Psychopathology Quiz #3

StPD: Treatment

seek assistance due to anxiety or depression this disorder increases the risk of developing major depression treatment include some of the same ones for depression not too many treatments one is combining antipsychotic meds, community treatment (team of support professionals providing therapeutic services) and social skills training reduces symptoms or postpone the onset of later schizophrenia promising prevention strategy

Schizoid Personality Disorder

show a pattern of detachment from social relationships and a limited range of emotions in interpersonal situations aloof, cold and indifferent to other people schizoid: turn inward and away from the outside world lack emotional expressiveness and pursued vague interest

Disinhibited social engagement disorder

similar child rearing circumstances pattern of behavior in which the child shows no inhibitions whatsoever to approaching adults might engage in inappropriately intimate behavior by showing a willingness to immediately accompany an unfamiliar adult figure somewhere without first checking back with caregiver

Schizotypal Personality Disorder

socially isolated and behave in way that would seem unusual to many people Tend to be suspicious and have odd beliefs on a continuum with schizophrenia but with no hallucinations and delusions

PPD: Treatment

unlikely to seek professional help when they need it difficulty developing the trusting relationships necessary for successful therapy first step is to established relationship with client and therapist Trigger to seek therapy is a life crisis use cognitive therapy to counter the person's mistaken assumptions about others, focusing on changing the person's beliefs that all people are malevolent and most people cannot be trusted no confirmed demonstrations that any form of treatment can significantly improve their lives low percentage think people with PPD will continue therapy long enough to be helped.

NPD: Clinical Description

unreasonable sense of self-importance and are so preoccupied with themselves that they lack sensitivity and compassion for others not comfortable unless someone is admiring them exaggerated feelings and their fantasies of greatness (grandiosity) create a number of negative attributes require and expect a great deal of special attention use or exploit others for their own interests and show little empathy envious and arrogant if others are more successful than them tend to be depressed

Dissociative fugue

"flight". memory loss revolves around a specific incident like trips usually left behind an intolerable situation assumes new identity or at least becomes confused about the old identity fugue end abruptly, can recall most or all of what happened

Characteristics: DID

"host" identity is the patient and ask for treatment attempt to hold various fragments of identity together but get over-whelmed usually not the original personality but developed later at least one is impulsive that handles sexuality and generates income some can abstain from sex cross gendered alters are common Switch: transition from one personality to another instantaneous might have physical transformations posture, facial expressions, patterns of facial wrinkling and physical disabilities might emerge

Family Influences

"typical" family of those with anorexia are successful, hard-driving, concerned about external appearances, and eager to maintain harmony deny or ignore conflicts or negative feeling and tend to attribute their problems to other people Mother's of girls with anorexia want their daughters to be thin after the onset of anorexia family relationships can deteriorate quickly parents become frustrated and show it in different ways because they want their kids to eat

Comprehension Check 5.5 Match the correct preliminary diagnosis with the cases below: (a) posttraumatic stress disorder, (b) acute stress disorder, and (c) delayed onset posttraumatic stress disorder 1. Cadence witnessed a horrific tornado level her farm 3 weeks ago. Since then, she's had many flashbacks of the incident, trouble sleeping, and a dare of going outside in storms. 2. Sanjay was involved in a car accident 6 weeks ago in which the driver of the other car was killed. Since then, Sanjay has been unable to get into a car because it brings back the horrible scene he witnessed. Nightmares of the incident haunt him and interfere with his sleep. He is irritable and has lost interest in his work and hobbies. 3. Patricia was raped at the age of 17, 30 years ago. Just recently, she has been having flashbacks of the vents, difficulty sleeping, and fear of sexual contact with her husband.

1. B 2. A 3. C

Concept Check 12.3 Correctly Identify the type of personality disorder described here. 1. Kayla has low self-esteem and usually feels empty unless she does dangerous and exciting things. She is involved in drugs and has casual unprotected sexual encounters, even with strangers. She threatens to take her own life if her partner suggests getting help or if they talk about leaving her. She alternates between passionately loving and hating them, sometimes going from one extreme to the next in a short time. 2. Lance is 19 and has been in trouble with the law for the past 2 years. He lies to his parents, vandalizes building in the community, and often fights with others. He shows no remorse for the people he injures or the grief that he causes his ailing parents. 3. Madison thinks she is the best at everything. She thinks her performance is always excellent and is extremely critical of anyone else's success. She constantly looks for admiration and reassurance from others. 4. Tyesha is known for being overly dramatic. She cries uncontrollably during sad movies, and her friends sometimes think that she is acting. She is vain and self-centered, interrupting many of class conversations to discuss her personal life.

1. Borderline Personality Disorder 2. Antisocial Personality Disorder 3. Narcissistic Personality Disorder 4. Histrionic Personality Disorder

Treatment if Borderline Personality Disorder

Antidepressant medications provide some short-term relief Dialectical behavior therapy* is most promising treatment Marsha Linehan "Dialectic": acceptance of difficulties and need for change ‣ need to accept ‣ able to learn and change Mindfulness Interpersonal effectiveness Distress tolerance to decrease reckless/self-harming behavior

Cluster B ("WILD")

Antisocial, borderline, histrionic and Narcissistic Personality disorders Cannot be diagnosed until age 18. All have varying levels of Affective Instability and Impulsivity

Stats: DID from the book

Average number of altered personalities is 15 women to men 9:1 (based on case studies not survey research) onset in childhood, 7 years after the appearance of symptoms before the disorder is identified chronic if not treated frequency of switching may decrease with age new alters may emerge in response to new life situations / trauma 3-6% in north america 1.55 prevalence in the previous year (nonclinical) comorbid with anxiety, substance abuse disorder, and personality disorders borderline personality disorder share many features with DID self destructive, suicidal behaviors, and emotional instability auditory hallucinations are common so misdiagnosed as a psychotic disorder but come from inside not outside like psychotic aware that the voices are hallucinations so they do not report or suppress them seen in other cultures, more like possession

Cluster C- some important considerations

Avoidant pers. DO - some genetic links with schizophrenia 1. lots of overlap with social anxiety disorder 2. want relationships but is too scare Dependent pers. DO - "codependency", gender issues 1. pervasive pattern of clingy to the relationship. Letting the other person do as they please and make their decisions. Even in bad relationships they do not want to leave and stand alone Obsessive-compulsive pers. DO - distinction from OCD 1. interactions with others is rigid, controlling, and stiff 2. interpersonal relationships

Cluster C ("WORRIED")

Avoidant, dependent, and Obsessive-Compulsive Personality disorders

Binge Eating Disorder (BED)

Characterized by binge eating without associated compensatory behaviors Associated with distress and/or functional impairment (e.g., health risk, feelings of guilt) Excessive concern with weight or shape may or may not be present Approximately 20% of individuals in weight-control programs have BED Approximately half of candidates for bariatric surgery have BED Better response to treatment than other eating disorders

Personality Disorder Clusters

Cluster A = Odd or Eccentric ("WEIRD") ◦ Paranoid personality disorder*, schizoid personality disorder*, and schizotypal personality disorder* Cluster B = Dramatic or Erratic ("WILD") ◦ Antisocial personality disorder*, borderline personality disorder*, histrionic personality disorder*, and narcissistic personality disorder* Cluster C = Anxious or Fearful ("WORRIED") ◦ Avoidant personality disorder*, dependent personality disorder*, and obsessive-compulsive personality disorder*

Abusive traits in domestic relationships

Cluster A: "Paranoid and Schizoid" 1. paranoid 2. mistrusting 3. suspicious 4. cognitive distortions 5. negative 6. Mistrusting Cluster B: "Extroverted/Unstable" 1. Emotional Dysregulation 2. Impulsivity 3. Unpredictability Cluster C: "Anxious/Withdrawn" 1. Shy 2. Passive 3. Avoids Confrontation 4. Overcontrolled

Personality Disorder Clusters from the book

Cluster A: off or eccentric: paranoid, schizoid, schizotypal Cluster B: dramatic, emotional or erratic: antisocial, borderline, histrionic, and narcissistic Cluster C: anxious or fearful: avoidant, dependent, and obsessive-compulsive

Dissociative Disorders from the book

Dissociative experiences: when people feel detached from themselves or their surroundings, almost as if they are dreaming or living in slow motion can happened after stressful events, if you're tired, sleep deprived not too concerning if u know the cause hard to measure dissociation depersonalization: perception alters so that you temporarily lose the sense of your own reality like a dream watching yourself part of a serious set of conditions where reality, experience and identity seem to disintegrate derealization: sense of reality of the external world is lost things can change shape or size, people seem dead or mechanical Can have alterations in our relationships to the self, world or memory processes happens during low-frequency rhythm coming from a specific brain region, retrosplenial cortex cognitive functions like episodic memory, navigation and imagining future events

Treatment of Antisocial Personality

Few seek treatment on their own are brought in by family, friends or the law Antisocial behavior is predictive of poor prognosis Emphasis is placed on prevention and rehabilitation Often incarceration is the only viable alternative May need to focus on practical (or selfish) consequences (e.g., if you assault someone you'll go to prison) self-awareness is a big part of treatment

Paranoid

"Delusional/Paranoid" Paranoia Distrustful Nature Doubts loyalty Keeps grudges Easily offended

Schizotypal

"Distorted Reality" Odd ideas Eccentricity Unusal experiences Superstition, religiosity Suspiciousness Reclusiveness

Schizoid

"Social Withdrawal" Aloof Uninterested in others Solitary, socially withdrawn Unaffected by praise and criticism

Concept Check 8.1 Check your understanding of eating disorders by identifying the proper disorder in the following scenarios: (a) bulimia nervosa, (b) anorexia nervosa, and (c) binge-eating disorder 1. Manny has been having episodes lately when he eats prodigious amounts of food. He's been putting on a lot of weight because of it. 2. I noticed Elena eating a whole pie, a cake, and two bags of potato chips the other day when she didn't know I was there. She ran to the bathroom when she was finished and it sounded like we was vomiting. This disorder can lead to an electrolyte imbalance, resulting in serious medical problems 3. Joo-Yeon eats large quantities of food in a short time. She then takes laxatives and exercises for long periods to prevent weight gain. She has been doing this almost daily for several months and feels she will become worthless and ugly if she gains even an ounce 4. Kirsten has lost several pounds and now weights less than 90 pounds. She eats only a small portion of the food her father serves her and fears that intake above her current 500 calories daily will make her fat. Since losing weight, Kirsten has stopped having periods. She sees a fat person in the mirror.

1. C 2. A 3. A 4. B

Concept Check 6.2 Diagnose the dissociative disorders described here by choosing one of the following: (a) dissociative fugue, (b) depersonalization-derealization disorder, (c) generalized amnesia, (d) dissociative identity disorder, and (e) localized amnesia 1. Nylah was found wandering the streets, unable to recall any important personal information. After searching her purse and finding an address, doctors were able to contact her mother. They learned that Nylah had just been in a terrible accident and was the only survivor. Nylah could not remember her mother or any details of the accident. She was distressed. 2. Gabriel was brought to a clinic by his mother. She was concerned because at times his behavior was strange. His speech and his way or relating to people and situations would change dramatically, almost as if he were a different person. What bothered her and Gabriel most was that he could not recall anything he did during these periods. 3. Jhene complained about feeling out of control. She said she felt sometimes as if she were floating under the ceiling and just watching things happen to her. She also experienced tunnel vision and felt uninvolved in the things that went on in the room around her. This always caused her panic and perspire. 4. Rashadis 64 and recently arrived in town. He does not know where he is from or how he got here. His driver's license proves his name, but he is unconvinced it is his. He is in good health, and not taking any medication. 5. Rosita cannot remember what happened last weekend. On Monday, she admitted to a hospital suffering from cuts, bruises, and contusions. It also appeared that she had been sexually assaulted.

1. C 2. D 3. B 4. A 5. E

Concept Check 12.1 Fill in the blanks to complete the following statements about personality disorders 1. ___ refers to meeting diagnostic criteria for multiple disorders, which is particularly common among individuals with personality disorders. 2. The personality disorders are divided into three clusters or groups: ___ contains the odd or eccentric groups; ___ contained the dramatic, emotional, and erratic disorders; and ___ contains the anxious and fearful disorders 3. It's debated whether personality disorders are extreme versions of otherwise normal personality variations (therefore classified as dimensions) or ways of relating that are different from psychologically healthy behavior (classified as ___ ) 4. Personality disorders are described as ___ because unlike many other disorders, they originate in childhood and continue throughout adulthood. 5. Although gender differences are evident in the research of personality disorders, some differences in the findings may be the result of ___

1. Comorbidity 2. Cluster A; Cluster B; Cluster C 3. categories 4. chronic 5. bias

Concept Check 12.4 Match the following scenarios with the correct personality disorder 1. During therapy session, Jorge gets up for a glass of water. Ten minutes later, Jorge still is not back. He first has to clean the fountain area and neatly arrange the glasses before pouring his glass of water. 2. Whitney is self-critical and claims she is unintelligent and has no skills. She is also afraid to be alone and seeks constant reassurance from her family and friends. She says and does nothing about her cheating husband because she thinks that if she shows any resolve or initiative, she will be abandoned and will have to take care of herself. 3. Jamar has no social life because of his great fear of rejection. His disregards compliments and reacts excessively to criticism, which feeds his pervasive feelings of inadequacy. Jamar takes everything personally.

1. Obsessive-Compulsive Personality Disorder 2. Dependent Personality Disorder 3. Avoidant Personality Disorder

Concept Check 12.2 Which personality disorders are described here? 1. Heidi trusts no one and wrongly believes other people want to harm her or cheat her out of her life earnings. She is sure her husband us secretly planning to leave her and take their three boys, although she has no proof. She no longer confides on friends or divulges any information to coworkers for fear that it will be used in a plot against her. She is usually tense and ready to argue about harmless comments made by family members. 2. Amara lives alone int he country with her birds and has little contact with relatives or any other individuals in a nearby town. She is extremely concerned with pollution, fearing that harmful chemicals are in the air and water around her. She has developed her own water purification system and makes her own clothes. If it is necessary for her to go outside, she covers her body with excessive clothing and wears a face masks to avoid contaminated air. 3. Santiago is a college student who has no close friends. He comes to class everyday and sits in a corner and is sometimes seen having lunch alone on the park bench. Most students find him difficult to engage and complain about his lack of involvement in class activities, but he appears indifferent to what others say. He has no desire for close or intimate relationships and expresses no desire to have sex. He is meeting with a therapist only because his family tricked him into going.

1. Paranoid 2. Schizotypal 3. Schizoid

Concept Check 8.2 Mark the following statements about the causes and treatment of eating disorders as either true or false. 1. Many young women with eating disorders have a diminished sense of personal control and confidence in their own abilities and talents, are perfectionists, and /or are intensely preoccupied with how they appear to others 2. Biological limitation, as well as the societal pressure to use diet and exercise to achieve nearly impossible weight goals, contribute to the high numbers of people with anorexia nervosa and bulimia nervosa. 3. One study showed that males consider a smaller female body size to be more attractive than women do. 4. Antidepressants help individuals overcome anorexia nervosa but have no effect on bulimia nervosa. 5. Cognitive-behavioral treatment (CBT) and interpersonal psychotherapy (IPT) are both successful treatments for bulimia nervosa, although CBT is the preferred method. 6. Attention must be focused on dysfunctional attitudes about body shape in anorexia, or relapse will most likely occur after treatment.

1. T 2. T 3. F (females find a smaller size more attractive than do men) 4. F (they help with bulimia nervosa, not anorexia) 5. T 6. T

APD: Defining Criteria

16 major characteristics of psychopathy created a 20-item checklist that serves as an assessment tool clinicians are able to gather info from interviews with a person, along with material from significant others and institutional files to assign the person a score on the check list high score indicate psychopathy focus on underlying personality traits Need to improve the reliability of diagnosis because because there has been changes in the significance of behaviors and personality traits

Stats: Obesity

1991 - 12% -> 37.7% in 2013-2014 medical costs for obesity and overweight are estimated at $147 billion higher mortality across the population as a whole BMI of 30, risk of mortality increases by 30% BMI of 40 or more, risk of mortality is 100% or more 6.3% of adult population Number of overweight youngsters tripled in the past 25 years stigma of obesity has a major impact on quality of life prejudice and discrimination in college, work and housing teasing and ridicule for obese kids may increase depression and binge eating Rates of obesity in eastern and southern European nations are as high as 50% and the rate is greatly increasing in industrializing nations main driver of type 2 diabetes which has reached epidemic status more hispanic people are obese black and hispanic adolescents more over weight

Bulimia Nervosa Treatment

1st stage: teaching the patient the physical consequences of binge eating and purging, as well as the ineffectiveness of vomiting and laxative abuse for weight talk about the adverse effects of dieting patient scheduled to eat small. manageable amounts of food 5-6 times per day with no more than a 3 hour interval between eliminates the alternating periods of overeating and dietary restriction Later stage: focuses on altering dysfunctional thoughts and attitudes about body shape, weight, and eating coping strategies for resisting the impulse to binge and/or purge arrange activities so that the individual will not spend time alone after eating during during the early stage of treatment good results and seem to last, but not for everyone Wider ranger of patients with bulimia like symptoms can be included CBT-E more efficient in terms of the number of sessions required and more effective at each time point assessed CBT-E is the treatment of choice family therapy directed at painful conflicts bc of Ed can be helpful access to CBT is limited bc trained therapist are not available

Disordered Eating Patterns in Cases of Obesity

2 maladaptive eating patterns: binge eating and night eating syndrome 7-19% of patients with obesity binge eat 6-16% of obese people seek weight loss treatment 55% seek bariatric surgery night eating syndrome (NES) consume a third or more of their daily intake after their evening meal and get out of bed at least once during the night to have a high-calorie snack not hungry in the morning and do not eat breakfast do not binge or purge during this time different from nocturnal eating syndrome (get up during the night and raid the fridge while still asleep) NES important target fir treatment in an obesity program to reregulate patterns of eating so that individuals eat more during the day when their energy expenditure is highest

Arousal Theories

APD: fearless, seeming insensitivity to punishment and thrill-seeking behaviors want to know the neurobiology that's behind this 2 hypothesis: 1. under-arousal: have abnormally low levels of cortical arousal ‣ people with levels too high or too low experience negative affect and perform poorly in situations ‣ low levels of cortical arousal are the primary cause of their antisocial and risk-taking behaviors in order to boos their chronically low levels of arousal ‣ may have lower skin conductance activity, lower heart rate during resting periods, and more slow-frequency brain wave activity 2. fearlessness: possess a higher threshold for experiencing fear than most other individuals ‣ things that are really scary have have little effect on psychopaths ‣ gives rise to all other major features of the syndrome Jeffery gray: three major brain system influence learning and emotional behavior the behavioral inhibition system, the reward system, and the fight/flight system ‣ BIS and reward explain the behavior of people with psychopathy ‣ BIS is responsible for our ability to stop or slow down when we are faced with impending punishment, non-reward, or novel situations, leads to anxiety and frustration ‣ reward is responsible for how we behave to positive reward, hope and relief, pleasure role in substance use and abuse Psychopaths may have malfunctioning of these systems ‣ an imbalance between the BIS and the reward system may make the fear and anxiety produced by the BIS less apparent and positive feelings associated with the reward system more prominent

Binge Eating Disorder Treatment

Adapted CBT for bulimia to obese binge eaters quite successful stopping binge eating is critical to sustaining weight loss in obese patients IPT is equally successful as CBT Prozac ineffective some behavioral weight loss programs for obese patients such as Weight Watchers have positive effects not as good as CBT Some racial and ethnic differences for BED blacks have higher BMI Hispanics more concerned about shape and weight tailoring treatment to this ethnic group would be useful Men response well to brief treatments, but would need longer treatments for more severe cases self-help procedures may be useful should be the first treatment offered more severe cases may need more intensive treatment from therapists especially when there are comorbities and low self esteem Matching treatment to individual based on their personal characteristics or patterns of responding should be the next important step for improving success rate of treatment if an obese person is bingeing, standard weight loss procedures will be ineffective without treatment

Defining feature: dissociation of personality

Adoption of several new identities (as many as 100; may be just a few; average is 15) Identities display unique behaviors, voice, and postures Alters* - different identities or personalities 1. kind of show something about the person's past 2. can be childlike 3. can be aggressive or act like a protector Host - the identity that keeps other identities together Switch - quick transition from one personality to another 1. quick from one alter to another Can hear voices may get use to their alters personalities and what they do during their time dissociation can occur as a result of other psychotic disorders Hallucination: specific sensory events that other people do not experience 1. marriage can be challenging

Causes: DID from the book

Almost every child is horribly abused as a child able to escape circumstances and become someone else. Only way they know how to cope. do what it takes to get through life 97% experiences trauma, like sexual or physical abuse can come from other trauma in childhood like war, death, violence Rooted n the natural tendency to escape or "dissociate" from, the unremitting negative affect associated with severe abuse also a lack of support Behaviors and emotions seem related to normal tendencies that all of us experience many people disassociate when in life-threatening situations feelings of unreality, blunting of emotional and physical pain, separation from body dissociative amnesia and fugue Only people with the appropriate vulnerabilities will someone react to stress with pathological dissociation DID may be an extreme subtype of PTSD focuses more on dissociation then anxiety vulnerability to the abuse closes at 9 years, after that DID is unlikely to develop

Binge Eating

Bingeing* is the hallmark of bulimia nervosa and binge eating disorder Eating excess amounts of food in a discrete period of time Eating is perceived as uncontrollable May be associated with guilt, shame, or regret or particularly stressful times May hide behavior from family members Foods consumed are often high in sugar, fat, or carbohydrates

Bulimia Nervosa

Binges are accompanied by compensatory behaviors Purging* Excessive exercise want to burn as many calories as possible Fasting or food restriction Associated medical features Most people with bulimia nervosa are within 10% of normal body weight pretty normal weight but the purging is the main concern Purging can result in severe medical problems Associated psychological features Most people with bulimia nervosa are overly concerned with body shape Fear of gaining weight Most people with bulimia nervosa have comorbid psychological disorders

Stats: ED from book

Bulimia: 90-95% are women males have later age of onset. gays, bisexual and transgender lifetime prevalences of EDs are higher in sexual minority groups body dissatisfaction is a particular stressor for transgender Male athletes in sports are require weight regulation are another large group of makes with ED adolescent girls are most at risk prevalence 2-3 times greater for women 3 month duration required for BED binge-eating symptoms are common in males anorexia and BED, but not bulimia begin after age 18 Median age of onset for all ED occurred narrow range of 18-21 anorexia beings as young as 15 years bulimia begins as early as 10 years Bulimia chronic, relatively poor prognosis tend to retain bulimic symptoms instead of shifting to symptoms of other ED anorexia also chronic but not as chronic as bulimia better if caught early and treated but continue to restrict food even if they no longer meet the criteria for diagnosis

Treatment for Bulimia

CBT - treatment of choice (address distorted body image and maladaptive attempts to control weight) Antidepressants to address bingeing/purging cycles

Narcissistic Personality Disorder

Causes are largely unknown 1. failure to learn empathy as a child 2. sociological view - product of the "me" generations Treatment options 1. focus on grandiosity, lack of empathy, unrealistic thinking 2. emphasize realistic goals and coping skills for dealing with criticism 3. Little evidence that treatment is effective Overview and clinical features 1. exaggerated and unreasonable sense of self-importance 2. preoccupation with receiving attention 3. lack sensitivity and compassion for other people 4. highly sensitive to criticism; envious and arrogant ‣ small sense of themselves so they feel inadequate. Outer persona is a shield Self-compassion 1. first element is mindfulness 2. second element is common humanity ‣ all interconnected and need each other 3. third element is self kindness ‣ need to extend the passion to ourselves that we do to the people you love when they are having a hard time Relates to narcissism because of self esteem and how they treat/think of themselves

PPD: Clinical Description

Defining characteristic is pervasive unjustified distrust suspicious in situations in which most other people would agree their suspicions are unfounded unrelated events are interpreted as personal attacks mistrust extends to people close to them and makes meaningful relationships difficult may be argumentative, may complain, or may be quiet style of interaction is communicated, sometimes nonverbally to others often resulting in discomfort among those who come in contact with them because of this volatility sensitive to criticism and have excessive need for autonomy increases the ricks of suicide and violent behavior, poor quality of life

Types of DSM-5 dissociative disorders

Depersonalization/derealization disorder* 1. experiences distance/distortion from themselves and how they experience the outside world. Can feel only one. Must impact their daily lives. Dissociative amnesia* (may involve 1. forgetting aspects of self or identity 2. who am i? how did i get here? 3. generally based on trauma, stress or traumatic experience. 4. forgetting aspects of themselves bc of trauma they experienced 5. fugue: memory lose around identity, travel somewhere, can not remember who they are, where they are, or how they got there Dissociative trance* 1. change and alteration in ones identity but experiences as another identity. 2. other identity takes hold and control 3. may seem like possession 4. if this experience is part of a cultural religious practice it would not be seen as a disorder Dissociative identity disorder* 1. used to be called split personality disorder or multiple personality disorder

Personality Disorders: An Overview

Enduring, inflexible predispositions common in approach and temperament Maladaptive, causing distress and/or impairment ◦ in the current moment ◦ may be used in a certain time for a specific purpose, but stays past the time it is needed and becomes maladptive High comorbidity with other disorders Generally poor prognosis Patients don't feel that treatment is necessary ◦ do not think anything is wrong, not aware ◦ do not want treatment because they like their life has it is and may have interpersonal problems so keeping away others is ideal "Ego-syntonic" vs "Ego-dystonic" ES: matches with how you view yourself "this is how i am, deal with it" ‣ less likely to seek support ED: does not match with how you view yourself "this doesn't feel like me" ‣ more likely to seek support "Kind" vs. "Degree" (dimensional approach)

Anorexia Nervosa

Extreme weight loss is the hallmark of anorexia 1. Restriction of calorie intake below energy requirements 2. Intense fear of weight gain accompanied by body image distortion Two subtypes: restricting and binge-eating-purging 1. restricting: eat very little food, below their calorie needs 2. BEP: occasional bingeing, but till dangerously underweight Associated medical features 1. Starving body borrows energy from internal organs, leading to organ damage including 2. Most deadly mental disorder due to physical consequences and suicide risk Comorbid psychological disorders are common: 70% of people with anorexia are depressed at some point Higher than average rates of substance misuse and obsessive-compulsive disorder

Treatment: DID

Focus is often on reintegration of personalities, but prognosis is guarded there will probably always be presence of separate parts of their personality Fundamental goal is to identify cues or triggers that provoke memories of trauma, dissociation, or both and to neutralize them Patient must confront and relive the early trauma and gain control over the events, at least as they recur in the patient's mind Hypnosis may be useful in this process Medication does not seem to add to the effectiveness of therapy One goal is to make the patient aware of these switches so they feel that they are more in control need self awareness to know what shifts take place need to start with stabilization hypnosis can be helpful but needs to be done by a trained professions might lead to a placebo affect

DID other names

Formerly known as multiple personality disorder or "split personality" changed bc the person's personality is fractured or dissociated. 2 or more separate and distinct identities each have unique behaviors, voice patterns, body language, mannerisms, posture, different handedness, score different on personality or standardized test

Developmental Influences

Forms of antisocial behaviors change from childhood to adulthood decline around the age of 40

Neurological Influences

General brain damage does not explain why some people become psychopaths or criminals

Treatment for Anorexia

Initial treatment goal is attaining a weight in the healthy range - SAFETY FIRST Psychoeducation 1. Behavioral and cognitive interventions 2. Target food, weight, body image, thought, and emotion Family focus of treatment 1. Has the most support from clinical trials for treating adolescents with anorexia group treatment not implemented until later on because group can hinder their progress, especially if they are in treatment against their wishes can be supportive later on

Treatment of PTSD

Judith Herman's model: STABILIZATION - INTEGRATION - RECONNECTION (Trauma and Recovery) "Bottoms-Up" brain-based model REGULATE - RELATE - REASON 1. relate to those around you 2. reason: forge a bath forward Cognitive-behavioral treatment 1. Exposure treatment 2. Increase positive coping skills 3. Increase social support 4. Highly effective Medications 1. SSRIs

Stats: PTSD

Large group trauma did not lead to an increase of psychiatric disorders might be as high as 30% in veterans 6.8% life time prevalence 3.5% annual prevalence adolescents 3.9% highest rates due to rape, being held captive, tortured, kidnapped or badly assaulted - "assaultive violence" 2.4-3.5 higher in women who experienced a single sexual assault or rape and 4.3-8.2 times higher for those who have been re-victimized Close exposure to trauma seems to be necessary to developing this disorder (personal and direct) chronic course every case needs to be taken seriously Some people who experience great trauma turn out psychologically healthy while other who experience mild stressful events get the disorder

PPD: Causes

Limited biological contributions might be slightly more common among relatives of people who have a schizophrenia although associations does not seem strong strong role of genetics psychological contributions less certain but interesting speculations have been made early mistreatment or traumatic childhood experiences may play a role (be careful with these stories bc there may be strong bias bc the world is viewed as a threat) Look at thought or schemes maladaptive way to view the world and it pervades every aspect of their lives roots may be in their early upbringing parents may teach them to be careful about making mistakes and may impress on them that there are different from other people vigilance causes them to see signs that other people are deceptive and malicious Cultural factors: certain groups are more susceptible because of past experiences prisoners, refugees, people with hearing impairments and older adults signs of paranoia are often one of the initial symptoms noticed in individuals who later develop severe cognitive disorders

Your brain on stress

Main road: 1. Observe 2. Interpret 3. Process 4. Evaluate Options 5. Plan 6. Act Danger at interpret goes into dirt road where they react (fight - flight - freeze) Then back to act

Eating Disorders: An overview

Major types of DSM-5 eating disorders Bulimia nervosa* and anorexia nervosa* Severe disruptions in eating behavior Weight and shape have disproportionate influence on self-concept Strong sociocultural origins - driven by Western emphasis on thinness • Binge eating disorder* Involves disordered eating behavior May involve fewer cognitive distortions about weight and shape more about disordered eating

Stats: Anorexia

Majority are female and white From middle- to upper-middle-class families Usually develops around early adolescence More chronic and resistant than bulimia Lifetime prevalence approximately 1% Cross-cultural factors Develops in non-Western women after they move to Western countries

Stats: Bulimia

Majority are women - 90%+ Some binge eating symptoms are relatively common in men Incidence among males is increasing, 0.8* bulimia, 2.9% BED 6 to 7% of college women suffer from bulimia at some point Onset typically in adolescence Tends to be chronic if left untreated

Gender Differences

Men display traits that are more aggressive, structured, self-assertive, and detached ◦ antisocial Women present with traits that are more submissive, emotional, and insecure ◦ dependent, Equal numbers have histrionic, and borderline Gender can have affect on the diagnosis, may lead to a misdiagnosis some clinicians think some PDs are biased against women features of histrionic PD (over-dramatization, vanity, seductiveness, and over-concern with physical appearance) are characteristics of the "stereotypical western woman" ◦ feminine traits ◦ no disorder with just masculine traits Bias can occur at different parts of the diagnostic process criteria for disorder may be biased criteria themselves do not but the clinicians can let their own bias seep through

Causal Factors of Antisocial Personality Disorders

Neurobiological theories: (1) underarousal of cortex (2) cortical immaturity (3) fearlessness, (4) Gray's model Reward > Inhibition Genetics (fam members more likely to have ASPD) Developmental (high conflict childhoods) is this immaturity in the cortex? reward center and its relation to arousal and impulse ASPD is the result of multiple interacting factors Early antisocial behavior alienates peers who would otherwise serve as corrective role models Antisocial behavior and family stress mutually increase one another

Distinct from Schizophrenia

Often confused with schizophrenia bc it was called split personality schizo is split, phrenia is mind, view of reality is split away from how others see it, not spilt personalities

Preventing Eating Disorders

Often focuses on promoting body acceptance in adolescent girls Identify people who may be at increased risk 1. Early weight concerns Screening for at-risk groups Provide education - to individuals, helping adults who may notice concerns

Borderline Personality Disorder

Overview and clinical features Unstable moods and relationships ‣ person's internal mood and their close relationships Impulsivity, fear of abandonment, very poor self-image Self-harm and suicidal gestures Comorbidity rates are high with other mental disorders, particularly mood disorders, substance use disorders, and eating disorders Causes: 1. Strong genetic component 2. High emotional reactivity may be inherited 3. May have impaired functioning of limbic system 4. Early trauma/abuse increase risk "Triple vulnerability" model 1. Generalized biological vulnerability 2. Generalized psychological vulnerability 3. Specific psychological vulnerability

Antisocial Personalty Disorders

Overview and clinical features failure to comply with social norms violation of the rights of others irresponsible, impulsive, and deceitful lack of a conscience, empathy, and remorse "Sociopathy", "psychopathy" typically refer to ver similar traits ‣ not in DMS may be very charming, interpersonally manipulative Often show early history or behavioral problems, including conduct disorder "Callous-unemotional" type of conduct disorder more likely to evolve into antisocial PD Families with inconsistent parental discipline and support Families often have histories of criminal and violent behavior Recent research suggests that psychopathy is a less reliable predictor of criminality

Histrionic Personality Disorder

Overview and clinical features: 1. Overly dramatic and sensational 2. May be sexually provocative 3. Often impulsive and need to be the center of attention 4. Thinking and emotions are perceived as shallow 5. More commonly diagnosed in females Treatment options 1. Focus on attention seeking and long-term negative consequences 2. Targets may also include problematic interpersonal behaviors 3. Little evidence that treatment is effective

Cluster A ("WEIRD")

Paranoid, schizoid, and schizotypal Personality disorders Positive symptoms: present Negative symptoms: absence of certain things disordered when it interferes with their daily functioning Schizoid: spilt off socially, hard to respond when people reach out, hard to engage socially Schizotypal: hardest to tell the difference with schizophrenia

An Integrative Model

People have a genetic vulnerability to to antisocial behaviors and personality traits may be differences in NY and neurohormone (dopamine and serotonin) influence aggressiveness and how people deal with stress may lead to callousness, impulsivity, and aggressiveness may not learn to avoid things that harm them abnormal responses to fear conditioning as a young child could be responsible for later antisocial behavior in adults deficits in amygdala functioning makes individuals unable to recognize cues that signal threat making them fearless genetic influences ( leading to damage in the amygdala) interact with environmental influences (learning to fear threats) to produce adults who are fearless and engage in harmful behaviors can also interact with environmental experiences such as childhood adversity more drawn to children like them, can lead to a harder adulthood

Treatment: DID from the book

People with dissociative amnesia or fugue usually get better on their own and remember what they have forgotten episodes related to current life stress therapy works on resolution of the distressing situations and increasing the strength of personal coping mechanisms DID, may be able to reintegrate the identity takes a long time treatments are based on accumulated clinical wisdom and procedures that are successful with PTSD need to identify triggers or cues that provoke memories of trauma, dissociation or both and neutralize them need to confront and relive the early trauma and gain control over the horrible events skillful and slow visualization until it is a memory not a current event some aspects of the experience may be unknown Hypnosis used to access unconscious memories and bring various alters into awareness not sure if it is necessary yet reemerging memories may trigger further dissociation might prescribe medication like antidepressants overall treatment is still in the works

Causes: PTSD

Precipitating event: trauma development of PTSD involves biological, psychological and social factors intensity of exposure to assaultive violence contributes to the etiology of PTSD but does not account for all of it the greater the vulnerability the greater the change of developing PTSD running in the family increases the chances, also having anxiety identical twins more likely to develop PTSD little to no evidence that genes cause the disorder Stress-diathesis model bc genetic factors predispose individuals to be easily stressed and anxious which may make it more likely that a traumatic experience will result in PTSD ex having s serotonin transporter gene involving two short alleles (SS) described as increasing the probability of experiencing symptoms of acute stress other factors include: minimal education, predict exposure to traumatic events in the first place higher intelligence predicted decreased exposure personality make it more likely to be in risky situations Psychological vulnerability come from early experiences with unpredictable or uncontrollable events ex family instability Social factors: having a strong and supportive group of people around you makes it less likely you will develop PTSD positive coping strategies involving active problem solving seemed to be protective becoming angry and placing blame on others increased the risk humans are social creatures so support from loved ones directly affects biological and psychological responses reduces cortisol and HPA axis activity Neurobiological systems involved elevated or restricted corticotropin releasing factor (CRF) heightened activity in HPA axis may lead to changes in brain function and structure ex in the hippocampus; persistent and chronic arousal disrupts learning and memory may be reversible in PTSD the initial alarm is true because there was real danger present may develop conditioned or learned alarm reaction to the stimuli is the alarm is severe enough may develop anxiety about the possibility of additional uncontrollable emotional experiences depends on our vulnerabilities

Stats: DID

Prevalence is not well known, perhaps 1.5% (pretty rare) More common in females Onset is almost always in childhood or adolescence High comorbidity rates with other psychological disorders if they seek treatment, seeking treatment for anxiety, mood disorders, and substance abuse do not come in for DID and then discover that they have it increased social media presence of DID Typically follows lifelong, chronic course has the same pattern for a long time

Personality Disorders: Stats and Facts

Prevalence of personality disorders affects about 10% of the general population Origins and course of personality disorders thoughts to begin in childhood tend to run a chronic course if untreated may transition into a different personality disorder Gender distributions and gender bias in diagnosis men more often show traits like aggression and detachment: women more often show submission and insecurity antisocial - more often male histrionic - equal numbers of male and female Comorbidity is the rule, not the exception often have two or more personality disorders or an additional mood or anxiety disorder

Treatment for BED

Previously used medications for obesity are now not recommended Psychological treatment CBT—effective Interpersonal psychotherapy—equally effective as CBT Self-help techniques, eg Overeaters Anonymous— effective

Treatment PTSD from the book

Psychological POV: face the original trauma, process the intense emotions, and develop effective coping procedures to overcome the effects Psychoanalytic therapy: reliving emotional trauma to relieve emotional suffering is called catharsis need to make sure its therapeutic and not traumatic hard to recreate and people don't want to try use imaginal exposure: trauma and emotions are worked through systematically Prolonged exposure therapy: work with the victim to develop a narrative of the experience and to expose the patients for an extended period of time to the image. Then review in treatment effects may be strengthened by strategically timing the exposure treatment with sleep take a nap after exposure because extinction learning appears to take place during slow wave sleep and because sleep quality reduces anxiety Cognitive therapy: correct negative assumption about the trauma such as blaming oneself, feeling guilt, or both some people repress the emotions and experience (automatic and subconscious) memory can rush back which is scary but therapeutic if handled properly treatment soon after the experience may help prevent the disorder more effective then medication subjecting victims to a single debriefing session in which they are forced to express their feelings as to whether they are distressed or not can be harmful having therapy with couples where one of them suffers from PTSD shows improvement in symptoms and more satisfaction in the relationship Drugs 1. SSRI for anxiety and panic attacks 2. D-cycloserine, promising but mixed. Can make good exposure better but bad exposure worse.

Causes of Obesity

Related to the spread of modernization more that technology advances the fatter we get promotion of an inactive, sedentary lifestyle and the consumption of a high-fat, energy dense diet is the largest contributor to the obesity epidemic not everyone exposed to the modernized environment becomes obese genetics, physiology and personality come in genetic smaller portion of the cause but helps explain why some people do or do not become obese genes influence fat cells 305 of causation but needs toxic environment to turn it on physiological processes: hormone regulation of appetite plays a large role in the initiation and maintenance of eating Addictive obese eating behavior: less control over eating and feeling of withdrawl if access to food is limited show similar neurocircuitry in the brain as people with substance use disorder psychological processes of emotional regulation, impulse control, attitudes, and motivation toward eating, and responsiveness to the consequences of eating are also important eating habits influenced by environment and family and friends chances to become obese increase if someone close to you is obese

Screening Questionnaire: SCOFF

Respond to each of the following with "yes" or "no." 1. Do you make yourself sick because you feel uncomfortably full after eating? (s-sick) 2. Do you worry that you have lost control over how much you eat? (c-control) 3. Have you recently lost 14 or more pounds in a three-month period? (o-one stone, 14 lb) 4. Do you believe yourself to be fat when others say you are too thin? (f-fat body image) 5. Would you say that food dominates your life? (f-food) This is an adaptation of the SCOFF, a screening instrument for eating disorders. If you have concerns about your own eating, you may want to discuss your concerns with a mental health professional.

Personality Disorders Under Study

Some controversial like sadistic personality disorder and passive-aggressive personality disorder Main beliefs associated with specific personality disorders ◦ paranoid - i cannot trust people ◦ schizotypal - it's better to be isolated from others ◦ schizoid - relationships are messy, undesirable ◦ histrionic - people are there to serve or admire me ◦ narcissistic - since i am special, i deserve special rules ◦ borderline - i deserve to be punished ◦ antisocial - i am entitled to break rules ◦ avoidant - if people know the real me they would reject me ◦ dependent - i need people to survive, to be happy ◦ obsessive-compulsive - people should do better, try harder

Overview of Dissociative Disorders

Severe alterations or detachments from reality Affect identity, memory, or consciousness memory: distorts what we remember or do not remember Depersonalization* 1. detachment from self and how you see yourself, sense of fragmentation from the self 2. is this who am i? am i real? 3. internal Derealization* 1. how you experience the world around you. Fuzzy, odd, dull colors, more vibrant colors 2. external

Clinical description of PTSD

Trauma exposure 1. there needs to be a cause!!!! (event or series of events) Continued re-experiencing 1. something happens day to day, triggers flashbacks, nightmares Avoidance 1. avoid situations, objects, or people that remind you of the event Emotional numbing 1. can recite the events but no emotion attached to it Reckless or self-destructive 1. shuts down 2. over use substances Interpersonal problems Refers to problems that persist for more than one month after the trauma 1. does not include complex trauma diagnosis: persist for a long time, with family or those near to you, abuse and neglect 2. many people with childhood sexual or physical abuse have symptoms that persist for years

Causes: DID

Typically linked to a history of severe, chronic trauma, often abuse in childhood Risk increases if there is no social support after the trauma greater risk if there is a longer duration and the trauma is more severe Dissociation offers an opportunity to escape from the impact of trauma self protective mechanism to get themself out of the situation adaptive at the time but an impairment later in life Closely related to PTSD, possibly an extreme subtype symptoms are different but casual factors may be similar Personality traits like suggestibility may play a role Biological vulnerability possible but not well understood main cause: horrific abuse/trauma in childhood only way for them to cope with such abuse, they fracture themselves so that the trauma only happened to one Criteria is symptoms based so do not need to have trauma, but the majority of them have had extremely traumatic childhoods

Cross-cultural considerations

Whites report more Develop in immigrants who have recently moved to Western countries prevalence somewhat varies among north American people of color Black girls have less body dissatisfaction, fewer weight concerns, and more positive self image compared to white girls Major risk factor for ED include being overweight, higher social class, and acculturation to the majority more common among native Americans than other ethnic groups

Prevention

aggressive behaviors in children are stable and likely to continue become more serious over time, early signs of homicides and assaults some become less aggressive after adolescence implemented in school and preschool settings emphasize behavioral support for good behavior and skill training to improve social competence prevention might be the best approach to the problem since treatment for adults is not that successful

DePD: Clinical Description

agree with other people when their own opinion differs so as not to be rejected desire to obtain and maintain supportive and nurturing relationships may lead to them being submissive, timidity, and passivity feel inadequate, sensitive to criticism, and need for reassurance cling to people in some cultures dependence and submission is a desired interpersonal trait

Five Factor Model

aka Big Five Extroversion (talkative, assertive, and active vs silent, passive and reserved), Agreeableness (kind, trusting, and warm vs hostile, selfish. and mistrustful), Conscientiousness (organized, thorough, reliable vs careless, negligent and unreliable), Neuroticism (even-tempered vs nervous, moody and temperamental), Openness to experience (imaginative, curious, and creative vs shallow and imperceptive) universal nature of the 5 dimensions with individual differences different plays have higher prevalence of different big 5 characteristics Cross-cultural research establishes the relatively universal nature of the five dimensions

An integrative model

all three Ed have much in common in terms of causal factors may have biological vulnerabilities. negative emotions, mood tolerance may trigger binge eating drug and psychological treatments proven to work for anxiety are chosen for treating ED Ed could be an anxiety disorder focused exclusively on a fear of becoming overweight social and cultural pressures to be thin motivate significant restrictions of eating, usually through dieting social interaction in high achieving families play some role bc of the emphasis on appearance to be liked and successful

Clinical Description: DID

alters: separate identities or personalities ex oh Jonah with 3 other alters. did not know of them. Sammy was calm adn rational and knew of the others King young and Usodda Abdulla were intense, violent and sexually. Knew of the others but indirectly all appeared after a traumatic incident in his life Criteria include amnesia, fragmented/dissociated identity

Developmental Considerations

anorexia and bulimia strongly related to development differential patterns of physical development in girls and boys interact with cultural influences to create ED girls gain weight primarily in fat tissue, boys in muscle and lean tissue Anorexia occasionally occur under age of 11 restrict fluid, and food intake (dangerous) percentage of weight concern, dieting, and extreme weight control behaviors increases with age can occur later in life after the age of 55

Cluster B Personality Disorders

antisocial, borderline, histrionic and narcissistic dramatic, emotional or erratic

AN Associated Psychological Disorders

anxiety disorders and mood disorders depression at some point in life OCD - unpleasant thoughts are focused on gaining weight and individuals engage in a variety of behaviors, some of them are ritualistic, to rid themselves of such thoughts shared genetic risks with some disorders like bipolar substance abuse is common and a strong predictor of death, usually by suicide

Adjustment Disorder

anxious or depressive reactions to life stress that are generally milder than acute destress disorder or PTSD but still impairing impairing with work or school performance, interpersonal relationships and other areas of life may provoke conduct problems in worth event may not be traumatic but person is unable to cope and need intervention chronic if it last for more than 6 months after the removal of the stress

Cluster C Personality Disorder

avoidant, dependent, obsessive-compulsive - anxious

AvPD: Treatment

behavioral intervention techniques for anxiety and social skills have had some success similar to social phobia medical treatments like Benzos, SSRIs, monoamine oxidase inhibitors effective Therapeutic alliance - the collaborative connection between therapist and client is an important predictor for treatment success

Treatment for Children and Adolescents

better for short term and long term behavior modification programs that include the parents includes strategies to change dietary habits, and reduce sedentary habits in children more successful because adults are fully engaged in a constructive way and provide constant and continuing support not fully engaged can have bad effects on child diet habits are less engrained and more physical activity more likely if they are presented with it brief, intensive, and focused on just eating and exercise by be able to get the bariatric surgery but still under investigation

Binge Eating Disorder from book

binge eating but do not engage in compensatory behaviors greater likelihood of occurring in males and later onset greater chance of remission and better response to treatment associated with more severe obesity 1/2 try dieting before bingeing, other 1/2 stats bingeing and then attempt to diet same concerns about shape and weight as anorexia and bulimia 1/3 binge to alleviate "bad moods" or negative affect Purging disorder: engage in purging behavior to influence their weight or shape by self-induced vomiting, using laxatives, diuretics, or other medications but do not binge Predictors: negative affect, functional impairment, internalization of the tin-ideal, body dissatisfaction, dieting, overeating, and mental health care low BMI and dieting is specific predictor of anorexia nervosa

Biological contributions: DID

biological vulnerability is hard to pinpoint mostly environmental but some be some evidence of hippocampal and amygdala volume People with seizure disorders experience many dissociative symptoms temporal love epileptic seizure associated with these symptoms symptoms in adulthood not associated with trauma some symptoms also arise bc of brain injuries but easily diagnosable sleep deprivation might cause hallucinatory activity, may worsen DID symptoms

Major types of eating disorders

bulimia nervosa: out of control eating episodes binges: out of control eating followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge (get rid) of the food Anorexia nervosa: the person eats only minimal amounts of food or exercises vigorously to offset food intake so body weight sometimes drops dangerously binge-eating disorder: binge repeatedly and find it distressing but do not attempt to purge the food top characteristics is an overwhelming, all-encompassing drive to be thin avoidant/restrictive food intake disorder (ARFID): limit their food intake not because they are concerned about weight or body shape but because they are simply not interested in eating or food or because they avoid certain sensory characteristics or consequences of food or eating ◦ impaired growth in kids and weight loss in adults Anorexia: 20% die from the disorder, highest mortality rate of any psychological disorder ◦ women with anorexia are 18xs more like to die by suicide than 15-34 yr old females int he general population ED highly prevalent worldwide, especially in women challenges with industrialization and urbanization are partly responsible for the increase of ED in many developed countries

Dissociative Identity Disorder from the book

can have up to 100 but average is 15 some are complete with behavior, tone of voice, and physical gesture only a few characteristics are complete bc the identities are partially independent changed from multiple personality disorder to DID

Aspects of Personality Disorders

chronic; originate in childhood and continue throughout adult hood affect every aspect of the person's life PD may cause distress to the person who has it or their actions cause distress to others in some cases, someone other than the person with the PD must decide whether the disorder is causing significant functional impairment because the affected person cannot make such a judgement 10 specific PDs tend to have other psychological problems and do poorly in treatment important factor: how the therapist feels about the client ‣ countertransference - therapist's emotion brought about by client. Tend to be negative, especially for Cluster A and Cluster B ‣ need to guard against their personal feeling so it does not interfere with treatment Category of PDs is controversial because it involves a number of unresolved issues Categorical and Dimensional Models people with PD display problem characteristics over extended periods and in many situations, which can cause great emotional pain for themselves, others, or both extreme versions of problems many of us face distinction between problems of degree and problems of kind issue that is debated is whether personality disorders are extreme versions of otherwise typical personality variations (dimensions) or ways of relating that are different from psychologically healthy behavior (categories) some things can be seen in both ways like gender and height you either have the disorder or you don't, no in between Convenient to use categorical models of behavior, but causes problems clinicians view disorder as "real" such as a physical injury people argue that PD do not exist but are points at which society decides a particular way of behaving is an issue several contenders for the basic personality dimensions

Comorbidity

close to 10% of the population have PD major concern is that people tend to be diagnosed with more than 1 changing the criteria so there is no comorbidity would further complicate the issue

AN Medical Consequences

common complication is cessation of menstruation (amenorrhea) also occurs in bulimia can be a physical indicator but does not happen to everyone dropped as criteria other signs include dry skin, brittle hair or nails, and sensitivity to or intolerence of cold temperatures lanugo - downy hair on the limbs and cheeks cardiovascular problems like low blood pressure and heart rate if vomiting, electrolyte imbalance and resulting cardiac and kidney problems

Real memories and false

concern about how accurate early trauma is, especially sexual abuse applies to all mental disorder bc memories are not always accurate and may seem true even if they aren't 2 windows of memory vulnerability when our memories can be changed significantly 1. when we initially store it (consolidate) 2. when we restore it after retrieval (reconsolidate) Lots of controversy 1. if sexual abuse did happen but is not remembered, important to reexperince with a therapists to relieve current suffering. Can develop PTSD or dissociative disorder if not. Important catch perpetrator 2. false memories bc of a careless therapists, false accusations are made with lasting damage to family or person 3. can sue therapist bc false memories can be created Young children are quite unreliable in reporting accurate details of events, especially emotional events Memories are malleable and easily distorted, especially in some individuals with certain personality traits and characteristics such as vivid imaginal capabilities (absorption) and openness to unusual ideas therapists need to be sensitive to signs of trauma that may not be fully remember older age when the abuse ended and emotional support following initial disclosures of the abuses were associated with higher rates of disclosures Prospective measures of abuse re rarely available in clinical practice so rely on retrospective measure of abuse poor agreement in a meta-analysis Need to nail down this issue

Psychological Dimensions of ED

diminished sense of personal control and confidence in their own abilities and talents may show as low self esteem, perfectionist attitudes perfectionist is weakly associated bc the person must consider themselves overweight and manifest low self-esteem before the trait perfectionist make a contribution occupied on how they appear to perceive themselves as frauds, considering false any impressions they make of being adequate, self-sufficient or worthwhile feel like imposters in their social groups and experience heightened social anxiety specific distortion in perception of body shape change often depending on day to day experience minor events related to eating may activate fear of gaining weight, further distortions in body image, and corrective schemes such as purging Subgroup has difficulties tolerating any negative emotion (mood tolerance) and may binge or engage in other behaviors in an attempt to regulate their mood (reduce their anxiety or distress by doing something they think will help them avoid being fat) there is a role of intense emotions triggered by food cues and fear of becoming fat anf faulty attempts to regulate these emotions as factors driving ED

DePD: Causes and Treatment

disruptions in the socialization process could cause people to grow up fearing abandonment genetic influences are important in the development of the disorder for treatment, they appear to be the ideal patient because they are attentive and want to give responsibility for their problems to the therapist therapy progresses gradually as the patient develops confidence in his ability to make decisions independently do not want them to become dependent on the therapist

Attachment Disorders

disturbed and developmentally inappropriate behaviors in children in which the child is unable or unwilling to form normal attachment relationships with caregiving adults due to inadequate or abusive child-rearing practice changes in primary caregiver or neglect failure to meet child's emotional needs for affection and comfort and basic necessities of daily living pathological reactions to early extreme stress Reactive attachment disorder: child will seldom seek out a caregiver for protection, support and nurturance and will seldom respond to offers from caregivers to provide this kind of care lack responsiveness, limited positive affect, and additional heightened emotionality (fearfulness and intense sadness) very hard to treat and goes into adulthood

Stats: PD from the book

do not get help on their own so hard to know prevalence 1 in 10 adults in the US might have a diagnosable PD numbers vary around the world worldwide 6% of adults may have at least one PD different survey methods and variables typically chronic: onset in childhood and continue into adulthood but possible that they remit over time replaced by other symptoms ex have one PD earlier in life and later have a different one Lacking research because patients seek help after years of distress, not in the early developmental stages cannot study them from the beginning Borderline Personality Disorder: volatile and unstable relationships. tend to have persistent problems in early adulthood, with frequent hospitalizations, unstable personal relationships, severe depression and suicidal gesture. Suicide rate 50xs higher than genreal pop. 8-10% of people with BPD have killed themselves symptoms improve if they survive into their 30s. elderly can still experience above average interpersonal difficulties Antisocial personality disorder: display a characteristic disregard for the rights and feelings of others, tend to continue their destructive behaviors of lying and manipulation thought adulthood some burn out in middle adulthood decline in the prevalence of antisocial personality disorder across the lifespan

Narcissistic Personality Disorder from the book

exaggerated sense of self-importance and are preoccupied with receiving attention

Paranoid Personality Disorder

excessively mistrustful and suspicious of others, without any justification assume other people are out to harm or trick them; therefore, they tend not to confide in others

BPD: Treatment

experience great distress and seek help symptomatic treatment may not be helpful problems with drug use, noncompliance with treatment, and attempts to take their own lives Dialectical behavior therapy (DBT)- involves helping people cope with the stressors tat seem to trigger suicidal behaviors and other maladaptive responses first target suicidal behaviors, that those that interfere with therapy and then those that interfere with quality of life taught how to identify and regulate emotions, problem solve for difficult situations, try to extinguish fears learn to trust their own responses may help m reduce suicide, treatment drop out and hospitalizations brain imaging to see how psychological treatment influence brain function

PTSD Book info

exposure to a traumatic event during which an individual experiences or witnesses death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation learning about traumatic events that happened to loved ones or enduring repeated exposure to details of a traumatic event are also setting events re-experience the even through memories and nightmares memories and strong emotion give them flashbacks avoid anything that reminds them or trauma restriction or numbing of emotions which impacts interpersonal relationships may be unable to remember certain details attempts to avoid the experience of the emotion chronically over-aroused, easily startled, and quick to anger "reckless or self-destructive behavior dissociative: experience less arousal and dissociative feelings of unreality respond differently to treatment Sleeping difficulties and recurring intrusive dreams Diagnosis at least one month after the occurrence PTSD with delayed onset: no symptoms at first but months or years later they develop full PTSD different trajectories is not understood (ex military)

HPD: Clinical Description

express emotions in an exaggerated fashion, vain, self-centered, uncomfortable when they are not in the limelight seductive in appearance and behavior, concerned about their looks seek reassurance and approval constantly, become upset or angry when they do not get the attention they want impulsive and have difficulty delaying gratification Cognitive style is impressionistic, view situations in black and white speech os vague, lacking in detail and characterized by exaggeration high rate of diagnosis in women Features like over dramatization, vanity, seductiveness and over concern with physical appearance are stereotypical gender bias

Avoidant Personality Disorder

extremely sensitive to the opinion of others and their anxiety leads them to avoid social relationships even tho they want them extremely low self esteem, fear of rejection limited friendships and dependent on those they feel comfortable with

BPD: Integrative Model

first vulnerability is a generalized biological vulnerability emotional reactivity and how it effects specific brain function second vulnerability is a generalized psychological vulnerability tend to view the world as threatening and react strongly to real and perceived threats Third vulnerability is a specific psychological learned from early environmental experiences when stressed, the biological tendency to be overly reactive interacts with the psychological tendency to feel threatened Still in the works

Obsessive-Compulsive Personality Disorder

fixation on things being done "the right way"

Conduct Disorders

for children that violate society's norms two subtypes: childhood-onset type: the onset of at least one criterion characteristic of CD prior to age 10 adolescent-onset type: the absence of any criteria characteristics of CD prior to age 10 new subtype: with the callous-unemotional presentation: young person presents in a way that suggest personality characteristics similar to an adult with psychopathy often boys, become juvenile offenders and tend to become involved in drugs children with antisocial behavior are likely to continue these behaviors as they grow older norm violations that appear in adults, also appear in children but related to their lives ex irresponsibility regarding work or family - truancy from school or running away from home some feel remorseful

Dissociative Amnesia

generalized amnesia: unable to remember anything, including who they are, localized or selective amnesia: failure to recall specific events, usually traumatic, that occur during specific period can have amnesia of the emotional reactions to the events absence of subjective experience of emotion is often present in DDD dissociative amnesia forgetting is selective for traumatic events or memories rather than generalized 1.8-7.3% most prevalent of the dissociative disorders disintegrated experience is more than memory loss, involving at lest some disintegration of identity, or adoption of a new one amok: Running disorder. in men. Kill people or animals. trancelike state, mysterious source of energy, runs or flees for a long time running disorders usually occur more in women except for amok seem to resemble dissociative fugue different across cultures can be seen as trance or possession most common in women, associated with stress or trauma part of religions or cultural practices so not seen as abnormal if the trance involves a perception of being possessed by an evil spirit or another person the individual would be diagnosed with an "other specified dissociative disorder (dissociative trance)

OCPD: Causes and Treatment

genetic contribution predisposed to favor structure in their lives, but to get really severe may need reinforcement of conformity and neatness therapy often attacks the fears that seem to underlie the need for orderliness afraid that they are inadequate so they procrastinate and excessively ruminate about important issues and minor details help them relax or use cognitive reappraisal techniques to reframe compulsive thoughts

Genetic Influences

genetic influence for antisocial and criminality more likely to become criminals if their mother is a felon gene-environment interaction genetic factors may be important only in the presence of certain environmental influences certain environmental influences are important only in the presence of certain genetic predispositions epigenetic is the study of factors other than inherited DNA sequence that alter the phenotypic expression of gene can have influence on the DNA by changing the gene expression genetic factors may present a vulnerability but actual development of criminality may require environmental factors ex adopted children who's real parents demonstrated antisocial and were exposed to chronic stress were at greater risk of a conduct problem

Can DID be faked?

hard question to answer Individuals are suggestible: possible that alters are created in response to leading questions from therapists, in psychotherapy or hypnotic state different identities usually score different on personality tests Objective assessment of memory, particularly implicit memory has the same memory processes when using methodologies of cognitive sciences DID ack like simulators that have no memory (interidentity amnesia) interviews with DID suggest that memories are different from one alter to the next however, if you memorize words as one identity the other will remember it, contrary to interidentity amnesia some psychiatrist question the validity of DID DID patients have 4.5 times the average number of changes in optical changes (measures of visual acuity, manifest refraction and eye muscle balance) hard to fake Jonahs personality had different physical reactions to emotional words shows in brain imaging DID more likely to try to hide symptoms tests for malingering have been developed, also more likely to show off symptoms DID controversial bc of its use in the justice system. Some criminals try to use it so they are not guilt by reason of insanity

Dietary Restraint

having food restricted makes people become preoccupied with food and eating dieting is one factor that can contribute to eating disorders along with dissatisfaction iwth one's body

Antisocial Personality Disorder from the book

history of failing to comply with social norms perform actions thought to be unacceptable like stealing from close ones irresponsible, impulsive and deceitful "social predators who charm, manipulate, and ruthlessly plow their way through life, leaving broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and empathy, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret" disorder that dates very far back

AvPD: Clinical Description

interpersonally anxious and fearful or rejection feel chronically rejected by others and are pessimistic about their future different from schizoid asocial behaviors

HPD: Treatment

little success try a modified version of the attention-getting behavior Theory focuses on the problematic interpersonal relationship manipulate others through emotional crises, using charm, sex seductiveness or complaining need to be shown how the short-term gains derived from this interactional style result in long-term cost need to be taught more appropriate ways of negotiating their wants and needs

APD: Clinical description

long history of violating the rights of others, aggressive because they take what they want, indifferent to the concerns of others lying and cheating, unable to tell the difference between the truth and the lies they make up to further their own goals no remorse or concern over the devastating effects of their actions substance use disorder is common and a life long pattern long term outcome is poor conduct disorder may be a precursor other names: manie sans delir (mainia without delirium), moral insanity, egopathy, sociopathy, and psychopathy debate if antisocial and psychopathy are different disorders

AN: Clinical Description

lots of overlap with bulimia bulimia have a history of anorexia, fasting to reduce their body weight below desirable levels people with anorexia have an intense fear of obesity and relentlessly pursue thinness most commonly begins in an adolescent who is overweight or who perceives herself to be starts a diet that escalates into an obsessive preoccupation with being thin punishing amounts of exercise dramatic weight loss achieved through severe caloric restriction or by combining caloric restriction and purging 2 types: 1. restricting type:diet to limit calorie intake 2. binge-eating-purge-type: rely on purge ‣ binge on small amounts of food and purge more consistently, almost every time they eat subtyping may not be useful in predicting the future course of the disorder but reflects a certain phase of stage of anorexia only refers to the past 3 months never satisfied with weight loss staying same weight or gaining any weight cause intense panic, anxiety and depression only continued weight loss every day for weeks on end is satisfactory DMS-5 criteria specify only significantly low body weight 15% below that expected, BMI close to 15.8 by the time treatment is sought Key criterion: marked disturbance in body image Can become good at putting on a front and saying what others expect to hear seldom seek treatment on their own usually pressure from the family some become interested in cooking and food while others hoard food in their room, looking at it occasionally.

Actue Stress Disorder

may be diagnosed in first month after trauma, severe reaction immediately Statistic 1. 3.5% annual prevalence, 6.8% lifetime prevalence Most people who experience traumatic events do not develop PTSD 1. type of trauma 2. proximity to trauma 50% develop PTSD not the best predictor of PTSD

OCPD: Clinical Description

may be work oriented with poor interpersonal relationships distantly related to OCD, do not have obsessions and compulsions to alleviate them one of the most common PD in general population Prevalence 2.1-7.9% not as disruptive as borderline and antisocial so less research goes into it psychological profiles of many serial killers point to the role of OCPD do not often fit the definition of someone with a severe mental illness but are masters of control in manipulating their victims need to control all aspects of the crime fits the pattern of people with OCPD this disorder and unfortunate childhood experiences may lead to the disturbing behavior pattern may also play a role among sex offenders, especially pedophiles also in gifted children whose quest for perfectionism can be quite debilitating

NPD: Causes and Treatment

may result from parents not modeling empathy early in a child's life child remains fixated at a self-centered, grandiose stage of development become involved in an endless and fruitless search for the ideal person who will meet their unfulfilled empathic needs increased prevalence in Western societies as a consequence of social change, individualism, competitiveness and success limit research on treatment therapy focuses on grandiosity, hypersensitivity to evaluation and lack of empathy Cognitive therapy works to replace their fantasies with a focus on day to day pleasurable experiences the Coping strategies with relaxation to help face and accept criticisms help them focus on the feelings of others treatment often initiated for the depression

Borderline Personality Disorder from the book

moods and relationships are unstable, and have poor self image feel empty and are at great risk of killing themselves

BPD: Causes

more prevalent in families with the disorder and somehow linked with mood disorders higher rate of concordance rate among monozygotic twins Neuro-imaging points to limbic network involve din emotional regulation and dysfunctional serotonin NT, linking these finding with genetic research low serotonergic activity is involved with the regulation of mood and impulsivity Emotional reactivity: emotional fluctuations and and greater emotional intensity, especially for negative emotions pretty accurate in identifying emotions on the face of others more likely to experience great shame. Associated with low self esteem, low quality of life, and high levels of anger and hostility, self harm Cognitive factors wonder how they process info and how it contributes to their difficulties Environmental risk factors: early trauma, sexual and physical abuse do not know if abuse and neglect directly correlates to BPD significant in women because girls are 2-3 times for likely to be sexually abused people diagnosed with BPD have suffered terrible abuse or neglect from parents, sexual abuse by others or combo look at temperament and neurological impairments and their interactions with parental styles to see how they can contribute to the diagnosis if there is no abuse also seen in people who have undergone rapid cultural changes problems of identity, emptiness, fears of abandonment and low anxiety threshold Abuse also contribute to other types of disorders

Surgical approach: Bariatric Surgery

more successful than diets, easier to maintain the loss lower mortality reserved only for the most severely obese people where it is an imminent health risk bc the surgery is permanent must have one or more obesity related physical conditions part of the stomach is removed to create a sleeve or tubelike structure also gastric bypass which creates a bypass of the stomach that limits food intake and calorie absorption some fail to lose significant weigh tot regain los weight after surgery can die during the operation or need rehab after risk of dying from diabetes significantly lowers surgery should not become routine until we understand more need to try all other options first and pass a psychological assessment to make sure they can adapt to the diet change Public health making moves to remove soft drink machines and other sources of unhealthy snack food proposed that they raise the tax to stop people from buying more sugary drinks/food but that controversial bc it implies that the government is controlling our behavior another public health choice is architecture - designing different ways in which choices can be presented to consumers ex labeling food with traffic lights based on nutritional value

Bulimia Nervosa from the book

most common psychological disorder on colleges campuses Clinical description: eating a larger amount of food - typically junk food - then most people would eat under similar circumstance amount of calories may differ amount of food and out of control feeling are the important criterion another important criterion is compensating for the binge eating and potential weight gain by purging techniques self induced vomiting right after eating, using laxatives (drugs that relieve constipation) and diuretics (drugs that result in loss of fluids thought greatly increased frequency of urination) other methods include: exercise excessively (usually seen in anorexia), fasting purging type and non purging type non purging rare 6-8% of cases purging not a good method of reducing calorie intake, gets rid of 50% laxatives and diuretics have little effect People with eating disorders have a distorted sense of self major features include: binging, purging, and over concern with body shape

Anorexia Nervosa Treatment

most important initial goal is to restore the patient's weight to a point that is at least within the low-normal range inpatient care may be recommended if body weight it too low or they are losing weight too fast because there can be severe medical complications if weight is not restored immediately outpatient if the weight loss is more gradual and seems to have stabilized regaining weight is the easiest part of treatment knowing they cannot leave until the gain weight is usually enough motivation for adolescents starvation induces loss of gray matter and hormonal changes in the brain After weight gain, need to address attitudes of body shape and interpersonal disruptions in their lives Restricting anorexics: need to treat their anxiety over becoming obese and losing control of eating and their indue emphasis on thinness as a determinant of self-worth best treatment is CBT-E other treatments can work as well family focused approach can be beneficial bc: 1) negative and dysfunctional communication in the family regarding food and eating must be eliminated and meal must be mode more structured and reinforcing 2) attitudes toward body shape and image distortion are discussed at some length in family session if not addressed, patients chances of relapse increase Lower rates of full recovery compared to bulimia but that is changing family based therapy (FBT) is as effective and more cost friendly than other forms of family therapy

SPD: Clinical Description

neither desire or enjoy closeness with others, including romantic or sexual cold and detached, not affected by praise or criticism social isolation may be extremely painful living on the street appears to be prevalent among people with this personality disorder, perhaps as a result of their lack of close friendships and lack of dissatisfaction about not having sexual relationships with another person similar with paranoid personality disorder but more extreme • do not have unusual thought processes that characterized the other disorders ◦ ideas of reference: mistaken beliefs that meaningless events relate to them ◦ share social isolation, poor rapport and constricted affect

Anorexia Nervosa from the book

nervosa = nervous loss of appetite too successful at losing weight that their lives are in danger morbid fear of gaining weight and losing control over eating major difference with bulimia is how successful the person is at losing weight anorexia: proud of their diets and extraordinary control bulimia: ashamed of both their eating issues and their lack of control issues in media with celebrities and models

Obesity

not a disorder but one of the most dangerous epidemics concerning public health measure with BMI focus on lower than 18.5 (undernourishment) and 30 or greater (obesity). Over 40 are severe or morbidly obese US has the highest rate of obesity which will continue to get worse causes health problems liek cardiovascular disease, diabetes, hypertension, stroke, gallbladder disease, respiratory disease, muscular skeletal problems, and hormone-related cancers mentioned because eating is a maladaptive emotion regulation strategy, associated with great emotion distress and significant physical and mental health problems not spending as many calories that are consumed, but there is a genetic factors

Obesity in depth

not an eating disorder anxiety and mood disorder somewhat elevated over normal population substance abuse is somewhat lower in 2000, the number of adults with excess weight worldwide surpassed the number of those who were underweight might be considered normal if it weren't for the serious implications for health

Drug Treatment of ED

not effective for anorexia may be useful for bulimia during bingeing and purging cycle antidepressants used for mood disorders and anxiety ◦ Prozac effectiveness measured by the reductions in the frequency of binge eating and the percentage of patients who stop binge eating and purging altogether, at least for a period of time SSRI can be helpful drugs alone do not have substantial long-lasting effects on bulimia should be used in conjunction to therapy

APD and Criminality

not every psychopath is a criminal or display outward aggressiveness IQ separates the groups that get in trouble with the law Some psychopaths function quite successfully in certain segments of society politics, business and entertainment Identifying psychopaths among the criminal population is important for predicting their future criminal behavior lack of remorse and impulsivity make it hard to stay out of the legal system people who score high on measures of psychopathy commit crimes at a higher rate and are at greater risk for more violent crimes and repeating offenses Not all criminals have antisocial or psychopathy

BPD: Clinical Description

one of the most common PD observed in every culture 1-2% in general pop, and 20-25% of all psychiatric admissions turbulent relationships, fearing abandonment but lack control over their emotions behaviors that are suicidal, self-mutilative, or both, cutting, burning, or punching themselves 10% kill themselves 90% achieve remission in the decade after seeking treatment Intense, cycles from anger to deep depression core feature is dysfunction in emotion and instability in emotion, interpersonal relationships, self-concept, and behavior can extend to impulsivity like drug use or self harm chronically bored and issues with their own identities comorbid with mood disorders and eating disorders and substance use disorder substance use is their way of coping with unstable emotions tend to improve during their 30s-40s but may have difficulties into old age

HPD: Causes

one theory is that it is associated with antisocial personality disorder may be sex-typed alternative expressions of the same unidentified underlying condition controversial

Treatment for Obesity

only moderately successful at the individual level with somewhat greater long-term evidence for effectiveness in children compared to adults organized in a series of steps from least intrusive to most step 1: self-directed weight-loss program in individuals who buy a popular diet book may loss some weight short term but also gain it back do not provide change to eating and exercise habits physicians don't really help but they can provide treatment recommendations and referral to professionals step 2: commercial self-help programs like weight watchers better chance of achieving some success but the majority is not successful in the long run most are free which is a good incentive and is beneficial to the medical field Most successful are professionally directed behavior modification programs restrict calorie intake, increased physical activity, and behavior therapy good for patients to attend group maintenance session periodically for those who are dangerously obese, very low calorie diets, possibly drugs, and behavior modification programs are recommended still regain weight but less drugs reduce internal cues signaling hunger but there are concerns about how they affect cardiovascular system

Histrionic Personality Disorder from the book

overly dramatic and often seem to be acting histrionic means theatrical in manner

Cluster A: from the book

paranoid, schizoid, and schizotypal share common features what resemble some of the symptoms seen in schizophrenia

Prolonged Grief Disorder

prolonged adaptation to the loss of a loved one; grief may even intensify with time little controversial deals with. how long the grieving period is difference with MDD: need to make all criteria for MDD Acute grief: changes in emotion, thoughts, and behaviors all cultures have death rituals for saying goodbye and providing comfort For some people grief does not pass but is prolonged and intensified Prolonged grief disorder: intense longing for and preoccupation with the deceased and a range of other symptoms that make it difficult to move on with life even after a year or more has passed 9.8-11% of adults experience this 6 months for children can produce traumatic reaction vulnerabilities increase the chance of PGD use some treatments for PTS that have been adapted for PGD

StPD: Clinical Description

psychotic like symptoms like believing everything related to them personally, social deficits and sometimes cognitive impairments or paranoia odd or bizarre bc of how they relate to others, how they think and behave and how they dress have ideas of reference, sometimes know that it is illogical odd beliefs or engage in "magical thinking" believing that have powers of some sort unusual perceptual experiences, feel the presence of another person when they are alone ‣ different from reporting that someone is in the room suspicious and have paranoid thoughts, express little emotions, dress or behave unusually It was seen in children that later developed this that they exhibit extreme social anxiety, hypersensitivity, being teased for oddness, and peculiar thoughts and language often have beliefs around religious or spiritual themes diff cultural beliefs may lead to misdiagnosis

Treatment

rarely think they need treatment can be manipulative with their therapist encourage identification of high-risk children so that treatment can be attempted before adulthood contemporary approaches try to help the people examine their own states of mind and understand others' minds and behave more pro-socially parent training is the most common treatment for kids taught to recognize behavior problems early and to use praise and privileges to reduce problem behaviors and encourage prosocial behavior may not work due to family dysfunction, socioeconomic disadvantage, family stress, parent's history of antisocial behavior and conduct disorder

AvPD: Causes

related to other sub-schizophrenia related disorders integrated biological and psychosocial influences as the cause of avoidant personality disorder parenting may contribute to the development of this disorder might be more likely to experience neglect, isolation, rejection and conflict with others

Dependent Personality Disorder

rely on others to make ordinary decisions as wall as important ones which results in an unreasonable fear of abandonment

Psychological and Social Dimensions

reward and punishment ex card game. Psychopaths will continue to play and lose without reward. o one psychopaths set their sights on a reward goal, they are less likely than non-psychopaths to be deterred despite signs the goal is no longer achievable fits for their behavior Aggression in children with APD may escalate, partly as a result of their interactions with their parents parents give the problem behavior displayed by their children ex parents tell kid to do something, he doesn't want to, start yelling at each other, parents end the argument to restore peace, kid gets what they want "coercive family process" combines with genetic influences, parental depression, poor monitoring of their child's activities and less parental involvement to help maintain aggressive behaviors modestly involved with the callous-unemotional traits that seem related to later psychopathy environmental factors are important to the etiology of criminality and APD conduct disorder and APD come from homes with inconsistent parental discipline

Biological Dimensions of ED

run in families and have a genetic component 4-5 times more likely to have an ED if their relative does female relatives for anorexia is higher significant risk for both identical twins to have Ed don't know exactly what is inherited might be more personality based. emotional instability and poor impulse control which leads to them dealing with stressors with food also perfectionist and negative affect Biological interacts with psychological and social hypothalamus plays an important role NT norepinephrine, dopamine and serotonin low levels of serotonin associated with impulsivity and bing eating most drugs target serotonin Hormones: increased hormone levels can lead to binging. Associated with a part of the menstrual cycle and puberty some neurological abnormalities do exist in people with ED may be a result of semi-starvation or binge-purge cycle may contribute to the maintenance

Medical Consequences

salivary gland enlargement caused by repeated vomiting, gives the face a chubby appearance erosion of dental enamel on the inner surface of the front teeth as well as tear the esophagus upset chemical balance of bodily fluids like sodium and potassium electrolyte imbalance: cardia arrhythmia, seizures, renal failure may develop more fat than a control group need to normalize eating habits intestinal problems from laxative abuse can cause constipation or colon damage

Suggestibility in DID

there's a range to how suggestible people are "self-hypnosis" individuals dissociate from most of the world around them and suggest to themselves something like they wont feel pain in their hand authohypnotic model: people who are suggestible may be able to use dissociation as a defense against extreme trauma when trauma becomes unbearable person's identity splits into multiple dissociated identities All suggestions are speculative bc of the lack of controlled studies

Preventing EDs from the book

these methods are important bc many EDs are resistant to treatment and some people who do not receive treatment suffer for a long time Need to target specific behaviors to change target high risk individuals, ex adolescent girls need to promote better eating and food habits. As well as acknowledge and change how they think about their body shapes and thinness can be delivered over e health preventing these disorders through widespread educational and intervention efforts would be clearly preferable to waiting until the disorders develop

Psychological treatments of ED

used to be directed towards low self esteem and difficulties developing an individual identity also targeted disordered patterns in family interaction and communication treatments alone were not enough Short-term CBT targets problems in eating behavior and associated attitudes about the overriding important and significance of body weight and shape ◦ choice treatment for bulimia Has been updated and improved 1) added new procedures to improve outcome 2) became trans-diagnostic so that it is applicable to all ED with minor alterations EDs overlap a lot similar causal influences, including similar inherited biological vulnerabilities, similar social influences, and strong gamily influence toward perfectionism shared anxiety focused on one's appearance and presentation to others as well as distorted body image CBT directed at causal factors common to al ED are targeted in integrated way anorexia with BMI too low would be need inpatient treatment until they are at a better weight principle focus is on the distorted evaluation of body shape and weight and on maladaptive attempts to control weight in the form of strict dieting (maybe binge eating) and methods ot compensate for overeating 9such as purging and laxative misuse) CBT-E (enhanced)

BN Associated Psychological Disorder

usually have anxiety and mood disorder (depression) thought that eating disorders was an expression of depression but has been shown that depression follows the eating disorder substance abuse strongly related to anxiety disorders bc of underlying traits of emotional instability and novelty seeking

PPD: Causes and Treatment

very little research done on the nature and causes May be brainstem inhibitory dysfunction more pronounced under fear and sadness in schizoid personality disorder childhood shyness is a precursor to later adult SPD may be inherited and serves as an important determinant in the development of the disorder abuse and neglect are also factors Over lap for ASD and SPD biological dysfunctions in both combine with early learning or early problems with interpersonal relationships to produce the social deficits that define SPD Rare to seek treatment expect in response to crisis like extreme depression or losing a job Therapist points out the value of social relationships may need to be taught the emotions felt by others to learn empathy receive social skills training role play effect is unknown

StPD: Causes

viewed by some as one phenotype of a schizophrenia genotype may have the genes but different factors like biological influences will show the disorder to be less severe the symptoms are similar but milder symptoms of schizophrenia family, twin , and adopting studies show an increased prevalence of schizotypal PD among relatives of people with schizophrenia hwo do not also have schizophrenia themselves Environment is a string factor childhood maltreatment among men can result in PTSD among women Mild to moderate decrements in their ability to perform on tests involving memory and learning, suggesting damage in the left hemisphere

Depersonalization-derealization disorder (DDD)

when feelings of unreality are so severe and frightening that they dominate an individuals life and prevent normal functioning part of several disorders like panic disorder and acute stress disorder affects 0.8-2.8% of the population show a distinct cognitive profile measure of attention, processing info, short-term memory and spatial reasoning easily distracted and slow to perceive and process new info correspond to "tunnel vision" (perceptual distortions) and "mind emptiness" (difficulty absorbing new info) have reduced emotional responding no psychological treatments yet

Social Dimensions of ED

young women think being thin is more important than being healthy in competitive environments self worth, happiness, and success are largely determined by body measurements and percentage of body fat have little to no correlation with personal happiness and success in the long run cultural result is dieting media shows women that are thinner than the average woman and show more over weight men risk for developing ED was directly related to the extent to which women internalize or "buy in" to media messages and images glorifying thinness over the years the average size and weight has increase because of improved nutrition men have different body perceptions than women men want to be heavier and more muscular people who use steroids to increase muscle mass possess distorted attitudes toward muscles, weight, and the "ideal man" to a greater depress than men who do not use steroids can lead to binge drinking and substance abuse studies show that friendship cliques tend to share the same attitudes toward body image, dietary restraints, and importance of attempts to lose weight does not cause ED, girls tend to choose friends who share similar attitudes Dangerous obsession with body weight can have tragic consequences failure to thrive: growth and development are severely stunted because of inadequate nutrition (child was chubby so put them on diet to prevent obesity later) mothers with anorexia restrict food for themselves and their kids Dieting can actually cause you to gain weight repeated cycles of "dieting" seems to produce stress-related withdrawal symptoms in the brain, much like other addictive substances, resulting in more eating than would have occurred without dieting Reverse anorexia nervosa: happens in male weight lifters mostly. Concerned about looking small even though they are muscular. Avoid places where their body may be seen, and use steroids. women think they are too big and men think they are too small strong genetic contribution to body size