Download Personality Disorder

Mental Illness
1
Defining Psychological Disorders
When behavior is:
Deviant (atypical)
Distressful
Dysfunctional
(and dangerous)
…it is labeled as a disorder
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Some early treatments of people with
psych disorders
trephination, exorcism, being caged, being
beaten, burned, castrated, mutilated, abandoned
in the wild, or imprisoned
Trephination (boring holes in the skull to remove evil forces)
3
Philippe Pinel & the Medical
Model
• Pinel introduced “talk therapy”
• Medical Model of Mental Illness
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–
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Diagnosed
Symptoms
Cured
Therapy (talk or pharmaceuticals)
• Brain structure/biochemistry  mental
illness
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Biopsychosocial Approach
5
Culture-bound Syndromes
• Share same underlying cause, yet the
manifestation is different
– Anxiety (anorexia vs. susto)
– Stress/guilt (koro vs. nervios)
– Anger (Hwa-byung vs. borderline)
• OR diagnoses vary based on gender
– ADHD versus depression
http://rjg42.tripod.com/culturebound_syndromes.htm
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Diagnostic & Statistical Manual of
Mental Disorders
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
7
Multiaxial Classification
Note 16 syndromes in Axis I
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Multiaxial Classification
Note Global Assessment for Axis V
9
Labeling Psychological Disorders
• Labels may stigmatize individuals
– Discrimination
• Labels bias perceptions
– Job interview study
• People who are told a person has a mental illness are more
likely to interpret their behaviors through that lens
– David Rosenhan study (1973)
• Rosenhan et al pretended to have mental illness
• Biased perceptions change others’ behaviors
– “self-fulfilling prophecy”
• People treat individuals with mental illnesses differently,
resulting in different interactions AND responses, compared to
someone who is “normal”
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Psychological Disorders in the U.S.
Approximately 25% of American
adults suffer from a mental illness
in a given year…
Theodore Kaczynski
(Unabomber)
Jared Loughner
(Arizona Shooter)
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Anxiety Disorders
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Generalized Anxiety Disorder
Panic Disorder
Phobias
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Understanding Anxiety Disorders
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Generalized Anxiety Disorder
1. Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal—sympathetic division
3. Inability to identify or avoid the cause of
certain feelings.
Panic Disorder
Minutes-long episodes of intense dread which may
include feelings of terror, chest pains, choking, or
other frightening sensations.
Anxiety is a component of both disorders. It
occurs more in the panic disorder, making
people avoid situations that cause it.
Panic Disorder-Sleep Paralysis
• Related to paralysis that occurs as a natural part of REM
sleep
– Occurs when the brain awakes from a REM state, but the body
paralysis persists
– Leaves the person fully conscious, but unable to move
– May be unable to move/speak for a few seconds up to a few
minutes
– Some may feel chest pressure or a sense of choking/inability to
breathe
• Symptoms may also include sensations of noises, smells,
levitation, paralysis, terror, and images of frightening
intruders, as a result of dream state overlaying on real
physical world
– Understandably results in panic in the sufferer!!
Phobias
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
Brain Imaging & OCD
Hyper-activity in the
frontal lobe areas
(anterior cingulate
cortex)
--monitors actions
--checks for errors
--ordering
--hoarding
Brain image of an OCD
Hoarding & OCD
• Acquisition and failure to
discard, a large number of
possessions that appear to
be of useless or of limited
value
• Living spaces so cluttered
they preclude activities for
which those spaces were
designed
Post-Traumatic Stress Disorder
4+ weeks of the following symptoms:
1. Haunting memories
2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
Explaining Anxiety Disorders
• Learning Perspective
• Biological Perspective
Learning Perspective
• Fear conditioning
– anxiety becomes associated
with other
objects/events/people (stimulus
generalization)
– Reinforced
• Example: You’re bitten by a
dog as a child and you come to
fear ALL dogs as result
– May also selectively remember
interacting with only “mean
dogs” and forget about the nice
ones. Thus your [faulty]
memory serves to reinforce
your fears
The Learning Perspective
• Investigators believe
that fear responses are
inculcated through
observational learning.
– Young monkeys develop
fear when they watch
other monkeys who are
afraid of various stimuli
– We may learn phobias
from our parents…like a
fear of drowning 
Biological/Evolutionary Perspective
• Twin studies suggest that
our genes may be partly
responsible for
developing fears and
anxiety. Twins are more
likely to share phobias.
Somatoform & DID
• Somatoform Disorders
– Conversion disorder (Freudian based)
• More extreme version of psychosomatic disorders
– Anxiety is converted into a physical symptom
– Makes NO sense physiologically, BUT has real physical
symptoms (i.e. they are NOT faking)
– E.g. person may report losing feeling in a limb, which makes no
neurological sense BUT, if stuck with pins in that limb, would
show no response
– Other examples: unexplained paralysis, blindness, inability to
speak, non-epileptic seizes, etc.
More Somatoform
• Somatoform Disorders
– Hypochondriasis (aka hypochondriac)
• Person regularly interprets normal symptoms as indicative of
terrible disease(s)
– Continuously seeking medical care for their imagined
“illness(es)”
– Sympathy or temporary relief from daily demands reinforces this
behavior
– “Psychosomatic”
• Physical disorder (with physical symptoms) caused/markedly
influenced by mental or emotional factors
– E.g. feeling sick in a class you hate and then feeling better the
minute you leave the classroom
Dissociative Disorders
• Amnesia: Conscious awareness
separated/dissociated from previous memories,
thoughts, & feelings
– Your running narrative of self “shuts off.” Akin to
blacking out, but you’re awake. No memory of self.
• Depersonalization: Also may have memory of
self BUT
– Have a sense of being unreal
– Feel separated from the body
– Watching yourself as if in a movie
Multiple Personality Disorder
(MPD)
A type of dissociative
identity disorder where a
person exhibits two or
more distinct and
alternating personalities
Some supporters believe
that it is a learned
response to trauma that
reinforces reductions in
anxiety
DID Critics
• Critics argue that the
diagnosis of DID
increased in the late
20th century.
• Other critics note that
DID has not been
found in other
countries.
• Some critics believe it
is role-playing by
people open to a
therapist’s suggestion
– i.e., the therapist is
leading them to believe
they have the disorder
Rates of Psychological Disorders
Mood Disorders
Mood Disorders
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•
•
•
Major Depressive Disorders
Dysthymia
Bipolar Disorder
Mania/Manic
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
Signs include:
1.
2.
3.
4.
5.
Lethargy and tiredness
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
Reduced cognitive functioning
Dysthymic Disorder
Lies between blue mood and major depressive disorder.
Characterized by depressive symptoms for most of the
day, more days than not, for at least 2 years.
Symptom-free interval cannot last longer than 2 months
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
Bipolar Disorder
Formerly called manic-depressive disorder,
alteration between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
Bipolar Disorder
Many great writers, poets, composers suffered
from bipolar disorder. During their manic
phases, their creativity surged and dropped off
during their depressive phases.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
Explaining Mood Disorders
Lewinsohn et al., (1985, 1995) note that a theory
of depression should explain:
1. Behavioral and cognitive changes
2. Common causes of depression
Theory of Depression
3. Gender differences
Theory of Depression
4. Depressive episodes self-terminate.
5. Stressful events often precede depression.
6. Depression is increasing, especially in the
teens.
Desiree Navarro/ Getty Images
Post-partum depression
Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
Women are more likely to attempt suicide, however,
men are 2-4 times more likely to succeed because
Biological Perspective
Genetic Influences: Mood disorders run in
families. Rates of depression is higher in
identical (50%) than fraternal twins (20%).
Neurotransmitters & Depression
Reduction of
serotonin has been
implicated in
depression.
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Depression Cycle
1. The negative stressful
events.
2. Pessimistic explanatory
style.
3. Hopeless depressed state.
4. Hampers the way the
individual thinks and acts,
and thus fuels personal
rejection.
Symptoms of Schizophrenia
Literal translation “split mind”. A group of
severe disorders characterized by:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate
behaviors (hallucinations, disorganized or
delusional talking)
Negative symptoms: the absence of appropriate
behaviors (expressionless faces, rigid bodies)
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Marry Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
This monologue illustrates fragmented, bizarre
thinking with distorted beliefs, called delusions
(“I’m Mary Poppins”).
Other forms of delusions include, delusions of
persecution (“someone is following me”) or
grandeur (“I am a king”).
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
In other words, they have difficulty ignoring
irrelevant stimuli (e.g. the hum of machinery,
the texture of the wall, etc.)
Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(flat affect or apathy).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
Onset and Development of
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually displays negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually shows positive
symptoms.
Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
Subtypes of Schizophrenia
Schizophrenia is a cluster of disorders.
Subtypes share some features but there are
other symptoms that differentiate these
subtypes.
Understanding Schizophrenia
Brain scans show abnormal activity in frontal
cortex, thalamus and amygdala of
schizophrenic patients. Also adolescent
schizophrenic patients show brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
Genetic Factors
The likelihood of individuals suffering from
schizophrenia is 50% if their identical twins
have the disease (Gottesman, 1991).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
Genetic Factors
Prevalence of schizophrenia in identical twins
as seen in different countries.
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual was
genetically predisposed (Nicols & Gottesman, 1983).
Genain Sisters
Personality
Disorders
Personality trait
• An enduring pattern of
perceiving, relating to,
and thinking about the
environment and
others.
Personality disorders
• Ingrained patterns of
relating to other
people, situations, and
events with a rigid and
maladaptive pattern of
inner experience and
behavior, dating back
to adolescence or early
adulthood.
The Nature of Personality
Disorders
A longstanding maladaptive pattern of inner
experience and behavior dating back to
adolescence or adulthood that is manifest
in at least two of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
The Nature of Personality
Disorders
At present, each personality disorder is
categorized distinctly in that a person’s
symptoms either fit it or they don’t.
Researchers who argue for a dimensional
approach point out that the most
commonly assigned Axis II diagnosis is
personality disorder not otherwise
specified.
DSM-IV Personality Disorder
Clusters
The DSM-IV includes a set of
separate diagnoses grouped into
three clusters based on shared
characteristics:
• CLUSTER A – The Eccentric Ones
• CLUSTER B – The Dramatic Ones
• CLUSTER C – The Anxious Ones
Because Cluster B disorders have been the most
extensively researched, we’ll start with them.
The Dramatic Ones
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
ANTISOCIAL PERSONALITY
DISORDER
A personality disorder characterized by a
lack of regard for society's moral or legal
standards.
ANTISOCIAL
History
– Philippe Pinel (1801)
- Defect of moral character
– Hervey Cleckley (1941)
- Psychopathy
– Robert Hare (1997)
Psychopathy Check List
– DSM
Goes beyond psychopathy traits
-
ANTISOCIAL
Associated Behaviors
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Deceitfulness
Impulsivity
Unlawfulness
Recklessness
Aggressiveness
Manipulativeness
Lack of remorse
Important Distinctions
• Adult Antisocial Behavior
Illegal or immoral behavior
such as stealing, lying, or
cheating

Criminal
A legal term, not a
psychological concept.
Perspectives on
Antisocial Personality
BIOLOGICAL
– Various brain abnormalities
– Diminished autonomic response to
social stressors
– Possible genetic causes
Perspectives on
Antisocial Personality
PSYCHOLOGICAL
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Neurological deficits related to
psychopathic symptoms
Response modulation hypothesis
Unable to process information not
relevant to their primary goals
Low self-esteem
Perspectives on
Antisocial Personality
SOCIOCULTURAL
• Family variables
• Childhood abuse
• Childhood neglect
TREATMENT OF ANTISOCIAL
PERSONALITY DISORDER
• Address low self-esteem
• Confrontational techniques
• Group therapy
BORDERLINE PERSONALITY DISORDER
A personality disorder characterized
by pervasive instability with a
pattern of poor impulse control.
Instability is evident in mood, interpersonal
relationships, and self-image.
Often sufferers are confused about their own
identity or concept of who they are.
BORDERLINE
Observed characteristics:
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Intense interpersonal relationships
Splitting
Feelings of emptiness
Anger, rage
Identity confusion
Shifting goals, plans, partners
Poor boundaries with others
Risk taking, self injurious behaviors
Parasuicidal
PERSPECTIVES ON BORDERLINE
PERSONALITY
BIOPSYCHOSOCIAL
– Vulnerable temperament
– Traumatic early childhood experiences
– Triggering events in adulthood
BIOLOGICAL
– Hippocampus smaller
– Amygdala smaller
PERSPECTIVES ON BORDERLINE
PERSONALITY
PSYCHOLOGICAL
• Physical or sexual abuse
• Childhood caregiver interaction
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Emotionally unavailable
Inconsistent treatment
Failed to validate their thoughts and feelings
Failed to protect from abuse
Anxious attachment style with mother
PERSPECTIVES ON BORDERLINE
PERSONALITY
PSYCHODYNAMIC
• Poor ego development
• Caregiver overinvolved
yet inconsistent
• Distorted perception of
others
PERSPECTIVES ON BORDERLINE
PERSONALITY
COGNITIVE-BEHAVIORAL
• Splitting
• Low sense of selfefficacy
• Lack of confidence
• Low motivation
• Inability to seek longterm goals

Modern pressures
on family
 Diminished social
cohesion and mental
cohesion
 Unstable family
patterns
TREATMENT OF BORDERLINE
PERSONALITY
• CHALLENGING AND COMPLEX
– Unlikely to remain in treatment long
– Unstable relationships with therapist
• TECHNIQUES
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–
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Confrontive or
Supportive
Dialectical Behavioral Therapy
May need medication
HISTRIONIC
PERSONALITY
DISORDER
A personality disorder
characterized by
exaggerated emotional
reactions, approaching
theatricality, in
everyday behavior.
Melodramatic.
The term
histrionic is
derived from
a Latin word
meaning
“actor.”
HISTRIONIC
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Dramatic, attention-getting behavior
Fleeting, shifting emotional states
More commonly diagnosed in women
Flirtatious and seductive
Need for immediate gratification
Easily influenced by others
Lack analytical ability
Superficial relationships
VIEWS AND TREATMENT OF
HISTRIONIC PERSONALITY
 COGNITIVE-BEHAVIORAL
– Feelings of inadequacy and need for others
– Global nature of thinking underlies diffuse,
exaggerated and changing emotional states
• TREATMENT GOALS
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–
–
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Learn how to think more objectively and precisely
Learn self-monitoring strategies
Learn impulse control
Acquire assertiveness skills
NARCISSISTIC
PERSONALITY
DISORDER
Personality disorder characterized by an
unrealistic, inflated sense of selfimportance and lack of sensitivity to other
people’s needs:
• egotistical
• arrogant
• exploitative of others
Named for Greek legend of Narcissus.
NARCISSISTIC SUBTYPES
Noting the many types of behaviors
involved, Millon and colleagues proposed
subtypes:
• elitist
• amorous
• unprincipled
• compensatory
THEORIES OF NARCISSISTIC
PERSONALITY
Freudian
– Stuck in early psychosexual stages
Cognitive-Behavioral
– Lack insight into or concern for feelings of others
– Grandiose sense of self clashes with real world
failures
TREATMENT OF NARCISSISTIC
PERSONALITY
PSYCHODYNAMIC and COGNITIVEBEHAVIORAL therapies overlap in their
goals for the client:





Reduce grandiose thinking.
Develop more realistic view of self.
Develop more realistic view of others.
Enhance ability to relate to others
Avoid demands for special attention
The Eccentric Ones
Paranoid Personality
Schizoid Personality
Schizotypal Personality
PARANOID PERSONALITY
DISORDER
• SUSPICIOUSNESS
• GUARDEDNESS
• PROJECTION OF NEGATIVITY AND
DAMAGING MOTIVES ONTO OTHERS
• ATTRIBUTION OF THEIR PROBLEMS
TO OTHERS
• LOW SELF-EFFICACY
TREATMENT OF PARANOID
PERSONALITY
COGNITIVE BEHAVIORAL
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COUNTER ERRONEOUS THINKING
ESTABLISH TRUSTING RELATIONSHIP
INCREASE FEELINGS OF SELF-EFFICACY
REDUCE VIGILANT AND DEFENSIVE STANCE
INSIGHT INTO OTHERS’ PERSPECTIVES
APPROACH CONFLICT ASSERTIVELY
IMPROVE INTERPERSONAL SKILLS
SCHIZOID
PERSONALITY
DISORDER
Main characteristic: Indifference to social
relationships, as well as a very limited
range of emotional experience and
expression.
SCHIZOID
• INDIFFERENCE TO SOCIAL AND SEXUAL
RELATIONSHIPS
• SECLUSIVE; PREFER TO BE ALONE
• NO DESIRE TO LOVE OR BE LOVED
• COLD, RESERVED, WITHDRAWN
• INSENSITIVE TO FEELINGS OF OTHERS
TREATMENT:
Unlikely to seek or respond to therapy.
SCHIZOTYPAL
PERSONALITY
DISORDER
Main characteristic:
Peculiarities and
eccentricities of
thought, behavior,
appearance, and
interpersonal style.
SCHIZOTYPAL
PERSONALITY
DISORDER

CONSTRICTED, INAPPROPRIATE
AFFECT
 IDEAS OF REFERENCE, MAGICAL
THINKING
 SOCIAL ISOLATION
 PECULIAR COMMUNICATION
TREATMENT: Parallels interventions
commonly used in treating schizophrenia.
The Anxious Ones
Avoidant Personality
Dependent Personality
Obsessive-Compulsive
AVOIDANT PERSONALITY DISORDER
Most prominent feature:
The individual desires, but is fearful of, any
involvement with other people and is
terrified at the prospect of being publicly
embarrassed.
AVOIDANT - THEORIES
COGNITIVE-BEHAVIORAL
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
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
Hypersensitive due to parental criticism
Feel unworthy of others’ regard
Expect not to be liked
Avoid getting close to avoid expected
rejection
 Distorted perceptions of experiences with
others
TREATMENT OF AVOIDANT
PERSONALITY
COGNITIVE-BEHAVIORAL
– BREAK NEGATIVE CYCLE OF
AVOIDANCE
– CONFRONT AND CORRECT
DYSFUNCTIONAL ATTITUDES AND
THOUGHTS
– GRADUATED EXPOSURE TO SOCIAL
SITUATIONS
– LEARN SKILLS TO IMPROVE CHANCE OF
INTIMACY
DEPENDENT PERSONALITY
DISORDER
Main characteristic: This individual is
extremely passive and tends to cling to
other people to the point of being unable to
make any decisions or to take independent
action.
Others may characterize them as “clingy.”
DEPENDENT
•
•
•
•
Fear of abandonment
Despondent without others
Unable to initiate activities
Insecure about making decisions without
others
• Go to extreme to get approval from others
• Devastated when relationships end
DEPENDENT - THEORIES
Theories
• PSYCHODYNAMIC
– Fixated at oral psychosexual stage because of
parental overindulgence or neglect
• OBJECT RELATIONS
– Insecure attachment to parents led to fear of
abandonment
– Low self-esteem leads them to rely on others
• COGNITIVE-BEHAVIORAL
– Thinking they are inadequate and helpless, they find
someone to take care of them
TREATMENT OF DEPENDENT
PERSONALITY
COGNITIVE-BEHAVIORAL
– Therapist and client develop structured
ways to increase client independence in
daily activities
– Identify skill deficits and improve
functioning
– Therapist must avoid becoming an
authority figure or making client
dependent on therapist
Main characteristic: Perfectionistic
So overwhelmed with their concern for
neatness and minor details that they have
trouble making decisions or getting things
accomplished.
OBSESSIVE-COMPULSIVE
• RIGID BEHAVIORAL PATTERNS
• FANATICAL CONCERN WITH
SCHEDULES
• STINGY WITH TIME AND MONEY
• TENDENCY TO HOARD WORTHLESS
OBJECTS
• LOW LEVEL OF EMOTIONALITY
THEORIES OF
OBSESSIVE-COMPULSIVE
• FREUDIAN
– Fixation at anal psychosexual stage
• OBJECT RELATIONS
– Insecure parent-child attachments
• COGNITIVE-BEHAVIORAL
– Distorted world view
– Unrealistic standard of perfection
TREATMENT: Difficult to treat. Therapy may
reinforce ruminative tendencies.
And in conclusion . . . ?
Personality disorders are
• Chronic and persistent
• Hard to explain
• Difficult to treat
• Subject to much further study
Who’s Yo’ Therapist?
Carrie: Had I crossed the line from pleasantly
neurotic…into annoyingly troubled? I
decided to seek my own professional
[shrink] help.
Stanford: How can you not have a shrink!?!
This is Manhattan, even the shrinks have
shrinks. I have three…
Carrie: You do not.
Stanford: I do! One when I want to be
cuddled…one when I want tough
love…and one for when I just want to look
at a really beautiful man.
Carrie: That’s sick.
Stanford: Which is why I see the other two…
113
Evaluating Psychotherapies
114
Psychological Therapies
Four major forms of psychotherapies based on
different theories of human nature:
1.
2.
3.
4.
Psychoanalytic theory
Humanistic theory
Behavioral theory
Cognitive theory
115
Defense Mechanisms- Ego’s way to reduce
anxiety by unconsciously distorting reality.
1.
2.
3.
4.
5.
6.
Repression banishes anxiety-arousing thoughts, feelings, and
memories from consciousness.
Regression leads an individual faced with anxiety to retreat
to a more infantile psychosexual stage.
Reaction Formation causes the ego to unconsciously switch
unacceptable impulses into their opposites.
Projection leads people to disguise their own threatening
impulses by attributing them to others.
Rationalization offers self-justifying explanations in place of
the real, more threatening, unconscious reasons for one’s
actions.
Displacement shifts sexual or aggressive impulses toward a
more acceptable or less threatening object or persons…
redirecting anger toward a safer outlet.
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Rationalization
Regression
Projection
Reaction Formation
Defense Mechanisms
Denial
Displacement
Oral
ego
Anal retentive
Genital
Psychosexual stages
Personality
(1856-1939)
superego
Latency
id
Phallic
Psychoanalysis
Unconscious mind
Dream analysis
Free association
117
Created a psychological
explanation for nervous
disorders.
Called the
“Psychodynamic
Perspective”
118
Psychodynamic Perspective
Freud’s a series of “firsts”:
•Comprehensive theory of
personality
•Recognizing the
unconscious mind,
•Sexuality in child nature
as psychosexual stages
•Defense mechanisms
119
Personality Structure
Personality develops as a result of our efforts to
resolve conflicts between our biological impulses
(id) and social restraints (superego).
120
Exploring the Unconscious Mind
Lay on the couch and
say whatever comes to
mind (free association)
to tap the unconscious.
Why use this
technique?
121
Because….Retrieval Cues!!
Memories are held in storage by a web of
associations. These associations are like anchors
that help retrieve memory.
water
smell
fire
smoke
Fire Truck
heat
hose
truck
red
122
Another method is interpreting manifest and
latent contents of dreams (dream analysis)
123
Psychoanalysis
Free association leads to
painful, embarrassing
unconscious memories. Via
psychoanalysis, these memories
are retrieved and released
helping the patient felt better.
124
It’s always about
Moth
Psychoanalysis:
Id-Ego-Superego Conflict
Free association--patient edits thoughts
to resist feelings and to resist expresses
emotions. Resistance is important in
analysis of conflict-driven anxiety.
Eventually the patient opens up and
reveals innermost private thoughts to
the therapist, developing positive or
negative feelings (transference) towards
the therapist.
125
Freud believed that personality formed
during life’s first few years divided into
five psychosexual stages.
126
Oedipus Complex
Referencing
Greek play by
Sophocles.
It’s a boy’s sexual
desires toward
his mother and
feelings of threat,
jealousy and
hatred for the
rival father.
Boys cope
with these
feelings by
repressing
them and by
identifying
with the rival
parent (i.e.
the father).
127
Assessing Unconscious Processes
Psychological instruments (projective tests)
that reveal hidden unconscious mind.
Thematic Apperception Test
(TAT)
People express their inner
feelings and interests through
the stories they make up about
ambiguous scenes.
Rorschach Inkblot Test
Seeks to identify people’s
inner feelings by analyzing
their interpretations of the
blots.
128
Before we begin class, write a quick story (paragraph or
two) about what’s going on in this picture:
129
Criticisms of the Psychoanalytic
Perspective
1.
Personality develops
throughout life and is
not fixed in
childhood.
2.
Freud
underemphasize peer
influence on the
individual which may
be as powerful as
parental influence.
3.
Gender identity may
WHO AM I:
• MY FAMILY SETTLED IN
MIRAMAR, FL., WHEN I
WAS 7, LIVING IN A
HOTEL UNTIL MY
FATHER FINDS WORK. I
WAS PRONE TO SELFINFLICTED KNIFE
WOUNDS – MY ARMS
STILL BEAR THE VISIBLE
SCARS – I STARTED
SMOKING AT 12, LOST MY
VIRGINITY AT 13,
STARTED DOING DRUGS
AT 14 AND EVENTUALLY
DROPPED OUT OF HIGH
SCHOOL AT 16 TO JOIN
THE GARAGE BAND,
130
“THE KIDS.”
Johnny Depp
131
Critiquing the Criticisms of the
Psychoanalytic Perspective
1. Personality develops throughout life and is
not fixed in childhood…BUT there are
aspects that are stable or fixed.
2. Freud underemphasize peer influence on
the individual which may be as powerful as
parental influence...BUT our experience
with our parents does, on some level,
motivate who we will or won’t chose as
friends as well as our life path (e.g.
132
Madonna or Johnny Depp).
Freud and the Unconscious Mind
Modern research shows the existence of
non-conscious information processing.
1.
Schemas that automatically control perceptions and
interpretations.
2.
Parallel processing during vision and thinking.
3.
Implicit memories.
4.
Emotions activate instantly without consciousness.
133
Evaluating Psychotherapies
134
Humanistic Perspective
By 1960s psychologists had become discontented with Freud’s
negativity and the mechanistic psychology of the behaviorists.
Humanistic therapists aims to boost self-fulfillment by helping
people grow in self-awareness and self-acceptance.
Abraham Maslow
(1908-1970)
Carl Rogers
(1902-1987)
135
Maslow’s Hierarchy of Needs
Starting with physiological needs we try to reach the
state of self-actualization fulfilling our potential.
136
Self-Actualizing People are:
•
•
•
•
•
Open
Spontaneous
Loving
Self-Accepting
Productive
137
Unconditional Positive Regard
Carl Rogers also believed in individual's selfactualization tendencies. He said UPD was an
attitude of acceptance of others amidst their failings.
Genuine
Accepting
Empathic
138
Client/Person-Centered Therapy:
“I’m okay—You’re okay”
Therapist listens to the patient in an accepting
and non-judgmental way, addressing their
problems in a productive way and building
his/her self-esteem
Therapist does active listening: echoes, restates,
clarifies patient’s thinking and
acknowledging expressed feelings (aka
“mirroring”)
Success is when the person’s ideal and actual
self are almost alike: the self-concept (i.e.,
http://video.google.com/videoplay?docid=2085790194779298727
“Who am I”) is postive
139
Criticisms of Humanistic Perspective
• Concepts are vague and subjective
– E.g. Maslow’s beliefs about what a selfactualized person looks like
• While, in general, individualism is good, it
can also lead to selfish, indulgent, morally
questionable behaviors
• Naïve in that it denies the evil in human
nature
140
Behavior Therapy
Therapy that applies learning principles to the
elimination of unwanted behaviors. Therapists do not
delve deeply below the surface looking for inner causes.
141
Exposure Therapy
142
Systematic Desensitization:
Here’s a nice, cuddly, STRESSOR
143
Aversive Conditioning:
Negative + Behavior
A type of
counterconditioning
that associates an
unpleasant state with
an unwanted
behavior. With this
technique, temporary
conditioned aversion
to alcohol has been
reported.
144
Operant Conditioning & Token Economy:
“Warden, I’ve been good…my cigarettes please!”
Person exchanges a token of
some sort, earned for
exhibiting the desired
behavior, for various
privileges or treats.
145
Cognitive Therapy:
Don’t “should” on yourself!
146
Example
Explanatory style plays a major role in becoming depressed.
147
Cognitive-Behavior Therapy:
In Your Face!
Alters the way people think and the way they
act.
148
Visualization-Guided Imagery
•
Your thoughts have a direct influence on the way
you feel and behave. If you tend to dwell on sad or
negative thoughts, you most likely are not a very
happy person. Likewise, if you think that your job
is enough to give you a headache, you probably
will come home with throbbing temples each day.
•
Your imagination can be a powerful tool to help
you combat stress, tension, and anxiety.
149
Group Therapy:
“Things I would not tell anyone, I tell the public.”
Can help more people and cost less as clients benefit
from knowing others have similar problems.
150
Hypnotherapy
• Therapist guides you to
remember the event(s)
that led to the first
reaction, separate the
memory from the
learned behavior, and
reconstruct the event
with new, healthier
associations.
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Your Therapist Has Issues…
•
•
•
•
Like his father, Albert Ellis' mother was emotionally
distant from her children. Ellis recounted that she was often
sleeping when he left for school and usually not home
when he returned. Instead of feeling bitter, he took on the
responsibility of caring for his siblings. He purchased an
alarm clock with his own money and woke and dressed his
younger brother and sister.
Albert Ellis had exaggerated fears of speaking in public
and during his adolescence he was extremely shy around
women. At age 19, already showing signs of thinking like a
cognitive-behavioral therapist, he forced himself to talk to
100 women in the Bronx Botanical Gardens over a period
of a month. Even though he didn't get a date, he reported
that he desensitized himself to his fear of rejection by
women.
Freud, a heavy cigar smoker, endured more than 30
operations during his life due to mouth cancer.
Freud also liked him some cocaine: “In my last serious
depression I took cocaine again and a small dose lifted me
to the heights in a wonderful fashion. I am just now
collecting the literature for a song of praise to this magical
substance.”
152