PSYC 407 1st Edition Lecture 19 Outline of Last Lecture I. What is substance use?II. What is substance intoxication?III. What is substance abuse?IV. What is substance dependence?Outline of Current Lecture I. Five Factor ModelII. Cluster A – odd or eccentric clusterIII. Cluster B – dramatic, emotional, erratic cluster IV. Cluster C – fearful or anxious clusterCurrent LectureImpulse-Control Disorders: Trichotillomania• Trichotillomania– Inability to resist the urge to pull hair; significant distress and social impairment– Observed in 1-5% of college students, mostly female– Stress involved; also hx. of PTSD– Clomipramine and CBT have been shown to be helpfulOther impulsive behaviors• May occasionally arise to “disorder” level– Shopping– Self-mutilation– Skin-picking– Nail-biting– Computer useThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.Personality DisordersPersonality Disorders: An Overview• The nature of personality disorders– Enduring and relatively stable predispositions:patterns of perceiving, relating to, and thinking about the environment and oneself that are seen in a wide range of personal and social contextsYour personality is….• All the characteristic ways a person behaves and thinks• We type people as behaving in one way in many situations. • People behave differently in different situations, but there are similarities in the basic style• Think shyness, extraverted, egocentric….• So to be part of your personality, a way of behaving is usually present in most situationsPersonality can change• You can learn to overcome shyness to reach out to people to be more assertive to tone down aggressive style• And having a trait like this probably doesn’t cause distress or impairmentBut Personality Disorders are:• inflexible and maladaptiveAND• causing subjective distress (not always) and/or significant functional impairment.• When someone can’t change….and has distress/impairment• This person may have a personality disorder.• -originate in childhood• -chronic• -pervade all areas of person’s life• (job, relationships)• Person may not feel distress, but the problems are acutely felt by individuals close to them…..• Person disregards feelings of others, And exhibit no remorse• This person often referred by others who recognize the impairmentPersonality Disorders TreatmentTreatment has improved,but many tend to do poorly in tx.The inflexible traits make it harder to modify the personality aspects that are troublesome.Therapists have to guard against countertransference (feelings toward a client—or, more generally, a therapist's emotional entanglement with a client.– Coded on Axis II of the DSM-IV-TR• Considered a chronic problem• AXIS I Depressive Disorder• AXIS II Avoidant P.D.• AXIS III No diagnosis• AXIS IV Relationship Problems• AXIS V GAF 62Categorical vs. dimensional views of personality disorders• P.D.s are seen as a matter of degree rather than kind.• They are extreme versions of personality traits• This distinction (the degree part) can be more clearly conceptualized as a – DimensionExample GENDERCategorical vs. dimensional views of personality disorders• Category systems advantages:– Convenience– Simplicity– Category systems disadvantages:– Reification: we tend to believe that it is real because it is a diagnosis• Dimensional systems have been proposed:• One example:Five-factor model (Costa and McCrae, 1990)People are rated on personality dimensionsOpen-mindednessConscientiousnessExtroversionAgreeablenessNeuroticismFive Factor ModelOpen-mindedness- imaginative & creative vs. shallow & imperceptiveConscientiousness Organized & reliable vs. careless & negligentExtroversion Assertive & active vs. passive and reservedAgreeableness kind & warm vs. distrustful, selfish, & hostileNeuroticism even-tempered vs. nervous, moody,& temperamental- Consistent across cultures with some individual differences: For example: the Dutch scored high on openness to experienceAdvantages to Dimensional System- More information on the person- More flexible- Avoid arbitrary assignment to a categoryPersonality Disorders: An Overview• DSM-IV-TR personality disorder clusters– Cluster A – odd or eccentric cluster– Cluster B – dramatic, emotional, erratic cluster – Cluster C – fearful or anxious clusterPersonality Disorders: Facts and Statistics• Prevalence of personality disorders– Affects about 0.5% to 2.5% of the general population (may be as much as 1 in 10)– Rates are higher in inpatient and outpatient settings• Origins and course of personality disorders– Thought to begin in childhood – Tend to run a chronic course if untreated– Comorbidity rates are high • Gender distribution and gender bias in diagnosis– Gender bias exists in the diagnosis• Females dx’d borderline more often• Females previously dx’d as histrionic and narcissisticBut males have caught upPDs under study1. Depressive PD-self-critical, dejected, judges others2. Passive-aggressive PD-negative attitudes toward routine demands and expectationsCLUSTER AOdd, eccentric:ParanoidSchizoidSchizotypalCluster A: Paranoid Personality Disorder• Overview and clinical features– Pervasive and unjustified mistrust and suspicion– Meaningful relationships difficultParanoid Personality DisorderDSM Criteria:distrust and suspiciousnesssuspicious that others are exploiting, deceivingfrequent doubts about loyalty of friendstendency to read hidden demeaning or threatening meanings into benign remarksgrudges over insults and slightsperceiving attacks on character others don’t seesuspicions about fidelity of spouse, partnernot occurring in course of schizophrenia, mooddisorder or other psychosis. Typical style: argumentative and complaining or very quiet. (people around them uncomfortable) appear tense and ready to pounce when they think they have been slighteddon’t confide in others; think others trying to harm or trick them; often isolate selfCauses– Biological and psychological contributions are unclear.• Relatives with schizophrenia• Genetic connection– Early learning that people and the world is a dangerous place• Early mistreatment and trauma• May learn that they need to be careful and that they are different from