Abnormal Psychology 4

Loosening of Associations

"derailment of associations" - person becomes distracted by irrelevant associations, cannot suppress them, wanders further off subject - train of thought slips away from its intended goal - cognitive slippage - tangeniality - intruding associations * sentence structure or syntax is not impaired, no educational or intellectual disability evidence, content unusual, meaning lost

neologisms

"new" words that the speaker invents, often by combining existing words

evidence of Psychosis

( - ) negative - delusions - hallucinations - grossly impaired speech or movement * like bizarre attributes were added to a person's psychological repertoire

Indirect evidence of Psychosis

+ negative - impairment in self-care - restricted range of emotion - poverty of speech content - inability to initiate goal-directed behavior * like something has been lost or removed from a person's psychological state

socioeconomic influences of schizophrenia

- "drift" hypothesis, Gerard and Houston (1953) found that the excess of schizophrenics from slum areas resulted almost entirely from young schizophrenics who had left home and rented rooms in rundown sections of town - showing a strong relationship between times of economic hardship and first-admission rates to mental hospitals (including schizophrenia) - Mintz and Schwartz (1971) offered an alternative interpretation of the relationship between social class and schizophrenia. They pointed out that the most impoverished areas of large cities are likely to include a mixture of people with different ethnic backgrounds. - more than half of psychotic men and women had a history of physical or sexual abuse in childhood

Treatment of Histrionic Personality Disorder

- Attempts at treatment typically target interpersonal relationships, social skills, and attention seeking. - believe that hypnosis or placebo treatments that include some level of clinical intensity may be most acceptable to these clients (Meyer & Deitsch, 1996). - Apart from scattered case studies, there is little information about treatment of this group in the literature at present.

Additional Psychotic Disorders

- Attenuated psychosis syndrome is a proposed label for those individuals who show subthreshold psychotic symptoms but do not fall into any other category of psychosis

Disturbances in Language & Thought

- Loosening of Associations - Delusions

Which of the following is NOT a behavioral treatment for paraphilic disorders?

- Sensate focus

types of hallucinations

- auditory - visual - gustatory - olfactory - somatic - tactile *can be considered as mood congruent or mood incongruent - certain types may be more common in some disorders

other specified sexual dysfunction

- available as a category to include dysfunctions that do not meet any other disorder's criteria. - An example might include symptoms of sexual aversion disorder, a former DSM-IV category that was discontinued due to its rarity. - individuals not only show a lack of interest in sexual activity but also an active aversion to, and avoidance of, sexual contact with a partner. - Sufferers react with disgust, fear, anxiety, and occasionally panic attacks when faced with a sexual situation involving the opportunity for sexual contact; these reactions cause significant distress. - Individuals may avoid possible sexual partners or situations by occupying nearly all their time in work, school, or family, or they may travel or attempt to make themselves unappealing through dress or habits. - The reactions can be specific to certain aspects of sexual activity or generalized to nearly all sexual stimuli, including kissing

treatment of schizotypal personality disorder

- commonalities between schizotypal personality disorder and schizophrenia suggest that antipsychotic medications could be useful in treatment - Limited studies have found a modest and generalized response to low-dose antipsychotic medication such as haloperidol in mixed groups of schizotypal and borderline personality disorders; results with antidepressant medications appear less certain - There have been no controlled treatment outcome studies of psychotherapies for schizotypal personality disorder

types of schizophrenias

- process - reactive - type 1 - type 2

Erectile Disorder

- persistent or recurrent difficulty in attaining an adequate erection for sexual activity or in maintaining the erection until the activity is completed. - Some men are unable to obtain any erection from the onset of the sexual event, while others may attain an initial erection but lose tumescence before penetration or during thrusting. - Erectile problems may be generalized to all sexual situations or may be specific to certain ones (for example, some may awake with morning erections or maintain erection only during solitary masturbation). - Affected men may experience anxiety about sexual performance and fear of failure. - Depression and substance disorders may co-occur, each of which has also been associated with erectile difficulties (American Psychiatric Association, 2000). - National representative survey data suggest that 10% of males report erectile problems; however, age is a significant factor, with incidence rising from about 5% at age 40 to 15% by age 70 (Segraves & Althof, 2002). - In earlier classifications, the condition was referred to by the pejorative term, impotence. - medical conditions such as arthritis or irritable bowel syndrome, other mental disorders such as depression, and previous history of sexual or physical abuse (American Psychiatric Association, 2013). Ironically, the most common pharmacological treatments for depression—the SSRIs—may themselves result in decreased desire (Fava & Rankin, 2002). Sexual desire tends to decrease with age for both men and women. - The androgen hormone testosterone plays a significant role in male sexual interest, and both androgens and estrogens are involved in female libido. - When levels of these hormones drop (during aging or after menopause), sexual desire often declines (LeVay & Valente, 2006). - Psychological factors, including relationship difficulties, stress, and negative attitudes about sex, may reduce sexual desire - in addition to performance anxiety, social learning histories contribute to the dysfunction. - In their study and treatment of men with primary impotence, 3 of the 32 subjects reported having had clearly seductive mothers. - In each instance, the son had slept in the mother's bedroom at least through puberty, and though there had been no actual intercourse, the relationship had involved strong erotic features - Six men came from a background in which there was a strong religious belief that sex was sinful. - Among males, erectile disorder has been linked to nicotine (smokers have twice the rate of erection problems as nonsmokers), alcohol (at higher doses), obesity, diabetes, spinal cord injury, stress, anxiety, and depression (LeVay & Valente, 2006). - Antipsychotic medications are known to produce sexual dysfunction, including erectile problems, as side effects (Baggaley, 2008). - Antidepressant medications, especially the SSRIs, produce sexual side effects as well (R. Rivas-Vazquez, Blais, Rey, & A. Rivas-Vazquez, 2000), including erectile dysfunction, reduced sexual interest, and ejaculatory difficulties.

schizophrenia history

- split mind, split between thought processes & emotions or to a general disorganization in thought and behavior

other sexual dysfunctions

-Substance/medication induced sexual dysfunction - other specified sexual dysfunction

Which of the following the the most accurate definition of alogia?

A lack of speech content and/or slowed speech response

Antoinette believes that her brother is not really her brother. He has, in fact, been replaced by a double. This is known as ___ syndrome.

Capgras

_____ used factor analysis to construct a 16-factor model of personality and devised the 16 Personality Factors questionnaire to measure them.

Catell and Stice

_____ personality disorders tend to present symptoms that observers consider odd or eccentric.

Cluster A

_____ is the least common male sexual complaint that occurs during the plateau phase.

Delayed ejaculation

_____ involves an inability to reach orgasm or an extra amount of time in reaching orgasm that follows a normal phase of sexual excitement.

Delayed ejaculation cont.

The neurotransmitters most implicated in the positive symptoms of schizophrenia are:

Dopamine and serotonin

Although chromosomal sex is determined at the time of conception, gender identity develops in early childhood by the age of 3, suggesting that causal factors for gender dysphoria point to all EXCEPT which of the following?

Environmental influences

_____ can occur in specific sexual circumstances, called situational type, or in all sexual activities, which is called generalized type.

Female orgasmic disorder cont.

Which DSM-5 disorder replaced two sexual pain disorders from the DSM-IV-TR?

Genito-pelvic pain/penetration disorder cont.

All of the following are characteristic of hallucinations EXCEPT:

Hallucinations are not mood-congruent or mood incongruent.

People are often attracted to Beth because she is very emotionally expressive and very energetic. In fact, some would describe her as flamboyant. However, she very rarely develops long-term relationships because others often think of her as shallow and self-centered. What personality disorder would most fit Beth?

Histrionic Personality Disorder cont.

The human sexual response cycle was defined by _____.

Masters & Johnson

Which was NOT a reason subtypes of schizophrenia were discontinued in the DSM-5?

Most individuals met more than one subtype

_____ individuals initially diagnosed with schizotypal personality disorder go on to develop schizophrenia.

Only a small percentage of

Schizophrenia, like _____, may be a product of the long-term effects of severe trauma.

PTSD

Mason always felt people were talking about him and that his neighbors were plotting against him in order to force him to move out of his home. What is Mason MOST likely experiencing?

Persecutory delusions cont.

Which type of schizophrenia is characterized by an early and gradual onset of symptoms, little social and intellectual competence, and more withdrawal and disorganization?

Process schizophrenia scenario

Jordan shows little emotional expression and appears cold and aloof to others. He tends to be a loner and has little interest in building relationships with family or friends. Which disorder is Jordan MOST likely meeting the criteria for

Schizoid personality disorder cont.

John has experienced several symptoms that indicate a schizophrenia-related condition, but his symptoms have only been present for 4 months. Which of the following would be the appropriate diagnosis?

Schizophreniform disorder scenario

All EXCEPT which of the following are interventions for the paraphilias?

Sensate focus cont.

Which of the following is correct about the structure differences in the brains of schizophrenic patients?

The majority of patients with schizophrenia have enlarged ventricles in their brains.

In delusional disorder, which of the following occurs?

The person behaves relatively normally

How do those diagnosed with a personality disorder act in the therapeutic process?

They resist or refuse treatment and may sabotage their own therapy.

_____ schizophrenia includes more active symptoms such as hallucinations and delusions, while ____ schizophrenia includes more negative symptoms such as flat affect, avolition, and alogia.

Type I; Type II

personality

a way of acting and thinking not a "thing"

Which is NOT a characteristic of people with paranoid personality disorder?

agreeable & cooperative

When a genetic male fetus does not physically respond to the effects of testosterone and develops genitalia resembling a female, this is known as _____.

androgen insensitivity syndrome

A pharmaceutical treatment for males with paraphilic disorders is to give hormones in an attempt to reduce sexual arousal. These drugs reduce the production and action of _____.

androgens

psychoticism

anger and aggression

The drugs MOST likely to be used to treat Cluster A personality disorders are

antipsychotics

The most common type of hallucination experienced by psychotic individuals is____.

auditory

Individuals who are preoccupied with and sensitive to criticism, enough though they avoid activities where disapproval is possible, and see themselves as inferior to others may qualify for a diagnosis of which disorder?

avoidant personality disorder cont.

Many people with schizophrenia have difficulty showing an interest in work or in completing goal-directed activities. This is known as _____.

avolition

Type 1 Schizophrenia

cases of the disorder in which active signs predominate like prominent delusions & hallucinations - more positive outcomes - reactive subgroup

Gustatory & Olfactory Hallucinations

characteristic of medical conditions or localized brain impairments - temporal lobe epilepsy not schizophrenia

affective flattening

characterized by a lack of range of emotions

Both masochistic and sadistic fantasies are likely to have been  present in _____.

childhood

The fantasies and behaviors involved in the paraphilias first appear during _____.

childhood

The first medication used widely to treat schizophrenia was _____.

chlorpromazine

A psychotic speaker may employ _____, which involves the use of a word not because of its meaning but because of its sound.

clanging

Which of the these is NOT one of the categories of personality disorders?

depressed or apathetic behavior

the dsm-5 distinguishes between loose associations or what?

derailments

Symptoms such as delusions, hallucinations, and grossly impaired speech or movements are considered _____ evidence of psychosis.

direct or positive

Which of the following can help in finding risk indicators either in predicting onset or prognosis of schizophrenia?

endophenotypes

The defining symptom of _____ is the persistent or recurrent inability to attain an adequate erection for sexual activity or to maintain the erection until the activity is completed.

erectile disorder

Robert believed that Beyoncé was in love with him, even though she has never met him. Robert's delusions are best described as _____.

erotomaniac

olfactory hallucinations

involve odors, usually unpleasant, such as decaying matter, or burning hair or rubber

Cluster A personality disorders

involve symptoms that are described as odd or eccentric. - 5.7% of the population meets the criteria for at least one Cluster A diagnosis. - involve restriction of social connection with others

Gustatory hallucinations

involve the perception of a taste, like blood - usually the taste is unpleasant

Sally, now age 33, has experienced sexual dysfunctions since she was 13 years old. The DSM-5 specifier choice for Sally's situation is _____.

lifelong type vs. acquired type

psychometricians

look for clusters of intercorrelated items w/in the tests to identify personality factors - clusters reveal info about the underlying foundational tendencies that make up personality

reactive schizophrenia

marked by relatively normal social & intellectual development - appears abruptly in the form of an acute reaction, usually in response to known life stressors - an acute reaction so may be severely disturbed, delusional, confused, & disorganized - good chance of recovery

A type of catatonic behavior that includes refusal to speak or respond to others is called _________.

mutism cont.

Frank believes he is more important than he really is. He has a grandiose sense of self-importance and is preoccupied with fantasies about his own success and brilliance. Frank would best be described as having _____.

narcissistic personality disorder cont.

People who exaggerate their own importance and are preoccupied with fantasies about their own success, brilliance, or beauty, may fit the DSM-5 diagnostic criteria for _____________.

narcissistic personality disorder cont.

The essential feature of _____ is intense sexual arousal to prepubescent children which persists at least 6 months.

pedophilic disorder

One disorder of schizophrenia

people vary greatly in their psychotic presentations—that is, one schizophrenic may appear very different from others

In working with schizophrenic patients, mental health professionals typically distinguish between __symptoms (an excess or distortion of normal behavior) and__symptoms (deficits in normal behavior).

positive; negative

Expressed emotion in families is thought to influence which of the following?

probability of relapse by schizophrenic patients

Research suggests that treatments like social skills training and CBT treatments

reduce relapses of schizophrenia

Which phase do men experience, but not women?

refractory period

schizophreniform disorder

same as schizophrenia, but duration less than 6 months - schizophrenia's criterion A= hallucinations, delusions, disorganized speech & behavior & negative psychotic symptoms - estimates that two thirds of those with schizophreniform disorder will likely develop either schizophrenia or schizoaffective disorder - incidence in developed countries such as the United States is only one fifth that of schizophrenia - 1 month minimum - slightly more common among males

Individuals who are detached, isolated, and have no interest in developing meaningful relationships with others are likely experiencing

schizoid

People with _____ are largely indifferent to criticism.

schizoid personality disorder cont.

Which of these related conditions has been proposed as a "subthreshold" for the patterns of behavior seen in the Cluster A disorders?

schizophrenia cont.

derailment

shifts between clauses of topics or referential frames & incoherence ( shifts within clauses)

An effective treatment for deficient arousal in males is _____.

sildenafil

The hormone _____ may increase sexual desire in men and women who experience sexual desire disorders.

testosterone

Individuals with antisocial personality disorder frequently are able to talk their way out of difficult situations and may "con" others into believing their good intentions for the future, demonstrating their _____.

the ability to make a good impression on others

thought broadcasting delusions

the belief that others can hear or receive one's thoughts

Sexual sadism disorder is defined as becoming repeatedly and intensely sexually aroused by:

the physical or psychological suffering of another individual.

Dr. Brown believes that personality is a collection of psychological characteristics, such as kindness or dependability, which can be identified and measured. She would be best described as a _____.

trait theorist

Which theory assumes that personality includes a collection of psychological characteristics which can be identified and measured?

trait theory

diagnosis of gender identity disorder

transsexualism: not given if there was a concurrent intersex condition - congenital adrenal hyperplasia: a genetic female (XX) fetus is exposed to high levels of androgens during fetal development. This may cause elongation of the clitoris to resemble a penis and fusion of the labia to resemble a scrotal sac; thus, the external genitals appear masculine - androgen insensitivity syndrome: a genetic male (XY) fetus shows general insensitivity during fetal development to androgens and is born with undeveloped sexual structures that, by default, resemble the external female genitalia. - In cases of these and other pseudohermaphroditic conditions, individuals troubled by persistent cross-gender identity may be diagnosed with gender dysphoria with the specifier "with a disorder of sex development.

What is the average number of personality disorders an individual is likely to be diagnosed with

two or more

alogia scenario

what is a dog? - a dog barks - a dog has four legs - a dog is mass, attracted by gravity to the earth's core * my arm died not my arm fell asleep

Female Sexual Interest/ Arousal Disorder

- A woman's persistent or recurrent deficiency in the desire for sexual activity, and in normal sexual fantasies or thoughts, that causes significant distress is diagnosed as female sexual interest/arousal disorder - intended to encompass those women who in the DSM-IV would be diagnosed with hypoactive sexual desire disorder and female sexual arousal disorder. - The low arousal or lack of desire may be generalized to all sexual activities or it may be situational, involving only one partner or a specific activity such as intercourse. - Typically the person does not seek or initiate sexual interaction but may participate reluctantly after partner initiation. - To make the diagnosis, the clinician must consider gender, age, health, and cultural contexts of the level of desire, as well as the context of the interpersonal relationships that are affected. - there is much variation in female sexual interest across ages and cultures. The incidence of the newly combined DSM-5 category is unknown - Decreased sexual desire can be associated with other mental disorders, such as depressive disorders, as well as with relationship problems. The diagnosis is not given in the absence of significant distress; a person who self-identifies as "asexual" would not receive the label - it can begin at any time after puberty, most frequently, deficit sexual desire develops after a period of relatively normal sexual interest, in connection with interpersonal problems and/or stressful events - To make the diagnosis, the clinician first considers issues such as age and health status and determines that the lack of arousal is not due to inadequate sexual stimulation. - Female sexual interest/arousal disorder can be accompanied by orgasm disorders, and it may result in painful intercourse and avoidance of sexual situations. - In earlier classifications, the condition was referred to by the pejorative term frigidity. - male equivalents of female sexual interest/arousal disorder consist of two diagnoses—male hypoactive sexual desire disorder and erectile disorder - 1/3 of U.S. women experience problems with low sexual desire, and 20% of females report arousal problems

olfactory aversive therapy

- Aversion approaches attempt to reduce sexual arousal to deviant stimuli by pairing them with aversive events such as electric shock or noxious odors -example: = presented sexual stimuli relating to children and to adults while undergoing plethysmographic assessment. An aversive odor (ammonia) was presented contingent on penile arousal to the child stimuli but not after arousal to adult stimuli. - Post-treatment assessments and follow-up indicated increased arousal to adult images and dramatic decreases in arousal to children.

Antisocial Personality Disorder

- Children and young adults who show a pattern of violence toward others, destruction of property, theft, or bullying may be at risk for developing antisocial personality disorder. - include deceitful, aggressive, manipulative, irresponsible, impulsive, and reckless - routinely violate the rights of others and appear to show no empathy, sympathy, or concern for the people around them. - can be superficially charming and may use this ability to exploit relationships and situations. - have a long history of such activities dating back to age 15 and evidence before that of conduct disorder (which involves patterns of serious rule violations, aggressiveness, deceitfulness, and destructiveness during adolescence). - As adults, they commonly engage in acts for which they could be arrested. - use dramatic acts in manipulative ways, such as threatening violence or suicide, to exploit others or to achieve some goal. - at higher risk for suicide than the general population - irresponsible parents and poor role models, and their offspring are subject to higher risk of mental disorders. - abuse or neglect of children is gone - Histories of violence and exploitative sexuality, together with lack of remorse and indifference to the suffering of others, contribute to stormy and assaultive relationships. - often in trouble with the law or are unemployed and may have spent long periods incarcerated in prisons or being homeless - good at gaming the system - Distinguishing adult antisocial behavior from antisocial personality disorder requires sufficient information to diagnose a personality disorder, in addition to evidence of a conduct disorder before age 15. - females may be underdiagnosed because of male aggression bias in the conduct disorder diagnosis - more prevalent, 70%, in certain settings like substance abuse treatment groups among the legally incarcerated - occur in 3% of males & 1% females

myths about human sexuality

- Direct stimulation of the clitoris is essential for the attainment of orgasms - Vaginal orgasms are better than clitoral orgasms. - Simultaneous orgasms represent a superior sexual accomplishment. - Size of penis contributes importantly to female sexual enjoyment.

biological factors of schizophrenia

- First-degree relatives (parents, siblings, children) show higher risks than second-degree relatives (grandchildren, nephews), who show slightly higher risk than third-degree relatives (first cousins). - A genetic vulnerability to schizophrenia has been demonstrated by both twin and adoption studies. - risks between identical twins as 48%, approximately 28% (that is, when one twin is schizophrenic, in 28% of cases the other twin is schizophrenic as well - both the twin studies and the adoption studies indicate that genetic factors contribute substantially to the development of schizophrenia, although estimates of the degree of influence have moderated somewhat over the past few decades - 89% of schizophrenics have no known relative with schizophrenia.

treatment of orgasmic disorders

- For deficient orgasm, sensate focus may be combined with education about sexual anatomy and masturbation training. - The assumption is that solitary masturbatory practice, without demand components, could shape orgasm techniques that could then be transferred to activity with a partner. Lobitz and LoPiccolo (1972), for example, incorporated a nine-step masturbation program for women who had never experienced orgasm; they reported 100% success in treating 13 women. - confirmed the effectiveness of masturbatory training for orgasmic disorder (Chambless et al., 1998; Segraves & Althof, 2002). - Sotile and Kilmann (1977), systematic desensitization are also successful in treating orgasmic dysfunctions - men with premature ejaculation, the couple is usually taught the squeeze technique, whereby the partner stimulates the penis until the man is about to ejaculate and then squeezes on the top and bottom surfaces immediately below the head of the penis. - This stops the ejaculatory process; after a brief pause, stimulation can be resumed. - In this way, the man comes to recognize the impending signs of ejaculation and can learn to increasingly delay the point of inevitability. - Masters and Johnson reported moderately high success rates, but subsequent evaluations suggest that gains are not maintained well over the long term - Pharmacological interventions for premature ejaculation seem to have followed from the recognition that several psychiatric drugs have the unintended side effect of delaying orgasm. - A variety of antipsychotic and antidepressant drugs have been used, with double-blind trials showing drugs superior to placebos (Segraves & Althof, 2002). - SSRIs appear to be more effective in delaying ejaculation if taken daily, rather than on-demand, and topical anesthetics may also delay ejaculation (Waldinger, 2007). - Pharmaceutical interest and activity are high in this area, raising concern among some researchers (e.g., Rowland & Burek, 2007) that it is distracting from work toward an important biobehavioral understanding of the condition

3 classifications of sexual dysfunctions

- Lifelong type vs. acquired type—Some dysfunctions may be lifelong, occurring since the age of puberty. Others develop at some point after a period of normal sexual functioning. - Generalized type vs. situational type—Generalized sexual dysfunctions occur in many or all types of circumstances, regardless of sexual stimulation, situations, or partners. Situational dysfunctions are limited to particular circumstances or to particular partners. - Severity (mild, moderate, or severe)—Ratings of severity are based on the degree to which the symptoms cause distress.

Premature (early) ejaculation

- Males diagnosed with premature ejaculation show almost the opposite symptoms from delayed ejaculation. - Instead, orgasm and ejaculation occur with minimal sexual stimulation, within approximately a minute of vaginal penetration or before the person wishes it in the case of nonvaginal sexual activities. - Ejaculation may occur before penetration is achieved or shortly thereafter. - The pattern must be recurrent and persistent and associated with significant distress. - When giving the diagnosis, the clinician must consider factors such as age, length of excitement phase, novelty of the practice or partner, and frequency of sexual activities. - most often seen in young men, and onset tends to date to their earliest attempts at intercourse. - Most males with the disorder can inhibit orgasm during masturbation longer than during intercourse. - About 27% of males indicated problems with early ejaculation in a representative national sample (American Psychiatric Association, 2000), making it among the most common sexual complaints. - it is estimated that only 1%-3% of men would meet the duration requirements (ejaculation in less than a minute and persistent for at least 6 months) of the DSM-5 diagnosis - prostate inflammation can result in rapid ejaculation (LeVay & Valente, 2006). - inadequate experience in providing sexual stimulation sufficient to produce orgasm. - Because of large gender differences in the incidence of masturbation, males have greater experience with orgasm at earlier ages. - the majority of female college students report faking an orgasm (Elliott & Brantley, 1997), - might give false feedback to partners about the ineffectiveness of their sexual techniques, further degrading the quality of stimulation. - Other possible causal factors include emotional conflicts over sexuality, relationship difficulties, or fear of pregnancy. - One perspective of premature ejaculation suggests that young males learn to masturbate to orgasm quickly in order to avoid detection, and this could shape faster ejaculations. - No empirical evidence exists in support of any particular causal theory for orgasm disorders. - The DSM-5 suggests a moderate genetic contribution to premature ejaculation but not for delayed ejaculation or female orgasmic disorder

Treatment of Dependent Personality Disorder

- No evidence is available from controlled reports concerning the relative effectiveness of medication or psychotherapy for dependent personality disorder. - Symptomatic treatments for depression or anxiety and directed skills training for assertiveness, independent living, and problem solving may be attempted.

treatment of avoidant personality disorder

- Pharmacological approaches to treatment of avoidant personality disorder essentially assume that the condition has a common basis with that of social phobia. - Case reports suggest certain antidepressant medications (MAO-Is and SSRIs) may be helpful, but controlled studies are needed - showed that behavioral treatments that involved graduated exposure and social skills training were more effective than a wait-list control; - less rigorous comparative studies and case studies have also supported cognitive therapy and supportive expressive dynamic therapy

treatment of schizoid personality disorder

- Psychological interventions may focus on social skills training and increasing social involvement; however, - in most cases, the individual is not interested in increased social connection - No controlled studies have been completed on either pharmacological or psychological treatment outcomes for schizoid personality disorder. - rare for people with schizoid personality disorder to seek treatment, and few case studies have been reported

cultural influences of schizophrenia

- Schizophrenia apparently exists in all cultures, from the most "primitive" to the most "advanced." - the conflict between satisfying the expectation of the community and pursuing interests of their own became sufficiently acute to precipitate the schizophrenic reactions— reactions that tended to occur either at the time the women were entering the marriageable age or later as their children were growing up and the satisfactions derived from the family were diminishing

treatment of gender dysphoria

- Sex reassignment surgery appears to be among the only effective treatments for chronic gender dysphoria in adults. - It is recommended that the person preparing for sex reassignment first complete a year of life-experience as the other sex and 6 months on continuous hormone treatments in order to be a candidate for surgery. - Male-to-female operations typically involve plastic surgery for creating a vagina and labia from penile and scrotal skin and modifying the remnant penis into a sensitive clitoris. - Sexual sensitivity can be maintained by using the clitoris as a base for the neophallus. - The female-to-male operation is less well established but can involve creating a phallus with skin from the forearm

Treatments for deficient sexual arousal

- Wolpe & Systematic desensitization: Over periods of up to 25 sessions, the partners would gradually increase contact and activity while maintaining a relaxed state. - Masters & Johnson + Sensate focus: 3 phases, pleasuring, genital stimulation, nondemand intercourse = pleasuring: the couple is instructed to gently touch and caress but not to have intercourse or orgasm = genital stimulation: involving light genital play but, again, without any orgasm or intercourse = nondemand intercourse: increasing gradually from brief penetration to full thrusting. = reported improvement for nearly 75% of males with acquired erectile dysfunction. Other psychotherapy studies have confirmed that significant gains and long-term improvements are realized by up to two thirds of patients who undergo treatment - prosthetic devices: such as semirigid rods or inflatable tubes, which were surgically implanted to provide erection for intercourse. = Vacuum devices, placed over the penis to draw blood into the organ and produce an erection, have been available for years. = A tension band placed over the base of the penis kept blood from flowing out. = Vasodilating medications such as papaverine, injected directly into the penis, produce erections within 15 minutes, although treatments involving this approach have high dropout rates = biggest advance in biological treatment has been the development of an oral medication, sildenafil, which relaxes a valve in the penis to allow increased blood flow. Pfizer introduced the drug in 1998 as Viagra®; unlike papaverine, it produces an erection only if sexual excitement is present (the drug does not produce desire or excitement itself, may also be helpful for erectile problems resulting from antidepressant medications = results with sildenafil in the treatment of female sexual arousal problems have been less promising

Male Hypoactive Sexual Desire Disorder

- a condition of recurrent deficiency in (or absence of) sexual desire and erotic thoughts or fantasies, persisting at least 6 months and causing significant distress - individual's age, health, and social/cultural context are taken into consideration when giving the diagnosis. - Men with this disorder may no longer initiate sexual activity with a partner or participate only minimally in response to another's initiation. Some sexual activities, including masturbation, may continue in the absence of desire. - Like women, men show cross-cultural variations in low sexual desire, and problems with sexual desire may affect a significant proportion of older men - although the persistent lack of desire appears to characterize only a small segment (less than 2%) of males aged 16-44

sexual dysfunction

- a disturbance in a person's sexual response or experience of sexual pleasure - diagnosis requires clinical judgement that the impairment is not a normal variation in response, considering the age and experience of the person, the adequacy of the sexual stimulation involved (in some cases, lack of knowledge about sexual anatomy and sexual techniques can play a role in the development of sexual disorders), and the level of subjective distress - Inter-rater diagnostic reliability was excellent for the sexual dysfunctions in the DSM-III field trials, ranging from 1.0 to .86 across the two phases - requires at least 6 months

delusional disorder cont.

- a more limited range of psychotic symptoms -delusions can be bizarre but not include prominent auditory or visual hallucinations - at least 1 month in duration - subtyped according to the predominant theme—erotomanic, grandiose, jealous, persecutory, somatic, mixed, or unspecified - does not seem to interfere with other aspects of the individual's thinking and behavior; the disorganization in these areas evident in schizophrenia or the extremes of elation and depression seen in the mood disorders are not present - uncommon, with population incidence as low as 0.2% - rare and may be more common in females although very little information is available

schizoid personality disorder

- a pervasive detachment from social relationships and a restricted range of emotional expression with others. - appear cold or aloof and seem to have little interest in relationships with families or friends - prefer to be alone and choose activities that will keep them so, including night jobs - lack of emotional expression is notable; they react passively to important events around them and are not easily aroused to anger or any emotional display. - They are not interested in sexual relationships or experiences; in the rare event that they date or marry, it is because they passively accept the initiation by others - largely indifferent to the praise or criticism of others—unlike paranoid personality disorder, where the response to even slight criticism is overblown - Prevalence of the disorder is between 3% and 5% of the population - increased prevalence of schizoid personality disorder in families where schizophrenia or schizotypal personality disorder is present - and it is diagnosed slightly more often in males

Obsessive- compulsive personality disorder

- a preoccupation with control, orderliness, and perfectionism. People with this condition are overinvolved with rules, schedules, and details - are insensitive to the resulting annoyance of others to the extent that inflexibility of procedure is more important than efficiency. - tend to be stubborn and inflexible about checking details, so that deadlines tend to be missed despite excessive devotion to work. - The same preoccupation with and dedication to tasks interferes with friendships or leisure activities. - Their emphasis is on perfect performance and rigid devotion to principles, and - they typically do not trust the abilities of others toward these ends. Consequently, - they rarely delegate tasks or collaborate with coworkers. - Unlike obsessive-compulsive disorder (described in Chapter 6), those with obsessive-compulsive personality disorder are not particularly distressed by their condition. - they can appear to be emotionally insensitive and unexpressive. Others may see them as overly conscientious and moralistic. - do not display true obsessions or compulsions. - People with anxiety disorders may have a higher risk for obsessive-compulsive personality disorder. - appear to overlap with Cluster A rather than Cluster C conditions, - there may be an association with eating disorders and depressive disorders (American Psychiatric Association, 2013). - Earlier Freudian perspectives invoked fixation at the anal stage of psychosexual development ("anal retentive" personalities - are preoccupied with order and neatness, as compared to "anal expulsive" personalities, - are disorganized and messy), possibly related to overcontrolling parents. - Later perspectives tend to emphasize overuse of defenses. - Without empirical data, little is known about these or other possible environmental or familial contributions to this condition. - According to the DSM-5, the condition may be among the most common personality disorder in the general population, - with incidence estimates ranging from 2% to nearly 8%. Its male-to-female ratio is 2:1

Sexual sadism disorder

- achieving sexual gratification by inflicting pain on his partners. - Sexual sadism disorder involves intense sexual arousal and fantasies, - persisting for 6 months, about causing physical or psychological suffering to others. - the person either has committed the act on a nonconsenting person or is distressed and impaired by the urges. - fantasies involve themes of dominance and control over another person and typically include bondage, whipping, spanking, burning, torturing, raping, or otherwise inflicting suffering. - tends to be chronic, and the activities may remain relatively mild or may increase in intensity and dangerousness - when severe, especially involving those with antisocial personality disorder, victims may be seriously injured or killed - The condition can be specified as in a controlled environment or in full remission. - The prevalence is unknown, but less than 10% of civilly committed sex offenders carry the diagnosis

emotional disturbance

- affective flattening - anhedonia

other specified paraphilic disorder

- all having in common the intense sexual arousal associated with urges, fantasies, and acts involving unusual sources of attraction. - recurrent and persist for at least 6 months - if they cause distress or social problems, they may be coded as other specified paraphilic disorder. - Some examples that have been reported include zoophilia (animals), necrophilia (corpses), coprophilia (feces), and klismaphilia (enemas)

Traditional ideas about sex

- among Western Christian cultures, sexual activity was something that authorities, concerned with proper conduct, viewed warily. - Many religious leaders advised that if sex was necessary at all, it should occur as rarely as possible and should not be enjoyed because it was a sin of the flesh. - Some influential men of science, such as Richard von Krafft-Ebing (1840-1902), considered all variations from "normal" sexuality to be diseases. - Kinsey and his colleagues (1948, 1953) were among the first to collect data on the prevalence of different kinds of sexual behavior such as masturbation, marital and premarital heterosexual intercourse, and homosexuality. - Sexual variations are no longer considered deviations or disorders a priori; instead, they must, in most cases, be recurrent, persistent, and distressing to the individual in order to earn a DSM label.

delayed ejaculation

- an inability to reach orgasm or a delay in reaching orgasm that follows a normal phase of sexual excitement. - The absence or delay of ejaculation is recurrent and persistent (lasting at least 6 months) and results in marked distress. - The orgasmic dysfunction is not due to inadequate sexual stimulation, a medical condition, or the effects of a substance. - Age is a diagnostic consideration because, as males age, they tend to require longer periods of stimulation before reaching orgasm. - Most cases appear to be situational, such as orgasm being inhibited during intercourse but occurring in masturbation or oral sex. - about 10% of males report occasional problems with inhibited ejaculation (American Psychiatric Association, 2000), but less than 1% report problems persisting more than 6 months, making delayed ejaculation the least common male sexual complaint

neurosis

- anxiety driven condition - results when ID impulses threaten to overwhelm the ego

treatment of paranoid personality disorder

- approach in psychotherapy requires careful work at relationship building, collaboration in planning the goals of therapy, avoidance of techniques that emphasize vulnerability (such as hypnosis), and gradual challenging and testing of beliefs - Antipsychotic medications may be prescribed to target symptoms of paranoid ideation - no controlled data concerning the relative effectiveness of such approaches - Cognitive therapy may be of value, although the only available data are from case study methods

social withdrawal

- avoid close interpersonal relationships - spend most of their time alone - retreat more into their own fantasy world - withdrawal is both physical & psychological - confusion about personal identity, gender, & sense of self that add to disrupted social relationships - volition seems impaired so work and self-care responsibilities are not completed - unintelligible speech makes them psychologically distant to others

types of delusions

- bizarre - delusional jealousy - erotomanic - grandiose - mood- congruent - delusions of being controlled - delusions of reference - persecutory - somatic - thought broadcasting - thought insertion * organized conceptually, not mutually exclusive * can have persecutory delusion that's mood congruent w/ depression while also being bizarre

gender dysphoria

- both (a) strong and persistent cross-gender identification and (b) persistent discomfort with one's assigned sex or with the gender role associated with it occur - the person experiences clinically significant distress or impairment in functioning. - diagnosed somewhat differently for children than for adults - the criteria for gender dysphoria in children are shown in DSM-5 - Children with gender dysphoria may express the wish to grow the genitals of the other sex; they prefer the stereotypic play, mannerisms, and attire of the other gender. - Boys may enjoy feminine toys and playing house, often role-playing female figures such as mothers or sisters, prefer girls as playmates to other boys, may also adopt feminine mannerisms, such as sitting down to urinate. - Girls may refuse to attend school or social events in which feminine attire is required, may cut their hair short, and may take on a boy's name, show little interest in dolls or typical girls' toys and prefer boys as playmates, enjoying rough-and-tumble play and contact sports - In adolescents and adults with gender dysphoria, there is frequent expression of the desire to live as or to become the other sex, including interest in sex-change surgery or hormonal treatments - specified by post- transition - Adults may show fluctuating course, with late-onset females more likely to engage in transvestic activities for arousal. - often feel socially isolated and may experience concurrent anxiety disorders or depression - gender identity develops in early childhood and is usually established by age 3, suggesting that causal factors for gender identity disorder are located in prenatal or early postnatal development - strong heritable component in gender identity disorder. However, Segal (2006) reported nonconcordance of female-to-male transsexualism in two pairs of identical twins, - prenatal hormonal influences as possible causal factors - rare, although little data exist; in clinical settings, males with the disorder outnumber females by a factor of least 2 or 3 in the United States - although in some countries (e.g., Japan and Poland), females with the condition may outnumber males

psychosocial factors of schizophrenia

- child-rearing attitudes in a direction more consistent with overcontrolling, intrusive behavior - children's perceptions of maternal behavior seemed to consistently show that children with schizophrenia perceive their mothers as being intrusively overcontrolling - having a seriously disturbed child may elicit more overprotective responses from a mother, confounding the direction of causality. - double bind: arises when (1) the child is emotionally dependent upon the parent, making it extremely important for him or her to understand communications accurately and respond appropriately; and (2) the parent expresses two contradictory messages = proposed that psychotic symptoms were a form of adaptation to an impossible situation - expressed emotion (EE) in the family home was the important factor. Expressed emotion consists of criticism, hostility, and emotional overinvolvement (intrusiveness)

treating personality disorders

- chronicity, stability, and involvement in several life areas, personality disorders are difficult to treat. - As mentioned earlier, many people with these disorders resist or refuse treatment or disagree with the need for change; they may enter therapy only because of social or legal coercion (Meyer & Deitsch, 1996). - They may also sabotage therapy - Social relationships are usually severely disrupted, and often the characteristics that produce interpersonal difficulties also interfere with the client-therapist connection. - Much effort is required to forge a therapeutic relationship, and clinicians are frequently confronted with boundary concerns and transference and countertransference issues

persecutory delusions

- concern the theme of being plotted against, attacked, cheated, threatened, or persecuted in some way by other various people or groups, like neighbors, competitors, bosses, politicians, or the FBI - people holding such beliefs may find confirmation in seeing a group of people laughing among themselves or in the frown of a passing pedestrian

psychosis

- concerns a more serious pathology that involves a loss of contact with reality - severe psychological disturbance involving personality disorganization & loss of contact with reality

environmental factors of schizophrenia

- concordance rates for identical twins are much less than 100% - biological context, such as different intrauterine environments, birth complications, or subsequent diseases, might contribute to the development of schizophrenia in one twin and not the other - Outside of early childhood, increasing attention is being given to adolescent development

treatment of Borderline Personality Disorder

- dialectical behavior therapy: complex and eclectic mix of group and individual sessions dealing with interpersonal skills, emotional regulation, problem solving, acceptance, and goal setting—was effective in reducing some symptoms, as compared with standard treatment, for borderline patients who also had drug dependencies - First-line pharmacology for borderline personality disorder involves antidepressants such as the SSRIs and antimanic drugs such as lithium - less solid support for antipsychotic or antiseizure medications to assist with psychotic symptoms and mood stabilization - suggests that antipsychotic medications and mood stabilizers are more effective in treating the core symptoms of borderline personality disorder (emotional dysregulation, impulsiveness, and cognitive/perceptual disturbance) than antidepressants, for which improvement was limited to emotional symptoms

treatment of antisocial personality disorder

- difficult, and no treatment evaluations have provided clear evidence of validated approaches - rarely motivated to attempt real change - working with them are typically advised to expect resistance and deception, confront deviant behavior, and challenge underlying psychopathic thinking - Targets for treatment often include overt aggression and anger management - treatment is more promising at earlier ages (for adolescent antisocial behavior) than once the pattern becomes more established in adults. - No specific medications are clearly recommended for treatment of antisocial personality disorder. Commonly, drugs are used to target components such as aggressiveness or impulsiveness - Cluster B patients found the anticonvulsant divalproex, which has also been used for bipolar mania, to be better than placebo in reducing scores on tests measuring aggressiveness and irritability; however, those in the drug group discontinued treatment at a higher rate than the placebo group - cognitive behavioral therapy appears to be less effective

paranoid personality disorders

- distrustful and suspicious and expect others to take advantage of them in nearly all circumstances. - do not show a sense of humor and rarely relax or let down their guard in social situations. - take offense readily and hold grudges easily for some unintentional slight that they have interpreted as malevolent. - Others may describe them as angry, litigious, hostile, stubborn, or sarcastic. These characteristics help keep them isolated from others; typically, they have few or no close friends or confidants - Jealousy and envy, together with an excessive view of one's own self-importance - pattern of interacting with others may be traceable to childhood but must begin by early adulthood for the diagnosis - periods of stress, those with paranoid personality disorder sometimes experience brief psychotic episodes - major depressive disorder, agoraphobia, obsessive-compulsive disorder, and substance disorders. - prevalence of paranoid personality disorder at between 2.3% and 4.4% of the general population. - more likely when a history of either schizophrenia or delusional disorder, persecutory type, exists within the family - Psychological mistreatment or trauma in childhood and particular cultural experiences might play a role in its development. - cause remain unknown - more commonly diagnosed among males

What are the direct and indirect symptoms described as?

- disturbances of language & thought - disturbances of sensation & perception - disturbances of motor behavior - emotional disturbances - social withdrawal

treatment of paraphilic disorders

- do not often seek treatment unless mandated by legal authorities; they may claim that therapy is not needed. - Lack of motivation for change represents a serious impediment to therapy; in fact, those in treatment may make deliberate attempts to fool the therapist into believing that the problem has improved when, in fact, it hasn't - SSRIs - Other pharmacological approaches attempt to inhibit sexual arousal by giving estrogen-like or progestin-like hormones to males. - These drugs reduce the production and action of androgens, and they have been associated with reduced sexual activity, including masturbation - masturbation retraining or orgasmic reconditioning - olfactory aversive therapy - covert sensitization

Transvestic disorder

- ecurrent, intense, sexually arousing fantasies, urges, or behaviors that involve cross-dressing. - The pattern must persist for at least 6 months and must be associated with distress or social impairment. - range from occasionally wearing a single object of women's clothing to complete cross-dressing with makeup, female mannerisms, and habits. - individuals with transvestic disorder experience the sexual arousal by imagining they are females, often visualizing female genitalia. - occurred only in heterosexual males. The DSM-5 no longer carries that requirement. - distinguished from the cross-dressing that may be involved in gender dysphoria, which is not done for purposes of sexual arousal. - specified with fetishism or with autogynephilia (arousal at thinking of self as a female) and if in a controlled environment or in full remission - a rare disorder in males and extremely rare in females, though actual incidence is not known.

neurobehavioral markers for schizophrenia

- endophenotypes: observable trait that can serve as a biomarker for a disorder - severity has varied widely - valuable as risk indicators either in predicting onset or prognosis of the disorder or in identifying neurological facets that may identify genetic foundations of schizophrenic functioning

personality disorders

- enduring and inflexible patterns that cause distress either for the person or for other people. - They involve disturbances in a combination of areas of global functioning—including mood, cognition, social interactions, and control of impulses—which are apparent across many different situations and cannot be better explained by a medical condition, the effects of a substance, or another mental disorder. - They are long-standing conditions that can be traced back, if not to childhood patterns, at least to adolescence or early adulthood. - may not seek, accept, or cooperate with clinical involvement. - exaggeration of symptoms is among the defining features - common for people in treatment to have 2 or more disorders concurrently - reliability problems have plagued the classifications - kappa values: 0.56 & 0.65 - Such poor levels of diagnostic reliability raise serious questions about the value of these classifications within the DSM system, - incidence in the general population of any personality disorder was recently estimated at just over 9% - 10 disorders into three clusters. The personality disorders within Cluster A (paranoid, schizoid, schizotypal) tend to present symptoms that observers consider odd or eccentric. - Those within Cluster B (antisocial, borderline, histrionic, narcissistic) are associated with dramatic, emotional, and erratic symptoms. - In Cluster C disorders (avoidant, dependent, obsessive-compulsive), people present symptoms that generally appear avoidant or fearful - Up to 50% of patients with either schizotypal personality disorder or borderline personality disorder also meet the criteria for a depressive disorder - treatment is directed at particular deficits or symptoms rather than any underlying condition - Cluster A symptoms appear to be best treated with atypical antipsychotic drugs, whereas SSRIs are most readily prescribed for those in Clusters B and C (Grossman, 2004). - In general, there has been very little controlled research on the relative effectiveness of treatments for personality disorders

histrionic personality disorder

- excessive emotionality and attention seeking. The rapidly shifting emotions may seem shallow, superficial, and exaggerated to others. - showing histrionic personality disorder desire to be the center of attention and act in dramatic ways to bring that about through both behavioral intensity and physical appearance. - may fish for compliments, act flirtatiously, and pretend that relationships are more intimate than they actually are. - often assume either a "victim" or a "princess" role in relating to others - may be seductive, manipulative, and theatrical in presentation, although they are also quite dependent. - Manipulative suicidal gestures, often with the goal of attracting attention, are not uncommon. - tend to seek out novelty and excitement and easily become bored with routine. - co-occurs with several other personality disorders, most often narcissistic personality disorder - associated with higher rates of somatic symptom disorder, conversion disorder, and major depressive disorder - The general incidence appears to be close to 2% of the population; although - the diagnosis is given more often to females

voyeuristic disorder

- experience intense sexual arousal connected to observing an unsuspecting person who is naked, disrobing, or engaged in sexual activities. - requires that the person has either acted on these urges or that the urges cause the person distress or impairment - signs of voyeurism must persist for at least 6 months. - does not seek sexual contact with the observed person, although he may harbor a fantasy of such activity. - violation of privacy that seems to be most arousing to the voyeur, who may masturbate during the viewing or at a later time while recalling the event. - begins by age 15, tends to have a chronic course, and may be the person's exclusive sexual outlet when severe - can be specified if in a controlled environment or in full remission. - Prevalence could be as high as 12% in males and one third that for females

delusions of reference

- false beliefs that events, people, or things in the immediate environment have a special & unique significance for the individual - person may believe that graffiti refers specifically to the private events of an individual's life - a song broadcast on the radio was meant to send a specific message to the person alone

psychoanalytic therapy of schizophrenia

- family therapy - behavioral therapy - cognitive- behavioral therapy: help prevent the development of schizophrenia in high-risk individuals.

performance anxiety

- fear of not being able to perform sexually, which in turn hinders sexual performance & may be central to the development of sexual dysfunctions - fears of not being able to perform increase the likelihood of failure, and each new failure increases the worries of failing next time, resulting in a vicious cycle.

causal factors of paraphilias

- first appear during childhood and become elaborated in adolescence and adulthood - both masochistic and sadistic fantasies are likely to have been present in childhood. - Psychoanalytic perspectives suggest that paraphilias result from regression or fixation at earlier stages of psychosexual development—that is, the individual reverts to sexual habits that aroused them earlier in life. - Other psychoanalysts consider them expressions of hostility to obtain revenge for a childhood in which parents punitively inhibited budding sexuality - Biological speculations have included excessive exposure to male hormones, focal brain damage, and chromosomal abnormalities; however, evidence is lacking to support any of these possibilities. - Social learning models proposed that lack of parental care, physical punishment, and aggressive behavior within the family increase the chances of pedophilic development. - People raised in such homes may demonstrate the low self-esteem, limited capacity for affection and intimacy, and impaired ability to postpone gratification that is reported among sexual offender samples - LaTorre (1980) reported that college students who had been rejected for dates responded more positively to pictures of women's legs and panties and less positively to pictures of women than did other men who had not been rejected, suggesting rejection as a factor in fetish development

covert sensitization

- imagery of the paraphilic act is paired with an anxiety-inducing or nausea-inducing verbal description. - Imagery of appropriate behavior is paired with descriptions of positive outcomes - degree of arousal was assessed in two ways: the physiological assessment of penile erection and the self-report using a card sort technique with cards that described various sexual situations - Combining these techniques with behavioral or conditioning approaches can result in better outcomes

Cluster C personality disorders

- include those in which symptom presentations tend to be avoidant or fearful - about 6% of the general displays at least one of the disorders

illusions

- incorrect perception of sensory stimuli - an actual sensory stimulus is perceived incorrectly - clothes in the closet misperceived as a lurking killer

Other specified personality disorder

- individuals present symptoms that meet the general definition of a personality disorder (see Table 8.1) but do not satisfy the specific criteria for any of the Cluster A, B, or C diagnoses. - Usually, these appear to be conditions in which the symptoms of different personality disorders are mixed together. - In those situations, a diagnosis of "other specified personality disorder" is given. - Even when structured clinical interviews are employed in diagnosis, - this classification is among the top three personality disorders in terms of prevalence; when interviews are not structured, this is the most common personality disorder diagnosis

masturbating retraining

- instructing the person to masturbate while engaged in the paraphilic fantasy and to continue masturbating for a much longer time (e.g., 1-2 hours) than is pleasurable, even after ejaculating. - Most males experience continued stimulation such as this as very uncomfortable; the goal is to make the paraphilic fantasy aversive. - can be combined with masturbation to nondeviant stimuli, in which case masturbation stops after ejaculation - another name is orgasmic reconditioning, masturbatory satiation, or masturbatory extinction

frotteuristic disorder

- intense sexual arousal from touching or rubbing against a nonconsenting person, persisting at least 6 months. - diagnosis can be made either if the individual has committed the act or if the urges and fantasies cause distress or impairment. - touching occurs in crowded settings, such as subways, elevators, sporting events, and busy sidewalks. - individual may rub his or her genitals or hands against the victim's thighs, buttocks, or breasts and then escape into the crowd without making further contact with the victim. - A male frotteurist may wear a protective cover, such as a plastic bag, over his penis at the time of his act to prevent his ejaculate from staining his clothes (LeVay & Valente, 2006). - At the time of contact, frotteurists sometimes fantasize about having a close relationship with the victim. - usually begins in adolescence and peaks between ages 15-25 before becoming less frequent - The disorder can be specified as in a controlled environment or in full remission. - the incidence of the disorder is assumed, however, to be much lower than that, perhaps below 10% - Frotteuristic acts such as inappropriate touching occur in almost a third of the male population;

pedophilic disorder

- intense sexual arousal to prepubescent children, persisting at least 6 months. - diagnosis requires that the person has either acted on these urges or is distressed or impaired by the urges or fantasies. - To distinguish it from other forms of child sexual contact, in pedophilia - the person must be at least age 16 and must be 5 or more years older than the child, who is generally 13 or younger. - can be subtyped as "exclusive" (in which case sexual attraction is limited to children) or "nonexclusive" (in which case sexual attraction has included adults). - Girls are the victims of pedophiles more often than boys. - Pedophilia can also be specified as "limited to incest" (which generally refers to first-degree relatives) or by victim category ("sexually attracted to males," "sexually attracted to females," "sexually attracted to both") - limit contact to undressing the child and looking; others fondle the child or expose themselves and masturbate. - Oral-genital contact or penetration can occur, as can intercourse, but these actions are less common - rationalize their behavior as being educational or pleasurable for the child or claim they were being provoked. - Those with the disorder may take jobs or engage in hobbies or activities that bring them into contact with children, and they may engage in very complex steps to get access to and prepare or "groom" their victims. - The course of pedophilia tends to be more chronic, and the relapse rate appears to be higher in those who are attracted to males - plethysmographic assessment: measuring changes in penile circumference in response to visual and auditory stimuli of a sexual nature) has been used to assist in diagnosis - incidence of pedophilia in the population is not known. - substantiated cases of child sexual abuse appear to have declined by over 50% since 1990 - male sex offenders tend to have lower IQ scores than nonoffenders - Its incidence is unlikely to be higher than 3%-5% of the male population, with the female incidence at only a fraction of that

treatments for deficient sexual desire

- intervention is difficult for low or absent sexual desire - no aphrodisiacs or medications that create sexual desire in an individual - testosterone supplementation may increase sexual desire in men and women who have lower-than-normal levels (LeVay & Valente, 2006). - Others suggest that high doses of androgens may improve low sexual interest in females (Segraves, 2003). - In 2015, the FDA approved flibanserin (marketed under the brand name Addyi®) for the treatment of deficient female sexual desire, based on trials showing a modest increase in desire and lowered distress; however, the FDA warned of serious side effects if mixed with alcohol - satisfying sexual activities increased by only 0.5-1.0 acts per month under the medication, yet it was premarketed aggressively even before FDA approval, perhaps to convince clinicians that a disease state existed that required pharmacological treatment (Quigley, 2015). - Psychotherapy appears to be modestly effective, with between 50% and 70% of patients showing improvement, although only half maintain improvement 3 years after therapy (Segraves & Althof, 2002). - Often, therapy involves marital or relationship counseling.

mood- incongruent delusions

- involve content that is not consistent with the prevailing mood - beliefs of unlimited wealth & power = incongruent with depression

delusions of being controlled

- involve the belief that some external force or agent is manipulating one's movements, thoughts, speech, or emotions - a murderous impulse, a sexual fantasy, or urge to commit suicide is imposed from the outside - controlling agents: gods, demons, parents, political groups or a "they" - mechanism of control can be spelled out: hypnotism, extrasensory perception, or influencing machines like a tv or an x- ray device

Genito-Pelvic Pain/ Penetration Disorder

- involves pain, or the fearful anticipation of pain, during intercourse or vaginal penetration. - The DSM-5 disorder replaces two sexual pain disorders in the DSM-IV—dyspareunia (painful intercourse) and vaginismus - may be triggered by actual or anticipated penetration by a penis, finger, speculum, or tampon. - In sexual interactions, the contracted muscles prevent intercourse and may sometimes prevent normal gynecological examination as well - tend to avoid intimate circumstances and sexual opportunities, often creating difficulties in relationships - tend to peak in early adulthood and near menopause - Trauma, such as rape or sexual assault, can be causal for sexual pain disorders, although Meyer and Deitsch (1996) considered the primary causes to be painful childbirth, inadequate lubrication, and abrasion by pubic hair

Schizotypal Personality Disorder

- involves social deficits and social discomfort, combined with distortions of perception and cognition and eccentric behavior. - find close relationships uncomfortable and usually, as with schizoid personality disorder, do not have close friends or confidants outside of family members. - not cold or aloof but instead feel anxious in social settings because they do not feel like they "fit in." - thinking and perception would seem unusual to other people. - may believe that they can cause events by thinking about them or have the idea that events in their surroundings have a special meaning for them(ideas of reference). - may dress and speak in unusual ways (for example, clothes that do not fit together or loosely connected speech). - Superstitions are common, and the individual may claim clairvoyance or telepathic abilities. - None of these unusual beliefs quite reaches delusional proportions, however. - term schizotypal reveals the assumed connection of this personality disorder to schizophrenia & to schizoid personality disorder - some suggest that the Cluster A disorders occur within a schizophrenic spectrum of related conditions - only a small percentage of these people later develop schizophrenia - frequently co-occurs with schizoid personality disorder - both this disorder and schizophrenia have the highest comorbidity rate of all personality disorders (37%) - high prevalence of depressive disorder in these individuals - runs in families, mainly those w/ schizophrenia - increased size of putamen ( dorsal striatum at the base of the forebrain) similar to schizophrenics - affects 4% of the population - more common in males

avoidant personality disorder

- involves social inhibition, hypersensitivity to being evaluated negatively, and feelings of inadequacy - These individuals are so preoccupied with and sensitive to criticism that they avoid activities where disapproval is possible, including occupational situations and social relationships. - They see themselves as inadequate and inferior to others and they are usually described as shy, lonely, and timid. - They resist new relationships or friendships without feeling certain that they will be accepted and liked. - take so few risks that they may turn down occupational opportunities or new social relationships because of the possibility of future criticism. - They may be vigilant in watching for early signs of social disapproval and their demeanor may evoke a critical reaction from others, which is then seen as confirmation of their self-doubt. - Depressive disorders and anxiety disorders, especially social phobia, are often comorbid (American Psychiatric Association, 2013), whereas the most common coexisting personality condition appears to be schizoid personality disorder (Zimmerman et al., 2005). - No clear gender differences in prevalence are apparent; - Nearly always, they expect others, to see their obvious faults, so they resist intimacy and act with restraint, remaining "invisible" in the social background. - Others, however, argue that avoidant personality disorder should be considered within the schizophrenic spectrum (Gooding, Talent, & Matts, 2007). - Possible psychological causes include parental or peer rejection in childhood, although little empirical evidence exists for any specific causal factors - involves social inhibition, hypersensitivity to criticism, and feelings of inadequacy. These individuals may resist new relationships or friendships when feeling uncertain that they will be accepted or liked. - it appears to affect about 1% of the general population

delusional jealousy

- involves the incorrect conviction that a person's spouse or sexual partner has been or is being unfaithful - unreasonably held, even in the face of proof or evidence to the contrary

previous characteristics of antisocial personality disorder

- lack of conscience or feelings of remorse - impulsivity; inability to delay gratification - inability to profit from mistakes - lack of emotional ties to other people - stimulus seeking - ability to make a good impression on others: talk their way out of tight spots; "con" people into dubious investments; or convince judges, juries, probation officers, or therapists of their good intentions for the future. - Cooke and Michie (2001) suggested the three main factors in psychopathy are arrogant and deceitful interpersonal style, deficient affective experience, and impulsive and irresponsible behavioral style. - runs in families - Environmental influences might include parental abuse, neglect, deficient parenting practices, and inept discipline techniques, all of which can be associated with having antisocial parents - faulty superego development and the consequent lack of counterbalance for the expression of the id are causal factors in the development of antisocial personality disorder - both genetic and environmental factors in the cause

inappropriate expression of emotions

- laugh, cry, giggle, or rage w/ no clear relationship to events in the social environment

female orgasmic disorder

- may experience normal sexual desire and excitement phases, but they also experience a recurrent absence or delay of orgasm, either in specific sexual circumstances (situational type) or in all sexual activities (generalized type), persisting at least 6 months and causing significant distress. - The diagnostic process requires careful consideration of factors such as age, sexual history, and whether the sexual stimulation received is adequate in focus, duration, and intensity for orgasm. - The female capacity for orgasm tends to increase with sexual knowledge and experience; once acquired, the ability is rarely lost. - may be lifelong rather than acquired (American Psychiatric Association, 2000). - In situational cases, females may be able to reach orgasm during solitary masturbation but not with a partner. - Inhibited orgasm is a relatively common problem among females; estimates are that from 10% to 41% of women report orgasm difficulty, and about 10% do not have orgasms during their lifetimes (American Psychiatric Association, 2013). - not all of these women report significant distress; some report satisfaction with their sexual lives even with few or no orgasms.

visual hallucinations

- may include lights, moving objects, places, and people - may appear as cartoon objects or as unformed images

What kinds of medical conditions are responsible for psychotic states?

- neurological conditions (epilepsy, MS) - endocrine disorders (hypothyroidism) - metabolic conditions - fever - other disorder with central nervous system involvement

Treatment of Obsessive-Compulsive Personality Disorder

- no controlled outcome studies on either pharmacological or psychological interventions for obsessive-compulsive personality disorder. - Therapy may be attempted for relaxation training or to reduce the nearly compulsive preoccupation with detail that is so characteristic of the behavior pattern. - Meyer and Deitsch (1996) recommend relaxation, modeling of humor, bibliotherapy techniques (use of written materials that may have life significance), and cognitive challenging, - although no empirical data support these interventions for obsessive-compulsive personality disorder.

sexual masochism disorder

- obtains intense sexual arousal through fantasies, urges, or behaviors involving the act of being bound, beaten, humiliated, or otherwise forced to suffer. - fantasies may involve being whipped, tortured, beaten, raped, pierced, shocked, or subject to other forms of physical or verbal abuse or humiliation; - they must have persisted for 6 months and must cause distress or interpersonal problems to qualify for the diagnosis. - individuals act on these urges or fantasies during solitary sexual behavior - others seek masochistic acts with partners. - course tends to be chronic, and the activities may remain relatively mild or may increase in intensity and dangerousness. - Specifiers include in a controlled environment and in full remission. - can also be specified for one type of masochistic act—asphyxiophilia, which involves oxygen-depriving activities such as choking, hanging, or suffocating; - several accidental deaths occur from these practices each year in the United States - It is possible that the interest in masochism and sadism is increasing, as indicated by widely available sadomasochistic pornography and best-selling novels such as Fifty Shades of Grey. - Some information exists that masochists are more common among higher socioeconomic levels, and many are highly educated and successful at work - Prevalence estimates of about 2% of males and 1% of females have been reported in Australia, but the U.S. incidence of the disorder is unknown

Personality change due to another medical condition

- persistent personality changes can be associated with chronic medical problems or events such as stroke, head trauma, epilepsy, autoimmune disorders, or other central nervous system dysfunctions. - Those afflicted may show emotional instability, aggression, paranoia, apathy, or poor impulse control, among a host of other possible dysfunctions. - When these changes can be directly linked to the underlying medical condition, this diagnosis would be appropriate.

Dopamine hypothesis of Schizophrenia

- proposed that schizophrenia resulted from a relative excess of dopamine activity in the brain, was an outgrowth of the attempt to explain the action of the antipsychotic medications that began appearing in the 1950s - First, among the frequent side effects of heavy and prolonged use of phenothiazines for schizophrenia are symptoms resembling Parkinson's disease - receives support from research with amphetamine drugs - As promising as the dopamine hypothesis is in explaining schizophrenia, there are data that do not appear to support it. For one third of schizophrenics, dopamine-blocking drugs are unhelpful. For those who do respond, it may take weeks to show improvement, even though the receptors are blocked almost immediately.

perceptual distortions

- psychotic individuals - world may seem flat, unreal, or remote, objects unusually small or large - time pass w/ unusual slowness or rapidity

catatonia

- psychotic persons may seem unresponsive to others & engage in strange, stereotyped gestures, postures, or facial grimaces - unusual movement or immobility associated with psychosis - can be present in schizophrenia or other psychotic disorders, major depressive disorder, or bipolar disorder - occur in head injuries & neurological diseases - could be associated with another mental disorder, due to another medical condition, or unspecified when the underlying condition is unclear

Symptoms of Schizophrenia

- requires 2 psychotic symptoms in a 1 month active phase - delusions - hallucinations - disorganized speech

Sexual response cycle

- same for men & women - 4 phases - excitement: begins with whatever is sexually stimulating and arousing for the particular person. Blood rushes into the genitals (vasocongestion), causing penile erection in males and vaginal lubrication and clitoral swelling in females - plateau: If the stimulation continues, excitement builds quickly to a point, in which the sexual arousal is maintained and intensified. If stimulation is terminated or ceases to be effective at this point, the person will not experience orgasm but will enter a prolonged period of gradually decreasing sexual tensions - orgasmic: the shortest period of the cycle, consists of those few seconds when the bodily changes resulting from stimulation reach their maximum intensity. Orgasm involves muscular contractions of the pelvic area. = In males, it consists of a stage of ejaculatory inevitability, after which the second stage, ejaculation of semen, cannot be controlled. Women do not report a corresponding point of inevitability before their orgasms, which include clusters of contractions that are intense and close together - resolution: sexual tensions decrease as the person returns to the unstimulated state. Women are capable of having another orgasm if effective stimulation is resumed. - For men, however, there is the refractory period, when rearousal and orgasm are impossible. The duration of the refractory period varies widely, from minutes to hours, and is influenced by many factors including the male's age and novelty of the sexual practice.

Narcisstic Personality Disorder

- self-centered and require the admiration of others. - exaggerate their own self-importance and are preoccupied with fantasies about their own success, brilliance, or beauty. - commonly feel entitled to special treatment; similar to those with antisocial personality disorder, they lack empathy and exploit others for their own purposes. - are described as arrogant, conceited, elitist, and grandiose and can frequently be contemptuous of others - do not care to wait in line or take their turn; they expect special privileges because of their obvious superiority to others. - are condescending and haughty in attitude and behavior. - tend to overstate their accomplishments while underestimating those of others. - may fish for compliments and expect to receive them. - Although preoccupied with self-importance, their self-esteem is actually very fragile; criticism may hurt them greatly, leaving them empty and humiliated and primed to counterattack but also susceptible to depression. - To prevent defeat and humiliation, they tend to avoid competitions that they may lose. - Narcissistic personality disorder may co-occur with anorexia nervosa and with substance (especially cocaine) use disorders. - tend to view it as an outgrowth of the natural ego-centered nature of the child or a defense against feelings of inadequacy; others suggest it may develop from overindulgence by parents - The diagnosis is more commonly given to males; its prevalence is unclear, with estimates ranging up to 6.2%

Biological therapy of schizophrenia

- serious and irreversible side effect of phenothiazines that has been found to develop in some patients given long-term phenothiazine treatment is tardive dyskinesia, an untreatable symptom pattern consisting of involuntary, slow, rhythmical, stereotyped movements of the legs, arms, or trunk, as well as oral movements such as lip smacking - "typical" antipsychotic drugs (as chlorpromazine and other drugs with similar pharmacological activity are called) are more effective than placebos and a number of other drugs, with about 60% - antipsychotic medications produce sexual dysfunctions in between 30% and 80% of patients - drugs (which include clozapine, risperidone, and olanzapine, sold as Clozaril®, Risperdal®, and Zyprexa®, respectively) block a broader range of receptors than the first-generation drugs and have less serious side effects

3 categories of psychosexual disorders by the DSM-5

- sexual dysfunctions: associated with disturbances of the sexual response cycle or with painful intercourse - paraphilic disorders: involve intense interest in or preference for unusual targets of sexual arousal - gender dysphoria: there is strong and persistent sense of incongruence between one's assigned gender and one's gender identity - diagnostic reliability for the psychosexual disorders was good to excellent overall, with a range of .92 to .75

fetishistic disorder

- sexual interest becomes focused on nonliving objects, such as fur, underwear, leather items, high-heeled shoes, or stockings, or on specific nongenital body parts, such as feet or toes. - The person experiences recurrent, intense, sexually arousing fantasies, urges, or behaviors involving these objects in sexual contexts, usually masturbating while fondling or smelling them or having the person's partner wear them. - The diagnosis requires that these urges, fantasies, or behaviors persist for at least 6 months and are distressing or cause interpersonal problems. - does not include items used in cross-dressing (transvestic disorder) or items specifically designed to provide sexual arousal (e.g., sex toys). - Most commonly, the fetish object becomes a required or strongly preferred aspect of sexual functioning; in its absence, males may experience erectile difficulties (American Psychiatric Association, 2000). - The DSM-5 diagnosis can be specified by object: body parts, nonliving objects, or other. - increasingly catered to by the pornography industry, in which fetish-related videos may make up a quarter of the output of some large companies, and the Internet, which has played a major role in connecting fetishists to each other (LeVay & Valente, 2006). - Although the paraphilia is not in itself illegal, occasionally individuals with fetishism come to the attention of legal authorities because large collections of shoes, panties, bras, or other items are discovered in their homes after reports of stolen items from apartments, clotheslines, or laundromats. - It is still almost exclusively a male disorder

Treatment of Narcissistic Personality Disorder

- some clinicians consider it even more difficult to engage the narcissistic person in therapy than the antisocial one

brief psychotic disorder cont.

- sudden onset of psychotic symptoms - last more than 1 day - do not persist more than 1 month, with eventual return to full functioning - at least 1 positive symptom: delusions, hallucinations, disorganized speech or catatonic behavior - not explained by the effects of drugs, medical conditions, or another mental disorder that can cause transient psychosis - can be specified "with marked stressors," "without marked stressors," or "with peripartum onset" - Up to 9% of cases of first-onset psychosis may be accounted for by brief psychotic disorder - twice as common among females as males - in their acutely disturbed state, people with this condition may be at much higher risk for suicide

Cluster B personality disorders

- symptom presentations that may be dramatic, emotional, or erratic - Threats of suicide, frequently of a manipulative nature, or self-mutilating acts are common - suggests that the main components of all Cluster B diagnoses include impulsivity, aggressiveness, and novelty-seeking behavior. - impulsiveness was more strongly associated with borderline personality disorder, while aggression correlated more strongly with antisocial and narcissistic diagnoses. - Cluster B personality disorders, as a group, may affect about 1.5% of the general population

treatment of sexual pain disorders

- systematic desensitization could be used effectively for dyspareunia and vaginismus in women. - Relaxation, sensate focus, and general counseling are usually part of psychological approaches to treatment. - Vaginismus can be effectively treated by a combination of relaxation training and Kegel exercises (which tense and release the vaginal muscles), followed by the self-insertion of a graduated series of dilators into the vagina. - Once this has been completed, partners become involved in gradual degrees toward full intercourse. - Success rates reported for these interventions range from 83% to 100% at 1-year follow-up

thought insertion delusions

- the belief that some external person or agency is inserting thoughts into one's consciousness - delusion can involve receiving special broadcasts through a special receiver implanted w/in the brain

exhibitionistic disorder

- the recurrent fantasy, urge, or behavior of exposing one's genitals to an unsuspecting stranger. - These fantasies, urges, or actions are experienced as sexually arousing and persist over a period of at least 6 months. - The diagnosis can be made either if the person acted on the urges or if the urges and fantasies cause the person significant distress or interpersonal difficulty. - Specifiers can be used to indicate whether the target was prepubertal children, physically mature individuals, or both. - Additional DSM-5 specifiers are "in a controlled environment" (where opportunities to expose are limited) and "in full remission" (symptom free for 5 or more years). - Occasionally the exhibitionist masturbates during the act of exposure or while fantasizing about the exposure later. - Most typically, no further attempt is made for sexual contact with the unsuspecting victim. - Some exhibitionists report that the shock or surprise of the victim is sexually arousing; others fantasize that the victim will become sexually aroused - takes place in some isolated place such as a park, a darkened movie theater, or a parked car. - one of the most common sexual offenses reported to the police in the United States. - frequently introverted and quietly appropriate in ordinary social relationships. - may be associated with significant impairment; in one study of 25 males with the disorder, over 90% had comorbid conditions including depression, substance abuse, and personality disorders. Suicidal ideation was also common - Onset is usually before age 18, and it may decrease in incidence as one ages. - incidence in the population is not known, but it is unlikely to be higher than 2%-4% of the male population (American Psychiatric Association, 2013).

paraphilic disorders

- those in which the disturbance concerns the focus or target of sexual desire. - The diagnostic criteria describe intense and recurrent sexual fantasies, sexual urges, or sexual behaviors involving objects, children, nonconsenting persons, or suffering and humiliation. - For some people with paraphilias, the fantasies or stimuli may be necessary for them to become sexually aroused; others may engage in them more episodically. - Several of the paraphilias involving children or nonconsenting persons involve criminal offenses in addition to mental disorders. - The legal system may be the source of referral of many of these people into treatment - may not necessarily indicate the presence of psychological problems. - much more common among men than women

What is the distinction between positive and negative symptoms?

- type 1 schizo - type 2 schizo

Borderline Personality Disorder

- unstable relationships & emotions - show dramatic shifts in the way they regard others over brief periods from excessive idealization to nearly complete devaluation - hate being alone & frantically seek to avoid it - experience chronic feelings of emptiness - active emotions are very unstable, these feelings include anger, guilt, shame, bitterness, & despair - may frequently shift career plans, life goals, or friends - suicidal or self- mutilating acts are common - show dissociative symptoms, may occur as manipulative, designed to prevent abandonment, reflect genuinely depressed mood - under stress, psychotic- like symptoms may occur briefly b/w 2%-6% of the population - family members of patients are 5x more likely to have the same disorder - increased risk for substance-related disorders, depressive disorders, and antisocial personality disorder - proposed that parental neglect or loss during childhood, or a deficient attachment between child and parent, is central to this type of personality development. - proposing that certain vulnerabilities, such as emotional instability and impulsive tendencies, interact with poor parenting, loss, or trauma to produce borderline personality disorder has been proposed - described high levels of physical or sexual abuse in childhood among borderline patients - 75% of the people diagnosed are women

considerations in the treatment of sexual dysfunctions

- variety of effective psychotherapies - behavioral & cognitive- behavioral approaches: produced success rates of 65% in 365 married couples presenting a range of sexual dysfunctions, and outcomes did not vary as a function of diagnosis, Therapy was provided in small groups over 15 weeks, the degree of improvement was below that reported for males - there is a clear and concerning trend toward medicalization of the sexual dysfunctions

Substance/medication-induced sexual dysfunction

- when there is a significant impairment in sexual function that results from intoxication, withdrawal, or exposure to a medication or other substance capable of producing the symptoms. - Among the possible substances are alcohol, opioids, sedatives, amphetamine, and cocaine, as well as antidepressants and antipsychotics, which frequently produce sexual side effects. - Some substances may not have their effects on sexual functioning until after a long delay (as in alcohol and nicotine), while others may produce dysfunction quickly (within 8 days of antidepressant use). - There is no duration requirement, but the dysfunction must cause distress and not occur exclusively during delirium. - The likelihood of the disorder appears to increase with age

Dependent Personality Disorder

-an excessive need to be taken care of by others. - That persistent need is associated with fears of separation and clinging and submissive behavior designed to evoke caregiving. - Individuals with dependent personality disorder are uncomfortable being alone because they fear being unable to care for themselves; thus, - they will urgently seek a replacement relationship if a close relationship ends. - Typically, they allow others to make important decisions about most life areas, including employment, use of free time, and choice of friends. - They may volunteer to do unpleasant tasks or participate in unwanted activities in hopes of securing the care and support they need. - Their pattern of dependency tends to keep them dependent because they do not gain the skills needed for self-support. - People with dependent personality disorder see themselves as inept and totally dependent on the advice and assistance of others. - To maintain the dependent bond, they may accept verbal, physical, or sexual abuse. - The condition tends to co-occur with borderline personality disorder and with mood and anxiety disorders. - provides no information about any familial influences in dependent personality disorder. - Some have speculated about possible histories of abuse, overprotective parenting, or delayed "weaning from nurturance" in childhood (Meyer & Deitsch, 1996). - However, no empirical evidence appears to support any particular genetic, biological, or psychological causal factors at present. - It is diagnosed more often among females than males, and its prevalence appears to be less than 1% of the population

Brief psychotic disorder involves the sudden onset of at least one positive psychotic symptom that lasts more than _____ but does not persist more than ____.

1 day / 1 month

What fraction of women experience low sexual interest and what percentage of females report arousal problems, respectively?

1/3; 20%

The DSM-5 lists _____ different primary personality disorders.

10

categories or dimensions for personality disorders

10 primary categories of personality disorders - person qualifies for a diagnosis depending on how many diagnostic criteria are met according to the diagnostician's judgment * the factors presumed to underlie personality are dimensional in structure, people are not either extroverted or introverted but can act in either or both ways to various degrees, depending on circumstances

It is recommended that the person preparing for sex reassignment first complete _____of life-experience as the other sex and____on continuous hormone treatments in order to be a candidate for surgery.

12 months/ 6 months

To distinguish pedophilic disorder from other forms of child sexual contact, the person diagnosed must be at least age _____and must be ____ or more years older than the child.

16; 5

The best estimate of the concordance rate for schizophrenia between monozygotic twins is _____.

28%

Although the actual incidence of pedophilia in the population is not known, proven cases of sexual abuse appear to have declined by more than _____.

50%

To meet criteria for a sexual dysfunction disorder, the minimum duration of dysfunction must be _____.

6 months

Of those diagnosed with borderline personality disorder, _____ are female.

75%

Approximately _____ of those who meet the diagnostic criteria for borderline personality disorder are _____.

75%, females

In the general population, _____ display at least one of the personality disorders.

9%

What is the rate of all personality disorders based on a sub-sample of the "National Comorbidity Survey" Replication?

9%

All EXCEPT which of the following are symptoms of someone with paranoid personality disorder

Agreeable and cooperative

All EXCEPT which of the following are criteria for male hypoactive sexual desire disorder?

An inability to achieve orgasm

Which of the following is NOT a required component of the male hypoactive sexual desire disorder?

An inability to achieve orgasm

_____ involves social inhibition, hypersensitivity to being evaluated, and feelings of inadequacy.

Avoidant personality disorder cont.

Although there has been little evidence of validated treatments for antisocial personality disorder, which of these approaches is less effective than the others?

Cognitive-behavioral therapy

tactile hallucinations

Concern the false feeling of being touched or having something just beneath the skin, such as splinters or crawling insects

Those diagnosed with antisocial personality disorder have a long history dating back to age 15 of violating the rights of others, along with deceit and destruction. This would have qualified for which other diagnosis?

Conduct disorder

Which personality disorder is characterized by a great need to be taken care of by others, lack of self-confidence, and a fear of separation?

Dependent Personality Disorder cont.

disturbances in motor behavior

Echopraxia, Catatonia, Sterotypy, Psychomotor agitation, Hyperactivity, Hypoactivity, Aggression, Acting out, Akathisia, Ataxia, mutism

According to Cooke and Michie (2001), which is NOT one of the three main factors in psychopathy?

Excessive emotionality and effective interpersonal style

_____ consists of criticism, hostility, and emotional overinvolvement in family interactions when a family member has schizophrenia.

Expressed emotion

What is a mathematical technique used to analyze a matrix of correlations to reduce dimensions and identify groupings of variables that may simplify and explain the relationships between them?

Factor analysis

Co-occuring disorders with paranoid personality disorder often include all EXCEPT which of the following

Generalized anxiety disorder

If an individual is diagnosed with paranoid personality disorder, they will often be diagnosed with all EXCEPT which of the following disorders?

Generalized anxiety disorder

Which of the following is true about the genetic basis of schizophrenia?

Genes are responsible for making some individuals more vulnerable to schizophrenia.

What are the primary causal factors for the development of antisocial personality disorder

Genetic and environmental

All EXCEPT which of the following are socioeconomic influences on schizophrenia?

Impoverished areas of large cities tend to include similar people with similar ethnic backgrounds, which can cause higher rates of schizophrenia

Which of the following does NOT support the idea that socioeconomic influences the development of schizophrenia?

Impoverished areas of large cities tend to include similar people with similar ethnic backgrounds, which can cause higher rates of schizophrenia.

All EXCEPT which of the following treatment approaches have been shown to be effective?

Insight-oriented psychotherapy

Which of the following is NOT effective in treating schizophrenia?

Insight-oriented psychotherapy

What is the current state of treatment approaches for low sexual interest?

Intervention is difficult for low or absent sexual desire, and the treatments available show modest improvements with short term benefits.

Which statement reflects the MOST effective treatment for deficient sexual desire?

Intervention is difficult for low or absent sexual desire, and the treatments available show modest improvements with short term benefits.

Is there an assumption that these disorders share a common cause, a common pathway, or even a common fundamental set of symptoms?

No - Psychotic symptoms can appear briefly (transiently) during periods of stress in individuals who have many different conditions and do not, in themselves, verify the presence of a psychotic disorder.

What type of symptoms are characteristic of Cluster A?

Odd or eccentric

The person with an acute onset of schizophrenic symptoms who is severely disturbed, delusional, and confused, but has a good chance of recovery, would be classified with which type of schizophrenia?

Reactive schizophrenia cont.

What is the MOST accurate statement regarding reliability in the diagnostic process for personality disorders?

Reliability issues have plagued the personality disorder classification in several DSM editions, raising questions abouts the value of these classifications

If an individual avoids close relationships, chooses solitary activities, and shows emotional coldness, they MOST likely have symptoms that correspond to which personality disorder?

Schizoid personality disorder

_____ appears to be among the only effective treatments for chronic gender dysphoria in adults?

Sex reassignment surgery

Masters and Johnson found that several subjects had seductive mothers with whom they shared a bed, while other subjects had negative experiences with prostitutes. What do these examples highlight as a possible causal factor of sexual dysfunction?

Social learning histories

In which intervention would two partners, over a period of several months, gradually increase contact and activity with each other while maintaining a relaxed state in order to treat deficient sexual arousal?

Systematic desensitization cont.

_____ is an occasional long-term side effect of phenothiazine treatment of schizophrenia that involves rhythmical, stereotyped movements and lip smacking.

Tardive dyskinesia

All EXCEPT which of the following are general diagnostic criteria for personality disorders?

The enduring pattern is flexible and inconsistent across a broad range of personal and social situations

What is commonly seen in families where the onset of schizophrenia is MORE likely to occur?

The mother and child relationship may include overprotectiveness and intrusiveness that may contribute to the development of schizophrenia

auditory hallucinations

The person hears voices that may condemn, praise, direct, or accuse - may be identified with a specific agent, like God, parents, devil, past acquaintances, or unspecified others - person may or may not realize it is unreal - may often come from an external source - individual may passively listen to the voices, act upon their commands, or talk back to them- arguing, pleading, or cursing them

Pedophiles use all EXCEPT which of the following to excuse their behavior?

The sexual activity was consensual between the child and the perpetrator

Which of the following is NOT a rationale that pedophiles use for their behavior?

The sexual activity was consensual between the child and the perpetrator

All EXCEPT which of the following statements are true regarding the role of culture and schizophrenia?

There is little difference in the onset, symptom presentation, and course of schizophrenia across different cultures

Which statement does NOT reflect the understanding of cultural influences on the incidence of schizophrenia?

There is little difference in the onset, symptom presentation, and course of schizophrenia across different cultures

Due to discontinuing subtypes for the DSM-5, what was suggested that clinicians use instead in the diagnostic process?

Utilize a dimensional rating of severity of symptoms

The lack of enjoyment in all aspects of life that often characterizes the schizophrenic person is sometimes referred to as _________.

anhedonia

John has recently incorporated the masochistic act of _____ into his sexual life. This involves oxygen-depriving activities such as choking, hanging or suffocating.

asphyxiophilia

phrenologists

attempted to assess traits by feeling the location of bumps on the skull which gave evidence of their presence

The use of written materials that may have life significance is called _____.

bibliotherapy

The biggest advance in _____ treatments has been the development of oral medications that relax a valve in the penis to allow increased blood flow.

biological

A man who believes he can fly on his own, which is obviously not plausible, may be suffering from what type of delusion?

bizarre delusion scenario

Who introduced the term schizophrenia in 1911 to refer to a split between thought processes and emotions or to a general disorganization in thought and behavior?

bleuler

Dialectical behavior therapy (DBT) is effective in treating which of the following?

borderline personality disorder cont.

Which of the following treatments for antisocial personality disorder has been shown to be the least effective?

cognitive- behavioral therapy

Mood- congruent delusions

concern content that is entirely consistent with expressed mood - belief that one is responsible for a deadly tornado, or that one's body is rotting= someone is depressed

somatic hallucinations

concern false sensations experienced as coming from inside the body - electricity or pressure

According to psychoanalytic theory, men and women with deficient sexual arousal show inhibited sexual excitement because, unconsciously, they perceive sexual activity as _____.

dangerous

Which psychotic disorder has subtypes such as grandiose, jealous, or persecutory?

delusional disorder

schizophrenia

delusions, hallucinations, disordered speech & behavior - diagnostic reliability improved to 0.81, good reliability bc of kappa of 0.46 - subtype: paranoid, disorganized, catatonic, undifferentiated, or residual - subtypes unstable, unreliable, and invalid - DSM-5 suggest a dimensional rating of severity not subtypes - 6 months minimum - more common among males - age of onset is late teens to mid- 30s - men have earlier onset, more negative symptoms - 1% of the general population or 0.3-0.7%

brief psychotic disorder

delusions, hallucinations, disorganized speech but duration less than 1 month - 1 day minimum - more common among females

Individuals with _____ are uncomfortable being alone because they fear being unable to take care of themselves, and they allow others to make important decisions in all areas of their life.

dependent personality disorder cont.

The central characteristic of _____ is an excessive need to be taken care of by others, along with a fear of separation.

dependent personality disorder cont.

what is the distinction among schizophrenia, schizenophreniform disorder, and brief psychotic disorder?

duration

process schizophrenia

early and gradual onset of symptoms, and poor prognosis for recovery - develops little social or intellectual competence - shows more withdrawal & disorganization

Dr. Napen had a difficult time interviewing the patient, who kept repeating everything that Dr. Napen asked. The patient was presenting with _____.

echolalia

The Cluster B personality disorders include individuals who may be described as _____.

emotional or dramatic

Changes in the pelvic region, a general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing occur during which phase of the sexual response cycle?

excitement

The proper order of the sexual response cycle consists of which of the following?

excitement phase, plateau phase, orgasmic phase, resolution phase

Which of the following is the CORRECT order of the human sexual response cycle as discussed by Masters and Johnson?

excitement, plateau, orgasm, resolution

A disorder involving repeated sexually arousing urges or fantasies about exposing one's genitals to others is known as:

exhibitionistic disorder

bizarre delusions

false beliefs that could not possibly be true, given what is known about the world - man who insists he is pregnant - man who believes his head is switched onto other bodies at night while he sleeps

somatic delusions

false convictions that concern the body - the belief that one is changing sexes - is pregnant - that internal organs are rotting

hallucinations

false sensory experiences - sensation or perception in the absence of an external source - person hears voices, sees visions, smells odors, has sensations of touch for which there are no identifiable external stimuli - distinguished from illusions - distinguished from the strange sensory experiences that are associated sometimes with falling asleep, dreaming, or awakening

A woman's persistent or recurrent deficiency in the desire for sexual activity that causes significant distress is called _________.

female sexual arousal interest/arousal disorder cont.

Seth is fascinated by women's shoes and stockings. He has recurrent, intense sexually arousing fantasies, urges, or behaviors that revolve around high heels, panty hose, and patent leather. He has 20 pairs of shoes and has stolen shoes from women's dressing rooms and from female coworkers. He often masturbates while merely smelling them or when a partner wears them. He would be diagnosed with _____.

fetishistic disorder cont.

Which groups in the United States show higher rates of schizophrenia than the general population?

first- and second-generation immigrants

Big Five

five factor model - openness to experience - conscientiousness - extroversion - agreeableness - neuroticism

What led to the distinction b/w process & reactive schizophrenias?

from earlier diagnoses, not all patients showed an irreversible course toward total deterioration

factor analysis

from mathematical attempts to tease apart the responses given in intelligence testing - applied to personality inventories

Antisocial personality disorder is the only personality disorder to show convincing data from research by Dahl (1993) for what type of causal factor?

genetic

volition

goal- directed behavior

grandiose delusions

grossly inflated self-importance, fame, power, wealth, or knowledge - may involve special relationships with powerful or holy entities or identification with a great person from history, such as a political, military, or religious leader

If an individual experiencing psychosis has false sensory experiences, including hearing voices, seeing visions, smelling odors, or has sensations of touch, what may they be experiencing?

hallucination scenario

If an individual experiencing psychosis has false sensory experiences, including hearing voices, seeing visions, smelling odors, or has sensations of touch, what may they be experiencing?

hallucinations

When Eleanor leaves her home, she often hears a voice saying, "You are leaving the house." Eleanor is not sure where the voice is coming from, but he thinks the voice is coming from an external source. What is Eleanor experiencing?

hallucinations cont.

What do legal and illegal substances produce?

hallucinations, delusions, verbal incoherence, & other psychotic behavior - direct result of use or upon abrupt withdrawal

what does damage to any sensory areas of the brain result in?

hallucinatory responses in those areas

alogia

impoverished speech which conveys little information - replies to questions are brief - repetitive, stereotyped, nonspontaneous - overgeneralized & hypermetaphorical

anhedonia

lack of enjoyment in all aspects of life that often characterizes the schizophrenic person

When do most cases of schizophrenia begin?

late teens to mid- 30s

Which is not an example of catatonia?

laughing

Personality disorders are difficult to treat because of all of the following reasons except their _____.

medical basis

The stop-start technique is used primarily to help:

men who have premature (early) ejaculations to learn to control their ejaculations.

____ are more commonly diagnosed with paraphilias than ____.

men, women

schizoaffective disorder

mood episode & hallucinations/ delusions occuring together - schizophrenia + mood components - both psychosis & mood disorder - incidence in developed countries such as the United States is only one fifth that of schizophrenia - prevalence of schizoaffective disorder is about one third that of schizophrenia - diagnostic reliability, at .50, was about equal to that for schizophrenia in the DSM-5 field trials - prognosis tends to be better than that for schizophrenia but worse than that for mood disorders - 2 weeks minimum - more common among females - Age of onset is usually young adulthood

catatonic excitement

move excitedly, sometimes wildly waving their arms and legs - move violently or unpredictably in catatonic excitement - waxy flexibility, molded into a posture that may be rigidly maintained over long periods

Type 2 Schizophrenia

negative symptoms like flat effect, avolition, alogia, & social withdrawal predominate - process subgroup

Roger, a 25-year-old man, occasionally wears dresses and skirts when he performs on stage for fun. Based on this information, Roger:

neither of the transvestic disorder or identify as a woman

What is a Freudian term for the anxiety-driven condition that results when id impulses threaten to overwhelm the ego?

neurosis

delusional disorder

nonbizarre delusions without other symptoms - 1 month minimum - equal sex ratio, males and females

delusions

not beliefs shared by other members of a culture or articles of religious faith shared by believers - extreme convictions that are firmly held despite what nearly everyone else in the subculture would consider incontrovertible evidence to the contrary - fixedness

About _____ of U.S. women report some difficulties with low sexual desire.

one third

The most common personality disorder diagnosis is most likely _____.

other specified personality disorder cont.

extroversion

outgoingness & social gregariousness

Noel is constantly concerned about the behavior of others. She thinks her coworker is looking to get her fired, that her best friend is spreading rumors about her, and that her boyfriend is cheating on her. In reality, none of these are true. This overly suspicious behavior on her part is most likely:

paranoid personality disorder cont.

Which of the following personality disordered individuals would have recurrent suspicions, without justification, regarding the fidelity of a spouse or sexual partner?

paranoid personality disorder cont.

erotomanic delusions

patently false beliefs that another person, often someone famous or of higher status or authority, is in love with the individual

echolalia

person repeats whatever someone else says - words or phrases

Among the frequent side effects of heavy and prolonged use of _____ for schizophrenia are symptoms that resemble Parkinson's disease.

phenothiazines

word salad

psychotic speech like a collection of words thrown together & tossed like a salad before presentation

mutism

refusal to speak

echopraxia

repetitively imitating the movements of others

Some have suggested that the Cluster A personality disorders occur within a _____spectrum of related conditions.

schizophrenic

Which of the following interventions is MOST effective in treating gender dysphoria?

sex reassignment surgery

_____ concerns sexual arousal involving the humiliation or physical or psychological suffering to others.

sexual sadism

Jane gets sexual gratification by inflicting pain on her partner through whippings and beatings with various hard leather objects and by inserting blunt objects into various orifices. She would be diagnosed with _____.

sexual sadism disorder

_____ proposes that lack of parental care, punishment, and aggressive behavior within the family can increase the chance of pedophilic development.

social learning theory

intruding associations

sometimes very personal - result in speech that is egocentric or autistic

tangeniality

speaker seems to follow tangents in the original utterance that lead loosely to other semantic pathways

A major problem contributing to high relapse of schizophrenia are side effects from medication known as _____.

tardive dyskinesia

Individuals may develop involuntary movements of the mouth, such as smacking their lips, while on medication to treat schizophrenia. These side effects are known as

tardive dyskinesia cont.

neuroticism

tendency to experience negative emotions

_____ proposes that psychotic symptoms were a form of adaption to an impossible situation in which there are no good solutions in a child and parent relationship.

the double bind

clanging

the use of a word not because of its meaning, but because of its sound (rhyming or punning)

DSM-5 problem with the clustering system

this clustering system, "although useful in some research and educational situations, has serious limitations and has not been consistently validated"

Several well-controlled double-blind studies supported the effectiveness of _____ to reduce the symptoms of schizophrenia

thorazine

Which drug has shown to be effective in the treatment of schizophrenia?

thorazine

Sex therapy often includes teaching or encouraging clients to masturbate. This technique can be especially helpful for:

women who do not have orgasms

what is the result of loose associations?

word salad