Psychological Disorders Flashcards
psychological disorder
- Pattern of behaviour or experience that is distressing and painful to the person
- leads to disability or impairment in important life domains (whether visible or not)
- associated with increased risk for further suffering, loss of function, death, or confinement
Abnormal/clinical psych
- study of mental disorders
- aka psychopathology
Defining abnormal
- DSM = leading text for defining “abnormality” and diagnosing it; ICD-10 Classification is the text published by the WHO that is also sometimes used
- Can be culturally/socially defined; (ie. what’s unacceptable?); being defined as abnormal might lead to stigma or a self-fulfilling prophecy; but also improves research
- Can be statistically defined (ie. what’s rare? ex. colour blindness)
- The psychological definition is not the same as being “weird”
- Abnormality = “statistical infrequency” (more than 2 standard deviations above or below the mean)
Personality vs. Disorder
Most psychologists believe that mental illness/disorder is not a part of personality; separate construct that should be managed
Personality Disorder (generally)
- Extreme and problematic degree of one or more aspects of personality
- Ie. Extremely high levels of neuroticism, introversion, etc.
Personality Disorder (according to DSM-5)
- Enduring pattern of experience and behaviour that differs greatly from expectations of a person’s culture; displayed across a variety of situations with long history
- Symptoms of personality disorders can be viewed as maladaptive variations within the domains of traits, emotions, cognitions, motives, and self-concept
- Lead to distress in key areas of life, such as work and relationships; all personality disorders have impaired social relations
- Pattern must not be attributable to drug abuse, medication, or other medical condition
General Personality Disorder
personality change due to another medical condition – ie. Frontal lobe lesion
Personality Disorders: Cluster A
- The “eccentric” cluster
- Persons with these disorders appear odd and eccentric; do not get along well with others
- paranoid, schizoid, and schizotypal personality disorders
Paranoid personality disorder
- Cluster A
- More common in males
- suspects deceit or malicious intent, preoccupied with doubts about others’ trustworthiness, bears grudges, perceived attacks on character, recurrent suspicions
- Unabomber may have had this
Schizoid personality disorder
- Cluster A
- more common in males
- neither desires nor enjoys close relationships, prefers to be alone, detached, indifferent to praise/criticism of others
Schizotypal personality disorder
- Cluster A
- more common in males
- want social relationships but can’t enter them to to excessive social anxiety, odd beliefs/behaviours, lack of close friends
- mostly due to genetic causes
Personality Disorders: Cluster B
- The “erratic cluster”
- Persons with these disorders appear erratic and emotional; have difficulties getting along with others
- Antisocial, borderline, histrionic, and narcissistic personality disorders
Antisocial Personality Disorder
- Cluster B
- more common in males
- Failure to conform to social norms, lying, deceitfulness, impulsivity, aggressiveness, disregard for safety of self or others, lack of remorse, irresponsible
- Must be 18; must have evidence of conduct disorder before age 15
- Up to 70-100% of men in prison meet criteria for APD
- Extreme APD -> psychopathy/sociopathy
- Unabomber could have been diagnosed with this, but he didn’t display symptoms prior to age 15
- environmental and genetic causes
Borderline Personality Disorder
- Cluster B
- more common in females
- INSTABILITY -> Pattern of unstable & intense relationships, unstable self-image, frantic efforts to avoid abandonment, recurrent suicidal or self-harm behaviour, emotional instability/reactivity, strong emotions -> ex. inappropriate/intense anger
- largely due to environment, not genes - childhood neglect
- Anakin Skywalker/Darth Vader may have BPD
Histrionic Personality Disorder
- Cluster B
- more common in females
- EXCESSIVE ATTENTION SEEKING, EMOTIONALITY, uncomfortable when not centre of attention; inappropriate, sexually seductive/provocative behaviour; shallow emotions; theatricality; suggestible, easily influenced
Narcissistic Personality Disorder
- Cluster B
- more common in males
- Grandiose sense of self-importance, believe they’re special/unique, requires excessive admiration, interpersonally exploitative, lacks empathy, envious of others
- Trump may not actually have this disorder -> doesn’t necessarily suffer from distress due to narcissism
Psychopathy & Sociopathy: nature vs. nurture
- Nature: Evidence for reduced fear response (low amygdala activity) and guilt/empathy response (low prefrontal cortex activity); brains show functional and structural differences; heritability of APD/psychopathic traits estimated at 69%
- Nurture: Individuals with APD/psychopathy more likely to have been abused early in life
Psychopathy
- Not present in DSM, but an extreme form of Antisocial personality disorder
- emphasizes more subjective traits, such as incapacity to experience guilt, superficial charm (glib), and callous social attitudes
- Only 25-28% of men in prison would be diagnosed with psychopathy according to the Psychopathy Checklist
- 21% of corporate professions have clinically significant levels of psychopathic traits -> “successful psychopaths”
- Robert Hare developed psychopathy checklist with 2 main clusters of traits: emotional/interpersonal traits and social deviance
- Tends to decline with age
Sociopathy
- Not present in DSM, but an extreme form of Antisocial personality disorder
- compared to psychopaths, some suggest they’re less organized/more apparent in their behaviour, less violent, and maintain some emotions; result from early life experiences, while psychopathy is more innate
Personality Disorders: Cluster C
- the “anxious” cluster
- Persons with these disorders appear anxious, fearful, and apprehensive; have trouble with social relationships
- avoidant, dependent, and obsessive-compulsive personality disorder
Avoidant Personality Disorder
- Cluster C
- more common in females
- Avoids activities over fears of criticism and rejection, restraint in relationships, inhibited, views self as socially inept and inferior, fear of embarrassment
- Unabomber may have had this
Dependent personality disorder
- Cluster C
- more common in females
- Difficulty making decisions on one’s own, difficulty expressing disagreement, difficulty working or doing things on one’s own, uncomfortable or helpless when alone, fears of being left to care for him/herself, seeks constant reassurance
Obsessive-compulsive personality disorder
- Cluster C
- more common in males
- NOT the same as OCD
- Preoccupied with details; detrimental perfectionism; excessively devoted to work; overly conscientious and inflexible; rigidity and stubbornness
Prevalence of Personality Disorders
- Estimated total prevalence rate for having at least one personality disorder is between 9-13%
- Obsessive-Compulsive personality disorder is most common; dependent least common
- Majority of personality disorders are more common in males; overall prevalence fairly equal
- 25-50% of people with personality disorder have another disorder (comorbidity) -> makes “differential diagnosis” (looking for support of 1 diagnostic category over others) difficult
Personality disorders: evidence for a dimensional approach (tied in with Big 5)
- Borderline = high neuroticism
- Schizoid = extreme introversion + low neuroticism
- Schizotypal = introversion + high neuroticism + low agreeableness + extreme openness
- Avoidant = extreme introversion + high neuroticism
- Histrionic = extreme extraversion
- Obsessive-compulsive = extreme conscientiousness
Revised approach to personality disorders
- Four traditional personality disorders removed because they’re not common or distinct enough (shizoid, histrionic, dependent, paranoid)
- Clusters also removed; everything else categorized as “personality disorder-trait specified”
- Though DMS-5 still takes categorical approach, it’s been suggested that clinicians should assess patients according to 5 trait domains (dimensional approach that captures greater specificity than categorical approach)
Revised approach to personality disorders: 5 trait dimensions
- Negative Affectivity – feeling negative emotions (*High Neuroticism)
- Detachment – emotional withdrawal/avoidance (*Low Extraversion)
- Antagonism – deceitfulness, manipulativeness (*Low Agreeableness)
- Disinhibition – carelessness, impulsiveness (*Low Conscientiousness)
- Psychoticism – bizarre thoughts or experience (*High Openness)
Dissociative Identity Disorder (DID)
- Previously Multiple Personality Disorder (MPD)
- Disruption of identity characterized by 2 or more distinct personality states (“alter egos”) which may be described in some cultures as an experience of possession
- Not a personality disorder, but alter egos often encapsulate a variety of severe personality disorders or features of personality disorders
- Classified in Dissociative Disorders in DSM-5, with Dissociative Amnesia and Depersonalization/Derealization Disorder
DID: prevalence, triggers, antecedents
- Prevalence estimated to be 1.5% in adults
- Alter egos can be triggered or brought out by certain stimuli
- 90% of cases associated with overwhelming experiences, traumatic events, or childhood abuse
DID: symptoms
- discontinuity in sense of self
- alterations in:
- Affect/emotion
- Behaviour
- Consciousness
- Perception
- Cognition
- Sensory-motor functioning
- Memory (recurrent memory gaps)
- May be observed by others or reported by the individual
Controversy re: disorders
- Are personality disorders true disorders, or just how we deal with people who don’t fit the norm?
- What are the potential implications of suggesting that some personalities are abnormal/disordered?
- Pathologizing “bad ways to be” -> where do we draw the line?
- Ie. Should we pathologize extreme biases (ie. Extreme racism or homophobia?)
- Labelling: helpful in some settings, but can be stigmatizing
- “Abnormal” = less of a sharp divide than previously assumed (dimensional vs. Categorical approach)
- Growing consensus that there exists no sharp divide between normal and abnormal behaviours
what should be considered before diagnosing someone with a personality disorder?
- culture (norms differ in different cultures)
- age (teens often “try out” different identities)
- life circumstances (may be reacting to traumatic life event)
- gender (some disorders experienced more frequently in males vs. females)
Psychopathy and the eye-blink startle method
- when people are anxious/started, they blink more
- psychopaths blink less when shown distressing images, even though they’ll say they were distressed -> report feeling emotions, but don’t actually feel them
- antisocial prisoners display reduced fear response to scary images
- this supports theory that psychopathy is mainly deficit in fear response
ambiguous facial expressions and BPD
- people with Borderline Personality Disorder struggle to identify neutral or mildly emotional faces
- suggests people with BPD may misperceive facial expressions as having no emotion, contributing to the symptoms of the disorder
neurotic paradox
although a behaviour solves one problem, it may also create a more severe problem
alexithymia
- difficulty identifying feelings, describing feelings
- externally bound cognitive style
- deficit in experiencing positive emotions and empathy
- people with this often go on to develop avoidant, dependent, and schizotypal disorders