week 21 - psychopathology III + treatment

Question 1

Define what is meant by a personality disorder.

Answer 1

When personality traits result in significant distress, social impairment, occupational impairment, etc.

Question 2

Identify the five domains of general personality.

Answer 2

Neuroticism (emotional instability) ↔ Emotional stability
Openness (unconventionality) ↔ Closedness (conventionality)
Agreeableness ↔ Antagonism
Extraversion ↔ Introversion
Conscientiousness ↔ Disinhibition

Question 3

Identify the six personality disorders proposed for retention in DSM-5.

Answer 3

Avoidant - pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
Combination of traits from introversion
Dependent - submissiveness, clinging behaviour, fears of separation, maladaptive agreeableness
Histrionic - disorder of maladaptive extraversion; attention seeking, seductiveness, melodramatic emotionality, strong attachment needs
Narcissistic - includes traits from neuroticism, extraversion, antagonism, arrogance, entitlement, lack of empathy, conscientiousness
Paranoid
Schizotypal - neuroticism, introversion, unconventionality, and antagonism

Question 4

Summarise the aetiology for antisocial and borderline personality disorder.

Answer 4

Antisocial - combination of traits from antagonism and low conscientiousness
Also includes some traits from low neuroticism and extraversion
Includes impairments in identity
Borderline - largely a disorder of neuroticism, including traits such as emotionally unstable, vulnerable, overwhelmed, rageful, depressive, and self-destructive
Generally considered to be the result of an interaction of a genetic disposition to negative affectivity interacting with a malevolent, abusive, or invalidating family environment

Question 5

Identify the treatment for borderline personality disorder.

Answer 5

Dialectical behaviour therapy and mentalization therapy:

Dialectical behaviour therapy is a form of cognitive-behaviour therapy that draws on principles from Zen Buddhism, dialectical philosophy, and behavioural science. The treatment has four components: individual therapy, group skills training, telephone coaching, and a therapist consultation team, and will typically last a full year. As such, it is a relatively expensive form of treatment, but research has indicated that its benefits far outweighs its costs, both financially and socially.

Mentalization theory - MBT is an integrative treatment approach for borderline and other severe personality disorders. It combines ideas from both psychoanalysis and modern research and is based on the unique human capacity to mentalize, or understand mental states underlying one’s own actions as well as those of others.

Question 6

antisocial

Answer 6

A pervasive pattern of disregard and violation of the rights of others. These behaviours may be aggressive or destructive and may involve breaking laws or rules, deceit or theft.

Question 7

avoidant

Answer 7

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Question 8

borderline

Answer 8

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.

Question 9

dependent

Answer 9

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation.

Question 10

five factor model

Answer 10

Five broad domains or dimensions that are used to describe human personality.

Question 11

histrionic

Answer 11

A pervasive pattern of excessive emotionality and attention seeking.

Question 12

narcissistic

Answer 12

A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy.

Question 13

obsessive-compulsive

Answer 13

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

Question 14

paranoid

Answer 14

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Question 15

personality

Answer 15

Characteristic, routine ways of thinking, feeling, and relating to others.

Question 16

personality disorder

Answer 16

When personality traits result in significant distress, social impairment, and/or occupational impairment.

Question 17

schizoid

Answer 17

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Question 18

schizotypal

Answer 18

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as perceptual distortions and eccentricities of behaviour.

Question 19

Learn about Cleckley’s classic account of psychopathy, presented in his book The Mask of Sanity, along with other historic conceptions.

Answer 19

Cleckley describes the psychopathic person as outwardly a perfect mimic of a normally functioning person, able to mask or disguise the fundamental lack of internal personality structure, an internal chaos that results in repeatedly purposeful destructive behaviour, often more self-destructive than destructive to others.

Question 20

Compare and contrast differing inventories currently in use for assessing psychopathy in differing samples (e.g., adults and younger individuals, within clinical-forensic and community settings).

Answer 20

One extensively researched measure for assessing psychopathic tendencies in youth is the Antisocial Process Screening Device, used with clinic-referred children ages 6 through 13. The APSD includes 20 items completed by parents or teachers. As with the PCL-R and PPI, the items of the APSD tap two distinct factors: a Callous-Unemotional (CU) traits factor, reflecting emotional insensitivity and disregard for others; and an Impulsive/Conduct Problems (I/CP) factor, reflecting impulsivity, behavioural deviancy, and inflated self-importance. Children high on the I/CP factor alone show below-average intelligence, heightened emotional responsiveness to stressors, and angry (reactive) aggression. By contrast, children high on both APSD factors show average or above-average intelligence, low reported levels of anxiety and nervousness, reduced reactivity to stressful events, and preference for activities entailing novelty and risk. They also learn less readily from punishment and engage in high levels of premeditated as well as reactive aggression and exhibit more persistent violent behaviour across time.
The most widely used instrument for diagnosing psychopathy in correctional and forensic settings is the Psychopathy Checklist-Revised, which comprises 20 items rated on the basis of interview and file-record information. The items of the PCL-R effectively capture the interpersonal-affective deficits and behavioural deviance features identified by Cleckley, but include only limited, indirect coverage of positive adjustment features.
The manual for the PCL-R recommends the use of a cutoff score of 30 out of 40 for assigning a diagnosis of psychopathy.
High overall PCL-R scores are correlated with impulsive and aggressive tendencies, low empathy, Machiavellianism, lack of social connectedness, and persistent violent offending. Given these correlates, and the omission of positive adjustment indicators, psychopathy as assessed by the PCL-R appears more similar to the predatory-aggressive conception of McCord and McCord than to Cleckley’s conception.
Psychopathy has most typically been assessed in noncriminal adult samples using self-report-based measures. Older measures of this type emphasised the antisocial deviancy component of psychopathy with limited coverage of interpersonal-affective features. Some newer instruments provide more balanced coverage of both.
One example is the now widely used Psychopathic Personality Inventory, which was developed to index personality dispositions embodied within historic conceptions of psychopathy. Its current revised form contains 154 items, organised into eight facet scales.

Question 21

Become familiar with the Triarchic model of psychopathy and its constituent constructs of boldness, meanness, and disinhibition.

Answer 21

This model conceives of psychopathy as encompassing three separable symptomatic components—disinhibition, boldness, and meanness—that can be viewed as thematic building blocks for differing conceptions of psychopathy.
Disinhibition as described in the Triarchic model encompasses tendencies toward impulsiveness, weak behavioural restraint, hostility and mistrust, and difficulties in regulating emotion
Meanness entails deficient empathy, lack of affiliative capacity, contempt toward others, predatory exploitativeness, and empowerment through cruelty and destructiveness. Referents for disinhibition and meanness include the finding of distinct I/CP and CU factors in the child psychopathy literature and corresponding evidence for distinct disinhibitory and callous-aggression factors underlying impulse control (externalising) problems in adults
Boldness encompasses dominance, social assurance, emotional resilience, and venturesomeness. Referents for this construct include the “mask” elements of Cleckley’s conception,

Question 22

antisocial personality disorder

Answer 22

Antisocial personality disorder - Counterpart diagnosis to psychopathy included in the third through fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2000). Defined by specific symptoms of behavioural deviance in childhood (e.g., fighting, lying, stealing, truancy) continuing into adulthood (manifested as repeated rule-breaking, impulsiveness, irresponsibility, aggressiveness, etc.).\

Question 23

psychopathy

Answer 23

Synonymous with psychopathic personality, used to designate mental disorders presumed to be heritable.

Question 24

triarchic model

Answer 24

Model formulated to reconcile alternative historic conceptions of psychopathy and differing methods for assessing it. Conceives of psychopathy as encompassing three symptomatic components: boldness, involving social efficacy, emotional resilience, and venturesomeness; meanness, entailing lack of empathy/emotional-sensitivity and exploitative behaviour toward others; and disinhibition, entailing deficient behavioural restraint and lack of control over urges/emotional reactions.

Question 25

Consider the impact of emerging treatment strategies in mental health.

Answer 25

Psychologists have been able to develop new treatment strategies in recent years, these approaches often focus on enhancing existing treatments such as cbt, with technological advances
Ex. internet and mobile delivered therapies make psychological treatments more available through smartphones and online access
Clinician supervised online cbt modules allow patients to access treatment from home on their own schedule (good for people with low SES)
Cognitive bias modification - exercises that help change problematic thought processes
CBT pharmaceutical agents - drugs used to improve the effects if therapeutic interventions
Certain drugs influence the biological processes known to be involved in learning, thus if people take the drugs while going through psychotherapy, they are better able to learn the techniques for improvement

Question 26

acceptance and commitment therapy

Answer 26

A therapeutic approach designed to foster nonjudgmental observation of one’s own mental processes.

Question 27

automatic thoughts

Answer 27

Automatic thoughts - Thoughts that occur spontaneously; often used to describe problematic thoughts that maintain mental disorders.

Question 28

cognitive bias modification

Answer 28

Cognitive bias modification - Using exercises (e.g., computer games) to change problematic thinking habits.

Question 29

cbt

Answer 29

Cognitive-behavioural therapy (CBT) - A family of approaches with the goal of changing the thoughts and behaviours that influence psychopathology.

Question 30

comorbidity

Answer 30

Comorbidity - Describes a state of having more than one psychological or physical disorder at a given time.

Question 31

DBT

Answer 31

Dialectical behaviour therapy (DBT) - A treatment often used for borderline personality disorder that incorporates both cognitive-behavioural and mindfulness elements.=

Question 32

dialectical worldview

Answer 32

Dialectical worldview - A perspective in DBT that emphasises the joint importance of change and acceptance.

Question 33

exposure therapy

Answer 33

Exposure therapy - A form of intervention in which the patient engages with a problematic (usually feared) situation without avoidance or escape.

Question 34

free association

Answer 34

Free association - In psychodynamic therapy, a process in which the patient reports all thoughts that come to mind without censorship, and these thoughts are interpreted by the therapist.

Question 35

integrative/eclective psychotherapy

Answer 35

Integrative ​or eclectic psychotherapy​ - Also called integrative psychotherapy, this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements).

Question 36

mindfullness

Answer 36

Mindfulness - A process that reflects a nonjudgmental, yet attentive, mental state.

Question 37

mindfulness based therapy

Answer 37

Mindfulness-based therapy - A form of psychotherapy grounded in mindfulness theory and practice, often involving meditation, yoga, body scan, and other features of mindfulness exercises.

Question 38

person centred therapy

Answer 38

Person-centred therapy - A therapeutic approach focused on creating a supportive environment for self-discovery.

Question 39

psychoanalytic therapy

Answer 39

Psychoanalytic therapy - Sigmund Freud’s therapeutic approach focusing on resolving unconscious conflicts.

Question 40

psychodymamic therapy

Answer 40

Psychodynamic therapy - Treatment applying psychoanalytic principles in a briefer, more individualised format.

Question 41

Reappraisal, or ​Cognitive restructuring

Answer 41

The process of identifying, evaluating, and changing maladaptive thoughts in psychotherapy.
Schema - A mental representation or set of beliefs about something.

Question 42

unconditional positive regard

Answer 42

Unconditional positive regard - In person-centred therapy, an attitude of warmth, empathy and acceptance adopted by the therapist in order to foster feelings of inherent worth in the patient.