Studied by 7 people
Chapters 12, 13, & 14
Personality Disorders
a persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships
consistent pattern that individuals will not seek out treatment
run a chronic course
no waxing and waning
distress comes from other people, individuals don’t recognize the distress and dysfunction
extremely treatment resistant
Personality Cluster A
odd, eccentric
includes Paranoid, Schizoid, Schizotypal
Overlap w/ schizophrenia
Personality Cluster B
dramatic, emotional, erratic
includes Antisocial, Borderline, Histrionic, Narcissistic
Personality Cluster C
Anxious, fearful
includes avoidant, dependent, obsessive-compulsive
Development of personality disorders
not that challenging to diagnose w/ personality disorder b/c of their pervasiveness (it is always there, it influences everything so it is easy to identify)
can trace this back to childhood; precursors seen in childhood
Comorbidity amongst personality disorders
if you have one personality disorder, it is common to have another personality disorder
Paranoid personality disorder (Cluster A)
pervasive and unjustified mistrust and suspicion
few meaningful relationships, sensitive to criticism
person feels like they cannot confide in anyone, doesn’t allow anyone to get close to them
even unrelated, neutral events, they will relate the event back to them somehow
they have to do everything themselves; extreme level of autonomy
poor quality of life
heightened risk of suicide
heightened risk of aggressive behaviors
Treatment of Paranoid Personality Disorder
few seek help on their own
treatment focuses on developing trust
other focus is to teach patient to interpret situations differently
lack of good outcome studies
Schizoid Personality Disorder (Cluster A)
pervasive pattern of detachment from social relationships
don’t have a desire to overcome this deficit, they could care less about social interaction
very limited range of emotions in interpersonal situations
appear indifferent to praise and critique
comorbidity with depression
some risk of suicide, but not as much as paranoid
Treatment of Schizoid Personality Disorder
few seek help on their own
focus on the value of interpersonal relationships
education of the value of social relationships; the benefits of them
emotion training
emotion recognition is the precursor to empathy
lack of good outcome studies
Schizotypal Personality Disorder (Cluster A)
behavior and dress is odd and unusual
not just one odd belief that makes them this way; this is how they are with everything
socially isolated and highly suspicious
magical thinking, ideas of reference, and illusions
many meet criteria for major depression
some conceptualize this as resembling a milder form of schizophrenia
feelings of someone else being there; feelings are frequent
Treatment of Schizotypal Personality Disorder
address comorbid depression
30-50% meet criteria for major depressive disorder
main focus is on developing social skills
medical treatment is similar to that used by schizophrenia
treatment prognosis is generally poor
Antisocial Personality Disorder (Cluster B)
**cannot be diagnosed until age 18
failure to comply with social norms
violation of the rights of others
irresponsible, impulsive, and deceitful
“Sociopathy,” “psychopathy” typically refers to this disorder or very similar traits
May be very charming, interpersonally manipulative
Genetic Influences on Antisocial Personality Disorder
more likely to develop antisocial behavior if parents have a history of antisocial behavior or criminality
Developmental Influences on Antisocial Personality Disorder
conduct disorder in childhood, especially “callous-unemotional” type
Treatment for Antisocial Personality Disorder
rarely patients realize they need treatment and they can still be manipulative, even with their therapists
most clinicians are pessimistic and there are few success stories
CBT (in some cases) 5 yrs down the road resulted in decreased violence in patients
lots of therapists believe incarceration to be the best course of action
most common treatment strategy is parent training
parents are taught to recognize behavior problems early and to use praise and rewards to reduce problem behavior and encourage prosocial behaviors
Causes and relation to psychopaths and criminality
lower IQs tend to be signifiers for higher risk of criminality in antisocial disorder
family history of crime increases risk of criminality
some studies show that people with psychopathic personality traits tend to avoid repeated contact w/ the legal system
Examples of people with Antisocial Personality Disorder
Bernie Madoff, Jeffrey Dahmer, and Ted Bundy
Psychological Influence of Antisocial Personality Disorder
less likely to give up when goal becomes unattainable
Borderline Personality Disorder
most common personality disorder observed
moods and relationships unstable
poor self image
tend to be self-destructive &/or suicidal
Afraid of detachment
HIGH comorbidity with depression, eating disorders, and substance abuse
tends to be more prevalent in families w/ the disorder
Treatment of Borderline Personality Disorder
dialectical behavior therapy: helps cope with stressors that cause suicidal behavior and thoughts
patients are taught how to identify and regulate their emotions
Drugs called mood stabilizers can help treat symptoms
Histrionic Personality Disorder (Cluster B)
tend to be overdramatic and often seen almost to be acting
also tend to be vain, self-centered & uncomfortable when not in the limelight
inclined to express their emotions with exaggerated fashion
seek reassurance and approval constantly & may become upset/angry when others do not attend or praise them
Treatment of Histrionic Personality Disorder
focuses on problematic interpersonal relationships; they need to be taught more appropriate ways of negotiating their wants and needs
Underarousal hypothesis (APD theory)
cortical arousal is too low
Fearlessness hypothesis (APD theory)
fail to respond to danger cues
Gray’s model (APD theory)
inhibition signals are outweighed by reward signals
Narcissistic Personality Disorder (Cluster B)
think highly of themselves-perhaps exaggerating their real abilities
think they deserve special treatment
so preoccupied with themselves that they lack sensitivity and compassion for other people
Treatment for Narcissistic Personality Disorder
focus on grandiosity, lack of empathy
emphasize realistic goals and coping skills for dealing with criticism
little evidence that treatment is effective
Avoidant Personality Disorder (Cluster C)
extremely sensitive to the opinions of others and although they desire social relationships, their anxiety lead them to avoid such associations
extremely low self esteem and fear of rejection
Treatment of Avoidant Personality Disorder
similar to treatment with social phobia
focus on social skills, entering anxiety-provoking situations
good relationship with therapist is important
Dependent Personality Disorder (Cluster C)
reliance on others to make major and minor life decisions
unreasonable fear of abandonment
clingy and submissive in interpersonal relationships
Treatment of Dependent Personality Disorder
research on treatment efficacy is lacking
therapy typically progresses gradually due to lack of independence
treatment targets include skills that foster confidence and independence
Obsessive-Compulsive Personality Disorder (Cluster C)
fixation on things being done “the right way”
unwilling to delegate tasks because others will do them wrong
difficulty with spontaneity
often have interpersonal problems
Treatment of Obsessive-Compulsive Disorder
treatment attacks the fears that seem to underlie the need for orderliness
Schizophrenia
A pervasive type of psychosis characterized by disturbed thought, emotion, behavior
Characterized by a split between thought and emotion
From Greek: Schizein= “to split” + Phren= “mind”
Schizophrenia= “splitting of the mind”
Difficulties reality testing
Schizophrenia is NOT
Multiple personalities= Dissociative Identity Disorder
Psychopathy= diminished empathy, cruelty, exploitation, disdain of close attachments, etc.
Positive Schizophrenia Symptoms
Positive ≠ “good”
Positive= excesses in functioning
over-activity in brain; perceptions of non-existent stimuli
delusions, hallucinations
Negative Symptoms of Schizophrenia
Negative ≠ “bad”
Negative= deficits in functioning
under-activity in brain; decreased or non-response to stimuli
apathy, lack of emotion, slowed speech, and movement
Disorganized Symptoms of Schizophrenia
Disorganized speech
cognitive slippage: illogical and incoherent speech
tangentiality: “going off on a tangent”
loose associations- conversation in unrelated directions
Disorganized affect
inappropriate emotional behavior
Disorganized behavior
includes a variety of unusual behaviors
behavior is the same everywhere
Catatonia
excessive movement or immobility
connects to the disconnect from reality
they are not recognizing this discomfort that normal people would feel
Delusions
gross misrepresentation of reality
most common:
delusions of grandeur
think that they are special or hold powers
delusions of persecution
think that everyone is out to get them
Theories for why delusions develop
Motivational view
you have some anxiety for a real problem (coping mechanism for existing anxiety)
Deficit View
neurological brain dysfunction
Hallucination
experience of sensory events without environment input
can involve all symptoms
most common: auditory
individuals not able to distinguish reality from hallucination
Spectrum of Schizophrenia negative symptoms
avoliton
algoia
anhedonia
affective flattening
Avoliton (or apathy)
lack of initiation and persistence (cannot get tasks done; seen a lot with keeping up with personal hygiene)
Algoia
relative absence of speech
short responses, minimal as possible speech
their brains are so confused that their brains cannot comprehend what is going on/ slows down their processing
when symptoms are under control, they’re able to have a normal conversation
Anhedonia
lack of pleasure, or indifference (associated w/ depression)
Affective flattening
little expressed emotion
no facial expressions, no tone change, no highs/lows
typically feel everything going on around them but cannot express it
Schizophreniform Disorder
experience symptoms of schizophrenia for a few months only
Schizoaffective disorder
people with symptoms of schizophrenia and exhibited characteristics of mood disorders
Delusional Disorder
a persistent belief contrary to reality in the absence of other characteristics of schizophrenia
Substance/Medication-induced psychotic disorder
delusional symptoms develop around the time of use of the substance
Psychotic disorder associated with another medical condition
medically the delusions/hallucinations are the direct cause of another medical condition
Brief Psychotic Disorder
sudden onset of delusion & mood sings only lasting one month or less
Development of Schizophrenia
first occur during late adolescence or early adulthood
children show early features such as mild abnormalities, poor motor coordination, and mild cognitive and social problems
including prodromal stage
a 1 to 2 year period before serious symptoms occur but less severe and unusual behaviors start to show
Genetic influences on schizophrenia
the more closely someone is genetically related to a person with schizophrenia, the greater risk that he or she will develop schizophrenia
however, how the disorder presents itself is not based on this
Neurobiological Influences on Schizophrenia
Dopamine
Hypothesis: schizophrenia is partially caused by overactive dopamine
Evidence- agonists result in schizophrenic-like behavior, antagonists reduce this behavior
Problem-overly simplistic; many neurotransmitters are likely involved
Brain Structure
structural and functional abnormalities in the brain
enlarged ventricles and reduced tissue volume
underdeveloped parts
hypofrontality: less active frontal lobes (dopamine pathway)
Prenatal and Perinatal influences
viral infections during prenatal development (findings inconclusive)
environmental stress of the fetus
use of marijuana
How Schizophrenia was Treated in the Past
historical precursors were generally ineffective and often barbaric
prefrontal lobotomies, insulin-induced comas, electroconvulsive therapy
Biological Interventions of Schizophrenia
Antipsychotic Medications
often the first line treatment for schizophrenia
most reduce or eliminate positive symptoms
lots of side effects
Noncompliance Issue
acute and permanent side effects are common with first-generation medications
Parkinson’s-like side effects
loss of muscle control, shaking
Akinesia
expressionless face, slow motor activity, and monotonous speech
Tardive dyskinesia
involuntary facial movements
Compliance Problems
aversion to side effects
patients will want to stop due to side effects, but if stopped, schizophrenia comes back full-force
the drugs work only if taken properly and the patients do not routinely take their medicine
financial cost
poor relationship with doctors
**there are VERY FEW people that will say not to use the medication because it is the best line of treatment
Behavioral on Inpatient Units (token economies)
the behavior/symptoms from the disorder is harmful to themselves or others so individuals are placed into an inpatient facility
token economies
small rewards or tokens for “corrected” or “good” behavior and release of patients is often sooner
Community Care Programs
Deinstitutionalized Movement:
on paper it sounds great
let’s integrate these people into the community so we’re gonna close these long-term facilities
poorly executed, not all patients have appropriate treatment and care after the facility is closed
this leads to lots of displaced patients being homeless because they cannot care for themselves and there is no longer a facility to take care of them
Social and Living Skills Training
lots of individuals w/ schizophrenia socially isolate themselves and do not know how to interact with people
this teaches these individuals social skills and basic life skills that give them more ability to take care of themselves
Behavioral Family Therapy
often the families are taking care of the individuals so this works through and teaches families how to deal with the delusions and paranoia
effective and maintainable after 1 year, but after 2 years, not effective
there needs to be check-ins and follow ups by professionals to remain effective
Vocational Rehabilitation
hiring people with a mental illness and assigning a mentor to them; the mentors have some special training done to help the individual
Neurodevelopmental Disorders
diagnosed first in infancy, childhood, or adolescence; presumed to be neurologically based
Include:
ADHD
Specific learning disorder
Intellectual disability
Communication and motor disorders
ADHD
pattern of inattention, or of hyperactivity and impulsivity
hyperactivity includes fidgeting, having trouble sitting for any length of time, and always being on the go
impulsivity includes blurting out answers before questions have been completed and having trouble waiting turns
can be comorbid with conduct disorder, mood disorders, anxiety disorders, and substance abuse
highly influenced by genetics
Psychosocial Treatment of ADHD
target to decrease hyperactivity and impulsivity
focus on behavioral interventions to help; the programs set goals to encourage and increase the amount of desired behavior
Biological Treatment of ADHD
stimulant medications reduce hyperactivity and impulsiveness
stimulant medications reinforce the brain’s ability to focus attention during problem-solving tasks
Combined Treatment of ADHD
behavioral interventions have the added benefit of improving aspects of the child and family that are not directly affected by medication
Specific Learning Disorder
a significant discrepancy between a person’s academic achievement and what would be expected for someone of the same age
Treatment of Specific Learning Disorder
medication is used if comorbid ADHD is present
specific skills instruction and strategy instruction are used to assist with problems related to cognitive skills including decision making and critical thinking
Deficits in Adaptive Functioning
age-appropriate behaviors necessary for people to be independent and to function safely and appropriately in daily life
involves three domains: conceptual, social, and practical
Society’s Perception of Deficits in Adaptive Functioning
Three typical views
medical problem that needs to be cured
tragedy that must be eliminated
something to be feared and pitied
Leads to
lower expectations
decreased opportunities
social isolation
denial of personal freedoms and human rights
Intellectual Disability Genetic Causes
Down Syndrome, Fragile X Syndrome
Intellectual Disability Cause: Problems during Pregnancy
Fetal Alcohol Spectrum Disorder
Malnutrition
Disease/illness in mother
Intellectual Disability Cause: Problem at Birth
oxygen deprivation
Intellectual Disability Cause: Problems After Birth
meningitis
brain injury
lead poisoning
Intellectual Disability Causes: Poverty and Cultural Deprivation
malnutrition and under-stimulation
Treatment of Intellectual Disability
Behavioral interventions teach:
basic skills
social skills
practical skills
Goals are similar across severity: level of assistance differs
Expectation: participation in community life, attend school and later hold a job, and have the opportunity for meaningful social relationships
Autism Spectrum Disorder (DSM-4)
umbrella term with specific disorders
Autism Spectrum Disorder (DSM-5)
a developmental disability
overlap with intellectual disability: 31%
symptoms: social interaction, social communication, repetitive behaviors
Clinical Description of Autism Spectrum Disorder
Two things required to make a diagnosis:
Social Communication and Social Interaction
Restricted/Repetitive patterns of behaviors, interests, or activities
Social Communication with Autism Spectrum Disorder
delayed language development
stereotyped and repetitive language
difficulty initiating and sustaining conversation
Social Interaction with Autism Spectrum Disorder
impairments in non-verbal behaviors
lack of reciprocal social interactions
failure to develop peer relationships
Restricted/repetitive patterns of behaviors, interests, or activities with Autism Spectrum Disorder
this includes stereotyped and ritualistic behaviors, which further interfere with social relationships
inflexible adherence to routines and rituals
Why have prevalence rates increased over the last ten years for Autism Spectrum Disorder?
Awareness
Why are boys four times more likely to be identified with autism?
stigma that women can’t have autism
biologically due to only 1 X chromosome in boys and 2 in girls
Autism Spectrum Disorder’s relationship to Intellectual Disability
both disorders show marked comparable deficits in IQ scores which represent deficits in adaptive functioning
only ASD can have a wider (or more normal) range
What causes autism?
ultimately, the causes are unknown
What is known:
neurodevelopmental disorder
genetic component
5-10 genes consistently related
environmental components
biological
overall increase in brain volume
decreased oxytocin levels in their blood
interruption in growth of amygdala
immune system??
ongoing research
NOT CAUSED BY VACCINES
Treatment for Autism
focused on teaching social skills; enhancing communication and daily living skills and reducing problem behaviors
psychosocial: focus on skill building and behavioral treatment of problem behaviors
biological: medicine has had little success
integrating: early intervention is crucial
Note
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