A patient tells the nurse that he is planning to hire a private ...

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A patient tells the nurse that he is planning to hire a private detective to follow his wife, who he believes is having an extramarital affair.
 
  The patient looks behind the door to be sure no one is eavesdropping and asks the nurse what she did with his medical record after he left. The patient's behaviors are most consistent with a diagnosis of: a. antisocial personality disorder.
  b. schizoid personality disorder.
  c. paranoid personality disorder.
  d. obsessive-compulsive personality disorder.

Question 2

The characteristic in individuals with personality disorders that makes it most necessary for staff to schedule frequent meetings is:
 
  a. flexibility and unconventional responses to stress.
  b. a desire to achieve emotional intimacy with staff.
  c. a tendency to evoke countertransference and conflict.
  d. an impaired ability to develop trusting relationships.

[steff9894]

Answer to Question 1

C
DSM-IV-TR criteria for paranoid personality disorder include suspiciousness, lack of trust in others, fear of confiding in others, fear that personal information will be used against the individual, holding grudges, and interpreting remarks as being demeaning or threatening. Suspecting loved ones of infidelity or disloyalty is also a frequent feature in this disorder. The patient with antisocial personality disorder is aggressive, manipulative, and exploitative. The patient with schizoid personality disorder is socially avoidant and reclusive. The patient with obsessive-compulsive personality disorder is a perfectionist, is rigid, and is preoccupied with details and control issues.

Answer to Question 2

C
One feature shared among the many personality disorders is an impaired or maladaptive style of relating to others. Another such shared factor is a tendency to rely on maladaptive coping mechanisms (such as splitting) to deal with anxiety. Those factors tend to stir strong emotional responses in staff, leading to countertransference responses (e.g., anger toward the patient), a loss of objectivity, reduced ability to be therapeutic, and possibly staff burnout. Staff meetings are one way to increase awareness of these dynamics and deal with them constructively as a group. Patients with personality disorder tend to be inflexible, demonstrate maladaptive responses to stress, and are unable to develop true intimacy with others and trusting relationships; some seek to avoid intimacy. The problem with trust exists but is not the characteristic that requires frequent staff meetings.