Problems r/t Personality Disorder

Question 1

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Is the totality of emotional & behavioral characteristics that are particular to a specific person & that remain somewhat stable & predictable over time

Answer 1

Personality

Question 2

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Are characteristics w/which an individual is born or develops early life

Personality disorders -
- rigid
- inflexible
- contribute to maladaptive patterns of behavior
- impairment in functioning

Answer 2

Traits

Question 3

Common sx’s in personality disorders -

• impairment in interpersonal relationship functions (41%)
• dysfunction in cognition (30%), affect (18%), & impulse control (12%)

Answer 3

Personality Development

> Disorders aren’t dx’d until early adulthood; 1 must complete all stages of personality development <maladaptive behavior patterns can be attributed to a personality disorder

• Heredity
• Temperament
• Experiential learning
• Social interaction

Question 4

Types of Personality Disorders

Answer 4

Organized into 3 clusters according to description of personality traits

Question 5

Cluster A: Behaviors that are odd or eccentric

• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

Answer 5

Cluster B: Behaviors described as dramatic, emotional, or erratic

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Question 6

Cluster C: Behaviors described as anxious or fearful

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder

Question 7

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Characterized by a pervasive, persistent, & inappropriate mistrust of others
* Suspicious of others’ motives & assume that others intend to exploit, harm, or deceive them
* More common in men than women

Answer 7

Paranoid Personality Disorder

Question 8

Paranoid Personality Disorder

• constantly on guard, hypervigilant
• tense & irritable
• hard exterior & become immune/insensitive to the feelings of others
• avoid interactions
• oversensitive & misinterpret even minute cues
• “testing” the honesty of others

Answer 8

• do not accept responsibility for their own behaviors & feelings & project this responsibility onto others
• envious & hostile toward those who are highly successful
• extremely vulnerable & constantly on the defensive
• loss of control can result in aggression/violence

Question 9

Predisposing Factors to Paranoid Personality Disorder

• Schizophrenia
• H/o childhood trauma including neglect
• Parental antagonism & harassment

Answer 9

DSM-5 PPD

Question 10

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Characterized primarily by a profound defect in the ability to form personal relationships
* Failure to respond to others in a meaningful emotional way
* More frequently in men than women
* Seen by others as eccentric, isolated, or lonely
* Many w/disorder are never observed in a clinical setting

Answer 10

Schizoid Personality Disorder

Question 11

Schizoid Personality Disorder

• aloof & indifferent to others
• emotionally cold
• no close friends; prefers to be alone
• appears shy, anxious, or uneasy in the presence of others
• inappropriately serious about everything

Answer 11

• typically unable to experience pleasure
• affect commonly bland & constricted

Question 12

Predisposing Factors to Schizoid Personality Disorder

• introversion = highly inheritable characteristic
• early interactional patterns
• bleak, cold, lacking empathy & nurturing childhood

Answer 12

DSM-5 Schizoid Personality Disorder

Question 13

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• behavior is odd & eccentric but NOT to the level of schizophrenia
• formerly known as “latent schizophrenic”
• considered part of the genetic spectrum of schizophrenia

Answer 13

Schizotypal Personality Disorder

Question 14

Schizotypal Personality Disorder

• aloof & isolated
• behave in a bland & apathetic manner

Answer 14

Symptoms include

• magical thinking
• ideas of reference
• illusions
• depersonalizations
• superstitiousness
• withdrawal into self
• exhibits bizarre speech pattern
• may decompensate & demonstrate psychotic sx’s, when under stress

Question 15

Predisposing Factors of Schizotypal Personality Disorder

• more common among the first-degree biological relatives of people w/schizophrenia
• (+) twin link
• reduced activation of brain areas responsive to motion perception & executive control of perception

Answer 15

DSM-5 Schizotypal Personality Disorder

! can’t be attributed to any other psychological condition that’s occurring

Question 16

Cluster B: Behaviors described as dramatic, emotional, or erratic: AS, BPD, His, Narc

Answer 16

• These individuals exploit & manipulate others for personal gain & are unconcerned w/obeying the law
• Have difficulty sustaining consistent employment & developing stable relationships
• Men > women; lower socioeconomic classes, esp among highly mobile inhabitants of impoverished urban areas

Question 17

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Pattern of socially irresponsible, exploitative, & guiltless behavior that reflects a general disregard for the rights of others

• men > women
• DSM-5 identifies it as synonymous w/psychopathy
• @ least 18 y.o., conduct disorder if younger

Answer 17

Antisocial Personality Disorder

Question 18

Antisocial Personality Disorder

• exploit & manipulate others for personal gain
• unconcerned w/obeying the law
• difficulty sustaining consistent employment & developing stable relationships
• cold, callous & intimidating

Answer 18

• very low tolerance for frustration
• act impulsively, easily provoked
• unable to delay gratification
• see themselves as victims
• disregard their & other’s safety through reckless sexual activity, substance abuse, reckless driving, or child neglect

Question 19

Predisposing Factors to Antisocial Personality Disorder: Biological influences

• more common among first-degree biological relatives
• (+) twin & adoptive studies [callousness & unemotional responses]
• MAOA gene
• temperament in the newborn may be significant
• increased if attention-deficit/hyperactivity disorder & conduct disorder as a child

Answer 19

• deficits in prefrontal cortex gray matter (which regulates cognitive control & inhibition)
• decreased activity in the amygdala (modulates fearful or threatening stimuli)
• dysregulation of neurotransmitters (dopamine & serotonin)
• endocrine abnormalities (testosterone & cortisol)

Question 20

Predisposing Factors to Antisocial Personality Disorder: Family Dynamics

• chaotic home environment
• parental deprivation during the first 5 yrs of life
• separation d/t parental delinquency
• physical abuse & neglect & teasing

Answer 20

• a dx is only made when the client is @ least 18 y.o.; but behavioral patterns are often seen earlier in childhood & adolescence

Question 21

When behaviors of ASD are identified in children & adolescents, the dx is ___ ___, and the common sx’s are bullying, fighting, physical cruelty to animals, & destruction of property & theft

Answer 21

conduct disorder

Question 22

DSM-5 Antisocial Personality Disorder

Question 23

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Characterized by
- intense & chaotic relationships
- affective instability
- fluctuating attitudes towards others
- 2x women > men
- individuals are impulsive, directly & indirectly self-destructive, & lack a clear sense of identity

Answer 23

Borderline Personality Disorder (BPD)

Question 24

Borderline Personality Disorder: Clinical Picture

• in a state of crisis
• frequent mood swings
• chaotic interpersonal relationships
• depression is common
• rage turned inward - self-injurious behaviors
• inability to be alone
• clinging & distancing
• splitting
• manipulation

Answer 24

• impulsivity (e.g., substance abuse, gambling, promiscuity, reckless driving, binging & purging); cutting, scratching, burning; suicide attempts

Question 25

Predisposing Factors to Borderline Personality Disorder - serotonin &/or norepinephrine dysregulation - major depression & substance use disorders in 1st deg relatives - environmental influences - 5x more likely to have a 1st deg relative w/BPD - inheritable characteristics - changes to the oxytocin system

Answer 25

- dec in the volume of the left amygdala & right hippocampus - in some instances, disorder has been likened to PTSD in response to childhood trauma & abuse - fixed in the rapprochement phase of development - unresolved grief toward nurturing they failed to receive results in internalized rage that manifests in depression

Question 26

DSM-5 Borderline Personality Disorder

Answer 26

Additional Cluster B Personality Disorders

Question 27

? - exaggerated sense of self-worth - lack humility, self-centered, exploit others - impaired interpersonal relationships - men > women - from a parent-child dynamic of either excessive pampering or excessive criticism - inc in disorders among children whose parents had disorder - dec volume of gray matter

Answer 27

Narcissistic Personality Disorder

Question 28

? - colorful, dramatic, extroverted, excitable, emotional - difficulty maintaining long-lasting relationships - require constant affirmation - women > men - more common among 1st deg biological relatives - learned behavior

Answer 28

Histrionic Personality Disorder

Question 29

Cluster C Personality Disorders

Question 30

? - socially withdrawn life - equally common in men & women - combo of biological, genetic, & psychological influences/causes [no clear cause]

Answer 30

Avoidant Personality Disorder

Question 31

? - lack of self-confidence & extreme reliance on others - tolerates mistreatment - offering suffering in silence - women > men - +twin connection - issues w/attachment

Answer 31

Dependent Personality Disorder

Question 32

? - overly disciplined, perfectionistic, preoccupied w/rules, inflexible - use the defense mechanism of reaction formation - men > women - more freq in 1st deg biological relatives - overcontrolling parents

Answer 32

Obsessive-Compulsive Personality Disorder ! obsessions & compulsions are absent

Question 33

Nursing Diagnoses: BPD

Answer 33

Nursing Interventions: BPD ✓ Convey an accepting attitude, encourage expression of feelings in an acceptable manner ✓ Act as role model ✓ Observe behavior, caution w/attending to self-injurious behaviors ✓ Monitor environment for safety risks ✓ Consistency ✓ Redirect, show of staff if necessary, rotate staff ✓ Promote independence

Question 34

Nursing Diagnoses: APD

Answer 34

Nursing Interventions: APD ✓ Convey an accepting attitude, be alert to attempts at manipulation ✓ Identify acceptable & non-acceptable behaviors, enforce limits ✓ Low level of stimuli in client's environment ✓ Remove all dangerous objects ✓ Verbalization of feelings ✓ Explore alternative ways of handling frustration ✓ Help the client gain insight into own behavior

Question 35

Treatment Modalities - Individual Psychotherapy - Milieu or Group Therapy - Cognitive-Behavioral Therapy - Dialectical Behavior Therapy - Psychopharmacology

Answer 35

Individual Psychotherapy - may be time-limited interpersonal or may involve long-term psychoanalytic therapy - interpersonal psychotherapy may be particularly appropriate b/c personality disorders largely reflect problems in interpersonal relationship skills - long-term psychotherapy attempts to understand & modify the maladjusted behaviors, cognition, & affects of clients w/personality disorders

Question 36

Milieu or Group Therapy - is esp appropriate for individuals w/antisocial personality disorder, who respond more adaptively to support & feedback from peers - feedback from peers is more effective than 1-to-1 interaction w/a therapist - group therapy, particularly homogenous supportive groups that emphasize the development of social skills, can be helpful for pts who have a dx of avoidant personality disorder

Answer 36

Cognitive-Behavioral Therapy (CBT) - Cognitive strategies help the client recognize & correct distorted & irrational thinking patterns & behavior strategies & offer reinforcement for positive change

Question 37

Dialectical Behavior Therapy (DBT) - as a treatment for the chronic self-injurious & parasuicidal behavior of clients w/BPD; 4 modes of treatment 1. group skills training 2. individual psychotherapy 3. telephone contact 4. therapist consultation & team meetings

Answer 37

Psychopharmacology - may be helpful in some instances - although these rx's have no direct effect on the disorder, but more as symptomatic relief can be achieved; antipsychotics for schizotypal personality disorder, BPD - treat comorbid conditions like depression