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Home , Envy, Remorse

ACUTE STRESS DISORDER AND POST -TRAUMATIC STRESS DISORDER • A traumatic experience is a disastrous or an extremely painful event that has severe psychological and physiological effects. Examples include: accidents, violence, war, riots, fires and earthquakes. • develops soon after a traumatic event. • The individual develops intense , helplessness or horror. • Most people are able to return to relatively normal functioning within days or weeks. • Others may not develop the disorder while others develop PTD when the symptoms persist for more than a month. Diagnostic features of Acute Stress Disorder and Post-Traumatic Stress Disorder –The disorder occurs within a month of a traumatic event. –It causes clinically significant distress or impairment that lasts up to 4 weeks. –They experience death or serious injury. –They also experience a physical threat to self or others. –They respond with intense fear, helplessness or horror. –Sense of detachment, numbing or lack of surrounding as in a trance (daze). – of unreality. –Inability to recall an important aspect of the trauma (dissociate amnesia). –Recurrent images, thoughts, dreams, illusions, flashback episodes, a sense of reliving the experience or the person feels intense distress when exposed to reminders of the event. –The individual avoids situations that evoke memories of trauma. –The individual experiences symptoms of , insomnia, , poor concentration and restlessness. THEORIES 1. Biological Theory • Biological abnormalities are manifested in the individual nervous system or hypersensitive to possible danger in the future. 2. Psychological Perspectives • Trauma causes the flooding of the ego’s defences with uncontrollable anxiety. • Painful memories are triggered and inability to keep these memories repressed causes disturbance. 3. Behavioural Perspectives • The person with PTSD has acquired a learned fear to the stimuli that were present at the time of trauma. 4. Cognitive Perspective • People’s beliefs about traumatic events influence how people cope with it. Thoughts such as self for events beyond your control cause disturbance . 5. Social Cultural Perspective • This includes devastating wars. Lack of social support may contribute to the disorder. • In certain ethnic groups, stigma is associated with seeking professional psychological help. • This can aggravate the experience of PTSD. TREATMENT –Medication –Psychotherapy – supportive therapy and stress management –Systematic desensitization –Dispute irrational thinking • Behavioural therapy: - - Establish a rapport with the client - Dispute irrationality - Problem solving skills - Confront the feared situation in thoughts and all settings - Confront barriers in form of feelings e.g. , , and distorted beliefs e.g. negative self image. Revision Questions • Define anxiety disorders • Identify any five categories of anxiety disorders • Discuss causes of specific phobia and social phobia • Differentiate between Acute Stress Disorder and Post- Traumatic Stress Disorder • Differentiate between Agoraphobia and Disorder with Agoraphobia • Discuss the various intervention strategies you will use to help a client with Anxiety Disorders SCHIZOPHRENIA • By the end of the lesson, the learner should be able to: - – Define Schizophrenia – State the phases of Schizophrenia – Discuss the theories and treatment of Schizophrenia Meaning of Schizophrenia • Schizophrenia means a split personality. • It is a disorder with a range of symptoms involving disturbances in content of thought, perception and effect, sense of self, , behaviour and interpersonal functioning. Characteristics of Schizophrenia • Four fundamental features include: - i. Association – evident incoherent speech. ii. – inappropriate expression of e.g. inappropriate laughter in a sad situation. iii. – inability to follow through a decision. iv. Autism. Phases of Schizophrenia • Schizophrenia marks disturbances lasting at least 6 months. 1.Prodromal Phase • Deterioration in social and interpersonal functioning. It is characterized by maladaptive behaviour such as social withdrawals, inability to work productively, poor grooming, inappropriate emotions, peculiar thoughts and speech, unusual beliefs and decreased energy and initiative. 2.Active Phase • Behaviour and negative symptoms such as speechlessness or lack of initiative. 3.Residual Phase • There are serious problems at work, relationship and self care. 1.Disturbance of thought content – Delusions deeply entrenched false beliefs are the most common disturbance of thought at this time. The false beliefs are not consistent with the client’s intelligence or background. – The person imagines that people want to harm them or prevent them from fulfilling their mission. 2. Disturbance in perception hallucinations . - These are false perception involving one of the fie senses the false perceptions do not correspond with the objective stimuli present in the environment e.g. hearing of sounds, seeing things that others don’t e.t.c. 3. Disturbance of thinking. • Language and communication: Disorganized speech. The persons thinking may lack cohesiveness and logic. Their language may be distorted to the point of incomprehensibility. 4. Disturbed Behaviour • The person may move in odd and disturbing ways. They may not respond to external stimuli. They at times portray repetitive bodily movements. 5. Negative symptoms such as: - – Affective flattening – unresponsive with minimum eye contact – Alogia – loss of words and unresponsiveness in conversation. – Avolitian – unwillingness to act – Anhedonia – loss of in experiencing from activities that others find pleasurable. 6. Social and occupational dysfunctions - They have difficulty interacting with others. Diagnostic Features of Schizophrenia • Delusions • Hallucinations • Disorganized speech. • Catatonic stupor (a state of being unresponsive to eternal stimuli) severe lack of motivation. Types of Schizophrenia 1.Catatonic Schizophrenia • It is characterized by psychomotor disturbance such as excessive purposeless motor activity. 2.Disorganized Schizophrenia • Characterized by disorganized speech, and inappropriate affect. 3.Paranoid Schizophrenia • They are pre-occupied with auditory hallucination related to a theme of being persecuted or harassed. They have tremendous interpersonal problems because of their suspicions and argumentative style. 4. Undifferentiated Schizophrenia • The person manifests delusions, hallucinations, incoherence and disturbed behaviour. 5. Residual Schizophrenia • They retain symptoms such as emotional dullness, social withdrawal and illogical thinking. Theories of Schizophrenia 1. Biological Perspective • The brain structure and genetics are recognized as contributing to an individual’s illogical vulnerability and Schizophrenia. 2. Physiological Perspectives • Caused by an over activity of neurons that communicate with each other via the transmission of dopamine. 3. Environmental Perspectives • Pre-natal infection, birth complications may disrupt the brain development of the fetal and potential period through infection or injury. 4. Diathesis Stress Model • Diathesis means physical vulnerability to a particular disorder, especially if the individual lives in a stressful environment . Treatment of Schizophrenia (i) Biological/Pharmacotherapy Treatment • - Giving effective medication (ii) Psychological treatment – Reward a person who acts in a socially acceptable manner. – Reinforce appropriate behaviour especially in interpersonal situations – Helps the client to develop a more positive approach and evaluating the ability to cope with daily problems. (iii) A family and friends therapy (iv) Use core conditions to create rapport. Revision Questions • Define the term schizophrenia • Identify the three phase of schizophrenia • Discuss any five symptoms of schizophrenia • Describe the diagnostic features of schizophrenia • Discuss catatonic and disorganized types of schizophrenia • Discuss any three major treatment for schizophrenia patents • By the end of the lesson, the learner should be able to • Define personality and personality disorder. • Identify the various categories of personality disorder. • Describe the diagnostic features of each personality disorder. • Describe causes and treatment of each personality disorders. • Differentiate the personality disorder. Introduction • Personality disorder are classified under axis 2 unlike the disorders we have already looked at, classified under axis 1 • A personality trait is an enduring pattern of perceiving, relating to and thinking about the environment and others, a pattern that is ingrained in the matrix of the individuals psychological make-ups. • A personality disorder involves a long lasting maladaptive pattern of inner experience and behaviour, dating back the adolescence of young adulthood that is manifested in at least two of the following areas: i. Cognition – (ways f perceiving self, other people and events. ii. Affectively – , intensity and appropriate of iii. Interpersonal functioning iv. Impulse control. • The pattern is inflexible and pervasive across a range of personal and social situations. The pattern causes distress or impairment. • The present system in the DSM-IV includes a set of separate diagnoses grouped into two cluster based on shared characteristics. CLUSTER A • It comprises paranoid, schizoid and schizotypal personality disorders. They all share the features of odd and eccentric behavior. CLUSTER B • This includes antisocial, borderline, historic and narcissistic personality disorder. • People with these disorders are overdramatic, emotional, emotional, erratic or unpredictable • Disorders here include avoidant, dependent and obsessive – compulsive personality disorders. • These disorders involve anxious and fearful behaviors. Such personality disturbances are often seen early in the person’s life and they continue through adulthood. • Those with personality disorders process several distinct psychological features including:- • Disturbances in self image • Ability to have successful interpersonal relationships • Ability to have appropriate range of emotions. • Ways of perceiving themselves, others and the world. • Difficulty in processing proper impulse control • These people are often quite dissatisfied with their lives. • Anxiety and depression are common complication. Diagnostic features • This diagnostic is assigned to adults who as children showed evidence of conduct disorders who form the age of 15 have shown a pervasive pattern of disregard for and violation of the rights of others. Examples of such behaviors include. – Repeated engagement in behaviors that are grounds for arrest. – Deceitfulness such as lying, using false identity or canning others for personal profit or pleasure. – or failure and plan ahead. – Irritability and aggressiveness such as repeated fights or assaults. – Reckless disregard for the safety of self or others. – Consistent irresponsibility such as repeated failure to keep a job or honour financial obligations. – Lack of , being indifferent or dishonest. – Lack of emotional expressiveness. • People with antisocial personality disorder lack regard for societal, moral or legal standards. THEORIES OF ANTISOCIAL PERSONALITY DISORDERS 1. Biological Perspectives – Abnormalities include various brain abnormalities including defects in the prefrontal lobes of the cerebral cortex area involved in planning future activities and in considering the moral implications of one’s actions. – The abnormality may have genetic causes e.g. it has been observed that criminal behaviour runs in families. – Antisocial behaviour in juvenile reflects the influence of external factors such as peers and home life. 2. Psychological Perspective – Antisocial personality is due to neuropsychological deficit reflected in abnormal patterns of learning and attention. –The person is unable to process any information that is not relevant to prove their competence by engaging in aggressive acts. 3. Social-Cultural Perspectives • They focus on factors in the family, early environment and socialization experiences that lead to individuals to develop psychopathic lifestyle. • Inconsistent discipline, unreasonable harshness and extreme laxity send confusing messages to the child about what is right and what is wrong. • Children with such parents fail to make a connection between their actions, bad or good, and the consequences. • Experiences of childhood victimization play a major role in influencing the likelihood of developing antisocial behaviour as an adult. • There is a relationship between childhood and the development of antisocial behaviour. Treatment of Antisocial Personality Disorders • People with this disorder are unlikely to seek professional help voluntarily because they see no reason to change. • They change their behaviour when they realize that what they have done is wrong. • The therapist helps the individual to feel worse about themselves and their situation. • The clinician adopts a confrontational approach, showing disbelief regarding the client fabrications. • The therapist reflects the selfish and self defeating nature of such behaviour.

• When the therapeutic process is successful, the client begins to feel remorse and guilt about his behaviour, followed by helplessness and despondency, which is hoped it will lead to behaviour change. BORDERLINE PERSONALITY DISORDER • It is characterized by a pervasive pattern of poor impulse control, fluctuating self image and unstable mood and unstable interpersonal relationships. • They engage in suicidal behaviours. • They generalize others or themselves as being all good or all bad. ••ImpulsiveImpulsive spending, sex, substance abuse and reckless driving. ••RecurrentRecurrent suicidal behaviours, gestures of threat or self mutilating behaviour. ••EmotionalEmotional instability such as intense episodes of , irritability or anxiety lasting a few days. • Chronic feelings of . • Inappropriate, intense or difficulty in controlling anger. • Occasional stress related paranoid thinking. Theories of Borderline Personality Disorder 1. Biological Perspectives - Personality disorder may result from earlier trauma. 2. Psychological Perspective - Personality disorder is a result of dwelled on trauma. 3. Social Cultural Perspective • Many people develop this disorder as a result of lack of harmony in the society. • Family pressures and ineffective parenting can give rise to this disorder. • There is lack of clearly defined cultural norms and expectations. Treatment of Borderline Personality Disorder - Clinicians try to balance levels of attention to issues of stability and boundaries. - Some clinicians recommend medication. 2. HISTRIONIC PERSONALITY DISORDER • It is a personality disorder characterized by exaggerated emotional reactions. Diagnostic Features of Histrionic Personality Disorder • Excessive and attention seeking are indicated by five or more of the following: - - Discomfort when not the centre of attention. - Inappropriate sexual seduction or provocative behaviour. - Shallow expression of emotions. • Use of physical appearance to draw attention. • Impressing speeches that lack detail. • Exaggerated expression of emotions. • Misinterpretation of relationships as being more intimate than they are. Treatment of Histrionic Personality Disorder • A therapist can help the client get a more objective way of approaching problems and situations. • Teach the client how to think precisely and objectively. • Clients should learn self monitoring strategies to keep their impulsive behaviour in check. • Client should learn assertive skills to improve interpersonal relationships. 3. NARCISSISTIC PERSONALITY DISORDER • It is characterized by unrealistic, inflated sense of self importance () and a lack of sensitivity to the needs of other people. Diagnostic Features of Narcissistic Disorder • The person shows a pervasive pattern of grandiosity ( very special and important), need for administration and lack of . The following features are evident: • Self importance • Preoccupation with fantasies of success, power, brilliance, beauty or ideal . • Belief that they are so special and should associate with other special people who can understand them. • Need for excessive • Lack of empathy • of others or believe that others are envious. • Arrogant behavior and attitudes. Treatment: • The therapist uses empathy to support the clients search for recognition and admiration at the same time attempting to guide the client towards a more realistic appreciation of others. • Te therapist helps the client to reduce grandiosity and enhancing the client’s ability to relate with others. 5. PARANOID PERSONALITY DISORDER. • The individual is extremely suspicious of others and is always a gourd against potential danger or harm. • They seek to confirm their expectations that others will take advantage of them. • They don’t even their friends and associates. Diagnostic Features - The person mistrusts and is very suspicious of others. The following features are the evident: • Unjustified that are exploiting harming or deceiving them. • Unjustified about others loyalty or trustworthy. • Reluctance to confide in others for fear that information will be used against them. • Tendency to read hidden demeaning or threatening meanings of harmless remarks or events. • Tendency to bear grudges. • Perception of personal attacks that are not apparent to others • Tendency to respond with angry counter-attacks. • Unjustified suspicions about the faithfulness of spouse or sexual partner. - Psychodynamic theorists explain that the individual relies heavily on the defenses mechanisms. They: They perceive others as having negative or damaging motives. Cognitive behavioral theorists regard the person or someone who suffers from mistaken assumptions about the world and attributes personal problems and mistakes to other. Treatment • Countering the client’s mistaken assumptions in an atmosphere aimed at establishing a sense of trust.

• The therapist attempts to increase the client’s feelings or self efficacy so that he feels able to handle situations without resorting to defensive and vigilant stance 6. SCHIZOID PERSONALITY DISORDER • It is characterized by an indifference to social and sexual relationship. The person has little rage of emotional experience and expression. • The individual prefers to be by themselves and appear to lack any to be accepted and loved, even by their family members. • Others perceive them as cold, reserved, withdrawn and seclusive yet the schizoid individual is unaware and typically insensitive to the feelings and thoughts of others. Diagnostic Features • People show a perceive pattern of detachments from relationships and a restricted emotional range. The following features are obvious:- • Lack of desire or enjoyment of close relationships • Strong references for solitary activities • Little or no interests in sexual intercourse • Lack of pleasure in few of any activities • Lack of close friends or confidants, other than immediate relatives. • Indifferent to praise or criticism. • Emotional coldness, detachment or flat emotionality NB/ nutritional deficiency during the prenatal period is a risk factor in development of this disorder by the age of 18 years. • Treatment is difficult because this people lack normal pattern of emotional responsiveness that play a role in human communications. 7. SCHIZOTYPAL PERSONALITY DISORDER • The disorder primarily involves peculiarities of thoughts, behavior, appearance and interpersonal style. • The person has peculiar ideas such as magical thinking and beliefs in psychic phenomena. • The content of their speech sounds strange to others. • They find it difficult to establish close relationships because they experience discomfort around others. • They are vulnerable to developing a full-blown psychosis if exposed to difficult life circumstances that challenge their ability to maintain contact with reality. Diagnostic Features - This person shows a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships and who experience cognitive or perceptual distortions and behavioral abnormalities such as: • Odd beliefs a magical thinking which influences their behavior e.g. belief in mind reading. • Odd thinking and speech. • Unusual perceptual experiences – including bodily illusions. • Suspiciousness or paranoid ideation • Inappropriate affect • Behavior or appearance that is odd • Lack of close friends • Excessive social anxiety that leads to be associated with paranoid fears. NB/ people with schizotypal disorders have biological anomalies as people with schizophrenia such as deficits and abnormality eye movement. 8. AVOIDANCE PERSONALITY DISORDER. • The most prominent feature is that the individual , but fearful of any involvement with other people and is terrified at the prospect of being publicly embarrassed. • The person retains almost entirely from social encounters, especially avoiding any situation with the potential for the personal harm or and steers clear of an activity that is not part of their usual everyday routine. • They are convinced that they are socially inferior to others. • They become extremely sensitive to rejection and ridicule, interpreting the most innocent remark as criticism. • The person desires closeness and feels a great deal of emotional about inability to make connections with others. • The person prefers to be alone and lacks a sense of distress about being involved with others. Diagnostic Features • The person has a pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluations. The following features are evident. • Avoidance of significant interpersonal contact because of fears of criticism, disapproval or rejection. • Unwillingness to get involved with others unlike certain of being liked. • Restraint within intimate relationships due to fear of being shamed or ridiculed. • Pre-occupational with being criticized or rejected in social situations. • Feelings of inadequacy and feeling inferior to others. • Reluctance to take personal risks or new activities due to fear of being embarrassed. Causes of avoidance personality • Fear of attachment in relationship. • Hypersensitivity to rejection due to childhood experiences of extreme parental criticism. • Core belief that he person is flawed and unworthy of other people regard. • Distorted perceptions of experiences with others as their sensitivity to rejection cause them to misinterpret neutral and even positive remarks. Treatment • If they can be assured of unconditional , they can enter into close and even intimate relationships. • Brea the negative cycle of avoidance. The client learns to articulate the automatic thoughts and dysfunctional attitudes that are interfering with interpersonal relationships and see the irrationality of these beliefs.- do so in a supportive atmosphere. • Flooding the client is exposed to increasingly threatening school situations and training on specific skills to improve, intimate relationships. 9. DEPENDENT PERSONALITY DISORDER • The main characteristics features is that the individual is extremely passive and tends to cling to other people, to the point of being unable to make to make any decisions or take independent actions. • The person is preoccupied with the fear that close ones will leave them. • They go to extremes to avoid being disliked including agreeing with other people’s opinions even when they believe these opinions are misguided. • They through their whole weight into a relationship and become devastated when they end. • They then seek another urgent relationship urgently to fill the void. Diagnostic features - The person has pervasive and excessive need to be taken care of, which leads to their submissive, clinging behavior and fear of separation as indicated by the following:- • Fear of separation • Need for others to assume responsibility for most major areas of life • Difficulty expressing disagreement with others due to fear of loss of support or approval. • Difficulty initiating projects or tasks because of low self esteem in judgment of abilities. Diagnostic Features • Instability of interpersonal relationships, self image affects, as indicated by some of the following features: • Imagined abandonment. • Unstable interpersonal relationships characterized by devaluing others. • Identity crisis characterized by unstable self image or sense of self. • Difficulty initiating projects or tasks because of low self esteem in judgment of abilities. • Feelings of discomfort or helplessness when alone due to fear of being unable to care for themselves. Pursuit of another relationship as a source of care and support immediately following end of a close relationship. • Preoccupation with fears of being left to take care of themselves. Causes of dependent personality disorders. – Psychodynamics regards the cause as regression or fixation at the oral stage of development due to parental overindulgence or parental of independency needs – Insecurity and constant fear of abandonment – Low self esteem, which makes them rely on others for guidance and support. – Unassertiveness; they believe they are inadequate and helpless and believe they are unable to deal with problems on their own. Treatment –Therapist helps the client to practice increasing levels of independence in carrying out daily activities. –Therapists help the client identify areas of skill deficits and acquire abilities necessary to perform these skills. However, the client should be encouraged not to get dependent on their therapist. 10. OBSESSIVE – COMPULSIVE PERSONALITY DISORDER. • The person feels immobilized by their inability to make decision. They are intensely perfectionists and inflexible and express these attributes in maladaptive ways. • In striving to attain perfectionism, they become caught up in a worried style of thinking and rigid behavior. • They have a lot of concern for neatness and detail and fanatical concern with schedules. Diagnostic features • The person is pr-occupied with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness and efficiency. The following features are obvious:- • Preoccupation with details, rules, order, organization, or schedules to such an extent that the major point of an activity is lost. • Excessive devotion to work and productivity to the exclusion of leisure activities and friendship. • They are not flexible about matters of morality, ethics or values. • Inability to get rid of worn-out and worthless objects. • Reluctance to delegate tasks to others unless they agree to an exact ways of doing things • Misery spending style towards self and others. • Rigidity and stubbornness. Causes • Freud believes the cause of OCD is fixation or regression at the anal stage of psychosexual development. • Cognitive theory believes the disorder is caused by unrealistic expectations. They have a problem with their self image. Their feelings of self worth are pegged on how perfect they are in doing things. Treatment • The therapist will focus on the client’s thought process. Revision Questions • Define personality and personality disorders • Describe the diagnostic features of personality disorder • Discuss the following personality disorders • Narcissistic personality disorder • Borderline personality disorder • Paranoid personality disorder • Differentiate between Schizoid and Avoidant Personality Disorders. • Differentiate between Antisocial Personality Disorder and Avoidant Personality Disorder .