Risk for self-mutilation related to parental emotional deprivation Risk for suicide related to unresolved grief Risk for other-directed violence related to underlying rage Complicated grieving related to maternal deprivation during rapprochement phase of development internalized as a loss with fixation in anger stage of grieving process Impaired social interaction related to extreme fears of abandonment and engulfment Disturbed personal identity related to underdeveloped ego Anxiety (severe to panic) related to unconscious conflicts based on fear of abandonment Chronic low self-esteem related to lack of positive feedback Outcomes Client Has not harmed self Seeks out staff when desire for self-mutilation is strong Is able to identify true source of anger Expresses anger appropriately Related to more than one staff member Completes activities of daily living independently Does not manipulate one staff member against the other to fulfill own desires Planning/Implementation Nursing intervention for the client with Borderline Personality Disorder is aimed at protection of the client from self-harm The nurse also seeks to assist the client to advance in the development of personality by confronting his or her true source of internalized anger Evaluation Evaluation of care for the client with borderline personality disorder is based on accomplishment of previously established outcome criteria o Histrionic Personality Disorder Behavior is: Excitable Emotional Colorful Dramatic Extroverted Prevalence is thought to be about 2--3% More common in women than in men Clinical Picture Self-dramatizing Attention-seeking Overly gregarious
Seductive Manipulative Exhibitionistic Highly distractible Difficulty paying attention to detail Easily influenced by others Difficulty forming close relationships Strongly dependent Somatic complaints are common Predisposing Factors Possible link to the noradrenergic and serotonergic systems Possible hereditary factor Biogenetically determined temperament Learned behavior patterns o Narcissistic Personality Disorder Characterized by an exaggerated sense of self- worth Lack of empathy Clien believe they have the inalienable right to receive special consideration Prevalence of the disorder is estimated at about 6% Diagnosed more often in men than in women Clinical Picture Overly self-centered Exploit others in an effort to fulfill their own desires Mood, which is often grounded in grandiosity, is unusually optimistic, relaxed, cheerful, and carefree Because of fragile self-esteem, mood can easily change if they do not: Meet self-expectations Receive the positive feedback they expect Criticism from others may cause them to respond with rage, shame, and humiliation Predisposing Factors
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- Spring '17