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An overview of various personality disorders, including cluster a disorders (paranoid, schizoid, and schizotypal), as well as cluster b disorders (narcissistic, antisocial, and borderline). It also covers paraphilic disorders, which involve persistent and recurrent patterns of sexual behavior and arousal, such as fetishism, pedophilia, and exhibitionism. The challenges of diagnosing and treating personality disorders, the role of sociocultural factors, and the similarities and differences between antisocial personality disorder and psychopathy. Additionally, it touches on the clinical features of various paraphilic disorders, including their diagnostic criteria and associated behaviors. Overall, this document offers a comprehensive understanding of these complex psychological conditions and the factors that contribute to their development and expression.
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personality disorder, p. 342 chronic interpersonal difficulties, problems with one’s identity or sense of self, and an inability to function adequately in society - enduring pattern of behavior must be pervasive and inflexible, as well as stable and of long duration - cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.
10 and 12 percent of people meet criteria for at least one personality disorder when the time period being asked about is the person’s behavior over the last 2 to 5 years paranoid personality disorder, p. 348 are suspicious and distrustful of others, often reading hidden meanings into ordinary remarks - see themselves as blameless, instead blaming others for their own mistakes and failures—even to the point of ascribing evil motives to others. schizoid personality disorder, p. 349 difficulty forming social relationships and usually lack interest in doing so - tend not to have good friends, with exception of a close relative - unable to express their feelings/seen by others as cold and distant - They often lack social skills and can be classified as loners or introverts, with solitary interests and occupations not all loners/introverts have schizoid personality Neither desires nor enjoys close relationships, including being part of a family - Almost always chooses solitary activities - Has little, if any, interest in having sexual experiences with another person - Takes pleasure in few, if any, activities - Lacks close friends or confidants other than first-degree relatives. schizotypal personality disorder, p. 351 also excessively introverted and have pervasive social and interpersonal deficits. But in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior - contact with reality is usually maintained, highly personalized and superstitious thinking is characteristic - often believe that they have magical powers and may engage in magical rituals Ideas of reference (excluding delusions of reference) - Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance,
slow return to a baseline emotional state. Affective instability is also characterized by drastic and rapid shifts from one emotion to another This is combined with a highly unstable self-image or sense of self - chronic feelings of emptiness and have difficulty forming a sense of who they really are - very fearful of abandonment - Self-mutilation Frantic efforts to avoid real or imagined abandonment - A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation - Identity disturbance: markedly and persistently unstable self-image or sense of self - Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior - Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) - Chronic feelings of emptiness - Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) - Transient, stress related paranoid ideation or severe dissociative symptoms - Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). avoidant personality disorder, p. 364 show extreme social inhibition and introversion, leading to life- long patterns of limited social relationships and reluctance to enter into social interactions. Because of their hypersensitivity to, and fear of, criticism and disapproval, they do not seek out other people, yet they desire affection and are often lonely and bored - Feeling inept and socially inadequate are the two most prevalent and stable features - Avoids occupational activities that involve significant inter- personal contact because of fears of criticism, disapproval, or rejection - Is unwilling to get involved with people unless certain of being liked - Shows restraint within intimate relationships because of the fear of being shamed or ridiculed - Is preoccupied with being criticized or rejected in social situations - Is inhibited in new interpersonal situations because of feelings of inadequacy - Views self as socially inept, personally unappealing, or inferior to others - Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. dependent personality disorder, p. 365 extreme need to be taken care of, which leads to clinging and submissive behavior. They also show acute fear at the possibility of separation or sometimes of simply having to be alone because they see themselves as inept - Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others - Needs others to assume responsibility for most major areas of his or her life - Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.) - Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence - judgment or abilities rather than a lack of motivation or energy) - Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant - Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself - Urgently seeks another relationship as a source of care and support when a close relationship ends - Is unrealistically preoccupied with fears of being left to take care of himself or herself. obsessive-compulsive personality disorder (OCPD), p. 367 Perfectionism and an excessive concern with orderliness and control - Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost - Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) - Is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) - Is unable to discard worn-out or worthless objects
even when they have no sentimental value - Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things - Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes - Shows rigidity and stubbornness - Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). dialectical behavior therapy (DBT), p. 370 Marsha Linehan, is a unique kind of cognitive and behavioral therapy specifically adapted for BPD - patients’ inability to tolerate strong states of negative affect is central to this disorder. One of the primary goals of treatment is to encourage patients to accept this negative affect without engaging in self-destructive or other maladaptive behaviors - based on a clear hierarchy of goals, which prioritizes decreasing suicidal and self-injurious behavior and increasing coping skills. The therapy combines individual and group components as well as phone coaching. psychopathy, p. 372
ideal. This is because many of the symptoms of spe- cific personality disorders are not very precisely defined. A great deal of judgment is needed to know if a person’s behavior meets the standard in each case.
addictive behavior, p. 385 behavior based on the pathological need for a substance substance abuse, p. 385 generally involves an excessive use of a substance resulting in (1) potentially hazardous behavior 2) continued use despite a persistent social, psychological, occupational, or health problem. substance dependence, p. 385 usually involves a marked physiological need for increasing amounts of a sub- stance to achieve the desired effects. - individual will show a tolerance for a drug and/or experience withdrawal symptom when the drug is unavailable psychoactive substances, p. 385 alcohol, nicotine, barbiturates, tranquilizers, amphetamines, heroin, Ecstasy, and marijuana. substance-related disorders, p. 385 considered to be disordered when consumed in excessive amounts leading to impairment and other negative consequences tolerance, p. 385 need for increased amounts of a substance to achieve the desired effects—results from biochemical changes in the body that affect the rate of metabolism and elimination of substance from the body. withdrawal, p. 385 refers to physical symptoms such as sweating, tremors, and tension that accompany abstinence from a drug Alcohol Use Disorder A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12 - month period alcohol amnestic disorder, p. 391 memory defect (particularly with regard to recent events), which is sometimes accompanied by falsification of events (confabulation) People with this disorder may not recognize pictures, faces, rooms, and other objects that they have just seen, although they may feel that these people or objects are familiar - treatment with thiamine leads to a reversal alcohol withdrawal delirium, p. 391 those who drink excessively for a long time - usually happens following a prolonged drinking spree when the person enters a state of withdrawal. Slight noises or suddenly moving objects may cause considerable excitement and agitation - The full-blown symptoms include (1) disorientation for time and place, in which, for example, a person may mistake the hospital for a church or jail (2) vivid hallucinations, particularly of small, fast-moving animals like snakes, rats, and roaches; (3) acute fear, in which these animals may change in form, size, or color in terrifying ways; (4) extreme suggestibility, in which a person can be made to see almost any animal if its presence is merely suggested; (5) marked tremors of the hands, tongue, and lips; and (6) other symptoms including perspiration, fever, a rapid and weak heartbeat, a coated tongue, and foul breath. (MCLP), p. 392 “pleasure path- way.” The mesocorticolimbic dopamine pathway - the center of psychoactive drug activation in the brain - made up of neuronal cells in the middle portion of the brain known as the ventral tegmental area - Alcohol produces euphoria by stimulating this area in the brain opium, p. 403 mixture of about 18 chemical substances known as alkaloids
morphine, p. 403 alkaloid present in opium in the largest amount (10– 15 percent) was found to be a bitter- tasting powder that could serve as a powerful sedative and pain reliever heroin, p. 403 if morphine was treated with an inexpensive and readily available chemical called acetic anhydride, it would be converted into another powerful analgesic dopamine theory of addiction, p. 405 suggests that addiction is the result of a dysfunction of the dopamine reward pathway endorphins, p. 405 human body produces its own opium-like substances, called endorphins, in the central nervous system and pituitary gland. Heroin plugs into opiate receptors (taking the place of endorphins), but works much more quickly and intensely, producing the extreme euphoria reward deficiency syndrome, p. 405 suggests addiction more likely to occur in peeps have genetic deviations in components of the reward pathway, leads them to be less satisfied by natural rewards (e.g., from food, sex, drugs, and other pleasurable activities), in turn leads them to overuse drugs and related experiences to adequately stimulate their reward pathway cocaine, p. 406 plant product discovered in ancient times and used ever since - leaves of the coca plant were wrapped around lime and placed inside the cheek to provide a slow release methadone, p. 406 a synthetic narcotic that is related to heroin and is equally addictive physiologically. amphetamine, p. 408 “wonder pills” that helped people stay alert and awake and function temporarily at a level beyond normal caffeine, p. 409 nicotine, p. 409 barbiturates, p. 411 powerful sedatives been available as an aid to falling asleep - they are extremely dangerous drugs associated with both physiological/psychological dependence & lethal overdoses - once widely used by physicians to calm patients and induce sleep. They act as depressants—some- what like alcohol—to slow down the action of the CNS - users can easily ingest fatal over- doses, either intentionally or accidentally. hallucinogens, p.412 are drugs that are thought to induce hallucinations. However, these preparations usually do not in fact “create” sensory images but distort them so that an - individual sees or hears things in different and unusual ways. These drugs are often referred to as psychedelics LSD, p. 412 odorless, color- less, and tasteless drug - discovered by the Swiss chemist Albert Hofmann in 1938 Ecstasy, p. 413 MDMA (3,4-methylenedioxymeth- ylamphetamine), is both a hallucinogen and a stimulant psilocybin, p. 413 obtained from a variety of “sacred” Mexican mushrooms known as Psilocybe mexicana. flashback, p. 413 an involuntary recurrence of perceptual distortions or hallucinations weeks or even months after an individual has taken the drug.
erectile disorder, p. 447 Marked difficulty in obtaining an erection during sexual activity - Marked difficulty in maintaining an erection until the completion of sexual activity - Marked decrease in erectile rigidity. female sexual interest/arousal disorder, p. 447 Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following male hypoactive sexual desire disorder, p. 449 Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity - acquired or situational rather than lifelong. Typical situational risk factors include depression and relationship stress. delayed ejaculation disorder, p. 452 Marked delay in ejaculation - Marked infrequency or absence of ejaculation female orgasmic disorder, p. 454 diagnosed in women who are readily sexually excitable - show persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase and who are distressed by this genito-pelvic pain/penetration disorder, p. 454 combines the genital pain of dyspareunia with muscle tension (not muscle spasms) and fear and anxiety related to genital pain or penetrative sexual activity - more likely to have organic than psychological causes. Some examples of physical causes include acute or chronic infections or inflammations of the vagina or internal reproductive organs, vaginal atrophy that occurs with aging, scars from vaginal tearing, or insufficiency of sexual arousal. SUMMARY Explain why it is difficult to define boundaries between normality and psychopathology in the area of variant sexuality.
positive symptoms, p. 466 those that reflect an excess or distortion in a normal repertoire of behavior and experience, such as delusions and hallucinations. Disorganized thinking (as revealed by disorganized speech) is also thought of in this way. schizoaffective disorder, p. 467 person not only has psychotic symptoms that meet criteria for schizophrenia but also has marked changes in mood for a substantial amount of time. (mood disorder) - period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia. schizophreniform disorder, p. 467 schizophrenia-like psychoses that last at least a month but do not last for 6 months and so do not warrant a diagnosis of schizophrenia paranoid schizophrenia, p. 467 clinical picture is dominated by absurd and illogical beliefs that are often highly elaborated and organized into a coherent, though delusional, framework disorganized schizophrenia, p. 467 characterized by dis- organized speech, disorganized behavior, and flat or inappropriate affect catatonic schizophrenia, p. 467 characterized by dis- organized speech, disorganized behavior, and flat or inappropriate affect delusional disorder, like schizophrenia, hold beliefs that are considered false and absurd by those around them. Unlike schizophrenia, however, may otherwise behave quite normally. does not show the gross disorganization and performance deficiencies characteristic of schizophrenia, and general behavioral deterioration is rarely observed in this disorder, even when it proves chronic brief psychotic disorder, p. 468 Brief psychotic dis- order is often triggered by stress - sudden onset of psychotic symptoms or disorganized speech or catatonic behavior. Even though there is often great emotional turmoil, the episode usually lasts only a matter of days Age-Corrected Incidence Rate Incidence is the number of new cases that develop. An age- corrected incidence rate takes into account predicted break- downs for subjects who are not yet beyond the age of risk for developing the disorder. candidate genes, p. 474 genes that are involved in processes that are believed to be aberrant in schizophrenia. An example is the COMT (catechol-O-methyltransferase) gene. This gene is located on chromosome 22 and is involved in dopamine metabolism. As you will soon learn, dopamine is a neurotransmitter that has long been implicated in psycho- sis (impaired reality testing) genome-wide association study (GWAS), p. 474 Study participants provide a sample of DNA and then millions of genetic variants are explored and compared across the two groups (disease/control). By using such an approach, researchers can identify single nucleotide polymorphisms (SNPs—pronounced “snips”), which are sequences of DNA, or other types of genetic variants, that are more frequently found in people with the disorder than without it. endophenotypes, p. 475 discrete, stable, and measurable traits that are thought to be under genetic control. By studying different endophenotypes, researchers hope to get closer to specific genes that might be important in schizophrenia
attenuated psychosis syndrome, p. 480 being perplexed by reality - mild psychotic symptoms that are not severe enough to meet clinical criteria for another full-blown psychotic disorder – thought to be at risk for later psychosis - People also reported losing control over the content of their thoughts or having ideas of being regarded in a negative way by others. prodromal, p. 480 or very early, signs of schizophrenia, dopamine, p. 488 Activity in the dopamine system may play a role in determining how much salience we give to internal and external stimuli. Dysregu- lated dopamine transmission may actually make us pay more attention to and give more significance to stimuli that are not especially relevant or important. glutamate, p. 489 an excitatory neurotransmitter that is widespread in the brain - dysfunction in glutamate transmission might be involved in schizophrenia expressed emotion (EE), p. 491 a measure of the family environment that is based on how a family member speaks about the patient during a private interview with a researcher - three main elements: criticism, hostility, and emotional overinvolvement (EOI). The most important of these is criticism, which reflects dislike or disapproval of the patient. antipsychotics (neuroleptics), p. 496 medications like chlorpromazine (Thorazine) and haloperidol (Haldol), which were among the first to be used to treat psychotic disorders. Antipsychotic medications work by blocking D2 receptors. But, as described earlier, researchers now believe that the most important dopamine abnormality in schizophrenia is occurring presynaptically. This means that cur- rent medications are working downstream from where the real problem may lie. cognitive remediation, p. 499 Using practice and other com- pensatory techniques, researchers are trying to help patients improve some of their neurocognitive deficits (e.g., problems with verbal memory, vigilance, and perfor- mance on card-sorting tasks). The hope is that these improvements will translate into better overall functioning (e.g., conversational skills, self-care, and job skills) perhaps the most powerful conclusion that can be drawn at this stage is that not all patients with schizophrenia need to be treated long term with medications. When patients are motivated to try a period without antipsychotics, medical professionals might do well to support this decision SUMMARY Describe the prevalence of schizophrenia and who is most affected. Schizophrenia affects just under 1 percent of the population. Most cases begin in late adolescence or early adulthood. The disorder begins earlier in men than in women. Overall, the clinical symptoms of schizophrenia tend to be more severe in men than in women. Women also have a better long-term outcome. 13.2 Identify the symptoms of schizophrenia as described in DSM-5. Schizophrenia is the most severe form of mental illness. It is characterized by impairments in many domains. Characteristic symptoms of schizophrenia include hallucinations, delusions, disorganized