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person has trouble perceiving and relating to situations and people-including themselves.
Rigid, unhealthy pattern of thinking and behaving no matter what the situation
A personality disorder exists when personality traits become
- cause distress
- cause functional impairment
situations are all or nothing....black or white....good or bad
how a person relates to thinking about the environment or oneself
What disorders make up Cluster A
What disorders make up Cluster B
What disorders make up Cluster C
What are Axis II Disorders
Personality Disorders and mental retardations
Why can self injurious behaviors become a compulsion like any other addictive behavior?
cuz cutting/burning causes release of endorphins
Behavior is comfortable to the individual...."there's nothing wrong with me"
Cluster A, B and only OCD from C
Behavior isn't comfortable to the individual, the behavior is inconsistent with one's thoughts and feelings, and values
Cluster C ONLY-Avoidant and Dependent
Dissociative Identity Disorder
- two or more personalities in a single individual
- only 1 personality is evident at any given moment
physical symptoms for which there is no demonstrable organic pathology
Pain, GI and sexual dysfunction
an alteration in perception or experience of the self.
Feel like having an out of body experience
an alteration in perception or experience where reality is lost
Dream like state, things seem unreal-larger, smaller, fuzzy or out of focus
Describe people with Paranoid Personality Disorder
- Cold Jealous
*self is good....others are BAD*
Describe people with Schizoid Personality Disorder
- In the presence of others they appear shy, anxious or uneasy
- Very Anxious
- Inappropriately Anxious always
- Aloof and cold
Describe people with Schizotypal Personality Disorder in normal every day life
- have magical thinking
- ideas of reference
Describe people with Schizoid personality disorder when they are Stressed....
- psychotic behaviors-
- bizarre behavior
This is all brief in duration
How would you describe the way people with antisocial personality disorder feel about other people?
- everyone is out to help them
- place trust in only themselves
- exploit other for personal gain
- socially irresponsible, guiltless
- disregard for the law
- if things go their way they are charming
- See themselves as victims, using projection as a defense mechanism-which justifies malicious behaviors
Describe the home environment typical for individuals who develop antisocial personality disorder
- chaotic home life
- parental deprivation in first 5 years
- Severely physically abused in childhood
- absence of parental discipline
- removal from the home
Identify behavioral characteristics of pt with Borderline Personality Disorder
- Volatility in relationships....UNSTABLE
- Extreme behaviors
- Frequent suicidal gestures
- Chaotic relationships
Borderline btwn neurotic and psychotic
Behaviorally pt with histrionic personality disorder can be described as colorful, extroverted, seductive, attention seeking and volatile. When they don't get the attention they want, how do they act?
- results in feelings of dejection and anxiety
- Will exhibit behavior to be the ctr of attn
- express exaggerated feelings
- over dramatic
- volatile temper tantrums, suicide gestures and assaultive behaviors
Name 2 examples of secondary gains for people with Histrionic PD
- Attention seeking actions (suicide/cutting)
- Somataform Disorders (GI upset, pain)
What type of relationships do individuals with Narcissistic PD tend to have?
- they are superior and entitled to rights and privileges
- optimistic and relaxed mood, but will change cuz of fragile self esteem
- respond with rage, shame, humiliation and dejections
- choose a mate that will praise them
What is the primary behavioral characteristic of pt with avoidant pd
- They are hypersensitive to rejaction, humiliation and shame.
- often lonely and express feelings of being unwanted
- Sooo...they AVOID situations they could be critiqued negatively
Describe behavioral characteristics of pt with dependent personality disorder
- they are passive...allow others to take responsibility for them
- don't like to be alone
- fear abandonment, rejection, criticism
- lack self confidence
What if something goes wrong when a person is working on something if they have dependent PD?
They say it wasn't their fault, cuz they like to be controlled or managed
How do pt with Obsessive Compulsive PD treat others who are subordinate to them?
Everything must go as they say, they are perfectionists, very inflexible.
If something goes wrong it wasn't their fault
How do you intervene with a pt who has Obsessive Compulsive PD
- encourage pt to examine behaviors
- give positive reinforcement for flexibility
- teach pt to understand how attitudes interfere with their relationships
Formulate an effective way to handle a client who doesn't accept responsibility for their problems and maintains that their difficulties are caused by other people
Teach them skills to change their thinking, emotions and behaviors
We want them to make wise choices, have good interpersonal skills (boundaries). Help them to understand their emotions and learn how to act when they are distressed and accept their crappy life and crisis
Whats important to establish for people with Cluster B PD?
Structure and ground rules
Name interventions for creating structure and ground rules for people with Cluster B
- Be clear with expectations
- develop treatment goals/behavior contracts
- have clear consistent consequences
- be firm and consistent
- set limits
- *have a primary nurse*
For individuals with DID, what often precipitates dissociate episodes?
Dissociative disorders are characterized by:
alteration in conscious awareness of behavior, affect, thoughts, memories and alteration in identity
4 Somatoform Disorders
preoccupation with the fear of having a serious disease despite medical evidence to the contrary
What is the secondary gain to hypochondria?
rewards for being ill
only 1 symptom involving deficits affecting voluntary motor or sensory function suggesting neurological condition. It begins and ends abruptly
person is indifferent to the loss of a bodily function
symptomatic disorder. It begins before the age of 30 and extends over a number of years. It is characterized by a combo of pain, GI symptoms, sexual disorders and neurological symptoms
What is the main defense mechanism for persons with Somatization disorder?
produces positive internal motivations....person is not bummed cuz they cant do something when they can justify it is from their disease.
has an external motivator....doing it for the attention
What purpose does SIB have?
- end of dissociative experience
- reorientation from flashback
- reconnecting to feeling of being real/alive
- seek distraction from emotional pain
- release of tension or energy
- for attention
- to manipulate others
People diagnosed with a PD don't realize that their thoughts or behavioral patterns are....
Describe a person with Obsessive Compulsive Disorder
What is pathologic for the antisocial person
Which disorders are NOT hereditary?
- Obsessive Compulsive PD
- Passive Aggressive PD
How can family facilitate paranoid personality disorder?
- parental antagonism and harassment
- scapegoats for parental aggression
- anticipates humiliation and betrayal so learns to attack first
How can family facilitate schizoid personality disorder
bleak childhood....cold, lacking empathy and nurturance
How can family facilitate schizotypical personality disorder
- indifferent, impassive or formal family dynamic leads to discomfort with affection
- this discomfort makes them unattractive companions-rejection
- rejection causes low self esteem and mistrust of others
- repeat social failure causes withdrawal
How can family facilitate histrionic personality disorder
- Positive reinforcement only given when performs admired behaviors
- child rarely receives positive or negative reinforcement
- inconsistent parental approval
- child starved for affection
What is the mother to child and father to child relationship with a histrionic person?
- didn't bond with mom
- abusive dad
How can family facilitate narcissistic personality disorder?
- parents are demanding and perfectionists
- unreal expectations placed on kids
- parents try to live vicariously thru kids
- child develops contempt for own failures
How can family facilitate avoidant personality disorder?
- parental rejection and censure, often reinforced by peers
- child belittled, abandoned, criticized
- optimism sucked out and replaced with low self worth
How can family facilitate dependent personality disorder?
- stimulation and nurturance experienced exclusively from one source
- overprotective parents discourage independent behavior
- dependent behaviors subtly rewarded
How can family facilitate obsessive compulsive personality disorder
- over controlling parents
- praise much less frequent than punishment
- child learns what not to do rather than what they should do
- positive achievements taken for granted, but only occasionally acknowledged
How can family facilitate passive aggressive disorder?
- inconsistent and unpredictable parental response
- child internalizes conflicting attitude about themself
- affection from parents verbalized, but undone thru behavior
- child learns to control anger and fear
Describe a child with passive aggressive PD
they are overtly polite and undemanding, but covertly hostile
How can family facilitate borderline personality disorder?
- childhood trauma-neglect/any abuse
- mother withdraws emotional support in response to normal separation behavior
- rewards clinging behavior
- punishes independent behavior
- lack of nurturing results in internalized rate and manifests as depression
How can family facilitate antisocial personality disorder?
- chaotic home
- parental deprivation in 1st 5 years
- presence of inconsistent or compulsive parent
- sever physical abuse
- maternal deprivation
Describe pharmacologic intervention for personality disorders
- have no effect on the disorder itself....
- only provides relief of accompanying symptoms
Drugs used with personality disorders
What treats psychotic decompensation associated with paranoid, schizotypical and borderline disorders?
For Borderline disorders what treats impulsivity and self destructive acts?
For people with Borderline PD what treats dysphoria, mood instability and impulsivity?
SSRI's with atypical antipsychotics
For people with antisocial PD what treats violent episodes?
What is given to treat avoidant PD
What treats panic disorders?
In interpersonal psychotherapy what are the goals?
modification of maladjusted behavior with the therapist functioning as a role model
What does psychoanalytical psychotherapy look at? Best to treat which PD?
- explores why client needs satisfaction from others
What does Mileu therapy do?
Best to treat with PD?
- believes feedback from peers is more effective than one on one
What does cognitive/behavioral therapy do?
reinforces positive changes and provides social skills and assertiveness training
Which personality disorders is cognitive/behavioral best to treat?
- obsessive compulsive
- passive aggressive
- anti social
4 primary roles for Dialectal Behavior Therapy
- group skills
- individual psychotherapy
- telephone contact
- therapist consultative team meetings
DBT is best to treat which PD's?
- self injurious
- parasuicidal behavior
What do you want to assess on a person with borderline pd?
- history of self harm/suicide
- body language
- clinging or distracting behavior
- psychotic symptoms
What do you want to asses on a person with antisocial pd?
- disregard for social norms
- manipulation of others
- inability to form relationships
- lack of basic health practices
When it comes to planning and implementation for Cluster A pd...what do you want to do?
Be gentle, interested and non invasive
When it comes to planning and implementation for Cluster B pd....what do you want to do?
- provide structure and consistency
- be clear with expectations
- make contracts
- have consequences
- set limits
- HAVE A PRIMARY NURSE
When it comes to planning and implementation for Cluster C pd....what do you want to do?
- help acknowledge avoidance behavior and teach assertion skills
- be patient...response to treatment is slow
- help them maintain hope
Interventions for a pt that self injures
- find out what the self harm behavior accomplishes
- identify triggers
- identify and name feelings
- contract for non self harm
- list alternatives
What care do I provide for a patient that self harms?
- Acknowledge what the function is of the behavior
- encourage therapy
- provide non judgmental compassionate care
- **use matter of fact approach when caring for injuries...discuss incident at another time and don't give it attention!!
sudden unexpected travel away from home or customary place of daily activities with the inability to recall some or all of ones past
usually happens after a major disaster and lasts hours to days
Nursing interventions for dissociative behaviors
- reassure client of safety and security
- stay with client
- develop a relationship with the original personality and all others that show up
- get as much info as can from family/friends
- id methods of coping with stress in the past
- encourage pt to discuss situation that have been stressful and to explore the feelings associated with those times
Body dysmorphic disorder
characterized by the exaggerated belief that the body is deformed or defective in some way
Discuss treatment approaches for pt with self injurious behavior
- observe pt frequently...but avoid appearing watchful
- secure a verbal contract
- care for wounds in a matter of fact way
- remove all dangerous objects
- may need a 1 on 1
inability of a patient to accept both positive and negative feelings about others.
You are either all good or all bad....do this to try and divide staff and relationships.