personality disorders (329 E2) Flashcards
Cluster A: eccentric
paranoid , schizoid, schiotypal
the people who PaSS on the party
-segregate & remove themselves from other people
-negative schiz sx
-do not lose contact w/ reality
-can be made aware of their thinking
Cluster B: erratic
borderline
narcissistic
histrionic
antisocial
Cluster C: anxious
avoidant
dependent
obsessive-compulsive
what is personality
The characteristics and behavior that comprise a person’s unique adjustment to life, including major traits, interests, drives, values, self-concept, abilities, and emotional patterns. Personality helps determine behavior
personality disorder
-An enduring pattern of deviant inner experiences and behavior
-Differ from cultural expectations
-Pervasive, inflexible, and stable
-Leads to distress or impairment
-Dysfunctions in cognition, impulse control, relationships, and affect
risk factors for personality disorders
-genetic & neurobiological
-psychosocial & environmental
-diathesis stress model
most common symptoms occurring in personality disorders
-impairment in interpersonal relationships
-dysfunction in cognition
-dysfunction in affect
-dysfunction in impulse control
overall treatment for personality disorders
-psychopharm
-therapy
-DBT
-family education & therapy
-social skills training groups
-group therapy
prognosis for personality disorders
treatable bc people continue to grow and change throughout life but prognosis is dependent on degree of impairment and person’s motivation
PD features and dx criteria
A specific and notable pattern of thinking, feeling, and behaving that has the following characteristics:
1) Enduring and persistent over time
2) Pervasive: across a broad range of situations
3) Involves both inner experience and external behavior
4) Differs significantly from individual’s culture
5) Involves two or more areas of functioning: thinking, feeling, interpersonal functioning, impulse control
6) Leads to significant distress/impairment in social, legal, occupational, financial, safety, etc.
7) Not better accounted for by another mental health condition
8) Not better accounted for by the direct physiological effects of a substance
9) Not accounted for by a medical condition
all cluster A personality disorders have
negative sx of schizophrenia
cluster A: schizotypal
distorted reality
-odd ideas
-eccentricity
-unusual experiences
-superstition, religiosity
-suspiciousness
-reclusiveness
cluster A: paranoid
delusional/paranoid
-paranoia
-distrustful nature
-doubts loyalty
-keeps grudges
-easily offended
cluster A: schizoid
soical withdrawal
-aloof
-uninterested in others
-solitary, socially withdrawn
-unaffected by praise and criticism
paranoid personality disorder
-Longstanding intense distrust and suspicion
-Reluctant to confide in others, anxious
-Jealous, controlling as adults
-Unwillingness to forgive & vindictive
-Hypervigilant, quick to anger, provoke others
occur w/o substance use or psychotic episodes
group therapy and paranoid PA
it is very scary for them but the feedback and social interaction is really good if we can get them to go
paranoid personality disorder guidelines for care
-Counteracting mistrust
-Adhere to schedules & boundaries (esp. when threatening)
-Avoid being overly friendly but acknowledge feelings
-Use simple, direct language
-Project a neutral but kind affect
schizoid personality disorder
-Loners, poor academic performance
-Increased prevalence of disordered family life
-Avoid close relationships
-Depersonalization, detachment
-Cold, detached, distant
schizoid personality disorder guidelines for care
-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
-Respect personal space while encouraging participation
schizotypal personality disorder
-Severe social and interpersonal deficits
-Rambling conversation
-Paranoia, suspiciousness, anxiety, distrust, odd and eccentric
-Brief episodes of hallucination or delusion
-Can be made aware of their odd beliefs and magical thinking (might be seen in cults)
schizotypal personality disorder guidelines for care
-Respect patient’s need for social isolation.
-Be aware of and intervene appropriately with patient’s suspiciousness.
-Reinforce socially appropriate behavior and dress
-Perform careful diagnostic assessment for symptoms that may need intervention (e.g., suicidal thoughts).
-use low dose psychotics and supportive psychological care
borderline personality disorder
-Suicidal behavior, gestures, or threats; or self-mutilating behavior
-Affective instability, mood swings
-Identity disturbance: Feelings of emptiness, dysphoria, & boredom
-Intense anger or difficulty controlling anger
-Paranoid ideation or severe dissociation
-Efforts to avoid real or imagined abandonment
-Unstable interpersonal relationships
-Identity disturbances
-Impulsivity in at least two areas that are self-damaging (spending, sex, substance abuse…)
-View themselves as victims
splitting
a defense mechanism in which they are unable to integrate and accept both positive and negative feelings
-people (including themselves) & life situations are either all good or all bad
commonly seen in borderline PD
borderline personality disorder guidelines to care
-Comprehensive assessment: risk assessment and emotional triggers
-Building trust and therapeutic relationships with consistency, empathy, and validation
-Teaching coping strategies for emotional regulation
-Setting boundaries and conflict resolution
-Safety! they live in crisis so have a safety plan and people to call in an emergency
antisocial personality disorder
-Antagonistic behaviors
-Disinhibited behaviors
-Lack of empathy, remorse or guilt
-Violation others’ rights
a psychopath or sociopath
-Evidence of conduct disorder with onset before age 15
-Need to prove superiority
-Center of the universe
-Irritability and aggressiveness
-Superficially charming but deceitful
how to tell the difference between borderline and antisocial PD
antisocial individuals typically have more legal involvement and more outwardly destructive where borderline is more self destructive & more common in females
antisocial personality disorder guidelines for care
-Identify blocks therapeutic relationship
-Identify dysfunctional thinking, develop new problem-solving behaviors
-Self-responsibility facilitation
-Anger control assistance
-Help build a new support system
-Self-awareness enhancement
histrionic personality disorder
-Excitable, dramatic, high functioning
-Bold; attention-seeking, provocative
-Self-centered; low-frustration level
-Excessive emotions; smothering
-No insight: Limited relationships
-Considers relationships more intimate than they are
-do not go up and down in their moods like someone in mania would
histrionic personality disorder guidelines for care
-Know seductive behavior is a response to distress
-Keep interactions professional; ignore flirtations
-Help patient clarify feelings
-Teach and role-model assertiveness
-Assess for suicidal ideation
-Set firm boundaries
narcissistic personality disorder
-Feelings of entitlement, self importance
-Lack of empathy; exploit others
-Low self-esteem and hypersensitivity
-Constant need for admiration
-only want to interact w/ other “special people” to show their superiority
narcissistic personality disorder guidelines for nursing care
-Remain neutral
-Promote a stronger patient self-identity
-Avoid power struggles or becoming defensive
-Role-model empathy
Cluster C: personality disorders
inhibited
-inferiority
-social w/drawal
-shyness
-avoidance
-embarrassment
-low self esteem
Cluster C: dependent
insecure
-indecision
-clinginess
-passivity
-requiring reassurance
-fear of aloneness
Cluster C: obsessive-compulsive
rigid, requiring order
-needs rules, organisation
-perfectionistic
-excessively moral
-constantly productive
-rigid
dependent personality disorder
-High need to be taken care of, clinging behavior
-Fears of separation and abandonment
-Manipulating others to take responsibilities;
submissiveness
-Intense anxiety when left alone even briefly
dependent personality disorder guidelines for care
-Help address current stressors
-Set limits
-Be aware of strong countertransference
-Use therapeutic relationship for assertiveness training
-Encourage independence and self-efficacy
psychotherapy is the treatment of choice
obsessive compulsive personality disorder
-Rigidity; inflexible standards
-Excessive goal-seeking that is self-defeating or relationship-defeating
-Strict standards interfere with project completion
-Unhealthy focus on perfection
-Does not interfere greatly with daily functioning as does the Obsessive-Compulsive disorder
obsessive compulsive personality disorder guidelines for care
-Guard against power struggles
-Remember the patient has difficulty with unexpected changes
-Provide structure, but with time to complete habitual behaviors
-Promote calm, supportive environment
-can give meds for anxiety and depression
avoidant personality disorder
-Low self-esteem
-Shyness that increases with age
-Feelings of inferiority
-Reluctance to engage with new people
-Subject to depression, anxiety, and anger
-Preoccupied with rejection, humiliation, and failure
avoidant personality disorder guidelines for care
-Friendly, accepting, reassuring approach
-Acceptance of patient fears
-Exercises to enhance new social skills
-Design exercises to prevent failures
-Assertiveness training
