Personality Disorder According DSM-IV Cluster - Assignment Example

Running head: MENTAL HEALTH Mental Health [Writer’s name] [Institution’s name] Mental Health Answer 1 Personality Disorder According DSM-IV cluster Cassandra’s behaviour can be diagnosed borderline personality disorder as thus According to the American Psychiatric Association (APA) Dictionary of Psychology, the DSM-IV, borderline personality disorder, which falls under Axis II, Cluster II, is characterized by: A long-standing pattern of instability in mood, interpersonal relationships, and self-image that is severe enough to cause extreme distress or interfere with social and occupational functioning. (Daniel etal 2006). Criteria Which the Patient Meets According to the DSM-IV diagnostic criteria, it can be said that the patient suffers from BPD; this is a pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following: In this case the patient seems to meet the criteria give below A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This could be seen in the relationship which she had with her boyfriend as they fought often, and thus the relationship ended in a break-up. Apart from this the fact that she idealizes her nurse and has idealistic relationship with her also seems to apart of these criteria. Identity disturbance. Markedly and persistently unstable self images or sense of self. Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex substance abuse, reckless driving, and binges eating) note do not include suicidal or self-mutilating behaviour covered in criterion five. She reported that she has fleeting ideas of self-harm. Apart from Cassandra has a recent history of eating disorder and admits to drinking more than 4 standard alcohol drinks mainly beers daily and sometimes she drinks more when stressed out. Recurrent suicidal behaviour, gestures or threats or self-mutilating behaviour. This too was found in behaviour as Cassandra had been found in a McDonald’s restaurant with self-inflicted cuts to both of her forearms. The wounds were significant which required sutures, though not life-threatening Affective instability due to marked reactivity of mood (e.g. intense episodic disphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days. This could be seen in Cassandra’s behaviour when the Police reported that she fluctuated between crying, pleading, physically fighting with them and using foul language. Apart from this she her mood was noted to fluctuate between being quite tearful at times and charming and joking at other times Prevalence of personality disorder in Australia 65% of Australian adolescents suffer from personality disorder they patients are most likely to be in their young adulthood, male, and bachelors (Oldham 2009). They may also suffer from anxiety disorder, an affective disorder, a substance use disorder, and at times they also suffer from a physical condition. Answer 2 Possible psychodynamic behind the development of Cassandra’s behaviour Borderline personality is associated with early childhood trauma, thus in case it could be fact that he physically, emotionally and sexually abused her from an early age. The fact that Cassandra’s father physically, emotionally and sexually abused her from an early age. According to Fonagy, P. & Bateman (2006) childhood abuse is also a major contributory factor in the etiology of borderline personality. Environmental and dispositions related to family like physical and sexual abuse, extreme lack of affection, and continuous parental neglect, all these factors can become the reason behind the onset of personality disorders. These are extremely strong influences that childhood abuse has developed into a diagnostic factor. It only makes sense that children who are abused form a distorted sense of reality filled with feelings of fear, anxiety, and unpredictability. On the whole, the etiology of border line personality seems to be a multifaceted exchange of chaotic forces which may be existing in the child’s present environment. The fact that most sexually, physically and emotionally abused children tends to show strong symptoms of unstable relationships and fear of abandonment. These symptoms are mostly found in patients with personality disorder like Cassandra’s. The fact that Cassandra was abused at a young age also cause her develop recurrent self mutilating behaviour; she tends to cut herself when ever someone emotionally hurts her as she does not know how to express her emotions. When her binge eating and drinking habits are due to the abuse she faced from her father. She uses this coping mechanism against her depression and difficult relationships with those who are close to her Answer 3 3 major issues/problem/risks Patients suffering from with personality disorder like Cassandra’s may also develop depression and anxiety disorders. In this personality disorder the above mentioned risk is quite high. Suicide is sadly common amongst people suffering from personality disorder like Cassandra’s. However, along with the personality disorder diagnosis, there are a few risk factors that may cause additional risk for an attempted suicide. For instance, if someone is suffering from borderline personality along with a substance use disorder or owns a gun, then that person is at a greater risk. Patients of personality disorder like Cassandra’s may also indulge in smoking and substance abuse. Answer 4 Nurses Management and Personality Disorder Within the clinical setting, a nurse, assist the patient with the prescribed therapy. Some interventions would include giving medications, controlling the milieu, and ensuring patient safety. The patient should be encouraged to identify sources of support, explore the causes and consequences of anomalous behaviour, and perform anxiety-reducing behaviours such as relaxation techniques or physical activity. The patient should be directed in identifying emotions appropriate responses to that emotion. All of these can be done in a 1:1 setting or in group setting (Stuart 2005). Medication The nurses should make sure that eth patient takes the medication on time as skipping the medication could lead to intense arousal of symptoms. The nurses should give antidepressants as they usually help with depression, apart from this the nurses may also give specific medicines like Prozac and Zoloft to help with impulse control. Mood stabilizers such as tegretol and depakote should also be given to the patients so that the mood swings and irritability can be controlled Nurses can also request the psychiatrist to recommend low doses of high potency neuroleptics as they may help in the disorganized thinking and a few of the intense psychotic symptoms. Nurse should keep in mind that sometimes depression can be controlled by neuroleptics and thus should make sure that patient takes this medication especially on time. Neuroleptics are mainly suggested for the psychotic symptoms which Cassandra had exhibited. Thus nurses should also always remember that dosages should normally be low and the medication must not be given without the prescription of the psychiatrist. Even today, much of psychiatric nursing practice is still grounded in tradition, unsystematic trial and error, and authority, rather than being based on sound empirical investigations (Wilson, 2004). Required Attitude Nurses who handle such patients have to be very careful with their attitudes. The have to keep an attitude with the client solely based on a person-to person manner. The nurse also has to pay considerable amount of attention to context, situation, and environment. Nurses often think patients with personality disorders are healthier than other patients as they talk and act in a “normal” behaviour (DeLaune, 2004). Thus, when they exhibit behaviours like being highly attached, selfish, demanding, or dominating. Nurses at this sage have to keep a positive attitude they must not think that the patient has tricked. Infact they should deal with the patient according to the patient’s mood. According to Bland and Rossen (2005) Personality disorder is usually diagnosed when people suffering from it exhibit strange behaviour while interacting with others and with environments, therefore provided that theorists suggest that individuals who appear to be functioning within stable environments may perhaps afterward present the false impression that they are stable. Nurse has to keep in mind this impression is only a mask of normality. From this point of view, personality disorder may be known as a situational disorder; the behaviour of the client might be determined via the circumstances in which they find themselves. The nurses always should consider significance of emotional personality variables that support the view that people with this disorder show constancy in their behaviour, behaviours seemed to be more controlled by the situations in which people were in and the belief that people responded differently, or inconsistently, as situations changed. There is, then, a plausible case that the prevailing social situation shapes the behaviour of the individual and, indeed, maintains the environment in which maladaptive and repetitive patterns occur, thus defining the personality disorder. Whereas the nurse should realize that every situation will have individual affects and change the environment just because they are there. Thus nurses also have should share the environment which there is experiencing for example the world of the ward or community. Negative Responses of Clients Thus, Nurses caring for such patients must realize that the negative responses of clients with a personality disorder can take place, due to the situations, circumstances, and particular confrontation in which they themselves are involved. Moreover, this all may be completely influenced by a useless, unaware, and unprepared nurse. This will make matters even worse. Nevertheless, these situational dimensions are usually neglected in nursing services, which don’t focus on the individual and thus they don’t pay attention to attention to context, situation, and psychosocial environment. According to Bland etal (2004) Nursing ‘theory’ thus states that therapeutic interaction is important in felid of to mental health nursing , whereas one of the most important predictors of positive change can be caused by ‘talking’ therapies, this increases the strength of the ‘therapeutic alliance’ In psychiatry mental health nurses are the main professional discipline which provides care daily. Nurses thus have an essential responsibility to develop strong and powerful therapeutic relationship. Answer 5 Cassandra’s statements are quite normal for patients who suffer from borderline personality disorder. As Cassandra like other personality disorder patients is exhibiting attachment relationships and attachment behaviours due to the trauma of childhood abuse she has gone through. As patients like Cassandra are shift from their home settings into hospital setting they tend to be exhibit a lot of hostile and attachment behaviour. Thus I would manage her statements by acting emphatically with the patient and by applying Transference-focused psychotherapy by further strengthening the relationship with the patient. It is obvious that patients like Cassandra who is emotionally unstable benefit from a reasonably long-lasting relationship with their caretakers in the hospital. As stable therapeutic attachment can be useful in assisting patients to function psychologically. Because this disorder is complicated in nature, nurses that care for these patients have to handle their hostility, dependency needs, attachment, and abandonment issues. They nurse need to talk patently and politely with these patients; like they could say II will not abandon you do not worry I am here now you can relax. Transference takes place with such patients, they tend to transfer the intense feeling of love, attachment or hate which they had with their parents. They then transference those original feelings with their relationship with the nurse. In this case Cassandra felt abandoned by her boyfriend or even her mother so she showed a fear of being abandoned to the nurse. Here if I was eth nurse I too would show positive behaviour as the response as counter transference affects the patient’s therapeutic relationship. References Bland, A. R., & Rossen, E. (2005). Clinical supervision of nurses working with patients with borderline personality disorder. Issues in Mental Health Nursing, 26(5), 507-517. Bland, A. R., Williams, C. A., Scharer, K., & Manning, S. (2004). Emotion processing in borderline personality disorders. Issues in Mental Health Nursing, 25(7), 655-672. Daniel F. Beckera, Thomas H. McGlashanb and Carlos M. Grilo ( 2006) Exploratory factor analysis of borderline personality disorder criteria in hospitalized adolescents ; Comprehensive Psychiatry Volume 47, Issue 2 DeLaune, S. C. (2004). Personality disorders. In C. R. Kneisl, H. S. Wilson, & E. Trigoboff (Eds), Contemporary psychiatric-mental health nursing pp. 479–505. New Jersey: Prentice Hall. Fonagy, P. & Bateman, A. (2006) Progress in the treatment of borderline personality disorder. British Journal of Psychiatry, 188, 1 –3. Oldham John (2009); Borderline Personality Disorder Journal of Psychiatric Practice. 15(3):159, Stuart, G., & Laraia, M. (2005). Principles and Practice of Psychiatric Nursing (8th Edition Ed.) St. Louis: Mosby. Wilson, H.S. (2004). Evidence-based practice in psychiatric — mental health nursing. In C.R. Kneisl, H.S. Wilson, & E. Trigoboff, (Eds), Contemporary psychiatric — mental health nursing pp. 42-56. New Jersey: Prentice Hall. Read More