Maladaptive Behavior Patterns—personality disorders and abuse <ul><li>What sort of future is coming up from behind, I real...
People with Personality Disorders have long term: <ul><li>Low frustration tolerance </li></ul><ul><li>Pain intolerance </l...
Nursing Issues with all PD: <ul><li>Balance in your expectations for change—hope, but not a quick fix </li></ul><ul><li>Be...
The Odd/Eccentric Group: Schizoid, Paranoid, Schizotypal <ul><li>Some nursing issues include: </li></ul><ul><li>ineffectiv...
Paranoid Personality D/O <ul><li>Fear others will harm or exploit </li></ul><ul><li>Hypervigilant and tend to be hostile (...
Schizoid Personality D/O <ul><li>Doesn’t want relationships </li></ul><ul><li>Flat affect, little emotion seen, not aware ...
Schizotypal PD <ul><li>Has social anxiety. Wants relationships but not skilled at getting them. </li></ul><ul><li>Often ha...
Dramatic/ Emotional PDs <ul><li>Includes Antisocial, Borderline, Histrionic, and Narcissistic </li></ul><ul><li>Focus more...
Antisocial PD (more men) <ul><li>Feels entitled, acts charming to get way </li></ul><ul><li>Deceitful, manipulative, venge...
Borderline PD (more women) <ul><li>Overwhelmingly emotionally needy, despairing. Angry, dysphoric, labile </li></ul><ul><l...
Histrionic PD <ul><li>Dramatic, flambouyant  </li></ul><ul><li>Charming, intense, but shallow in relationships </li></ul><...
Narcissistic PD <ul><li>Self absorbed and self centered </li></ul><ul><li>Overestimates own self worth as a defense to cov...
Anxious and Fearful PD: avoidant, dependent, and obsessive compulsive <ul><li>Of all three, dependent is most common </li>...
Avoidant PD <ul><li>Often co-occurs with social phobias </li></ul><ul><li>See social isolation </li></ul><ul><li>Very sens...
Dependent Personality D/O <ul><li>Passive, submissive, self sacrificing </li></ul><ul><li>Few self initiated behaviors </l...
Obsessive Compulsive PD <ul><li>R/t OCD </li></ul><ul><li>Thrifty, saving, verbose, organized </li></ul><ul><li>Critical o...
Abuse: Incidence is high <ul><li>1.8-2.9 million battered women each yr in US. Battering is single most common cause of in...
Why abuse continues ( a few reasons) <ul><li>Society legitimizes violence and privacy </li></ul><ul><li>Intergenerational ...
Power and Control Issues-ways abusers act <ul><li>Threats and coercion </li></ul><ul><li>Economic restriction </li></ul><u...
Cycle of Violence <ul><li>Tension building—tension, blaming, aggression in abuser </li></ul><ul><li>Abuse (battering) epis...
Myths that create problems in stopping abuse <ul><li>If the abuse was that bad the victim would tell or get out </li></ul>...
Abusers typically: <ul><li>Victims of abuse in youth </li></ul><ul><li>Lack empathy, and minimize seriousness of abuse </l...
Some Assessment findings that hint at abuse: <ul><li>Frequent ER visits </li></ul><ul><li>Withdrawn/depresd </li></ul><ul>...
Some assessment questions <ul><li>What happened? </li></ul><ul><li>Have you been in a fight? Tell me about it. </li></ul><...
Some nursing interventions <ul><li>Make time and privacy to talk </li></ul><ul><li>Listen and validate, not judge </li></u...
Educational Interventions <ul><li>Cycle of violence </li></ul><ul><li>Community resources </li></ul><ul><li>Danger of homi...
Safety Plans-a few basics <ul><li>Cash, checks, keys, credit card, essentials bag, hidden out of home </li></ul><ul><li>Co...
Security Plan if you leave <ul><li>Bring kids with you or go back for them with police </li></ul><ul><li>Lock everything, ...
Some other Intervention Issues <ul><li>Be wary of marriage counseling, people who advise to stay with abuser, abusive pare...
Post-traumatic Stress Disorder <ul><li>Exposure to trauma </li></ul><ul><li>Re-experiencing traumatic event </li></ul><ul>...
Re-experiencing the event <ul><li>Intruding reminders/memories/flashbacks </li></ul><ul><li>Nightmares </li></ul><ul><li>A...
Types of Avoidance <ul><li>Thought/feelings/conversations about the event </li></ul><ul><li>Stays away from people and pla...
Treatment of PTSD <ul><li>Antianxiety agents for short term relief </li></ul><ul><li>Antidepressants, particularly SSRI’s ...
Rape-types <ul><li>Blitz rape—out of the blue, fast </li></ul><ul><li>Confidence rape—more of a set up involved, may know ...
Rape Intervention-a few points <ul><li>Collecting Evidence while maintaining dignity, respect in initial response </li></u...
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Abuse

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Maladaptive Behavior Patterns—personality disorders and abuse

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Abuse

  1. 1. Maladaptive Behavior Patterns—personality disorders and abuse <ul><li>What sort of future is coming up from behind, I really don’t know. But the past, spread out ahead, dominates everything in sight. R.M Pirsig from Zen and the Art of Motorcycle Maintenance </li></ul>
  2. 2. People with Personality Disorders have long term: <ul><li>Low frustration tolerance </li></ul><ul><li>Pain intolerance </li></ul><ul><li>Over reaction to life events </li></ul><ul><li>Lack of impulse control </li></ul><ul><li>Immature coping strategies (over use of defense mechanisms) </li></ul><ul><li>Impaired personal relationships </li></ul>
  3. 3. Nursing Issues with all PD: <ul><li>Balance in your expectations for change—hope, but not a quick fix </li></ul><ul><li>Be authentic, patient, trustworthy </li></ul><ul><li>Have good limit setting skills </li></ul><ul><li>Have good ego boundaries </li></ul><ul><li>Have good team communication, to decrease splitting </li></ul>
  4. 4. The Odd/Eccentric Group: Schizoid, Paranoid, Schizotypal <ul><li>Some nursing issues include: </li></ul><ul><li>ineffective individual coping </li></ul><ul><li>social isolation </li></ul><ul><li>defensive coping </li></ul>
  5. 5. Paranoid Personality D/O <ul><li>Fear others will harm or exploit </li></ul><ul><li>Hypervigilant and tend to be hostile (as a response to perceived threat) </li></ul><ul><li>Can become psychotic if stressed </li></ul><ul><li>Nursing—be consistent, truthful, out in the open. Approach with care and tell what is happening, what you are doing </li></ul>
  6. 6. Schizoid Personality D/O <ul><li>Doesn’t want relationships </li></ul><ul><li>Flat affect, little emotion seen, not aware there is a problem with this </li></ul><ul><li>Few relationships, can become delusional if stressed </li></ul><ul><li>Nursing-build trust slowly, consistent, not overly emotional or smothering </li></ul>
  7. 7. Schizotypal PD <ul><li>Has social anxiety. Wants relationships but not skilled at getting them. </li></ul><ul><li>Often has eccentric thinking and/or behavior </li></ul><ul><li>Nursing-be consistent, trustworthy, keep clear boundaries, help ct. with very gradual change in social bx. </li></ul>
  8. 8. Dramatic/ Emotional PDs <ul><li>Includes Antisocial, Borderline, Histrionic, and Narcissistic </li></ul><ul><li>Focus more study energy on Antisocial and Borderline </li></ul><ul><li>Sample nursing diagnoses include: Altered family process, ineffective individual coping, self mutilation, risk for violence, low self esteem </li></ul>
  9. 9. Antisocial PD (more men) <ul><li>Feels entitled, acts charming to get way </li></ul><ul><li>Deceitful, manipulative, vengeful </li></ul><ul><li>Seeks risks, stimulation (drugs, sex, crime, gambling) </li></ul><ul><li>Has no conscience or empathy </li></ul><ul><li>Irresponsible and unsafe </li></ul>
  10. 10. Borderline PD (more women) <ul><li>Overwhelmingly emotionally needy, despairing. Angry, dysphoric, labile </li></ul><ul><li>Lives in a crisis and creates a crisis if too calm </li></ul><ul><li>Abandonment issues are key </li></ul><ul><li>Self destructive behavior and mutilation occur </li></ul><ul><li>Splitting, dichotomous thinking </li></ul>
  11. 11. Histrionic PD <ul><li>Dramatic, flambouyant </li></ul><ul><li>Charming, intense, but shallow in relationships </li></ul><ul><li>Center of attention, if not gets upset and creates stir </li></ul><ul><li>May have dramatic ups and downs. </li></ul>
  12. 12. Narcissistic PD <ul><li>Self absorbed and self centered </li></ul><ul><li>Overestimates own self worth as a defense to cover self doubt </li></ul><ul><li>Grandiose. Wants attention, praise, admiration. If this doesn’t happen, becomes upset/angry/vengeful </li></ul><ul><li>Very critical. Little tolerance for imperfection </li></ul>
  13. 13. Anxious and Fearful PD: avoidant, dependent, and obsessive compulsive <ul><li>Of all three, dependent is most common </li></ul><ul><li>Nursing diagnosis can include: </li></ul><ul><ul><li>Self esteem disturbance </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Hopelessness </li></ul></ul><ul><ul><li>powerlessness </li></ul></ul>
  14. 14. Avoidant PD <ul><li>Often co-occurs with social phobias </li></ul><ul><li>See social isolation </li></ul><ul><li>Very sensitive to criticism and afraid of being judged negatively </li></ul><ul><li>Feels rejected a lot, fears being rejected </li></ul><ul><li>Low self esteem </li></ul>
  15. 15. Dependent Personality D/O <ul><li>Passive, submissive, self sacrificing </li></ul><ul><li>Few self initiated behaviors </li></ul><ul><li>Little decisionmaking </li></ul><ul><li>Tolerates maltreatment, being bossed </li></ul><ul><li>Urgent need to be in relationship in which someone else is in control </li></ul>
  16. 16. Obsessive Compulsive PD <ul><li>R/t OCD </li></ul><ul><li>Thrifty, saving, verbose, organized </li></ul><ul><li>Critical of self and others </li></ul><ul><li>Rigid emotionally; taskmasters, have a hard time expressing emotion </li></ul>
  17. 17. Abuse: Incidence is high <ul><li>1.8-2.9 million battered women each yr in US. Battering is single most common cause of injury to women. 8% women are battered before or during pregnancy. </li></ul><ul><li>2 million reported cases of child abuse each yr in US (2000-5000 die) </li></ul><ul><li>0.5-1 million cases of elder abuse in US yearly. </li></ul>
  18. 18. Why abuse continues ( a few reasons) <ul><li>Society legitimizes violence and privacy </li></ul><ul><li>Intergenerational –acting like we have seen growing up </li></ul><ul><li>Structural inequality of abused persons </li></ul><ul><li>Stockholm syndrome (discuss) </li></ul>
  19. 19. Power and Control Issues-ways abusers act <ul><li>Threats and coercion </li></ul><ul><li>Economic restriction </li></ul><ul><li>Intimidation(pets, weapons, breaking) </li></ul><ul><li>Emotional abuse </li></ul><ul><li>Isolate the abused person </li></ul><ul><li>Denial </li></ul><ul><li>Threaten loved ones (esp. children) </li></ul>
  20. 20. Cycle of Violence <ul><li>Tension building—tension, blaming, aggression in abuser </li></ul><ul><li>Abuse (battering) episode—acute episode of abuse </li></ul><ul><li>Calm/honeymoon—acts calmer, nicer, may apologize/gifts/promises. In severe abuse this may be minimal </li></ul>
  21. 21. Myths that create problems in stopping abuse <ul><li>If the abuse was that bad the victim would tell or get out </li></ul><ul><li>Victim deserves it </li></ul><ul><li>Abuse only occurs among the poor and uneducated </li></ul><ul><li>Families should be kept together at all costs </li></ul><ul><li>If it weren’t for drugs and alcohol, the abuse wouldn’t have occurred </li></ul><ul><li>Victims are lying or exaggerating to get attention </li></ul><ul><li>Batterers are uneducated men who can be spotted easily </li></ul><ul><li>Families should always be kept together </li></ul>
  22. 22. Abusers typically: <ul><li>Victims of abuse in youth </li></ul><ul><li>Lack empathy, and minimize seriousness of abuse </li></ul><ul><li>Controlling </li></ul><ul><li>Jealous </li></ul><ul><li>Impulsive </li></ul><ul><li>Low frustration tolerance </li></ul><ul><li>Angry, violence focused </li></ul><ul><li>Attribute failure to others’ behavior </li></ul><ul><li>Traditional views </li></ul><ul><li>Often alcohol/drug abuse </li></ul>
  23. 23. Some Assessment findings that hint at abuse: <ul><li>Frequent ER visits </li></ul><ul><li>Withdrawn/depresd </li></ul><ul><li>Inconsistent physical findings </li></ul><ul><li>Multiple suicide attempts </li></ul><ul><li>Overprotective family member </li></ul><ul><li>Alcohol or other drug abuse </li></ul><ul><li>One car accident </li></ul><ul><li>Delay in seeking medical care </li></ul><ul><li>Injury to head, sexual organs </li></ul><ul><li>Injuries in various stages of healing </li></ul>
  24. 24. Some assessment questions <ul><li>What happened? </li></ul><ul><li>Have you been in a fight? Tell me about it. </li></ul><ul><li>The injuries you have look like the kind I have seen when___. Have you been hurt in this way? </li></ul><ul><li>Are you involved in an abusive relationship? Tell me about it. </li></ul>
  25. 25. Some nursing interventions <ul><li>Make time and privacy to talk </li></ul><ul><li>Listen and validate, not judge </li></ul><ul><li>Document impartially and completely </li></ul><ul><li>Ask. Don’t assume info will be offered </li></ul><ul><li>If abuse is suspected but denied, give info anyway (privately) </li></ul><ul><li>Assist with practical needs </li></ul><ul><li>Remember the legal issues involved with children and elders </li></ul>
  26. 26. Educational Interventions <ul><li>Cycle of violence </li></ul><ul><li>Community resources </li></ul><ul><li>Danger of homicide, esp re leaving the abuser </li></ul><ul><li>Safety planning </li></ul><ul><li>Self esteem issues—redefine self as the survivor </li></ul>
  27. 27. Safety Plans-a few basics <ul><li>Cash, checks, keys, credit card, essentials bag, hidden out of home </li></ul><ul><li>Copies of all vital docs hidden out of home </li></ul><ul><li>Code system, older kids involved </li></ul><ul><li>Route of escape, tell trusted people </li></ul>
  28. 28. Security Plan if you leave <ul><li>Bring kids with you or go back for them with police </li></ul><ul><li>Lock everything, all the time </li></ul><ul><li>Private mail/phone </li></ul><ul><li>Picture of abuser to people who may see </li></ul><ul><li>Don’t keep it a secret, it is not your fault </li></ul>
  29. 29. Some other Intervention Issues <ul><li>Be wary of marriage counseling, people who advise to stay with abuser, abusive parent at all costs </li></ul><ul><li>Note, there are mandatory reporting laws for children and elders. </li></ul><ul><li>Can’t heal trauma well when still under future risk. Safety is paramount. </li></ul>
  30. 30. Post-traumatic Stress Disorder <ul><li>Exposure to trauma </li></ul><ul><li>Re-experiencing traumatic event </li></ul><ul><li>Numbing </li></ul><ul><li>Avoidance of reminders of event </li></ul><ul><li>Anxiety/arousal responses </li></ul><ul><li>Distress in important areas of functioning </li></ul>
  31. 31. Re-experiencing the event <ul><li>Intruding reminders/memories/flashbacks </li></ul><ul><li>Nightmares </li></ul><ul><li>Acting or feeling like the event(s) re-occurring </li></ul><ul><li>Leads to anxiety and acute distress </li></ul>
  32. 32. Types of Avoidance <ul><li>Thought/feelings/conversations about the event </li></ul><ul><li>Stays away from people and places associated with event </li></ul><ul><li>Repression </li></ul><ul><li>Lack of participation with others, detachment, short sense of future </li></ul>
  33. 33. Treatment of PTSD <ul><li>Antianxiety agents for short term relief </li></ul><ul><li>Antidepressants, particularly SSRI’s </li></ul><ul><li>At risk for developing substance abuse due to self-medication for distress </li></ul>
  34. 34. Rape-types <ul><li>Blitz rape—out of the blue, fast </li></ul><ul><li>Confidence rape—more of a set up involved, may know victim and repeat, use threats </li></ul><ul><li>Inability to consent issue— </li></ul><ul><li>Aggression or Sexual Expression? </li></ul>
  35. 35. Rape Intervention-a few points <ul><li>Collecting Evidence while maintaining dignity, respect in initial response </li></ul><ul><li>Privacy, time to talk, one to one contact, rape counselor, follow up </li></ul><ul><li>Anticipatory Guidance </li></ul><ul><li>Community Resources </li></ul>

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