Shared Flashcard Set


Personality disorders
Not Applicable

Additional Nursing Flashcards






Personality traits




 enduring patterns of relating


Characteristics traits and responses
healthy personality
positive self concept, body image, can relate to others openly and honestly

Personality Disorders


common characteristics



qAre an enduring pattern of inner experience and behavior that deviates markedly from the expectation of the individual’s culture


qAre pervasive & inflexible


qHave an onset in adolescence or early adulthood


qAre stable over time, and leads to distress or impairment


qConsistent problems with daily functioning in thoughts, emotions, & interpersonal relationships


qTolerates stress poorly


qLife events & losses increase anxiety


qUnconsciously use primitive defenses to defend themselves

Need treatment when in crisis

qLack or have weak conscience, no guilt


qCo-morbidity with substance abuse, depression


qPoor success in education, profession, love


qVery good at causing interpersonal conflict



defense mechanisms review


qProjection – denies own feelings & puts responsibility for those feelings outside one’s self (think of Im not angry you are angry at me)
qSplitting – inability to integrate the good & bad about people or objects, polarity of feelings
qDissociation – separate mental processes from behavior & from consciousness
qProjective identification 


   justifies feelings by assigning those feelings onto another

qEntitlement – feels deserving of special attention & demands it
qIdealization – views others as perfect with unrealistic powers to fulfill all needs
qDevaluation – criticizes others to defend feelings of inadequacy
qOmnipotence – fantasies of exaggerated importance or greatness


Clusters of personaliy disorders

A) odd, eccentirc

Schizoid, Schizotypical, Paranoid


B) dramatic, emotional, erratic

Antisocial, Borderline, histrionic, Narcissiatic


C ) Anxious, fearful

avoidant, dependaent, obsessive compulsive



Paranoid Personality disorder




qSuspicious of others without reason
qDoubts loyalty of friends & co-workers
qReads hidden meaning & personal attacks into everyday remarks or actions
qSuspects significant other of unfaithfulness without justification 

S: Spouse fidelity suspected

U: Unforgiving, bears a grudge

S: Suspicious of others

P: Perceives attacks (and reacts quickly)

E: “Enemy or friend,” suspects associates & friends

C: Confiding in others is feared

T: Threats perceived in benign events


Schizoid Personality


qPrefers to be alone (lives in own word, dont care)
qIndifferent to praise or criticism 
qIndifferent to social relationships other than with 1st degree relatives
qEmotionally cold & detached with flattened affect

D: Detached or flattened affect

I: Indifferent to criticism and praise

S: Sexual experiences of little interest

T: Tasks (activities) done solitarily

A: Absence of close friends

N: Neither desires or enjoys close relationships

T: Takes pleasure in few activities


Schizotypal personality disorder


qUncomfortable with social interaction so usually isolated
qMagical thinking & odd beliefs
qIdeas of reference
qIllusions, delusions, hallucinations
qInappropriate affect
qBizarre speech & appearance
Think of star trek weirdos and comicon conventions
qSuspicious & withdrawn

M: Magical thinking or odd beliefs

E: Experiences unusual perceptions

P: Paranoid ideation

E: Eccentric behavior or appearance

C: Constricted (or inappropriate) affect

U: Unusual (odd) thinking and speech

L: Lacks close friends

I: Ideas of reference

A: Anxiety in social situations

R: Rule out psychotic disorders and pervasive developmental disorder



Cluster A (odd or eccentric)

Personaliy Disorder Interventions and treatment

qBe aware of tendency toward isolation & suspiciousness
qAvoid being “too nice” or overly friendly
qUse neutral, matter of fact approach
qGive clear, straight forward explanations
qSupportive psychotherapy
qAntidepressants or antipsychotics
Antisocial Personality disorder


qSuperficial charm
qViolates rights of others
          C: Conformity to law lacking
O: Obligations ignored
R: Reckless disregard for safety of self or others
R: Remorse lacking
U: Underhanded (deceitful, lies, cons others)
P: Planning insufficient (impulsive)
T: Temper (irritable and aggressive)



Antisocial personality disorder

interventions and treatment



qDocument manipulation, aggression, impulsivity
qSet up clear boundaries & consequences
qUse clear, realistic limits on specific behaviors
qStaff should guard against being manipulated or feeling guilty
qUse team meetings to gather support
qAsk patient to control their behavior but assist prn
qAssess threats
qGet help if patient out of control
qIncrease restrictions for client/unit safety
qOffer antianxiety meds or antidepressants for anxiety, agitation
qRitalin for ADHD
qAnticonvulsants to decrease impulsive behavior
qGoals are to improve relationships, gain insight into feelings & behaviors


Histrionic Personality disorder


qNeeds to be center of attention
qDramatic & flamboyant
qSeductive & provocative
qOverly concerned with need to impress
qExaggerates to gain attention
qColorful extroverted behavior in excitable, emotional people


          P: Provocative or sexually seductive behavior
R: Relationships considered more intimate than they are

         A: Attention, are uncomfortable when not the center of attention
I: Influenced easily
S: Style of speech is impressionistic, lacks detail
E: Emotions are rapidly shifting and shallow

         M: Made up, uses physical appearance used to draw attention to self

         E: Emotions exaggerated & theatrical



histrionic personality disorder

interventions and treatment



qSeductive & flamboyant behavior used as response to stress
qKeep nurse-pt relationship professional
qEncourage/model use of concrete language
qTeach & model assertiveness
qGroup therapy
qGoals are to prevent suicide, gain insight into unrealistic expectations & fears


narcissistic personality dissorder


qGrandiose self-importance
qExploits others
qSense of entitlement
qFantasies of power & greatness
qArrogant, patronizing, rude
qCovering a fragile ego
qWhen limits are set feels humiliated & may counter attack


         S: Special, believes he or she is special and unique
P: Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
E: Entitlement
C: Conceited with grandiose sense of self-importance

         I: Interpersonal exploitation
A: Arrogant

         L: Lacks empathy


Narcissist personality disorder

interventions and treatment



qStay neutral & avoid power struggles
qAvoid being defensive when client is critical
qConvey unassuming self-confidence
qPsychotherapy if pt acknowledges narcissism
qGroup therapy
qLithium for mood swings, antidepressants
qGoals are to promote healthier sense of individuality, recognize others as separate people, improve coping


Borderline personality disorder


qMood shifts, anger, depression
qUnstable, intense relationships
qImpulsive, self-mutilating, or suicidal
qFeelings of chronic emptiness
qFear of abandonment
qLacks clear identity, life plan, values
qSplitting, all or nothing thinking

Episodes of psychotic regression



A: Abandonment issues




M: Mood instability (marked reactivity of mood)




S: Suicidal or self-mutilating behavior




U: Unstable and intense relationships




I: Impulsivity in two potentially self-damaging areas




C: Control of anger is lacking




I: Identity disturbance




D: Dissociative or paranoid symptoms that are transient and stress-related




E: Emptiness, feelings of chronic emptiness 








Borderline Personality disorder

interventions and treatment



qAssess: impulsivity, SI, self-mutilation, aggressiveness, psychosis
qMaintain safety
qSet clear, realistic goals
qBe alert to manipulative behavior
qHelp to cope/control emotions by structured environment, journaling, & consistent limits
qDecrease splitting & staff conflicts by team communication
qCheck self for counter-transference
qDo not reject or rescue
qBehavioral problems are addressed by revisiting goals & boundaries
qPsychotherapy, Dialectical Behavior Therapy, group therapy
qAntipsychotics to control anger & psychosis


Avoidant personality disorder


qFeels inadequate
qIs uninvolved
qFears disapproval & rejection
qSelf-perceived to be socially inept

       C: Certainty of being liked required before willing to get involved with others
R: Rejection or criticism preoccupies one's thoughts in social situations
I: Intimate relationships are restrained due to fear of being shamed
N: New interpersonal relationships are inhibited
G: Gets around (avoids) occupational activity involving significant interpersonal contact
E: Embarrassment (potential) prevents new activity or taking personal risks
S: Self viewed as unappealing, inept, or inferior



Avoidant personality disorder

interventions and treatment



qFriendly, accepting, reassuring approach
qEase into social situations very gradually
qPsychotherapy & group therapy for trust issues
qAssertiveness training
qAntidepressants & antianxiety agents
qAlpha adrenergic agents to reduce ANS hyperactivity


Dependent personality disorder


qDecreased self confidence
qWants to be taken care of
qAnxious, helpless, fearful
qPassive & clinging

      R: Reassurance required for decisions
E: Expressing disagreement is difficult due to fear of loss of support or approval
L: Life responsibilities need to be assumed by others

       I: Initiating projects is difficult due to lack of self-confidence)

       A: Alone, feels helpless and uncomfortable when alone
N: Nurturance, goes to excessive lengths to obtain nurturance and support from others
C: Companionship from another relationship sought urgently when close relationship ends
E: Exaggerated fears of being left to care for self



Dependent personality disorder

interventions and treatment



qIdentify & help address stressors
qNeed to meet pt’s needs while setting limits on clinging behavior
qModel assertiveness
qPsychotherapy, behavioral, group & family therapy
qAntianxiety agents & antidepressants for specific symptoms
qImipramine for panic attacks



Obsessive compulsive

personality disorder



qPreoccupied with details, rules, organization
qToo busy for friends, stays polite & formal
qInner struggle to control self, others, environment
qNo actual obsessions or compulsions

     L: Loses point of activity due to preoccupation with  detail

     A: Ability to complete tasks due to perfectionism
W: Worthless objects can’t be discarded

       F: Friendships & leisure activities excluded due to a preoccupation with work
I: Inflexible, scrupulous, over conscientious on ethics, values, or morality, not accounted for by religion or culture
R: Reluctant to delegate unless others submit to exact guidelines
M: Miserly toward self and others

         S: Stubbornness & rigidity



Obsessive compulsive personality disorder

intervention and treatments



qGuard against power struggles & use of defense mechanisms (intellectualization, rationalization, isolation, undoing, reaction formation)
qClomipramine & SSRIs for obsessional thinking & depression


Etiology of personality disorders


qGenetics & child’s temperament
qPsychological factors
qEnvironmental factors
qDiathesis-Stress Model
ØDiathesis: biology & environment, inc. temperament
ØStress:  influences on personality ie., physical, social, psychological, emotional


Assessment of personality disorders


qMinnesota Multiphasic Personality Inventory
qMedical history
qMeds used, other substances used/abused, food & money habits
qInvolvement with court system
qCurrent level of crisis
qDysfunctional coping style


Self Awareness


qHave capacity to frustrate providers
qPerceived as aggravating & demanding by staff, value judgments
qWill try to merge personal boundaries with staff
qHave problems with trust so difficult to engage in treatment
qEffective care is at risk – staff need to set clear boundaries!




of personality disorders



qRealistic goal setting is important!
qExpect improved relationships
qCommunicate positive expectations
qCase management geared toward reducing the need for hospitalization
qShort Term Goal: specific to immediate problem, insure safety, decrease acting out behavior, offer structure
qLong Term Goal: will tolerate anxiety while learning to relate openly & directly
qCan learn to cope with support from provider
qClient’s ability is change is limited yet prognosis is more optimistic than in past
qProtect client from harm, to self or others
qFocus on strengths, behavior, expectations, positive reinforcement
qUse limits & verbal contracts to decrease splitting, clinging, & other primitive defense mechanisms
qCheck context when client blames
qOrient to reality
qEncourage client to verbalize or journal feeling vs. acting out or self-harm
qMeds for anxiety, depression, psychosis
qCase management


Dialectical Behavior therapy


qSome success with Borderline Personality Disorder clients
qEvidenced based
qLong term, structured weekly therapy
qPhone access for support in crisis
qDialectics is method of argument using contradictory facts to resolve differences into united whole


treating impulsive behavior


qIdentify antecedent needs & feelings
qDiscuss current & previous acts
qExplore impact on self & others
qRecognize cues to impulsive behavior
qRefer/teach coping skills & alternative behaviors
qRole play new skills offering feedback & support
qIdentify strengths
qUse clear communication




During the assessment interview your client says, “I’m a free agent who tries to live off the grid.  No way for the government to monitor me if I keep to myself.  People tell me I’m paranoid but I’m just looking out for myself.”  Which approach would work best with this client with Paranoid Personality Disorder?

a.  interpretation of his behaviors


b.  active friendliness and nurturing


c.  a neutral but courteous and concerned manner


d.  a cynical, joking approach


C. a neutral but courteous and concerned manner


Which should a nurse include as a primary outcome for an individual with Schizoid Personality Disorder?


a.Validates ideas with someone before taking action


b.Is able to function independently in the community


c.Can cope with stress and control emotions


d.Is able to recognize limits


B is able to function independently in the community


Which of the following statements, if made by a client during a group therapy session, would the nurse identify as reflecting a client’s narcissistic personality disorder?


a.  I’m sick of hearing about all your life tragedies.


b. I know I’m interrupting others, so what?


c. I just can’t stop wanting to slash myself.


d. I just have no hope for the future.


a. Im sick of hearing about all your life tragedies


A client with Borderline Personality Disorder has just cut their arm with a sharp piece of plastic.  How should the nurse respond?


a.Care for the wounds without offering sympathy or attention.


b.Act quickly to dress the wounds so the client feels safe.


c.Call the doctor to dress the wounds so the client feels important.


d.Let the client dress the wounds themselves.


A. care for the wounds without offering sympathy or attention


A client on a psychiatric unit is very demanding and critical, talking with others and telling them how mean one of the nurse is to clients.  Which nursing diagnosis is most appropriate for this client?


a.Social isolation related to negative behavior.


b.Chronic low self-esteem related to use of the defense mechanism splitting.


c.Risk for other-directed violence related to negative verbal communication.


d.Ineffective coping related to inability to interact with unit personnel.


B. chronic low self esteem related to use of the defense mechanism splitting


Which interventions should a nurse plan for a client with Avoidant Personality Disorder?  Select all that apply.


a.Provide support and reassurance.


b.Explore positive self-aspects.


c.Use reframing.


d.Identify negative responses from others.


e.Offer de-catastrophizing.


f.Make group attendance mandatory.


a.Provide support and reassurance.


b.Explore positive self-aspects.


c.Use reframing.
e.Offer de-catastrophizing.


Limit setting is an important part of working with clients who have personality disorders.  What strategy could the nurse first use to make limit setting more accepted by the client?


a.  state a value judgment regarding the behavior and its consequences


b.  reflect back to the client an understanding of the client’s distress


c.  confront the client with the inappropriateness of the behavior


d.  explore with the client the underlying dynamics of the behavior


B. reflect back to the client an understanding of the clients distress
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