Behavior Disorders Exam 4

Dimensional model

Individuals are rated on the degree to which they exhibit various personality traits 

Five factor model of personality (“Big Five”) 

• Openness to experience 

• Conscientiousness 

• Extraversion 

• Agreeableness 

• Neuroticism 

Prevalence of personality disorders 

Affects about 10% of the general population

Origins and course of personality disorders 

• Thought to begin in childhood 

• Tend to run a chronic course if untreated 

• May transition into a different personality disorder

Gender distribution and gender bias in diagnosis 

Men more often show traits like aggression and detachment; women more often show deference to others and insecurity in interpersonal relationships 

• Antisocial Personality Disorder – more often male 

• Dependent Personality Disorder – more often female 

Cluster A

Odd or Eccentric 

• Paranoid, Schizoid, and Schizotypal personality disorder 

Cluster B

Dramatic or Erratic 

• Antisocial, Borderline, Histrionic, and Narcissistic personality disorder

Cluster C

Anxious or Fearful 

• Avoidant, Dependent, and Obsessive-compulsive personality disorder 

Cluster A (Odd or Eccentric)

• Paranoid Personality Disorder 

(Overview and clinical features)

• Pervasive and unjustified mistrust and suspicion 

• Few meaningful relationships, sensitive to criticism 

• Distrust and suspiciousness of others such that their motives are interpreted as malevolen

Cluster A (Odd or Eccentric)

• Paranoid Personality Disorder 

(Causes)

May involve early learning that people and the world are dangerous or deceptive

Cluster A (Odd or Eccentric)

• Paranoid Personality Disorder 

(Cultural factors)

More often found in people with experiences that lead to mistrust of others (e.g., prisoners, refugees) 

Cluster A (Odd or Eccentric)

• Paranoid Personality Disorder 

(Treatment)

Focuses on development of trust; cognitive therapy to counter negativistic thinking 

Cluster A (Odd or Eccentric)

• Schizoid Personality Disorder 

(Overview and clinical features)

• Detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

• Very limited range of emotions in interpersonal situations 

• Etiology is unclear but may have significant overlap with autism spectrum disorder 

Cluster A (Odd or Eccentric)

• Schizoid Personality Disorder 

(Treatment)

Focus on the value of interpersonal relationships and on building empathy and social skills 

Cluster A (Odd or Eccentric)

• Schizotypal Personality Disorder

(Overview and clinical features)

• Behavior and beliefs are odd and unusual 

• Socially isolated and highly suspicious 

• Magical thinking, ideas of reference, and illusions (not delusions) 

• Many meet criteria for major depression 

• Some conceptualize this as resembling a milder form of schizophrenia 

Cluster A (Odd or Eccentric)

• Schizotypal Personality Disorder

(Causes)

• Mild expression of “schizophrenia genes”? 

• May be more likely to develop after childhood maltreatment or trauma, especially in men 

• More generalized brain deficits may be present

Cluster A (Odd or Eccentric)

• Schizotypal Personality Disorder

(Treatment)

• Address comorbid depression 

• Main focus is combination of medication, cognitive behavior therapy, and social skills training 

Cluster B (Dramatic or Erratic):

• Antisocial Personality Disorder 

(Overview and clinical features)

• Failure to comply with social norms 

• Violation of the rights of others 

• Irresponsible, impulsive, and deceitful

• Lack of a conscience, empathy, and remorse 

• May be very charming, interpersonally manipulative 

• “Sociopathy” and “psychopathy” typically refer to very similar traits 

Psychopathy

Similar to antisocial personality disorder but with less emphasis on overt behavior

• Indicators include superficial charm, lack of remorse, and other personality characteristics

Cluster B (Dramatic or Erratic):

• Antisocial Personality Disorder 

(Causes)

• Often show early histories of behavioral problems, including conduct disorder 

  • “Callous-unemotional” type of conduct disorder more likely to evolve into antisocial PD 

• Families with inconsistent parental discipline and support 

• Families often have histories of criminal and violent behavior 

• Recent research suggests that psychopathy is a less reliable predictor of criminality (and there are “successful psychopaths”)

Neurobiological Contributions to Antisocial Personality

• Prevailing neurobiological theories 

  • Underarousal hypothesis – cortical arousal is too low 

  • Cortical immaturity hypothesis – cerebral cortex is not fully developed 

  • Fearlessness hypothesis – fail to respond to danger cues 

  • Gray’s model: Inhibition signals are outweighed by reward signals 

Underarousal hypothesis

Cortical arousal is too low 

Cortical immaturity hypothesis

Cerebral cortex is not fully developed 

Fearlessness hypothesis

fail to respond to danger cues 

Gray’s model

Inhibition signals are outweighed by reward signals 

Development of Antisocial Personality

(Genetic influences) 

More likely to develop antisocial behavior if parents have a history of antisocial behavior or criminality

Development of Antisocial Personality

(Developmental influences ) 

High-conflict childhood increases likelihood of APD in at-risk children 

Development of Antisocial Personality

(Impaired fear conditioning) 

Children who develop APD may not adequately learn to fear aversive consequences of negative actions (e.g., punishment for setting fires) 

Development of Antisocial Personality

(Arousal theory) 

People with APD are chronically under-aroused and seek stimulation from the types of activities that would be too fearful or aversive for most 

Development of Antisocial Personality

(Psychological and social influences) 

In research studies, psychopaths are less likely to give up when goal becomes unattainable

• May explain why they persist with behavior (e.g., crime) that is punished

Development of Antisocial Personality (APD)

(Causes) 

• APD is the result of multiple interacting factors 

• Mutual biological-environmental influence 

  • Early antisocial behavior alienates peers who would otherwise serve as corrective role models

• Antisocial behavior and family stress mutually increase one another 

Treatment of Antisocial Personality

• Few seek treatment on their own 

• Antisocial behavior is predictive of poor prognosis 

• Emphasis is placed on prevention and rehabilitation 

• Often incarceration is the only viable alternative 

• May need to focus on practical (or selfish) consequences (e.g., if you assault someone you’ll go to prison) 

Cluster B (Dramatic or Erratic):

Borderline Personality Disorder (BPD)

• Unstable moods and relationships 

• Impulsivity, fear of abandonment, very poor self-image 

• Suicidal and nonsuicidal self-injurious thoughts and behaviors 

• Comorbidity rates are high with other mental disorders, particularly mood disorders, substance use disorders, and eating disorders 

Risk for Borderline Personality Disorder 

• Strong genetic component 

• High emotional reactivity may be inherited 

• May have impaired functioning of limbic system 

• Early trauma/abuse increases risk 

Risk for Borderline Personality Disorder 

(“Triple vulnerability” model)

• Generalized biological vulnerability 

• Generalized psychological vulnerability 

• Specific psychological vulnerability Linehan’s Biopsychosocial Model of Risk 

Borderline Personality Disorder Treatment 

• Antidepressant medications provide some short-term relief 

• Dialectical behavior therapy* is most promising treatment 

• Focus on dual reality of acceptance of difficulties and need for change 

• Focus on interpersonal effectiveness 

• Focus on distress tolerance to decrease reckless/self-harming behavior 

Dialectical behavior therapy (DPT)

Most promising treatment for Borderline Personality Disorder (BPD)

• Involves exposing the client to stressors in a controlled situation

• Helping the client regulate emotions and cope with stressors

Cluster B (Dramatic or Erratic):

Histrionic Personality Disorder 

(Overview and clinical features)

• Overly dramatic and sensational 

• May be sexually provocative 

• Often impulsive and need to be the center of attention 

• Thinking and emotions are perceived as shallow 

• More commonly diagnosed in females 

Histrionic Personality Disorder 

(Causes)

Etiology unknown due to lack of research 

Histrionic Personality Disorder 

(Treatment options)

• Focus on attention seeking and long-term negative consequences 

• Targets may also include problematic interpersonal behaviors

• Little evidence that treatment is effective 

Cluster B (Dramatic or Erratic):

Narcissistic Personality Disorder

(Overview and clinical features)

• Exaggerated and unreasonable sense of self-importance

• Preoccupation with receiving attention 

• Lack sensitivity and compassion for other people 

• Highly sensitive to criticism; envious and arrogant 

Narcissistic Personality Disorder

(Causes)

• Largely unknown 

• Failure to learn empathy as a child 

• Sociological view - Product of the “me” generation (Baby Boomers) 

Narcissistic Personality Disorder

(Treatment)

• Focus on grandiosity, lack of empathy, unrealistic thinking 

• Emphasize realistic goals and coping skills for dealing with criticism 

• Little evidence that treatment is effective 

Cluster C (Anxious or Fearful):

Avoidant Personality Disorder
(Overview and clinical features)

• Extreme sensitivity to the opinions of others 

• Highly avoidant of most interpersonal relationships 

• Interpersonally anxious and fearful of rejection 

• Low self-esteem

Avoidant Personality Disorder
(Causes)

• May be linked to schizophrenia; occurs more often in relatives of people with schizophrenia 

• Experiences of early rejection 

• Childhood experiences of neglect, isolation, rejection, and conflict with others

Avoidant Personality Disorder
(Treatment)

• Similar to treatment for social phobia 

• Focus on social skills, entering anxiety-provoking situations

• Good relationship with therapist is important 

Cluster C (Anxious or Fearful):

Dependent Personality Disorder

(Overview and clinical features)

• Reliance on others to make major and minor life decisions 

• Unreasonable fear of abandonment 

• Clingy and submissive in interpersonal relationships 

Dependent Personality Disorder

(Causes)

Not well understood but may be linked to failure to learn independence 

Dependent Personality Disorder

(Treatment options)

Therapy typically progresses gradually due to lack of independence 

Cluster C (Anxious or Fearful):

Obsessive-Compulsive Personality Disorder (OCPD)

(Overview and clinical features)

• Excessive and rigid fixation on doing things the right way 

• Highly perfectionistic, orderly, and emotionally shallow 

• Unwilling to delegate tasks because others will do them wrong 

• Difficulty with spontaneity 

• Often have interpersonal problems 

• Obsessions and compulsions are rare 

Obsessive-Compulsive Personality Disorder (OCPD)

(Causes)

Are not well known 

• Moderate genetic contribution 

Obsessive-Compulsive Personality Disorder (OCPD)

(Treatment )

• Treatment targets include cognitive reappraisal techniques to reframe compulsive thoughts 

• Target rumination, procrastination, and feelings of inadequacy 

Attention deficit hyperactivity disorder (ADHD)

Maladaptive levels of inattention, excessive activity, and impulsiveness

Specific learning disorder

Academic performance that is substantially below what would be expected given the person’s age, intelligence quotient (IQ) score, and education.

Childhood-onset fluency disorder

Stuttering

Language Disorder

Limited speech in all situations 

Tourette’s disorder

Motor and vocal tics 

• High comorbidity with ADHD and OCD 

Three subtypes of ADHD

Inattentive presentation

Hyperactivity -fidgeting

Impulsivity - blurting out things

ADHA Genetic contributions

Seems to fun in families

• DAT1 – dopamine transporter gene has been implicated, as have norepinephrine, GABA, and serotonin

Neurobiological correlates of ADHD

Smaller brain volume 

Inactivity of the frontal cortex and basal ganglia 

Abnormal frontal lobe development and functioning 

ADHD represents a Delay not a ….

not a Deviation in brain development

Biological Treatment of ADHD

Goal of biological treatments: reduce impulsivity and hyperactivity, improve attention

(T/F) ADHD is diagnosed more often in boys than girls

True

Causes of Specific Learning Disorder 

Learning disorders run in families, but specific difficulties are not inherited 

Two main areas of impairment in Autism Spectrum disorder

Two main areas of impairment: Communication and social interaction 

• 10% to 33% don’t acquire effective speech 

Restricted, repetitive patterns of behavior, interests, or activities

Rett disorder (genetic disorder associated with MeCP2 gene) 

Constant hand-wringing, intellectual disability, and impaired motor skills.

Defects in Joint attention

The ability to communicate interest in an external stimulus and another person at the same time 

Naturalistic teaching strategies

Arranging the environment so that the child initiates an interest (such as placing a favorite toy just out of reach)

Lesch-Nyhan syndrome

Intellectual disability, symptoms of cerebral palsy, self-injurious behavior 

Phenylketonuria (PKU)

Cannot break down phenylalanine, which is found in some foods

• Results in intellectual disability when the individual eats phenylalanine 

Down syndrome

Most common chromosomal cause of intellectual disability 

• Extra 21st chromosome (Trisomy 21) 

• Distinctive physical symptoms

Fragile X syndrome

Symptoms include learning disabilities, hyperactivity, short attention span, gaze avoidance, perseverative speech 

• Primarily affects males 

Cultural-familial intellectual disability

Refers to intellectual disability influenced by social environmental factors, such as: 

• Abuse 

• Neglect 

• Social deprivation 

(T/F) If someone has PKU, dietary manipulations can prevent them from developing intellectual disability?

True

Delirium

Temporary confusion and disorientation

Major or mild neurocognitive disorder

Broad cognitive deterioration affecting multiple domains 

Alzheimer’s disease causes dementia

Due to prion disease 

• proteins in the brain that reproduce and cause damage 

Frontotemporal

Due to Parkinson’s Disease

• Dopamine pathway damage 

• Motor problems- Tremors, posture, walking, speech 

Vascular

Due to Huntington’s disease

• genetic autosomal dominant disorder 

• Caused by a gene on chromosome 4 

• involuntary limb movements

Aphasia

difficulty with language

Apraxia

impaired motor functioning

Agnosia

failure to recognize objects

Vascular Neurocognitive Disorder 

Caused by blockage or damage to blood vessels 

• Second leading cause of neurocognitive disorder after Alzheimer’s disease 

• Onset is often sudden (e.g., stroke) 

Pick’s disease

Produces a cortical dementia like Alzheimer’s

• Occurs relatively early in life (around 40s or 50s) 

Neurocognitive Disorder Due to Lewy Body Disease

Lewy bodies are microscopic protein deposits that damage the brain over time 

• Symptoms onset gradually 

• Symptoms include impaired attention and alertness, visual hallucinations, motor impairment

Creutzfeldt-Jakob disease

Type of Prion Disease
May result from a number of sources, including the consumption of beef from cattle with “mad cow disease.”

Deterministic genes

Rare genes that inevitably lead to Alzheimer’s 

• Beta-amyloid precursor gene 

• Presenilin-1 and Presenilin-2 genes 

Susceptibility genes

Make it more likely but not certain to develop Alzheimer’s 

• ApoE4 gene is located on chromosome 19 and associated with late onset Alzheimer’s 

Civil commitment laws

When a person can be legally declared to have a mental illness and be placed in a hospital for treatment 

Deinstitutionalization

Movement of people with mental illness out of institutions 

• Problem: Led large numbers of ill people to become homeless 

Transinstitutionalization

In practice, people with mental illness have been moved out of large mental hospitals to other institutions, including prisons and nursing homes 

Criminal commitment

Accused of committing a crime and are also Detained in mental health facility 

Diminished capacity

Reduced ability to understand their behavior

Requirements for competence 

• Understanding of legal charges 

• Ability to assist in one’s own defense 

• Essential for trial or legal processes 

• Burden of proof is on the defense 

Tarasoff v. Regents of the University of California 

Must warn individual in danger 

Clinical efficacy axis

Involves thorough consideration of scientific evidence to determine whether intervention is effective compared to alternative treatment 

Clinical utility axis

Concerned with the effectiveness of the intervention in the practice setting (i.e., are results generalizable to real world)