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Abnormal Psychology and Personality Disorders An Introduction Prof. Craig Jackson Head of Psychology Birmingham City University
Abnormal? Core models (with several variations within them) attempt to offer diagnosis, definitions and frameworks for abnormality Each approach also attempts to ‘treat’ abnormality in their distinct way Treating the mentally ill is problematic, not least because of the number of approaches, cultural variations, lack of consensus and human error involved in the prognosis and treatment of mental disorders.
Definition & Frame of Reference Abnormal? Normal? Normative Ideographic Vs Nomothetic Statistical Consensus Social approval
Definition & Frame of Reference Abnormal behaviours? Criminal Mad Bad Unethical Mad – Bad Overlap Distinguishing
Definition & Frame of Reference At the risk of offending...
Biological Abnormal behaviour results from a physical illness There is a discrete cause, prognosis and where mental health can be physically treated Modern mental health legislation is a result of the medical model Kraepelin ( ) carefully observed, described and catalogued symptoms of patients displaying abnormal behaviour resulting in the development of two major classification systems
DSM V - TR American Psychiatric Association (also used in the UK) first published in 1952 DSM system is a multi-axial system allowing an individuals mental state to be evaluated on five axes: Axis 1: Presence or absence of clinical syndrome Axis 2: Presence or absence of stable long-term conditions (personality disorder/learning disability) Axis 3: Physical health information Axis 4: Psychosocial/Environmental Problems Axis 5: Global level of functioning range from 1 (persistent violence, suicidal behaviour or inability to maintain personal hygiene to 100 (symptom free)
DSM V – TR Axis 1: Cocaine-related disorders Axis 2: Anti-social personality disorder Axis 3: Exhaustion; Fatigue Axis 4: Drug-using partner; history of cannabis-related use; extremes stress Axis 5: Level of current functioning: 50 (frequent trips to A&E, instability, erratic eating behaviour, mood swings)
Psychodynamic & Psychoanalytic (Freud, 1900; Jung, 1912; Klein, 1927) The child is father of the man Effects of early experiences (Oedipus complex, Electra complex, attachment) Effects of trauma (abuse, deprivation) Anxiety, defence mechanisms & unresolved conflicts (repression, denial)
Psychodynamic & Psychoanalytic Abnormal behaviour results from underlying unconscious conflict or psychopathology (Wachtel & Messer, 1997) Model based on Freud’s stages of Psychosexual Development and the resulting conflict between the ID, Ego and Superego Conflict is managed (unconsciously) by defence mechanisms (e.g. repression, denial and projection) Mental health problems are a result of either ego anxieties (fixation during a developmental stage) or the defence mechanisms.
Psychodynamic & Psychoanalytic Oral Stage (18-24 months) gratification through sucking, crying or oral exploration. Driven by the ID and therefore selfish pleasure is more important aspect. Anal Stage (24-48 months) gratification via anus, infant aware of impact on others and begins to understand they are rewarded for being good and punished for being bad. Development of the Ego. Phallic Stage (48 months-6 years) Superego development characterised by child’s experiences of sexual conflict (oedipal complex and penis envy). Latency Stage (6 years-puberty onset) Sexual and aggressive urges channelled through sport and hobbies. Genital Stage (Puberty-Adulthood) Individual driven by sex and aggression but these are balanced and discharged via appropriate means.
Psychodynamic & Psychoanalytic Positives Discovery of the unconscious Discovery of the unconscious Ideas of transference learn relationships & transfer onto significant others Ideas of transference learn relationships & transfer onto significant others Alternative to the medical model Alternative to the medical model Without the need for medical intervention - long-term outpatient treatment Without the need for medical intervention - long-term outpatient treatment Linked to theory of personality Linked to theory of personalityNegatives Freudian processes (e.g. Ego) are unconscious and cannot be tested! Freudian processes (e.g. Ego) are unconscious and cannot be tested! Theories based on a small group of middleclass Viennese women Theories based on a small group of middleclass Viennese women Freud’s theory constantly changed over time and without any reason Freud’s theory constantly changed over time and without any reason Freud would have been classed as ‘abnormal’ by DSM! Freud would have been classed as ‘abnormal’ by DSM!
Behavioural Toxic exposure Social Learning Conditioning (secondary gains) Labelling theory
PsychosocialStressGender Socio-economic class RaceDisabilityInequality Neglect, abuse, deprivation Family discord & breakdown
Cultural Prejudice, and discrimination Social change & uncertainty Urban stressors – violence and homelessness
Family Systems Model Family and other social groups are interrelated and what happens to one individual in the group will affect another Good interactions with other people help to prevent mental health problems (e.g. depression) and bad ones may increase the risk Systemic therapy approaches aim to look at the functionality of the family in terms of both their overall structure (Structural Family Therapy) and their ability to adjust to the Demands placed upon them (Strategic Family Therapy) The importance of the family systems model is that it moves beyond the individual
Personality Disorder Inflexible Pervasive Egosyntonic Maladaptive coping skills Depression Anxiety Distress Adolescent / Childhood trauma Diagnosis rare in children
Do you have… o An obvious self-focus in interpersonal exchanges o Problems in sustaining satisfying relationships o A lack of psychological awareness o Difficulty with empathy o Problems distinguishing the self from others o Hypersensitivity to any insults or imagined slights o Vulnerability to shame o Haughty body language o Flattery towards people who admire and affirm you o Detesting those who do not admire you o Using other people without considering the cost of doing so o Pretending to be more important than you really are o Bragging / exaggerating (subtly but persistently) achievements o Claiming to be an "expert" at many things o Inability to view the world from the perspective of other people o Deny remorse Thomas 2012
Personality Disorder Fixed views and beliefs Faulty schemata / Dysfunctional schemata Inflexible behavioural patterns Social and Personal difficulties 1 in 10 UK population
Personality Disorder – Causes? Oversensitive temperament at birth Excessive admiration never balanced with reality Excessive praise for good behaviours Excessive criticism for bad behaviours in childhood Overindulgence and overvaluation by parents & others Being praised for exceptional looks / abilities by adults Severe emotional abuse in childhood Unpredictable or unreliable caregiving from parents Valued by parents as way to regulate their self-esteem Groopman & Cooper 2006
Diagnosis Must satisfy following criteria as well as specific criteria for specific PD under consideration Subjective and contentious Some disagreement between ICD 10 and DSM IV
Characteristic enduring behaviour and inner experience deviate markedly from cultural norm, in more than one of the following: Cognition + Affectivity + Impulse control + Relating Inflexible, dysfunctional, maladaptive behaviour across many social situations Personal distress & Impact on social environment Deviation is stable & of long duration:onset in adol. Exclude other mental disorders Exclude organic brain / neuropsychological disease
DSM V - Axis II Cluster A Paranoid PD + Schizoid PD + Schizotypal PD Cluster B Antisocial PD + Borderline PD Histrionic PD + Narcissistic PD Cluster C Avoidant PD + Dependent PD Obsessive Compulsive PD NoS PD not otherwise specified
deadly sins… 7 deadly sins… SHAMELESSNES: the inability to process shame in healthy ways. MAGICAL THOUGHTS: Narcissists see themselves as perfect, using distortion and illusion known as magical thinking. They also use projection to dump shame onto others. ARROGANCE: A narcissist who is feeling deflated may re-inflate by diminishing others ENVY: A narcissist may secure a sense of superiority by using contempt to minimize others. ENTITLEMENT: Narcissists hold unreasonable expectations of particularly favourable treatment and automatic compliance because they consider themselves special. Failure to comply is considered an attack on their superiority, and the perpetrator is considered an "awkward" or "difficult" person. Defiance of their will is a narcissistic injury that can trigger narcissistic rage. EXPLOITATION: Can take many forms but always involves the exploitation of others without regard for their feelings or interests. Often the other is in a subservient position where resistance would be difficult or even impossible. POOR BOUNDARIES: Narcissists do not recognize that they have boundaries and that others are separate and are not extensions of themselves. Others either exist to meet their needs or may as well not exist at all. Those who provide “Narcissistic supply” to the narcissist are treated as if they are part of the narcissist and are expected to live up to those expectations. Hotchkiss et al. 2003
Paranoid PD Suspiciousness + Mistrust of others + Paranoid Hyper-sensitive /easily offended Vigilant scanning to confirm their beliefs Guarded + Constricted emotional lives Incapacity for emotional relationships Isolated lifestyle Subtypes Fanatic + Malignant + Obdurate Querulous + Insular
Schizoid PD Tendency to insularity Emotional coldness Secrecy No interest in social relationships Sexually apathetic Avoidant attachment styles Subtypes Languid + Remote + Depersonalised + Affectless
Antisocial PD Disregard for others Violation of others' rights Psychopathy Sociopathy Lack of remorse + Lack of empathy Irresponsible work behaviour Promiscuity Lying / stealing Boundary violations Subtypes Covetous + Reputation defending + Risk taking Nomadic + Malevolent
Borderline PD Variability of mood Unusual instability of mood Idealisation & Devaluation of others Chaotic relationships Disturbed sense of self Subtypes Discouraged + Petulant + Self-destructive + Impulsive
Obsessive Compulsive PD Preoccupation with orderliness Perfectionism Mental and personal control Lack of flexibility, openness, efficiency Routine & rule obsessed Conscientious Subtypes Conscientious + Puritanical + Bureaucratic Parsimonious + Bedeviled
Anxious (avoidant) PD Social inhibition Inadequacy Sensitivity to negative evaluations Avoidance of social interaction Socially inept Shyness + Low self-esteem Subtypes Conflicted + Hypersensitive + Phobic Self-deserting
Dependent PD Pervasive dependence on others Reliant on others to fulfill emotional needs Low view of self Feel inadequate Feel helpless Subtypes Disquieted + Accommodating + Immature Ineffectual + Selfless
Other PD Narcissistic Passive-Aggressive Eccentric Haltlose Psychoneurotic Immature Unspecified Mixed and Other
Narcissistic PD Unprincipled narcissist Deficient conscience; unscrupulous, amoral, disloyal, deceptive, Amorous narcissist Sexually seductive, enticing, glib and clever; declines real intimacy Compensatory narcissist offsets deficits by creating illusion of being superior, exceptional, Elitist narcissist Feels privileged and empowered by virtue of special childhood status and pseudo achievements Fanatic narcissist heroic or worshipped person with a grandiose mission.
Narcissistic Personality Inventory Raskin & Terry 1988 Measures 7 factors over 40 items (fixed choice) Authority Superiority Exhibitionism Entitlement Vanity Exploitativeness Self-sufficiency Raskin, R.; Terry, H. (1988). "A principal-components analysis of the Narcissistic Personality Inventory and further evidence of its construct validity". Journal of Personality and Social Psychology, Vol 54(5),
Narcissistic Personality Inventory Score high on the NPI? More likely to: Cheat in games and sports Cheat in relationships Take more resources for self Leave fewer resources for others Value material things Obsess about appearance
Narcissistic Personality Inventory US undergraduate students Twenge et al., 2008
Narcissistic Personality Inventory
Legal Defence Diagnosis or suspicion of PD not a legal defence May be a mitigating factor Does not prevent individual from knowing law and ethics
Questions about PD Treatment locations Prison v. Hospital Nicola Edgington case
Ethicality of treatment Mental Health Act Use to treat individual if harm to themselves or others Long term process What right do we have to change a fundamental?
Questions about PD Relatively new area Contradictory status Curable / incurable Whose role? Cultural diversity weakens clarity of diagnosis
Some References Bennett, P. (2005). Abnormal and Clinical Psychology – An Introductory Textbook (2nd Ed.) Open University Press: Berkshire & New York Butcher, J.N., et al (2008) Abnormal Psychology: concepts. Ch 2. Pearson. Carr, A. (2001). Abnormal Psychology, Psychology Press: Hove & New York Ellis, A. (1977). The basic clinical theory of rational-emotive therapy, in A. Ellis & R. Grieger (eds) Handbook of Rational-Emotive Therapy. New York: Springer Freud, S. (1900). The Interpretation of Dreams. New York: Wiley Jung, C.G. (1912) Symbols of Transformation. New York: Bollingen, no. 5 Kraepelin, E. ( 1981) Clinical Psychiatry (trans. A.R. Diefendorf). Delmar, NY: Scholar’s Facsimiles and Reprints Moffatt, G. Wounded Innocents and Fallen Angels: Child Abuse and Child Aggression. Westport, CT: Praeger, Nevid, J.S., et al (2008) Abnormal Psychology in a changing world. (7 th Ed.) Ch 2. Pearson. Pantziarka, P. Lone Wolf: True Stories of Spree Killers. London: Virgin Books, Segal, L. (1991). Brief Therapy: the MRI approach. In A. Gurman and D. Kniskern (eds ), Handbook of Family Therapy (vol.2, pp ). New York: Brunner Mazel Skinner, B.F. (1953). Science and Human Behaviour. New York: Macmillan Tyrer, P. & Steinberg, D. (1998). Models of Mental Disorder: Conceptual Models in Psychiatry (3rd edn). Chichster: Wiley Wachtel, P. & Messer, S. (1997). Theories of Psychotherapy: Origins and Evolution. Washington, DC: APA Watson, J.B, & Rayner, R. (1920). Conditioned emotional reaction. Journal of Experimental Psychology, 3: 1-14 Watzlawick, P., Weakland, J.H. and Fisch, R. (1974). Challenge: Principles of Problem Formulation and Problem Resolution. New York: W.W. Norton.