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- Prodromal (gradual deterioration)
- Active (symptoms erupt), Residual
Prognosis related to length of prodromal phrases
the shorter- the better is the prognosis, age of onset, and more
- Hallucination, delusions,
- etc- excesses
Alogia (?) , avolition, flat affect, anhedonia
- Positive, Negative,
Long-lasting, maladaptive, inflexible patterns of inner experience and behavior, manifested in 2 of 4 areas: - Cognition, affect interpersonal, impulse control. Comorbidity with alcohol and drug abuse.
Difficulties in Diagnosis
- Symptoms Overlap and Comorbidity (more than one Personality Disorder
- -As separate clinical category or variation over normal behavior
- -“PD Not Otherwise Specified” is the most common diagnosis
- -CLUSTER A – The Eccentric
- -Paranoid Personality
- -Schizoid Personality
- - Schizotypal Personality
- -CLUSTER B – The Dramatic
- -Antisocial personality disorder
- -Borderline Personality Disorder
- -Histrionic Personality Disorder
- -Narcissistic Personality Disorder
- -CLUSTER C – The Anxious
- -Anxiety-related personality Disorders
- -Obsessive-compulsive personality disorder
Psychopath personality type:
- - Lack of remorse for shameful and cruel acts
- -Poor Judgment
- - Egocentricity
- -Inability to learn from experience
- -Lack of emotional responsiveness to others
- A personality disorder characterized by a lack
- of regard for society's moral or legal standards-
- - Childhood: Reflected in Conduct Disorder in children, expressed in cruelty to animals, vandalism, violence toward others.
- -Maturation Hypothesis: suggesting a reduction in antisocial behavior toward middle age.
- -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.
- - thought to be in between psychosis and neurosis.
- -Note “splitting”, parasuicide, chronic boredom, intense anger, fear of being abandoned, and
- -A personality disorder characterized by exaggerated emotional reactions,
- approaching theatricality, in everyday behavior. Melodramatic.
-Personality disorder characterized by an unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs:
-abnormal patterns of learning and attention; failing to show normal response of anxiety (note Lykken and the “fearlessness” hypothesis, may be related to cortical under-arousal (explains why they can pass the lie detector)
Response modulation hypothesis
proposing that psychopaths are not able to process any information that is not relevant to their primary goal.
Note summary of Lykken of the relationship of the antisocial to childhood abuse-(p. 318). Lykken concludes that the parents of the antisocial are themselves psychopaths (that is- the environment reflects the genetic factor).
Theories about Causes of Borderline
- -The Biopsychosocial model—vulnerable
- temperament (genetic), early trauma, and current life event that elicits stress.
- -Biological correlates, such as neurotransmitter dysregulation.
- - Hypothesis: sexual abuse in childhood
- may make the sympathetic nervous system (the one that reacts to stress)
- pathways hypersensitive to stress. Note that abuse occurs within the context of
- dysfunctional family, making it difficult to tease apart the genetic vs. environmental factors (that is- the abusive parents themselves display psychopathology).
emotionality and attention-seeking; shallow emotions
Self-love, egocentricity, grandiosity; sense of entitlement
Paranoid: extreme suspicion and
guardedness; bears grudges; reads malevolent meaning in innocent comments
- -Schizotypal: Regarded as a dormant form
- of schizophrenia, along the
- -Bizarre behavior; magical thinking, beliefs in telepathy, depersonalization
- -Note biological similarities to schizophrenia- enlarged ventricles;
- -First-degree relatives with
- -Schizophrenia-like qualities.
- -Regarded within the schizophrenia .
- -Limited range of emotional experiences
- and expressions.
- -Indifference to social and sexual relationships.
- -Note clinical picture. Note risk factor of prenatal nutritional deficiency.
Avoidant (from cluster C)
- -desires closeness but is
- extremely sensitive to possible rejection. Seems to be a more severe form of
- social phobia. Differs from the schizoid who does not seek social connections.
Dependent (Cluster C)
- cannot make their own
- decisions, cling to others. Feel despondent and abandoned of not taken care
- of. Note symptoms. Good response
- to treatment.
Obsessive-compulsive personality disorder
- This condition is different
- from OCD- that we discussed within the anxiety disorders. This condition does
- not have specific obsessions or compulsive acts, but rather a rigid, inflexible
- style of relating to the world, accompanied by a tendency toward perfectionism
- and orderliness.