Abnormal Notes Week 10
Abnormal Notes Week 10 PSYC 3560
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This 12 page Class Notes was uploaded by Ashlyn Masters on Thursday April 14, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 14 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 04/14/16
Personality Disorders 4/12/16 Personality Disorders • Personality Traits o OCEAN § Openness: being curious, original, intellectual, creative and open to new ideas § Conscientiousness: being organized, systematic, punctual, achievement-oriented and dependable § Extraversion: being outgoing, talkative, sociable, and enjoying social situations § Agreeableness: being affable, tolerant, sensitive, trusting, kind and warm § Neuroticism: being anxious, irritable, temperamental and moody • Criteria for personality disorders o An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: § Cognition (i.e., ways of perceiving/interpreting self, others and events § Affectivity (i.e., range, intensity, lability, fit of emotional response) § Interpersonal functioning § Impulse control o The enduring pattern is inflexible and pervasive across a broad range of personal and social situations o The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood o Clinically significant distress or impairment o Not better explained as a consequence of another mental disorder o Not attributable to effects of a substance or another medical condition • Definition o Long-standing pattern of maladaptive behaviors, thoughts and feelings § Pervasive and inflexible, stable, and causes distress/impairment o 3 clusters (A, B, and C) o Rough lifetime estimate: 10-13% will meet criteria for a PD o Controversy: extremes of normal personality or separate categories altogether? § In DSM-5, separate categories are used for clinical diagnosis § Dimensional models are used for research Cluster A Personality Disorders (odd-eccentric) • Cluster A PD’s o Have unusual ways of relating and thinking, but no delusions or hallucinations o “Schizophrenia spectrum” § Often occur in people with 1 degree relatives with schizophrenia § Can tell reality from fantasy?? Can or can’t?? § May be paranoid, speak in odd eccentric ways • Paranoid Personality Disorder o Suspects, without sufficient basis, that others are exploiting, harming or deceiving her/him o Preoccupied with unjustified doubts about the loyalty/trustworthiness of friends o Reluctant to confide in others because of unwarranted fear that the information will be used maliciously against her/him o Reads hidden demeaning or threatening meanings into benign remarks/events o Persistently bears grudges (i.e., is unforgiving of insults, injuries or slights) o Perceives attacks on her/his character or reputation that are not apparent to others and is quick to react angrily or to counterattack o Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner o Main points § Suspiciousness and mistrust of others § Tendency to see self as blameless § On guard for perceived attacks by others § Interpersonal behavior: withdraw or act aggressively/arrogantly • Schizoid Personality Disorder o Neither desires nor enjoys close relationships, including being part of a family o Almost always chooses solitary activities o Has little, if any, interest in having sexual experiences with another person o Takes pleasure in few, if any, activities o Lacks close friends or confidants other than first-degree relatives o Appears indifferent to the praise or criticism of others o Shows emotional coldness, detachment or flattened affectivity o Main points § Impaired social relationships § Inability and lack of desire to form attachments to others § Not anxious § Interpersonal behavior: withdrawn, show little emotion in interpersonal interactions • Schizotypal Personality Disorder o Ideas of references (excluding delusions of reference) o Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy or “sixth sense”) o Unusual perceptual experiences, including bodily illusions o Odd thinking and speech (e.g., overelaborate or stereotyped) o Suspiciousness or paranoid ideation o Inappropriate or constricted affect o Behavior or appearance that is odd, eccentric or peculiar o Lack of close friends of confidants other than first-degree relatives o Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self o Main points § Peculiar thought patterns • Superstitious thinking • Ideas of reference § Oddities of perception and speech that interfere with communication and social interaction • Unusual perceptual experiences § Interpersonal behavior: blunted affect; tangential speech • Epidemiology of Cluster A o Lifetime Prevalence § Paranoid: 2.3% - 4.4% § Schizoid: 3.1% - 4.9% § Schizotypal: 0.6% - 4.6% o Gender Ratio § Males > Females Cluster B Personality Disorders (dramatic-emotional) • Histrionic Personality Disorder o Is uncomfortable in situations in which he or she is not the center of attention o Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior o Displays rapidly shifting and shallow expression of emotions o Consistently uses physical appearance to draw attention to self o Has a style of speech that is excessively impressionistic and lacking in detail o Shows self-dramatization, theatricality and exaggerated expression of emotion o Is suggestible (i.e., easily influenced by others or circumstances) o Considers relationships to be more intimate than they actually are o Main points § Self-dramatization and theatricality § Over-concern with attractiveness • Controls others through seduction and emotional manipulation § Discomfort if no the center of attention § Physical appearance used to draw attention § Unsatisfying relationships- partners get tired providing so much attention • Narcissistic Personality Disorder o Grandiose sense of self-importance (e.g., exaggerates achievements/talents, expects to be recognized as superior without commensurate achievements o Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love o 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) o Requires excessive admiration o Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations o Is interpersonally exploitative (i.e., takes advantage of others to achieve her/his own ends) o Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others o Is often envious of others or believes that others are envious of her/him o Shows arrogant, haughty behaviors or attitudes o Main points § Grandiosity § Preoccupation with receiving attention § Self-promoting § Lack of empathy § Sense of entitlement § Bragging • Causal Factors: Histrionic and Narcissistic o Attention vs. Admiration o Histrionic § Maybe a common underlying predisposition with Antisocial PD § Extreme expression of both Neuroticism and Extraversion § Maladaptive schemas • “Unless I entertain people, no one will like me” • “People will leave me if I don’t captivate them” o Narcissistic § Low on Agreeableness, High on Openness and Neuroticism § Social learning theory • Unrealistic parental overvaluation (parents pamper and indulge child) • Epidemiology: Histrionic and Narcissistic o Lifetime Prevalence § Histrionic: 2-3% § Narcissistic: 1-6.2% o Gender Ratio § Histrionic: Females > Males § Narcissistic: Males > Females • Antisocial Personality Disorder o Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest o Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure o Impulsivity or failure to plan ahead o Irritability and aggressiveness, as indicated by repeated physical fights or assaults o Reckless disregard for safety of self or others o Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations o Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another o Main points § Violates social norms and values § Criminal offenses § Poor impulse control § Sensation seeking § History of conduct problems as a child • Psychopathy o Not all people with antisocial PD are psychopaths o Characteristics of psychopathy § Superficial charm § Usually absence of anxiety § Unreliability § Untruthfulness and insincerity § Lack of guilt remorse, shame § Proactive violence § Failure to learn by experience § Egocentric § Unstable interpersonal relations § Impulsivity § Impersonal sex § Failure to follow any life plan o Two Dimensions § Affective interpersonal factor • Lack of remorse and guilt, callousness/lack of empathy, glib and superficial charm, inflated and arrogant self- appraisal § Impulsive antisociality factor (similar to antisocial PD) • Antisocial, impulsive, and socially deviant lifestyle (poor behavioral control and parasitic lifestyle) o 80% with psychopathy meet criteria for ASPD o Psychopathy is the best predictor of violence and recidivism • Epidemiology: Antisocial Personality Disorder o Prevalence § 1 – 3.3% lifetime (psychopathy < 1%?) o Gender Ratio § 3:1 Male to Female o Comorbidity § Substance use disorders o No racial/ethnic differences in rates o Sociocultural Influence § ASPD and Psychopathy occur in a wide range of cultures § Exact manifestations and prevalence are influenced by sociocultural context • Less prevalent in cultures with strong discouragement of aggression • Cultures characterized by individualism have higher rates than those characterized by collectivism • Borderline Personality Disorder o Impulsiveness o Rocky interpersonal relationships o Fear of abandonment o Inappropriate anger o Drastic mood shifts o Chronic feelings of bore o Non-suicidal self-injury and/or suicidal behavior o Transient, stress-related paranoid ideation or severe dissociative symptoms o Epidemiology § Most commonly diagnosed PD § Prevalence • 1.6-5.9% § Gender Ratio • 3:1 females in treatment settings (3:1 ratio) • Equal male to female ratio in general population § Comorbidity • Mood disorders, SUDs, eating disorders, and other PDs Cluster C Personality Disorders (anxious-fearful) • Avoidant Personality Disorder o Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection o Is unwilling to get involved with people unless certain of being liked o Shows restraint within intimate relationships because of the fear of being shamed or ridiculed o Is preoccupied with being criticized or rejected in social situations o Is inhibited in new interpersonal situations because of feelings of inadequacy o Views self as socially inept, personally unappealing, or inferior to others o Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing o Main points § Hypersensitivity § Shyness § Insecurity in social interaction and initiating relationships § Will likely meet criteria for Social Anxiety Disorder • Dependent Personality Disorder o Difficulty making everyday decisions without an excessive amount of advice and reassurance form others o Needs others to assume responsibility for most major areas of her/his life o Has difficulty expressing disagreement with others because of unrealistic fear of loss of support or approval o Has difficulty initiating projects of doing things on his or her own (lack of self-confidence in judgment or abilities not lack of motivation of energy) o Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant o Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself o Urgently seeks another relationship as a source of care and support when a close relationship ends o Unrealistically preoccupied with fears of being left to take care of themselves o Main points § Difficulty separating in relationships § Discomfort at being alone § Subordination of needs in order to keep others involved in a relationship § Indecisiveness • Obsessive-Compulsive Personality Disorder o Excessive concern with order, rules and trivial details o Perfectionism often interferes with accomplishments o Lack of expressiveness and warmth o Difficult relaxing and having fun o No true obsessions or compulsive rituals o Rigid with schedule o Stubborn, upset about changes Schizophrenia and Other Psychotic Disorders 4/14/16 Schizophrenia • The hallmark of schizophrenia is psychosis: being unable to tell the difference between what is real and unreal • Symptoms need to last at least 6 months • **Not Dissociative Identity Disorder** • Symptom categories o Positive (something is being added to the person’s experience) § Delusions: erroneous belief that is fixed and firmly held despite contradictory evidence • Common types o Thought broadcasting (worried people can hear their thoughts) o Persecution (someone trying to hurt them/coming after them) o Reference (they think a message is directed specifically toward them) o Thought insertion/withdrawal (the belief that other people can insert/withdraw thoughts into their head) • Bizarre vs. Non-bizarre o Implausible for culture vs. plausible for culture o Cheated, poisoned, spied upon, plotted against § Hallucinations: a sensory experience that seems real but occurs in the absence of any real stimulus • Can occur in any sensory modality o Auditory (75%) – not good things they hear o Visual (40%) – see something unpleasant to them o Olfactory o Tactile/Haptic o Gustatory • Auditory hallucinations often interact with an individual: o By commenting on their behavior o By ordering them to do things o By warning them of impending dangers o By talking to other voices about the individual • Visual hallucinations o Can be very clear or vague/distorted § From seeing a shadow move out of the corner of one’s eye to seeing a loved one turn into a demon o Negative (something is being taken away from the person’s experience) § Flat affect: not displaying much emotion • Expression vs. experience § Alogia: poverty of speech § Asociality: IP impairments § Apathy: decreased interest § Negative symptoms suggest poor prognosis o Disorganized § Speech • Loose associations (tangential speech) o Words/phrases that may seem illogical o E.g., “Here is your medication, XVX” Response: “Blue” • Clang associations (kind of like a poet) o “Eating wires setting fires” • Neologisms o Looks like a real word o E.g., “detone” “flowable” • Word salad (combining words into a sentence that don’t form sentences § Behavior • Disruption in goal directed activity • Cannot maintain hygiene • Disregard for safety • Unusual dress § Catatonic symptoms • Absence of all movement, speech • Rigidity, hold unusual postures without seeming discomfort • DSM-5 Criteria o 2 or more of the following for at least one month: § Delusions (90%) § Hallucinations § Disorganized speech § Disorganized or catatonic behavior § Negative symptoms o Social/occupational impairment o Total disturbance at least 6 months • Epidemiology o Lifetime prevalence: 0.3-0.7% o Found in almost all cultures, although some variability in prevalence § Higher prevalence in low-SES communities § African Americans are more likely to be misdiagnosed with schizophrenia o More common in men than women (maybe because estrogen is a protective factor) o Higher risk (2-3x) if father > age 45 at birth o Comorbidity § Anxiety § Depression § Substance Use • Onset of Schizophrenia o Onset = early adulthood § Men earlier and more severe than women § Women have bimodal onset § Rapid in small number of cases, but slow, insidious onset in most cases o Prognosis was poor before introduction of antipsychotic medications • Correlates of better prognosis o Good premorbid functioning o Acute onset o Later age of onset o Being female (estrogen protective) § Bimodal onset in women when estrogen levels decrease o Treatment with antipsychotic medication o Good inter-episode functioning o No family history of schizophrenia Other Psychotic Disorders (disturbance cannot be the result of substance use) • Schizoaffective Disorder: combination of schizophrenia and mood disorder o Meet criteria for a Mood Disorder episode (timing can be somewhat different) o A Major Depressive Episode or a Manic Episode (Bipolar and Depressive Type) o During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms o Symptoms that meet criteria for a mood episode are present for a large portion of the total duration of the active and residual periods of the illness • Schizophreniform Disorder: like schizophrenia but only 1-6 months duration o Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated) § One must be: delusions, hallucinations, or disorganized speech o An episode lasts 1-6 months o No major depressive or manic episodes have occurred concurrently with the active-phase symptoms • Delusional Disorder: delusions, but otherwise normal behavior o The presence of one of more delusions for at least a month o Note: Hallucinations, if present, are not prominent and are related to the delusional theme § E.g., the sensation of being infested with insects associated with delusions of infestation o Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd o Themes of Delusions § Erotomanic type: belief that another person is in love with them § Grandiose type: conviction of having some great (but unrecognized) talent or having made some important discovery § Jealous type: one’s spouse or lover is unfaithful § Persecutory type: belief that she/he is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals § Somatic type: bodily functions or sensations § Mixed type: no one delusional theme predominates § Unspecified type: cannot be clearly determined or is not described in the specific types • Brief Psychotic Disorder: usually lasts only a matter of days o Presence of one or more of the following symptoms § One must be: delusions, hallucinations, disorganized speech § Grossly disorganized or catatonic behavior o Duration of an episode of the disturbance is between 1 day – 1 month, with eventual full return to premorbid level of functioning
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