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Chapter 10 Personality Disorders
Personality Disorders: An Overview
• Personality a set of unique traits and behaviors that characterize an individual • Five Factor Model of Personality Traits (OCEAN) openness, conscientiousness, extraversion/introversion, agreeableness, and neuroticism.
• Personality disorder (formerly known as a character disorder) certain traits that are so inflexible and maladaptive that the patient cannot adequately perform roles expected of them by society.
• two common features: chronic interpersonal difficulties and problems with one’s identity or sense of self.
• DSM criteria: pervasive and inflexible pattern of behavior that is stable and of long duration. It must cause clinically significant distress or impairment in functioning
• They typically do not stem from debilitating reactions to past stress, but rather from the gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world.
• Personality disorders are divided into 3 clusters:
• Cluster A includes paranoid, schizoid, and schizotypal personality disorders. People with these disorders seem odd and eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment.
• Cluster B includes histrionic, narcissistic, antisocial, and borderline personality disorders. People with these disorders tend to be dramatic, emotional, and erratic. Don't forget about the age old question of What is target return pricing?
• Cluster C Includes avoidant, dependent, and obsessivecompulsive personality disorders. People with these disorders tend to show anxiety and fearfulness. • Prevalence estimates for personality disorders have ranged from 4.4 to 14.8 percent. • One review of 6 studies estimated that about 13 percent of the population will meet criteria for at least one personality disorder at some point in their lives.
• It is somewhat difficult to diagnose personality disorders because the diagnostic criteria are not as sharply defined and must be inferred to some degree by the clinician.We also discuss several other topics like What does acid produce in the water?
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• Relatively little is known about causal factors as well mainly because it is a recent field of research, beginning in 1980.
• There is a high level of comorbidity of personality disorders many patients fit the criteria for multiple.
• possible biological factors: infant temperament
• possible psychological factors: excessive or insufficient gratification as an infant, learning based habit patterns, maladaptive cognitive styles, ineffective parenting practices, any type of abuse.
• Social stressors, societal changes, and cultural values have been implicated as causal factors as well.
Cluster A Personality Disorders
• People with these disorders seem odd and eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment.
• For all of these disorders, it is estimated that they occur more frequently in males then they do females.
• Paranoid Personality Disorder
• Characterized by pervasive suspiciousness and a distrust of others. They often see themselves as blameless and are chronically tense and “on guard”. They have a high level of neuroticism and antagonism (low agreeableness). Don't forget about the age old question of What is a subspecies?
• These individuals are not usually psychotic and are still in touch with reality. • Prevalence: 0.52.5%
• Schizoid Personality Disorder
• Characterized by impaired social relationships and an inability and lack of desire to form attachments to others. They are unable to express feelings and are seen by others as cold and distant. They have a high level of introversion and a low level of openness. • Patients with this disorder may be seen as loners and introverts. Don't forget about the age old question of Chemical, virus, or radiation that causes damage to the zygote, embryo, or fetus.
• Prevalence: <1%
• Schizotypal Personality Disorder
• People with this disorder experience the social and interpersonal deficits of schizoid personality disorder with additional symptoms of cognitive and perceptual distortions and oddities in communication and behavior. We also discuss several other topics like What is fraud and how does that relate to tort?
• Contact with reality is usually maintained, superstitious thinking and transient psychotic symptoms may occur. Many with this disorder believe they have magical powers and take part in magical rituals.
• It is closely linked with development of schizophrenia.
• Prevalence: 3%
Cluster B Personality Disorders
• People with these disorders tend to be dramatic, emotional, and erratic. • Histrionic Personality Disorder
• Characterized by overdramatization, vanity, excessive attentionseeking behavior, emotionality, and extroverted behavior. Patients have high levels of extraversion and neuroticism.
• Some, but not all, suggest that this disorder occurs more frequently in women than in men but overall the ratio seems generally equal.
• This disorder is highly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder.
• Prevalence: 23%
• Narcissistic Personality Disorder
• Characterized by an exaggerated sense of selfimportance, a preoccupation with being admired, and a lack of empathy for others.
• Many studies support the idea that there are two subtypes of narcissism: grandiose and vulnerable.
• Frequently observed more often in men than in women.
• Prevalence: <1%
• Antisocial Personality Disorder
• Characterized by a violation and disregard for the rights of others through deceitful, aggressive, and antisocial behavior. Patients with this disorder seem to lack remorse and loyalty, and are seen as impulsive, irritable, and irresponsible.
• This pattern of behavior MUST have been occurring since age 15 with symptoms of a conduct disorder prior to that.
• Frequently observed more often in men than in women.
• Prevalence: 1% for females, 3% for males
• Borderline Personality Disorder
• Characterized by impulsivity and instability in relationships, selfimage, and moods. • People with BPD often selfmutilate or commit suicide.
• BPD commonly cooccurs with a variety of other disorders ranging from unipolar and bipolar mood and anxiety disorders, to substance use and eating disorders. BPD also often cooccurs with histrionic, dependent, antisocial, and schizotypal personality disorders.
• Prevalence: 2%
Cluster C Personality Disorders
• People with these disorders tend to show anxiety and fearfulness.
• Avoidant Personality Disorder
• characterized by extreme social inhibition and introversion that leads to lifelong patterns of limited social relationships and interaction. Unlike schizoid personalities, people with this disorder do not enjoy their aloneness.
• Men and women experience this disorder equally.
• Prevalence 0.51%
• Dependent Personality Disorder
• characterized by an extreme need to be taken care of, clinging, fear of separation, and submissive behavior.
• Women may experience this disorder more frequently than men.
• DPD often is comorbid with mood, anxiety, and eating disorders.
• Prevalence: 12%
• ObsessiveCompulsive Personality Disorder
• characterized by excessive concern with maintaining order, a thirst to keep control, and perfectionism.
• differs from OCD in that OCPD sufferers don't have specific obsessions and compulsions.
• This disorder occurs more frequently in men than in women.
• Prevalence: 1%
Treatment of Personality Disorders
• Personality disorders are difficult to treat because they are enduring, pervasive, and inflexible. • Many believe they don't need to change.
• Therapeutic techniques must be adapted to help overcome personality disorders. • Patients may need to be hospitalized, especially ones with BPD.
• Antidepressants, antipsychotics, and mood stabilizers are often used to treat BPD. • Dialectical behavior therapy is a unique kind of cognitive and behavioral therapy specifically adapted for BPD.
• Mentalization, developed by Bateman and Fonagy, helps patients develop the skills understand their own feelings and emotions as well as others.
• Treatment of cluster A and B personality disorders is not promising. No treatment has produced anything approaching a cure.
• Treatment of cluster C disorders are somewhat more promising.
• Psychopathy/sociopathy common terms used to describe the symptoms of ASPD. • There are two dimensions of psychopathy the first reflects traits such as lack of remorse or guilt, callousness, superficial charm, grandiose sense of self worth, and pathological lying, while the second reflects behavior of antisocial or impulsive acts, social deviance, a need for stimulation, poor behavior controls, irresponsibility, and a parasitic lifestyle. • Genetic and temperamental, learning, and adverse environmental factors seem to be important in causing psychopathy and ASPD.
• Psychopaths show deficiencies in fear and anxiety as well as general emotional deficits. • Treatment of ASPD is difficult, because often patients do not believe they are doing anything wrong.
Chapter 11 SubstanceRelated Disorders
• Addictive behavior behavior based on the pathological need for a substance • Psychoactive substances chemicals that work on mental functioning and the central nervous system, ex) alcohol, nicotine, barbituates, tranquilizers, psychadelics, amphetamines, heroin, ecstasy, and marijuana
• Substance abuse generally involves an excessive use of a substance resulting in 1) potentially hazardous behavior, or 2) continue to use the substance despite persistent social, psychological, occupational, or health problem. Substance dependence includes more severe forms of substance use disorders involving marked psychological need for increasing amounts of a substance to achieve the desired effects (also called tolerance) • Withdrawal physical symptoms that accompany abstinence from a drug.
• Alcohol abuse and dependence is common among all age, educational, occupational, and socioeconomic boundaries.
• It is estimated that 50% of adults 18 or older are current regular drinkers, and only 21% are lifetime abstainers.
• Alcoholism is among the most destructive of psychiatric disorders because of the impact it can have on users lives and those of their families and friends.
• Heavy drinking is associated with vulnerability to injury, marital discord, and being involved in intimate partner violence. Alcohol also significantly lowers performance in cognitive tasks such as problem solving.
• Alcohol is strongly correlated to crime ex) automobile deaths, murders, rapes, and assaults • The lifespan of a person with alcohol dependence is 12 years shorter than the average person.
• Men become problem drinkers at a higher rate 5:1.
• Over 37% of people suffering from alcoholism also suffer from some other mental disorder, ex) depression and eating disorders.
• Alcohol acts on the pleasure centers of the brain, which release opioids that are stored in the body.
• The drinker begins to experience impaired motor functioning, impaired judgement, and decreased inhibitions.
• A blood alcohol level of .05 leads to unconsciousness, and is usually lethal if it goes any higher.
• Several psychoses related to alcoholism have been identified: withdrawal delirium, chronic alcoholic hallucinosis, and dementia.
• The mesocorticolimbic dopamine pathway (MCLP) is the center of psychoactive drug activation in the brain.
• involved in functions such as control of emotions, memory, and gratification. • Heredity plays an important role in a person’s developing sensitivity to the addictive powers of drugs and alcohol.
• As far as psychological effects go, failures in parental guidance, psychological vulnerability, stress, expectations of social success, and problems in relationships may all be a factor in why one drinks.
• Alcohol is used widely in a social setting, making it easily available to the average person. • Treatment of alcoholism’s main objectives typically include detoxification, physical rehabilitation, mental health counseling, etc. Abstinence is normally ideal. • Biological treatments such as drugs that block the desire to drink and reduce the side effects of alcohol withdrawal are used often.
• Psychological treatments such as group therapy, environmental intervention, behavioral and cognitive behavioral therapy is often used.
• Some people believe that controlled drinking is possible, but others disagree. • Relapse is common. Things such as Alcoholics Anonymous help prevent this.
Drug Abuse and Dependence
• The psychoactive drugs most commonly abused are narcotics, sedatives, stimulants, antianxiety drugs, pain medication, hallucinogenics, caffeine, and nicotine. • 8% of the population have reported using an illicit drug within a month before surveys were conducted.
• Possible causal factors in drug abuse include the influence of peer groups, the existence of drug culture, and the availability of drugs.
• The discovery of endorphins has suggested that a biochemical basis for drug addiction may exist.
• Narcotics (opium and its derivatives)
• Opium is a mixture of about 18 chemical substances known as alkaloids, the most common being morphine which gives sedative and pain relieving effects.
• Morphine treated with acetic anhydride makes heroin.
• Opium has been used for centuries to treat many medical conditions such as epilepsy, asthma, fevers, melancholy, etc.
• Opium can be smoked, snorted, ingested, or injected into the body.
• Treatment may include the use of the drug methadone or buprenorphine, a synthetic narcotic that satisfies the craving for the drug without all of the physiological impairment. • Stimulants (cocaine and amphetamines)
• Cocaine is a plant product discovered in ancient times and used ever since. • Like opiates, it can be smoked, snorted, or injected into the body.
• Naltrexone may be used to help treat cocaine addiction.
• Amphetamines such as benzedrine and dexedrine were originally marketed to treat stuffy noses, but the public began using it for kicks.
• Speed (methedrine) is significantly more dangerous and lethal.
• Methamphetamine is a highly addictive drug that can be cooked in makeshift laboratories • Meth increases the level of dopamine in the brain.
• It is considered extremely dangerous due to how quickly one can become addicted, structural changes that can occur in the brain, and severe problems with learning, memory, and cognitive dysfunction.
• Treatment relapse is common.
• Sedatives (barbituates)
• Historically, sedatives were used to aid sleep.
• Because they slow down the action of the CNS, they give a feeling of relaxation and tendency towards drowsiness.
• Excessive use can lead to dependance, brain damage, and personality deterioration. Large doses can be lethal.
• The people who do become dependent on barbiturates are often middle aged and older people who use them as sleeping pills.
• Withdrawal symptoms of barbituates are even stronger, more dangerous, and sever than opiate withdrawal.
• Hallucinogenics (LSD, etc)
• these drugs induce hallucinations and distorted sensory perception.
• LSD is an odorless, colorless, and tasteless drug with an amount smaller than a grain of salt.
• flashback an involuntary recurrence of perceptual distortions and hallucinations weeks or even months after taking the drug
• Mescaline, which comes from part of the peyote cactus, and psilocybin, a mushroom from Mexico, are also commonly used hallucinogenics.
• Ecstasy, or MDMA, is a hallucinogenic and a stimulant.
• memory impairment, psychosis, or panic disorders may occur with prolonged use • Marijuana dried green leaves and flowers that are smoked in cigarette form or in pipes. • Gives a sense of mild relaxation and euphoria with heightened perceptual activity. • Synthetic marijuana, or “spice”, is also used by some people.
• Caffeine and Nicotine
• Others suffer addictions to gambling: an estimated 12% of the population.
Chapter 12 Sexual Variants, Abuse, and Dysfunction
• Sexual desire and activity is normal in fact, many think no sexual desire is a dysfunction. • Dysfunction lies in how one expresses the sexuality.
• Normal sexual behavior changes throughout time over time and between cultures. • Sociocultural influence on sexual standards
• For a long time, homosexuality was societally unacceptable. It was included in the DSM until 1973.
• Degeneracy theory and abstinence theory both maintained that sexual activity should only occur for matters of procreation because wasting semen is harmful. Both were influential for a long period of time.
• Sexual and gender variants
• Paraphilias recurrent, intense sexually arousing fantasies, urges, or behaviors that last a minimum of 6 months.
• Causal factors people with paraphilias often have a strong sex drive and an inciting incident that led to the paraphilia.
• Fetishism arousal from a specific inanimate object or a part of the body that is typically not found erotic. ex) feet
• Transvestic fetishism arousal from crossdressing as a woman
• Voyeurism arousal from watching people undress or people engaging in sexual activities
• Exhibitionism arousal from exposing oneself to unsuspecting and nonconsenting individuals
• Frotteurism arousal from touching or rubbing oneself against an unsuspecting and nonconsenting individual
• Sadism arousal from inflicting physical or psychological pain onto others • Masochism arousal from being humiliated, tortured, etc.
• Gender identity disorder (gender dysphoria) discomfort with one’s sex relevant physical characteristics or one’s assigned gender.
• In childhood, kids may show this by expressing interest in the other gender’s clothes, toys, etc.
• Often, these kids are brought in for psychotherapy
• Transsexualism adults who desire to change their sex and live as so. It is considered rare.
• Autogynephilia arousal from thoughts, images, or fantasies of themselves dressing as a woman.
• The only treatment proven to work for transsexualism is sex reassignment surgery.
• Sexual abuse is sexual contact that involves physical or psychological coercion or at least one individual cannot reasonably consent.
• includes pedophilia, incest, rape, etc.
• Childhood sexual abuse is more common than was previously assumed, and it is important to understand it’s causes and effects.
• Short term consequences may include fear, PTSD, sexual inappropriateness, and low self esteem.
• Long term consequences may include BPD, DID, somatization disorder with dissociative symptoms, sexual aversion, or sexual promiscuity.
• Pedophilic disorder a paraphilic disorder that occurs when arousal occurs during thoughts or fantasies of sexual activity with a prepubescent child generally 13 or younger. • Men are much more likely to be pedophiles than women,
• Most pedophiles prefer girls on a scale of 3:1
• Hebephilia attraction to adolescents going through puberty
• Incest culturally prohibited sexual relations between family members
• Since procreation with similar genetics may cause defects in the child, humans have evolved to avoid it as much as possible.
• Brothersister incest is most common, with fatherdaughter being second common. • Some incestuous child molesters have pedophilic arousal patterns
• Rape sexual activity that occurs under actual or threatened forcible coercion. • statutory rape occurs when a person under the age of consent is involved, even if consent is given.
• Treatment and recidivism
• In general, sex offender recidivism is actually markedly lower than for many other types of crime and tends to decrease as age increases.
• However, sex offenders with deviant sexual preferences have higher rates of recidivism. • Sexualized violence is the strongest predictor of recidivism, with others being negative social influences, poor cognitive problemsolving, and loneliness.
• Treatment of sex offenders has not as yet proved highly effective in most cases, although promising research in this area is being conducted.
• Sexual dysfunction refers to impairment either in desire for sexual gratification or the ability to achieve it.
• occurs in all couples regardless of sexual orientation.
• can be caused by physical, psychological, or interpersonal factors.
• Four Phase Model of Sexual Arousal
• Desire phase consists of fantasies or a sense of desire to have sexual activities. • Excitement (arousal) phase characterized by both a subjective sense of sexual pleasure and by physiological changes that accompany this, ex) penile erection, vaginal lubrication • Orgasm phase characterized by a release of sexual tension and a peaking of sexual pleasure.
• Resolution phase characterized by a sense of relaxation and well being. • Dysfunction can occur in the first three stages of this model.
• A survey done by NHSLS in 1999 found that 43% of women and 31% of men experienced having a sexual dysfunction in the past 12 months.
• As age increased, women tended to have less problems while men began to experience more.
• Sexual dysfunctions in men
• Erectile disorder problem achieving or maintaining a full erection
• treatment often uses 1) medications to promote erections, 2) injections or muscle relaxing drugs into the penis, or 3) vacuum pumps.
• Male hypoactive sexual desire disorder persistent and recurringly deficient or absent sexual thoughts or desires for at least 6 months
• treatment may include testosterone injections
• Early ejaculation persistent and recurrent onset of orgasm with minimal stimulation
• often, men with this problem use a technique called the pause and squeeze or edging, which involves masturbation up to the point of orgasm and then a pause. This prolongs sexual stamina.
• Delayed ejaculation persistent inability to ejaculate during intercourse. • treatment often includes refocusing on having orgasms only during intercourse vs. by masturbation.
• Sexual dysfunctions in women
• Female sexual interest/arousal disorder dysfunctionally low desire with dysfunctionally low sexual arousal.
• psychological factors often play more of a role in this than biological factors do. • Genitopelvic pain/penetration disorder genital pain of dyspareunia with muscle tension and the addition of fear and anxiety related to sexual activity.
• Female orgasmic disorder persistent or recurrent delay in or absence of orgasm • This may be a lifelong problem or a situational problem.
Answers to actual test questions!
8. B, Paranoid personality disorder
27. D, Men
28. D, decreases, decreases
• all personality disorders (focusing a little bit more on borderline and antisocial) • clusters of personality disorders
• treatments for BPD
• percentage of inmates with antisocial personality disorder and psychopathy • difference between OCD and OCPD
• Case descriptions > diagnoses
• alcohol illegal blood limit, treatments for alcohol abuse
• opiates, amphetamines, hallucinogens, marijuana
• fetishism and sadism and masochism
• sexual dysfunction disorders (at the end of chapter 12)
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