Notes on Personality Disorders - Abnormal Psychology | PSYCH 383, Study notes of Abnormal Psychology

Download Notes on Personality Disorders - Abnormal Psychology | PSYCH 383 and more Study notes Abnormal Psychology in PDF only on Docsity! Personality Disorders 11/11/2011 I. On Personality Disorders A. Personality- pattern of characteristic traits, coping styles, and ways of interacting with the social environment Personality disorder- an enduring pattern of traits, coping styles, and ways of interacting that is so inflexible and maladaptive that the individual’s ability to function adaptively and in compliance with society’s norms is significantly impaired o Onset is not later than early adulthood; may not come to clinical attention until relatively later in life o Classified on Axis II  Individuals with a personality disorder coded on Axis II will often have a clinical syndrome that is coded on Axis I o Etiology:  Comorbidity B. Diagnostic Criteria – pg. 59 o The enduring pattern is manifested in two (or more) of the following areas:  Cognition  Affectivity  Interpersonal functioning  Impulse control o Personality disorder is not dependent on the situation; it cuts across all situation; defines who the individual is as a person o Leads to clinically significant distress or impairment in functioning o The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood  II. Three Clusters of Personality Disorders A. Cluster A: odd and eccentric o Schizotypal  More common in men  Peculiar thought patterns  Oddities of perception and speech  Most strongly related to schizophrenia o Schizoid (Loner)  More common in men  Impaired social relationships  Inability to form attachments to others o Paranoid – pg. 60  Think others are “out to get them”  Have difficulty building relationships and getting along with others  Bears grudges  Preoccupied w/ unjustified doubts about the loyalty or trustworthiness of friends  Has recurrent suspicions regarding fidelity of spouse or sexual partner B. Cluster B: dramatic, emotional, and erratic o Histrionic  Equally common among genders  Self-dramatization  Over-concern with attractiveness  Tend to be irritable and may have temper tantrums if they feel they are not receiving enough attention  Self-centered o Appear before early adulthood o Are typical of the individual’s long term functioning (general behavior in most all situations) o Do not occur exclusively during an episode of an Axis I disorder  Distinguishing between the ten personality disorders o Diagnostic criteria are not as sharply defined. o People often show characteristics of more tan one personality disorder o High level of comorbidity amongst the personality disorders  Distinguishing between a personality disorder and a personality trait o Personality Disorder Not Otherwise Specified (NOS) o Disorder of personality functioning that does not meet criteria for any specific personality disorder o Only becomes a personality disorder when it’s maladaptive (definition on top of page 54)  IV. Categorical Versus Dimensional Model for Personality Disorders  Categorical Perspective- Each of the personality disorders are qualitatively distinct with their own set of defining criteria  Dimensional Model- Suggests that personality disorders represent maladaptive variants of normal personality traits o Occurs on a continuum (Normal to Maladaptive: Mildly or Severely)  V. Course and Treatment  Once diagnosed, usually fairly stable  Some disorders are more likely to remit with age (Borderline personality & Antisocial)  OCD & Schizotypal are least likely to remit  Treatment o Very difficult o Have relatively enduring, pervasive, and inflexible patterns of behavior and inner experience o Do not believe that they need to change and so are reluctant to enter therapy o Medication doesn’t usually help much – increased rates of suicide o Cluster C disorders seem to respond the best to treatment (The ones based on anxiety & fear) o Cluster A disorders seem to be most resistant to change o Not much research – relative newcomer to the DSM o Cognitive Therapy – works well for people with avoidant disorder of Cluster C (the individual who is shy and reluctant to initiate and maintain relationships)  Borderline personality disorder – has received the most attention because of its high risk of suicide. Schizophrenia and Other Psychotic Disorders11/11/2011 O 1) On Schizophrenia  Psychotic Disorder o Inability to distinguish reality from fantasy o Prototypical of abnormality o Effects our thinking, what we feel and how we express it, our behavior, and our perceptual ability o “Best example of abnormal behavior” o Occurs in every culture in people from all walks of life o 1 out of 100 individual will experience a schizophrenic episode o 1% is significant due to the severity of the illness  Age of Onset o Onset is typically in late adolescence and early adulthood  Men – 25  Women – 29  Rarely occurs in childhood  Gender Differences o Men: earlier onset, a little more severe in nature, slightly higher prevalence, worse long-term functioning  Poor Insight o At the beginning, may notice something is not quite right but once fully psychotic – they do not realize they are wrong  Myth o Violence is associated with Schizophrenia o Most individuals with schizophrenia are not going to be violent. o Echolalia- pathological, parrot-like or apparently senseless repetition of a word or phrase just spoken by another person; potential symptom of both catatonic schizophrenia and autism o Echopraxia- repetitive imitation of the movements of another person o Undifferentiated- symptoms that meet the defining criteria for schizophrenia are present, but additional criteria are not met for the Paranoid, Disorganized, or Catatonic Type; “catch all” for schizophrenia o Residual- absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior, but continuing evidence of this disturbance is present in a milder form  IV. Etiological Factors for Schizophrenia  In many cases, disorders are caused by multiple disorders that work together  Strong genetic component o Family studies: odds of being schizophrenic  1/100 – if you are a member of a random group of 100 people  1/10 – if you have an afflicted first-degree biological relative  ½ - if you have an afflicted monozygotic twin o Twin studies- have shown that the concordance rate for schizophrenia is higher for monozygotic twins than dizygotic twins o Not entirely genetic, just genetically influenced; individual can inherit a genetic predisposition for the disorder o Genetic predisposition for developing schizophrenia:  Multiple genes works together to make an individual susceptible to schizophrenia  The more schizophrenia genes inherited  more likely to develop schizophrenia  Environmental factors o Prenatal virus factors o Early nutritional deficiencies o Birth complications  Neurodevelopmental disorder- disorder that stems from a brain lesion that occurs very early in development, perhaps before birth  Schizophrenogenic mother- cold and aloof mother who causes schizophrenia; part of a false hypothesis about the cause of schizophrenia  V. Outcome and Treatment for Schizophrenia A. Outcome o 16% of schizophrenics will recover fully o 38% will have a favorable outcome; given that they stay on medication, or continue treatment of some kind, they will probably be able to function pretty well o 33% will have continued signs of the illness, despite the continuation of medication and treatment o 12% will need long-term institutionalization o We are getting much better at recognizing symptoms, diagnosing it early, and treatment it B. Pharmacological treatment o 1950s – first generation of antipsychotic medications; many bad side effects o 1980s – second generation of antipsychotics; much fewer side effects; alleviate the positive and negative symptoms of schizophrenia; utilize dopamine  Schizophrenia and dopamine  Receptor cells supersensitive to dopamine  excess of dopamine in schizophrenics  Antipsychotic drugs act to block some of the dopamine receptors (thus reducing the amount of dopamine) o Recently discovered that estrogen has some clinical benefits; women with schizophrenia can be given estrogen to minimize schizophrenic symptoms Sexual and Gender Identity Disorders 11/11/2011  I. On Sexual and Gender Identity Disorders   II. Same-Sex Orientation  A. What is sexual orientation  Erotic or romantic attraction one or both sexes  B. Prevalence of Sexual Orientations  Same Sex Orientation o 5% of adult men o 3% of adult women  Believed to be an underestimation  Bisexuality believed to be rare, however it is difficult to measure so may be more common than we think  C. Historical Changes in our Understanding and Treatment of Same-Sex Orientation 1. Homosexuality as a crime, a sin or a sickness o 3 Way Venn Diagram (Crime, Sin, Sickness) with a little overlap each way o Individuals who committed this crime were often incarcerated or killed 2. Kinsey on homosexuality (1940s/1950s) o Conducted large national survey about sexual attitudes and behaviors o Found that homosexual behavior was more common than previously believed o Started challenging existing beliefs about homosexuality o Many believe that the 1950s was when the gay rights movement really began, but didn’t catch momentum until the 60s 3. The 1960s and the Stonewall Riot 1. Sex- refers to the biological/physical differences of the sex chromosomes of the sex chromosomes and sex organs of males and females o Sex chromosomes o Internal genitalia o External genitalia 2. Physical Intersex Condition- a disconnect between the components that define your biological sex o True Hermaphrodite- typically XX, 1 ovary and 1 testis, external genitalia ambiguous o Pseudohermaphrodite- XY with testes and female/ambiguous genitalia, XX with ovaries and male/ambiguous genitalia 3. Gender- refers to the psychosocial condition of being masculine or feminine o Assumed to be approximate for a given sex by members of a society: behaviors, traits, interests o Gender identity- one’s view of oneself as a male or female 4. Transexualism- a disconnect between one’s biological sex and one’s gender or gender identity o Transsexual- an individual who views himself or herself as being the sex opposite his or her biological sex; can be male or female; cross dress because it fits their gender identity B. Gender Identity Disorder- DSM-IV-TR diagnosis for transsexuals who report significant distress over their condition C. Gender Identity Disorder NOS- this alternative diagnosis is for disorders n gender identity that do not meet all the criteria for Gender Identity Disorder D. Transvestism (Transvestic Fetishism)- paraphilia in which a heterosexual male achieves sexual arousal by wearing women’s clothing  Transvestites are only heterosexual males IV. Normal Sexual Response Cycle A. Female sexual response cycle 1. Excitement o Vasocongestion- engorgement of blood vessels o Transudation- vaginal lubrication o Tenting effect- lengthening and expansion of vagina; elevation of uterus o Fibrillations- rapid, irregular contractions of the uterus o Sex flush- reddening or darkening of the skin, often in the facial region o Myotonia- increase in muscle tension o Increase heart rate, blood pressure, and respiration 5. Plateau o Orgasmic platform- engorged tissue at outer portion of vagina; results in narrowing of vaginal opening o Seminal pool- small pocket at back of vagina; seminal fluid collects here o Orgasm- rapid and rhythmic contractions of the uterus and anal sphincter (muscle that surrounds the anal opening) 6. Resolution- period during which the female’s body returns to a pre-aroused state  B. Male sexual response cycle 1. Excitement o Vasocongestion o Penile tumescence (erection) o Widening of urethral opening o Thickening of scrotal sac and elevation of testes o Sex flush o Myotonia o Increase in heart rate, blood pressure, and respiration 2. Plateau o Erection maintained o Continued vasocongestion, sex flush, and myotonia o Darkening of penis o Droplets of fluid from Cowper’s gland appear on tip of penis 3. Orgasm o Orgasm Stage 1: Emission stage of ejaculation  Seminal fluid collects in urethral bulb  Bladder sphincter closes  Subjective feeling of ejaculatory inevitability o Orgasm Stage 2: Expulsion stage of ejaculation  Contractions of urethral bulb and urethra  Semen expelled through urethra 4. Resolution o Period during which the male’s body returns to a pre-aroused state o Also referred to as the refractory period   V. Sexual Dysfunctions  A. Sexual dysfunctions- pg. 69; recurrent sexual problems that interfere with normal sexual performance and cause distress for the individual and/or cause interpersonal difficulty; Axis 1  Lifetime prevalence of sexual dysfunctions: o 43% of women o 31% of men  Though stimulation can receive orgasm, but not intercourse  Typically victims of rape and others experience timidity towards this 5. Sexual dysfunctions due to a general medical condition o Ex: male erectile disorder due to diabetes o Criteria:  Marked distress or interpersonal difficulty  Fully explained by direct physiological effects of a general medical condition 6. Substance induced sexual dysfunction o Criteria:  Marked distress or interpersonal difficulty  Fully explained by substance abuse  C. General causes of sexual dysfunction 1. Medications and illicit drugs o Alcohol  take away or defer sexual desire  Interferes with male erection  Interferes with orgasm and time to develop one  Decrease intensity in women  Antidepressants  same side effects as alcohol o Psychological factors  Anxiety  Depression  Guilt or shame  Past sexual drama (rape) o Relationship problems  Control issues  Resentment  Fear of intimacy  D. Treatment of sexual dysfunctions 1. Trends o Assess medical and psychological o Assess relationship as a whole o Only see one therapist for both partners o Relapse prevention 2. Medical treatments o Surgical implants  Men with erectile dysfunction get penile replacement o Oral medications  Viagra (can cause headaches and blurred vision) o Sex therapy  Go to counselor together  Stress mutual responsibility  Emphasized education  Modify attitudes and expectations  Eliminate performance anxiety  Address impersonal factors   VI. Paraphilias  A. About deviant sexual behavior 1. Historical development of atypical sexual behavior o Law, Religion, & Medical Science have all shaped the definition o Changes in our understanding of Sexually Deviant Behavior: Revisions of the DSM  DSM I (1950s) - included category of disorders called sexual deviations  DSM II (1970s) – Removed homosexuality as a deviant disorder  DSM IV (1990s) – Refers to sexual deviations as paraphilias 2. Distinctions in terminology o Freud – called them perversions (that’s why we call people perverts) a. Atypical (or uncommon) sexual behavior o Uncommon and not practiced by the majority of individuals; ex: same sex orientation b. Sexually deviant (or abnormal) behavior (paraphilia) o Involves a pathological component that is distressing to the person or causes problems in his or her life c. Atypical vs. sexually deviant practices o Deviant practices are atypical, but atypical behavior is not necessarily deviant  B. DSM-IV-TR criteria for paraphilia