Is he mentally ill?

Psychopathy

• Cleckley; Hare--two basic dimensions: affective and interpersonal core and behavioral aspects
• DSM diagnosis may omit those who don’t show violence

3-4 % of men, 1% of women

Studied a lot in jails—among urban jails, apd is linked to violent crimes; about 70-80% of prison inmates have apd

• Studied a lot in jails—among urban jails, apd is linked to violent crimes; about 70-80% of prison inmates have apd

• For many, criminal behavior declines after 40; behaviors change more than psychopathy

• Higher rates of alcoholism and substance-related disorders

• About 50% of kids with ADHD also have CD

Psychodynamic

• Psychodynamic

• Absence of parental love during infancy leading to a basic lack of trust—respond to early inadequacies by becoming emotional distant, build relationships through power and destructiveness.
• Support—more likely than others to have had significant stress in childhood, particularly poverty, parental conflict, divorce, family violence

• Behaviorists

• Modeling or imitation—lots of parents with the disorder
• Patterson—coercion theory/reinforcement trap

• Cognitive view

• Trivialize importance of other people’s needs
• Genuine difficulty recognizing viewpoint other than their own

• Biological factors

• Experience less anxiety than others, lower arousal levels—slow EEG waves, slow autonomic arousal

Approximately ¼ of those with APD get tx for it, yet tx is typically ineffective

• Approximately ¼ of those with APD get tx for it, yet tx is typically ineffective

• Major obstacle—lack of conscience and lack of motivation

• Most are forced to attend—work, court, family

• About 70% leave tx prematurely (Gabbard & Coyne, 1987)

• Cognitive-behavioral—increasing self-control, self-critical thinking, social-perspective taking; victim awareness, anger management, curing drug addiction

• Requires a controlled situation; even the best programs have only a modest improvement

Keenly sensitive to criticism, rejection, disapproval

• Keenly sensitive to criticism, rejection, disapproval

• Reluctant to enter relationships unless they know they’ll be liked

• Afraid of being perceived as foolish or being embarrassed by blushing or looking anxious

• Believe they are incompetent or inferior

• Avoid school and work

• Overlap with Dependent PD and BPD

• .5-2% prevalence

• Males=females

• Similar to social phobia; often have both dx

• Key difference—social phobics fear social circumstances, avoidant pd fear social relationships

Assumed to be related to the same causes as anxiety disorder, but this has not yet been shown by research

• Assumed to be related to the same causes as anxiety disorder, but this has not yet been shown by research

• Psychodynamic

• Focus mainly on sense of shame; think punishment for early bowel accidents—may develop negative self-image—leads individual to feel unlovable

• Cognitive

• Harsh criticism and rejection in early childhood lead people to believe that environment will always treat them negatively
• Expect rejection; misinterpret the reactions of others to fit that expectation; discount positive feedback; generally fear social involvements
• Support—pts recall feelings rejected and isolated; receiving little encouragement from parents; experiencing few displays of parental love or pride

• Bio—inhibited temperament

Come to tx to experience affection and acceptance

• Come to tx to experience affection and acceptance

• Keeping them in tx is a challenge—soon begin to avoid sessions

• Key—gaining trust

• Treating much as one would treat social phobia has shown modest success

• Cognitive—carry on the face of painful emotions; improve self-image; challenge distressing thoughts

• Behavioral tx—social skills training; exposure tx

• Group tx—practice in social situations

• Antianxiety and antidepressants show some success

Lacks self-confidence and self-reliance

• Lacks self-confidence and self-reliance

• Passively allow spouses/partners to assume responsibility for choice of jobs, housing, even friends

• Can’t initiate activities

• Agree even when they know it is wrong

• Uncomfortable when left alone—even panicky

• Unable to make demands on others

• Seek new relationships quickly when old ones end

• May accept abuse to stay in relationships

• Both dependent behavior and attachment problems

• 2%; either males=females or females>males

Causes

• Causes

• Small genetic influence
• Psychodynamic—unresolved oral issues; attachment issues; fear of abandonment
• Behaviorists—parents unintentionally reward clinging and loyal behavior, while punishing acts of independence, perhaps through withdrawal of love
• Cognitive—two key views: I am inadequate and helpless to deal with the world and I must find a person to provide protection so I can cope.
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