Quiz #3: Personality Disorders Flashcards Preview

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Flashcards in Quiz #3: Personality Disorders Deck (37):
1

Personality

-Set of deeply ingrained enduring patterns of thinking, feeling, and behaving
-Shaped by biology “temperament” and social learning

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Personality Disorders

A set of patterns or traits that hinder a person’s ability to maintain meaningful relationships, feel fulfilled and enjoy life

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Characteristics of Personality Disorders

-Onset adolescent and early adulthood
-Pervasive and inflexible; continuous
-Leads to distress and impairment
-They are unable to adjust and adapt to the demand or expectations of others or situations

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Personality Disorders: Essential element of diagnosis is that it is

Fixed and long-lasting

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Personality Disorders: Even with treatment,

It is not possible to completely change someone’s personality but can improve symptoms, distress, general functioning

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Key Features of Personality Disorders

-Individual has few strategies for relating
-Inflexible, maladaptive approach to relationships and environment
-Needs, perceptions, and behavior foster vicious cycles; promote unhelpful patterns, provoke negative reactions from others
-Unstable, fragile coping skills
-Lack of resilience in stressful situations

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Personality Clusters: Cluster A

personality disorders of odd or eccentric nature (paranoid, schizoid, schizotypal personality disorders)

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Personality Disorder Clusters: Cluster B

disorders of erratic, dramatic, or emotional nature (antisocial, borderline, histrionic, narcissistic personality disorders)

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Personality Disorder Clusters: Cluster C

disorders of anxious or fearful nature (avoidant, dependent, obsessive-compulsive personality disorders)

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Use table 24-2 (page 464-465) as a study aid!

:)

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Common Maladaptive Responses of Cluster B Personality Disorders

-Manipulation
-Narcissism
-Impulsivity

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Manipulation

-Behavior in which people treat others as objects and form relationships around control issues
-Manipulators are goal- or self-oriented, not other-oriented

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Narcissism

Involves egocentric attitude, fragile self-esteem, constant seeking of praise and admiration, and envy

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Antisocial Personality Disorder

-Diagnosis is applied when individual consistently ignores social rules
-Is manipulative, exploitative, or dishonest
-Lacks remorse for actions
-Involved in criminal activity

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Features of Antisocial Personality Disorder

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years.
B. The individual is at least age 18 years. 
C. There is evidence of conduct disorder with onset before age 15 years. 
D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic episode

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Features of Antisocial Personality Disorder: There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following: 

(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 
(3) impulsivity or failure to plan ahead 
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults 
(5) reckless disregard for safety of self or others 
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations 
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another 

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Borderline Personality Disorder Prevalence

-Diagnosed in 1 – 6% of general population
-Most prevalent personality disorder (8 – 20%) in mental health settings
-Diagnosed more often in women than men (Sociocultural expectations and role stereotypes may contribute to diagnosis in women and evidence to suggest that victimization / trauma as a child is linked to BPD)

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Borderline Personality Disorder Characteristics

-Impulsive aggression is the hallmark of borderline personality disorder, and it plays a pivotal role in the borderline person’s self-mutilation, unstable relationships, violence, and completed suicides
-Behaviors not consciously planned – defense against fear of loneliness
-Pathological fear of separation and intensive sensitivity to perceived personal rejection
-Ineffective and harmful self-soothing habits – cutting, promiscuous sexual behavior, and numbing with substances (May result in unintentional death)

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What is an unusual feature of borderline personality disorder?

-Splitting which is an inability to view both positive and negative aspects of others.
-View someone as either a wonderful person or as a horrible person

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Borderline Personality Disorder is manifested by

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.

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Features of Borderline Personality Disorder: Indicated by five or more of the following

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

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Narcissistic Personality Disorder

-Involves egocentric attitude, fragile self-esteem, constant seeking of praise and admiration, envy
-Many successful people are narcissistic

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Problems associated with Narcissistic Personality Disorder

-When person does not gain status he/she thinks is deserved or tries to have interpersonal relationships
-Frustration caused by lack or loss of recognition may be expressed by anger, depression, substance abuse, or other manipulative behaviors

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Features of Narcissistic Personality Disorder

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) 
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love 
3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) 
4. Requires excessive admiration 
5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations 
6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends 
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others 
8. Is often envious of others or believes that others are envious of him or her 
9. Shows arrogant, haughty behaviors or attitudes

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Other Personality Disorders (Cluster B): Histrionic

-Extremely emotional and attention-seeking
-Self-centered and demanding
-Uses theatrical gestures and mannerisms and exaggerated, grandiose language to describe ordinary events
-May continually change their appearance, opinions, and beliefs in order to attract and impress people

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Other Personality Disorders (Cluster A): Schizoid

SIR SAFE
(S) Solitary lifestyle
(I) Indifferent to praise or criticism
(R) Relationships of no interest

(S) Sexual experiences not of interest
(A) Activities not enjoyed
(F) Friends lacking
(E) Emotionally cold and detached

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Other Personality Disorders (Cluster A): Schizotypal

UFO AIDER
(U) Unusual perceptions
(F) Friendless except for family
(O) Odd beliefs, thinking, and speech

(A) Affect – inappropriate
(I) Ideas of reference
(D) Doubts others – suspicious
(E) Eccentric – appearance & behaviors
(R) Reluctant in social situations, anxious

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Other Personality Disorders (Cluster A): Paranoid

Longstanding distrust and suspiciousness of others based on belief that others want to exploit, harm, or deceive the person

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Paranoia Characteristics

-Hypervigilant and anticipate hostility
-May provoke hostile responses by initiating a “counterattack”
-Difficult to interview because are reluctant to share information
-Anxious about being harmed
-Project – blame others for their shortcomings

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Other personality disorders (Cluster C): Avoidant

-Low self-esteem associated w/ functioning in social situations
-Feel inferior to others
-Reluctant to engage in unfamiliar activities w/ new people
-Hypersensitive to negative criticism, rejection or shame

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Other Personality Disorders (Cluster C): Dependent

-High need to be taken care of -> patterns of submissiveness w/ fears of separation and abandonment
-Clingy, passive, fear of aloneness
-Vulnerable to exploitation

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Obsessive-Compulsive PD Characteristics

-Most prevalent PD
-Rigidity and inflexible standards of self and others
-Preoccupation with trivial detail, orderliness, perfectionism, and control
-Feel genuine affection for friends/family but no insight into own difficult behavior
-Fearful of imminent catastrophe
-Do not have full blown obsessions or compulsions but may seek tx for anxiety or mood disorder
-High burden on workplace – loss of productivity

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Predisposing Factors for Personality Disorders

-Personality composed of temperament (inherited) and character (learned)
-Various predisposing neurobiological, early development, and sociocultural factors

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Explore relevant areas during assessment of Personality Disorders including

-Biological
-Developmental
-Sociocultural

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Expected Outcome for Personality Disorders

Patient will obtain maximum interpersonal satisfaction by establishing and maintaining self-enhancing relationships with others

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Nursing Care for Patients with Personality Disorder

-Establish therapeutic relationship**
-Maintain patient’s and staff’s safety**
-Facilitate patient’s participation in care
-Select least restrictive intervention
-Facilitate behavioral change
-Help patient assume responsibility for behaviors**
-Show genuine interest in patient, try to understand patient by clarifying meanings, validating perceptions**
-Be empathetic with focus on appropriate boundaries** of relationship
-Provide structured environment**
-Serve as emotional sounding board
-Diagnose conflicts, consequences of actions
-Facilitate adaptive change in behavior: Hold manipulative patients responsible for their behavior, although they are skilled at placing responsibility on others
-Limit setting:** Angry, punitive limit setting confirms patient’s expectations. Should not be viewed as way to control patient but as working together toward process of change
-Focus on strengths**
-Journaling
-Behavioral strategies: can help decrease antisocial behavior, including social skills training, anger management
-Dialectal Behavior Therapy (useful for borderline)
Combines cognitive and behavioral techniques w/ mindfulness

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Medications for Personality Disorders

-Have limited role in treatment of personality disorders – used primarily to relieve symptoms such as anxiety, mood swings, impulsive aggression
-Patients with cluster B disorders may need mood-stabilizing medication or atypical antipsychotic drugs for subtle signs of bipolar disorder