- Identity disturbance with chronic feelings of emptiness (Anhedonia) - Marked mood swings and impulsive unpredictable behavior with potential for self-destruction. - Intense , brief, unstable interpersonal relationships with impulsiveness, manipulation, physical fights and temper tantrums A borderline patient indicates an improvement when she state, “I ran around the block rather than cutting myself”. Borderline personality with a history of cutting her wrist shows an intense & a changeable affect during the middle phase of nurse-pt relationship. The patient says, "You’re a smart nurse. I want to be just like you.” This statement shows Transference A patient borderline state, “You’re a phony. You don’t know what happened to me.” Best response of the nurse will be, “I’ll ensure what is necessary will be done to you Intervention for borderline d/o includes setting of limits through saying, “The policy of the unit is that, ‘You can’t leave in the unit in 1 st 24 hrs.’” C. Histrionic Personality Disorder - More common in women, 2-3 % of the population THEORY : Llacks Electra complex (no father figure) Papa’s girl CHARACTERISTICS: - Emotional, dramatic, theatrical - wants to be the center of attention - Manipulative , Sexually seductive or provocative - Exaggeration of emotion, Style of speech is excessively impressionistic - Labile emotion, Positive: Creative, imaginative - Extroverted, manipulative, vain with behavior directed toward gaining attention to self; - Emotionally unstable; uses somatic complaints to avoid responsibility D. Narcissistic Personality Disorder - Usually Men - Another: Metrosexual CHARACTERISTICS : - Vanity in personal appearance - Exaggerated or grandiose sense of self-importance - Boastful, egotistical, superiority complex - preoccupied with fantasies: Power, success, beauty - Excessive admirations; envies other, arrogant, lack of empathy - Overblown sense of importance , grandiosity; with strong need for attention and admiration from others CLUSTER C: ANXIOUS / FEARFUL
A. Obsessive –Compulsive Personality Disorder - More in women - Obsession – irresistible thought, Compulsion – irresistible action THEORIES: Genetic: Serotonin imbalance Anal fixation strict toilet training Overpowering mother CHARACTERISTICS: - Cardinal Signs: RITUALISTIC - #1 DEFENSE MECHANISM: Undoing, Repression, Symbolization # 1 Ritual: handwashing Other Ritualistic behaviors : 4 C’s: C ontrolling perfectionism C ollects or hoarding C leaning C hecking • Rigid, over-conscientious, perfectionist, inflexible, cold affect • Driven by obsessive concerns • Sets high standards for self and others • Preoccupied with details, rules and organization STEP TO STEP PRIORITY NURSING DIAGNOSIS: Altered Sleeping Patterns Altered Skin Integrity Ineffective Individual Coping PRIORITY NURSING INTERVENTIONS : 1. Give appropriate time to do rituals to decrease anxiety In OCD, intervention includes giving an extra ½ hr to the pt to do the ritual before starting the task.
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- Fall '17
- Borderline personality disorder, The Unconscious