wk 9 personality & dissociative disorders

Ch 20 Somatic Symptom and Dissociative Disorders and Ch. 22 Personality Disorders

personality disorders happen when someone’s personality becomes… and what else should you know?

pathological

• can occur with other mental health disorders

• don’t believe they have a problem

ego syntonic thinking

thinking that everything is fine and that nothing is wrong with them

Cluster A characteristics

odd or eccentric traits

• weird

Cluster B characteristics

Dramatic, erratic, and emotional

• VERY manipulative

• wild

Cluster C characteristics

Anxious or fearful traits; insecure and inadequate

• worry

what are the three types of personality disorders in Cluster A

• paranoid

• schizoid

• schizotypal

paranoid personality disorder

• distrust and suspiciousness towards others

paranoid personality disorder interventions

• 1:1 patient teaching

• clear and simple communication

establish trust, pt can’t focus on a group setting

schizoid personality disorder

• detached

• doesn’t want to form close relationships

• pt just doesn’t want to spend time with people and form bonds

  • causes isolation — prefers it, even if family

schizoid personality disorder interventions — what kind of jobs are good for them?

don’t force them to socialize

• don’t force to do things that requires socialization in life in general

• jobs good for them: computer work, coding 

schizotypal personality disorder

• odd beliefs

  • can affect social interpersonal relationships with others

• magical thinking

  • witchcraft, or speaking in metaphors — thinks that they have external supernatural energy around them

• will probably join or lead a cult

schizotypal personality disorder interventions

clarify and ask to interpret their words

• “What do you mean by that?”

what are the four types of personality disorders in Cluster B

• antisocial

• borderline

• histrionic

• narcissistic

antisocial personality disorder

• lacks empathy and accountability

• sense of entitlement

• charming

• impulsive

antisocial personality disorder interventions and what happens if you don’t

confrontation

• be firm! these pts like to test and read you

• if ur not firm, they will manipulate you into doing what they want

boderline personality disorder

• black and white thinking (no gray area, either a or b)

• intense mood swings

• fear of abandonment

• impulsive 

  • things that can hurt themselves, to try to manipulate

• engages in splitting

splitting

a defense mechanism that can be used to manipulate

ex: ur the best nurse ever but if u do something wrong, you’re the worst nurse ever

• switching up

boderline personality disorder interventions

safety

histrionic personality disorder

• seductive for attention

  • sexually inappropriate, seductive

histrionic personality disorder interventions

limit setting

• pull them away from situations where they make others uncomfortable

narcissistic personality disorder

grandiose sense of importance

they think they are entitled to things, that they are better than everyone

narcissistic personality disorder interventions

establish a sense of fairness

in the environment they’re in

if pt thinks they are entitiled to an extra snack or 10 mins more on otp wtyd

you tell them they can’t do that, it’s not fair to anyone else

what are the three types of personality disorders in Cluster C

• avoidant

• dependent

• obsessive compulsive

avoidant personality disorder

• afraid of commitment

• feels they’re inferior or “not good enough”

emotionally unavailable, not ready for a relationship (at all)

because they think they would not be good enough for a partner

dependent personality disorder

• REALLY relies on others

  • to make big decisions for them, they don’t know what they want

• no brakes after a breakup

obsessive compulsive personality disorder

• absolute perfectionist

pt needs a VERY detailed plan and it needs to go their way only

general interventions for all CLUSTERS

• don’t argue with them

• don’t be too friendly

• be direct

is saying “you can’t do this because I said so/ it’s not good for you” a good general intervention 

no, be direct and say these are the rules 

somatic disorders (4)

• somatic symptom disorder

• illness anxiety disorder

• conversion disorder

• factitious disorder

somatic symptom disorder

• genuinely feeling distressing symptoms without significant physical findings

• patient and healthcare workers can get frustrated with them

pt keeps going to ER saying they feel a certain way but everything is reading as fine (ekg, vitals, ct scan)

illness anxiety disorder

• misinterpretation of physical symptoms or overexaggerating

• will think symptoms will elad to a deadly disease

ex) numbness in lungs thinks they’re paralyzed

dr. google disorder — they go to the ER but doesn’t warrant a visit

somatic vs anxiety

they go and get it checked vs they just feel it and don’t really do anything about it

conversion disorder and ex of sx

• emotional conflicts channel towards physical symptoms

  • examples of physical symptoms: loss of senses, no voice, paralysis

• rule out organic pathology

  • taking hearing test to see if they actually lost hearing

ex: saw a car accident and you go blind

factitious disorders

• artificially, deliberately, and dramatically inflicting injury and illness towards self or others

• extremely manipulative act

there’s always a motive — gaining attention or to get away with something

factitious disorders types

• munchausen

• munchausen by proxy

has to happen regularly, can’t be a one off

dissociation

• involves separating ideas and memories from events and experiences

• too much dissociating can cause amnesia and reduced consciousness

DUE TO TRAUMA!!!!!!!!!

can develop all the disorders below

dissociative disorders (3) what must all these disorders need to have and how are they developed?

• dissociative amnesia

• dissociative identity disorder

• depersonalization-derealization disorder

all disorders need to have TRAUMA INVOLVE

developed by dissociation!  to get away from trauma

dissociative amnesia

• extreme trauma to the point where they cannot recall things

  • consistently see something traumatic

• rule out substance abuse or other medical conditions

  • ex dementia, taking lot of downers

dissociative fugue

sudden, unexpected travel away from community

• new identity or lifestyle can be made

you forget who you are, you run away to another life

dissociative identity

• presence of two or more distinct personality states called “alters”

  • minimum of 2 alters to be diagnosed — assumes the hosts body

  • forms subconsciously, gets alters to process trauma for them

• each alter has its own personality and way of perceiving things

• gaps in memory

dissociative identity how do you talk to them

• talk to them like you are addressing the host AND the alters

• refer to them in pleural: address the group

• pt will say we instead of i

use they, them, you guys

why could dissociative identity disorder be underdiagnosed/studied?

• may believe pt is trying to get away with something

• ppl may think it’s scary

depersonalization and what would that pt say

INTERNALLY BASED — personal thing, not there or present

individual doesn’t feel like a physical person

“I know my hand is moving, but this is not really my hand. It’s someone else’s hand.”

derealization

EXTERNALLY BASED

individual doesn’t feel like the world around them doesn’t exist