Mood Disorder and Suicide Mood - Enduring period of emotionality Mood disorder is related to a persons emotional tone or affective

state and can have an effect on behavior and can influence a persons personality and world view. The most commonly diagnosed and most severe depression is MAJOR DEPRESSIVE EPISODE. Major Depressive Episode - an extremely depressed mood state that lasts at least 2 weeks; include cognitive symptoms (such as feelings of worthlessness and indecisiveness) Anhedonia loss of energy and inability to engage in pleasure activities or have any fun duration if untreated approximately 4 to 9 months Depressive Symptoms Mnemonic: SIGECAPS S I G E C A P S leep (increase / decrease) nterest (diminished) uilt / low self-esteem nergy (poor/low) oncentration (poor) ppetite (increase/ decrease) sychomotor (agitation /retardation) uicide ideation

impairment in social or occupational functioning The Structure of Mood Disorders Unipolar Mood Disorder Individuals who experience either depression or mania. Bipolar Mood Disorder Someone who alternates between depression and mania, travelling from one pole of the depressionelation continuum to the other and back again Dysphoric Manic episode or mixed manic episode An individual can experience manic symptoms but feel somewhat depressed or anxious at the same time. Mood Disorders and Suicide Depression and mania may differ from one person to another in terms of their severity, their course (frequency), and occasionally, the accompanying symptoms. An important feature of major depression episodes is that THEY DONT GO ON FOREVER. Lasting from as little as 2 weeks to several months or more if untreated Manic episode abate on their own without treatment after approximately 3 to 4 months. Therefore it is important to DETERMINE the course of temporal patterning of the episodes. Course modifiers for mood disorders characterize the mood state in the past which helps us better predict the future of the disorder. determine the patter of recurrence and whether the timing of the episode is related to other mood-related features.

A depressed mood for 2 or more weeks, plus 4 SIGECAPS = major depressive disorder A depressed mood, plus 3 SIGECAPS for 2 years, most days = dysthymia MANIA - Period of abnormally excessive elation or euphoria, associated with some mood disorders; duration if untreated typically 3to 6 months Hypomanic episode - A less severe version of a manic episode that does not cause marked

Mood Disorders are divided into: a.) Major Depressive disorder, Single Episodeabsence of manic or hypomanic episodes before or during the disorder.

Median lifetime number : 4 (25% experienced 6 or more episodes) - Median duration of recurrent : 4 to 5 months (shorter than the average length of the first episode) b.)Dysthymic disorder - as a persistently depressed mood that continues at least 2 years, during which the patient cannot be symptom free for more than 2 months at a time. Double Depression - individuals have been studied who suffer from both major depressive episodes and dysthmic disorder. c.) Depression NOS - does not meet the criteria for major depression and other disorders Bipolar I - Alternation of full manic and depressive episodes Average onset is 18 years Tends to be chronic High risk for suicide

Major Depressive Disorder: Etiology Biological (genetic, brain structures, neurotransmitters) Behavior and cognition Emotion Social and cultural factors Developmental factors Major Depression: Genetics

Family studies: Relatives of those with a mood disorder are two to three times more likely to have a mood disorder (usually major depression) Twin studies: If one identical twin has a mood disorder the other twin is 3 times more likely than a fraternal twin to have a mood disorder (particulrly for bipolar disorder) Genetics- Severe mood disorders may have stronger genetic contribution than less severe disorders. Heritability rates are higer for females Neurotransmitters: Low levels of serotonin deregulates the activity of other neurotransmitters Endorcrine System: Elevated cortisol Cognition Learned helplessness (Seligman) -Experience of uncontrollable events

Bipolar II- Alternation of Major Depression with hypomania Onset Bipolar I - Average age : 18 Bipolar II - Average age: between 19-22 Cyclothymia most common age of onset to be 12 to 14 years Prevalence 4.9% 3.2% 0.8% 0.5% 13% Average onset is 22 years Tends to be chronic 10% progess to full biploar I disorder

-outcomes were independent of responses Loss of self-esteem after adverse external events Loss of sense of control Learned Helplessness- Attribution of lack of control over stress leads to anxiety and depression Depressive attributional style is internal, stable, and global Negative cognitive styles (Aaron Beck)

Disorders Major Depression Dysthymia Bipolar I Biploar II MDD (Postpartum)

Negative view of self; World is hostile and demanding; Expectation of suffering and failure Depression is the result of negative interpretations (wearing gray instead of rose colored glasses, e.g. Eyore in Winnie the Pooh) Key Components of Negative Interpretations Maladaptive attitudes (negative schema) Automatic thoughts Cognitive triad Errors in thinking

Marital Status and MDD Percentage w/MDD Ethnicity and Prevalence of MDD Percentage by Ethnicity

Major Depression: Developmental Factors Children Teens Elderly

Treatment Major Depression: Overview Biological Treatments Medication ECT Special note about antidepressants and children Psychological Treatments Cognitive Therapies Interpersonal Psychotherapy (IPT) NIMH Collaborative Treatment Study

Seligman -- Interpretation (theory) Attributions are: Internal Stable Global

I am inadequate (internal) at everything (global) and I always will be (stable). Dark glasses about why things are bad Beck -- Description Negative interpretations about: Themselves Immediate world (their place) Future (their place)

Antidepressant Medication with Children The effectiveness of antidepressant medication with children is questionable. Benefit did not outweigh the risks (including suicidal thoughts and behavior and agression). Prozac was exempted. Psychological Treatments Cognitive-Behavioral Treatment Clients are taught to examine carefully their thought processes while they are depressed and to recognize depressive errors in thinking. Interpersonal Therapy (IPT) - Focuses on resolving problems in existing relationships and learning to form important new interpersonal relationship.

I am not good at school (self). I hate this campus (world). Things are not going to go well in college (future). Dark glasses about what is going on Major Depression: Social and Cultural Factors Stressful life events Social support -marital relationship (see chart) Mood disorders in women Gender Culture (see chart)

Suicide 8th leading cause of death in the U.S. Overwhelmingly white phenomena

Suicide rates also quite high in Native American Rate of suicide is increasing in adolescents and elderly Males are more likely to commit suicide Females are more likely to attempt suicide (except China)

60 years Widowed or Divorced White or Native American Living alone (social isolation) Unemployed (financial difficulties) Recent adverse life events Chronic Illness

5 Myths and Facts About Suicide Myth #1: People who talk about killing themselves rarely commit suicide. Fact: Most people who commit suicide have given some verbal clues or warnings of their intentions Myth #2: The suicidal person wants to die and feels there is no turning back. Fact: Suicidal people are usually ambivalent about dying; they may desperately want to live but can not see alternatives to problems. Myth # 3: If you ask someone about their suicidal intentions, you will only encourage them to kill themselves. Fact: The opposite is true. Asking lowers their anxiety and helps deter suicidal behavior. Discussion of suicidal feelings allow for accurate risk assessment. Myth # 4: All suicidal people are deeply depressed. Fact: Although depression is usually associated with depression, not all suicidal people are obviously depressed. Once they make the decision, they may appear happier/carefree. Myths # 5: Suicidal people rarely seek medical attention. Fact: 75% of suicidal individuals will visit a physician within the month before they kill themselves. Sociodemographic Risk Factors Male

Clinical Risk Factors Previous Attempts Clinical depression or schizophrenia Substance Abuse Feelings of hopelessness Severe anxiety, particularly with depression Severe loss of interest in usual activities Impaired thought process Impulsivity

Clinical Considerations of Suicide Assessment For those who are reluctant to assess suicide: Asking questions may feel intrusive but not asking has dangerous consequences. A calm and genuinely concerned approach is effective. Causes Past Conceptions Risk Factors Family History -if a family member committed suicide, there is an increased risk in the family. Neurobiology-low level of serotonin (associated with impulsivity, instability and the tendency to overreact to situations. Existing Psychological Disorders-more than 90%ofpeople who kill themselves suffer from a psychological disorder Stressful life- severe stressful event experienced as shameful or humiliating such as a failure (real or imagined) in school or at work, an unexpected arrest or rejection by a loved one.

Suicide:Treatment

Problem-solving Cognitive behavioral therapy Coping skills Stress reduction

Conversion disorder Pain disorder Body Dysmorphic disorder

Hypochondriasis Hypochondria region below the ribs, and the organs in this region affected mental state. physical complaints without a clear cause. severe anxiety is focused on the possibility of having a serious disease. The threat seems so real that reassurance from physicians does not seem to help.

Suicides types: Altruistic suicide- individual who brought dishonor to himself or his family. Egoistic suicide loss of social support Anomic suicide result of marked disruptions, such as sudden loss of a high-prestige job. (Anomie is the feeling of lost and confused) Fatalistic suicide loss of control over ones own destiny.

Clinical Description many features with the anxiety and mood disorders, particularly panic disorder. similar age of onset, personality characteristics and patterns of familial aggregation (running in families).

Somatoform disorders - Exaggerates the slightest physical symptom. Run to doctor even though there is nothing really wrong with them. Preoccupation with their health or appearance becomes so great that it dominates their lives. Soma means body, and the problems preoccupying these people seem, initially to be physical disorders Dissociative disorders - felt detached from yourself or your surroundings. ( This isnt really me, or That doesnt really look like my hand) some people feel as if they are dreaming. slight alterations, or detachments, in consciousness or identity, - dissociation / dissociative experiences. lose their identity entirely and assume a new one or they lose their memory or sense of reality and are unable to function.

Facts about Hypochondriasis Prevalence: 1-5% (community) 2-7% (primary care outpatients) Gender: Equal rates (50-50) Age of Onset: Any age, most common in early adulthood Course: Typically chronic

Associated w/: Fears of aging and death, doctor shopping, poor relationships with physicians, past experience with disease, family and work problems Causes basically a disorder of cognition or perception with strong emotional contributions (faulty interpretation) biological or psychological vulnerabilities (runs in families)

Five (5) Somatoform Disorders Hypochondriasis Somatization disorder

Other 3 factors may contribute to etiological process seems to develop in the context of a stressful life. (e.g. death or illness) tend to have a disproportionate incidence of disease in their family when they were children (strong memories of illness) social and interpersonal influence (benefits of being sick might contribute to the development of the disorder)

Cause History of family illness or injury during childhood Genetic contributions runs in families Social and cultural factors

Treatment CBT- providing reassurance, reducing stress, reducing the frequency of helpseeking behaviors. Drugs Anti-depressant ; side effects such as nausea, agitation or head aches are often frightening to these patients making the drugs difficult to tolerate

Treatment psychodynamics psychotherapy reassurance and education explanatory therapy CBT Stress-management treatment Drugs anti-depressants, Paroxetine (Paxil), SSRI

Conversion Disorder physical malfunctioning such as paralysis, blindness, or difficulty speaking without any physical or organic pathology to account for the malfunction. blindness, paralysis, and aphonia, total mutism, and the loss of the sense of touch, globus hystericus (difficult to swallow, eat or sometimes talk) The symptom or deficit is not intentionally feigned (as in Factitious Disorder or Malingering) Malingering Disorder-Intentional production of false or grossly exaggerated physical or psychological symptoms; Motivated by external incentives (avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs) Marked discrepancy between the persons claimed stress or disability and the objective findings Lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen The presence of Antisocial Personality Disorder

Somatization Disorder Hydrochondriasis - take immediate action on noticing a symptom by calling the doctor or taking medication. Somatization disorder- Do not feel the urgency to take action but continually feel weak and ill.

Facts about Somatization Disorder Prevalence: 0.2-2% in women <0.2% in men 2:1 female Gender: More common in women (gender difference smaller in some cultures) Age of Onset: Initial symptoms adolescence Criteria met mid 20s Course: Chronic Culture:Symptoms of complaint differ across cultures

Factitious Disorder-Intentional production or feigning of physical or psychological signs or symptoms; The motivation for the behavior is to assume the sick role External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent Facts about Factitious Disorder Prevalence: Pretty much unknown 1% of hospital cases in which mental health professionals are consulted Gender: More common in females Age of onset: Typically early adulthood Course: Typically episodic

Represses the conflict, making it unconscious Anxiety continues to increase, threatens to emerge into consciousness and the person converts into physical symptoms.

the individual receives greatly increased attention and sympathy from loved ones and also be allowed to avoid a difficult situation or task. Causes Social and Cultural influences Biological vulnerability to develop the disorder when under stress

Treatment Thinking of the etiology Principle strategy - to identify and attend to the traumatic or stressful life event collaborate with both patient and family to eliminate CBT

Motivation: Factitious Disorder no external incentives are present, rather, the motivation is a desire to maintain the sick role Malingering external incentives are present Facts about Conversion Disorder Prevalence: 0.01-0.5% Gender: 2-10 times more common in women Age of Onset: Late childhood early adulthood Rarely before 10 or after 35 Course: Onset is typically acute or sudden Symptoms remit in about 2 weeks Symptoms will recur in 1/5-1/4 of cases Culture: More common in rural areas, lower SES, developing areas, and lower educational levels

Pain Disorder - refers to pain in one or more sites in the body that associated with significant distress or impairment. Prevalence: Unknown 10-15% of U.S. adults experience chronic, disabling pain/year Gender: Appears to be equal Women tend to have more chronic pain Age of onset: At any age Course: Can be acute or chronic

Cause (Conversion Disorder) Freud 4 basic process in devt of CD Individual experiences a traumatic experience

Associated w/: Unemployment, disability, family problems, substance abuse/dependence (esp. opiods), depression, suicide, sleep disturbance, money spent on health care Body Dysmorphic Disorder Excessive concern with real or imagined defects in appearance, especially facial marks or features.

Frequent visits to plastic surgeons Culturally-influenced, but not culture-bound May be a symptom of more pervasive disorders: Obsessive-compulsive or delusional disorder, for example. Prevalence: Unknown (community) 5-40% of patients with Anxiety/Depressive Disorder 6-15% of cosmetic surgery/dermatology clients Gender: Equally common in men and women Age of Onset: Childhood-adolescence Course: Chronic, continual, may wax and wane

detached from their bodies. Most patients are conscious of their impairments. Treatment : -Psychological treatments similar to those for panic disorder may be helpful Stresses associated with onset of disorder should be addressed tends to be lifelong

Dissociative Amnesia Inability to recall information, usually about stressful or traumatic events in persons lives Cannot be explained by ordinary forgetfulness; No evidence of an underlying brain disorder Most common dissociative disorder; Can occur at any age Occur more often in women than men and more often in young adults than in older adults Diagnosis The forgotten information is usually of a traumatic or stressful nature. Symptoms are not limited to amnesia that occurs in the course of DID. Do not result from general medical condition or ingestion of substance.

Associated w/: Excessive checking/grooming, removal of mirrors, social isolation, surgical procedures, suicide Cause and treatment little information about either the etiology and treatment psychoanalytic speculations defensive mechanism underlying unconscious conflict Cross-cultural explorations Drugs: that block reuptake of serotonin Clomipramine (Anafranil), and Fluvoxamine (Luvox)

Clinical Features Abrupt onset and termination of the amnesia Patients are usually aware that they have lost their memories Some patients are upset but others appear to be unconcerned Amnestic patients are usually alert before and after the amnesia occurs Depression and anxiety

Dissociative Disorders - Characterized by alterations in perceptions, a sense of detachment from ones own self, from the world or from memories DEPERSONALIZATION-The feeling that the body or the personal self is strange and unreal DEPERSONALIZATION DISORDER- A persistent or recurrent alteration in the perception of the self to the extent that a persons sense of his or her own reality is temporarily lost Patients with depersonalization disorder may feel that they are mechanical, in a dream or

Adaptive Strategies Confabulation- Invention of false information to cover up a gap in memory

Self-monitoring-Done to protect themselves from memory loss

Dissociative Fugue Patients travel away from their customary homes or work situations and fail to remember important aspects of their previous identities. Many fugues seem to represent disguised wish fulfillment. Patients seem to be running away from something of which they are unaware. May last from brief-hours to days. Occasionally, it may lasts months, with a few extreme cases noted Causality Heavy alcohol use may predispose persons to dissociative fugue, the cause of the disorder is thought to be basically psychological Essential motivating factor seems to be a desire to withdraw from emotionally painful experiences. Patients with mood disorders and certain personality disorders are predisposed to develop dissociative fugue A variety of stressors and personal factors predispose a person to the development of dissociative fugue. Psychosocial factors include marital, financial, occupational and war-related stressors. Other fugues are related to feelings of rejection or separation, or they may develop as an alternative to suicidal or homicidal impulse. Other associated predisposing features include depression, suicide attempts, organic disorders (especially epilepsy), and a history of substance abuse A history of head trauma also predisposes dissociative fugue. Definition of Terms

Personality. An entity with a firm, persistent, and well-founded sense of self and of a characteristic and consistent pattern of behavior and feelings in response to stimuli. Birth Person. It is also known as the Original Personality. This is the person that was present from birth, the one born into the body. For the majority of people, this is the person that began life before the multiplicity was created. Core Personality. The general belief is that this is the birth personality. The thought held by some in the psychological community is this person is often asleep or at least very distant from the system. Believed to be fragile, and one of the last personalities to be found. Although, this is not always the case. Host. For most multiples, this is the personality which most often is present and is in control of the body. This is the person who deals with daily functioning, and the system within, as a whole. Some multiples may have more several personalities that serve as their hosts. Alter. A generic term, for any personality, useful because, in clinical situations, it often is unclear which personalities are original, host, and so forth, or whether an entity is sufficiently distinct and elaborate for a more precise label. Co-Consciousness. The degree of knowledge and awareness that alters have with one another. They can communicate and work together as a group and have very little if any time loss. Inner Self Helper (ISH). serene, rational and objective commentators and advisors; designs and programs all alters to do whatever is necessary to keep the child alive; responsible for assigning the personalities to come out if they are appropriate to the situation especially trauma. Integration. This is the process of merging or joining alters so that the multiple becomes one person.

Dissociative Identity Disorder- It is characterized by the existence in an individual of two or more distinct personalities, with at least two of the personalities controlling the patient's behavior in turns. Characterized by switching to alternate identities when under stress. The identities are distinct. Each multiple has a specific way they see the inside of their mind, where the alters live when they are not in control of the body. These are their internal houses where they go when they are not out or when they are hiding. Everybody is born with only one personality. Therefore, there can be no such thing as a Multiple Personality Disorder." The problem focuses on the belief that a person has other identities. So the problem is not on the personality but on the belief. Because the alters alternate in controlling the patient's consciousness and behavior, the affected patient experiences long gaps in memory. Common types of Identities present: A depressed, exhausted host. A strong, angry protector. A scared, hurt child. A helper. An internal persecutor who blames one or more of the alters for the abuse they have endured.

time of the appearance of the first alter, may create many more. An innate ability to dissociate easily Repeated episodes of severe physical or sexual abuse in childhood Lack of a supportive or comforting person to counteract abusive relative(s) Influence of other relatives with dissociative symptoms or disorders Symptoms Amnesia- marked by gaps in the patient's memory for long periods of their past, and, in some cases, their entire childhood. Depersonalization-a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Derealization - Patients may see walls, buildings, or other objects as changing in shape, size, or color. DID patients may fail to recognize relatives or close friends. Identity Disturbances- DID patients are often frightened by their dissociative experiences, which can include losing awareness of hours or even days, meeting people who claim to know them by another name, or feeling "out of body." Signs of Multiplicity Reports of time distortions, lapses, and discontinuities. Being told of behavioral episodes by others that are not remembered by the patient. Being recognized by others or called by another name by people whom the patient does not recognize. Notable changes in the patients behavior reported by a reliable observer; the patient may

Left untreated, DID can last a lifetime. Treatment for the disorder consists primarily of individual psychotherapy. Causality Severe and prolonged trauma experienced during childhood. A manufactured alter may suffer while the primary identity "escapes" the unbearable experience. Over time, the child, who on average is around six years old at the

call himself or herself by a different name or refer to himself or herself in the third person. Other personalities are elicited under hypnosis or during amobarbital interviews. Use of the word we in the course of an interview. Discovery of writings, drawings, or other productions or objects among the patients personal belongings that are not recognized or cannot be accounted for. Headaches. History of severe emotional or physical trauma as a child. DISSOCIATIVE DISORDER NOT OTHERWISE SPECIFIED- The category of dissociative disorder not otherwise specified includes disorders in which the predominant feature is a dissociative symptom but does not meet the criteria for any specific dissociative disorder. Dissociative Trance Disorder (DTD)- Trance or possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that context. Cause: not well understood, but often seem related to the tendency to escape psychologically from memories of traumatic events. Treatment involves helping the patient reexperience the traumatic events in a controlled therapeutic manner to develop better coping skills. often long term and may include antidepressant drugs. Essential with DID: sense if trust between therapist and patient.

Character-characteristics acquired during our upbringing and connotes a degree of conformity to virtuous social standards. Temperament -refers to the basic biological disposition toward certain behaviors. Personality Trait -a long-standing pattern of behavior expressed across time and situations Maladaptive -inability to modify behavior/personality accordingly with change Distress -pain/suffering caused by stress affecting the body or mind Impairment-a damage/deterioration on body/mental health and functioning PERSONALITY DISORDER-Characterized by inflexible, long-standing and maladaptive personality traits that cause significant functional impairment or subjective distress for individual; an enduring pattern of inner experience and behavior that deviate, markedly from the expectations of the individuals culture. This pattern is manifested in two or more of the following: cognition, affectivity, interpersonal functioning, impulse control Cluster A Odd or Eccentric Disorders Cluster B Dramatic, Emotional or Erratic Disorders Cluster C Anxious or Fearful Disorders

Personality Disorder Not Otherwise Specified 1} the individual's personality pattern meets the general criteria for a Personality Disorder and traits of several different Personality Disorders are present, but the criteria for any specific Personality Disorder are not met; or 2} the individual's personality pattern meets the general criteria for a Personality Disorder, but the individual is considered to have a Personality Disorder that is not included in the

Personality -a global descriptive label for a persons observable behavior and his/her subjectively reportable inner experience.

Classification (e.g., passive-aggressive personality disorder). Statistics and Development 1 in10 adults in the US may have a diagnosable personality disorder < women borderline PD < Men Antisocial PD

Causes: Biological contributions Psychological Contributions Cultural factors

Treatment : Therapists : atmosphere conducive to developing a sense of trust Cognitive therapy

Personality Disorders under study Proposed for inclusion: Sadistic PD - people who receive pleasure by inflicting pain on others. Self-defeating PD-people who are overly passive and accept the pain and suffering imposed by others.

Schizoid Personality Disorder - loner show a pattern of detachment from social relationships and limited range of emotions interpersonal situations Aloof, cold and indifferent to other people; lack emotional expressiveness schizoid tendency to turn inward and away from the outside world.

Personality Disorders under study Depressive PD -include self-criticism, dejection, a judgmental stance toward others and tendency to feel guilty. Negativistic PD - is characterized by passive aggression in which people adopt a negativistic attitude to resist routine demands and expectations.

DISTANT (four criteria) Causes: genetics and environment Childhood shyness -Abuse and neglect in childhood Neurochemical lower density of dopamine -detachment Treatment rare for a person with this disorder to request treatment therapist often treatment by: pointing out the value of social relationships D [7]Detached (or flattened) affect I [6}Indifferent to criticism and praise S [3]Sexual experiences of hittle interest T [2}Tasks (activities) done solitarily A [5]Absence of close friends N [1}Neither desires nor enjoys close relations T [4lTakes pleasure in few activities

Paranoid Personality Disorder being too distrustful can interfere with making friends excessively mistrustful and suspicious of others without any justification sensitive to criticism and have an excessive need for autonomy.

SUSPECT (four criteria) S [7]Spouse fidelity suspected U [5]Unforgiving (bears grudges) S [1]Suspicious of others P [6]Perceives attacks (and reacts quickly) E *2+ Enemy or friend (suspects associates and friends) C [3]Confiding in others feared T [4]Threats perceived in benign events

to be taught the emotions felt by others to learn empathy receive social skills training role-playing and helps the patient practice establishing and maintaining social relationships

Schizotypal Personality Disorder - Socially isolated Seem unusual, tend to be suspicious & have odd beliefs Believing everything relates to them personally odd beliefs or engage in magical thinking

-Anti-psychotic medication and community treatment (a team of support professionals providing therapeutic services) Social skills training treat the symptoms experienced by individual with this disorder.

Antisocial Personality Disorder It is an inability to conform to the social norms that govern many aspects of a persons behaviour. It is characterized by continual antisocial criminal acts and pervasive violation of others rights. Psychopaths are believed to possess some constitutional disposition to the syndrome. Sociopaths are biologically normal, but develop antisocial characteristics through hostile socialization, mainly defective parenting. Antisocial are pertaining to a pattern of behavior in which social norms and the rights of others are persistently violated CORRUPT (three criteria) C [1} Conformity to law lacking [6] Obligations ignored R [5] Reckless disregard for safety of self or others R [7] Remorse hacking U [2l Underhanded (deceitful, lies, cons others) P {3} Planning insufficient (impulsive) T [4} Temper (irritable and aggressive)

ME PECULIAR (five criteria) Cause Genetics Environment - womans exposure to influenza in pregnancy Brain structure - some damage in the left hemisphe M [2] Magical thinking or odd beliefs E [3] Experiences unusual perceptions P [5] Paranoid ideation E [7] Eccentric behavior or appearance C [6] Constricted (or inappropriate) affect U [4] Unusual (odd) thinking and speech L [8] Lacks close friends I [1] Ideas of reference A [9] Anxiety in social situations R R ule out psychotic disorders and pervasive developmental

Treatment: 30- 50% - Major Depressive Disorder Medical and psychological treatment depression Combination approach

ETIOLOGY: Genetic Influence Factors known to directly affect the development of the organism. Factors that often accompany the appearance of a syndrome but with an uncertain developmental role.

Cleckley (1950) said antisocials suffer what he called a semantic aphasia. psychopaths suffer an inborn inability to understand and express the meaning of emotional experience Deficits in frontal lobe activity explain the psychopaths inattention to morality. Low serotonin levels - associated with displays of aggression, and impulsivity; associated with antisocial personality disorder and comorbid substance abuse High testosterone levels- associated with antisocial behavior in male veterans (not in college students) Genetic basis for antisocial or criminal behaviour (heredity) PSYCHOLOGICAL PERSPECTIVE The ego develops, but the superego does not. The personality is dominated by the infantile id & its pleasure principle. Antisocials are centered on their own immediate needs and violate shared standards of living. Antisocials appear, in the words of Prichard, morally insane. lack of conscience is perhaps the most stunning characteristic of the antisocial personality INTERPERSONAL PERSPECTIVE Antisocials not only seek control, but also do so pridefully. Exploitation of others makes them proud. They guiltlessly abuse and injure others physically to secure control over a relationship or express their own autonomy. Children exposed to neglect, hostility, and physical abuse learn that the world is a cold, unforgiving place.

Without adequate parental controls, future antisocials never learn to control aggression adequately. A violent parent provides a violent role model COGNITIVE PERSPECTIVE poor planning abilities and inability to foresee consequences; cognitive style is deviant, impulsive and egocentric. unable to create mental models of consequences of actions they are too susceptible to their desire for instant rewards If I am not the aggressor, then I will be the victim.

Treatment Intensive Group therapy (usually prison setting; 80 hours per week) Parent training - parents are taught to recognize behavior problems early and how to use praise and privileges to reduce problem behavior and encourage prosocial behaviors

Prevention emphasize behavioral supports for good behavior and skills training to improve social competence. using parent training for young children

Borderline Personality Disorder borderline people who could not be fit easily into existing diagnoses of emotional or psychotic disorders and are extremely difficult to treat instability- in mood, self-image, behavior, interpersonal relationships disrupts family, work life, long-term planning and sense of self-identity; overlaps with other personality disorder Characteristics

mood swings frequent severe depression, anxiety and anger for no good reason chronic feelings of boredom and emptiness cling to others to fill the void distort relationships through splitting self-doubt and self-importance lack of sense of self-identity Unpredictable behavior Not able to maximize abilities Impulsive and self-destructive behavior to elicit help, express anger or numb themselves Transient dissociative states

childhood marked by instability, abuse, neglect and parental psychopathology histories of significant others discounting and criticizing their emotional experiences

Treatment Dialectical Behavior Therapy (DBT)involves helping people cope with the stressors that seem to trigger suicidal behaviors. -Medication: Tricyclic antidepressants minor tranquilizers lithium

AM SUICIDE (five criteria) A {1]Abandonment M [6] Mood instability (marked reactivity of mood) S [5} Suicidal (or self-mutilating) behavior U [2} Unstable and intense relationships I [4} Impulsivity (in two potentially selfdamaging areas) C [8]Control of anger I [3] Identity disturbance D [9}Dissociative (or paranoid) symptoms that are transient and stress related E [7] Emptiness (chronic feelings of)

Histrionic Personality Disorder histrio meaning actor display of an enduring pattern of attention-seeking and excessively dramatic behaviors excitable, emotional, colorful, dramatic and extroverted fashion of behavior Common in women

Characteristics attention-seeking behavior needs of being the center of attention, being approved and praised self-dramatization and theatricality shallow range of emotions turning off and on too quickly manipulative rather than expressive of true feelings seductive and flirtatious psychosexual dysfunction- anorgasmic or impotent endless need for reassurance superficial relationships vain and self-absorbed trusting and gullible major defenses: repression and dissociation

Etiology Biological heredity volume and activation of the amygdala, volume of the hippocampus abnormal change in blood flow and decrease in metabolism in the prefrontal cortex low levels of serotonin Psychological and Social poor views of themselves and others poor early relationships with caregivers

PRAISE ME (five criteria)

P [2] Provocative (or sexually seductive) behavior R [8} Relationships (considered more intimate than they are) A [1} Attention (uncomfortable when not the center of attention) I [7} Influenced easily S [5} Style of speech (impressionistic, lacks detail) E [3] Emotions (rapidly shifting and shallow) M [4] Made up (physical appearance used to draw attention to self) E [6} Emotions exaggerated (theatrical) Etiology Biological Psychological and Social special behavior otherwise unworthy of attention learning of getting wants by drawing attention to themselves

Cause:

P [2] Preoccupied with fantasies (of unlimited success, power, brilliance, beauty or ideal love) E [8] Envious (of others, or believes others are envious of him or her) E [5] Entitlement E [4] Excess admiration required C [1] Conceited (grandiose sense of self importance) I [6] Interpersonal exploitation A [9] Arrogant (haughty) L [7] Lacks empathy

infants being self-centered and demanding profound failure of modeling empathy by the parents early in childs devt remains fixated and self-centered

Treatment: Cognitive Therapy aims replacing their fantasies with focus on day-to-day Coping strategies (relaxation) - help them face and accept criticism

Treatment: Little evidence of success Rewards and fines Focus on interpersonal relations

Avoidant Personality Disorder extremely sensitive to the opinions of others avoid most relationships Low self-esteem Fear of rejection Dependent on those they feel comfortable with

Narcissistic Personality Disorder think highly of themselves exaggerating their real abilities exaggerated sense of self- importance and are preoccupied with receiving attention. have an unreasonable sense of selfimportance lack sensitivity and compassion for other people arent comfortable unless someone is admiring them.

CRINGES (four criteria) C [2] Certainty (of being liked required before willing to get involved with others) R *4+ Rejection (or criticism) preoccupies ones thoughts in social situations I [3] Intimate relationships (restraint in intimate relationships due to fear ofbeing shamed)

SPE3CIAL (five criteria) S [3] Special (believes he or she is special and unique)

N [5) New interpersonal relationships (is inhibited in) G [1] Gets around occupational activity (involving significant interpersonal contact) E [7] Embarrassment (potential) prevents new activity or taking personal risks S [6] Self viewed (as unappealing, inept, or inferior) Causes: Biological Influences

L [2} Life responsibilities (needs to have these assumed by others) I [4) lnitiating projects difficult (due to lack of self-confidence) A [6] Alone (feels helpless and discomfort when alone) N [5] Nurturance (goes to excessive lengths to obtain nurturance and support) C {7] Companionship (another relationship) sought urgently when close relationship ends E [8]Exaggerated fears of being left to care for self Causes: Biological Influences Psychological Influences Social / Cultural Influences

Innate characteristics may cause rejection Psychological Influences -Low-self-esteem fear of rejection, criticism lead to fear of attention -Extreme sensitivity Resembles social phobia Social and Cultural Influences Insufficient parental affection

Treatment: Very little research Appear as ideal clients submissiveness negates independence

Treatment Behavioral Intervention techniques for anxiety systematic desensitization behavioral rehearsal Social skills problems

Obsessive Compulsive Personality Disorder Fixation on things being done the right way rigidity, tend to have poor interpersonal relationships Obsessive thoughts and compulsive behaviors LAW FIRMS (four criteria) L [1} Loses point ofactivity (due to preoccupation with detail) A [2] Abihity to complete tasks (compromised b perfecionism) w [5 }Worthless objects (unable to discard) F [3] Friendships (and leisure activities) excluded (due to a preoccupation with work)

Dependent Personality Disorder (DPD) defined a personality disorder characterized by a longstanding need for the person to be taken care of a fear of being abandoned or separated from important individuals in his or her life Dependent- relying on another for help/support RELIANCE (five criteria) R [1] Reassurance (required for decisions) E [3] Expressing disagreement difficult (due to fear of loss of support or approval)

Causes:

I [4] Inflexible, scrupulous, overconscientious (on ethics, values, or morality, not accounted for by religion or culture) R [6] Reluctant to delegate (unless others submit to exact guidelines) M [7] Miserly (toward selfand others) S [8} Stubbornness (and rigidity)

Biological Influences Psychological Influence Social Cultural Influences

Treatment: Little Information Therapy attacks fears behind need Relaxation or Distraction techniques redirect compulsion to order