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CHAPTER 10 PERSONALITY DISORDERS Cluster C includes avoidant, dependent, and

obsessive- compulsive personality disorders;

10.1 What are some of the general features of
individuals with these disorders show fearfulness or
personality disorders?
tension, as in anxiety-based disorders. Children with
Personality disorders appear to be rather inflexible an inhibited temperament may be at heightened risk
and distorted behavioral patterns and traits that result for avoidant personality disorder, and individuals high
in maladaptive ways of perceiving, thinking about, on neuroticism and agreeableness, with authoritarian
and relating to other people and the environment. and overprotective parents, may be at heightened risk
for dependent personality disorder.
Three general clusters of personality disorders have
been described in DSM, although researchers have 10.6 What are the clinical features of borderline
increasingly questioned the validity of these clusters. personality disorder and how is this disorder
10.2 What are some of the difficulties of doing
research on personality disorders? Borderline personality disorder is characterized by
emotional instability, fears of abandonment,
Even with structured interviews, the reliability of impulsivity, self-mutilating behavior, and an unstable
diagnosing personality disorders typically is less than sense of self. People with BPD have intense and
ideal. Most researchers today agree that a dimensional stormy personal relationships.
approach for assessing personality disorders would be
preferable. There is relatively little research on treatments for
most personality disorders. However, a form of
It is difficult to determine the causes of personality behavior therapy called dialectical behavior therapy
disorders as categories because most people with one (DBT) is beneficial for people with BPD. DBT helps
personality disorder also have at least one more and patients learn to manage their emotions and develop
because most studies to date are retrospective. new coping skills. Other recently developed forms of
10.3 What characteristics do the Cluster A therapy for BPD include transference-focused
personality disorders have in common? psychotherapy and mentalization-based treatment. A
wide range of medications (antidepressants,
Cluster A includes paranoid, schizoid, and antipsychotic medications, and mood stabilizing
schizotypal personality disorders; individuals with medications) are also used sometimes. 10.7 What are
these disorders seem odd or eccentric. Little is known the features of antisocial personality disorder and
about the causes of paranoid and schizoid disorders, psychopathy?
but genetic and other biological factors are implicated
in schizotypal personality disorder. A person with psychopathy shows elevated levels of
two different dimensions of traits: (1) an affective-
10.4 What characteristics do the Cluster B interpersonal set of traits reflecting lack of remorse or
personality disorders have in common? guilt, callousness/lack of empathy,
Cluster B includes histrionic, narcissistic, antisocial, glibness/superficial charm, grandiose sense of self-
and borderline personality disorders; individuals with worth, and pathological lying, and (2) antisocial,
these disorders share a tendency to be dramatic, impulsive, and socially deviant behavior;
emotional, and erratic. Little is known about the irresponsibility; and parasitic lifestyle. A person
causes of histrionic and narcissistic disorders. Certain diagnosed with ASPD is primarily characterized by
biological and psychosocial causal factors have been traits from the second dimension of psychopathy.
identified as increasing the likelihood of developing Genetic and temperamental, learning, and adverse
borderline personality disorder in those at risk environmental factors seem to be important in
because of high levels of impulsivity and affective causing psychopathy and ASPD.
Psychopaths also show deficiencies in fear and
10.5 What characteristics do the Cluster C anxiety as well as more general emotional deficits.
personality disorders have in common?
Treatment of individuals with ASPD psychopathy is attention; their lively, dramatic, and excessively
difficult, partly because they rarely see any need to extraverted styles often ensure that they can charm
change and tend to blame other people for their others into attending to them.
ANTISOCIAL PERSONALITY DISORDER show an exaggerated sense of self-importance, a
(ASPD) - is their tendency to persistently disregard preoccupation with being admired, and a lack of
and violate the rights of others. They do this through empathy for the feelings of others.
a combination of deceitful, aggressive, and antisocial
obsessive-compulsive personality disorder (OCPD)-
behaviors. These people have a lifelong pattern of
Perfectionism and an excessive concern with
unsocialized and irresponsible behavior with little
maintaining order and control characterize individuals
regard for safetyeither their own or that of others.
with obsessive-compulsive personality disorder
These characteristics bring them into repeated
conflict with society, and a high proportion become PARANOID PERSONALITY DISORDER-
incarcerated. have a pervasive suspiciousness and distrust of others,
leading to numerous interpersonal difficulties. They
tend to see themselves as blameless, instead blaming
show extreme social inhibition and introversion,
others for their own mistakes and failureseven to
leading to lifelong patterns of limited social
the point of ascribing evil motives to others. Such
relationships and reluctance to enter into social
people are chronically tense and on guard,
interactions. Because of their hypersensitivity to, and
constantly expecting trickery and looking for clues to
fear of, criticism and rebuff, they do not seek out
validate their expectations while disregarding all
other people, yet they desire affection and are often
evidence to the contrary.
lonely and bored.
PERSONALITY DISORDER- certain traits that
are so inflexible and maladaptive that they are unable
(BPD) - show a pattern of behavior characterized by
to perform adequately at least some of the varied
impulsivity and instability in interpersonal
roles expected of them by their society, in which case
relationships, self-image, and moods.
we may say that they have a personality disorder
DEPENDENT PERSONALITY DISORDER- (formerly known as a character disorder).
show an extreme need to be taken care of, which
leads to clinging and submissive behavior. They also
show acute fear at the possibility of separation or SCHIZOID PERSONALITY DISORDER-
sometimes of simply having to be alone because they usually unable to form social relationships and usually
see themselves as inept lack much interest in doing so. Consequently, they
tend not to have good friends, with the possible
exception of a close relative. Such people are unable
developed by Marsha Linehan, is a unique kind of
to express their feelings and are seen by others as cold
cognitive and behavioral therapy specifically adapted
and distant.
for BPD. Linehan believes that patients inability to
tolerate strong states of negative affect is central to SCHIZOTYPAL PERSONALITY DISORDER-
this disorder. One of the primary goals of treatment is are also excessively introverted and have pervasive
to encourage patients to accept this negative affect social and interpersonal deficits (like those that occur
without engaging in self-destructive or other in schizoid personality disorder), but in addition they
maladaptive behaviors. have cognitive and perceptual distortions, as well as
oddities and eccentricities in their communication and
Excessive attention-seeking behavior and
emotionality are the key characteristics of individuals
with histrionic personality disorder. these individuals
tend to feel unappreciated if they are not the center of
CHAPTER 11 SUBSTANCES RELATED Sociocultural factors such as attitudes toward alcohol
DISORDERS may predispose individuals to alcohol-related
11.1 what is alcohol abuse and dependence?
11.2 what is drug abuse and dependence?
Substance-related disorders such as alcohol or drug
abuse and dependency are among the most Possible causal factors in drug abuse include the
widespread and intransigent mental health problems influence of peer groups, the existence of a so-called
facing us today. drug culture, and the availability of drugs as tension
reducers or pain relievers.
Many problems of alcohol or drug use involve
difficulties that stem solely from the intoxicating Some recent research has explored a possible
effects of the substances. physiological basis for drug abuse. The discovery of
endorphins, opium-like substances produced by the
Dependence occurs when an individual develops a
body, has led to speculation that a biochemical basis
tolerance for the substance or exhibits withdrawal
of drug addiction may exist.
symptoms when the substance is not available.
The so-called pleasure pathwaythe
Several psychoses related to alcoholism have been
mesocorticolimbic pathway (MCLP)has come
identified: withdrawal delirium, chronic alcoholic
under a great deal of study in recent years as the
hallucinosis, and dementia associated with alcoholism.
possible potential anatomic site underlying the
Drug-related abuse disorders may involve addictions.
physiological dependence on substances such as
The treatment of individuals who abuse alcohol or
opiatesparticularly heroinor barbiturates;
drugs is generally difficult and often fails. The abuse
however, psychological dependence may also occur
may reflect a long history of psychological difficulties;
with any of the drugs that are commonly used
interpersonal and marital distress may be involved;
todayfor example, marijuana.
and financial and legal problems may be present.
A number of factors are considered important in the
In addition, all such problems must be dealt with by
etiology of substance-abuse disorders. Some
an individual who may deny that the problems exist
substances, such as alcohol and opiates, stimulate
and who may not be motivated to work on them.
brain centers that produce euphoriawhich then
becomes a desired goal. Several approaches to the treatment of chronic
substance-related disorders have been developed
It is widely believed that genetic factors play some
for example, medication to deal with withdrawal
role in causing susceptibility to alcohol-abuse
symptoms and withdrawal delirium, and dietary
problems through such biological avenues as
evaluation and treatment for malnutrition.
metabolic rates and sensitivity to alcohol.
Psychological therapies such as group therapy and
Psychological factorssuch as psychological
behavioral interventions may be effective with some
vulnerability, stress, and the desire for tension
alcohol- or drug-abusing individuals. Another source
reductionand disturbed marital relationships or
of help for alcohol abusers is Alcoholics Anonymous;
failure in parental guidance are also seen as important
however, the extent of successful outcomes w ith this
etiologic elements in substance-use disorders.
program has not been sufficiently studied.
Although the existence of an alcoholic personality
Most treatment programs require abstinence;
type has been disavowed by most theorists, a variety
however, some research has suggested that some
of personality factors apparently play an important
alcohol abusers can learn to control their drinking
role in the development and expression of addictive
while continuing to drink socially. The controversy
surrounding controlled drinking continues.
Relapse prevention strategies have proved successful
in helping substance-abusing patients to deal with the
challenges encountered in abstinence-based treatment The negative effects of caffeine involve intoxication
approaches. rather than withdrawal. Unlike addiction to drugs
such as alcohol or nicotine, withdrawal from caffeine
11.3 Are there addictive disorders other than
does not produce severe symptoms, except for
alcohol and drugs?
headache, which is usually mild.
This chapter also includes discussion of several
COCAINE- Is a plant product discovered in ancient
addictive disorders that are different than alcohol or
times and used ever since. cocaine was considered as
drug abuse, caffeine, tobacco and gambling.
the high for the affluent. However, with more
widespread availability and lowering of prices, the
drugs use increased significantly in the United States
ADDICTIVE BEHAVIOR- behavior based on the during the 1980s and 1990sto the point where its
pathological need for a substancemay involve the use was considered epidemic, especially among
abuse of substances such as nicotine, alcohol, Ecstasy, middle- and upper-income groups.
or cocaine. Addictive behavior is one of the most
prevalent and difficult-to-treat mental health DELIRIUM TREMENS- SAME AS ALCOHOL
problems facing our society today. WITHDRAWAL DELIRIUM


(formerly known as delirium tremens) This reaction hallucinogen and a stimulant that is popular as a party
usually happens following a prolonged drinking drug among young adults. The drug was further
spree when the person enters a state of withdrawal. evaluated and tested during the 1970s and 1980s as a
Slight noises or suddenly moving objects may cause potential medication for use in psychological
considerable excitement and agitation. treatment for a wide range of conditions such as
posttraumatic stress, phobias, psychosomatic
ALCOHOLIC- SAME AS ALCOHOLISM disorders, depression, suicidality, drug addiction, and
ALCOHOLISM- a state, psychic and usually also relationship difficulties
physical, resulting from taking alcohol, characterized ENDORPHINS- The human body produces its
by behavioral and other responses that always include own opium-like substances, called endorphins, in the
a compulsion to take alcohol on a continuous or brain and pituitary gland. These substances are
periodic basis in order to experience its psychic produced in response to stimulation and are believed
effects, and sometimes to avoid the discomfort of its to play a role in an organisms reaction to pain.
absence; tolerance may or may not be present
FLASHBACK- An interesting and unusual
AMPHETAMINE- The earliest amphetamine to be phenomenon that may occur sometime following the
introducedBenzedrine, or amphetamine sulfate use of LSD. an involuntary recurrence of perceptual
was first synthesized in 1927 and became available in distortions or hallucinations weeks or even months
drugstores in the early 1930s as an inhalant to relieve after the individual has taken the drug. Flashbacks
stuffy noses. these preparations were considered to be appear to be relatively rare among people who have
wonder pills that helped people stay alert and taken LSD only oncealthough they do sometimes
awake and function temporarily at a level beyond occur.
HALLUCINOGENS- are drugs that are thought to
BARBITURATES- barbiturates have been induce hallucinations. However, these preparations
available as an aid to falling asleep. Barbiturates were usually do not in fact create sensory images but
once widely used by physicians to calm patients and distort them so that an individual sees or hears things
induce sleep. They act as depressantssomewhat like in different and unusual ways. These drugs are often
alcoholto slow down the action of the CNS and referred to as psychedelics. The major drugs in this
significantly reduce performance on cognitive tasks category are LSD (lysergic acid diethylamide) or
CAFFEINE- The chemical compound caffeine is acid, mescaline, and psilocybin.
found in many commonly available drinks and foods.
HASHISH- derived from the resin exuded by the MORPHINE- a bitter-tasting powder that could
cannabis plant and made into a gummy powder. serve as a powerful sedative and pain reliever
Hashish, like marijuana, is usually smoked. Although
NICOTINE- The poisonous alkaloid nicotine is the
marijuana can be considered a mild hallucinogen,
chief active ingredient in tobacco; it is found in such
there are significant differences between the nature,
items as cigarettes, chewing tobacco, and cigars, and it
intensity, and duration of its effects and those
is even used as an insecticide. The use of tobacco is a
induced by drugs like LSD, mescaline, and other
significant problem in the general population.
major hallucinogens.
OPIUM- is a mixture of about 18 chemical
substances known as alkaloids.
LSD- The most potent of the hallucinogens, the
odorless, colorless, and tasteless drug LSD can
recurrent problematic gambling behavior leading to
produce intoxication with an amount smaller than a
clinically significant impairment or distress, as
grain of salt.
indicated by the individual exhibiting four (or more)
MARIJUANA- comes from the leaves and flowering of the following in a 12-month period
tops of the hemp plant, Cannabis sativa, which grows
PSILOCYBIN- same as mescaline
in mild climates throughout the world. In its prepared
state, marijuana consists chiefly of dried green PSYCHOACTIVE SUBSTANCES- The most
leaveshence the colloquial name grass. It is commonly used problem substances are those that
ordinarily smoked in the form of cigarettes (variously affect mental functioning in the central nervous
referred to as pot, reefers, joints, stash, system (CNS) psychoactive substances: alcohol,
weed, etc.) or in pipes. In some cultures the leaves nicotine, barbiturates, tranquilizers, amphetamines,
are steeped in hot water and the liquid is drunk, much heroin, Ecstasy, and marijuana.
as one might drink tea.
SUBSTANCE ABUSE- generally involves an
MESCALINE- Both drugs have mind-altering and excessive use of a substance resulting in (1) potentially
hallucinogenic properties, but their principal effect hazardous behavior such as driving while intoxicated
appears to be enabling an individual to see, hear, and or (2) continued use despite a persistent social,
otherwise experience events in unaccustomed ways psychological, occupational, or health problem.
transporting him or her into a realm of non ordinary
reality. SUBSTANCE DEPENDENCE- includes more
severe forms of substance-use disorders and usually
MESOCORTICOLIMBIC DOPAMINE involves a marked physiological need for increasing
PATHWAY (MCLP)- is the center of psychoactive amounts of a substance to achieve the desired effects.
drug activation in the brain. The MCLP is made up of Dependence in these disorders means that an
neuronal cells in the middle portion of the brain individual will show a tolerance for a drug and/or
known as the ventral tegmental area and connects to experience withdrawal symptoms when the drug is
other brain centers such as the nucleus accumbens unavailable.
and then to the prefrontal cortex.
METHADONE- Methadone hydrochloride is a seen all around us: in extremely high rates of alcohol
synthetic narcotic that is related to heroin and is abuse and dependence, and in tragic exposs of
equally addictive physiologically. Its usefulness in cocaine abuse among star athletes and entertainers
treatment lies in the fact that it satisfies an addicts
craving for heroin without producing serious TOLERANCE- the need for increased amounts of a
psychological impairment, if only because it is substance to achieve the desired effectsresults from
administered as a treatment in a formal clinical biochemical changes in the body that affect the rate
context and can result in reduced drug use and of metabolism and elimination of the substance from
improved cognitive performance the body.
WITHDRAWAL- refers to physical symptoms such biological sex. Most boys who have this disorder
as sweating, tremors, and tension that accompany grow up to have a homosexual orientation; a much
abstinence from the drug. smaller number become transexuals. Prospective
studies of girls who have this disorder have reported
similar results.
Transsexualism is a very rare disorder in which the
person believes that he or she is trapped in the body
12.1 Why is it difficult to define boundaries of the wrong sex and goes through elaborate steps
between normality and psychopathology in the necessary to change his or her sex. It is now
area of variant sexuality? recognized that there are two distinct types of male-
to-female transsexuals: homosexual transsexuals and
Defining boundaries between normality and autogynephilic transsexuals, each with different
psychopathology in the area of variant sexuality is characteristics and developmental antecedents. The
very difficult, in part because sociocultural influences only known effective treatment 12 summary for
on what have been viewed as normal or aberrant transsexuals is a sex change operation. Although its
sexual practices abound. use remains highly controversial, it does appear to
Degeneracy theory and abstinence theory both have fairly high success rates when the people are
maintained that sexual activity should only occur for carefully diagnosed before the surgery as being true
purposes of procreation because wasting semen was transsexuals. 12.3 What are the three primary types of
harmful; both were very influential for long periods of sexual abuse?
time in the United States and many other Western There are three overlapping categories of sexual
cultures and led to very conservative views on abuse: pedophilia, incest, and rape. All three kinds of
heterosexual sexuality. abuse occur at alarming rates today.
In contrast to Western cultures, in the Sambia tribe Pedophilia is defined as sexual interest in prepubertal
in Melanesia, homosexuality is practiced by all children.
adolescent males in the context of male sexual
initiation rites; these males transition to Incest involves sexual activity between blood
heterosexuality in young adulthood. relatives.

Until rather recently in many Western cultures, Rape describes sexual activity that occurs under
homosexuality was viewed either as criminal behavior actual or threatened forcible coercion by one person
or as a form of mental illness. However, since 1974 on another.
homosexuality has been considered by mental health
Treatment of sex offenders has not as yet proved
professionals to be a normal sexual variant. 12.2 What
highly effective in most cases, although promising
do we mean by sexual and gender variants?
research in this area is being conducted. 12.4 What is
Sexual deviations in the form of paraphilias involve a sexual dysfunction?
persistent and recurrent patterns of sexual behavior
Sexual dysfunction involves impairment either in the
and arousal, lasting at least 6 months, in which
desire for sexual gratification or in the ability to
unusual objects, rituals, or situations are required for
achieve it. Dysfunction can occur in the first three of
full sexual satisfaction. They occur almost exclusively
the four phases of the human sexual response: the
in males, who often have more than one of them. The
desire phase, the excitement phase, and orgasm.
paraphilias include fetishes, transvestic fetishism,
voyeurism, exhibitionism, sadism, masochism, Male hypoactive sexual desire disorder is diagnosed
pedophilia, and frotteurism. in men when they have little or no interest in sex. In
extreme cases they may actually have an aversion to
Gender dysphoria occurs in children and adults.
sexual activity.
Childhood gender dysphoria occurs in children who
have unbold and dysphoria/distress about their
Erectile disorder occurs in men who are unable to FEMALE ORGASMIC DISORDER- can be
attain or to maintain an adequate erection until the diagnosed in women who are readily sexually
completion of sexual activity. excitable and who otherwise enjoy sexual activity but
who show persistent or recurrent delay in or absence
Formerly called premature ejaculation, early
of orgasm following a normal sexual excitement
ejaculation occurs in men who persistently and
phase and who are distressed by this (see DSM-5
recurrently have the onset of orgasm and ejaculation
Criteria on p. 433).
occurs after only minimal sexual stimulation.
Delayed ejaculation refers to the persistent inability
DISORDER- women with low desire tend to have
to ejaculate during intercourse.
low levels of sexual arousal during sexual activity and
Female sexual interest/arousal disorder is diagnosed vice versa. There are no common syndromes in which
in women who persistently show a lack of interest in women with low sexual desire have normal levels of
sexual activity and/ or great difficulty getting sexual arousal, or vice versa. Thus for women, DSM-
adequately aroused enough to have an orgasm. 5 has combined dysfunctionally low desire with
dysfunctionally low sexual arousal in the disorder
Genito-pelvic pain/penetration disorder is diagnosed Female Sexual Interest/Arousal Disorder.
in women who have persistent or recurrent
difficulties in at least one of the following four areas: FETISHISM- the individual has recurrent, intense
1. Marked difficulty having vaginal sexually arousing fantasies, urges, and behaviors
intercourse/penetration 2. Marked vulvovaginal or involving the use of some inanimate object or a part
pelvic pain during vaginal intercourse/penetration of the body not typically found erotic (e.g., feet) to
attempts 3. Marked fear or anxiety either about obtain sexual gratification
vulvovaginal or pelvic pain or vaginal penetration 4.
FROTTEURISM- is sexual excitement at rubbing
Marked tensing or tightening of the pelvic floor
ones genitals against, or touching, the body of a
muscles during attempted vaginal penetration
nonconsenting person.
AUTOGYNEPHILIA- a paraphilia in which their
GENDER DYSPHORIA- is discomfort with ones
attraction is to thoughts, images, or fantasies of
sex-relevant physical characteristics or with ones
themselves as a woman
assigned gender.
refers to the persistent inability to ejaculate during
INCEST- Culturally prohibited sexual relations (up
DESIRE PHASE- consists of fantasies about sexual
to and including coitus) between family members
activity or a sense of desire to have sexual activity.
such as a brother and sister or a parent and child
ERECTILE DISORDER- male sexual dysfunction
EXCITEMENT (OR AROUSAL) PHASE- achieve or maintain an erection sufficient for
characterized both by a subjective sense of sexual successful sexual intercourse was formerly called
pleasure and by physiological changes that accompany impotence. It is now known as male erectile disorder
this subjective pleasure, including penile erection in and can be diagnosed only when the difficulties are
the male and vaginal lubrication and clitoral considered to originate from either psychogenic or a
enlargement in the female. combination of psychogenic and medical factors (see
DSM-5 Criteria on p. 432).
in a person with recurrent, intense urges, fantasies, or MALE HYPOACTIVE SEXUAL DESIRE
behaviors that involve exposing his genitals to others DISORDER- Hypoactive sexual desire disorder is
(usually strangers) in inappropriate circumstances and diagnosed in men who have for at least 6 months
without their consent been distressed or impaired due to low levels of
sexual thoughts, desires, or fantasies.
MASOCHISM- a person experiences sexual TRANSVESTIC DISORDER- heterosexual men
stimulation and gratification from the experience of who experience recurrent, intense sexually arousing
pain and degradation in relating to a lover. fantasies, urges, or behaviors that involve cross-
dressing as a female may be diagnosed with
ORGASM- a release of sexual tension and a peaking
transvestic disorder
of sexual pleasure.
voyeuristic disorder- voyeurism according to DSM-
PARAPHILIAS- have recurrent, intense sexually
5 if he has recurrent, intense sexually arousing
arousing fantasies, sexual urges, or behaviors that
fantasies, urges, or behaviors involving the
generally involve (1) nonhuman objects, (2) the
observation of unsuspecting females who are
suffering or humiliation of oneself or ones partner,
undressing or of couples engaging in sexual activity
or (3) children or other nonconsenting persons.
PEDOPHILIC DISORDER- when an adult has
recurrent, intense sexual urges or fantasies about CHAPTER 13 SCHIZOPHRENIA AND
sexual activity with a prepubertal child; acting on OTHER PSYCHOTIC DISORDERS
these desires is not necessary for the diagnosis if they
13.1 what are the symptoms of schizophrenia?
cause the pedophile distress
Schizophrenia is the most severe form of mental
RAPE- describes sexual activity that occurs under
illness. It is characterized by impairments in many
actual or threatened forcible coercion of one person
domains. Characteristic symptoms of schizophrenia
by another
include hallucinations, delusions, disorganized speech,
RESOLUTION- the person has a sense of disorganized and catatonic behavior, and negative
relaxation and well-being. symptoms such as flat affect or social withdrawal.
SADISM- sexual purposes, inflicted such cruelty 13.2 what is the prevalence of schizophrenia and
on his victims that he was eventually committed when does it begin? who is most affected?
as insane.
Schizophrenia affects just under 1 percent of the
SEXUAL ABUSE- is sexual contact that involves population. Most cases begin in late adolescence or
physical or psychological coercion or at least one early adulthood. The disorder begins earlier in men
individual who cannot reasonably consent to the than in women. Overall, the clinical symptoms of
contact (e.g., a child). schizophrenia tend to be more severe in men than in
women. Women also have a better long-term
shows extreme aversion to, and avoidance of, all
genital sexual contact with a partner. Even though schizophrenia first shows itself
clinically in early adulthood, researchers believe that it
SEXUAL DYSFUNCTION- refers to impairment
is a neurodevelopmental disorder. Problems with
either in the desire for sexual gratification or in the
brain development are implicated. Some of the genes
ability to achieve it. The impairment varies markedly
implicated in schizophrenia play a role in brain
in degree, but regardless of which partner is alleged to
be dysfunctional, the enjoyment of sex by both
parties in a relationship is typically adversely affected. 13.3 what are the risk and causal factors
associated with schizophrenia?
Genetic factors are clearly implicated in
TRANSSEXUALISM- occurs in adults with gender
schizophrenia. Having a relative with the disorder
dysphoria who desire to change their sex, and surgical
significantly raises a persons risk of developing
advances have made this goal, although expensive,
partially feasible.
Other factors that have been implicated in the
development of schizophrenia include prenatal
exposure to the influenza virus, early nutritional if their relatives are high in expressed emotion (EE).
deficiencies, rhesus incompatibility, maternal stress, High-EE environments may be stressful to patients
and perinatal birth complications. and may trigger biological changes that cause
dysregulations in the dopamine system. This could
Urban living, immigration, and cannabis use during
lead to a return of symptoms.
adolescence have also been shown to increase the risk
of developing schizophrenia. 13.7 what is the clinical outcome of schizophrenia
and how is it treated?
Current thinking about schizophrenia emphasizes
the interplay between genetic and environmental For many patients, schizophrenia is a chronic
factors. disorder requiring long-term treatment or
institutionalization. However, when treated with
13.4 How is the brain affected in schizophrenia?
therapy and medications, around 38 percent of
Patients with schizophrenia have problems in many patients can show a reasonable recovery. Only about
aspects of their cognitive functioning. They show a 14 percent of patients recover to the extent that they
variety of attentional deficits (e.g., poor P50 have minimal symptoms and function well socially.
suppression and deficits on the Continuous
Patients with schizophrenia are usually treated with
Performance Test). They also show eye-tracking
first- or second-generation antipsychotic
(neuroleptic) medications. Secondgeneration
Many brain areas are abnormal in schizophrenia, antipsychotics are about as effective as first-
although abnormalities are not found in all patients. generation antipsychotics but cause fewer
The brain abnormalities that have been found include extrapyramidal (motor abnormality) side effects.
enlarged ventricles (which reflects decreased brain Antipsychotic drugs work by blocking dopamine
volume), frontal lobe dysfunction, reduced volume of receptors.
the thalamus, and abnormalities in temporal lobe
Psychosocial treatments for patients with
areas such as the hippocampus and amygdala.
schizophrenia include cognitive-behavioral therapy,
Major changes in the brain occur during adolescence. social-skills training, cognitive remediation training,
These include synaptic pruning, decreases in the and other forms of individual treatment, as well as
number of excitatory neurons, and increases in the case management. Family therapy provides families
number of inhibitory neurons. There is also an with communication skills and other skills that are
increase in white matter which enhances the helpful in managing the illness. Family therapy also
connectivity of the brain. Some of these changes may reduces high levels of expressed emotion.
be abnormal in people who will later develop
ALOGIA- means very little speech.
Some of the brain abnormalities that are
medications like chlorpromazine (Thorazine) and
characteristic of schizophrenia get worse over time.
haloperidol (Haldol), which were among the first to
This suggests that, in addition to being a
be used to treat psychotic disorders. Sometimes
neurodevelopmental disorder, schizophrenia is also a
referred to as neuroleptics (literally, seizing the
neuroprogressive disorder. 13.5 what
neurotransmitters are implicated in schizophrenia?
The most important neurotransmitters implicated in
schizophrenia are dopamine and glutamate. Research AVOLITION- the inability to initiate or persist in
shows that the dopamine (D2) receptors of patients goal-directed activities.
with schizophrenia are supersensitive to dopamine.
13.6 why is the family environment important for its name suggests. It involves the sudden onset of
the wellbeing of patients with schizophrenia? psychotic symptoms or disorganized speech or
Patients with schizophrenia are more likely to relapse catatonic behavior.
CANDIDATE GENES- host genes that are known NEGATIVE SYMPTOMS- reflect an absence or
to be involved in processes that are believed to be deficit of behaviors that are normally present.
aberrant in schizophrenia
CATATONIC SCHIZOPHRENIA- involves picture is dominated by absurd and illogical beliefs
pronounced motor signs that reflect great excitement that are often highly elaborated and organized into a
or stupor coherent, though delusional, framework
excess or distortion in a normal repertoire of behavior
DELUSION- is essentially an erroneous belief that is
and experience, such as delusions and hallucinations.
fixed and firmly held despite clear contradictory
evidence. The word delusion comes from the Latin PRODROMAL- very early, signs of schizophrenia,
verb ludere, which means to play. researchers are hoping to improve their ability to
detect, and also perhaps intervene with, people who
DELUSIONAL DISORDER- hold beliefs that are
appear to be on a pathway to developing the disorder
considered false and absurd by those around them.
Unlike individuals with schizophrenia, however, PSYCHOSIS- loss of contact with reality
people given the diagnosis of delusional disorder may
otherwise behave quite normally.
diagnosis is conceptually something of a hybrid, in
DISORGANIZED SCHIZOPHRENIA- that it is used to describe people who have features of
characterized by disorganized speech, disorganized schizophrenia and severe mood disorder. In other
behavior, and flat or inappropriate affect words, the person not only has psychotic symptoms
that meet criteria for schizophrenia but also has
marked changes in mood for a substantial amount of
like disordered speech and disorganized behavior that
were previously thought to reflect positive symptoms
might be better separated from true positive SCHIZOPHRENIA- occurs in people from all
symptoms like hallucinations and delusions. cultures and from all walks of life. The disorder is
characterized by an array of diverse symptoms,
DOPAMINE- The most well-studied
including extreme oddities in perception, thinking,
neurotransmitter implicated in schizophrenia
action, sense of self, and manner of relating to others.
ENDOPHENOTYPES- discrete, stable, and
measurable traits that are thought to be under genetic
category reserved for schizophrenia-like psychoses
that last at least a month but do not last for 6 months
EXPRESSED EMOTION (EE)- is a measure of and so do not warrant a diagnosis of schizophrenia.
the family environment that is based on how a family Two (or more) of the following, each present for a
member speaks about the patient during a private significant portion of time during a 1-month period
interview with a researcher (or less if successfully treated). At least one of these
must be (1), (2), or (3): 1. Delusions. 2.
FLAT AFFECT- blunted emotional expressiveness Hallucinations. 3. Disorganized speech (e.g., frequent
GLUTAMATE- is an excitatory neurotransmitter derailment or incoherence). 4. Grossly disorganized
that is widespread in the brain. or catatonic behavior. 5. Negative symptoms (i.e.,
diminished emotional expression or avolition).
HALLUCINATION- is a sensory experience that
seems real to the person having it, but occurs in the
absence of any external perceptual stimulus.