Videbeck: Psychiatric-Mental Health Nursing, Sixth Edition; Chapter 18: Personality Disorders; PrepU

When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which of the following is the most relevant question the nurse should ask?

"Do you always practice safe sex?" BPD results in impulsive behavior and often sexual promiscuity; therefore, the most relevant question the psychiatric nurse can ask is whether the client always practices safe sex.

A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse?

"I get upset once in a while, too." Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse cannot know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. (less)

A 43 year old female client is observed walking and dancing around unit dressed in red high heels and provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which of the following is the most therapeutic nursing intervention?

"I need for you to get off his lap, this behavior is not appropriate." Clients with have a long-standing pattern of excessive emotionality and attention-seeking behaviors. A matter-of-fact approach to limit-setting and boundaries effectively limits the manipulative and attention-seeking behaviors. (less)

The adult children of a woman with narcissistic personality disorder meet with the therapist as part of their mother's treatment. The nurse is aware which of the following statements by the daughter is consistent with behavior typically associated with this personality disorder?

"My mother never really seemed to see me as a person with my own thoughts and problems." Clients with narcissistic personality disorder have a lifelong pattern of self-centeredness, self-absorption, inability to empathize with others, grandiosity, and extreme desire for the admiration of others. They feel that they are unusually special and often exaggerate their accomplishments to appear more important than they actually are. As sensitive as they are to the opinions of others, they are particularly insensitive to the needs or feelings of others and lack empathy. (less)

A client asks the nurse to go to lunch with her one day next week after she is discharged. Which statement is the most therapeutic response?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge." Clients with borderline personality disorder may display negative behaviors that can interfere with therapy. The nurse will have to confront clients about their behaviors and set appropriate limits. (less)

A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling him about the unit rules, he asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" The most therapeutic nursing response would be which of the following?

"No, only one cigarette is allowed per break time." The client is trying to manipulate the nurse in order to gratify his immediate need for a cigarette. In responding to manipulative behavior, the most therapeutic intervention is to maintain the limits that have been set and not to change the rules or make concessions for the client. The correct answer is the only option that is clear and assertive and maintains the rules. (less)

A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client's sister is visiting, and she asks the nurse to explain why the client sometimes does this to herself. Which response by the nurse would be most appropriate?

"Sometimes the self-injurious behavior is undertaken to relieve stress." Clients with borderline personality disorder are impulsive and may respond to stress by harming themselves. Self-harm is an effort to self-soothe by activating endogenous endorphins to provide comfort. The behavior is not sedating or calming, and it is not used to prevent delusional thinking or mood swings. (less)

A client diagnosed with borderline personality disorder tells the nurse that she "frequently spaces out." Which response by the nurse would be most appropriate?

"What's happening around you when this occurs?" To determine a pattern for the client's coping skills, it is important to ask the client what is happening in the environment when dissociation occurs. In addition, this is the only question that is open ended; therefore, it will elicit more information than a closed-ended question would. (less)

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

"You'll be expected to attend group therapy each day." Rules and explanations must be brief, clear, and leave little room for misinterpretation. A client with antisocial personality disorder tends to disregard rules and authority and be socially irresponsible. The words "You'll be expected to attend..." are concise and concrete and convey precisely what behavior is expected. The other options leave open the interpretation that attendance is suggested but not mandatory. (less)

Which of the following is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables A combination of psychosocial and biologic factors is believed to be responsible for the formation of personality itself and personality disorders.

The nurse is interviewing a client with a history of violence. He boasts that he "put a kid in a wheelchair" once when he was younger and has maimed others. He states, "Who cares? Life's tough." Violence and insensitivity are associated with which of the following personality disorders?

Antisocial personality disorder Those with antisocial personality disorder display aggressive, irresponsible behavior that often leads to conflicts with society and subsequent involvement in the criminal justice system. People with this disorder commonly display behaviors such as fighting, lying, stealing, abusing children and spouses, abusing substances, and participating in confidence schemes. These people, while often superficially charming, lack genuine warmth. (less)

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by which of the following?

Anxious or fearful behaviors Clients with Cluster C personality disorders—which include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder—are often anxious, tense, and fearful. (less)

A client who has a diagnosis of borderline personality disorder and lives at home with her parents. She has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which of the following would be most therapeutic when Cheryl's parents come in to discuss discharge plans?

Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder. (less)

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to focus on when teaching the family about this disorder?

Boundary setting Family members of clients with antisocial personality disorder usually need help in establishing boundaries. Because there is a long-term pattern of interaction in which family members feel responsible for the client's antisocial behavior, these patterns need to be interrupted. Anger management and self-responsibility are appropriate for the client, not the family. Medication therapy is usually not prescribed unless the client has another disorder. (less)

A personality disorder is defined as a collection of traits that do which of the following?

Cause behavioral dysfunction and inner distress A personality disorder can be defined as a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder also can be considered a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness. (less)

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which of the following situations?

Child sexual abuse The most severe form of invalidation occurs in situations of child sexual abuse. Often, the abusing adult has told the child that this is a "special secret" between them. The child experiences feelings of fear, pain, and sadness, yet this trusted adult continuously dismisses the child's true feelings and tells the child what he or she should feel. Divorce, marriage, and death of a family member are not the most severe forms of invalidation. (less)

A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation?

Client attributes own feelings falsely to others. Clients falsely attributing to others their own unacceptable feelings, impulses, or thoughts is termed projective identification. Lacking a definitive sense of self reflects issues with separation-individuation. Misinterpreting environmental stimuli reflects cognitive schema. The inability to control emotional reactions in social situations reflects emotional dysregulation. (less)

Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?

Client fears criticism from others, including staff. Symptoms suggesting an avoidant personality disorder include fear of rejection, avoidance of relationships, and censorship of expression of thoughts and feelings because of fear of a negative reaction. Borderline personality disorder presents with unstable interpersonal relationships, labile affect, and complaints of emptiness. Clients with histrionic personality disorder are overly dramatic, manipulative, and attention-seeking. Clients with schizoid personality disorder are indifferent to and lack concern for interpersonal contacts. (less)

Dialectical behavior therapy (DBT) combines behavior therapy with which of the following types of therapy?

Cognitive DBT combines cognitive and behavior therapy strategies. Clinicians partner with clients and focus on the many interconnected behaviors.

The client is a 29-year-old woman who is having a great deal of difficulty with her new job. She has been unable to make decisions on her own and feels overwhelmed when she needs to begin a new project. She often relies on one of her co-workers to help her with her decisions and projects. Which of the following would describe the client correctly?

Dependent personality Clients with dependent personality have a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation. In addition, they need so much approval from others that they have tremendous difficulty making independent decisions or starting projects. In effect, they do not trust their own judgment and often believe that others have better ideas. (less)

The way in which personality disorders are different from personality traits is best described as follows:

Disorders cause impairment in social and occupational functioning, whereas traits do not. Personality disorder is a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder is a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness (less)

A client diagnosed with schizoid personality disorder is described by family members as which of the following?

Eccentric and a loner A client diagnosed with schizoid personality disorder is described by family members as being eccentric and a loner, not dramatic and emotional, nervous and fearful, or tired and sad. (less)

A nurse is preparing a teaching plan for a client with antisocial disorder. Which of the following would the nurse most likely employ to promote successful education?

Engaging the client in a discussion to direct the topic to the client. Client education efforts have to be creative and thought provoking. In teaching a person with ASPD, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue and then direct the topic to the major educational points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked. (less)

The nurse in charge of an inpatient psychiatric unit finds herself frustrated and angry with a client who has borderline personality disorder. Which of the following steps should the nurse take?

Examine her own feelings to discover the source of her anger. Working with clients who have personality disorders is difficult. For this reason, nurses may find it helpful to discuss their emotional reactions to clients who have personality disorders with knowledgeable and trusted nurse colleagues. Doing so can facilitate nurses working through negative countertransferences, resulting in their tolerating and accepting feelings of irritation and anger as natural reactions to clients with personality disorders. This realization can increase the nurse's own self-awareness and sense of emotional control. (less)

After teaching a group of nursing students about different personality disorders, the instructor determines that the education was successful when the students identify which of the following as characteristic of schizotypal personality disorder?

Increased eccentricity Individuals with schizotypal personality disorder are dramatically. These individuals are perceived as strikingly odd or strange in appearance and behavior, even to laypersons. They may have unusual mannerisms, an unkempt manner of dress that does not quite "fit together," and inattention to usual social conventions (e.g., avoiding eye contact, wearing clothes that are stained or ill-fitting, and being unable to join in the give-and-take banter of coworkers). (less)

Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?

Narcissistic Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control. (less)

When the nurse is not informed of developmental and cultural issues related to the client's background, which of the following may be expected?

Normal patterns of behavior may be labeled as deviant, immoral, or insane. If the nurse does not remain culturally sensitive, it is possible that symptoms or behaviors that are observed might be misinterpreted as deviant or immoral. Client behavior is always based upon client history and cultural background; understanding of behavior cannot be obtained simply from conventional wisdom. (less)

A client attends an outpatient mental health clinic accompanied by his wife for an assessment. The client's wife reports the client is easily irritated if the home is not maintained in a specific order and when he is unable to complete his "to do" list on time. The client has a serious and formal demeanor. Which of the following personality disorders best describes this client?

Obsessive-compulsive personality disorder Perfectionism, rigidity, controlling behavior, and extreme orderliness characterize people with obsessive-compulsive personality disorder. Their rigid perfectionism often results in indecisiveness, preoccupation with detail, and an insistence that others do things their way. Resisting authority and insisting that they and they alone are right are common behavioral patterns. Hoarding worthless objects, displaying stinginess, working excessively, showing stubbornness, and moralizing also occur to a high degree in people with this disorder. (less)

A client is a 25-year-old man who has a long history of being suspicious of his friends and wife. He persistently accuses his wife of being unfaithful. He accuses his friends of making statements that are insulting to his character. Which of the following is the most accurate description of the client's personality?

Paranoid People with paranoid personality disorder are suspicious and quick to take offense. They usually cannot acknowledge their negative feelings toward others and project these negative feelings on them. They may have few friends, look for hidden meaning in innocent remarks, be litigious and guarded, or bear grudges for imagined insults or slights. Marital or sexual difficulties are common and often involve issues related to fidelity. (less)

Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)?

Parental overcontrol The basis of the compulsive patterns seen in OCPD is parental overcontrol and overprotection that is consistently restrictive and sets distinct limits on the child's behavior. Lack of nurturing is not implicated in this disorder, nor is substance use within the family. Clients diagnosed with paranoid personality disorder may have been hyperactive as a child. (less)

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note?

Participating in relationships in which the client has control Individuals with borderline personality disorder restrict their relationships to ones in which they feel control. They distance themselves from groups when feeling anxiety (which is most of the time) and rarely use their support systems. They are reluctant to share their feelings. To meet their interpersonal needs, they idealize others and establish intense relationships that violate interpersonal boundaries of others, leading to rejection. (less)

Which of the following statements accurately reflects the prognosis for a client with a personality disorder?

Prognosis varies based on the degree of functional impairment and the client's motivation to change. At one time, the prognosis for all personality disorders was considered grim, because the general consensus was that these conditions were untreatable. Because people continue to grow and change throughout life, however, current views emphasize that personality disorders are treatable. Prognosis varies widely, based on the degree of functional impairment and the client's motivation to change. (less)

A client with borderline personality disorder has been admitted to the inpatient unit after she was found in her parents' bedroom, burning her arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which of the following is highest nursing care priority for this client during the first 24 hours of her admission?

Protection from self mutilation Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves. (less)

A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity, and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify as a priority?

Risk for Other-Directed Violence Although they can be interpersonally charming, these clients can become verbally and physically abusive if their expectations are not met. Protection of other clients and staff from manipulative and sometimes abusive behavior is a priority. Thus, a nursing diagnosis of Risk for Other-Directed Violence would be a priority. Clients with antisocial personality disorder are less likely to engage in self-injury or self-violence; rather, they are more likely to strike out at those who are perceived to be interfering with their immediate gratification. Risk for Suicide would be a priority if the client was also experiencing depression. (less)

Which of the following would be a priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?

Risk for Self-Mutilation One of the first diagnoses to consider with this client population is Risk for Self-Mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but Risk for Self-Mutilation would be the priority. (less)

The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?

Self-dramatization The client with histrionic personality disorder uses self-dramatization and emotional exaggeration to draw attention to self. The antisocial personality tends to be manipulative. Paranoid personality disorder causes the client to be suspicious and distrust others. In obsessive-compulsive personality disorder, the client's perfectionism interferes with task completion. (less)

A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which she has been receiving outpatient treatment. The client tells the nurse that she recently found out her therapist is moving and will not longer be able to work with her. What is the highest priority nursing diagnosis for this client?

Self-mutilation Although all the above are problems for this patient, the highest priority nursing diagnosis is self-mutilation. If left untreated, self-mutilation can lead to suicide attempts.

A client on an inpatient psychiatric unit has features of borderline personality disorder: She is frequently angry, has an unstable sense of herself, and is highly impulsive. She can be verbally abusive to staff, who feel manipulated by her behaviors. Which of the following interventions does the nurse determine as a priority?

Setting limits The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.

When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense?

Splitting Because clients with BPD view the world in absolutes, nurses and other treatment team members are alternately categorized as all good or all bad. This primitive defense is called splitting, and it presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. This is not an example of defending, invalidating, or projective identification. (less)

Which of the following occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way?

Splitting Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones. (less)

The nurse-therapist is conducting a group therapy session in which one of the participants is a male adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern?

The client's mother catered to his every need and the client used temper tantrums to successfully get his way. Narcissistic personality disorder is characterized by an exaggerated sense of self-importance. It is plausible that a client's high degree of control and entitlement early in life may have contributed to or exacerbated such tendencies. The other patterns of interaction would not tend to promote entitlement or a grandiose self-view. (less)

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder?

This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened. Personality disorders are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive. Individuals have identity problems such as egocentrism or being self-centered, and their sense of self-esteem comes from gaining power or pleasure that is often at the expense of others. Their behavior often fails to conform to cultural, social, or legal norms, and they are motivated by personal gratification. Individuals with these disorders are often withdrawn, defensive, guarded, and impulsive, and may demonstrate an escalation of anger or make hostile or threatening comments. The remaining options are specific to certain types of personality disorders. (less)

The treatment plan for which of the following clients would most likely include a family treatment approach?

Those with dependent personality disorders Clients with borderline, dependent, histrionic, and avoidant personality disorders may benefit from family treatment approaches.

Which of the following is a technique used to help the client with borderline personality disorder (BPD) gain control over self critical thoughts?

Thought stopping Thought stopping is a practice that may help the patient control the a technique to alter the process of negative or self critical thought patterns such as "I'm dumb, I'm stupid, I can't do anything right." (less)

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder?

believes he or she is incapable of functioning independently Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit care taking from others. The dependent person must rely on others to make decisions and assume responsibility of major areas of life. Low self-esteem and exaggeration are seen in avoidant personality disorder. Attention seeking is seen in narcissistic personality disorder. (less)

When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success?

collaborating with the client when establishing treatment goals Because clients with personality disorders need to feel in control, it is important to involve them in formulating their care plan. The nurse asks what the client would like to accomplish in concrete terms, such as minimizing problems at work, or getting along with others. Clients are more likely to engage in the therapeutic process if they believe they have something to gain. When planning interventions with a client who has a personality disorder, it is important to recognize that the person has disturbed values that do not reflect the views held by the general population. Because of these disturbances, the nurse needs to collaborate with the client regarding the goals that are identified during treatment. The remaining options although appropriate will not be attainable if the client does not recognize the interventions as being useful and personally applicable. (less)

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care?

ineffective coping Nursing diagnoses commonly used when working with these clients include ineffective coping, ineffective role performance, risk for other-directed violence. The client with antisocial personality disorder is impulsive, manipulative, and dishonest. Clients with this disorder are frequently involved in illegal matters. Self-mutilation and disturbed identity are more appropriate for clients with borderline personality disorder. Social isolation would apply more readily to Cluster A disorders. (less)

Behavior and characteristics of individuals with personality disorders are best described with which of the following?

rigid and inflexible. The behavior of clients with personality disorders is enduring and inflexible and pervades a wide range of personal and social contexts.

The nurse working with clients who have borderline personality disorder (BPD) understands that they need help to both recognize genuine respect from others as well as reciprocate that respect for others. How can the nurse model self-respect? Select all that apply.

• Be assertive. • Clearly communicate expectations. • Observe personal limits. The nurse in the therapeutic relationship models self-respect by observing personal limits, being assertive, and clearly communicating expectations.

Clients with borderline personality disorder commonly exhibit which of the following symptoms? Select all that apply.

• Fear of abandonment • History of unstable, insecure attachments • Constant need for reassurance People with borderline personality disorder have an extreme fear of abandonment and a history of unstable and insecure relationships. They constantly seek reassurance and acceptance from others. (less)

People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply.

• Gambling • Shopping beyond their means • Binge eating • Abusing alcohol Impulsivity is a characteristic of people with borderline personality disorder (BPD). They have difficulty delaying gratification and often act "in the moment." Gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances are typical. (less)

After reviewing the different types of personality disorders, a group of nursing students demonstrates understanding when they identify which of the following as being associated with emotional volatility? Select all that apply.

• Histrionic • Narcissistic Personality disorders characterized by emotionally volatility include histrionic and narcissistic personality disorders. Avoidant, dependent and obsessive -compulsive personality disorders are characterized by anxiety and fear.

When reviewing the history of a client with antisocial personality disorder, which of the following would the nurse expect to find? Select all that apply.

• Lack of remorse for actions • Episodes involving scams for personal gain • Repeated incidents involving assaults A client with antisocial personality disorder shows a pervasive pattern of disregard for and violation of the rights of others. History may reveal repeated incidents of physical fights or assaults demonstrating irritability and aggressiveness, repeated failure to sustain consistent work behavior or honor financial obligations, lack of remorse for actions, conning others for personal profit or pleasure, and impulsivity or failing to plan ahead. (less)

When assessing a client with borderline personality disorder, which of the following behaviors would the nurse expect to find? Select all that apply.

• Repeated, frequent crisis episodes • Self-directed anger • Learned helplessness • Deceptive competence Behavior patterns associated with BPD include: emotional vulnerability (high sensitivity to negative emotional stimuli), self-invalidation (self-directed anger and no personal awareness), active passivity (learned helplessness), unrelenting crises (repeated, stressful, negative environmental events/roadblocks), inhibited grieving, and apparent competence (appearing more competent than person actually is). (less)

When describing the etiology of pyromania to group of nurses, which neurotransmitter would the nurse identify as being linked to this disorder. Select all that apply.

• Serotonin • Norepinephrine Early research demonstrated low serotonin and norepinephrine levels associated with arson. No other neurtotransmitters have been linked to this disorder.