W6_Personality Disorder_Eating Disorder Flashcards by . .

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)

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Acronyms to Remember for
Personality Disorders

WWW

A
S.S.P.

B
B.A.N.H

C
A.D.OC.

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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

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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

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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

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Methods of Treatment of Personality Disorders

Psychopharmacology
Individual psychotherapy
Dialectical-behavioral therapy
Group therapy
Family education and therapy

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Purging

EG. VOMITING, LAXATIVES/DIURETICS ABUSE, ENEMAS, SLIMMING PILLS, ETC.

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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.