Cluster B: Dramatic, Emotional, or Erratic

Antisocial

Socially irresponsible, exploitative, and guiltless

General disregard for RIGHTS OF OTHERS

Exploits and manipulates for PERSONAL GAIN

Doesn’t obey the law

Exploitation and manipulation for personal gain

Lack of remorse/guilt

UNABLE TO DELAY GRATIFICATION

Low frustration tolerance (rage, anger, and violence)

Impulseive

Criminal behavior

Antisocial

What does the inability to delay gratification mean?

struggles to resist the temptation of a short-term reward to achieve a more significant, long-term goal. This often manifests as impulsive actions

What is a major risk of working with a patient who has antisocial personality disorder?

Aggression/Violence

Goal for a patient with antisocial personality disorder

• No harm to self/others

• Rechannel Hostility

Priority interventions for a patient with antisocial personality disorder

STRICT RULES

Form limits

Be consistent

Encourage appropriate ventilation of anger

Low environmental stimuli

What to be mindful of with Antisocial personality disorder

Escalating behavior (aggressive)

Borderline personality disorder (BPD)

Pattern of intense and chaotic relationships with affective instability and fluctuating attitudes toward other people

• impulsive

• self-destructuve

  • lack identity

Fluctuating and extreme attitudes regarding other people

IMPULSIVE

Self-destructive

Clinging/inability to be alone

Splitting

Manipulative

BPD

What is splitting?

BPD

• everything is either al good or all bad

• Shifting of allegiances and valuing/devaluing

• Turns people against one another

What is a major risk for BPD

Self injury

Suicide

Goal for the patient with BPD

No harm to self

ID behaviors and source of anger

How should the nurse react when a patient with BPD self-injures

NONREACTICE → avoid reinforcement

• Don’t react with alarm

• Calmly clean the wound: “lets talk later about what led to this”

What alternatives can you suggest to cutting?

Exercise, journaling → release tension

How can you minimize splitting amount staff?

• Rotate staff who work with the patient (prevent dependence)

• Discuss with pt and other staff when it is apparent that the pt is pitting one member against another

• Don’t listen patient degrade other staff members

• Remain consistent

People with BPD always seem to be in a state of…

CRISIS → frequent mood swings → extreme intensities

Histrionic

Colorful, DRAMATIC, extrovertic, excitable, emotional

Require constant affirmation of approval and acceptance from other

Self-Dramatizing

Attention seeking

Overly Gregarious

Seductive

Manipulative

Easily influenced by others

Difficulty forming cose relationships

Histrionic

Narcissistic

Exaggerated sense of self-worth

Lack empathy

Hypersensitive to evaluation of others

Lack empathy/humility

Need praise and admiration

Self-centered

Vain

Fragile self-esteem

Narcissistic

How does a Narcissist respond to criticism

RAGE, shame, and humiliation

CANNOT HANDLE