Psychopathology Exam 3

Abnormal Psychology Exam 3 -- includes topics like Personality disorders, etc.

Personality Disorder

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

*deviates markedly from one’s culture

Behavior patterns in Personality Disorders must manifest in ≥2 of the following:

1. Cognition

2. Affectivity

3. Interpersonal Functioning

4. Impulse Control

3 clusters of personality disorders

A, B, and C

based on what were thought to be important similarities or features

Cluster A (of Personality Disorders)

paranoid, schizoid and schizotypal personality disorders

include disorders characterized by eccentric behavior

viewed as slightly odd, unusual, or peculiar

Cluster B (of Personality Disorders)

histrionic, narcissistic, antisocial, and borderline personality disorders

marked by dramatic, emotional, or erratic behaviors

^ includes impulsivity, inflated (or apparent inflated) sense of self, and a tendency to seek stimulation

Cluster C (of Personality Disorders)

avoidant, dependent and obsessive-compulsive personality disorders

people who appear anxious, fearful, and/or highly restricted

tend to be inner directed and may draw little or no attention to themselves

Paranoid Personality Disorder

pervasive suspiciousness and distrust of others; always on guard against potential danger or harm

• virtually impossible for them to trust anyone

• become hostile when criticized

Causal factors of Paranoid PD

Little is known…possibly:

• Genetics

• Parental neglect or abuse

• Exposure to voilent adults

Treatment of Paranoid PD

CBT

• usually don’t seek professional help

• very difficult to work with

• high rates of divorce and very poor interpersonal relationships

Schizoid PD

inability or indifference to form social relationships as well as a very limited range of emotional experience and expression

• odd beliefs, behavior, appearance and interpersonal style

• maladaptive social functioning

Schizoid PD 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 and insensitive to other’s feelings or emotions

• cold, withdrawn

Schizotypal PD

odd beliefs, ideas, or preoccupations, behavior, appearance, and interpersonal style

similar to Schizoid PD, but also have cognitive & perceptual distortions as well as oddities & eccentricities in their communication & behavior

• usually contact with reality is maintained

• 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

  • i.e. are vulnerable to developing full-blown psychosis if exposed to difficult life

    circumstances

Pennsatucky from OITNB

Schizotypal PD characteristics

• belief other’s conversations and gestures have special meaning

• odd speech

• paranoid beliefs

• believe they have magical powers (extreme cases)

Histrionic PD

characterized by exaggerated emotional reactions, approaching theatricality in everyday behavior

• feel unappreciated / furious if not center of attention

Histrionic PD characteristics

• self-centered and vain

• reactive, shallow, and insincere

• flirtatious

• excessively extroverted

• overly concerned with appearance

Narcissistic PD (used to be Grandiose PD)

unrealistic, exaggerated sense of self-importance, preoccupation with being admired, and a lack of empathy / sensitivity to the needs of others

Miranda Priestly or Regina George

Characteristics of Narcissistic PD

• inability to take others’ perspective into account

• only see things through their own eyes

• excessive need for admiration

• disregard for others’ feelings

• inability to handle criticism

• sense of superiority & entitlement

3 factors of Narcissism

• agentic

• antagonistic

• neurotic

Agentic (Narcissism)

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

Antagonistic (Narcissism)

showing or feeling active opposition or hostility toward someone or something

Neurotic (Narcissism)

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

Subtypes of Narcissistic PD

grandiose & vulnerable

Grandiose subtype (Narcissism)

traits related to grandiosity, aggression, and dominance

intense entitlement, high self-esteem, overestimation of abilities

Vulnerable subtype (Narcissism)

fragile & unstable sense of self-esteem

arrogance is merely a facade for intense shame and hypersensitivity to rejection & criticism

Causal factors of Narcissistic PD

genetics & environment

causal factors of vulnerable subtype (narcissism)

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

causal factors of grandiose subtype (narcissism)

same parenting behavior as vulnerable subtype’s, as well as overvaluation

Antisocial PD (ASPD)

disregard for society’s moral or legal standards and an impulsive and risky lifestyle

• once called psychopathy or sociopathy

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

ASPD stuff

• behavior becomes evident during adolescence, must start by age 15, and prior must have had symptoms of conduct disorder

• can only receive diagnosis at 18 y/o or older

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

• many become incarcerated

childhood symptoms of AntiSocial Personality Disorder

• cruelty to animals

• bullying

• explosion of anger

• social isolation

• theft

• vandalism

• poor performance in school

• severe impulsivity

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

Diagnostic criteria of ASPD

pervasive pattern of (three or more):

• failure to conform to social norms

• deceitfulness

• impulsivity

• aggressiveness

• disregard for safety of self or others

• irresponsibility

• lack of remorse

Borderline PD

pervasive pattern of poor impulse control and instability in mood, interpersonal relationships, and sense of self

sees the world in black and white

Diagnostic criteria of BPD (≥5)

• 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

Causal factors of BPD

• genetics

• bad parents

• emotional dysregulation

  • lack of awareness, understanding, or acceptance of emotions

  • inability to control intensity or duration of emotions

  • unwillingness to experience emotional distress (even in goal pursuit)

often the result of a parent with debilitating depression, or who’s highly abusive, that feels bad / tries to compensate right after their instances of abuse / neglect by being the “best parent ever”

Cluster C PDs

people who appear anxious or fearful and may seem highly restricted

tend to be inner directed and may draw little attention to themselves

Avoidant PD

have low estimation of their social skills and are fearful of disapproval, rejection, and criticism, and fear shame & embarassment

• inability to relate causes acute anxiety, coupled with low self-esteem & self-consciousness

• desire social relationships but avoid them for fear of rejection

considered a more severe form of social anxiety disorder

Schizoid PD vs. Avoidant PD

• enjoys vs. dislikes being alone

• cold & indifferent to criticism vs. shy, insecure, and hypersensitive to criticism

• lacks desire or ability for social relationships vs. desires social relationships but avoids it for fear of rejection

Causal factors of Avoidant PD

• “inhibited” temperament

• rejection as a child

• parental criticism

• severe bullying

Treatment of Avoidant PD

CBT & Exposure therapy

Dependent PD

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

learn that they can’t trust their own judgement

“clingy”

Obsessive-compulsive PD

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

• rigid

• stubborn

• cold

• reluctant to delegate

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

*obsessions & compulsions are NOT present*

views the world as black & white, only one correct way to do things

hoarding and preoccupation with details

paraphilia

para meaning “faulty” or “abnormal”

philia meaning “attraction”

so; “faulty attraction”

paraphilic disorders

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

nonhuman objects,

children or other nonconsenting persons,

or the suffering or humiliation of self or partner

essential feature of paraphilic disorder

psychologically dependent on target of desire; unable to experience arousal unless target is present

≥ 6 months

Pedophilic Disorder [paraphilic disorder]

adult is sexually aroused by children / adolescents

• ≥18 y/o and also ≥5 years older than who they’re attracted to

*key feature: sexual arousal with children that is equal to or greater than what is felt with peers / adults

Exhibitionistic Disorder [paraphilic disorder]

intense sexual urges and arousing fantasies involving the exposure of genitals to a stranger

• often comorbid conditions include major depressive disorder and substance abuse

Flashers

Voyeuristic Disorder [paraphilic disorder]

compulsion to derive sexual gratification from observing the nudity / sexual activity of others

• most common paraphilia

peeping Toms

Fetishistic Disorder [paraphilic disorder]

preoccupied with an object; depends on this object rather than intimacy with partner to achieve sexual gratification

Partialism [paraphilic disorder]

interested solely in sexual gratification from non-genital body part, such as feet

Frotteuristic Disorder [paraphilic disorder]

intense sexual urges / sexually arousing fantasies of rubbing against or fondling an unsuspecting stranger

Sexual masochism disorder [paraphilic disorder]

attraction to achieving sexual gratification by being hurt

• aroused by being beaten, bound, or otherwise made to suffer

Sexual sadism disorder [paraphilic disorder]

sexually aroused from the physical or psychological suffering of another person

Transvestic Disorder [paraphilic disorder]

“transvestism” or “cross-dressing” refers to the behavior of dressing in the clothing of the other sex

• not “normal” clothing…undergarments

essential features

• must experience arousal because of behavior

• must experience distress or impairment from behavior

Causal factor theories of paraphilia

• genetic, hormonal, and/or sensory factors

• issues with the temporal lobe (which is believed to alter sexual arousal)

• early physical / sexual abuse

Treatment of paraphilias

• Castration

• Medication

• CBT

  • Empathy training

  • Impulse control training

• Relapse prevention

Most effective treatment: combination of androgen-reducing medication & psychotherapy

sexual dysfunction

abnormality in an individual’s sexual responsiveness and reactions

• can’t attribute divergence to a psychological disorder, effects of a substance, or a general medical condition

ratings of sexual dysfunction

lifelong or acquired

generalized or situational

lifelong (sexual dysfunction)

since sexually active

acquired (sexual dysfunction)

asymptomatic at some prior point

generalized (sexual dysfunction)

all sexual situations

situational (sexual dysfunction)

only occur with certain types of sexual stimulation, situations, or partners

Masters & Johnson Sexual Response Cycle

4 phases

1. excitement (arousal) [prior abuse & past]

2. plateau

3. orgasm [nerves]

4. resolution [physical issues]

arousal disorders

issues 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 unable to have sex

gender dysphoria

distress that may accompany the incongruence between a person’s experienced gender and assigned gender

biological sex

sex determined by a person’s chromosones

gender identity

sense of maleness or femaleness

current criteria for gender dysphoria

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

transphobia

negative stereotyping and fear of people who are transgender

Schizophrenia

disorder with a range of symptoms involving disturbances in

• content of thought

• form of thought

• perception

• affect

• sense of self

• motivation

• behavior

• interpersonal functioning

delusion

deeply entrenched false belief not consistent with the client’s intelligence or cultural background

types of delusions

• grandeur

• control

• reference

• persecution

• self-blame

• somatic

• infidelity

• thought broadcasting

• thought insertion

hallucinations

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

disorganized speech

language that is incoherent / 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 / perception that others wish to cause you harm

inappropriate affect

emotional expressiveness which fails to correspond to the content of what is being discussed

delusions of grandeur

believing you’re all powerful, universally loved, invulnerable, etc

delusions of control

believing you’re being controlled by some outside force, like the gov’t or aliens

delusions of reference

believing people on the tv are talking to you

delusions of persecution

believing people are always out to get you

delusions of self-blame

believing that you are responsible for terrible atrocities just because you think / say / dream something

somatic delusions

believing you have a tumor / are pregnant

delusions of infidelity

believing your partner is cheating on you

delusions of thought broadcasting

believing others can hear your thoughts

delusions of thought insertion

believing that your thoughts are not your own / that some outside force is planting them inside your head

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

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

> 1 day

< 1 month

Schizophreniform disorder

psychotic symptoms that are essentially the same as those found in schizophrenia, except for the duration of the symptoms

brief stints lasting from 1 to 6 months

Schizoaffective disorder

involving 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

more of a mood disorder than a psychotic disorder, but does occasionally experience psychosis

delusional disorders

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

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

5 types

erotomanic type (of delusional disorder)

falsely believe another person is in love with them