PSY 204 exam 4

transference-focused therapy

a highly structured psychodynamic treatment for borderline personality disorder that uses the relationship between patient and therapist to help patients develop a more realistic and healthier understanding of their interpersonal relationships

night eating disorder

an eating disorder characterized by the regular intake of excessive amounts of food after dinner and into the night

sociocultural contributors to CD and ODD

associated with lower SES and urban areas difficult temperament interacts with poor parenting and stressful environment physical abuse or severe neglect in childhood tend to choose peers and partners with similar conduct problems which reinforces behaviors

echolalia

communication abnormality in which an individual simply repeats back what he or she hears rather than generating his or her own speech

cognitive contributors to CD and ODD

view others as aggressive and interpret events and others' actions to support this view view aggression as an appropriate response alternative responses viewed as useless or unattractive

Negative emotionality vs. emotional stability

fearful, bitter vs. relaxed, optimistic

the MacDonald Triad

fire starting, cruelty to animals, bed wetting (weak support for bedwetting in subsequent studies)

biological contributors to CD and ODD

genetic: MAOA gene variant plus childhood maltreatment leads to aggressive traits and conduct disorder abnormal functioning in prefrontal cortex and less amygdala activity in response to emotional cues exposure to neurotoxins prenatally high blood serotonin levels and testosterone

drug therapies for CD and ODD

stimulants used when comorbid with ADHD moderate affect on aggression SSRI/SNRI: target irritability and aggression -antipsychotic and mood stabilizers target aggression mood stabilizers tend to have fewer side effects

Treatment of bulimia

SSRIs (helps 25-40% of people) CBT or E/RP (65% stop binge-purge cycle) combined approach most effective- 90% recovery at 10-year follow up

ASPD vs. criminality

-"criminal" is a legal term defining convicting for breaking a law -not all people with ASPD are criminals (or in jails) -not all people in jail are considered to have ASPD -not all people with ASPD are psychopaths -not all psychopaths are serial killers -most people with ASPD or psychopathy are not in jail

Treatment of autism

-early intervention is the gold standard: help adapt better to environment but no treatment fully reverses it -behavior therapy (ABA, modeling, conditioning) -communication training (ASL, augmentative communication) -stress management (swings, rocking chairs) -parent training (support groups) -community integration (group homes)

sociocultural explanation for ASPD

-gender expression: males=physical aggression vs. females=relational aggression -prevalence of serial killers much high in US and UK -much lower rates in highly collectivist cultures

CD with limited prosocial emotions

-CD in which individual displays at least two: lack of remorse or guilt for their actions lack of empathy for others lack of concern about performance at school shallow emotions or use emotions to manipulate -traits characterize psychopathy: more severe aggression and difficult-to-treat pattern of behavior predictive of long-term problems

Steps in Diagnosing a Personality Disorder

-Determining an individual's level of functioning in terms of their sense of self or their relationships with others -Determining whether the individual has any pathological personality traits -Determining whether individuals meet the criteria for personality disorders

Problems with DSM categories for PD

-PDs are important and troubling patterns but hard to diagnose, easy to misdiagnose and raise serious issues of reliability and validity -criteria can't always be observed directly, ex: lack of remorse in antisocial PD -criteria change in each DSM -heavy gender bias

biological dimension of ADHD

-genetics: runs in families and is higher in MZ twins than DZ twins -brain structures: smaller volume of cerebral cortex less (or delayed) connectivity b/w frontal cortex and other areas (motor, attention) -birth complications: hypoxia (reduced oxygen at childbirth) substance use in utero

schizotypal personality disorder

-a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior -range of interpersonal problems odd (even bizarre) ways of thinking and perceiving and behavioral eccentricities -socially withdrawn, seek isolation and have few friends - most "severe" in cluster A - slightly more males -therapy difficult, some benefits with meds

schizoid personality disorder

-a pattern of detachment from social relationships and a restricted range of emotional expression -pervasive indifference to others -diminished range of emotions and expressions -socially isolated, lacking in social relationships -generally don't seek tx due to poor social skills, but benefit from behavioral techniques

paranoid personality disorder

-a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent -although inaccurate, suspicion usually not "delusional" -often avoid relationships -do not see themselves as needing help, so treatment not effective -more common in males

Psychological dimension of EDs

-body dissatisfaction/ distortion -perfectionism -low self-esteem -lack of control

Psychosocial dimension of ADHD

-chaos or frequent disruptions -hostile or aggressive parenting: never the cause of ADHD, but environment can influence it -parental substance use -cultural divided attention becoming the norm

personality disorder

-chronic pattern of maladaptive cognition, emotion, and behavior that begins by adolescence or early adulthood and continues into later adulthood -very rigid pattern of experience and behavior -seen in most interactions, unexpected by others and continues for years

Early childhood predictions of aspd

-co-morbid AD/HD and conduct disorder diagnosis most at risk for severely aggressive ASPD or psychopathy -called "fledgling psychopaths" -parental antisocial behaviors (esp. fathers) -poor parenting- neglect, abuse, lack of or excessive disciplining

Other specified feeding or eating disorder DSM-5

-describes majority of people in frequent in programs AN in normal weight range lower frequency binge/purge (<1x/ week or <3 months) -night eating disorder (excessive eating in evening or night only)

Classifying PDs

-difficult: little known of origins or development -often co-morbid with other disorders- PD complicates and reduces chances for recovery -ten personality disorders separated into 3 categories or "clusters"

pitfalls of ADHD diagnosis

-dsm criteria also describes normal kids -no physical or lab markers -significant overlap with other dx -public awareness and misinformation

ways to accurate ADHD diagnosis

-history -standardized checklists/ questionnaires - but fakeable -computer based tests -behavioral -classroom, home, meals, leisure -interviews with peers -medical (developmental milestones)

DSM-5 autism

-impaired social interactions poor nonverbal activity (eye contact) lack of age-appropriate peer relationships does not show emotional give and take -impaired communication delay in spoken language development if language is present, does not initiate abnormal speech (echolalia) -restrictive, repetitive and stereotyped behavior patterns restricted range of interests insists on routines stereotyped movements preoccupation with parts of objects or universal attachment to objects -show signs before age 3 (social, communication, play)

psychological explanations for ASPD

-learning theory psychopath's learning improves when anxiety is increased respond to punishment if near certainty but do not suppress behavior if highly uncertain more likely to respond to losing money than physical punishment/ pain -psychodynamic: underdeveloped super ego due to poor parenting -cognitive: "do unto others before they do unto you"

Prevalence of APD

-males= 3-4%, females=1% -psychopathy: 1% general population -prison: 20-80% of prisoners -common among abusers, con artists, gang members, corrupt politicians, unethical lawyers and doctors, terrorists, cult leaders -recidivism 2x other offenders; violent recidivism 3x -IQ tends to predict who gets incarcerated -heritability of ASPD (as well as social behavior) estimated at 50%

treatment of ADHD

-medications stimulants and other meds (combo w/ antidepressants) -therapy behavior modification neurofeedback training -structured schedule and environment -neurotransmitter function norepinephrine dopamine

Treatment of BED

-monitor food intake -structured eating (meal plan vs. suggested meal guidelines) -alternative activity/ structured time -problem-solving -avoiding diets, diet rules

Treatment for ASPD

-most don't seek treatment for ASPD (usually substance abuse) -no treatment shown to be efficacious -more likely to end up in jail than in treatment -will not work w/o social support and refraining from substance use/abuse -focus is on prevention: target antisocial children

diagnosing ADHD

-most often suggested by teacher DSM-5 criteria 6 symptoms of -inattention and/or -hyperactivity and -impulsivity and -onset before age 12 -impairment in at least 2 settings -impairment in social, academic, or occupational function -no other pervasive disorder

diagnosing personality disorders

-must cause impairment or distress -recognizable in adolescence or early adulthood -pattern evident across settings and environments -pattern is chronic -generally, person doesn't see behavior as undesirable or problematic -estimated 9-13% of adults may have a PD

Biological dimension of EDs

-neurotransmitter: serotonin -genetic factors

Caveat on stimulants for ADHD

-problems misinformation: college student use undermines the legitimacy -controlled substance -adverse effects: sleep disturbance, appetite suppression, and tics -overprescribed: Boys in 2007 were 30x more likely to be taking meds than boys in 1987

Binge eating disorder DSM-5

-recurrent episodes of binge eating without compensating behavior: eating more rapidly than normal eating until feeling uncomfortably full eating large amounts when not physically hungry eating alone because of embarrassment disgusted with oneself, depressed, or very guilty after a binge -often leads to obesity -depression is common

Sociocultural dimension of EDs

-social comparison -media presenting distorting images -cultural definitions of beauty -parental attitudes and behaviors -history of being teased about body -peer pressure with weight/ eating

etiology of autism

-sociocultural: overemphasized and not supported by research -psychological: early bio problems prevented proper cognitive development -biological: no clear explanation but promising leads strong genetic factor; likely multiple genes -10% may be behavioral problems associated with specific condition -geographic disputes in high tech communities

Prevalence: bulimia

-somewhat more common in females -likely a culture-based syndrome -2-3.5% lifetime prevalence -associated with anxiety reduction, emotional distress, seasonal-related depression, personality disorders -complications: tooth decay, gastric, rectal, and esophageal irritation/ swelling, arrhythmia, and cardiac arrest

Treatment of anorexia

-team approach- absolutely necessary -residential treatment preferred (historically) -poor support for medication effectiveness goals: -restore healthy weight -treat physical complications Then: more traditional treatment, CBT; family therapy

other explanatory models of autism

-theory of mind: ability to attribute mental states to self and others to understand and predict behavior, individuals on spectrum less proficient "mind readers" -emphathizing-systemizing theory (Simon Baron-Cohen) systemizing: evolutionary advantage for male hunter gatherers empathizing: advantageous for female caregivers argues 2/3 of people on spectrum have extreme s-type brain -social dyslexia (Lorraine Wolf)

Treatment for borderline personality disorder

-therapy can lead to some improvement -termination often incredibly difficult -dialectical behavior therapy most effective -combination of psychodynamic and CBT -drug therapy can help with severe mood

Biological explanations for ASPD

-under-arousal hypothesis -low-fear hypothesis -link w/ substance abuse (i. e., reward system) -brain abnormalities

personality

-unique and long-term patterns of thinking, emotions, and behavior that tend to be enduring -often consistent and described as "traits": inherited, learned or both -flexible allowing us to adapt to new environments

two parts of ASD

1. deficits in social interactions and communication 2. restricted, repetitive patterns of behaviors and activities

Theories about EDs

1. western society's obsession with unnatural thinness; media portrayal 2. feminist theory has shown links with sexism, power, and control 3. CBT (cognitive biases, negative emotional reactions) 4. brain differences in men and women (e.g., female amygdala responds to unpleasant words about body image) 5. family factors (e.g., high rate of thinness)

childhood-onset conduct disorder

A conduct disorder characterized by aggression, destructiveness, deceitfulness, and rules violation beginning before age 10 that tends to worsen with age

five-factor model

A dimensional perspective that posits that everyone's personality is organized along five broad personality traits: negative emotionality, extraversion, openness to experience, agreeableness, and conscientiousness

DSM-5 criteria for ASPD

A. pattern of disregard for and violation of rights of others occurring since age 15 as indicted by 1. failure to obey laws and norms by engaging in behavior which results in criminal arrest or would warrant criminal arrest 2. lying, deception, and manipulation, for profit or self-amusement 3. impulsive behavior 4. irritability and aggression, manifested as frequent assault others and engages in fighting 5. blatantly disregards safety of self and others 6. a pattern of irresponsibility 7. lack of remorse for actions B. at least 18 years old C. evidence of conduct disorder before age 15 D. behavior not schizophrenia or manic

bulimia nervosa DSM-5 criteria

A. recurrent episodes of binge eating eating more food than most people in 2-hour period feeling lack of control over eating B. recurrent compensatory behaviors (vomiting, laxatives, diuretics, excessive exercise) C. occur at least 1x per week for 3 months D. self-evaluation by body shape and weight (more realistic than anorexia) E. does not happen during anorexia nervosa

Anorexia Nervosa DSM-5 criteria

A. restriction of energy intake leading to significant low body weight relation to age, sex, development, and physical health B. intense fear of gaining weight or becoming fat C. Disturbances in how body weight or shape is experienced

CBT for CD and ODD

Goal= change how children interpret interpersonal interactions take and respect others' perspectives, use self-talk to control impulsive behavior, develop ways to solve problems other than aggression interactions at home, school, and with peers reduces aggressive and impulsive behaviors in children difficult to maintain improvements when parenting is problematic

Hare psychopathy checklist

Factor 1: callous emotional and interpersonal detachment; unrelated to environmental factors (e.g., dysfunctional family), lifetime stability; correlated with narcissistic and histrionic personality, negatively correlated with anxiety and empathy Factor 2: chronic and unstable lifestyle; socially deviant antisocial behaviors; tends to extinguish about age 40; correlated with criminal behavior

Predominantly hyperactive/impulsive presentation

Six or more symptoms of hyperactivity- impulsivity less than six symptoms of inattention

combined presentation

Six or more symptoms of inattention and hyperactivity-impulsivity

life-course-persistent antisocial behavior

a form of conduct disorder involving aggression, destructiveness, deceitfulness, and rules violation that persists into adulthood

medicalization-based treatment

a form of psychodynamic treatment for borderline personality disorder on attachment

adolescent-onset conduct disorder

a conduct disorder characterized by aggression, destructiveness, deceitfulness, and rules violation beginning after age 10

negative affectivity

a dimension of personality characterized by negative mood states

personality trait

a facet of personality on which people differ from one another

histrionic personality disorder

a pattern of excessive emotionality and attention seeking; dramatic, seductive, or provocative behavior; suggestible; shallow emotional expression and relationships -dresses eccentrically or seductively -seen as self-centered, vain, or demanding -historically diagnose mainly in women -will seek treatment on their own, but attempt to please or seduce therapist

narcissistic personality disorder

a pattern of grandiosity, need for admiration, and lack of empathy; entitlement, arrogant, and exploitative attitudes, and behavior -convinced of own great success, power, or beauty -exaggerate achievements and talents and often appear arrogant -"narcissistic wound" ex: loud yawn reaction -mostly in males -one of the most difficult patterns to treat -e.g., manipulate the therapist into supporting sense of superiority

borderline personality disorder

a pattern of instability in self-image, mood, and interpersonal relationships and marked impulsivity; transient dissociation states; highly reactive to real or imagined abandonment -great instability; major shifts in mood -impulsivity: substance abuse, reckless behavior, self-injury, suicidal actions and threats -prone to bouts of anger, can lead to physical aggression or self-harm -some links to parental loss or abuse in childhood -more common in women

obsessive-compulsive personality disorder

a pattern of preoccupation with orderliness, extreme perfectionism, and control, leading to emotional constriction, rigidity in one's activities and relationships, and anxiety about even minor disruptions in one's routines -preoccupied with values, excessively moralistic, judgmental -unreasonably high standards (self and others) -more often in males -don't seek treatment for OCPD but will for anxiety or depression -meds don't work but psychodynamic or CBT does

avoidant personality disorder

a pattern of social inhibition, feeling of inadequacy, and a fear of being criticized, which lead to the avoidance of social interactions and nervousness -shy and socially uncomfortable but desires social contact -avoid due to fear of embarrassment of criticism -extremely sensitive to negative evaluation -looks like social phobia, but fear intimacy (not social settings) -come to therapy seeking acceptance and affection

Autism Spectrum Disorder (ASD)

a spectrum of neurodevelopmental disorders characterized by disrupted social and language development (formerly referred to as autism) -severe autism -autistic savant (less than 10% w/ASD) -high functioning autism

Cluster B includes 4 disorders characterized by dramatic, erratic, or emotional behavior and interpersonal relationships

antisocial personality disorder, histrionic personality disorder, borderline personality disorder, narcissistic personality disorder -self-absorbed, prone to exaggerate the importance of events -extreme difficulty maintaining close relationships -more commonly diagnosed than others

neurocognitive disorders

behavioral disorders known or presumed to result from disruptions of brain structure and functioning

neurodevelopmental disorders

behavioral disorders with onset during childhood known or presumed to result at least in part from disruption of brain development

dialectical behavior therapy

cognitive-behavioral intervention aimed at teaching problem-solving skills, interpersonal skills, and skill at managing negative emotions

autism

childhood disorder marked by deficits in social interaction (such as a lack of interest in one's family or other children), communication (such as failing to modulate one's voice to signify emotional expression), and activities and interests (such as engaging in bizarre, repetitive behaviors)

openness vs. closedness to experience

creative, broad-minded vs. pragmatic, rigid

Cluster C includes 3 disorders characterized by anxious and fearful emotions and chronic self-doubt

dependent personality disorder, avoidant personality disorder, obsessive-compulsive personality disorder -often anxious, fearful and depressed

atypical anorexia nervosa

disorder characterized by all the criteria for anorexia nervosa except that despite significant weight loss, the weight of the affected individual remains within or above the normal range

pervasive developmental disorders

disorders characterized by severe and persisting impairment in several areas of development

Binge Eating Disorder (BED)

eating disorder in which people compulsively overeat either continuously or on discrete binges but do not behave in ways to compensate for the overeating

bulimia nervosa

eating disorder in which people engage in bingeing and behave in ways to prevent weight gain from the binges, such as self-induced vomiting, excessive exercise, and abuse of purging drugs (laxatives)

anorexia nervosa

eating disorder in which people fail to maintain body weights that are normal for their age and height and have fears of becoming fat, distorted body images, and amenorrhea

antagonism

hostility toward others

disinhibition

lack of restraint

agreeableness vs. antagonism

naive, cooperative vs. cynical, arrogant

Cluster A includes 3 disorders characterized by odd or eccentric behaviors and thinking

paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder -not psychosis -superficial similarity with mild schizophrenia

dependent personality disorder

pattern of submissive and clinging behavior related to an excessive need to be taken care of and leading to high levels of dependence on others -pervasive, excessive need to be taken care of -clingy, obedient, fear separation from loved ones -rely on others so much, cannot make the smallest decision for themselves -many feel distressed, lonely, and sad -at risk for depression and anxiety disorders -treatment at least modestly helpful -role switching with client

antisocial personality disorder

pervasive pattern of critical, impulsive, callous, and/or ruthless behavior, predicated on disregard for the rights of others and an absence of respect for social norms -persistently disregard and violate others' rights -likely to lie repeatedly, be reckless, sexually promiscuous, and impulsive -sometimes described as "psychopaths" or "sociopaths" -person must be at least 18 years of age for dx

other specified feeding or eating disorder

presentations of an eating disorder that cause clinically significant distress or impairment but do not meet the full diagnostic criteria for any of the eating disorders otherwise identified

psychoticism

proneness to psychotic-like symptoms, such as illusions

conscientiousness vs. undependability

reliable, reflective vs. disorganized, careless

psychopathy

set of broad personality traits including superficial charm, a grandiose sense of self-worth, a tendency toward boredom and need for stimulation, pathological lying, an ability to be cunning and manipulative, and a lack of remorse

Predominantly inattentive presentation

six or more symptoms of inattention, less than six of hyperactivity-impulsivity

extraversion vs. introversion

sociable, dominant vs. passive, cautious

conduct disorder

syndrome marked by chronic disregard for the rights of others, including specific behaviors such as stealing, lying, and engaging in acts of violence

attention-deficit/hyperactivity disorder (ADHD)

syndrome marked by deficits in controlling attention, inhibiting impulses, and organizing behavior to accomplish long-term goals

Oppositional Defiant Disorder (ODD)

syndrome of chronic misbehavior in childhood marked by belligerence, irritability, and defiance, although not to the extent found in a diagnosis of conduct disorder -symptoms begin toddler and preschool years -compare to CD- less severe pattern of chronic misbehavior

detachment

the inability to connect with others

binge/purge type of anorexia nervosa

type of anorexia nervosa in which periodic bingeing or purging behaviors occur along with behaviors that meet the criteria for anorexia nervosa

restricting type of anorexia nervosa

type of anorexia nervosa in which weight gain is prevented by refusal to eat