Download Unit 9 Lecture: Personality, Disorder, and Therapy

Intro psych overheads unit 9: personality, disorder, and therapy
1
Personality, Disorder, and Therapy
Personality: an individual’s unique constellation of consistent
behavioural traits.
Traits: durable dispositions to behave in a particular way in a variety
of situations.
- a small number of fundamental traits determine other, more
superficial ones
- Cattell (1950) used factor analysis to derive16 basic traits.
- McCrae & Costa (1987) derived the “Big Five”!
1) extraversion
2) neuroticism
3) openness to experience
4) agreeableness
5) conscientiousness
Freud’s Psychoanalytic theory
 early childhood experiences, unconscious motives and
conflicts, and how people cope with sexual & aggressive urges.
 Freud was controversial for 3 big reasons:
1) said people are not masters of their own minds
2) said we are not the masters of our own destinies
3) offended conservative and Victorian attitudes
Intro psych overheads unit 9: personality, disorder, and therapy
2
 Freud’s Structure of personality
 id: primitive, instinctive, operates according to the pleasure
principle, demands immediate gratification
 ego: decision-making component, operates according to the
reality principle, seeks to delay gratification until appropriate
outlets and situations can be found
o age 1-2
o needs to handle both the id and the superego
 superego: moral component, standards of right and wrong.
o age 3 to 5, internalizing parents’ teachings
o if too demanding, excessive guilt, inadequacy
 Freud’s 3 levels of awareness
1) the conscious: what one is aware of at a particular
point in time
2) the preconscious: material just beneath the surface of
awareness that can be easily retrieved
3) the unconscious: thoughts, memories, desires that
are below conscious awareness but that exert great
influence on behaviour
Carl Jung
 analytical psychology  the unconscious consists of 2 layers:
o the personal unconscious
o the collective unconscious, a storehouse of latent
memory traces inherited from people's ancestral past.
o archetypes: emotionally charged images and thought
forms that have universal meaning
 introverted and extraverted personality types
o Introverts: preoccupied with their own thoughts, feelings,
and experiences
o Extraverts: interested in people and things
Intro psych overheads unit 9: personality, disorder, and therapy
3
Alfred Adler
 individual psychology: the foremost source of human
motivation is a striving for superiority, a universal drive to adapt,
improve oneself, and master life’s challenges.
 Compensation: efforts to overcome imagined or real
inferiorities by developing one’s own abilities.
 Inferiority complex: exaggerated feelings of weakness and
inadequacy due to parental neglect or pampering.
 Overcompensation: trying to conceal feelings of inferiority by
seeking status, power, trappings of success
 Birth order:
o Only children: spoiled by attention from the parents
o Firstborns are “dethroned” by a second child
o Second-borns have to struggle to catch up to the eldest
Behaviourism: scientific psychology should study only observable
behaviour. They explain personality in terms of learning.
Skinner and personality:
- determinism - behaviour is determined by environmental
stimuli
- personality is a collection of response tendencies that are
tied to various stimulus situations
- people are shaped by operant conditioning
- personality is a lifelong journey, as you are shaped by the
contingencies of reward and punishment in your
environment
Bandura’s social learning theory
 while environment does affect behaviour, behaviour also affects
environment.
 reciprocal determinism: internal mental events, external
environmental events, and overt behaviour all influence one
another.
Intro psych overheads unit 9: personality, disorder, and therapy
4
 observation learning: when an organism’s responding is
influenced by the observation of models
o classical & operant conditioning can occur vicariously
o model: a person whose behaviour is observed by
another
o An influential model:
 is respected/liked by the observer
 is seen as attractive, powerful
 is similar to the observer
 gets rewarded for their behaviour
 self-efficacy: belief about one’s ability
o high: people feel confident that they can execute
responses necessary to earn reinforcers
o low: people worry that the necessary responses may
be beyond their abilities
o subjective and specific to certain kinds of tasks
o can influence which challenges people tackle and how
well they perform
o emphasis on warm support , early independence
training, and non-punitive disciplinary techniques
o authoritarian, intrusive, or neglectful parents are likely
to undermine self-efficacy in their kids
Humanism: people can rise above their animal heritage and control
their biological urges; people are rational beings who are not
dominated by unconscious irrational needs
Carl Rogers’ person-centered theory
 the self, or self-concept: a collection of conscious beliefs
about one’s own nature, unique qualities, and typical behaviour.
o incongruence: the degree of disparity between one’s
self-concept and one’s actual experience
Intro psych overheads unit 9: personality, disorder, and therapy
5
 Rogers’ views on Development of the self
o If parents make their love conditional, kids may block out
those experiences that make them feel unworthy of love,
in order to secure parental affection
o if parents make their love unconditional, kids will not block
out unworthy experiences; they feel worthy of affection no
matter what they do
 Rogers’ views on Anxiety and defense:
o the more inaccurate your self-concept is, the more likely
you are to have experiences that clash with it, which
leads to anxiety
Abraham Maslow’s theory of self-actualization
 human motives are organized into a hierarchy of needs: a
systematic arrangement of needs, according to priority, in which
basic needs must be met before less basic needs are aroused.
o when a person satisfies a level of needs, this activates
needs at the next level.
o we have an innate drive toward growth.
o “growth needs”: knowledge, understanding, order, beauty,
self-actualization: the need to fulfill one’s potential.
 The healthy personality: self-actualized people
o at peace with themselves, tuned in to reality
o fresh appreciation of the world
o sensitive to others’ needs
o rewarding interpersonal relationships
o not dependent on others for approval, not afraid to be
alone
o enjoy their work, sense of humour, more “peak
experiences”
o childlike and mature, rational and intuitive, conforming
and rebellious
Intro psych overheads unit 9: personality, disorder, and therapy
6
The Behavioural perspective on Personality
 is it inherited?
Eysenck’s (1967) theory: all aspects of personality emerge form just
three higher-order traits
Extraversion: sociable, assertive, active, lively
Neuroticism: anxious, tense, moody, low in self-esteem
Psychoticism: egocentric, impulsive, cold, and antisocial
 born with differences in the way we physiologically function.
 some people can be conditioned more readily than others.
 this influences the development of personality traits
o e.g. introverts have higher levels of physiological arousal
which makes them more easily conditioned than
extraverts. They acquire more conditioned inhibitions,
which makes them uneasy in social situations.
Behavioural genetics and personality:
 twin studies: heritability estimates range from 40% to 58%.
 shared family environment has very little impact on personality.
o children in the same family experience their home
environments very differently
Evolutionary approach to personality
David Buss (1991): the Big 5 traits had adaptive implications.
 ability to bond with others [extraversion]
 willingness to cooperate and collaborate [agreeableness]
 tendency to be reliable and ethical [conscientiousness]
 capacity to problem-solve [openness to experience]
 ability to handle stress [neuroticism]
Evaluating the biological perspective:
o heritability estimates are just ball-park estimates
o nature and nurture can’t be separated cleanly
o no comprehensive biological theory of personality
Intro psych overheads unit 9: personality, disorder, and therapy
7
Abnormal Behaviour
The Medical Model of Abnormal Behaviour
 behaviour as disease
 critique: Szasz (1974)  “problems in living”, not diseases.
Criteria of abnormal behaviour:
 deviance
 maladaptive behaviour
 personal distress
1952: the American Psychiatric Association unveiled the DSM.
 Current edition: DSM-IV-TR
 5 axes, or dimensions
o Axis 1: clinical syndromes
o Axis 2: personality disorders or mental retardation
o Axis 3: general medical conditions
o Axis 4: psychosocial and environmental problems
o Axis 5: global assessment of functioning scale
Anxiety Disorders: feelings of excessive apprehension and anxiety.
- elevated rates of depression
- 17% of the population
- 4 types
1)




Generalized Anxiety Disorder:
chronic high level of anxiety not tied to any specific threat.
Worries about family, finances, work, personal illness.
trouble making decisions
trembling, tension, diarrhea, dizziness, faintness, sweating,
heart palpitations
2) Phobic Disorder:
 persistent irrational fear of object/situation that presents no
realistic danger.
 fears interfere with everyday behaviour.
 Common phobias: fear of heights, enclosed spaces, storms,
water, animal and insect phobias
Intro psych overheads unit 9: personality, disorder, and therapy
8
3) Panic Disorder and Agoraphobia:
 recurrent attacks of overwhelming anxiety that occur suddenly
and unexpectedly.
 apprehension about when the next attack will happen, which
can escalate to agoraphobia: a fear of going out to public
places
 most are female
4) Obsessive-Compulsive Disorder:
 persistent uncontrollable intrusions of unwanted thoughts
(obsessions) and urges to engage in senseless rituals
(compulsions).
 obsessions can center on inflicting harm on others, suicide,
sexual acts
 compulsions can involve rituals that temporarily relieve anxiety
 specific compulsions are associated with specific obsessions
Mood disorders: emotional disturbances of varied kinds that may
spill over to disrupt physical, perceptual, and thought processes.
 unipolar disorder: emotional extremes at one end of the
continuum - depression.
 bipolar disorder: emotional extremes at both ends of the
continuum - depression and mania.
Major Depressive Disorder
 persistent feelings of sadness and despair and a loss of interest
in previous sources of pleasure.
o Gloomy, hopeless, socially withdrawn, irritable
o Slowness of thought processes, obsessive worrying,
inability to make decisions, negative self-image, selfblame, delusions of guilt and disease
o Less active, tired, trouble sleeping, decreased sex
drive, decreased appetite
o Coexisting anxiety disorders and substance use
disorders are common
Intro psych overheads unit 9: personality, disorder, and therapy
9
 onset can be any time in the life span; median duration is 5
months
 most sufferers(75 - 95%) have more than one episode
 mild version: dysthymic disorder
 lifetime prevalence rate of about 17%
 women are twice as likely as men
Bipolar Disorder
 one or more manic episodes usually accompanied by periods of
depression.
 Manic episode: euphoric, sociable, impatient; racing thoughts,
flight of ideas, impulsive behaviour, talkativeness, self
confidence, impaired judgment, delusions of grandeur;
hyperactive, tireless, less sleep, increased sex drive
 cyclothymic disorder: chronic but relatively mild symptoms
 less common than unipolar - just over 1% of the population
 equal in males and females
 onset peaks between 20 and 29
 20% of bipolar patients exhibit a rapid cycling pattern: 4 or
more manic or depressive episodes within a year
Schizophrenic disorders: delusions, hallucinations, disorganized
speech, deterioration of adaptive behaviour.
 delusions and irrational thought.
o Delusions, delusions of grandeur
o thinking becomes chaotic; “loosening of associations”
 deterioration of adaptive behaviour.
o routine functioning deteriorates
 hallucinations.
o perceptions in the absence of real external stimuli, or
are gross distortions of perceptual inputs.
 disturbed emotion.
o blunted affect; inappropriate; emotionally volatile
Intro psych overheads unit 9: personality, disorder, and therapy
10
Subtypes, course, outcome
1) paranoid type: delusions of persecution, along with
delusions of grandeur
2) catatonic type: striking motor disturbances, ranging from
muscular rigidity (catatonic stupor) to random motor activity
(catatonic excitement)
3) disorganized type: severe deterioration of adaptive
behaviour. Emotional indifference, incoherence, social
withdrawal, delusions centering on bodily functions
4) undifferentiated type: can’t be placed into any of the above
3 categories. Idiosyncratic mixtures of symptoms.
Positive versus Negative Symptoms
 Nancy Andreason (1990): view schizophrenia in terms of
positive or negative symptoms
o Negative symptoms: behavioural deficits, like flattened
emotions, social withdrawal, apathy, impaired attention,
poverty of speech
o Positive symptoms: behavioral excesses or
peculiarities, like hallucinations, delusions, bizarre
behaviour, wild flights of ideas
 a predominance of positive symptoms is associated with better
adjustment prior to onset of schizophrenia and greater
responsiveness to treatment
 however, most patients have both + and – symptoms
Course and Outcome:
 onset is usually in adolescence or early adulthood. It can be
sudden or gradual.
 Males tend to have earlier onset, more hospitalizations, and
higher relapse rates
Intro psych overheads unit 9: personality, disorder, and therapy
11
 3 broad courses
1) some are treated successfully and enjoy a full recovery
2) some have a partial recovery but have relapses and are in
and out of treatment facilities for the rest of the their lives
3) some have chronic problems that can result in permanent
hospitalization
Etiology of schizophrenia
 genetic vulnerability: hereditary factors play a role.
o 48% concordance for identical twins versus 17% for
fraternal twins
o child of 2 schizophrenic parents has a 46% probability of
developing it
o polygenically transmitted vulnerability
 neurochemical factors:
o too much dopamine. Effective drug therapies work by
dampening dopamine activity in the brain
o seratonin may also be implicated
 structural abnormalities in the brain:
o CT and MRI scans show enlarged brain ventricles in
people with chronic schizophrenia
 they may be an effect rather than a cause of
schizophrenia
o thalamus is smaller, shows less metabolic activity
 the neurodevelopmental hypothesis: schizophrenia is
caused in part by various disruptions in the normal maturational
processes of the brain before or at birth
o insults to the brain during prenatal development or birth
can cause subtle damage that elevates a person’s
vulnerability years later
o viral infections, prenatal malnutrition, obstetrical
complications
o Mednick (1988): elevated incidence of schizophrenia in
people who were in their 2nd trimester during a 1957 flu
epidemic in Finland
Intro psych overheads unit 9: personality, disorder, and therapy
12
o Elevated incidence in people who were prenatally
exposed to severe famine during WW II in the
Netherlands
o Schizophrenics more likely to have history of obstetrical
complications
o more likely to have slight physical anomalies suggestive
of prenatal neurological damage
 expressed emotion (EE): the degree to which a relative of a
schizophrenic patient displays highly critical or emotionally
over-involved attitudes toward the patient.
o A family’s EE is a good predictor of the course of the
patient’s illness
o high EE predicts a higher relapse rate
o could be because patients from high EE homes may be
more disruptive
 precipitating stress: high stress precipitates the disorder in
those with biological/psychological vulnerability
Personality Disorders
Personality disorders: extreme, inflexible personality traits that
cause subjective distress or impaired social and occupational
functioning.
The anxious-fearful cluster
 maladaptive efforts to control anxiety and fear about social
rejection.
o avoidant personality disorder (socially withdrawn while
desiring acceptance for others)
o dependent personality disorder (allows others to make
all decisions, subordinates own needs for others)
o obsessive-compulsive personality disorder (rules,
lists, schedules, details; extremely conventional, serious,
formal)
Intro psych overheads unit 9: personality, disorder, and therapy
13
The odd-eccentric cluster
 distrustful, socially aloof, unable to connect with others
emotionally
o schizoid personality disorder (absence of warm, tender
feelings for others; cannot form social relationships)
o schizotypal personality disorder (social deficits and
oddities of thinking, perception, and communication that
resemble schizophrenia)
o paranoid personality disorder (suspiciousness and
mistrust of people, overly sensitive, prone to jealousy)
The dramatic-impulsive cluster
 overdramatizing everything, or impulsiveness
o histrionic personality disorder (dramatic, exaggerated
emotional expressions, seeking attention)
o narcissistic personality disorder (self-important,
success fantasies, expecting special treatment, lacking
empathy)
o borderline personality disorder (unstable self-image,
impulsive, unpredictable)
o antisocial personality disorder (violating others’ rights,
rejecting social norms, few social attachments,
inconsistent work behaviour, exploitativeness,
recklessness)
A closer look at ASPD
 lack an adequate conscience
 more common in men than women
 3-4% of the population
 40% of convicted felons
 others operate within the bounds of the law
 rarely have genuine affection for another person
 sexually predatory and promiscuous
 pursue immediate gratification
 unreliable, unfaithful, inattentive, and undependable
Intro psych overheads unit 9: personality, disorder, and therapy
14
 causes:
o genetic predisposition
o Eysenck (1982): sluggish ANS, leading to slow acquisition
of inhibitions through classical conditioning.
o Inadequate socialization, dysfunctional families with
erratic, ineffective, or abusive discipline
o More likely to come form a home where one or both
parents displays antisocial traits
Therapy
There are 3 major categories of therapy.
1) insight therapies
2) behaviour therapies
3) biomedical therapies
Clients:
 15% of the US population use services in a given year
 anxiety and depression
 everyday problems
 women are more likely than men
 many who need therapy don’t receive it
o lack of health insurance
o stigma of receiving mental health treatment
Therapists
 clinical and counseling psychologists
 psychiatrists
 others: clinical social workers, psychiatric nurses, counselors
Insight therapies
Psychoanalysis: emphasizes the recovery of unconscious conflicts,
motives, and defenses through techniques such as free association
and transference.
Intro psych overheads unit 9: personality, disorder, and therapy
15
Freud:
 unconscious conflicts left over from early childhood
 defense mechanisms to avoid confronting these conflicts
 only partially alleviate anxiety, guilt
Probing the unconscious:
 free association
 Dream analysis
Interpretation: the therapist attempts to explain the inner
significance of the client’s thoughts, feelings, memories, and
behaviors.
Resistance: largely unconscious defensive maneuvers intended to
hinder the progress of therapy because clients don’t want to face up
to the painful, disturbing conflicts in their unconscious.
Transference: client transfers conflicting feelings about important
people onto the therapist.
Client centered therapy (Carl Rogers): emphasizes providing a
supportive emotional climate for clients, who play a major role in
determining the pace and direction of their therapy.
 incongruence between self-concept and reality
 clients are encouraged to respect their own feelings and values
Therapeutic climate
1) Genuineness
2) Unconditional positive regard
3) Empathy
Therapeutic process: client and therapist are equals. Therapist
helps clarify the client’s true feelings.
Intro psych overheads unit 9: personality, disorder, and therapy
16
Cognitive Therapy (Aaron Beck): emphasizes recognizing and
changing negative thoughts and maladaptive beliefs.
 e.g. depression is caused by “errors” in thinking
o blame setbacks on personal inadequacies
o focus selectively on negative events
o make unduly pessimistic projections about the future
o draw negative conclusions based on insignificant events
Goals and techniques
 teach clients to detect their automatic negative thoughts
 train clients to subject these thoughts to reality testing
 help clients use more reasonable standards of evaluation
 4 to 20 sessions
 “homework assignments” to change overt behaviours
Evaluating Insight Therapies
o Evaluating effectiveness is tricky
o insight therapy is better than no treatment or to placebo
Behaviour therapy:
 behaviour is the product of learning
 what has been learned can be unlearned (via classical
conditioning, operant conditioning, observational learning)
Systematic desensitization:
 anxiety response are acquired through classical conditioning
o step 1: build an anxiety hierarchy
o step 2: train the client in deep muscle relaxation
o step 3: client works through the hierarchy, learning to
remain relaxed while imagining each stimulus
 may be encouraged to confront the real thing too
 counterconditioning: reversing the process of classical
conditioning by associating the stimulus with a new conditioned
response, i.e. relaxation
Intro psych overheads unit 9: personality, disorder, and therapy
17
Aversion therapy:
 client endures shocks or drug-induced nausea, paired with a
stimulus that elicits an undesirable response
 alcohol and drug abuse, sexual deviance, gambling, shoplifting,
stuttering, cigarette smoking, overeating.
Biomedical therapies: physiological interventions intended to reduce
the symptoms associated with psychological disorders.
 disorders are caused at least in part by biological malfunctions
 drug treatments (psychopharmacotherapy)
1) antianxiety drugs
2) antipsychotic drugs
3) antidepressant drugs
Antianxiety drugs:
 Valium (diazepam), Xanax (alprazolam) (benzodiazepines)
 overprescribed in the 1970s
 side effects: drowsiness, depression, nausea, confusion,
withdrawal
 Buspar (buspirone)
Antipsychotic drugs:
 Thorazine (chlorpromazine); Mellaril (thioridazine); Haldol
(haloperidol)
 70 to 90% of psychotic patients respond favourably
 can take several months before full effects are seen
 many schizophrenics are on these drugs indefinitely; if they
stop, 2/3 relapse
 side effects: drowsiness, constipation, cotton mouth, Parkinsonlike motor deficits
 tardive dyskinesia: involuntary writhing, tics of mouth, tongue,
face, hands, or feet
 atypical antipsychotic drugs (e.g. clozapine, olanzapine,
quetiapine)
Intro psych overheads unit 9: personality, disorder, and therapy
Antidepressant drugs:
 pre-1987: tricyclics and MAO inhibitors
o beneficial for 80% of depressed patients
o both can cause serious adverse reactions
 post-1987: selective serotonergic reuptake inhibitors (SSRIs)
o slow the reuptake of serotonin at the synapse
o rapid reduction of symptoms, fewer side effects
o also useful for OCD and panic disorder
o side effects: reduced sexual functioning, withdrawal
Lithium: bipolar mood disorders
 can help prevent future episodes of mania and depression
 can bring a person out of a current manic or depressive state
 dangerous side effects if not managed carefully
18