Personality Disordera And Cycle of Violence and Abuse

8/9/2019 Personality Disordera And Cycle of Violence and Abuse

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Maladaptive Behavior Patternspersonality disorders and abuse

What sort of future is coming up frombehind, I really dont know. But thepast, spread out ahead, dominateseverything in sight. R.M Pirsig from Zenand the Art of Motorcycle Maintenance


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People with Personality

Disorders have long term:

Low frustration tolerance

Pain intolerance Over reaction to life events

Lack of impulse control

Immature coping strategies (over use ofdefense mechanisms) Impaired personal relationships


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Nursing Issues with all PD:

Balance in your expectations forchangehope, but not a quick fix

Be authentic, patient, trustworthy

Have good limit setting skills

Have good ego boundaries

Have good team communication, todecrease splitting


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The Odd/Eccentric Group:

Schizoid, Paranoid, Schizotypal

Some nursing issues include:

ineffective individual copingsocial isolation

defensive coping


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Paranoid Personality D/O

Fear others will harm or exploit

Hypervigilant and tend to be hostile (asa response to perceived threat) Can become psychotic if stressed

Nursingbe consistent, truthful, out inthe open. Approach with care and tellwhat is happening, what you are doing


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Schizoid Personality D/O

Doesnt want relationships

Flat affect, little emotion seen, notaware there is a problem with this

Few relationships, can becomedelusional if stressed

Nursing-build trust slowly, consistent,not overly emotional or smothering


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Schizotypal PD

Has social anxiety. Wants relationshipsbut not skilled at getting them.

Often has eccentric thinking and/orbehavior

Nursing-be consistent, trustworthy,

keep clear boundaries, help ct. withvery gradual change in social bx.


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Dramatic/ Emotional PDs Includes Antisocial, Borderline,

Histrionic, and Narcissistic

Focus more study energy on Antisocialand Borderline

Sample nursing diagnoses include:

Altered family process, ineffectiveindividual coping, self mutilation, riskfor violence, low self esteem


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Antisocial PD (more men) Feels entitled, acts charming to get way

Deceitful, manipulative, vengeful Seeks risks, stimulation (drugs, sex,

crime, gambling) Has no conscience or empathy

Irresponsible and unsafe


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Borderline PD (more women) Overwhelmingly emotionally needy,

despairing. Angry, dysphoric, labile

Lives in a crisis and creates a crisis iftoo calm

Abandonment issues are key

Self destructive behavior and mutilationoccur

Splitting, dichotomous thinking


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Histrionic PD

Dramatic, flambouyant

Charming, intense, but shallow inrelationships

Center of attention, if not gets upsetand creates stir

May have dramatic ups and downs.


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Narcissistic PD Self absorbed and self centered

Overestimates own self worth as adefense to cover self doubt

Grandiose. Wants attention, praise,admiration. If this doesnt happen,

becomes upset/angry/vengefulVery critical. Little tolerance for

imperfection


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Anxious and Fearful PD: avoidant,

dependent, and obsessive compulsive

Of all three, dependent is most common

Nursing diagnosis can include:Self esteem disturbance

Anxiety

Hopelessness

powerlessness


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Avoidant PD

Often co-occurs with social phobias

See social isolationVery sensitive to criticism and afraid of

being judged negatively

Feels rejected a lot, fears being rejected

Low self esteem


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Dependent Personality D/O

Passive, submissive, self sacrificing

Few self initiated behaviors Little decisionmaking

Tolerates maltreatment, being bossed

Urgent need to be in relationship inwhich someone else is in control


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Obsessive Compulsive PD

R/t OCD

Thrifty, saving, verbose, organized

Critical of self and others

Rigid emotionally; taskmasters, have ahard time expressing emotion


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Abuse: Incidence is high 1.8-2.9 million battered women each yr in US.

Battering is single most common cause of

injury to women. 8% women are batteredbefore or during pregnancy.

2 million reported cases of child abuse eachyr in US (2000-5000 die)

0.5-1 million cases of elder abuse in USyearly.


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Why abuse continues ( a few

reasons) Society legitimizes violence and privacy

Intergenerational acting like we haveseen growing up

Structural inequality of abused persons

Stockholm syndrome (discuss)


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Power and Control Issues-

ways abusers act

Threats and coercion

Economic restriction Intimidation(pets, weapons, breaking) Emotional abuse

Isolate the abused person Denial

Threaten loved ones (esp. children)


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Cycle of Violence

Tension buildingtension, blaming,aggression in abuser

Abuse (battering) episodeacuteepisode of abuse

Calm/honeymoonacts calmer, nicer,

may apologize/gifts/promises. In severeabuse this may be minimal


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Myths that create problems in

stopping abuse If the abuse was that

bad the victim would

tell or get out Victim deserves it

Abuse only occursamong the poor anduneducated

Families should be kepttogether at all costs

If it werent for drugsand alcohol, the abusewouldnt have occurred

Victims are lying orexaggerating to getattention

Batterers areuneducated men whocan be spotted easily

Families should alwaysbe kept together


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Abusers typically: Victims of abuse in

youth

Lack empathy, andminimizeseriousness of abuse

Controlling

Jealous

Impulsive

Low frustrationtolerance

Angry, violencefocused

Attribute failure toothers behavior

Traditional views Often alcohol/drug

abuse


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Some Assessment findings

that hint at abuse: Frequent ER visits

Withdrawn/depresd

Inconsistent physicalfindings

Multiple suicide

attempts Overprotective

family member

Alcohol or otherdrug abuse

One car accident Delay in seeking

medical care

Injury to head,

sexual organs Injuries in various

stages of healing


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Some assessment questions What happened?

Have you been in a

fight? Tell me aboutit.

The injuries youhave look like the

kind I have seenwhen___. Have youbeen hurt in thisway?

Are you involved inan abusive

relationship? Tell meabout it.


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Some nursing interventions Make time and

privacy to talk

Listen and validate,not judge

Documentimpartially and

completely Ask. Dont assume

info will be offered

If abuse issuspected but

denied, give infoanyway (privately)

Assist with practicalneeds

Remember the legalissues involved withchildren and elders


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Educational Interventions Cycle of violence

Community resources

Danger of homicide, esp re leaving theabuser

Safety planning

Self esteem issuesredefine self as thesurvivor


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Safety Plans-a few basics Cash, checks, keys, credit card,

essentials bag, hidden out of home

Copies of all vital docs hidden out ofhome

Code system, older kids involved

Route of escape, tell trusted people


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Security Plan if you leave Bring kids with you or go back for them

with police

Lock everything, all the time Private mail/phone

Picture of abuser to people who may

see Dont keep it a secret, it is not your

fault


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Some other Intervention

Issues Be wary of marriage counseling, people

who advise to stay with abuser, abusiveparent at all costs

Note, there are mandatory reportinglaws for children and elders.

Cant heal trauma well when still underfuture risk. Safety is paramount.


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Post-traumatic Stress Disorder Exposure to trauma

Re-experiencing traumatic event Numbing

Avoidance of reminders of event

A

nxiety/arousal responses Distress in important areas of

functioning


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Re-experiencing the event Intruding

reminders/memories/flashbacks

Nightmares

Acting or feeling like the event(s) re-occurring

Leads to anxiety and acute distress


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Types ofAvoidance Thought/feelings/conversations about

the event

Stays away from people and placesassociated with event

Repression

Lack of participation with others,detachment, short sense of future


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Treatment of PTSD Antianxiety agents for short term relief

Antidepressants, particularly SSRIs

At risk for developing substance abusedue to self-medication for distress


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Rape-types Blitz rapeout of the blue, fast

Confidence rapemore of a set upinvolved, may know victim and repeat,use threats

Inability to consent issue

Aggression or Sexual Expression?


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Rape Intervention-a few

points Collecting Evidence while maintaining

dignity, respect in initial response

Privacy, time to talk, one to onecontact, rape counselor, follow up

Anticipatory Guidance

Community Resources

Personality Disordera And Cycle of Violence and Abuse

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