G8-ABPSY-1 Personality Disorders - Group 8 PDF

Group 8 Perso nality Cluster A, B, Disorders C  GROUP 8 BUNCAL, GARCIA, Berlin Christine Mae FRANCO, DAVID, Erika Kayezheiah hat is rsonality Disorder? A personality disorder is a persistent pattern of...

Group 8 Perso nality Cluster A, B, Disorders C  GROUP 8 BUNCAL, GARCIA, Berlin Christine Mae FRANCO, DAVID, Erika Kayezheiah hat is rsonality Disorder? A personality disorder is a persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships (American Psychiatric Association, 2013). DSM-5 notes that having a personality disorder may distress the affected person. Individuals with personality disorders may not feel any subjective distress, however; indeed, it may in fact be others who acutely feel distress because of the actions of the person with the disorder. Cluster A. Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Cluster B. Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Cluster C, Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder General Criteria for Personality Disorder A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events). 2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response). 3. Interpersonal functioning 4. Impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better explained as a manifestation or consequence of another mental disorder. F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).  Presented by: Berlin Buncal Paranoid Personalit y Disorder Cluster A: Odd and Eccentric Pattern Personality Disorder a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.  People with paranoid personality disorder are suspicious in situations in which most other people would agree their suspicions are unfounded. Suspiciousness and mistrust can show themselves in a number of ways. People with paranoid personality disorder are excessively mistrustful and suspicious of others, without any justification. They assume other people are out to harm or trick them; therefore, they tend not to confide in others. These individuals are sensitive to criticism and have an excessive need for autonomy. Having this disorder increases the risk of suicide attempts and violent behavior, and these people tend to have a poor overall quality of life.  Causal Factors · Genes relatives of individuals with schizophrenia may be more likely to have paranoid personality disorder than people who do not have a relative with schizophrenia. · Schemas Some psychologists point directly to the thoughts (also referred to as “schemas”) of people with paranoid personality disorder as a way of explaining their behavior.  Causal Factors · Childhood Experiences Psychological contributions suggests that early mistreatment or traumatic childhood experiences may play a role in the development of paranoid personality disorder. · Cultural Influences Cultural factors have also been implicated in paranoid personality disorder. Certain groups of people, such as prisoners, refugees, people with hearing impairments, and older adults, are thought to be particularly susceptible because of their unique experiences. Diagnostic Criteria A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. Diagnostic Criteria 5. Persistently bears grudges, unforgiving of insults, injuries, or slights. 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.  Treatments · Cognitive Therapy They often use cognitive therapy to counter the person’s mistaken assumptions about others, focusing on changing the person’s beliefs that all people are malevolent and most people cannot be trusted. (there are no confirmed demonstrations that any form of treatment can significantly improve the lives of people with paranoid personality disorder) a pattern of detachment from social relationships and a restricted range of emotional expression.  They seem aloof, cold, and indifferent to other people. Individuals with schizoid personality disorder seem neither to desire nor to enjoy closeness with others, including romantic or sexual relationships. they appear cold and detached and do not seem affected by praise or criticism. are sensitive to the opinions of others but are unwilling or unable to express this emotion. Causal Factors ·Genetic, Neurobiological, and Psychosocial It may be that this personality trait is inherited and serves as an important determinant in the development of this disorder. Abuse and neglect in childhood are also reported among individuals with this disorder.  Diagnostic Criteria A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, activities. Diagnostic Criteria 5. Lacks close friends or confidants other than first-degree relatives. 6. Appears indifferent to the praise or criticism of others. 7. Shows emotional coldness, detachment, or flattened affectivity. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.  Treatments · Social Therapy Therapists often begin treatment by pointing out the value in social relationships. The person with the disorder may even need to be taught the emotions felt by others to learn empathy. · Role Playing Technique The therapist takes the part of a friend or significant other in a technique known as role-playing and helps the patient practice establishing and maintaining social relationships (Skodol & Gunderson, 2008). This type of social skills training is helped by identifying a social network—a person or people who will be supportive  Schizotyp al Personalit y Disorder A pattern of acute discomfort in close relationship, cognitive or perceptual distortions and eccentricities of behavior · typically socially isolated, like those with schizoid personality disorder · they tend to be suspicious and to have odd beliefs · some to be on a continuum (that is, on the same spectrum) with schizophrenia but without some of the more debilitating symptoms, such as hallucinations and delusions · have psychotic-like symptoms, social deficits, and sometimes cognitive impairments or paranoia Causal Factors Genetics Genetic research also seems to support a relationship. Family, twin, and adoption studies have shown an increased prevalence of schizotypal personality disorder among relatives of people with schizophrenia who do not also have schizophrenia themselves. Influences, Experiences Some research suggests that schizotypal symptoms are strongly associated with childhood maltreatment among men, and this childhood maltreatment seems to result in posttraumatic stress disorder (PTSD) symptoms among women. Diagnostic Criteria A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Ideas of reference (excluding delusions of reference). 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations). 3. Unusual perceptual experiences, including bodily illusions. Diagnostic Criteria 4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped). 5. Suspiciousness or paranoid ideation. 6. Inappropriate or constricted affect. 7. Behavior or appearance that is odd, eccentric, or peculiar. 8. Lack of close friends or confidants other than first-degree relatives. 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.  Treatments antipsychotic medication cognitive behavior therapy social skills training One study used a combination of approaches, including antipsychotic medication, community treatment and social skills training, to treat the symptoms experienced by individuals with this disorder. The idea of treating younger persons who have symptoms of schizotypal personality disorder with some combination of antipsychotic medication, cognitive behavior therapy, and social skills training in order to avoid the onset of schizophrenia is proving to be a promising prevention strategy.  Presented by: Christine Garcia Anti-social Personalit y Disorder Cluster B: dramatic, emotional and erratic ANTI SOCIAL PERSONALITY DISORDER (ASPD) People with antisocial personality disorder are among the most puzzling of the individuals a clinician will see in a practice and are characterized as having a history of failing to comply with social norm They perform actions most of us would find unacceptable, such as stealing from friends and family. They also tend to be irresponsible, impulsive, and deceitful (De Brito & Hodgins, 2009). DSM-5 provides a separate diagnosis for children who engage behavior that violates social norms, conduct disorder. 2 Subtypes: a. childhood-onset type ( the onset of at least one criterion characteristics of CD prior to age 10 years) b. adolescent- onset type (the absence of any criteria characteristic of CD prior to age 10 years)  Causal Factors Genetic predisposition- Evidence suggests a genetic component, with family, twin, and adoption studies showing higher risk among biological relatives.​ Neurobiological factors- Abnormalities in the brain, particularly in the prefrontal cortex, which is involved in decision-making, impulse control, and regulation of behavior.​ Impaired fear conditioning- Reduced physiological responses to fear or punishment, making individuals less sensitive to negative consequences.​ Impulsivity and aggression- Linked to abnormalities in serotonin and other neurotransmitters associated with aggression and impulsivity.​  Causal Factors Childhood environment - Early exposure to adverse environments, such as parental neglect, abuse, or inconsistent discipline, increases the risk of developing ASPD.​​ Cognitive factors- Individuals often show a pattern of justifying or rationalizing their behavior and have difficulties forming lasting moral or ethical standards.​ Low arousal levels- People with ASPD often exhibit chronically low levels of arousal, leading to a need for stimulation and risk-taking behavior.​ Environmental stressors- Poverty, exposure to violence, and chaotic family environments can contribute to the development of ASPD.​ ​ Diagnostic Criteria A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: Neither desires nor enjoys close relationships, including being part of a family. Almost always chooses solitary activities. Has little, if any, interest in having sexual experiences with another person. Diagnostic Takes pleasure in few, if any, activities. Criteria Lacks close friends or confidants other than first-degree relatives. Appears indifferent to the praise or criticism of others. Shows emotional coldness, detachment, or flattened affectivity. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizoid personality disorder (premorbid).” 1. Cognitive Behavior Therapy 2. Parent Training for children 3. Prevention  Presented by: Christine Garcia borderline Personalit y Disorder Cluster B: dramatic, emotional and erratic Borderline Personality Disorder People with borderline personality disorder lead tumultuous lives. Their moods and relationships are unstable, and usually they have a poor self-image. These people often feel empty and are at great risk of dying by their own hands.  Causal Factors Genetic predisposition- Family history of BPD or other personality disorders, mood disorders, and impulse-control issues increases the risk.​ Environmental factors- Childhood trauma, particularly abuse (physical, sexual, emotional) and neglect, is a significant factor in developing BPD.​ Emotional dysregulation-Difficulty managing emotions, leading to intense and unstable emotions and mood swings.​ Attachment issues- Problems with early attachment to caregivers, often resulting in fear of abandonment and unstable relationships.​  Causal Factors Impulsivity- High levels of impulsive behavior, including risky activities like substance abuse, self-harm, or reckless driving.​ Brain structure and function-Abnormalities in brain areas that regulate emotions, such as the amygdala (emotion processing) and the prefrontal cortex (impulse control and decision-making).​ Invalidating environment- Growing up in an environment where emotional responses were minimized, invalidated, or punished.​ Stress-related dissociation- Individuals with BPD may experience brief periods of dissociation or feeling disconnected from reality, often triggered by stress.​ Diagnostic Criteria A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) A pattern of unstable and intense interpersonal relation- ships characterized by alternating between extremes of idealization and devaluation. Identity disturbance: markedly and persistently unstable self- image or sense of self. Diagnostic Criteria Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). Chronic feelings of emptiness. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). Transient, stress-related paranoid ideation or severe dissociative symptoms.  General Observations: Individuals with BPD are more likely to seek treatment compared to those with other personality disorders. Treatment is complicated by drug abuse, non-compliance, and suicide attempts. Medical Treatment: Mood Stabilizers: Can be effective for disturbances in affect, such as anger and sadness. Challenges: Many clinicians are hesitant to treat BPD patients due to the complexity of the disorder. Dialectical Behavior Therapy (DBT): Developed by Marsha Linehan. A cognitive-behavioral approach specifically designed to help individuals with BPD.  Presented by: Erika Franco histrionic Personalit y Disorder Cluster B: Odd and Eccentric Pattern  Histrionic Personality Disorder (HPD) Histrionic personality disorder (HPD) is a mental health condition marked by unstable emotions, a distorted self-image and an overwhelming desire to be noticed “histrionic” means “dramatic or theatrical.” It marked by intense distorted self-image, They often don’t realize their behavior and way of thinking may be problematic. Females are more likely to be diagnosed with HPD than men.  Causal Factors Cause of histrionic personality disorder, Genetics, Childhood trauma, Parenting styles. Being rewarded for attention seeking behavior as a child. A family history of personality disorders, anxiety, or depression. Learning behaviors from a parent or caregiver with histrionic personality disorder. A lack of criticism or punishment as a child. Diagnostic The essential feature Criteria of histrionic personality disorder is pervasive and excessive emotionality and attention-seeking behavior, usually begins in your late teens or early 20s. Diagnosis criteria for histrionic personality disorder require meeting five (or more) of the following persistent behaviors: 1. Needs to be the center of attention. (e.g., make up stories, create a scene, being flattering, bringing gifts.) 2. Seductive or Provocative Behavior. (The individual has a sexual or romantic interest, Inappropriate sexually seductive or provocative behavior.) 3. Shifting and Shallow emotions. (Rapidly shifting and shallow expression of emotions, Draw attention to themselves.) Diagnostic Criteria 4. Use Appearance to draw attention to self. (Expend an excessive amount of time, energy, and money on clothes and grooming.) 5. Impressionistic and Vague Speech. (Has a style of speech that is excessively impressionistic and lacking in detail.) 6. Dramatic or Exaggerated emotions. (e.g. embracing casual acquaintances with excessive ardor, sobbing uncontrollably on minor sentimental occasions, having temper tantrums). 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Think relationships are closer than they are. (Considers relationships to be more intimate than they actually are.)  Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a therapist or psychologist.  Psychodynamic psychotherapy: This type of therapy focuses on the psychological roots of emotional distress.  Supportive psychotherapy: This type of therapy aims to improve symptoms and maintain, restore or improve self-esteem and coping skills.\  Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions.  Presented by: Erika Franco Narcissisti c Personalit y Disorder Cluster B: dramatic, emotional and erratic  Narcissistic Personality Disorder Narcissistic Personality Disorder or (NPD) is a mental health condition, it affects a person sense of self-esteem, identity, and how they treat themselves and others, Having NPD means you have an excessive need to impress others or feel important, It also affects yourself and relate to others.  Causal Factors Genetics- People with NPD are more likely to have parents or close relatives with it. Observation and imitation- Children can observe, imitate and learn traits and behaviors that can develop into NPD. Negative childhood experiences-Trauma, rejection, neglect and lack of support during childhood can all contribute to developing narcissistic traits. Parenting style- Overindulging children and overprotective may lead to a child who grows to expect and demand the same treatment they received from parents or parental figures. Culture- Research indicates that the culture you grow up in can influence your risk of developing NPD.  Diagnostic Factors The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood. 1. Grandiose sense of self-importance. (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Frequent fantasies about having or deserving (preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.) 3. Belief in superiority. (Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Need for admiration. (Struggle with severe internal self-doubt, self-criticism, and emptiness results in their need to actively seek others’ admiration.) Diagnostic Factors 5. Entitlement. (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). 6. Willingness to exploit others. (i.e., takes advantage of others to achieve his or her own ends). 7. Lack of empathy. (Unwilling to recognize or identify with the feelings and needs of others. ) 8. Frequent envy. (often envious of others or believes that others are envious of him or her.) 9. Arrogance. (Shows arrogant, haughty behaviors or attitudes.)  Complications of Narcissistic Personality Disorder? It’s very common for NPD to overlap with other mental health conditions and concerns. Some of the most common overlaps or complications include: Mood disorders or bipolar disorder. Anxiety and depression are more likely to happen in people with NPD. Body dysmorphic disorder. People with NPD may also have body dysmorphic disorder (also known as “body dysmorphia”). Substance use disorders (SUDs). People with NPD may turn to alcohol or substance use to help them when reality doesn’t meet their expectations. Suicide. People with NPD may experience extreme depression or even despair when faced with challenges, failure or rejection.  Treating NPD usually involves some form of mental health therapy (psychotherapy). Some of the therapy types that are most common with NPD include (but aren’t limited to) the following: Dialectical behavioral therapy (DBT)- Learn to accept themselves and their emotions and thoughts as they are, without judgment, and work toward making positive changes to build a life worth living. Cognitive behavioral therapy (CBT)- Aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. Metacognitive therapy- a type of therapy where you learn about how you think, so you can better control your attention, thoughts, and feelings. Group therapy- a form of psychotherapy in which a group of patients meet to describe and discuss their problems together under the supervision of a therapist. Couples or family therapy- Couples therapy involves the two people who make up the couple. Family therapy involves the members of the family unit.  Presented by: Kayezheiah David Cluster C: anxious or fearful disorders  AVOIDANT PERSONALITY a pervasive pattern of social inhibition, feelings of inadequacy, and DISORDER hypersensitivity to negative evaluation, beginning by early adulthood and present  Causal Factors Biological Environmental  Diagnostic 1. Criteria Avoids occupational activities that involve significant interpersonal contract because of fear of criticism, disapproval, or rejection 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed and ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situation because of feeling of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to other. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.  CBT Psychodynamic Therapy Medication  Presented by: Kayezheiah David DEPENDE NT Personalit y Disorder Cluster C: anxious and fearful  DEPENDENT A PERSONALITY pervasive and excessive need to be taken care of, which leads to DISORDER submissive and clinging behaviour and fears of separation.  Causal Factors The cause of this disorder is unknown. Diagnostic Factors 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life 3. Has difficulty expressing disagreement with other because of fear of loss of support of approval. 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of motivation or energy. 5. Goes excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care of himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.  CBT Medication  Presented by: Kayezheiah David OBSESSIVE - COMPULSI VE Personality Cluster C: anxious and fearful Disorder  OBSESSIVE- COMPULSIVE PERSONALITY A pervasive pattern of preoccupation with orderliness, perfectionism and DISORDER mental and interpersonal control, at the expense of flexibility, openness, and efficiency.  Causal Factors Genetics Environmental Diagnostic Factors 1. Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the central point of the activity is lost. 2. Perfectionism that interferes with task completion. 3. Excessive devotion to work and productivity, excluding leisure activities and friendships. 4. Over-conscientiousness and inflexibility about morality, ethics, or values. 5. Difficulty in discarding worn-out or worthless objects with no sentimental value. 6. Reluctance to delegate tasks or work. 7. Adoption of a miserly spending style toward self and others. 8. Demonstration of rigidity and stubbornness.  CBT Psychodynamic Therapy Medication Other Personality Disorders Personality change due to another medical condition a persistent personality disturbances that is judged to be the direct pathophysiological consequence of another medical condition (e.g., frontal lobe lesion) Other specified personality disorder a category provided for two situations: (1) individuals personality patterns meets the general criteria, different personality disorders are present but the criteria for any specific personality disorder are not met. (2) individuals personality patterns meets the general criteria but the individual is considered to have personality disorder that is not included on DSM-5 (e.g., passive- aggressive personality disorder) Unspecified personality disorder which symptoms characteristics of a personality disorder are present but there is insufficient to make more specific diagnosis.  Types of Psychotherapy Psychoanalytic/psychodynamic/transference-focused therapy Dialectical behavior therapy Cognitive behavioral therapy Group therapy Psychoeducation (teaching the individual and family members about the diagnosis, treatment and ways of coping)  SUMMAR Y 10 personality disorders (PaSS, ADHN, DSM-5 include ADOC) 3 clusters Cluster A: odd and eccentric (PaSS) Cluster B: dramatic, emotional or eratic (ADHN) Cluster C: anxious or fearful (ADOC)  Personality disorders were thought to originate in childhood and continue into the adult years. More sophisticated analyses suggest that personality disorders can remit over time, however, they may be replaced by other personality disorders. (Cloninger & Svakic, 2009) Therapy are often paired by medication due to overlapping of other disorders (depression, anxiety, etc.) which is more effective than therapy only. Prevalence: 3.6% for Cluster A, 4.5% for Cluster B and 2.8% for Cluster C. The features of Personality Disorders usually become recognizable during early adulthood or adolescence. Case study #1 Jake grew up in a middle-class neighborhood, and although he never got in serious trouble, he had a reputation in high school for arguing with teachers and classmates. After high school, he enrolled in the local community college, but he flunked out after the first year. Jake’s lack of success in school was partly attributable to his failure to take responsibility for his poor grades. He began to develop conspiracy theories about fellow students and professors, believing they worked together to see him fail. Jake bounced from job to job, each time complaining that his employer was spying on him at work and at home. At age 25—and against his parents’ wishes—he moved out of his parents’ home to a small town out of state. Unfortunately, the letters Jake wrote home daily confirmed his parents’ worst fears. He was becoming increasingly preoccupied with theories about people who were out to harm him. Case study #1 Jake spent enormous amounts of time on his computer, exploring websites, and he developed an elaborate theory about how research had been performed on him in childhood. His letters home described his belief that researchers working with the CIA drugged him as a child and implanted something in his ear that emitted microwaves. These microwaves, he believed, were being used to cause him to develop cancer. Over 2 years, he became increasingly preoccupied with this theory, writing letters to various authorities trying to convince them he was being slowly killed. After he threatened harm to some local college administrators, his parents were contacted, and they brought him to a psychologist. Case study #2 Claire and I went to school together from the eighth grade through high school, and we’ve kept in touch periodically. My earliest memory of her is of her hair, which was cut short and rather unevenly. She told me that when things were not going well, she cut her own hair severely, which helped to “fill the void.” I later found out that the long sleeves she usually wore hid scars and cuts that she had made herself. Claire was the first of our friends to smoke. What was unusual about this and her later drug use was not that they occurred (this was in the 1960s when “If it feels good, do it” hadn’t been replaced by “Just say no”) or that they began early; it was that she didn’t seem to use them to get attention, like everyone else. Claire was also one of the first whose parents divorced, and both of them seemed to abandon her emotionally. Case study #2 She later told me that her father was an alcoholic who had regularly beaten her and her mother. She did poorly in school and had a low opinion of herself. She often said she was stupid and ugly, yet she was neither. In our later teens, we all drifted away from Claire. She had become increasingly unpredictable, sometimes berating us for a perceived slight (“You’re walking too fast. You don’t want to be seen with me!”), and at other times desperate to be around us. We were confused by her behavior. With some people, emotional outbursts can bring you closer together. Unfortunately for Claire, these incidents and her overall demeanor made us feel that we didn’t know her. Case study #2 As we all grew older, the “void” she described in herself became overwhelming and eventually shut us all out. Claire married twice, and both times had passionate but stormy relationships interrupted by hospitalizations. She tried to stab her first husband during a particularly violent rage. She tried a number of drugs but mainly used alcohol to “deaden the pain.” Now, in her mid-50s, things have calmed down some, although she says she is rarely happy. Claire does feel a little better about herself and is doing well as a travel agent. Although she is seeing someone, she is reluctant to become involved because of her personal history. Case study #3 Willie was an office assistant in a small law firm. Now in his early 30s, Willie had an extremely poor job history. He never stayed employed at the same place for more than 2 years, and he spent considerable time working through temporary employment agencies. Your first encounter, however, would make you believe that he was extremely competent and that he ran the office. If you entered the waiting room, you were greeted by Willie, even though he wasn’t the receptionist. He would be extremely solicitous, asking how he could be of assistance, offer you coffee, and ask you to make yourself comfortable in “his” reception area. Willie liked to talk, and any conversation was quickly redirected in a way that kept him the center of attention. This type of ingratiating manner was welcomed at first but soon annoyed other staff. This was especially true when he referred to the other workers in the office Case study #3 The conversations with visitors and staff often consumed a great deal of his time and the time of other staff, and this was becoming a problem. He quickly became controlling in his job—a pattern revealed in his other positions as well—eagerly taking charge of duties assigned to others. Unfortunately, he did not complete these tasks well, and this created a great deal of friction. When confronted with any of these difficulties, Willie would first blame others. Ultimately, however, it would become clear that Willie’s self-centeredness and controlling nature were at the root of many of the office inefficiencies. During a disciplinary meeting with all of the law firm’s partners, an unusual step, Willie became explosively abusive and blamed them for being out to get him. He insisted that his performance was exceptional at all of Case study #3 Ultimately, his behavior—including lateness and incomplete work —resulted in his termination. In a revealing turn of events, Willie reapplied for another position at the same firm 2 years later. A mix-up in records failed to reveal his previous termination, but he lasted only 3 days—showing up late to work on his second and third days. He was convinced he could be successful, yet he could not change his behavior to conform to even the minimal standards needed to be successful at work. Case study #4 Each day at exactly 8 a.m., Daniel arrived at his office at the university where he was a graduate student in psychology. On his way, he always stopped at the 7-Eleven for coffee and the New York Times. From 8 a.m. to 9:15 a.m., he drank his coffee and read the paper. At 9:15 a.m., he reorganized the files that held the hundreds of papers related to his doctoral dissertation, now several years overdue. From 10 a.m. until noon, he read one of these papers, highlighting relevant passages. Then he took the paper bag that held his lunch (always a peanut butter and jelly sandwich and an apple) and went to the cafeteria to purchase a soda and eat by himself. From 1 p.m. until 5 p.m., he held meetings, organized his desk, made lists of things to do, and entered his references into a new database program on his computer. Case study #4 At home, Daniel had dinner with his wife and then worked on his dissertation until after 11 p.m., although much of the time was spent trying out new features of his home computer. Daniel was no closer to completing his dissertation than he had been 4.5 years ago. His wife was threatening to leave him because he was equally rigid about everything at home and she didn’t want to remain in this limbo of graduate school forever.  ANY QUESTIONS? THANK YOU BEYONCÉ !! “The journey is never ending. There’s always gonna be growth, improvement, adversity; you just gotta take it all in and do what’s right, continue to grow, continue to live in the moment.” – Antonio Brown