Unit 8 Personality Disorders CLUSTER B - Histrionic, Antisocial, Borderline, Naricisstic Chapter 24

Question 1

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

Answer 1

b. Borderline

Question 2

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

Answer 2

A.Histrionic

Question 3

What characteristic describe Histrionic Personality Disorder?

Answer 3

 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

Question 4

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.

Answer 4

A. wearing bright clothes and lipstick to get attention.

Question 5

Is it easy for patient with Histrionic Personality Disorder to KEEP a relationship?

A. Yes
B. No

Answer 5

B. No

Relationships don’t last – no insight into their personal role in the breakup

Question 6

Are patients with Histrionic Personality Disorder good at making friends?

A. Yes
B. No

Answer 6

A. Yes

-they have a hard time keeping long lasting relationships.

Question 7

With patients with Histrionic Personality Disorder ,do they get upset for little to no reason?

A. Yes
B. No

Answer 7

A. Yes

-very dramatic
-low frustration tolerance
ASSESS SUICIDALITY

Question 8

Nursing Care for Histrionic Personality Disorder

Answer 8

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

Question 9

Does patients with Histrionic Personality Disorder need everyone to know their in the room?

A. No
B. Yes

Answer 9

B. Yes

Question 10

Treatment FOR Histrionic Personality Disorders

Answer 10

Treatment
 Psychotherapy to identify true feelings

 Group therapy can be beneficial, but individual can disrupt group

 Meds – possible antidepressant, antianxiety or antipsychotics

Question 11

What type of group member would a histrionic patient be during group therapy?

A. Monopolozing
B. Silent
C. Disruptive

Answer 11

A. Monopolozing

The monopolizer is a group member who makes excessive verbal contributions, preventing equal participation by other group members

Question 12

Antisocial Personality Disorders , what are their characteristics?

Answer 12

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

Question 13

Are patients with Anti social personality disorder really anti social ?

A. Yes
B.No

Answer 13

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

Question 14

Do patients with Antisocial disorder lack empathy and remorse?

A. Yes
B. No

Answer 14

A. Yes

 Callousness – lack of empathy, lack of concern about other’s feelings and the absence of remorse or guild except
when facing punishment

Question 15

Which of the following personality disorders is the MOST dangerous?

A. Boderline
B. Dependent
C. Antisocial
D. Histrionic

Answer 15

C. Antisocial

Question 16

Which of the following personality disorders are is common to abuse drugs and have criminal misconduct?

A. Boderline
B. Dependent
C. Antisocial
D. Histrionic

Answer 16

C. Antisocial

Criminal misconduct and substance misuse are common

-very manipulative , THEY ARE CON ARTIST AND LIARS

Question 17

Nursing Care for patient with Antisocial disorder

Answer 17

 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

Question 18

Pharmacological treatment for Antisocial disorder

Answer 18

Treatment
 Mood stabilizer may help aggression, impulsivity and depression
 SSRIs to reduce irritability and anxiety

-lithium for agression
-clozapine for aggression

Question 19

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

Answer 19

A. Arrogant , grandiose thoughts of ones self

Question 20

What is the characteristic of Narcissistic personality Disorder?

Answer 20

 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

Question 21

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

Answer 21

A. Narcissistic

 Come across as arrogant

-lack of empathy

Question 22

Do Narcisstic Personality Disorders believe they deserve special treatment?

A. yes
B. no

Answer 22

A. yes

-grandious
-self importance

Question 23

Do NPD take criticisms as a a personal attack?

A. Yes
B.No

Answer 23

A. Yes

 Reality the individual has a weak self-esteem and hypersensitive to criticism.

Question 24

Nursing care for Narcotic personality disorder?

Answer 24

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.

Question 25

What is the source of Narcisstic behavior

Answer 25

Nurses should remain neutral and recognize the source of narcissistic behavior—shame and fear of abandonment.

Question 26

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,”

Answer 26

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

Question 27

What are the characteristics of Borderline Personality disorder

Answer 27

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)

Question 28

Which defense mechanism is popular in patients with with Borderline personality disorder?

A. Altruism
B. Conversion
C. Splitting
D. Projection

Answer 28

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

Question 29

Are patients with Borderline Personality Disorder exhibit impulsive behaviors?

A. Yes
B. No

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

B. for attention

Question 32

NONSUICIDAL SELF-INJURY

Answer 32

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

Question 33

Chronic Suicidal ideation

Answer 33

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.

Question 34

Examples of Self destructive behaviors

Answer 34

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.

Question 35

Nursing Care for Borderline Personality disorder

Answer 35

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

Question 36

What is the priority should you assess for with Borderline Personality Disorder?

Answer 36

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

Question 37

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

Answer 37

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

Question 38

What is the use for Dialectal Behavioral Therapy?

Answer 38

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