1
Q
Personality Disorders
- signs
- prevalence
- Diagnostic criteria
A
Behavior patterns involving overly rigid and maladaptive expression of personality traits; reflect extreme variations on underlying personality traits such as undue suspiciousness, excessive emotionality, and impulsivity.
−Warning signs of P disorder may emerge in childhood with behaviors involving disturbed conduct, depression, anxiety, and immaturity
−Estimated 6 to 10% of population affected
- 18 and older
2
Q
Personality
A
describes the set of distinct traits and behaviors that make us unique and help account for consistency in behavior.
3
Q
Ego syntonic
A
(psychodynamic term) describes how most with P disorder tend to perceive their traits as a natural part of themselves
4
Q
Ego dysntonic
A
describes those with mood and anxiety disorders who do not see their behaviors as parts of their identities.
5
Q
Personality Disorder Clusters
A
- Cluster A: Those who are perceived as odd or eccentric; includes paranoid, schizoid, and schizotypal p disorders
- Cluster B: Those who are perceived as overly dramatic, emotional, or erratic; consists of antisocial, borderline, histrionic, narcissistic p disorders.
- Cluster C: Those who appear anxious; includes avoidant; dependent, and OCD p disorders
6
Q
Personality disorders characterized by odd or eccentric behavior
- common characteristics
A
Includes paranoid, schizoid, and schizotypal disorders
•Often have difficulty relating to others or show little or no interest in developing social relationships
7
Q
Paranoid Personality Disorder
- Prevalence/gender
- Cultural diffs
A
pervasive suspiciousness, tendency to interpret other’s behavior as threatening or demeaning; excessive mistrust in others; overly sensitive to critiscism; readily angered and hold grudges; Tend to remain hyperviligent; deny blame for misdeeds; Not delusional (unlike paranoid schizo)
- Perceived by others as: Aloof, cold, scheming, devious, and humorless, arguementative
- 2.3-4.4% more in men
- immigrants of minorities may seem guarded and defensive but this may reflect unfamiliarity with the language or customs.
8
Q
Schizoid Personality Disorder
- Prevalence/Gender
A
persistent lack of interest in social relationships, flattened affect, and social withdrawal. Social isolation the cardinal feature
• Emotions appear blunt but not to the degree found in schizo
• They rarely experience joy, anger, or sadness; rarely smile
• May seem indifferent to criticism
• Seem to be wrapped up in abstract ideas
- 3.1- 4.9%
- may still have curiosities about ppl and wishes for love they cannot express
In some cases sensitivity is expressed in deep feelings for animals rather than ppl
9
Q
Schizotypal Personality Disorder
- Prevalence/Gender
- Culture
- Spectrum
A
- persistent difficulties in forming close relationships with others and display behaviors, mannersims and thought patterns that seem odd but not disturbed enough to merit schizo.
• Lack of coherent sense of self; distorted self-concept or lack of self-direction.
• Lack the capacity for empathy, lack of understanding how their behavior affects others or misinterprets other’s behaviors.
• Anxious in social situations; Social anxiety often linked to paranoid thinking ( fears that others mean them harm) rather than to concerns about being rejected by others. - 4.6% higher in males
- Higher rates in Blacks than whites or Mex’s
- Appears to share same genetic base as schizo; similar brain abnormalities
however Relatively few of those with this p disorder develop schizo
10
Q
Schizotypal behaviors
-5
A
- May have unusual perceptions or illusions such as feeling precscence of dead family member. (they know person isn’t acutally there)
- May develop ideas of reference such as beleiveing that others are talking about them behind their back
- May engage in magical thinking such as believing they have a sixth sense (can tell future) or that others can sense their feelings.
- they may attach unusal meaning to words and speech may become unusally abstract or vague; thought processes appear odd and marked by metaphorical thinking (but without loose assocs in schizo)
- They may appear unkept and talk to themselves; show little emotion or laugh at wrong times
11
Q
Personality disorders characterized by dramatic emotional or erratic behavior
- common characteristics
A
Antisocial, BPD, Histrionic, Narcisstic
• Exhibit behaviors that are excessive, unpredictable, or self-centered
• Difficulty maintaining relationships and show antisocial behavior
12
Q
Antisocial Personality Disorder
- Diagnostic criteria
- Prevalence/Gender
- Research
- Sociocultural factor
- Key features of antisocial behavior (7)
A
antisocial and irresponsible behavior and a lack of remorse for misdeeds; violate rights of others; disregard social norms; break the law; Use others However, They don’t seek to avoid people; Tend to be impulsive and fail to live up to commitments to others; Often show a superficial charm and posses average intelligence; Have little anxiety when faced with threating situations;Punishments do nothing
- 3+ symptoms
- 6% in men, 1% women
- Most researched p disorder
- Disorder is most common in lower SES groups; one explanation is that ppl with this disorder drift downward occupationally; those with lower SES levels may also be more likely to have parents who modeled antisocial behavior
- Failure to adhere to social rules, norms, laws
- Aggressive behavior
- Lack of responsibility- failure to maintain job due to abscences/ pay debts/ maintain relationships
- impulsive behavior
- Lack of truthfulness (using ppl)
- Reckless behabior
- Lack of remorse for misdeeds
- Failure to adhere to social rules, norms, laws
13
Q
Psychopath and sociopath (2)
A
- Clinicians once used terms such as pscyopath and sociopath to refer to those who are classified as antisocial
- Roots of the word psychopath focus on the idea that there is something amiss pathologically in the person’s functioning; roots of sociopath center on their social deviance
14
Q
Course of Antisocial disorder (2)
A
- emerge before the age of 15 in form of conduct disorder; These early forms of adolescent behavior may include truancy, running away, initiating physical fights, use of weapons, sexual activities, cruelty to people or animals, destruction of property, lying, stealing, robbery
- Overtime antisocial behavior assoc with the disorder tends to decline with age and may disappear by age 40 but no so for the underlying traits assoc with the disorder (egocentric, manipulativeness, lack of empathy, guilt, remorse, callousness towards others) these may even increase with age
15
Q
Antisocial behavior and criminality (5)
A
- Antisocial behavior is assoc with an increase risk of criminality but not all criminal have this personality; many actually law abiding ppl
- Investigators view on two dimensions:
I.Personality dimension- consists of traits such as superficial charm, selfishness, lack of empathy callous, and remorseless use of other (applies to those who have these traits but aren’t law breakers)
II. Behavioral dimension- adoption of unstable and antisocial lifestyle including freq problems with the law, poor employment history, unstable relationships - Many antisocial individuals show both sets of traits
- Only about half of all inmates could be diagnosed with this disorder
- Only a minority of those with the disorder are afoul of the law
16
Q
Profile of antisocial person
- traits
- Hervey Cleckly
- psychopathic traits
- common trait
A
failure to conform to social norms, irresponsibility, aimlessness, lack of long-term goals, impulsivity, outright lawlessness, violence, unemployment, marial problems, sub abuse, disregard for the truth
- argued that the characteristics used to define psychopathic antisocial personality (self-centeredness, irresponsibility, impulsivity, and insensitivity to needs of others) exist not only among criminals but politicians, lawyers, docs and business executives as well.
•Psychopathic traits can be grouped in four basic dimensions:
1.interpersonal factor – grandiosity, superficiality, deceitfulness
2.affective factor – lack of remorse and empathy and failure to accept responsibility
3.antisocial factor- poor behavioral control and antisocial behavior
4.lifestyle factor- characterized by impulsivity and lack of goals
•Irresponsibility, a common trait among antisocial ppl may be seen in a personal history dotted by repeated unexplained absences from work, abandonment of jobs; often extends to financial matters with failure to repay debts
17
Q
Borderline Personality Disorder
- Prevalence/Gender
- Gender behaviors diffs
- Onset
- Culture diffs
- Famous ppl
A
deeps sense of emptiness, unstable self-image, history of unstable relationships, dramatic mood changes, impulsivity, difficulty regulating negative emotions, self-injurious behavior, recurred suicidal behaviors. Often uncertain about values, goals, and even sex orientation. Cannot tolerate being along; Fear of abandonment leads them to be clinging and demanding in relationships. Feelings towards others are intense and shifting
- 1.6-5.9% more in women
- Women tend to show more inwardly directed aggression in forms of self-mutilation; Men tend to show outward expressions
- Usually diagnosed in early adulthood although signs of disorder may be seen in adolescence
- More common among Lat’s than whites and Blacks
- Marilyn Monroe, Lawrence of Arabia, Adolf Hitler, and the philosopher Soren Kierkegaard all had this.
18
Q
“Borderline Personality”
A
Term BP originally used to refer to individuals who’s behavior appeared to be on the border between neuroses and psychoses
19
Q
Central features of BPD
- maladaptive behaviors
- suicide rates (2)
A
difficulty regulating emotions; mood changes from anger to depression
- cutting, substance abuse, and lashing out in anger may be attempts at controlling negative emotions; suicide attempt to escape emotions. Self mutilation may also be attempt to manipulate others
- Three out of four make suicide attempts and about 1 in 10 commits suicide
20
Q
Splitting
A
abrupt shifts in feelings are signs of inability to reconcile the positive and negative aspects of ones experience of oneself and others.
21
Q
BPD symptoms course of development (2)
A
- Many features of BPD tend to improve over period of years
* Impulsivity tends to burn out with increasing age
22
Q
Histrionic personality disorder
- old term
- Prevalence
A
excessive emotionality and overwhelming need to be center of attention; approval; appraise. Tend to be dramatic and emotional but there emotions seem shallow and exaggerated and volatile. • Self-centered and intolerant of delays of gratification Grow restless quickly and crave novelty stimulation; drawn to fads. May have a certain charm; flirty and deducing but too wrapped up for intimate relationships or to have deep feelings.Use physical appearance as means of drawing attention to themselves
- Formerly called hysterical personality ; replacement allowed professionals to distance themselves from the notion that the disorder is intractely bound up with females. (hyster-uterus) However, the disorder is diagnosed more in women
- 1.8%
23
Q
Narcissistic Personality Disorder
- compared to histrionic
- compared to BPD
- Prevalence/Gender
- healthy
- rejection
A
inflated self-image and extreme need for attention and admiration; brag and expect others to praise; self-absorbed and lack empathy for others; insatiable ambition not for money but for adulation that comes with success
• Share features with histrionics such as demanding attention however they have more inflated views of themselves and are less melodramatic
- more organized in thoughts and actions and better relationships
- Affects 1 - 6.2% more than half are men
- A certain degree of narcissism may represent a healthful adjustment to insecurity; shield from criticism; motive for achievement
- Narcissistic injuries is being extremely sensitive to slightest hint of rejection or criticism; hurt deeply because they reopen old psych wounds
24
Q
Personality Disorders Characterized by Anxious or Fearful Behavior
A
Avoidant, dependent, OCP
25
Avoidant Personality Disorder
- Prevalence/Gender
- Comorbidity
avoidance of social relationships due to fear of rejection; only enter relationships with ardent acceptance. Unlike schizoid qualities with whom they share the feature of social withdrawal they do have interest in other and warmth towards people. Fear public embarrassment; stick to routines and exaggerate risks of trying new things
- Affects 2.4%; equally common in genders
- Often comorbid with social anxiety disorder; suggests they may share common genetic factors
May turn out that avoidant p disorder is just severe form of social anxiety disorder
26
Dependent Personality Disorder
- Prevalence/Gender
- Culture
- Controversy
- Other disorder link
difficulty making independent decisions and overly dependent behavior; overly submissive and clinging in relationships; difficulty making independent decisions and overly dependent behavior; overly submissive and clinging in relationships. Overly sensitive to criticism and fear rejection. They may do degrading things to please others
- Less than 1% more in women
• May differ among cultures (arranged marriages/ patriarchal societies)
• Applying diagnosis to women may seem controversial and seem to be blaming the victim bc women in our society are often socialized to dependent roles
- linked to mood disorders and social phobia; also to hypertension, CVD, and gastro disorders like ulcers and colitis
27
Psychodynamic theory of dependent disorder -3
1. Link between this disorder and oral behavior problems like smoking, eating disorders, and alcoholism
2. Psychodynamic theorists trace dependent behaviors to utter dependence of the new born baby and baby’s seeking of nourishment through oral means (food may symbolize love)
3. Those with this disorder often attribute problems to physical rather than emotional causes and seek help from doctors instead of psychologists
28
Obsessive -Compulsive personality disorder
| - Prevalence/Gender
rigid ways of relating to others, perfectionistic tendencies, lack of spontaneity, excessive attention to detail; excessive orderliness; difficulty coping with ambiguity, difficutly expressing feelings and meticulous work habits; often leads them unable to complete work in time
-Affects 2.1-7.9% of the population Twice as common in men as women
29
Problems with the classification of personality disorders -6
1. Categories or dimensions?
2. Problems distinguishing personality disorders form other clinical syndromes
3. Overlap among disorders
4. Difficulty in distinguishing between normal and abnormal behavior
5. Confusing labels with explanations
6. Sexist Biases
30
Personality disorders – Categories or Dimensions? (3)
- Dimensional model of p disorders (2)
- Antisocial on dimensional model
1. are they distinct categories marked by particular symptoms or behavioral OR variations of common personality dimensions found in general population?
2. DSM is categorical and may rely too much on arbitrary cutoffs
3. Many of features assoc with disorders found in general pop
- an alternative to the traditional categorical model of the DSM; depicts p disorders as maladaptive and extreme variations along a continuum of traits in general pop
- Thomas Widiger; p disorders can be represented as exreme varaitions of the following five basic traits of personality that comprise the five-factor model: 1. Neuroticism (or emotional instability) 2. Extraversion 3. Openness to experience 4. Agreeableness (friendliness) 5. Conscientiousness
- low levels of conscientiousness and agreeableness
31
Proposed model for DSM 5.1
| - advantage
Hybrid dimensional categorical model- diagnosis of p disorder would be based on meeting specified criteria for particular disorders (the categorical) together with ratings of extreme or pahtologial tratis (dimensional)
- allows examiners to make judgement of the severity of problem as opposed to merely a dichotomous judgment
32
Problems distinguishing personality disorders form other clinical syndromes (2)
1. Often difficulty distinguishing between OCD and the p disorder
2. Clinical syndromes are believed to be variable over time whereas personality disorders are held to be generally more enduring patterns of disturbance; yet, the features of some p disorders may vary over time and clinical disorders can follow a more chronic course
33
Overlap among disorders (3)
1. Most receiving diagnosis of p disorder meet criteria for more than one
2. Many share common traits such as problems in interpersonal relationships (Example: antisocial p disorder and BPD both have impulsivity, unstable relationships)
3. • Comorbidity is common suggesting that DSM system may not be distinct enough; some disorders may not acutally be disorders but subtypes
34
Difficulty in distinguishing between normal and abnormal behavior - 3
1. P disorders involve p traits wich in lesser degress describe normal ppl
2. Clinicians should only apply diagnosis when the patterns are so pervasice they interfere with functioning or cause distress
3. We still lack the evidence we need to determine the particular points at which personality traits become maladaptive and to justify a diagnosis of p disorder.
35
Confusing labels with explanations - 3
1. May fall into trap of circular reasoning: using behavior to make a diagnosis, then using the diagnosis as an explanation for the behavior.
2. Also, labeling those with disturbing behaviors as have disorder overlooks the social and environmental contexts of the behavior
3. Underpinnings of p disorders do not consider cultural differnces, social inequalities, or gender diffs
36
Sex Biases
1.
2. (research study)
1. Diagnostic criteria may seem to label stereotypical feminine behaviors as pathological with greater frequency than stereotypical masculine behaviors. Ex: histrionic personality- feminine personality: flighty, emotional, shallow, seductive, attention seeking.
2. Researchers presented case to 311 psychologists; half of the smapel was presented with a case as a female other male. Clinicians more often diagnosed the case identifies as female as having BPD
37
Psychodynamic theorists and their focused personality
Hans Kohut (Narcissim), Otto Kernberg (BPD), Margaret Mahler(BPD)
38
Psychodynamic Perspective
1. Freudian theory
2. Recent theories
3. Limitations
4. Childhood abuse
1. focuses on probs in Oedipus complex as foundation for p disorders; after resolving complex they identify with opposite gender parent and incorp parents morals into superego
2. focused on earlier pre-Oedipal period of 18 months to 3 years during which infants begin to develop identities separate from those of their parents; this theory focuses on the development of the sense of self in explaining disorders like narcissistic and BPD
3. based largely on inferences from behavior and retrospective accounts of adults rather than observation of children
4. linked to later development of p disorder suggesting failure to form close bond with parents plays role
39
Hans Kohut
- his theory?
- Personality is?
- Narcissitic personality?
- Childhood stage
Developed "self psychology"
- Unlike Freud who thought resolution of Oed complex central to developing personality, Kohut said what matters most was how the self develops- self-esteem, values, cohesive realistic sense of self as opposed to narcissistic personality.
- mount façade of self-importance to cover up deeper feelings of inadequacy. Narcissist’s self- esteem is like a reserviour that needs to be constantly replenished with a steady stream of praise and attention
- Early childhood involves a normal stage of healthy narcissism. Infants feel powerful as though world revolves around them, they perceive parents as towers of strength and wish to be one with them and share their power.
40
Hans Kohut
- Empathetic parent
- Non empathetic parent
- The empathetic parent nourishes their self-esteem or can be critical but eventually unrealistic expectations fade and replace with more realistic ones - Childhood idealization is transformed into realistic admiration for parents, friends ect. In adulthood these ideas develop into a set of internal ideals, values, and goals.
- sets the stage for pathological narcissism-> involves construction of a grandiose façade of self-perfection that cloaks perceived inadequacies. Façade always on brink of crumbling and needs to be constantly replenshised with reassurance that one is special. Children who are not prized by their parents fail to develop self-esteem. Feel in cable of being loved and admired.
41
Kohut's therapy
provides clients who have narcissistic personalities with an initial opportunity to expres their grandiose self-images and to idealize the therapist. Overtime the therapist helps them explore the childhood roots of narcissim and points out imperfections to encourage clients to form more realistic images of self and others.
42
Otto Kernberg
- BPD view
- View of parent's role
views BPD in terms of failure in early childhood to develop a sense of constancy and unity in ones image of self and others
BPD individuals cannot synthesize contradictory (pos and neg) elements of themselves and others into complete stable wholes. Rather than view ppl in lives as sometimes loving and sometimes regjecting they shift back and forth between pure idealization and pure hatred. (Splitting)
- even excellent parents fail to meet all their child’s needs; infants therefore face the early developmental challenge of reconciling images of the nurturing, comforting good mother whith those of the withoholding frustrateding bad mother; Failure to reconcile these opposing images into unity of parental image may effect child by psychologically fixtated in pre-oedipal stage
43
Margaret Mahler
- 2
- BPD view
BPD in terms of separation from mother figure; during first year infants develop symbiosis attachment to mother. - Symbiosis is interdependence meaning to live together; state of oneness which child’s identity is fused with mother’s. Separation-individuation is the development of a separate identity form mother and recognition of personal traits that define ones identity; may be a stormy process bc child may vacillate between seeking greater independence and shadowing mother. - Tendencies of those with BPD to react to others with ambivalence and to alt between love and hate are suggestive of these early sep-indiv processes; BPD may arise form failure to master this developmental challenge
44
Learning Perspective
- view of p disorders
- cause
- limitations
- Theorist and disorder focused
•Focus on maladaptive behaviors rather than disorder of personality. Interested in identifying the learning histories and environmental factors that gave rise to behaviors assoc with disorders and reinforcers that maintain them
- Suggest that childhood experiences shape the pattern of maladaptive habits of relating to others
- grounded in theory rather than in obsevations of family interactions
- Theodore Millon (OCP & Histio)
45
Theodore Millon
- OCP
- Histrionic
- suggests that children whose behavior is rigidly controlled and punished may develop perfectionistic standards. As they mature they strive to develop themselves in an area in which they excel as a way of avoid parental criticism; but bc of overattention to a single area they don’t become well-rounded
- rooted in childhood experiences which social reinforcers like parental attention are connected to childrs appearance and willingness to perform for others especially when reinforcers are dispensed inconsistenly. Inconsistent attention teaches them not to take approacal for granted and to strive for it continually. Those with this disorder also may identify with the dramatic parent. Extreme sibling rivalry also increases motivation to perform for others.
46
Socio Cognitive theory
- focused on
- Theorists and focused disorders (2&2)
emphasisze role of reinforcemtn in explaining antisocial behaviors; also show that the ways in which ppl with disorders interpret their social experiences influences behavior.
- Ulmann & Krasner (antisocial)
- Payl Babiak & Dave Hare (Psychopathy)
47
Ullman & Krasner
- Antisocial disorder
- Normal children
- Antisocial children
- Limitation
proposed that ppl with antisocial disorder failed to learn to respond to to other ppl as potential reinforcers.
- Most children learn to treat others as reinfroceing agenst bc they praise them for good behavior.
• In contrast those with antisocial p disorders are not socialized in this way bc early learning expereicnes lacked consistency. May have been sometimes rewarded for things but not often.
As adults they do not place much value on what others expect bc as children they see no connection between behavior and reinforcement
• Although Ulmann and Krasner’s views may account form some fearure of antisocial p disorder, they may not adequately address the development of the charming type of antisocial p disorder
48
Paul Babiak & David Hare
pointed out the numbers of psychopathic personalities who attain executive positions where they can control others and use charm to cause damage to others, exceeds the numbers in prisons or in society by far
49
Albert Bandura
showed that children acquire skills, by observing others. However he did not believe that children and adults display aggression in mechanical way rather they don’t imitate behavior unless provoked and believe they will be rewareded for it.
50
Evidence of Antisocial ppl
1. emotions
2. antisocial adolescents
- difficulty reading emotions in other’s especially the emotion of fear.
- Antisocial adolsescents tend to have hostile cog biases- they incorrectly interpret other people’s behavior as threatening
51
Therapy for antisocial children
Problem solving therapy - therapy helps aggressive antisocial children and teen reconceptualize conflict situations as problems to be solved rather than as threats to be responded to aggressively. Chilren learn to generate nonviolenet soultions to social confrontations and test the promising ones.
52
Family perspectives
1. BPD
2. Dependent
3. OCP
-rate of antisocial children who have been neglected
1. Researchers find that those with BPD remember their parents as having been more controlling and less caring; When BPD ppl recall their earliest memory likely to paint significant others as evil; “Splitting” is function of having learned to cope with unpredictable and harsh behavior form parents
2. Fear of abandonment may also evolve from failure to make secure bonds with parent.
3. may emerge with a strongly moralistic and rigid family environment which doesn’t permit minor deviances form expected roles
- Although family factors may be implicated many neglected children do not later show antisocial or other abnormal behaviors.
53
Mixed view of antisocial disorder
-mix between psychodynamic and learning theories focused on role of parental rejection or neglect; suggest that children normally learn to assoc parental approval with conformity to paraentaly practices and disapproval with disobedience. When temtped to transgress children feel anxious about losing parental love, Anxiety signals the child to inhibt antisocial behavior. Eventually the child identifies with parents and internalizes these social controls in the form of a conscious, When parents do on t show love for their children, this identification does not occur. Children does not fear loss of love bc they never had it.
54
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Biological perspective (4)
4 theories
```
1. Genetics
2. Lack of emotional response
3. Craving for stimulation model
4. Brain Abnormalities
55
Genetic factors
- implicated in what disorders?(4)
- implicated in what traits?(4)
- BPD
- interaction of genetics and?
- antisocial, narcissistic, paranoid, and borderline types
- trats that underliey the psychopathic personality such as callousness, antisocial behavior, impulsivity and irresponsibility
- genetic indicators in a particular chromosome linking to features of borderline personality disorder
- p traits assoc with p disorders may represent interactions of genetics with life experiences; investigators found a variant of a particular gene assoc with antisocial behavior in adult men but only those with bad childhood.
56
Lack of emotional response
Hervey Cleckley said ppl with antisocial personalities can maintain their compsure in stressful situations that would induce anxiety in most ppl.
Lack of anxiety in response to stress may help explain the failure of punishment to induce them to relinquish behavior
−Ppl with antisocial disorder fail to inhibit behavior that has led to punishment in the past, perhaps bc they have little fear about being punished.
−Galvanic Skin Response sign of activation of sympathetic branch of ANS; Hare showed that ppl with antisocial personalitites had lower GSR levels when they were expecting painful stimuli; ANS of ppl with antisocial p is underresponsive to threats
57
Craving for stimulation model
Antisocial personlaity’s lack of emotial response may be due to levels of stimulation necessary to mainatian an optimal level of arousal. Optimal level of arousal is degree at which you feel best and function most efficiently
Those with antisocial disorder appear to have exaggerated cravings for stimulation; perhaps they require a higher than normal threshold of stimulation to get state of arousal- may explain why they tend to beomce more bored easily and use dangerious activities to stimulate arousal
58
Brain Abnormalities
1. Antisocial and BPD
2. Antisocial
3. BPD
1. dysfunctions in parts of the brain involved in regulating emotions and restraining impulsive behaviors Areas most implicated are PFC and deeper limbic system
−PFC involved in controlling impulsive behavior, weighing consequences, and solving problems (keeps impulses from becoming expressed in violent or aggressive behaviors)
−Limbic involved in processing emotions and forming memories
2. Brain imaging shows diffs involving circuit that connects the amygdala in limbic to PFC (may explain difficulties with impulse control prolcems that we see)
3. possibility that the PFC fails to inhibit impulsive behaviors in face of strong negative emotions
59
Sociocultural Perspective
| - Antisocial (3)
1. reported most freq among low SES so stressors encountered by these families may contribute
2. Neglect and abuse may translate into lack of empathy and disregared for welfare of other that are assoc with antisocial ppl
3. Children in poverty also likely to be exposed to deviant role models
− Maladjustment in school may lead to alientation and frustration with the larger society
60
IPDE
| - outcome?
Goal of WHO, US drug and Mental health Admin was to develop and standardize instruments that could be used to arrive at psychiatric diagnoses worldwide; result was international personality disorder exam a semistructured interview protocol for diagnosing personality disorders
− Turned out to be reliable although more research is needed, investigators found the BPD and avoidant to be most freq diagnosed
61
Psychodynamic treatments
- Main goal
- challenges
- Promising results for? Do?
- With BPD
•Used to help them become aware of roots of self-defeating behavior patterns and learn more adaptive ways of relating to others.
-those with BPD and narcissitic often present challenges to therapist
• structured forms of psychodynamic oriented therapies in treating p disorders- these therapies raise client’s awareness of how their behaviors cause problems in relationships.Therapist takes a more direct confonrtational approach that address the clients defenses
• therapist helps clients better understand their own and other ppls emotional responses in context of relationships.
62
CBT treatment
- Focuses
- two forms of therapy
•Focuses on changing their maladaptive behaviors and dysfunctional thought patterns rather than personality structures.
1. Beck: focuses on helping them identify and correct disortortions such as tendencies to see oneself as completlely defective, bad and helpless
2. Marsha Linehan: DBT
63
DBT
- treats, combines
- "Dialectic"
- Treating patients
- Results
-designed to treat BPD; combines CBT and Buddhist mindfulness meditation to help them accept and tolerate stong negative emotions and learn more adaptive eays of realting to others.
•Dialectic applies to form of reasoning in which you consider both sides of an argument and try to reconcile them through rational discussion; attempts to reconcile the contradictions of acceptance and change
•DBT therapists recognize the need to show acceptance of ppl with BPD by validating their feelings while also gently encouraging them to make adaptive changes in their behavior
•The tension between acceptance and mild encouragement of change constitutes the dialectical approach
- DBT has shown good benefits
64
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Biological Treatments
(Drugs)
(BPD)
(Results)
(other meds)
```
−Drug therapy doesn’t directly treat disorders
−Antideps sometimes used to treat depression and anxiety
−NeuroT activity implicated in aggressive behavior in BPD. Serotonin helps put brakes on impulsive behaviors
−SSRI’s (Prozac) increase serotonin in synaptic connections between neurons and can help with feelings of anger
− However we have yet to see antidpeps produce any substantial effect relative to placebo in treating BPD
− Atypical antipsychotics may have benefits in controlling aggressive and self-destructive behavior in ppl with BPD but effects are modest and bad side effects
65
Impulse-control Disorders
| - comorbidity
failure to control impulses, temptations, or drives, resulting in harm to oneself or others. Experience rising level of tension or arousal just prior to the impulsive act followed by a sense of relief after act
- Often have other disorders especially mood disorders; leads investigators to question whether they should be classified within a broader spectrum of mood disorders
66
Kleptomania
- Prevalence/Gender
- Diff from OCD
- Psychodynamic view
repeated acts of compulsive stealing; stolen objects typically of little value;
- Rare less than 1%; more in W 3:1 ratio
- those with OCD expereicne only temp relief from anxiety when they perform compulsive acts; by contrast ppl with klepto experience excitement or gratification when they steal;
- klepto as defense against unconscious penis envy in women and castration anxiety in men
67
IED
- Prevalence rates
- Biological perspective
impulsive aggression, feelings of rage, destroy property; core feature is impulsive aggression; Typically they attempt to justify their behavior but feel remorse or regret become of harm they caused
- Becoming more common as other disorders
-serotonin which puts brakes on impulsive behavior
Prozac shown promise in treatment of aggression
PFC functioning which curbs impulses may be impaired
68
Pyromania
- Prevalence
- motive for fire setting
compulsive fire setting in response to irresistible urges
- Only small percentage of arsonists diagnosed with this
- Anger and revenge
Abnormal
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