personality disorders (ch 24) Flashcards
A set of deeply ingrained, enduring patterns of
thinking, feeling and behaving
-includes temperament, character, values
-shaped by biology and social learning
personality
continuous patterns or traits that hinder a person’s ability to maintain meaningful relationships, feel fulfilled, and enjoy life
personality disorders
4 common characteristics of all personality disorders
- inflexible and maladaptive responses to stress
- disability in working and loving
- ability to evoke interpersonal conflict and provoke negative reactions
- capacity to have intense effect on others
DSM 5 criteria for personality disorder (generalized)
- enduring deviation of inner experience and behavior
- atleast 2: cognition, affect, interpersonal functioning, impulse control
- inflexible in broad range of situations
- leads to distress
- traced back to adolescence/early adult
- not due to other mental disorder
- not due to substance or other medical condition
cluster A personality disorders (PaSS on the party)
Paranoid
Schizoid
Schizotypical
nursing considerations for interactions for paranoid pt (in cluster a personality disorder)
- avoid being overly friendly
- be clear and straightforward
- get it in writing
S+S schizoid personality (cluster a personality disorder)
- no desire for relationships
- loners
- emotional coldness
- flat affect
nursing considerations for interactions for schizoid pt (in cluster a personality disorder)
- don’t try to re-socialize
- avoid being too friendly
- through assessment questioning
S+S schizotypical personality (cluster a personality disorder)
- withdrawn
- odd beliefs, fantasy or magical thinking
- social anxiety
nursing considerations for interactions with schizotypical pt (in cluster a personality disorder)
- respect need for isolation
- other considerations for schizoid and paranoid
cluster b personality disorders (BAHNed from party)
Borderline
Antisocial
Histrionic (dramatic)
Narcissistic
S+S antisocial personality in cluster b personality disorder
- stealing, lying, cruelty
- deceitful
- irresponsibility
- lack of remorse
- can be charming
- interacts with. manipulation, aggression
nursing considerations for interactions with antisocial personality (cluster b personality disorder)
- avoid being manipulated by flattery, seductiveness, guilt
- set clear expectations to be followed
what is kholberg theory of moral development
- bottom tier: obtain personal rewards, avoid personal punishment
- middle tier: obey laws and contracts, follow family and group rules
- top tier: ethical principles, inner conscience
S+S borderline personality in cluster b personality disorder
- intense, unstable relationships
- impulsive and damaging behaviors
- acting out instead of expressing emotions
- suicidal/self harm in response to rejection
- chronic emotional emptiness
- outbursts of emotion
- splitting
DSM 5 for borderline personality disorder (I DESPAIR)
Identity disturbance
Dysphoria/emptiness Emotional instability Suicide and self harm Psychotic/dissociative Anger Impulsivity Relationships
nursing consideration with borderline personality disorder
- avoid manipulation
- avoid rejecting or rescuing client
- be straightforward with clear consistent boundaries
- assess for safety
S+S histrionic personality disorder in cluster b
- draw attention to selves
- concerned with appearance
- excessive emotionality
- shallow
- smothering
- no empathy
- instant gratification with affection
nursing considerations for histrionic PD
- remain professional
- reinforce personal qualities
S+S narcissistic PD in cluster b
- uses others to meet needs
- persistent entitlement
- belittles others
- grandiose, lacks empathy
- controlling, power struggles
- overcompensation for lack of self esteem
nursing considerations for narcissistic PD
- convey self confidence
- avoid power struggles
- reinforce social appropriateness
S+S dependent PD in cluster C
- overly agreeable, passive
- unable to be without a relationship
- clingy, lacks own interests
- difficulty with decisions
nursing considerations for dependent PD
- identify real v perceived needs
- meet needs (with limits)
- teach assertiveness
S+S obsessive compulsive disorder in cluster c
- inflexible, rigid control
- perfectionistic
- highly moral and ethical
- lists, rules, schedules
nursing considerations for OCD
- avoid power struggles
- look for intellectualization, rationalization, reaction formations
S+S avoidant PD in cluster c
- social phobia
- feeling of inadequacy
- fears criticism and rejection
- avoids new situations
nursing considerations for avoidant PD
- friendly and reassuring
- gradually introduce to social situations
cluster c personality disorders (party is Dead On Arrival)
Dependent
Obsessive compulsive
Avoidant
therapy that helps individuals to identify and change inaccurate core perceptions of themselves and others and relationship problems.
-helps with reduction of anxiety and SI
cognitive behavioral therapy (CBT)
evidence based therapy that treats chronically suicidal pts with borderline personality disorder
-focuses on mindfulness
dialectical behavior therapy (DBT)
therapy that focuses on the way individuals view themselves with borderline personality disorder
schema focused therapy
med options borderline personality disorder
- SSRIs
- anticonvulsants
- 2nd gen antipsychotics
- lithium
typical behavior of cluster a PDs
odd/eccentric
typical behavior of cluster b PDs
dramatic, emotional, erratic
typical behavior of cluster c PDs
anxious, fearful
