Personality Disorders PDF

Personality: patterns of perceiving, feeling, thinking about, and relating to oneself and the environment. Personality trait: prominent aspect of personality that is relatively consistent across time and across situations (being outgoing, caring, impulsive, unstable). Five-factor model: dimensional...

Personality: patterns of perceiving, feeling, thinking about, and relating to oneself and the environment. Personality trait: prominent aspect of personality that is relatively consistent across time and across situations (being outgoing, caring, impulsive, unstable). Five-factor model: dimensional perspective that claims personality is organized along 5 broad personality traits - Big 5 - negative emotionality, extraversion, openness to experience, agreeableness, and conscientiousness. PERSONALITY DISORDER An enduring pattern of thinking, feeling, and behaving that is relatively stable over time, and the particular personality features must be evident by early adulthood. In 18 year olds -> personality patterns present for at least 1 year (except antisocial personality disorder). Cluster A - odd / eccentric behaviors and thinking - paranoid, schizoid, schizotypal (still maintain grasp on reality) Cluster B - dramatic, erratic, emotional behavior and interpersonal relationships - antisocial, histrionic, bpd, narcissistic (behave in exaggerated ways, manipulative, volatile) Cluster C - anxious and fearful emotions and chronic self-doubt - dependent, avoidant, ocd (little self-confidence and difficulty in relationships) CLUSTER A: ODD-ECCENTRIC PERSONALITY DISORDERS Similar to schizophrenia, but retaining grasp on reality to a greater degree. Paranoid, speak in eccentric ways, unusual beliefs or perceptual experiences falling short of delusions and hallucinations. - Paranoid personality disorder: - Pattern of pervasive distrust and suspiciousness of others. - Belief that other people are chronically trying to deceive or exploit them, concerns about being victimized or mistreated by others. - Hypervigilant for evidence surrounding their suspicions - Increased risk of clinical disorders (major depression, anxiety, substance abuse) - Schizoid personality disorder: Preference of turning attention inward and away from the outside world, engaging in solitary activities. - Pervasive pattern of detachment from social relationships - Restricted range of emotional expression in interactions with others - Indifference to opportunities to develop close relationships - Emotionally aloof or cold, uninteresting, humorless. - Indifference to praise or criticism Treatment: therapy -> increasing a person’s awareness of their feelings - Schizotypal personality disorder: Similar to schizophrenia but more mild. - Socially isolated -Restricted range of emotions -Uncomfortable in interpersonal interactions 1. Paranoia / suspiciousness: perceive people as deceitful and hostile 2. Ideas of reference: random events have a particular meaning just for them 3. Odd beliefs / magical thinking: belief others know what they're thinking 4. Illusions short of hallucinations: - Mid speech - Odd behaviors Treatments: drugs -> neuroleptics (haloperidol), atypical antipsychotics (olanzapine) / therapy CLUSTER B: DRAMATIC-EMOTIONAL PERSONALITY DISORDERS Behaviors that are dramatic and impulsive with little regard for safety. - Antisocial personality disorder: - Disregard for rights of others - Criminal behavior - Impulsive and deceitful - Lack of remorse - Borderline personality disorder: - Out of control behaviors that cannot be smoothed - Hypersensitivity to abandonment - Tendency to cling too tightly to people - Self-harm - Deficits in identity and interpersonal relationships (go from idealizing others to despising them) - Impulsivity - Hyperattentive to negative emotional stimuli -> make more negatively biased interpretations Causes: childhood marked by instability, neglect, parental psychopathology People with this disorder come to rely on others to help them cope with difficult situations but do not have enough self-confidence to ask for this help in mature or effective ways (ouch ily siham im sorry). Never learned to fully differentiate their view of themselves from their view of others, making them extremely reactive to others’ opinions of them and to the possibility of abandonment. Treatments: dialectical behavior therapy - gain a more realistic and positive sense of self, learn adaptive skills for regulating emotions, and correct dichotomous thinking. STEPPS (systems training for emotional predictability and problem solving): group intervention that combines cognitive techniques and behavioral techniques Transference-focused therapy: used relationship b/w patient and therapist to help patients develop a more realistic understanding of themselves and interpersonal relationships. Mentalization-based treatment: provides patients with validation and support. - Histrionic personality disorder: Behave in ways to draw attention to themselves across situations. Need of flattering nurturance and preferential attention. - Overly trusting and influence by others - Pursue of attention by being highly dramatic - Overtly seductive, emphasizing positive qualities of their physical appearance. - Self-centered and shallow, demanding, overly dependent - Narcissistic personality disorder: - Seek admiration from others - Shallow emotional expressions - Rely on their inflated self-evaluations - Grandiosity - Make demands and exploit others - Arrogant and condescending Grandiose narcissist: copes with difficulties in self-esteem by viewing themself as superior and unique by engaging in grandiose fantasies (arrogant, entitled, manipulative). Vulnerable narcissist: copes with difficulties in self-esteem by engaging in grandiose fantasies to quell intense shame (self-focused hypersensitive to rejection and criticism, distrustful). CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS Chronic sense of anxiety or fearfulness and behaviors intended to ward off feared situations. - Avoidant personality disorder - low self-esteem, prone to shame - extremely anxious about being criticized - socially isolated - negative affectivity and detachment - terrified of embarrassment - discount any positive feedback - Dependent personality disorder Anxious about interpersonal interactions, stemming from a deep need to be cared for by others - deny own thoughts and feelings that might displease others - difficulty making decisions for themselves - rely on advice and reassurance - fear of losing relationship supports and independent responsibility Treatment: psychodynamic treatment, humanistic therapy, cbt -> increase assertive behaviors and decrease anxiety - Obsessive-compulsive personality disorder (different from OCD) Base their self-esteem on their productivity and on meeting unreasonably high goals. - Compulsive - Perfectionistic - Persist in a task even when their approach is failing - Difficulty appreciating others - Force others to follow strict standards of performance More general way of interacting with the world than OCD (specific obsessional thoughts, and compulsive behaviors). OCPD view their concerns as part of their personalities. - Tensely in control of their emotions - Workaholics - “Flaws, defects, or mistakes are intolerable” Alternative big 5 model: - Negative affectivity: even-tempered and calm, handle stress vs insecure, overactive to stress (neuroticism) - Detachment: appropriately outgoing and trusting of others - Antagonism: honesty, modesty, concern for others - Disinhibition: tendency to be responsible, organized and cautious - Psychoticism: high unusual beliefs and perceptions, eccentric. Somatic symptom disorder: physiological symptoms that were the result of painful emotions or memories Pseudocyesis: false pregnancy 5 disorders: 1. Somatic symptom disorder 2. Illness anxiety disorder 3. Conversion disorder 4. Factitious disorder 5. Psychological factors affecting other medical conditions SOMATIC SYMPTOM DISORDER Having distressing physical symptoms and spending a great deal of time thinking about these symptoms. People have health concerns that are excessive given their actual physical health, they persist even when evidenced that they are well. ILLNESS ANXIETY DISORDER Similar to the previous one, but people worry that they will develop or have a serious illness but do not always experience severe physical symptoms. Excessive health-related behaviors or maladaptive avoidance: - Care-seeking type - Care-avoidant type People with these disorders often have dysfunctional beliefs about illness, assuming they are common and misinterpret any physical change as a sign for concern. These disorders may be part of PTSD by a person who has survived a severe stressor. Treatment: - Psychodynamic therapy: recalling events that may have triggered symptoms. Eliminate reinforcements while increasing positive rewards for healthy behavior. - CBT: learn to interpret physical symptoms appropriately and avoid catastrophizing. - Mindfulness - Acceptance and commitment therapy - Antidepressants CONVERSION DISORDER (functional neurological symptom disorder) Loss of neurological functioning in a part of their bodies, not due to medical causes. Paralysis, blindness, mutism, seizures, loss of hearing… Diagnosis criteria: - at least 1 symptom if altered motor or sensory function not due to a condition Glove anesthesia: loss of feeling in one hand, as if wearing a glove. A person can have repeated episodes of conversion involving different parts of the body. “Conversion disorder” = a psychological distress is converted into a physical symptom Primary gain -> reduction in anxiety Secondary gain -> reinforcing conversion symptoms La belle indifference: unexpected lack of concern or emotional distress about their symptoms. Physical symptoms represent traumas the soldiers had witnessed. Treatment: - Psychoanalytic treatment - CBT: relieving anxiety FACTITIOUS DISORDER Faking an illness specifically to gain medical attention and play the sick role. (to gain medical attention) Malingering: faking a symptom in order to avoid an unwanted situation ( to avoid situations) Factitious disorder imposed on another: when an individual falsifies illness in another Dissociation: a process in which components of mental experience are split off from consciousness but remain accessible through dreams and hypnosis DISSOCIATIVE IDENTITY DISORDER Alters Host Persecutor personality: inflict pain or punishment on other personalities by self-mutilation. Protector personality: to offer advice or perform functions the host personality is unable to perform. Dissociative fugue: travelling to a new place and assuming a new identity with no memory of their previous identity. Treatment: goal is to integrate all alters into one coherent personality and rebuild capacity for coping with stress. DISSOCIATIVE AMNESIA Amnesia during periods where alters are in control Organic amnesia: brain injury, disease, drugs… Anterograde amnesia: inability to remember new information Psychogenic amnesia: in absence of any brain injury, but cause of psychological causes Retrograde amnesia: inability to remember information about the past. DEPERSONALIZATION / DEREALIZATION Feeling detached from their own mental processes or body, as if being outside observers of themselves. Genome: complete set of genes an organism possesses Eugenics: notion that we can design the future of the human species by fostering the reproduction of people with certain traits. Percentage of variance: individuals vary from each other Heritability: degree to which genetic differences between individuals cause differences in an observed property. (refers to differences in a sample, not to an individual) Heritability is a way to measure how much of the differences we see in a trait (like height, personality, or intelligence) among people are due to their genes, rather than their environment. If heritability is 50%, it means half of the differences between people in that trait are because of their genes, and the other half is because of things like upbringing, culture, or life experiences. It’s about groups of people, not one person. Phenotypic variance: observed individual differences Genotypic variance: individual differences in total collection of genes possessed. (heritability of 0.5 means that 50% of observed phenotypic variance is attributable to genotypic variation). Environmentality: percentage of observed variance in a group of individuals attributed to environmental differences. (the larger the heritability > the smaller the environmentality) Selective breeding: identifying dogs with desired characteristics and having them mate with similar dogs. Family studies: degree of genetic relatedness among family members with degree of personality similarity. (flaw -> families share an environment) Twin studies: estimate heritability by gauging whether identical twins are more similar than fraternal twins (share 50% of genes). Monozygotic twins (identical): come from a single zygote (fertilized egg) Dizygotic twins (fraternal): come from 2 eggs separately fertilized Equal environments assumption: if environments experienced by identical twins are no more similar to each other than are the environments experienced by fraternal twins. Adoption studies: correlations between adopted children and adoptive parents (evidence environment influences personality). Selective placement: if adopted kids are placed with adoptive parents who are very similar to their biological parents. This could make it look like the adoptive parents' environment has a bigger effect than it really does. Genes can influence: - Smoking & drinking - Marriage Genotype-environment interaction: differential response of individuals with different genotypes to the same environments. Genotype-environment correlation: differential exposure of individuals with different genotypes to different environments. the ways in which an individual's genetic makeup influences their exposure to specific environments. - Passive: when parents provide both genes and environment to children, but the children do nothing to obtain that environment. - Reactive: when parents respond to children differently, depending on their genotypes. - Active: a person with a particular genotype seeks out a particular environment. Molecular genetics: identifies the specific genes associated with personality traits D4DR: short arm of chromosome 11, codes for a dopamine receptor. Association with a personality trait -> novelty seeking since people with long D4DR genes are a bit unresponsive to dopamine. (not entirely confirmed, there are studies that prove the opposite) Traits: internal properties of persons that cause their behavior 2 major formulations of traits: 1. Traits = internal causal properties of persons that affect overt behavior 2. Traits = descriptive summaries of overt behavior Act nomination: procedure designed to identify which act belongs in which trait categories. Prototypicality judgment: identifying which acts are most central to each trait category Recording of Act Performance: securing information on the actual performance of individuals in their daily lives. Identification of most important traits:  - Lexical approach: starting point is the natural language. Words are invented over time for differences among people that are important. A trait is more important if it has synonym frequency and cross-cultural universality. - Statistical approach: used statistical procedures -> having people rate themselves on items to identify the major dimensions. Factor analysis: identifies groups of items that covary but tend to not covary with other groups of items. Factor loadings: indexes (numbers) of how much of the variation in an item is explained by the factor. - Theoretical approach: relies on theories and dictates in a highly specific manner which variables are important to measure. Hans Eysenck Developed a model of personality based on traits he considered highly heritable = PEN Extraversion-introversion (E) neuroticism-emotional stability (N) (respond more negative to stress, prone to disorders) Psychoticism (P) (insensitive, aggressive, disregard danger, antisocial) Hierarchical structure: 1. Super trait 2. Narrow traits 3. Habitual acts 4. Specific acts (if repeated frequently they become habitual) Cattell’s Taxonomy: the 16 personality factor system True factors should be found across self-reports and lab tests. Factors A-O and Q1-Q4 Criticized cause a smaller number of factors can capture the most important ways in which individuals differ. Circumplex taxonomies of personality Timothy Leary Jerry Wiggins - one kind of individual difference pertains to what people do to each other -> interpersonal traits. Other kinds of individual differences are specified by: temperament, character, material, attitude, mental & physical. The 2 resources that define social exchange are: - Love: emotional consequences - Status: clear-cut social status This model has an advantage of providing explicit and precise definition of interpersonal transactions. It also specifies the relationships between each trait. 3 types or relationships specified: 1. Adjacency: how close traits are to each other in the circumplex 2. Bipolarity: at opposite sides of the circle and negatively correlated 3. Orthogonality: traits that are perpendicular to each other -> 0 correlation Five-Factor model Fails to capture underlying causal personality processes I. Surgency/extraversion II. Agreeableness III. Conscientiousness IV. Emotional stability (neuroticism) V. Openness-intellect Measured in 2 ways: self-ratings of single-word adjectives and self-ratings of sentence items Surgency or extraversion: social attention Agreeableness: “let’s all get along” (opposite = aggressiveness) Conscientiousness: industrious and get ahead, hard working bla bla bla Emotional stability: cope with stresses Openness or intellect: experimentation, new experiences Personality-descriptive nouns Dumbbell babe/cutie Philosopher Lawbreaker Joker Jock psychopathology: focuses on atypical/unexpected behaviors Dysfunction: interfere daily Distress: in oneself or others Deviance: deviations from social norm Dangerousness Cultural relativism: there are no universal standard or rules for labeling a behavior abnormal - biological theories: view abnormal behavior as similar to physical diseases - supernatural theories: view abnormal behavior as a result of divine intervention - psychological theories: view abnormal behavior as a result of psychological processes trephination: drilling hole into skulls using a trephine Human body said to contain a positive force (yang) and a negative force (yin) “Wandering Uterus” attributed only to women: the uterus was believed to wander around the body like an animal, hungry for semen, creating physical ailments. This was later named hysteria (hystera -> uterus). Marriage, intercourse & pregnancy were the ultimate treatment. psychic epidemics: phenomenon in which large numbers of people engage in unusual behaviors that appear to have a psychological origin mental hygiene movement: humane treatment for mental health general paresis: a disease that led to paralysis, insanity & death behaviorism: study of impact of reinforcements and punishments on behavior patient’s rights movement -> deinstitutionalization (integration into communities) halfway houses: long-term mental health opportunity to live in a supportive environment day treatment centers: partial hospitalization programs Managed care: a collection of methods for coordinating care that ranges from simple monitoring to total control over what care can be provided and paid for. According to the diathesis-stress model, the creation of a disorder requires both an existing diathesis to a disorder and a trigger, or stress. Transdiagnostic risk factors: factors that increase risk for psychological problems Cerebral cortex (outer layer of cerebrum) Subcortical structures (under cerebrum): Thalamus: directs information from sense receptors to cerebrum Hypothalamus: regulates eating, drinking, and processing basic emotions Limbic system: structures that regulate behaviors Amygdala: emotions Hippocampus: memory Reuptake: initial neurons releasing neurotransmitters into the synapse reabsorb the neurotransmitters, decreasing the amount left in the synapse Degradation: receiving neurons release an enzyme into the synapse that breaks down the neurotransmitter into other biochemicals Serotonin Dopamine Norepinephrine (coke and amphetamine prolong its action by slowing its reuptake process) GABA (inhibits action of other neurotransmitters) Pituitary gland: produces largest number of different hormones Polygenic: critical number of altered genes come together Epigenetics: environmental conditions that affect the expression of heritable genes Antipsychotic drugs: reduce the symptoms of psychosis Antidepressant drugs: reduce symptoms of depression SSRI (selective serotonin reuptake inhibitors) SNRI (selective serotonin-norepinephrine reuptake inhibitors) Side effects: diarrhea, nausea, headache, tremor, agitation, sexual dysfunction, daytime sedation Lithium: mood stabilizer Side effects: nausea, blurred vision, diarrhea, tremors, twitches. Anticonvulsants: treatment of mania Antianxiety drugs: benzodiazepines Electroconvulsive therapy (ECT): brain seizure is induced by passing electrical current through the brain Repetitive transcranial magnetic stimulation (rTMS): high-intensity magnetic pulses focused on particular brain structures. Psychosurgery: prefrontal lobotomy (frontal lobes are severed from lower centers) Behavioral approaches: Focus on the influence of reinforcements and punishments in producing behavior. - Classical conditioning: US -> stimulus that naturally produces a response UR -> response created by the US. CS -> previous neutral stimulus CR -> response that the previous elicits - Operant conditioning: behaviors followed by a reward are strengthened (law of effect). Continuous reinforcement schedule (behaviors are continuously paired with a reward/punishment). Partial reinforcement schedule: only sometimes in response to behavior. Extinction: eliminating a learned behavior Modeling: learn behaviors from imitating behaviors modeled by important people Observational learning: a person observes the rewards and punishments that another person receives for their behavior and then imitates it. Systematic desensitization therapy: gradual method for extinguishing anxiety responses to stimuli Causal attribution: answer to why an event happened Cognitive-behavioral therapy (CBT): cognitive + behavioral techniques Id: system from which libido emerges, and its drives and impulses seek immediate release (pleasure principle) Ego: force that seeks to gratify our wishes and needs within constraints (reality principle) Superego: rules and regulations for conducting behavior Oedipus complex: boys become sexually attracted to their mother and hate their father as a rival Electra complex: girls develop attraction for their father in hopes he will provide the penis they lack (HELLO????) Object relations: early relationships create unconscious mental images Classic psychoanalysis - 3/4 sessions a week over many years (interpretation of transferences and resistances Modern psychodynamic therapy - years or even 12 weeks (current situations in client’s life and symptom relief) Dialectical behavior therapy focuses on difficulties in managing negative emotions and controlling impulsive behaviors Assessment: process of gathering information about people’s symptoms and its causes Diagnosis: label for a set of symptoms that occur together Validity: accuracy of a test in assessing what it is supposed to measure - Concurrent validity: test yields the same results as other measures - Predictive validity: test predicts the behavior it is supposed to measure - Construct validity: measures what it is supposed to measure Reliability: indicates consistency in measuring what it is supposed to measure - Test-retest reliability: consistency of results of a test over time - Internal reliability: different parts of the same test produce similar results - Alternate form reliability: two versions produce similar results - Interrater reliability: 2+ judges who score a test come to similar conclusions Personality inventories: questionnaires meant to assess people’s typical ways of behaving. CT - computerized tomography: x ray beams pass through the head from different angles PET - positron-emission tomography: picture of activity in the brain through injecting radioactive isotope MRI - magnetic resonance imaging: no radiation exposure and provides image of brain at every angle EEG - electroencephalogram: measures electrical activity along the scalp by firing specific neurons Projective test: when presented with an ambiguous stimulus (drawing) they will interpret it in line with their current feelings comorbidity: meeting the criteria for another disorder when diagnosed with one. 2 mood disorders: 1. bipolar disorders 2. depressive disorders anhedonia: loss of interest in life major depressive disorder 2 weeks+ persistent depressive disorder most of the day, for more days than not for 2 years Depression subtypes - anxious distress - mixed features - melancholic features (physiological symptoms) - psychotic features (delusions)  - catatonic features (strange behaviors - mutism. posturing, agitation) - atypical features (odd symptoms - hypersomnia, weight gain) - seasonal pattern SAD - peripartum onset premenstrual dysphoric disorder: mix of depression, anxiety, irritability, mood swings… Bipolar disorder - bipolar I disorder: experience mania - bipolar II disorder: experience hypomania (mild manic eps - 4 days max) - cyclothymic disorder: alternate b/w hypomanic and depressive symptoms - 2y - rapid cycling bipolar disorder: 4+ mood episodes that meet criteria for manic, hypomanic or MDE within 1 year hypothalamic-pituitary-adrenal axis = HPA axis : fight-or-flight response Sociocultural theories Cohort effects: psychological variable depends on era in which they were born Gender differences Ethnicity/race differences Treatments: drugs, electroconvulsive therapy (ECT), transcranial magnetic stimulation (rTMS), vagus nerve stimulation & deep brain stimulation drugs - selective serotonin reuptake inhibitors: less worse side effects and safer if taken in overdose - selective serotonin & norepinephrine reuptake inhibitors: slight advantage in preventing a relapse of depression - bupropion; norepinephrine-dopamine reuptake inhibitor: for ppl w psychomotor retardation, anhedonia, hypersomnia… - tricyclic antidepressants: lots of side effects, fatal in overdose - monoamine oxidase inhibitors: no longer used for depression, dangerous side effects Mood stabilizers (relieve symptoms of mania) Lithium: improves functioning of intracellular processes, but small difference b/w an effective dose and a toxic dose. Anticonvulsant & atypical antipsychotic medications: valproate reduces seizures and stabilizes mood, doesn’t prevent suicide effectively Electroconvulsive therapy: for schizophrenia initially, now also depression and other mood disorders. A brain seizure is induced by passing electrical current through the patient’s head. Can lead to memory loss and difficulty learning new information. High rate of relapse. rTMS - repetitive transcranial magnetic stimulation: exposure to high-intensity magnetic pulses focused on particular brain structures (noninvasive). Targets left prefrontal cortex in depression Vagus nerve stimulation (VNS): the vagus nerve is stimulated by a small electronic device (kinda pacemaker) that is surgically implanted under the patient’s skin in the left chest wall. (might have antidepressant effects) Deep brain stimulation: electrodes are surgically implanted deep into the brain and connected to a pulse generator placed under the skin, stimulating brain areas (barely works) Light therapy: exposure to bright light for a few hours each day during winter Psychological treatments for mood disorders: Behavioral therapy: focuses on increasing positive reinforces and decreasing aversive experiences by changing patterns of interactions with the environment (12 weeks = 3 months). Cognitive-behavioral therapy: blending of cognitive & behavioral theories of depression. Aims to change the negative patterns of thought and then solve concrete problems in life (6-12 weeks) Interpersonal therapy: therapists look for 4 types of problems in depressed individuals. 1. Loss of a loved one (breakup, death…) 2. Interpersonal role disputes (modify patterns of communication) 3. Role transitions (from college to work…) 4. Deficits in interpersonal skills Interpersonal & social rhythm therapy (ISRT): enhancement of interpersonal therapy for people with bipolar disorder Family-focused therapy (FFT): reduce interpersonal stress in people with bipolar disorder but within context of families Suicide “Death from injury, poisoning, or suffocation where there is evidence that the injury was self-inflicted and that the decedent intended to kill themself” NSSI - nonsuicidal self-injury Emile Durkheim proposed there are 3 types of suicide: - egoistic suicide: people who feel alienated from others and are alone in an unsupportive world - anomic suicide: people who experience severe disorientations bc of a major chance in their relationship to society. anomie = complete confusion of one’s role in society - altruistic suicide: people who belive that taking their life will benefit society Epilepsy is the illness most strongly related to suicidal thoughts Schizophrenia spectrum & other psychotic disorders Psychosis: unable to tell the difference between what is real and unreal SCHIZOPHRENIA Form of psychosis where thinking & speech are disorganized, lose touch with reality and difficulty caring for themselves. Symptoms Positive symptoms: –Delusions: ideas that an individual believes are true but are highly unlikely. Self-deceptions are at least possible and occasional and they know it might be wrong. - Persecutory delusion: belief that one is being persecuted - Delusion of reference: belief that events have an unusual personal significance - Grandiose delusion: belief that one has great power - Delusion of being controlled: belief that one’s behavior is being imposed/controlled - Thought broadcasting: thoughts are being broadcast for every one to hear - Thought insertion: something else is inserting thoughts into one’s mind - Thought withdrawal: thoughts are being removed - Delusion of guilt or sin: belief one has committed a terrible act - Somatic delusion: part of one’s body is diseased or altered –Hallucinations: unreal perceptual experiences - Auditory: hearing sounds - Visual: seeing shit - Tactile: perception that something is happening to the outside of the person’s body - Somatic: something is happening inside the person’s body –Disorganized thought and speech: formal thought disorder. Slipping from on topic to one unrelated with little coherent transition (loose associations / derailment). Neologisms -> making up words that only mean something to oneself. Clangs -> make associations of words rather than on content –Disorganized or catatonic behavior: catatonia -> unresponsiveness to the environment Negativism -> lack of response to instructions Mutism -> lack of response Catatonic excitement: excessive motor activity for no reason Negative symptoms: –Restricted affect: severe reduction in absence of emotional expression. They experience anhedonia (loss of ability to experience pleasure) –Avolition/asociality: inability to initiate at common goal-directed activities (being slowed down or unmotivated) Diagnosis Prodromal symptoms: before the acute phase Residual symptoms: after the acute phase A. Two or more of these symptoms during 1 month. At least one must be 1, 2 or 3 - Delusions - Hallucinations - Disorganized speech - Grossly disorganized or catatonic behavior - Negative symptoms B. Low level of functioning C. Signs of disturbance for at least 6 months (1 month of symptoms of criterion A) Prognosis Life expectancy 10-20 years shorter than average Women with schizophrenia have a better prognosis than men Other psychotic disorders –Schizoaffective disorder: mix of schizophrenia + mood disorder (psychotic symptoms & mood symptoms). Diagnosis: A. Uninterrupted period of illness with a major mood episode current with c.A of schizo. B. Delusions/hallucinations for 2 or more weeks in absence of major mood episode –Schizophreniform disorder: experience confusion but not blunted Diagnosis A. Criteria A, D, E of schizophrenia are met B. An episode lasts at least 1 month but less than 6 –Brief psychotic disorder: sudden onset of delusions, hallucinations, etc. But only for 1 day to 1 month –Delusional disorder: delusions lasting at least 1 month regarding situations irl. Show no other psychotic symptoms –Schizotypal personality disorder: lifelong pattern of significant oddities in their self-concept, social relationships, thoughts & behavior. Perceive other people as deceitful and hostile. They have episodes symptomatic of brief psychotic disorder. Factors Schizophrenia can be hereditary (genes play a role). Birth complications-> perinatal hypoxia (oxygen deprivation at birth or right after) Prenatal vital exposure-> mothers exposed to viral infections while pregnant Dopamine Drugs that reduce symptoms of schizophrenia -> phenothiazines, neuroleptics : block reuptake of dopamine Stress Immigration Treatment Neuroleptics (antipsychotic drug) Chlorpromazine -> calms agitation and reduces hallucinations/delusions Positive symptoms are more easily treated effectively than negative symptoms. Medication does not work for everyone Akinesia = slowed motor activity Akathisia = agitation making you pace and unable to sit still Tardive dyskinesia = involuntary moves of the tongue, face, mouth, or jaw. Atypical antipsychotics: clozapine, influences dopamine and serotonin CBT (operant conditioning) Family therapy Assertive community treatment programs Anorexia nervosa Starve themself, eat little or no food for long periods of time, convinced they need to lose more weight. Amenorrhea: loss of menstrual period  - Distorted image of body - Fear of gaining weight Diagnosis criteria: Restriction of energy intake leading to low body weight. Fear of gaining weight Body dysmorphia Low body weight (BMI lower 18.5) - restricting type: no binging or purging, weight loss accomplished through dieting/fasting - binge-eating/purging type: binge eating or purging Bulimia nervosa Bingeing followed by behaviors to prevent weight gain from the binges 1-3 episodes of inappropriate compensatory behavior per week -> mild 4 or more episodes per week -> extreme - Realistic self image - Self-induced vomiting Diagnosis criteria Binge eating: large proportions, longer times, lack of control Behaviors to prevent weight gain ^^ at least 1 per week for 3 months Binge-eating disorder Eat continuously throughout the day, no planned mealtimes. Eat rapidly and in large amounts. - Eating in a daze (blackout kinda) - Overweight - Chronic Other specified feeding or eating disorder Atypical anorexia nervosa: meets all criteria for anorexia nervosa except weight Bulimia nervosa of low frequency and/or duration: binge eating less than once a week Night eating disorder: eating excessively after dinner and into the night Sleep-eat: being unaware of eating Obesity A BMI of 30+ Treatments Psychotherapy for anorexia nervosa: long and difficult process - Cbt - Family therapy Psychotherapy for bulimia nervosa and binge eating disorder: - Cbt (3-6 months, 10-20 sessions) - IPT: interpersonal therapy - Supportive expressive psychodynamic therapy - Behavioral therapy SSRIs Stress: subjective feeling produced by events that are uncontrollable or threatening. Interactional model: objective events happen to people, but personality factors determine the impact of those events by influencing people’s ability to cope. Transactional model: personality has 3 potential effects: 1. Influence coping 2. Influence how a person interprets events (environment) 3. Influence events themselves Health behavior model: adds another factor to the transactional model. Personality affects health indirectly, through health-promoting or degrading behaviors. Predisposition model: personality and illness are both expressions of an underlying predisposition. Associations exist between personality and illness bc of a third variable. Illness behavior model: action that people take when they think they have an illness Stressors: events that cause stress General adaptation syndrome: GAS - Alarm stage: fight-or-flight response of the sympathetic nervous system - Resistance stage: if the stressor continues, the body uses its resources at an above average rate. Stress is being resisted. - Exhaustion stage: susceptibleness to illness and disease Four varieties of stress: Acute stress: from sudden onset of demands and expressed in tension headaches, emotional upsets, gastrointestinal disturbance… Episodic acute stress: repeated episodes of acute stress Traumatic stress: massive instance of acute stress (PTSD) Chronic stress: stress that does not end Stress has additive effects -> the effects of stress add up and accumulate over time. In order for stress to be evoked for a person, two cognitive events must occur: - Primary appraisal: person has to perceive that the event is a threat to their personal goals - Secondary appraisal: person concludes they don't have the resources to cope with the demands of the threatening event. Optimism negative life events are unstable (temporary) and specific and they actually influence outcomes in life (external factors) Pessimism: negative events are stable, global and internal (personal flaws), Helpless Dispositional optimism: expectation that good events will be plentiful in the future, and bad events will be rare in the future. Self-efficacy: belief that one can do the behaviors necessary to achieve a desired outcome. Optimistic bias: belief that one is at lower risk for negative events than the average person Disclosure: telling someone about a private aspect of oneself Type A personality: high chance heart disease - syndrome of several traits. 3 subtraits 1. Competitive achievement motivation: work hard and achieve goals 2. Time urgency: hate wasting time 3. Hostility: blocked from attaining their goals -> frustration Arteriosclerosis: build up of fat molecules on the inside of arteries, blocking the arteries. ○ Mental health Neuroticism precedes anxiety Neurotic cascade - the recurrence of states of anxiety and depression (Suls and Martin) - aka stuff that make you more vulnerable to develop psychopathology □ Heightened reactivity to signs of threat □ Being exposed to more negative events □ Tendency to appraise neutral and positive events in negative terms □ Negative mood in one area of life spills into another one □ Excessive rumination, intolerance of uncertainty □ Lower emotional clarity □ Use negatively toned life narratives - everything will result in negative outcomes The healthy personality □ Bleidorn - low neuroticism, high extraversion, high on conscientiousness, high agreeableness, high openness Telemetry: a process by which electrical signals are sent from the participant to the polygraph through radio waves instead of by wires. Measures of interest: - Electrodermal - Cardiovascular - Brain Electrodermal activity Autonomic nervous system: prepares body for action (sympathetic nervous system -> fight-or-flight response). Electrodermal activity / skin conductance: more water in skin, easier conducts electricity. Some people show skin conductance in absence of external stimuli. Cardiovascular activity Cardiac reactivity: blood pressure and heart rate go up during a task in large increases Type A personality: behavior pattern characterized by impatience, competitiveness, and hostility. Brain activity fMRi EEG Extraversion-introversion Ascending reticular activating system (ARAS): structure in the brainstem thought to control overall cortical arousal. Arousal level Arousability: arousal response Sensitivity to reward and punishment Reinforcement sensitivity theory: alternative biological theory of personality Behavioral activation system (BAS): responsive to incentives (cues for reward), approach motivation (sensitive to reward), responsible for impulsivity. Behavioral inhibition system (BIS): responsive to cues for punishment, inhibits behavior (sensitive to negative emotions) Sensation seeking Tendency to seek out thrilling and exciting activities. Sensory deprivation: the need for sensory input Hebb’s theory of optimal level of arousal: people are motivated to reach an optimal level of arousal. Zuckerman’s Research: some people have a high need for sensation (sensation seekers) Comorbidity: when 2 of more disorders occur simultaneously Monoamine oxidase: responsible for maintaining the proper levels of neurotransmitters High sensation seekers -> low MAO levels. With low MAO levels, sensation seekers have less inhibition in their nervous systems and therefore less control over behavior, etc. Neurotransmitters and personality Dopamine -> pleasure Serotonin Norepinephrine -> activates sympathetic nervous system Cloninger’s Tridimensional Personality model: three personality traits are tied to levels of the three neurotransmitters 1. Novelty seeking: based on low levels of dopamine. 2. Harm avoidance: abnormalities in serotonin 3. Reward dependence: low levels of norepinephrine Morningness-Eveningness Persons in preferences for different times of the day Circadian rhythms: 24 hour all around cycle Free running: no time cues to influence your behavior or biology Short rhythm -> morning persons Long rhythm -> evening persons Brain asymmetry: EEG Alpha wave: oscillates at 8-12 times a second The less alpha wave activity present, the more we can assume that part of the brain was active Left hemisphere -> positive emotions Right hemisphere -> negative emotions Frontal brian asymmetry: can be considered an indicative of underlying biological disposition or trait Cortisol: to assess emotional reactivity Emotions can be defined by 3 components: - Subjective - Accompanied by bodily changes - Action tendencies Emotional states: are transitory, they have a specific cause outside of the person Emotional trait: pattern of emotional reactions that a person consistently experiences in life Categorical approach: primary emotions are the key (irreducible set of emotions) Dimensional approach: we experience various degrees of pleasantness and arousal. gathering of data by having subjects rate themselves (pleasant/unpleasant emotion + high/low arousal) Content: specific kind of emotion a person experiences. Style: the way an emotion is experienced Part of being happy is to have a positive illusion of oneself. Reciprocal causality: causality can flow in both directions Neuroticism is due to a tendency of the limbic system to become easily activated. Anterior cingulate: deep inside towards center of brain Prefrontal cortex: executive control center DIathesis-stress model: there is a pre-existing vulnerability (diathesis) that is present in people who later become depressed. A stressful event must occur in order to trigger depression. Beck’s cognitive theory: cognitive schema (way of looking at the world) distorts the incoming information in a negative way, leading to depression. Neurotransmitter theory of depression: depressed feeling of not having energy might be the cause of neurotransmitter imbalance at the synapses. Hostility: tendency to respond to everyday frustrations with anger Type A is a syndrome (cluster of several traits) Affect intensity: how strong people experience their emotions and are emotionally reactive and variable. Mood variability: fluctuations in emotional lives