Learning Activities
(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to the interactive activities are provided as immediate feedback.)
Please respond to the following questions.
1. Compare the difference between obsessive-compulsive personality disorder and the anxiety disorder of obsessive-compulsive disorder (OCD).
2. Name that personality disorder. Read each scenario and choose a personality disorder associated with the traits included in the scenario:
a) Darla enters the breakroom at her job. She is dressed provocatively with excessive jewelry. She makes eye contact with everyone. She sits down and quickly interjects herself into the conversation. When one of her coworkers shares pictures of her new puppy, she pulls out her cell phone to show pictures of herself and tells the group how she had a romantic weekend with her handsome, rich boyfriend.
b) Bob has been summoned to his supervisor’s office. Despite his adequate job performance, he thinks to himself, “I knew it! She’s out to get me and I am getting fired! She and others walk by my desk several times a day just to check up on me and see what I am doing. And that new employee has been trying to strike conversations with me, but I am not falling for that. I am sure he just wants something from me.”
c) Debbie is distraught after her boyfriend called her and told her their relationship was over. She began yelling on the phone, “I love you and can’t live without you.” The ex-boyfriend ends the phone call. Debbie begins calling him over and over; however, he doesn’t answer the phone. She then leaves a message stating, “I hate you. I never want to see you again.” Overcome with emotion, she begins to cut her wrist with a bobby pin.
d) George is a loner and lives alone with his five cats. He has family members who live in the area, but he hasn’t seen them in years, and that is okay with him. He has never been married or been in an intimate relationship. He does not have any close friends. He enjoys his job as a night security guard because there is little requirement for social interaction.
e) Jordan is always trying to please others. She has trouble starting or completing projects because of a lack of self-confidence. She requires much reassurance and advice when making ordinary decisions. She allows her boyfriend to tell her what to wear, what kind of job to look for, and with whom to associate. She is afraid of him leaving her, so she is very careful not to get him mad at her.
f) Roger has been arrested several times for domestic abuse and driving while intoxicated. He shows no remorse for any of his actions or the injuries he has caused others. He lies, breaks laws, and has no regard for the feelings of others. As a teenager, he was always in trouble and truant from school. He was incarcerated in the past but found it easy to manipulate the guards into breaking the rules for him.
g) Deanna has very few friends. She is shy and avoids social interaction, even at work. She is worried that if she did get to know people better, she might say or do something embarrassing, and they might criticize or reject her. During her performance evaluation with her supervisor, she left the office crying because of minor constructive feedback she received. To prevent these painful experiences, she believes it is best to keep to herself.
h) Billy tells everyone how important he is to his company. He believes there is no way the company would be successful without him. During work meetings, he monopolizes the conversation and strives to be the center of attention. He often asks others, “Don’t you think I did a great job with that?” Although he does not have any close relationships with coworkers, he does collaborate with a few of them because they are able to help him accomplish his goals.
i) Bobbi works as an administrative assistant. She is very organized and spends a lot of time making lists, scheduling, and reviewing details. Although she has several friends, she often passes on the opportunity to get together because she spends most of her time devoted to work. Sometimes, despite her efforts, she has difficulty finishing a project because she feels the need to check things “one more time.”
j) Paul is loner and lacks close friends outside of his immediate family. Most view him as being very unusual, including his odd way of dressing. He wears ill-fitting and bizarre clothing combinations, such as winter boots with shorts. He is very superstitious and believes he is psychic. He believes prime numbers are unlucky and avoids objects (e.g., building floors and house numbers) that are prime numbers.
3. Check your medication knowledge. Select which medications are commonly used to treat severe symptoms of personality disorders.
a) What medications are used to treat hallucinations and paranoia?
b) What medications are used to treat depressed mood, mood lability, anger, and anxiety?
c) What medications are used to treat self-injurious behavior?
4. Compare normal adolescent development with trait similarities of personality disorders.
Case Study
Nurse Handoff Report:
Situation: Tara Mitchell was admitted to the hospital last night for observation after being found outside the back door of a local bar where she works as a waitress, burning her arm with a cigarette. She has a history of non-suicidal self-injurious behavior since she was a teenager, including cutting, burning herself, and pulling out her hair. Eight months ago, she was admitted to the hospital after a suicide attempt in which she jumped out in front of a car after her shift at another local bar. She states that thinking about suicide helps her relax and she feels like she can “escape” from her distracted thoughts that occur throughout the day.
Background: Tara was diagnosed with borderline personality disorder following her most recent hospitalization. She has been non-compliant with therapy. Her medical records indiate that when growing up, her father was in the military and was often physically abusive, especially when using alcohol or drugs. He was diagnosed with PTSD after returning from serving in Somalia. Her mother worked two jobs when she was growing up and was not around much. She has two siblings, a brother and a sister, but neither remains in the area and she has not had contact with them for “several years.” Tara dropped out of college with one year of classes left to complete a Graphic Design degree. She has spent the past three years changing jobs frequently, mostly working as a bartender or waitress in local restaurants and bars.
Assessment: Since admission, Tara has been quiet and withdrawn in her room. She complains of the “worst pain ever” related to 8 circular burn marks that are present on her left forearm in the shape of the number 8. She does not make eye contact when communicating, but instead looks outside the door or over the person’s shoulder. Her hair is down and her makeup is smeared below her eyes. She is wearing hospital scrubs. During her admission assessment, Tara stated she burned her arm because she was “upset at the bartender because they did not make her drink order first.” She said, “They hate me. I don’t know why I keep coming back to that job. They are the most incompetent people in the world!”
Tara “zones out” at times during conversation, even in the middle of speaking a sentence. She states, “I don’t even know who Tara is. I feel like I’m watching what she does from outside of my body.”
Tara explains that she has a long history of frequently changing hobbies, jobs, fashion sense, and relationships based on her current social circle. At times, she thinks her friends, family, and partner are “the best thing that ever happened to me,” buying them gifts and sending caring messages frequently. At other times, she completely turns on her relationships, saying, “I can’t stand them” and lashes out at them in person, physically, and/or on social media. These actions cause her to feel remorse, and she feels immediate regret and a strong fear that they will leave her. Tara also has a history of sexual promiscuity, even with partners she didn’t even know, and doing such acts so that her current partner doesn’t know.
When asked about why she burned herself with the cigarette, she explains that she was angry that she had to work while her current boyfriend, Josh, went to a bachelor party for his best friend, Ben. She states, “I was sure that Josh was going to hook up with someone else at the party.”
Reflective Questions:
1. What CUES do you recognize as relevant for providing client-centered care for Tara?
2. What is your hypothesis for Tara’s priority nursing problem(s)?
3. What are your first steps in providing nursing care for Tara?