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Chapter 12

Abnormal Psychology CHAPTER 12 NOTES - I got a 4.0 in the course

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PSY 240
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Chapter 12: Personality Disorders An Overview of Personality Disorders: • Personality disorders are enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts and are inflexible and maladaptive, and cause significant functional impairment or subjective distress Aspects of Personality Disorders: • PDs are chronic, they do not come and go but originate in childhood and continue throughout adulthood. Because they affect personality these chronic problems pervade every aspect of a person’s life • The emotions of therapists brought out by clients (countertransference) tend to be negative for those diagnosed with PDs0-us experience temporarily, such as being shy or suspicious • The issue that continues to be debated in the field is whether PDs are extreme versions of otherwise normal personality variations (dimensions) or ways of relating that are different from psychologically healthy behavior (categories) • Five factor model: people can be rated on a series of personality dimensions, and the combination of five components describes why people are so different. Five factors are: extroversion, agreeableness, conscientiousness, neuroticism openness to experience • An alternative model that derives from clinical work with Westen and Shedler identifies twelve personality dimensions that not only overlap with DSM criteria but also introduce new aspects of personality Personality Disorder Clusters: • Cluster Ais called the odd or eccentric cluster; it includes paranoid, schizoid, and schizotypal personality disorders • Cluster B is the dramatic, emotional, or erratic cluster; it consists of antisocial, borderline, histrionic, and narcissistic PDs • Cluster C is the anxious or fearful cluster; it includes avoidant, dependent, and obsessive- compulsive PDs Statistics and Development: • As many as 1 in 10 adults in the US may have a diagnosable PD which makes them relatively common • Worldwide, about 6% of adults may have at least one PD • More women are diagnosed with borderline PD and more mend identified with antisocial PD • PDs are thought to originate in childhood and continue into the adult years; they are also thought to be so ingrained that an onset is difficult to pinpoint • Many individuals do not seek treatment in the early developmental phases of their disorder but only after years of distress Gender Differences: • Borderline PD is diagnosed more often in females • Equal numbers of males and females may have histrionic and dependent PD ClusterA Personality Disorders: Paranoid Personality Disorder: • Excessively mistrustful and suspicious of others, without any justification. They assume other people are out to harm or tick them, therefore they tend not to confide in others • Apervasive unjustified distrust • Are suspicious in situations in which most other people would agree their suspicions are unfounded • Such mistrust often extends to people close to them and makes meaningful relationships difficult • May be argumentative, may complain, or may be quiet • They often appear tense and “ready to pounce” when they think they’ve been slighted by someone. These individuals are sensitive to criticism and have an excessive need for autonomy Causes: o Some research suggests the disorder may be slightly more common among the relatives of people who have schizophrenia, although the association does not seem to be strong o Retrospective research suggests that early mistreatment or traumatic childhood experiences may play a role in the development of paranoid PD o One view is that people with this disorder have the following basic mistaken assumptions about others: “People are malevolent and deceptive” o This is a maladaptive way to view the world, yet it seems to pervade every aspect of the lives of these individuals o Their parents may teach them to be careful about making mistakes and may impress on them that they are different from other people. This vigilance causes them to see signs that other people are deceptive and malicious o Cognitive and cultural factors may interact to produce the suspiciousness observed in some people with paranoid PD Treatment: o Are unlikely to seek professional help when they need it and they have difficult developing the trusting relationships necessary for successful therapy o Therapists try to provide an atmosphere conducive to developing a sense of trust o To date there are no confirmed demonstrations that nay form of treatment can significantly improve the lives of people with paranoid PD Schizoid Personality Disorder: • Show a pattern of detachment from social relationships and a limited range of emotions in interpersonal situations. They seem aloof, cold, and indifferent to other people • Seem neither to desire nor to enjoy closeness with others, including romantic or sexual relationships • Homelessness appears to be prevalent among people • They do not seem to have the unusual thought processes that characterize the other disorders in Cluster A • Those with schizoid PD share the social isolation, poor rapport, and constricted affect Causes and Treatment: o Childhood shyness is reported a s a precursor to later adult schizoid PD o Abuse and neglect in childhood are also reported among individuals o Research over the past several decades point to biological dysfunction found in both autism and schizoid PD combines with early learning or early problems with interpersonal relationships to produce the social deficits that define schizoid PD o May even need to be taught the emotions felt by others to learn empathy. Because their social skills were never established or have atrophied through lack of use, people with schizoid PD often receive social skills training Schizotypal Personality Disorder: • Behave in ways that would seem unusual to many of us, and they tend to be suspicious and to have odd beliefs • Psychotic like (but not psychotic) symptoms (such as believing everything relates to them personally), social deficits, and sometimes cognitive impairments or paranoia • Have ideas of reference, which means they think insignificant events relate directly to them • Have odd beliefs or engage in “magical thinking”, believing, for example that they are clairvoyant or telepathic. They report unusual perceptual experiences, including such illusions as feeling the presence of another person when they are alone • Tend to be suspicious and have paranoid thoughts, express little emotion, and may dress or behave in unusual ways • Tend to be passive and unengaged and are hypersensitive to criticism • Mental health workers have to be particularly sensitive to cultural practices that may differ from their own and can distort their view of certain seemingly unusual behaviors Causes: o The idea of the relationship between schizotypal PD and schizophrenia arises partly from the way people with the disorder behave. Many characteristics of schizotypal PD, including ideas f reference, illusions, and paranoid thinking, are similar but milder forms of behaviors o Family studies show an increased prevalence of schizotypal PD among relatives of people with schizophrenia o Environment can strongly influence schizotypal PD o Cognitive assessment points to mild to moderate decrements in their ability involving memory and learning, suggesting some damage in the left hemisphere Treatment: o 30-50% of the people with schizotypal who request clinical help also meet the criteria for major depressive disorder o One study used a combo of approaches, including antipsychotic meds, community treatment, and social skills training Cluster B Personality Disorders: Antisocial Personality Disorder: • Are among the most puzzling of the individuals a clinician will see in a practice and are characterized as having a history of failing to comply with social norms. They perform actions most of us would find unacceptable. They also tend to be irresponsible, impulsive, and deceitful • Lacking in conscience and empathy, they selfishly take what they want and do as they please, violating social norms • Are often described as being aggressive because they take what they want, indifferent to the concerns of other people • Substance abuse is common, occurring in 60% of people • Defining criteria: o Hervey Cleckley identified a constellation of 16 major characteristics, most of which are personality traits and are sometimes referred to as the Cleckley criteria o Hare developed a 20 item checklist that serves as an assessment tool • Antisocial Personality, Psychopathy, and Criminality: o Some psychopaths are not criminals and some do not display the aggressiveness that is a criteria for antisocial PD o Antisocial PD as outlined in the DSM and criminality, which includes all people who get into trouble with the law o Not everyone who has psychopathy or antisocial personality disorder becomes involved with the legal system o Some psychopaths function quite successfully in certain segments of society (politics, business, etc) • Conduct Disorder o Provides a separate diagnosis for children who engage in behaviors that violate society’s norms o The likelihood of an adult having antisocial PD increases if he or she had both conduct disorder andADHD as a child o Lack of remorse is included under antisocial personality disorder but not in the conduct disorder criteria. Some children with conduct disorder do feel remorseful about their behavior Genetic Influences: o Genetic influence on both antisocial PD and criminality o Genetic factors may be important only in the presence of certain environmental influences o Genetic factors may present a vulnerability, but actual development of criminality may require environment factors, such as a deficit in early, high quality contact with parents Neurobiological Influences: o According to the under arousal hypothesis, psychopaths have abnormally low levels of cortical arousal o The Yerkes Dodson curve suggests that people with either high or low levels of arousal tend to experience negative affect and perform poorly in many situations, whereas individuals with intermediate levels of arousal tend to be relatively content and perform satisfactorily in most situations o The abnormally low levels of corticol arousal characteristic of psychopaths are the primary cause of their antisocial and risk taking behaviors: they seek stimulation to boost their chronically low levels of arousal o According the
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