The client, a 32-year-old woman, presents with a history of manipulative, exploitative, irresponsible, and unlawful behaviors meeting criteria for antisocial personality disorder. The PMHNP diagnoses antisocial personality disorder based on symptoms of disregard for laws, blaming others, aggression, and lack of remorse. They refer the client for psychological testing to confirm the diagnosis and identify comorbidities. Testing confirms antisocial personality disorder. The client is then referred to group-based cognitive behavioral therapy, which has been shown to effectively treat personality disorders by modifying maladaptive thoughts and improving social skills.

1. Personality disorder Decision Tree
Personality disorder Decision TreePersonality disorder Decision TreePermalink: https://
/personality-disorder-decision-tree/Personality disorder Decision TreeDecision
TreeIntroductionPersonality disorders are characterized by inflexible and unhealthy
thinking patterns, as well as unhealthy functioning and behaviors. People with personality
disorders experience problems when it comes to the perception and relating to people and
situations. This leads to significant problems and challenges in social activities,
relationships, academics, and even work (Ekselius, 2018) Personality disorder Decision
Tree. People with personality disorders might not be aware of their personality disorders
because their way of thinking and behavior seems normal to them. They may even put the
blame other individuals for their issues and problem. Personality disorders normally start
during adolescence or early adulthood. There are various types of personality disorders.
The 32-year-old client, in this case, the study presented with symptoms of being
manipulative, exploitative, lack of remorse, blaming other people for her mistakes,
irresponsibility, stealing, and often breaking the law Personality disorder Decision Tree.
These behaviors started manifesting during the client’s childhood. The purpose of this
paper is to identify the differential diagnosis for the client, evaluate the available treatments
and finally present decisions about the diagnosis and treatment for the client.Decision #1:
Differential DiagnosisThe diagnosis for this client is an antisocial personality disorder. This
decision was selected because the client manifests symptoms consistent with the symptoms
outlined in DSM-5 diagnostic criteria for antisocial personality disorder. According to the
DSM-5 diagnostic criteria, the characteristic symptoms of the antisocial personality
disorder include disregarding and violating the law and rights of other people; manipulating
and deceiving others; problems with maintaining interpersonal relationships; blaming
other people for self-mistakes; irresponsible behaviors; and lack of remorse (Grenyer et al.,
2018) Personality disorder Decision Tree. The client in the case study manifests symptoms
such as disregarding the law; manipulative and exploitative behaviors; disregard for the law
as indicated by imprisonment; blaming third-parties for her mistakes; delinquent behaviors
such as stealing; lack of remorse; relationship behaviors; aggression; illegal possession of a
gun; and recklessness as indicated by her inability to manage finances. Moreover, the
behaviors started manifesting since childhood and hence confirming the diagnosis of
antisocial personality disorder.Selecting antisocial personality disorder as the diagnosis for
this client hoped that the correct diagnosis for the client was made. Therefore, this
facilitates the right treatment for this client. The correct diagnosis ensures that there is no

2. misdiagnosis and thus an individual receives treatment for the ailment (Singh et al.,
2017).Since the client exhibits symptoms of antisocial personality disorder as per the DSM-
5 diagnostic criteria, there is no difference between the achieved outcome and the expected
outcome Personality disorder Decision Tree.Decision #2: Treatment Plan for
PsychotherapyThe second decision is to refer the client to a psychologist for psychological
testing. The reason for referring the client for psychological testing is to have her undergo a
comprehensive assessment. The psychological assessment should include the
administration of psychological tests to the client to objectively, comprehensively and
consistently assess her behavior (Bornstein, 2015). Therefore, the client will be
administered with some clinical, behavioral and psychological assessment tools that will
identify any cognitive problems, behavioral problems, or personality problems (Jadhakhan
et al., 2019).The expected outcome by referring the client for psychological testing is that
the diagnosis (antisocial personality disorder) would be verified. Secondly, it is anticipated
that the administration of psychological tests would identify other mental health conditions
or comorbidities that could be contributing to the symptoms the client is manifesting
(Jadhakhan et al., 2019) Personality disorder Decision Tree.According to the findings from
the comprehensive psychological battery test, the client exhibits symptoms of various
personality disorders. However, the highest score was on the traits associated with
antisocial personality disorder and this, therefore, is suggestive that the diagnosis for this
client is an antisocial personality disorder. Therefore, there is no difference between the
achieved outcome and the expected outcome. This is because as was expected, the
psychological testing revealed that the client’s diagnosis was an antisocial personality
disorder. Moreover, the psychological testing indicated a probability of other comorbidities
for the client as demonstrated by the results showing that the client has symptoms of
personality disorder Personality disorder Decision Tree. Evidence demonstrates that the
majority of individuals with one personality disorder also manifest symptoms and signs of
other personality disorders (Grenyer et al., 2018). This explains why the client manifests
symptoms for multiple personality disorders, even though the score was highest for
antisocial personality disorder.Decision #3: Treatment Plan for PsychopharmacologyThe
third decision that was selected is to refer Rhoda to group-based cognitive behavior
therapy. This decision was chosen because the group-based cognitive behavior therapy (G-
CBT) has been demonstrated to be effective in improving symptoms and treating many
personality disorders such as antisocial personality disorder. According to CBT, antisocial
personality disorder results from the maladaptive beliefs as well as environmental factors
that facilitate and promote the problematic behaviors associated with the disorder (Mancke
et al, 2018). Additionally, the lack of the appropriate skills to adjust and respond suitably to
situations is associated with the development of antisocial personality disorder. Therefore,
the CBT utilizes different therapeutic techniques to change the negative thinking patterns
and beliefs and thus eventually modify the behavior. Also, CBT equips people with the
necessary skills to adapt, handle and respond suitably to situations (Mancke et al, 2018).
More importantly, the CBT is a group-CBT and thus this will allow the client to interact with
other members of the group (Mancke et al, 2018). This will improve the client’s social skills
and thus improve her ability to maintain interpersonal relationships.The selection of G-CBT

3. for this client hoped that the behavioral deficits and symptoms the client is manifesting
would greatly improve. The G-CBT will alter and modify the negative thinking pattern and
maladaptive beliefs for this client. Additionally, a G-CBT will equip her with the essential
social skills. G-CBT will lead to the client adopting a maladaptive thinking pattern and thus
result in behavior change, and at the same time, the client will adopt the socially accepted
behaviors (Mancke et al, 2018) Personality disorder Decision Tree.Ethical
ConsiderationsThe first ethical consideration that the therapist should consider is informed
consent. The PMHNP should obtain informed consent from the client before starting any
assessment or treatment. The autonomy of the client should also be respected and therefore
is she refuses any treatment, the PMHNP should accept the client’s decision. Thirdly, any
information that the client reveals during the therapy including issues associated with
breaking the law should be kept confidential and private (Warrender, 2017). Lastly,
evidence shows that people with personality disorders may sometimes fail to respect the
boundary issues and the therapeutic relationship. Therefore, the PMHNP should ensure that
the client is educated about the expected boundaries during the treatment. Boundary issues
common among people with personality disorders include irrational demands associated
with the availability and accessibility of the therapist, irrationality, disrespect, and excessive
phone calls to the therapist (Warrender, 2017). Therefore, it is the responsibility of the
PMHNP to identify the honest needs of this client and maintain firm boundaries to ensure
the provision of ethical and competent treatment. Personality disorder Decision
Tree.ConclusionThe diagnosis for this client was identified as an antisocial personality
disorder. This decision was selected since the client reported and manifested symptoms
associated with antisocial personality disorder according to the DSM-5 diagnostic criteria.
The second decision that was chosen was to refer the client to a psychologist form
comprehensive psychological testing to confirm or rule out the diagnosis of antisocial
personality disorder and any other associated comorbidity. The final decision was to refer
Rhoda to a G-CBT due to the intervention’s efficacy in the treatment of personality
disorders. In conclusion, the ethical considerations during the treatment for this client
involve autonomy, informed consent, as well as boundary issues Personality disorder
Decision Tree.ReferencesBornstein R. (2015). Personality Assessment in the Diagnostic
Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities. J Pers Assess,
97(5), 446–455.Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala
journal of medical sciences, 123(4), 194–
204. https://doi.org/10.1080/03009734.2018.1526235.Grenyer, B., Lewis, K. L., Fanaian,
M., & Kotze, B. (2018). Treatment of personality disorder using a whole of service stepped
care approach: A cluster randomized controlled trial. PloS one, 13(11),
e0206472. https://doi.org/10.1371/journal.pone.0206472.Jadhakhan, F., Lindner, O. C.,
Blakemore, A., & Guthrie, E. (2019). Prevalence of common mental health disorders in
adults who are high or costly users of healthcare services: protocol for a systematic review
and meta-analysis. BMJ Open, 9(9), e028295. https://doi.org/10.1136/bmjopen-2018-
028295.Mancke F, Schmitt R, Winter D, Inga N, Sabine H & Scmahl C. (2018). Assessing the
marks of change: how psychotherapy alters the brain structure in women with borderline
personality disorder. J Psychiatry Neurosci, 43(3), 171–181.Sadock, B. J., Sadock, V. A., &

4. Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical
psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.Singh, H., Schiff, G. D., Graber, M. L.,
Onakpoya, I., & Thompson, M. J. (2017). The global burden of diagnostic errors in primary
care. BMJ quality & safety, 26(6), 484–494. https://doi.org/10.1136/bmjqs-2016-
005401.Warrender D. (2017). Borderline personality disorder and the ethics of risk
management: The action/consequence model. Nursing Ethics, 25(7), 918-927. Personality
disorder Decision Tree Decision TreeFor this Assignment, as you examine the client case
study in this week’s Learning Resources, consider how you might assess and treat adult and
older adult clients presenting symptoms of a mental health disorder.Learning
ObjectivesStudents will:• Evaluate clients for treatment of mental health disorders• Analyze
decisions made throughout diagnosis and treatment of clients with mental health
disorders** Assigned in Week 3 and submitted in Week 4 Personality disorder Decision
TreeExamine Case 1: You will be asked to make three decisions concerning the diagnosis
and treatment for this client. Be sure to consider co-morbid physical as well as mental
factors that might impact the client’s diagnosis and treatment.At each Decision Point, stop
to complete the following:• Decision #1: Differential Diagnosiso Which Decision did you
select?o Why did you select this Decision? Support your response with evidence and
references to the Learning Resources.o What were you hoping to achieve by making this
Decision? Support your response with evidence and references to the Learning Resources.o
Explain any difference between what you expected to achieve with Decision #1 and the
results of the Decision. Why were they different?• Decision #2: Treatment Plan for
Psychotherapyo Why did you select this Decision? Support your response with evidence
and references to the Learning Resources.o What were you hoping to achieve by making
this Decision? Support your response with evidence and references to the Learning
Resources. Personality disorder Decision Treeo Explain any difference between what you
expected to achieve with Decision #2 and the results of the Decision. Why were they
different?• Decision #3: Treatment Plan for Psychopharmacologyo Why did you select this
Decision? Support your response with evidence and references to the Learning Resources.o
What were you hoping to achieve by making this Decision? Support your response with
evidence and references to the Learning Resources.o Explain any difference between what
you expected to achieve with Decision #3 and the results of the decision. Why were they
different?• Also include how ethical considerations might impact your treatment plan and
communication with clients and their family.Note: Support your rationale with a minimum
of three academic resources. While you may use the course text to support your rationale, it
will not count toward the resource requirement Personality disorder Decision Tree.By Day
7A woman with personality disorder Case #1 A woman with personality disorder
SUBJECTIVE Rhonda is a 32-year-old Hispanic female who presents to your office for her
initial appointment. When you ask what brought her to your office, she states: “I’m at the
end of my rope, I don’t know what else to do.” She then bursts into tears. Rhonda explains
that she has very few friends left, and everyone seems to have “abandoned” her. Rhonda
explains that she goes out of her way to help other people, and to be nice to them, but this
does not seem to help. Rhonda then stands up and begins to pace around your office at
times using wild hand gestures to explain the circumstances that led up to her making the

5. appointment with you. She describes the recent breakup with her boyfriend as traumatic
and explains “when we first met, he was the best guy in the world. He treated me really well.
But he just became a complete monster! Even though he broke off the relationship with me,
I was glad to see it end. I hate his guts!” Rhonda explains that her current financial situation
is also precarious. She states that she recently purchased an automobile, and is not certain
how she is going to pay for it. She states that she had a car that was repossessed last year at
that time, and that she borrowed some money from a friend to help pay for the car; the
friend later turned around and accused her of theft. “It was my friend’s fault. She told me
she would loan me the money and then backed out. I only took the money because she said
she would loan it to me … people just can’t go back on their word like that when other
people are counting on them.” Rhonda reports that she was “always in trouble” as a kid. She
states that people were always picking on her, to which she adds: “the other kids my age
were just stupid. They didn’t know how to have fun.” She says “I have always been
impulsive, but it’s fun. Sometimes people can be such prudes … you only go around life once,
so you have to make the best of it.” OBJECTIVE Rhonda is currently single. She has no
children. Educationally, she had completed two semesters toward her bachelor of arts
degree in fine arts. Rhonda currently works as a waitress at a local restaurant Personality
disorder Decision Tree. She has held this job for about 2 weeks. Prior to this, Rhonda
worked as a housekeeper for a local hotel chain. She states that she was fired from this job
because her coworkers were jealous of her and “planted” evidence of her stealing from
hotel patrons. She was also arrested for cashing checks under an alias, for which she spent
120 days in jail. Rhonda has a history of multiple incarcerations for offences ranging from
larceny to possession of controlled substances to possession of an illegal firearm. She was
also arrested several times for fighting and on at least one occasion, used a baseball bat to
beat up a girl who she thought was trying to “set her up” with the police. MENTAL STATUS
EXAM Rhonda is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed,
and spontaneous. She reports her mood as “terrible!” Affect is labile and seems to change
rapidly with the subject being discussed. Her eye contact is normal, but at times, she
appears to stare at you. Rhonda is oriented to person, place, and time. She denies
visual/auditory hallucinations, no overt paranoia or delusional thought processes noted.
Rhonda denies any suicidal or homicidal ideation. Decision Point One BASED ON THE
INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING
DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER
(PMHNP) GIVE TO RHONDA? In your write-up of this case, be certain to link specific
symptoms presented in the case to DSM–5 criteria to support your diagnosis. Decision Point
One Borderline Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS,
SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin
dialectical behavior therapy Begin treatment with Abilify 5 mg orally daily Decision Point
One Histrionic Personality Disorder Decision Point Two BASED ON THIS DIAGNOSIS,
SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for psychological testing Begin
Seroquel 25 mg orally at bedtime Refer to group therapy for personality-disordered
individuals Decision Point One Antisocial Personality Disorder Decision Point Two BASED
ON THIS DIAGNOSIS, SELECT YOUR CHOICE OF ACTIONS: Refer to psychologist for

6. psychological testing Begin Haldol 5 mg orally daily Refer for psychodynamic
psychotherapy Borderline Personality Disorder Histrionic Personality Disorder Antisocial
Personality Disorder Personality disorder Decision Tree