Cyterski PSYC 3230 Exam 4 Lecture notes
Cyterski PSYC 3230 Exam 4 Lecture notes 3230.0
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Date Created: 12/05/15
Lecture Notes, Week 13 November 9, 2015 Exam 3 November 10, 2015 Chapter 13: Personality Disorders Personality: unique and stable ways that people think, feel and behave Answer the question: “I am…kind, loyal, hard-working” o How did you become this way? Personality develops over time Infants don’t have personalities, they have “temperaments” that may actually be inheritable Personality Disorders o Very hard to change and very resistant to treatment o Personality traits tend to be consistent but may be flexible To be considered a “trait” it has to be pretty consistent, otherwise it would just be how you acted one time o Extreme traits and significant dysfunction o There were serious changes to the personality disorders section of the DSM5 proposed but they were very controversial and didn’t end up happening Comorbidity: having more than one disorder at a time, very confusing and problematic when trying to diagnose personality disorders o A categorical approach is used today, you either get the diagnosis or don’t—there is no sliding scale o There are concerns about the validity (accuracy) and reliability (consistency) of assessment of personality disorders Lowest reliability and validity of all diagnoses listed in the DSM5 Classifying Disorders o There are 10 personality disorders listed in the DSM5 that can be grouped into 3 groups or “clusters” 1. Odd or eccentric behavior Paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder 2. Dramatic, emotional or erratic behavior Antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder 3. Anxious or fearful behavior Avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder Suggested Movie: Girl Interrupted http://www.imdb.com/title/tt0172493/ Paranoid Personality Disorder o Suspicious, secretive, hypervigilant, jealous o May be irritable and hostile o NOT delusional / NO hallucinations o Very critical to others but very sensitive to criticism o Hold grudges o Not open/trusting of therapist Schizoid Personality Disorder o Avoidance of social relationships – “loners” o Limited emotional expression—very indifferent to everything: don’t care what people say or think, don’t care to have friends o Withdrawn, reclusive, flat, cold, humorless o Some biological influences are suspected o Abuse could play a role o Don’t usually go to therapy, when they do, they don’t really care what their therapist has to say Therapists try to teach these clients social skills Schizotypal Personality Disorder o Extremely uncomfortable in close social relationships, bizarre ways of thinking, eccentric behaviors o Most closely resembles schizophrenia of the three disorders in this cluster o Bizarre thinking—may believe completely in horoscopes, may believe psychics are real, may believe an author wrote a book with them in mind o Ideas of reference, bodily illusions (not as intense/serious as delusions/hallucinations) o Attention o Loose associations o Linked to high dopamine activity and other mood disorders (very high comorbidity) o Could be a precursor to schizophrenia November 13, 2015 VIDEO: What is Schizotypal Personality Disorder? http://www.videojug.com/interview/schizotypal-personality-disorder Borderline Personality Disorder (BPD) o Great instability, huge and fast mood swings, unstable self-image, insecure, jealous o Deep seeded fears off abandonment o Clingy/needy behavior (which can lead to dysfunctional relationships/abandonment) Movie Example: Fatal Attraction o Interpersonal relationship dysfunction o More common in women o Bouts of unexplained anger/hostility o May self-harm Problems these days with online communities supporting self- harming o Prognosis isn’t good o Severe depression common—suicidal behaviors—sometimes truly suicidal, sometimes suicidal for the attention or holding it over another person’s head (“if you break up with me, I will kill myself”) o Impulsivity: drugs, alcohol, sex, other behaviors like gambling and shopping o People with BPD can be very calm, intelligent, articulate, and even be aware of the fact that their episodes “are crazy” VIDEO: Liz, talks openly about her life with Borderline Personality Disorder http://visual.pearsoncmg.com/mypsychlababnormal/index.php?clipId=18 o Liz mentions impulsive and compulsive behaviors o Mentions anger management problems, being hospitalized for suicide attempt for her own safety, went through a 2 week diagnostic period while hospitalized o “extreme loneliness” o Relationship brought on suicide attempt—boyfriend was leaving her for air force training, relationship was rocky, found an unimportant email from a girl….”after 5 seconds I decided I didn’t want to live anymore” Object-Relations Theorists o Lack of acceptance in early life by parents o Abuse/neglect as a child o Conditional love and/or inconsistent punishment Suggested Biological Causes o Overactive amygdala (emotionality) and underactive prefrontal cortex (impulse control) o Lower serotonin activity—suicidality and impulsive aggression Dialectical Behavioral Therapy o Emotion regulation addressed o Offering unconditional positive regard VS challenging patient to address irrational behaviors and thoughts…there must be a balance o BPD is extremely hard to treat o Eclectic combination of therapy approaches Antisocial Personality Disorder (ASPD) o Distinct from psychopaths o Persistently disregard and violate the rights of others o Sign of ASPD: conduct disorder before age 15 Cruelty to animals Skipping school Fighting at school Setting fires o Aggressive, impulsive, irresponsible, often commit crimes o Must be at least 18 years old to be diagnosed Lecture Notes, Week 14 November 16, 2015 75-80% of prison populations have ASPD 20-25% of the prison populations are psychopaths Psychopaths are grandiose, likeable, smooth talkers, glib, charming “Not everyone that has major childhood trauma grows up to have ASPD or be a psychopath, but almost all psychopaths and people with ASPD experienced childhood trauma” Antisocial Personality Disorder o Pathological lying, reckless, impulsive, NO remorse o Typically sadistic, cruel, aggressive, violent o Ex. Ted Bundy (serial killer and criminal psychopath)—very well educated with a nonviolent past, serial murdered tons of women Explanations of Antisocial Personality Disorder o Lower serotonin levels Explains impulse aggression o Deficient functioning and/or structural anomalies in frontal lobes Area of brain responsible for controlling impulses and thinking ahead to the consequences of actions o Lower levels of anxiety and arousal and fear Flat affect Low CNS functioning—people with ASPD typically hate routines, can’t keep jobs, are very prone to boredom Crimes may stimulate CNS to level of that of a normal person o Treatment is usually very ineffective Major obstacle is the individual’s lack of conscience “Have you ever done or said anything you regret, feel bad about or wished you hadn’t?” – Very confusing question to people with this disorder—“no why would I ever feel bad about that?” o Do these people recognize that they have this disorder? Typically don’t believe it, get very defensive, believe you’re just jealous and that it’s a problem with you and not them, write it off Suggested Book: Without Conscience by Dr. Robert Hare VIDEO: Serial Killer Tommy Lynn Sells talks to Martin Bashir https://www.youtube.com/watch?v=ohi_-rExJag o Structural impairment of the amygdala, which is the emotion center of the brain (in the limbic system) o Sells blames childhood sexual abuse for his behavior Histrionic Personality Disorder o Extremely emotional o Continually seeking to be the center of attention Will do things to make sure they are—dress provocatively, cause a scene, throw a tantrum, get way drunker than appropriate for the situation, cry, etc. o Constantly searching for approval and praise o Insecure but want to be seen as “the most attractive person in the room” o Stems from fears of abandonment that were developed during childhood Poor parenting, selfish parents—idea that “negative attention is better than no attention” o More common in women vs men May be diagnostic cultural bias Narcissistic Personality Disorder o Grandiose, need admiration, feel no empathy with others, harsh/critical of others, arrogant o Typically will not accept responsibility for their mistakes, very quick to shift the blame o Essentially a mask for a very fragile self-esteem o Psychodynamic view Caused by cold, rejecting parents o Cognitive-behavioral view Treated too positively vs too negatively as a child Helicopter parents—save their children from any and all trouble, hurt, embarrassment etc., “you’re special,” “the rules don’t apply to you,” etc. o One of the most difficult personality disorders to treat because these ideas are so engrained, these people completely deny that anything is wrong with them VIDEO: Joseph Burgo: Narcissistic Personality Disorder https://www.youtube.com/watch?v=PuB_ng5uVaI o Didn’t finish in class—very interesting and gives clear examples for diagnostic criteria for narcissistic personality disorder November 18, 2015 Avoidant Personality Disorder o Uncomfortable and inhibited in social situations o Feelings of inadequacy o Very worried about social situations o A lot of anxiety about how they present themselves to others in social situations o Similar to social anxiety disorder o Early trauma o Conditioned fear Dependent Personality Disorder o Clingy and obedient o Difficulty with separation o Can’t make decisions for themselves, always seeking advice of their social support network, don’t trust themselves, even down to decisions like “what should I wear, what should I eat” o At risk for depression, anxiety, eating disorders o Feelings of “I am inadequate, not good enough” o Therapy: branch out, make their own decisions, take responsibility for their actions Assertiveness training o May have had parents that indirectly rewarded this behavior “You can’t do that without me, you should ask my advice/help” vs “you can do it on your own, be independent, make your own decision!” May be a conditioned behavior Obsessive-compulsive personality disorder o Preoccupied with perfection, order, control o Rigid and stubborn o May get very upset when things don’t go according to their plan o “do everything myself” type of people o Distinct from OCD—no link found between OCPD and OCD Don’t see things like obsession with germs and compulsive handwashing with OCPD o Very hard to treat—treatment is often met with defensiveness and stubbornness Are there better ways to classify personality disorders? o The “Big Five” theory of personality Idea that there are 5 “super traits” that make up personality Openness—closed Conscientiousness—undirected Extroverted—introverted Agreeable—disagreeable Neuroticism—stable (emotional stability) o Personality Disorder Trait Specified (PDTS) Do away with categorical diagnosis Instead, diagnose people with PDTS, with specification of what traits are distorted and the levels of dysfunction (on a scale of 1- 4) that each distorted trait is causing the patient o http://www.outofservice.com/bigfive/ o Figure from book—personality disorder traits, purple and orange squares Chapter 14: Disorders of Childhood and Adolescence Used to be called developmental disorders Originate in childhood Abnormal functioning can occur at any point during lifetime Worry is a common experience for children 1/5 of children have some sort of childhood disorder o Boys outnumber girls even though women outnumber men in adult disorders Attention-Deficit Hyperactivity Disorder (ADHD) o Difficulty attending to tasks, behave over actively, impulsively or both o Problems arise when ADHD interferes with learning or ability to communicate o Usually becomes more prevalent when kids start school Typically teacher suggested to test child o Problem: ADHD is over-diagnosed Could be due to the differences in the expectations of children these days (kindergarten used to be ½ day, now we expect 4 year olds to go a whole day) o Poor school performance—children aren’t learning material due to inattention o Difficulty interacting with other children o Mood or anxiety problems commonly comorbid o Social skills: studies show that kids don’t want to be friends with the disruptive kid, leads to not making friends and therefore not developing social skills 4-9% of kids have ADHDof those diagnosed, 70% are boys May be due to bias—boys are more likely to have behavioral symptoms, girls are more likely to have attention symptoms, behavioral symptoms are noticed first Assessment o Look at behaviors across several situations and environments o Get reports from parents and teachers o Look at behaviors over time VIDEO: How to recognize ADHD symptoms in children https://www.youtube.com/watch?v=1GIx-JYdLZs o 3 key components: Behavior analysis Time (do symptoms persist for 6+ months?) Pediatrician Visit o Does behavior interfere with the child’s relationship with other children AND adults? o Mom smoking while pregnant increases child’s likelihood of developing ADHD by 2x Causes o Thought to be biologically based Abnormal dopamine, serotonin, GABA and/or norepinephrine o Genetic basis: monozygotic twins have a higher concordance level o Frontal-striatal region of the brain o Home environment November 20, 2015 About 80% of those diagnosed are boys Characterized by extreme social withdrawal o No eye contact, cuddling, getting picked up Can be extreme aloof/cold or get extremely upset “lack of responsiveness and social reciprocity” Communication problems o Total lack of language, or limited/basic language skills o No small talk—don’t understand the relevance—but may talk extensively about a subject matter that they are interested in o Echoalia: repeating things you say to them o Pronominal reversal: getting pronouns confused—he, she, it, they o Preservation of sameness: restriction of activities, becoming obsessed with one thing (ex. Thomas the train), self-stimulation (rocking) to soothe themselves, may also engage in self-injurious activities (head- banging) Intelligence levels may vary o May not be able to take a traditional IQ test due to them involving too many motor or verbal skills Some children with autism spectrum disorder are considered intellectually disabled and others can be “geniuses” VIDEO: Autism Signs and Symptoms https://www.youtube.com/watch?v=mc1H0aVqn20 o Tip toe walking o Lining up toys o Spinning wheels over and over ADHD—thought to be a largely biological based but there are inconsistencies in the literature More structured homes provide a better prognosis Symptoms may themselves create additional symptoms Can have consequences on learning when left untreated o Astronaut study with roleplaying Kids w ADHD didn’t learn/do better after observing tasks they were to perform How is ADHD treated? o Drug therapy, behavioral therapy or a combination of both o Drug therapy is more effective alone that behavioral therapy alone, but a combo is the most effective treatment o Ritalin/Adderall Increase dopamine & norepinephrine levels at certain synapses in the frontal striatal area Higher risk of addiction with adderall than other ADHD drugs bc it’s an amphetamine Autism Spectrum Disorder o Extreme unresponsiveness to other people, severe communication deficits, highly rigid/repetitive behaviors, interests and activities o Exists on a continuum o Symptoms appear early in life o Prevalence is increasing at an alarming rate 10 yrs ago, 1 in 2,000 kids Now, data shows anywhere between 1 and 88 to 1 in 600 kids o Feeding an autistic child can be very challenging Causes o Cognitive limitations and brain abnormalities o Something happened early in life/possibly prenatally that stunted or altered brain growth/development o Genetic component—high concordance rate Failure to develop theory of mind/mindblindness (same thing – used interchangeably) Develops over time, ability to take the perspective of another person, know or imagine what their thoughts/feelings/intentions might be Trouble playing make believe Theoryofmindinventory.com/task-battery/ o Biological factors Genetic factors Research looking at X chromosome defect Prenatal difficulties or birth complications Cerebellum dysfunction MMRI Vaccine Vaccination time is about the same time as symptoms present Correlation DOES NOT mean causation!11 Faulty study published linking the two, later retracted bc one of the researchers falsified records Week 15 Lecture Notes November 30, 2015 Biological causes o Genetic factor o Prenatal difficulties or birth complications o Cerebellum o MMRI vaccine No real correlation, only one study found a correlation and that study was falsified Brain scans of autism vs. no autism o Autistic brains show many areas extremely overactive areas of the brain Treatments o Cognitive-behavioral therapy Speech, social skills, classroom skills, and self-help skills, while reducing negative behaviors Rewards (candy is very effective), praise Early identification and intervention are key to goof prognosis Overall, treatments are relatively poorly effective, but more effective the earlier implemented and higher intensity (best are ~40hrs a week of intensive therapy at home and in school) Sign language (speech is often deficient/absent) use to enhance communication About ½ of those with autism are either speechless or significantly limited in speech Communication boards Parent training—important so children are constantly working on these skills around the clock Applied Behavioral Analysis (ABA) Therapy VIDEO: autism therapy – ABA : Myrtle beach National https://www.youtube.com/watch?v=NbVG8lYEsNs o “what are we working for?” o Very fast paced Good information—autismspeaks.org Childhood Anxiety Disorders o Prone to anxious temperament Biological predisposition o Difference between adults and children: kids are just not as articulate as adults, cannot explain or may not even know what it is that’s bothering them o Symptoms often manifest physically (stomach ache) or emotionally (tantrums, crying etc.) o 8% and 29% of all children and adolescents display an anxiety disorder o Also triggered by current events and situations—moving, divorce, remarriage, birth of a new sibling o Routines are very helpful with anxious children o Separation anxiety disorder—can be seen in children as young as 4 years old Normal for all children/infants to have some level of separation that occurs within conjunction of brain development/object More extreme behaviors required for a diagnosis of separation anxiety 4-10% of children May escalate into a school phobia or school refusal o Childhood anxiety can produce selective mutism VIDEO: Instructor Video on Launchpad – Selective Mutism o Emily is very talkative at home, bubbly, laughs, fun personality, not shy at all, but won’t speak at school o Only speaks to family or close friends o “it’s like stage fright, but the whole world is a stage” Treatment o Two-thirds of anxious children go untreated o One of the worst things you can do is push an anxious child to do something they aren’t ready to do—best thing you can do is let it ride out (supported by research/studies) o Play therapy Lack of verbal skills makes it hard to articulate emotions, play therapy helps allow those feelings to emerge as they are comfortable Major Depressive Disorder o May be triggered by negative life events (particularly losses), major changes, rejection, ongoing abuse o Sex differences—no sex differences in depression prevalence up until about 13 16+, females are significantly more likely to experience depression than males May be attributed to cultural differences and self-image pressures o Symptoms manifest more somatically (stomach aches, headaches) Bipolar Disorder and Disruptive Mood Dysregulation Disorder o Bipolar disorder o Now called Disruptive Mood Dysregulation Disorder (DMDD) in children in DSM-5 Frequent temper outbursts—verbal or physical Persistent, chronic, irritable mood—MUST be present for diagnosis Oppositional Defiant Disorder o Argumentative and defiant, angry and irritable, sometimes vindictive o Different than DMDD—ODD presents with similar symptoms to DMDD, but with lower levels of intensity If you have a child that meets requirements for both disorders, the diagnosis should be the more severe disorder o VIDEO: Jayden’s Meltdown EXTREME BEHAVIOR (not for children) https://www.youtube.com/watch?v=0FiPCs8VFs0 December 2, 2015 o Relatively new diagnosis, not a lot of research Conduct disorder o Much more severe pattern of symptoms o Repeatedly violate the basic rights of others o Criminal behavior is more common the older the kid gets o Aggressive/gruel to people and animals o Shoplifting, forgery, mugging, armed robbery Juvenile delinquents o Conduct disorder is MUCH more common in boys than girls Aggression is still seen in girls, but girls are less likely to get in fights etc Relational aggression is more common in girls—hurt them with words, hurt their relationship with others, hurt their relationship, goal of socially isolating another person o Usually begins between 7 and 15 years of age o 10% of children, three quarters of those diagnosed are boys o Can be different patterns—some are more overt, some are more secretive o If left untreated, conduct disorder can morph into antisocial personality disorder o Conduct disorder is often comorbid with ADHD—brain based similar causes (impulsivity, not being able to see consequences of actions, etc.) o “doesn’t come out of nowhere….most kids, up to 90% of these kids, are coming from an abusive home” VIDEO: “Ty” Juvenile Delinquency interviews https://www.youtube.com/watch?v=P3W-Iz8C4iU o Expelled from school for fighting—assault charge o “I got involved with all the wrong people” o Stealing cars o “I liked [behaving that way]….I’m from LA….the court system is way stricter out here” o 2 ½ years of time in jail total….only 16 years old o “I’m trying to stay out of trouble for my family now” o Now has plans to go to college Treatment for Oppositional defiant disorder and conduct disorder o Begin early—ideal age of identification of symptoms: 4 years old o Treat symptoms of rage and defiance o Family interventions Teach about properly disciplinary tactics o Community and school programs After school programs keeping them busy, mentors to encourage student’s going to school and doing homework and behave well o Juvenile training centers Youth Detention Centers You should only remove a child from their home if their home is abusive and they are “better off” than at home, or if they are a danger towards themselves or other people Scared Straight programs—research shows that scared straight programs are actually harmful to children, they increase risk of crime commitment and incarceration rather than decreasing the chance o Problem solving skills, anger management o Address substance abuse VIDEO: Boy gets beaten up – Beyond Scared Straight https://www.youtube.com/watch?v=qEBjIc-D_0A o Punishment typically has a more negative effect than positive in any type of behavior modification system Chapter 16: Law, Society, and the Mental Health Profession Psychology in law? How do clinicians influence the criminal justice system? Forensic psychology December 4, 2015 Forensic psychology: application of psychological knowledge, concepts and principles to civil and criminal justice systems o Hostage negotiations, work in field of corrections, counseling for victims or criminals or cops, not typically “criminal profiling” (most forensic psychologists consider it more an art than a science) Are defendants responsible for committing crimes? o Job of many forensic psychologists—make an evaluation of the criminal defendant’s mental state now and at the time of the commission of the crime o Are they capable of defending themselves in a court of law? Are they competent enough to withstand trial? Able to aid in their own defense, able to communicate with a lawyer Criminal Commitment o If someone is accused of a crime and are then judged by a court to be unable to withstand trial by reason of mental health, they are usually criminally committed to a mental health institution o After some treatment, usually people are able to be brought to a level of mental health that allows a trial to occur o Mentally unstable at the time of the crime = responsibility and insanity o Mentally unstable at the time of trial = competency Issue of malingering—faking mental health problems to get out of punishment o Requirements for insanity and competency are very strict Almost impossible for people to legally qualify for insanity defense Questions to ask: Was the person too mentally ill to know the difference between right and wrong? Even if they did know, were they too mentally ill to control their behavior? Concern that our legal process is just and fair “insanity” is a legal term—is not used in the psychology field Not all mental disorders qualify o Personality disorders are automatically excluded from insanity defense Our country goes through periods in history of being very strict, then very lenient, then back to strict again etc. In what percentage of all felony cases in the US is the insanity defense attempted? o One in three The M’Naughten test o 1800s o Man attempted to assassinate the PM, failed, charge for attempted assassination o Pleaded not guilty by reason of mental insanity (delusions of persecution), resulting in public outcry and changes made in the o Idea of was the person able to know the difference between right and wrong at the time of commission of the crime Were there elements of planning? Intentions? Hiding the crime afterwards? All of these things indicate being able to tell the difference The irresistible impulse test o Some people know the difference between right and wrong but they have a serious, brain based mental illness that truly inhibits their ability to control themselves The Durham Rule—“unlawful act was the product of mental disease or defect” American Law Institute Test o “ [if a mental disease]….prevented them from knowing right or wrong OR from being able to control themselves to follow the law” o People think this is “too liberal” o Formulated to be a little more liberal, combine idea of right vs wrong and impulse control Case Examples o 2012—James Eagan Holmes Movie theater shooting in Colorado Delusional, very invested in batman movies, dyed hair to look like the joker Very smart, got into a grad program, mental state deteriorated badly during grad school Concerns were raised by many people on different occasions prior to crime Found guilty, sentenced to life without parole o John Hinckley, Jr. Assassination attempt on Reagan Delusions about a movie, assassination attempt was in order to impress actress Jodie Foster VIDEO: NBC nightly news video about Holmes’ trial – Aug 9, 2012 – Holmes may plead insanity, experts say http://www.nbcnews.com/video/nightly-news/48601863#48601863 VIDEO: Columbine Survivor Survives Virginia tech – U.S. News & World Report https://www.youtube.com/watch?v=xHbDwPTxvoI
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