W 6: Personality disorders Flashcards
What is a personality disorder?
= psychological qualities that contribute to an individual’s enduring/consistent and distinctive patterns of feeling, thinking, and behaving
Define personality disorder
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s
culture. This pattern is manifested in two (or more) of the following areas:
- Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
- Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
- Interpersonal functioning.
- Impulse control
What are some key traits of personality disorders?
- The enduring pattern is inflexible and pervasive (all area of ones life) across a broad range of personal and social situations.
- The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder. - The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
What are people with cluster A personality disorder described as and what disorders are included in each?
Odd/eccentric
- Paranoid
- Schizoid
- Schizotypal
*less likley to seek treatment
What are people with cluster B personality disorder described as and what disorders are included in each?
Dramatic/erratic
- antisocial
- borderline (BPD)
- histrionic
- narcissistic
*more likley to come to the notice of health professionals
What are people with cluster C personality disorder described as and what disorders are included in each?
Anxious/fearful
- avoidant
- dependant
- obsessive-compulsive
*May seek treatment
What is the DSM V Criteria For BPD?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts,
- as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment (e.g. doesn’t get an instant text back).
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. (e.g. black and white thinking. You can go from the best to the worst nurse)
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour (feel as they can only control their life or death)
6. Affective instability due to a marked reactivity of mood. (up and down mood and can be miss diagnosed as bipolar)
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
- these symptoms of episodical and can be changed by life events
Why do those with BPD have high rates of interaction with the healthcare system?
- they have an increased risk of suicide
- they have an increased risk of suffering co-morbidities
- a lack of support for BPD so they just have to go to emergency
Why is there a great stigma around BPD?
- those with BPM transfer/project their emotions which makes it hard to work with and challenges empathy.
- a lack of understanding in nurses
What are the causes BPD?
- Not fully understood
- Likely to involve biological, social and/or environmental factors
- May relate to childhood experiences of trauma or neglect
Remember:
- The person may not have caused all of their problems, but they have to solve them anyway
- Having BPD is not deliberate; it is a disorder people do not choose to have. And, people can recover!
What is emotional regulation?
The ability to:
- Inhibit impulsive and inappropriate behavior related to strong negative or positive emotions
- Organise oneself for coordinated action in the service of an external goal
- Self-soothe any physiological arousal that the strong emotion has induced
- Refocus attention in the presence of strong emotion
What is dysemotional regulation?
- Difficulties regulating painful emotions
Characterised by;
- inability to regulate intense physiological arousal
- problems turning attention away from stimuli
- cognitive distortions and failures in information processing
- insufficient control of impulsive behaviours related to strong emotions
- This results in dysfunctional behaviours
Why and what dysfunctional behaviours are used by people in BPD to cope?
= dysfunctional behaviour planning and thinking about distracts from the emotional pain
Coping straties
- suicide
- self harm (physical harm interrupts and distracts from emotional harm)
What are some key nursing considerations/points to consider when helping someone with BPD ho has experienced crisis?
- Many people with BPD experience crisis, resulting in need for support from healthcare services
- Onset associated with a precipitating event (severe or seemingly trivial), sudden overwhelming emotional distress and psychosocial dysfunction that lasts for days to weeks
- Characterised by emotional distress
- strong emotions ‘feels like they are going to explode - Every person’s experience of crisis is different; coping strategies are different
- ask what might have helped them in crisis before - Difficulty articulating their experience
- this is when they often go to self harm as it communication the notion of not being ok - May feel unable to cope and may expect others to take responsibility for their needs
- don’t mother them
- we want to promote recovery - Increase in risk of suicide and self-harm (not always)
- Crisis impacts carers and loved ones so look after them also. Could be in a parallel crisis because they hate seeing a loved on in distress
What are some ways interventions for someone with BPD who is in crisis?
- Respond promptly, whether reported by the person or by a family member or carer.
- Listen to the person – validates the person’s experience and shows that you believe the person’s distress is real. Let the person ‘ventilate’ – this can relieve tension.
- Be supportive, non-judgemental, and show empathy and concern. Express concern if the person mentions suicidal thoughts or other risks to their safety.
- Assess the person’s risk. Check if there is any change in the pattern of self-harm and suicidality that could indicate high immediate risk. Check for repeated traumatic experiences or new adverse life events.
- Assess mental health status and rule out co-occurring mental illness.
- Stay calm and avoid expressing shock or anger.
- Focus on the here and now
- Take a problem-solving approach.
- Plan for the person’s safety in collaboration with them. Do not assume that you know best about how to help them during a crisis. Ask the person to say if they want help and to explain what kind of help they would like. Provide practical help.
- Clearly explain your role and the roles of other staff members.
- Communicate with and involve the person’s family, partner or carers, if appropriate.
- Offer support to the person’s family, partner or carers.
- Where possible, liaise with other clinicians/teams/hospitals involved in the person’s care.
- These should be identified in the person’s management plan and crisis plan (if available).
What actions should you take If The Person Is At High Acute Risk Of Suicide?
- Do not leave the person alone. If necessary, use the powers of local mental health legislation.
- Prevent or reduce access to the means of suicide. (take meds if they plan to OD)
- Do not use threats or try to make the person feel guilty. “think of your family or kids”
- Consult senior staff.
- Contact all involved in the person’s care (e.g. medical practitioner, crisis team, mental health service, hospital, family, partner, carers, other supports).
- Find out what, or who, has helped in the past.
- Clearly explain your actions.
- Do not agree to keep the suicide plan a secret.
- Make a management plan
What are some treatment goals for someone with BDP?
- Long term engagement is psychotherapy
- Suicide prevention
- Prevention of self-harm
- Avoiding the need for hospital admission
- Improving relationships
- Learning skills for coping
- Overcoming personal problems
- Personal employment and occupational goals
- Developing the ability to deal with situations that trigger emotional crises
- Learning self-soothing or distraction techniques
- Reducing or managing anger
- Reducing depression or anxiety
- Managing co-occurring conditions
- Reducing or controlling problem behaviours (problem for the person) such as impulsivity
- Discovering a personal reality and developing the ability to describe and represent this reality
What are some Key Principles For Working With People With
Personality Disorder?
- Be compassionate
- Demonstrate empathy
- Listen to the person’s current experience
- Validate the person’s current emotional state
- Take the person’s experience seriously, noting verbal and non-verbal communications
- Maintain a non-judgemental approach
- Stay calm
- Remain respectful
- Remain caring
- Engage in open communication
- Be human and be prepared to acknowledge both the serious and funny side of life where appropriate
- Foster trust to allow strong emotions to be freely expressed
- Be clear, consistent, and reliable
- Remember aspects of challenging behaviours have
survival value given past experiences - Convey encouragement and hope about their capacity for change while validating their current emotional experience
Define Transference reactions
Transference: transfers beliefs, feelings, thoughts or behaviours that occurred in one situation, usually in their past, to a situation that is happening in their present.