Mastering Borderline Personality Disorder: Essential Exam Questions and Correct Answers for Success

Mastering Borderline Personality Disorder: Essential Exam Questions and Correct Answers for Success A helpful technique for managing feelings is known as the COMMUNICATION TRIAD. The triad provides a specific syntax and order for clients to identify and express their feelings and seek relief. The sentence" consists of three parts: An ------------ statement to identify the prevailing feeling A nonjudgmental statement of the --------------- What the client would like ------------- or what would restore comfort to the situation - ANS "I" emotional trigger differently The PMH-APRN must emphasize with clients that they begin with the: 1.) "I" statements (i.e. I get mad when you treated me that way) or 2.) condition (you treated me that way and I got mad) Why? - ANS "I" statements because condition becomes accusatory, provokes defensiveness Three activities associated with thought stopping are effective: Taking a quick deep breath when the behavior is noted (this also stimulates relaxation) Visualizing a stop sign or saying "---------" when possible (this allows the person to hear externally and internally) Deliberately replacing the undesired behavior with a positive alternative (e.g., instead of ruminating about an angry situation, think about a neutral or positive self-affirmation). The sequencing and combining of the steps puts the person back in ----------- - ANS STOP control. The Office of the U.S. Surgeon General produced a report indicating that the unmet mental health needs of children and their families is a public health crisis (Department of --------- and Human Services [DHHS], 2001). The report calls for a national action agenda to promote mental health in children and treat more effectively their mental disorders. Among the many important goals in this national agenda are plans to: Improve assessment and recognition of children's mental health needs. Eliminate ------------- and socioeconomic disparities in access to care. Educate mental health providers as well as front-line, primary care providers to better recognize and manage children's mental health issues. - ANS -Health and Human Services -racial/ethnic - Psychodynamic Theory - Psychodynamic theory originated with ------------ in his conceptualization of psychoanalysis but has evolved substantia1ly since its original formulation (Gabbard, 2004). Much of ---------- speculation regarding psychosexual stages of development has been rejected, but many components of his ----------theory continue to serve as a foundation for assessment and treatment in child psychiatry (Muratori et al., 2002 A central component of this theory is the concept of psychic --------- which proposes that the child's initial perceptions of the world are defined substantially during the first 5 to 6 years of life and will influence the child's later views and behavior in a causal way. While this stance seems almost a given in today's world, the concept was unheard of when ----------- first proposed it. - ANS Sigmund Freud Freud's (stages of development rejected) PERSONALITY theory still valid psychic determinism, Freud Psychodynamic theory also holds that the child is born with instincts or drives for the --------------- of needs to ensure survival. L--------- is described as the psychic energy that makes the child try to meet these needs. If the needs are not satisfied during development, the child may become so fixated on meeting the needs that they influence much of his or her ----------- - ANS -gratification -Libido -behavior. Psychodynamic Theory: Because the ego and superego prevent the id from getting all needs met, Freud proposed that children attempt to cope with the anxiety associated with need deprivation through the unconscious mental processes known as defense mechanisms. Defense mechanisms commonly employed by children are re---------, re-------- formation, and pro-------------. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. However, the unconscious content continues to influence the behavior and conscious thoughts of the child, often in ways that severely impair his or her ability to function in life. Defense mechanisms are, therefore, considered to be symptoms of -------------- - ANS repression, reaction formation, and projection. mental health problems. Psychodynamic Theory: The focus of treatment is attempting to bring repressed conflicts and issues into awareness so that they can be addressed and resolved. A primary way in which this occurs is through --------, a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. So the relationship between therapist and child is used as a focus for interpretation and change. - ANS transference Developmental Theory - An understanding of developmental theory helps you identify ---------- in adolescent growth and development processes and intervene appropriately. The theories of Freud, Erikson, and ----------- provide considerable insight into the adolescent's struggle to attain adulthood. The development of an adolescent's sense of identity entails a preoccupation with self----------. It also entails a connection between future role and past experiences. In the search for a new sense of sameness and continuity, many adolescents must repeat the crisis resolutions of earlier years to integrate these past elements and establish the lasting ideals of a final identity. According to Erikson, these crisis periods or stages are reviews of the adolescent's sense of t-------, a---------, i--------, and i-------, in that order. Equally important for an adolescent's development is c--------Piaget's research reveal - ANS deviations Sullivan self-image. trust, autonomy, initiative, and industry cognition. formal (3rd stage) 12-14, adult level self-reflective Object-Relations Theory - Object-relations theory is built on the foundation of ------------ theory and is based on the work of Fairbairn, Winnicott, Klein, Mahler, Stem, and others (Kaslow & Magnavita, 2002). In this theory, an object is defined as a -------- or thing in the child's environment that has psychological significance to the child. A major assumption of the theory is that rather than being driven simply by physical needs or instincts that enhance survival, infants have an innate biologic need for -----------. These ------- increase in quality and complexity as a child develops. - ANS psychodynamic person or thing relationships/relationships. Object-Relations Theory - Initially infants are (differentiate or undifferentiate --------------) from the object they seek (the primary caregiver) and are in a state of diffuse, unorganized experiences. The child is totally dependent on the mother to organize the child's different experiences into an ------------. As the young child begins to (differentiate or undifferentiate --------------), that is, separate and develop a sense of his or her own self as an individual, the relationships with interpersonal "objects" in the world of the child are (externalized or internalized ----------) and become the internal mental representations that form the self. The differentiated self forms the basis for the child's future views of his or her own worth and the availability and responsiveness of others. Ultimately, it determines whether or not the child becomes healthy, strong, and creative. Development of the self is c - ANS undifferentiate understandable whole. differentiate internalized repeat in relationships Attachment Theory - Attachment theory builds on the psychodynamic concepts of psychic ---------- and the impact of --------- processes. As in object-relations theory, -----------s are viewed as the organizing principle for the development of psychological well-being in the child. However, the concept of ---------- within the relationship is the main focus of attachment theory. Attachment theory was originally described by ---------- and later extended by Ainsworth and others (Hankin & Abela, 2005). - ANS determinism unconscious relationships security Bowlby/Ainsworth Attachment Theory: Attachment refers to the ---------- bond of the child to another person (the attachment figure) who is perceived as strong or powerful and who can be turned to for ---------- and support in situations of perceived danger or adversity. Infants are viewed as coming into the world with an innate neurobiological structure called the a--------- b-------- system. This evolutionary-based adaptive system monitors and processes information regarding un-------, str---------, or potential -------- as well as the accessibility of the attachment figure during these situations. The infant appraises both the environmental conditions and his or her emotional state to determine how much proximity or contact is needed in order to feel --------. The child then uses attachment behaviors (p------------ or contact-promoting behaviors such as calling, approaching, or ----------) to acquire a sense of security. - ANS socio-emotional protection attachment behavioral uncertainty, stress, or potential danger secure. proximity clinging Attachment Theory: The ways the attachment figure responds to the child's attachment behaviors are considered critical to the foundation of the child's internal working models (Belsky, 2006). These models are ways of viewing relationships that will come to guide the child's evaluation of his or her own capacity to handle e stress, as well as the responses he or she expects of others in times of need. Four major patterns of attachment have been identified as resulting from the initial experiences with the primary attachment: s--------- insecure-a----------- insecure-r-------- dis----------- While the first three patterns reflect different internal working models, the --------- is viewed as a lack of any integrated or consolidated model to guide attachment behavior during situations where comfort or felt security is needed. --------- security is the emotional security a child feels when either physical or emotiona - ANS secure insecure-avoidant insecure-resistant disorganized. disorganized Felt security Attachment Theory: These various patterns can be seen in children by ----- months of age and eventually stabilize into cognitive frameworks that influence all of their intimate relationships in adulthood. While the primary attachment relationship is seen as central to the development of these life patterns, other significant relationships and the child's own degree of resilience or temperamental ------------- are recognized as important mediators in developing secure or insecure attachment patterns. - ANS 12 vulnerability Humanistic-Interactionist Theory - As an PMH-APRN, you not only need knowledge about developmental theories and psychobiology, you must also integrate humanistic-interactionist principles into assessment and interventions to develop a trusting, caring interpersonal relationship with children and adolescent clients. The adolescent developmental period is a time when identity, values, and goals are in a state of flux. You should take into account not only the immediate situation but also the impact of the developmental stage; the social, ethnic, and cultural factors; family influences; and psychodynamic conflicts on the adolescent's behavior. To accomplish this, explore the meaning of the identified problem or ---------- - ANS behavior. Cognitive Behavioral Theory - The origins of cognitive behavioral theory stem from ---------'s behavioral learning school of thought. However, current views integrate more recent cognitive theory and social learning theory traditions (Friedberg & McClure, 2002). The basis of this theory is the importance of the environment in the child's psychological development. The environment encompasses everything to which the child is exposed, including the immediate caregiving environment (the family, school, and neighborhood), as well as the larger socio-cultural milieu within which values and expectations are developed. Infants are viewed as coming into the world with a relatively "blank slate," and they develop personality by being conditioned to respond in certain ways by others in the environment. ---------- is important as well, whereby children learn by watching others and what happens to those people as a result of t - ANS Skinner's Modeling Cognitive Behavioral Theory - The original views of behavioral theory were that positive and negative ---------- alone could condition a child's behavior. These views expanded to recognize the child's ability to deliberate consciously on what occurs and make certain choices about which behaviors are used. This process is called r--------- determinism. The environment provides information that influences the child in choosing how to behave, but interpretation of the ------------ is the determinant of the child's behavior, not the environment itself. However, without the environment, the child has no stimulus toward growth or development. - ANS reinforcement reciprocal interpretation of the environment=behavior Cognitive Behavioral Theory Cognitive theorists emphasize that psychopathology results from particular mental sets or cognitive schemata that involve distortions of reality. Children's experiences with the environment create these schemata, or ways of viewing the world, which then influence what is perceived and how it is processed and understood in all future interactions. Biased or inaccurate ways of thinking or processing information can take a number of forms; for instance: Interpreting things as worse than they are over---------- Selective ------------ Disqualifying the positive Jumping to conclusions P------------ events that are not actually related to the child. Treatment is thus focused on a reeducation or relearning process aimed at the child's --------- beliefs and their related behaviors (Stallard, 2005). This process can occur individually or in a group situation. - ANS Overgeneralizing selective perception Personalizing irrational (group or 1:1) Biologic Theory - Advanced practice psychiatric/mental health nursing in the 21st century requires that you integrate a biologic focus into your practice, to accommodate both --------- client needs and an expanding biologic knowledge base. An appreciation of hormonal changes, growth spurts, stress and ------------ function, chronic illness, depression, and other mental disorders can help you evaluate children and adolescents from a more effective and comprehensive perspective. There are many hypotheses regarding the particular biologic characteristics that may make children and adolescents vulnerable to developing certain psychiatric disorders (Hankin & Abela, 2005). While the exact relationship between various biological factors and mental illness is not yet understood, several hypotheses are discussed in this unit. - ANS changing immune f(x) Biologic Theory - Neurobiological Factors - There is considerable evidence for the role of neurobiological factors in the development of disorders such as a-------- disorder and childhood-onset s------------ Children with these disorders have more physical anomalies, neurologic soft signs, and brain abnormalities on electroencephalograms (EEGs) and in computed tomography (CT) and magnetic resonance imaging (MRI) scans. -Similarly, ----------- poisoning, -------- trauma, and i--------- in childhood have all been implicated as possible causative factors. These problems are considered potential causes of the mental disorder. - ANS autistic schizophrenia. lead CNS infections Biological Theory There has been great concern among parents, consumer advocacy groups, and health care professionals that vaccines given to infants may be linked to the increase in autism. Because of this concern, some parents have been reluctant to have their children protected from childhood diseases through vaccination. Two reasons are generally given for this concern. The first is the use of t-------- (a preservative in vaccines that contains trace amounts of ethylmercury). The second is related to the ------------ immunization schedule for infants. The data do not support the hypothesis that exposure to t------------ causes autism. The rate of autism has increased even with the exclusion of t----------- from childhood vaccines (Schecter & Getcher, 2008). Studies in Canada yield similar results. In fact, one study (Fombonne, Zakarian, Bennett, Mung, & McLean-Heywood, 2006) found that the increase was higher - ANS thimerosol measles-mumps-rubella (MMR) thimerosal/thimerosal/thimerosal/thimerosal MMR Biological Theory Neurotransmitter Secretion - There is growing support for the existence of certain abnormalities in neurotransmitter secretion (Hankin & Abela, 2005). Dopamine and serotonin (5-HT) have been of major interest in a number of disorders. For instance, studies suggest that ------------- levels may be elevated in autism but depleted in childhood depression. However, it is often unclear whether the dysfunction in neurotransmitter levels causes the disorder, or whether the disorder may create nervous system changes that cause the neurotransmitter abnormality. - ANS -5-HT (serotonin) elevated in autism, depleted in depression - Biological Theory Nervous System Responsiveness - Studies also indicate that problems with nervous system responsiveness may be related to certain psychiatric disorders. For example, children with schizophrenia have unusually -------- autonomic system reactivity when in baseline or resting states, and children with ADHD appear to have a ---------- excitability in the reticular activating system of the brain, requiring more stimulation in order to feel optimally aroused. - ANS schizophrenia=high autonomic system ADHD=lowered excitability in reticular activating system