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Personality Disorders 11/11/
I. On Personality Disorders A. Personality- pattern of characteristic traits, coping styles, and ways of interacting with the social environment Personality disorder- an enduring pattern of traits, coping styles, and ways of interacting that is so inflexible and maladaptive that the individual’s ability to function adaptively and in compliance with society’s norms is significantly impaired o Onset is not later than early adulthood; may not come to clinical attention until relatively later in life o Classified on Axis II Individuals with a personality disorder coded on Axis II will often have a clinical syndrome that is coded on Axis I o Etiology: Comorbidity B. Diagnostic Criteria – pg. 59 o The enduring pattern is manifested in two (or more) of the following areas: Cognition Affectivity Interpersonal functioning Impulse control o Personality disorder is not dependent on the situation; it cuts across all situation; defines who the individual is as a person o Leads to clinically significant distress or impairment in functioning o The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood II. Three Clusters of Personality Disorders A. Cluster A: odd and eccentric o Schizotypal
More common in men Peculiar thought patterns Oddities of perception and speech Most strongly related to schizophrenia o Schizoid (Loner) More common in men Impaired social relationships Inability to form attachments to others o Paranoid – pg. 60 Think others are “out to get them” Have difficulty building relationships and getting along with others Bears grudges Preoccupied w/ unjustified doubts about the loyalty or trustworthiness of friends Has recurrent suspicions regarding fidelity of spouse or sexual partner B. Cluster B: dramatic, emotional, and erratic o Histrionic Equally common among genders Self-dramatization Over-concern with attractiveness Tend to be irritable and may have temper tantrums if they feel they are not receiving enough attention Self-centered
C. Cluster C: anxious and fearful o Avoidant Equally common in males and females Hypersensitivity to rejection Shyness Insecurity in initiating relationships Would like to have relationships, it is just difficult for them o Dependent Equally common in males and females Difficulty in separating in relationships Discomfort at being alone Subordination of needs to maintain a relationship o Obsessive-Compulsive- pg. 62; does not have true obsessions or compulsions but do have a personality that is obsessive compulsive in nature. 4+ of 8 symptoms Distinguishable from the trait of being organized, etc. Hoarding – In extreme cases, more often associated with the anxiety disorder (rather than personality disorder) You can get diagnosed with both (Anxiety disorder from Axis 1 and Personality Disorder on Axis II) III. Differential Diagnosis Distinguishing between a personality disorder and an Axis 1 mental disorder o A person has an Axis 2 personality disorder when the defining characteristics:
o Appear before early adulthood o Are typical of the individual’s long term functioning (general behavior in most all situations) o Do not occur exclusively during an episode of an Axis I disorder Distinguishing between the ten personality disorders o Diagnostic criteria are not as sharply defined. o People often show characteristics of more tan one personality disorder o High level of comorbidity amongst the personality disorders Distinguishing between a personality disorder and a personality trait o Personality Disorder Not Otherwise Specified (NOS) o Disorder of personality functioning that does not meet criteria for any specific personality disorder o Only becomes a personality disorder when it’s maladaptive (definition on top of page 54) IV. Categorical Versus Dimensional Model for Personality Disorders Categorical Perspective- Each of the personality disorders are qualitatively distinct with their own set of defining criteria Dimensional Model- Suggests that personality disorders represent maladaptive variants of normal personality traits o Occurs on a continuum (Normal to Maladaptive: Mildly or Severely) V. Course and Treatment Once diagnosed, usually fairly stable Some disorders are more likely to remit with age (Borderline personality & Antisocial) OCD & Schizotypal are least likely to remit Treatment o Very difficult o Have relatively enduring, pervasive, and inflexible patterns of behavior and inner experience o Do not believe that they need to change and so are reluctant to enter therapy o Medication doesn’t usually help much – increased rates of suicide o Cluster C disorders seem to respond the best to treatment (The ones based on anxiety & fear) o Cluster A disorders seem to be most resistant to change o Not much research – relative newcomer to the DSM o Cognitive Therapy – works well for people with avoidant disorder of Cluster C (the individual who is shy and reluctant to initiate and maintain relationships) Borderline personality disorder – has received the most attention because of its high risk of suicide.
Psychotic Disorder o Inability to distinguish reality from fantasy o Prototypical of abnormality o Effects our thinking, what we feel and how we express it, our behavior, and our perceptual ability o “Best example of abnormal behavior” o Occurs in every culture in people from all walks of life o 1 out of 100 individual will experience a schizophrenic episode o 1% is significant due to the severity of the illness Age of Onset o Onset is typically in late adolescence and early adulthood Men – 25 Women – 29 Rarely occurs in childhood Gender Differences o Men: earlier onset, a little more severe in nature, slightly higher prevalence, worse long-term functioning Poor Insight o At the beginning, may notice something is not quite right but once fully psychotic – they do not realize they are wrong Myth o Violence is associated with Schizophrenia o Most individuals with schizophrenia are not going to be violent.
II. DSM-IV-TR Criteria for the Diagnosis of Schizophrenia A. Characteristic Symptoms (p. 63) o Delusion- Erroneous beliefs that are fixed and firmly held despite contradictory evidence; 90% of schizophrenics will be delusional at some point Persecutory delusion- person believes he or she is being tormented, followed, tricked, spied on, or ridiculed; most common type of delusion Referential delusion- person believes that certain gestures, comments, newspapers, or other environmental cues are specifically directed at him or her Grandiose delusion- false beliefs of greatness; person believes they have a unique relationship with God or they have an exaggerated idea of self-importance Non-bizarre delusion: plausible Bizarre delusion: implausible, wouldn’t actually happen Thought withdrawal- thoughts have been taken away by some outside force Thought insertion- alien thoughts have been put into their mind Thought broadcasting- private thoughts are being broadcast indiscriminately to others o Hallucination- a sensory experience that occurs in the absence of an external perceptual stimulus Auditory- (most common) hearing something that does not exist; about 75% of schizophrenics will have an auditory hallucinations at some point; hearing two or more voices conversing with each other is enough to fulfill Criterion A Visual- seeing something that does not exist Olfactory- smelling something Tactile- feeling something (ex: feeling a snake crawling inside your body) o Disorganized speech- because we cannot see or hear exactly what is inside someone’s head, we make assumptions about what their thought form is, based on what they say Derailment- (or loosening of associations) individual moves from one topic to another; subjects are loosely associated to one another Tangentiality- person answers a question, and the answer is either slightly or very unrelated to the question that was asked Incoherence- (word salad) speech is so severely disturbed or disorganized that it is almost incomprehensible Poverty of content- the person is saying a lot of stuff, but there is not much content
o Echolalia- pathological, parrot-like or apparently senseless repetition of a word or phrase just spoken by another person; potential symptom of both catatonic schizophrenia and autism o Echopraxia- repetitive imitation of the movements of another person o Undifferentiated- symptoms that meet the defining criteria for schizophrenia are present, but additional criteria are not met for the Paranoid, Disorganized, or Catatonic Type; “catch all” for schizophrenia o Residual- absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior, but continuing evidence of this disturbance is present in a milder form IV. Etiological Factors for Schizophrenia In many cases, disorders are caused by multiple disorders that work together Strong genetic component o Family studies: odds of being schizophrenic 1/100 – if you are a member of a random group of 100 people 1/10 – if you have an afflicted first-degree biological relative ½ - if you have an afflicted monozygotic twin o Twin studies- have shown that the concordance rate for schizophrenia is higher for monozygotic twins than dizygotic twins o Not entirely genetic, just genetically influenced; individual can inherit a genetic predisposition for the disorder o Genetic predisposition for developing schizophrenia: Multiple genes works together to make an individual susceptible to schizophrenia The more schizophrenia genes inherited more likely to develop schizophrenia Environmental factors o Prenatal virus factors o Early nutritional deficiencies o Birth complications Neurodevelopmental disorder- disorder that stems from a brain lesion that occurs very early in development, perhaps before birth
Schizophrenogenic mother- cold and aloof mother who causes schizophrenia; part of a false hypothesis about the cause of schizophrenia V. Outcome and Treatment for Schizophrenia A. Outcome o 16% of schizophrenics will recover fully o 38% will have a favorable outcome; given that they stay on medication, or continue treatment of some kind, they will probably be able to function pretty well o 33% will have continued signs of the illness, despite the continuation of medication and treatment o 12% will need long-term institutionalization o We are getting much better at recognizing symptoms, diagnosing it early, and treatment it B. Pharmacological treatment o 1950s – first generation of antipsychotic medications; many bad side effects o 1980s – second generation of antipsychotics; much fewer side effects; alleviate the positive and negative symptoms of schizophrenia; utilize dopamine Schizophrenia and dopamine Receptor cells supersensitive to dopamine excess of dopamine in schizophrenics Antipsychotic drugs act to block some of the dopamine receptors (thus reducing the amount of dopamine) o Recently discovered that estrogen has some clinical benefits; women with schizophrenia can be given estrogen to minimize schizophrenic symptoms
o Stonewall Riot- protest by gay men in response to police raid of Stonewall Inn, solidifying the beginning of the gay rights movement in the US.
- Removal from the DSM-II by the APA (1974) o APA voted to take homosexuality out of what was then, the DSM II (part in response to pressure from gay rights movement, part in response to more empirical evidence that it was not a mental disorder)
- Research on adjustment of homosexual individuals o Gay men have higher rate of: Anxiety Depression Suicidal Ideation o Lesbians have higher rate of substance abuse o Most gay men and lesbians do not have a mental disorder
- Changes in the law (2000s) a. Can same-sex couples legally engage in sexual relations? b. Can same-sex couples marry? Sodomy- imprecise legal term applied to sexual behavior other than heterosexual penile-vaginal intercourse o Usually refers to oral sex and intercourse between same-sex partners and, in some state, also between opposite- sex partners o In South Carolina, defined as oral and anal sex between both same-sex and opposite-sex partners and, until the summer of 2003, was a felony Bowers v. Hardwick- (1986) U.S. Supreme Court case which upheld Georgia anti-sodomy law, ruling that the Constitution did not protect the right of homosexuals to have sex in their own home Lawrence & Garner v. Texas- (2003) U.S. Supreme Court case which struck down Texas anti-sodomy law, ruling that the Constitution did protect the right of individuals to engage in sexual relations with someone of the same sex American public on homosexual sex: polls show that 6 out of 10 Americans believe that homosexual sex between consenting adults should be legal D. Where gay marriage is legal:
- District of Columbia
- Massachusetts
- Connecticut
- Iowa
- Vermont
- New Hampshire
- New York E. Sexual orientation and the DSM
- Normal sexual variant- same-sex orientation is not considered a psychological disorder as defined by the DSM, but instead a nonpathological (or normal) sexual variant
- Sexual disorder not otherwise specified (NOS)- includes sexual disturbances that do not meet the criteria for a specific sexual disorder; ex: persistent and marked distress about sexual orientation F. Is sexual orientation a matter of choice? Socioenvironmental/psychological/biological 3-way Venn diagram with overlapping in the middle Americans who believe sexual orientation is at least partially biological are more likely to support gay and lesbian civil rights than those who believes it is determined primarily by the environment G. Sexual orientation and current issues Don’t Ask, Don’t Tell, Don’t Pursue- (1993) prohibits asking recruits about sexual orientation, but views disclosure of same- sex orientation as misconduct worthy of discharge Don’t Ask, Don’t Tell, Repeal Act- (2010) ultimately repeals the 1993 law that prevented openly gay people from serving in the U.S. Armed Forces Gay parents commonly lose visitation/custody rights based on the belief that their sexual orientation will harm their child’s development o Few if any differences found in children depending on parents’ sexual orientation Does not effect self-esteem, gender roles, sexual orientation, development, school problems, well-being III. Gender Identity Disorders A. Biological sex vs. gender
o Transudation- vaginal lubrication o Tenting effect- lengthening and expansion of vagina; elevation of uterus o Fibrillations- rapid, irregular contractions of the uterus o Sex flush- reddening or darkening of the skin, often in the facial region o Myotonia- increase in muscle tension o Increase heart rate, blood pressure, and respiration
- Plateau o Orgasmic platform- engorged tissue at outer portion of vagina; results in narrowing of vaginal opening o Seminal pool- small pocket at back of vagina; seminal fluid collects here o Orgasm- rapid and rhythmic contractions of the uterus and anal sphincter (muscle that surrounds the anal opening)
- Resolution- period during which the female’s body returns to a pre-aroused state B. Male sexual response cycle
- Excitement o Vasocongestion o Penile tumescence (erection) o Widening of urethral opening o Thickening of scrotal sac and elevation of testes o Sex flush o Myotonia o Increase in heart rate, blood pressure, and respiration
- Plateau
o Erection maintained o Continued vasocongestion, sex flush, and myotonia o Darkening of penis o Droplets of fluid from Cowper’s gland appear on tip of penis
- Orgasm o Orgasm Stage 1: Emission stage of ejaculation Seminal fluid collects in urethral bulb Bladder sphincter closes Subjective feeling of ejaculatory inevitability o Orgasm Stage 2: Expulsion stage of ejaculation Contractions of urethral bulb and urethra Semen expelled through urethra
- Resolution o Period during which the male’s body returns to a pre-aroused state o Also referred to as the refractory period V. Sexual Dysfunctions A. Sexual dysfunctions- pg. 69; recurrent sexual problems that interfere with normal sexual performance and cause distress for the individual and/or cause interpersonal difficulty; Axis 1 Lifetime prevalence of sexual dysfunctions: o 43% of women o 31% of men
10-15% experience this life-long non-orgasm Inhibited female orgasm Frigidity *Most women need sexual stimulation in order to achieve orgasm; women need stimulation during orgasm b. Male orgasmic disorder Cannot ejaculate during intercourse, but typically can during masturbation OR if it takes along than avg. time to ejaculate (typically 2 min. after penetrating vagina) c. Premature ejaculation Has orgasm before ready to 1/3 of all men have it Most common dysfunction
- Sexual pain disorders a. Dyspareunia (male or female) Physical component Physical pain during sexual intercourse Almost always associated w/ medical condition for men (ex: UTI) Pain for women that is different than pain she experiences for not having lubrication b. Vaginismus (women only) Pain and spasms of vaginal muscles during intercourse A lot more common Prevent penetration of penis, tampon, or masturbation
Though stimulation can receive orgasm, but not intercourse Typically victims of rape and others experience timidity towards this
- Sexual dysfunctions due to a general medical condition o Ex: male erectile disorder due to diabetes o Criteria: Marked distress or interpersonal difficulty Fully explained by direct physiological effects of a general medical condition
- Substance induced sexual dysfunction o Criteria: Marked distress or interpersonal difficulty Fully explained by substance abuse C. General causes of sexual dysfunction
- Medications and illicit drugs o Alcohol take away or defer sexual desire Interferes with male erection Interferes with orgasm and time to develop one Decrease intensity in women Antidepressants same side effects as alcohol o Psychological factors Anxiety Depression
