[Exam 3] Chapter 18 - Personality Disorders Flashcards
(133 cards)
1
Q
What is personality?
A
Ingrained, enduring patterns of behaving and relating to the self and others. Includes perceptions, atittudes, and emotions
2
Q
What are personality disorders?
A
Diagnosed when there is impairment of personality functioning and personality traits that are maladtive
3
Q
Individuals may have identity problems such as
A
egocentrism or being self-centered
4
Q
Personality disorders are not diagnosed until when?
A
At age 18 when personality is more compeltely formed
5
Q
Personality Disorders: DSM-5 definition of this?
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Generalized pattern of behaviors, thoughts, and emotions that begins in adolescence and remains stable over time. Characterized by
Impaired personality functioning
Pathological personality factors
6
Q
Personality Disorders: Clusters of this?
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Cluster A - Odd or Eccentric Behaviors
Cluster B- Erratic or Dramatic BEhaviors
Cluster C- Anxious or fearful disorders
7
Q
Personality Disorders: What fulls under Cluster A?
A
Paranoid personality disorder
Schizoid Personality Disorder
Schizotypal Personality disorder
8
Q
Personality Disorders: What falls under Cluster B?
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Antisocial Personality Disorder
Borderline Perosnality Disorder
Histrionic Personality Disorder
Narissistic Disorder
9
Q
Personality Disorders: what falls under Cluster C?
A
Avoidant Personaltiy Disorder
Dependent Personality Disorder
Obsessive Personality Disoroder
10
Q
Personality Disorders: In psychiatric seettings, nurses most often encounter which type of client?
A
Antisocial and Borderline Personality Disroder
11
Q
Personality Disorders: What is Depressive Behavior
A
Characterized by pervasive pattern of depressive cognitions and behaviors in various contexts. It occurs more often in people with relatives who have major depressive disorders. People with depressive personality disorders often seek tx for their distress
12
Q
Personality Disorders: What is passive-aggressive behavior?
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Chacterized by a negative attitude and a pervasive pattern of passive resistance to demand for adeequate social and occupational performance
13
Q
Personality Disorders & Onset/Clinical: How common?
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10-20% of population
14
Q
Personality Disorders & Onset/Clinical: Percentage of psychiatric inpatients?
A
15% have primary diagnoses of personality disorder.
15
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Personality Disorders & Onset/Clinical: This has been highly correlated with what?
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Criminal behavior, alcoholism, and drug abuse
16
Q
Personality Disorders & Onset/Clinical: These people are often described as what?
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Treatment resistant. This is due to personality being deeply ingrained.
17
Q
Personality Disorders & Onset/Clinical: Another barrier to treatment?
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Many patients do not perceive their dysfunctional or maladaptive behaviors as a problem. Will view themselves as having strong personality that can’t be pushed around
18
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Personality Disorders & Onset/Clinical: When does this tend to dimish?
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In the 40s and 50’s.
19
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Personality Disorders & Onset/Clinical: What tendancies do those with borderline personality disorder tend to demonstrate as they age?
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Decreased impulsive behavior, increased adaptive behavior and more stable relationships by 50
20
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Personality Disorders & Biologic Theories: Personality develops how
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through interaction of hereditary dispositions and environmental influences
21
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Personality Disorders & Biologic Theories: What does temperament refer to?
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Biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotions
22
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Personality Disorders & Biologic Theories: What are the for temperament traits?
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harm avoidance, novelty seeking, reward dependence, and persistence
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Personality Disorders & Biologic Theories: Those with high harm avoidance exhibit what?
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Fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability and pessimistic worry in anticipation of problems
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Personality Disorders & Biologic Theories: tHose with low harm avoidance act how?
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Carefree, energetic, outgoing and optimistic
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Personality Disorders & Biologic Theories: High harm avoidance behaviors may result in what?
maladaptive inhibition and excesive anxiety
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Personality Disorders & Biologic Theories: Low harm avoidance behaviors may result in what?
unwarranted optimism and unresponsiveness to potential harm or danger
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Personality Disorders & Biologic Theories: High novely-seeking temperament results in someone who
is quick tempered, curious, easily bored, impulsive, extravagant, and disorderly. Easily bored and distracted with life and prone to angry outbursts
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Personality Disorders & Biologic Theories: Person with low novelty seeking acts how?
Is slow-tempered, stoic, reflective, frugal, reserved, orderly, adn tolerant of monotony. Adheres to routine of activites
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Personality Disorders & Biologic Theories: People high in reward dependence act how?
Are tenderhearted, sensitive, socialable, and socially dependent. Become overly dependent on approval from others adn readily assume ideas or wishes of others without regrd for their own beliefs
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Personality Disorders & Biologic Theories: People with low reward dependence act how?
Are practical, tough-minded, cold, socially insensitive, irresolute and indifferent to being a lone. Social withdrawal, detachment and aloofness can result
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Personality Disorders & Biologic Theories: How do highly persisitent people act?
Are harmworking and overachievers who respond to fatigue as personal challenge. May perserve even with siutation dictates they should change or stop.
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Personality Disorders & Biologic Theories: How do low persistent people act?
Inactive, indolent, unstable and erratic. They tend to give up easily when frustrated and rarely strive for higher accomplishments
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Personality Disorders & Psychodynamic Theories: What is character/
Consists of concepts about the self and the external world. Develops over time as perosn comes into contact with people
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Personality Disorders & Psychodynamic Theories: Three major character traits?
Self-fDirectedness, Cooperativeness, and Self-Transcedence
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Personality Disorders & Psychodynamic Theories: Wha is self-directedness?
Extend to which a person is responsible , reliable, resourceful, goal-oriented and self-confident.
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Personality Disorders & Psychodynamic Theories: Self-directed people act how
are realistic and effective and can adapt to their behavior to achieve goals
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Personality Disorders & Psychodynamic Theories: People low in self-directedness act how
they blame, are helpless, irresponsible and unreliable . Cannot pursue goals
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Personality Disorders & Psychodynamic Theories: What is cooperativeness?
Refers to the extent to which a person sees him or herself as integral part of human society.
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Personality Disorders & Psychodynamic Theories: How are highly coperative people described?
As empathic, tolerant, compassionate, supportive and principled
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Personality Disorders & Psychodynamic Theories: People with low cooperativeness are described how?
As self-absorbed, intolerant, critical, unhelpful, revengeful and opportunistic
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Personality Disorders & Psychodynamic Theories: What is self-transcedence?
Describes extent to which a person considers themselves to be an integrl part of the universe. Are spiritual, unpretentious, humble and fulfilled.
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Personality Disorders & Psychodynamic Theories: People low in self-transcendence act how?
Are practial, self-conscious, materialistic, and controlling. May have difficulty accepting suffering, loss of control and material losses
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Personality Disorders & Psychodynamic Theories: Personality disorders results when
combination of temperament and character development produces maladaptive, inflexible ways of viewing self, coping with world, and relaitng ot others
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Personality Disorders & Psychopharmacology: The four symptom categories that underlie personaltiy disorders are cognitive-perceptual distortions including:
Psychotic symptoms
Affective symptoms and mood dysregulation
Aggression and behavioral dysfunction
Anxiety
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Personality Disorders & Psychopharmacology: Low reward dependence corresponds with what disorder?
Affective dysregulation, ddetachment adn cognitive disturbances
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Personality Disorders & Psychopharmacology: High novely seek corresponds with what?
target symptoms of impulsiveness and aggression
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Personality Disorders & Psychopharmacology: High harm avoidance corersponds with what?
Categories of anxiety and depression symptoms
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Personality Disorders & Psychopharmacology: Cognitive-perceptual disturbances include what?
magical thinking, odd beliefs, illusions, suspiciousnes, ideas of reference and low-grade psychotic symptoms
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Personality Disorders & Psychopharmacology: Aggression may occur in what type of people?
Impulsive people, those who exhibit predatory or cruel behavior, or peope with organic like impulsivity, poor social judgement and emotional lability
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Personality Disorders & Psychopharmacology: What is prescribed to treat aggresion?
Lithium, anticonvulsant mood stabilziiers, and benzodiazepines
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Personality Disorders & Psychopharmacology: What may be useful in modifying predatory aggression?
Low-dose neuroleptic
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Personality Disorders & Psychopharmacology: Mood dysregulations symptoms include what
emotional instability, emotional detachment, depression adn dysphoria
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Personality Disorders & Psychopharmacology: Emotional instability and mood swings respond favorably to what?
Lithium
Carbamazepine (Tegretol), Valproate (Depakote)
Low dose Neuroleptics like Haloperidol (Haldol)
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Personality Disorders & Psychopharmacology: Emotional detachment, cold and aloof emotions, and disinterest in social relations often respond to what
SSRIs or atypical antipsychotics such as risperidone (Risperdal), Olanzapine (Zyprexa) and Quetiapine (SEroquel)
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Personality Disorders & Psychopharmacology: Atypical depression treated how
SSRI
MAOI
Low dose Antipsychotic meds
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Personality Disorders & Psychopharmacology: Chronic cognitive anxiety responds to what
SSRI and MAOIs
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Personality Disorders & Psychopharmacology: What does Chronic somatic anxiety or anxiety manifested as multiple physical complain respond to?
SSRI and MAOIs
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Personality Disorders & Psychopharmacology: Episodes of severe acute anxiety are best treated with
MAOIs or low-dose antipsychotic meds
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Personality Disorders & Individual/Group Psychotherapy: When is inpatient hospitalization indicated?
When safety is concern. Such as if person with BPD has suicidal ideas or engages in self-injury
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Personality Disorders & Individual/Group Psychotherapy: This focuses onw hat?
Building trust, teaching basic living skills , providing support, decreasing disressing symptoms sucha s anxiety and improving interpersonal relationships
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Personality Disorders & Individual/Group Psychotherapy: What helps manage anxiety?
Relaxation or medication techniques
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Personality Disorders & Individual/Group Psychotherapy: Assertiveness training groups can assist with what??
People to have more satisfying relationships with others and to build self-esteem when that is needed
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Personality Disorders & Individual/Group Psychotherapy: What cognitive restructuring techniques are used?
Thought stopping
Positive Self Talk
Decatastrophizing
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Personality Disorders & Individual/Group Psychotherapy: What has been particularly helpful for clients with personality disorders?
CBT
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Personality Disorders & Individual/Group Psychotherapy: What is Dialectiral Behavior Therapy?
designed for those with BPD. Focuses on distorted thinking and behavior based on teh assumption that poorly regulated emotions are the underlying problem
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Personality Disorders & Individual/Group Psychotherapy: Schizoid Symptoms?
Detached from social relationships, restricted affect, involve with things more than people
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Personality Disorders & Individual/Group Psychotherapy: Schizotypal Symptoms?
Acute discomfort in relationships, cognitive or perceptual distortions, eccentric behavior
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Personality Disorders & Individual/Group Psychotherapy: Histrionic symptoms?
Excessive emotionality and attention seekings
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Paranoid Personality Disorder/Clinical Picture: What is this?
Pervasive mistrust and suspiciousness of others. View others actions as potentially harmful. During stress, may develop transient psychotic symptoms
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Paranoid Personality Disorder/Clinical Picture: How do clients appear?
Aloof and withdrawn and may remain a consideerable physical distance from the nurse. They are guarded and survery the room. Sit near the door ready to exit.
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Schizoid Personality Disorder & Clinical: What is this
Characterized by pervasive pattern of detachment from social relationships and restricted range of emotional expression in interpersonal settings
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Schizoid Personality Disorder & Clinical: How is there emotion?
Display constricted afect and little emotion.Appear emotionally cold and indifferent. Report no liesure or pleasurable activies
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Schizoid Personality Disorder & Clinical: How is their fantasy life?
Have a extensive fantasy life but may be reluctant to reveal that information. Usually revolve around someone client has met only briefly.
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Schizoid Personality Disorder & Clinical: How do they feel about relationships?
Have a lack of desire for involvement with others. Do not have or desire freinds and they rarely date or marry.
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Schizoid Personality Disorder & Nursing Intervention: Focus on what?
Improved functioning in community.
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Schizotypal Personality Disorder: What is this?
Characterize dby pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as cognitive or perceptual distortions.
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Schizotypal Personality Disorder: These people may develop what?
Schizophrenia
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Schizotypal Personality Disorder: How is their appearance?
Odd. Unkempt and disheveled and their clothes are often ill-fitting, do not match, or may be strained or dirty.
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Schizotypal Personality Disorder: How is their speech?
Use words incorrectly. Speech sounds bizzare. If asked about sleep they will respond "sleep is slow, REMs don't flow.
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Schizotypal Personality Disorder: Emotions here
Restricted range of emotions. Lack the ability to experience and express a full range of emotions
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Schizotypal Personality Disorder: Cognitive distortions include what
ideas of reference, magnical thinking, odd orunfounded beliefs and a preoccupation with parapsychology
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Schizotypal Personality Disorder: How is their anxiety?
Experience great anxiety around other people, especially those who are unfamilar. Does not improve with time or repeated exposures. Belief that strangers cannot be trusted
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Schizotypal Personality Disorder and Nursing Interventions: Focus here?
Development of self-care and social skills and improved functioning in the community
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Schizotypal Personality Disorder and Nursing Interventions: What does nurse encourage?
Client to establish a daily routine for hygiene and groming.
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Antisocial Personality Disorder: What is this?
Pervasive pattern of disregard for and violation of right of others and by the central characteristics of deceit and manipulation.
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Antisocial Personality Disorder and History: Onset occurs when?
Not made until client is 18 .
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Antisocial Personality Disorder and History: Childhood characteristic predictors of this?
Enuresis, sleepwalking and syntonic acts of cruetly
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Antisocial Personality Disorder and History: How will they act in adolescnce?
engaged in lying, trauancy, sexual promiscuity, cigarette smoking, substance use, adn illegal activites
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Antisocial Personality Disorder and General Appearance/Motor Behavior: What signs may they exhibit in interview?
Are total normal and charming. In interview, may show mild or moderate anxiety
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Antisocial Personality Disorder and Mood/Affect: Emotions?
Usually display false emotions to suit siutation. Emotions are quite shallow. They cannot empathize with others.
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Antisocial Personality Disorder and Thought Process/Content: View of world?
Narrow and distorted. They tend to believe that others are similarly governed. View world as cold and hostile.
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Antisocial Personality Disorder and Sensorium/Intellectual?
Oriented and have average or above average IQs
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Antisocial Personality Disorder and Judgement/Insight: Judgement?
Poor. Pay no attention to legality of their actions and do not consider mroals or ethics when making decisions. Behavior determine primarily by waht they want
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Antisocial Personality Disorder and Judgement/Insight: Insight?
Impulsivity ranges from simple failure to use of normal caution to extreme thrill-seeking behaviors such as driving recklessly.
Never see their actions as cause of problem
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Antisocial Personality Disorder and Self-Concept: How are they here?
Confident, self-assured, and accomplished. They feel fearless, disregard their own vulnerablity and suually cannot believe they cannot be caught in lies
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Antisocial Personality Disorder and Roles/Relationships: How do they tret others?
Manipulate and exploit those around them. View relationships as serving thier needs an dpursue others only fo rpersonal gain
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Antisocial Personality Disorder and Forming Therapeutic Relationship and Promoting Responsible Behavior: What must a nurse do?
Provide structure, identify acceptable and expecte dbehaviors, and be consistent in those expectations.
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Antisocial Personality Disorder and Forming Therapeutic Relationship and Promoting Responsible Behavior: Limit setting is used and involves wha tthree steps
1. State the behavioral limit
2. Identify the consequences if the limit is exceeded
3. Identify the expected or desired behavior
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Antisocial Personality Disorder and Forming Therapeutic Relationship and Promoting Responsible Behavior: Example of using limit setting if client flirts with yu?
"It is not acceptable for you to ask personal questions .If you continue, I will terminate our interaction. We need to use this time to work on solving your job-related problems"
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Antisocial Personality Disorder and Forming Therapeutic Relationship and Promoting Responsible Behavior: How is confrontation used?
used to manage manipulative or deceptive behavior. Nurse points out client's problematic behavior while remaining neutral and matter of fact. Avoids accusing the client.
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Antisocial Personality Disorder and Helping Client Solve Problems and Control Emotions: How do clients react with confronted with problems?
REact impulsively.
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Antisocial Personality Disorder and Helping Client Solve Problems and Control Emotions: How can nurse help here?
Can teach problem-solving skills. This includes identifying the problem, exploring alternative soltuons and related consequences, choosing and implementing an alternative and evaluating results
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Antisocial Personality Disorder and Helping Client Solve Problems and Control Emotions: Exammple of problem solving seen here?
Car stops working, so they stop going to work. The problem is transportation and we should teach them to recognize alternative soltuions
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Antisocial Personality Disorder and Helping Client Solve Problems and Control Emotions: How can time-out be useful?
This assits the client in anticipating stresful siutations and to learn ways to avoid negative future consequences.
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Antisocial Personality Disorder and Enhancing Role Performance: A nurse helps clients identify what?
Specific problems at work or home that are barrier to success in fulfilling roles
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Borderline Personality Disorder: What is?
Pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as mark impulsivity
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Borderline Personality Disorder: Nonsuicidal self-injury usually a sign of what?
cry for help, an expression of intense anger or helplessness or a form of self-punishment.
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Borderline Personality Disorder: How do these clients act as times?
Ask her help one minute, be angry the next minute. They may attempt to manipulate staff to gain immediate gratification of needs and may sabotage their own treatment
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Borderline Personality Disorder and History: Report disturbed early relationships with parents beginning at
18-30 months of age
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Borderline Personality Disorder and History: Attempts to achieve developmental independnce were met with what?
Punitive responses from parents or threats of withdrawal of parental support and approval
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Borderline Personality Disorder and History: Clients tend to use transitional objects, which are what?
Teddy bears, pillows, and blankets. Similar to facorite items from childhood that they used for comfort or secuirty
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Borderline Personality Disorder and General Appearance/Motor: When dysfunction severe, clients appear how
disheveled and may be unable to sit still or they may display labile emotions. In other cases, they may appear normal
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Borderline Personality Disorder and Mood/Affect: Pervasive mood is dysphoric, meaning what
involving unhappiness, restlessness, and malaise
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Borderline Personality Disorder and Mood/Affect: Clients often report what?
Intense loneliness, boerdom, frustration and feeling "empty". Rarely experience satisfaction.
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Borderline Personality Disorder and Mood/Affect: Emotions?
They experience intense emotiosn such as anger and rage but rarely express them productively or usefully. Usually hypertensive to others emotions which can easily trigger reactions
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Borderline Personality Disorder and Mood/Affect: Minor changes can do what?
Precipitate severe emotional crisis. Such as if a theraptic takes a vacation
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Borderline Personality Disorder and Thought Process/Content: thoughts about oneself are often what?
Polarized and extreme. Tend to adore and idealize other people even after a brief acquaintance but quickly devalue them
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Borderline Personality Disorder and Thought Process/Content: What may occur during dissociative episodes?
Self-harm behaviors often occur during the dissociative episodes though at other times, clients may be fully aware of injuring themselves.
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Borderline Personality Disorder and Sensorium and Intellectual Processes: How is orientation?
Fully oriented to reality. Exception is transient psychotic symptoms where they may report auditory hallucinations encouraging self-harm
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Borderline Personality Disorder and Judgement/Insight: Clients frequently report behaviors consistent with
impaired judgement and lack of care and concern for safety such as gambling, shoplifting and reckless driving. Based decisions on emotions rather than facts
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Borderline Personality Disorder and Judgement/Insight: How do they view lifes problems?
As the result of others shortcomings. Others are always to blame
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Borderline Personality Disorder and Self-Concept: How do they view tehmselves?
In an unstable vieew. They may appear needy and dependent one moment and angry and hostile the next.
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Borderline Personality Disorder and Self-Concept: What kind of threats common?
suicidal threats, gestures and attempts. This includes cutting , punching, or burning.
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Borderline Personality Disorder and Roles/Relationships: They hate being alone but what isolates them?
Their erratic, labile, and sometimes dangerous behaviors.
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Borderline Personality Disorder and Roles/Relationships: How are relationships?
Unstable, stormy, and intense.
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Borderline Personality Disorder and Roles/Relationships: How do they view being alone?
Have extreme fears of abandonment and difficultty believing a relationship still exists once person is away from them
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Borderline Personality Disorder and Roles/Relationships: How are feelings for others often disrtoed?
If they meet someone once or twice, they will be convicned that they are the love of their life. If the person doesn't feel teh same, they feel rejected and become hostile.
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Borderline Personality Disorder and Roles/Relationships: History in school?
Poor school and work performance because of constantly changing career goals and shifts in identity or aspirations, preoccupation with maintaining relationships and fear of real or perceived abandonment
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Borderline Personality Disorder and Physiological/Self-Care: What other behaviors may they engage in?
Binging, purging, susbtance abuse, unprotected sex, or reckless behavior such as ddriving while intoxicated
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Borderline Personality Disorder and Interventions: Usually involved in what treatment?
Long-term psychotherapy to address issues of family dysfunction and abuse. Nurses will remain in contact during times of crisis
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Borderline Personality Disorder and Promoting Client's Safety: What must nurse always be prepared for?
Suicidal ideation with presence of a plan, access to means for enacting the plan and self-harm behaviors and institute appropriate interventions
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Borderline Personality Disorder and Promoting Client's Safety: It is common practice to encourage clients to enter into a no-self harm contract which is what
client promises not to engage in self-harm and to report to the nurse when he or she is losing control
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Borderline Personality Disorder and Promoting Therapeutic Relationship: How cna nurse help promote this?
Provide structure. That may mean seeing client for scheduled appointments of a predetermined length rather than whenever client appears.
