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PSYCH257 Chapter Notes -Sadistic Personality Disorder, Atypical Antipsychotic, Attachment Theory

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David Moscovitch

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Personality disorders = enduing patterns of receiving, relating to, and thinking abt env’ and oneself tht are exhibited
in wide range of social and personal contexts; are inflexible and maladaptive, and cause
significant f’nal impairment/subjective distress
Are chronic; dN come and go but originate in childhood and cont’ t/o adulthood
Chronic problems pervade every aspect of life
Many who have PD in addition to other psychological problems tend to do poorly in trtmt
Categorical and Dimensional Models
Debated: whether PDs are extreme v.’s of otherwise normal personality variations (dimensions) or ways of
relating tht are diff from psychologically healthy beh’ (categorical)
Categorical models of beh’ adv: convenience
- w/ simplification comes problems (leads to reification of Ds—real ―things‖)
- dN rate HOW ______ you are when yu have ______ PD
Adv↑’s of dimensional model:
1.) retain more info abt each indvdl
2.) be more flexible b/c would permit both categorical & dimensional differentiations among indvdls
3.) avoid often arbitrary decisions involved in assigning person to diagnostic category
Widely accepted basic personality dimension: five-factor model of personality (―Big Five‖)
- ppl can be rated on series of personality dimensions and combo of 5 describes why ppl are so diff
- factors are: i.) extraversiontalkative, assertive & active vs. silent, passive & reserved
ii.) agreeablenesskind, trusting &warm vs. hostile, selfish & mistrustful
iii.) conscientiousnessorganized, thorough & reliable vs. careless, negligent & unreliable
iv.) neuroticismnervous, moody & temperamental vs. even-tempered
v.) openness to experienceimaginative, curious & creative vs. shallow & imperceptive
- on each dimension, ppl rated high/low/somewhere inbtwn
Statistics and Development
PD found in 0.5-2.5% of general pop’n—10-30% of those served in inpatient settings, and 2-10% of those
in outpatient settings
Gender Differences
F make up 75% of identified BPD cases
Being a F i’d likelihood of being diagnosed w/ histrionic PD (i.e. instead of ASPD)
Paranoid Personality Disorder
Excessively mistrustful & suspicious of others w/o any justification in situations most other ppl would
agree tht their suspicions are unfounded
- even events tht have nothing to do w/ them are interpreted as personal attacks
i.e. barking dog or delayed airline flight seen as deliberate attempt to annoy them
Assume ppl are out to harm/trick them (TF) tend not to confide in others
- extends to ppl close to them and makes meaningful rel’nshps very difficult
Often appear tense and ―ready to pounce‖ when they think they’ve been slighted by someone
Sensitive to criticism and have excessive need for autonomy
Suspiciousness dN reach delusional proportions
Relatives of indvdls w/ scz MAY be more likely to have PPD than ppl who dN have relative w/ scz

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Maladaptive way of seeing world by those w/ PDD misinterpretation (vicious cycle)
Speculation: roots in early upbringing
i.e. parents may teach to be careful abt making mistakes and to impress tht they are diff from others
Cultural factors: certain groups of ppl thought to be susceptible b/c of unique exp’s
i.e. imagine you were immigrant who had difficulty w/ lang and customs of new culture; innocuous
things as others laughing and talking quietly might be interpreted as somehow directed at you
Unlikely to seek professional help b/c mistrustful
When they do, trigger usually crisis in life/other problems (i.e. depression, anxiety) and not necessarily PD
Therapists try to provide atmosphere conducive to dvlp’g sense of trust
- often use cognitive therapy to counter person’s mistaken assumptions abt others, focusing on changing
person’s beliefs tht all ppl are malevolent and most ppl cannot be trusted
To date: no confirmed form of trtmt tht can significantly improve lives of ppl w/ PPD
Schizoid Personality Disorder
Pattern of detachment from soc’ rel’nshps and very limited range of emotions in interpersonal situations
Neither desire/enjoy closeness w/ others, including romantic/sexual rel’nshps
- aar ―aloof‖, ―cold‖, and ―indifferent‖ to others
dN seem affected by praise/criticism
homelessness prevalent
―consider themselves to be obsv’rs rather than pp’s in world around them‖
Causes and Treatment
Preference for soc’ isolation resembles aspects of autism
- possible tht ~ bio’ dysf’n combines w/ early learning or early problems w/ interpersonal rel’nshps to
produce social deficits
Rare for person w/ this to request trtmt (except in response to crisis such as extreme depression / losing job)
Therapists often begin trtmt by pointing out value in soc rel’nshps
May need to be taught emotions felt by others in order to learn empathy
Social skills training
Therapist takes part of friend/significant otherrole-playing
Schizotypal Personality Disorder
Typically socially isolated
Tend to be suspicious, have odd beliefs, have paranoid thoughts, express little emotion, and may dress/
behave in ways tht would seem unusual to many of us
Have ideas of referencethink insignificant events relate directly to them
Engage in magical thinkingbelieving, for i.e., tht they are clairvoyant or telepathic
Report unusual perceptual exp’s such as illusionsfeeling presence of another when alone
i↑’d prevalence of schizotypal PD among relatives of ppl w/ scz who dN also have scz themselves
env’ can strongly influence schizotypal PD
cognitive assessment of ppl w/ D point to mild-moderate decrements in their ability to perform on tests
involving memory and learning
- suggest some damage in LH
estimate: 30-50% who seek help also meet criteria for major depressive D
general approach: teach social skills to help reduce isolation from and suspicion of others
unusual tactic: not to encourage major changes, but to help person accept and adjust to solitary lifestyle
meds trtmt ~ to scz
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