Personality Disorders and Self-Mutilation, Exams of Nursing

Download Personality Disorders and Self-Mutilation and more Exams Nursing in PDF only on Docsity! RNSG 2213 MH Module 7: Personality Disorders the intentional act of tissue destruction to one's own body with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Can be described as a mechanism for addressing deep emotional pain, serving as a coping or survival strategy. Provides a psychological release from emotional pain. - AnswerSelf-mutilation deeply ingrained personal patterns of behavior, traits and thoughts that evolve as person's style and way of adapting to the envioronment - AnswerPersonality: Definition Long-term, inflexible, and maladaptive patterns of feeling, relating and behaving. *Patterns interfere with daily life and relationships. *behavior deviates significantly from expectations within individual's culture *higher risk of incarceration and homelessness Diagnosis on Axis II; **NOT caused by another mental disorder and challenging to treat. - AnswerPersonality disorder Clients: 1) lack insight into own behavior 2) often do not seek help AND: 1) lack physiological cause 2) ingrained nature *Since PD is not caused by another mental disorder, patient must have a major mental illness diagnosis to be admitted for inpatient treatment - AnswerPersonality Disorders: Reason Difficult to Treat 1) Distorted thinking patterns (about self, others, events) 2) problematic emotional responses RNSG 2213 MH Module 7: Personality Disorders 3) interpersonal difficulties 4) over- or under-regulated impulse control - AnswerPersonality Disorders: Core Features What are risk factors associated with self-mutilation? - AnswerTypically women who began engaging in the behavior during adolescence, but can affect people of all ages/genders. Often have underlying mental illnesses (schizophrenia, depression, borderline personality disorder, dissociative identity disorder, or substance dependence). H/O parental/peer conflicts and/or violence, sexual abuse How do nurses differentiate between self-mutilating behavior and suicidal gestures? - AnswerTypically self-mutilators are not trying to kill themselves but sometimes do accidentally. Hence, a careful assessment is always in order. Specifically ask the patient if he or she was trying to commit suicide. A therapeutic response to the patient who utilizes self-mutilation to cope with trauma is: A. "How long has this been going on?" B. "I noticed that the scars form a pattern on your right arm." C. "What happened?" D. "Why do you hurt yourself on purpose?" - AnswerB. "I noticed that the scars form a pattern on your right arm." Correct Most responsive and initiates therapeutic communication via making an observation predictable set of behaviors - AnswerPersonality Personality Disorders: Three Clusters of Behavior - AnswerCluster A: odd & eccentric behaviors Cluster B: dramatic, emotional and erratic Cluster C: anxious, fearful What does personality disorder behavior Cluster A include? - AnswerCluster A—Odd & Eccentric (odd, eccentric behavior; suspicious ideation, social isolation) RNSG 2213 MH Module 7: Personality Disorders Narcissistic Personality Disorder - Answercluster B excessively needs to be admired; grandiose self-importance; sense of entitlement; takes advantage of others; lacks empathy *NOTE: has underlying shame and fears of rejection/abandonment Histrionic & Narcissistic PDs: Interventions - Answer1) set limits 2) consistent approach 3) matter-of-fact 4) focus on here and now 5) use supportive confrontation for discrepancies and contradictions 6) support self-esteem Antisocial Personality Disorder - AnswerCluster B personality disorder. 1) Pattern of disregard of the rights of others; lies and deceives 2) Non-conforming to rules or social norms. Often found in criminal justice system. May seek hospitalization to avoid the law. 3) Absence of empanhy MAIN: antagonistic, deceitful and manipulative for personal gain; may appear charming and confident Low tolerance for frustration; cannot delay gratification of impulses. Impulsive, or fail to plan ahead. Deny and rationalize behavior. Little guilt or remorse. May be aggressive, sexually inappropriate, or abusive. May appear charming and confident. Self-interest comes before needs of others and hostile if needs are blocked Disregard for others' safety. RNSG 2213 MH Module 7: Personality Disorders Unable to sustain close personal relationships. Sex life is impersonal and impulsive. COMORBIDITY: substance abuse disorders What is the etiology of antisocial personality disorder? - AnswerGenetic—can be inherited trait or predisposition. Neurobiological—ANS under-responds to stress (low heart rate, lack of increase in anxiety). Low activity in frontal lobe. Unable to learn from rewards and punishment & insensitive to emotional connotations of language. *increased DA and decreased serotonin Psychologically, history of disordered life functioning, parent-child relationship often is unstable, and h/o childhood characteristics of lying, stealing, harm to animals, truancy. What are interventions/treatment for antisocial personality disorder? - AnswerEssential for staff to agree on rules and stick with them. Set firm limits. ***Will try to play one staff or shift against another. Point out effect of behavior on others. Point out consequences of behavior. Manage aggressive or assaultive behavior. Best form of treatment—peer counseling and self-help groups, where peers can confront and offer feedback; if applicable, substance abuse groups cluster B personality disorder; criteria elements include: ** unstable, intense relationships; fear of abandonment and frantic efforts to avoid it. ***Marked identity and self-image disturbances. Chronic feelings of emptiness. ** Impulsivity and low frustration tolerance. Recurrent self-destructive behavior. RNSG 2213 MH Module 7: Personality Disorders **Affective instability, rapid mood shifts, problems with anger. When under stress may experience transient, paranoid thoughts or delusions, or dissociative symptoms. - AnswerBorderline personality disorder BPP: Common Behaviors - Answer1) "splitting" or "black or white thinking": another person is either horrible of wonderful *cannot resolve feelings that others are not perfect and cannot meet all their needs *transference is a common phenomenon, i.e., a great nurse or a bad nurse 2) self-injuring behavior (SIB) Often use self-injurious behavior for purpose of self-punishment, to relieve tension, improve mood, or prove that they are "real" and can feel. High suicide risk. BPP: Comorbidities - Answermood/anxiety disorders; substance abuse; eating disorders HTN, fibromyalgia and chronic pain Somatic symptoms may result in high number of HCP office visits/phone calls/scripts Borderline Personality Disorder: Primary Features - AnswerEMOTIONAL LABILITY and low frustration tolerance emotions go from one extreme to the other and are DISPROPORTIONATE to the circumstances Borderline Personality Disorder: Margaret Mahler - Answerbelieved that BPP a result of the disruption of the normal "separation-individuation" of the child from the mother *child does not progress to developing a sense of self and safety away from the mother in early years; fear of abandonment develops What is the etiology for borderline personality disorder? - AnswerA biological predisposition plus childhood experiences is current accepted theory. RNSG 2213 MH Module 7: Personality Disorders Assist to decrease anxiety and need for perfection. Groups on assertiveness training, Stress management, Leisure skills; most clients seen as outpatients What medications can address severe, disabling symptoms of personality disorders? - Answer1) SSRIs, (SNRIs for cluster C) 2) mood stabilizers, 3) antianxiety agents; **Treatment of comorbid Axis I disorders should be a priority I don't think my psychiatrist understands me," states the patient. The nurse will most appropriately respond: A. "What concerns do you have?" B. "I don't understand." C. "Why don't you think so?" D. "Yes, she can be difficult at times." - AnswerA. "What concerns do you have?" Correct Facilitates the patient to go on and forms a basis for assessment; initiation of therapeutic rapport During report, a staff member tells the charge nurse, "I can't stand that patient because she whines so much." How should the charge nurse respond to this staff member? A. "What about the whining is so bothersome to you?" B. "Let's discuss how to best approach this patient; are others having difficulty too?" C. "I think you should not work with someone you feel so negatively about. Let's change your assignment." D. "You really shouldn't feel that way; that patient is really ill." - AnswerB. "Let's discuss how to best approach this patient; are others having difficulty too?" Correct Initiates a discussion with the staff member and invites others to share their feelings regarding what may be a difficult patient; focuses on problem solving It is most essential that the nurse employ limit setting when a patient engages in: RNSG 2213 MH Module 7: Personality Disorders A. avoidance. B. blaming. C. isolation. D. manipulation. - AnswerD. manipulation. Correct Manipulation presents the most concerning of the options with patients and would require firm limits by the nurse. The likely outcome for a nurse who sets unrealistically high expectations for a patient with antisocial personality disorder is: A. feelings of anger and frustration by the patient. B. feelings of anger and frustration by the nurse. C. feelings turned inward by the patient thereby resulting in the possibility of depression. D. positive efforts by the patient to measure up to the expectations of the nurse. - AnswerB. feelings of anger and frustration by the nurse. Correct Changes on the part of the patient will come slowly if at all; patience and consistency are key in the work of the therapeutic nurse-patient relationship The nurse working with an individual experiencing borderline personality disorder would need to employ interventional strategies that are: A. firm, structured, and strict. B. kind, gentle, and passive. C. grandiose, broad, and rapid. D. consistent, fair, and planned. - AnswerD. consistent, fair, and planned. Correct Nurses who intervene with predictability, planning, and equanimity best forge therapeutic relationships with such an individual.