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Chapter 11

Psychology 2030A/B Psychology- Human Adjustment Chapter 11 and 14

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Psychology 2030A/B
Hayden Woodley

Chapter  11-­  Personality  Disorders Clinical  Features  of  Personality  Disorders -­  adult  personality;;  attuned  to  the  demand  of  society -­  societal  expectations Personality  Disorder;; Psychodynamic  theorists:  “character  disorders” Characterized  by  two  leading  principles: 1.  chronic  interpersonal  difficulties 2.  problems  with  one’s  identity  or  sense  of  self General  DSM-­IV-­TR  Standards  to  classify  one  with  personality  disorder;; -­  must  be  pervasive  and  inflexible -­  stable  and  of  long  duration -­  cause  clinically  significant  distress  or  impairment  in  functioning -­  manifested  in  at  least  two:  cognition,  affectivity,  interpersonal  functioning,  impulse  control To  the  general  public  they  are: -­  confusing,  exasperating,  unpredictable,  unacceptable -­  do  not  stem  from  deliberating  reactions  to  stress  in  the  recent  past  (i.e.  PTSD) -­  stem:  from  gradual  development  of  inflexible  and  distorted  personality  and  behavioural  patterns  that result  in  persistent  maladaptive  ways  of  perceiving,  thinking  about  and  relating  to  the  world -­  stressful  life  events  play  impact  (early) -­  13%  of  people  suffer  from  at  least  one  personality  disorder  at  least  once  in  their  life DSM-­IV-­TR/DSM  III/DSM-­III-­R Axis  II:  different  enough  from  the  standard  psychiatric  syndromes  o  warrant  separate classification Axis  I:  also  present,  i..e  mood  disorders,  anxiety  disorders,  sexual  deviance,  substance  abuse etc. Difficulties  Doing  Research  on  Personality  Disorders Diagnosing: -­  not  sharply  defined -­  diagnosis  based  on  inferred  traits/  consistent  behaviours -­  requires  more  judgement -­  semistructured  interviews/  self-­report  inventories;;  diagnostic  reliability  has  increased -­  research  results  are  rarely  replicated  in  comparison  to  other  research  reports -­  diagnostic  categories  are  not  mutually  exclusive -­  person  containing  more  than  one  personality  disorder  (  i.e.  mistrust,  paranoid personality  disorder,  but  also  with  schizoid) -­  hence,  unreliability  of  diagnostics -­  led  to  the  creation  of  dimensional  systems  of  assessment  for  disorders  i.e.  Dimensional Assessment  of  Personality  Pathology  (DAPP) Five  Factor  Model  of  Personality  traits;; 1.  Neuroticism 2.  extroversion/introversion 3.  openness  to  experience 4.  agreeableness/antagonism 5.  conscientiousness -­  commonalities  and  distinctions  between  the  different  personality  disorders  by  assessing  how these  individuals  score  on  the  five  basic  personality  traits -­  i..e  trait  neuroticism  comprises  of  six  facets  :  anxiety,  angry  hostility,  depression, self-­consciousness,  impulsiveness,  vulnerability -­  i.e.  trait:  Extraversion:  warmth,  gregariousness,  assertiveness,  activity,  excitement  seeking, positive  emotions Difficulties  in  Studying  the  Causes  of  Personality  Disorders;; -­  little  is  known  about  causal  factors  (DSM  III  published  1980  -­  not  too  long  ago) -­  high  level  of  comorbidity i.e.  85  %  who  qualified  for  one  personality  disorder  diagnosis  also  qualified  for  at  least one  more -­  adds  to  the  difficulty  of  untangling  which  causal  factors  are  associated  with  which disorder -­  little  prospective  research -­  Biological  factors;;  infant’s  temperament  (unborn  disposition  to  effectively  react  to environmental  stimuli) -­  predisposes  to  development  (personality  traits  or  disorders) -­  temperament;;  lays  foundation  for  human  personality  development  (but  not  the  sole determinant) -­  most  are  moderately  heritable -­  most  have  genetic  contribution -­  Twin  Study;;  1500  monozygotic  and  dizygotic  twins -­  18-­84 -­  disorders  are  mediated  by  the  genetic  contributions  to  the  primary  trait  dimensions  most implicated  in  each  disorder  rather  than  to  the  disorders  themselves -­  psychodynamic  theorists;;  development  of  character  disorders  to  an  infant  getting  excessive  vs. insufficient  gratification  of  his/her  impulses  in  the  first  few  years  of  life -­  learned  based  habit  patterns  +  maladaptive  cognitive  styles=  most  probable  causal  factors -­  disturbed  parent-­child  attachment  relationships -­  parental  psychopathology  and  ineffective  parenting  practises -­  early  emotional  physical  and  sexual  abuse -­  socio  cultural  factors:  social  stressors,  societal  changes,  cultural  values Categories  of  Personality  Disorders: -­  DSM-­  IV-­  TR Cluster  A -­  odd/eccentric -­  unusual  behaviour  (distrust,  suspiciousness,  social  detachment) -­  paranoid,  schizoid,  schizotypal  personality  disorders  (PSS) Cluster  B -­  dramatic,  emotional  ,  erratic -­  histrionic,  narcissistic,  antisocial,  borderline  personality  disorders  (  BANH) Cluster  C -­  anxiety  and  fearfulness -­  avoidant,  dependent,  obsessive-­compulsive  personality  disorders  (  DAO) Additional  Personality  Disorders: -­  depressive -­  passive-­aggressive (provisional  category  in  appendix) DISORDE EXPLANATION CRITERIA R Paranoid -­  pervasive  suspiciousness A.  Evidence  of  pervasive  distrust  or Personality -­  distrust  of  others suspiciousness  of  others  present  in  at  least  four  of Disorder -­  interpersonal  difficulties the  following: -­  see  themselves  as  blameless -­  pervasive  suspiciousness  in  being  deceived, -­    on  guard  all  the  time harmed,  or  exploited -­  bear  grudges -­  unjustified  doubts  about  loyalty  or -­  quick  to  react  with  anger trustworthiness  of  friends  or  associates -­  not  usually  psychotic -­  reluctance  to  confide  in  others  because  of      -­  clear  contact  with  realitdoubts  of  loyalty  or  trustworthiness -­  paranoid  schizophrenia  shares -­  hidden  demeaning  or  threatening  meanings  read symptoms into  benign  remarks  or  events          -­  but  p.  schiz.s  have  additional -­  bears  grudges problems  (persistent  loss  with -­  angry  reactions  to  perceived  attacks  on reality,  delusions,  hallucinations character  or  reputation etc.) -­  recurrent  suspicions  regarding  fidelity  of  spouse -­  prevalence;;  0.5-­  2.5% or  sexual  partner Causal  Factors: B.  Does  not  occur  exclusively  during  course  of  -­  genetic  transmissions schizophrenia,  Mood  Disorder  with  Psychotic          -­  heritability  of  high  levels  of Features,  or  other  psychotic  disorder antagonism  (low  agreeableness) and  neuroticism  (angry  hostility) -­  psychosocial        -­  parental  neglect        -­  exposure  to  violence Schizoid -­  unable  to  form  social A.  Evidence  of  a  pervasive  pattern  of  detachment Personality relationships from  social  relationships  and  a  restricted  range  of Disorder -­  lac  interest expression  of  emotions  in  interpersonal  settings -­  unable  to  express  feelings shown  in  at  least  four  of  the  following  ways -­  generally  apathetic  mood -­  doesn’t  desire/enjoy  close  relationships Five  factor  Model -­  chooses  solitary  activities -­  high  levels  of  introversion -­  no  interest  in  sexual  activity (especially  low  on  warmth, -­  pleasure  in  only  few/if  any  activities gregariousness  and  positive -­  no  close  friends/confidants emotions) -­  indifferent  to  praise/criticism -­  low  on  openness  to  feelings -­  emotional  coldness,  detachment,  flat  affect -­  prevalence  <1% Causal  Factors -­  precursor  to  the  development  of schizophrenia -­  genetic;;  failed  to  establish hereditary  basis -­  cognitive  ;;  are  cool  and  aloof because  of  maladaptive  underlying schemas        -­  lead  them  to  view  themselves as  self-­sufficient  loners        -­  view  others  as  intrusive Schizotypal -­  like  schizoid:  pervasive  social A  pervasive  pattern  of  social  and  interpersonal Personality and  interpersonal  deficits deficits  marked  by  acute  discomfort  with,  and Disorder -­  cognitive  and  perceptual reduced  capacity  for,  close  relationships  as  well distortions  and  eccentricities  in as  by  cognitive  or  perceptual  behavioural their  communication  and eccentricities  as  indicated  by  at  least  five  of  the behaviour following: -­  personalized/superstitious -­  ideas  for  reference thinking -­  odd  beliefs  or  magical  thinking -­  transient  psychotic  symptoms -­  unusual  perceptual  experiences -­  believe  they  have  magical -­  odd  thinking  and  speech powers -­  suspiciousness  or  paranoid  ideation -­  engage  in  magical  rituals -­  inappropriate  or  constricted  affect -­  oddities  in  thinking,  talking  etc. -­  behaviour  or  appearance  that  is  odd,  eccentric, -­  similar  to  those  in  schizophrenic or  peculiar patients  (are  actually  first -­  lack  of  close  friends/confidants diagnosed  as  simple/latent -­  excessive  social  anxiety schizophrenia) Causal  Factors -­  prevalence  3.3  % -­  moderately  heritable -­  genetic/biological  association with  schizophrenia -­  same  deficit  in  inability  to  track moving  target  visually -­  mild  impairments  in  cognitive functioning -­  inability  to  sustain  attention -­  deficits  in  memory -­  deficits  in  ability  to  inhibit attention  to  a  second  stimulus  that rapidly  follows  presentation  of  the first      i.e.  loud  noise;;  startle  response -­  teenagers:  higher  risk  of developing  schizophrenia  / schizophrenia-­spectrum  disorders Histrionic -­  excessive  attention  seeking A  pervasive  pattern  of  excessive  emotionally  and Personality behaviour attention  seeking,  as  indicated  by  at  least  five  of Disorder -­  feel  unappreciated the  following: -­  others  tire  of  providing  attention;;-­  discomfort  when  not  the  center  of  attention no  close  friends  etc. -­  sexual  seductive/provocative  behaviour -­  deal  of  dependence -­  rapidly  shifting/shallow  expression  of  emotions -­  self-­centred,  vain -­  psychical  appearance  to  attract  attention -­  concerned  about  everyone’s -­  impressionistic  style  of  speech approval -­  self-­dramatization  and  exaggerated  expressions -­  2-­3% -­  overly  suggestible -­  women  >  men -­  relationships  to  be  more  intimate  than  they -­  maladaptive  variants  of  female actually  are related  traits Causal  Factors -­  extreme  versions  of  two personality  traits      -­  neuroticism  +  extroversion (both  have  partial  genetic  basis) -­  Extroversion:  high  levels  of gregariousness(fond  of  company), excitement  seeking,  positive emotions -­  Neuroticism:  depression/  self consciousness  facets  +need  for attention/  self  worth Narcissisti -­  exaggerated  sense  of  self A  pervasive  pattern  of  grandiosity c importance (fantasy/behaviour),  need  for  admiration,  and Personality -­  grandiosity;;  most lack  of  empathy;;  five  of  the  following;; Disorder important/widely  used  criterion  for-­  grand  self  importance diagnosing  patients -­  preoccupation  about  fantasies  of  unlimited -­  overestimate  their  abilities success,  power  beauty -­  underestimate  others -­  s/he  is  special  and  unique -­  self  references  and  bragging -­  entitlement -­  understood  only  by  high  status -­  lacks  empathy people  (apparently) -­  interpersonally  exploitative -­  unwillingness  to  forgive -­  envious  of  others/  believes  others  are  envious  of -­  fragile  and  unstable  self  esteem s/he underneath -­  arrogant,  haughty  behaviours/attitudes -­  fantasies  of  outstanding achievement -­  cannot  see  through  someone else’s  eyes -­  i.e.  greater  tendencies  to  sexual desires  when  they  were  rejected by  the  target Five-­Factor  Model -­  low  agreeableness/high antagonism -­  low  modesty,  arrogance, grandiosity -­  low  altruism  (expecting favorable  treatment) -­  tough  mindedness -­  high  levels  of  angry  hostility/  self consciousness  (so  high neuroticism) -­  men>women Causal  Factors -­  Kohut:  children:  primitive grandiosity        -­  parents  must  do  something -­  Millon:  unrealistic  parent  over-­ evaluation Antisocial -­  violate  and  show  disregard  for Personality rights  of  others  through  deceitful, Disorder aggressive  or  antisocial  behaviour -­  no  remorse/loyalty -­  impulsive,  irritable,  aggressive -­  irresponsible  behaviour Borderline -­  occupy  border  between  neurotic Pervasive  pattern  of  instability  of  interpersonal Personality and  psychotic relationships,  self-­image,  and  affects,  and  marked Disorder -­  no  longer  considered  to  be impulsivity  as  indicated  by  at  least  five  of: associated  with  schizophrenia -­  frantic  efforts  to  avoid  real  or  imagined (which  it  was  before,  via abandonment schizotypal) -­  unstable  and  intense  interpersonal  relationships -­  over  idealizations  about  friends -­  identity  disturbance  characterized  by  a -­  self-­mutilation persistently  unstable  self  image  or  sense  of  self -­  self  injurious  behaviour  -­  relief -­  impulsivity  in  at  least  two  potentially  self from  anxiety  or  dysphoria damaging  areas  (eg.  spending  ,  sex,  substance, -­  analgesia;;  absence  of  pain  in  the reckless  driving) presence  of  a  painful  stimulus -­  recurrent  suicidal  behaviour -­  transient  episodes;;  out  of -­  affective  instability  due  to  marked  reactivity  to contact  with  reality  and mood experience  delusions/  other -­  feelings  of  emptiness psychotic  like  symptoms  i.e. -­  intense  inappropriate  anger hallucinations  paranoid  ideas, -­  transient,  stress  related  paranoid  ideation  or dissociative  symptoms severe  dissociative  symptoms -­  75  %  receiving  diagnosis  are women Comorbidity  with  Axis  I  and Axis  II -­  significant  impairment  in  social, academic  and  occupational functioning  -­  occurring  with  axis  I -­  relationship  with  mood  disorders -­  Axis  II  disorders  i.e.  dependent, avoidant,  obsessive-­compulsive -­-­>  commonly  associated  with depression  than  is  borderline personality  disorder -­cocurrence  with  others: especially  histrionic,  dependent, antisocial,  schizotypal -­  prototypic  schizotypal  -­-­>  lacks the  emotionality  of  the  borderline, and  tends  to  be  more  isolated, odd  and  peculiar Causal  Factors genetic  factors;;    -­    personality  traits  of  impulsivity and  affective  insatbility-­-­>  heritible  -­    serotonin  transporter  gene  + monoamine  oxidase-­-­>  may  play in  the  role  of  development  of disorder Biological    -­  lowered  functioning  fo  the neurotransmitter  serotonin (involved  with  inhibiting behavioural  responses) -­  disturbances  in  the  regulation  of noradrenergic  neurotransmitters (similar  to  those  seen  in  chronic stress  conditions  i.e.  PTSD) Psychosocial -­  memories  of  their  past  to discover  the  antecedents  of  the disorder -­  negative  events  in  childhood -­  early  childhood  trauma  (which rely  on  self  reports-­-­> exaggerated/distorted,  is  not  a specific  correlation  to  BPD, childhood  abuse  spurs  from places  with  other  disorders anyways) Multidimensional  Theory  of  BPD -­  high  levels  of  two  traits: impulsivity  and  affective  instability -­  may  be  the  key  to  getting  BPD (alongside  a  trauma  etc.) -­  impulsive/unstable:  tend  to  be difficult  or  troublesome  children (increased  risk  of  abuse) -­  weakening  family  structure  in today’s  society  is  direct correlation Avoidant -­  desire  affection  and  are  lonelypervasive  pattern  of  social  inhibition,  feelings  of Personality and  bored inadequacy  and  hypersensitivity  to  negative Disorder -­  unlike  schizoid evaluation,  as  indicated  by  at  least  four  of  the        -­  avoidants  do  not  enjoy following;; loneliness -­  avoids  occupational  activities  that  involved        -­  feeling  inept  and  sociallinterpersonal  contact awkward -­  unwillingness  to  get  involved  with  people  unless        -­  schizoid  is  aloof,  cold  certains  of  being  liked relatively  indifferent  to  criticism  +-­  restraint  within  intimate  relationships  because  of lacks  the  desire  to  form  social the  fear  of  being  shamed  or  ridiculed relationships -­  preoccupation  with  being  rejected        -­  avoidant  is  shy  timid -­  inhibited  in  new  interpersonal  situations hypersensitive  to  criticism between  of  feelings  of  inadequacy +desires  interpersonal  contact  but -­  views  self  as  socially  inept  or  inferior  to  others avoids  it  through  fear -­  extreme  reluctance  to  take  personal  risks  or -­  generalized  timidity  and engage  in  any  new  activities  via  fear  of avoidance  of  many  novel embarrassment situations  and  emotions -­  deficits  in  ability  to  experience pleasures -­  are  cases  of  social  phobias without  avoidant  but  little  cases where  avoidance  is  without  social phobia  (same  genetic  factors contribute  to  both) Causal  Factors: -­  inhibited  temperament  (leave  the child  shy) -­  fear  of  being  negatively evaluated  (heritable) -­  introversion  and  neuroticism  are both  elevated;;  moderately heritable -­  children  who  experience childhood  abuse,  rejection humiliation  from  parents  who  are not  affectionate -­  anxious  and  fearful  attachment patterns  in  temperamentally inhibited  children Dependent -­  clinging  and  submissive Pervasive  and  excessive  need  to  be  taken  care  of Personality behaviour that  leads  to  submissive  and  clinging  behaviour Disorder -­  subordinate  their  own  need  and and  fears  of  separation,  as  indicated  by  at  least views  to  keep  people  involved five  of  the  following: with  them -­  difficulties  making  everyday  decisions  without -­  fail  to  et  appropriately  angry excessive  advice  and  reassurance  from  others because  they  fear  of  losing  them -­  needs  others  to  take  responsibility  for  most i.e.  abusive  relationships major  areas  of  life -­  overlap  with  histrionic, -­  difficulty  expressing  disagreement  with  others borderline,  avoidant because  of  fear  of  loss  of  support  or  approval -­  borderline  and  dependent  fear -­  diff.  initiating  projects  or  doing  things  on  his  her abandonment-­-­>  however  B own  time reacts  with  emptiness  or  rage -­  goes  to  excessive  lengths  to  obtain  nurturance whereas  dependent  -­-­> and  support submissiveness  and  appeasement -­  uncomfortable  when  alone  because  fears  of and  then  urgently  seeking  for  a being  unable  to  take  care  of  oneself new  relationship -­  urgently  seeks  another  relationship  for  care  and -­  histrionic  and  dependent  ;;  both support  when  a  close  relationship  ends have  strong  needs  for  reassurance -­  unrealistic  preoccupation  with  fears  of  being  left and  approval  but  histrionic  is to  take  care  of  himself much  more  gregarious,  flamboyant whilst  dependent  is  docile,  self effacing -­  dependent  and  avoidant;;  hard  to distinguish;;  dependent  has difficultly  separating  because  they feel  incopetent  on  their  own,  and avoidant  fear  relationships because  they  fear  criticism  or rejection (avoidant  co-­occurs  with dependent) Causal  Factors -­  31%  accounted  by  genetic factors -­  neuroticism  and  agreeableness (traits)    most  prominent  and  have genetic  component Obsessive-­ -­  excessive  concerns  with A  pervasive  pattern  of  preoccupation  with Compulsiv maintaining  order  and  control orderliness,  perfectionism,  and  mental  and e -­  use  their  time  poorly interpersonal  control,  as  indicated  by  at  least  four Personality -­  difficulty  seeing  the  larger  pictureof;; Disorder -­  work  to  the  exclusion  of  leisure -­  preocc.  with  details,  rules,  order,  or  schedules activities  and  may  have  difficulty to  the  extent  that  the  major  point  of  an  activity  is relaxing lost -­  have  difficulty  delegating  tasks, -­  extreme  perfectionism  interfering  with  task are  rigid,  stubborn  and  cold completion -­  do  not  have  true  obsessions  or -­  excessive  devotion  to  work  to  the  exclusion  of compulsions  that  are  a  source  of leisure  and  friendships extreme  anxiety  or  distress  in -­  overly  inflexible  and  overconscientious  about people  with  Axis  I  OCD matters  of  morality,  ethics,  or  values -­  OCPD;;  lifestyle  characterized -­  inability  to  discard  worn  out  or  worthless by  overconscientious  s, objects inflexibility,  perfectionism  (withou-­t  reluctance  to  delegate  tasks  or  to  work  with obsessive  compulsive  rituals) others  unless  others  do  exactly  the  same  things -­  overlap  with  narcissistic, -­  miserliness  in  spengint  style  toward  both  self antisocial,  schizoid and  others -­  nar.  and  antisocial  share  lack  of -­  shows  rigidity  and  stubbornness generosity  towards  others,  former -­  indulge  within  themselves  whilst later  equally  unwilling  to  be generous  to  themselves -­  lacks  capacity  for  close relationships  b/c  of  excessive devotion  to  work Causal  Factors -­  high  on  assertiveness  (facet  of extraversion) -­  low  on  compliance  (facet  of agreeableness) Biological  Dimension  approach 1.  novelty  seeking  -­-­>  low-­-­> avoid  change 2.  reward  dependence-­-­>  low -­-­>  work  excessively  at  expense of  pleasure 3.  harm  avoidance-­-­>  high-­-­> avoid  aversive  stimuli -­  27%  genetic  factor Provisional Passive  Aggressive Depressive  Personality  Disorder  : Categories Personality  Disorder: -­  pattern  of  depressive  cognitions  and  behaviours of -­  “  negativistic  personality which  are  pervasive  in  behavior  (extensive) Personality disorder” -­  usual  mood  :  unhappiness,  gloom,  dejection Disorder  in -­  reliability  and  validity  is  limited -­  prone  to  worry DSM-­IV-­T for  the  diagnosis -­  pessimistic R -­  pervasive  pattern  resistance  to -­  difficult  to  distinguish  b/w  early  onset  dysthymia demands  in  social  or  work (disorder  of  mood  regulation)  and  depressive situations personality  disorder -­  i.e  simple  resistance  to  do  a task,  to  being  sullen  and argumentative,  or  altering  between defiance  and  submission -­  complain  about  personal misfortunes  of  being misunderstood/unappreciated Treatments  and  Outcomes -­  very  difficult  to  treat -­  goals:  reducing  subjective  distress,  changing  specific  dysfunction  behaviour,  changing  whole  patterns  of behaviour  or  the  entire  structure  of  the  personality -­  patients  often  believe  they  do  not  need  change -­  Odd/centric  Cluster  A  and  erratic/dramatic  Cluster  B  =  difficulties  in  forming  and  maintaining  good relationships  (including  with  a  therapist) -­  Cluster  B-­-­>  pattern  of  acting  out  during  therapy,  and  verbally  abusive -­  people  with  both  Axis  I  and  Axis  II -­  do  not  do  well  in  treatment  for  Axis  I  disorders  as  would  patients  withot  cormobid  disorders -­  b/c  people  with  personality  disorders  have  rigid  ingrained  personality  traits -­  makes  them  resistant  and  uncooperative  towards  improving  their  Axis  I  disorder Adapting  Therapeutic  Techniques  to  Specific  Personality  Disorders -­  individual  therapy  tends  to  make  dependent  people  even  more  dependant  (helpful  discovery) -­  anxious/fearful  Cluster  C  i.e.  dependent/avoidant-­-­  may  be  hypersensitive  to  any  criticism -­  severe  personality  disorders: -­  most  effective  when  acting-­out  behaviour  can  be  constrained i.e.  BPD  -­-­  are  hospitalized  b/c/  of  suicidal  behaviour -­  partial  hospitalization  programs -­  intermediate  and  less  expensive -­  patients  live  at  home -­  receive  extensive  group  and  rehab -­  some  therapeutic  techniques-­  cognitive -­  central  to  idea  that  dysfunctional  feelings  and  behaviour  that  are  associated  with  personality disorders  =  result  of  schemas  that  tend  to  produce  consistently  biased  judgements  plus  tendencies  to make  cognitive  errors -­  changing  underlying  schemas  is  difficult -­  monitoring  thoughts,  challenging  faulty  logic,  assigning  behavioural  tasks,  challenging dysfunctional  beliefs Treating  Borderline  Personality  Disorder Biological;; -­  medication  is  controversial -­  antidepressant  medication  from  SSRI  category  -­-­>  safe  and  useful  -­-­>  treats  rapid  mood shifts,  anger,  anxiet
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