Exam 3 Flashcards
this psychological treatment of mood disorders addresses cognitive errors in thinking, with the hope of substituting more realistic thoughts
-also includes behavioral components (ex. exercise, increased social activities)
-collaborative, empirical approach
-structured, time-limited; use of homework (thought records)
cognitive therapy (CBT)
this psychological treatment of mood disorders involves increased contact with reinforcing events
behavioral activation
two components of behavioral activation
exercise and increased social contact
this psychological treatment of mood disorders focuses on problematic interpersonal relationships
interpersonal psychotherapy (IPT)
are psychological treatments (CBT and IPT) comparable to medications?
yes
true or false: combined treatment (psychotherapy and medication) may be more useful for chronic depression
true
is maintenance treatment important for the prevention of relapse?
yes
these studies emphasize the role of family tension in relapses
-didactics about illness
-work on family communication
milkowitz studies
what is the 10th leading cause of death in the US (2010)?
suicide
suicide is overwhelmingly a phenomenon among which racial populations?
white and native american
two protective factors for suicide:
- religion (african americans tend to be more religious)
- familial support (more prevalent in african american cultures)
states with the highest rates of suicide:
white, rural, conservative places
-high gun ownership
-mental health more stigmatized
-high white population
-lots of alcohol consumption
are suicide rates very high or low in elderly populations?
very high
are suicide rates higher or lower in those divorced, separated, widowed?
higher ; lowest in those married
most common method of suicide
firearm (50% completed)
gender differences of suicide:
___ are more likely to commit suicide (4-5x) higher
___ are more likely to attempt suicide (3x higher)
males (commit) ; females (attempt)
___ choose more lethal methods (gun, jumping, etc.), while ___ tend more to use pills (more latitude for surviving)
men ; women
suicidal attempts (___:___)
-ratio of attempts to completions
25:1
mental illness is prevalent in ___% of completed suicides
90%
true or false: suicide risk may be 6x higher if family member committed suicide
true ; probably a biological connection
risk factors for suicide:
___ dysregulation (related to depression, impulsivity, and aggression)
serotonin dysregulation
is evidence of a pre existing psychological disorder a risk factor for suicide?
-depression is linked to suicide but redundant - ___ is key
yes ; hopelessness is key
alcohol use and abuse is implicated in ___-___% of suicides
25-50%
is past suicidal behavior a risk factor for suicide?
yes
is experiencing a shameful/humiliating stressor a risk factor of suicide?
yes
interpersonal-psychological theory of suicide (joiner)
3 key factors:
- sense of thwarted belongingness
- perception of self as a burden
- acquired capability for suicide
feeling socially isolated and alone is characteristic of
a sense of thwarted belongingness
the belief that others would be better off if individual was not alive is characteristic of
the perception of self as a burden
person must desensitize the thought of death and physical pain
-repeated attempts (the norm) and non-suicidal self-injury may help with both aspects
acquired capability for suicide
professions with high rates of suicide
doctors, vets, first responders, police officers, emts, pilots, army vets, military personnel
treatment intervention for suicide:
(5 characteristics)
- never be afraid to ask about suicide
- well-developed plan?
- means?
- no suicide contract - specific treatment plan
- hospitalization (last resort)
three major types of DSM-5 eating disorders
anorexia nervosa, bulimia nervosa, binge eating disorder
characterized by severe disruptions in eating behavior, and extreme fear and apprehension about gaining weight
eating disorders
do eating disorders have strong sociocultural origins?
yes ; westernized views
what percentage of eating disorders are young females from wealthy families?
90%
a collection of signs and symptoms which is restricted to a limited number of cultures primarily be reason of certain of their psychosocial features
culturally bound syndrome
is anorexia culturally bound?
no ; descriptions of similar syndrome described in other cultures, a long time ago
-AN has been seen in every non-western culture
is bulimia culturally bound?
yes ; exists in non-western cultures, but not in the absence of western influence
what is the hallmark of bulimia?
binge eating
eating excessive amounts of food ; eating is perceived as uncontrollable
binge
compensatory behaviors related to bulimia nervosa:
purging and excessive exercise or fasting
self-induced vomiting, diuretics, laxatives
purging
binge eating and compensatory behaviors occur at least __ a week for ___ months
1 a week for 3 months
most are 10% within normal weight
-purging can result in severe medical problems
-erosion of dental enamel
-electrolyte imbalance of sodium and potassium
-kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
associated medical features of bulimia nervosa
most are overly concerned with body shape
-fear of gaining weight
-between binges, individuals will typically restrict calories and avoid high fat foods and “trigger foods”
-high comorbidity - anxiety, mood, and substance abuse
associated psychological features of bulimia nervosa
what is the hallmark of anorexia nervosa?
successful weight loss
restriction of energy intake relative to requirements that lead significantly low body weight in context of age, sex, developmental trajectory, and health
-defined as 15% below expected weight (DSM-IV)
anorexia nervosa
how does anorexia often begin?
with dieting ; intense fear of obesity
two DSM-5 subtypes of anorexia:
restricting subtype and binge-eating/purging subtype
this subtype of anorexia is characterized by limiting caloric intake via diet, fasting, and excessive exercise
restricting subtype
this subtype of anorexia is like bulimia, but with significant weight loss
binge-eating/purging subtype
marked disturbance in body image
-high comorbidity with other psychological disorders
-weight loss methods have life threatening consequences
-never satisfied with weight - need continuous loss to feel comfortable
associated features of anorexia nervosa
amenorrhea (loss of period)
-dry skin
-brittle nails and hair
-sensitivity to cold temperatures
-lanugo (downy hair on limbs and cheeks)
-cardiovascular problems
medical consequences of anorexia
depression, withdrawal, anxiety, irritability, reduced sex drive (may be secondary to starvation)
psychological consequences of anorexia nervosa
this disorder is characterized by engaging in food binges without compensatory behaviors
-perceived loss of control during binges
-binging associated with eating more rapidly, until uncomfortably full, when not hungry, feeling embarrassed about intake, feeling disgusted/guilty after
-distressed about binge eating
binge eating disorder
how often must binge eating occur to be considered binge eating disorder?
once a week for three months
many are normal weight or overweight or obese
-often older than bulimics or anorexics
-more psychopathology vs. non-binging obese people
-concerned about shape and weight
-binging used as a coping mechanism
-no major differences across gender or cultural/racial groups
associated features of binge eating disorder
true or false: majority of those with bulimia are female
true (90%)
onset for bulimia
16-19 years of age
___-___% of college women suffer from bulimia
6-8%
does bulimia tend to be chronic if left untreated?
yes
risk factors for bulimia (2)
childhood obesity and early pubertal onset
majority of those who have anorexia are:
females from middle-to-upper middle class families
when does anorexia usually develop?
around age 13 or early adolescence
is anorexia more or less chronic and resistant to treatment than bulimia?
more
anorexia is found in ___ cultures
westernized
medical treatment of bulimia nervosa:
___ help reduce binging and purging, but are not efficacious in the long term
antidepressants
psychological treatment of choice for bulimia nervosa
CBT or interpersonal psychotherapy (does not work as fast as CBT)
medical treatment for binge eating disorder
sibutramine (meridian) - used to control hunger
psychological treatment for binge eating disorder
CBT, interpersonal psychotherapy
medical treatment of anorexia nervosa
none exists with demonstrated efficacy
psychological treatment of anorexia nervosa: primary goal
weight restoration
is the longterm prognosis for anorexia better or poorer than bulimia?
poorer
schizophrenia vs. psychosis
psychosis: broad term (ex. hallucinations, delusions)
schizophrenia: a type of psychosis
nature of schizophrenia and psychosis:
this person used the term dementia praecox (premature dementia)
-focused on subtypes of schizophrenia (paranoid, catatonic)
-recognized it as a “disease of the brain”
-recognized that several distinct symptoms appeared to be part of a broader syndrome
-differentiated “dementia praecox” from manic-depressive illness
emil kraepelin
nature of schizophrenia and psychosis:
this person introduced the term “schizophrenia”
-“splitting of the mind” ; inability to keep a consistent train of thought
-described “positive” and “negative” symptoms
eugen bleuler
characteristic symptoms: two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
-delusions
-hallucinations
-disorganized speech (frequent derailment or incoherence)
-grossly disorganized or catatonic behavior
-social/occupational dysfunction
-continuous signs of disturbance for at least 6 months
-not schizoaffective or mood disorder
-not due to substance abuse
DSM-IV diagnostic criteria for schizophrenia
active and obvious manifestations of abnormal behavior, excess or distortion of normal behavior
the positive symptoms of schizophrenia
two positive symptoms of schizophrenia
delusions and hallucinations
distortion in thought content
-erroneous beliefs that usually involve a misinterpretation of perception or experiences. beliefs are typically held very strongly
delusions
the most common delusion
-“the FBI is after me”
persecutory delusion
___ delusion: “when madonna waved to the audience, she was really signaling to me”
referential delusion
___ delusion: “madonna is in love with me”
erotomanic delusion
___ delusion: “my liver is dead and rotting inside me”
somatic delusion
___ delusion: “the world is ending”
nihilistic delusion
___ delusion: “I am the president of the entire world”
grandiose delusion
___ delusions: thought insertion, thought withdrawal, outside forces are controlling one’s body or actions
“bizarre” delusions
experience of sensory events without environmental input
-can experience any sensory mode (auditory, visual, olfactory, gustatory, tactile)
hallucinations
___ are the most common hallucinations; usually in the form of “voices,” familiar or not, that are heard as being distinct from own thoughts
auditory hallucinations
scary form = “___” hallucinations
command hallucinations
___ or more voices conversing or ___ voice keeping a running commentary are considered highly characteristic of schizophrenia
two ; one
absence or insufficiency of normal behavior
the negative symptoms of schizophrenia
spectrum of negative symptoms: (5 A’s)
- avolition (or apathy)
- alogia
- anhedonia
- asociality
- affective flattening
lack of initiation and persistence (ex. lack of hygiene)
avolition (or apathy)
relative absence of speech - may be due to a decrease in thought production
alogia
lack of pleasure, or indifference
anhedonia
limited interest in social interactions
asociality
little expressed emotion
affective flattening
include severe and excess disruptions in speech, behavior, and emotion
the disorganized symptoms of schizophrenia
the nature of disorganized speech (3 components)
- tangentiality (going off on a tangent)
- loose associations (conversation in unrelated directions)
- word salad; neologisms (make up new words)
inappropriate emotional behavior - behavior not consistent with context (ex. smiling when talking about death)
nature of disorganized affect
includes a variety of unusual behaviors (disheveled; odd appearance; inappropriate or unpredictable behavior)
-catatonia (wild agitation, waxy flexibility, immobility)
nature of disorganized behavior
schizophrenic symptoms for a few months (less than 6; more than 1)
-impaired functioning not required
-some never progress on to schizophrenia, but more do (or schizoaffective disorder)
schizophreniform disorder
symptoms of schizophrenia and a mood disorder (unlike a mood disorder with psychotic features)
-both disorders are independent of one another (at times, you are psychotic when you are not in a mood state)
-prognosis is similar for people with schizophrenia
-such persons do not tend to get better on their own
-need to have delusions and/or hallucinations that are present for at least two weeks in the absence of the mood disorder
schizoaffective disorder
two types of schizoaffective disorder:
bipolar type and depressive type
if mania is part of the presentation
bipolar type
if only major depressive episodes are part of the presentation
depressive type
presence of one or more delusions that persist for one month or more
-lack other positive and negative symptoms
-rare (0.2%)
-better prognosis than schizophrenia
delusional disorder
one or more positive symptoms of schizophrenia (delusions, hallucinations, disorganized behavior/speech)
-lasts at least 1 day but not longer than 1 month
-not due to substance use
-usually precipitated by extreme stress or trauma
-tends to remit on its own
brief psychotic disorder
may reflect a less severe form of schizophrenia
-immense idiosyncrasies
-lies on the schizophrenia spectrum
schizotypal personality disorder
classification systems and their relation to schizophrenia:
process vs. reactive distinction
process: insidious onset, biologically based, negative symptoms, poor prognosis
reactive acute onset (extreme stress), notable behavioral activity, best prognosis
classification systems and their relation to schizophrenia:
good vs. poor premorbid functioning in schizophrenia
focus on functioning prior to developing schizophrenia (no longer widely used)
classification systems and their relation to schizophrenia:
type I vs. type II distinction
type I: positive symptoms, good response to medication, optimistic prognosis, and absence of intellectual impairment
type II: negative symptoms, poor response to medication, pessimistic prognosis, and intellectual impairments
defunct subtypes of schizophrenia: (5 types)
- paranoid type
- disorganized type (hebephrenic)
- catatonic type
- undifferentiated type
- residual type
presence of prominent hallucinations and delusions (usually persecutory or grandeur) but have relatively intact cognitive skills and affect; organized around coherent theme
-do not show disorganized behavior (speech, thought, or affect)
-later onset
-the best prognosis of all types of schizophrenia
paranoid type
marked disruptions in speech and behavior
-flat or inappropriate affect
-hallucinations and delusions, if present, tend to be fragmented (unlike paranoid type)
-develops early, tends to be chronic, associated with a continuous course without remissions
disorganized type (hebephrenic)
show unusual motor responses and odd mannerisms (immobility, excessive motor activity, motor negativism - resistance to instructions or attempts to be moved, waxy flexibility)
-tends to be severe and quite rare
catatonic type
wastebasket category (if a patient did not fit in another subtype, they would be classified in this way)
-major symptoms of schizophrenia
-fail to meet criteria for another type
undifferentiated type
past diagnosis of schizophrenia
-absence of prominent delusions, hallucinations, disorganized speech and behavior (positive symptoms have faded, negative symptoms remain)
-continue to display less extreme residual symptoms
residual type
when does schizophrenia usually develop?
early adulthood
onset of first psychotic episode for men vs. women
men - early to mid 20s
women - late 20s
bimodal distribution for women (second onset in 40s)
what percentage of those with schizophrenia die via suicide? what percentage of those attempt suicide?
5-6% die via suicide ; 20% attempt suicide
are positive or negative symptoms more treatable?
positive
schizophrenia affects males and females about equally, but there is a slightly higher prevalence in ___
men
____ tend to have a better long-term prognosis for schizophrenia
females
high comorbidity of schizophrenia with ___ use disorder and ___ disorders
tobacco use disorders and anxiety disorders
____ deficits (ex. working memory) are common and partially explain significant functional impairment
cognitive deficits
true or false: schizophrenia has a weak genetic component
false ; strong genetic component
family studies: inherit a ___ for schizophrenia ; do not inherit specific forms of schizophrenia
tendency
monozygotic twins vs. fraternal (dizygotic) twins risk for schizophrenia:
monozygotic: 48%
fraternal: 17%
twin studies: both parents schizophrenic - ___%
one schizophrenic parent - ___%
46% ; 16%
according to adoption studies, risk for schizophrenia remains ___ in cases where a biological parent has schizophrenia
high
among the most prominent theories of schizophrenia
-drugs that increase dopamine (agonists, amphetamines, L-Dopa) result in schizophrenic like behavior
-drugs that decrease dopamine (antagonists) reduce schizophrenic-like behavior and produce side effects that look like parkinson’s disease, which is known to be related to too little dopamine
the dopamine hypothesis
is the dopamine hypothesis problematic?
yes
current theories emphasize many ____
-higher density of dopamine receptors
-may make and release more dopamine
-excessive stimulation of dopamine D2 receptors in the striatum
-deficient stimulation of prefrontal dopamine D1 receptors
neurotransmitters
enlarged lateral ventricles (50 studies) ; real problem is that the areas next to the ventricles may never have developed fully or atrophied ; not found in all schizophrenics ; found in “healthy” siblings of schizophrenic patients
-less active frontal and temporal lobes
-less frontal, temporal, and whole-brain volume (smaller hippocampus - most reliable difference)
-BRAIN DYSFUNCTION APPEARS BEFORE ONSET OF SCHIZOPHRENIA
structural and functional abnormalities in the brain
those with schizophrenia exhibit higher or lower intelligence and achievement scores than healthy siblings as children
lowe
normalities or abnormalities in social behavior? more or less socially responsive, more or less positive emotion, better or poorer social adjustment?
abnormalities ; less ; less ; poorer
true or false: delays and abnormalities in motor development (ex. walking)
true
subclinical signs of psychosis (unusual ideas and sensory experiences; eccentric behavior - signs of schizotypal personality disorder) show during ___
adolescence
mothers exposed to influenza in second trimester may have children more predisposed
viral infections during early prenatal development
cognitive dysfunctions are substantial and are linked with functional impairment (2)
episodic memory and executive functioning
medical treatment of schizophrenia:
historical precursors (5)
- wrap in wet sheets
- electric shock
- insulin comas
- frontal lobotomies
- institutionalized
usually the first line treatment for schizophrenia
antipsychotics (neuroleptics)
most antipsychotics reduce or eliminate ___ symptoms
positive
what is often a problem with medications for schizophrenic patients?
compliance with medications (3/4 patients stop taking medication for at least 1 week in a two year period)
true or false: acute and permanent side effects are common
true
extrapyramidal side effects
movement problems
expressionless face, slow motor activity, shuffling gait
parkinsonian symptoms
feeling restless and a need to move
akathisia
abnormal muscle tone - muscle spasms
dystonia
involuntary movements of the tongue, face, mouth, and jaw (ex. tongue sticking out, chewing motions)
tardive dyskinesia
according to this psychologist, personality is an individual’s characteristic patterns of thought, emotion, and behavior together with the psychological motivation behind those patterns
finder
according to this psychologist, a personality trait is a long-standing pattern of behavior expressed across time and in many different situations
millon
five factor model: OCEAN
Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
personality disorders are composed of personality traits that are: (3)
- inflexible
- maladaptive
- cause signification, functional impairment, or subjective distress
various ___ disorders are associated with:
-decreased social functions
-decreased occupation functions
-increased risk of substance abuse
-increased risk of depression/anxiety
-increased risk of schizophrenia
-increased risk of suicide
-increased risk of imprisonment
-increased risk of hospitalization
personality disorders
an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture. this pattern is manifested in two (or more) of the following areas:
-cognition
-affectivity
-interpersonal functions
-impulse control
DSM-IV/5 criteria for personality disorders
the ways of perceiving and interpreting self, other people, and events
cognition
range, intensity, lability, and appropriateness of emotional response
affectivity
theoretical issues with personality disorders: comorbidity
if diagnosed with a personality disorder, likely to have more than one
certain personality disorders are believed to be more common in men vs. women
___: paranoid, schizoid, schizotypal (cluster A); antisocial, narcissistic, OCPD
___: histrionic, borderline, dependent
men ; women
coverage: most common personality disorder diagnosis in clinical practice
PD NOS
PD NOS
personality disorder not otherwise specified (have a PD not recognized by the DSM or have features of more than one PD but don’t meet criteria for any specific PD but features cause distress/impairment)
DSM-5 personality disorders: cluster A is referred to as
“the weird”
three cluster A (“the weird”) personality disorders
paranoid PD, schizoid PD, and schizotypal PD
a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
paranoid PD
a pattern of detachment from social relationships and a restricted range of emotional expression
schizoid PD
a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior
schizotypal PD
which two cluster A personality disorders were almost removed as a diagnosable disorder from DSM-5
paranoid PD and schizoid PD
DSM-5 cluster B personality disorders are referred to as
“the wild” (dramatic/erratic)
4 cluster B (“the wild”) personality disorders:
- antisocial personality disorder
- borderline personality disorder
- histrionic personality disorder
- narcissistic personality disorder
a pattern of disregard for, and violation of, the rights of others
-chronic criminality - chronic violation of rules, laws, norms
antisocial PD
a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
-tremendous emotional instability
-variability in how you view yourself - no core sense of identity
borderline PD
a pattern of excessive emotionality and attention seeking
-emotions change in a manipulative/attention-seeking way
histrionic PD
a pattern of grandiosity, need for admiration, and lack of empathy
narcissistic PD
DSM-5 cluster C personality disorders are referred to as
“the worried”
three cluster C (“the worried”) personality disorders:
- avoidant PD
- dependent PD
- OCPD
a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
avoidant PD
a pattern of submissive and clinging behavior related to the excessive need to be taken care of
-“you need someone to captain your ship”)
dependent PD
a pattern of preoccupation with orderliness, perfectionism, and control
OCPD (obsessive-compulsive personality disorder)
a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- has a grandiose sense of self-importance
- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- believes that he or she is “special” and unique and can only be understood by, or should associate with other special or high-status people (or institutions)
- requires excessive admiration
- has a sense of entitlement
- is interpersonally exploitative
- lacks empathy
- is often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
DSM-5 criteria for narcissistic personality disorder (NPD)
assessment issues: self-report vs. other report
problems with both
gold standard assessment:
semi-structured interviews
psychopathy described by the five factor model: (11 characteristics)
- glib and superficial charm
- grandiose sense of self-worth
- pathological lying
- conning/manipulative
- lack of remorse or guilt
- callous lack of empathy
- impulsivity
- irresponsibility
- early behavior problems
- parasitic lifestyle
- failure to accept responsibility for own actions
theoretical implications:
using a general model of personality is very clearly a dimensional approach - no attempt to delineate normal from “disordered”
dimensional vs. categorical
theoretical implications:
the number of PD diagnoses patients typically receive varies: 2.4 and 4.6
-comorbidity expected to the extent that the same broad domains and/or specific traits underlie the various PDs
comorbidity
theoretical implications:
gender differences in prevalence rates of PDs should be consistent with gender differences in general personality functioning
gender differences
men lower in agreeableness
antisocial, narcissistic
women higher in neuroticism
borderline, dependent
coverage: most common PD diagnosis in clinical practice
PD NOS (personality disorder not otherwise specified)
DSM-5 was set to use a radical new approach, derived largely from the type of FFM-like work
-viewed as too untested at the last moment, and was put in section ___ for further study
section III
this DSM-5 section approach is:
-moderate or greater impairment in personality (self/interpersonal) functioning
-one or more pathological traits
-inflexible/pervasive
-longstanding
section III approach
two forms of impairment
self and interpersonal
two components of self impairment
identity and self-direction
experience oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity/ability to regulate emotional experience
-impairment potentially evidence of a personality disorder
identity
pursuit of coherent and meaningful short and long-term goals; use of constructive and prosocial internal standards of behavior; ability to self-reflect
self-direction
two components of interpersonal impairment
empathy and intimacy
comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding the effects of one’s own behavior on others
empathy
depth and duration of connection with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior
intimacy
DSM-5 trait model:
5 domains (25 specific traits)
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychoticism
according to the DSM-5 trait model, only six disorders would remain:
- schizotypal
- antisocial
- borderline
- narcissistic
- avoidant
- OCPD
prevalence of personality disorders in the general population
about 0.5% to 2.5% of the general population
___-___% prevalence of personality disorders in inpatient settings
10-30%
personality disorders are thought to begin in ___
-predicted by sexual, physical, emotional abuse, neglect
childhood
personality disorders run a ___ course
chronic
comorbidity rates are ___ both within and across different psychopathology (other personality disorders and other disorders)
high
men are more likely to have cluster ___ PDs (APD, NPD, OCPD)
A
women are more likely to have
bordeline, histrionic, dependent
pervasive and unjustified mistrust and suspicion
causes:
-biological and psychological contributions are unclear
-early learning that the world is a dangerous place
-evidence unclear whether it is a variant of a psychotic disorder; research suggests “no” or “maybe”
treatment:
-few seek professional help on their own
-treatment focuses on development of trust
-cognitive therapy to counter negativistic thinking
-lack of good outcome studies
paranoid PD
pervasive pattern of detachment from social relationships
-not interested in close relationships
-little interest in sexual experiences
-no close friends
-indifferent to praise or criticism
-very limited range of emotions in interpersonal situations (takes pleasure in few things; flattened affectivity - appear cold, detached)
causes:
-etiology unclear
-preference for social isolation resembles autism; extreme variant of shyness/introversion
treatment options:
-few seek professional help on their own
-focus on the value of interpersonal relationships
-building empathy and social skills
-lack good outcome studies
schizoid PD
which cluster A PDs were almost removed from the DSM-5? (2)
paranoid and schizoid were going to be removed - only schizotypal to remain
odd and unusual behavior, appearance, and cognition
-most are socially isolated, highly suspicious (paranoid)
-magical thinking, ideas of reference, and illusions
-unusual perceptual experiences
-many meet criteria for major depression
causes:
-phenotype of a schizophrenia genotype?
-diagnosis came about as a result of research on family members of schizophrenics; higher rates of schizotypal PD in family members of schizophrenic
-generalized cognitive deficits
treatment options:
-main focus on developing social skills
-treatment also addresses comorbid depression
-medical treatment similar to schizophrenia - use of antipsychotics
-treatment prognosis is generally poor
schizotypal PD
noncompliance with social norms
-violate rights of others
-irresponsible, impulsive, and deceitful
-lack empathy and remorse
-lack concern for safety of self or others
-must be evidence of conduct disorder before age 15
antisocial PD
early histories of behavioral problems (ex. conduct disorder)
-families with inconsistent parental discipline and support
-families have histories of criminal and violent behavior
relation with conduct disorder and early behavioral problems
neurobiological contributions and treatment of antisocial personality
brain damage - little or large support for this view?
little support
neurobiological contributions and treatment of antisocial personality
underarousal hypothesis: ___
-future criminals have lower skin conductance activity, lower resting heart rate, and more slow frequency brain activity
cortical arousal is too low
neurobiological contributions and treatment of antisocial personality
cortical immaturity hypothesis - ___
-based on evidence that theta waves are correlated with psychopathy. theta waves uncommon in adults; could be due to lack of anxiety
cortex is not fully developed
neurobiological contributions and treatment of antisocial personality
fearlessness hypothesis - ___
fail to respond to danger cues
underactive “behavioral inhibition system” paired with overactive “behavioral activation system”
gray’s model of behavioral inhibition and activation
cognitive problem: once psychopathic people have a routine set, they do not take in new information to change course very easily
response modulation difficulties
There is a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:
-Frantic efforts to avoid real or imagined abandonment
-A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
-Identity disturbance: marked and persistently unstable self-image or sense of self
Impulsivity in at least two areas that are potentially self-damaging
-Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
-Affective instability due to marked reactivity of mood
-Chronic feelings of emptiness
-Inappropriate, intense anger or difficulty controlling anger
-Transient stress-related paranoid ideation or severe dissociative symptoms
borderline PD
most common of ten DSM-IV personality disorders in psychiatric settings
borderline PD
the causes: runs in families (see higher rates in families with mood disorders)
-early trauma and abuse seem to play some role
causes of borderline PD
major theory: biosocial theory (linehan) - two components
emotionally vulnerable individual and invalidating environment
excessive reaction to stress; long recovery rate following stressor
emotionally vulnerable individual
broadly conceived, being told feelings are not okay or reasonable, being told perceptions are wrong; physical or sexual abuse - invalidates one’s autonomy, sense of boundaries, privacy
invalidating environment
antidepressant medications - short-term relief
antipsychotic - reduces aggression
-dealectical behavior therapy (DBT) - most promising treatment
treatment options for borderline PD
Overly dramatic, sensational, and sexually provocative
Impulsive and need to be the center of attention
Thinking and emotions are perceived as shallow
Common diagnosis in females
histrionic PD
etiology largely unknown
-sex-typed variant of antisocial personality? variant of NPD?
the causes of histrionic PD
focus attention seeking long-term consequences
-address problematic interpersonal behaviors
-little evidence that treatment is effective
treatment options for histrionic PD
exaggerated/unreasonable sense of self-importance
-preoccupation with receiving attention
-lack sensitivity and compassion for other people
-sensitive to criticism, envious, and arrogant
-mainly causes social impairment. mildly distressing over time, but secondary to impairment it causes
narcissistic PD
Link with early failure to learn empathy as a child because of parents’ fai;ure to effectively “mirror” child (Kohut)
Parents are spiteful and cold but find 1 talent or quality in the child to reward (ex. Athlete, student, genius). Grandiosity conceals concerns about defectiveness (Kernberg)
Child over-valued - parents provide non-contingent praise, attention, and tribute to the child (Millon)
Appears that over OR under valuation can cause it. Too much or too little attention; pampering or neglecting; excessive praise or no praise
causes of NPD
Extreme sensitivity to the opinions of others
Highly avoidant of most interpersonal relationships
Interpersonally anxious and fearful of rejection
“Look like” schizoid individuals - different motivations for similar outward behavior
avoidant PD
Numerous factors have been proposed
Difficult temperament and early rejection
Recall feeling isolated and rejected in childhood
Extreme variant of introversion?
causes of avoidant PD
Several well-controlled treatment outcome studies exist
Treatment is similar to that used for social phobia
Treatment targets include social skills and anxiety-reduction
treatment options for avoidant PD
which cluster C personality disorder was proposed to be removed from DSM-5?
dependent PD
Reliance on others to make major and minor life decisions
Unreasonable fear of abandonment
Clingy and submissive in interpersonal relationships
Focused on maintenance of supportive/nurturing relationships
Correlates strongly with borderline PD
dependent PD
Still largely unclear
May be due to feelings of incompetence and low self-efficacy
Linked to early disruptions in learning independence
Early disruption of important attachment relationships
Temperamental differences in negative emotionality
causes of dependent PD
Research on treatment efficacy is lacking
Therapy typically progresses gradually
Treatment targets include skills that foster independence
On surface, seem to be perfect patient population; must confront patients’ dependence on therapy and therapist
treatment options for dependent PD
Excessive and rigid fixation on doing things the right way (ex. “My way or the highway”)
Frugal
Highly perfectionistic, orderly, and emotionally shallow
True obsessions and compulsions are rare
“Can’t see the forest for the trees”
Looking at the specifics, missing the full picture
obsessive-compulsive PD
Largely unknown
Impairment may be more limited than other PDs
causes of OCPD
Data supporting treatment are limited
Addresses fears related to the need for orderliness
Address rumination, procrastination
treatment options for OCPD
