Psychopathology Exam 3

personality Disorders/

Personality Disorder

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

• a personality disorder deviates significantly from the individual’s culture, and leads to distress or impairment

behavior patterns in personality disorder (must manifest at least 2 areas)

1. cognition

2. affectivity

3. interpersonal relationships

4. impulse control

Cluster A (for personality disorders)

• disorders characterized by eccentric behavior, are viewed as slightly off, unusual or peculiar

• paranoid, schizoid and schizotypal personality disorders

Cluster B (for personality disorders)

• marked by dramatic, emotional or erratic behaviors which include impulsivity, inflated (or apparent inflated) sense of self and a tendency to seek stimulation

• histrionic, narcissistic, antisocial and borderline personality disorders

Cluster C (for personality disorders)

• involves people who appear anxious or fearful and may seem highly restricted. tend to be inner directed and may draw little attention to themselves

• avoidant, dependent, and obsessive-compulsive personality disorders

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 factors of Paranoid personality disorder

little is known however the belief is..

• genetics

• parental neglect or abuse

• exposure to violent adults

treatment for paranoid personality disorder (and treatment issues)

• CBT

treatment issues:

• usually don’t seeks 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 very limited range of emotional experience and expression

• involves odd beliefs, behavior, appearance and interpersonal style

• overall maladaptive social functioning

• 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 & 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  • cold, withdrawn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 psychotic phenomenon

• similar to schizoid, but also have cognitive and perceptual distortions as well as oddities and eccentricities in their communication and behavior

• characteristics:

  • belief that other’s conversations and gestures have special meaning

  • odd speech

  • paranoid beliefs

  • belief 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:

  • self-centered and vain

  • reactive, s hallow, 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:

  • unable to take others perspective into account. only see things through their own eyes

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

The 2 subtypes of narcissistic personality disorder

(1)grandiose narcissism and (2)vulnerable narcissism

Grandiose Narcissism

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

Vulnerable Narcissism

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

Antisocial Personality Disorder (ASPD)

characterized by a disregard for society’s moral or legal standards and an impulse and risky lifestyle

• commonly exhibit deceitful and aggressive behavior, typically without remorse or loyalty to anyone

• once referred to as psychopathy and sociopathy

• behavior evident at adolescence, must start by age 15 and had prior conduct disorder symptoms (can only receive diagnosis at 18 or older)

  • childhood symptoms: cruelty to animals, bullying, social isolation, explosion of anger, theft, vandalism, poor performance in school, and severe impulsivity

• the behaviors become extreme during late teens and early 20s often resulting in repeated conflict with society (many become incarcerated)

Diagnostic Criteria for ASPD

• failure to conform to social norms

• deceitfulness

• impulsivity

• aggressiveness

• disregard for safety of self or others

• irresponsibility

• lack of remorse

(need pervasive pattern of 3 out of the 7 symptoms)

Biological Perspective (for ASPD)

• strong evidence in favor of genetics

• mutation on monoamine oxidase A (MAOA gene)

• dependency during pregnancy

• malnutrition in early life

• hippocampus

• deficits in frontal lobe functioning

Psychological Perspectives (for ASPD)

• neuropsychological deficits: abnormal learning and attention

• the reasonable 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

• have a very black and white view on life (don’t see gray areas)

Diagnostic Criteria for BPD

• 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

(must reflect 5 out of the 9 behaviors)

Causal Factors of BPD

• 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

• has desire for social relationships but avoid it for fear of rejection

• considered a more severe form of social anxiety disorder

• treatment:

  • CBT and exposure therapy

Causal factors of avoidant personality disorder

• inhibited temperament

• rejection as a child

• parental criticism

• severe bullying

Dependent Personality Disorder

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

• keyword: clingy

Obsessive-Compulsive Personality Disorder

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

• characteristics:

  • rigid

  • stubborn

  • cold

  • reluctant to delegate

  • sense of self and self worth are in terms of productivity

• perfectionism, preoccupation with details, and hoarding

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

Delusion

deeply entrenched false belief not consistent with the clients 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—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 

Positive symptoms

• Exaggerations or distortions of normal thoughts, emotions and behaviors including delusions, hallucinations, disorganized speech, and grossly abnormal psychomotor behavior 

Negative symptoms

Involve functioning below normal level of behavior

• Affective flattening: restricted range of expressed emotions

• Alogia: inability to speak

• Avolition: lack of initiative or interest

• Anhedonia: inability to experience pleasure

• Asociality: inability to socialize, lack of interest in social engagement, inability to empathize 

Brief Psychotic Disorder

 a diagnosis used when an individual develops symptoms of psychosis that do not persist past a short period of time 

• Must experience 1 of 4 symptoms: delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior for more than a day but recover in less than a month 

Schizophreniform Disorder

disorder with psychotic symptoms that are essentially the same as those found in schizophrenia, except for the duration of the symptoms. Usually last  from 1 to 6 months

Schizoaffective Disorder

disorder involving the experience of a major depressive, manic or mixed episode while also meeting the diagnostic criteria for schizophrenia 

• Must have a 2 week period with psychotic symptoms without mood disorder symptoms. However for the majority of the illness duration, must have frequent major mood episodes plus symptoms of schizophrenia 

Delusional Disorder

disorders where the only symptom is delusions that have lasted for at least 1 month 

• No other symptoms of schizophrenia are presented and have never met the criteria for schizophrenia

• Comes in 5 types:

1. Erotomanic type: falsely believe another person is in love with them

2. Grandiose type: exaggerated view of oneself 

3. Jealous type: falsely believe their romantic partner is unfaithful 

4. Persecutory type: falsely believe someone is treating them in a malevolent manner

5. Somatic type: falsely believe they have a medical condition (not anxiety based)

Neurocognitive Disorders

• Acquired cognitive decline in one or more domains of cognition based upon concerns of the client or someone who knows the client well and performance on objective assessment 

• Neurocognitive disorder replaced dementia

• clinician tests:

  • neuropsychological testing

  • neuroimaging techniques

  • medical history

Major Neurocognitive Disorder

disorders involving significant cognitive decline from a previous level of performance

Mild Neurocognitive Disorder

 involves modest cognitive decline from a previous level of performance. Does not interfere with everyday living

Domains for cognitive disorders

• Complex attention

• Executive function

• Learning and memory

• Language

• Perceptual motor

• Social cognition

Delirium

neurocognitive disorder temporary in nature involving disturbance in attention or awareness. Symptoms appear abruptly and fluctuate over the course of having the disorder 

• acute state of confusion or impairment in cognitive processing that affects memory, orientation, executive functioning, use of language, visual perceptions and learning

• must be caused by a general medical condition

• hours or days and fluctuates over the course of the day

Neurocognitive Disorder due to Alzheimer’s

neurocognitive disorder associated with progressive, gradual declines in memory, learning and at least 1 other cognitive domain

• Symptoms become worse over time

• Can only diagnose by exclusion

• Can only know for sure after autopsy

Neurocognitive Disorder due to TBI

evidence of impact to the head along with cognitive and neurological symptoms that persist past the acute post injury period

• Symptoms must occur immediately after the trauma or after recovering consciousness 

Neurocognitive Disorder due to substances/medications or HIV infections

• ND due to another general medical condition

• Amnesia: inability to recall information that was previously learned or to register new information . memory loss must persist over time

Substance Related Disorder

Korsakoff’s Syndrome

• results in amnesia of past events

Wernicke’s disease

• neurological disorder caused by a deficiency of vitamin B1

• associated with chronic alcoholism

• affects memory

• leads to mental confusion

Erotomanic Type (of delusional disorder)

Falsely believe another person is in love with them

Jealous Type (of delusional disorder)

falsely believe their romantic partner is unfaithful

Persecutory Type (of delusional disorder)

falsely believe someone is treating them in a malevolent manner

Somatic Type (of delusional disorder)

falsely believe they have a medical condition (not anxiety based)

Grandiose Type (of delusional Disorder)

exaggerated view of oneself