NLE Psychiatric Disorders — Personality, Somatic, and Eating DisordersCheat Sheet

Section Title

Personality Disorders — Cluster Classification

Important Facts

• Three clusters: A (Odd/Eccentric), B (Dramatic/Erratic), C (Anxious/Fearful)
• Cluster A: Paranoid, Schizoid, Schizotypal
• Cluster B: Borderline, Antisocial, Histrionic, Narcissistic
• Cluster C: Avoidant, Dependent, Obsessive-Compulsive Personality Disorder
• Clients often lack insight into their own patterns (ego-syntonic)
• Personality disorders are ENDURING — not acute episodes; stable over time
• Medication targets SYMPTOMS, not the disorder itself

Key Definitions

Diagrams To Know

• Cluster A–B–C triangle showing characteristics of each
• Behavioral patterns within each cluster

Section Title

Cluster A — Odd or Eccentric

Important Facts

• PARANOID: Does NOT have true delusions; distrust is based on interpretation, not fixed false beliefs
• SCHIZOID: No distress with isolation; hallmark is RESTRICTED AFFECT (flat, cold)
• SCHIZOTYPAL: Sits between schizoid and schizophrenia; has perceptual oddities but not psychosis
• Cluster A often misdiagnosed as autism spectrum or intellectual disability — key is the interpersonal/behavioral pattern
• Nursing approach: HONEST, CONSISTENT, NON-INTRUSIVE; respect need for distance

Key Definitions

Diagrams To Know

• Spectrum from schizoid (withdrawn) → schizotypal (odd thinking) → early psychosis

Section Title

Cluster B — Dramatic, Emotional, Erratic

Important Facts

• BORDERLINE: Most common PD in psychiatric settings; highest suicide risk in PD group
• BPD hallmarks: FEAR OF ABANDONMENT, SPLITTING, UNSTABLE INTENSE RELATIONSHIPS, IDENTITY DISTURBANCE, CHRONIC EMPTINESS, SELF-MUTILATION & SUICIDAL BEHAVIOR
• BPD: Impulsivity in ≥2 areas (substance abuse, binge eating, reckless driving, sexual behavior)
• ANTISOCIAL: Onset of symptoms by age 15 (conduct disorder in childhood); prevalence higher in males; prison population ≈50%
• ANTISOCIAL: Manipulation and deceitfulness are core; charm is a TOOL, not genuine
• HISTRIONIC: Highly emotional but emotions are reactive/performative; seeks reassurance constantly
• NARCISSISTIC: Can hold high-status jobs BUT lacks empathy and exploits relationships; fragile self-esteem beneath grandiosity
• NURSING for Cluster B: FIRM, CONSISTENT LIMITS; UNIFIED TEAM APPROACH (all staff agree on plan); SAFETY PRIORITY for BPD; DO NOT TAKE MANIPULATION PERSONALLY

Key Definitions

Diagrams To Know

• Cycle of idealization → disappointment → devaluation in BPD relationships
• Manipulation tactics used by ASPD and how to recognize them
• BPD emergency response flowchart (suicide threat → assessment → intervention)

Section Title

Cluster C — Anxious or Fearful

Important Facts

• AVOIDANT: NOT the same as avoidant attachment; involves pervasive avoidance across all social contexts
• AVOIDANT: Distinguishing feature is DESIRE for connection but FEAR of rejection prevents it
• DEPENDENT: Similar fear of abandonment as BPD, but mechanism is CLINGING, not idealization/devaluation
• DEPENDENT: Decision-making paralysis is hallmark; seeks reassurance excessively
• OCPD: RIGID THINKING; preoccupied with CONTROL and EFFICIENCY; contrasts with impulsive Cluster B
• OCPD: Is NOT OCD (Obsessive-Compulsive Disorder in Anxiety chapter); OCPD involves personality traits; OCD involves unwanted intrusive thoughts
• NURSING for Cluster C: ENCOURAGE INDEPENDENT DECISION-MAKING; PROVIDE SUPPORT WITHOUT FOSTERING DEPENDENCE; SET REALISTIC GRADUAL GOALS

Key Definitions

Diagrams To Know

• Continuum: Avoidant (fear-driven withdrawal) vs. Dependent (fear-driven clinging) vs. OCPD (control-driven rigidity)
• Decision-making support pathway for dependent clients

Section Title

Personality Disorders — Universal Nursing Management

Important Facts

• CONSISTENT STRUCTURED APPROACH across all caregivers; unified team communication prevents splitting and manipulation
• CLEAR, ENFORCED LIMITS non-punitively; clients need to understand consequences AND feel respected
• SAFETY ASSESSMENT PRIORITY: BPD (suicidal/self-harm), ASPD (harm to others), NARCISSISTIC (relationship harm)
• DBT is TREATMENT OF CHOICE for BPD (especially self-harm/suicidality); involves 1-year+ commitment
• Medication: Targets SYMPTOMS (mood instability, impulsivity, transient psychosis), NOT disorder; no cure medication
• Common meds: SSRIs (mood), antipsychotics low-dose (paranoid ideation, impulsivity), mood stabilizers (borderline/antisocial impulsivity)
• THERAPEUTIC RELATIONSHIP: Professional, boundaried, warm but not over-involved; avoid countertransference (anger at manipulation, pity for dependence)
• HOLD ACCOUNTABLE without being punitive: 'I see you're upset. That choice led to this consequence. What will you do differently next time?'
• Teach family: Consistency, non-judgmental stance, not rescuing the client; recognize that change is SLOW and NONLINEAR

Key Definitions

Diagrams To Know

• Four-pronged DBT approach (individual therapy + skills + phone + consultation)
• Nursing intervention pyramid for personality disorders (safety → limits → engagement → growth)

Section Title

Somatic Symptom and Related Disorders — Overview

Important Facts

• KEY DISTINCTION: Symptoms are REAL to the client and NOT INTENTIONALLY PRODUCED in SSD, IAD, and conversion
• FACTITIOUS is INTENTIONAL deception but for the SICK ROLE, not for money/work avoidance (that's malingering)
• All somatic disorders can COEXIST with genuine medical illness; rule out organic causes first
• SSD: Excessive thoughts/behaviors (rumination, reassurance-seeking, health-related research, body scanning)
• IAD: Symptoms MINIMAL but preoccupation is HIGH; frequent doctor visits, medical tests, reassurance-seeking
• CONVERSION: Neurologic deficits that DON'T match anatomical/neurologic patterns (e.g., stocking-glove anesthesia, non-anatomic paralysis)
• CONVERSION: Often linked to recent psychological stressor; may have insight that it's psychological or may not
• NURSING: VALIDATE symptoms as real; DO NOT confront 'it's all in your head'; AVOID excessive attention that reinforces sick role
• NURSING: Limit time spent discussing symptoms; redirect to healthy coping, activity, stress management
• NURSING: Maintain CONSISTENT PRIMARY PROVIDER to reduce doctor-shopping and redundant tests

Key Definitions

Diagrams To Know

• Somatic spectrum: IAD (thoughts) → SSD (symptoms + thoughts) → Conversion (neurologic) → Factitious (intentional)
• Decision tree: Organic illness ruled out → Symptoms present but not explained → Is it intentional? (Yes=Factitious; No=SSD/Conversion/IAD)

Section Title

Somatic Disorders — Nursing Management

Important Facts

• FIRST: Rule out genuine medical illness (MI, appendicitis, thyroid, infection) before labeling as somatic
• ACKNOWLEDGE the symptoms are REAL; pain, dizziness, and fatigue are genuine experiences from the client's perspective
• MATTER-OF-FACT approach: Provide standard medical care without excessive attention that reinforces sick role
• AVOID: Excessive reassurance ('You're fine'), confrontation ('It's not real'), or dismissal ('Stop complaining')
• LIMIT secondary gain: Reduce privileges tied to sick role (e.g., extended time out of activities, special meals, constant monitoring)
• REDIRECT: Toward healthy coping, activity engagement, stress management, and work/social reintegration
• TEACH CONNECTION: Help client gradually recognize link between stress/emotions and physical symptoms; this takes TIME
• FAMILY INVOLVEMENT: Educate family to avoid reinforcing sick role (e.g., not excusing from responsibilities, normalizing activity)
• PSYCHOTHERAPY: CBT, mindfulness, acceptance and commitment therapy (ACT) are effective
• MEDICATION: Antidepressants (SSRIs) help if comorbid depression/anxiety; not curative for the somatic disorder itself
• DO NOT order repeated tests to 'prove' nothing is wrong; increases anxiety and reinforces health preoccupation
• CONSISTENT PRIMARY PROVIDER reduces fragmentation of care and multiple investigations

Diagrams To Know

• Somatic symptom management cycle: Stress → Symptoms → Health anxiety → Reassurance-seeking → Temporary relief → Cycle repeats

Section Title

Eating Disorders — Overview & Epidemiology

Important Facts

• HIGHEST MORTALITY RATE OF ANY PSYCHIATRIC ILLNESS (anorexia nervosa: 5–10% mortality, including cardiac death and suicide)
• Onset typically ADOLESCENCE/YOUNG ADULTHOOD; female > male (though rising in males)
• Eating disorders are NOT about food — they involve CONTROL, SELF-WORTH, BODY IMAGE, PERFECTIONISM
• Often comorbid with: Major depression, anxiety, OCD, substance use, personality disorders
• Significant medical complications from malnutrition and/or purging behaviors (electrolyte imbalance, cardiac arrhythmias, organ damage)
• Medical monitoring and stabilization PRECEDE psychological treatment in severe cases
• Family involvement is CRITICAL, especially in adolescents; family-based therapy is first-line for anorexia in teens
• Prognosis: Variable; 40–60% full recovery; some chronic relapsing course; higher mortality if early-onset, severe weight loss, or comorbid disorders

Key Definitions

Diagrams To Know

• Eating disorder spectrum: Restrictive (anorexia-restricting) → Binge-purge (anorexia-BP, bulimia) → Exercise compulsion

Section Title

Anorexia Nervosa (AN)

Important Facts

• DIAGNOSTIC CRITERIA: (1) Restriction → low body weight; (2) Intense fear of weight gain; (3) Distorted body image; (4) Underweight (typically BMI <17.5)
• RESTRICTING subtype: Weight loss via dieting/fasting/exercise only; no regular binge-purge
• BINGE-EATING/PURGING subtype: Regular binge eating and purging (self-induced vomiting, laxatives, diuretics); also restrictive calories
• PERSONALITY: Perfectionism, high achievement, rigid thinking, control-seeking; often high-functioning academically/professionally
• AMENORRHEA: Loss of ≥3 consecutive menstrual cycles (though DSM-5 made this optional criterion); common finding
• PHYSICAL FINDINGS (from starvation):
• • BRADYCARDIA (slow HR; adaptive but can be severe)
• • HYPOTENSION (low BP; postural hypotension)
• • HYPOTHERMIA (low body temp; feeling cold always)
• • DRY SKIN, brittle hair, hair loss
• • LANUGO: Fine soft body hair (compensatory response to cold)
• • CONSTIPATION (from dehydration, low intake, motility)
• • ELECTROLYTE IMBALANCE: Hypokalemia (especially with purging), hyponatremia, hypophosphatemia
• SEVERE COMPLICATIONS:
• • CARDIAC ARRHYTHMIAS & CARDIAC FAILURE (leading cause of death in AN)
• • OSTEOPOROSIS & FRACTURES (early-onset due to calcium loss, estrogen deficiency)
• • ORGAN DAMAGE: Renal, liver, GI tract
• • GI COMPLICATIONS: Esophageal rupture (rare but fatal), gastric ulcers, motility dysfunction
• • COGNITIVE: Impaired concentration, depression, anxiety, obsessive thoughts
• • LABORATORY: ↑Cholesterol, ↓Thyroid hormones (T3 syndrome), ↑Cortisol

Key Definitions

Diagrams To Know

• Starvation cascade: Low intake → Nutrient depletion → Electrolyte loss → Cardiac dysfunction
• Brain-heart-gut-metabolism connections in AN

Section Title

Bulimia Nervosa (BN)

Important Facts

• DIAGNOSTIC CRITERIA: (1) Recurrent binge eating; (2) Recurrent compensatory behaviors; (3) ≥1x/week for ≥3 months; (4) Self-evaluation unduly influenced by body weight/shape
• BODY WEIGHT: Usually NORMAL or SLIGHTLY OVERWEIGHT (unlike AN); can hide eating disorder longer
• BINGE: Eating unusually large amount in short time (e.g., 1–2 hours) with sense of loss of control; followed by shame/guilt
• COMPENSATORY: Vomiting (most common), laxative abuse, diuretic misuse, fasting, excessive exercise
• SHAME & SECRECY: Binges are hidden; client feels shame and loss of control; cycle becomes reinforced
• PHYSICAL FINDINGS (from PURGING, especially vomiting):
• • HYPOKALEMIA & METABOLIC ALKALOSIS (hallmark; vomiting = loss of H+ = alkalosis + K+ loss)
• • DENTAL EROSION & DENTAL CARIES (from stomach acid; characteristic pattern on lingual surfaces)
• • RUSSELL'S SIGN: Calluses/scars on knuckles from teeth during self-induced vomiting
• • PAROTID GLAND SWELLING (sialoadenitis; enlarged glands from repeated purging)
• • ESOPHAGITIS & RISK OF ESOPHAGEAL RUPTURE (from repeated vomiting); rare but can be fatal
• • DENTAL ENAMEL EROSION: Tooth decay progresses rapidly
• • SEVERE DEHYDRATION & ELECTROLYTE IMBALANCE: Hypokalemia, hyponatremia, hypochloremia
• • CARDIAC ARRHYTHMIAS: From electrolyte loss; sudden cardiac death possible
• • GI: Gastric ulcers, gastroesophageal reflux, pancreatitis
• • METABOLIC: Metabolic alkalosis, hypokalemia, hypochloremia (classic triad from vomiting purging)

Key Definitions

Diagrams To Know

• Binge-purge cycle: Restriction → Hunger/emotion trigger → Binge → Guilt/shame → Purge → Temporary relief → Restriction
• Vomiting consequences: Stomach acid → Electrolyte loss → Cardiac vulnerability

Section Title

Refeeding Syndrome — The Most Critical Complication

Important Facts

• PATHOPHYSIOLOGY:
• • Severe malnutrition = cellular electrolyte depletion (body 'hides' K+, Mg2+, PO4- inside cells; serum levels seem OK)
• • When nutrition starts → Insulin rises → Anabolic state → Electrolytes driven INTO cells from serum
• • Result: SEVERE HYPOPHOSPHATEMIA (hallmark), hypokalemia, hypomagnesemia, fluid overload
• HALLMARK: HYPOPHOSPHATEMIA (<2.5 mg/dL) — most dangerous; causes respiratory/cardiac failure, rhabdomyolysis
• TIMELINE: Occurs within FIRST 3–5 DAYS after refeeding begins (not immediately, not weeks later)
• CLINICAL SIGNS:
• • Weakness, myalgia, respiratory distress (phosphate)
• • Cardiac arrhythmias, palpitations (K+, Mg2+, PO4-)
• • Seizures (Mg2+, PO4-)
• • Pulmonary edema, heart failure (fluid overload)
• • Death (cardiac/respiratory failure, rhabdomyolysis)
• RISK FACTORS:
• • BMI <16 or >40
• • Weight loss >15% in past month
• • Minimal oral intake >7 days
• • History of alcohol/substance abuse
• • Electrolyte abnormality on admission
• PREVENTION & NURSING CARE:
• • START SLOWLY: Begin with 500–1000 kcal/day; advance GRADUALLY over 5–7 days per protocol
• • MONITOR CLOSELY: Baseline electrolytes BEFORE refeeding; repeat daily (especially phosphate, K+, Mg2+)
• • REPLACE AGGRESSIVELY: Replete phosphate, potassium, magnesium as needed; often needs IV supplementation
• • CARDIAC MONITORING: Continuous if phosphate <2.0 mg/dL
• • FLUID BALANCE: Monitor for pulmonary edema; may need fluid restriction initially
• • DAILY WEIGHTS: Monitor for sudden weight gain (edema/fluid overload)
• • THIAMINE (Vitamin B1): Give BEFORE feeding (prevents Wernicke encephalopathy)
• • MULTIVITAMIN & mineral supplement: Standard
• • Document vitals, strict I&O, weight trends, labs, cardiac rhythm

Key Definitions

Diagrams To Know

• Refeeding cascade: Malnutrition → Nutrition starts → Insulin surge → Electrolyte redistribution → Hypophosphatemia/hypokalemia → Cardiac/respiratory crisis

Section Title

Eating Disorders — Comprehensive Nursing Management

Important Facts

• PRIORITY HIERARCHY (Maslow):
• 1. PHYSIOLOGIC/SAFETY: Medical stabilization (electrolytes, cardiac status, hydration, refeeding protocol)
• 2. NUTRITION RESTORATION: Structured eating plan with supervision
• 3. PSYCHOLOGICAL: Body image work, emotion regulation, therapy
• MEDICAL STABILIZATION FIRST:
• • Correct fluid and electrolyte imbalances (IV therapy often needed)
• • Cardiac monitoring if arrhythmias or severe electrolyte abnormality
• • Treat complications: Esophagitis, ulcers, pancreatitis, etc.
• • Baseline labs: CBC, BMP (electrolytes, glucose, renal function), phosphate, magnesium, LFTs, ECG, EKG
• STRUCTURED EATING PLAN:
• • Specify calories, meal times, food choices (may be restricted if client uses food to self-harm)
• • Start SLOWLY in AN (refeeding risk); advance gradually per protocol
• • BN: Meals should be REGULAR to normalize eating patterns and reduce binge-purge cycle
• SUPERVISION DURING & AFTER MEALS:
• • OBSERVE DURING MEAL: Ensure client is eating (not hiding, throwing away)
• • SUPERVISE × 1 HOUR AFTER MEAL (BN): Prevent bathroom access for purging; note if client goes to bathroom during meal
• • MONITOR FLUID INTAKE: Some clients drink excessive water to feel full or avoid food
• MONITORING & ASSESSMENT:
• • WEIGHT: Same time daily, same scale, light clothing, post-void; track trend (not single number)
• • INTAKE & OUTPUT: Document all food/fluid consumed; note binges, purges, laxative use
• • VITAL SIGNS: HR (bradycardia in AN; check for arrhythmia), BP, orthostatic changes, temperature
• • ELECTROLYTES & LABS: Phosphate, potassium, magnesium monitored frequently; ECG if abnormal
• • MENTAL STATUS: Mood, anxiety, suicidal ideation (both eating disorders have increased suicide risk)
• PSYCHOSOCIAL INTERVENTIONS:
• • MATTER-OF-FACT, NON-PUNITIVE approach; avoid power struggles over food
• • COGNITIVE-BEHAVIORAL THERAPY (CBT): Gold standard; targets distorted thoughts about food/body
• • FAMILY-BASED THERAPY: First-line for adolescent AN; engages parents in refeeding and behavioral change
• • INDIVIDUAL THERAPY: Address perfectionism, control issues, emotional regulation
• • SUPPORT GROUPS: Peer support (carefully selected to avoid competitive comparison)
• BODY IMAGE WORK:
• • Avoid discussing appearance; don't reassure 'you look healthy' (reinforces weight-related thinking)
• • Help separate self-worth from weight/appearance
• • Gradually increase mirror exposure (in BN/AN) combined with cognitive work
• MEDICATION:
• • FLUOXETINE (Prozac): Approved for bulimia nervosa; reduces binge-purge frequency; dose higher than depression (60 mg/day)
• • SSRIs: Help if comorbid depression/anxiety; NO proven benefit for anorexia nervosa itself
• • BUPROPION: CONTRAINDICATED in eating disorders (especially purging BN) — lowers seizure threshold; risk of seizure if electrolyte imbalance
• • ANTIPSYCHOTICS: Low-dose (aripiprazole) may help with obsessive thoughts about food/body; limited evidence
• • MOOD STABILIZERS: Topiramate studied in BN; not routine
• DISCHARGE PLANNING:
• • OUTPATIENT FOLLOW-UP: Regular psychiatric/nutrition visits; frequency depends on severity
• • MEDICAL FOLLOW-UP: Continued labs, cardiac monitoring if needed, assess for complications
• • SCHOOL/WORK: Gradual return; avoid overexertion
• • FAMILY INVOLVEMENT: Psychoeducation on the chronic relapsing nature; teach signs of relapse; involve in therapy
• • EMERGENCY PLAN: Warning signs of medical crisis (severe palpitations, chest pain, weakness) — when to go to ED

Diagrams To Know

• Eating disorder nursing care protocol: Assessment → Stabilization → Nutrition → Observation → Monitoring → Therapy → Discharge

Section Title

Philippine Legal & Ethical Framework

Important Facts

• MENTAL HEALTH ACT (RA 11036): Persons with mental health conditions have RIGHT TO:
• • Dignity, respect, and freedom from abuse/discrimination
• • Access to quality mental health services in community setting
• • Informed consent for treatment (except in true emergency/danger)
• • Confidentiality and privacy
• • Consultation in their treatment plan
• INVOLUNTARY COMMITMENT: Only if danger to self/others; requires legal process and periodic review; NOT indefinite
• NURSING PRACTICE (RA 9173): Nurse must:
• • Practice within scope (assessment, planning, intervention, evaluation per nursing process)
• • Maintain confidentiality and client rights
• • Practice competently with current evidence
• • Report safety issues and abuse (mandated reporter)
• • Document accurately and timely
• • Work within healthcare team collaboratively
• ETHICAL PRINCIPLES in eating disorder & personality disorder care:
• • AUTONOMY: Respect client's choices; informed consent for treatment (balance with safety)
• • BENEFICENCE: Act in client's best interest; promote recovery
• • NON-MALEFICENCE: Do no harm; avoid enabling self-harm or manipulation
• • JUSTICE: Fair, equitable treatment; advocate for access to care
• DUTY TO WARN/PROTECT: If client poses danger to self/others, nurse has duty to break confidentiality and inform appropriate parties (suicide/homicide risk)

Key Definitions

Diagrams To Know

• Client rights framework under RA 11036 and nursing accountability

Rows

Columns

• Cluster
• Key Feature
• Examples
• Nursing Approach
• Suicide Risk

Table Title

Personality Disorder Clusters at a Glance

Rows

Columns

• Feature
• Anorexia Nervosa
• Bulimia Nervosa

Table Title

Anorexia vs. Bulimia Nervosa — Key Differences

Rows

Columns

• Feature
• Somatic Symptom Disorder (SSD)
• Factitious Disorder

Table Title

Somatic Symptom Disorder vs. Factitious Disorder

Rows

Columns

• Feature
• Conversion Disorder
• Malingering

Table Title

Conversion Disorder vs. Malingering

Rows

Columns

• Feature
• Borderline Personality Disorder
• Antisocial Personality Disorder

Table Title

Borderline vs. Antisocial Personality Disorder