Personality Disorders Psych
Q: What are personality disorders and at what age are they diagnosed? A: Personality disorders are deeply ingrained, enduring patterns of behavior that do not change easily, and clients are often unaware of their maladaptive traits. We do not formally diagnose these until age 18.
Q: What are the etiology and risk factors for Paranoid Personality Disorder? A: The incidence is estimated at 0.5% to 4% of the general population, and it is more common in males than females. There is limited data on prognosis because these clients are highly reluctant to seek or remain in treatment.
Q: What is the core definition and presentation of Paranoid Personality Disorder? A: This disorder is characterized by pervasive mistrust and suspiciousness of others. Clients are hypervigilant, aloof, withdrawn, and guard their physical distance. They exhibit a restricted affect, an inability to demonstrate warmth, and frequently use projection as a defense mechanism.
Q: What are the top nursing priorities and safety risks for Paranoid Personality Disorder? A: During periods of extreme stress, the immediate danger is that the client may develop transient psychotic symptoms or their mood may rapidly shift from suspicious to hostile.
Q: How should a nurse use therapeutic communication and self-awareness with a Paranoid Personality Disorder client? A: Approach the client in a formal, business-like manner and avoid jokes or social chitchat, as the client will interpret this with suspicion. Be consistently reliable, keep your commitments, and be on time. The nurse must evaluate their own feelings to remain straightforward and objective rather than taking the client's mistrust personally.
Q: What are key interventions and milieu management strategies for Paranoid Personality Disorder? A: Involve the client in their care plan to allow them to feel a sense of control. Ask the client what they want to accomplish and help them validate their ideas before taking action.
Q: What client and family education is required for Paranoid Personality Disorder? A: Teach the client to base their decisions on reality and work to prevent them from acting on paranoid beliefs.
Q: What pharmacology is associated with Paranoid Personality Disorder? A: While there are no specific medications for the personality disorder itself, cognitive-perceptual disturbances and severe anxiety may be treated with low-dose antipsychotic medications.
Q: What are the etiology and risk factors for Schizoid Personality Disorder? A: This disorder affects about 3% to 5% of the general population and is more common in males. Clients often remain in their parental home well into adulthood.
Q: What is the core definition and presentation of Schizoid Personality Disorder? A: It is characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression. Clients appear emotionally cold, uncaring, and unfeeling, rarely experiencing enjoyment. They have a rich and extensive fantasy life and are often intellectually accomplished, but they decline opportunities to engage with others and are loners.
Q: What are the top nursing priorities and safety risks for Schizoid Personality Disorder? A: These clients exhibit a passive and disinterested response to stress and have great difficulty experiencing and expressing emotions, particularly anger or aggression. They may also experience dissociation from bodily or sensory pleasures.
Q: How should a nurse use therapeutic communication and self-awareness with a Schizoid Personality Disorder client? A: Do not try to force extensive social interactions. These clients lack social skills, do not engage in social conversation, and are indifferent to praise, criticism, and the emotions of others.
Q: What are key interventions and milieu management strategies for Schizoid Personality Disorder? A: Focus on improved functioning in the community. Establish a working relationship with a case manager to help manage finances and health care needs, relating these needs to one specific person for better success.
Q: What client and family education is required for Schizoid Personality Disorder? A: Help find suitable housing that accommodates their desire for solitude, such as a board and care facility that provides meals and laundry with minimal social interaction required. Assess if identified family members can continue providing primary support.
Q: What pharmacology is associated with Schizoid Personality Disorder? A: Symptoms of emotional detachment may be managed with SSRIs or atypical antipsychotics.
Q: What are the etiology and risk factors for Schizotypal Personality Disorder? A: The incidence is about 4% of the general population. There is a potential for this disorder to develop into schizophrenia.
Q: What is the core definition and presentation of Schizotypal Personality Disorder? A: It is characterized by acute discomfort with close relationships, social/interpersonal deficits, cognitive or perceptual distortions like magical thinking and ideas of reference, and behavioral eccentricities. The client often presents with a bizarre, unkempt appearance and uses loose, vague, or incorrect words that make their speech sound bizarre.
Q: What are the top nursing priorities and safety risks for Schizotypal Personality Disorder? A: Clients may experience transient psychotic episodes under extreme stress. They experience great anxiety around unfamiliar people that does not improve with time or exposure.
Q: How should a nurse use therapeutic communication and self-awareness with a Schizotypal Personality Disorder client? A: Talk clearly with the client to role-model communication and help reduce bizarre conversations. Identify one safe person with whom the client can discuss their unusual or bizarre beliefs.
Q: What are key interventions and milieu management strategies for Schizotypal Personality Disorder? A: Focus on self-care and establish a daily routine for hygiene and grooming. Maintaining a nonbizarre appearance is vital to reduce negative reactions and discomfort from others.
Q: What client and family education is required for Schizotypal Personality Disorder? A: Provide social skills training and role-play interactions so the client can practice making clear and logical requests. Prepare a list of necessary community contacts for the client.
Q: What pharmacology is associated with Schizotypal Personality Disorder? A: Cognitive-perceptual disturbances and transient psychotic episodes are treated with low-dose antipsychotic medications.
Q: What are the etiology and risk factors for Antisocial Personality Disorder? A: It is prevalent in about 3% of the general population, more common in males, and up to 70% in prison populations. Childhood histories often reveal enuresis, sleepwalking, and acts of cruelty to animals, while family history often includes poverty, divorce, harsh or abusive parenting, depression, and substance use. Behaviors peak in the 20s and diminish significantly after age 45.
Q: What is the core definition and presentation of Antisocial Personality Disorder? A: It is characterized by a pervasive disregard for the rights of others, deceit, and manipulation. They lack empathy and remorse, exploit others for personal profit, and view the world as cold and hostile.
Q: What are the top nursing priorities and safety risks for Antisocial Personality Disorder? A: There is a high risk for violence, aggression, rule-breaking, and exploitation of others. They may display false emotions to suit an occasion or seek treatment purely to avoid jail.
Q: How should a nurse use therapeutic communication and self-awareness with an Antisocial Personality Disorder client? A: The client may be very engaging and charming, which can fool the nurse. Limit setting is crucial, and the nurse must not be manipulated by false emotions and should hold the client accountable, redirecting blame when the client refuses to accept responsibility.
Q: What are key interventions and milieu management strategies for Antisocial Personality Disorder? A: Teach problem-solving skills, and manage emotions by anticipating stressful situations and taking a time-out to regain control. Always assess for substance use, as it heavily impacts role performance.
Q: What client and family education is required for Antisocial Personality Disorder? A: Educate the client on identifying barriers to success at work or home and examining realistic sources of their problems. Refer to vocational or job programs.
Q: What pharmacology is associated with Antisocial Personality Disorder? A: Aggression is managed with lithium, valproate, or antipsychotics. Avoid benzodiazepines completely due to the high potential for misuse.
Q: What are the etiology and risk factors for Borderline Personality Disorder? A: It affects up to 3% of the population, is three times more common in females, and is five times more common if a first-degree relative is diagnosed. Early childhood trauma is highly significant, with 44% of clients having a history of childhood sexual abuse, physical abuse, or parental alcohol use disorder.
Q: What is the core definition and presentation of Borderline Personality Disorder? A: It is characterized by unstable interpersonal relationships, self-image, and affect, marked by severe impulsivity. Clients experience an excessive fear of abandonment and engage in splitting, where they quickly adore someone and then suddenly devalue them.
Q: What are the top nursing priorities and safety risks for Borderline Personality Disorder? A: Suicide and self-mutilation are the top priorities. Eight percent to 10% of clients with BPD die by suicide, and deliberate self-harm is frequently used to block emotional pain or express anger. Transient psychotic symptoms and dissociative episodes can also occur under extreme stress.
Q: How should a nurse use therapeutic communication and self-awareness with a Borderline Personality Disorder client? A: Discuss self-harm urges nonjudgmentally, and use strict limit setting and confrontation techniques. Nurses must manage their own frustration, as clients are prone to shifting dramatically from dependent/needy to angry/hostile.
Q: What are key interventions and milieu management strategies for Borderline Personality Disorder? A: Keep the environment safe to prevent self-injury during rage or dissociative episodes. Provide high structure by using scheduled appointments of predetermined length and spending specific amounts of time on specific issues.
Q: What client and family education is required for Borderline Personality Disorder? A: Long-term psychotherapy is necessary. Teach Dialectical Behavior Therapy (DBT) principles and cognitive restructuring, such as thought stopping and decatastrophizing.
Q: What pharmacology is associated with Borderline Personality Disorder? A: Emotional instability and mood swings are treated with lithium, carbamazepine, valproate, and low-dose neuroleptics. Transient psychotic symptoms respond to low-dose antipsychotics.
Q: What are the etiology and risk factors for Histrionic Personality Disorder? A: It is found in 2% to 3% of the general population and is diagnosed four times more frequently in females. They often seek treatment for secondary issues like depression, unexplained physical problems, or relationship difficulties.
Q: What is the core definition and presentation of Histrionic Personality Disorder? A: It is characterized by excessive emotionality and attention-seeking behaviors. Clients are gregarious, highly suggestible, dramatically overdress for occasions, use theatrical speech lacking detail, and display flirtatious behavior.
Q: What are the top nursing priorities and safety risks for Histrionic Personality Disorder? A: Clients have rapid mood shifts, exaggerate intimacy in relationships, and may create public scenes or fabricate stories for attention. They are easily devastated by criticism.
Q: How should a nurse use therapeutic communication and self-awareness with a Histrionic Personality Disorder client? A: The nurse must provide factual, objective feedback on social interactions, such as pointing out when a client's behavior might be interpreted in a sexual manner. Provide genuine confidence in the client's abilities, but remain professional.
Q: What are key interventions and milieu management strategies for Histrionic Personality Disorder? A: Teach social skills through role-playing in a safe environment, modeling eye contact, active listening, and personal space. Discuss social situations to explore the client's perception of others' reactions.
Q: What client and family education is required for Histrionic Personality Disorder? A: Educate the client on assertive communication using "I" statements rather than dramatic acting out. Outline appropriate topics for different types of relationships.
Q: What pharmacology is associated with Histrionic Personality Disorder? A: Medications target specific presenting symptoms, such as antidepressants if they seek treatment for comorbid depression.
Q: What are the etiology and risk factors for Narcissistic Personality Disorder? A: It affects approximately 5% of the general population, predominantly males. Traits are common in adolescence but do not always indicate an adult disorder, and hospitalization is very rare unless comorbid conditions exist.
Q: What is the core definition and presentation of Narcissistic Personality Disorder? A: It is characterized by pervasive grandiosity, a need for admiration, and a profound lack of empathy. Clients are preoccupied with fantasies of success and power, believe they are superior, and tend to belittle or discount the feelings of others.
Q: What are the top nursing priorities and safety risks for Narcissistic Personality Disorder? A: Despite their grandiosity, their underlying self-esteem is incredibly fragile and vulnerable. They are hypersensitive to criticism.
Q: How should a nurse use therapeutic communication and self-awareness with a Narcissistic Personality Disorder client? A: Nurses face significant challenges as these clients can be rude, arrogant, abrasive, and critical. The nurse must actively use self-awareness skills to avoid becoming angry or taking the client's belittling comments personally.
Q: What are key interventions and milieu management strategies for Narcissistic Personality Disorder? A: The primary goal is to gain the client's cooperation with treatment. Set firm limits on rude or verbally abusive behavior, and explain expectations clearly and matter-of-factly.
Q: What client and family education is required for Narcissistic Personality Disorder? A: Provide teaching about any comorbid conditions, medications, and self-care.
Q: What pharmacology is associated with Narcissistic Personality Disorder? A: Medications are utilized only if there are comorbid conditions present, such as treating concurrent depression or anxiety.
Q: What are the etiology and risk factors for Avoidant Personality Disorder? A: It occurs in 1.5% to 2.5% of the population, is equally common in both sexes, and clients are likely to report being overly inhibited as children.
Q: What is the core definition and presentation of Avoidant Personality Disorder? A: It is characterized by pervasive social discomfort, social inhibition, feelings of inadequacy, and severe hypersensitivity to negative evaluation. Clients intensely avoid unfamiliar situations, appear sad and anxious, and strongly desire social acceptance but are paralyzed by the fear of making a mistake or being rejected.
Q: What are the top nursing priorities and safety risks for Avoidant Personality Disorder? A: Deep social alienation and low self-esteem are priorities. They may remain in entry-level jobs for years despite being qualified to advance out of fear of failure.
Q: How should a nurse use therapeutic communication and self-awareness with an Avoidant Personality Disorder client? A: The nurse must be careful and patient, providing extensive support and reassurance. Do not expect rapid implementation of social skills.
Q: What are key interventions and milieu management strategies for Avoidant Personality Disorder? A: Practice self-affirmations and positive self-talk to promote self-esteem. Use cognitive restructuring techniques such as reframing and decatastrophizing to enhance self-worth.
Q: What client and family education is required for Avoidant Personality Disorder? A: Teach social skills and practice them within the safety of the nurse-client relationship to counterbalance their social fears. Help them explore possible reasons for their intense self-criticism.
Q: What pharmacology is associated with Avoidant Personality Disorder? A: Chronic cognitive or somatic anxiety may be managed with SSRIs or MAOIs.
Q: What are the etiology and risk factors for Dependent Personality Disorder? A: It occurs in about 1% of the population, runs in families, and is more common in the youngest child.
Q: What is the core definition and presentation of Dependent Personality Disorder? A: It is characterized by a pervasive and excessive need to be taken care of, leading to submissive and clinging behaviors. Clients are pessimistic, highly self-critical, and lack confidence in their own judgment.
Q: What are the top nursing priorities and safety risks for Dependent Personality Disorder? A: Clients possess an intense fear of separation and perceive themselves as unable to function outside of a relationship, feeling completely helpless when alone.
Q: How should a nurse use therapeutic communication and self-awareness with a Dependent Personality Disorder client? A: The nurse must absolutely refrain from giving advice or making decisions for the client. Instead, support them by exploring problems and discussing alternatives.
Q: What are key interventions and milieu management strategies for Dependent Personality Disorder? A: Foster autonomy and self-reliance, and help the client express feelings of grief and loss. Assist in daily functioning skills such as planning menus, shopping, and budgeting.
Q: What client and family education is required for Dependent Personality Disorder? A: Teach problem-solving and decision-making skills, and help the client apply these to daily life. Refer to community agencies for services if needed.
Q: What pharmacology is associated with Dependent Personality Disorder? A: If severe acute anxiety or atypical depression is present, SSRIs, MAOIs, or low-dose antipsychotics may be utilized.
Q: What are the etiology and risk factors for Obsessive-Compulsive Personality Disorder (OCPD)? A: It affects 3% to 8% of the population, is twice as common in males, and has a higher incidence in oldest children and in professions requiring strict precision.
Q: What is the core definition and presentation of OCPD? A: It is characterized by a pervasive preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility and efficiency. Clients have a constricted emotional range, literal interpretation of rules, and are highly frugal, refusing to discard old items.
Q: What are the top nursing priorities and safety risks for OCPD? A: Clients miss deadlines due to an unrelenting striving for perfection and suffer strained marital and parent-child relationships due to an inability to express warm or tender feelings.
Q: How should a nurse use therapeutic communication and self-awareness with an OCPD client? A: The client's demeanor will be very formal and serious with precise details in their responses. Ask questions to actively challenge their rigid thinking.
Q: What are key interventions and milieu management strategies for OCPD? A: Help clients with decision-making by encouraging them to set deadlines for project completion. Practice negotiation with family and friends and encourage the client to relinquish some control.
Q: What client and family education is required for OCPD? A: Use cognitive restructuring to help clients accept "less than perfect" work. Encourage risk-taking in planning family activities.
Q: What pharmacology is associated with OCPD? A: SSRIs or MAOIs may be indicated if chronic anxiety or atypical depression is present.
Q: What is the general approach to psychopharmacology for personality disorders? A: There is no specific medication that cures a personality disorder because the behavior is deeply ingrained, so pharmacologic treatment focuses purely on target symptoms.
Q: What medications are used to target aggression and behavioral dysfunction in personality disorders? A: Lithium, valproate, and low-dose antipsychotics. Benzodiazepines must be avoided in impulsive or aggressive clients due to the high potential for misuse.
Q: What medications target cognitive-perceptual distortions or transient psychosis? A: Low-dose antipsychotics.
Q: What medications manage mood dysregulation and instability? A: Lithium, carbamazepine, valproate, or low-dose neuroleptics.
Q: What medications manage emotional detachment and anxiety? A: SSRIs and atypical antipsychotics. For severe or chronic anxiety and atypical depression, SSRIs or MAOIs are utilized.
Q: Where are personality disorders primarily managed, and when is acute hospitalization appropriate? A: Personality disorders are primarily managed in outpatient community settings. Acute inpatient psychiatric hospitalization is rarely used for treatment of the personality disorder itself; it is strictly used for short-term safety concerns, such as active suicidal ideation in Borderline Personality Disorder.
Q: What are the community-based care and health promotion goals for these clients? A: Treatment goals aim at mood stabilization, decreasing impulsivity, and developing social and relationship skills. Addressing unmet foundational needs—like self-care hygiene, managing budgets, and sexual expression—can vastly improve their overall well-being and health. Clients should be referred to group or individual therapy, self-help groups, and community support programs.
Q: What are the primary NCLEX safety risks to prioritize when studying personality disorders? A: Focus heavily on Antisocial violence and Borderline self-mutilation.