Personality Disorders + Sex related disorders PDF

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“The genderbread person” - Gender identity: Psychological, Who you believe yourself to be, a spectrum - Gender expression: what you express out to the worlld, how you demonstrate yourself to the world - Biological sex: anatomy, physiology - Best ase for someone born intersex is to wait and not arbritarily assign gender, difficult in society that wants to put people into a box - Sexual orientation - Has to do with who are drawn to Gender dysphoria - Used to be called gender identity disorder - contreversial : and should it e a disorder - Dysphoria refers to distress - Biological sex does not match gender identity - Independent of sexual orientation - Opposite of being cisgender - Distress is caused for a person by society - Could be that the next dsm changes this - On the one hand it shines a light on the struggles - This daignosis could have implications in terms of paying for hormones and gender reassignment surgery Why do we need a word cisgender and straight? - Because otherwise we assume that is the default and is normal - There Stages of the sexual response - Desire - Arousal - Plateau - Organsm - Resoluton - Something can go wrong and cause dysfuntion at any of these stages - Only sex specific - Premature ejaculation and painful vaginal Treatment for sexual dysfunction - Often times people turn to medecine, but often times psycholgoical - Education: people need to learn more realistic explanations - Increased communication

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Sensate focus (nondemand pleasuring): assignment to explore each others bodies and have fun and feel good without demand for organsm- remove that pressure will take away preformance anxiety Cbt for preformance anxiety: talk about automatic thoughts having, how to relax body, identify negative thoughts Self-pleasuring? Assign masterbation, a lot of people do not know their own bodies Possible medication: the role of hormones - Do not rush to pathologize hormone levels

Paraphilic disorders (no longer “paraphilias”): remnamed to indicate not just attraction, but dangers caused by attraction - Fetishistic disorder: objects of attraction that are not typical - Distress and impairment, geting in the way - Voyeuristic and exhibitionistic disorders: sexual gratification from observing someone without their knowledge or consent - The fact that it is a violation is part of the arousal - Run into issues with the law - Cause distress to people being victimized - Transvestic disorder: arousal from articles of clothing that causes distress and impairment - Sexual sadism and masochism disorder: sexual gratification from inflicting pain or being dominant or the reverse - Frotteuristic disorder: someone rubbing up against someone unexpectedly; a violation; is an assault- the person gets off on the fact it is a violation - Sadistic rape: people for whome the causing of pain and horror and distress is exactly what is gratifiying to them - Pedophillic disorder and incest: case of the actual prepubestent child being what the person is attracted to, not all people with this willl go onto harm children, not synomonous with being a child molester - Potential genetic link - Alot of these disrders caus edistress in partnerships - Sex offenders history are often those of escalation, increasing appettte Causes of paraphillic disorders - There is a genetic propencity, but still unclear - Difficulty forming “normal” rleationships - Defecitis in typical sexual experiences - Relationship diffiulties in childhood or adolescene - Early experiences may lead to sexual associations by chance- then reinforced through masturbaton - Often have a very high sex drive - Supressing unwanted fantasies may parasoxically increase them

Treatment of paraphillic diosders - Covert sensitization: putting in an adverse stimulus and connecting it to a persons sexual trigger, so eventually overtime have a negative association wth that trigger - Orgasmic reconditioning: apply sexual desire and energy to a more appropriate stimulus - Gradually conditionned to be sexually gratified by more appriorate stimulus - Coping and relapse prevention: if you are going to continue to have exposure to stimulus - Multiple victims higher predictor of relase - Job loss can increase risk of relapse - Keep in mind high comorbidity- mood, anxiety, and substance-related disorders - Sometimes a visous cycle Modern technology - Much harder to escape temptations Extremely contrevrsial - We are basically saying your personality is so bad it can be classified as a disrder - Does not always hold up with validity - Gender bias - It was expected that in the new DSM, the personality disorder section would be completely re-classified Personalities - Do not fluctuate - Not a personality if certain situations cause you to act a certain way Personality disorders - Personality part: enduring patterns of perceiving, relating to, and thinking about the enviorment and oneself that are exhibited in a wide range of social and personal contexts - Disorders part: such patterns are also: inflexible and maladaptive, and cause either significant functional impairment or subjective distress - Maladaptive: not workng for you, yet it persists Personality disorders - Originate in childhood and continue - We don’t really diagnose personaliity orders until adulthood - Has to be prior evidence so kind of a paradox - High comorbity with other disorders - Pervade every aspect of someone’s life - notoriously hard to treat - Some more hope than others Five-factor model

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Neuorticism (remaned emotional stability) - Flipped around valence spectrum Extravesrsion - How energizing being around people is Agreeableness Conscientiousness - Punctuality, organizaiton Openess to experience - The only one that somewhat correlates to intelligence - Intelligence is the ability to solve problems

No pure set of factors that can describe what it is to be human Three clustes - a : odd or ecentric - B: dramatic, emootional, or eratic - C: Gender bias - Criterior gender bias (criteria is biased) - Assessment gender bias (measures are biased) CLUSTER A Paranoid personalitydisorder: mistrust - Pervasively beleive no one else can be trusted, extremely argumentative, not very happy - Does not rise to level of psychosis - These traits have existed since childhood - Diathesis stress model - If soemone has reason to be paranoid, this makes sense Schizoid personality disorder: detachment - A severe level of detachment from the world and your own emotions - Can look like autism disorder - Not an interest in devleoping these relationships - Its not an disorder until it starts to significantly impair daily life - Hard to come on the raider of treatment - Role play, create motivation to have interactions you need to have Schizotypal personality diosrder: odd - Instead of hallucinations, have illusions - Not true delusions, but have magical ideas of reference that are a little bit out of touch with reality - Similar factors that go into szchophrenia

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Prognosis not ideal because folk not on radar Day to day life not cohesive enoguh to call and get therapy Homelessness common

CLUSTER B Antioscial personality disorder: violation - One of the most common personality disorders - The very basis of it, willing to violat eothers, willing to step on other people - No remorse, undeterred , tend to lack empathy, want what they want - Opposite of prosocial - Psychopathy: CEO’s score very high - Sociopathy - Inability or non-acknowledgement to feel empathy - Low level of arousal, don’t care - Many are slick charmers - Lack empathy and remorse - Not “antisocial” in the steroetypical sense - Substance abuse heavily prevalent: they want to feel something - Under arousal hypothesis: not enough arousal in day to day life - Genetic component to some extent, but not everything - Maybe frontal cortex is under developed - Very high threshold for fear Antisocial Persoanlity Disorder - Underarousal hypothesis: from a central nervous standpoint, chronicallly underarousedwhat contributes to them being able to violate boundaries without feeling super upset - Prevention more effective than treatment - Children who show early signs end up in the folds of consuct disorder - Early intervention: trying to devleop empathy, create motivation for getting along with other people, increase trust for other people - Success in life has less to do with academic achievement than emotional intelligence 1 - Tending to gardens or animals: develop attachments - Dsm diagnosis has attempted to focus more on the actual violation than the personality traits themselves Borderline Personality Disorder: I hate you. Don’t Leave me! - Very strong up and down, erratic relationships - How did it get its name? Borderline does not make such sense; name is artificact- border or neurosis and psychosis - Characterized by tumultuous, unstable relationships - Fear of abandonment at core, push people away because so scared of being pushed away first

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Self harm and cutting very popular among this population; part of the urge is show others how much they are hurting inside; othertimes, it is litterally just attempting to step out of the pain; others, punishing htemselves Suicidal gestures also common; often times its the case, that these gestures are meant to not intentionally kill themselves A lot of pain inside; anger and rage to deep sadness and depression really quickly, instability of relationships Not borderline- not seeing manic epiosdes, triggered by interactions in relationship Bipolar manic episodes, come from within Mood driven changes driven by what you perceive in your enviroment Very large chunk of personality disroders; accounts for as many of half of personality disorders total; prefdominantly female- but is this bias (when men engage in this behavior does it display itselves idfferently?) Dialtetical behavioral therapy (specfiically developed for borderline disorder) - Teaches people mindfulness in the moment, teaches them to pause and choose a different path that is not as reactant and harmful Dunking head i ice water: short circuits system, resets panic control button and gets you to acknowledge tools People with borderline persoanlity disorder often love to go to therapy; complaint often puts blame on others, do not acklnowledge role in problem Often times fear of abandomnet comes from a place of actually eperiencing abandonmnet

Comorbd disorders - 80 percent also have major depression, 10 % are bipolar - Suicide attempts- 10 percent - 67% are diagnosed with at least one substance use disorder - Eating disorders - 25 percent of bulimia patients ahve borderline persoanlity disorder - 20 percent have anorexia causes - Strong genetic component - Also linked to depression genetically - High emotional raectivity may be inherited - May have impaired functionning of limbic system - Early trauma/abuse increase risk - Learning that you should be afraid of being abandonned because it does happen - Many bpd patients have high levels of shame and low self esteem - Feeling of shame activate in an intelorable way - Antidepressent medications providee some short-term relief - Dialetical behavior therapy is most promising treatment (DBT) - Focus on dual realtiy of aceptance of difficultings, and need for change

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Focus on interpersonal effectiveness and coping mechanisms Focus on distres tolerance to decrease reckless/self harming behavior

Histrionic persoanlity disorder: dramatic - So dramatic that it causes them problems, people chronicalyl want to be the center of attention and want audiences - People spend a lot of time on papearance, want people’s attention will do anthing to sustain it - Difficulty delaying gratification, impulsivity - Hard to form truly intamate relationships because everything is on the surface Narcissistic personality disorder: self-importance - I deserve more than you do - Very arrogant, lack sensity to others - Envious when other people get what they think they deserve - Willing to exploit other people - Generational need for validation through others - A lot kds just told they were great, inevertently increased narcissim because taught kids they were so special they desrved to be above others r - Believe that they are entitled to more than everyone else - Deep down a lot of insecurity, but this has been there way to try to compensate for soething - Trying to convince yourself you are better tha everyone else because i naturally do not believe in myself Final cluseter - So anxious about negative evaluation of others, extremely avoidant of life - Become part of persoanltiy - Different from schziod because comes from a place of anxiety about interactions, want, but scared of other people reecting them Dependent personality disorder - Involves another perosn - Anxiety make sit such that they rely on others for decisions - Dependence could shift from one person to the next or could be one person - Co-dependent: two people in mesh with each other in such a way they are reliant - Anxiety keeping them from venturing into new area of life - Obsessive compulsive personalty disorder (OCPD) - Rigidity - Lends fire to stigma of ocd - Not obessions and compulsions - Perfectionistic, rigid, inflexible way of dealing with life - Treatment: learning to tolerate anxiety of uncertainty

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Pervasive way of behavig since a kid

Summary of personality disorders - Long standing patterns of behavior - Begin early in development and run a chronic course - Disagreement exists over how to categorize personality disorders - Categorical vs. dimensional, or some combination of both - For most, little is known about causese or treatment Developmental markers - Vocal expression, Time - Diagnosed first in infancy, childhood, or adolescence - Include th following attention defecit hyperactivity disorder (AHD) - Specific laearning disorder - Autism spectrum disorder - Intellectual disability - Communication and motor disorders - The sooner we can identify disorders, the more options we have...