Psychiatric Mental Health Nursing by Videbeck

16 PERSONALITYDISORDERS 383

APPLICATION OF THE NURSING
PROCESS: ANTISOCIAL
PERSONALITY DISORDER

Assessment

Clients are skillful at deceiving others, so during as-
sessment it helps to check and to validate information
from other sources.

HISTORY

Onset is in childhood or adolescence, although formal
diagnosis is not made until the client is 18 years of
age. Childhood histories of enuresis, sleepwalking,
and syntonic acts of cruelty are characteristic pre-
dictors. In adolescence, clients may have engaged in
lying, truancy, vandalism, sexual promiscuity, and
substance use. Families have high rates of depres-
sion, substance abuse, antisocial personality disorder,
poverty, and divorce. Erratic, neglectful, harsh, or
even abusive parenting frequently marks the child-
hoods of these clients (Johnson et al., 2000).

GENERAL APPEARANCE AND

MOTOR BEHAVIOR

Appearance usually is normal; these clients may be

quite engaging and even charming. Depending on the

circumstances of the interview, they may exhibit signs

of mild or moderate anxiety especially if another per-

son or agency arranged the assessment.

MOOD AND AFFECT

Clients often display false emotions chosen to suit the

occasion or to work to their advantage. For example, a

client who is forced to seek treatment instead of going

to jail may appear engaging or try to evoke sympathy

by sadly relating a story of his or her “terrible child-

hood.” The client’s actual emotions are quite shallow.

These clients cannot empathize with the feelings

of others, which enables them to exploit others with-

out guilt. Usually they feel remorse only if they are

caught breaking the law or exploiting someone.

THOUGHT PROCESS AND CONTENT

Clients do not experience disordered thoughts, but

their view of the world is narrow and distorted. Be-

cause coercion and personal profit motivate them,

they tend to believe that others are similarly gov-

erned. They view the world as cold and hostile and,

therefore, rationalize their behavior. Clichés such as,

“It’s a dog-eat-dog world,” represent their viewpoint.

Clients believe that they are only taking care of them-

selves because no one else will.

SENSORIUM AND INTELLECTUAL

PROCESSES

Clients are oriented, have no sensory-perceptual

alterations, and have an average or above-average IQ.

JUDGMENT AND INSIGHT

These clients generally exercise poor judgment for

various reasons. They pay no attention to the legality

Steve found himself in the local jail again after being ar-

rested for burglary. Steve had told the police it wasn’t

breaking and entering; he had his friend’s permission to

use his parents’ home, but they’d just forgotten to leave

the key. Steve has a long juvenile record of truancy,

fighting, and marijuana use, which he blames on “hav-

ing the wrong friends.” This is his third arrest, and Steve

claims the police are picking on him ever since an el-

derly lady in the community gave him $5,000 when he

CLINICALVIGNETTE: ANTISOCIALPERSONALITYDISORDER

was out of work. He intends to pay her back when his

ship comes in. Steve’s wife of 3 years left him recently,

claiming he couldn’t hold a decent job and was running

up bills they couldn’t pay. Steve was tired of her nag-

ging and was ready for a new relationship anyway. He

wishes he could win the lottery and find a beautiful girl

to love him. He’s tired of people demanding that he

grow up, get a job, and settle down. They just don’t un-

derstand that he’s got more exciting things to do.

◗ SYMPTOMS OFANTISOCIAL

PERSONALITYDISORDER

• Violation of the rights of others


• Lack of remorse for behavior


• Shallow emotions


• Lying


• Rationalization of own behavior


• Poor judgment


• Impulsivity


• Irritability and aggressiveness


• Lack of insight


• Thrill-seeking behaviors


• Exploitation of people in relationships


• Poor work history


• Consistent irresponsibility