Abnormal Psychology Exam 3

What are the personality disorders in Cluster A?

paranoid, schizoid, schizotypal

What do callous and unemotional traits predict, as well as impulsiveness and narcissism?

-Delinquency (criminal charges) -More aggressive ASPD in adulthood -High callous/unemotional traits at age 13 predicts psychopathy at age 24!

According to McGlashan et al 2005, what are the 9 main symptoms of BPD and how common are they? Do people with BPD need to show all 9 symptoms? What is the likelihood of remission from these symptoms?

1. Affect disregulation: 95% and remission rate is 20% 2. Anger: 85%; rr = 20% 3. Impulsivity: 80% and rr: 20% 4. Unstable relationships: 80% and rr: 30% 5. Emptiness: 70% and rr: 40% 6. Stress: 70% and rr: 35% 7. Identity instability: 60% and rr: 40% 8. Fear of abandonment: 60% and rr: 45% 9. Self harm: 60% and rr: 45%

What is emotional vulnerability, an invalidating environment, and chronic emotional dysregulation? Provide examples

1. Emotional vulnerability is a predisposition to react to certain things in a very sensitive way: easily upset and everything is a big deal and it takes a long time to feel normal again. An example would be if you did not get the job you wanted, being unbearably upset, feeling horrible about yourself, taking months to feel happy again. 2. Invalidating environment is one that labels emotional expressions as unjustified and reinforces extreme expression. For example, if you were emotionally vulnerable and you lived with your dad and you did not get the job that you wanted, your dad might tell you that you're overreacting and you need to get over it. 3. Chronic emotional dysregulation is the inability to accept and understand your emotions. In the example, you feel intense disappointment over circumstances in your life, but your environment tells you that those emotions are wrong, so you feel like you can never trust your emotions.

What does emotional dysregulation lead to?

1. Identity confusion: unstable sense of self, changing lifestyle, changing goals and values 2. Interpersonal chaos: relationship conflicts, changing perceptions of others, fear of abandonment 3. Cognitive dysregulation: paranoia, dissociation 4. Dangerous Impulsivity: Acting to emotional urges, relieving tension or reducing numbness

What is the structure of DBT?

1. Individual therapy: at least one hour/week 2. Skills group (DBT manual): at least 2 hours a week, teaches coping strategies 3. Consultation team: for the therapist; keeps a non-judgmental stance and keeps a positive, acceptive energy 4. Coaching calls: non-emergency calls from client to therapist 5. Uncontrolled Ancillary Treatments: having a psychiatric evaluation, pharmacotherapy, support group, good hobbies, etc. 6. Diary cards, behavioral analyses (evaluate when emotion gets in the way), treatment-interfering behaviors plan (show up to every meeting, don't call too frequently, etc.)

What are the two types of anorexia nervosa?

1. Restricting type 2. Binge-eating/purging type (subjective binge)

What are the behavioral patterns of BPS seen in the biosocial model (Linehan)?

1. The core behavioral pattern is emotional vulnerability- not being able to cope with or understand emotions. 2. Self-invalidation: constant tendency to not trust yourself and your emotions 3. Unrelenting crises: never ending problems 4. Inhibited grieving: cannot properly grieve 5. Active passivity: "I cannot change"; prevents self help 6. Apparent competence: might not seem as unstable as they are, especially in certain environments

What are callous and unemotional traits and how are they measured?

1. Uncaring - do not try their best and do not try to make others happy 2. Callous - do not care about getting in trouble, very cold and not empathetic 3. Unemotional - do not express themselves to others - they do not even neurologically empathize Measured by self ratings, parent ratings, teacher ratings

What is a personality?

A combination of a person's traits, beliefs, and actions.

What is bulimia nervosa?

A fear of obesity and drive for thinness, including a binging and purging cycle- but always an objective binge.

What is anorexia nervosa?

A fear of obesity, a drive to be thin, extreme dietary restriction, body image disturbance, etc. See thin people as self-sufficient, in charge, accomplished, etc. In order to be diagnosed, they need to have a BMI lower than 18.5 and need to show a restriction of energy intake relative to energy requirements (body needs more food, water, rest, etc. than it is getting.)

Characteristics and Causes of Borderline PD:

A pattern of unstable moods and relationships, fear of abandonment, impulsivity, poor/unstable self-image, hot and cold relationships, affect instability, chronic emptiness, stress-related paranoia or blackouts, and intense anger. History of self mutilation and suicidal gestures. Lifetime prevalence: 1-2% and more common in women. The biosocial model shows how BPD might develop.

What is schizophrenia?

A type of psychosis that includes a disturbance in 3 areas: thoughts, behaviors, and emotions. Very heterogeneous symptoms- positive and negative.

What is the difference between Antisocial PD and Psychopathy?

ASPD is more about behavior- like criminal or impulsive behavior, where psychopathy is more cognitive and about callous/unemotional traits. They do both have a slight overlap with criminality and each other.

What are the remission and recurrence rates for BPD? (Zanarini et al 2003)

After 2 years: 30% remission After 4 years: 50% remission After 6 years: 70% 6+: over 70% After four years there is a roughly 5% recurrence rate that continues through the years, but there is no recurrence rate prior to that

What is the official definition of a personality disorder?

An enduring pattern of inner experiences and behaviors that deviates markedly from the expectation's of the individual's culture. It is pervasive and inflexible, and has an onset in adolescence or early adulthood. It is stable over time, and leads to distress and impairment. It manifests in cognition, affect, interpersonal functioning, and impulse control.

What is purging?

Attempts to compensate for binge eating and prevent weight gain. Includes: self-induced vomiting, laxative misuse, diuretics, excessive exercise, enemas, chewing and spitting out food...

What does the Biosocial cycle of BPD look like?

BPD is caused by two factors: emotional vulnerability and invalidating environment. These two things contribute to one another and bounce off of each other and make each other worse, which leads to chronic emotional dysregulation.

What is a delusion and what are the main types of delusions?

Beliefs contrary to reality. They include: 1. Persecution: most common, people are out to get you 2. Grandeur: you believe you're very powerful or important 3. Reference: everything is happening to communicate a secret sign or message to you 4. Control: feeling that you are being controlled by another person 5. Broadcasting (thought related): people know or can hear everything you think about 6. Insertion (thought related): someone is putting your thoughts into your head 7. Withdrawal (thought related): you do not forget your thoughts, they are being pushed or stolen out of your head. 8. Capgras syndrome: everyone around you is an impersonator

What is psychosis?

Broad term involved in psychotic disorders- not the same as schizophrenia but it is part of schizophrenia. It includes hallucinations and delusions.

What is the difference between a categorical and a dimensional view of a disorder? Are personality disorders more categorical or dimensional?

Categorical: A person with a disorder is in their own distinct category that is different from a person without the disorder. Dimensional: There are multiple dimensions that make up people, and someone with a disorder is on the extreme for that dimension although we are all somewhere on that spectrum. PDs are dimensional.

How does antisocial personality disorder progress throughout a person's lifetime?

Children cannot be diagnosed with ASPD, but rather with Childhood Conduct Disorder. 60% of people with antisocial personality disorder show childhood conduct disorder that continues as ASPD into adolescence and adulthood. The other 40% experience an onset in adulthood.

What are the major clusters of personality disorders?

Cluster A: odd or eccentric Cluster B: dramatic, emotional, erratic Cluster C: anxious or fearful

DBT v CBT for drop-out rates and suicide

DBT reduces suicide attempts

DBT v CBT for suicidal behavior

DBT reduces suicide attempts

DBT v Community treatment for hospitalizations related to psychiatric incident and suicide.

DBT reduces suicide attempts

DBT v Control for parasuicide, suicide, self-harm, and hospitalization

DBT reduces suicide attempts

DBT v TAU for Hopelessness, depression, and suicidal ideation

DBT reduces suicide attempts more: however DBT doesn't change emotions much

Characteristics and Causes of Dependent PD:

Difficult to treat, extreme dependence and over reliance on others, passive, fear, of abandonment, clingy... not even about love or relationship with the other person, just about support. Less than 1.5% prevalence, more common in women.

What is Binge Eating?

Eating a large amount of food in a short period of time until you're uncomfortably full, eating alone from embarrassment, feeling disgusted, depressed, and guilty, does not count if it is cultural.

What are personality traits?

Enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts; the core and essence of a person.

Characteristics and Causes of Narcissistic PD:

Exaggerated self-importance, sense of entitlement, lack of empathy, attention-seeking. Their needs are the most important needs and they need to be more important than other people. Lifetime prevalence: less than 1% and maybe slightly more common in men.

Characteristics and Causes of Avoidant PD:

Extreme sensitivity to others' opinions, avoid most interpersonal relationships, socially anxious, fear of rejection and judgment. Very different from Cluster B, less than 1% lifetime prevalence.

Where does the term personality disorder come from? What does it mean now?

First coined to describe someone whose disorder is stable, pervasive, and affecting areas of a person's life.

Characteristics and Causes of Obsessive Compulsive PD:

Generally rigid and perfectionistic, overly concerned with routines, rules, order, and doing things "the right way," different from OCD (more stable and less anxious), hard on themselves and others, 1% lifetime prevalence.

What are the negative symptoms of schizophrenia?

Lack of interest, lack of motivation, lack of pleasure, social withdrawal, blunted affect, lethargy, apathy, logia, anhedonia,

Characteristics and Causes of Antisocial PD:

Noncompliance with social norms, violate the rights of others, lack of empathy or remorse. Behaviors make them more aggressive and dangerous. Likely to hurt animals. They do not show emotions to others. Irresponsible, seek immediate gratification, BUT are good at navigating social situations. Lifetime prevalence shows 3% in men and 1% in women, is more common in low SES, and is highly comorbid with substance abuse. Family, twin (MZ>DZ), and adoption studies support that their is a genetic contribution to ASPD, along with gene-environment interaction. Other causes may be neurobiological, such as brain damage (little support), and an imbalance between behavioral inhibition system (BIS) and reward system (BAS).

Do you have to have stress or impairment to qualify for a PD?

Not necessarily. The stress and impairment is associated with PD, but it does not need to be in the individual, it is seen in the people around the person with PD as well.

Characteristics and Causes of Schizotypal PD:

Odd people with strange patterns of thought, behaviors, and strange appearance. They partake in magical thinking, hidden meaning (ideas of reference), illusions (their thoughts are not present or accurate to real life perhaps); They do not know that they're odd, they think everyone else is strange. They might secretly long for connection but they do not understand other people or their actions. Their lifetime prevalence is 3% and it is slightly more common in men- there is also an increased risk for schizophrenia.

What is being changed in DBT? What is the difference between operant and respondent behaviors?

Operant: learned and maintained by consequences, i.e. cutting myself gives me attention. Respondent: a habitual response or reaction, i.e. first response to rejection is a need to self-harm. - these responses need to be evaluated and changed in DBT

Characteristics and Causes of Histrionic PD:

Overly dramatic, attention-seeking, self-centered, sexually provocative, emotionally shallow, impulsive, can switch in and out of extreme emotions quickly. Lifetime prevalence: 2-3% and more common in women

Characteristics and Causes of Schizoid PD:

Pattern of pervasive detachment from social relationships- not out of fear but out of lack of interest. See others as boring, invasive, annoying. Lifetime prevalence is less than 1% and more common in men. Causes are unknown but related to a preference for social isolation and might be caused by self-sufficient cognitive conditioning.

Why might it be difficult to give therapy to people with BPD?

People with BPD do not fit the model for most therapies, like supportive therapy. A lot of therapies practice the idea that the client knows all the answers deep down, but for a person with BPD has chronic emotional dysregulation so they do not trust what they know deep down.

Characteristics and Causes of Paranoid PD:

Pervasive, unjustified mistrust and suspicion of others; unjustified belief that others are hostile or jealous which results in them isolating themselves from relationships. People with Paranoid PD can function in society but they live an isolated life. The lifetime prevalence is 1% and it is more common in men. We are unsure of causes but possible explanations include: genetic vulnerability, cognitive shaping early in life (being taught to trust no one and that the world is dangerous).

What are hallucinations and the different types?

Sensory experiences in the absence of stimulation from the environment. They can be auditory (most common and usually very negative/critical or command voices that tell them to do bad things), tactile, visual, olfactory (very uncommon and dangerous), and gustatory.

What is binge eating disorder?

Significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa.

What makes someone with a personality disorder different than someone without one?

There are abnormalities in the way that they interact with, view, and/or have relationships with other people. They see other people as distinctly different from them and assume that there is something wrong with others and that they are the normal one.

What is the psychodynamic model of BPD?

There is a spectrum of human personality, with neurotic being on the far left and psychotic being on the far right. The average person is more on the neurotic side, and someone with BPD is in the middle. This model is not used anymore. Neurotic means very sensitive, anxious, cautious, thinking about others, where psychotic means lack of regard and concern.

What is the "central dialectic" of DBT and what does it mean?

This is like a scale, with acceptance on one end and change on the other. Therapy (DBT) balances the two of these while the patient jumps from one extreme to the other. Acceptance and change are the main two forces behind DBT.

What does "heterogeneity of symptoms mean" and why is it pertinent to PDs?

This means that symptoms can be diverse and vary in how common they are and whether or not each person belonging to a disorder will have them. Theres heterogeneity in most PDs.

What are the personality disorders in Cluster B?

antisocial, borderline, histrionic, narcissistic

What are the personality disorders in Cluster C?

avoidant, dependent, obsessive-compulsive

What are the positive symptoms of schizophrenia?

hallucinations delusions bizarre behavior disorganized speech