Flashcards in Psychopathology Deck (30):
Personality disorders are enduring patterns that manifest in 2 or more areas of _______
3. interpersonal functioning
4. impulse control
Disorder is a harmful dysfunction wherein harmful is a value based on societal norms and dysfunction is scientific term referring to the failure of mental mechanism. Who wrote this?
What are important elements of a mental status exam?
1.appearance 2. Attitude 3. behavior
4. Speech and language 5. Mood
6. Affect 7. Thought processes
8. thought content 9. orientation 10. Memory
11. Attention/concentration 12. Judgment/insight
13. Impulse control/Frustration tolerance
A GAF score of 51-60 represents
moderate symptoms and moderate difficulty functioning
What is the essential feature of BPD (borderline personality disorder)?
a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts
Grove et al.'s (2000) meta-analysis of clinical vs. actuarial judgment found which to be superior?
Actuarial judgment. Mechanical prediction techniques were equal or superior to clinical prediction methods. (Clinical interviews, when included, resulted in even worse clinical judgments).
What are the four broad dimensions of personality disorders suggested by Widiger & Samuel (2005)
1 Emotional Dysregulation,
2 Dissocial Behavior,
Widiger & Trull's (2007) critiques of categorical model?
-does not account for severity
-heterogenity means same disorder but very diff. presentations
-Inadequate scientific basis for 16 major diagnostic classes
-lacks developmental perspective
What model is proposed to serve a dimensional approach to diagnosis?
Costa & McCrae's Five-Factor Model
What are Krueger et al.'s (2005) issues w/ categorical diagnostic systems?
2 excessive NOS diagnoses,
3 arbitrary cutoffs between normal/abnormal
What are some difficulties with moving from a categorical to dimensional model?
1 longer compatible with medical model
2 No longer can use EST designed for specific disorders
3 Incompatible w/ current 3rd party billing
4 Huge change in language, thought
Categorical diagnostic systems often present dilemmas, due to?
comorbidity, boundary distinctions (Widiger & Samuel, 2005)
What is the multicultural critique of diagnostic systems?
They might not be valid across cultural perspectives (Widiger & Sankis, 2000)
When should one not use the DSM?
i)Legal issues: criminal insanity, child custody, competence for trial
ii)Cross cultures: use for diagnosing personality disorders or psychosis
iii)Presenting concern don’t warrant diagnosis
iv)When symptoms don’t adequately fit current diagnostic system
v)When diagnostic label may result in undue harm to the individual and the individual is unable to consent to such diagnostic assessment
vi)When inadequate information is obtained to make an accurate diagnosis
viii)Make causality statements about behavior –
ix)Should not be used to determine eligibility for entrance into jobs, programs of study etc.
What are advantages of a dimensional diagnostic system?
- broader range of maladaptive personality functioning along a single dimension (E.g. introversion vs. extraversion)
-Traits organized within a hierarchy: e.g. Five-Factor Model of Personality (Costa & McCrae, 1999)
-more valid and internally consistent way of describing pathology
-easier to use – no overlap
-integrates pathology and personality
-disorders = complex interaction of factors
-addresses challenge of comorbidity
-NOS’s would decrease “wastebasket”
-covers greater range of functioning
-overall addresses weaknesses of old syste
What are some difficulties of moving into a dimensional diagnostic system?
-incompatible with medical model
-incompatible with diagnosis specific EST’s
-incompatible with 3rd party billing (insurance)
-change in language, use, thought of pathology
-requires more research to demonstrate advantages over current system as well as to establish appropriate cutoff points (needs anyway!)
A large genetic study out of New Zeeland found that genetic factors, along with severe maltreatment played a strong role in the development of what?
Becoming antisocial (Caspi et al., 2002)
What are some factors of depression?
-Gender/being a woman (Nolen-Hoeksema (2001)
-Negative life events (Kendler et al., 2004)
-disruption of close relationships (Weissman et al., 1999)
-attitudes and beliefs (Beck, 1991; Comer, 2006; Evans et al., 2005; Nolen-Hoeksema, 2004)
-brain neurotransmitter and receptor sensitivity (Duman, 2004; Hecimovic & illiam, 2006)
-Genetic causes (McGriffin et al., 1996; Richard & Lyness)
Essential feature of BPD is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts. This is indicated by 5 or more of the following
-Frantic efforts to avoid real or imaginary abandonment
-Pattern of unstable and intense interpersonal relationships- alternating extremes of idealization and devaluation
-Identity disturbance—markedly and persistently unstable self-image or sense of self
-Impulsivity in at least 2 areas that are potentially damaging—spend, sex, substance abuse, etc.
-Recurrent suicidal behavior, gestures, or threats
-Affective instability due
-Chronic feelings of emptiness
-Inappropriate, intense anger lack of anger control
-Transient, stress-related paranoid ideation or severe dissociative symptoms
What are some things likely observed in sessions working with a person with BPD?
- idealized me as a caregiver in first several sessions (DSM, p. 707)
Switched quickly from idealizing me to devaluing me,
-Talked about expecting rejection and abandonment, like other therapists
-Expressed sudden sudden shifts in personality.
Impulsivity—gambling, drugs, unsafe sex, etc
-Affect instability, irritability, changes in mood (extreme) in response to interpersonal stressors
-Dissociative symptoms during extreme stress
-Over time (in 30s and 40s—relationships with others begins to stabilize)
-Co-occurs with mood disorders
-May seem similar to histrionic, paranoid personality disorder, and narcissistic personality disorder. The latter two have more stable self-image.
What are some "bottom up" factors that influence SWB (subjective well-being)?
-Wealthy, healthy, religious, married, and attractive = happy
-age likely unrelated (Horley & Lavery, 1995)
-women more depression (Eaton & Kessler, 1981)
-goal-setting, job morale, job satisfaction, education = happier
-in total, external, objective, and demographic factors account for less than 15% of variance in SWB (Argyle, 1999)
What are some top-down factors that influence SWB?
-active coping, positive illusions, downward social comparison = happy
-Personality = biggest/most consistent influence
-genetics (Tellegen, 1988)
-extraversion = happy, neuroticism = unhappy (Watson & Clark, 1997)
-downward social comparison = happy (Lyubomirsky & Ross, 1997)
-intrinsic, chosen, feasible goals= happy (Cantor & Sanderson, 1999)
-people adapt to most events (Suh, Diener, & Fujita, 1996)
What are some differences between East and West in SWB?
(Diener, Oishi, & Lucas, 2003)
a)high SWB (in western cultures) have self-serving biases: Overly positive self-evaluations, exaggerated perceptions of control and mastery, unrealistic optimism about the future
b) Eastern cultures, high SWB is associated with acceptance from others, emphasis on the importance of interdependence, not achieving too much difference from one’s peer group.
Therapists consistently underestimate clients' ____________
suicidality (Firestone, 2013)
What are predictors of suicide?
(Pope & Vasquez, 1991)
a.Isolation, living alone, loss of support: Fewer social supports associated with greater overall ideation
b.Depressive disorder: 60-70% more likely to be at suicide risk
c.Family History: Family hx of suicide contributes a twofold increase in risk of suicide, even when controlling for family psychiatric hx, which is also a predictor
d.Alcoholism e.dysregulated impulse control
f.intense psychological pain g.Suicidal ideation
h.Prior suicide attempts i.Lethal methods
j.Hopelessness, cognitive rigidity
k.Stress/stressful events l.Anger/aggression
What is the Firestone Assessment of Self-Destructive Thoughts? (FAST)
(Firestone & Firestone, 1996)
i.Extreme self-hatred: "You don't deserve to live."
ii.Personalized hopelessness: "Nothing matters anymore. "
iii.Pushing away friends and family: "What's wrong with you? "
iv.Isolation: "Just be by yourself.
v.Thoughts of not belonging: "You don't fit in anywhere."
vi.Thoughts of being a burden to others:
those who self harm are _____ times more likely to commit suicide than general public
100x (Owens, Horrocks, & House, 2002)
What are three types of self-harmers?
i.Compulsive: OCD type, self-harm serves to manage intrusive thoughts (anxiety-based)
ii.Impulsive, episode-based: no pre-planning, impulsive response to environment, may not identify as “self-harmer”
iii.Impulsive repetitive: any time there is a stressor they respond w/ self-harm
What are specific steps to take with a suicidal client?
(1)Team up with the client to formulate a personal set of warning signs (not sleeping, feeling agitated, critical inner voice), that help client recognize suicidal state
(2)Work with clients to remove dangerous items
(3) develop a complete safety plan.
(4) identify support who they can call if they start to feel bad
(5)Make yourself available for the client to call
(6)Inform of professional help that is available 24/7
(7)Provide National Suicide Prevention Lifeline
(8)safety plan: copy for the client, copy for file
(9)Obtain a commitment to treatment from the client, what you will do and what they will do to create a life worth living.