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Special Psychological Vulnerabilities of Young
Children
-- They do not have as realistic views of themselves and their world They have less selfunderstanding, and less experience coping with stress They are more dependent on others TERM 2
Classification of Childhood & Adolescent
Disorders
DEFINITION 2 -- Earliest diagnostic systems: no categories for childrens disorders-- Recent decades: more attention to developmental factors in diagnoses for children-- Still, however, children are sometimes viewed as miniature adults and adult diagnoses are expected to applysuch as in affective and anxiety disorders TERM 3
Disorders of Childhood &
Adolescence
DEFINITION 3 -- Oppositional defiant disorder & conduct disorder-- AttentionDeficit/Hyperactivity Disorder -- Autism and Aspergers Syndrome-- Mental Retardation -- Learning Disorders -- Other (Anxiety and Depression) TERM 4
Oppositional Defiant Disorder
(ODD)
DEFINITION 4 Recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures Verbal; not usually harmful Persists for at least 6 months Causes functional impairment Caution: Oppositional characteristics periodically occur in most children & adolescents TERM 5
ODD Course
DEFINITION 5 Emerges ~ 8 to 12 years of age More common among males than females Sometimes progresses to Conduct Disorder Many grow out of this by adolescence;comorbidity complicates this
Conduct Disorder
Persistent, repetitive violation of rules and a disregard for the rights of others, with 3 or more of: Aggression: people, animals Destroying property Lying/Stealing Breaking major rules Developmentally, usually preceded by ODD Risks for progression from ODD: parental conflict, parental antisocial behavior, fewer socioeconomic resources TERM 7
Conduct Disorder Course
DEFINITION 7 Conduct disorder is more likely to progress to Antisocial Personality Disorder if it... Has an onset that is early (~9), as opposed to during adolescence (but still only 2540% develop ASPD) Is preceded by early onset ODD (~6) Is comorbid with attentiondeficit/hyperactivity disorder Adolescentonset conduct disorder does not usually progress to ASPD Problems limited to adolescence Different causal factors TERM 8
ODD & Conduct Disorder: Cycle of
Causes
DEFINITION 8 Heritability of : Difficult temperament Lower verbal intelligence Neuropsychological deficits Poor selfcontrol, planning, and sustained attention Resists parents parenting efforts, including reading Enters school with less readiness Low school resources,needs are neglected Older than classmates,so socially rejected Placed with similar peers,who all model behavior problems Behavior problems adopted for social acceptance TERM 9
ODD & Conduct Disorder: Cycle of
Causes
DEFINITION 9 Additionally... Family discord and antisocial behaviors model this approach to the social world And,due to difficult temperament... Rejection by parents and teachers Joins deviant peer group for social connection TERM 10
ODD & Conduct Disorder:
Treatments
DEFINITION 10 Punitive treatments appear to intensify rather than correct behavior Effective treatments tend to focus on The cohesive family model Must alter childs environment Improve parenting skills Behavioral techniques Again, often used with parents, to teach them to reinforce appropriate behaviors Parents, eventually, may feel more positively toward child
ADHD in Adults?
In adulthood ADHD does not initially emerge But it may be initially recognized Common symptom profile in adults Problems with sustained attention, processing speed Forgetfulness, disorganization Difficulty with routines & meeting deadlines Problems tolerating stress Restlessness and tension (rather than hyperactivity) TERM 17
ADHD Causal Factors
DEFINITION 17 Heritability estimated at 70% Structural brain alterations in areas involved in attentionalexecutive functioning (e.g., frontal cortex) Other potential causal factors are uncertain Exacerbating factors Family environments that are conflictive Lack of knowledge of problems, and family and school environments that are unresponsive: repeated frustration & failures TERM 18
ADHD Treatment
DEFINITION 18 Medications (children & adults) Ritalin Antidepressants (if comorbid conditions) Behavioral & psychological interventions Parent training Selfmanagement skills Use of technology (improves scheduling, organizing, spelling) Therapy Individual, Family, Marital Counseling for career, academic choices TERM 19
What are Personality Disorders?
DEFINITION 19 Personality -- Enduring traits and characteristics -- Lead a person to behave in relatively predictable waysacross a range of situationsPersonality disorders -- Enduring pattern of inflexible and maladaptive thoughts,feelings, and behaviors -
- Across a range of situations -- Leading to distress or dysfunction TERM 20
What are Personality Disorders?
DEFINITION 20 -- Per DSM, manifested in 2 or more:-- 1. Affect - range, intensity, and changeability of emotions--Behavior 2. Impulse control 3. Interpersonal functioning-- 4. Cognition - perceptions and interpretations of events, other people, and oneself--Example: Borderline Personality Disorder
What are Personality Disorders?
-- To be diagnosed with a personality disorder, maladaptive traits:-- Should date back at least to adolescence -- Should not be better accounted for by:-- substance use or abuse -- another psychological disorder --medical condition TERM 22
Assessing Personality Disorders
DEFINITION 22 -- Diagnosis based on: -- What the patient says-- Pattern of complaints -- Personality inventories or questionnaires-- Information from family members--Take into account: -- persons culture, ethnicity -- persons social circumstances (chronic stress?) TERM 23
DSM Multi-axial System
DEFINITION 23 -- Axis I: Clinical syndromes or other conditions (V codes)-- Axis II: Personality disorders -- Axis III: General medical conditions -- Axis IV: Psychosocial & environmental stressors -- Axis V: Global assessment of functioning TERM 24
Diagnoses Organized Into Clusters
DEFINITION 24 A: Odd or Eccentric: Paranoid, Schizoid, SchizotypalB: Dramatic/Erratic: Antisocial, Borderline, Histrionic ,NarcissisticC: Fearful/Anxious: Avoidant, Dependent, Obsessive-Compulsiv TERM 25
Criticisms of Personality Disorders Diagnoses
(DSM)
DEFINITION 25 -- Treats personality disorders as categorically distinct from normal personality -- Versus on a continuum-- Criteria create an arbitrary cutoff between normal and abnormal-- Specific personality disorders not clearly distinct from one another...-- ...or from some other disorders -- Diagnostic criteria not sharply defined (compared to Axis I)-- Decreases reliability
Attachment Style
--- Childs emotional bond and style of interaction with primary caretaker--- Secure attachment : Positive view of self worth & availability of others--- Insecure attachment: Negative view of self worth, and expectation that others will be unavailable- Can develop because of childhood abuse, neglect, or inconsistent discipline- Often seen in those with personality disorders = common ingredient TERM 32
Treatment for Attachment Stye
DEFINITION 32 --- Overall, less research, with some exceptions --- Lasts longer --- Challenge: disorder itself makes therapeutic relationshipdifficult --- Medications relieve some symptoms, but do not truly treat thedisorder --- Psychological treatments- Cognitive-behavior therapy: Learn emotional regulation, Learn interpersonal skills, Identify, and change, dysfunctional beliefs TERM 33
Insecure Attachment is in Cluster A: Odd or
Eccentric
DEFINITION 33 Consider to be on less severe end of schizophrenia- related disorders: PARANOID,SCHIZOID, SCHIZOTYPAL TERM 34
Paranoid Personality Disorder
DEFINITION 34 --- Persistent and pervasive mistrust and suspiciousness --- Tendency to interpret others motives as hostile --- Better able to evaluate whether their suspicions are basedon reality than those with paranoid schizophrenia--- Sources of perceived threats are known individuals, not strangers or bizarre signals--- Cannot be easily persuaded that these beliefs do not reflect reality--- Tend to be difficult to get along with ---Suspiciousness leads them to be secretive, argumentative, or hold a grudge TERM 35
Schizoid Personality Disorder
DEFINITION 35 --- Restricted range of emotions in social interactions and few if any close relationships--- Lack of social skills --- May not pick up on normal social cues--- Appear to be emotionless --- Often dont express anger, even when provoked--- Indifferent to other people - -- Function best when isolated from others--- Generally dont marry or express a desire for sexual intimacy
Schizotypal Personality Disorder
--- Eccentric thoughts, perceptions, and behaviors, in addition to having very few close relationships-- Nine symptoms, organized into three groups: - Cognitive perceptual: Magical thinking, unusual perceptual experiences, ideas of reference, paranoid ideation - Interpersonal: No close friends because of a preference for being alone, constricted affect, social anxiety, paranoid ideation- Disorganized: Odd/eccentric behaviors,odd speech TERM 37
Schizotypal Personality Disorder
DEFINITION 37 --- Schizotypal differs from schizoid personality disorder--- Schizotypal includes cognitive-perceptual symptoms--- Generally thought of as a milder form of schizophrenia--- Some researchers proposed moving it to Axis I TERM 38
Causes of Schizotypal Personality Disorder
DEFINITION 38 ---- Schizotypal personality disorder has been most researched---- Clusters in families, along with schizophrenia---- Some evidence for problems with brain structure/function similar to schizophrenia : - Smaller temporal lobes - Altered (heightened) dopaminergic functioning ---- Family-of-origin abuse/neglect ---- May be mistreated by peers because they appear different TERM 39
Cluster B: Dramatic,Emotional, Erratic
DEFINITION 39 -- HISTRIONIC-- ANTISOCIAL-- NARCISSISTIC-- BORDERLINE TERM 40
Diagnostic categories not mutually exclusive
for Cluster B Disorders
DEFINITION 40 --- Histrionic: -Discomfort when not the center of attention,- Rapidly shifting emotions--- Narcissistic: -Excessive need for admiration--- Borderline: - Impulsivity in self damaging areas,
- Affective instability--- Antisocial: -Impulsivity
Treating Borderline Personality Disorder
- Dialectical behavior therapy (DBT) -Developed by Marsha Linehan -Psychological therapy of choice -Incorporates skill development and cognitive restructuring from CBT- Underscores importance of a warm and collaborative bond between patient and therapist TERM 47
Treating Borderline Personality Disorder
DEFINITION 47 ---- DBT Incorporates: - An emphasis on validating the patientsexperience: thoughts feeling and behaviors makes sense in the context of personal experience - A Zen Buddhist approach: see and accept painful realities of life - A dialectics component : accepting the situation and aspects that cannot be changed, while recognizing that change must occur in order to feel better TERM 48
Treating Borderline Personality Disorder
DEFINITION 48 --- DBT entails both group and individual therapy --- Initial priority is reducing self-harming behaviors --- As these behaviors are reduced, treatment focus shifts to other behaviors that interfere with therapy and quality of life--- Development of skills to change what can be changed and recognize aspects of life that cannot change--- Lasts about 1 year TERM 49
Antisocial Personality Disorder (ASPD)
DEFINITION 49 --- DSM-IV Criteria:-- At least 18 years of age-- Persistent disregard for, or violation of, others rights, since age 15 (need 3): - Lawbreaking, -Deceitfulness, -Impulsivity, - Aggressiveness, - Irresponsibility, - Lack of remorse--- Conduct Disorder, onset before 15 TERM 50
Conduct Disorder
DEFINITION 50 ---- Persistently violating rights of others, with 3 or more of:- Aggression: people,animals - Destroying property - Deceitfulness/theft - Serious rule violation
Psychopathy (Sociopathy)
--- Hervey Cleckley, 1940s--- DSM-like characteristics, PLUS...: -No empathy, -Arrogance, -Glib, -superficial charm, - Deceitful, -Grandiosity, --- Purposefully omitted from DSM ASPD criteria(objective) TERM 52
Psychopathy &
ASPD
DEFINITION 52 --- Robert Hare--- Psychopathy: Affective/ Interpersonal: -lack of remorse, -no empathy, -callousness, -glibness/charm --- Behavioral (DSM-IV ASPD) : -need for stimulation,-poor behavior controls,-irresponsibility TERM 53
DSM-IV Approach on Psychopathy &
ASPD
DEFINITION 53 --- Pro: - Behaviorally-specific--- Con: -Psychopathy increases predictive validity regarding violent reoffense, - Misses those low on behavioral dimension, who might not get caught TERM 54
Clinical Picture on Psychopathy &
ASPD
DEFINITION 54 -- Poorly developed conscience: may not be apparent**-- Irresponsible & Impulsive : parasitic: take,rather than earn -- Impressive to others, then exploitative: Attuned needs/weaknesses of others TERM 55
Causal Factors of Psychopathy &
ASPD
DEFINITION 55 --- Genetic contributions:- Moderate heritability, - ASPD; psychopathy traits--- Candidate Gene: Monoamine oxidase-A gene (MAO-A) --- Social environment: -Low MAO-A activity, PLUS early childhood maltreatment, - G x E interaction
Avoidant Personality Disorder
---Hypersensitivity to rejection or social derogation---Shyness ---Insecurity in social interaction and initiating relationships--- Want social connections, but very anxious (compare to schizoid) ----Causal factors: inhibited temperament TERM 62
Dependent Personality Disorder
DEFINITION 62 ---Difficulty in separating in relationships ---Discomfort at being alone ---Subordination of needs in order to keep others involved in a relationship ---Indecisiveness ---Causal factors: - Inheritance of high neuroticism and agreeableness TERM 63
Obsessive-Compulsive Personality Disorder
DEFINITION 63 ---Excessive concern with order, rules, and trivial details--- Perfectionism---Lack of expressiveness and warmth--- Difficulty in relaxing and having fun---No true obsessions & compulsions, as on OCD TERM 64
SchizophreniaTerms & Historical
Origins
DEFINITION 64 Emil Kraepelin (1896): German psychiatrist dementia praecox (precocious dementia): apparent mental deterioration at early age Eugen Bleuler (1911): Swiss psychiatrist Introduced term Schizophrenia to describe mind split from reality Hallmark characteristic: psychosisa significant loss of contact with reality Not the only psychotic disorder TERM 65
SchizophreniaEpidemiology &
Onset
DEFINITION 65 Affects people from all walks of life Is about as prevalent as epilepsy Average lifetime risk: ~ 1% Usually begins in late adolescence or early adulthood
SchizophreniaGender
Generally less common and less severe in women than in men (M:F = 1.4:1.0) Why? Hypothesis: estrogen protection Monthly changes in estrogen levels associated with symptom severity changes Later onsets in women tend to be more severe TERM 67
SchizophreniaClinical Picture
DEFINITION 67 Symptoms: 2 or more present more often than not during 1 month: Positive symptoms :Delusions, Hallucinations, Disorganized speech, Disorganized or catatonic behavior Negative symptoms: --Dysfunction: -work, -relationships, selfcare, --Ongoing for at least 6 months, Note: logically, requires 1 positive symptom TERM 68
Delusions
DEFINITION 68 A false belief Fixed and firmly held despite clear contradictory evidence Disturbance in thought content Example: The CIA is listening to all of my phone conversations. Occur in most (~90%) persons suffering from schizophrenia, at some point during their illness TERM 69
Delusions
DEFINITION 69 Delusions of control: Made feelings or impulses: controlled by others, Thought broadcasting, Thought insertion or withdrawal Delusions of reference: -neutral stimulus believed to have special significance, Ex: song on the radio Paranoid/persecutory delusions: -- CIA is listening to me; someone trying to harm me TERM 70
Hallucinations
DEFINITION 70 A false sensory experience Seems real; occurs in absence of external stimulus Occur in any sensory modality, with auditory most common Occur in ~75% of persons with schizophrenia Voices of known, or unknown, persons, or God or theDevil Primarily negative (rude, abusive); some pleasant
