PSYB32H3 Study Guide - Final Guide: Head Injury, Human Sexual Response Cycle, Attention Deficit Hyperactivity Disorder

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Published on 26 Jan 2013
Chapter 12
DSM-IV-TR distinguishes between substance dependence and substance abuse
Dependence refers to a compulsive pattern of substance use and consequent serious psychological and
physical impairment
Less prevalent but more notorious, perhaps because of their illegality are the opiates, including heroin,
and the barbiturates, which are sedatives; and amphetamines and cocaine, which are stimulants; heroin
has been the focus of concern in recent years because usages is up and stronger varieties have become
available; barbiturates have for some time been implicated in both intentional and accidental suicides,
they are particularly lethal when taken with alcohol
Available evidence indicates that marijuana, when used regularly is not benign; can damage the lungs and
cardiovascular system and lead to cognitive impairments
Hallucinogens, LSD, mescaline and psilocybin are taken to alter or expand consciousness
Some benefits have been observed for treatments using such drugs as clonidine, naltrexone, and
Chapter 13
Personality disorders are defined as enduring patterns of behavior and inner experience that disrupt
social and occupational functioning. They are usually codiagnosed with such Axis I disorders as depression
and anxiety disorders. Although these diagnoses have become reliable in recent years, they overlap
considerably and it is usual for a person to meet diagnostic criteria for more than one personality
disorder. This high cormorbidity, coupled with the fact that personality disorders are seen as the extremes
of continuously distributed personality traits, has led to proposals to develop a dimensional rather than a
categorical means of classifying these disorders
Personality disorders are grouped into 3 clusters in DSM-IV-TR. Specific diagnoses in the first cluster
odd/eccentric include paranoid, schizoid, and schizo-typal. These disorders are usually considered to be
less severe variant of schizophrenia, and their symptoms are similar to those of the prodromal or residual
phases of schizophrenia. Behavior-genetic research gives some support to this assumption, especially for
schizotypal personality disorder.
The dramatic/erratic cluster includes borderline, histrionic, narcissistic, and anti-social personality
disorders. The major symptom of borderline personality disorder is unstable, highly changeable emotions
and behavior; of histrionic personality disorder, exaggerated emotional displays; of narcissistic personality
disorder, seriously anti-social behavior. Theories of the etiology of the first three of this cluster of
diagnoses focus on early parent-child relationships. For example, object relations theorists such as
Kernberg and Kohut, have proposed detailed explanations for borderline and narcissistic personality
disorders, focusing on the child developing an insecure ego because of inconsistent love and attention
from the parents. Linhan’s cognitive-behavioral theory of borderline personality disorder proposes an
interaction between a deficit in emotional regulation and an invalidating family environment.
Psychopathy is related to the anti-social personality disorder but it is not an official DSM diagnosis.
More is known about the anti-social personality disorder and psychopathy than about other disorders in
the dramatic/erratic cluster. Though they overlap a great deal, the two diagnoses are not exactly
equivalent. The diagnosis of anti-social personality focuses on anti-social behavior, whereas that of
psychopathy, influenced by the writings of Cleckley, emphasizes emotional deficits such as a lack of fear,
regret or shame. Psychopaths are thought to be unable to learn from experiences, to have no sense of
responsibility, and to be unable to establish genuine emotional relationships with other people.
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Research on their families indicates that psychopaths tend to have fathers who themselves were anti-
social and that discipline during their childhoods were either absent or inconsistent. Genetic studies,
particularly those using the adoption method, suggest that a predisposition to anti-social personality is
The core problem of psychopath may be that impending punishment creates no inhibitions about
committing anti-social acts. A good deal of overlapping evidence supports this view: (1) psychopaths are
slow to learn to avoid shock; (2) according to their electrodermal responses, psychopaths show little
anxiety, but as indicated by their faster heart rates, they seem more able than normal people to tune out
aversive stimuli; and (3) psychopaths have difficulty altering their responses, even when their behavior is
not producing desirable consequences. A lack of empathy may also be a factor in the psychopath’s callous
treatment of others
The anxious/fearful cluster includes avoidant, dependent and obsessive-compulsive personality disorders.
The major symptom of avoidant personality disorder is fear of rejection or criticism; of dependent
personality disorder, low self confidence; and of obsessive- compulsive personality disorders, a
perfectionist, detail-oriented style. Theories of etiology focus on early experience. Avoidant personality
disorder may result from the transmission of fear from parent to child via modeling. Dependent
personality may be caused by disruptions of the parent-child relationship that lead to the fear of losing
other relationships in adulthood. Obsessive-compulsive personality disorder may result from a fear of loss
of control
Little has been discovered about effective therapy for the various personality disorders for several
reasons. The high level of comorbidity among the diagnoses make it difficult to evaluate reports of
therapy. Some promising evidence is emerging, however, for the utility of dialectical behavior therapy for
borderline personality disorder. This approach combines client-centered acceptance with a cognitive-
behavioral focus on making specific changes in thought, emotion and behavior.
Psychotherapy for psychopathy is rarely successful. In addition to pervasiveness and apparent
intractability of an uncaring and manipulative lifestyle, the psychopath is by nature a poor candidate for
therapy. People who habitually lie and lack insight into their own or others’ feelings and have no
inclination to examine emotions will not establish a trusting and open working relationship with therapist.
Chapter 13
Gender identity disorder involves the deep and persistent conviction of the individual that his or her
anatomic sexual makeup and psychological sense of self as a man, woman, are discrepant. Child rearing
practices may have encouraged the young child to believe that he or she was of the opposite sex.
Hormonal causes have also been considered, but the data is equivocal
There is preliminary evidence that behavior therapy can help bring gender identity into line with anatomy
in some cases
In the paraphilias, unusual imagery and acts are persistent and necessary for sexual excitement of
gratification. The perincipl paraphilias are fetishism, reliance on inanimate objects for sexual arousal;
transvectic fetishism, sometimes called transvestism, the practice of dressing in the clothing of the
opposite sex, usually for the purpose of sexual arousal but without gender identity confusion of a person
with GID; pedophilia and incest, marked preference for watching others in a state of undress or in sexual
situations; exhibitionism, obtaining sexual gratification by exposing oneself to unwilling strangers,
frotteurism, obtaining sexual contact by rubbing against or fondling women in public places’ sexual
sadism, a reliance on inflicting pain and humiliation on another person to obtain or increase sexual
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