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Personality Disorders -

ASPD Genetic Influences

  • clearly runs in families

  • adoption studies show strong genetics but also environ.

  • MZ twins 55% DZ twins 13%

Personality Disorders -

ASPD Neurobiological Influences
  • general brain damage - NOT the cause
  • Underarousal hypothesis: low levels of cortical arousalso they seek stimulation via risks
  • Fearlessness hypothesis: higher threshold for fear so commit more crimes
Personality Disorders -

ASPD PscyhoSocial Influences

  • Different response to reward & punishment

  • Coercive Family Processes: ineffective parental discipline and noncompliant child - push to get their way

  • Stress and trauma may cause some to act in violent, illegal ways

Personality Disorders - Cluster B

Histrionic PD

  • excessive emotionality and attention-seeking

  • drama queens

  • very exaggerative, overreactive, vain, theatrical

  • Ultimately interferes with daily life

Personality Disorders - Cluster B

Narcissistic PD
  • Grandiosity - think highly of themselves
  • Excessive need for admiration
  • Lack empathy
  • Continuum from low self-esteem to narcissism
Personality Disoders - Cluster B

Borderline PD description
  • Between neurotic &psychotic
  • Very distressed, mood swings, splitting (all or nothing), manipulative, fear of being alone, take up most of doctors' time
Personality Disorders - Cluster B

Borderline PD Prevalence, Onset, Course
  • 2% of population
  • 75% of those being women
  • Occurs globally
  • Tends to be lifelong
  • 6% of patients commit suicide
Personality Disorders - Cluster B

Borderline PD Biological factors
  • 5x greater risk in 1st degree relatives
  • Adoption and twin show some genetic component
  • Too little serotonin
  • Inherited traits like impulsivity
  • Neurological impairments: exposure to drugs/alcohol in utero
Personality Disorders - Cluster B

Borderline PD Cognitive vulnerability
memory bias to remember the bad things; this creates distorted perceptions of life events
Personality Disorders - Cluster B

Borderline PD Environmental factors
MOST RELEVANT CAUSE
75-90% of patients experienced severe trauma and stress like sexual victimization

Personality Disorders - Cluster B

Borderline PDTREATMENT
  • Historically very difficult to treat.
  • Dialectical Behavior Therapy by Marsha Linehan
  • 1.  Focuses on the suicidal self
  • 2.  Focuses on behaviors that interfere with therapy
  • 3.  Focuses on quality of life issues

Personality Disorders -

Cluster C
  • anxious, fearful
  • Avoidant PD
  • Dependent PD
  • Obsessive-Compulsive PD
Personality Disorders - Cluster C

Avoidant PD
  • social inhibition despite their desire to be social
  • feelings of inadequacy
  • hypersensitivity to negative evaluation
Personality Disorders - Cluster C

Dependent PD
  • excessive need to be taken care of, leading to submissive and clinging behaviors
  • fears of separation
  • controversial because of sexist component
Personality Disorders - Cluster C

Obsessive-Compulsive PD
  • OCD = anxiety disorder
    OCPD = personality disorder
  • preoccupation with orderlness, perfectionism, mental and interpersonal control
  • have trouble allocating time and finishing projects if not perfect
  • 1% prevalence, more commonly men
Malingering Disorder
  • NOT A PSYCH DISORDER
  • Symptoms are made up intentionally, LIES!
  • Motive: to get external incentive like insurance money, get out of jail, etc.
Factitious Disorder
  • PSYCH DISORDER
  • Intentional production of physical or psychological symptoms
  • Symptoms are real but created by patient, have knowable cause
  • Motives: incentive is to assume the sick role but this is unconscious
Factitious by Proxy

(Munchausen)
  • caregiver is creaeting real symptomd in the child, elderly person, etc.
  • known medical cause
  • caregiver assumes sick role through the patient
  • no external incentive
Somatoform Disorders
all have physical symptoms with no known medical cause, all psychologically caused and associated with stress
Somatoform Disorders

Conversion Disorder
  • a loss or alteration of physical functioning whcih suggests a physical disease, but no psychical cause can be found
  • sx: real! blindness, double vision, inability to walk, seizures
  • motive: none, unconscious response to stress
  • PSYCHO DISORDER
  • More common in women than men (60-80% with this are women)
  • onset early adoloscence or adulthood, abrubt, goes away.77
Somatoform Disorders

Somatization Disorder
  • many physical sx for several years, beginning before the age of 30
  • more common in women
  • 4 pain sx: head, neck, abdomen, back, etc
  • 2 GI sx: nausea, bloating, vomiting
  • 1 sexual problem
  • 1 pseudoneurological sx (conversion or dissociative sx)
  • Genetic - closely related to ASPD - may share the same predisposition. women likely to get somatization; males likely to get ASPD
Somatoform Disorders

Hypochondriasis
have a fear of a serious disease, probably caused by the faulty interpretation of physical sx like in panic disorder
Somatoform Disorders

Pain Disorders
complaints of severe pain that cannot be explained by physical, medical causes but the pain is real.

stress-related, psychological
common in women
pain meds do not work
Somatoform Disorders

Body Dysmorphic Disorder
  • pathological preoccupation with an imaginary defect in physical appearance
  • excessive hair, asymmetrical face, large features, etc.
  • onset: early childhood - adol.
  • equal in men and women
Dissociative Disorders
a sudden change in memory, identity, or consciousness that is related to stress
Dissociative Disorders -

Dissociative Amnesia
  • suddenly unable to recall important personal info. usually of a traumatic nature, cannot be explained by ordinary forgetfullness
  • more common in female adol. and young men in war
  • comes and goes very quickly
  • usually only one incidence
Dissociative Disorders -

Dissociative Fatigue
sudden and unexpected travel away from home with inability to recall one's past and confusion about one's identity or adoption of new identitiy

can be short or long-term
Dissociative Disorders -

Depersonalization disorder
  • one feels unreal and disconnected from self, as if outside observer
  • maybe an adaptive technique
  • 50% of people experience at least one
  • onset around age 16
Dissociative Disorders -

Dissociative Identity Disorder
  • AKA multiple personality disorder
  • 2+ distinctive personalities existing within an individual, alternating which one is in control
  • 50% of people with this disorder have over 10 personalities
  • dominant - who you are demographically
  • onset assumed to be childhood
  • causes: severe trauma, lack social support, diathesis-stress model
  • treatment: hypnosis and psychodynamic theory
Sexual Response Cycle
Masters & Masters
1.  Desire
2.  Arousal
3.  Orgasm
4.  Resolution
Sexual Desire Disorders

Hypoactive sexual desire disorder

deficient sexual fantasies and desires accompanied by distress or interpersonal difficulty

highly subjective diagnosis
Sexual Desire Disorders

sexual aversion disorder
person has extreme aversion to and avoidance of genital sexual contact accompanied by distress or interpersonal conflict

not very common

Female sexual arousal disorder
inability to attain or maintain the adequate lubrication-swelling response accompanied by distress/interpersonal conflict

not otherwise accounted for by medical condition

Male Erectile disorder
inability to attain or maintain an adequate erection (impotence)
  • performance anxiety and fear of failure lead to spectatoring which further dampens arousal
  • age, onset, course varies
  • older men do not necessarily lose the ability to have erection
  • will still have erections in sleep if it is psychologically caused
Orgasmic Disorders

Female Orgasmic disorder
delay in or absence of orgams that causes distress or interpersonal conflict

women have to learn how to orgasm

20% of women do not orgasm
Orgasmic Disorders

Male Orgasmic disorder
delay in or absence fo orgasm

pretty rare
Orgasmic Disorders

Premature ejaculation
ejaculation with minimal sexual stimulation before, during, or shortly after penetration and before the man wishes it

more of a problem in men with new partners or coming off heavy alcohol usage

pause and squeeze technique
Sexual Pain Disorders

Dyspareunia
men or women
painful sexual intercourse not explained medically
Sexual Pain Disorders

Vaginismus
only in women
imvoluntary tightening or spasm of vaginal wall that prevents penetration, not explained medically
Paraphilias
  • deviation of what a person is attracted to based on cultural norms
  • recurrent, intense, sexually-arousing fantasies, urges, or behaviors involvingnon-human subjects, suffering or humiliation, children or other non-consenting persons.
  • MEN more common
  • Usually done in secrecy
Paraphilias

Gene Abel's findings
  • Most commit more that 1 or 2 crimes.
  • Most have as many as 10 different forms of paraphilia.
  • Also have normal sexual relations with an adult partner.
Paraphilias

Exhibitionism
  • over a period of 6 months, a series of uncontrollable, overwhelming urges or fantasies involving the exposure of one's genitals to an unsuspecting stranger
  • usually stereotypical male victimizing female
  • early traditional view that they were harmless
  • current view: Abel found that 46% admitted to having molested children and 25% to raping an adult
Paraphilias

Voyeurism
  • over a period of 6 months, recurrent, intense, sexually-arousing fantasies, urges, or desires involving observing an unsuspecting person who is naked, disrobing or having sex.
  • can be shy individuals afraid of sexual contact, or agressive individuals who go on to harm
  • onset prior to age 15
  • course is fairly chronic
Paraphilias

Fetishism
  • ...involving the use of nonliving objects (lingerie, shoes, feet)
  • onset by adol.
  • chronic
  • not illegal
Paraphilias

Transvestic fetishism
  • ..a heterosexual male..involving cross-dressing
  • not illegal, so we don't know much
  • often done in secrecy
Paraphilias

Sadism

  • Sexual gratification from inflicting pain or humiliation on others

  • Some have willing partners (legal), others do not (illegal).

  • Prevalence unknown because of secrecy.

  • Can lead to death of partner

  • Chronic

Paraphilias

Masochism
sexual gratification from being subjected to pain or humiliation
Paraphilias

Pedophilia
  • Current criteria is horrible
  • ...involving sexual activity with a prepubescent child, at least 16 and must be 5+ years older than victim
  • Chronic, especially if they also have ASPD
  • 80% offenders men
  • 80% victims women
  • no racial or SES differences
Paraphilias

Frotteurism
  • touching and rubbing against a non-consenting person
  • onset adolscence
  • chronic
Gender Identity Disorder
  • Identify more with the oppostie sex
  • Discomfort within their own sex
  • fairly rare, especially in females
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