Download Abnormal Psychology - The Great Pretender: The Art of Passing

Abnormal Psychology
Lina Medaglia-Miller, Ph.D.
The Great Pretender: The Art of Passing
GSSC 1073
May 2010
The “Big 5” Personality Traits
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Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
• personality disorders represent extreme variations
of OCEAN
The Five-Factor Model of Personality
Openness to Experience
 Down-to-earth – Imaginative
 Uncreative – Creative
 Conventional – Original
 Prefer routine – Prefer variety
 Uncurious – Curious
 Conservative – Liberal
Conscientiousness
 Negligent – Conscientious
 Lazy – Hardworking
 Disorganized – Well-organized
 Late – Punctual
 Aimless – Ambitious
 Quitting – Persevering
Extraversion
 Reserved – Affectionate
 Loner – Joiner
 Quiet – Talkative
 Passive – Active
 Sober – Fun-loving
 Unfeeling – Passionate
Agreeableness
 Ruthless – Soft-hearted
 Suspicious – Trusting
 Stingy – Generous
 Antagonistic – Acquiescent
 Critical – Lenient
 Irritable – Good-natured
Neuroticism
 Calm – Worrying
 Even-tempered – Temperamental
 Self-satisfied – Self-pitying
 Comfortable – Self-conscious
 Unemotional – Emotional
 Hardy – Vulnerable
Defining Mental Disorder
 Defining Mental Disorders
 Discussing Particular Disorders
 Therapy Regimens
Defining Mental Disorder
Three Classic Symptoms of Mental Disorders:
– Hallucinations: false sensory experiences
– Delusions: disorders of logical thinking
– Affective Disturbances: inappropriately
strong or absent emotional response
Defining Mental Disorder
No
Mild
Moderate
Disorder Disorder Disorder
Severe
Disorder
Defining Mental Disorder
•
•
•
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Distress
Maladaptiveness
Irrationality
Unpredictability
Unconventionality
Observer
Discomfort
Defining Mental Disorder
• Reasons for differences in rates of disorders and
types of symptoms -- are there real cultural
differences?
• Personality / cognitive style
• Definitions of mental illness
• Acceptability of mental (as opposed to
physical) distress
• Usage of medical and psychological services
• Views of the origins and treatment of illness
Cultural Perspective
• Can you think of examples of culturallybased behaviours that we would consider
maladaptive?
• Can you think of examples of culturallybased sanctions against behaviours that are
considered maladaptive?
Defining Mental Disorder
Assumptions of the DSM-IV
• Personality pathology is
suited to be classified
into discrete types or
disorders
• These disorders group
themselves into three
clusters
• The diagnostic criteria
naturally fall into the
particular personality
disorders to which they
have been assigned
Defining Mental Disorder
Homosexuality was defined as a disorder in
previous DSM Manuals
David Klonsky – University of Virginia
“The DSM practice of putting expert
opinions into writing and only then
conducting tests of reliability and validity
cannot lead to an acceptable classification
system. Rather it directs scientists to conduct
research on, and practitioners to put their
trust in, diagnostic labels that may or may
not map onto valid constructs that exist in
nature. Instead, researchers must turn to
objective, empirical methodologies to
discover the dimensions or personality
pathology, letting the data fall where they
may and letting the data determine how
personality disorder is best classified”
Types of Mental Disorders
1) Personality Disorders
2) Anxiety Disorders
3) Mood Disorders
4) Other Disorders
(1) Personality Disorders
 Inflexible pattern of inner experience and
outward behavior which deviates markedly
from one’s culture.
 Paranoid, Schizoid, Antisocial, Borderline,
Narcissistic, Histrionic, Avoidant, Dependent
Factsabout
aboutPersonality
PersonalityDisorders
Disorders
Facts
Onset usually late childhood, early adolescence
Causes others distress
Affects behavior in many situations
Poor insight
Little behavior change
General
Diagnostic
Criteria
for
PDs
General Diagnostic Criteria for PDs
 Enduring pattern of inner experience or behavior
that deviates from expectations of culture,
manifested in two or more of the following:
-- cognition (perception of self, others)
-- affectivity (intensity, range of emotions)
-- interpersonal functioning
-- impulse control
 Enduring pattern is inflexible, pervasive in many
situations
General Diagnostic Criteria for PDs
General Diagnostic Criteria for PDs
 Enduring pattern leads to distress, impairment in
important areas of functioning
 Pattern is stable and of long duration, can be
traced back to childhood
 Pattern not better explained by another disorder
 Pattern not due to substance abuse or medical
condition
Types of Personality Disorders (Clusters)
 Paranoid personality
 Schizoid personality
 Schizotypal personality
 Antisocial personality
 Borderline personality
 Histrionic personality
 Narcissistic personality
 Avoidant personality
 Dependent personality
 Obsessive-compulsive personality
(includes impulse-control disorders)
Cluster A
Cluster B
Cluster C
“Cluster A” PDs
 Paranoid, schizoid, and
schizotypal personality disorders
 Marked by eccentricity, odd
behavior, not psychosis
 Share a superficial similarity
with schizophrenia (a milder
version)
People who have been called
eccentric– are these people
disordered?
Cluster A: Odd or eccentric
• Paranoid PD – is a pattern of distrust
and suspiciousness such that others’
motives are interpreted as malevolent
• Schizoid PD – is a pattern of
detachment from social relationships
and restricted range of emotional
expression
• Schizotypal PD – is a pattern of acute
discomfort in close relationships,
cognitive or perceptual distortions, and
eccentricities of behaviour
Paranoid Personality Disorders
 Lack of trust in others
 Fear that friends may be
disloyal, unfaithful
 Being hypersensitive,
overly suspicious,
perceived as hostile
DSM-IV Diagnostic Criteria for Paranoid PDs
Pervasive distrust, suspicion of others, and four or
more of the following:
 suspects, without basis, that others are exploiting, harming,
deceiving
 is preoccupied with unjustified doubts of loyalty or
trustworthiness of people
 is reluctant to confide in others
 reads hidden, demeaning, threatening meaning into benign
actions
 persistently bears grudges
 perceives attacks on reputation
 has unjustified suspicions about fidelity of others
Facts about Paranoid Personality Disorder
Affects 0.5–2.5 percent of population
Sometimes several individuals band
together into groups that share paranoid
beliefs
More common in males
Schizoid Personality Disorder
Enduring pattern of
thinking and behavior
characterized by
 pervasive indifference to
others
 diminished range of
emotional experiences,
expressions
 socially isolated, lacking in
social relationships
DSM-IV Criteria for Schizoid PDs
Detachment from social relationships,
restricted emotions, as indicated by four or
more of the following:
 neither desires nor enjoys social relationships
 prefers solitary activities
 has little interest in sexual experiences
 gets pleasure from few activities
 lacks close friends
 appears indifferent to praise or criticism
 shows emotional coldness, detachment, flat affect
Schizotypal Personality Disorder
Enduring pattern of discomfort with others
and odd, peculiar thinking and behavior
Shares symptoms with both paranoid and
schizoid personality disorders
Most closely linked to schizophrenia
DSM-IV Criteria for Schizotypal PD
Acute discomfort with social
relationships, eccentric behavior, and
five or more of the following:
 ideas of reference
 odd beliefs
 unusual perceptual experiences
 odd speech
 suspiciousness
 inappropriate or constricted affect
 odd or eccentric appearance and behavior
 lack of close friends
 excessive social anxiety
“Cluster B” PDs
Antisocial, borderline,
histrionic, and narcissistic
personality disorders
Being self-absorbed, prone to
exaggerate importance of
events
Having difficulty maintaining
close relationships
Cluster B: Dramatic, emotional, or erratic
• Antisocial PD – is a pattern of
disregard for, and violation of, the
rights of others
• Borderline PD – is a pattern of
instability in interpersonal
relationships, self-image, and affects,
and marked impulsivity
• Histrionic PD – is a pattern of
excessive emotionality and attention
seeking
• Narcissistic PD – is a pattern of
grandiosity, need for admiration, and
lack of empathy
Antisocial Personality Disorder
 Shows a pervasive pattern of
disregard for, and violation of other
people’s rights.
 Up to 3.5% manifest an antisocial
personality disorder (APA, 1994)
 Symptoms: Repeatedly deceitful,
irresponsible with money, impulsive,
tendency to start fights, egocentric, no
regard for safety of self or others.
Antisocial Personality
 Tend to be skillful at manipulating
people.
 Are not distressed by the pain they
cause, often perceived as lacking any
moral conscience.
 “They glibly rationalize their actions
by characterizing their victims as weak
and deserving of being conned or stolen
from” (Comer, 1997)
DSM-IV Criteria for Antisocial PD
Pattern of disregard for
rights of others since age 15,
as indicated by three or
more of the following:
failure to conform to social
norms, respect lawful
behavior
deceitfulness, lying, conning
others for profit or pleasure
impulsivity, failure to plan
ahead
irritability, aggressiveness,
repeated fights
DSM-IV Criteria for Antisocial PD
reckless disregard for
safety of others
consistent
irresponsibility, failure to
honor obligations
lack of remorse
Individual is at least 18 years
old
Evidence of conduct disorder
before age 15
Facts about Antisocial PD
Affects 2.5–3.5 percent of population
More common in men
Highest prevalence among men 25–44 yr old
40 percent of affected men and 24 percent of
affected women were diagnosed with conduct
disorder as children
Causes of Antisocial PD
Genetics
Birth trauma
Sensation-seeking
Family dynamics
Modeling and media
Borderline Personality Disorder
 Characterized by mood shifts,
unstable self-image, and impulsivity.
 2% of the U.S. population suffer
from Borderline personality disorder
(APA, 1994).
 Symptoms: Intense, conflict filled
relationships, overstep relationship
boundaries, fear of desertion,
suicidal thoughts, self-mutilation,
emptiness, boredom, confusion
about identity.
Borderline Personality Disorder
Enduring pattern of thinking, behavior that
involves
instability of mood, self-image, interpersonal
relationships
frantic efforts to avoid real or imagined
abandonment
unrealistically positive or negative opinions
about others (intense relationships or
nonexistance)
Facts about Borderline PD
 Affects 2 percent of
population
 More common in
women
 Threats/actions of selfharm are common
 Attributed to parental
loss or abuse in
childhood
 Treatment mostly
unsuccessful – often
use dialectical behavior
therapy
DSM-IV Criteria of Borderline PD
Instability in relationships, selfimage, marked impulsivity, and
five or more of the following:
frantic efforts to avoid real or
imagined abandonment
pattern of unstable, intense
relationships
identity disturbance
impulsivity in two or more areas
that are self-damaging
DSM-IV Criteria of Borderline PD
recurrent suicidal behavior, gestures, threats
affective instability
chronic feelings of emptiness
inappropriate intense anger
transient, stress-related paranoid ideas
Histrionic Personality Disorder
 Enduring pattern of
thinking, behavior
characterized by excessive
emotionality and
attention-seeking behavior
 Person is typically selfcentered, vain, demanding
 Appears in 2–3 percent of
the population
 Mainly diagnosed in
women
 Person dresses
eccentrically, seductively
DSM-IV Criteria for Histrionic PD
Excessive emotionality,
attention-seeking, and five or
more of the following:
 being uncomfortable when not
center of attention
 rapidly shifting moods
 uses physical appearance to draw
attention
 interactions characterized by
provocative, seductive behavior
 exaggerates in dramatic manner
 is suggestible, easily influenced
 considers relationships more intimate
than they are
Narcissistic Personality Disorder
Enduring pattern of
thinking, behavior
characterized by
grandiosity,
preoccupation with
own achievements
and abilities
DSM-IV Criteria for Narcissistic PD
Grandiosity in fantasy and
behavior, need for
admiration, lack of empathy,
and five or more of the
following:
has grandiose sense of selfimportance
is preoccupied with fantasies of
power, success, love
believes he or she is special or
unique
DSM-IV Criteria for Narcissistic PD
requires excessive
admiration
has sense of entitlement
takes advantage of others
to achieve own needs
lacks empathy
is often envious of others
is arrogant, haughty
“Cluster C” PDs
Avoidant, obsessive-compulsive, dependent
disorders
People are often anxious, fearful, and
depressed
Cluster C: anxious or fearful
• Avoidant PD – is a pattern of social inhibition,
feelings of inadequacy, and hypersensitivity to
negative evaluation
• Dependent PD – is a pattern of submissive and
clinging behaviour related to an excessive need to
be taken care of
• Obsessive-Compulsive PD – is a pattern of
preoccupation with orderliness, perfectionism, and
control at the expense of flexibility
Avoidant Personality Disorder
Enduring pattern of
thinking, behavior
characterized by
pervasive social discomfort
fear of negative evaluation
social isolation
being easily hurt
fear of disapproval
shyness and social
discomfort, but desire for
social contact
avoidance due to fear of
embarrassment or criticism
Obsessive-Compulsive Personality Disorder
Enduring pattern of
thinking, behavior
characterized by
perfectionism,
inflexibility
Preoccupied with
rules, excessively
moralistic,
judgmental
Dependent Personality Disorder
Enduring pattern of
submissive, dependent
behavior
Exceedingly dependent on
others for advice,
reassurance
Feelings of anxiety and
helplessness when alone
Impulse-control disorders
 Impulse control disorders
are considered to be part of
the obsessive-compulsive
spectrum.
 Failure to resist an impulse
or drive
 Experience a build-up of
tension that is only relieved
by acting out the impulse
 Temptation to perform an
act that is harmful to self or
others
 Not diagnosed when PD
diagnoses are more
appropriate
A young woman stripping in front of a
crowd of young men on Spring break,
Cancun 2009
Some types of Impulse-control disorders
Intermittent explosive disorder
Kleptomania
Pyromania
Pathological gambling
Trichotillomania
Intermittent explosive disorder
Aggressive outbursts
leading to assaults or
destruction of property
Outbursts are unprovoked
or out of proportion to
event
More common among
men
Actor Mel Gibson
Kleptomania
Theft of worthless
objects
Act of theft is seen
as intrinsically
rewarding
Act relieves tension
Higher rates among
women
Pyromania
Setting fires to
relieve tension and
feel pleasure
Not financially
motivated
More common
among men
Pathological gambling
Excessive gambling
despite continued loss
or family harm
Losses spur further
gambling to win back
losses
Found in 1–3 percent
of the population
Trichotillomania
Pulling out one’s scalp, facial, or body
hair
More common in women
(2) Anxiety Disorders
 Generalized Anxiety
Disorder
 Phobias
 Panic Disorder
 Obsessive Compulsive
Disorder
 Post Traumatic Stress
Disorder
Generalized Anxiety Disorder
 General “free floating”
anxiety about everything
 3.8% of the U.S. population
exhibit symptoms (APA,
1994).
 Symptoms: Restlessness,
Quick to Fatigue, Trouble
Concentrating, Irritability,
Muscle Tension, Sleep
Problems.
Phobia
 Persistent and unreasonable fear
of a particular object or thing
 10-11% of the U.S. population
exhibit symptoms (Magee et al.,
1996).
 Common Phobias: Heights,
Death, Snakes, Interacting with
others, Crowds, injections,
doctors, spiders, flying.
Phobia
Luposlipaphobia:
The fear of being
pursued by
timber wolves
around a kitchen
table while
wearing socks on
a newly waxed
floor
(Gary Larson,
“The Far Side”)
Panic Disorders
 Periodic, discrete bouts of panic
that occur abruptly and peak
within 10 minutes
 2.3 % of the U.S. population
suffer from Panic Disorder
(Weissman et al., 1997)
 Symptoms: Palpitations of the
heart, shortness of breath, chest
pains, choking sensation,
faintness, dizziness
The Scream, Edvard Munch, 1893
Obsessive-Compulsive Disorder
 OCD is classified by some
theorists as an anxiety disorder
 Obsession – Persistent thoughts,
ideas, impulses, or images that
invade consciousness
 Compulsion – Repetitive and
rigid behaviors or mental acts that
a person feels compelled to
perform to reduce distress
 2% of the U.S. population suffer
from OCD (APA, 1994).
PTSD (Posttraumatic Stress Disorder)
 Distinct patterns of behavior
that arise in reaction to a
psychologically traumatic event.
 7.8% of U.S. population will
experience at least one episode in
their lifetime
 Symptoms: Re-experiencing
traumatic event, avoidance,
reduced responsiveness,
increased arousal (anxiety/guilt)
(3) Mood Disorders
 Unipolar depression
 Bipolar Depression
Unipolar Depression
 Severe, long lasting, and
debilitating sadness.
 5-10% of the U.S. population
experiences clinical depression
in a given year (Kessler et al,
1994)
 Symptoms: Feelings of
sadness, loss of sense of
humor, lack of drive, suicidal
thoughts, anxiety, staying in
bed, easily distracted
Bipolar Depression
 Depressive episodes followed by
manic episodes.
 Mania – dramatic and
inappropriate elevations of mood.
 1.5% of the U.S. population
suffers from bipolar depression
(Kessler et al, 1994)
 Symptoms: hyperactivity,
insomnia, arbitrary decision
making, delusions.
(4) Other Disorders
 Memory disorders (Alzheimer’s, Amnesia,
Korsakoff’s )
 Perceptual disorders (Agnosia, Prosopagnosia,
Neglect, Balint’s)
 Language disorders (Broca’s Aphasia, Wernicke’s
Aphasia)
 Physical Disorders (Anorexia, Bulimia, Obesity)
 Misc. (Phantom Limb, Imposter Effect, Autism,
Schizophrenia)
Therapy Regimens
1) Behavioral Therapy
2) Cognitive Therapy
3) Psychoanalytic Therapy
4) Humanistic Therapy
5) Family Therapy
6) Biomedical Therapy
Behavioral Therapy
Why would somebody be
afraid of white furry objects?
Behaviour Therapy
Systematic Desensitization: therapy in which the patient is gradually
introduced to similar things until, finally, the feared object is faced
Behaviour Therapy
Flooding: a therapy in which the patient is
inundated/flooded with many manifestations
or images of the feared object
Behaviour Therapy
Aversion Therapy: associating an unpleasant
experience with the undesired behaviour
+
Ipecac
+
=
Alcohol
=
Sobriety
Behaviour Therapy
 Other Behavioral Therapies
 Social Learning Therapy
 Operant Conditioning Therapy
Cognitive Therapy
Constant Repetition
of Negative
thoughts leads to
abnormality
Cognitive Therapy
Nobody likes me  Even people who like me
occasionally get mad at me
I’m a moron
 I’m smart, even if I do
make some mistakes
I’m worthless
 I’m a good person
My jokes are bad  It’s not my fault the class
has no sense of humor.
Classical Psychoanalytic Therapy
Freud and his couch
•Talking cure
•Family history
•Free association
•Dream analysis
Jungian Analytic Psychology
•Collective Unconcious
•Archetypes
Carl Jung
Humanistic Therapy
The patient best knows
his or her own mind.
The psychologist’s job is
to facilitate self-therapy
Carl Rogers
Humanistic Therapy
The 3 necessary elements of
Humanistic Therapy
1) Unconditional Positive
Regard
2) Genuineness
3) Non-Directive Guidance
Family Therapy
Interpersonal Dynamics lead to Abnormality
•Switch Roles
•Switch Power
structure (as in The
Simpsons)
•Group Discussion
Biomedical Therapy: pharmacology
Biomedical Therapy: psychosurgery
Psychosurgery
Biomedical Therapy: electroconvulsive therapy
Electroconvulsive
Therapy
Induce small seizures
to correct for
chemical imbalances
The End