse of indifference - C. Manson)
Cluster C : Anxious - Fearful
- Avoidant (avoids social activities, fear of criticism, feelings of inferiority)
- Dependent (Difficulty making decisions or taking care of self, needs excessive advice for everyday activities)
- Obsessive - compulsive (Perfectionist, Devoted to work and productivity, Hoarders)
Nursing Interventions -
Identify behavioral patterns as maladaptive symptoms
-Acknowledge that patient will rely on these maladaptive
coping skills
• Understand defense mechanisms = overused
- Projective identification
* Blaming unacceptable thoughts on an external object - Repression/suppression
* Conscious exclusions of painful thoughts
Nursing Implications
-Understand defense mechanisms
Sublimation - Substitute socially acceptable behavior for unacceptable behavior
Cutting - Relieves anxiety
Reaction formation - Acting the opposite of how one feels
Denial - Failure to admit reality of a situation
Application of the Nursing Process
- Safety
- Consistency
- Limit setting
- Boundary setting
- Appropriate self‐disclosure
- Ongoing staff support and supervision
Difficult Behaviors
Manipulation
-Use of limit setting – WHY?
-Limit setting is an nursing intervention that puts external
controls into place while client develops internal controls
Interventions for Manipulative Behavior
Assign one primary staff member
• Maintain realistic, consistent, firm limits with enforceable
consequences
• Give a rationale for limits and consequences
• Maintain consistency amongst staff members
• Confront client each time manipulation occurs
– Example: Both staff confront client when manipulative
behavior (i.e.: splitting) occurs
Interventions
Understand your own reactivity
• Consistent approach
• Structured environment
• Assist patients in recognizing
*Negative effect/consequences of behavior
*Appropriate boundaries and control
• Firm assertive limits versus authoritative punitive stance
• Encourage follow up on therapeutic modalities, constructive support
Interventions - continued
Your energy can be drained from working with diagnoses. What would you do to ensure good care, yet keep your sanity when a client:
– Causes commotion amongst the other clients in milieu
(tell them to SETTLE DOWN)
– Asks you for clothing because she has no clothing
(contact Social Worker)
– Asks you for money because she is being discharged and her children have no food because the does not pay child support (contact Social Worker)
– Threatens suicide at discharge; keep in mind they do this at EVERY discharge
(you have to decide - call MD)
