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69 Cards in this Set
- Front
- Back
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Substance-related disorders involve
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problems associated with using and abusing drugs that alter patterns of thinking, feeling, and behaving.
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The term substance refers to chemical compounds that are ingested in order to alter
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mood or behavior, and includes alcohol, nicotine, caffeine.
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Psychoactive substances refers to a broad class of agents that alter mood and/or behavior which are ingested to become
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intoxicated or high, with abuse of such substances related to dependence and addiction.
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Substance use is simply the ingestion of psychoactive substances
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on occasion.
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whereas the physiological reaction to ingested substances (e.g., drunkenness, getting high) is referred to as
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substance intoxication.
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Intoxication depends on
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the drug, the amount of the drug ingested, and the person’s biological reaction!
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Substance abuse is difficult to define on the bases of amount of substance ingested. According to the DSM IV, substance abuse is defined on the basis of
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interference with the user’s life.
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DSM-IV criteria for Substance Abuse
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A: A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
recurrent substance use resulting in a failure to fulfill major role obligations at work, school, home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) The symptoms have never met the criteria for Substance Dependence for this class of substances. |
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substance dependence is usually described as
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addiction; though there is considerable disagreement about how to define addiction. Dependence can exist without abuse (Morphine for cancer patients)
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Addiction as physiological dependence on the drug or drugs
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= requiring greater and greater amounts of the drug to experience the same effect (i.e., tolerance), while responding physically in a negative way when the substance is not longer ingested (i.e., withdrawal).
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Tolerance and withdrawal are physiological reactions to the
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chemicals ingested. Withdrawal from many substances can cause chills, fever, diarrhea, nausea and vomiting, and aches and pains.
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Drug-seeking behaviors as a measure of dependence (e.g. desperate need to ingest more of the substance, standing outside in the freezing cold to smoke, and likelihood that use will resume after a period of abstinence)
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Such reactions are sometimes referred to in terms of psychological dependence, not physiological dependence.
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The DSM-IV-R definition of substance dependence combines the physiological aspects of tolerance and withdrawal with the
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behavioral and psychological aspects.
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DSM-IV criteria for Substance Dependence
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A: A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
Tolerance, as defined by either of the following: - A need for markedly increased amounts of the substance to achieve intoxication or desired effect - Markedly diminished effect with continued use of the same amount of the substance Withdrawal, as manifested by either of the following: - The characteristic withdrawal syndrome for the substance (e.g. vomiting, chills) - The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms The substance is often taken in larger amounts or over a longer period than was intended There is a persistent desire or unsuccessful efforts to cut down or control substance use A great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain smoking), or recover from its effects Important social, occupational, or recreational activities are given up or reduced because of substance use The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption) |
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DSM-I&II: alcoholism and drug abuse
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= sociopathic personality disturbances and symptom of another problem
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= sociopathic personality disturbances and symptom of another problem
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Depressants result in behavioral sedation and include alcohol, sedative, hypnotic, and anxiolytic drugs belonging to the barbiturates and benzodiazepine classes.
Stimulants increase alertness and can elevate mood and include amphetamines, cocaine, nicotine, and caffeine. Opiates primarily produce analgesia and euphoria and include heroin, opium, codeine, and morphine. Hallucinogens alter sensor perception and can produce delusions, paranoia, and hallucinations, and including drugs like marijuana and LSD. Other drugs of abuse include inhalants, anabolic steroids, and over the counter meds. |
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Depressants primarily decrease
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central nervous system activity, reduce arousal, and help people to relax.
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→ Included in this group are
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alcohol and the sedative, hypnotic, and anxiolytic drugs and those prescribed for insomnia.
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These substances are among the most likely to produce symptoms of
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physical dependence, tolerance, and withdrawal
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DSM-IV: Alcohol Abuse Disorders
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A: A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:
Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household). Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine). Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct). Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights). ! These symptoms must never have met the criteria for alcohol dependence! |
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DSM-IV: Alcohol Dependence
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A: A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:
1. Tolerance, as defined by either of the following: - A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. - Markedly diminished effect with continued use of the same amount of alcohol. 2. Withdrawal, as defined by either of the following: - The characteristic withdrawal syndrome for alcohol (e.g. hallucinations, agitation, insomnia ). - Alcohol is taken to relieve or avoid withdrawal symptoms. 3. Alcohol is often taken in larger amounts or over a longer period than was intended. 4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use. 5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects. 6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption). |
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Short-term Physiological Effects of Alcohol ...
Initial effect is |
stimulation from a depression of inhibitory centers in the brain. Continued drinking depresses other brain areas that interfere with functioning and include
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The glutamate system, is excitatory in nature, helps neurons fire, and is believed to affect learning and memory. Blackouts, or the loss of memory that occurs with alcohol intoxication,
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may result from the interaction of alcohol with the glutamate system.
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The serotonin system is also sensitive to alcohol and this system is known to
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affect mood, sleep, and eating behavior, including cravings for alcohol.
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Withdrawal from chronic alcohol use includes
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tremors, and within several hours, nausea and vomiting, anxiety, transient hallucinations, agitation, insomnia
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withdrawal delirium (or delirium tremens – DTs).
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DTs can produce frightening hallucinations and body tremors.
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Consequences of long-term excessive drinking include
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liver disease [slide], pancreatitis, cardiovascular disorders, and brain damage.
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2 types of serious brain syndromes
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Dementia = general loss of intellectual abilities and can result directly from neurotoxicity or poisoning of the brain by excessive amounts of alcohol.
- Wernicke’s disease results in confusion, loss of muscle coordination, and unintelligible speech and is believed to be caused by thiamine deficiency; a vitamin that is metabolized poorly by heavy drinkers. |
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Nature of Stimulants
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Most widely consumed drug in the US
- Such drugs increase alertness and increase energy - Ex. Include (meth) amphetamines, Cocaine, nicotine, and caffeine. |
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Alcohol: Facts and Figures
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In the United States:
-Most adults view themselves light drinkers or abstainers -over 50% of the us (> 12 years old) report current use - 23% report binge drinking in last months (42% among students) 15 million Americans are alcohol dependent (prevalence: 15%, incidence 5%) -Rates are highest among Caucasian and Native Americans Males use and abuse alcohol more than females -Violence is associated with alcohol -Alcohol alone does not cause aggression |
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Alcohol cross cultural aspects
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Geographical location serves as proxy of drinking culture I.e. Nordic countries (e.g. Finland) Higher drinking levels
Gender: Higher alcohol use in male-dominant drinking cultures (males more likely to drink more frequently, higher quantities) Ethnicity: At Highest risk in US = White, Native American, and male (also increase in Asian American males) |
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Amphetamine Use Disorders
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Effects of Amphetamines
→ Produce elation, vigor, reduce fatigue → Effects are followed by extreme fatigue and depression → prescribed for ADHD (ritalin), Narcolepsy Ecstasy and Ice (crystallized amphetamine, also called “designer drugs”) → Produces effects similar to speed, but no “comedown” → 2% of college students report using Ecstasy → Both drugs can result in dependence (tolerance builds up quickly) Amphetamines stimulate CNS by → Enhancing release of norepinephrine and dopamine → Reuptake is subsequently blocked |
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Cocaine Use Disorders
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Crack cocaine = crystallized form of cocaine that is smoked
Effects of Cocaine → Short lived sensations of elation, vigor, reduce fatigue → Blocks reuptake of dopamine → 2/3 experience paranoia resulting in social isolation → Highly addictive, but addiction develops slowly → UPS Heart Rate = irregularities can be fatal DSM-IV-TR Criteria for Cocaine Intoxication and Withdrawal → Psychological symptoms (e.g. apathy and boredom) → Physiological symptoms (e.g. Tachycardia, sweating, seizures) Course: Most Cycle Through Patterns of Tolerance and Withdrawal |
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Nicotine Use Disorders
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Effects of Nicotine
→ Stimulates nicotinic acetylcholine receptors → Results in sensations of relaxation, wellness, pleasure → Nicotine is highly addictive! → Relapse rates equal those for alcohol and heroin users DSM-IV-TR Criteria for Nicotine Withdrawal Only → Psychological symptoms (eg. Dysphoria, anger → Physiological symptoms (e.g. restlessness, insomnia Complex relationship between smoking and negative affect Nicotine Users Dose Themselves → Maintain a steady level of nicotine in the bloodstream → Examples include smoking before sleep or after waking |
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Caffeine Use Disorders
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Effects of Caffeine – The “Gentle” Stimulant
→ Found in tea, coffee, cola drinks, and cocoa products → Blocks the reuptake of the neurotransmitter adenosine → Small doses elevate mood and reduce fatigue → Used by 90% of Americans → Regular use can result in tolerance and dependence DSM-IV-TR Criteria for Caffeine Intoxication → Psychological symptoms (Nervousness) → Physiological symptoms (e.g. insomnia) |
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(3) Opioids
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The Nature of Opiates and Opioids
→ Opiate – Narcotic like chemical in the opium poppy → Opioids – Substances that produce narcotic effects → Often referred to as analgesics ( I.e. help relieve pain ) → Examples include heroin, opium, codeine, morphine, methadone (synthetic variation) Effects of Opioids → Activate body’s enkephalins and endorphins (brain already has natural opioid system) → Low doses – Euphoria, drowsiness, and slow breathing → High doses can be fatal → Withdrawal symptoms can be lasting and severe |
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DSM-IV-TR Criteria for Opioid Intoxication and Withdrawal
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→ Psychological symptoms (e.g. impairment in attention)
→ Physiological symptoms (e.g. vomiting, chills) → Mortality rates are high for opioid addicts (Hser et al. study: 27.7% dies- homicide, suicide, accidents, overdose (1/3)) → Users at increased risk for HIV infection |
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(4) Hallucinogens
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Nature of Hallucinogens
→ Substances that alter perceptions of the world (not up or down but Distortion of senses) → Produce delusions, paranoia, hallucinations, and/or altered sensory perception → Examples include marijuana, LSD Marijuana → Active chemical is tetrahydrocannabinol (THC) → Symptoms – Mood swings (“extremely funny”), paranoia, hallucinations (individually very different reactions to same dose) → Impairment in motivation ( apathy, or amotivational syndrome) is not uncommon → mixed reports on tolerance (“reverse tolerance” – more pleasure → Withdrawal and dependence are uncommon |
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facts about marijuana
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SHORT-TERM EFFECTS:
Dry mouth and throat Increased heart rate Bloodshot eyes Impaired learning, memory, judgment and complex motor skills Difficulty speaking, listening, thinking, and problem solving Anxiety or panic attacks Paranoia in some users Distorted perception: (sight, sound, time, touch) LONG-TERM EFFECTS: Psychological dependence Asthma Cancer of the lungs - as with anything smoked ( medical use) Lowered sperm production & decreased sperm mobility Immune system damage There is some evidence of long-term memory damage from “prolonged use”. |
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LSD and Other Hallucinogens
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- LSD is most common form of hallucinogenic drug which is produced synthetically
- Other hallucinogens occur naturally, e.g. mescaline (cactus) Tolerance tends to be rapid Withdrawal symptoms are uncommon Can produce psychotic delusions & hallucinations (“horror trip” – jumping out of window, can also cause onset of psychosis!) Mechanisms remain largely unknown DSM-IV-TR Criteria for Hallucinogen Intoxication - Psychological (e.g., impaired judgment) and physiological symptoms (increase appetite, tachycardia) |
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IV. Biological Treatment of Substance-Related Disorders
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Agonist Substitution
- Substitute safer drug with a similar chemical composition. Examples include methadone and nicotine gum or patch Heroin addicts may become addicted to methadone (cross-tolerance), but reduces criminality Antagonistic Treatment - Drugs that block or counteract pleasurable drug effects Examples include naltrexone for opiate and alcohol problems have to be clean and highly motivated |
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IV. Biological Treatment of Substance-Related Disorders (cont.)
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Aversive Treatment
- Drugs that make use of drugs extremely unpleasant Examples include Antabuse for alcoholism and silver nitrate for nicotine addiction vomiting, nausea, ups HR compliance! Efficacy of Biological Treatment - e.g. antidepressants (high relapse) - Generally ineffective when used alone (without e.g. CBT) |
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IV. Psychosocial Treatment of Substance-Related Disorders
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Inpatient vs. Outpatient Care
- Biological treatment alone are not efficient, combination with psychosocial treatments is encouraged Inpatient care very costly (>90% compared to out patient care), effect often not empirically evaluated (research suggests no difference to outpatient care) Controlled Use vs. Complete Abstinence as Treatment Goals Study by Sorbell: controlled drinking vs abstinence at 2FU 85% of controlled drinkers were doing well compared to of abstinence groups.42% Community Support Programs Alcoholics Anonymous and related groups up to 3% of pop. Attended AA, total abstinence ) Efficacy hard to test b/c of anonymity but probable up to 75% drop out at 12 month) - Seem helpful and are strongly encouraged |
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IV. Psychosocial Treatment of Substance-Related Disorders (cont.)
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- Comprehensive Treatment (treatment package) and Prevention Programs
-Individual and group therapy Aversion therapy and convert sensitization ( conditioning ) - Contingency management ( find different rein forcers) Community reinforcement (family, identify people and situations, assistance for finding a job Relapse prevention identifying high risk situations, lapse versus relapse - Preventative efforts via education (skill training, willpower redefining individualism) |
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A personality disorder is
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a pattern of deviant or abnormal behavior that the person doesn't change even though it causes emotional upsets and trouble with other people at work and in personal relationships. (note DSM AXIS II: A pervasive pattern of …)
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It is not limited to episodes of mental illness , and it is not caused by
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drug or alcohol use, head injury, or illness.
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There are about a dozen different behavior patterns classified as personality disorders by DSM-IV.
All the personality disorders show up as deviations from normal in one or more of the following: |
1) cognition – i.e. perception, thinking, and interpretation of oneself, other people, and events. (2) affectivity – i.e. emotional responses (range, intensity, lability (someone very vulnerable), appropriateness) (3) interpersonal functions
(4) impulsivity |
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The Nature of Personality and Personality Disorders
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- Enduring and relatively stable predispositions (i.e. ways of relating and thinking)
- Predispositions are inflexible and maladaptive, causing distress and/or impartment. - Coded on Axis II of the DSM-IV and DSM-IV-TR |
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DSM-IV and DSM-IV-TR Personality Disorder Clusters
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Cluster A
- Odd or eccentric - Paranoid PD, schizoid PD, schizotypal PD Cluster B - Dramatic, emotional, erratic - antisocial, borderline, histrionic, narcissistic Cluster C - Fearful or anxious avoidant, obsessive-compulsive, dependent |
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Facts and Figures
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Prevalence of Personality Disorders
About 0.5% to 2.5% on the general population Rater are higher in inpatient and outpatient treatment Origins and Course of Personality Disorders Thought to begin in childhood Freud: “psychosexual disturbances”; Kohut/Object-relations: “failure in early nurturing environment → lack of own sense of self”; biolog. theory “related to serotonin”; early trauma/abuse Run a chronic course Comorbidity rates are high among PDs and Axis 1 |
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Cluster A: Paranoid Personality Disorder
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The essential feature for this type of paranoid personality disorder is interpreting the actions of others as deliberately
threatening or demanding . People with paranoid personality disorder are untrusting, unforgiving, and prone to angry or aggressive outburst without justification because they perceive others as unfaithful, disloyal, condescending or deceitful. This type of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally “cold” or excessively serious. |
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Cluster A: Paranoid Personality Disorder: DSM-IV
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A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her reads hidden demeaning or threatening meanings into benign remarks or events persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner |
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Cluster A: Schizoid Personality Disorder
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Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker.
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Cluster A: Schizoid Personality Disorder: DSM-IV
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A: A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
neither desires nor enjoys close relationships, including being part of a family almost always chooses solitary activities has little, if any, interest in having sexual experiences with another person takes pleasure in few, if any, activities lacks close friends or confidants other than first-degree relatives appears indifferent to the praise or criticism of others shows emotional coldness, detachment, or flattened affectivity |
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Cluster A: Schizotypal Personality Disorder
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A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing . Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves . They also display signs of “magical thinking ” by saying they can see into the future or read other people’s minds.
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Cluster A: Schizotypal Personality Disorder: DSM-IV
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A: A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
ideas of reference (excluding delusions of reference) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations) unusual perceptual experiences, including bodily illusions odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) suspiciousness or paranoid ideation inappropriate or constricted affect behavior or appearance that is odd, eccentric, or peculiar lack of close friends or confidants other than first-degree relatives excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self |
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Cluster B: Narcissistic Personality Disorder
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People with narcissistic personality have an
exaggerated sense of self importance, are absorbed by fantasies of unlimited success, and seek constant attention (self-image depends completely on others ). The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships. Prevalence <1%, more males, improve over time. |
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Cluster B: Narcissistic Personality Disorder : DSM-IV
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A: A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) requires excessive admiration has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends lacks empathy: is unwilling to recognize or identify with the feelings and needs of others is often envious of others or believes that others are envious of him or her shows arrogant, haughty behaviors or attitudes |
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Cluster B: Antisocial Personality Disorder
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People with antisocial personality disorder characteristically act out their conflicts and ignore rules of social behavior .
These individuals are impulsive, irresponsible, and callous . Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behavior, aggressive and even violent relationships. They show no respect for other people and feel no remorse about the effects of their behavior on others (“social predators”) These people are at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom. Prevalence: 3%, M:F=4:1, dissipates after age of 40 |
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Cluster B: Antisocial Personality Disorder : DSM-IV
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A: There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3. impulsivity or failure to plan ahead 4. irritability and aggressiveness, as indicated by repeated physical fights or assaults 5. reckless disregard for safety of self or others 6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations 7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another B: The individual is at least age 18 years. C: There is evidence of Conduct Disorder with onset before age 15 years. |
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Six core traits of psychopathy
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1. Superficial charm
2. Lack of remorse 3. Antisocial behavior 4. Poor judgment/ failure to learn 5. incapacity for love 6. inability to express/ feel emotions Other descriptions: Fearless dominance (interpersonal/affective) & impulsive antisocial (behavior component) |
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Differences between antisocial personality disorder & psychopathy
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Failure to conform to social norms;
Deceitfulness, manipulativeness; Impulsivity, failure to plan ahead; Irritability, aggressiveness; Reckless disregard for the safety of self or others; Consistent irresponsibility; Lack of remorse after having hurt, mistreated, or stolen from another person Glib and superficial charm; Grandiose sense of self-worth; Need for stimulation; Pathological lying; Conning and manipulativeness; Lack of remorse or guilt; Shallow affect; Callousness and lack of empathy; Parasitic lifestyle; Poor behavioral controls; Promiscuous sexual behavior; […] Higher IQ? |
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Neurobiological Contributions and Treatment of Antisocial Personality
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Prevailing Neurobiological Theories
- Brain damage – little support for this view Under arousal hypothesis – cortical arousal is too low (skin conductance during rest) –lead to risk-taking behaviors Cortical immaturity hypothesis – Cortex is not fully developed - Fearlessness hypothesis – fail to respond to danger cues Gray’s model of behavioral inhibition and activation (failed reward/inhibition/fight-flight system) Treatment - Few seek treatment on their own - Antisocial behavior is predictive of poor prognosis - Emphasis is placed on prevention and rehabilitation 9e.g. parent training for high-risk children) - Often prison is the only viable option |
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Search for successful or subclinical psychopath
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Widom 1977 study:
Wanted: charming, aggressive, carefree people who are impulsively irresponsible but are good at handling people and at looking after number one |
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Cluster B: Borderline Personality Disorder : DSM-IV
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A: pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- frantic efforts to avoid real or imagined abandonment. - a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation - identity disturbance: markedly and persistently unstable self-image or sense of self - impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). - recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior affective instability due to a marked reactivity of mood (e.g., intense episodic – dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) - chronic feelings of emptiness - inappropriate, intense anger or difficulty controlling anger (e.g., frequent - displays of temper, constant anger, recurrent physical fights) - transient, stress-related paranoid ideation or severe dissociative symptoms |
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Cluster B: Histrionic Personality Disorder : DSM-IV
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A: A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
is uncomfortable in situations in which he or she is not the center of attention interaction with others is often characterized by inappropriate sexually seductive or provocative behavior displays rapidly shifting and shallow expression of emotions consistently uses physical appearance to draw attention to self has a style of speech that is excessively impressionistic and lacking in detail shows self-dramatization, theatricality, and exaggerated expression of emotion is suggestible, i.e., easily influenced by others or circumstances considers relationships to be more intimate than they actually are |
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Cluster B: Avoidant Personality Disorder : DSM-IV
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A: A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection - is unwilling to get involved with people unless certain of being liked shows restraint within intimate relationships because of the fear of being shamed or ridiculed - is preoccupied with being criticized or rejected in social situations is inhibited in new interpersonal situations because of feelings of inadequacy views self as socially inept, personally unappealing, or inferior to others is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing |
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Cluster B: Dependent Personality Disorder : DSM-IV
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A: A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
has difficulty making everyday decisions without an excessive amount of advice and reassurance from others - needs others to assume responsibility for most major areas of his or her life has difficulty expressing disagreement with others because of fear of loss of support or approval. has difficulty initiating projects or doing things on his or her own (because of - a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant - feels uncomfortable or helpless when alone because of exaggerated fears of - being unable to care for himself or herself urgently seeks another relationship as a source of care and support when a close relationship ends is unrealistically preoccupied with fears of being left to take care of himself or herself |
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Cluster B: Obsessive-Compulsive Personality Disorder : DSM-IV
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A: A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost shows perfectionism that interferes with task completion is excessively devoted to work and productivity to the exclusion of leisure activities and friendships - is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values is unable to discard worn-out or worthless objects even when they have no sentimental value is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes - shows rigidity and stubbornness |
