Personality:
-defined as an individual's enduring and consistent attitudes, values, beliefs, and patterns of behavior
personality disorders
personality disorders lead to;
-maladaptive traits leading to psychological and emotional disturbances
-this impairs relationships with others
personality disorder review
-developmental tasks are not met (autonomy, trust, independence, meaningful relationships) and long term repetitive, maladaptive behaviors characterize a personality disorder
-doesn't get diagnosed overnight
marked deviation in behavior in these areas:
1 cognition
2 affectivity
3 interpersonal functioning
4 impulse control
-behavior is rigid and inflexible
-ego syntonic behavior
diagnostic criteria
-patterns are inflexible and fixed in personal and social situations
-these patterns lead to significant distress and impairment in social, occupational and other areas of functioning
-patterns may be stable for long durations and onset traced back from c
prevalence
-10-15% live with personality disorders in the U.S
-more likely to co exist with another mental issue;
-anxiety disorders
-mood disorders
-impulse control problems
-ADHD
-substance abuse or dependence
low levels of serotonin
impulsivity
aggression
suicidal gestures
-serotonin is considered the feel good hormone
genetic studies
-links to criminality and other antisocial behavior
-combination of genetic characteristics along with environmental forces are the most likely factor in personality disorder
-high prevalence of child abuse = maladaptive issues
-high prevalence of sexual
Cluster A
-withdrawn
-odd and eccentric (come off as "strange")
-these are the main components
-paranoid
-schizoid
-schizotypal
paranoid personality disorder
-great fear that others will harm them
-argumentative, transient ideas
-quick to anger
-avoids blame and guilt
-fears losing power
-secretive
-rigid, minimal intimacy
-jealous,. envious (sees others as threatening)
-suspicious
-these people have severe tr
schizoid personality disorder
-emotionally detached (avoids relationships)
-indecisive
-absent minded
-anxious in social situations
-indifferent to criticism
-suspicious of others
-fears of intimacy
-shy or seclusive
-may be a precursor to schizophrenia or delusional disorder
schizotypal personality disorder
-ideas of references
-magical thinking
-unusual perceptual experiences
-eccentric appearance
-intense anxiety in social situations
-impaired relationships
-minimal intimacy-suspicious
-magical thinking is the key to schizotypal personality disorder
Cluster A flower
-odd/eccentric/withdrawn leading to;
-paranoid, schizoid, schizotypal
-stems into;
social isolation, defensive coping, ineffective individual coping
-these people have 0 need for relationships. they don't mind being alone. they find it comforting.
Cluster B
-dramatic, erratic (unpredictable), emotional
-antisocial
-borderline
-histrionic
-narcissistic
antisocial personality disorder
-egocentric (think only for themselves)
-lacks remorse, no sense of guilt
-poor impulse control or behavior impulse
-lying
-impersonal sex life, quick to anger
-selfish
-irresponsible and manipulative
-detached and distant to others
-abusive
-incapable of
borderline personality disorder
-self mutilation
-suicide gestures
-impulsive behaviors
-splitting
-anger outbursts
-anxious
-depressed and suspicious of others
-egocentric and stormy relationships
-manipulative, devalues others
-suspicious
-these patients are extremely difficult to dea
histrionic personality disorder
-seductive and flamboyant
-self centered
-emotional instability
-vain, self dramatization
-seeks attention
-excitable
-over reactivity
-manipulative
-dependent on others, concerned about others conception of them
-extremely self centered. seductive and fl
narcissistic personality disorder
-granidose
-inability to accept failure
-exploitative
-arrogant and self centered
-entitled leading to rages against criticism
-requires excessive admiration
-avoids guilt and blame
-lacks empathy and remorse
-fears helplessness and humiliation
-manipulat
Cluster B flower
-dramatic, emotional, erratic, leads to;
-antisocial, borderline, histrionic, narcissistic and presents as;
-self mutilation, powerlessness, risk for violence, altered family process
Cluster C
-anxious and fearful
-avoidant
-dependent
-obsessive compulsive
avoidant personality disorder
-overly sensitive
-easily hurt by criticism, angry at self
-embarrassment
-anxious, avoids but yearns for social contact
-sensitive to reaction of others
dependent personality disorder
-passive
-unable to make decisions
-fears abandonment and rejection
-anxious with disapproval, dependent on others
-sensitive to reaction of others
obsessive compulsive disorder
-overly conscientious
-moralistic
-perfectionist
-inflexible
-controls anger
-fears disapproval
-criticism and loss of control
-task oriented but leaves incomplete
-formal quality of relationships
-controls others with rules and procedures
-these people l
Cluster C flower
-anxious and fearful leading to;
-avoidant, dependent, obsessive compulsive branches into things like;
-anxiety, self esteem disturbance, hopelessness
safety considerations
-cluster B personality disorders have more problems with substance abuse and suicidal behaviors
-frequent inquiries about suicidal ideation are warranted, regardless of whether the patient raises the subject
-paranoid and antisocial high potential for hom
assessment
-areas of impairment
-caring and nonjudgmental approach
-obtain ethnic, culture and social background
-assess for a loss
-personality disorders are usually exacerbated by a loss of a supporting member of their live
assessment cont.
-explore presenting problem by asking the patient and others involved
-what is the patient's emotional state
-verbalize self harm or harming others?
-toxicology screening
-recognize that behaviors are resistant to change. these are difficult patients
-a l
nursing interventions
-maintain awareness of unique individual needs through every contact
-respect a client's need for social isolation (like a patient with schizotypal)
-be aware of a client's feelings and what is being experienced (suspicious or fear)
-praise appropriately,
nursing interventions cont.
-avoid power struggles or becoming defensive in response to there comments (like someone who is narcissistic)
-understand seductive behavior as a response to stress. communication and interactions must remain professional
-encourage and teach concrete lan
treatment approach: psychotherapy
-learning process in which mental health professionals seek to help patients who have mental health issues
-it is a process that is accomplished by exchange of verbal communication
-often referred to as talk therapy
treatment approach: cognitive behavioral therapy
-identifies the distortions and engages the patient in efforts to reformulate perceptions and behaviors.
treatment approach: dialectial behavioral therapy
-most effective with borderline disorder
-skilled based therapy used in group or an individual basis
-emphasis on development of coping skills to improve affective stability and impulse control and reduce self harm behavior
psychopharmacology
-limited success in use of psychotropic medications unless there is an axis 1 diagnosis
-medications used to manage aggressive, impulsive, psychosis, mood and anxiety
-anticonvulsants and atypical neuroleptics used to control impulsivity
-currently there
anticonvulsant
valproic acid (depakote)
atypical neuroleptic
risperidone (risperdal)
antidepressant
SSRI - sertraline (zoloft)
benzos'
-potential risk for dependency. never a first line of defence
-most personality disorders at high risk for impulse control issues and risk for addictive behavior
role of the nurse
-recognize behaviors representative of the personality disorder
-model adaptive behaviors by mastering feelings and responses to the client with personality disorder
personality disorder that's characterized by mistrust is:
paranoid personality disorder
-not antisocial
-not dependent personality
-not scizotypical personality
patients with most personality disorders, the treatment of choice is primarily:
individual psychotherapy (talk therapy)
-not group therapy
-not self help support group
-not inpatient therapy
ideas of reference and magical thinking is a way of thinking in:
schizotypal personality disorder
-not borderline disoder
-not scizoid disorder
-not histrionic disorder
the hallmark of borderline personality is:
-impulsive
-not reckless disregard for others
-not unlawful behavior
-not irresonsibility
if a patient with dependent personality disorder reports physical complaints, the nurse should:
-assess them in a matter of fact way
-never overlook symptoms
-wasn't encourage them to talk about their symptoms
-not disregard there complaints
a patient obsessed with organization and lists is likely to have:
obsessive compulsive disorder
not histrionic disorder
not schizotypal disorder
not narcissistic disorder
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paranoid personality disorder (cluster A)
-1.7 % prevalence
-longstanding distrust and suspiciousness of others based on there beliefs of people
-hypervigilant, anticipate hostility, and may provoke hostile reponses
-jealousy, controlling behaviors, unwilling to forgive
-difficult to interview be
schizoid personality disorder (cluster A)
-0.9% of the population
-poor ability to function
-relationships are affected because these people have severe emotional detachment
-dont seek or enjoy relationships
-viewed as "loners"
-dont care if you approve or reject them
-employment and relationship
schizotypal personality disorder (cluster A)
-more commen in men than women
-less than 1% of the population
-unusual and debilitating disorders
-personality disorder and meets schizophrenia spectrum disorders
-severe social and interpersonal anxiety
-paranoid is present with this; suspicious and anx
histrionic personality disorder (cluster b)
-1.5%
-generally live a quality life
-impulsive, reduced agreeableness, and introversion
-emotional attention seeking behavior
-self centered, low frustration tolerance, and excessive emotionality
-impulsive and act flirtatiously or provoke
-relationships
narcissistic personality disorder (cluster b)
-less than 1%
-affects QOL
-arrogant person with inflated view of themselves with self importance
-need for constant admiration
-lack empathy for others. this strains most relationships
-personal entitlement
-exploit other people
-feel intense shame under
avoidant personality disorder (cluster c)
-fairly common at 1.7%
-low self esteem, inferiority compared to peers
-reluctant to engage in activities with new people
-parental rejection and criticism is linked
-similar to social anxiety disorder
-timid temperament in infancy and childhood can be as
dependent personality disorder (cluster c)
-0.7%
-moderate to low problems in functioning
-high need to be taken care of
-submission to fears of seperation and abandonment
-feelings of insecurity about themselves
-can be from chronic illness or punishment in childhood
-can also be a submissiveness
obsessive compulsive personality disorder (cluster c)
-most prevalent at 2.1%
-affects workplace and productivity
-rigid and inflexible standards that persist
-they do a goal until a point it's like beating a dead horse. they dont give up easily
-no insight to their own behavior but are genuine to others
-in
paranoid personality disorder and nursing guidlines (A)
-these people project blame and are suspicious and mistrustful
-hostile and violent
-avoid being to nice or friendly
-clear explanations of tests before hand
-simple language
-neutral but kind affect
-warn about any changes to anything
schizoid personality disorder and nursing guidlines (A)
-these people are reclusive, avoidant and uncooperative.
-dont be too nice or friendly
-do not try to increase socialization
schizotypal personality disorder and nursing guidlines (A)
-cognitive and perceptual distortions.
-social inept and anxious.
-magical thinking
-respect there need for isolation
-be aware of there suspiciousness
-careful assessment for these people
antisocial personality disorder and nursing guidlines (B)
-can seem normal with no exhibits of anxiety.
-manipulative and exploit others. aggressive and seductive.
-prevent or reduce untoward effects of manipulation
-set clear limits. every staff member must adhere
-they can try and instill guilt when they dont
borderline personality disorder and nursing guidlines (B)
-seperation anxiety.
-impulsive is the key thing to these people
-engages in splitting
-set realistic goals for these people
-watch for manipulative behavior
-provide clear consistent boundaries
-use clear communication
-calm approach
-avoid rejecting or
histrionic personality disorder and nursing guidlines (B)
-seductive and flamboyant
-attention seeking and shallow
-depressive and suicidal when admiration isn't present
-understand there seductive behavior as a response to distress
-keep communication professional. don't bite at there attempts to manipulate you
narcissistic personality disorder and nursing guidlines (B)
-explotive and granidose
-self importance and filling with rage
-sensitive to rejection, criticism
-dont show empathy
-remain neutral, dont engage in a power struggle with these people
avoidant personality disorder and nursing guidlines (C)
-excess anxious in social situations.
-hypersensitive to negative evaluation
-desire social interaction
-friendly accepting approach
-dont force them into social situations
dependent personality disorder and nursing guidlines (C)
-excessive clinging or self sacrificing
-submissive and needy
-i.d current stresses
-try to satisfy there needs but also must set limits
-be aware of countertransference for these people because they demand your attention
obsessive compulsive personality disorder and nursing guidlines (C)
-perfectionist, need for control
-inflexible, rigid, preoccupied with details
-gaurd against power struggles with these people. they have a high need for control
-they use many defense mechanisms
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--------------------EVOLVE BEGINS---------------
A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An h
Borderline
The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exp
A patient was admitted to the psychiatric in-patient unit due to manipulative and aggressive behavior. What appropriate strategy does the nurse follow while interacting with the patient?
The nurse asks questions to explore the patient's situation.
The nurse should try to explore the patient's feelings by asking questions about the situation. It helps to assess the patient's condition and to prepare an effective treatment plan. The nurse s
A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest prior
anxiety
Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsiv
A nurse observes that a patient with osteoarthritis behaves rudely to the staff and refuses to take treatment. On inquiry, the nurse learns that the patient thinks that all staff members are planning to harm and deceive him or her. What is the patient lik
paranoid disorder
Patients with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defence system and try to counterattack the other person, and reject the treatment. They behave ru
The nurse tells a patient diagnosed with borderline personality disorder, "A new case manager has been assigned to work with you." Which initial reaction is most likely for this patient?
anger
This scenario is likely to cause the patient to feel rejected. Patients diagnosed with borderline personality disorder show separation anxiety and emotional lability (rapidly moving from one emotional extreme to another). Typically, these emotional
A patient is withdrawn and suspicious and states he or she has always preferred to be alone. The patient describes him- or herself as having "special powers" and states, "I believe we can all read each other's thoughts at times." Based on this presentatio
Schizotypal (STPD)
The main traits that describe STPD are psychoticism, such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obse
A nurse who is idealized by a patient is at risk for
Becoming over-involved and being protective and indulgent
Finding an approach for helping patients with personality disorders who have overwhelming needs can be overwhelming for caregivers. For example, a borderline female patient may briefly idealize her
A nurse caring for a patient who has been diagnosed with a personality disorder should expect that the patient will exhibit which behavior?
maladaptive responses to stress
Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder. Psychosis, abnormal ego functioning, and careg
What term is used to identify the inability to view both positive and negative aspects of others as part of a whole?
splitting
Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative patient. The patient can enjoy the spectacle and do as he or she pl
When providing care for a patient diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the patient's
Mood shifts, impulsivity, and splitting
Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. They often driv
What are the features of antisocial personality disorder?
Prevalence is higher among African-American men.
The prevalence of antisocial personality disorder is higher among African Americans and it is more common among men. The symptoms peak in the late teenage years and the mid-20s. A change in serotonin transm
What personality disorder is more common among men?
paranoid
Paranoid personality disorder is more common among men than among women. People with this disorder believe that others want to exploit, harm, or deceive them. Avoidant personality disorder is equally prevalent among men and women. People with thi
A patient with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve interpersonal effectiveness skills in the patient. Which therapy does the nurse follow to effectively work with
Dialectical behavior therapy
Dialectical behavior therapy is used in patients with borderline personality disorder who have chronic suicidal intentions. The therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation. It h
What appropriate symptoms should the nurse asses to identify borderline personality disorder when interviewing patients? Select all that apply.
sarcasstic
mood shifts
"feeling empty inside"
The nurse can assess borderline personality disorder by evaluating the tendency of sarcasm, anger, and bitterness in the patient. The nurse should asses feelings of emptiness and loneliness. A patient with bor
Patients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpe
Impaired social interaction
For a patient who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.
Research has indicated that the antisocial personality may present with which characteristic?
Lack of remorse
Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. Social isolation, learning difficulties, and difficulty with reality generall
Which characteristic demonstrated by a patient diagnosed with a personality disorder will result most likely in an admission to a psychiatric unit?
Borderline personality disorder and reporting stress.
Patients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. Neither paranoia, narcissism nor dependent personality traits are reason