Psychopathology (PSYC 4240) Day 13
Psychopathology (PSYC 4240) Day 13 PSYC 4240
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This 7 page Class Notes was uploaded by Selin Odman on Thursday June 2, 2016. The Class Notes belongs to PSYC 4240 at University of Georgia taught by Miller in Summer 2016. Since its upload, it has received 15 views. For similar materials see Psychopathology in Psychology (PSYC) at University of Georgia.
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Date Created: 06/02/16
Psychopathology (PSYC 4240) – Day 13 6/2/16 Personality and Personality Disorders -Can’t really talk about personality disorders with talking about personality Funder: personality is “an individual’s characteristic patterns of thought, emotional, and behavior.” Millon: A personality trait is “a long-stranding pattern of behavior expressed across time and in many different situations.” Five Factor Model: Openness to Experience (not applicable to all cultures) Conscientiousness Extraversion Agreeableness Neuroticism A personality trait is a long-standing pattern of behavior expressed across time and in many different situations Personality disorders are composed of personality traits that are -Inflexible (adaptive personality is flexible but not unstable) -Maladaptive -Causes significant functional impairment or subjective distress The Nature of Personality and Personality Disorders -Enduring and relatively stable predispositions (i.e. ways of relating and thinking) -Predispositions are inflexible and maladaptive, causing distress and/or impairment -Coded on Axis II of the DSM-IV and DSM-IV-TR Problems: PD’s “neighbor” and reputation Consequences of Personality Disorders Various personality disorders are associated with: -Decreased social functioning -Decreased occupational functioning -Increased risk of substance abuse -Increased risk of depression and anxiety -Increased risk of schizophrenia -Increased risk of suicide -Increased risk of imprisonment or hospitalization The DSM-IV/5 gives these general criteria for all personality disorders An enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: -Cognition: ways of perceiving and interpreting self, other people, and events (i.e. believing you’re worse or better than you actually are) -Affectivity: range, intensity, lability, and appropriateness of emotional response (i.e. having a big range or smaller range of emotions that may have too much or too little intensity) -Interpersonal functioning -Impulse control The enduring pattern is inflexible and pervasive across a broad range of personal and social situations The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning The pattern is stable and of long duration, and its onset can be traced back to adolescence or early adulthood Theoretical Issues Dimensional versus Categorical -Borderline PD: 5 of 9 symptoms for diagnosis; 4 of 9 no diagnosis -Once someone is diagnosed, homogeneity is assumed; most patients look alike 125 ways to have 5 Borderline PD symptoms -Not meeting criteria (i.e. 3 or 4 symptoms) is not the same of being asymptomatic -Dichotomizing dimensional variables always result in loss of information -Cut-off are not empirically derived; don’t look different and don’t functioning differently -Causes problems with stability and inter-rater reliability (i.e. 5 symptoms in past, 4 symptoms now; dimensionally stable but categorically not) -Almost unanimous consensus that PDs should be NOT used in a categorical manner Frances (1993): “Not whether, but then and which [dimensions will be considered and when the change will happen].” Comorbidity -If diagnosed with a PD, you’re likely to have more than 1 (usually 4 or 5) Gender Differences Certain PDs believed to be more common in men vs. women -Med: Paranoid, Schizoid, Schizotypal (Cluster A), Antisocial, Narcissistic, OCPD -Women: Histrionic, Borderline, Dependent Coverage: Most common PD diagnosis in clinical practice is PD NOS (Verheul & Widiger, 2004) -Have a PD not recognized by the DSM -Have features of more than one PD but don’t meet criteria for any specific PD but features cause distress/impairment 10 DSM-5 Personality Disorders: Cluster A “The Weird” Paranoid PD: a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent Schizoid PD: is a pattern of detachment from social relationships and a restricted range of emotional expression Schizotypal PD: is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities or behavior 10 DSM-5 Personality Disorders: Cluster B “The Wild” Antisocial PD: is a pattern of disregard for and violation of the rights of others (i.e. psychopathic criminals) Borderline PD: is a pattern of instability in interpersonal relationships, self-image, and affects and marks impulsivity Histrionic PD: is a pattern of excessive emotionality and attention seeking Narcissistic PD: is a pattern of grandiosity, need for admiration, and lack of empathy 10 DSM-5 Personality Disorders: Cluster C “The Worried” Avoidant PD: is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Dependent PD: is a pattern of submissive and clinging behavior related to the excessive need to be taken care of OCPD: is a pattern of preoccupation with orderliness, perfectionism and control Assessment Issues Self-report vs. other report -problems with both Gold standard? -Use semi-structured interviews Fundamental Questions: Can psychopathy be captured by the Five Factor Model? Psychopathy: glib and superficial charm, grandiose sense of self-worth, pathological lying, conning/manipulative, lack of remorse or guilty, callous/lack of empathy, impulsivity, irresponsibility, early behavior problems, parasitic lifestyle, failure to accept responsibility for own actions Theoretical Implications Dimensional vs. Categorical: using a general model of personality is very clearly a dimensional approach, no attempt to delineate normal from “disordered” Comorbidity: # of PD diagnoses patients typically receive varies: 2.4 to 4.6 -Trait approach to comorbidity: comorbidity is expected to the extent that the same board domains and/or specific traits underline the varies PDs -Narcissism and Antisocial should be comorbid given the strong shared component of Antagonism Gender Differences -Gender differences in prevalence rates of PDs should be consistent with gender differences in general personality functioning -Meta analyses of gender differences in personality support: Men lower in Agreeableness – Antisocial, Narcissistic; Women higher in Neuroticism – Borderline, Dependent Coverage: Most common PD diagnosis in clinical practice – PD NOS -Use of general trait models provides substantial breadth to understand personality pathology DSM-5 was set to use a radical new approach, reflecting the type of FFM-like work described -Viewed as too untested at the last moment and put in Section III for further study -DSM-IV PDs imported unchanged into the main portion of the DSM-5 DSM-5 Section III approach -Moderate or greater impairment in personality (self/interpersonal) functioning -One or more pathological traits -Inflexible/pervasive -Longstanding Impairment Self -Identity: experience oneself as unique, with clear boundaries between self and others; stability of self-esteem and accuracy of self-appraisal; capacity/ability to regulate emotional experience -Self-direction: pursuit of coherent and meaningful short and long-term goals; use of constructive and prosocial internal standards of behavior ability to self-reflect Interpersonal -Empathy: comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding the effects of one’s own behavior on others -Intimacy: depth and duration of connection with others; desire and capacity for closeness; mutuality of regard reflected in interpersonal behavior DSM-5 trait model 5 domains (25 specific traits) -Negative Affectivity -Detachment -Antagonism -Disinhibition -Psychoticism Only 6 disorders would remain: schizotypal, antisocial, borderline, narcissistic, avoidant, and OCPD DSM-5 Section III: Antisocial PD Impairment: egocentrism; goal setting based on personal gratification; lack of concern for other; exploit, deceive, dominant, coercive) Traits: (6 of 7) Manipulative, callousness, deceitfulness, hostility, risk taking, impulsivity, irresponsibility Personality Disorders: Statistics Prevalence of PD -About 0.5-2.5% of the general population -10-30% in inpatient settings -up to 15% in outpatient settings Origins and Course of Personality Disorders -Thought to begin in childhood: predicted by childhood sexual, physical and emotional abuse; neglect. -Childhood psychopathology predicts later PD status -Pretty chronic, but not as chronic or untreatable as people thought -Comorbidity rates are high Gender Distribution and Gender Bias -Men: Cluster A, APD, Narcissistic, OCPD -Women: Borderline, Histrionic (?), Dependent (?) -Do these differences come from a bias? Maybe? -Gender bias exists in diagnosis (given the same symptoms description, diagnosis changes based on male/female) -Criterion vs. assessment gender bias Cluster A: Paranoid PD (supposed to be dropped in DSM-5) Overview and Clinical Features -Pervasive and unjustified mistrust and suspicion Causes -Biological and psychological contributions are unclear -Early learning that world is a dangerous place -Living in an unsafe environment, lower SES -Evidence unclear whether it is a variant of a psychotic disorder; research suggests yes Treatment Options -Few seek professional help on their own -Treatment focuses on development of trust -Cognitive therapy to counter negativistic thinking -Lack good outcome studies Cluster A: Schizoid PD (supposed to be dropped in DSM-5) Overview and Clinical Features Pervasive pattern of detachment form social relationships -Not interested in close relationships -Little interest in sexual experiences -No close friends -Indifferent to praise or criticism Very limited range of emotions in interpersonal situations -Takes pleasure in few things -Flattened affectivity; appears cold and detached Causes -Etiology is unclear -Preference for social isolation resembles autism; extreme variant of shyness/introversion? Treatment Options -Few seek professional help on their own -Focus on the value of interpersonal relationships -Building empathy and social skills -Lack good outcome studies Cluster A: Schizotypal PD (almost moved to Schizophrenia subtypes) Overview and Clinical Features -Odd and unusual behavior, appearance, and cognition -Most are socially isolated, highly suspicious -Magical thinking, ideas of reference, and illusions -Unusual perceptual experiences -Many meet criteria for major depression Causes -A phenotype of a schizophrenia genotype? -Diagnosis came as a result of research on family members of people with SZ; higher rates of schizotypal PD in family members of patients with SZ -Generalized cognitive deficits Treatment Options -Main focus is on developing social skills -Treatment also addresses comorbid depression -Medical treatment similar to SZ: use of antipsychotics but not very effective -Treatment prognosis is poor but not as bad as SZ (***usually, SZ patients want to get to this schizotypal level during treatment) Cluster B: Antisocial PD Overview and Clinical Features -Noncompliance with social norms -Violate rights of others -Irresponsible, impulsive, and deceitful -Lack empathy and remorse -Lack concern for safety of self or others -Must be evidence of Conduct Disorder before age 15 Psychopathy and Antisocial Personal Disorder (APD) have similar constructs but operationalized differently (personality traits vs. behavior) -Asymmetrical: 90% of criminal psychopaths meet the criteria for APD; 20- 30% of inmates with APD also meet criteria for psychopathy (probably b/c cutoff from psychopathy is stringent) Relation with Conduct Disorder and Early Behavior Problems -Early histories of behavioral problems -Families with inconsistent parental discipline and support (i.e. inconsistent discipline, harsh punishment like physical abuse) -Families have histories of criminal and violent behavior (evidence of genetic impact on criminality and APD) -ADHD and conduct disorder may be a “recipe” for later psychopathy Neurobiological Contributions and Treatment of Antisocial Personality Prevailing Neurobiological Theories -Brain damage: little support for this view -Under arousal hypothesis: cortical arousal is too low Future criminals have lower skin conductance activity, lower resting heart rate, and more slow frequency brain activity -Cortical immaturity hypothesis: cortex is not fully developed Based on evidence that Theta waves are correlated with psychopathy; theta waves uncommon in adults; could be due to lack of anxiety -Fearlessness hypothesis: fail to responds to danger cues -Gray’s model of “behavioral inhibition system” paired with an overactive “behavioral activation system” -Response modulation difficulties Treatment -Few seek treatment on their own; tend to externalize blame -Antisocial behavior is predictive of poor prognosis -Emphasis is placed on prevention and rehabilitation -Often incarceration is the only viable alternative
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