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Lecture 9

Lecture 9 - Personality and Substance Related Disorders

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Konstantine Zakzanis

PSYB32 Lecture 9 – Personality Disorders and Substance Abuse PERSONALITY DISORDERS: Slide 3: -a lot of overlap in these disorders -likely to be comorbid with another personality disorder -they are very difficult to treat, more so than the axis 1 disorders [personality disorders are on axis 2] -avoidant personality disorder may not be abnormal in some cultures -BUT it must cause distress and disability -extremes of several traits … these are traits that we all have -age related decline as people get older … they tend to fizzle out; often these people move from the morning of their life into the afternoon of their life because they self-actualize -acute symptoms will especially go away -great deal of comorbidity -egodystonic: unaware that they have a disorder – so even if its causing disability or distress, they don’t realize that its because of their personality Slide 4: -Cluster A – Odd or eccentric, avoidance of social contact -Cluster B – Dramatic, emotional, or erratic -Cluster C – Fearful Slide 5: -the easiest one to recognize is narcissistic, and avoidant – they have high interrater reliability -the least interrater reliable disorder is dependent personality disorder (cause its often characterized by someone who looks depressed) and obsessive compulsive personality disorder (cause it could be confused with obsessive compulsive disorder) -test retest reliability: the most stable ones – antisocial (hard to rehabilitate these ppl); least stable – schizotypal (it often gets misdiagnosed as schizophrenia or it can evolve into it), also dependent Slide 6: -ODD/ECCENTRIC CLUSTER: -paranoid is one of the more common personality disorders -they expect to be mistreated, exploited by others, are very secretive, always on the lookout for signs of trickery/abuse, may misread/interpret the simplest things (ex. a dog barking.. They might think the owner is trying to keep them awake), extremely jealous -most diagnosed in men -comorbid with schizotypal, borderline, avoidant -has to be impacting the persons social or occupational functioning -schizoid; described as person who doesn’t desire or enjoy social relationships; dull, bland, aloof (don’t display a lot of emotions), don’t experience any strong emotions, no interest in sex, anhedonic (don’t find pleasure in typical things), indifferent to praise, loners, distrustful -prevalence of 1% -more common in men -typically comorbid with schizotypal, avoidant, and paranoid -schizotypal; like schizoid but they have magical thinking -described as an attenuated form of schizophrenia (milder form) -they look like schizophrenics when they’re in the prodromal and residual phases of schizophrenia -these patients have negative symptoms that characterize a schizoid patient and they have magical beliefs -ex. they may have a feeling there’s a dead person in the room (rather than it being a hallucination) -ex. belief that they can read the thoughts of others -may have paranoid ideation (not full blown paranoid though) -flat affect -shows schizoid traits (withdrawn, no desire for social relationships, flat affect), no psychotic symptoms (differentiates from schizophrenia); the absence of symptoms help the clinician to make the diagnosis -the magical thinking separates the schizoid and schizotypal personality disorders Slide 7: -DRAMATIC/ERRATIC CLUSTER: -borderline personality disorder: also one of the more common disorders -often described as someone who will have rapid shifts of emotions in very short periods of time (without real reason) -they are argumentative, sarcastic, irritable, quick to take offense, hard to live with, unpredictable, impulsive in behaviour (may engage in risky gambling, indiscriminate sexual activities), can’t bear to be alone, demand attention -has a great deal of comorbidity; can have chronic depression (dystimia), also comorbid with substance abuse, PTSD, and eating disorders -often suicidal -prevalence is 1-2% -more common in women -more likely than any other personality disorder to be comorbid with an axis 1 disorder Slide 8: -video of someone with borderline personality disorder -one of the most serious personality disorders -unpredictable emotional responses -self destructive (sometimes cutting or burning themselves) -cause of this is unclear, but much attention focussed on early childhood experience with unreliable and unstable caregivers -often a history of sexual abuse -treatment is with pharmacology and psychotherapy -accept the patient as they are but attempt some behavioural alteration -the women in the video also suffers from anorexia -was suicidal; reacted to bad things by getting suicidal -cuts her wrists, tried to hang herself, tried to overdose -some were cries for help, but others were real attempts to end her life -had a lot of medical hospitalizations for anorexia before she was even 25 -her mother didn’t believe in “doctors or illness” -during college she was feeling out of it and not in the real world -her feelings of hopelessness comes and goes; she doesn’t have very much optimism or belief in things; she feels like shes wasted her whole life; when she feels overwhelmed she feels suicidal – almost every day she feels like she wants to die but usually she doesn’t feel like acting on it -at a time she was drinking a lot, but she stopped on her own -she gets attached to her doctors, but when they leave she gets very devistated Slide 9: -DRAMATIC/ERRATIC CLUSTER: -histrionic; overly dramatic and attention seeking; do nothing but draw attention to themselves, they always have to be the centre of attention, show emotions extravagantly, emotionally shallow -self centred (they come first even though they know that they place themselves first) -uncomfortable when theyre not the centre of attention, easily influenced by others, state very strong opinions but behind these opinions they have little thought or support for why theyre opinionated (so much that they’ll talk over other people) -2-3% prevalence -more common in women -depression is quite common in these people, also comorbid with bordeline personality disorders -video 1: -anna nicole smith was thought to exhibit histrionic personality disorder -NOT the female form of antisocial personality disorder like ppl used to think it was -manipulative behaviour, chronic lying, vapid, dependent, play victim role -marilyn monroe and displayed these traits -excessive demand for attention; often through appearance (lady gaga) -excessive emotionality; emotions always greater than normal -rapidly shifting emotions -seductive-provocative behaviour; uses sexual attraction to draw people to them –through appearance, leadership capacity, artistically, mental/cognitive ability -self dramatic behaviour; somatoform disorders – vague complaints about things (so they draw attention to themselves through false/dramatic issue); suicidal threats and actions – use it in order to draw attention to themselves; exaggeration – go to great lengths to show ppl how incredible they are -expressionistic speech; like motivational speeking – shallow, vapid, unaffective, not filled with a high degree of substance -video 2: -suggestibility; more heavily influenced by ppl in high power and with authority; are often expressive a level of emotional dependency that underlies this disorder; reflects the dependency of this individual -shallow relationships; relationships more superficial than one with substance; claim to know ppl when they don’t -characterized by 3 main traits: constant seeking of attention, constant level of emotionality and rapid shift of shallow emotions, the incredible levels of seductive behaviour -often lack true empathy though they are still capable of it; not interpersonally exploitive; don’t think of themselves as grandiose (don’t think much of themselves – so its different from narcissistic) -narcissistic; think highly of themselves -preoccupied with fantasies of great success -self centred, require constant attention, require successive admiration, lack empathy, very arrogant, great sense of entitlement -1% prevalence -co-occurs with histrionic personality disorder, and borderline -video: -charles manson -has grandiose fantasies with an exaggeration of accomplishments and his place in the world: claims to be the king, 10x as great as the pope, doesn’t need more money cause hes “got all the money in the world” -extreme selfishness and self centredness with lack of empathy for others and a sense of entitlement: doesn’t feel any remorse for killing ppl, feels like he can do what he wants to ppl because “that’s how hes been treated”, doesn’t know how to care -overly sensitive to criticism or any challenge to their false self-image: as soon as someone challenges him he blows up and tries to be the tough guy Slide 10: -DRAMATIC/ERRATIC CLUSTER: -if the narcissist shows antisocial behaviour hes got anitsocial personality disorder -only personality disorder requiring a previous diagnosis: conduct disorder; so you can’t have antisocial personality disorder without having been diagnosed with conduct disorder earlier on (under 15) -ex. of conduct disorder: setting an animal on fire, chopping up an animal and enjoying it, setting fire to property; when they grow older, the antisocial behaviour continues into adulthood – they engage in criminal activity -irresponsible social behaviour, break laws, irritable, physically aggressive, reckless, very impulsive (key), fail to plan ahead (key), typically show no remorse (key) -the frontal lobe (executive functioning) controls impulsivity, planning, and remorse ? So this disorder may have something to do with the frontal lobes -psychopathy: someone who may engage in the same antisocial acts, but the emphasis is on their thoughts and feelings; whereas antisocial person has emphasis on their behaviour Slide 11: -video on the scarborough rapist, Paul Bernardo -in 1990, 12 young women had been brutally raped in the last 3 years in scarborough -bernardo was engaged to karla homolka -karla’s 15 year old sister tammy had died from “asphyxia and had a huge burn on her face”; at the funeral paul would not leave her body alone – kept calling her “his angel” and kept playing with her hair ^ they actually drugged Tammy with tranquilizer from the vet clinic Karla worked at so that Paul could rape her while she was unconscious … Karla played a part in this as well; but at the time this was unknown -paul and karla then moved to st catharines (a house in port dalhousie) -a girl was attacked on her way home from school in st catharines -they brought bernardo in but considered him co-operative and forthcoming so did not consider him a suspect -in june 1991, paul and karla married … on the same day police found the body of a dismembered teenage girl that was encased in cement; her name was Leslie Mahhofy and was found in Gibson Lake near st. catharines -not long after, the body of Kristen French was found in the woods.. -on Feb 1
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