Is he mentally ill?

Dx relies on inferred traits or consistent patterns of beh rather than more objective means

There are self-report inventories and semi-structured interviews, but no good assessment device

Diagnostic reliability and validity is still low

Categories are not mutually exclusive

Difficulties in studying causes

• Comorbidity
• Little prospective research --almost all is retrospective among people already dx’d
• Temperamental characteristics are possible biological factors
• Possible psych factors include maladaptive habits and cognitive styles that may originate in disturbed attachment, ineffective parenting, early emo, phys or sexual abuse
• Sociocultural factors—social stressors, societal changes, cultural values

Cluster A—odd—paranoid, schizoid, schizotypal—odd or eccentric behaviors that are similar to, but not as extensive as those seen in schizophrenia. Often leave person isolated.

• Cluster A—odd—paranoid, schizoid, schizotypal—odd or eccentric behaviors that are similar to, but not as extensive as those seen in schizophrenia. Often leave person isolated.

• Cluster B—dramatic—antisocial, borderline, histrionic, narcissistic—dramatic, emotional, erratic. Almost impossible to have a satisfying, giving relationship. More commonly dx’d than others.

• Cluster C—anxious—avoidant, dependent, obsessive compulsive pd—anxious and fearful behavior, similar sx to anxiety disorders, but no direct link between these and Axis I

Suspicious of people, frequently angry, hostile, expects to be mistreated and abused.

• Suspicious of people, frequently angry, hostile, expects to be mistreated and abused.

• Thus—secretive, looking for signs of trickery, reluctant to confide; blaming, bear grudges, way jealous, doubts about loyalty and trustworthiness, may read hidden messages \

• Prevalence maybe .5-2.5%, males>females

• Causal factors—little is known, inconsistent findings on genetic transmission

• High concordance between MZ twins
• Psychosocial factors are suspected

• Treatment of Paranoid PD:

• Do not typically see selves as needing help; few come willingly
• View role of pt as inferior and distrust/rebel against therapists
• Therapy has limited effect and moves slowly

Central symptoms

• Central symptoms

• Inability to form social relationships and an indifference toward developing them.
• Demonstrate little emotion
• Focus mainly on themselves
• Little affected by praise or criticism
• Not interested in sex

• <1%, males > females

Causal factors

• Causal factors

• Used to think that this was a precursor to schizophrenia
• No evidence of hereditary link
• Parents may have been abusive or unaccepting of children
• Cognitively—thoughts seem to be vague and empty, unable to pick up emotional cues

• Treatment—social withdrawal keeps them from entering therapy

• Generally remain emotionally distant from therapist, seem not to care about treatment, and make limited progress at best.
• Cognitive therapists—help them focus on pleasurable experiences or think about emotions
• Behavioral therapists—teach social skills—role playing, exposure therapy, homework assignments

Extreme introversion

• Extreme introversion

• Sensitivity

• Eccentricity

• Oddities of thought, perception and speech that are similar to schizophrenia (ideas of reference, bodily illusions –such as having extrasensory abilities or being able to sense external forces

• 3% prevalence

• Males>females

Perhaps similar causes to schizophrenia.

• Perhaps similar causes to schizophrenia.

• High activity of dopamine
• Higher rates of this among relatives of those with schizophrenia and those with depression

• Therapy is difficult—need to reconnect with the world and recognize limits of thinking and powers. Try to set clear limits. Increase positive social contacts. Ease loneliness.

• Cognitive—try to help them see inaccuracy of thoughts
• Behavioral methods—speech lessons, social skills training, tips on appropriate dress and manners
• Low doses of antipsychotics may have some success

Overly dramatic and attention seeking

• Overly dramatic and attention seeking

• Explain emotion extravagantly

• Very shallow, self-centered

• Overly concerned with physical attractiveness

• Uncomfortable when not the center of attention

• Believe relationships are more intimate than they are

• Inappropriately provocative

• Easily influenced by others

• Speech vague, lacks details

•  2-3% prevalence

• Males=females or females slightly greater

Psychodynamic

• Psychodynamic

• Cold and controlling parents left them feeling unloved and afraid of abandonment; to defend against fear of loss, act provocatively so that they have to be rescued
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