Personality disorders

• Psychopathology

  • The study of psychological disorders, including their symptoms, etiology (causes) and treatment

• Psychological disorder 

  • A condition characterized by abnormal thoughts, feelings and behaviors 

• Cultural expectations - violating cultural expectations is not enough by itself to identify a psychological disorder. Social norms vary between cultures

• Harmful Dysfunction (Wakefield 1992)  dysfunction occurs when an internal mechanism breaks down and can not perform its normal function. For a dysfunction to be classified as harmful - leads to negative consequences for the individual as judged by the standards of individual culture. 

• Diagnosis (DSM) - appropriately identifying and labeling a set of defined symptoms Requires classification systems that organize psychological disorders systematically.

  • Mental health and mental illness are widely stigmatized in the US

  • DSM-5 is the classification system used by most mental health professionals.

  • Categories and describes each disorder.

  • Diagnostic features – overview of the disorder.

  • Diagnostic criteria – specific symptoms required for diagnosis.

  • Prevalence – percent of population thought to be afflicted.

  • Risk factors.

    • Comorbidity - the co-occurence of two disorders

• DSM 5 is most used because of the amount of categories to formally get diagnosis 

• International classification of diseases - Used to examine general health of populations and monitor prevalence of diseases/health problems internationally. Worldwide, the ICD is more frequently used for clinical diagnosis, whereas the DSM is more valued for research. DSM includes more explicit disorder criteria as well as extensive explanatory text. DSM is the classification system used among U.S. mental health professionals.

• Supernatural perspective – psychological disorders attributed to a force beyond scientific understanding.

• Dancing Mania - Epidemic in Western Europe (11th-17th centuries) in which groups of people would suddenly begin to dance with wild abandon.  Some would dance for days or weeks, screaming of terrible visions. Although the cause is unknown, the behavior was attributed by many to supernatural forces.

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  • Biological factors in disorders - Genetic factors, chemical imbalances, and brain abnormalities

  • Diathesis-stress model -a diagnostic model that proposes that a disorder may develop when an underlying vulnerability is coupled with a precipitating event

• Anxiety disorders 

  • Fear - an instantaneous reaction to an imminent threat.

  • Anxiety - apprehension, avoidance, and cautiousness regarding a potential threat, danger, or other negative content

• Agoraphobia - Characterized by intense fear, anxiety, and avoidance of situations in which it might be difficult to escape or receive help if one experiences a panic attack.

• Rachman (1977) -

  • Classical Conditioning.- Child is bitten by dog (US) → dogs become associated with biting (CS) → child experiences fear around dogs (CR). Conditioned fears develop more readily to fear-relevant stimuli (images of snakes and spiders) than to fear-irrelevant stimuli (images of flowers).

  • Vicarious Learning. Child observes cousin react with fear around spiders → the child later expresses the same fears even though spiders have never presented any danger to him.

  • .Verbal transmission of information. A child is continuously told that snakes are dangerous → the child starts to fear snakes.

• Social anxiety - characterized by extreme and persistent fear or anxiety and avoidance of social situation

• Safety behaviors - mental or behavioral acts that reduce anxiety in social situations by reducing the chance of negative social outcomes.

• Panic Disorder -  recurrent and unexpected panic attacks, along with at least one month of persistent concern about additional panic attacks, worry over the consequences of the attacks, or self-defeating changes in behavior related to the attacks. Comorbidity -  anxiety disorders or major depressive disorder.

• Panic attack - a period of extreme fear or discomfort that develops abruptly and reaches a peak within 10 minutes.

• Panic attacks alone are not a disorder 

• Symptoms feeling dizzy, unsteady, lightheaded, shortness of breath, chest palpitations and or accelerated heart rate, nausea or abdominal distress 

• Panic disorder causes. 

  • Genetics 43% heritability (which can also be influenced by learned behavior) + trigger 

  • Neurobiological theories - Locus coeruleus in the brainstem is possibly involved. Major source of norepinephrine (neurotransmitter that triggers flight or fight response. Activation is associated with anxiety and fear produces panic like symptoms in nonhuman primates 

  • Conditioning theories - panic attacks are classical conditioning responses to subtle bodily sensations resembling those normally occurring when one is anxious or frightened 

  • Cognitive theories - individuals with panic disorder are prone to interpret ordinary bodily sensations catastrophically, setting the state for panic attacks. In some patients, reducing catastrophic cognitions about sensations has proven to be as effective as medication in reducing panic attacks

• Generalized Anxiety Disorder (GAD) - a relatively continuous state of excessive, uncontrollable and pointless worry and apprehension. Comorbid with mood disorders and other anxiety disorders.

  • Worry represents a mental strategy to avoid more powerful negative emotions perhaps stemming from earlier unpleasant or traumatic experiences.

  • Worrying acts as a distraction from remembering painful childhood experiences.

  • Longitudinal study found childhood maltreatment was strongly related to development of the disorder during adulthood.

• OCD - Involves thoughts and urges. Obsessions leads to completions urges that are intrusive and unwanted (obsessions) and or need to engage in repetitive behaviors or mental acts (compulsion)

  • Common obsessions, concerns about germs and contamination, doubts, orders and symmetry aggressive and lustful urges

• PTSD - individual was exposed to witnessed or experienced the details of a traumatic experience ( actual or threatened death, serious injury or sexual violence)

  • Symptoms occur for at least one month. Feeling detached from others, flashbacks, persistently negative emotional states.

• Conditioning Theories

• •Traumatic event (UCS) → Extreme fear and anxiety (UCR).

• •Cognitive, emotional, physiological, and environmental cues associated with the traumatic event become conditioned stimuli.

• •Traumatic reminders (CS) → Extreme fear and anxiety (CR).

• Cognitive Theories

• Two key processes in development and maintenance of PTSD:

• 1.Disturbances in memory for the event.

• •Poorly encoded memories of trauma can become fragmented, disorganized, and lacking in detail.

• •Individuals cannot remember events in a way that gives meaning and context.

• •May become haunted by these fragments involuntarily triggered by stimuli associated with the event.

• Mood disorders

  • Depressive disorders - (intense and persistent sadness) is the main feature 

  • Bipolar and related disorders 

    • Mania - (extreme elation and agitation) is the main feature

    • Manic episode - a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity in energy 

• Major depressive disorder (most prevalent in the population) - depressed mood most of the day, nearly every day

  • Loss of interest and pleasure in usual activities

  • At least 5 symptoms for at least a two week period

  • Symptoms cause a significant distress or impair normal functioning and are not caused by a substance or medical condition

    • Symptoms

    • Weight loss or weight gain

    • Difficulty falling asleep 

    • Psychomotor agitation

    • Fatigue

    • Feelings of worthlessness or guilt 

    • Difficulty concentrating 

    • Suicidal idealtion

Subtypes of depression

• Seasonal pattern - applies to situations in which a person experiences the symptoms of major depressive disorder 

• Postpartum depression - major depression during pregnancy or in the four weeks following birth

• Persistent depressive disorder (dysthymia) - depressed moods most of the day nearly every day for at least two years as well as at least two of the other symptoms of major depression

  • Chronically sad but do not meet all the criteria for major depression

Bipolar disorder 

• Comorbidity - anxiety disorder and substance abuse disorder

• People are more prone to stop using medication. Medication seeks to balance mood, since it is normal for moods to fluctuate. Many people who enjoy the manic side because of the heightened mania. 

Biological factors 

• Elevated levels of cortisol Cortisol activates the amygdala and deactivates the prefrontal cortex (disturbances connected to depression).

Neurotransmitters

• Particularly serotonin and norepinephrine impact imbalances of mood disorders 

  • Medications for depression - usually increase serotonin and norepinephrine activity 

  • Medication for bipolar - lithium ( a mineral that we have to watch since it can build up in the liver) which blocks norepinephrine activity at the synapse.  

• Brain Anatomy 

  • Depression

    • Amygdala - important in assessing the emotional significance of stimuli and experiencing emotions 

    • Depressed individuals individuals react to negative stimuli ( a sad face) with greater amygdala activation that do non-depressed individuals more prone to respond to react emotionally to negative stimuli 

    • Genetic vulnerability - alteration in the 5-HTTLPR gene (regulates serotonin

      • 1 or 2 short alleles + stressful life events -> increasingly likely to experience a depressive episode 

Aron beck - Theorized that depression- prone people possess mental predispositions to think about most things in a negative way ( depressive schemas) 

Depressive schemas  contain themes of loss failure rejection worthlessness and inadequacy 

• hopelessness theory - cognitive theory of depression proposing that a style of thinking that perceives negative life events as having stable and global causes leads to a sense of hopelessness and then to depression

• Negative thinking - refers to a tendency to perceive negative life events as having stable and global causes 

• Rumaniation - repetitive and passive focus on the fact that one is depressed and dwelling on depressed symptoms, rather than distracting one’s self from the symptoms or attempting to address them in an active, problem-solving manner.

• Suicide 

  • 90% of those who complete suicides have a diagnosis of at least one mental disorder (most frequently mood disorders)

  • Risk factors - Substance abuse problems, previous suicide attempts, access to lethal means in which to act, serotonin dysfunction.

  • Precursors - withdrawal from social social relationships, feeling like a burden, engaging in reckless and risk taking behaviors. 

  • More Likely in men

• Schizophrenia - hallucinations

SCHIZOPHRENIA: SYMPTOMS

• Hallucinations - perceptual experience that occurs in the absence of external stimulation. 

(Auditory hallucinations are most common).

• Delusions – beliefs that are contrary to reality.

• Paranoid delusions – belief that other people or agencies are plotting to harm them.

• Grandiose delusions – belief that one holds special power, unique knowledge, or is extremely important.

• Somatic delusions – belief that something highly abnormal is happening to one’s body.

• Thought withdrawal/insertion

• Disorganized thinking – disjointed and incoherent thought processes.

• Disorganized or abnormal motor behavior – unusual behaviors/movements.

• Catatonic behaviors – decreased reactivity to the environment

• Negative Symptoms - decreases and absences in certain behaviors, emotions, drives.

• Avolition – lack of motivation to engage in self-initiated and meaningful activity.

• Alogia– reduced speech output.

• Asociality – social withdrawal.

• Anhedonia – inability to experience pleasure.

  • Causes of schizophrenia - risk is 6x greater if one parent has schizophrenia (even if adopted)

  • Neurotransmitters - Dopamine Hypothesis - an overabundance of dopamine or too many dopamine receptors are responsible for the onset and maintenance of schizophrenia 

  • High levels of dopamine in the limbic system - hallucinations and delusions 

  • Low level of dopamine in the prefrontal cortex 

  • Enlarged ventricles 

  • Reduced gray matter in the frontal lobes 

  • Many show less frontal lobe activity when performing cognitive tasks 

  • Events during pregnancy - obstetric complications during birth, mothers exposure to influenza during the first trimester. Mothers emotional stress 

• Dissociative disorders -

  •  dissociative amnesia - inability to recall important person

• Dissociative fugue - individual suddenly wanders away from home, experiences confusion about their identity and is some cases may adopt a new identity 

• Depersonalization/derealization disorder - characterized by recurring episodes of depersonalization, derealization or both 

  • Depersonalization - feelings of “unreality or detachment form , or unfamiliarity with one's whole self or from aspects of the self”

  • Derealization -  a sense of “unreality or detachment or unfamiliarity with the world be it individuals, inanimate objects or all surroundings”

• dissociative identity disorder - individual exhibits two or more separate personalities or identities

  • Involves memory gaps for the time during which another identity is in charge 

  • Individuals tend to report a history of childhood trauma- adoption of multiple personalities may serve as a psychologically important coping mechanism for threat and danger

• Personality Disorders 

  • Cluster A - 

    • paranoid personality disorder 

    • Schizoid personality disorder 

    • Schizotypal personality disorder

  • Cluster B -

    • Antisocial personality disorder 

    • Histrionic personality disorder - characteristics of being overly dramatic 

    • Narcissistic personality disorder - overinflated sense of self. Extremely vindictive

    • Borderline personality disorder 

  • Cluster C -

    • Avoidant personality disorder

    • Dependent personality disorder - when a person cannot make decisions of their own 

    • Obsessive compulsive disorder - People who like order and control, not to the point of how people with OCD feel. Neat orderly people. 

• Borderline personality disorder

  • Cannot tolerate the thought of being alone - will make frantic efforts to avoid abandonment or separation 

  • Unstable view of self - might suddenly display a shift in personal attitudes interests career plans and choice of friends 

  • Relationships are intense and unstable

  • My be highly impulsive and may engage in reckless self destructive behaviors 

  • May sometimes show intense and inappropriate anger

  • Can be moody, sarcastic, bitter and verbally abusive

• Antisocial personality disorder - characterized by complete lack of regard for other people's rights or feelings genetic factors may influence personality and temperament dimensions related to this disorder. 

• Brain anatomy - less activation in brain regions involved 

• Antisocial vs avoidant - antisocial no empathy no conscious, avoidant is equivalent to just avoidant.  

  • Repeatedly performing illegal acts 

  • Lying to conning others 

  • Impulsivity and recklessness

  • Irritability and aggressiveness 

  • Failure to act in responsible ways 

  • Lack of remorse

  • Overinflated sense of self

  • Lack of ability to empathize

ADHD - constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning 

• NEURODEVELOPMENTAL DISORDERS - often impact people with ADHD, involve developmental problems in personal social academic and intellectual functioning

• Inattention

  • Difficulty sustaining attention 

  • Failure to follow instructions 

  • Disorganization

  • Lack of attention to detail 

• Hyperactivity 

  • Excessive movement 

  • Interrupting and intruding on others 

  • Blurting out responses before questions have been completed 

  • Difficulty waiting ones turn

• Genetics 

  • Inattention - 71% heritable 

  • Hyperactivity - 73% heritable s

• Neurotransmitters 

  • Dopamine 

    • Genes involved are thought to include at least two that are important in regulation of dopamine 

    • Individuals with ADHD show less  dopamine activity in key brain regions (especially those associated with motivation and rewards)

    • Medications have a stimulant qualities and elevate dopamine activity 

• Brain anatomy 

  • Studies show smaller frontal lobe volume and less activation when performing mental tasks 

  • Frontal lobe inhibits behavior - may explain hyperactive, uncontrolled behavior of ADHD.

• Autism spectrum disorder 

  • Deficits in social interaction - turn head away prefer playing alone 

  • Deficits in communication difficulty maintaining conversation 

  • Repetitive patterns of behavior or interests 

    • Genes involved are those important in formation of synaptic circuits that facilitate communication between different areas of the brain