Alexa is a 27-year-old female who has come to group therapy while she is in the city jail.

Alexa is a 27-year-old female who has come to group therapy while she is in the city jail.

Answer:

Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was arrested for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is sentenced to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family. but they are all jerks

Alexa is a 27-year-old female patient who presents at the local hospital emergency department complaining of neck pain. She was arrested for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. It was only because some police officers recognized her that she could post bail, so she begins at this time in the city jail awaiting trial. During group therapy she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family, but they are all jerks

Alexa is 27 years old and in jail for apparently sleeping in her car. This is the first time she has been to a psychiatrist, but she is not diagnosed with any DSM-IV psychiatric disorders. She has a traumatic past, growing up with an alcoholic mother, living on the streets, and struggling to provide for herself and to retain relationships with those who support her. She is angry at her mother because she refuses to help her out of the situation, blaming her for all of her problems. Alexa harbors strong feeling of resentment towards everyone around her, including Melanie, who is not able to help due to an accident that occurred outside of Alexa’s control. It does not seem that these situations are also caused by a personality disorder because it seems she acts upon her emotions and feelings, rather than being controlled by them.

Alexa does not want to feel these feelings. She does what she does because she thinks it will help her feel better; however, the negative consequences of her actions prove to be a poor solution to the problem. The nursing diagnosis is disturbed personal identity. This theory can help explain Alexa’s behavior as resulting from an interaction between her biography (past) and her present situation. Her past includes being abandoned by her family at age 10, moving in with a mother who verbally abused her, being arrested for stealing and selling drugs, and being expelled from school after the third grade. Current situations include being unable to support herself due to lack of employment or educational opportunities, depression secondary to perceived helplessness, and sensory overload created by long periods of incarceration

Alexa has Antisocial Personality Disorder (APD). This is different than the more common, though still rare, diagnosis of Sociopathy. In APD, there is no remorse, guilt or shame. It’s a frustrating diagnosis, because it’s hard to figure out how to treat someone who has absolutely no conscience or concern regarding the impact they have on other people. You can only imagine how difficult this would be in group therapy; an environment where you are supposed to feel supported, understood and part of something bigger than yourself. Why would anyone want to work so hard in group to create healthy connections and then go out and intentionally hurt people by selling drugs or soliciting prostitution? And why on earth would someone get into a fight over nothing with a victimless crime like prostitution? The best way to help Alexa through her incarceration is through medication compliance and behavioral interventions. We have evidence that compliance is related to better functioning outcomes post-release from jail.

Alexa presents with a multiaxial diagnosis of Axis I Major Depressive Disorder, Dysthymic Disorder, Alcohol Dependence with severe alcohol use in the past year (alcohol dependence with 4 criteria), Global Assessment of Functioning-Self Deficient, and Personality Disorder NOS.

Alexa has diagnoses of an Anti-social Personality Disorder. People with anti-social personality disorder don’t follow social rules and often struggle with authority figures like teachers, bosses, police officers. They are impulsive in ways that hurt others such as drinking and driving, doing drugs, having unprotected sex, stealing money or objects from someone. They often struggle with addiction of many kinds (drugs, alcohol, gambling) and may have problems with their own mood (keeping a job, a place to live) . Anti-social personality is at the root of a lot of things including low self-esteem, depression and anxiety along with repetitive bad decisions.

 Alexa is a 27-year-old female who has come to group therapy while she is in the city jail.

Alexa meets criteria for the diagnosis of antisocial personality disorder, which is marked by a childhood history of conduct disorder, irritability and aggressiveness, impulsivity, lying and stealing, poor behavioral control, and a lack of a conscience.

Alexa has demonstrated behavior consistent with Antisocial Personality Disorder. A contributing factor to her arrest was her need to answer the call of criminal activity. This could be due to her difficulty following society’s rules and norms, as well as a high degree of criminal activity likely due to an insensitivity to punishment.

Question:

Alexa is a 27-year-old female who has come to group therapy while she is in the city jail. She was arrested for vagrancy because she was sleeping in her car in a parking lot at a local shopping center. She could not post bail, so she is sentenced to 14 days in jail. During group, she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family. but they are all jerks

because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss fired her for no reason. Alexa has a history of arrests for buying illegal drugs and prostitution. The last time she was in jail, her sentence was extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders?

 

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