Psychopathology

◆ Most psychological disorders are “extreme expressions” of otherwise normal emotions, behaviors, and thoughts. They are more persistent or intense. A matter of degree!!

◆ Mental Disorders are NOT distinct from normal life experiences – they are just more severe or prolonged compared to what is normally experienced.

3 Main Areas

1) Clinical Description (DSM)2) Etiology: study of causation3) Treatment and Outcomes - having an effect is NOT the same

as having a cause.

DSM

◆ Divided into 5 axis: I) Clinical Disorders: Mental Illnesses

that have a definite onset, course beginning and end.

II) Mental Illness and Personality Disorders: enduring patterns of perceiving, relating to, and thinking about the environment and oneself.

Personality Disorders

◆ The idea that the person’s personality is altered, damaged or flawed meaning that they would manifest these problematic perceptions, cognitions, and behaviors across many different settings and cause impairment or distress.

Diagnosis (dx)

- A person cannot be dx with a PD prior to the age of 18 in order to see a history of the behaviors.

- The DSM has a list of symptoms for each disorder and a person must meet at least 7 symptoms over their history to be diagnosed.

Axis IICluster A of Personality Disorders

(PD)- Described as odd or eccentric.- People with these disorders tend to be

hypersensitive to criticism and have ideas of reference (others are laughing, talking or seeking them out for mal intentions).

- There are some links/overlaps between Cluster A and the Schizophrenia Spectrum, but more research needs to be done.

Cluster A of Personality Disorders (PD)

Described as odd or eccentric➢ PPD = Paranoid Personality Disorder Fear or suspicion of others➢ Schizoid = Don’t desire relationships

with others (connection to Autism?)➢ Schizotypal = Want relationships, but

don’t know how and usually have odd ideas or behaviors.

Cluster A and Schizophrenia

• It is suggested that Schizoid PD may have genetic links to Autism and dysfunction in the Dopamine system; similar to Schizophrenia.

• There are many similarities b/w Cluster A and Schizophrenia when discussing genetics, but again, more info is needed.

Schizophrenic Spectrum

• Psychotic Condition: Schizophrenia Spectrum: cognitive and

emotional dysfunction with delusions, hallucinations, disorganized speech, and inappropriate behaviors. “out of touch with reality”

2.5-2.8 Million diagnosis (dx) in the US1 in 10 commit suicide after dx

Schizo. Subtypes

1) Paranoid Type: more intact that others and responds better to tx. Also most violent

- delusions are often complex and elaborate.

2) Disorganized Type: disruptions in speech, many bizarre behvs, flat affect (can’t show emotion), and inappropriate emotions.

3) Schizoaffective: chronic pattern of both mood disorders and psychosis.

4) Undifferentiated: Majority of Schizophrenics fit in this type;

Cluster B◆ Exaggerated emotional displays or

impulsive and unpredictable behvs.1) Antisocial PD: 3:1 male:female ratio and

are essentially criminals and includes angry outbursts, potential violence, and other forms of law violation, and disregard to others.

Recidivism: is the act of a person repeating an undesirable behavior after they have either experienced negative consequences of that behavior, or have been treated or trained to extinguish that behavior. It is also known as the percentage of former prisoners who are rearrested.

Cluster B

◆ ASPD can also be labeled; psychopaths and are 4x more likely to be violent than non-psychopaths.

◆ Issue with diagnosis (dx):◆ Definition of violence◆ Known and unknown acts of violence◆ Known and unknown criminal behvs.

Cluster B

◆ Tx for psychosocial disorders reduces recidivism in non-psychopaths, tx appears to increase recidivism in psychopaths.

- Ted Bundy, Charles Manson, Hannibal Lector

◆ Borderline PD: Most common PD, 50% and is 15% of psychiatric admissions.

Cluster B◆ Borderline PD: Most common PD, 50% and

is 15% of psychiatric admissions. - Frantic efforts to avoid abandonment,

unstable relationships through extremes of idealization and devaluation (splitting; all black and white, no grey), persistent unstable self-image, impulsivity in at least 2 damaging areas (sex, shopping, reckless driving…), recurrent suicidal behvs/self-mutilation, depression, anxiety, chronic feelings of emptiness, inappropriate or intense anger, rage-episodes.

Cluster B

◆ Most BPD report history of neglect or abuse, but this is not necessary for dx.

◆ Core issues: difficulty with emotional regulation and lack of self-soothing skills…high suicide rate, 6%.

Cluster C

◆ Characterized by anxiety and fear in specific situations; both social and individual.

◆ There are similarities between social phobias and cluster C, but it is a matter of degree!

Cluster C

◆ Avoidant PD: sever concern with social rejection, tendency to avoid relationships and contact with other ppl despite a desire for normal relationships and social interaction (what schizophrenia type?). This person actively avoids relationships out of fear of criticism and rejection.

Cluster C

◆ Dependent PD: same fear and anxiety of rejection as APD, but DPD technique of avoidance is giving their decision making to someone else. This person is very clingy and fears abandonment.

Cluster C

◆ Obsessive-Compulsive Personality Disorder: This person is excessively worried that things must be done “right” or in the “right way” (which is defined by themselves). This person is preoccupied with details, task-oriented to an extreme, and are often perceived as rigid and inflexible in their routines and patterns of behvs.

◆ OCPD doesn’t have the ritualized/compensatory thoughts and behavs as OCD (axis I, clinical disorder).

Dissociative Identity Disorder◆ 2 or more distinct identities or

personalities states, each with its own relativity enduring pattern.

◆ At least 2 of these identities recurrently take control of the person’s behavior.

◆ Inability to recall important information that is too extensive to be explained by ordinary forgetfulness.

◆ Not due to direct physiological effects of a substance or a general medical condition.

DID Characteristics

◆ The transition from one personality to the next is called a switch; and is usually instantaneous.

◆ Physical transformations may occur: - posture, facial expressions, facial

wrinkling and sometimes physical disabilities. 37% of cases reported a change in handedness.

Cross gender switches are not uncommon.

DID

- 9:1 female:male ratio- The average # of personalities: 15• Onset is almost always in early

childhood…as early as 4 years old.• Almost all patients (97%) with DID

report extremely horrible childhood abuse.

Review

◆ Definitions:1)What is etiology?2)What is recidivism? Including an

example.3)Define and explain the following: - Anxiety - Fear - Panic

Review

4) Define the following: - Intoxication - Abuse - Dependence5) What are obsessions in OCD?

Include an example.

Review: Short Answer

1) What are the general descriptions for disorders on Axis I and II?

◆ Compare and Contrast Axis I and II with an example disorder for each.2) Explain how matter of degree is

vital to Psychopathology. Include an example.

Essay

1) Prepare one of the following disorders including symptoms/behv examples, triggers, the Axis location, and 3 more details (the more the better):

ASPDDIDAnorexia NervosaBPDOCD (not OCPD)Schizophrenia