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Antisocial PD

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constant disregard for others through exploitation and repeated unlawful actions. No remorse for others, neglect responsibilities, tell lies, and perform destructive or illegal acts w/o developing any insight into consequences. *Psychopaths/Sociopaths*

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Nursing Guidelines for Antisocial PD

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1. Try to prevent or reduce untoward effects of manipulation (flattery, seductiveness, instilling of guilt): • Set clear and realistic limits on specific behavior. • Ensure that limits are adhered to by all staff. • Carefully document signs of manipulation or aggression. • Document behaviors (give times, dates, circumstances). Provide clear boundaries and consequences. 2. Be aware that antisocial patients can instill guilt when they are not getting what they want. Guard against being manipulated through feelings of guilt. 3. Substance abuse is best handled through a well-organized treatment program before counseling and other forms of therapy are started.

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Avoidant PD

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extreme sensitivity to rejection and robust avoidance of interpersonal situations demonstrate poor self-confidence and are prone to misinterpreting others' feedback because they are overly sensitive to rejection.

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Nursing Guidelines for Avoidant PD

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1. A friendly, accepting, reassuring approach is the best way to treat patients. 2. Being pushed into social situations can cause extreme and severe anxiety.

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Borderline PD

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most common and dramatic, is characterized by severe impairments in functioning; instability in emotion regulation, interpersonal relationships, impulsivity, identity or self-image distortions, and unstable mood.

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Nursing Guidelines for Borderline PD

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1. Set realistic goals, use clear action words. 2. Be aware of manipulative behaviors (flattery, seductiveness, instilling of guilt). 3. Provide clear and consistent boundaries and limits. 4. Use clear and straightforward communication. 5. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment. 6. Avoid rejecting or rescuing. 7. Assess for suicidal and self-mutilating behaviors, especially during times of stress.

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splitting

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the primary defense or coping style used by persons w/ borderline PD, is the inability to incorporate + and - aspects of oneself or others into a whole image.

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Dependent PD

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establish relationships in which they are submissive, self-doubting, and avoid self responsibility. find it difficult to sustain autonomy and often seek out relationships in which they can be taken care of.

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Nursing Guidelines for Dependent PD

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1. Identify and help address current stresses. 2. Try to satisfy patient's needs at the same time that limits are set up in such a manner that patient does not feel punished and withdraw. 3. Be aware that strong countertransference often develops in clinicians because of patient's excessive clinging (demands of extra time, nighttime calls, crisis before vacations); therefore, supervision is well advised. 4. Teach and role-model assertiveness.

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diathesis-stress model

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a general theory that explains psychopathology using a systems approach. This theory helps us understand how personality disorders emerge from the multifaceted factors of biology and environment.

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Temperament

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our tendency to respond to challenges in predictable ways ex. "laid back" referring to calm or "uptight" referring to anxious

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dialectical behavior therapy

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evidence-based theory to successfully treat chronically suicidal pts w/ borderline personality disorder. combines cognitive behavioral techniques with mindfulness, which emphasizes being aware of thoughts and actively shaping them.

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histrionic PD

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marked by emotional attention-seeking behavior in which the person needs to be the center of attention. -impulsive,melodramatic, flirtatious and provocative.

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Nursing Guidelines for histrionic PD

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1. Understand seductive behavior as a response to distress. 2. Keep communication and interactions professional, despite temptation to collude with the patient in a flirtatious and misleading manner. 3. Encourage and model the use of concrete and descriptive rather than vague and impressionistic language. 4. Teach and role-model assertiveness.

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Narcissistic PD

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arrogance w/ grandiose view of self-importance. Has the need for constant admiration, along w/ a lack of empathy for others, which strains relationships. results in exploitation of others. Underneath this personality is a person w/ intense shame and fear of abandonment.

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Nursing Guidelines for Narcissistic PD

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1. Remain neutral; avoid engaging in power struggles or becoming defensive in response to the patient's disparaging remarks. 2. Convey unassuming self-confidence.

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obsessive-compulsive PD

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characteristics of perfectionism w/ a focus on orderliness and control. These people become so preoccupied w/ details and rules that they may not be able to accomplish a given task.

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Nursing Guidelines for Obsessive-Compulsive PD

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1. Guard against power struggles with patient. Need for control is very high. 2. Intellectualization, rationalization, reaction formation, isolation, and undoing are the most common defense mechanisms.

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paranoid PD

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characterized by distrust and suspiciousness toward others based on the belief that others want to exploit, harm, or deceive the person. these people are hypervigilant, anticipate hostility, and may provoke hostile responses by initiating a "counterattack." demonstrate jealousy, controlling behaviors, and unwillingness to forgive

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Nursing Guidelines for Paranoid PD

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1. Avoid being too "nice" or "friendly." 2. Give clear and straightforward explanations of tests and procedures beforehand. 3. Use simple, clear language; avoid ambiguity. 4. Project a neutral but kind affect. 5. Warn about any changes, side effects of medication, and reasons for delay. Such interventions may help allay anxiety and minimize suspiciousness. A written plan may help encourage cooperation.

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Schizoid PD

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Emotionally detached! Does not seek out or enjoy close relationships. this individual may be able to function in a solitary occupation but shows indifference to praise or criticism from others. Depersonalization may occur.

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Nursing Guidelines for Schizoid PD

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1. Avoid being too "nice" or "friendly." 2. Do not try to increase socialization. 3. Perform thorough diagnostic assessment as needed to identify symptoms or disorders the patient is reluctant to discuss.

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schizotypal PD

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expressed in strikingly odd characteristics, including magical thinking, derealization, perceptual distortions, and rigid, peculiar ideas. speech patterns may be distinctive and bizarre.

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Nursing Guidelines for Schizotypal PD

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1. Respect patient's need for social isolation. 2. Be aware of patient's suspiciousness, and employ appropriate interventions. 3. As with schizoid patient, perform careful diagnostic assessment as needed to uncover any other medical or psychological symptoms that may need intervention (e.g., suicidal thoughts).

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personality

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an individual's characteristic pattern of thinking, feeling, and acting.

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personality disorder - DSM def

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an enduring pattern of experience & behavior that deviates significantly from the expectations w/in the individuals culture axis II disorders

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Cluster A personality disorders

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characteristics of eccentric and odd behaviors, such as social isolation and detachment. may also be perception distortions, unusual levels of suspiciousness, Paranoid PD, Schizoid OD, & Schizotypal PD

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Cluster B Personality Disorders

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Dramatic, emotional, erratic behavior; problems with impulse control and emotional processing, and relationships; manipulations and acting out; Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD

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Cluster C Personality Disorders

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Anxious or fearful behavior; rigid patterns of social shyness, hypersensitivity, need for orderliness, and relationship dependency; Avoidant PD, Dependent PD, Obsessive-Compulsive PD

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limit-setting

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establishing the parameters of desirable and acceptable pt behavior

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anger control assistance

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facilitation of the expression of anger in an adaptive, nonviolent manner

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Impulse control training

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assisting the pt to mediate impulsive behavior through application of problem-solving strategies to social and interpersonal situations

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A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client *will* exhibit which of the following characteristics? A. Frequent episodes of psychosis B. Constant involvement with the needs of significant others C. Inflexible and maladaptive responses to stress D. Abnormal ego functioning

answer

Inflexible and maladaptive responses to stress

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Which statement is descriptive of clients with personality disorders? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.

answer

They are resistant to behavioral change.

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Research has indicated that antisocial personality may be characterized by: A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.

answer

lack of remorse.

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The primary goal of milieu therapy for clients with personality disorders is A. manage the affect behavior has on the entire group. B. one-on-one therapy. C. to help the client remain uninvolved with other patients. D. a laissez faire attitude.

answer

manage the affect behavior has on the entire group.

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Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior

answer

grandiose, exploitive, and rage-filled behavior.

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Which client with a personality disorder is *most* likely to be admitted to a psychiatric unit? A. Mr. A, with paranoid personality disorder who is suspicious of his neighbors B. Mr. B, with narcissistic personality disorder who is highly self-important C. Ms. C, with borderline personality disorder who is impulsive D. Mrs. D, with dependent personality disorder who clings to her husband

answer

Ms. C, with borderline personality disorder who is impulsive

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Characteristics the nurse will assess in the client with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. need for others to assume responsibility for decision-making and seeks nurture.

answer

deceitfulness, impulsiveness, and lack of empathy.

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Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

answer

splitting.

question

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

answer

sees things as divided into "all good" or "all bad."

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A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are *most* consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.

answer

antisocial personality disorder.

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Which behavior would be *inconsistent* with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence

answer

Interdependence

question

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

answer

mood shifts, impulsivity, and splitting.

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A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse *expect* to assess? A. Anxious, fearful B. Odd, eccentric C. Dramatic, emotional, erratic D. Disoriented, disorganized

answer

Anxious, fearful

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A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of *highest* priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.

answer

respect need for social isolation.

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A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing *improvement* in the client's condition? A. "My son's suggestion hurt me greatly." B. "My son is less at fault than my daughter-in-law." C. "I'm going to need help to afford to rent an apartment." D. "How will I ever live alone with no one to look after my affairs?"

answer

"I'm going to need help to afford to rent an apartment."

question

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is A. a response to stress. B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others.

answer

a response to stress.

question

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The *best* response for the nurse would be A. "I will be continuing to follow the care plan for Mr. D." B. "I see you are trying to control Mr. D's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "Mr. D's care is really of no concern to you or to other clients."

answer

"I will be continuing to follow the care plan for Mr. D."

question

The *priority* nursing intervention for a client with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

answer

assess for suicidal and self-mutilating behaviors.

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A danger of working with a client who idealizes the nurse is A. becoming over-involved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.

answer

becoming over-involved and being protective and indulgent.

question

Clients with 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 interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.

answer

impaired social interaction.

question

Antisocial PD - DSM criteria

answer

pervasive disregard for rights of others (AFTER age 15) - noncomformity (inc arrests); breaking law, repeatively - decietfulness/lying - impulsive - irritable/aggressive - disregard for safety/irresponsible - exploitation - often eval by court order * must be 18 yrs to be diagnosed; * if prior to 15: conduct disorder

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Borderline Personality (notes)

answer

* most well know/dramatic instability throughout life constant crisis strong attachment; intense anger from perception of being ignored or mistreated self-mutilation common -- expression of anger (internal); cry for help; attempt to numb self of emotional pain

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Borderline Personality - characteristics

answer

intense mood swings/impulsive unstable personal relationships substance abuse; distorted self image; miserable inc anxiety; diff to achieve full potential in any aspect of life *splitting is most common defense (can be very charming/complementary behavior;friendly) *10% commit suicide*

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Borderline Personality - DSM criteria

answer

frantic attempts to prevent abandonment unstable relationships (alternate between idealization and devaluation) identity disturbance self-damaging impulsiveness recurrent suicidal behavior marked reactivity of behavior (dysphoria/irritablity) chronic feelings of emptiness; intense anger transient paranoia or dissociative symptoms r/t stress

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Histrionic Personality (notes)

answer

emotional attention seeking behavior impulsive; flirtatious; melodramatic irritating; very needy

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Histrionic Personality - DSM criteria

answer

5 or more: uncomfortable when self is not center of attention interaction often sexually provactive rapidly shifting, shallow emotions uses physical appearance to draw attention to self vague speech, lacking detail overly dramatic expression of emotion early suggestibility belief that relationships are more intimate than they really are

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Narcissistic Personality (notes)

answer

arrogant, grandoise view of self importance need for constant admiration lack of empathy exaggerate accomplishments traits are ONLY abnormal in ADULTHOOD

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Narcissistic Personality - DSM criteria

answer

5 or more: grandiose sense of self importance preoccupation of fantasies of beauty, brilliance, ideal love, power, or limitless success belief that he is 'special' & can only be understood by & associate w other special people requires excessive admiration exudes entitlement interpersonally exploitative lacks empathy envious of others or believes others are envious of him arrogant, haughty behaviors, attitude

question

personality disorder - DSM criteria

answer

lasting pattern of behavior & inner experience that markedly deviates from cultural norm pattern manifested in at least 2 areas: affect; cognition; impulse control; interpersonal functioning (can manifest in all areas) pattern is fixed & affects personal/social situations pattern causes clinically signif distress; impairs work, social, or personal functioning pattern has lasted a long time, roots in adolescence or young adulthood pattern is not better explained by any other mental dx pattern is not caused by medical condition or substance

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Paranoid PD (notes)

answer

unjustified distrust & suspicion of others needs unintended meaning into benign comments/actions resentment harbored for long time rigid, bears grudges urgent need to be self-sufficient cold, calculated, guarded avoids blame & intimacy occupational difficulties common

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Schizoid PD (notes)

answer

indifferent to society neither wants nor likes close relationships successful at solitary jobs takes pleasure in few activities, if any unaffected by praise or criticism excessive daydreaming frequently attach to animals detached, flat affect remain reality oriented *not hallucinating; but having beginning sx of schiz*

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Schizotypal PD

answer

beg early adulthood experience isolation & discomfort w social relationships as well as peculiar behavior & cognitive distortions *unexplained behavior

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Schizotypal PD qualities

answer

present in a variety of situations at least 5 noted: - ideas of reference - magical thinking - paranoia - unusual perceptions or bodily illusions - odd speech (vague, abstract) - constricted or inappropriate affect - odd behavior, appearance - lack of close friends - marked anxiety in social situations

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Paranoid PD: characteristics

answer

distrust & suspiciousness based on unfounded belief that others desire to do them harm hypervigilant hostile jealous controlling lack forgiveness unwilling to share anything about themselves

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Schizoid PD: characteristics

answer

emotional detachment lack of close relationships indifferent to praise or criticism can be precursor to schizophrenia common in families w hx of schizophrenia

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Schizotypal PD: characteristics

answer

magical thinking de-realization perceptual distortions rigid, peculiar ideas inappropriate response to social cues distinct, bizarre speech patterns seek help for depression & anxiety

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Antisocial PD (notes)

answer

dramatic, emotional behavior poor impulse control interpersonal difficulties limited insight into anything (cant connect behavior to consequences) entitlement acting-out (self destructive; cutters) manipulation

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Dependent PD (notes)

answer

pervasive & excessive need to be taken care of that leads to submissive & clinging behavior & fear or separation

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Dependent PD: DSM criteria

answer

5 or more: difficulty making decisions needs others to assume resp for major life areas diff expressing disagreement (fear of loss of support) diff initiating projects (lack of self confidence) goes to excessive lengths to be nurtured feels uncomfortable when alone urgently seeks new relationships when one ends unrealistically preoccupied w fears of being left to care for self

question

OCD (notes)

answer

pervasive pattern of preoccupation w orderliness, perfectionism, & control, at the expense of flexibility, openness, & efficiency

question

OCD - DSM criteria

answer

4 or more: preoccupied w details, rules, lists, order, organization, or schedules to the extent that major point of activity is lost perfectionism that interferes w task completion excessively devoted to work & productivity to the exclusion of leisure activity & friendships over-conscientious, scrupulous, inflexible regarding matters of morality, ethics, values unable to discard worn out objects (hoarders) reluctant to delegate tasks miserly spending style rigidity & stubbornness (very much control)

question

Avoidant PD (notes)

answer

pervasive pattern of social inhibition, feelings of inadequacy, & hypersensitivity to negative evaluation

question

Avoidant PD - DSM criteria

answer

4 or more: avoids jobs that involve signif interpersonal contact for fear of criticism or rejection unwilling to get involved w ppl unless certain of being liked shows restraint within intimate relationships for fear of being shamed or ridiculed preoccupied w being criticized or rejected in social sit inhibited in new interpersonal situations views self as socially inept, inferior to others unusually reluctant to take personal risks

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