Psych Exam 3 Personality D/O

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Psych Exam 3 Personality D/O
2011-04-03 00:11:53
Nursing Psych

Personality Disorders
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  1. Define Personality
    • Complex pattern of characteristics, largely outside of the person’s awareness
    • Distinctive patterns of perceiving, feeling, thinking, coping and behaving
    • Emerges within biopsychosocial framework
  2. Define Personality Disorder
    • An enduring pattern of deviant inner experiences and behavior
    • Differ from cultural expectations
    • Pervasive, inflexible, and stable
    • Leads to distress or impairment
  3. List causes of Stalled Personality
    • Abuse
    • Trauma
    • Loss of parent/ death
  4. List 3 Cluster Types of Personality Disorders
    • Odd-eccentric/ Mature Type: schizo behavior, but not schizo
    • Dramatic and emotional/ Immature Type: Dramatic, attention seeking
    • Anxious-fearful/ Anxious Type: People feeling anxious and fearful
  5. List 3 Types of Cluster A Odd-eccentric/ Mature Type
    • Paranoid personality disorder(not axis I Paranoia)
    • Schizoid personality disorder
    • Schizotypal personality disorder
  6. List 4 Types of Cluster B Dramatic & Emotional/ Immature Type
    • Antisocial personality disorder
    • Borderline personality disorder
    • Histrionic personality disorder
    • Narcissistic personality disorder
  7. List 3 Types of Cluster C Anxious- fearful/ Anxious Type
    • Avoidant personality disorder
    • Dependent personality disorder
    • Obsessive-compulsive disorder(not axis II Obsessive Compulsive Disorder)
  8. List Common Features and Diagnostic Criteria for Personality Disorders
    • A specific and notable pattern of thinking, feeling, and behaving that has the following characteristics:
    • 1.enduring
    • 2.pervasive
    • 3. inner experience & external behavior
    • 4.differs significantly from the expectations of the individual’s culture
    • 5.involves two or more important areas of functioning: thinking, feeling, interpersonal fxning, impulse control
    • 6. Distress or impairment
  9. List Characteristics of (A) Paranoid Personality Disorder
    • Must have at least 4 out of 7 characteristics:
    • Feels others are exploiting
    • Doubts of loyalty
    • Reluctant to confide
    • Suspections of fidelity
    • Thinks demeaning from benign remarks
    • Holds grudges, unforgiving
    • Angry, counter-attack
  10. List Etiology & Nsg Mgt of Paranoid Personality Disorder
    • Etiology: unclear, possible genetic predisposition
    • Nursing management
    • Patients often seen for other health problems, will present with an underlying suspiciousness
    • Nursing diagnosis: disturbed thought process
    • Nursing interventions: it can be difficult to establish nurse–patient relationship
    • if trust is established, help patient identify problem areas
    • changing thought patterns takes time, outcomes are evaluated in small changes in thinking and behavior
  11. List How Others See Paranoid Personality Disorder
    • take everything personally
    • question every motive or intention
    • get angry & obsessed over small things done wrong
    • blow small things out of proportion
    • are touchy or thin-skinned
    • seem scary for no obvious reason
    • have a “with me or
    • against me” attitude
    • are a blaming victim
    • persist in endless angry storytelling
    • persist in “yes-butting”
    • are rigid in their conclusions
    • dismiss out of hand possible alternate interpretations of other people’s motives
    • have a chip on their shoulder
    • are spoiling for a fight
    • are vindictive
  12. List Features of Schizoid Personality Disorder
    • Pervasive pattern of detachment from social relationships
    • Restricted range of expression of emotions with others
    • lacking desire for intimacy
    • indifference to opportunities for close relationships
    • little satisfaction from being part of a family or social group
    • preference for alone time rather than being with others; choosing solitary activities or hobbies
    • little if any interest in having sexual experiences with others
    • reduced pleasure from sensory, bodily, or interpersonal experiences
    • no close friends or relatives
    • indifference to approval or criticism from others
    • emotional coldness, detachment, or flattened affect
  13. List Epidemiology of Schizoid Personality Disorder
    • Rarely diagnosed in clinical settings
    • Least common Mature Type
    • Avoidant personality disorder & Dependent and Obsessive-compulsive disorders may coexist with this disorder
  14. List Nsg Mgt of Schizoid Personality Disorder
    • Nursing diagnosis: impaired social interactions and chronic low self-esteem
    • Goal: to enhance experience of pleasure, prevent social isolation, and increase emotional responsiveness to others.
    • Increase the patient’s ability to feel pleasure.
    • Interventions: It’s difficult to establish a therapeutic relationship, Provide social skill training, Encourage social interactions
  15. List How Others See Schizoid
    • cold
    • aloof
    • blank
    • zombie-like
    • dead
    • forgettable
    • impossible to talk to or interview
  16. List Features of Schizotypal Personality Disorder
    • Pervasive pattern of social and interpersonal deficits evidenced by acute discomfort; reduced capacity for close relationships; cognitive and perceptual distortions; and eccentric behavior
    • Ideals of reference (incorrect interpretations of events as having special personal meaning)
    • Odd beliefs or magical thinking influencing behavior, such as superstitions, and preoccupation with paranormal phenomena, special powers
    • Perceptual alterations
    • Odd thinking and speech
    • Suspiciousness or paranoid ideation
    • Stiff, inappropriate. Or constricted interactions
    • Odd or eccentric behavior or appearance
    • Few close friends
    • Anxiety in social situations
  17. List Etiology & Nsg Mgt of Schizotypal Personality Disorder
    • Etiology: unknown
    • Nursing management:
    • If symptoms are severe, treatment is similar to that with schizophrenia
    • Increase self-worth/increase positive attributes
    • Provide social skills training
    • Reinforce socially appropriate dress and behavior
    • Focus on enhancing cognitive skills
  18. List How Others See Schizotypal
    • weird
    • Strange
    • Eccentric
    • oddly anxious
    • inside their own head
    • Different
    • crazy or a genius ventertaining
    • full of odd incongruent statements
    • Confusing
    • these are good, kind people just WEIRD
  19. Discuss (B) Borderline Personality Disorder
    • Pervasive patterns of instability of interpersonal relationships, self-image and affects
    • Frantic efforts to avoid real or imagined abandonment
    • Pattern of unstable and intense interpersonal relationships
    • Identity disturbances (unstable self-image or sense of self)
    • Impulsivity in at least two areas that are potentially self-damaging(spending, sex, substance abuse…)
    • Recurrent suicidal behavior, gestures, or threats; or self-mutilating behavior
    • Affective instability due to a marked reactivity of mood
    • Chronic feelings of emptiness
    • Inappropriate, intense anger or difficulty controlling anger
    • Transient, stress-related paranoid ideation or severe dissociation
    • Beginning by early adulthood
  20. Discuss Splitting
    • People with BPD tend to view people, circumstances, and overall life experience in terms of extremes, either all good or all bad (masters of manipulation)
    • Hospital not a good environment
  21. Discuss Affective Instability
    Rapid and extreme shifts in moods. This is a core characteristic of BPD and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. These people are viewed as moody, irresponsible, or intense.
  22. Discuss Identity Disturbance
    These people have no sense of their own identity and direction. It is often manifested by chronic feelings of emptiness and boredom. It is not uncommon for people to direct their actions in accord with the wishes of others.
  23. Discuss Unstable Interpersonal Relationships
    They have extreme fear of abandonment as well as a history of unstable insecure attachments. In an attempt to meet their interpersonal needs they idealize others, establish intense relationships that violate others’ interpersonal boundaries which then leads to rejection. Intense shame and self-hatred follow. These feelings often result in self-injurious behaviors.
  24. List Diagnostic Criteria for BPD
    • At least 5 of 9
    • Abandonment
    • Unstable
    • Identity
    • Impulsiveness. self-damaging
    • Sucidial
    • Affective instability
    • Emptiness
    • Anger
    • Paranoid
  25. Discuss Cognitive Dysfunctions of BPD
    The thinking of people with BPD is dichotomous. They evaluate experiences, people, and objects in terms of mutually exclusive categories (good or bad, success or failure…). The normal interpretation would be viewed as including both positive and negative aspects. Dissociation can also occur. Dissociation refers to times when thinking, feeling, or behaviors occur outside of person’s awareness. It can be as minor as daydreaming all the way to not having any awareness of a traumatic event.
  26. Discuss Dysfunctional Behaviors of BPD
    • Impaired problem solving
    • Impulsivity
    • Self-injourious behavior
  27. Discuss Borderline Personality Disorder in Special Populations
    • Moodiness
    • Self-destruction
    • Impulsiveness
    • Lack of temper control
    • Rejection sensitivity
    • Sx begin in adolescence, dx in adulthood
    • Family h/o
  28. List Risk Factors for BPD
    • Physical and sexual abuse
    • Parental loss and separation
  29. Discuss Biological Etiology for BPD
    • Biologic: There is clear evidence of central nervous system dysfunction and possible structural changes affecting:
    • Abnormalities associated with affective instability, transient psychotic episodes, and impulsive, aggressive, and suicidal behavior
  30. Discuss Psychological Etiology for BPD
    • Psychoanalytic theory (separation-individuation; projective identification)
    • Maladaptive cognitive processes (develop dysfunctional beliefs and maladaptive schemas leading to misinterpretation of environmental stimuli)
  31. Discuss Interdisciplinary Tx for BPD
    • BPD is a lifelong disorder requiring ongoing treatment
    • It is very complex and requires the whole mental health care team
  32. List Meds for BPD
    • Antidepressants: controlling emotional deregulation
    • Anticonvulsants: reducing impulsivity
    • Antipsychotics: managing transient psychotic episodes
  33. List Psychotherapy for BPD
    • Dysfunctional moods
    • Impulsive behavior
    • Self-injurious behavior
  34. Discuss Dialectic Behavior Therapy- DBT
    • Most Effective
    • Combines cognitive and behavior therapy
    • Pts participate in goals, identifying tx
    • 1:1
    • Pts love attention
  35. Discuss Family Response to BPD
    • Pts with have chaotic families
    • Family adds to chaos
    • Family members are afraid to disagree w/ them or refuse to meet their needs for fear of destructive behavior
    • "Burned out and withdraw"
  36. List How Others See BPD
    • Unreasonable
    • Hostile
    • Chronic emotional pain
    • Overly intense
    • Rageful
    • Manipulative
    • Extremely thin-skinned
  37. Define (B) Antisocial Personality Disorder- APD
    A pervasive pattern of disregard for, and violation of the rights of others. also referred to as psychopath or sociopath
  38. List Diagnostic Criteria for Antisocial
    • Failure to conform, unlawful, arrest
    • Deceitfulness, lying
    • Impulsivity
    • Irritability, fights
    • Safety
    • Irresponsibility, work, finances
    • Lack of remorse
    • 18 or older
    • Conduct d/o
  39. Discuss Antisocial Personality Disorder
    • 18 or older
    • Jail
    • Conduct disorder before 15 years old
    • Driven by need to prove their superiority and see themselves as the center of the universe
  40. List Risk Factors for Antisocial
    • 1 or more childhood:
    • Conduct d/o
    • ADHD
    • Aggression to animals or people
    • Destruction of property
    • Deceitfulness or theft
    • Serious violation of rules
  41. List Etiology for Antisocial
    • Chromosome abnormality
    • Low Dopamine
    • Insecure attachments
    • Abuse or neglect
  42. Discuss Tx for Antisocial
    • Rarely seek tx
    • If tx for: depression, substance abuse, uncontrolled anger
    • Tx has to alter cognitive schema
    • Dev sense of attachment and empathy
  43. Discuss How Others See Antisocial
    • Charming and sincere, then
    • Untrustworthy and deceitful
    • Immature
    • Self-centered
    • Manipulative
  44. Discuss (B) Histrionic Personality Disorder
    • Attention-seeking, life of the party
    • Insatiable need for attention and approval
    • Moody and often experience a sense of helplessness when others are disinterested
    • Sexually seductive in their attempts to gain attention, uncomfortable with single relationship
    • Appearance is provocative and speech dramatic
    • Loyalty and fidelity are lacking
  45. List Diagnostic Criteria for Histrionic
    • Center of attention
    • Seductiveness
    • Shallow
    • Appearance for attention
    • Impressionistic
    • Theatrical
    • Suggestible
    • More Intimate
  46. Discuss How Others See Histrionic
    • Superficial
    • Melodramatic
    • Seductive
    • Relentlessly demanding attention
  47. Define (B) Narcissistic Personality Disorder
    A Pervasive pattern of grandiosity, an inexhaustible need for admiration, and a lack of empathy
  48. List Diagnostic Criteria for Narcissistic
    • Self-importance, exaggerates, superior
    • Unlimited
    • Special
    • Admiration
    • Entitlement
    • Exploitative
    • Lacks empathy
    • Envious
    • Arrogant
  49. Discuss Epidemiology of Narcissistic
    • Respected professions
    • Only child and first-born boys
    • Coexists with other Axis 2 d/o
  50. Discuss Etiology of Narcissistic
    Parents overvaluation and over indulgence
  51. Discuss Nsg Mgt of Narcissistic
    • Do not seek tx
    • Difficult pts
    • Use self-awareness skills in interacting
  52. Discuss How Others See Narcissistic
    • Selfish
    • Presumptuous
    • Uncaring
    • Demanding
    • Unsatisfiable
  53. Define (C) Avoidant Personality Disorder
    • Avoids interpersonal contacts and social situations
    • Perceive themselves as socially inept
  54. Define (C) Dependent
    • Submissive pattern
    • Cling to others to be taken care of
    • Prevalent in clinical samples
  55. Discuss (C) Obsessive-compulsive
    Different than OCD, not as many obsessions and compulsions, but rigidity, perfectionism, and control
  56. List Diagnostic Criteria for Avoidant Personality Disorder
    • Interpersonal, criticism, disapproval, rejection
    • Needs to be liked
    • Inhibited in intimacy
    • Criticized
    • Inadequacy
    • Inept, unappealing, inferior
    • Reluctant, embarrassment
  57. Discuss Nsg Mgt of Avoidant
    • Assess: lack of social contacts, fear of criticism, low self-esteem
    • Interventions: Establish relationship
  58. Discuss How Others See Avoidant
    • Wallflower
    • Hypervigilant
    • Inadequate
    • Anxious and fearful
    • Timid
    • Daydreamer
  59. List Diagnostic Criteria for Dependent Personality Disorder
    • Can't make decisions
    • Needs reassurance
    • No responsibility
    • Difficult disagreeing and initiating
    • Lack of confidence
  60. Discuss How Others See Dependent Personality
    • Desperate for caretaking
    • Clingy
    • Wishy-washy
    • Fearful
    • Can't see their own
  61. Define Obsessive-compulsive Personality Disorder
    Pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness, and efficiency
  62. List Diagnostic Criteria for Obsessive-compulsive
    • Details, looses major point
    • Excessively devoted
    • Overconscientious
    • Unable to discard
    • Reluctant to delegate
    • Stubborn
  63. Discuss Etiology of Obsessive-compulsive
    • Parental overcontrol and overprotection
    • Play is shameful
  64. Discuss Nsg Mgt of OCD
    • Short term antidepressants
    • Seek help for anxiety
    • Psychotherapy is needed for compulsive
  65. Discuss How Others See OCD
    • Stingy
    • Perfectionist
    • Indecisive
    • Hoarding
    • Anxious
    • Workaholic
  66. Discuss Overall Tx
    • Psychopharmacology
    • Individual therapy
    • Dialectical behavior therapy (DBT)
    • Group therapy
    • Family education and therapy