Identity disturbance with chronic feelings of

- 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.