Anxiety, Somatoform, Dissociative, & Personality Disorders
DISORDER CHARACTERISTICS MEDICAL TREATMENT
Excessive worry/apprehension
Generalized Anxiety all the time.
Disorder (GAD)
Panic Disorder Episodes can last minutes to
hours.
There are times when they
have no anxiety/panic.
Great fear of future attacks, so
limit lifestyle to prevent.
May develop phobias.
Obsessive- Inability to control thoughts
(obsessions) and behaviors
Compulsive (compulsions). Recognizes
Disorder rituals are ridiculous but can't
stop. The O/Cs greatly
interfere with ADLs. Could
be a secondary gain involved.
Phobia(s) Intense fear of someone or
thing.
Inability to overcome the fear.
Goes to a lot of trouble to
avoid the object of the fear.
Post traumatic Grieving behaviors after a
major trauma (rape, fire,
Stress Disorder MVA, war, etc.)
(PTSD) Sense of powerlessness.
Extreme anxiety
Acute: within 6 months Keep reliving event.
of event
Delayed: later than 6
months
DISORDER CHARACTERISTICS
Acute Stress Occurs within 1 month of
traumatic event
Must display 3 dissociative
Relaxation training
Benzodiazepines
Psychotherapy
Relaxation training
Benzodiazepines
Aerobic exercise (but be
careful about panic that can
develop secondary to lactic
acid buildup/pain in muscles)
Benzodiazepines.
Non-reinforcement of
secondary gains.
Modeling desired behavior.
Response delay (wait longer
and longer intervals to act out
compulsion).
Thought stopping.
Benzodiazepines.
SSRIs (Paxil- social phobia).
Behavioral techniques: social
skills training and
desensitization (exposure in
small doses)
Benzodiazepines
Antidepressants
Individual therapy to gain
cognitive mastery of the
situation.
MEDICAL TREATMENT
Relaxation techniques
Benzodiazepines
Individual therapy
NURSING CARE
Assist to ID events that
increase anxiety and those that
bring calm.
Relaxation
Accompany with activities
when too anxious to attend
alone.
Safety is very important for
him and others.
Stay with him during attack.
Maintain calm environment.
Decrease stimuli as much as
possible during an attack.
Use short, clear sentences.
Get him involved in tasks that
are physically tiring to use up
energy .
Help him examine/find what
triggers panic attacks.
Initially, provide time to
carry out rituals. Then little
by little limit rituals (can't go
"cold turkey"). Do NOT
interrupt a ritual once it is
started. Assist with self care.
Get him to journal about
events surrounding the O/Cs.
Don't force.
Behavioral techniques
Initially adjust environment to
prevent exposure to object of
fear.
Encourage talk/expression of
emotions
Be non-judgmental
Safety
Might need suicide
precautions.
Support group for client and
family
NURSING CARE
Same as PTSD
 symptoms (numbing,
detachment, derealization,
depersonalization,
dissociative amnesia, reduced
awareness of surroundings,
sense of absence of emotional
responsiveness from the
experience)

Somatoform
Disorders:
Conversion Disorder Conversion: Loss of physical
function but no physical
basis (paralysis, blindness,
etc.). The loss of function is
very real to the client. Could
be a secondary gain.
Must carefully rule out a
physical problem first.
Psychotherapy
Rehabilitation to overcome
disability.
Anxiolytics, antidepressants
Remember it is real to them.
Be non-judgmental.
Encourage self-care as much
as possible.
Provide safety.
Monitor for new symptoms.
Suicide precautions.
Support for family.

Hypochondriasis Hypochondriasis: Must carefully rule out Remember it is real to them.

Preoccupation with belief of
having a serious illness. No
physical basis. Could be
secondary gain. Anxious,
depressed.
physical problem first.
Psychotherapy.
Relaxation techniques.
Anxiolytics, antidepressants.
Be non-judgmental.
Relaxation techniques, coping
skills
Monitor for new symptoms.
Suicide precautions.

Somatization Somatization Disorder:
Many physical complaints or
belief of serious illness over
many years. No physical
basis.
Must carefully rule out
physical problem first.
Psychotherapy
Anxiolytics, antidepressants.
Listen objectively but don't
encourage dwelling on
symptoms.
Be non-judgmental.
Involve client in his care.

Factitious Disorder: Careful physical workup. Consider abuse and protocol

Factitious Intentionally produced
physical or psychological
symptoms to gain attention
Malingering: symptoms
created for a secondary gain.
Usually it is the mother (or for reporting.
other perpetrator) who needs Care for client and
treatment, not the client. perpetrator.
Benzodiazepines
Relaxation techniques
Coping skills

Munchausen's Syndrome:
usually a mother telling of
child's S&S or actually
causing S&S so as to bring
attention to what a good
mother she is.

DISORDER CHARACTERISTICS MEDICAL TREATMENT NURSING CARE

Dissociative
Disorders:
Dissociative Identity Multiple, individual
Disorder personalities within a person

Can't recall personal

 Dissociative Amnesia information
Can't recall personal
information and also shows
Dissociative Fugue up somewhere away from
normal place of living.
Out of body experience.
Depersonalization Doesn't feel real. Detached.
Disorder Oriented but has sense of
one's own reality temporarily
lost.
Personality All have denial of problems,
thus rarely seek psychiatric
Disorders: help. They are not the
problems--everyone else is.
Rigid, maladaptive behaviors.
Cluster A:
(odd & eccentric)
Paranoid Suspicious. Misperceives.
Schizoid Distant and aloof. Unable to
form relationships. Usually
solitary.
Schizotypal Eccentric behavior. Magical
thinking. Difficulty with
relationships.
DISORDER CHARACTERISTICS
Cluster B:
(dramatic/emotional)
Antisocial Irresponsible, impulsive.
Manipulates and exploits
others. Hostile outbursts.
Believes actions are
justified.
Borderline Impulsive. Outbursts of
anger/rage. Self-mutilation.
Master of manipulation.
Can get staff fighting among
Counseling
Hypnotherapy
Anxiolytics, antidepressants
Neuroleptic therapy.
Symptoms management.
Confrontation not effective.
Outpatient therapy to increase
interpersonal comfort.
Neuroleptic therapy.
Social skills.
Assistance with daily affairs.
Intensive psychotherapy
usually not effective.
MEDICAL TREATMENT
Group psychotherapy.
Confrontation of
inappropriate behaviors.
Group psychotherapy
Individual psychotherapy
Supervised, structured living.
Neuroleptics.
Safety.
Suicide precautions.
Encourage verbalization of
feelings. Don't force issues
they aren't ready to
accept/know
Clarify meanings and contexts
of situations, conversations,
etc. (Can't whisper, etc.)
Develop/nurture trust (He
might have to have foods in
unopened containers, etc.)
Safety.
Allow physical and emotional
space as needed.
Assist to develop social skills.
Safety.
Social skills.
Assist with ADLs.
NURSING CARE
Stable environment.
Consistent and judicious
behavioral limits.
Assist to take responsibility
for consequences of actions.
Stable, structured, consistent
environment.
Adhere strictly to treatment
plan.
 selves (this is called splitting)
Histrionic Melodramatic. Highly
energetic. Bursts of
exaggerated emotions.
Temper tantrums.
Demanding. Self-centered.
Narcissistic Inflated sense of
importance. Feels entitled to
recognition. Needs constant
attention.
Cluster C:
(anxiety & fear-
based)
Hypersensitive to rejection.
Avoidant
Uncomfortable in social
settings.
Unassertive, passive. No
Dependent decision making.
Self-devaluation.
Preoccupied with order and
OCPD rules. Perfectionism.
Inefficient due to constant
worry about doing things
right. Overly concerned with
telling how to do things right.
Review overall interventions for any of the personality disorders at the end of the Blackboard outline provided for class.
Outpatient therapy
Individual or group therapy
Relaxation exercises.
Assertiveness training.
Social skills training.
Relaxation exercises.
Assertiveness training.
Behavior therapy.
Cognitive therapy.
Leisure activities.
Refuse to engage in 3rd party
conversations (don't talk with
him about others).
Teach ways to delay needs
for gratification.
Assist in assuming mature,
adult behavior.
Assist to find ways to express
self in socially acceptable
ways.
Stable, safe environment.
Consistent limit setting.
Assist to find ways to express
self in socially acceptable
ways.
Enhance self-esteem and self-
worth.
Role play--what if?
Enhance ability to confront
social situations.
Enhance ability to speak up
and assume age-appropriate
responsibilities.
Give assignments that involve
risk-taking behaviors.
Confront invalid assumptions
and assist client to develop
new perspectives.
Assist to identify new
solutions to life situations.