psychopathology exam 3

personality disorder

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

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

true

behavior patterns must manifest themselves in at least two of these four areas:

1. cognitions

2. affectivity

3. interpersonal functioning

4. impulse control

Personality disorders are grouped into 3 clusters on the basis of what were originally thought to be important similarities or features:

cluster a, b, and c

cluster a features

paranoid, schizoid and schizotypal personality disorder

cluster b features

histrionic, narcissistic, antisocial, and borderline personality disorders

cluster c features

avoidant, dependent, and obsessive-compulsive personality disorders

cluster a personality features

include disorders characterized by eccentric behavior, are viewed as slightly odd, unusual or peculiar

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 becomes hostile

causal factors of paranoid personality disorder

• genetics

• parental neglect or abuse

• exposure to violent adults

treatment for paranoid personality disorder

• cognitive behavioral treatment

• 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

• enjoys being alone

• cold and indifferent to criticism lacks the desire or ability for social relationships

characteristics of schizoid personality disorder

• 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• cold, withdrawn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

• usually contact with reality is maintained but highly personalized and superstitious thinking is a main component

• fall under the extremely maladaptive end of the psychoticism dimension

• represent a latent form of schizophrenia meaning they are vulnerable to developing a full-blown psychosis if exposed to difficult life circumstances

schizotypal characteristics

• belief other’s conversations and gestures have special meaning

• odd speech

• paranoid beliefs

• believe they have magical powers (extreme cases)

cluster b 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

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 perspectives into account. only see things through their own eyes

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

recent literature on narcissism argues that there are some factors covering the construct

agentic, antagonistic, and neurotic

agentic

desire control on one’s own behalf or on the behalf of another

antagonistic

showing or feeling active opposition or hostility toward someone or something

neurotic

the trait disposition to experience negative effects, including anger, anxiety, self-consciousness, irritability, emotional instability, and depression

subtypes of narcissistic personality disorder

grandiose narcissism and 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

casual factors of narcissism are believed to involve

genetic and environmental factors

vulnerable subtype

considered from abuse or neglect, controlling, intrusive, and/or cold parenting

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 timeline

• 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 old or older

• the behavior becomes extreme during late teens and early 20’s, oftentimes, resulting in repeated conflict with society. many become incarcerated

central features of antisocial personality disorder were once labeled as

psychopathy

who developed the set of criteria for psychopathy

hervey cleckly (1976)

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

• insincerity

psychopathy diagnostic criteria (must have 3 out of 7)

• failure to conform to social norms

• deceitfulness

• impulsivity

• aggressiveness

• disregard for the safety of self or others

• irresponsibility

• lack of remorse

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

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 the 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

borderline personality disorder diagnostic criteria (reflect 5 out of 9)

• 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

borderline personality disorder causal factors

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

avoidant personality disorder

have a 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

• 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

avoidant personality disorder 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

obsessive-compulsive personality disorder characteristics

• rigid

• stubborn

• cold

• reluctant to delegate

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

• OCPD has no true obsessions or compulsive rituals

obsessive-compulsive personality disorder causal factors

• modest genetic influence

• parental issues

• low self-esteem

obsessive-compulsive personality disorder 3 traits that overlap with obsessive compulsive disorder (ocd)

• perfectionism

• preoccupation with details

• hoarding

obsessive-compulsive personality disorder treatment

cbt: cognitive behavioural therapy

paraphilic disorder

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

1. non-human objects

2. children or other nonconsenting persons

3. the suffering or humiliation of self or partner

para meaning faulty or abnormal; philia meaning “attraction”

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

how long must someone experience the essential feature of a paraphilic disorder to be diagnosed

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 who attracted to

• key feature: sexual arousal with children that is equal to or even greater than what is felt with fellow adults

exhibitionistic disorder

the 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

the person has the compulsion to desire sexual gratification from observing the nudity or sexual activity of others

• most common paraphilia

fetishistic disorder

the person is preoccupied with an object and depends on this object rather than sexual intimacy with a partner to achieve sexual gratification

partialism

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

frotteuristic disorder

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

sexual masochism disorder

marked by an attraction to achieving sexual gratification by having painful stimulation applied to one’s body

• aroused painful stimulation applied to one’s own body

masochism

seeking pleasure from being in pain

sexual sadism disorder

sexually aroused from the physical or psychological suffering of another person

transvestic disorder (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

transvestic disorder (cross-dressing) theories

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

transvestic disorder (cross-dressing) treatment

• castration: intended to destroy the body’s production of testosterone through surgical castration (removal of the testes) or chemical castration (medication that suppresses 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 (a neurotransmitter involved in sexual arousal)

• cbt

• empathy training

• impulse control training

• relapse prevention

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

transvestic disorder (cross-dressing) psychological perspective

• 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

sexual dysfunction categories

lifelong: since sexually active

acquired: at some point prior asymptomatic

generalized: all sexual situations

situational: only occurs with certain types of sexual stimulation, situations or partners

masters & johnson sexual response cycle 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 can’t 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

erectile disorder theories for males

physiological abnormaliities, vascular, neurological or hormonal or caused by alcohol, drugs and smoking

erectile disorder treatment

viagra, levitra, and cialis: all work as phosphodiesterase (pde) inhibitors which increase blood flow to the penis during sexual stimulation

the working group for a new view of women’s sexual problems biological

hormonal replacement therapy (estrogen and progesterone)

• estrogen cream

• testosterone therapy

the working group for a new view of women’s sexual problems psychological

• cognitive work

• couples therapy

• senate 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

• gender identity: sense of maleness or femaleness

current criteria for gender dysphoria

must identify with the other sex, having the feeling of being “in the wrong body” and must cause discomfort and a 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

dsm-5 changed gender identity disorder to

gender dysphoria

• with this change in the term the focus of treatment has changed from what is “wrong” to a more fluid view of gender. avoid the binary male-female dichotomy

transphobia

the negative stereotyping and fear of people who are transgendered

schizophrenia

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

• considered a broad category that 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

different types of delusion

• grandeur

• control

• reference

• persecution

• self-blame

• somatic

• infidelity

• thought broadcasting

• thought insertion

• just thinks in their head

hallucination

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

• believed they seen the demon

disorganized speech

language that has an 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

2 or more of the following symptoms:

• delusions

• hallucinations

• disorganized speech

• grossly abnormal psychomotor behavior

• negative symptoms

criterion b

occupational dysfunction

criterion c

duration of at least 6 months

criterion d

no evidence of schizoaffective, depressive or bipolar