ABNORMAL PSYCH FINAL REVIEW

Personality

the way we act, think, & feel that make each of us unique
-stable across time/situations

Personality disorders

long-standing (stable) pattern of maladaptive behaviors, thoughts, & feelings
-features must be evident by early adulthood

Diagnosis for Personality disorders

-Major depression
-Generalized anxiety disorder
-Paranoid personality disorder

Personality Clusters

1. Cluster A: "odd eccentric"
2. Cluster B: "dramatic-emotional"
3. Cluster C: "anxious-fearful

Cluster A

Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

Cluster B

Antisocial Personality Disorder
Histrionic Personality Disorder
Borderline Personality Disorder
Narcissistic Personality Disorder

Cluster C

Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

Paranoid Personality Disorder

pervasive distrust & suspiciousness of others; their motives interpreted as malevolent
-tend to misinterpret situations in line with their suspicions
ie wife's excitement = having an affair
-onset by early adulthood
-present in a variety of contexts

Paranoid Personality Disorder Prevalence & Course

-0.5 to 5.6% of general population
-in treatment, 3x more men than women
-chronic course
-paranoid PD inevitably contributes to other disorders

Family History Studies for Paranoid Personality Disorders

-somewhat more common in families of people with schizophrenia
-twin & adoption studies have not yet been done

Cognitive Theory of Paranoid Personality Disorder

This personality disorder results from:
1) underlying belief that other
people are malevolent & deceptive
2) lack of self-confidence about
being able to defend oneself

Schizoid Personality Disorder

*pervasive detachment from social relationships
&
restricted range of expression of emotions in interpersonal settings (interactions)*
-onset by early adulthood
-present in a variety of contexts

Prevalence of Schizoid Personality Disorder

-very rare: 0.4 to 1.7% lifetime prevalence
-3x more men than women

Biology of Schizoid Personality Disorder

-indirect evidence of relationship to Schizophrenia
-twin studies indicate personality traits associate with schizoid personality are heritable

Treatment of Schizoid Personality Disorder

psychosocial treatments focus on increasing social skills/contacts & increasing one's awareness of own feelings

Schizotypal Personality Disorder

-pervasive social & interpersonal deficits
-acute discomfort & reduced capacity for close relationships
-cognitive or perceptual distortions & eccentricities
-onset in early adulthood
-present in a variety of contexts

Prevalence of Schizotypal Personality Disorder

-0.6 to 5.2% lifetime prevalence
-2x more men than women

Biology of Schizotypal Personality Disorder

-studies suggest genetic relationship between Schizotypal PD & Schizophrenia
-Schizotypal PD may be milder form of Schizophrenia

Treatment of Schizotypal Personality Disorder

-same drugs that treat Schizophrenia
-AND increased social contact, social skills training

Antisocial Personality Disorder

-failure to confirm
-deceitfulness
-impulsivity, failure to plan ahead
-irritability & aggressiveness
-reckless disregard for safety of self or others
-consistent irresponsibility
-lack of remorse

Psychopathy

-a clinical concept related to ASPD, but not included in the Diagnostic nomenclature
-includes personality features along with behavior

Nature of Psychopathy

-glibness (superficial charm)
-grandiose sense of self-worth
-proneness to boredom/need stimulation
-pathological lying
-conning (manipulative)
-lack of remorse
-parasitic lifestyle

Checkley Psychopathy

-low emotional reactivity
-lack of remorse
-overall good psychological well-being
-charming, but insincere
-easily bored/need of stimulation
-pathological lying
-was ASPD until DSM-III b/c diagnosis became more behaviorally based
-current more reliable or

John Wayne Gacy

-example of a psychopath
-rapist & serial killer of young men

Ted Bundy

-example of a psychopath
-rapist/kidnapper that assaulted & killed women
-was handsome & charismatic used to lure them

Successful Psychopaths

-superficially charming, glib, cold, callous, & lack of empathy
-able to function effectively in the business world
-possible differences with psychopaths who are arrested/incarcerated?

Antisocial Personality Disorder Prevalence

-3% lifetime prevalence
-most common personality disorder
-men more likely to be diagnosed than women
-no real ethnic differences

Antisocial Personality Disorder Correlates

-related with low levels of education
-80% of people diagnosed w/ASPD abuse substances

Biological Factors of Antisocial Personality Disorder

-genetic predisposition
-executive functions
-low arousability
-testosterone

Psychological Factors of Antisocial Personality Disorder

harsh & inconsistent parenting
-interpretation of interpersonal
situations in ways that promote
aggression

Treatment of Antisocial Personality Disorder

-most don't believe they need treatment
-most treatments attempt to control anger & impulsive behaviors by:
-recognizing triggers
-developing alternative coping
strategies
-some treatments also attempt to develop empathy
-drug treatment evidence inconclus

Borderline Personality Disorder

-frantic efforts to avoid real or imagined abandonment
-unstable & intense relationships
-identity disturbance
-impulsivity in 2+ damaging areas
-recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
-affective instability
-chronic f

Prevalence of Borderline Personality Disorder

-1 to 2% lifetime prevalence
-more commonly diagnosed in women & hispanics

Course of Borderline Personality Disorder

-chronic & distressing course
-50% have used some kind of patient mental-health services
-75% attempt suicide
-10% die by suicide

Biological Theory of Borderline Personality Disorder

-evidence of genetic transmission mixed
-amygdala activation
-impulsivity related to low levels of serotonin

Fundamental Deficit in Emotion Regulation
(Borderline Personality Disorder Theory)

Etiology/Maintenance of Symptoms:
1. extreme emotional reactions lead to impulsivity
2. emotional experiences are discounted, criticized by others
3. Support from others is necessary to cope
4. individuals lacking self-confidence & become manipulative

Treatment of Borderline Personality Disorder

Dialect Behavior Therapy:
-emotion regulation
-mindfulness
-interpersonal skills training
-distress tolerance

Histrionic Personality Disorder

-uncomfortable in situations in which not the center of attention
-interactions characterized by inappropriate sexual or provocative behavior
-rapidly shifting, shallow expression of emotion
-consistent use of physical attention to draw attention to self

Histrionic Personality Disorder Prevalence

1.3 to 2.2% lifetime prevalence

Histrionic Personality Disorder Theory

-more likely to be separated or divorced than married
-usually present for treatment for exaggerated medical conditions or other mental disorders

Histrionic Personality Disorder Treatment

no treatments have been tested

Narcisstic Personality Disorder

-grandiose sense of self-importance
-preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
-believes he/she is special, unique & can only be understood by or associated with other special/high status people
-requires ex

Narcisstic Personality Disorder Prevalence

<1% lifetime prevalence

Narcisstic Personality Disorder Psychodynamic Interpretation

narcissitic behavior is a reaction to poor self-worth

Narcisstic Personality Disorder Cognitive Interpretation

indulgent parenting encourages exceptional view of self

Narcisstic Personality Disorder Treatment

don't seek treatment UNLESS confronted with severe interpersonal problems

Avoidant Personality Disorder

-avoids occupational activities involving social contact
-unwilling to get involved with people
-restraint within intimate relationships
-preoccupied with being criticized or rejected
-inhibited in new interpersonal situations
-views self as socially inep

Avoidant Personality Disorder Prevalence & Course

-1% 12-month prevalence
-no gender differences
-comorbid with mood & anxiety disorders

Dependent Personality Disorder

-difficulty making everyday decisions
-needs others to assume responsibility for major areas of his/her life
-difficulty expressing disagreement with others
-difficulty doing things on his or her own
-lengths to obtain nurturance or support from others
-f

Dependent Personality Disorder Prevalence & Course

-<1% lifetime prevalence
-more women than men
-one study estimated heritability to be ~0.8
-CBT use to increase assertive behaviors & decrease anxiety

Obsessive-Compulsive Personality Disorder

-preoccupied with rules, lists, order, organization, or schedules such that the main point is lost
-perfectionism interferes with task completion
-excessively devoted to work
-overconscientious
-unable to discard worn-out/worthless objects
-reluctant to d

Obsessive-Compulsive Personality Disorder Prevalence & Course

-DOES NOT EQUAL OCD
-1.9 to 4.7% prevalence
-prone to depression & anxiety (but to a less extent than other cluster C's)
-usually treated with Cognitive Behavioral therapies

Problems with Personality Disorders

1. Diagnostic overlap & reliability
2. Gender Biases
3. Ethnic/Racial Biases

Diagnostic overlap & reliability
(Problem with Personality Disorders)

-most people meet criteria for >1 PD
-diagnosing requires info that is hard to obtain
-believed to be stable: symptoms vary over time in number & severity

Gender Biases
(Problem with Personality Disorders)

-histrionic, dependent, & borderline PD more likely to be diagnosed in females
-antisocial, paranoid, & obsessive compulsive PD more likely to be diagnosed in males

Ethnic/Racial Biases
(Problem with Personality Disorders)

many over diagnose paranoid & antisocial PD in African Americans because they perceive violence & hostility

Health Psychology

-behavioral medicine
-biological factors (genetics, age, sex)
-social factors (culture, STRESS)
-psychological factors (smoking, exercising, diet)

Factors of a stressful event

-uncontrollability
-unpredictability
-duration

Allostasis

-body learns to react more efficiently to stress
-not to be so severe
-not to persist for long periods of time

Allostatic load

caused by persistent uncontrollable & unpredictable stress
-when stressor is chronic (cannot fight or flee)
-constant psychological arousal leads to extreme physical damage to the body

Psychological Factors of Stress

1. Appraisals & pessimism
2. Coping strategies
-avoidance coping
VS.
-talking about emotions & seeking
social support
3. Physical Health

Coping

-gender differences
-marriage
-culture

Sleep Deprivation

-impairs memory, learning, reasoning, decision making, math & learning abilities
-can be deadly
-over half of all Americans
-effects are cumulative

Stages of Sleep

-Awake
-Step 1
-Step 2
-Step 3&4
-Step 5: REM Sleep

Awake Stage
(of Sleep)

brain waves are measured by an electroencephalogram (EEG)

Step 1
(of Sleep)

-light sleep
-brain activity decreases
-become relaxed
-drift in & out of consciousness
-5 to 10 min

Step 2
(of Sleep)

-brain activity slows & muscles relax more
-heart rate slows
-body temperature decreases
-eye movements cease
-accounts for 45-65% of time spent sleeping

Step 3&4
(of Sleep)

Delta Sleep"
-deepest sleep
-necessary to feel fully rested upon waking
-10 to 30 min

Step 5: REM Sleep
(of Sleep)

-brain waves resemble wakefulness
-heart rate & blood pressure increase
-rapid/irregular breathing
-most dreaming occurs
-10 to 20 min

REM Facts

-we dream more during REM sleep than during non-REM sleep (Stages 1-4)
-REM dreams are more intense than non REM
-REM sleep is likely biologically essential
-our bodies are paralyzed during REM sleep

Dyssomnias

1. insomnia
-10 to 15% of adults
-more common in women
-distress about sleeplessness
maintains the disorders
-cognitive model
-sleep hygiene
2. hypersomnia
3. narcolepsy
4. sleep apnea

Parasomnias

1. nightmare disorder
2. sleep terror disorder
3. sleepwalking disorder

Involuntary commitment

court ordered confinement to inpatient mental health facility

Criminal commitment

incompetent to stand trial & insanity defense

Competence to Stand Trial in Florida

1. understand severity of charges
2. understand adversarial nature of criminal justice system
3. understand the role & function of Courtroom personnel
4. able to work with attorney in preparing a defense
5. able to behave appropriately in court
6. able to

Competence to Stand Trial in General

-approximately 60,000 per year in the U.S.
-concerned with current functioning
-defendant evaluated by licensed psychologist
-psychologist may be called to testify
-varies by state, by generally judge determined whether someone is competent
-defendant mus

Incompetent to Stand Trial (IST)

-involuntarily committed to mental health facility
-competency must be re-evaluated periodically (every 6 months)
-if never found competent:
-Dead docket: postponed
indefinitely but may be reinstated
at any time
-Nolle Processed: drop criminal
charges
-in

Ricky Ray Rector

Why are these evaluations important?
2002 Atkins vs. Virginia:
executing mentally retarded violates 8th Amendment (cruel & unusual punishment)

Not Guilty by Reason of Insanity (NGRI)

Insanity = legal term
insanity defense: people cannot be held fully responsible if they were mentally ill at the time
-evaluations focuses on mental state at TIME OF THE CRIME
-insanity plea = 1% of cases & successful in about 25% of those cases

Not Guilty by Reason of Insanity Terms

1. the accused was suffering from a delusional compulsion that overmastered his will to resist committing the act
2. accused was unable to distinguish right from wrong in relation to the alleged act (due to mental illness or involuntary intoxication)
3. t

Not Guilty by Reason of Insanity Results

results in hospitalization (longer than if found guilty charges)
-released when determined to not be danger
-conditional release

Conditional release (NGRI)

-must follow certain criteria (attend mental health appointments, take psychotropic meds, live in a certain place, abstain from drugs/alcohol)
-may be on conditional release for rest of life

Guilty but Mentally Ill (GBMI)

-if person has a significant psychiatric treatment history but does not seem to be a factor at time of crime
-can result in separate housing prison
-some evidence that individuals found GBMI are incarcerated in prison longer than those individuals who are

Malingering

the purposeful production of exaggerated feigned symptoms of a mental or physical disorder which is motivated by external incentives
-20 to 30% of defendants
undergoing competency
evaluations have been shown to
be doing this

Sexually Violent Predators

-at least 18 yrs old
-at least 1 conviction for a sexually motivated offense
-in lawful custody

Sexually Violent Predators Eligibility for Commitment

-at least 18 yrs old
-at least 1 conviction for a sexually motivated offense
-in lawful custody
&
-evidence of a mental abnormality/ personality disorder that makes it likely that the person won't commit another sexually violent offense w/out long-term ca

Myths about Sex Offenders

-majority of sexual offenders recidivate
-sexual violence is increasing
-childhood sexual abuse causes person to sexually offend as an adult

Cluster A

have symptoms similar to those w/schizophrenia like inappropriate or flat affect, odd thought/speech patterns, & paranoia BUT maintain grasp on reality

Cluster B

-manipulative, volatile, & uncaring in social relationships
-prone to impulsive/violent behaviors that show little to no regard to safety for others or self

Cluster C

concerned about being criticized or abandoned by others & have dysfunctional relationships with others

Paranoid Personality Disorder Treament

-difficult to treat b/c therapy & therapists are interpreted in line with paranoid beliefs
-cognitive therapy tries to increase their sense of self-efficacy in hard situations thus decreasing their fear & hostility towards others (reduce fear, not challen