N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide

©2017 Achieve Test Prep Page 21 of 140 1.4 Personality Disorders Personality disorders are diagnosed when personality patterns or traits are inflexible, enduring, pervasive, maladaptive, and cause significant functional impairment or subjective distress. Patients frequently experience their personality patterns as natural or comfortable (ego syntonic), rather than painful or uncomfortable (ego dystonic). Personality disorders are classified in three diagnostic clusters: • Cluster A disorders: characterized by off or eccentric behavior (paranoid, schizoid, and schizotypal); approach the patient in a gentle, interested, but nonintrusive manner; respect patient’s needs for distance and privacy; be mindful of own nonverbal communication because a patient may perceive others as threatening; gradually encourage interaction with others, if appropriate • Cluster B disorders: antisocial, borderline, histrionic, and narcissistic; be patient when emotional and erratic behavior is displayed; provide a consistent and structured milieu to avoid manipulation and power struggles; safety is always first priority of care, protect patient from suicide and self-mutilation until they can protect themselves; set limits as necessary to help patient maintain impulse control to protect both the patient and others from injury; help the patient recognize and discuss fear of abandonment; help the patient recognize presence of dichotomous thinking or splitting, in which self and others are perceived as all good or all bad; encourage direct communication to minimize attention seeking through use of dramatic, seductive behavior • Cluster C disorders: avoidant, dependent, and obsessive compulsive; point out avoidance behaviors and related losses and secondary gains; provide problem solving and assertiveness training to increase self-confidence and independence; encourage expression of feelings to decrease rigidity and need for control; help patient acknowledge and discuss sense of inadequacy and fear of rejection Treatment • Psychopharmacology: Antipsychotic agents may be prescribed on a short-term basis to alleviate psychotic symptoms. SSRIs may be prescribed to diminish rapid mood swings and impulsive, aggressive, or self-destructive behavior associated with borderline personality disorder. • Individual and group therapy: This is based on the patient’s level of function and specific needs. Behavioral therapy involves impulse control training designed to support patient safety by decreasing the risk of suicide or self-mutilation through use of antihero contracts. It involved setting limits to discourage a tendency to test and manipulate others, behavioral modification to include social skills for patients who are helpless and dependent, and anxiety reduction.

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