NLE Psychiatric Disorders — Personality, Somatic, and Eating DisordersConcept Map

Sub concepts

• Cluster A — Odd or Eccentric (Paranoid, Schizoid, Schizotypal)
• Cluster B — Dramatic, Emotional, or Erratic (Borderline, Antisocial, Histrionic, Narcissistic)
• Cluster C — Anxious or Fearful (Avoidant, Dependent, Obsessive-Compulsive Personality)
• General Nursing Management: Consistent approach, clear limits, safety prioritization, DBT for borderline PD

Relationship to central

Enduring, inflexible patterns of inner experience and behavior deviating from cultural norms; begin by adolescence/early adulthood; cause distress or impairment

Sub concepts

• Somatic Symptom Disorder: Distressing physical symptoms with excessive health-related thoughts and behaviors
• Illness Anxiety Disorder (formerly Hypochondriasis): Preoccupation with serious illness with minimal/no somatic symptoms
• Conversion Disorder (Functional Neurological Symptom Disorder): Neurologic symptoms inconsistent with recognized disease; may show la belle indifférence
• Factitious Disorder: Deliberate falsification of symptoms to assume sick role
• Nursing Management: Rule out genuine medical illness, acknowledge symptoms as real, limit secondary gain, connect stress to symptoms

Relationship to central

Physical symptoms or health-related anxiety not intentionally produced and not fully explained by medical conditions; symptoms are real to the client

Sub concepts

• Anorexia Nervosa: Restriction of intake, significantly low body weight, intense fear of weight gain, disturbed body image; subtypes — restricting and binge-eating/purging
• Bulimia Nervosa: Recurrent binge eating followed by compensatory behaviors; usually normal weight or slightly overweight
• Refeeding Syndrome: Life-threatening complication from rapid nutrition reintroduction; hypophosphatemia is hallmark, plus hypokalemia and hypomagnesemia
• Assessment and Complications: Cardiac arrhythmias, electrolyte imbalances, amenorrhea, bradycardia, lanugo in anorexia; dental erosion, Russell's sign in bulimia
• Nursing Management: Address life-threatening complications first, establish structured eating plan, observe during and after meals, monitor weight and electrolytes, gradual nutrition reintroduction, family involvement

Relationship to central

Severe disturbances in eating behavior and body image with control, self-worth, and body perception as central issues; highest mortality of any psychiatric disorder

Sub concepts

• Paranoid PD: Pervasive distrust and suspiciousness of others' motives
• Schizoid PD: Detachment from social relationships, restricted emotional expression, preference for solitude
• Schizotypal PD: Social discomfort with cognitive-perceptual distortions and eccentric behavior
• Nursing Approach: Be honest, consistent, and non-intrusive; respect need for distance while gently encouraging engagement

Relationship to central

Characterized by social detachment, distrust, and eccentric perception; limited insight into maladaptive patterns

Sub concepts

• Borderline PD: Instability of relationships, self-image, affect; fear of abandonment, splitting, self-mutilation, suicidal behavior, chronic emptiness
• Antisocial PD: Disregard for rights of others, deceitfulness, manipulation, impulsivity, lack of remorse
• Histrionic PD: Excessive emotionality and attention-seeking
• Narcissistic PD: Grandiosity, need for admiration, lack of empathy
• Nursing Approach: Set clear, firm, consistent limits; use unified team approach to prevent manipulation and splitting; prioritize safety; hold accountable without being punitive; DBT especially effective for borderline PD

Relationship to central

Characterized by emotional instability, impulsivity, attention-seeking, and manipulative behaviors; high risk for self-harm and interpersonal conflict

Sub concepts

• Avoidant PD: Social inhibition, feelings of inadequacy, hypersensitivity to criticism
• Dependent PD: Excessive need to be taken care of, submissive and clinging behavior, difficulty making decisions
• Obsessive-Compulsive PD (OCPD): Preoccupation with orderliness, perfectionism, and control; distinct from OCD
• Nursing Approach: Encourage independent decision-making and assertiveness; provide support without fostering dependence; set gradual, realistic goals

Relationship to central

Characterized by anxiety, fear of abandonment or inadequacy, and excessive need for control or reassurance

Sub concepts

• Core Features: Fear of abandonment, unstable intense relationships (idealization-devaluation cycle), identity disturbance, self-mutilation, recurrent suicidal behavior, chronic emptiness, splitting (all good/all bad thinking)
• Nursing Priorities: Safety first (prevent self-harm and suicide), set firm consistent limits, use unified team approach so client cannot play staff against each other, recognize and manage splitting
• Treatment: Dialectical Behavior Therapy (DBT) teaches distress tolerance, emotion regulation, and interpersonal skills; medication for symptom management (mood instability, impulsivity, transient psychosis), not curative

Relationship to central

Most dangerous Cluster B disorder requiring specialized nursing intervention; presents with splitting, self-harm, and unstable relationships

Sub concepts

• Key Clinical Features: Restriction of intake, significantly low body weight, intense fear of weight gain, disturbed body image, perfectionism, need for control
• Physical Findings Reflecting Starvation: Amenorrhea (absence of menses), bradycardia (slow heart rate), hypotension (low blood pressure), hypothermia (low body temperature), dry skin, lanugo (fine body hair), constipation
• Life-Threatening Complications: Cardiac dysrhythmias and cardiac failure, severe electrolyte imbalances (especially hypokalemia), osteoporosis and bone loss, organ failure, death
• Subtypes: Restricting type (diet, fasting, exercise only) and Binge-Eating/Purging type (binge eating with self-induced vomiting or laxative misuse)

Relationship to central

Severe restrictive eating disorder with characteristic physical manifestations reflecting starvation state; carries highest mortality among psychiatric disorders

Sub concepts

• Key Clinical Features: Recurrent binge eating episodes (lack of control), compensatory behaviors (self-induced vomiting, laxative/diuretic misuse, fasting, excessive exercise), usually normal weight or slightly overweight, shame and guilt after episodes
• Physical Findings Largely from Purging: Severe electrolyte imbalances (hypokalemia, metabolic alkalosis from vomiting), dental enamel erosion and caries from stomach acid exposure, Russell's sign (calluses on knuckles from self-induced vomiting), parotid gland swelling (from chronic vomiting), esophagitis and esophageal tears, cardiac arrhythmias from electrolyte loss
• Why Harder to Detect: Maintained normal body weight masks severity; families and clinicians may not recognize disorder; health consequences often delayed

Relationship to central

Binge-purge eating disorder with primarily purging-related complications; often hidden due to maintained normal weight

Sub concepts

• What Happens: When severely malnourished body switches from catabolic to anabolic state, insulin surges and drives electrolytes into cells; profound shifts in phosphate, potassium, magnesium occur
• Hallmark Finding: Hypophosphatemia (low phosphate) is the hallmark, accompanied by hypokalemia (low potassium) and hypomagnesemia (low magnesium)
• Life-Threatening Consequences: Cardiac arrhythmias, heart failure, respiratory failure, seizures, neurologic complications, death
• Prevention and Nursing Care: Reintroduce nutrition slowly and advance calories gradually per protocol, monitor electrolytes closely (especially phosphate, potassium, magnesium) and replace as needed, monitor cardiac rhythm and fluid balance, watch for signs of fluid overload, daily weight monitoring, educate client and family on slow refeeding necessity

Relationship to central

Life-threatening metabolic emergency occurring when nutrition is reintroduced too rapidly to severely malnourished client; most critical complication in eating disorder treatment

Sub concepts

• Priority 1 — Medical Stabilization: Address life-threatening physical complications first (cardiac dysrhythmias, severe electrolyte imbalances, dehydration), correct fluid and electrolyte imbalances, monitor cardiac status, medical assessment precedes psychological intervention
• Priority 2 — Nutritional Rehabilitation: Establish structured eating plan with specific calorie goals, observe during meals and for about one hour after (prevent purging, hiding, or discarding food), monitor weight consistently (same time, same scale, same clothing), track intake and output, monitor lab values (electrolytes, phosphate, magnesium, potassium)
• Priority 3 — Psychological Support: Use matter-of-fact, non-punitive approach, avoid power struggles and excessive focus on food itself, build self-esteem and healthy coping mechanisms, address distorted body image, set realistic weight goals
• Pharmacologic Support: Fluoxetine (SSRI) helps especially in bulimia; bupropion is CONTRAINDICATED in eating disorders (lowers seizure threshold in purging clients)
• Family Involvement: Family therapy particularly important for adolescents, educate families on chronic relapsing nature, need for consistent approach, signs of relapse and medical danger

Relationship to central

Multifaceted nursing care prioritizing medical stabilization, nutritional rehabilitation, psychological support, and relapse prevention

Sub concepts

• Core Definition: Neurologic symptoms (paralysis, blindness, seizures, aphonia) that are inconsistent with recognized medical disease or anatomical distribution
• La Belle Indifférence: Striking lack of concern or emotional distress about the symptom despite its apparent severity; the client seems surprisingly unconcerned, which distinguishes it from genuine medical illness where distress is expected
• Why This Occurs: Symptom unconsciously serves a psychological function, resolving or reducing intrapsychic conflict (primary gain); secondary gains may include attention, relief from responsibility, or avoiding unpleasant situations
• Nursing Approach: Do not confront or suggest symptoms are fake; treat with respect while avoiding excessive attention; help client connect stress and emotions to symptom onset; supportive rehabilitation and stress management

Relationship to central

Unique presentation within somatic symptom disorders showing dissociative features and psychological defense mechanism

Sub concepts

• Somatic Symptom Disorders: Symptoms are UNINTENTIONAL, NOT produced deliberately, REAL to the client, not under conscious control, driven by psychological distress; client genuinely distressed about symptoms; no conscious deception
• Factitious Disorder: Deliberate, intentional falsification or induction of symptoms; client CONSCIOUSLY produces symptoms to ASSUME SICK ROLE; may be life-threatening (e.g., injecting bacteria, poisoning); distinct from simple malingering; psychological motivation to be seen as ill
• Malingering: Feigning symptoms for EXTERNAL GAIN (avoiding work, obtaining disability benefits, avoiding legal consequences, obtaining medications); conscious deception for external rewards; NOT a psychiatric diagnosis
• Nursing Implication: Somatic disorders require validation and therapeutic connection of stress to symptoms; factitious disorder requires careful monitoring and limit-setting; malingering requires firm, matter-of-fact approach without enabling

Relationship to central

Critical differential diagnosis: three different etiologies and client presentations require different nursing approaches

Sub concepts

• RA 11036 (Mental Health Act): Protects rights of persons with mental health conditions, promotes humane and community-based treatment, emphasizes dignity and self-determination, mandates non-discrimination
• RA 9173 (Nursing Practice Act): Defines scope of nursing practice in Philippines, requires client advocacy, competent and ethical care, therapeutic communication, respect for autonomy
• Application to These Disorders: Clients with personality disorders cannot be denied care for difficult behavior; must maintain therapeutic attitude; somatic symptom clients must have symptoms validated while rule-outs occur; eating disorder clients need family support within legal/ethical bounds
• Documentation: Clear, objective documentation of assessment findings, interventions, and client responses; no judgmental language; maintain confidentiality; communicate within team using consistent terminology

Relationship to central

All nursing care for personality, somatic, and eating disorders must comply with Philippine Mental Health Act (RA 11036) and Philippine nursing practice standards (RA 9173)