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Suicide. MDD and bipolar disorder are at higher risk for suicide than most disorders . Prediction is difficult due to lack of research . H opelessness may be better predictor of suicide than depressed mood. Intense agitation is also a powerful predictor of suicide risk .
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Suicide • MDD and bipolar disorder are at higher risk for suicide than most disorders. • Prediction is difficult due to lack of research. • Hopelessness may be better predictor of suicide than depressed mood. • Intense agitation is also a powerful predictor of suicide risk.
Personality Disorders • Should only be diagnosed when • Personality traits first appear by adolescence • Traits are inflexible, stable, and expressed in a wide variety of situations • Traits lead to distress or impairment • Show substantial comorbidity with Axis I. They are coded on Axis II. • DSM-IV groups these conditions into three clusters.
Table 15.11 (continued)The DSM-IV Classification of Major Personality Disorders.
Borderline Personality Disorder • Mainly women, about 2% of population. • Marked by instability in mood, identity, and impulse control; often highly self-destructive; instability in mood, identity, and impulse control; unpredictable; drug abuse; sexual promiscuity; overeating, and self-mutilation, like cuttingthemselves when upset. They may threaten suicide to manipulate others. • In Linehan’s sociobiological model, individuals with BPD overreact to stress and experience lifelong difficulties with regulating their emotions.
Psychopathic Personality • marked by superficial charm, dishonesty, manipulativeness, self-centeredness, and risk taking. “psychopath” or “sociopath” • Overlaps with antisocial personality disorder, marked by a lengthy history of irresponsible and/or illegal actions. Primarily males, about 25% of the prison population meets the criteria for PPD.
Psychopathic Personality • Causes are unknown, but may stem in part from a deficit in fear. As a consequence of lack of fear, they aren’t motivated tolearn from punishment and repeat the same mistakes. • Alternatively, they may be perpetually underaroused and experiencing stimulus hunger. They’re bored and seek out excitement. This hypothesis may help to explain why those with psychopathic personality tend to be risk takers.
Dissociative Disorders • Involve disruptions in consciousness, memory, identity, or perception. Most often following a stressful experience. • Depersonalization disorder: frequently feeling detached from yourself, as if you’re living in a movie or dream or out-of-body-experiences. Such experiences are common amongadolescents and students. • In dissociative amnesia, people can’t recall personal information. Psychologists diagnose it when adults report gaps in their memories for child abuse. • In dissociative fugue, people not only forget significant events in their lives, but flee theirstressful circumstances.
Dissociative Identity Disorder (DID) • Characterized by presence of two or more distinct identities (alters). These “alters” are often very different from the primary or“host” personalityand may be of different names,ages, genders, and even races. • Is DID a response to early trauma, or is it a consequence of social and cultural factors? • Primary controversy surrounds issue of posttraumatic vs sociocognitive models.
Dissociative Identity Disorder • Little evidence to support the posttraumatic model. • Support for sociocognitive model includes • Most DID patients don’t show alters prior to therapy. • Treatment reinforces idea that person has alters. • Treatment tends to increase number of alters seen. The media have played large role in the recent increase in DID diagnoses.
Sheri Storm was diagnosed with DID, but later became convinced that a therapist had inadvertently implanted her alter personalities using suggestive techniques. This painting—completed by Storm duringtherapy—depicts the seemingly endless parade of her alters emerging in treatment.
Schizophrenia • Severe disorder of thought and emotion associated with a loss of contact with reality. • Symptoms include disturbances in attention, thinking, language, emotion, and relationships. • Less than 1% of population, but over half of people in mental institutions. A large proportion of homeless people would receive diagnoses of SCH.
Schizophrenia • Delusions – strongly held, fixed beliefs with no basis in reality. • This and other psychotic symptoms reflect serious distortions in reality. • Hallucinations are sensory perceptions that occur in the absence of external stimuli. They can be auditory (hearing), olfactory (smell), gustatory(taste), tactile (the sense of feeling, touch), or visual (seeing).
In the film, “A Beautiful Mind,” actor Russell Crowe portraysNobel Prize–winning mathematician John Nash, who was diagnosed with SCH. Nash is shown talking to a friend whom he sees—but does not exist. What’s scientifically unrealistic about this scene?
Schizophrenia • Disorganized speech (word salad) and behavior (echolalia, catatonia) are also common symptoms.
Catatonic individualsmay permit their limbs to be moved to any position, and maintain this posture for lengthy periods of time, a condition called waxy flexibility.
Explanations for Schizophrenia • Psychosocial factors play a role in SCH, but only trigger it in persons with genetic vulnerabilities. • schizophrenogenic (schizophrenia-producing) mothers as overprotective, rejecting and controlling. • Family members can influence whether patients relapse (expressed emotion). • Number of brain abnormalities seen • Enlarged ventricles • Increased sulci size • Hypofrontality
In one identical twin with SCH, the fluid-filled ventricles of the brainare enlarged relative to his or her cotwinwithout SCH. Such enlargement reflects a deterioration in brain tissue surrounding the ventricles, which expand to fill the missing space.
Explanations for Schizophrenia • Neurotransmitter differences also found, such as abnormalities in dopamine (DA) receptors. • DA, NE, glutamate, and serotonin (5-HT) are all disturbed. • Highly genetically influenced disorder as well.
Positive & negative symptoms • Positive symptoms of SCH include hallucinations, delusions, anddisorganized speech and behavior. • Negativesymptomsreflect decreases or losses of normal functions. These symptoms includesocial withdrawal and diminished motivations, decreased expression of emotions, andbrief and limited speech. • Positive symptoms result from DA excesses in some brain regions, and negative symptoms from DA deficits in otherbrain regions.
Vulnerability to Schizophrenia • Diathesis-stress models propose that MI is a joint product of a genetic vulnerability (diathesis)and stressors that trigger this vulnerability. • Early warning signs of schizophrenia vulnerability • Social withdrawal • Thought and movement problems • Lack of emotions, decreased eye contact • learning and memory deficits, • elevated neuroticism, • temporal lobe abnormalities, • impaired attention, and • eye movementdisturbances when tracking moving objects
Many people with schizotypal personality disorder are prone to “magical thinking”—the belief that their thoughts can influence actions through supernatural or otherwise mysterious processes. They may believe that stepping on a crack in the sidewalk will create misfortune.
Autistic Disorder • Marked by severe deficits in language, social bonding, and imagination. • Often accompanied by mental retardation (MR). • Dramatic increase in autism diagnoses from early 1990s to today, but why?
Many parents remain convinced that vaccines trigger autism, despite scientific evidence to the contrary.
Autistic Disorder • Many have blamed MMR vaccines, starting with a 1998 UK study. • Study was later retracted by the journal that published it as flawed in several ways. • Subsequent research showed no link between vaccines and autism.
Attention-Deficit/Hyperactivity Disorder (ADHD) • Primary problems include inattentive, impulsive, and hyperactivity symptoms. • Diagnosable in 3-7% of school children, more males than females (3:1). • Related to numerous functional problems in both children and adults.
Attention-Deficit/Hyperactivity Disorder • Highly genetically influenced, can be successfully treated with stimulant medications. But, these medications occasionally have serious side effects.
Many children have problems concentrating. There can be a fine line between children who have trouble paying attention in class and children diagnosed with ADHD.
Children are particularly likely to receive a diagnosis ofearly-onset bipolar disorder when they show rapid mood changes, reckless behavior, irritability, and aggression.
