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ch 32 personality disorders
Terms in this set (49)
The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time
-Personality traits are characteristics with which an individual is born or develops early in life.
-They influence the way in which he or she perceives and relates to the environment and are quite stable over time
-Personality disorders occur when these traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning
-People with personality disorders are not often treated in acute care settings in cases in which the personality disorder is their primary psychiatric disorder.
-Many clients with other psychiatric and medical diagnoses manifest symptoms of personality disorders.
-Nurses are frequently likely to encounter clients with these personality characteristics in all health-care settings.
Personality development occurs in response to a number of biological and psychological influences:
-The first recognition that personality disorders, apart from psychosis, were cause for special concern was in 1801 with the recognition that an individual can behave irrationally even when the powers of intellect are intact.
-Ten specific types of personality disorders are identified in the DSM-5.
paranoid personality disorder
-Definition: A pervasive, persistent, and inappropriate mistrust of others
-Individuals with this disorder are suspicious of others' motives and assume that others intend to exploit, harm, or deceive them.
-The disorder is more common in men than in women.
personality disorder clinical picture
-Constantly on guard
-Ready for any real or imagined threat
-Trusts no one
-Constantly tests the honesty of others
-Insensitive to the feelings of others
-Tends to misinterpret minute cues
-Magnifies and distorts cues in the environment
-Does not accept responsibility for his/her own behavior
-Attributes shortcomings to others
predisposing factors to paranoid personality disorder
-Possible hereditary link
-Subject to early parental antagonism and harassment
schizoid personality disorder
-Characterized primarily by a profound defect in the ability to form personal relationships.
-Failure to respond to others in a meaningful emotional way.
-Diagnosis occurs more frequently in men than in women.
-Prevalence within the general population has been estimated at 3 to 7.5 percent.
schizoid personality disorder clinical picture
-Aloof and indifferent to others
-No close friends, prefers to be alone
-Appears shy, anxious, or uneasy in the presence of others
-Inappropriately serious about everything and has difficulty acting in a light-hearted manner
predisposing factors to schizoid personality disorders
-Possible hereditary factor
-Childhood has been characterized as:
--Notably lacking in nurturing
schizotypal personality disorder
-A graver form of the pathologically less severe schizoid personality pattern
-Affects approximately 1 to 2 percent of the population
schizotypal personality disorder. clinical picture
-Clients are aloof and isolated.
-Clients behave in a bland and apathetic manner
-Exhibits bizarre speech pattern.
-When under stress, may decompensate and demonstrate psychotic symptoms.
-Demonstrates bland, inappropriate affect
schizotypal personality disorder symptoms
-Ideas of reference
-Withdrawal into the self
predisposing factors of schizotypal personality disorders
-Possible hereditary factor
-Possible physiological influence such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain
-Early family dynamics characterized by:
-These factors lead to a pattern of discomfort with personal affection and closeness.
antisocial personality disorder
-A pattern of behavior that is:
-Behavior reflects a disregard for the rights of others.
-Prevalence estimates in the United States range from 2 to 4 percent in men to about 1 percent in women.
antisocial personality disorder clinical picture
-Fails to sustain consistent employment.
-Fails to conform to the law.
-Exploits and manipulates others for personal gain.
-Fails to develop stable relationships.
borderline personality disorder
-Characterized by a pattern of intense and chaotic relationships with affective instability
-Fluctuating and extreme attitudes regarding other people
-Directly and indirectly self-destructive
-Lacks a clear sense of identity
-Affects about 1 to 2 percent of the population
-More common in women than in men
histrionic personality disorder
-Prevalence is thought to be about 2 to 3 percent.
-More common in women than in men
histrionic personality disorder clinical picture
-Difficulty paying attention to detail
-Easily influenced by others
-Difficulty forming close relationships
-Somatic complaints are common.
predisposing factors to histrionic personality disorder
-Possible link to the noradrenergic and serotonergic systems
-Possible hereditary factor
-Biogenetically determined temperament
-Learned behavior patterns
narcissistic personality disorder
-Characterized by an exaggerated sense of self-worth
-Lack of empathy
-Clients believe they have the inalienable right to receive special consideration.
-Prevalence of the disorder is estimated at about 6 percent.
-Diagnosed more often in men than in women
narcissistic personality disorder clinical picture
-Exploit others in an effort to fulfill their own desires.
-Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and carefree.
-Because of fragile self-esteem, mood can easily change if they do not:
--Receive the positive feedback they expect
-Criticism from others may cause them to respond with rage, shame, and humiliation.
predisposing factors to narcissistic personality disorders
-As children, their fears, failures, or dependency needs were responded to with criticism, disdain, or neglect
-Parents were often narcissistic themselves
-Parents may have overindulged their child and failed to set limits on inappropriate behavior
avoidant personality disorders
--Extreme sensitivity to rejection
-Prevalence is about 1 percent and is equally common in men and women.
avoidant personality disorder clinical picture
-Awkward and uncomfortable in social situations
-Desire close relationships but avoid them because of their fear of being rejected.
-Perceived as timid, withdrawn, or cold and strange
-They are often lonely and feel unwanted.
-They view others as critical and betraying.
predisposing factors of avoidant personality disorders
-No clear cause is known.
-May be a combination of biological, genetic, and psychosocial influences
-Primary psychosocial influences are parental rejection and censure, which are often reinforced by peers.
When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior?
A. Odd beliefs and magical thinking
B. Grandiose sense of self importance
C. Pattern of intense and chaotic relationships
D. Submissive and clinging behaviors
Correct answer: B
Clients diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth. They are often grandiose and believe they have an inalienable right to receive special consideration
dependent personality disorder
-Characterized by a pattern of relying on others for emotional support
-Relatively common within the population
-More common among women than men
-More common in the youngest children of a family than in the older ones
dependent personality disorder clinical picture
-They have a notable lack of self-confidence that is often apparent in their:
-Typically passive and acquiescent to desires of others
-Overly generous and thoughtful while underplaying their own attractiveness and achievements
-Low self-worth and easily hurt by criticism and disapproval
-Avoid positions of responsibility and become anxious when forced into them
-Assume passive and submissive roles in relationships
predisposing factors to dependent personality disorder
-Possible hereditary influence
-Stimulation and nurturance are experienced exclusively from one source.
-A singular attachment is made by the infant to the exclusion of all others
obsessive/compulsive personality disorder
-Characterized by inflexibility about the way in which things must be done
-Devotion to productivity to the exclusion of personal pleasure
-Occurs more often in men than in women.
-Within the family constellation, it appears to be most common in oldest children.
ocd personality clinical picture
-Especially concerned with matters of organization and efficiency
-Tend to be rigid and unbending
-Socially polite and formal
--Ingratiating with authority figures
--Autocratic and condemnatory with subordinates
-On the surface, they appear to be very calm and controlled.
-Underneath there is a great deal of:
predisposing factors to ocd personality disorders
-Overcontrol by parents
-Notable parental lack of positive reinforcement for acceptable behavior
-Frequent punishment for undesirable behavior
A client diagnosed with a personality disorder is cold, aloof, and avoids others on the unit. The nurse recognizes that this behavior is symptomatic of which personality disorder?
A. Schizoid personality disorder
B. Dependent personality disorder
C. Borderline personality disorder
D. Antisocial personality disorder
Correct answer: A
A hallmark of the schizoid personality is a marked withdrawal from social contact. The client behaviors presented in the question are indicative of schizoid personality disorder.
borderline personality disorder
-Designated as "borderline" because of the tendency of these clients to fall on the border between neuroses and psychoses.
-Instability of interpersonal relationships
-Intensity of affect and behavior
--Inability to be alone
--Clinging and distancing behaviors
predisposing factors to borderline personality disorder
-Biochemical: Possible serotonergic defect
-Genetic: Possible familial connection with depression
-Childhood trauma and abuse
--Fixed in the rapprochement phase of development (16 to 24 months old). The child fails to achieve task of autonomy
A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe?
A. Social isolation
B. Suspiciousness of others
C. Bizarre speech patterns
D. Generates conflict among the staff
Correct answer: D
Clients diagnosed with borderline personality disorder, having little empathy toward others, are unable to accept both positive and negative feelings, and view others as all good or all bad. They tend to split staff, generating conflict
In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?
B. Controlled anger
C. Little tolerance for being alone
D. Stable and satisfactory relationships
Correct answer: C
Clients diagnosed with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship no matter how unsatisfactory rather than experience feelings of loneliness, emptiness, and boredom.
nursing diagnoses for borderline personality disorder
-Risk for self-mutilation related to parental emotional deprivation
-Risk for suicide related to unresolved grief
-Risk for other-directed violence related to underlying rage
-Complicated grieving related to maternal deprivation during rapprochement phase of development internalized as a loss with fixation in anger stage of grieving process
-Impaired social interaction related to extreme fears of abandonment and engulfment
-Disturbed personal identity related to underdeveloped ego
-Anxiety (severe to panic) related to unconscious conflicts based on fear of abandonment
-Chronic low self-esteem related to lack of positive feedback
outcomes for borderline personality disorder
-Has not harmed self
-Seeks out staff when desire for self-mutilation is strong
-Is able to identify true source of anger
-Expresses anger appropriately
-Relates to more than one staff member
-Completes activities of daily living independently
-Does not manipulate one staff member against the other to fulfill own desires
-Nursing intervention for the client with Borderline Personality Disorder is aimed at protection of the client from self-harm.
-The nurse also seeks to assist the client to advance in the development of personality by confronting his or her true source of internalized anger.
antisocial personality disorder
-Not often seen in most clinical settings.
-Most frequently encountered in prisons, jails, and rehabilitation services.
-When clients are seen, it is commonly a way to avoid legal consequences.
-Sometimes they are admitted to the health-care system by court order for psychological evaluation.
common behaviors a an antisocial personality disorder
-Exploitation and manipulation of others for personal gain
-Belligerent and argumentative
-Unable to delay gratification
-Low frustration tolerance
-Inconsistent work or academic performance
-Failure to conform to societal norms
-Impulsive and reckless
-Inability to function as a responsible parent
-Inability to form lasting monogamous relationship
Predisposing Factors to Antisocial Personality Disorder
-Possible genetic influence
-Having a disruptive behavior disorder as a child (ADHD, conduct disorder)
-History of severe physical abuse
-Absent or inconsistent parental discipline
-Removal from the home
-Growing up without parental figures of both genders
-Always being rescued when in trouble
An individual, with a history of antisocial personality disorder, was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected?
A. "It's not my fault."
B. "I'm too ashamed to talk about it."
C. "I just don't remember doing it."
D. "I'm really sorry about all the people I've hurt."
Correct answer: A
Individuals diagnosed with antisocial personality disorder lack remorse about their actions and view themselves as victims. This individual would most likely refuse to acknowledge responsibility for the accident.
nursing diagnosis for antisocial personality disorder
-Risk for other-directed violence related to rage reactions, negative role-modeling, inability to tolerate frustration
-Defensive coping related to dysfunctional family system
-Chronic low self-esteem related to repeated negative feedback resulting in diminished self-worth
-Impaired social interaction related to negative role modeling and low self-esteem
-Ineffective health maintenance evidenced by demonstration of inability to take responsibility for meeting basic health practices
outcomes for antisocial personality disorder
-Discusses angry feelings with staff and in group sessions
-Has not harmed self or others
-Can rechannel hostility into socially acceptable behaviors
-Follows rules and regulations of the therapy environment
-Can verbalize which of his or her behaviors are not acceptable
-Shows regard for the rights of others by delaying gratification of own desires when appropriate
-Does not manipulate others in an attempt to increase feeling of self-worth.
-Verbalizes understanding of knowledge required to maintain basic health needs.
Nursing care of the client with antisocial personality disorder is aimed at:
-Ensuring the safety of client and others
-Helping client recognize and decrease unacceptable behaviors
-Assisting client to gain insight into own behaviors
-Helping client to learn to delay gratification
tx for personality disorders
Milieu or Group Therapy
Dialectical Behavior Therapy
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