Psychopathology - Chapters 8, 9 & 15

Personality Disorders

• Inflexible patterns of thinking & behaving that persist across contexts

• Difficulty forming a healthy sense of self and maintaining healthy interpersonal relationships

Cluster A

Odd and eccentric personalities

Includes:

• Paranoid PD

• Schizoid PD

• Schizotypal PD

Cluster B

Dramatic and unpredictable

Includes:

• Antisocial PD

• Narcissistic PD

• Histrionic PD

• Borderline PD

Cluster C

Anxious and fearful

Includes:

• Avoidant PD

• Dependent PD

• Obsessive-compulsive PD

Key Features: Paranoid

Distrust and suspiciousness of others

Key Features: Schizoid

Detachment from social relationships and restricted range of emotional expression

Key Features: Schizotypal

Cognitive distortions, eccentric behavior, and lack of capacity for close relationships

Key Features: Antisocial

Disregard for and violation of the rights of others

Key Features: Borderline 

Instability of interpersonal relationships, self image, and affect, impulsivity

Key Features: Histrionic

Excessive emotionality and attention seeking

Key Features: Narcissistic

Grandiosity, need for admiration, lack of empathy

Key Features: Avoidant

Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

Key Features: Dependent

Excessive need to be taken care of, submissive behavior, fear of seperation

Key Features: Obsessive-compulsive

Preoccupation with order, perfection, and control

AMPD Criterion A

Personality Functioning:

• Self: identity, self-direction

• Interpersonal: empathy, intimacy

AMPD Criterion B

Maladaptive Personality Traits:

• Negative Affectivity

• Detachment

• Antagonism

• Disinhibition

• Psychoticism

Paranoid PD

Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent

• Four or more symptoms

Schizoid PD

Pattern of detachment from social relationships and a restricted range of emotional expression

• Four or more symptoms

Schizotypal PD

Pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior

• Four or more symptoms

Borderline PD

Pattern of instability in impersonal relationships, self-image, affects, and is marked by impulsivity

• Five or more symptoms

Narcissistic PD

Pattern of grandiosity, need for admiration, and lack of empathy

• Five or more symptoms

Histrionic PD

Pattern of excessive emotionality and attention seeking

• Five or more symptoms

Antisocial PD

• Pattern of disregard for, and violation of the rights of others

• Irresponsible, impulsive, deceitful 

• Three or more symptoms (at least 15 years old) 

Avoidant PD

Pattern of social inhibition, feelings of inadequacy, and hypersensitivity

• Four or more symptoms

Dependent PD

Pattern of submissive and clinging behavior related to excessive need to be taken care of

• Five or more symptoms

Obsessive-compulsive PD

Pattern of preoccupation with orderliness, perfectionism, and control

• Four or more symptoms

Treatment for Personality Disorders

• Psychotherapy (primarily used)

• Psychodynamic therapy

• Cognitive Therapy

• Disorder-specific treatments are limited due to a lack of research

Dissociations 

a disruption or discontinuity in consciousness, memory, identity, emotion, etc.

Dissociative Identity Disorder

Adoption of several new Identities that each display unique behaviors, voices, and postures

Causes of D.I.D.

• Linked to childhood trauma and abuse

• Closely related to PTSD

• Mechanism to escape from the impact of trauma

Alters

Different identities of personalities; “parts”

Host

The identity that keeps other identities together

Switch

Quick transition from one personality to another

Treatment Stages of D.I.D.

1. Building Safety and Stabilization

2. Processing Trauma

3. Focusing on the Future

Psychotic Disorders

Characterized By:

• Hallucinations

• Delusions

• Negative Symptoms 

• Disorganized speech & behavior

Core features of Schizophrenia

• Positive symptoms

• Negative symptoms

• Psychomotor/disorganized symptoms

Delusions

fixed beliefs that are resistant to change despite evidence that proves otherwise

Hallucinations

involuntary perceptual and sensory experiences that occur without external stimulus (seeing, feeling, hearing things that aren’t really happening or there)

Positive Symptoms

• Delusions

• Hallucinations

Negative Symptoms

An absence of insufficiency of normal behavior

Spectrum of NS’s

Includes:

• Avolition

• Alogia

• Anhedonia

• Associality

• Affective flattening

Avolition

lack of initiation

Alogia

relative absence of speech

Anhedonia

lack of pleasure

Asociality

lack of interest in social interactions

Affective Flattening

little expressed emotion

Disorganized Symptoms

confused or abnormal speech, behavior and emotion

Schizophrenia

2 or more symptoms that each have to be present for a significant amount of time over a 1 month period

Schizophrenia Symptoms

• Delusions

• Hallucinations

• Disorganized speech

• Negative symptoms

• Catatonic behavior

Schizophreniform Disorder

2 or more symptoms from criteria A over a month long period

• Episode lasts at least one month but less than six months

Schizophreniform Symptoms

Two or more of: 

• hallucinations

• delusions

• disorganized speech

Other disorders have been ruled out

Brief Psychotic Disorder Symptoms

Presence of one or more:

• delusions

• hallucinations

• disorganized speech 

• catatonic behavior

An episode of disturbance has to last at least one day but less than a month

Symptoms appear suddenly and resolve within a month

Schizoaffective Disorder

An uninterrupted period of illness during which there is a major mood episode (depressive or manic) that is concurrent with criteria A of schizophrenia

Delusional Disorder

presence of 1 or more delusions with a duration of one month or longer

• Criteria A of schizophrenia isn’t met

• Functioning is not markedly impaired

Catatonia

Disorder marked by unusual motor responses, odd mannerisms, agitation, and immobility

Catatonia Symptoms

Must have 3 or more of the following:

• Waxy flexibility

• Mimicking others’ speech or movement

• Repetitive, meaningless motor behaviors

• Opposition or lack of response to instructions

• Mutism, or maintaining the same pose for hours

Erotomanic Delusions

delusions that another person is in love with the individual

Grandiose Delusions

delusion of having some great unrecognized talent or insight

Jealous Delusions

delusions that the individual’s spouse or lover is unfaithful

Persecutory Delusions

delusions that the individual is being conspired against in pursuit of long-term goals

Somatic Delusions

delusions that involve bodily functions or sensations

Mixed Delusions

no delusion theme predominates

Unspecified Delusions

delusional belief that can’t be clearly determined or described specifically

Treatment for Schizophrenia

• Antipsychotic

• Behavioral family therapy

• Targeting negative symptoms

• Main goal - reduce symptoms and improve functioning