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abnormal psych final notes.docx

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University of Toronto Scarborough
Konstantine Zakzanis

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 methadone 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.  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 inherited  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 gratification; and sexual masochism, obtaining or enhancing sexual gratification through being subjected to pain, usually for a sadist  Many hypotheses have been put forward to account for the several paraphilias. Psychoanalytic theories generally hold that they are defensive in nature, protecting the person from repressed conflicts and representing fixations at immature stages of psychosexual development. According to this perspective, the person with a paraphilia is basically fearful of conventional heterosexual relationships. Fetishists and pedophiles, for example, are hypothesized to suffer from castration anxiety that makes it too threatening to engage in conventional sex with adults  Behavioral and cognitive theorists focus more directly on the sexual behavior itself. One view is that a fetishistic attraction to objects, such as boots, arises from accidental classical conditioning of sexual arousal. Another behavioral hypothesis posits social skills deficiencies that make it difficult for the person to interact normally with other adults. Cognitive distortions appear to be involved, as voyeurs may claim that the women they
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