Psychoses & personality disorders

Schizophrenia

A severe psychological disorder characterized by distorted thoughts, perceptions, emotions, and behavior. The term means "split mind," referring to a split from reality.

Positive Symptoms (of Schizophrenia)

Symptoms that represent excesses or distortions in normal functioning, including delusions, hallucinations, disorganized thinking, and agitation.

Negative Symptoms (of Schizophrenia)

Deficits in normal emotional and behavioral functioning, such as flat affect, social withdrawal, lack of motivation, and neglect of personal hygiene.

Delusions

False beliefs that are resistant to reason or contrary evidence. Common types include grandiose delusions, persecutory delusions, referential delusions, somatic delusions.

Hallucinations

Sensory perceptions that occur in the absence of a real external stimulus. Most common are auditory, such as hearing voices.

Loose Associations (Disorganized Thinking)

Incoherent, tangential, or illogical speech patterns often seen in individuals with schizophrenia. Ideas are only loosely connected.

Catatonic Stupor

A state of immobility and unresponsiveness to external stimuli. May include rigidity or repetitive movement.

Flat Affect

An absence or severe reduction of emotional expression; the individual may appear emotionally neutral or unresponsive.

Deterioration in Functioning

Marked decline in social, academic, or occupational functioning. Includes neglect of self-care and hygiene.

Dopamine Hypothesis

Theory that schizophrenia is linked to excessive dopamine activity. Supported by effectiveness of antipsychotic drugs that block dopamine receptors.

Neurodevelopmental Hypothesis

Suggests that disruptions during prenatal brain development (e.g., viral infections, malnutrition, obstetrical complications) increase risk of schizophrenia later in life.

Epigenetics in Schizophrenia

Changes in around 1/200 genes in individuals with schizophrenia, particularly in genes involved in neurotransmission and brain development.

Expressed Emotion (EE)

A family environment marked by high levels of criticism, hostility, or emotional over-involvement. High levels of this is associated with increased relapse rates in schizophrenia.

Personality Disorder (DSM-5 Definition)

An enduring pattern of inner experience and behavior that deviates markedly from cultural expectations, is inflexible, begins in adolescence or early adulthood, and causes distress or impairment.

Cluster A Personality Disorders

Core trait: Pervasive distrust and suspicion of others

• Believes others are out to harm, deceive, or exploit

• Reads hidden meanings into harmless remarks

• Holds grudges, hypervigilant

Paranoid Personality Disorder

Characterized by pervasive distrust and suspicion of others. Often interprets others' motives as malevolent without justification.

Cluster B Personality Disorders

Core Traits: Dramatic, Emotional, Erratic

• Unstable emotions

• Attention-seeking (manipulative behavior)

• Impulsivity

• Intense interpersonal issues

• Unpredictable, intense relationships

Narcissistic Personality Disorder

Cluster: B (Dramatic & Emotional)
Traits:

• Grandiose sense of self-importance

• Believes they are special and unique

• Needs excessive admiration

• Lacks empathy, exploits others

Borderline Personality Disorder

Characterized by instability in relationships, self-image, and emotions. Includes frantic efforts to avoid abandonment, impulsivity, self-harm, and emotional dysregulation.

Antisocial Personality Disorder

Cluster: B (Dramatic & Emotional)
Traits:

• Disregard for others’ rights

• Deceitful, manipulative, impulsive

• Irresponsible, often criminal behavior

• Lacks remorse or empathy

Cluster C Personality Disorders

Core Trait: Anxious & Fearful

• Highly anxious

• Self-critical

• Obsessively controlling

• Behavior is driven by fear of rejection, failure, or losing control.

Obsessive-Compulsive Personality Disorder (OCPD)

Cluster: C (Anxious & Fearful)
Traits:

• Perfectionism, preoccupied with rules, order, control

• Rigid, stubborn, inflexible

• Overdevotion to work; difficulty delegating

• NOT the same as OCD — no obsessions/compulsions

Avoidant Personality Disorder

Characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Avoids social situations due to fear of criticism or rejection.

DSM-5 Schizophrenia Subtype Removal

The DSM-5 discarded traditional subtypes of schizophrenia (e.g., paranoid, disorganized) because there were no meaningful differences between them in causes, prognosis, or response to treatment. Instead, schizophrenia is now diagnosed based on the presence and severity of core symptoms.

Dissociative Amnesia

A dissociative disorder marked by sudden, temporary memory loss of personal information, often after trauma or stress.
- No physical brain injury is present.
→ Example: A person involved in a serious accident can’t remember their name or past.

Persecutory Delusions

Belief that someone is out to harm, spy on, or sabotage them.

• Most common type!

• Example: “My neighbors are spying on me and tampering with my mail.”

Grandiose Delusions

Belief that one has exceptional power, wealth, fame, or is a famous figure.

Example: “I’m Prince Charles in hiding. The world needs me.”

Referential Delusions

Belief that neutral events or people (TV shows, strangers, street signs) are sending special messages meant just for them.

Example: “The newscaster is talking in code directly to me.”

Erotomanic Delusions

Belief someone’s in love with them

Nihilistic Delusions

Belief that parts of body/world don’t exist

Somatic Delusions

Belief of body illness or abnormality

Bizarre Delusions

Implausible, fantastical beliefs (e.g., brain replaced by chip)

Concordance Rate – Schizophrenia (Identical Twins)

The likelihood that both identical twins will develop schizophrenia:
→ 48%

Schizoid Personality Disorder

A Cluster A personality disorder marked by:

• Emotional coldness and detachment

• No desire for close relationships

• Preference for solitary activities

Occurs far more frequently in males than in females.

Paranoid Personality Disorder

A Cluster A disorder marked by:

• Chronic suspicion and mistrust of others

• Belief that others are out to deceive, exploit, or betray them

• Often jealous, guarded, and emotionally distant

• May misinterpret neutral or kind gestures as threatening

Schizotypal Personality Disorder

Cluster: A (Odd & Eccentric)
Traits:

• Eccentric behavior and appearance

• Magical thinking and odd beliefs (e.g., telepathy)

• Social anxiety and discomfort in close relationships

• Paranoia, unusual speech, and suspiciousness

Dependent Personality Disorder

Cluster: C (Anxious & Fearful)
Traits:

• Excessive need to be taken care of

• Clingy and fears being alone

• Has trouble making decisions without advice or reassurance

• Submissive and avoids conflict to maintain support

Autistic Spectrum Disorder (ASD)

A neurodevelopmental disorder typically diagnosed in early childhood, marked by:

• Social communication deficits

• Restricted, repetitive behaviors

• Sensory processing issues

• Considered a childhood-onset disorder

Child-Onset Schizophrenia (COS)

A very rare and severe form of schizophrenia that begins before age 13.

Key Features:

• Same core symptoms as adult schizophrenia:

  • Hallucinations (especially auditory)

  • Delusions

  • Disorganized speech and behavior

  • Negative symptoms (flat affect, avolition)

• Symptoms must persist for at least 6 months

  • Extremely rare — far less than 1% of schizophrenia cases!

Cluster A Disorders: 3

1. Paranoid

2. Schizoid

3. Schizotypal

Cluster B Disorders: 4

1. Antisocial

2. Borderline

3. Histrionic

4. Narcissistic

Cluster C Disorders: 3

1. Avoidant

2. Dependent

3. Obsessive Compulsive (OCPD)

Histrionic Personality Disorder

Cluster: B (Dramatic & Emotional)
Traits:

• Seeks attention and approval constantly

• Overly emotional, theatrical, and flirtatious

• Easily influenced by others

• Feels uncomfortable when not the center of attention

Attention-Deficit/Hyperactivity Disorder (ADHD)

A neurodevelopmental disorder characterized by patterns of inattention, hyperactivity, and/or impulsivity. Key Features must be present before age 12!

Symptoms must:

• Last 6+ months

• Be present in 2 or more settings (e.g., home and school)

• Significantly impair daily functioning

ADHD: Inattention symptoms

Inattention symptoms:

• Easily distracted

• Forgetful

• Poor focus

• Trouble organizing tasks

• Frequently loses things

ADHD: Hyperactivity-Impulsivity symptoms

• Fidgeting, restlessness

• Talks excessively

• Interrupts others

• Difficulty waiting their turn

• Acts without thinking

Types of ADHD

• Predominantly Inattentive Type (formerly ADD)

• Predominantly Hyperactive-Impulsive Type

• Combined Type (most common)

Not Criminally Responsible on Account of Mental Disorder (NCRMD)

Canadian legal term
A person is not held legally responsible for a crime if, at the time of the act, they were suffering from a mental disorder that rendered them:

• Incapable of knowing what they were doing, or

• Incapable of knowing that it was wrong.

To succeed in an NCRMD defense, lawyers must show:

The defendant had a mental disorder at the time of the offense that made them:

• Incapable of understanding what they were doing, or

• Incapable of knowing it was morally or legally wrong

M’Naghten Rule (Insanity Defense)

A legal standard stating that a person is not criminally responsible if, at the time of the offense, they had a mental disorder that made them:

• Incapable of understanding the nature of the act, or

• Incapable of knowing that it was wrong

Used as the basis for NCRMD in Canada.

Insanity Defence (NCRMD) – Success Rate

According to Lymburner & Roesch:

• The defense is rarely used

• When used, it is rarely successful

• Public beliefs about people “getting off easy” are inaccurate

Even successful cases often lead to long-term psychiatric treatment, not freedom.

Cultural Universality in Mental Disorders

Researchers agree that the principal categories of serious psychological disorders (e.g., schizophrenia, major depression) are identifiable in all cultures.
- While symptom expression and meaning vary, core features are globally recognizable.

Koro

A syndrome primarily found in Southeast Asian cultures, especially among Chinese men in Malaysia or Southern China.

Core Feature:

• Intense fear that the genitals are retracting into the body and will lead to death

• Sometimes occurs in epidemic/mass hysteria form

• Associated with anxiety, guilt, and cultural beliefs about sexual health or morality

Pibloktoq (Arctic Hysteria)

Indigenous Arctic communities (e.g., Inuit people in Greenland, Canada, Alaska)
Core Features:

• Sudden, brief episodes of extreme, uncontrollable behavior — screaming, stripping off clothes, running into the snow

• Followed by amnesia for the event

• Often occurs in females and during long, dark winter months

  - Linked to cultural stress, isolation, and harsh environment

Wi(e)ndigo Psychosis

Algonquin-speaking First Nations (e.g., Cree, Ojibwa, Saulteaux in Canada)
Core Features:

• Intense craving for human flesh and belief one is turning into a cannibalistic monster

• Often triggered by starvation or food scarcity during winter

• Sometimes ends in suicidal behavior or being killed by the community as a protective act

  - Tied to cultural mythologies + real survival fears