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41 Cards in this Set

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What is a personality disorder?
1. Enduring pattern of inner experiences and behavior that deviates markedly from the individual's culture
2. Is pervasive and inflexible
3. Is stable over time
4. Leads to distress and impairment

Onset is generally adolescence or early adulthood
Biological Correlates
1. Genetics - cluster A (schizophrenia type disorders) only
2. Neurotransmitters - change could be either the cause or the result
3. Hormonal - cortical arousal of autonomic nervous system (Anxiety/ Inhibition theory or Hypothalamus dysregulation = aggression)
Sociocultural Correlates
1. Cultural Norms/ Values
2. Family Structure/ Dynamics - Environment is 100% a correlate to the development of a personality disorder
Incidence
Difficult to determine because they often go untreated - the disorder the individual's effective way of coping
Psychosocial Theories
1. Difficulty with separation-individuation and autonomy developmetal tasks

Ego Development deficiencies
Ego Competencies vs. Incompetence
1. Reality Testing - what is real and what isn't?
2. Stimulus filter/ barrier - overstimulated all the time easily excitable
3. thought processes - urgent thought requires immediate reaction
4. Mood
5. Judgement
6.Impulse control
7. Self-perception
8. Relatedness - ADL's and how they go about it
Cluster A Personality disorders
odd and eccentric

1.Paranoid
2. Schizoid
3. Schizotypal
Paranoid Personality Disorder
Pervasive distrust and suspiciousness without justification
- Defensive, abrasive, sarcastic, hostile
- Avoidant, jealousy
- Attempts to appear unemotional
- Common defense mechanism: PROJECTION

Holds grudges, abrasive, hostile

Usually labile, but try to project that nothing bothers them
Therapeutic Management of Paranoid Personality Disorder
1. Communication - supportive, honest, concrete
2. Therapies: supportive, rarely present for treatment
3. Pharmacological: occasional anti-psychotics
Schizoid Personality disorder
Detachment and restricted emotional expressions (think breakfast club)

1. Constricted, indifferent, remote
2. Lack a desire for intimacy
3. React passively to adverse circumstances
4. Common Defense Mechanism: Intellectualization

*Difference in schizoid vs. schizotypal is that schizoid has not DESIRE for relationship.
Therapeutic Management of Schizoid Personality disorder
1. Communication: goal is to engage
2. therapies - short term, solution focused, brief
3. Unlikely to seek treatment
4. Pharmacological - short term for symptoms of Axis 1
Schizotypal Personality disorder
Interpersonal deficits and acute discomfort with close relationships

1. Perceptual disturbances, eccentricities
2. Constricted, distrustful
3. Common defense mechanisms: Undoing

See themselves as different from others - superstitious or magical thinking

Desire to have relationships with other people
Therapeutic Management - Schizotypal Personality Disorders
1. Communication
2. Therapies: supportive, structured therapies that encourage social interaction; social skills training
3. Pharmacological: acute psychosis may appear with stress, requiring short-term use of medications
Cluster B personality Disorders
"Dramatic, emotional, and/or erratic"

1. Antisocial
2. Borderline
3. Histrionic
4. Nacissistic
Antisocial Personality Disorder
Serial killers
*Disregard for violation of the right of others

1. Deceitful, manipulative, callous
2. Irresponsible, impulsive, aggressive
3. Must be > 18 year old with history of Conduct disorder > 15 yo
4. Common Defense Mechanism: acting out
Therapeutic Management - Antisocial Personality Disorder
Don't seek treatment
1. Communication
2. Therapeutic community - token systems, limit setting (do best in environments with enforced limits)
3. Considered one of the most difficult to treat
4. Pharmacological - Actute Axis 1 or extreme aggression
Borderline Personality Disorder
*Instability of interpersonl relationships, self-image, and affect

1. Marked impulsivity
2. Manipulative and volatile
3. Common defense mechanism: regression (revert back to an earlier time of development)
Associated Features of Borderline Personality Disorder
1. Patterns of undermining themselves
2. Self-inflicted abuse behaviors
3. Premature death from suicide - often accidental
4. Recurrent job loss, broken relationships
Epidemiology - Borderline Personality Disorder
1. Family History - physical/ sexual abuse, neglect, hostile conflict, loss or seperation
2. 2% general population, other 30-60%
3. 75% with Bipolar Disorder
4. 5 x's more common in those with first degree relatives
Course: Borderline Personality Disorder
Early Adulthood - chronic instability, serious dyscontrol

Young adult - greatest time of risk for impairment and suicide

30s-40s - stabilizes
Therapeutic Management - Borderline Personality Disorder
1. Communication
2. Therapies: behavioral base: boudaries and limits
3. Health care providers must work as team to avoid splitting behaviors
4. Pharmacological: transient symptoms of Axis I disorders; mood stabilizers
Histrionic Personality Disorder
Pattern of excessive emotionality and attention seeking behavior

1. Need to be center of attention
2. Dramatic, manipulative, superficial
3. High degree of suggestibility
4. Common defense mechanism: dissociation

Cannot control their dramatic reactions
Therapeutic Management: Histrionic Personality Disorder
1. No known effective therapy
2. therapeutic techniques - modeling, concrete/ detailed interaction
3. Quicker than other to seek treatment, often exaggerating symptoms
4. Emotionally needy - reluctant to stop therapy treatments
Associated Features of Narcissistic Personality Disorders
1. Grandiosity and need for admiration: lack of empathy - also need everyone else to know how important they are
2. Act self-assured, non-chalant
3. Arrogant, exploits others, lies
4. Common defense mechanism: rationalization "I am being as honest as I can."
Therapeutic Management: Narcissistic Personality Disorder
1. Communication: nonchalant
2. Therapies: brief & supportive or long term and intensive

Often terminate the therapeutic relationship prematurely - symptoms become less severe as the patient gets older and wiser
Cluster C Personality disorders
"Anxious and/ or fearful"

1. Avoidant
2. Dependent
3. Obsessive-Compulsive
Avoidant Personality disorder
*Social inhibition, feelings of inadequacy and hypersensitivity

1. Ambivalen
2. Preoccupied, gaurded, emptiness
3. Common defense mechanism: Fnatasy
Therapeutic Management: Avoidant Personality Disorder
1. Communication - empathetic, reassurance, friendly
2. Therapies: assertiveness training; social exposure and relaxation training; cognitive therapies
3. Pharmacological: co-morbid anxiety disorders
Dependent Personality Disorder
*Excessive need to be taken are of leading to submissive and clinging behavior, fear of seperation

1. Timid, kind, passive, gullible
2. Common Defense Mechanism: Introjection - keeping individual thoughts to themself
Associated Features: Dependent Personality disorders
1. Refer to themselves as "stupid"
2. Take criticism as proof they have no worth
3. Avoids positions of responsibility
4. Go to extensive lengths for nurturing
5. worry about abandonment
Therapeutic Management: Dependent Personality disorder
1. communication - limits feedback
2. Therapies: insight oriented therapies; assertiveness and social skills; anxiety management; combination therapies

Prognosis is good
Obsessive-Compulsive Personality disorder
*Preoccupation with orderliness, perfectionism, and mental and interpersonal control ath the expense of flexibility and efficiency

Tense, disciplined, industrious

common defense mechanism: reaction formation
therapeutic Management: Obsessive-Compulsive Personality disorder
Treatment is difficult secondary to intellecualizing

therapies: combination therapies

Pharmacological: SSRI's have been beneficial for some, TCA;s ofr some...
Nursing Priorities
1. Safety - suicidal/ homicidal ideation
2. Loss
3. Current medical or pther psych disorder?
4. Mid- or late life personality change?
Therapeutic Management of ALL personality Disorders
1. Boundaries - lack boundaries due to underdeveloped ego
2. Consistency
3. Persistence
Therapeutic Strategies regarding the Dependent Client
1. convey optimism regarding abilities
2. Limits on negative remarks and behaviors
3. Explore underlying feelings (inadequacy, shame, anxiety, and fear)
4. Options and choices
5. Encourage self-care and participation
5. Positive feedback and reinforcement
The Manipulative Client
1, Verbal characterisitics
2. Non-verbal characteristics

Don't do things TO patients, do things WITH patients
Therapeutic Strategies - the manipulative client
1. Joint plan development
2. Identify strengths
3. Stress reduction
4. Assertiveness
5. Problem solving
6. role playing

DO NOT NEGOTIATE
Therapeutic Strategies - the angry client
1. LISTEN - angry people believe that no one has
2. calm, unhurried, don't touch - don't get defensive
3. "I" statements
4. Communicate (+) expectations
5. Talk-out instead of act out
6. Assist with external controls
7. Problem-solving after situation is calm

"I need you to lower your voice"
Therapeutic Strategies - the Impusive Client
1. Identify needs/feelings
2. Discuss current/ previous
3. Explore impact
4. Recognize cues
5. Anger management
6. Assertive skills
7. Role play
Goals and ECO's
1. Absence of Suicidal ideation
2. No thoughts of self harm
3. No self mutiliation
4. Recognize distorted thoughts
5. Identify impulsice patterns
6. Identify isolative patterns
7. Maintain increased level of functioning
8. Tolerate interaction
9. Identify new problem-solving strategies
10. Reward self - physically and emotionally
11. Identify with positive models