behavior disorders EXAM 4

sexual paraphilia and personality disorders

PERSONALITY DISORDERS

is the next topic

personality

Regularities and consistencies in behavior thinking, perceiving, and feeling

•Stable across situation and time

•Integrated and cohesive

amount of criterions and clusters for PDs

Citerion A, B, C, and D

Cluster A, B, C,

General Personality Disorder

Criterion A:

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:

• Cognition (i.e., ways of perceiving and interpreting self, other people, and events)

• Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)

• Interpersonal functioning

• Impulse control

Personality Disorder

Axis II

•Criterion B:

•The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

•Criterion C:

The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

•Criterion D:

The pattern is stable and of long duration, and its onset can be traced back at least to adolescents or early childhood.

Cluster A (3 disorders):

Odd-Eccentric

•Behaviors similar to Schizophrenia

•Flat affect, odd thought or speech patterns

•Differ in their grasp on reality

•Symptoms do not reach the severity seen in Schizophrenia

•Comprises three disorders:

•Paranoid Personality Disorder

•Schizotypal Personality Disorder

•Schizoid Personality Disorder

Schizotypal Personality Disorder (Cluster A)

•Symptoms of Schizophrenia that are not severe enough to warrant a diagnosis of Schizophrenia

•Mild perceptual and cognitive distortions:

• Odd beliefs

• Unusual perceptual experiences

•Odd/Eccentric behaviors:

• Odd speech patterns

•Discomfort with and deficits in interpersonal relations

• Wants close relationships but often avoids them

Cluster B

Dramatic-Emotional

•Manipulative and potentially uncaring

•Show little regard for others and potentially their own safety

•Emotional Dysregulation

•Can demonstrate highly erratic emotional responses

•Inappropriately sexual and seductive behavior:

•Extreme focus on appearance

4 disorders in cluster B

Histrionic, ASPD, Narcissistic, Borderline

Histrionic Personality Disorder (Cluster B)

Exaggerated emotionality that lacks depth:

•Emotions are shallow and shift rapidly

•Discomfort when not center of attention:

•Constantly seeks reassurance, approval, and praise

•Inappropriately sexual and seductive behavior:

•Extreme focus on appearance

Histrionic core beliefs and learning history

Core Beliefs:

•Self:

•If I can’t entertain people they will abandon me

•Other:

•If other people don’t respond to me they are rotten

•Learning History:

•Selective interpersonal reinforcement by family and peer relationships leads to excessive attention-seeking behaviors

Antisocial Personality Disorder (Cluster B)

Antisocial Personality Disorder:

•Characterized by a disregard for and violation of the rights of others:

•Failure to conform to social norms with respect to lawful behavior

•Deceitfulness

•Impulsivity or failure to plan ahead

•Irritability and aggressiveness

•Reckless disregard for safety of others

•Consistent irresponsibility

•Lack of remorse for behaviors

ASPD early history

•Early History:

•Moral Insanity

•Not psychotically deranged

•No deficit in reasoning abilities

•“Constitutionally deficient in moral faculties”

DSM III (ASPD)

Diagnosis focused on antisocial behaviors and social deviance

•E.g., acts of aggression

•Critiqued for de-emphasis on trait and personality characteristics

Psychopath

Term similar to ASPD, but includes:

•Grandiosity, arrogance, superficiality

•An inability to form emotional bonds

•A lack of anxiety

Prevalence of ASPD

•Overrepresented in criminal and substance abuse settings:

•76% of prisoners diagnosed with ASPD

•Community Samples:

•8% of men

•3% of women

genetic contributions of ASPD

Twin Studies:

•29% concordance for ASPD

•Individuals were more likely to behave like biological parents; not adoptive parents

heritability of personality traits (MMPI)

Psychopathic deviate scale :

•Assesses family discord, authority conflict, social alienation, low social anxiety

•Heritability = .61

•Mania scale:

•Amorality, social confidence and imperturbability, ego inflation (grandiosity)

• Heritability = .55

early learning environment for ASPD

Characterized by either:

•Passive or neglectful parenting attitudes

•Overly harsh parenting style

continued

Passive or neglectful parenting attitudes:

•No demands for responsible and non-aggressive behaviors

•Children who receive little response- contingent attention for (+) behaviors

might engage in (-) behavior for attention

continued

Harsh parenting styles:

•Use of aggression for discipline

•Modeling conflict and problem- solving

•Develop hostile information processing style in social interaction

learning and performance deficits

Deficits in acquiring learned responses:

•Incapable of profiting from reward/punishment:

•Psychopaths performed as well as controls when incorrect responses resulted in loss of cigarettes or money

•Not responsive to shocks or positive or negative social comments

Deficits in acquiring fear responses

•Psychopaths slow to develop conditioned response to fear

• Inclined to ignore painful shocks that controls learned to avoid

• Less influenced by fear reaction

• Behaviors unfettered by psychological deterrents such as anxiety and fears of consequences

chronic low levels of arousal

Aversive physiological state resulting from a lack of novel/rewarding stimuli

•Lower baseline levels of arousal and rapid adaptation to novel stimuli

•ASDP individuals spend less time attending to boring material

•.Higher initial attention to novel stimuli, rapid habituation

•Need to increase arousal levels, ASPD individuals will engage in higher- risk sensation-seeking

history of narcissism

• Narcissism is both old both as an idea and a formal psychological construct.

• Greek myth of Narcissus

• Introduced into psychological literature by early psychoanalytic theorists (Ellis, 1898, Freud, 1914) and extended in the 1960s to object relations theory (e.g., Kernberg, 1967).

• Was added as a formal diagnosis in the DSM-III (American Psychological Association, 1980)

• Has since received wide ranging interest across several scientific disciplines from clinical/psychiatric researchers to social, personality, and organization psychology

is narcissim consistently assessed?

No

• This diversity in operationalizing narcissism filters in to our empirical understand of it:

• e.g., Reports from clinicians working with pathological narcissism are at odds with prevalence rates in epidemiological studies (0.0% to 5.7%, median <1.0%)

• Tower of Babel

• Clinical and social/personality psychologists differ in how they conceptualize and measure narcissism

• Ultimately, there is no one gold standard definition or theoretical model of narcissism

Healthy narcissism

Consensus that there exist both healthy expressions and maladaptive forms of narcissism:

• “Narcissism can be conceptualized as one’s capacity to maintain a relatively positive self-image through a variety of self-, affect-, and field regulatory processes, and it underlies individuals’ needs for validation and affirmation as well as the motivation to overtly and covertly seek out self- enhancement experiences from the social environment...” (cite, year)

healthy narcissim continued

Narcissism contributes to well-being by increasing an individual’s sense of personal agency

High scores on the Narcissistic Personality Inventory (NPI):

• Negative associations with trait neuroticism and depression

• Positive associations with achievement motivation and self-esteem

two adaptive subtypes of narcissism

Autonomy Subtype (Wink et al., 2005):

high functioning/exhibitionistic

autonomy subtype

• Correlated with self-ratings and partner-ratings of creativity, empathy, achievement orientation, and individualism.

• Prototype generally associated with positive trajectories in longitudinal studies

high-functionig/exhibitionistic

• Exaggerated sense of self-importance.

• Outgoing, articulate, and energetic.

• Show “good adaptive functioning and use their narcissism as a motivation to succeed” (p. 1479).

two main dimensions of pathological narcissism

grandiose narcissism

vulnerable narcissism

grandiose narcissism

associated with arrogant, conceited, and domineering attitudes and behaviors

• Also internal manifestations:

• Repressing negative aspects of self

• Distorting disconfirming external information

• Can lead to entitled attitudes and an inflated self-image without . . requisite accomplishments and skills

• Engaging in regulatory fantasies of unlimited power, superiority, perfection, and adulation.

Grandiose/malignant subtype is characterized by:

• Seething anger

• Manipulativeness

• Pursuit of interpersonal power and control

• Lack of remorse

• Exaggerated self-importance

• Feelings of privilege

• Externalize negative life events

• Have little insight into their behavior

Vulnerable narcissism

• DSM-V criteria for NPD is most closely aligned with grandiose narcissism

• Fragile/hypersensitive subtype is characterized by:

• An inability to consistently maintain a grandiose sense of self

• Prone to narcissistic injury

• Emotional states characterized by shame, anxiety, depression, and feelings of inadequacy

Grandiose vs vulnerable

Grandiose self-states oscillate or co-occur with vulnerable self-states and affective dysregulation

Grandiosity can’t be maintained:

• Vulnerable and grandiose states associate with different behaviors

• Treatment utilization

ironically predictive question for narciccists

To what extent do you agree with this statement:

I am a narcissist.

1 = not very true of me 7 = very true of me

etiological factors

• Heritability estimates range widely from .37 to .77

Heritability estimates depend on the specific traits under investigation

• Grandiosity/entitlement - .23/.35 (Brown et al., 2009)

• Communal narcissism - .42 (Gebauer et al., 2012)

• Different variations of narcissism differ substantially in their genetic (as well as environmental) determinants

Developmental and learning history

• Overvaluation by parents not balanced w/ realistic feedback

• Child fails to develop adaptive means to handle “narcissistic injuries”

• Lack of valuation and idealization by parents

• Individual fails to perceive that they have value and can obtain love for their own sake

Borderline personality disorder (cluster B)

Characterized by:

Instability in emotion, cognition, behavior, sense of self, and interpersonal relationships

Efforts to change the name to “unstable personality disorder” and described as “emotionally unstable disorder” in the ICD-10.

Profound fears of abandonment (real or imagined) and desperate bids to avoid abandonment

early learning factors

Early lives also involve significantly more maternal and paternal absences, more discord between parents, more experiences of being raised by other relatives or in foster homes, and more physical violence in the family.

more early learning factors

BPD patients are at a higher likelihood of having experienced early trauma in the form of physical abuse, sexual abuse, or neglect

more early learning

A common theme across theoretical models of borderline personality disorder is an invalidating early attachment environment

“good enough mothering” (Winnicott, 1953) Linehan (1993)

Parental responses to the child’s inner experiences are met with. inappropriate or erratic responses from parents and caregivers

Instability in self-concept

Good and bad object relations

biological factors

In a twin sample, Torgersen et al. (2000) found a concordance rate of 35% in monozygotic (MZ) twins compared with a concordance rate of 75 for dizygotic (DZ) twins

Note: To date, no adoption studies have been conducted

What is inherited:

Much like other personality disorders, it is more likely that certain predisposing traits are inherited as opposed to symptoms of the disorder

E.g., rates of anxiety and mood disorders, impulse control problems, ASPD, affective instability, and cognitive dysregulation in relatives of those with BPD

CLUSTER C:

ANXIOUS FEARFUL

extreme concern of criticism and abandonment that leads to impaired relationships

culster C disorders

avoidant personality disorder,

dependent personality disorder,

obsessive-compulsive personality disorder

avoidant personality disorder

Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection.

Avoidance of activities of daily living (e.g., work) involving people for fear of criticism or rejection.

Low-self esteem and social isolation

Dependent personality disorder

Feelings of helplessness, submissiveness, dependence, reassurance seeking.

Difficulty making independent decisions.

Avoidance of adult activities and tolerance of abuse and maltreatment

obsessive compulsive personality disorder (OCPD)

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts,

indicated by four or more of the following

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

4. Is over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

5. Is unable to discard worn-out clothes or worthless objects even when they have no sentimental value

6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

8. Shows rigidity and stubbornness.

miscellaneous notes about OCPD

Most common personality disorder (deReus and Emmelkamp, 2012), with some evidence of high prevalence in men.

Diagnostic issues:

 Critiqued for lacking a hallmark diagnostic feature

 DSM-V recommends perfectionism as the primary feature

 Heterogenous diagnostic category

heterogeneity

Heterogeneity in diagnostic entity has severely impaired empirical findings on etiology and course:

 Different studies suggest it is stable over time whereas others do not, owing to the specific symptoms in play (problems delegating versus miserly behaviors).

 Some studies suggest major overlap with OCD whereas others show them as distinct

 Inconsistent findings with respect to etiological factors (e.g., heritability)

SEXUAL PARAPHILIAS

is the next topic

types of sexual disorders

sexual disfunctions

paraphilas

sexual dysfunction

• Problems in the psychophysiology characteristic of the sexual response cycle

• Represent quantitative problems with the strength/intensity of sexual response

paraphilias

• Sexual arousal to non-normative or deviant stimuli and the associated sexual behaviors

• Represent deviations in the qualitative aspects of sexuality or direction of sexual feelings

DSM-5

DSM-5 redefined paraphilia to describe a persistent, intense, atypical sexual arousal pattern, independent of whether it is the source of impairment or distress versus

• Paraphilic disorder to describe a paraphilia that is accompanied by clinically significant distress or impairment.

divisions of paraphilias

victimless

involving victim

paraphilia NOS

victimless

• Fetishism

• Transvestic Fetishism

• Sexual Masochism & Sadism

involving victim

• Exhibitionism

• Frotteurism

• Pedophilia

• Sexual Masochism & Sadism

• Voyeurism

paraphilia, NOS

Telephone Scatalogia (obscene telephone calling)

Necrophilia (corpses)

Zoophilia (animals)

Coprophilia (feces)

Urophilia (urine)

etiological and developmental factors: learning models

• Classical conditioning:

• Pairing of a neutral stimulus with sexual arousal

• Fetishes conditioned in normal volunteers

• Imprinting:

• Early sexual experiences influence the shaping of subsequent sexual desires and fantasies

• Conditioning and fantasy rehearsal:

• Self-directed conditioning paradigm (jacking it)

• Early sexual trauma:

• Control over painful memory through mastery

• Identification with the aggressor

fetishism

Erotic attraction to nonliving objects:

• Wide variety of behavioral manifestations

• Masturbation with object

• Incorporation of object into sexual behavior

• Theft or collection of objects

partialism

• A form of fetishistic behavior involving intense erotic attraction to specific parts of the body

• Distinguished from normal erotic attraction by the tendency to override sexual interest in the partner or partner’s body as a whole

Sadism

• Involves excitement in response to the infliction of psychological and physical

suffering

masochism

• Involves excitement in response to being humiliated or made to suffer

• Some individuals become excited in either role, whereas some only become aroused in a particular role

sexual sadism and masochism

Sadomasochistic behaviors can include:

• Beating/Burning

• Restraint

• Blindfolding

• Body piercing

• Humiliation

• Forcing someone to crawl or wear infantile clothing

paraphillic disorder diagnosis

• A diagnosis of a paraphilic disorder requires (a) a nonconsenting person or (b) cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning”

• Not just distress from social disapproval

BDSM

Sexual consent in the Bondage and Discipline, Dominance and Submission, Sadism and Masochism (BDSM) community:

• “Safe, Sane, and Consensual (SSC)” and “Risk-Aware Consensual Kink (RACK).”

• Explicit safety measures:

• Negotiation and safe words

• e.g., pushing non-negotiated activities or sexual boundaries during a. scene that were not established during pre-scene negotiation is considered a serious offense

• The BDSM community enforces community-defined boundaries and serves to regulate community norms of safety and consent

• Provides mechanisms for vetting versus blocklisting potential partners

pedophilia

• Adults for whom prepubescent children are the focus of erotic attraction and interest

• Highly culture-specific

• Heterogeneity of behavioral manifestations

• Subtypes:

• Opportunistic

• Pervasively angry

• Sexual

exhibitionism

• Recurrent urge for exposure of the genitals to strangers or unsuspecting persons

• Arousal response to shock, fear, or embarrassment of victims

• Associated with:

• Acts of sexual aggression

• Antisocial traits or heterosocial deficits

• Heterosocial: Describes social relations with the opposite sex of the . nonsexual nature

frotteurism

• Characterized by the individual’s touching or rubbing his genitals against the leg, buttocks, or other body parts of an unsuspecting person.

• Typically occurs in situations where behavior will go undetected by victim

• Associated with:

• Withdrawn, immature or socially avoidant personality style

Voyeurism

• Involves the observation of an unsuspecting person or persons who are nude, disrobing, or engaging in a sexual act.

• Essential feature is the lack of awareness of the victim

• Often involves masturbation during or immediately following voyeurism

• Associated with:

• Sadism, aggression, & sexual assault

• Little sexual experience and lack of heterosocial skills

• Strong feelings of inferiority

etiological and developmental learning models

• Classical conditioning, imprinting, and conditioning through fantasy rehearsal still apply.

• Early sexual trauma:

• More commonly associated with the development of paraphilias that involve non-consensual victims

• Often show features of sexual compulsivity, poor impulse control, or distorted cognition about consent.

• Vicarious learning:

• Children exposed to sexual violence may learn that sexual coercion is

normative or associated with pleasure/power.

• Control over painful memory through mastery

• Identification with the aggressor

characteristic profile

• Offenders are predominantly men

• Impulsivity, anger, aggression, dominance, etc.

• Heterosocial deficits

• Early attachment problems

• Comorbid pathology:

• Mood disorder

• Anxiety

• Substance Abuse