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Lecture

PSY 325 NOV 23 2012.doc

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School
Ryerson University
Department
Psychology
Course
PSY 325
Professor
Karen Milligan
Semester
Fall

Description
PSY 325 L11 11/23/12 **ADDED IN LECTURE CLASS #11 PERSONALITY DISORDERS CON'TAND EATING DISORDERS TREATMENT OF PDS • SOCIAL SKILLS TRAINING (E.G., SCHIZOTYPAL) • PROBLEM SOLVING SKILLS TRAINING • ANGER MANAGEMENTAND RELAPSE PREVENTION (E.G.,ASPD) • CBT FOR PD’S • DBT (E.G, BPD) • RELAXATION TECHNIQUES (E.G, OCPD) DSM-5 • NEW DIAGNOSTIC CRITERIAPROPOSED FOR PERSONALITY DISORDER TYPES: • ANTISOCIAL • AVOIDANT • BORDERLINE • NARCISSISTIC • OBSESSIVE-COMPULSIVE • SCHIZOTYPAL • DEPENDENT, SCHIZOID, PARANOID AND HISTRIONIC PDSARE ALL BEING REMOVED • FOR MORE INFORMATION REGARDING REVISIONS, VISIT: WWW.DSM5.ORG CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS • SIMILAR BEHAVIOURS AS SEEN IN SCHIZOPHRENIA • HOWEVER, THEY RETAIN MORE OFAGRASP ON REALITY • “SCHIZOPHRENIASPECTRUM” (SEE NIGG & GOLDSMITH, 1994) • PRECURSOR TO OR AMILDER FORM OF SCHIZOPHRENIA. • HIGHER PREVALANCE IN FIRST DEGREE RELATIVES WITH SCHIZOPHRENIA CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS PARANOID PERSONALITY DISORDER • CHRONIC AND PERVASIVE MISTRUSTAND SUSPICION OF OTHERS • HYPERVIGILANT TO CUES • OVERLY SENSITIVE TO CRITICISM OR POTENTIAL CRITICISM. • PREVALENCE – 0.5 TO 5.6 % OF POPULATION IN US • MALES OUTNUMBER FEMALES 3:1 • INTERPERSONAL RELATIONSHIPS ARE UNSTABLE PSY 325 L11 • PROGNOSIS IS GENERALLY POOR, WITH THEIR SYMPTOMS INTENSIFYING UNDER STRESS. IMPACTED BY POOR EMOTION REGULATION CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS PARANOID PERSONALITY DISORDER – COGNITIVE THEORY • DISTORTED BELIEFS • PEOPLE ARE MALEVOLENTAND DECEPTIVE + • LACK OF SELF-CONFIDENCEABOUT BEINGABLE TO DEFEND ONESELF AGAINST OTHERS (BECK & FREEMAN, 1990) PARANOID PD - CBT • DIFFERS FROM TRADITIONALCBT • THERAPIST CANNOT DIRECTLY CONFRONT THE CLIENT'S PARANOID THINKING • RELY ON MORE INDIRECT MEANS OF RAISING QUESTIONS IN THE CLIENT'S MIND ABOUT HIS OR HER TYPICALWAY OF INTERPRETING SITUATIONS. • GOAL IS TO LEARN TO TRUST MORE THERAPY EXAMPLE FROM TEXT THERAPIST: YOU'RE REACTINGAS THOUGH THIS IS AVERY DANGEROUS SITUATION.WHATARE THE RISKS YOU SEE? ANN: THEY'LL KEEP DROPPING THINGS AND MAKING NOISE TOANNOY ME. THERAPIST: SO YOU DON'T THINK THERE'S MUCH CHANCE OF THEM ATTACKING YOU OR ANYTHING? ANN: NAH, THEYWOULDN'T DO THAT. THERAPIST: IF THEY DO KEEP DROPPING THINGS AND MAKING NOISES, HOW BAD WILL THAT BE? ANN: LIKE I TOLD YOU, IT'S REALAGGRAVATING. IT REALLY BUGS ME. THERAPIST: SO IT WOULD CONTINUE PRETTY MUCHAS IT'S BEEN GOING FOR YEARS NOW. ANN: YEAH. IT BUGS ME, BUT I CAN TAKE IT. THERAPIST:AND YOU KNOW THAT IF IT KEEPS HAPPENING, AT THE VERY LEAST YOU CAN KEEP HANDLING IT THE WAYYOU HAVE BEEN—HOLDING THE AGGRAVATION IN, THEN TAKING IT OUT ON YOUR HUSBAND WHEN YOU GET HOME. SUPPOSE WE COULD COME UPWITH SOME WAYS TO HANDLE THE AGGRAVATION EVEN BETTER OR TO HAVE THEM GET TO YOU LESS. IS THAT SOMETHING YOU'D BE INTERESTED IN? CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS SCHIZOID PERSONALITY DISORDER • NOT INTERESTED IN ANDAVOIDS RELATIONSHIPS • MAYAPPEAR COLD • RELATIONSHIPS VIEWEDAS UNREWARDING, MESSY, AND INTRUSIVE • PREVALENCE: 0.4-1.7% • CAN FUNCTION BUT CHOOSE OCCUPATIONS WITH LITTLE SOCIAL INTERACTION • TWIN STUDIES – PERSONALITYTRAITS OF LOW SOCIABILITYAND LOW WARMTH MAY BE PARTIALLY INHERITED (COSTA& WIDIGER, 2002) CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS SCHIZOID PERSONALITY DISORDER & TREATMENT • INCREASING SOCIAL SKILLS, SOCIAL CONTACTS, AND SELF-AWARENESS • SOCIAL SKILLS TRAINING MAY INCLUDE ROLE PLAYS, BEHAVIOURALEXPERIMENTS CLUSTERA:ODD-ECCENTRIC PERSONALITY DISORDERS SCHIZOTYPAL PERSONALITY DISORDER PSY 325 L11 • SOCIALLY ISOLATED • SPEECH IS TANGENTIAL, VAGUE OR OVERELAPBORATE • 4 COGNITIVE DISTORTIONS ◦ PARANOIA OR SUSPICIOUSNESS ◦ IDEAS OF REFERENCE ◦ ILLUSIONS ◦ ODD BELIEFS OR MAGICALTHINKING- SUPERSTITIOUSNESS CLUSTERA: ODD-ECCENTRIC PERSONALITY DISORDERS SCHIZOTYPAL PERSONALITY DISORDER • INFORMATION PROCESSING WEAKNESS ARE SIMILAR TO SCHIZOPHRENIA(WORKING MEMORY, RECALL, ATTENTION) • SIMILAR DYSREGULATION OF DOPAMINE AS SCHIZOPHRENIA • NOTAS SEVEREAS SCHIZOPHRENIA • MORE COMMON IN MALES (2:1) • GENETICALLY TRANSMITTED, IN PART TREATMENT = CBT & MEDICATION CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS AVOIDANT PERSONALITY DISORDER • MOST STUDIED • AVOID INTERACTIONS THAT MAY BE ASSOCIATED WITH CRITICISM • WHEN THEY DO INTERACT ►RESTRAINED, NERVOUS, HYPERVIGILANT TO CUES OF CRITICISM • DEPRESSEDAND LONELY (AT RISK FOR DOUBLE DEPRESSION- DYSTHYMIAAND MAJOR DEPRESSIVE DISORDER) • WANT RELATIONSHIPS BUT FEEL UNWORTHY CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS AVOIDANT PERSONALITY DISORDER • 1-7% OF POPULATION • OVERLAP WITH SOCIAL PHOBIA • GENERALIZED FEAR AND SENSE OF INADEQUACYVS. FEAR OF SPECIFIC SITUATIONS • BROADER PATTERN OFAVOIDANCE (E.G., AVOIDANCE OF EMOTIONAL DISTRESSAND DISCOMFORT WITH POSITIVE EMOTIONS) CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS AVOIDANT PERSONALITY DISORDER • LITTLE RESEARCH ON GENETIC BASIS BUT SOME RESEARCH SUGGESTS LINK VIA TEMPERAMENT (SHY, FEARFUL) • COGNITIVE THEORIES ►DISTORTED BELIEFS ABOUT BEING WORTHLESS • COGNITIVE AND BEHAVIOURALTREATMENTS – FOCUS ON SKILLS TRAINING, BEHAVIOURAL EXPERIMENTSAND CHALLENGING NEGATIVE AUTOMATIC THOUGHTS CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDER DEPENDENT PERSONALITY DISORDER • ANXIETY IS EXPERIENCED IN RELATIONSHIPS DUE TOADEEP NEED TO BE CARED FOR BY OTHERS • CANNOT MAKE DECISIONS FOR THEMSELVES OR INITIATE ACTIVTIES (UNLESS ACTING TO PLEASE OTHERS) • DO NOT FEAR CRITICISM PSY 325 L11 • 1.6-6.7%, MORE COMMON IN WOMEN • FREQUENTLY SEEK TREATMENT (CBTAND BT) ◦ GOAL IS TO INCREASEASSERTIONAND INDEPENDENCE CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS • OBSESSIVE COMPULSIVE PERSONALITY DISORDER • SIMILAR TO OCD IN TERMS OF FEATURES BUT IS AGENERALIZED PATTERN OF NAVIGATING ONE’S WORLD • EGODYSTONIC VS. EGOSYNTONIC (IN LINE WITH PERSONALITY) (DISTRESS) • 1.7% -7.7% • MORE COMMON IN MEN THAN WOMEN • PRONE TO DEPRESSION CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS OBSESSIVE COMPULSIVE PERSONALITY DISORDER • FREUD – OCPD REFLECTEDAFIXATIONAT THE ANAL STAGE • COGNITIVE THEORY = DYSFUNCTIONAL BELIEF ►FLAWS OR MISTAKES VIEWEDAS INTOLERABLE. • TREATMENT IS SUPPORTIVE AND BT/ERP ATTACHMENTAND PERSONALITY DISORDERS WHAT IS ATTACHMENT? • AN EFFECTIVE BOND BETWEEN INFANTAND PRIMARY CAREGIVER (AINSWORTH, BLEHAR, WATERS, & WALL, 1978) • SURVIVAL MECHANISM – “SAFE HAVEN” • CHILD IS ABLE TO MOVE IN AND OUTAND EXPLORE APOTENTIALLY DANGEROUS WORLD KNOWING THAT CAREGIVER IS THERE FOR THEM (BOWLBY, 1988) • WHEN SAFETY IS THREATENED, THE ATTACHMENT SYSTEM IS “ACTIVATED”AND INFANT BEHAVES IN AN ORGANIZED MANNER TO ENSURE PROXIMITY TO THEIR CAREGIVER • ACTIVATION OCCURS WHENACHILD IS: ◦ EMOTIONALLY UPSET (AFRAID, SAD) ◦ PHYSICALLY HURT ◦ ILL • INFANTS DEVELOP EXPECTANCIES OR WORKING MODELS ABOUT THEIR PARENTSABILITY TO FULFILL THE ROLES OF PROTECTOR, PROVIDER, AND EMOTION REGULATOR • WORKING MODELS INFLUENCE EMOTION REGULATION, RESPONSE APPRAISAL, AND BEHAVIOUR (JOHNSON & WHIFFEN, 1999) PATTERNS OFATTACHMENT SECURITY • STRANGE SITUATION (AINSWORTH ETAL., 1978) SECURE (65%) --AUTONOMOUS • SEEK PROXIMITYTO CAREGIVER • MAINTAIN PHYSICAL CONTACT • SHOW LITTLE OR NOAVOIDANCE • SETTLE QUICKLYWHEN THE CAREGIVER IS PRESENTANDAREABLE TO RETURN TO EXPLORING ► BOTH EXPRESS AFULL RANGE OF EMOTIONSAND EMOTION REGULATIONASSISTANCE IS PROVIDED BY PARENT AVOIDANT/DISMISSING (INSECURE) (20%) • DO NOT SEEK PROXIMITY TO CAREGIVER • DO NOT MAINTAIN CONTACT PSY 325 L11 • RARELY DISTRESSED BY SEPARATION • FOCUSATTENTIONAWAY FROM THE CAREGIVER EXPRESSION OF NEGATIVE AFFECT RESULTS IN REJECTION► MINIMIZE NEED FOR THE ATTACHMENT SYSTEM RESISTANT/PREOCCUPIED (INSECURE) (10%) • SEEK PROXIMITY • MAINTAIN CONTACT • HIGH LEVELS OF RESISTANCE, LOWAVOIDANCE • VERY DISTRESSED, CANNOT BE COMFORTED ►NEGATIVE EMOTIONS HEIGHTENED TO MAINTAIN PROXIMITY ►ANXIOUS DUE TO UNPREDICTABILITY OF CAREGIVING DISORGANIZATION • DO NOT HAVE AN ORGANIZED SYSTEM OFATTACHMENT BEHAVIOUR • OFTENASSOCIATED WITH UNRESOLVED TRAUMAIN THE PARENT (SOLOMAN & GEORGE, 1999) • CO-CLASSIFIED INTO BEST ORGANIZED STRATEGY (SECURE, AVOIDANT, AMBIVALENT- RESISTANT) ATTACHMENTAND PERSONALITY DISORDERS • INTERPERSONAL CHAL
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