PSYC 100 Winter W21

Psychopathology and Therapeutic Orientations

Personality

Characteristic, routine ways of thinking, feeling, and relating to others

Five-Factor Model

Five broad domains or dimensions that are used to describe human personality

Neuroticism (Emotional Instability)

Fearful, apprehensive, angry, bitter, pessimistic, glum, timid, embarrassed, tempted, urgency, helpless, fragile

Emotional Stability

Relaxed, unconcerned, cool, even-tempered, optimistic, self-assured, glib, shameless, controlled, restrained, clear-thinking, fearless, unflappable

Extraversion

Cordial, affectionate, attached, sociable, outgoing, dominant, forceful, vigorous, energetic, active, reckless, daring, high-spirited, excitement seeking

Introversion

Cold, aloof, indifferent, withdrawn, isolated unassuming, quiet, resigned, passive, lethargic, cautious, monotonous, dull, placid, anhedonic

Openness (Unconventionality)

Dreamer, unrealistic, imaginative, aberrant, aesthetic, self-aware, eccentric, strange, odd, peculiar, creative, permissive, broad-minded

Closeness (Conventionality)

Practical, concrete, uninvolved, no aesthetic interest, constricted, unaware, alexthymic, routine, predictable, habitual, stubborn, pragmatic, rigid, traditional, inflexible, dogmatic

Agreeableness

Gullible, naive, trusting, confiding, honest, sacrificial, giving, docile, cooperative, meek, self-effacing, humble, soft, empathetic

Antagonism

Skeptical, cynical, suspicious, paranoid, cunning, manipulative, deceptive, stingy, selfish, greedy, exploitative, oppositional, combative, aggressive, confident, boastful, arrogant, tough, callous, ruthless

Conscientiousness

Perfectionistic, efficient, ordered, methodical, organized, rigid, reliable, dependable, workaholic, ambitious, dogged, devoted, cautious, ruminative, reflective

Disinhibition

Lad, negligent, haphazard, disorganized, sloppy, casual, undependable, unethical, aimless, desultory, hedonistic, negligent, hasty, careless, rash

DSM

Provides a common language + standard criteria for the classification and diagnosis of mental disorders

Manual used by clinicians, researchers, health insurance companies, and policymakers

DSM-5 Personality Disorders

Antisocial, Avoidant, Borderline, Dependent, Histrionic, Narcissistic, Obsessive-Compulsive, Paranoid, Schizoid, Schizotypical

Personality Disorders

When personality traits result in significant distress, social impairment, and/or occupational impairment

Avoidant

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Dependent

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation

Antisocial

A pervasive pattern of disregard + violation of the rights of others. These behaviours may be aggressive or destructive and may involve breaking laws or rules, deceit or theft

Obsessive-Compulsive

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental + interpersonal control, at the expense of flexibility, openness, and efficiency

Schizoid

A pervasive pattern of detachment from social relationships + restricted range of expression of emotions in interpersonal settings; confined largely to traits of introversion

Borderline

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity;  largely a disorder of neuroticism, including traits as emotionally unstable, vulnerable, overwhelmed, rageful, etc.

Histrionic

A pervasive pattern of excessive emotionality and attention seeking; largely a disorder of maladaptive extraversion (attention-seeking, melodramatic emotionality, etc.)

Narcissistic

A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, lack of empathy; traits from neuroticism, extraversion, antagonism, and conscientiousness

Schizotypal

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as perceptual distortions and eccentricities of behaviour

Paranoid

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent

Ego-Syntonic

Means that people are largely comfortable with their selves, typically lack insight into the maladaptivity of their personality

Psychopathy

Synonymous with psychopathic personality, the term used by Cleckley (1941/1976), and adapted from the term psychopathic introduced by German psychiatrist Julius Koch (1888) to designate mental disorders presumed to be heritable

Pinel and Manie sans Delire

Dramatic episodes of recklessness and aggression occurred in individuals not suffering from obvious clouding of the mind

Cleckley and The Mask of Sanity

Described psychopathy as a deep-rooted emotional pathology concealed by an outward appearance of good mental health

McCord and McCord

Described the condition of psychopathy in more generally pathologic terms, highlighting "guiltlessness" and "lovelessness"

Antisocial Personality Disorder (ASPD)

Counterpart diagnosis to psychopathy included in the 3rd through 5th editions of the DSM. Defined by specific symptoms of behavioural deviancy in childhood (e.g., fighting, lying, stealing, truancy) continuing into adulthood (manifested as repeated rule-breaking, impulsiveness, irresponsibility, aggressiveness, etc.)

Psychopathy Checklist-Revised (PCL-R)

Most widely used instrument for diagnosing psychopathy in correctional and forensic settings

Comprises 20 items rated on the basis of interview + file record information

Capture the interpersonal-affective deficits and behavioural deviance features identified by Cleckley, but include only limited, indirect coverage of positive adjustment features

High PCL-R Scores

Correlated with impulsive and aggressive tendencies, low empathy, Machiavellianism, lack of social connectedness, persistent violent offending

Interpersonal-Affective Factor

Relates to indices of narcissism, low empathy, proactive aggression, and to some extent, adaptive tendencies such as high social assertiveness and low fear, distress, and depression

High Scores on Antisocial Deviance Factor

Associated with maladaptive tendencies and behaviours, including impulsiveness, sensation seeking, alienation, mistrust, reactive aggression, early and persistent antisocial deviance, substance related problems

Psychopathic Personality Inventory

Was developed to index personality dispositions embodied within historic conceptions of psychopathy

Fearless Dominance (FD) Factor

Reflects social potency, stress immunity, fearlessness

Self-Centered Impulsivity (SCI)

Reflects egocentricity, exploitativeness, hostile rebelliousness, lack of planning

Scores on PPI-FD

Associated with indices of positive psychological adjustment + measures of narcissism, capturing a more adaptive expression of dispositional fearlessness

Scores on PPI-SCI

Associated with multiple indicators of deviancy - including impulsivity and aggressiveness, child and adult antisocial behaviour, substance abuse problems, heightened distress and dysphoria, and suicidal ideation

Antisocial Process Screening Device (APSD)

Used with clinic-referred children 6-13, includes 20 items completed by parents or teachers

Tap a callous-unemotional factor and an impulsive/conduct problems factor

Callous-Unemotional (CU) Factor

Reflecting emotional insensitivity and disregard for others

Impulsive/Conduct Problems (I/CP) Factor

Reflecting impulsivity behaviour deviancy, and inflated self-importance

Triarchic Model

Conceives of psychopathy as encompassing three symptomatic components: boldness, meanness and disinhibition

Boldness - Triarchic Model

Involving social efficacy, emotional resiliency, and venturesomeness

Meanness - Triarchic Model

Entailing lack of empathy/emotional-sensitivity and exploitative behaviour toward others

Disinhibition - Triarchic Model

Entailing deficient behavioural restraint and lack of control over urges/emotional reactions

Triarchic Psychopathy Measure (TriPM)

Contains 58 items comprising three sub scales that correspond to the constructs of the model

The Id - Freud

Represents pleasure-driven unconscious urges

The Superego

Semi-conscious part of the mind where morals and societal judgment are internalized

The Ego

Partly conscious, mediates between the id and superego

Psychoanalytic Therapy

Freud's therapeutic approach focusing on resolving unconscious conflicts

Psychodynamic Therapy

Treatment applying psychoanalytic principles in a briefer, more individualized format

Free Association

 A process in which the patient reports all thoughts that come to mind without censorship, and these thoughts are interpreted by the therapist (sometimes applied specifically to childhood recollections)

Person-Centered Therapy (PCT)

A therapeutic approach focused on creating a supportive environment for self-discovery

Belief is that mental health problems result from an inconsistency between patients’ behaviour and their true personal identity

Goal is to create conditions under which patients discover their self-worth, feel comfortable exploring their own identity, and alter their behaviour to better reflect this identity

Unconditional Positive Regard

In PCT, an attitude of warmth, empathy, and acceptance adopted by the therapist in order to foster feelings of inherent worth in the patient

Cognitive Behavioural Therapy (CBT)

A family of approaches with the goal of changing the thoughts and behaviours that influence psychopathology

Automatic Thoughts

From Beck; thoughts that occur spontaneously; often used to describe problematic thoughts that maintain mental disorders

Types of Schemas/Belief Systems with CBT

Beliefs about the self, beliefs about the world, beliefs about the future

Schemas

A mental representation or set of beliefs about something

Techniques in CBT

Technique of reappraisal/cognitive restructuring, goal is to help people make adaptive appraisals

Rational-Emotive-Behavioural Therapy (REBT) & Ellis 1957

Encourages patients to evaluate their own thoughts about a situation

Reappraisal/Cogntiive Restructuring

The process of identifying, evaluating, and changing maladaptive thoughts in psychotherapy

Exposure Therapy

A form of intervention in which the patient engages with a problematic (usually feared) situation without avoidance or escpae

After repeated exposure, the patient experiences less physiological fear + maladaptive thoughts, breaking tendency for anxiety and subsequent avoidance

Mindfulness-Based Therapy (MBT)

A form of psychotherapy grounded in mindfulness theory and practice, often involving meditation, yoga, body scan, and other features of mindfulness exercises

Mindfulness-Based Stress Reduction (MBSR)

Uses meditation, yoga, and attention to physical experiences to reduce stress; hope is that reducing a person's overall stress will allow that person to more objectively evaluate their thoughts

Mindfulness-Based Cognitive Therapy (MBCT)

Attention is focused on one's thoughts and their associated emotions

Dialectical Behaviour Therapy (DBT)

A treatment often used for borderline personality disorder that incorporates both cognitive-behavioural and mindfulness elements

Dialectical Worldview

A perspective in DBT that emphasizes the joint importance of change and acceptance

Acceptance and Commitment Therapy (ACT)

A therapeutic approach designed to foster nonjudgmental observation of one's own mental processes

Cognitive Bias Modification

Using exercises (e.g., computer games) to change problematic thinking habits

Comorbidity

Describes a state of having more than one psychological or physical disorder at a given time

Integrative or Eclectic Psychotherapy

Some clinicians incorporate techniques from multiple approaches