A patient with antisocial personality disorder belches loudly. A staff member asks "Do you know why people find you repulsive?" This statement most likely would elicit which of the following client reaction?

Appeared in: SJH Nursing Officer - 2019

Explanation

Patients with Antisocial Personality Disorder (ASPD) typically react to criticism or confrontation with anger, hostility, and defensiveness.
A core feature of ASPD is a profound lack of empathy, shame, or remorse for their actions.
They tend to externalize blame, meaning they will see the staff member as the problem, not their own behavior.
The staff's question is a personal attack, which triggers a defensive response rather than self-reflection in a person with ASPD.

Why Other Options Were Wrong

Option B: Embarrassment requires a concern for the opinions of others and an understanding of social norms, which are characteristically absent in individuals with ASPD.
Option C: Shame is a deep-seated feeling of being flawed, which requires a level of self-awareness and conscience that is not present in ASPD. They do not experience shame over their behavior.
Option D: A lack of remorse is a hallmark diagnostic criterion for antisocial personality disorder. They do not feel sorry for their actions or the impact they have on others.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Behavioral responses of patients with Antisocial Personality Disorder (ASPD) to confrontation to guide bedside assessment, documentation, and the next nursing action.
When interacting with patients with ASPD, nurses must use a calm, neutral, and matter-of-fact tone. Focus on the behavior, not the person.
The primary nursing intervention is setting firm, consistent limits on unacceptable behavior to ensure a safe environment for everyone.
What if? If the staff member had said, 'The loud belching is disruptive to the group. We need you to be more mindful of others,' the patient might still be irritable, but the focus on the specific behavior (not their character) reduces the likelihood of an explosive defensive reaction and reinforces clear boundaries.

How to Approach the Question

First, identify the core diagnosis in the question stem: Antisocial Personality Disorder (ASPD).
Recall the key characteristics of ASPD: lack of empathy, no remorse or shame, impulsivity, and a tendency to react to criticism with anger or by blaming others.
Analyze the staff's intervention. The statement, 'Do you know why people find you repulsive?' is a shaming, personal attack, not a therapeutic communication.
Based on the ASPD profile, predict how the patient will react to an attack. They will defend themselves, not engage in self-reflection.
Evaluate the options. Eliminate 'Embarrassment,' 'Shame,' and 'Remorseful' as these emotions are fundamentally absent in ASPD.
Conclude that 'Defensiveness' is the only reaction consistent with the personality structure of someone with ASPD when confronted in this manner.

Concept Tested & Keywords

Concept Tested: Behavioral responses of patients with Antisocial Personality Disorder (ASPD) to confrontation.
Stem keywords: antisocial personality disorder, staff member, repulsive, client reaction
Lead-in keywords: most likely
Clinical cues: The patient's diagnosis of antisocial personality disorder is the key to predicting their reaction.
Clinical cues: The staff member's statement is shaming and non-therapeutic, which is likely to provoke a negative response.

Question ID

Q79RRE0uCJwAdn884cIgfM

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3880-3882

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1828-1830

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