Class Notes (808,754)
Canada (493,378)
Psychology (2,034)
PSYCH 257 (141)

Chapter 12 Text Notes.docx

11 Pages
Unlock Document

University of Waterloo
Allison Kelly

PSYCH 257: March 21 & 26, 2013 Chapter 12: Personality Disorders Personality Disorders: enduring maladaptive patterns for relating to the environment and oneself, exhibiting a wide range of contexts that cause significant functional impairment or subjective distress An Overview - Personality disorders are chronic (Axis 2) and affects every aspect of the person’s life - May distress the person as well as people around them o Someone other than the affected must make the judgement whether it is causing significant functional impairment because the affected person cannot make such a judgement - People who have personality disorder and other psychological problems tends to do poorly in treatment CATEGORICAL AND DIMENSIONAL MODELS - Are psychological issues extreme versions of normal personality traits (dimensions) or ways of relating that are different from psychologically healthy behaviour (categories)? - Categorical models of behaviour o Pro: convenience o Cons: yes or no (no in-betweens) - Implementing a dimensional model in the DSM will: 1. Retain more information about each individual 2. Be flexible because it would permit categorical and dimensional differentiations 3. Avoid the arbitrary decisions involved in assigning a person to a diagnostic category - Five-factor model of personality (Big Five): people are rated high, low, or in-between based on 5 dimensions: 1. Extraversion (talkative, active vs. passive, reserved) 2. Agreeableness (kind, trusting, warm vs. hostile, selfish, mistrustful) 3. Conscientiousness (organized, thorough, reliable vs. careless, negligent, unreliable) 4. Neuroticism (nervous, moody, temperamental vs. even-tempered) 5. Openness to experience (imaginative, curious, creative vs. shallow, imperceptive) o Model is universal with people from different cultures receiving the same results - Western and Shedler model: 12 personality dimensions , some of which not listed by the DSM - The obstacle to adopting a dimensional model is the lack of consensus about framework PERSONALITY DISORDER CLUSTERS - Divided into 3 clusters by the DSM based on resemblance o Cluster A: odd, eccentric  Paranoid, schizoid, schizotypal o Cluster B: dramatic, emotional, erratic, elevated impulsivity  Antisocial, borderline, histrionic, narcissistic o Cluster C: anxious, fearful  Avoidant, dependent, obsessive-compulsive STATISTICS AND DEVELOPMENT - American studies find that personality disorders are relatively common - Schizoid, narcissistic, and avoidant personality disorders are relatively rare - Paranoid, schizotypal, histrionic, dependent, and obsessive-compulsive disorder are found in 1-4% of the general population - Thought to originate in childhood or adolescence and continue into adult years - Research is lacking because people only seek treatment after years of experiencing the disorder - Borderline personality disorder: volatile and unstable relationships, persistent problems in early adulthood, frequent hospitalizations, severe depression, suicidal gestures o Symptoms gradually improve if they survive into their 30s - Antisocial personality disorder: disregard for the rights and feelings of others, continue destructive behaviour like lying and manipulation through adulthood o Some burnout by 40 and engage in less criminal activity GENDER DIFFERENCES - Borderline personality disorder is diagnosed way more in women than men (75% of cases) - Histrionic and dependent personality used be to more identified with females but it is now equal between both genders - Psychologists may have incorrectly diagnosed more women with histrionic personality disorder - Many characteristics of histrionic personality disorder are extreme typical traits of women - Bias can occur at different stages of the diagnostic process: bias criteria (criterion gender bias), bias assessment measures and implementation (assessment gender bias), clinician’s personal bias COMORBIDITY - Personality disorders have high comorbidity (patients tend to be diagnosed with more than one) - There is a considerable overlap of the different disorder Cluster A Disorders PARANOID PERSONALITY DISORDER: Cluster A disorder involving pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent Clinical Description - Defining characteristic is pervasive unjustified mistrust - Suspicions can be unfounded and events completely unrelated are interpreted as personal attacks (ideas of reference) - Mistrust with the people close to them makes relationships difficult - Can be loud or quiet but obviously hostile towards others, appear tense, sensitive to criticism, and have an excessive need for autonomy - Although related to paranoid type of schizophrenia and delusional disorder, people with paranoid personality disorder do not have delusional suspicions and psychotic symptoms (eg. hallucinations) Causes - Genetics do play a strong role in paranoid personality disorder - Early mistreatment or traumatic childhood experiences may play a role in the development o However, there may be a bias because these people are prone to viewing the world as a threat - Early upbringing may have instilled maladaptive assumptions about others (eg. “people are malevolent and deceptive”) - Certain cultural groups such as prisoners, refugees, people with hearing impairments, and the elderly are more susceptible because of their unique experiences Treatment - Mistrustful of people and unlikely to seek professional help - When they do seek therapy, it is usually for another problem (anxiety or depression) or there is a crisis trigger in their lives - First step is to establish a meaningful therapeutic alliance between the client and therapist - Cognitive restructuring therapy may be used to counter the person’s beliefs that all people are malevolent and cannot be trusted - Only a small percent (11%) of patients will continue with treatment long enough to be helped SCHIZOID PERSONALITY DISORDER: Cluster A disorder featuring a pervasive pattern of detachment from social relationships and a restricted range of expressed emotions Clinical Description - Neither desire or enjoy closeness with others, romantic or sexual relationships - Appear cold, aloof, and detached; is not affected by criticism or praise - Homelessness is prevalent because of their lack of close friendships and lack of dissatisfaction about not having a sexual relationship - Consider themselves to be observers of the world rather than participants - Do not have very unusual thought processes that characterize other cluster A disorders - Social isolation, poor rapport, and constricted affect (no positive or negative emotion) Causes and Treatments - Childhood shyness is reported as a precursor to schizoid personality disorder later in life - Abuse and neglect in childhood are reported among individuals with this disorder - Parents of children with autism are more likely to have it - Biological dysfunction found in autism and schizoid combines with early learning or early problems with interpersonal relationships to produce the social deficits of the schizoid - People with a lower density of dopamine receptors have a higher measure of detachment - Rare for people with schizoid to request treatment until it is for another crisis like extreme depression or losing a job - Treatment involves pointing out the value in social relationships, teaching emotions felt by others to learn empathy, social skills training, role-playing to help patient practice SCHIZOTYPAL PERSONALITY DISORDER: Cluster A disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as, by cognitive or perceptual distortions and eccentricities of behaviour - Similar to schizophrenia but without some of the more debilitating symptoms (ie. Hallucinations and delusions) Clinical Description - Have psychotic-like symptoms, social deficits, and sometimes cognitive impairments or paranoia - May be odd/ bizarre in the way they relate to other people, in their behaviour and how they dress - Have ideas of reference (insignificant events relate directly to them) but can acknowledge the illogic ideas unlike people with schizophrenia - May have odd beliefs or engage in “magical thinking”; think they are clairvoyant or telepathic - Only a small portion of people with schizotypal will go on to develop schizophrenia - Tend to be suspicious, have paranoid thoughts, and express little emotion - Children who went on to develop schizotypal were found to be passive, unengaged, and hypersensitive to criticism Causes - Some people are thought to have “schizophrenia genes” (the genotype) but will have a less severe schizotypal personality disorder (phenotype) because of the lack of biological influences or environmental stresses - Many characteristics of schizotypal are similar but milder forms of behaviours in people with schizophrenia - There is an increased prevalence of schizotypal among relatives of people with schizotypal - Environmental factors can strongly influence the chance of schizotypal in children (eg. exposure to influenza during pregnancy) - From cognitive assessments, people with schizotypal may have mild to moderate decrements in their ability to perform on tests involving memory and learning - Semantic association abilities may be attributed to the thinking oddities displayed by schizotypal individuals - There are generalized brain abnormalities in patients with schizotypal Treatment - Since 30-50% of people with schizotypal have depression, treatment includes medical and psychological treatments for depression as well - Teach social skills to reduce isolation and suspicion of others - An unusual tactic: not encourage major changes and help the person accept and adjust to a solitary lifestyle - Medical treatment is similar to those with schizophrenia such as giving haloperidol - Some people with treatment do not improve over time and develop more severe characteristics of schizophrenia Cluster B Disorders ANTISOCIAL PERSONALITY DISORDER: Cluster B disorder involving a pervasive pattern of disregard for and violation of the rights of others - Similar to psychopathy but with a greater emphasis on overt behaviour rather than on personality traits Clinical Description - Have a long history of violating other people’s rights, aggressive, indifferent, lying and cheating is very frequent, unable to tell the difference between the truth and the lies they make up - Substance abuse is common (60%) and is a lifelong pattern - Regardless of gender, the outcome for antisocial is poor; antisocial boys twice as likely to die an unnatural death - Has had a number of different names; one of them is psychopathy (different definition than antisocial personality disorder) - The Cleckley criteria: 16 major characteristics of psychopathic personality - Robert Hare’s Revised Psychopathy Checklist (PCL-R): 20 item checklist o High scores on this checklist indicate psychopathy o Focuses more on underlying personality traits - DSM-IV-TR criteria for antisocial personality disorders focus on observable behaviours o Eg. impulsively and repeatedly changes in employment, residence, or sexual partners - Some psychopaths are not criminals and do not display aggressiveness o Suggests that people with a higher IQ may protect some people from developing more serious problems or getting caught - Some psychopaths do function quite successfully in certain segments of society - Identifying psychopaths in the criminal population helps identify who might reoffend and improve from a therapy program - Psychopaths rarely commit spontaneous murders but are usually planned out with a selfish goal in mind - Conduct disorder: children who engage in behaviours that that violate society’s norms - Psychoticism: an older label for a personality characterized by high impulsivity and low empathy - Many adults with antisocial personality disorder/ psychopathy had conduct disorder as children o Likelihood increases even more when child had conduct disorder and ADHD Genetic Influences - There is a genetic influence on criminality and antisocial behaviour o However, the actual development of criminality may require environmental factor like a deficit in early, high-quality contact with parents/ parent-surrogates - A personality characteristic, dissocial behaviour, has a large genetic component Neurological Influences - There has been a difference between the executive functions and attention-related abilities of incarcerated psychopaths and incarcerated non-psychopaths o Deficit in their abilities to maintain a plan and inhibit irrelevant information - Two major neurobiological theories in the area of psychopathy: 1. Under-arousal hypothesis  Psychopaths have abnormally low-levels of cortical arousal which is the primary cause of their antisocial and risk-taking behaviours  Seek stimulation to boost their levels of arousal  Cortical immaturity hypothesis: because of the excessive theta waves in psychopaths, the cerebral cortex may be insufficient developed and could be the reason why their actions are childlike and impulsive  The higher levels of theta waves can also indicate drowsiness, boredom, or relative absence of anxiety 2. Fearlessness hypothesis  Psychopaths possess a higher threshold for experiencing fear than others  In a conditioning study of galvanic skin response (GSR), psychopaths displayed a significantly weaker and shorter lasting response than nonpsychopaths  Psychopaths may have difficulty associating certain cues or signals with impending punishment or danger - There is a possible genetic component to aggressiveness o The condit
More Less

Related notes for PSYCH 257

Log In


Don't have an account?

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.