W6_Personality Disorder_Eating Disorder Flashcards
Name the 10 Personality Disorders
and 3 Clusters (ABC)
WWW, SSP, BANH, A.D.OC
Cluster A (Weird)
- Schizoid
- Schizotypal
- Paranoid
Cluster B (Wild)
- Borderline
- Antisocial
- Narcissistic (Grandiose)
- Histrionic (Grandiose)
Cluster C (Worried) <–>Genetic A/w Anxiety Disorders
- Avoidant (Cowardly)(Anxiety of general situations) vs Social Phobias (Anxiety of specific situations e.g. public speaking)
- Obsessive Compulsive P.D. (Compulsive) Revs Obsessive Compulsive Disorder
- Dependent (Clingy)
Acronyms to Remember for
Personality Disorders
WWW
A
S.S.P.
B
B.A.N.H
C
A.D.OC.
Prognosis for Personality disorder
Some improve by mid-life; but usually by then damage to personal life and others around may be too damage to revive.
Most continue as it is.
Risk of alcohol use and substance abuse
10% in Cluster B have complete suicide
Comorbidities and Dual diagnoses for persons with personality disorders
Persons with personality disorders are at risk for major mental health disorders, such as:
Major depression
Anxiety disorders
Suicide crises
Goals of Treatment for Personality Disorders
- Immediate problem solving
- Enhancement of coping strategies
- Improvement of social skills
- Increased tolerance of anxiety without resorting to maladaptive coping mechanisms
- Increased self-awareness
Methods of Treatment of Personality Disorders
Psychopharmacology
Individual psychotherapy
Dialectical-behavioral therapy
Group therapy
Family education and therapy
Assessment for Personality Disorders
Clients with personality disorders seldom seek psychiatric assistance unless they experience comorbid conditions
Assess for personality disorders in those with symptoms of: depression and other mood disturbances, anxiety, psychosis, substance abuse, or suicide crisis
No specific physical findings are associated with any personality disorders
Goals of Care for Patients with Personality Disorders
R.A.S.
Risk control:
The client will experience physical safety
Adherence behavior:
The client will participate in therapy
Symptom control:
The client will exhibit improved coping & tolerance of anxiety
Implementation (Clients with Personality Disorders)
- Promoting participation in treatment
- Enlisting the family in the treatment plan
- Improving coping skills
- Reducing inappropriate behaviors
- Confronting the client
Setting limits - Providing for physical safety
Client outcomes for Personality Disorder
The client demonstrates** trust** in the nurse and treatment team
The client **attends group therapy and individual therapy **regularly
The client models more adaptive coping skills and greater tolerance of stress
The client has no suicide crises
The client voices insight into thoughts, feelings, and behaviors
What are the different types of Eating Disorder?
AN, BN, BED, NOS
A.N.
Eat & vomit
B.N.
Eat & Exercise
B.E.D.
Eat only
N.O.S.
Not Otherwise Specified
What is Eating disorder?
COMPLEX DISORDERS
(PERSONALITY/ CHILDHOOD EXPERIENCE)
POTENTIALLY LIFE-THREATENING
NOT JUST ABOUT FOOD/WEIGHT
COPING WITH DEEPER PROBLEMS
TOO PAINFUL/DIFFICULT TO DEAL WITH DIRECTLY
DIFFICULTIES WITH:
IDENTITY, SELF-CONCEPT AND SELF-ESTEEM
FEELINGS OF GUILT, SELF-BLAME, SHAME WRT EATING
Diagnostic Criteria for A.N.
- REFUSAL TO MAINTAIN BODY WEIGHT AT OR ABOVE A MINIMALLY NORMAL WEIGHT FOR AGE & HT
- (BODY WEIGHT LESS THAN 85% {< BMI 17.5 })
- INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT, EVEN THOUGH UNDER WEIGHT
- DISTURBANCE IN THE WAY IN WHICH ONE’S BODY WEIGHT OR SHAPE IS EXPERIENCED
- IN POSTMENARCHEAL FEMALE,
AMENORRHOEA (AT LEAST 3 CYCLES)
TYPES : RESTRICTING / BINGE-PURGE
Diagnostic Criteria for Bulimia Nervosa (B.N.)
RECURRENT EPISODES OF BINGE EATING
RECURRENT PURGING OR EXCESSIVE EXERCISE
AT LEAST ONCE A WEEK FOR 3 MONTHS
SELF-EVALUATION IS INFLUENCED BY BODY SHAPE & WT
TYPES: PURGING / NON-PURGING TYPE
Binge-eating
EATING, IN A DISCRETE PERIOD OF TIME, AN AMOUNT OF FOOD THAT IS DEFINITELY LARGER THAN MOST PEOPLE WOULD EAT DURING A SIMILAR PERIOD OF TIME AND UNDER SIMILAR CIRCUMSTANCES
A SENSE OF LACK OF CONTROL OVER EATING DURING THE EPISODE
Purging
EG. VOMITING, LAXATIVES/DIURETICS ABUSE, ENEMAS, SLIMMING PILLS, ETC.
Cause of Eating Disorder
(Bio-psycho-social-personality)
AETIOLOGY (MULTIFACTORIAL)
GENETIC
HERITABILITY (48-74% AN / 54-83% BN)
GENOME-WIDE LINKAGE ANALYSIS IDENTIFIED SUSCEPTIBILITY LOCI
PERSONALITY
PERFECTIONISM
PHYSICAL
EARLY MENARCHE
OBESITY
PSYCHOLOGICAL
MATURITY FEARS, LACK OF CONTROL
SOCIO-CULTURAL
DIETING (INCREASES RISK 8-FOLD)
CRITICISM, TEASING
Co-morbid Psychiatric illness for Eating disorder
DEPRESSION
ANXIETY DISORDER (AD)
OBSESSIVE - COMPULSIVE DISORDER (OCD)
PERSONALITY DISORDER
B: BORDERLINE P.D.
C: OBSESSIVE-COMPULSIVE P.D.
Complications of Eating Disorder
FLUID AND ELECTROLYTE ABNORMALITIES
GASTROINTESTINAL (GI)
CARDIOVASCULAR (Cardio)
HYPOTENSION, BRADYCARDIA, ARRYHTHMIA, ECG CHANGES
METABOLISM
MUSCULO-SKELETAL (MSK)
MUSCLE WASTING,
OSTEOPOROSIS,
SUBOPTIMAL HEIGHT
CNS
SECONDARY DEPRESSION,
COGNITIVE IMPAIRMENT,
CEREBRAL ATROPHY
REPRODUCTIVE
REPRODUCTIVE IMMATURITY,
HYPOESTROGENIC STATE
(Erectile dysfunction (ED) etc.)
Treatment for Eating Disorder
- MEDICAL STABILIZATION
(fluid & electrolyte imbal., cardiac) - WEIGHT RESTORATION
BMI 18.5, restoration of menses, resumption of G&D,
approx. < 1 kg/ week - NUTRITIONAL REHABILITATION
(done in gradual manner) Meal supervision, defusing anxiety & tension, social element of eating. - PSYCHOSOCIAL TREATMENT
(Self esteem issues, anxieties, personalities issues, relationship issues etc.) - MEDICATION (SSRI)
MULTI-DISCIPLINARY TEAM
Medications for Eating Disorder
PHARMACOTHERAPEUTICS
INDICATIONS FOR MEDICATION:
1) CO MORBID PSYCHIATRIC DIAGNOSIS
2) BULIMIC SYMPTOMS – BINGEING
3) TREATMENT RESISTANCE
4) SYMPTOMATIC TREATMENT
SSRIS
NO ADVANTAGE REGARDING WEIGHT GAIN
PERSISTENT DEPRESSION, ANXIETY, O-C AND BULIMIC SYMPTOMS
2nd GEN ANTIPSYCHOTICS E.G.. OLZP, RISP, QTP MAYBE USEFUL IN WEIGHT RESISTANCE;
OBSESSIVE & NEAR-DELUSIONAL DENIAL
ANTI-ANXIETY AGENTS
- MAY BE USEFUL TO REDUCE ANTICIPATORY ANXIETY BEFORE EATING
Personality Disorder
- Symptoms
- Nursing interventions
Paranoid
S/S:
Mistrust and suspicions of others;
guarded, restricted affect
Nursing Interventions
Serious, straightforward approach; teach client to
validate ideas before taking action; involve
client in treatment planning
Personality Disorder
- Symptoms
- Nursing interventions
Schizoid
S/S
Detached from social relationships;
restricted affect; involved with
things more than people
Nursing Interventions
Improve client’s functioning in the community;
assist client in finding case manager
Personality Disorder
- Symptoms
- Nursing interventions
Schizotypal
S/S:
Acute discomfort in relationships;
cognitive or perceptual
distortions; eccentric behavior
Nursing Interventions
Develop self-care skills; improve community
functioning; social skills training
Personality Disorder
- Symptoms
- Nursing interventions
Antisocial
S/S:
Disregard for rights of others,
rules, and laws
Nursing Interventions
Limit setting; confrontation; teach client to solve
problems effectively and manage emotions of
anger or frustration
Personality Disorder
- Symptoms
- Nursing interventions
Borderline
S/S:
Unstable relationships, self-image,
and affect; impulsivity; self-
mutilation
Nursing Interventions
Promote safety; help client to cope and control
emotions; cognitive restructuring techniques;
structure time; teach social skills
Personality Disorder
- Symptoms
- Nursing interventions
Histrionic
(Drama queen)
S/S:
Excessive emotionality and
attention seeking
Nursing Interventions
Teach social skills; provide factual feedback about
behavior
Personality Disorder
- Symptoms
- Nursing interventions
Narcissistic
S/S:
Grandiose; lack of empathy; need
for admiration
Nursing Interventions
Matter-of-fact approach; gain cooperation with
needed treatment; teach client any needed self-
care skills
Personality Disorder
- Symptoms
- Nursing interventions
Avoidant
S/S:
Social inhibitions; feelings of
inadequacy; hypersensitive to
negative evaluation
Nursing Interventions
Support and reassurance; cognitive restructuring
techniques; promote self-esteem
Personality Disorder
- Symptoms
- Nursing interventions
Dependent
S/S:
Submissive and clinging behavior;
excessive need to be taken care
of
Nursing Interventions
Foster client’s self-reliance and autonomy; teach
problem-solving and decision-making skills;
cognitive restructuring techniques
Personality Disorder
- Symptoms
- Nursing interventions
Obsessive-compulsive
S/S:
Preoccupation with orderliness,
perfectionism, and control
Nursing Interventions
Encourage negotiation with others; assist client in
making timely decisions and complete work;
cognitive restructuring techniques
What is the primary characteristic of schizoid personality disorder?
A pervasive pattern of detachment from social relationships and a restricted range of emotional expression.
True or False: Individuals with avoidant personality disorder desire social interactions but avoid them due to fear of negative evaluation.
True
Fill in the blank: People with _____ personality disorder may appear aloof and indifferent to others.
schizoid
Which personality disorder is characterized by feelings of inadequacy and hypersensitivity to negative evaluation?
Avoidant personality disorder
Multiple Choice: Which of the following is a common trait of avoidant personality disorder? A) Lack of interest in relationships B) Desire for acceptance C) Emotional coldness
B) Desire for acceptance
What is the primary characteristic of Obsessive-Compulsive Disorder (OCD)?
The primary characteristic of OCD is the presence of obsessions (intrusive thoughts) and compulsions (repetitive behaviors) that the individual feels driven to perform.
True or False: Obsessive-Compulsive Personality Disorder (OCPD) involves the presence of obsessions and compulsions.
False: OCPD is characterized by a preoccupation with orderliness, perfectionism, and control, without the presence of true obsessions and compulsions.
Fill in the blank: In OCD, individuals often recognize that their obsessions and compulsions are __________.
unreasonable
Which disorder is more likely to cause significant distress and impairment in functioning, OCD or OCPD?
OCD is more likely to cause significant distress and impairment in functioning.
What is a key difference in the motivation behind behaviors in OCD compared to OCPD?
In OCD, behaviors are performed to reduce anxiety caused by obsessions, while in OCPD, behaviors are driven by a need for control and perfectionism.
Key differences between Schizoid & Avoidant Personality Disorders
Here are some explicit examples and differences between schizoid and avoidant personality disorders:
Schizoid Personality Disorder
Example: A person with schizoid personality disorder might prefer to live alone, have few friends, and show little interest in romantic relationships. They may seem detached and indifferent to the emotions of others, and they may not experience strong emotions themselves.
Avoidant Personality Disorder
Example: A person with avoidant personality disorder might fear rejection and criticism so much that they avoid social situations altogether. They may have a strong desire for close relationships but feel they are unworthy of them. They may be hypersensitive to negative feedback and have low self-esteem.
Key Differences
* Desire for Relationships:
People with schizoid personality disorder do not desire close relationships, while people with avoidant personality disorder do but fear rejection.
- Sensitivity to Criticism:
People with schizoid personality disorder are generally indifferent to criticism, while people with avoidant personality disorder are highly sensitive to it. - Emotional Range:
People with schizoid personality disorder often experience a limited range of emotions, while people with avoidant personality disorder may experience a full range of emotions but suppress them due to fear of rejection.
It’s important to note that these are just examples, and the symptoms of these disorders can vary greatly from person to person. If you’re concerned about your own personality traits or those of someone you know, it’s best to consult with a mental health professional for an evaluation.
