Personality Disorder Cluster B

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  1. Cluster B Antisocial PD
    • A pattern of behavior that is
    • - social irresponsible
    • - exploitative
    • - without remorse
    • APA defines as "a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescents and continues into adulthood"
    • prevalence estimates in the United states range from 2 to 4 percent in men to about 1 percent in women
  2. Cluster B Antisocial PD
    clinical picture
    • fails to sustain consistent employment
    • fails to conform to the societal laws
    • impulsive and aggressive
    • fails to develop stable relationships, can interact mutually
    • failure to accept responsibility for actions, ego inflation
    • formally known as sociopaths, lies, steal, violate laws and hurt people for personal gains
    • dangerous on unit- no touchy feelings, therapeutic takes advantage and exploits others
    • manipulative
  3. Cluster B Antisocial PD
    clinical picture
    • exploit and manipulates others for personal gain
    • belligerent and argumentative
    • lacks remorse
    • rage/aggression occurs when challenged
    • unable to delay gratification
    • low frustration tolerance
    • Inconsistent work or academic performance
    • inability to function as a responsible parent
  4. Cluster B Antisocial PD
    predisposing factors
    • multifactorial elements including substantial childhood trauma, abuse, neglect
    • childhood victimization- absence attachment, harsh parenting
    • absent family unit feeling guilty and rescuing when in trouble
    • often history of family involvement in illegal activities
    • having disruptive behavior as child- ADHA, CD)
    • extreme poverty or removal home
  5. Cluster B Antisocial PD
    • hardest to treat, rarely seek treatment voluntarily, no respons well to meds or traditional therapy
    • tx service are usually predicated by criminal activity ie admitted to the health care system by court order for psychological evaluation
    • vital not to allow for opportunity for manipulation when in tx and very difficult to monitor in acute psych setting where other patients are vulnerable **
  6. NANDA antisocial disorder
    • risk for other-directed violence r/t rage reaction, negative role modeling, inability to tolerant frustration
    • defensive coping r/t dysfunctional family function
    • chronic low self esteem r/t repeated negative feedback, resulting in diminished self worth
    • impaired social interaction r/t negative role modeling and low self esteem
    • ineffective health maintenance, evidence by demonstration of inability to take responsibility for meeting basic health practices
  7. Outcomes Antisocial
    • discuss angry feelings with staff and in group
    • has not harmed self or others
    • can re-channel hostility into socially acceptable behaviors
    • follows rules and regulations of the therapy environment
    • can verbalize which of his or her behaviors arenot acceptable
    • shows regard for the rights of others by delaying gratification of own desires when approriate
    • does not manipulate others in a attempt to incre feeling of self worth
    • verbalizes understanding of knowledge required to maintain basic health needs
  8. Planning/intervention/eval
    • ensuring safety of pt and others
    • helping pt to recognixe and dec unacceptable behaviors
    • assisting pt to gain insight into own behaviors
    • helping client to learn to delay gratification
    • provide structure in milleu
    • engage in frequent staff to reduce splitting of staff
  9. Cluster B Borderline PD
    • more in woman than man
    • affects 1-2% of pop
    • fluctuating and extreme attitudes regarding other people
    • extreme attention seeking, whether negative or positive
    • characterized by a pattern of intense and chaotic relationships with affective instability- love drama
    • most function at very low level and subsequently utilize a high proportion of medical and behavioral resources
    • learn how to survice
    • most difficult pt to work with
    • non ability to understand peeps
  10. Cluster B Borderline PD
    clinical picture
    • emotionally unstable
    • directly and indirectly self destructive- ie swallowing batteries,
    • engage in suicide gestures to evoke rescue response- looking for attention
    • lacks a clear sense of identity
    • fear abandonment so strong 'master of manipulation'
    • any behavior is acceptable if it means to avoid abandonment, often playing one individual off another to ally these fears
    • extreme mood fluctuations (which makes it difficult to distinguish from bi-polar)
    • suffer identity diffusion and are unable to tolerate being alone
  11. Cluster B Borderline PD
    defense mechanism
    • use immature defense mechanisms such as clinging, distancing, and splitting
    • Clinging: patterns of interacting that appears childlike helpless and over-idealistic a single individual. They 'love' intensely and insist on spending all their time frequently need to talk, jealous when other interfere. when denies access or break up they act out and usually self injury
    • Distancing: when separate, 'hate' intensely and devaluate discredit or undermine the object of their clinging as personally insignficance or weak
    • splitting: primitive ego defense due to a lack of achievement of object constancy. makes it hard to integrate positive and negative feelings (all good or all bad)
    • cant be alone
  12. Cluster B Borderline PD
    clinical picture-2
    • instability of interpersonal relationships
    • unstable self image
    • marked impulsivity
    • intensity of affect and behavior
    • chronic depression
    • designated as borderline because of the tendency of these pts to fall on the border between neuroses and pyschoses
  13. Cluster B Borderline PD
    predisposing factors
    • Bio influence:
    • biochemical- possible serotonergic defect
    • some studies suggest amygdala- limibic system altered
    • genetic- possible familial connection w/depression
    • one theory is that something interfered with psychosocial development early in life that left an absence in their biochemical foundation
    • predictor is sustained childhood abuse/trauma**
    • developmental factors- fixed in the rapprochement phase of development (16-24 months) the child fails to achieve task of autonomy- gets suck
  14. NANDA- borderline PD
    • risk for self-multilation r/t parental emotional deprivation
    • risk for suicide r/t unresolved grief
    • risk for other directed violence r/t underlying rage
    • complicated grieving r/t maternal deprivation during rapprochement phase of development internalized as a loss, with fixation in anger stage of grieving process
    • impaired social interaction r/t extreme fears of abandonment and engulfment
    • disturbed personal identity r/t under-developed ego
    • anxiety (severe to panic) r/t unconscious conflicts based on fear of abandonment
    • chronic low self esteem r/t lack of positive feedback
  15. Outcome borderline PD
    • has not harmed self
    • seeks out staff when desire for self mutilation is strong
    • is able to identify true source of anger
    • expresses anger approriately
    • related to more than one staff member
    • completes activity of daily living independently
    • does not manipulate one staff memeber against the other fulfill own desires
    • does not engage in substance use
    • is less manipulative with staff and fellow pts
  16. Planning/implementation/eval
    • protection of pt from self harm
    • nurse helps pt confront true source of internalized anger
    • be aware pt challenging, highly manipulative and require alot of energy
    • firm, consistent, matter of facts limits, avoiding arguing or power struggles
    • encourage direct communication to reduce attention seeking drama & help pt recognize and discuss fear of abandonment
    • Safety!!! when pt act out, at high risk for suicidal behavior - deprivation- when parent comes and leaves
  17. Cluster B Borderline PD
    • mood stabilizer- limited success
    • dialectical behavior therapy (specialist in BPD only)- focus on pt change process to build skills in problem solving, pervasive emotional regulation, healthier self soothing techniques and coping skills
    • mindfulness practice and biofeedback has been helpful
    • behavior mod and other therapies have had minimial success
    • multidiscplinary team is cohesiveness crucial, collaborate frequently. clear boundaries, timeframes and expectations
    • ensure other memebers present when any physical assessment must occur to avoid misinterpretation of contact
    • assess lethality of self-injury and suicidality daily0 all the time
  18. Self injurious behavior
    • include cutting, burns, scratches, insertion of objects into orifices and swallowing dangerous, sharp or painful objects/ issue become self injury meant to ease may cause death unintentionally
    • theory
    • 1. pt with BPD has higher levels of endorphins and an incr threshold for pain, feel pain realize they are alive and releases stress
    • 2/ may be due to state of depersonalization or derealization and pain is used to counteract these feelings/ pt reports to feel pain is better to feel nothing at all
  19. Cluster B Histrionic PD
    • prevelance 2-3%
    • more common in woman
    • it is all about me== we use physical appearance to draw attention
    • uncomfortable if not the center of attention
    • easily persuaded and highly suggestible to influence of others
    • mean girls
  20. Cluster B Histrionic PD
    clinical pic
    • self-dramatizing
    • attention-seeking
    • overly gregarious
    • seductive
    • manipulative
    • exhibiyionistic
    • excitable
    • emotional
  21. Cluster B Histrionic PD
    clinic picture 2
    • highly distractible
    • extroverted, loud and attention seeking
    • colorful and dramatic
    • takes small issues to extremes
    • difficulty paying attention to detail
    • difficulty forming close relationships & appear cruel
    • somatic compliants are common
  22. Cluster B Histrionic PD
    predisposing factors
    • possible link to the nonadrenergic and serotonergic systems
    • possible hereditary factor
    • biogenetically determined temperament
    • learned behavior patterns**
    • learned that approval and admiring behaviors were the only way to gain parental attention
    • often enters adolescent with an insatiable thirst for love, belonging and attention
  23. Cluster B Histrionic PD
    • CBT and psychotherapy will aid patients to identify patterns of their behavior, connect thought to their behaviors and relearn how to establish healthy relationships
    • these pts do not do well in group therapy, since then tend to monopolize the session, get very degrading to others and can become quite dysregulated if confronted by fellow pts
    • pharmacological agents may need to be considered if co-occuring mental health conditions exist ie depression and anxiety
    • bounderies and strict limits on flirtatious acts must be consistently maintained by the mental health team
    • ensure other members present when any physical assessment myst occur to avoid misinterpretation of contact
    • help pt displaying entitlement to acknowledge needs of others
  24. Cluster B Narcissistic PD
    • seen as exaggerated sense of worth
    • lack of empathy
    • belief in the inalienable right to receive special consideration
    • prevalence- about 6%
    • more in men
    • criticism may cause them to respond in rage, shame, and humiliation
  25. Cluster B Narcissistic PD
    clinical picture
    • overly self-centered
    • grandiose, self-perfection
    • very adapt at exploiting other in effort to fulfill own desires
    • Mood-grandiose, is usually optimistic, relaxed cheerful, and carefree however, bc of fragile self esteem mood can easily change if they dont meet self expectations or recieve positive feedback they expect
    • symptoms inc with age, and are at the most extreme in 40's-50's
  26. Cluster B Narcissistic PD
    predisposing factors
    • as children- fears, failure, or dependency need were responded to with criticism disdain or neglect
    • parents were narcississ themselves
    • parents may have over indulged their child and failed to set limits on inapproriate behavior
    • this causes conflict between their overblown expectations and indulgence and real world consequence that produce extreme shame based proneness
  27. Cluster B Narcissistic PD
    • CBT and psychotherapy with therapist experience in the disorder may aid patients to connect thoughts to their behaviors and explore what drives the shame. long term therapy
    • pharm consider if co-occuring mental illness- depression/anxiety
    • individually confront the patronizing and condecending behavior towards others in a matter of fact empathetic manner that does not embarrass or shame the pt in front of others
    • may need short term hospitalization if they become impulsive and self destructive
    • provide consistent structured milieu
Card Set:
Personality Disorder Cluster B
2016-11-30 16:27:14

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