Psych Personality Disorders

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julianne.elizabeth
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Psych Personality Disorders
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2015-03-19 21:58:27
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lccc psych nursing personalitydisorders
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For Cummings Exam 2
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  1. Define personality
    • from the latin term persona
    • means theatrical mask
    • personality disorders are axis 2 diagoses
  2. Historically, how were personality disorders classified?
    • 1801 first recognition, referred to as moral insanity
    • An individual can behave irrationally even when their powers of intellect are intact
    • previously called character disorders
  3. What are the four characteristics of personality disorders?
    • 1. Inflexible, maladaptive response to stress
    • 2. Disability in working and loving
    • 3. Ability to evoke interpersonal conflict
    • 4. Capacity to get under the skin of others
  4. Where do personality disorders fall on the mental health continuum?
    Fall to the right of the continuum, right before psychosis
  5. What are the three classifications of the 10 personality disorders according to the DSM 5?
    • Cluster A: odd or eccentric behaviors (paranoid, schizoid, schizotypal)
    • Cluster B: Dramatic, erratic or emotional behaviors (borderline, histrionic, narcissistic, antisocial)
    • Cluster C: Anxious or fearful behaviors (Avoidant, dependent, obsessive-compulsive)
  6. Describe the odd/eccentric personality disorder (Cluster A)
    • Paranoid: people suspicious of others (more men than women)
    • Schizoid: people who do not enjoy social relationships and usually have no close friends. (more men than women)
    • Schizotypal: the same as schizoid, but they also show eccentric thoughts and behaviors which can be considered a milder version of the symptoms of schizophrenia.  Often aloof, bizarre, superstitious, magical thinking
  7. What criteria does the DSM-5 give for Paranoid Personality Disorders (cluster A)?
    • Four of the following:
    • expects exploitation
    • questions loyalty and trustworthiness of friends
    • reads hidden meaning into innocuous events
    • holds grudges
    • reluctant to confide
    • easily slighted, quickly responds with anger
    • questions spouses fidelity
    • You may also see: constantly on guard, overly sensitive, testing honest of others, hyper vigilant, tense, irritable
  8. What traits may be displayed by a client with Paranoid personality disorder? Describe treatment
    • Intense insecurity r/t real or perceived inferiority
    • lack of maternal bonding
    • chip on their shoulder
    • often used as scapegoats as children
    • The rarely seek treatment due to their mistrust, view everyone else as the problem
    • Psychotherapy most often used
    • Medications often not used because it can arouse suspicion, but anti-anxiety meds may be used for those with high anxiety
  9. What is the DSM-5 criteria for Schizoid Personality Disorder (cluster A)?
    • Four of the following:
    • no desire for close relationships
    • prefers solitary activities (often intellectual pursuits)
    • no strong emotions (detachment)
    • indifferent to praise/criticism
    • little interest in sexual contact
    • flat affect 
    • inappropriately serious about everything, shy, aloof, no spontaneity
  10. What is the DSM 5 criteria for Schizotypal PD?
    • 5 of the following:
    • ideas of reference (excluding delusions of reference)
    • odd beliefs/magical thinking that influences behavior and is inconsistent with norms
    • Unusual perceptual experience - body illusions
    • Odd thinking and speech
    • suspicious or paranoid ideation
    • (often superstitious with social anxiety)
  11. What is the schizophrenia continuum?
    • Common among first degree relatives of individuals with schizophrenia
    • Close link between schizotypal and schizophrenia
    • Lack of bonding, families were indifferent, formal, lead to discomfort with affection and closeness
    • Lack of social skills: shunner, overlooked, rejected, humiliated by others...begin to tune out reality because fantasy is better. Low self-esteem, distrust of interpersonal relations
  12. What interventions can be done for Cluster A personality disorders?
    • Be aware of client isolation, suspiciousness
    • Avoid being too nice, overly friendly
    • Use neutral, kind approach
    • Clear, straight forward explanations
    • Simple, clear language
    • Give warning about changes, reasons for delay, medication side effects
  13. Describe Cluster B disorders
    • Borderline (most common PD): intense emotionality, unstable identity and impulsivity. Typically, attitudes and feelings about other people considerably vary for no apparent reason
    • Histrionic (formerly hysterical): the key feature of histrionic PD is overy dramatic and attention-seeking behavior
    • Narcissistic: people that have a grandiose view of their abilities and are preoccupied with fantasies of great success.  They want to be admired. Self centered
    • Antisocial (psychopathy) (oldest recognized disorder): disregard for the rights of others.  Show irresponsible and antisocial behavior.  irritable and aggressive.  Absence of empathy and a lack of feelings of guilt after a transgression.
  14. For anti-social personality disorder, what are the s/s?
    • Often a history of conduct prior to age 15
    • At least 4 of the following:
    • unstable work history
    • fails to conform to social norms (illegal actions)
    • irritable and aggressive
    • fails to honor financial obligations
    • fails to plan ahead (homeless)
    • no regard for the truth
    • irresponsible parenting style
    • not able to sustain monogamous relationships
    • lacks remorse (charming and intelligent on surface)
  15. What the DSM-5 criteria for Antisocial PD?
    • Since the age of 15 there has been a disregard for and violation of the right's of others, those right's considered normal by the local culture, as indicated by at least 3 of the following:
    • -repeated acts that could lead to arrest
    • -conning for the pleasure of profit, repeated lying, or the use of aliases
    • -failure to plan ahead or being impulsive
    • -repeated assaults on others
    • -reckless when it comes to their or other's safety
    • -Poor work behavior or failure to honor financial obligations
    • -Rationalizing the pain they inflict on others
    • Must be at least 18 yrs of age
    • Evidence of conduct disorder with its onset before the age of 15
    • Symptoms not due to another mental disorder
  16. What factors predispose someone to antisocial PD?
    • Often physical abuse
    • Absence of parental discipline/erratic discipline
    • Extreme poverty
    • Removal from the home
    • Growing up without parental figures of both sexes
    • Maternal deprivation
    • Being rescued every time they were in trouble-no consequences
    • More men than women
  17. What interventions can be done for antisocial PD?
    • set clear, realistic limits on specific behaviors 
    • all limits adhere to by all staff
    • use of many staff for appearance of strength and control
    • document objective physical signs of manipulation or aggression
    • provide clear boundaries, consequences
    • guard against letting client make you feel guilty
    • guard against being manipulated
    • Screen for dangerous objects
    • Group therapy is best option, but no therapy is truly successful
  18. What is the DSM-5 criteria for Borderline PD?
    • 5 of the following:
    • intense fear of abandonment
    • unstable, intense personal relationships
    • marked impulsivity*
    • affective instability
    • anger problems
    • chronic suicidal ideation, self mutilation
    • Boredom
  19. What are the s/s of Borderline PD?
    • intense, unstable mood
    • chronic, underlying depression
    • anger- directed at staff or others
    • Fear of abandonment
    • Clinging and distancing
    • splitting***
    • manipulation
    • umpulsivity
  20. What are the biological and psychodynamic components of borderline PD?
    • Biological: genetic predisposition. Relationship with affective disorder. Serotonin disturbance. More women than men
    • Psychodynamic: border between neurosis/psychosis
    • Mahler's theory of object relations- a child is rewarded for dependent behaviors and punished for independent ones
  21. What is the most common defense mechanism for clients with borderline PD?
    • Cognitive distortions
    • Dichotomous thinking or splitting*
  22. What interventions can be done for borderline PD?
    • Set clear, realistic goals
    • be aware of manipulative behaviors
    • clear, consistent boundaries/limits
    • for behavioral problems, review therapeutic goals and treatment boundaries
    • avoid rejecting, rescuing
    • assess for suicidal, self mutilating behaviors (suicide precautions)
    • Long term family, cognitive therapy
  23. What is the DSM-5 criteria for Histrionic PD?
    • 4 of the following:
    • constantly seeks attention
    • inappropriately sexually seductive
    • over concerned with appearance
    • expresses emotion with exaggeration
    • uncomfortable when NOT the center of attentions
    • shifting and shallow emotions (easily angered)
    • self-centered*
    • superficial
  24. What is the mnemonic PRAISE ME for histrionic PD?
    • P rovacative or seductive behavior
    • R elationships considered more intimate than they are
    • A ttention, must be the center of attention
    • I nfluenced easily
    • S peech that impressive, lacks detail
    • E motionally labile, shallowness

    • M ake-up that puts draws attention to the physical appearance
    • E exaggerated emotions, theatrical
  25. What is the DSM-5 criteria for Narcissistic PD?
    • 5 of the following:
    • reacts to criticism with rage and humiliation
    • exploitative in relationships
    • grandiose
    • believes their problems are unique
    • preoccupied with fantasies of greatness
    • sense of entitlement
    • lacks empathy
    • envious
  26. What interventions can be done for narcissistic PD?
    • Stay neutral, avoid power struggles
    • Don't be defensive when disparaged
    • Convey unassuming self-confidence
    • Group and cognitive therapy
  27. What interventions can be done for Cluster B personality disorders?
    • Focus on SAFETY, maintaining a stable mood, and effective social interactions
    • NO primary nursing
    • openly discuss manipulation
    • MUST communicate between shifts
    • limit setting- clear, consistent, enforceable
    • avoid power struggle
  28. Describe Cluster C personality disorders
    • Avoidant personality disorder: fear of rejection of criticism
    • Dependent personality disorder: excessive reliance on others
    • Obsessive-compulsive personality disorder: perfectionistic, detail-oriented style
    • *Research of disorders in this cluster have focused on parents.  Transmission of fear from parents to child, whether avoidant or dependent relationships
  29. What is the DSM-5 criteria for Avoidant PD?
    • 4 of the following:
    • easily hurt, insulted
    • no close friends
    • unwilling to get involved unless they will be liked
    • socially uncomfortable, *sensitive to rejection
    • fears being embarrassed
    • exaggerates dangers/risks
  30. What does avoidant PD look like? What are some predisposing factors?
    • Awkward individuals
    • Slow, fragmented speech
    • Lonely and feel unwanted

    • Predisposing factors:
    • parental rejection, reinforced by peers
    • reared in homes where they are belittled, abandoned, criticized
    • feelings of low self- worth
  31. What is the DS-5 criteria for Dependent PD?
    • 5 of the following:
    • unable to make decisions
    • agrees with others, even if they are wrong
    • needs others to assume responsibility for major areas of their life
    • difficulty initiating anything on own
    • volunteers in order to gain acceptance
    • uncomfortable being alone
    • urgently seeks another relationship when one ends
    • unrealistically preoccupied with being abandoned
  32. What are the s/s of dependent PD?
    • Have a lack of self confidence that is apparent in their voice, posture and mannerisms
    • Typically passive 
    • Assume submissive role
    • Will do anything to earn the acceptance of others, even if unpleasant
  33. What is the DSM-5 criteria for Obsessive-compulsive PD?
    • 5 of the following:
    • perfectionist
    • details, rules, lists
    • insists on doing it their way (stubborn)
    • excessive devotion to work
    • inflexible
    • restricts affection
    • lacks generosity, stingy
    • unable to discard old objects

    Affects more men than women, common in first borns
  34. Describe what obsessive-compulsive PD looks like
    • Experts at learning what they must do to avoid punishment and receive praise (learned from childhood expectations)
    • Often a preoccupation with time/planning
  35. What interventions can be done for cluster C personality disorders?
    • focused on:
    • anxiety reduction
    • social interaction
    • indecisiveness
    • problem-solving skills
  36. Describe Passive Aggressive PD. What is the etiology? Give a example
    • Pervasive patterns:
    • -negative attitudes and passive resistance
    • people are passively expressing covert aggression
    • -relatively common

    • Etiology:
    • -inconsistent responses from parent
    • -double bind communication

    • Example:
    • purposefully being late

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