CHAPTER 10 PERSONALITY DISORDERS
obsessive- compulsive personality disorders;
10.1 What are some of the general features of
personality disorders?
Personality disorders appear to be rather inflexible
and distorted behavioral patterns and traits that result
in maladaptive ways of perceiving, thinking about,
and relating to other people and the environment.
Three general clusters of personality disorders have
been described in DSM, although researchers have
increasingly questioned the validity of these clusters.
10.2 What are some of the difficulties of doing
research on personality disorders?
Even with structured interviews, the reliability of
diagnosing personality disorders typically is less than
ideal. Most researchers today agree that a dimensional
approach for assessing personality disorders would be
preferable.
It is difficult to determine the causes of personality
disorders as categories because most people with one
personality disorder also have at least one more and
because most studies to date are retrospective.
10.3 What characteristics do the Cluster A
personality disorders have in common?
Cluster A includes paranoid, schizoid, and
schizotypal personality disorders; individuals with
these disorders seem odd or eccentric. Little is known
about the causes of paranoid and schizoid disorders,
but genetic and other biological factors are implicated
in schizotypal personality disorder.
10.4 What characteristics do the Cluster B
personality disorders have in common?
Cluster B includes histrionic, narcissistic, antisocial,
and borderline personality disorders; individuals with
these disorders share a tendency to be dramatic,
emotional, and erratic. Little is known about the
causes of histrionic and narcissistic disorders. Certain
biological and psychosocial causal factors have been
identified as increasing the likelihood of developing
borderline personality disorder in those at risk
because of high levels of impulsivity and affective
instability.
10.5 What characteristics do the Cluster C
personality disorders have in common?
Cluster C includes avoidant, dependent, and
individuals with these disorders show fearfulness or
tension, as in anxiety-based disorders. Children with
an inhibited temperament may be at heightened risk
for avoidant personality disorder, and individuals high
on neuroticism and agreeableness, with authoritarian
and overprotective parents, may be at heightened risk
for dependent personality disorder.
10.6 What are the clinical features of borderline
personality disorder and how is this disorder
treated?
Borderline personality disorder is characterized by
emotional instability, fears of abandonment,
impulsivity, self-mutilating behavior, and an unstable
sense of self. People with BPD have intense and
stormy personal relationships.
There is relatively little research on treatments for
most personality disorders. However, a form of
behavior therapy called dialectical behavior therapy
(DBT) is beneficial for people with BPD. DBT helps
patients learn to manage their emotions and develop
new coping skills. Other recently developed forms of
therapy for BPD include transference-focused
psychotherapy and mentalization-based treatment. A
wide range of medications (antidepressants,
antipsychotic medications, and mood stabilizing
medications) are also used sometimes. 10.7 What are
the features of antisocial personality disorder and
psychopathy?
A person with psychopathy shows elevated levels of
two different dimensions of traits: (1) an affective-
interpersonal set of traits reflecting lack of remorse or
guilt, callousness/lack of empathy,
glibness/superficial charm, grandiose sense of self-
worth, and pathological lying, and (2) antisocial,
impulsive, and socially deviant behavior;
irresponsibility; and parasitic lifestyle. A person
diagnosed with ASPD is primarily characterized by
traits from the second dimension of psychopathy.
Genetic and temperamental, learning, and adverse
environmental factors seem to be important in
causing psychopathy and ASPD.
Psychopaths also show deficiencies in fear and
anxiety as well as more general emotional deficits.
Treatment of individuals with ASPD psychopathy is attention; their lively, dramatic, and excessively
difficult, partly because they rarely see any need to extraverted styles often ensure that they can charm
change and tend to blame other people for their others into attending to them.
problems.
NARCISSISTIC PERSONALITY DISORDER-
ANTISOCIAL PERSONALITY DISORDER show an exaggerated sense of self-importance, a
(ASPD) - is their tendency to persistently disregard preoccupation with being admired, and a lack of
and violate the rights of others. They do this through empathy for the feelings of others.
a combination of deceitful, aggressive, and antisocial
obsessive-compulsive personality disorder (OCPD)-
behaviors. These people have a lifelong pattern of
Perfectionism and an excessive concern with
unsocialized and irresponsible behavior with little
maintaining order and control characterize individuals
regard for safetyeither their own or that of others.
with obsessive-compulsive personality disorder
These characteristics bring them into repeated
conflict with society, and a high proportion become PARANOID PERSONALITY DISORDER-
incarcerated. have a pervasive suspiciousness and distrust of others,
leading to numerous interpersonal difficulties. They
AVOIDANT PERSONALITY DISORDER -
tend to see themselves as blameless, instead blaming
show extreme social inhibition and introversion,
others for their own mistakes and failureseven to
leading to lifelong patterns of limited social
the point of ascribing evil motives to others. Such
relationships and reluctance to enter into social
people are chronically tense and on guard,
interactions. Because of their hypersensitivity to, and
constantly expecting trickery and looking for clues to
fear of, criticism and rebuff, they do not seek out
validate their expectations while disregarding all
other people, yet they desire affection and are often
evidence to the contrary.
lonely and bored.
PERSONALITY DISORDER- certain traits that
BORDERLINE PERSONALITY DISORDER
are so inflexible and maladaptive that they are unable
(BPD) - show a pattern of behavior characterized by
to perform adequately at least some of the varied
impulsivity and instability in interpersonal
roles expected of them by their society, in which case
relationships, self-image, and moods.
we may say that they have a personality disorder
DEPENDENT PERSONALITY DISORDER- (formerly known as a character disorder).
show an extreme need to be taken care of, which
Psychopathy-
leads to clinging and submissive behavior. They also
show acute fear at the possibility of separation or SCHIZOID PERSONALITY DISORDER-
sometimes of simply having to be alone because they usually unable to form social relationships and usually
see themselves as inept lack much interest in doing so. Consequently, they
tend not to have good friends, with the possible
DIALECTICAL BEHAVIOR THERAPY-
exception of a close relative. Such people are unable
developed by Marsha Linehan, is a unique kind of
to express their feelings and are seen by others as cold
cognitive and behavioral therapy specifically adapted
and distant.
for BPD. Linehan believes that patients inability to
tolerate strong states of negative affect is central to SCHIZOTYPAL PERSONALITY DISORDER-
this disorder. One of the primary goals of treatment is are also excessively introverted and have pervasive
to encourage patients to accept this negative affect social and interpersonal deficits (like those that occur
without engaging in self-destructive or other in schizoid personality disorder), but in addition they
maladaptive behaviors. have cognitive and perceptual distortions, as well as
oddities and eccentricities in their communication and
HISTRIONIC PERSONALITY DISORDER-
behavior
Excessive attention-seeking behavior and
emotionality are the key characteristics of individuals
with histrionic personality disorder. these individuals
tend to feel unappreciated if they are not the center of
CHAPTER 11 SUBSTANCES RELATED Sociocultural factors such as attitudes toward alcohol
DISORDERS may predispose individuals to alcohol-related
disorders.
11.1 what is alcohol abuse and dependence?
11.2 what is drug abuse and dependence?
Substance-related disorders such as alcohol or drug
abuse and dependency are among the most Possible causal factors in drug abuse include the
widespread and intransigent mental health problems influence of peer groups, the existence of a so-called
facing us today. drug culture, and the availability of drugs as tension
reducers or pain relievers.
Many problems of alcohol or drug use involve
difficulties that stem solely from the intoxicating Some recent research has explored a possible
effects of the substances. physiological basis for drug abuse. The discovery of
endorphins, opium-like substances produced by the
Dependence occurs when an individual develops a
body, has led to speculation that a biochemical basis
tolerance for the substance or exhibits withdrawal
of drug addiction may exist.
symptoms when the substance is not available.
The so-called pleasure pathwaythe
Several psychoses related to alcoholism have been
mesocorticolimbic pathway (MCLP)has come
identified: withdrawal delirium, chronic alcoholic
under a great deal of study in recent years as the
hallucinosis, and dementia associated with alcoholism.
possible potential anatomic site underlying the
Drug-related abuse disorders may involve addictions.
physiological dependence on substances such as
The treatment of individuals who abuse alcohol or
opiatesparticularly heroinor barbiturates;
drugs is generally difficult and often fails. The abuse
however, psychological dependence may also occur
may reflect a long history of psychological difficulties;
with any of the drugs that are commonly used
interpersonal and marital distress may be involved;
todayfor example, marijuana.
and financial and legal problems may be present.
A number of factors are considered important in the
In addition, all such problems must be dealt with by
etiology of substance-abuse disorders. Some
an individual who may deny that the problems exist
substances, such as alcohol and opiates, stimulate
and who may not be motivated to work on them.
brain centers that produce euphoriawhich then
becomes a desired goal. Several approaches to the treatment of chronic
substance-related disorders have been developed
It is widely believed that genetic factors play some
for example, medication to deal with withdrawal
role in causing susceptibility to alcohol-abuse
symptoms and withdrawal delirium, and dietary
problems through such biological avenues as
evaluation and treatment for malnutrition.
metabolic rates and sensitivity to alcohol.
Psychological therapies such as group therapy and
Psychological factorssuch as psychological
behavioral interventions may be effective with some
vulnerability, stress, and the desire for tension
alcohol- or drug-abusing individuals. Another source
reductionand disturbed marital relationships or
of help for alcohol abusers is Alcoholics Anonymous;
failure in parental guidance are also seen as important
however, the extent of successful outcomes w ith this
etiologic elements in substance-use disorders.
program has not been sufficiently studied.
Although the existence of an alcoholic personality
Most treatment programs require abstinence;
type has been disavowed by most theorists, a variety
however, some research has suggested that some
of personality factors apparently play an important
alcohol abusers can learn to control their drinking
role in the development and expression of addictive
while continuing to drink socially. The controversy
disorders.
surrounding controlled drinking continues.
Relapse prevention strategies have proved successful
in helping substance-abusing patients to deal with the
challenges encountered in abstinence-based treatment
approaches.
11.3 Are there addictive disorders other than
alcohol and drugs?
This chapter also includes discussion of several
addictive disorders that are different than alcohol or
drug abuse, caffeine, tobacco and gambling.
ADDICTIVE BEHAVIOR- behavior based on the
pathological need for a substancemay involve the
abuse of substances such as nicotine, alcohol, Ecstasy,
or cocaine. Addictive behavior is one of the most
prevalent and difficult-to-treat mental health
problems facing our society today.
ALCOHOL WITHDRAWAL DELIRIUM-
(formerly known as delirium tremens) This reaction
usually happens following a prolonged drinking
spree when the person enters a state of withdrawal.
Slight noises or suddenly moving objects may cause
considerable excitement and agitation.
ALCOHOLIC- SAME AS ALCOHOLISM
ALCOHOLISM- a state, psychic and usually also
physical, resulting from taking alcohol, characterized
by behavioral and other responses that always include
a compulsion to take alcohol on a continuous or
periodic basis in order to experience its psychic
effects, and sometimes to avoid the discomfort of its
absence; tolerance may or may not be present
AMPHETAMINE- The earliest amphetamine to be
introducedBenzedrine, or amphetamine sulfate
was first synthesized in 1927 and became available in
drugstores in the early 1930s as an inhalant to relieve
stuffy noses. these preparations were considered to be
wonder pills that helped people stay alert and
awake and function temporarily at a level beyond
normal.
BARBITURATES- barbiturates have been
available as an aid to falling asleep. Barbiturates were
once widely used by physicians to calm patients and
induce sleep. They act as depressantssomewhat like
alcoholto slow down the action of the CNS and
significantly reduce performance on cognitive tasks
CAFFEINE- The chemical compound caffeine is
found in many commonly available drinks and foods.
The negative effects of caffeine involve intoxication
rather than withdrawal. Unlike addiction to drugs
such as alcohol or nicotine, withdrawal from caffeine
does not produce severe symptoms, except for
headache, which is usually mild.
COCAINE- Is a plant product discovered in ancient
times and used ever since. cocaine was considered as
the high for the affluent. However, with more
widespread availability and lowering of prices, the
drugs use increased significantly in the United States
during the 1980s and 1990sto the point where its
use was considered epidemic, especially among
middle- and upper-income groups.
DELIRIUM TREMENS- SAME AS ALCOHOL
WITHDRAWAL DELIRIUM
ECSTASY- The drug Ecstasy, or MDMA is both a
hallucinogen and a stimulant that is popular as a party
drug among young adults. The drug was further
evaluated and tested during the 1970s and 1980s as a
potential medication for use in psychological
treatment for a wide range of conditions such as
posttraumatic stress, phobias, psychosomatic
disorders, depression, suicidality, drug addiction, and
relationship difficulties
ENDORPHINS- The human body produces its
own opium-like substances, called endorphins, in the
brain and pituitary gland. These substances are
produced in response to stimulation and are believed
to play a role in an organisms reaction to pain.
FLASHBACK- An interesting and unusual
phenomenon that may occur sometime following the
use of LSD. an involuntary recurrence of perceptual
distortions or hallucinations weeks or even months
after the individual has taken the drug. Flashbacks
appear to be relatively rare among people who have
taken LSD only oncealthough they do sometimes
occur.
HALLUCINOGENS- are drugs that are thought to
induce hallucinations. However, these preparations
usually do not in fact create sensory images but
distort them so that an individual sees or hears things
in different and unusual ways. These drugs are often
referred to as psychedelics. The major drugs in this
category are LSD (lysergic acid diethylamide) or
acid, mescaline, and psilocybin.
 HASHISH- derived from the resin exuded by the
cannabis plant and made into a gummy powder.
Hashish, like marijuana, is usually smoked. Although
marijuana can be considered a mild hallucinogen,
there are significant differences between the nature,
intensity, and duration of its effects and those
induced by drugs like LSD, mescaline, and other
major hallucinogens.
HEROIN-
LSD- The most potent of the hallucinogens, the
odorless, colorless, and tasteless drug LSD can
produce intoxication with an amount smaller than a
grain of salt.
MARIJUANA- comes from the leaves and flowering
tops of the hemp plant, Cannabis sativa, which grows
in mild climates throughout the world. In its prepared
state, marijuana consists chiefly of dried green
leaveshence the colloquial name grass. It is
ordinarily smoked in the form of cigarettes (variously
referred to as pot, reefers, joints, stash, system (CNS) psychoactive substances: alcohol,
weed, etc.) or in pipes. In some cultures the leaves
are steeped in hot water and the liquid is drunk, much
as one might drink tea.
MESCALINE- Both drugs have mind-altering and
hallucinogenic properties, but their principal effect
appears to be enabling an individual to see, hear, and
otherwise experience events in unaccustomed ways
transporting him or her into a realm of non ordinary
reality.
MESOCORTICOLIMBIC DOPAMINE
PATHWAY (MCLP)- is the center of psychoactive
drug activation in the brain. The MCLP is made up of
neuronal cells in the middle portion of the brain
known as the ventral tegmental area and connects to
other brain centers such as the nucleus accumbens
and then to the prefrontal cortex.
METHADONE- Methadone hydrochloride is a
synthetic narcotic that is related to heroin and is
equally addictive physiologically. Its usefulness in
treatment lies in the fact that it satisfies an addicts
craving for heroin without producing serious
psychological impairment, if only because it is
administered as a treatment in a formal clinical
context and can result in reduced drug use and
improved cognitive performance
MORPHINE- a bitter-tasting powder that could
serve as a powerful sedative and pain reliever
NICOTINE- The poisonous alkaloid nicotine is the
chief active ingredient in tobacco; it is found in such
items as cigarettes, chewing tobacco, and cigars, and it
is even used as an insecticide. The use of tobacco is a
significant problem in the general population.
OPIUM- is a mixture of about 18 chemical
substances known as alkaloids.
PATHOLOGICAL GAMBLING- Persistent and
recurrent problematic gambling behavior leading to
clinically significant impairment or distress, as
indicated by the individual exhibiting four (or more)
of the following in a 12-month period
PSILOCYBIN- same as mescaline
PSYCHOACTIVE SUBSTANCES- The most
commonly used problem substances are those that
affect mental functioning in the central nervous
nicotine, barbiturates, tranquilizers, amphetamines,
heroin, Ecstasy, and marijuana.
SUBSTANCE ABUSE- generally involves an
excessive use of a substance resulting in (1) potentially
hazardous behavior such as driving while intoxicated
or (2) continued use despite a persistent social,
psychological, occupational, or health problem.
SUBSTANCE DEPENDENCE- includes more
severe forms of substance-use disorders and usually
involves a marked physiological need for increasing
amounts of a substance to achieve the desired effects.
Dependence in these disorders means that an
individual will show a tolerance for a drug and/or
experience withdrawal symptoms when the drug is
unavailable.
SUBSTANCE-RELATED DISORDERS- can be
seen all around us: in extremely high rates of alcohol
abuse and dependence, and in tragic exposs of
cocaine abuse among star athletes and entertainers
TOLERANCE- the need for increased amounts of a
substance to achieve the desired effectsresults from
biochemical changes in the body that affect the rate
of metabolism and elimination of the substance from
the body.
TOXICITY-
WITHDRAWAL- refers to physical symptoms such
as sweating, tremors, and tension that accompany
abstinence from the drug.
CHAPTER 12 SEXUAL VARIANTS, ABUSE,
AND DYSFUNCTIONS
12.1 Why is it difficult to define boundaries
between normality and psychopathology in the
area of variant sexuality?
Defining boundaries between normality and
psychopathology in the area of variant sexuality is
very difficult, in part because sociocultural influences
on what have been viewed as normal or aberrant
sexual practices abound.
Degeneracy theory and abstinence theory both
maintained that sexual activity should only occur for
purposes of procreation because wasting semen was
harmful; both were very influential for long periods of
time in the United States and many other Western
cultures and led to very conservative views on
heterosexual sexuality.
In contrast to Western cultures, in the Sambia tribe
in Melanesia, homosexuality is practiced by all
adolescent males in the context of male sexual
initiation rites; these males transition to
heterosexuality in young adulthood.
Until rather recently in many Western cultures,
homosexuality was viewed either as criminal behavior
or as a form of mental illness. However, since 1974
homosexuality has been considered by mental health
professionals to be a normal sexual variant. 12.2 What
do we mean by sexual and gender variants?
Sexual deviations in the form of paraphilias involve
persistent and recurrent patterns of sexual behavior
and arousal, lasting at least 6 months, in which
unusual objects, rituals, or situations are required for
full sexual satisfaction. They occur almost exclusively
in males, who often have more than one of them. The
paraphilias include fetishes, transvestic fetishism,
voyeurism, exhibitionism, sadism, masochism,
pedophilia, and frotteurism.
Gender dysphoria occurs in children and adults.
Childhood gender dysphoria occurs in children who
have unbold and dysphoria/distress about their
biological sex. Most boys who have this disorder
grow up to have a homosexual orientation; a much
smaller number become transexuals. Prospective
studies of girls who have this disorder have reported
similar results.
Transsexualism is a very rare disorder in which the
person believes that he or she is trapped in the body
of the wrong sex and goes through elaborate steps
necessary to change his or her sex. It is now
recognized that there are two distinct types of male-
to-female transsexuals: homosexual transsexuals and
autogynephilic transsexuals, each with different
characteristics and developmental antecedents. The
only known effective treatment 12 summary for
transsexuals is a sex change operation. Although its
use remains highly controversial, it does appear to
have fairly high success rates when the people are
carefully diagnosed before the surgery as being true
transsexuals. 12.3 What are the three primary types of
sexual abuse?
There are three overlapping categories of sexual
abuse: pedophilia, incest, and rape. All three kinds of
abuse occur at alarming rates today.
Pedophilia is defined as sexual interest in prepubertal
children.
Incest involves sexual activity between blood
relatives.
Rape describes sexual activity that occurs under
actual or threatened forcible coercion by one person
on another.
Treatment of sex offenders has not as yet proved
highly effective in most cases, although promising
research in this area is being conducted. 12.4 What is
a sexual dysfunction?
Sexual dysfunction involves impairment either in the
desire for sexual gratification or in the ability to
achieve it. Dysfunction can occur in the first three of
the four phases of the human sexual response: the
desire phase, the excitement phase, and orgasm.
Male hypoactive sexual desire disorder is diagnosed
in men when they have little or no interest in sex. In
extreme cases they may actually have an aversion to
sexual activity.
Erectile disorder occurs in men who are unable to
attain or to maintain an adequate erection until the
completion of sexual activity.
Formerly called premature ejaculation, early
ejaculation occurs in men who persistently and
recurrently have the onset of orgasm and ejaculation
occurs after only minimal sexual stimulation.
Delayed ejaculation refers to the persistent inability
to ejaculate during intercourse.
Female sexual interest/arousal disorder is diagnosed
in women who persistently show a lack of interest in
sexual activity and/ or great difficulty getting
adequately aroused enough to have an orgasm.
Genito-pelvic pain/penetration disorder is diagnosed
in women who have persistent or recurrent
difficulties in at least one of the following four areas:
1. Marked difficulty having vaginal
intercourse/penetration 2. Marked vulvovaginal or
pelvic pain during vaginal intercourse/penetration
attempts 3. Marked fear or anxiety either about
vulvovaginal or pelvic pain or vaginal penetration 4.
Marked tensing or tightening of the pelvic floor
muscles during attempted vaginal penetration
AUTOGYNEPHILIA- a paraphilia in which their
attraction is to thoughts, images, or fantasies of
themselves as a woman
DELAYED EJACULATION DISORDER-
refers to the persistent inability to ejaculate during
intercourse
DESIRE PHASE- consists of fantasies about sexual
activity or a sense of desire to have sexual activity.
ERECTILE DISORDER- male sexual dysfunction
EXCITEMENT (OR AROUSAL) PHASE-
characterized both by a subjective sense of sexual
pleasure and by physiological changes that accompany
this subjective pleasure, including penile erection in
the male and vaginal lubrication and clitoral
enlargement in the female.
EXHIBITIONISTIC DISORDER- is diagnosed
in a person with recurrent, intense urges, fantasies, or
behaviors that involve exposing his genitals to others
(usually strangers) in inappropriate circumstances and
without their consent
FEMALE ORGASMIC DISORDER- can be
diagnosed in women who are readily sexually
excitable and who otherwise enjoy sexual activity but
who show persistent or recurrent delay in or absence
of orgasm following a normal sexual excitement
phase and who are distressed by this (see DSM-5
Criteria on p. 433).
FEMALE SEXUAL INTEREST/AROUSAL
DISORDER- women with low desire tend to have
low levels of sexual arousal during sexual activity and
vice versa. There are no common syndromes in which
women with low sexual desire have normal levels of
sexual arousal, or vice versa. Thus for women, DSM-
5 has combined dysfunctionally low desire with
dysfunctionally low sexual arousal in the disorder
Female Sexual Interest/Arousal Disorder.
FETISHISM- the individual has recurrent, intense
sexually arousing fantasies, urges, and behaviors
involving the use of some inanimate object or a part
of the body not typically found erotic (e.g., feet) to
obtain sexual gratification
FROTTEURISM- is sexual excitement at rubbing
ones genitals against, or touching, the body of a
nonconsenting person.
GENDER DYSPHORIA- is discomfort with ones
sex-relevant physical characteristics or with ones
assigned gender.
GENITO-PELVIC PAIN/ PENETRATION
DISORDER-
INCEST- Culturally prohibited sexual relations (up
to and including coitus) between family members
such as a brother and sister or a parent and child
MALE ERECTILE DISORDER- Inability to
achieve or maintain an erection sufficient for
successful sexual intercourse was formerly called
impotence. It is now known as male erectile disorder
and can be diagnosed only when the difficulties are
considered to originate from either psychogenic or a
combination of psychogenic and medical factors (see
DSM-5 Criteria on p. 432).
MALE HYPOACTIVE SEXUAL DESIRE
DISORDER- Hypoactive sexual desire disorder is
diagnosed in men who have for at least 6 months
been distressed or impaired due to low levels of
sexual thoughts, desires, or fantasies.
MASOCHISM- a person experiences sexual
stimulation and gratification from the experience of
pain and degradation in relating to a lover.
ORGASM- a release of sexual tension and a peaking
of sexual pleasure.
PARAPHILIAS- have recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors that
generally involve (1) nonhuman objects, (2) the
suffering or humiliation of oneself or ones partner,
or (3) children or other nonconsenting persons.
PEDOPHILIC DISORDER- when an adult has
recurrent, intense sexual urges or fantasies about
sexual activity with a prepubertal child; acting on
these desires is not necessary for the diagnosis if they
cause the pedophile distress
RAPE- describes sexual activity that occurs under
actual or threatened forcible coercion of one person
by another
RESOLUTION- the person has a sense of
relaxation and well-being.
SADISM- sexual purposes, inflicted such cruelty
on his victims that he was eventually committed
as insane.
SEXUAL ABUSE- is sexual contact that involves
physical or psychological coercion or at least one
individual who cannot reasonably consent to the
contact (e.g., a child).
SEXUAL AVERSION DISORDER- a person
shows extreme aversion to, and avoidance of, all
genital sexual contact with a partner.
SEXUAL DYSFUNCTION- refers to impairment
either in the desire for sexual gratification or in the
ability to achieve it. The impairment varies markedly
in degree, but regardless of which partner is alleged to
be dysfunctional, the enjoyment of sex by both
parties in a relationship is typically adversely affected.
SEXUAL SADISM DISORDER- same as sadism
TRANSSEXUALISM- occurs in adults with gender
dysphoria who desire to change their sex, and surgical
advances have made this goal, although expensive,
partially feasible.
TRANSVESTIC DISORDER- heterosexual men
who experience recurrent, intense sexually arousing
fantasies, urges, or behaviors that involve cross-
dressing as a female may be diagnosed with
transvestic disorder
voyeuristic disorder- voyeurism according to DSM-
5 if he has recurrent, intense sexually arousing
fantasies, urges, or behaviors involving the
observation of unsuspecting females who are
undressing or of couples engaging in sexual activity
CHAPTER 13 SCHIZOPHRENIA AND
OTHER PSYCHOTIC DISORDERS
13.1 what are the symptoms of schizophrenia?
Schizophrenia is the most severe form of mental
illness. It is characterized by impairments in many
domains. Characteristic symptoms of schizophrenia
include hallucinations, delusions, disorganized speech,
disorganized and catatonic behavior, and negative
symptoms such as flat affect or social withdrawal.
13.2 what is the prevalence of schizophrenia and
when does it begin? who is most affected?
Schizophrenia affects just under 1 percent of the
population. Most cases begin in late adolescence or
early adulthood. The disorder begins earlier in men
than in women. Overall, the clinical symptoms of
schizophrenia tend to be more severe in men than in
women. Women also have a better long-term
outcome.
Even though schizophrenia first shows itself
clinically in early adulthood, researchers believe that it
is a neurodevelopmental disorder. Problems with
brain development are implicated. Some of the genes
implicated in schizophrenia play a role in brain
development.
13.3 what are the risk and causal factors
associated with schizophrenia?
Genetic factors are clearly implicated in
schizophrenia. Having a relative with the disorder
significantly raises a persons risk of developing
schizophrenia.
Other factors that have been implicated in the
development of schizophrenia include prenatal
exposure to the influenza virus, early nutritional
deficiencies, rhesus incompatibility, maternal stress,
and perinatal birth complications.
Urban living, immigration, and cannabis use during
adolescence have also been shown to increase the risk
of developing schizophrenia.
Current thinking about schizophrenia emphasizes
the interplay between genetic and environmental
factors.
13.4 How is the brain affected in schizophrenia?
Patients with schizophrenia have problems in many
aspects of their cognitive functioning. They show a
variety of attentional deficits (e.g., poor P50
suppression and deficits on the Continuous
Performance Test). They also show eye-tracking
dysfunctions.
Many brain areas are abnormal in schizophrenia,
although abnormalities are not found in all patients.
The brain abnormalities that have been found include
enlarged ventricles (which reflects decreased brain
volume), frontal lobe dysfunction, reduced volume of
the thalamus, and abnormalities in temporal lobe
areas such as the hippocampus and amygdala.
Major changes in the brain occur during adolescence.
These include synaptic pruning, decreases in the
number of excitatory neurons, and increases in the
number of inhibitory neurons. There is also an
increase in white matter which enhances the
connectivity of the brain. Some of these changes may
be abnormal in people who will later develop
schizophrenia.
Some of the brain abnormalities that are
characteristic of schizophrenia get worse over time.
This suggests that, in addition to being a
neurodevelopmental disorder, schizophrenia is also a
neuroprogressive disorder. 13.5 what
neurotransmitters are implicated in schizophrenia?
The most important neurotransmitters implicated in
schizophrenia are dopamine and glutamate. Research
shows that the dopamine (D2) receptors of patients
with schizophrenia are supersensitive to dopamine.
13.6 why is the family environment important for
the wellbeing of patients with schizophrenia?
Patients with schizophrenia are more likely to relapse
if their relatives are high in expressed emotion (EE).
High-EE environments may be stressful to patients
and may trigger biological changes that cause
dysregulations in the dopamine system. This could
lead to a return of symptoms.
13.7 what is the clinical outcome of schizophrenia
and how is it treated?
For many patients, schizophrenia is a chronic
disorder requiring long-term treatment or
institutionalization. However, when treated with
therapy and medications, around 38 percent of
patients can show a reasonable recovery. Only about
14 percent of patients recover to the extent that they
have minimal symptoms and function well socially.
Patients with schizophrenia are usually treated with
first- or second-generation antipsychotic
(neuroleptic) medications. Secondgeneration
antipsychotics are about as effective as first-
generation antipsychotics but cause fewer
extrapyramidal (motor abnormality) side effects.
Antipsychotic drugs work by blocking dopamine
receptors.
Psychosocial treatments for patients with
schizophrenia include cognitive-behavioral therapy,
social-skills training, cognitive remediation training,
and other forms of individual treatment, as well as
case management. Family therapy provides families
with communication skills and other skills that are
helpful in managing the illness. Family therapy also
reduces high levels of expressed emotion.
ALOGIA- means very little speech.
ANTIPSYCHOTICS (NEUROLEPTICS)- are
medications like chlorpromazine (Thorazine) and
haloperidol (Haldol), which were among the first to
be used to treat psychotic disorders. Sometimes
referred to as neuroleptics (literally, seizing the
neuron)
ATTENUATED PSYCHOSIS SYNDROME-
AVOLITION- the inability to initiate or persist in
goal-directed activities.
BRIEF PSYCHOTIC DISORDER- is exactly what
its name suggests. It involves the sudden onset of
psychotic symptoms or disorganized speech or
catatonic behavior.
CANDIDATE GENES- host genes that are known
to be involved in processes that are believed to be
aberrant in schizophrenia
CATATONIC SCHIZOPHRENIA- involves
pronounced motor signs that reflect great excitement
or stupor
COGNITIVE REMEDIATION-
DELUSION- is essentially an erroneous belief that is
fixed and firmly held despite clear contradictory
evidence. The word delusion comes from the Latin
verb ludere, which means to play.
DELUSIONAL DISORDER- hold beliefs that are
considered false and absurd by those around them.
Unlike individuals with schizophrenia, however,
people given the diagnosis of delusional disorder may
otherwise behave quite normally.
DISORGANIZED SCHIZOPHRENIA-
characterized by disorganized speech, disorganized
behavior, and flat or inappropriate affect
DISORGANIZED SYMPTOMS- some symptoms
like disordered speech and disorganized behavior that
were previously thought to reflect positive symptoms
might be better separated from true positive
symptoms like hallucinations and delusions.
DOPAMINE- The most well-studied
neurotransmitter implicated in schizophrenia
ENDOPHENOTYPES- discrete, stable, and
measurable traits that are thought to be under genetic
control.
EXPRESSED EMOTION (EE)- is a measure of
the family environment that is based on how a family
member speaks about the patient during a private
interview with a researcher
FLAT AFFECT- blunted emotional expressiveness
GLUTAMATE- is an excitatory neurotransmitter
that is widespread in the brain.
HALLUCINATION- is a sensory experience that
seems real to the person having it, but occurs in the
absence of any external perceptual stimulus.
LINKAGE ANALYSIS-
NEGATIVE SYMPTOMS- reflect an absence or
deficit of behaviors that are normally present.
PARANOID SCHIZOPHRENIA- the clinical
picture is dominated by absurd and illogical beliefs
that are often highly elaborated and organized into a
coherent, though delusional, framework
POSITIVE SYMPTOMS- are those that reflect an
excess or distortion in a normal repertoire of behavior
and experience, such as delusions and hallucinations.
PRODROMAL- very early, signs of schizophrenia,
researchers are hoping to improve their ability to
detect, and also perhaps intervene with, people who
appear to be on a pathway to developing the disorder
PSYCHOSIS- loss of contact with reality
SCHIZOAFFECTIVE DISORDER- This
diagnosis is conceptually something of a hybrid, in
that it is used to describe people who have features of
schizophrenia and severe mood disorder. In other
words, the person not only has psychotic symptoms
that meet criteria for schizophrenia but also has
marked changes in mood for a substantial amount of
time.
SCHIZOPHRENIA- occurs in people from all
cultures and from all walks of life. The disorder is
characterized by an array of diverse symptoms,
including extreme oddities in perception, thinking,
action, sense of self, and manner of relating to others.
SCHIZOPHRENIFORM DISORDER- is a
category reserved for schizophrenia-like psychoses
that last at least a month but do not last for 6 months
and so do not warrant a diagnosis of schizophrenia.
Two (or more) of the following, each present for a
significant portion of time during a 1-month period
(or less if successfully treated). At least one of these
must be (1), (2), or (3): 1. Delusions. 2.
Hallucinations. 3. Disorganized speech (e.g., frequent
derailment or incoherence). 4. Grossly disorganized
or catatonic behavior. 5. Negative symptoms (i.e.,
diminished emotional expression or avolition).