Abnormal Psychology

Abnormal Psychology Lina Medaglia-Miller, Ph.D. The Great Pretender: The Art of Passing GSSC 1073 May 2010

The “Big 5” Personality Traits • Openness to experience • Conscientiousness • Extraversion • Agreeableness • Neuroticism • personality disorders represent extreme variations of OCEAN

The Five-Factor Model of Personality Openness to Experience • Down-to-earth – Imaginative • Uncreative – Creative • Conventional – Original • Prefer routine – Prefer variety • Uncurious – Curious • Conservative – Liberal Conscientiousness • Negligent – Conscientious • Lazy – Hardworking • Disorganized – Well-organized • Late – Punctual • Aimless – Ambitious • Quitting – Persevering Extraversion • Reserved – Affectionate • Loner – Joiner • Quiet – Talkative • Passive – Active • Sober – Fun-loving • Unfeeling – Passionate Agreeableness • Ruthless – Soft-hearted • Suspicious – Trusting • Stingy – Generous • Antagonistic – Acquiescent • Critical – Lenient • Irritable – Good-natured Neuroticism • Calm – Worrying • Even-tempered – Temperamental • Self-satisfied – Self-pitying • Comfortable – Self-conscious • Unemotional – Emotional • Hardy – Vulnerable

Defining Mental Disorder • Defining Mental Disorders • Discussing Particular Disorders • Therapy Regimens

Defining Mental Disorder • Three Classic Symptoms of Mental Disorders: • Hallucinations: false sensory experiences • Delusions: disorders of logical thinking • Affective Disturbances: inappropriately strong or absent emotional response

Defining Mental Disorder No Mild Moderate Severe Disorder Disorder Disorder Disorder

Defining Mental Disorder • Distress • Maladaptiveness • Irrationality • Unpredictability • Unconventionality • Observer Discomfort

Defining Mental Disorder • Reasons for differences in rates of disorders and types of symptoms -- are there real cultural differences? • Personality / cognitive style • Definitions of mental illness • Acceptability of mental (as opposed to physical) distress • Usage of medical and psychological services • Views of the origins and treatment of illness

Cultural Perspective • Can you think of examples of culturally-based behaviours that we would consider maladaptive? • Can you think of examples of culturally-based sanctions against behaviours that are considered maladaptive?

Defining Mental Disorder

Assumptions of theDSM-IV • Personality pathology is suited to be classified into discrete types or disorders • These disorders group themselves into three clusters • The diagnostic criteria naturally fall into the particular personality disorders to which they have been assigned

Defining Mental Disorder Homosexuality was defined as a disorder in previous DSM Manuals

David Klonsky – University of Virginia “The DSM practice of putting expert opinions into writing and only then conducting tests of reliability and validity cannot lead to an acceptable classification system. Rather it directs scientists to conduct research on, and practitioners to put their trust in, diagnostic labels that may or may not map onto valid constructs that exist in nature. Instead, researchers must turn to objective, empirical methodologies to discover the dimensions or personality pathology, letting the data fall where they may and letting the data determine how personality disorder is best classified”

Types of Mental Disorders • Personality Disorders • Anxiety Disorders • Mood Disorders • Other Disorders

(1) Personality Disorders • Inflexible pattern of inner experience and outward behavior which deviates markedly from one’s culture. • Paranoid, Schizoid, Antisocial, Borderline, Narcissistic, Histrionic, Avoidant, Dependent

Facts about Personality Disorders Facts about Personality Disorders • Onset usually late childhood, early adolescence • Causes others distress • Affects behavior in many situations • Poor insight • Little behavior change

General Diagnostic Criteria for PDs General Diagnostic Criteria for PDs • Enduring pattern of inner experience or behavior that deviates from expectations of culture, manifested in two or more of the following: -- cognition (perception of self, others) -- affectivity (intensity, range of emotions) -- interpersonal functioning -- impulse control • Enduring pattern is inflexible, pervasive in many situations

General Diagnostic Criteria for PDs General Diagnostic Criteria for PDs • Enduring pattern leads to distress, impairment in important areas of functioning • Pattern is stable and of long duration, can be traced back to childhood • Pattern not better explained by another disorder • Pattern not due to substance abuse or medical condition

Types of Personality Disorders (Clusters) • Paranoid personality • Schizoid personality Cluster A • Schizotypal personality • Antisocial personality • Borderline personality • Histrionic personality Cluster B • Narcissistic personality • Avoidant personality • Dependent personality Cluster C • Obsessive-compulsive personality (includes impulse-control disorders)

“Cluster A” PDs • Paranoid, schizoid, and schizotypal personality disorders • Marked by eccentricity, odd behavior, not psychosis • Share a superficial similarity with schizophrenia (a milder version) People who have been called eccentric– are these people disordered?

Cluster A: Odd or eccentric • Paranoid PD – is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent • Schizoid PD – is a pattern of detachment from social relationships and restricted range of emotional expression • Schizotypal PD – is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour

Paranoid Personality Disorders • Lack of trust in others • Fear that friends may be disloyal, unfaithful • Being hypersensitive, overly suspicious, perceived as hostile

DSM-IV Diagnostic Criteria for Paranoid PDs Pervasive distrust, suspicion of others, and four or more of the following: • suspects, without basis, that others are exploiting, harming, deceiving • is preoccupied with unjustified doubts of loyalty or trustworthiness of people • is reluctant to confide in others • reads hidden, demeaning, threatening meaning into benign actions • persistently bears grudges • perceives attacks on reputation • has unjustified suspicions about fidelity of others

Facts about Paranoid Personality Disorder • Affects 0.5–2.5 percent of population • Sometimes several individuals band together into groups that share paranoid beliefs • More common in males

Schizoid Personality Disorder Enduring pattern of thinking and behavior characterized by • pervasive indifference to others • diminished range of emotional experiences, expressions • socially isolated, lacking in social relationships

DSM-IV Criteria for Schizoid PDs Detachment from social relationships, restricted emotions, as indicated by four or more of the following: • neither desires nor enjoys social relationships • prefers solitary activities • has little interest in sexual experiences • gets pleasure from few activities • lacks close friends • appears indifferent to praise or criticism • shows emotional coldness, detachment, flat affect

Schizotypal Personality Disorder • Enduring pattern of discomfort with others and odd, peculiar thinking and behavior • Shares symptoms with both paranoid and schizoid personality disorders • Most closely linked to schizophrenia

DSM-IV Criteria for Schizotypal PD Acute discomfort with social relationships, eccentric behavior, and five or more of the following: • ideas of reference • odd beliefs • unusual perceptual experiences • odd speech • suspiciousness • inappropriate or constricted affect • odd or eccentric appearance and behavior • lack of close friends • excessive social anxiety

“Cluster B” PDs • Antisocial, borderline, histrionic, and narcissistic personality disorders • Being self-absorbed, prone to exaggerate importance of events • Having difficulty maintaining close relationships

Cluster B: Dramatic, emotional, or erratic • Antisocial PD – is a pattern of disregard for, and violation of, the rights of others • Borderline PD – is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity • Histrionic PD – is a pattern of excessive emotionality and attention seeking • Narcissistic PD – is a pattern of grandiosity, need for admiration, and lack of empathy

Antisocial Personality Disorder • Shows a pervasive pattern of disregard for, and violation of other people’s rights. • Up to 3.5% manifest an antisocial personality disorder (APA, 1994) • Symptoms: Repeatedly deceitful, irresponsible with money, impulsive, tendency to start fights, egocentric, no regard for safety of self or others.

Antisocial Personality • Tend to be skillful at manipulating people. • Are not distressed by the pain they cause, often perceived as lacking any moral conscience. • “They glibly rationalize their actions by characterizing their victims as weak and deserving of being conned or stolen from” (Comer, 1997)

DSM-IV Criteria for Antisocial PD Pattern of disregard for rights of others since age 15, as indicated by three or more of the following: • failure to conform to social norms, respect lawful behavior • deceitfulness, lying, conning others for profit or pleasure • impulsivity, failure to plan ahead • irritability, aggressiveness, repeated fights

DSM-IV Criteria for Antisocial PD • reckless disregard for safety of others • consistent irresponsibility, failure to honor obligations • lack of remorse Individual is at least 18 years old Evidence of conduct disorder before age 15

Facts about Antisocial PD • Affects 2.5–3.5 percent of population • More common in men • Highest prevalence among men 25–44 yr old • 40 percent of affected men and 24 percent of affected women were diagnosed with conduct disorder as children

Causes of Antisocial PD • Genetics • Birth trauma • Sensation-seeking • Family dynamics • Modeling and media

Borderline Personality Disorder • Characterized by mood shifts, unstable self-image, and impulsivity. • 2% of the U.S. population suffer from Borderline personality disorder (APA, 1994). • Symptoms: Intense, conflict filled relationships, overstep relationship boundaries, fear of desertion, suicidal thoughts, self-mutilation, emptiness, boredom, confusion about identity.

Borderline Personality Disorder Enduring pattern of thinking, behavior that involves • instability of mood, self-image, interpersonal relationships • frantic efforts to avoid real or imagined abandonment • unrealistically positive or negative opinions about others (intense relationships or nonexistance)

Facts about Borderline PD • Affects 2 percent of population • More common in women • Threats/actions of self-harm are common • Attributed to parental loss or abuse in childhood • Treatment mostly unsuccessful – often use dialectical behavior therapy

DSM-IV Criteria of Borderline PD Instability in relationships, self-image, marked impulsivity, and five or more of the following: • frantic efforts to avoid real or imagined abandonment • pattern of unstable, intense relationships • identity disturbance • impulsivity in two or more areas that are self-damaging

DSM-IV Criteria of Borderline PD • recurrent suicidal behavior, gestures, threats • affective instability • chronic feelings of emptiness • inappropriate intense anger • transient, stress-related paranoid ideas

Histrionic Personality Disorder • Enduring pattern of thinking, behavior characterized by excessive emotionality and attention-seeking behavior • Person is typically self-centered, vain, demanding • Appears in 2–3 percent of the population • Mainly diagnosed in women • Person dresses eccentrically, seductively

DSM-IV Criteria for Histrionic PD Excessive emotionality, attention-seeking, and five or more of the following: • being uncomfortable when not center of attention • rapidly shifting moods • uses physical appearance to draw attention • interactions characterized by provocative, seductive behavior • exaggerates in dramatic manner • is suggestible, easily influenced • considers relationships more intimate than they are

Narcissistic Personality Disorder Enduring pattern of thinking, behavior characterized by grandiosity, preoccupation with own achievements and abilities

DSM-IV Criteria for Narcissistic PD Grandiosity in fantasy and behavior, need for admiration, lack of empathy, and five or more of the following: • has grandiose sense of self-importance • is preoccupied with fantasies of power, success, love • believes he or she is special or unique

DSM-IV Criteria for Narcissistic PD • requires excessive admiration • has sense of entitlement • takes advantage of others to achieve own needs • lacks empathy • is often envious of others • is arrogant, haughty

“Cluster C” PDs • Avoidant, obsessive-compulsive, dependent disorders • People are often anxious, fearful, and depressed

Cluster C: anxious or fearful • Avoidant PD – is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation • Dependent PD – is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of • Obsessive-Compulsive PD – is a pattern of preoccupation with orderliness, perfectionism, and control at the expense of flexibility

Avoidant Personality Disorder Enduring pattern of thinking, behavior characterized by • pervasive social discomfort • fear of negative evaluation • social isolation • being easily hurt • fear of disapproval • shyness and social discomfort, but desire for social contact • avoidance due to fear of embarrassment or criticism

Obsessive-Compulsive Personality Disorder • Enduring pattern of thinking, behavior characterized by perfectionism, inflexibility • Preoccupied with rules, excessively moralistic, judgmental

Abnormal Psychology