Psychopathology Exam 3 - Dr. Herman Rutgers

Personality Disorder Definition

- 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.

Behavior patterns must manifest themselves in at least two of these four areas (for a personality disorder):

Cognition

Affectivity

Interpersonal functioning

Impulse control

Cluster A Personality Disorders

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.

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.

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- cold, withdrawn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.

- Usually contact with reality is maintained but highly personalized and superstitious thinking is a main component.

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

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.

- Unable to take other's perspective into account. Only see things through their own eyes.

Subtypes of Narcissistic Personality Disorder

- Grandiose narcissism: traits related to grandiosity, aggression, and dominance. Intense entitlement, high self-esteem, and overestimate abilities.

--> Considered from abuse or neglect, controlling, intrusive, and/or cold parenting.

- Vulnerable narcissism: fragile and unstable sense of self-esteem where arrogance is merely a façade for intense shame and hypersensitivity to rejection and criticism.

--> 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.

- Central features of antisocial personality disorder were once labeled as psychopathy.

--> 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, and insincerity.

Diagnostic Criteria of ASPD

pervasive pattern of 3 out of 7 of the following:

- Failure to conform to social norms

- Deceitfulness

- Impulsivity

- Aggressiveness

- Disregard for safety of self or others

- Irresponsibility

- Lack of remorse

Biological Perspective of ASPD

- Strong evidence in favor of genetics

- Mutation in monoamine oxidase A (MAOA gene)

Psychological Perspective of ASPD

- 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.

Borderline Personality Disorder (BPD)

- Characterized by a pervasive pattern of poor impulse control and instability in mood, interpersonal relationships and sense of self.

Causal Factors of BPD

- Genetics

- parenting (abuse and/or neglect)

- emotional dysregulation: lack of awareness, understanding or acceptance of emotions, inability to control the intensity or duration of emotions, unwillingness to experience emotional distress as in pursuing goals or engaging in goal-directed behavior.

Cluster C Personality Disorders

- 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 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.

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.

Paraphilic Disorders

- Paraphilic disorders: Behaviors in which an individual has recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving (1) nonhuman objects (2) children or other nonconsenting persons or (3) the suffering or humiliation of self or partner.

- 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.

--> Must experience the condition for 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 whom attracted to.

Exhibitionist Disorder

- A 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

- Person has a compulsion to derive sexual gratification from observing the nudity or sexual activity of others.

- Most common paraphilia.

Fetishistic Disorder

- Person is preoccupied with an object and depends on this object rather than sexual intimacy with partner for achieving sexual gratification.

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

Frotteuristic Disorder

- Person has intense sexual urges and sexually arousing fantasies of rubbing against or fondling an unsuspecting stranger.

Sexual masochism disorder

- ("masochism"-seeking pleasure from being in pain) marked by an attraction to achieving sexual gratification by having painful stimulation applied to one's own body.

- Aroused by being beaten, bound or otherwise made to suffer.

Sexual sadism disorder

- Sexually aroused from the physical or psychological suffering of another person.

Transvestic disorder

- ("transvestism" or "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.

Treatment (sexual disorders)

- Castration: intended to destroy the body's production of testosterone through surgical castration (removal of the testes) or chemical castration (medication that suppress 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 (neurotransmitter involved in sexual arousal).

Sexual Dysfunction

- abnormality in an individual's sexual responsiveness and reactions.

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.

Gender Dysphoria

- Gender dysphoria: distress that may accompany the incongruence between a person's experienced or expressed gender and that person's assigned gender.

Current criteria for gender dysphoria

- must identify with the other sex, having the feeling of "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.

Schizophrenia

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

--> Considered a broad category which 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.

Types of delusions

Grandeur - person believes they are all powerful.

Control - believe they are controlled by some absurd greater figure.

Reference - believe that everyone is speaking directly to them or about them, even for example people on TV.

Persecution

Self blame - people believe that because they have bad thoughts they caused traumatic real life events to occur.

Somatic - believe something physical is actually occurring to them, like if they were pregnant they would believe their stomach is getting bigger.

Infidelity - believe their signiifcant other talking to someone else or cheating on them when none of it is actually happening.

Thought broadcasting

Thought insertion

Hallucination

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

Disorganized speech

- language that is 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.

Positive symptoms

- exaggerations or distortions of normal thoughts, emotions and behaviors including delusions, hallucinations, disorganized speech, and grossly abnormal psychomotor behavior.

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

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

Schizophreniform disorder

- Disorder with psychotic symptoms that are essentially the same as those found in schizophrenia, except for the duration of the symptoms. Usually last from 1 to 6 months.

Schizoaffective disorder

- Disorder involving the experience of a major depressive, manic, or mixed episode while also meeting the diagnostic criteria for schizophrenia.

Delusional disorders

- Disorders where the only symptom is delusions that have lasted for at least one month.

- No other symptoms of schizophrenia are presented and have never met the criteria for schizophrenia.

- Comes in 5 types.

5 Diagnoses for Delusional Disorder

- Erotomanic type: falsely believe another person is in love with them.

- Grandiose type: exaggerated view of oneself.

- Jealous type: falsely believe their romantic partner is unfaithful.

- Persecutory type: falsely believe someone is treating them in a malevolent manner.

- Somatic type: falsely believe they have a medical condition (Not anxiety based).

Treatments (schizophrenic disorders)

- Primary treatment: antipsychotic medication (neuroleptics).

- "Typical" antipsychotics: dopamine receptors.

- "Atypical": affect both serotonin and dopamine neurotransmitters.

Neurocognitive disorder

- Acquired cognitive decline in one or more domains of cognition based upon concerns of the client or someone who knows the client well and performance on objective assessment measures.

- Neurocognitive disorder replaced dementia.

Major neurocognitive disorders

- Disorders involving significant cognitive decline from a previous level of performance.

Mild neurocognitive disorder

- Involves modest cognitive decline from a previous level of performance. Does not interfere with everyday living.

Domains for cognitive disorders include

- Complex attention: sustained, selective, divided.

- Executive function: planning, decision making, working memory, mental cognitive flexibility.

- Learning and memory: immediate and recent.

- Language: expressive language, grammar and syntax, receptive language.

- Perceptual-motor: visual, visuoconstructional, praxis, gnosis.

- Social cognition: recognition of emotions, theory of mind.

- Delirium: neurocognitive disorder temporary in nature involving disturbances in attention or awareness. Symptoms appear abruptly and fluctuate over the course of having the disorder.

Delirium diagnosis

- For diagnosis: must show changes in consciousness or awareness over a very short period of time, hours or days, tending to fluctuate over the course of a day, and must be caused by a general medical condition.

- Must specify if from a substance intoxication, substance withdrawal, a medication or other medical condition and as acute (a few hours or days) or persistent (weeks or months).

Neurocognitive disorder due to Alzheimer's disease

- Neurocognitive disorder associated with progressive, gradual declines in memory, learning and at least 1 other cognitive domain.

- Pseudodementia: false dementia, a set of symptoms caused by depression that mimic those apparent in the early stages of AD.

Neurocognitive Disorder due to traumatic brain injury

- ND due to TBI: evidence of impact to the head along with cognitive and neurological symptoms that persist past the acute post-injury period.

--> Symptoms must occur immediately after the trauma or after recovering consciousness.

Amnesia

- inability to recall information that was previously learned or to register new information. Memory loss must persist over time.