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Lecture 9

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Western University
Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  12:   Personality  Disorders  (pp.428-­‐475)     Personality  Disorders:  An  Overview  (pp.428-­‐429)   • Personality   o Enduring  and  relatively  stable  predispositions  (i.e.,  ways  of  relating   and  thinking)   • Five  Factor  Model   o Agreeableness,  extraversion,  conscientiousness,  neuroticism,  and   openness  to  experience   • Cross-­‐Cultural  Studies  –  these  5  dimensions  are  universal   • Personality  Disorders   o Predispositions  are  inflexible  and  maladaptive,  causing  distress  and/r   impairment   o Coded  on  axis  II  of  the  DSM-­‐IV-­‐TR   • Categorical  vs.  Dimensional  Views  of  Personality  Disorders     Personality  Disorders:  Facts  and  Statistics  (pp.430-­‐433)   • Prevalence  of  Personality  Disorders   o About  0.5%  to  2.5%  of  the  general  population  (U.S.)   o Canadian  data  are  scarce  (Health  Canada,  2002)   • Origins  and  Course  of  Personality  Disorders   o Thoughts  to  begin  in  childhood  –  few  studies  on  development  –  not   seek  treatment  in  early  stages   o Tend  to  run  a  chronic  course  unless  treated  (poor  outcome  even  when   treated)   • Co-­‐Morbidity  (with  other  psychological  disorders)  Rates  are  High  (poorer   prognosis)   • Gender  Bias  in  Diagnosis   o Gender  differences  may  be  dues  to  bias  on  the  part  of  the  diagnosing   clinician  –  may  be  due  to  society’s  bias  against  feminine  traits     Cluster  A:  Paranoid  Personality  Disorder  (pp.433)   • Overview  and  Clinical  Features   o Pervasive  and  unjustified  mistrust  and  suspicion   • The  Causes   o Biological  and  psychological  contributions  are  unclear   o Early  learning  that  people  and  the  world  is  a  dangerous  place  ??   • Treatment  Options   o Few  seek  professional  help  on  their  own   o Treatment  focuses  on  development  of  trust,  thus  therapy  needs  to  be   long  term  (>  1  year)   o Cognitive  therapy  to  counter  negativistic  thinking   o No  Evidence  of  treatment  success       Cluster  A:  Schizoid  Personality  Disorder  (pp.435-­‐436)   • Overview  and  Clinical  Features   o Pervasive  pattern  of  detachment  from  relationships   o Limited  range  of  emotions  in  interpersonal  situations   o Normal  behaviour,  beliefs,  and  thought  patterns  vs.  paranoid  and   schizotypal   • The  Causes   o Etiology  is  unclear   • Treatment  Options   o Few  seek  professional  help  on  their  own   o Focus  on  the  value  of  interpersonal  relationships,  empathy,  and  social   skills   o Treatment  prognosis  generally  poor  –  not  motivated   o Lack  good  outcome  studies  re:  treatment  efficacy       Cluster  A:  Schizotypal  Personality  Disorder  (pp.436-­‐438)   • Overview  and  Clinical  Features   o Behaviours  and  dress  is  odd  and  unusual   o Most  are  socially  isolated  and  may  be  highly  suspicious  of  others  –   may  have  the  feeling  someone’s  in  the  room  vs.  schizophrenic  who   strongly  believes  there  is  (when  no  one  is)   o Magical  thinking,  ideas  of  reference  (but  sense  they  are  unreal),  and   illusions  are  common,  but  sense  they  are  unreal   o Risk  for  developing  schizophrenia  is  high   o Many  also  meet  criteria  for  major  depression   • The  Causes   o Schizoid  personality  –  a  phenotype  of  a  schizophrenia  genotype?   o Left  hemisphere  and  more  generalized  brain  deficits   • Treatment  Options   o Main  focus  is  on  developing  social  skills   o Treatment  also  addresses  comorbid  depression   o Medical  treatment  is  similar  to  that  used  for  schizophrenia   o Treatment  prognosis  is  generally  poor     Cluster  B:  Antisocial  Personality  Disorder  (pp.438-­‐443)   • Overview  and  Clinical  Features   o Failure  to  comply  with  social  norms,  violation  of  the  rights  of  others,   irresponsible,  impulsive,  and  deceitful   o Lack  a  conscience,  empathy,  and  remorse   • Psychopathy  and  Antisocial  Personality  Disorder   o Psychopathy  older  term  –  16  major  characteristics  from  Cleckley   Criteria  –  e.g.,  superficial  charm  and  good  intelligence,  lack  of  remorse   or  shame   o Robert  Hare  developed  a  20  item  Revised  Psychopathy  Checklist   (PCL-­‐R)  –  assesses  six  main  criteria:  Glibness/superficial  charm,   grandiose  sense  of  self-­‐worth,  proneness  to  boredom/need  for   stimulation,  pathological  lying,  conning/manipulative,  lack  of  remorse   o Cleckley/Hare  checklist  (psychopathy)  focuses  on  personality  traits   vs.  DSM’s  (APD)  focus  on  behaviours   o Low  IQ  separates  those  who  get  in  trouble  with  the  law   o Olaf  (UBC)  –  criminals  who  score  high  on  the  C/H  checklist  put  in  less   effort  and  showed  fewer  improvements  vs.  nonpsychopathic  criminal   o Homicides  by  psychopaths  have  higher  levels  of  sadistic  violence   • Relation  Between  ASPD,  Conduct  Disorder,  and  Early  Behaviour  Problems   o Many  have  early  histories  of  behavioural  problems,  including  conduct   disorder  –  children  (adolescents)   o Many  come  from  families  with  inconsistent  parental  discipline  and   support   o Families  often  have  histories  of  criminal  and  violent  behaviour   o Sexual  molesters  –  no  conscious  or  empathy   o 64%  of  sex  offenders  of  adults  and  children  were  psychopaths   o Rapists  scored  higher  for  psychopathy  than  child  molesters   o Important  to  assess  level  of  psychopathy  to  predict  reoffending     Genetic  and  Neurobiological  Contributions  of  Antisocial  Personality  (pp.443-­‐447)   • Family,  Twin,  and  Adoption  Studies   o Gene-­‐environment  interaction  appears  involved   • Prevailing  Neurobiological  Theories   o Brain-­‐damage  –  little  support  for  this  view   o Underarousal  hypothesis  –  cortical  arousal  is  too  low   o Cortical  immaturity  hypothesis  –  cerebral  cortex  is  not  fully   developed   o Fearlessness  hypothesis  –  psychopaths  fail  to  respond  with  fear  to   danger  cues  –  underreact  to  the  threat  of  punishment   o Gene  for  monoamine  oxidase  A  on  X  chromosome  (only  males)  –  low   levels  lead  to  a  buildup  of  neurotransmitters  –  abused  children  who   have  high  levels  of  MAOA  expression  did  not  exhibit  antisocial   behaviour;  those  without  this  genotype  more  likely  develop  antisocial   problems   o Gray’s  model  of  behavioural  inhibition  and  activation    BIS,  REW   • Environment   o Inconsistent  discipline   o Stress  (combat  vets)   o Children  traumati
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