Personality Disorders: Nursing Practice – Theoretical Perspectives and Interview

00:01 So let's think about some theoretical perspectives that might undermine or choose become the foundations, theoretical perspectives that are the foundations to some of these personality disorders.

00:19 We can think about Freud.

00:21 And Freud looked at antisocial, borderline, histrionic, narcissistic personality disorders.

00:28 And he saw all of that as being part of that phallic part of life as we're developing these relationships with self and others.

00:40 We also have object relation basis where we are looking at the stability and depth of a person's relationship with the people around them, the caretakers, the significant others.

00:54 And we sort of see that manifested by warmth, dedication, concern, tactfulness.

01:03 Babies who don't get that have to figure out another way of coping.

01:08 They have to figure out another way of developing a personality that allows them to get what they need.

01:16 What they need: water, food, touch, love, attention, very basic needs, how to get them.

01:30 And if they're not coming to them, then that's what we have to start thinking, how do we give them that missing experience of being cared about? Let's start thinking about the interview with a patient who has a personality disorder.

01:47 We're going to do a semi-structured interview.

01:51 And we want to use a valid and reliable scale to measure the personality impairment.

01:57 Why? Why would we want to do this? That's because sometimes our own judgment might get in the way of being able to do a clinical assessment that is valid, that is free of bias.

02:11 And so when we think about how charming and manipulative some of the patients might be, we might want to do things for them, and help them out, which in fact, is reflective of the impairment that is caused by, for example, a dependent personality disorder.

02:31 We also want to make sure that we get a full medical and psychological history on the patient.

02:37 We need to be mindful to know if that patient has ever used any substances or if they are currently using some substances.

02:48 And right now, it's important to remember that in many states, marijuana is a legal substance and they may not think about telling you.

02:58 It's very common for us to be able to say, "So, do you smoke pot?" Are you using any alcohol at all? And if so, how frequently and how much? These are really important questions to ask when you are asking about substances.

03:17 You might also say, "Are you taking any medications on a routine basis?" "Do you take anything every morning, even if it's a vitamin, can you let me know?" Because they may be self-medicating with over the counter drugs to help them to calm some anxiety.

03:35 There is medication called calm, but it's magnesium.

03:39 And it is a very nice way to calm a person down.

03:43 But how much are they taking and magnesium can cause heart disease and problems with their heart.

03:50 So we want to make sure that we know everything that they're taking.

03:54 We also want to know if there's any background history of abuse, whether there was abuse as childhood, whether there is ongoing abuse.

04:04 One of the things that I normally do is there are two simple questions that usually highlight whether or not there is abuse going on.

04:13 The first question is, "Can you tell me if there's anyone who you are afraid of?" The second question is, "Can you tell me if there's anyone you are afraid for?" These two questions will allow you to see whether or not this person is currently in an abusive relationship or you can say, "In the past, was there anyone you were ever worried for in your family?" And normally, the answer you'll get will let you know whether there is any history at all of abuse.

04:46 Also, you want to know if that person has ever hurt themselves, if they have ever hurt anyone else, or if they have ever tried to take their life by suicide.

04:58 These are important even though they are difficult questions to ask.

05:02 They're extremely important.

05:05 You also want to take a sexual history.

05:08 And you yourself have to be comfortable asking them for sexual history.

05:13 Because a person should not be able to feel uncomfortable themselves, if they have questions about their own gender, if they have questions about their sexuality, and if they find that they are engaging, or using sex, as a powerful or as some sort of exchange.

05:34 These are important for us to know.

05:38 Also, when we are going to be interviewing someone, we want to understand that as we are speaking, we are being evaluated by the patient.

05:51 But also we want to be aware of these aspects of the patient story themselves.

05:57 So listen for the tone of voice, but also listen for your own tone of voice.

06:04 Because a question like, "Do you have anything you want to talk to me about regarding your sexuality?" Can be said this way or gonna be say, "So is there anything you want to tell me about with your sexuality?" These are the same words, but the tone of voice implies a completely different meaning.

06:28 So listen to your own tone of voice while also evaluating your client's tone of voice.

06:35 You also want to be watching body language.

06:38 As you noticed, before when my tone of voice became somewhat judgmental, my hands went across my chest, sort of indicating, "I'm closed off to whatever you have to say." You also want to watch what your patient's body languages.

06:54 If your patient has a somewhat conclave, if they look like they have a collapsed chest.

07:02 This usually lets us know that there is a sense of withdrawal as opposed to somebody who's standing up there and kind of has an image where they're almost daring you to say something.

07:17 That body language can be written down and be quite objective.

07:24 Choice of words are also extremely important.

07:28 If your patient has a dependent personality disorder, their choice of words are going to be words that are going to be flattering to you, and try and get you to take care of them.

07:42 But your choice of words are also important.

07:45 Oftentimes, when I'm doing a semi-structured interview, when the patient will say something to me, I might simply repeat what they say.

07:54 So if they say, "You know, I had a difficult childhood." I might say, "Wow, a difficult childhood." And just by repeating that, allows them to go on and explain it a little bit more.