W6 - Personality Disorders

Question 1

Definition of personality disorders?

Answer 1

• Fixed & rigid personality traits + behavioural patterns -> distress + problems
• Not produced by another disorder

Question 2

Causes?

Answer 2

Psychosocial (abuse, neglect, trauma, inadequate parenting) + biological factors

Question 3

What are the Cluster A Personality Disorders? (3)

PSS

Answer 3

• odd or eccentric behaviours

1. Paranoid
   - believe that ppl are out to harm them; distrust + suspicious of ppl + need to feel in control < involve client in treatment planning
   - alw scanning surroundings
   - take things seriously < be formal, serious, straightforward

—— teach client to validate their ideas with someone they trust before taking action -> prevents them from acting based on paranoid ideas

2. Schizoid
   - shy, timid, withdrawn -> difficult to build r/s
   < improve community functioning
   - intellectual, likes abstract concepts < assist client in finding case manager (acts as NOK) to help client obtain services & healthcare, manage finances
3. Schizotypal
   - may be unkempt & disheveled, clothes stained/dirty < teach self care skills
   - unable to answer qns clearly & avoid close r/s with others < social skills training to help them talk clearly with others + help them fxn in community with minimal discomfort
   - odd/eccentric behaviour + appearance

Question 4

What are the Cluster B Personality Disorders & the nursing interventions? (4)

BANH (mi)

Answer 4

• dramatic, emotional, or erratic manifestations

1. Borderline = UNSTABLE
   - poor self-concept < cognitive restructuring: recognise negative thoughts & feelings & replace with positive
   - fear of abandonment but their erratic behaviour often isolates them < teach social skills
   - impulsive, impaired judgment + self-harm < promote safety: no-self-harm contract - pt promises not to engage in self-harm & report to the nurse when they are losing control + limit setting
   - intense world views < cognitive restructuring techniques
   - constant mood: dysphoric - unhappy, restless, malaise (general feeling of discomfort, illness, or unease whose exact cause is difficult to identify) < help them cope & control emotions
2. Antisocial
   - Disregard rules & laws
   - Manipulate & exploit ppl for personal gain < confrontation: point out client’s behaviour neutrally
   - Impulsive, poor judgment < teach step by step problem-solving skills & manage emotions by taking a timeout
   - Views the world as cold & hostile + cannot empathise with the feelings of others -> exploits others w/o guilt < DO limit-setting: state behaviour limit / unacceptable behaviour -> identify consequences if limit is exceeded -> identify desired behaviour
3. Narcissistic
   - Arrogant, self-absorbed, dismissive, low empathy < Limit setting + explain expectations to client
   - Poor insight: believe they are superior & blame their faults on others
   - Only associate with ppl they deem worthy < gain their cooperation
   - Fragile self-esteem < teach self-care skills
4. Histronic = DRAMA, SHALLOW
   - Usually high-functioning social skills but are manipulative < teach social skills
   - Blames personal failure on others, cant take criticism well < give factual feedback about interactions with others + describe & model alternatives
   - Overly dramatic & emotional
   - Attention seeking, ALWAYS TRIES to be in centre of attention

Question 5

What are the Cluster C Personality Disorders? (3)

Answer 5

• anxious / fearful behaviours

1. Obsessive Compulsive PD
   - obsessed with routine, perfection & control < cognitive restructuring techniques: help client accept less than perfect work/decisions
   - dont want to give away control < encourage negotiation with family & friends to reduce need for control
   - serious & replies with precision & detail
   - limited insight: oblivious to ppl’s annoyance
2. Dependent PD
   - excessive need to be taken care of -> clingy + separation anxiety < Foster self-reliance + identify strengths & needs
   - believe they will fail on their own, no confidence to make their own decisions < teach problem-solving & decision-making skills
3. Avoidant
   - intense fear of social interactions & situations < decatastrophise + teach social skills
   - low self-esteem + feels inadequate < support & reassurance + practice positive self affirmations
   - hypersensitive to negative opinions

Question 6

Goals of treatment of PD?

Answer 6

• treatment is self-dependent: only can teach them to enhance social, coping skills, self-awareness, increase tolerance to anxiety w/o resorting to negative coping mechanisms
• immediately solve the problem they face

Question 7

Goals of care of pts with PD?

Answer 7

1. Risk control: Pt is safe
2. Adherence therapy: Pt will participate in therapy
3. Symptom control: Pt will hv improved tolerance & coping of anxiety

Question 8

Methods of treatment of PD?

Answer 8

1. Psychopharmacology
2. Individual psychotherapy
3. Group therapy
4. Family education & therapy
5. Dialectical-behavioural therapy