Unit 8 Personality Disorders CLUSTER B - Histrionic, Antisocial, Borderline, Naricisstic Chapter 24 Flashcards
Josie, a 27-year-old patient, complains that most of the staff do not like her. She says she can tell whether you are a car- ing person. Josie is unsure of what she wants to do with her life and her “mixed-up feelings” about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it “makes the numbness stop.” Given this presentation, which personality disorder would you suspect?
a. Obsessive-compulsive
b. Borderline
c. Antisocial
d. Schizotypal
b. Borderline
Persuasive pattern of excessive emotionality and attention seeking behavior. Which phrase does this personality disorder relate to?
A.Histrionic
B. Schizoid
C. Schizotypal
D. Dependent
A.Histrionic
What characteristic describe Histrionic Personality Disorder?
Excitable, dramatic, often high functioning “drama queen”
Emotional attention-seeking, self-centeredness, low frustration tolerance, excessive emotionality
Impulsive, flirtatious, provocative
Relationships don’t last – no insight into their personal role in the breakup
What type of behavior will with Histrionic Personality Disorder will exhibit?
A. wearing bright clothes and lipstick to get attention.
B. Wearing a red hat at a casual event.
C. very dependent on her husband to pay the bills.
D. self isolated behavior.
A. wearing bright clothes and lipstick to get attention.
Is it easy for patient with Histrionic Personality Disorder to KEEP a relationship?
A. Yes
B. No
B. No
Relationships don’t last – no insight into their personal role in the breakup
Are patients with Histrionic Personality Disorder good at making friends?
A. Yes
B. No
A. Yes
-they have a hard time keeping long lasting relationships.
With patients with Histrionic Personality Disorder ,do they get upset for little to no reason?
A. Yes
B. No
A. Yes
-very dramatic
-low frustration tolerance
ASSESS SUICIDALITY
Nursing Care for Histrionic Personality Disorder
Nursing Care
Understand that seductive behavior is a response to distress
Boundaries – keep interactions professional
Concrete and descriptive language rather than vague
Teach and role model assertiveness
Assess suicidality
Does patients with Histrionic Personality Disorder need everyone to know their in the room?
A. No
B. Yes
B. Yes
Treatment FOR Histrionic Personality Disorders
Treatment
Psychotherapy to identify true feelings
Group therapy can be beneficial, but individual can disrupt group
Meds – possible antidepressant, antianxiety or antipsychotics
What type of group member would a histrionic patient be during group therapy?
A. Monopolozing
B. Silent
C. Disruptive
A. Monopolozing
The monopolizer is a group member who makes excessive verbal contributions, preventing equal participation by other group members
Antisocial Personality Disorders , what are their characteristics?
Deceitful and manipulative for personal gain. Exploit others
Hostile if needs are blocked
Disinhibited – high risk taking, disregard for responsibility and impulsivity
Criminal misconduct and substance misuse are common
Main concern – gaining personal power or pleasure
Callousness – lack of empathy, lack of concern about
other’s feelings and the absence of remorse or guild except
when facing punishment
MOST LIKELY TO BE CRIMINALS
VIOLATES THE RIGHTS OF OTHERS
Are patients with Anti social personality disorder really anti social ?
A. Yes
B.No
B.No
they are social chameleons
Def: “social chameleons.” They engage in high levels of self-presentation and present different “versions” of themselves, depending on the situation. They blend in
Do patients with Antisocial disorder lack empathy and remorse?
A. Yes
B. No
A. Yes
Callousness – lack of empathy, lack of concern about other’s feelings and the absence of remorse or guild except
when facing punishment
Which of the following personality disorders is the MOST dangerous?
A. Boderline
B. Dependent
C. Antisocial
D. Histrionic
C. Antisocial
Which of the following personality disorders are is common to abuse drugs and have criminal misconduct?
A. Boderline
B. Dependent
C. Antisocial
D. Histrionic
C. Antisocial
Criminal misconduct and substance misuse are common
-very manipulative , THEY ARE CON ARTIST AND LIARS
Nursing Care for patient with Antisocial disorder
Set clear, realistic boundaries and consequences
Be aware the patient can manipulate without the feelings of guilt
Understand that the patient may demonstrate anger, aggression
Pharmacological treatment for Antisocial disorder
Treatment
Mood stabilizer may help aggression, impulsivity and depression
SSRIs to reduce irritability and anxiety
-lithium for agression
-clozapine for aggression
What statement is the following is associated with Narcissistic Personality Disorder?
A. Arrogant , grandiose thoughts of ones self
B. Highly seductive , and attention seeking
C. high self harm rate and impulsivity
D. life long pattern of social withdrawal
A. Arrogant , grandiose thoughts of ones self
What is the characteristic of Narcissistic personality Disorder?
Feeling entitled, exaggerated belief of one’s importance!!!!
Reality the individual has a weak self-esteem and hypersensitive to criticism.
Feel intense shame and have a fear of abandonment .
Come across as arrogant
-lack of empathy
A group of patients are speaking about how the death of their loved ones has affected their livihood. One group member says , “Oh, get over it”. What type of personality disorder is this patient exhibiting?
A. Narcissistic
B. Schizoid
C. Avoidant
D. Dependent
A. Narcissistic
Come across as arrogant
-lack of empathy
Do Narcisstic Personality Disorders believe they deserve special treatment?
A. yes
B. no
A. yes
-grandious
-self importance
Do NPD take criticisms as a a personal attack?
A. Yes
B.No
A. Yes
Reality the individual has a weak self-esteem and hypersensitive to criticism.
Nursing care for Narcotic personality disorder?
Nursing Care
Remain neutral and recognize the source of the narcissistic behavior is shame and
fear of abandonment
Avoid power struggle and Role Model Empathy
Avoid engaging in power struggles or becoming defensive in response to the patient’s disparaging remarks.
* Do not directly challenge grandiose statements.
What is the source of Narcisstic behavior
Nurses should remain neutral and recognize the source of narcissistic behavior—shame and fear of abandonment.
Which of the following statements describe Borderline Personality Disorder?
A. “don’t leave me if you do I am going to kill myself.”
B. “Doesn’t my dress look beautiful.”
C.” I know your love for me can cross the ocean and back, just buy this car for me.”
D. “ I just want to be left alone,”
A. “don’t leave me if you do I am going to kill myself.”
** Ineffective and often harmful self-soothing**
-cutting
-burning
habits – chronic suicidal ideations
What are the characteristics of Borderline Personality disorder
One of the primary features of borderline personality dis- order is emotional lability, that is, rapidly moving from one emotional extreme to another.
Severe impairments in functioning
Marked instability in emotional control or
regulation (labile), impulsivity, identity or
self-image distortions, unstable mood and
unstable interpersonal relationships.
Self-destructive behaviors are prominent
Ineffective and often harmful self-soothing
-cutting
-burning
habits – chronic suicidal ideations
Splitting – inability to view both positive
and negative aspects as part of a whole
(Either good or bad, black or white – no in
between)
Which defense mechanism is popular in patients with with Borderline personality disorder?
A. Altruism
B. Conversion
C. Splitting
D. Projection
C. Splitting
Splitting – inability to view both positive
and negative aspects as part of a whole
(Either good or bad, black or white – no in
between)
I love you or I hate you
-gain friends very quickly and hates them the next day
BLACK OR WHITE
-one nurse is an angel vs one nurse is devil
Are patients with Borderline Personality Disorder exhibit impulsive behaviors?
A. Yes
B. No
A. Yes
Another disruptive trait common in people with border- line personality disorder is impulsivity, or acting quickly in response to emotions without considering the consequences. This results in damaged relationships and even in suicide attempts.
may turn into accidental death due to impulsivity and self harm tactics
What is the priority assessment for patients with Borderline Personality disorder?
A. Risk for falls
B. Risk for suicide
C. ineffecive coping mechanisms
D. Risk for fluid imbalance
B. Risk for suicide
may turn into accidental death due to impulsivity and self harm tactics
Ineffective and often harmful self-soothing
-cutting
-burning
habits – chronic suicidal ideations
What is the main reason patients exhibit non suicidal injuries?
A. for monetary gain
B. for attention
C. for support from physicians
D. to get cured of the borderline personality disorder
B. for attention
NONSUICIDAL SELF-INJURY
These injuries are deliberate and direct
attempt to inflict shallow but painful injuries
* There is NOT an intent to end one’s life
* Cutting, burning, scratching, scraping
* Intent
* Alleviate psychic pain
* Pierce psychic numbness
Get attention
* Escape a responsibility
* Avoid a situation
Chronic Suicidal ideation
Chronic suicidal ideation is also a common feature of this dis- order and influences the likelihood of accidental deaths. Co- occurring mood, anxiety, or substance disorders complicate the treatment and prognosis of the condition.
Examples of Self destructive behaviors
Self-destructive behaviors are prominent in this disorder. Ineffective and often harmful self-soothing habits such as cut- ting, promiscuous sexual behavior, and numbing with substances are common and may result in unintentional death.
Nursing Care for Borderline Personality disorder
SAFETY IS PRIORITY
-if patient reports of suicidal ideation , immediate 1 to 1 intervention.
-Assess for hx of suicidal thoughts, aggressive behavior, hx of abuse
Be aware the patient may experience intense feelings of abandonment
Care for the patient in a matter of fact Way.
-do not bring so much attention to self harm tactics , because if you do you will fulfill the attention they are craving and looking for and they will resort in cutting or harming themselves again
Relationships form quickly
What is the priority should you assess for with Borderline Personality Disorder?
Assess for hx of suicidal thoughts, aggressive behavior, hx of abuse
Be aware the patient may experience intense feelings of abandonment
Care for the patient in a matter of fact ay.
Relationships form quickly
What is the number one treatment for Borderline Personality Disorder?
A. Trauma focused cognitive behavioral therapy
B. Dialectal Behavioral Therapy
C. Cognitive Behavioral Therapy
D. Eye Movement Desensitization and Reprocessing
B. Dialectal Behavioral Therapy
Treatment
Therapy – CBT, individual, group,
Address self-destruction
Meds – Lithium has some efficacy in Chronic Suicidality, Meds for
comorbidities, tx aggression
What is the use for Dialectal Behavioral Therapy?
Function:
Minimizes strong responses and improves ability to manage emotions
-used for liable emotions can decrease impulsivity of suicdal or nonsuicidal injuries.
What is involved:
Mindfulness, deep breathing, relaxation, distress tolerance, and interpersonal effectiveness training
