* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Personality Disorders, Eating Disorders, and Sexual Disorders
Survey
Document related concepts
Classification of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Schizoid personality disorder wikipedia , lookup
Personality disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Abnormal psychology wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Ego-dystonic sexual orientation wikipedia , lookup
Transcript
Personality Disorders, Eating Disorders & Sexual Disorders Nur 305 Personality is a set of deeply ingrained, enduring patterns of thinking, acting, & behaving. Personality Disorder Definition: The individual has few strategies for relating and his or her approach to relationships and to the environment is inflexible and maladaptive. Prevalence of personality disorders in the general population is 10-18% A “healthy personality” means: Maintaining healthy relationships Experiencing intimacy while maintaining own separate identity Maintaining a continuum of dependent and independent behavior Adaptive responses Solitude Autonomy Mutuality Interdependence Maladaptive responses Manipulation Impulsivity Narcissism Personality disorders (characteristics) Chronic, maladaptive social responses Can be associated with depression, substance abuse, and suicide. Clusters of personality disorders DSM-IV-TR Cluster A includes disorders of an odd or eccentric nature (paranoid, schizoid, schizotypal) Cluster B includes disorders of an erratic, dramatic, or emotional nature (antisocial, borderline,histrionic, narcissistic) Cluster C includes those of an anxious or fearful nature (avoidant, dependent, obsessive-compulsive) Cluster A Personality Disorders Paranoid: “People will eventually hurt me.” “People cannot be trusted.” Schizoid: “Why should I be close to people?” “I am my own best friend.” Schizotypal: “I am defective.” Relationships are threatening.” Paranoid personality disorder A pervasive distrust and suspiciousness of others without sufficient basis Person persistently bears grudges (unforgiving) Person is preoccupied with unjustified doubts about the loyalty of friends Person exhibits feelings of inadequacy Treatment of Paranoid Personality Establish a therapeutic relationship Antipsychotic meds may be useful Empathetic response to patient’s anxiety Psychotherapy Schizoid Personality Disorder Pervasive pattern of detachment from social relationships (beginning by early adulthood). Chooses solitary activities Lacks close friends other than first degree relatives Emotional coldness, detachment or shows flat affect Schizotypal Personality Interpersonal deficits, cognitive distortions, eccentricities, feeling misunderstood, & odd beliefs (begins by early adulthood). Superstitions, beliefs in telepathy or “sixth sense,” bizarre fantasy or preoccupations. Lack of close friends Inappropriate affect Excessive social anxiety Schizoid & schizotypal personality treatments Therapist must be patient and proceed at a slow pace. Dysfunctional thought record as a HW device Social skills training Low doses of antipsychotics Anxiolytics Cluster B personality disorders Antisocial personality: exploitive & manipulative. “Rules are meant to be broken.” “My pleasure comes first.” Borderline personality: unstable, impulsive, profound mood shifts, & self-destructive behavior Cluster B disorders cont. Histrionic personality: attention seeking, superficial relationships, appearances are important, excessive emotionality. Narcissistic personality: arrogant, need for admiration, socially exploitive, manipulative. Antisocial personality (DSM-IV criteria) A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years. Failure to conform to social norms with respect to lawful behaviors Repeated lying and conning others Irritable and aggressive Consistent irresponsibility Lack of remorse Antisocial Personality Main Defense Mechanism: Projection: places responsibility for antisocial behavior on others. Borderline Personality A pervasive pattern of instability of interpersonal relationships. Main defense mechanisms: Splitting: inability to integrate the good and bad aspects of oneself. Projection: projects parts of oneself onto others. EBR on families of BP Patients view their relationships with their mothers as highly conflictual, distant, or uninvolved. Both physical and sexual abuse are common. 25% of BP patients have a history of parent-child incest. EBT Treatments for BD DBT: Dialectic Behavioral Therapy Partial hospitalization involving group and individual psychotherapy for 18 months reduces the number of suicide attempts and acts of self-harm. Also increases the quality of social and interpersonal functioning. Medications Cluster C personality disorders Anxious; Fearful Avoidant: social inhibition; withdraw from social and occupational situations. Dependent: submissive;low selfesteem,dependency in relationships Cluster C disorders cont. Obsessive-compulsive: unable to express affection, overly cold, preoccupation with trivial detail, orderliness, perfection. Treatment: CBT, Psychotherapy Primary Nursing Diagnoses Chronic low self-esteem Risk for self-mutilation Impaired social interaction Risk for self-directed violence Outcome Identification The patient will obtain maximum interpersonal satisfaction by establishing and maintaining self enhancing relationships with others. Planning & Interventions Focus on helping pt. Change the thinking and the behavior that result from the personality disorder Set mutual goals Protection from self-harm Family and staff consistency Set limits and structure environment Focus on patient’s strengths Eating Disorders Chapter 25 Predisposing Factors Biological: dysregulation of neurochemical mechanism for appetite Low serotonin level Decreased dopamine receptor Genetics: 52% risk in monozygotic twins Psychological: low self-esteem, body image dissatisfaction, alcohol & substance abuse, perfectionism. Diagnosis & Classification: Anorexia Nervosa AN Refusal to maintain body wt at or above minimal normal wt for age and height. Intense fear of gaining wt Distorted body image Amenorrhea (3 cycles) Diagnosis & Classification (AN) AN Subtypes: Restricting Type: limited intake of food Binge eating/purging types Key features of AN (without binging or purging) Rare vomiting More severe wt loss More introverted Sexually inactive Hunger denied Death form starvation Amenorrhea Diagnosis: Bulimia Nervosa Fear of not being thin. Recurrent episodes of binge eating. Recurrent inappropriate compensatory behaviors at least 2X/week for 3 months (self-induced vomiting, laxative use, diuretics, enemas, fasting or excessive exercise). A persistent fixation with body shape and weight. Key Features of Bulimia Frequent vomiting Less weight loss More extraverted More sexually active Irregular menses or absent Obsessional features Death from hypokalemia or suicide Other Eating Disorders Binge eating disorder (absence of purging or fasting) Obesity Pica (eating non-food items) Rumination (regurgitation & rechewing food) Complications of AN & BN Bradycardia, arrhythmias, CHF Electrolyte disturbance (low K) Loss of dental enamel, osteo (lack of Ca) Hair loss Anemia, leukopenia Delayed gastric mobility (r/t chronic laxative use) pancreatitis Eating Disorders Co-morbidity AN may be co-morbid with histrionic or obsessive-compulsive personality disorder Bulimia is co-morbid with borderline and major depression Eating Disorder Assessment Eating pattern Body image Binge/purging episodes Current and ideal body weight Exercise pattern Coping resources Motivation to change Eating Disorder Coping mechanism Denial Avoidance Intellectualization Cognitive distortions in maladaptive eating Magnification of the significance of undesired events Superstitious thinking Dichotomous or all-or-none thinking: thinking in extremes Selective abstraction: basing a conclusion on isolated details Overgeneralization Nursing Diagnoses related to eating disorders Anxiety Disturbed body image Imbalanced nutrition Powerlessness Low self-esteem Risk for self-mutilation Treatment goals Nutritional stabilization Identification of precipitating factors Re-establishment of normal eating behavior Treatment of AN Medical: SSRI’s for relapse prevention Weight restoration Psycho-education on nutrition and health Behavioral and cognitive interventions Involve pt’s family Long term prognosis is poorer than bulimia Treatment for Bulimia Antidepressants produce short-term reductions in binge eating and purging (Prozac). CBT is most effective in eliminating core features of Bulimia. Sexual Disorders Criteria for adaptive sexual responses Two consenting adults Mutually satisfying to both Not psychologically or physically harmful to either Lacking in coercion Conducted in private Criteria for maladaptive sexual responses Dysfunction in sexual performance Harmful, forceful sexual behavior Not conducted in private Non-consenting between two adults Behaviors related to sexual responses Heterosexuality: sexual attraction to members of the opposite sex. Homosexuality: sexual attraction to members of the same sex. Bisexuality:sexual orientation or attraction to both men and women. Transvestism: cross-dressing or dressing in the clothes of the opposite sex. Transsexualism: one has a profound discomfort with his/her own sex and a strong identification with the opposite gender. Stages of the sexual response cycle Stage 1: Desire Stage 2: Excitement Stage 3: Orgasm Stage 4: Resolution Sexual dysfunction More common in women than men Vaginismus: painful involuntary spasm Lack of orgasm Problems seen in males: Erectile dysfunction (impotence) Ejaculatory disorders Precipitating Stressors Physical illness or injury ( post MI, CA hysterectomy) Psychiatric illness (depression, hypersexuality, manic) Medications (antihypertensives, antihistamines, anticholinergics, chemo agents) Aging process Coping Mechanisms Fantasy Rationalization Denial Projection Primary Nursing Diagnosed related to variations in sexual response Sexual dysfunction Ineffective sexuality pattern Medical Diagnoses Sexual dysfunctions Paraphilias Gender disorders Paraphilia A persistent association, lasting at least 6 months, between intense sexual arousal, desire, acts, or fantasies. Medical diagnoses related to paraphilia’s (sexual perversion or deviation) Exhibitionism: sexual arousal when exposing genitals to stranger Fetishism: persistent assoc. between sexual arousal and non-living objects; such as female underwear Frotteurism: persistent assoc. between sexual arousal and rubbing against a non-consenting person Pedophilia: sexual arousal assoc.with one or more children aged 13 or under (criminal) Medical Diagnoses cont. Sexual masochism: sexual arousal assoc. with being humiliated, beaten, or being made to suffer. Sexual sadism: sexual arousal assoc with real or simulated psycho-physical suffering. Voyeurism: observing unsuspecting people who are naked or engaging in sexual activity Outcome Identification The patient will obtain a maximum level of adaptive sexual responses to maintain health. Treatments for sexual disorders Cognitive Behavioral CBT Somatic treatments that lower testosterone levels,such as medroxyprogesterone are also somewhat effective. Sexual dysfunction treatment Erectile disorders Pharmacological (sidenafil) and SSRI’s. Response of the nurse; difficulties with sexual orientation Homosexuality is NOT a disorder of mental illness Society’s lack of acceptance is a factor in the increased risk for suicide for homosexuals and bisexuals. Avoid negative attitudes and irrational fears (homophobia). Show acceptance and sensitvity of sexual orientation. Ensure quality care. Do not make the heterosexism assumption.