Psychopathology Dr. Herman Exam 3

Personality disorder

is an ingrained pattern of relating to other people, situations, and events with a rigid and maladaptive pattern of inner experience and behavior, dating back to adolescence or early adulthood

- people with these don't even realize they have a disorder because it is apart of their personality

A personality disorder deviates markedly from the individual's culture and leads to _____ or _______

distress; impairment

Is a personality disorder neurotransmitter related ? why or why not?

- It is not neurotransmitter related, there is not an abnormal amount of serotine or dopamine like bipolar or depression.

Personality Disorder Behavior patterns must manifest themselves in at least two of these four areas...

cognition, affectivity, interpersonal Functioning, impulse control

T or F: A personality disorder doesn't have to impair function.

false

Personality Disorder 3 clusters on the basis of what were originally thought to be important similarities or features

cluster A, cluster B, cluster C

Cluster A in personality disorder

paranoid, schizoid and schizotypal personality disorders; include disorders characterized by eccentric behavior, are viewed as slightly odd, unusual or peculiar.

Cluster B personality disorder

histrionic, narcissistic, antisocial, and borderline personality disorders; include those that are marked by dramatic, emotional or erratic behaviors which include impulsivity, inflated (or apparent inflated) sense of self and a tendency to seek stimulation.

Cluster C personality disorder

avoidant, dependent and obsessive-compulsive personality disorders; involve people who appear anxious or fearful and may seem highly restricted. Tend to be inner directed and may draw little attention to themselves

Paranoid Personality Disorder

characterized by pervasive suspiciousness and distrust of others, always on guard against potential danger or harm; virtually impossible for them to trust anyone; when criticized become hostile

Causal factor of Paranoid Personality disorder

genetic, parental neglect or abuse, exposure to violent adults

Treatment for Paranoid Personality

CBT

- usually don't seek professional help

- very difficult to work with

- high rates of divorce and very poor interpersonal relationships

Schizoid Personality Disorder

inability or indifference to form social relationships as well as a very limited range of emotional experience and expression.

- Involves odd beliefs, behavior, appearance and interpersonal style

- overall, maladaptive social functioning

Schizoid Personality Disorder Characteristics

-prefers to be alone

-lack of desire for acceptance or love

-little pleasure in most activities

-rarely experience positive or negative emotions (apathetic)

-unaware and insensitive to other's feelings or emotions

-cold, withdrawn

Schizotypal Personality Disorder

odd beliefs, behavior, appearance and interpersonal style. May have bizarre ideas or preoccupations such as magical thinking and beliefs in psychic phenomenon.

- Similar to schizoid but also have cognitive and perceptual distortions as well as oddities and eccentricities in their communication and behavior

True or False: Schizotypal Personality Disorder: Usually contact with reality is maintained but highly personalized and superstitious thinking is a main component.

True

Fall under the extremely maladaptive end of the psychoticism dimension.

Schizotypal Personality Disorder

3 multiple choice options

Schizotypal Personality Disorder represent a latent form of blank meaning they are vulnerable to developing a full-blown psychosis if exposed to difficult life circumstances

schizophrenia

Schizotypal Personality Disorder Characteristics

-belief other's conversations and gestures have special meaning

-odd speech

-paranoid beliefs

-believe they have magical powers (extreme cases)

Histrionic Personality Disorder

characterized by exaggerated emotional reactions, approaching theatricality in everyday behavior.

- Feel unappreciated if not the center of attention. Can be furious if not

Characteristics of Histrionic Personality Disorder

- Self-centered and vain

- Reactive, shallow, and insincere

- Flirtatious

- Excessively extraverted

- Overly concerned with appearance

Narcissistic Personality Disorder

characterized by an unrealistic, exaggerated sense of self-importance, preoccupation with being admired, and a lack of empathy or sensitivity to the needs of others.

Characteristics of Narcissistic Personality Disorder

- Unable to take other's perspective into account. Only see things through their own eyes.

- An excessive need for admiration, disregard for others' feelings, an inability to handle any criticism, and a sense of superiority and entitlement.

Recent literature on narcissism argues that there are three factors covering the construct

agentic, antagonistic, and neurotic

Narcissism: Agentic

Desire control on one's own behalf or on the behalf of another.

Narcissism: Antagonistic

showing or feeling active opposition or hostility toward someone or something.

Narcissism: Neurotic

The trait disposition to experience negative affects, including anger, anxiety, self‐consciousness, irritability, emotional instability, and depression

Subtypes of Narcissistic Personality Disorder Grandiose narcissism

traits related to grandiosity, aggression, and dominance. Intense entitlement, high self-esteem, and overestimate abilities.

Subtypes of Narcissistic Personality Disorder Vulnerable narcissism

fragile and unstable sense of self-esteem where arrogance is merely a façade for intense shame and hypersensitivity to rejection and criticism.

Narcissistic Personality Causal factors

genetic and environmental

Narcissistic Personality Vulnerable subtype

Considered from abuse or neglect, controlling, intrusive, and/or cold parenting.

Narcissistic Personality Grandiose subtype

Also considered from the above parenting behavior, in addition to overvaluation.

Antisocial Personality Disorder (ASPD)

characterized by a disregard for society's moral or legal standards and an impulsive and risky lifestyle.

- Once referred to as psychopathy and sociopathy

- Commonly exhibit deceitful and aggressive behavior, typically without remorse or loyalty to anyone.

Antisocial Personality Disorder (ASPD) age ranges

Behavior becomes evident during adolescence, must start by age 15, and prior must have had symptoms of conduct disorder.

Childhood symptoms include cruelty to animals, bullying, explosion of anger, social isolation, theft, vandalism, poor performance in school, and severe impulsivity.

Can only receive this diagnosis at 18 years of age or older.

The behavior becomes extreme during late teens and early 20's, oftentimes, resulting in repeated conflict with society. Many become incarcerated.

Hervey Cleckly (1976) developed a set of criteria for psychopathy.

a cluster of traits that form the core of the antisocial personality including lack of remorse or shame, poor judgment, failure to learn from experience, extreme egocentricity, incapacity for love, lack of emotional responsiveness, impulsivity, absence of "nervousness", unreliability, untruthfulness, and insincerity.

Antisocial Personality Disorder (ASPD) Diagnostic Criteria

pervasive pattern of 3 out of 7 of the following

- Failure to conform to social norms

- Deceitfulness

- Impulsivity

- Aggressiveness

- Disregard for safety of self or others

- Irresponsibility

- Lack of remorse

Antisocial Personality Disorder (ASPD) Biological Perspectives:

- Strong evidence in favor of genetics

- Mutation in monoamine oxidase A (MAOA gene)

- Dependency during pregnancy

- Malnutrition in early life

- Hippocampus (short term memory processing)

- Deficits in frontal lobe functioning

Antisocial Personality Disorder (ASPD) Neuropsychological deficits

abnormal learning and attention

The response modulation hypothesis

individuals high in psychopathy are unable to pay attention to secondary cues rather than switch attention as needed.

Early life experience

Considered to be the most significant factor in development of antisocial personality disorder.

Borderline Personality Disorder (BPD):

characterized by a pervasive pattern of poor impulse control and instability in mood, interpersonal relationships and sense of self.

Criteria for the disorder has changed over time and reflects continuous revisions.

BPD Diagnostic Criteria

Must reflect 5 out of a possible nine behaviors:

- Frantic efforts to avoid abandonment

- Unstable and intense relationships

- Identity disturbance

- Impulsivity in areas such as sexuality, spending or reckless driving

- Recurrent suicidal behavior

- Affective instability

- Chronic feelings of emptiness

- Difficulty controlling anger

- Occasional feelings of paranoia or dissociative symptoms

BPD causal factors

-genetics

-parenting (abuse and/or neglect)

-emotional dysregulation: lack of awareness, understanding or acceptance of emotions, inability to control the intensity or duration of emotions, unwillingness to experience emotional distress as in pursuing goals or engaging in goal-directed behavior.

Avoidant Personality Disorder

have low estimation of their social skills and are fearful of disapproval, rejection, and criticism. Also, fear becoming ashamed or embarrassed.

- Inability to relate causes acute anxiety, coupled with low self-esteem and self-consciousness.

- Desire social relationships but avoids it for fear of rejection.

- Considered a more severe form of social anxiety disorder.

Schizoid Personality disorder

enjoys being alone.

- cold and indifferent to criticism

- lacks the desire or ability for social relationships.

Avoidant Personality disorder

dislikes being alone

- shy, insecure, and hypersensitive to criticism.

- desires social relationships but avoids it for fear of rejection.

Avoidant Personality disorder Causal Factors

"Inhibited" temperament

Rejection as a child

Parental criticism

Severe bulling

Treatment

CBT and Exposure therapy

Dependent Personality Disorder

characterized by extremely passive and tends to cling to other people, unable to make decisions, or take independent action.

Key word: "clingy"

Obsessive-compulsive Personality Disorder:

Preoccupation with intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity.

-rigid

-stubborn

-cold

-reluctant to delegate

Sense of self and self-worth are in terms of productivity.

T or F: OCPD has no true obsessions or compulsive rituals

True

The 3 traits of OCPD that overlap with OCD include

Perfectionism, preoccupation with details, and hoarding

OCPD causal factors

Modest genetic influence, parental issues and low self-esteem

Paraphilic Disorders word meaning

para meaning "faulty" or "abnormal"

philia meaning "attraction"

Paraphilic disorders

: Behaviors in which an individual has recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving

(1) nonhuman objects

(2) children or other nonconsenting persons or

(3) the suffering or humiliation of self or partner.

Essential feature of a paraphilic disorder:

becomes psychologically dependent on the target of desire and are unable to experience sexual arousal unless this target is present in some form.

Must experience the condition for at least 6 months.

Pedophilic Disorder

a paraphilic disorder in which an adult is sexually aroused by children or adolescents

- Must be at least 18 and at least 5 years older than the children whom attracted to

- Key feature: sexual arousal with children that is equal to or even greater than what is felt with fellow adults.

Exhibitionistic Disorder

person has intense sexual urges and arousing fantasies involving the exposure of genitals to a stranger.

- Often comorbid conditions include major depressive disorder and substance abuse.

Voyeuristic Disorder

person has a compulsion to derive sexual gratification from observing the nudity or sexual activity of others.

Most common paraphilia

Fetishistic Disorder

person is preoccupied with an object and depends on this object rather than sexual intimacy with partner for achieving sexual gratification.

Partialism

interested solely in sexual gratification from a specific body part other than the genitals, such as feet.

Frotteuristic Disorder

person has intense sexual urges and sexually arousing fantasies of rubbing against or fondling an unsuspecting stranger.

Sexual masochism disorder: ("masochism"-seeking pleasure from being in pain)

marked by an attraction to achieving sexual gratification by having painful stimulation applied to one's own body.

Aroused by being beaten, bound or otherwise made to suffer.

Sexual sadism disorder

sexually aroused from the physical or psychological suffering of another person

Transvestic disorder:

"transvestism" or "cross-dressing" refers to the behavior of dressing in the clothing of the other sex.

For diagnosis must show symptoms of a paraphilic disorder and have distress or impairment.

Theories of Sexual Disorders

Biological: genetic, hormonal and sensory factors.

Also, issues with the temporal lobe which is believed to alter sexual arousal combined with early physical or sexual abuse.

Treatment for sexual disorders

Castration: intended to destroy the body's production of testosterone through surgical castration (removal of the testes) or chemical castration (medication that suppress the production of testosterone).

Medication that alters neurotransmitter levels, esp. some antidepressants and those that involve GABA or glutamate receptors which decrease the activity of dopamine (neurotransmitter involved in sexual arousal)

Most effective: combination of hormonal drugs intended to reduce androgens (male sex hormone levels) and psychotherapy

Psychological perspective on sexual disorders

-Freud's psychoanalytic view.

-John Money: lovemaps view.

-"victim-to-abuser cycle" or "abused-abusers phenomenon" view.

Sexual Dysfunction

abnormality in an individual's sexual responsiveness and reactions.

Can't attribute divergence to a psychological disorder, effects of a substance such as drug abuse or medication, or a general medical condition

Clinicians rate sexual dysfunction based on whether it is lifelong or acquired and generalized or situational.

Lifelong: since sexually active

Acquired: at some point prior asymptomatic

Generalized: all sexual situations

Situational: only occur with certain types of sexual stimulation, situations or partners

Masters & Johnson Sexual Response Cycle

4 phases:

Excitement (arousal)

Plateau

Orgasm

Resolution

Arousal disorders

when sexual disorders occur during the initial phases of the sexual response cycle, have low or no sexual desire or are unable to achieve physiological arousal.

As a result, avoid having or been unable to have sexual intercourse.

Male hypoactive sexual desire disorder

males have abnormally low levels of interest in sexual activity.

Female sexual interest/arousal disorder

interested in having intercourse but her body does not physiologically respond during the arousal phase.

DSM-5 now characterizes female sexual interest/arousal disorder as involving a range of behaviors including:

Loss of interest, arousal, erotic thoughts and enjoyment of sexual activity or intensity of sensations during sexual activity.

Erectile disorder

male cannot attain or maintain an erection during sexual activity that is sufficient to allow him to initiate or maintain sexual activity.

Most researched of all sexual dysfunction disorders.

"The Working Group for a New View of Women's Sexual Problems"

Criticized the DSM for failing to take into account the greater focus in women on relational aspects of sexuality and individual variations in sexual experiences.

Emotional, physical or relational.

Theories and Treatment for males sexual disfunction

Causes: physiological abnormalities, vascular, neurological or hormonal or caused by alcohol, drugs & smoking.

Medications: Viagra, Levitra & Cialis: all work as phosphodiesterase (PDE) inhibitors which increase blood flow to the penis during sexual stimulation.

Theories(Bio and Psych) and Treatment for females sexual disfunction

Biological: hormonal replacement therapy (estrogen & progesterone)

estrogen cream

testosterone therapy

Psychological: cognitive work couples therapy

sensate focus: method of treating sexual dysfunction in which the interaction is not intended to lead to orgasm, but to experience pleasurable sensations during the phases prior to orgasm.

Gender dysphoria

distress that may accompany the incongruence between a person's experienced or expressed gender and that person's assigned gender.

Biological sex:

sex determined by a person's chromosomes

sex determined by a person's chromosomes

sense of maleness or femaleness

Current criteria for gender dysphoria

must identify with the other sex, having the feeling of "in the wrong body" and must cause discomfort and sense of inappropriateness about assigned gender.

Transsexualism

a term sometimes used to refer to gender dysphoria, specifically pertaining to individuals choosing to undergo sex reassignment surgery.

Unlike transvestic disorder. No sexual gratification from cross-dressing.

Transphobia

the negative stereotyping and fear of people who are transgendered

Schizophrenia

a disorder with a range of symptoms involving disturbances in content of thought, form of thought, perception, affect, sense of self, motivation, behavior, and interpersonal functioning.

Schizophrenia Considered a broad category which includes

a set of disorders in which individuals experience distorted perception of reality and impairment in thinking, behavior, affect, and motivation.

Delusion

deeply entrenched false belief not consistent with the client's intelligence or cultural background.

Types of delusions

-grandeur

-control

-reference

-persecution

-self-blame

-somatic

-infidelity

-thought broadcasting

-thought insertion

Hallucination

a false perception not corresponding to the objective stimuli present in the environment.

Disorganized speech

language that is incoherent meaning incomprehensible.

Reflects loosening of associations

a flow of thoughts that are vague, unfocused, and illogical.

Neologisms

made up words

Catatonia

marked psychomotor disturbances including decreased, excessive, or peculiar motor activity

Paranoia

irrational belief or perception that others wish to cause you harm.

Inappropriate affect

emotional expressiveness which fails to correspond to the content of what is being discussed.

Criterion A/Active phase

2 or more of the following symptoms: delusions, hallucinations, disorganized speech, grossly abnormal psychomotor behavior and negative symptoms.

- a period during schizophrenia in which psychotic symptoms are present.

During this phase there are both positive and negative symptoms present.

Criterion B

Occupational dysfunction

Criterion C

Duration of at least six months

Criterion D

No evidence of schizoaffective, depressive or bipolar

Criterion E

Symptoms are not due to substance use disorder or a general medical condition