Personality Disorders: Exam 3

Question 1

Personalities are like trees. Healthy trees are __________. When a storm rolls through, they can sway in the breeze. Rigid trees, however, cannot withstand strong winds. They splinter and fall.

Answer 1

Flexible

Question 2

Individuals with healthy personalities adapt to difficult situations. They “read” other people and change their interaction style when needed. Their relationships with others are reciprocal. They maintain their own boundaries and respect the boundaries of others.

Answer 2

Normal Personalities

Question 3

Individuals with personality disorders have difficulty adapting to the needs of the moment. They rigidly stick to dysfunctional interaction styles. This inflexibility causes significant distress to themselves and others. These problems cause them to ramp up these maladaptive thoughts, emotions, and behaviors, creating a vicious cycle. They have trouble maintaining and respecting boundaries.

Answer 3

Personality Disorders

Question 4

Schneider’s Four E’s

Answer 4

Early
Enduring
Egosyntonic
Externalization

Question 5

The beginnings of the disorder were present early in life and became fully developed in adulthood.

Answer 5

Early

Question 6

Personality disorders do not come and go. These maladaptive patterns are present in all situations and with all people.

Answer 6

Enduring

Question 7

Clients have ______ insight. They believe others are the source of their distress. If they seek treatment, it is usually for a comorbidity (e.g., depression). They don’t understand or accept they have this problem.

Answer 7

__Core___
Egosyntonic

Question 8

Clients with a personality externalize their stress onto __________; it’s the people around them that feel uncomfortable.

Answer 8

___Other___
Externalization

Question 9

The DSM-5 identifies _____ specific personality disorders. These disorders are organized into ______ clusters.

Answer 9

10
ABC

Question 10

A disorders are characterized by _______ or eccentric behaviors. They are sort of like mild, functional versions of schizophrenia.

Answer 10

__Odd___
Cluster

Question 11

clients are highly _________of others—even close companions. They stay on the alert lest someone try to sabotage them or take advantage. They are private and reveal little about themselves—someone could use personal information against them.

Answer 11

___ Suspicious ___
Paranoid Personality Disorder

Question 12

clients are reclusive and have very limited social interaction. They are not lonely or fearful of rejection. Rather, they have little interest in others. They prefer solitude. Others find them to be awkward and strange. Cut off from other people, they are okay, little interest in others.

Answer 12

Schizoid Personality Disorder

Question 13

Clients have disorganized speech and behavior. They are odd and eccentric. They do not have hallucinations or delusion, but they may engage in magical thinking and experience illusions (e.g., UFO sightings). Similar to schizophrenia , ongoing, and higher motor skills and can live on their own

Answer 13

Schizotypal Personality Disorder

Question 14

Cluster B disorders are characterized by dramatic, emotional, and erratic behaviors. These clients have trouble respecting personal _________________ and can cause significant distress to others. Antisocial and borderline personality disorders are the focus of this lesson. We’ll discuss them in a moment.

Answer 14

Boundaries

Question 15

clients are dramatic and love the spotlight. They usually dress ___________ and can be very flirtatious. Relationships are intense, but shallow and short-lived.

Answer 15

____Seductively___
Histrionic Personality Disorder

Question 16

clients are very _________ and outspoken about their talents and achievements. They very preoccupied with themselves. Their interest in someone can be strong if they believe that person may help them get what they want. Just as quickly, their interest will vanish when that person is no longer needed. They are entitled.

Answer 16

___Proud____
Narcissistic Personality Disorder

Question 17

Cluster C disorders are characterized by __________ emotions and behaviors.

Answer 17

Anxious

Question 18

clients crave relationships but feel too awkward or inept to pursue them. They fear _____________ so much, they find it easier to avoid new relationships. Their only relationships are with a few old friends.

Answer 18

____Rejection_____
Avoidant Personality Disorder

Question 19

Clients feel a desperate need to be _______ for and nurtured by someone else. They are needy, unassertive, and overly submissive. They have few interests of their own and view the world through other people’s eyes.

Answer 19

___Cared___
Dependent Personality Disorder

Question 20

clients are overly concerned with rules, order, and routines. They are true _______ and have trouble delegating. They are usually stingy with money and have trouble throwing things away. They are inflexible in relationships; it’s their way or the highway.

Answer 20

______ perfectionists ______
Obsessive-Compulsive Personality Disorder

Question 21

Clients had serious behavior problems starting in childhood (i.e., conduct disorder). As they have grown up, they’ve maintained these selfish, ruthless, violent behaviors. These clients lie, cheat, steal, and destroy. They have an “every man for himself” and “survival of the fittest” worldview. There is a more sophisticated, “white collar” version of antisocial personality disorder. Instead of physically attacking their victims, these con-artists are professionals at smooth talking people into giving them what they want (e.g., money, sex, power).
Sometimes the term ___________________ is used to describe a more severe version of this disorder. These clients are extremely cold, predatory, and have no remorse for their terrible deeds. They prey on the weak, poor, elderly, and intellectually disabled.

Answer 21

____Psychopathy____
Anti-Social Personality Disorder

Question 22

What is the epidemiology of Anti-Personality Disorder?

Answer 22

The lifetime prevalence of antisocial personality disorder is 2-5%. men are three times more likely to have this disorder.

Question 23

Clients with antisocial personality tend to have difficult childhoods. Parental affection was often withheld. Many experienced physical abuse and neglect.

Answer 23

Psychosocial Factors of Anti-Personality Disorder

Question 24

There seems to be evidence of genetic risk factors and neurobiological abnormalities.

Answer 24

Biological Factors of Anti-Personality Disorder

Question 25

What are the effective treatments of Anti-social personality disorder?

Answer 25

Psychotherapy
Pharmacotherapy

Question 26

is generally ineffective. CBT may help those with mild versions of antipsychotic, who have good insight, and are motivated to change.

Answer 26

Psychotherapy

Question 27

There is no effective medication for antisocial personality disorder. Medications can, however, treat comorbid psychiatric disorders. Second generation antipsychotics can treat severe aggression. Medications with abuse potential should be avoided.

Answer 27

Pharmacotherapy

Question 28

What are nursing interventions for anti-social personality disorder?

Answer 28

Clients with antisocial personality disorder can be difficult to care for. Don’t allow yourself to have personal “triggers.” Monitor your thoughts and emotions. Watch out for counter-transference.

Remember to convey unconditional positive regard. Maintain the attitude that it is not the person but his or her behavior that is unacceptable.

Observe the client’s behavior frequently. Remove dangerous objects from the environment.

Set clear limits on unacceptable and manipulative behavior. Remember to use a calm, matter-of-fact tone.

Use clear, understandable terminology. Explain what the consequence will be if the limits are broken.
Ensure consistency among staff in explaining and enforcing these limits.

Give positive feedback when clients behave appropriately.

Clients with antisocial personality disorder often misuse the ego defense mechanism of
displacement. Help clients realize this and recognize that real source of their anger.

Encourage clients to express their anger in healthy ways (e.g., assertive communication, punching bag, jogging, exercise bike).

Ensure sufficient staff is available to present a “show of strength” if necessary. Remember to use the least restrictive means necessary.

Question 29

Clients have intense fears of ______________ . Clients cling tightly to relationships. They become angry when others do not meet their unrealistic expectations. These behaviors drive others away, fulfilling their greatest fear.

Answer 29

___Abandonment__
Borderline Personality Disorder

Question 30

___________ is a common ego defense mechanism. Clients handle feelings of rejection by vilifying the person that offended them. At the same time, they imagine other friends or relatives are saintly. This false caricature serves to highlight the misdeeds of the person who angered them and justify the clients’ intense rage. Friends and family often describe them as being either “hot” or “cold.”

Answer 30

__Splitting__
Borderline Personality Disorder

Question 31

What is the epidemiology of borderline personality disorder?

Answer 31

The lifetime prevalence of borderline personality disorder is 5.9%. Rates are roughly equal between men and women. Women, however, are more likely to seek treatment.

Question 32

What is the psychosocial factors related to borderline personality disorder?

Answer 32

Many clients who have borderline personality disorder experienced childhood trauma (e.g., physical or sexual abuse).

Question 33

What is the biological factors related to borderline personality disorder?

Answer 33

Research also suggests genetic and neurobiological risk factors.

Question 34

What is the psychotherapy related to borderline personality disorder?

Answer 34

Dialectical behavioral therapy is the primary therapy for this disorder.

Question 35

What is the pharmacotherapy related to borderline personality disorder?

Answer 35

Pharmacotherapy is targeted at specific symptoms that often accompany borderline personality disorder. Antidepressants can help treat depression. Antipsychotics and mood stabilizers can treat emotional instability, impulsivity, and aggression.

Question 36

What are the nursing interventions for Borderline Personality Disorder?

Answer 36

Clients with borderline personality disorder can be difficult to care for. Don’t allow yourself to have personal “triggers.” Monitor your thoughts and emotions. Watch out for counter-transference.

Remember that clients who have borderline personality disorder have strong fears of
a b a n d o n m e n t . They often exhibit clinging and distancing behaviors. Help these clients understand that you are available but do not promote dependent, clinging behaviors. Consider rotating staff members.

Splitting is a primary ego defense mechanism of clients with borderline personality disorder. These clients tend to see people as either all g o o d or all e v i l . One day someone may be the client’s favorite caregiver; the next day that same person may be the client’s sworn enemy. Don’t get sucked into flattery, and don’t entertain discussions about how terrible another team member is. Encourage the client with borderline personality disorders to discuss those feelings directly with the staff member involved.

Encourage clients who engage in self-mutilating behaviors to seek out a team member if the urge returns. Remove dangerous objects and frequently monitor the client.

Encourage clients to v e r b a l i z e painful emotions. Provide physical outlets for strong emotions (e.g., punching bag, jogging, exercise bike). Give positive reinforcement when clients express anger appropriately.

If self-mutilation occurs, do not r e i n f o r c e for the behavior by giving lots of sympathy or showing lots of interest in the wounds. Instead, matter-of-factually treat the wounds and encourage the client to discuss the emotions that preceded the self-injury. The goal is to help the client find better coping strategies next time the urge returns.

Assess for suicidal idealization. About 1 0 % of clients with borderline personality disorder will complete suicide.