BPD Symptoms: Fear of/efforts to avoid abandonment splitting idealization/devaluation lack of sense of self impulsivity self-injurious behavior unstable

nstable affect/affective liability frequent, uncontrollable anger chronic feelings of emptiness stress-induced dissociation/paranoia Axis-II disorders *10% of the general population *30% of psychiatric inpatients Traits/Temperament: stable patterns of perceiving, relating to, and thinking about our environment and ourselves specific, characteristic pattern of cognitive, behavioral, emotional and mood responses to the things in our environment e.g. impulsivity: predisposition to respond to stimuli in our environment, including motivationally salient stimuli like rewards, without appropriate forethought or consideration of the potential negative consequences of our actions o characteristic pattern of responses - affective, cognitive, and behavioral that is elicited by a situation where there is the choice that requires regulating your behavior to maximize long-term gain Dimensionality: traits are, for the most part, normally distributed in the population, and the tail ends of these distributions are where we begin to see problems arise. o But: these kinds of disorders arent just defined by the tail end of one personality trait. For the most part, these disorders lie at the intersection of the tails of multiple traits. o so, two issues: ! First, figure out which traits are the most important for defining dysfunction and impairment, and ! Second, deciding at what point variability in a trait transitions from normal to abnormal, that is, defining diagnostic cutoffs Axis II Clusters: o A the weird, marked by eccentric behavior and acute interpersonal deficits o B the wild, characterized by impulse control deficits and unstable or inappropriate affect o C the worried, characteristic symptom is - you guessed it! anxiety Cluster A Paranoid personality disorder: o pervasive and unjustified suspicion o argumentative, doubtful, secretive o feelings of hostility common Schizoid PD: o Unable and uninterested in social bonds o Severely restricted affect o Indifferent towards others Schizotypal PD: o Social and interpersonal deficits o Perceptual and cognitive distortions

Cluster B Antisocial PD: o Aggression and impulsivity o Little remorse, conscience o Disregard for rules, morals, social norms Borderline PD: o Unstable, intense moods and relationships o Fear of abandonment o Impulsivity and poor emotion regulation Histrionic PD: o Exaggerated emotions, vain and self-centered o Attention and approval-seeking o Impulsive Narcissistic PD: o Exaggerated sense of self-importance, grandiosity o Exploitative and unempathic o Arrogant, preoccupied with getting attention Psychopathy Two general domains of dysfunction: o Emotional/Interpersonal o Antisocial lifestyle APD vs. Psychopathy DSM criteria based on observable behavior. You can meet criteria if youre someone who just gets into fights, is impulsive, and commits crimes. It doesnt matter which crimes, it can be drug possession, shoplifting, assault or murder APD maps on pretty well to the antisocial behavior features of psychopathy, but very poorly to the emotional and interpersonal features. most psychopaths will meet criteria for APD, the overwhelming majority of people who meet criteria for APD are not psychopaths why? APD is fundamentally a diagnosis of criminality. Remember that the DSM is concerned primarily with reliability, which is why it focused on the most readily observable symptoms in constructing the APD diagnosis what were really picking up with the APD diagnosis is just a propensity to commit crimes Hervey Cleckley and The Mask of Sanity Bob Hare and the PCL-R PCL-R: Psychopathy Checklist-Revised Two factors: Factor 1: Emotional/Interpersonal deficits Factor 2: Impulsive-Antisocial lifestyle KNOW WHICH PCL-R ITEMS MAP ON TO WHICH FACTORS Diagnostic cutoff at ~30 PCL-R mean in prisoners is ~22 PCL-R mean in general population is ~6 KNOW CHILDHOOD DISORDERS STUFF FROM SLIDE

o Eccentric in manner and speech

PSYCHOPATHS COMMITT SO MUCH CRIME! Crazy high recidivism rates for psychopaths at 1, 3, and 20 years traditional treatment modalities can make psychopaths worse (i.e. more likely to reoffend violently) Antisocial behavioral generally is heritable (~50%) -separate etiological mechanisms for factor 1, factor 2, and factor 1 + factor 2 combined -in kids, antisocial behavior (ASB) alone has weak heritability, callous/unemotional traits (CU) alone have very high heritability, and ASB+CU has the highest heritability of all. Bottom-up vs. top-down models: bottom-up: deficit in generating an appropriate emotional response top-down: context-specific deficit in appropriately allocating attention to emotional stimuli in the environment when attention is focused elsewhere. Bottom-up approaches: Low Fear hypothesis: specific deficit in generating appropriate fear responses. This hypothesis came out of a series of studies showing that psychopaths have lower physiological responses when anticipating things that should induce fear in healthy people. Violence Inhibition Mechanism hypothesis: When you look at facial emotion recognition in psychopaths, you see that they actually really suck at it. And theyre the worst of all for fearful and sad faces. So this would be consistent with the idea that psychopaths show high aggression and low empathy because they arent able to accurately read the kind of emotions that might otherwise inhibit aggression and spur empathic feelings People with damage to these regions show many of these same deficits in physiological responses to fear-evoking stimuli and punishment, they dont show fear conditioning, and they also have a hard time identifying emotional facial expressions When you give psychopaths tasks that look at things like punishment learning, fear conditioning, and emotional face processing, they show dysfunction in the amygdala and in medial prefrontal cortex. o But unlike the depressed and anxious folks, who show greater activation during these kinds of tasks, psychopaths show much, much less activity compared to controls o amygdala and mPFC show structural and connectivity changes in psychopaths Amygdala and vmPFC dysfunction during moral decision-making in psychopaths Greater ventral striatal dopamine release and fMRI signal during reward processing in people with impulsive-antisocial psychopathic traits o So in addition to having decreased corticolimbic activity during fear and punishment, people with psychopathic traits appear to have enhanced striatal function during reward processing. This combination of increased reward motivation and decreased sensitivity to punishment and negative social cues may explain why you see both high levels of antisocial behavior and emotional-interpersonal deficits in psychopaths Eating Disorders ANOREXIA: has the highest mortality rate among all psychiatric disorders. Anorexia is the #1 killer in the DSM Anorexia alone has a prevalence rate of nearly 1%, rivaling schizophrenia. 10% of people with anorexia will die within 10 years of its onset, and lifetime mortality rates top 20% o Overwhelming, Drive to Be Thin; fear of obesity o Preoccupied with food and with eating rituals o Distorted body image; denial, often treatment-resistant

we divide anorexia into two types - a restricting type and a binging and purging type Bulimia: most of the same core cognitive features are present. Theres the same overwhelming drive to be thin, the same fear of obesity. o You see the same obession with food and with food rituals. And you also see the same distorted body image, denial, and treatment resistance. The primary thing that differentiates bulimia and anorexia are the behaviors. anorexics use food restriction to achieve weight loss, while bulimics tend to engage in patterns of binge eating - uncontrollable bouts of excessive eating, which are in turn followed by purges accomplished through vomiting, laxatives and diuretics. Eating disorders have a pretty stereotyped course, with an age of onset in early adolescence typically between ages 13-18. Now. The single biggest risk factor for eating disorders is the presence of two X chromosomes (being a woman). This is one of the biggest gender splits that we see for any form of psychopathology - 90-95% of people with eating disorders are female DO WE HAVE THIS RIGHT? o Separate diagnoses of anorexia and bulimia arent particularly well validated. Theres a ton of diagnostic crossover here, and we commonly see people with anorexia developing bulimic symptoms o high comorbidity with other disorders o most common eating disorder diagnosis isnt anorexia or bulimia, but is EDNOS - eating disorder not otherwise specified. This suggests that were not capturing what is core about these disorders with out current classification criteria ETIOLOGY: CULTURE: o Cultural models of etiology describe four steps through which cultural influences might influence risk o 1) first, young women are exposed to the thin ideal; 2) second, they internalize this ideal; 3) they experience a discrepancy between their current state and the ideal; and 4) this discrepancy drives body dissatisfaction and corrective measures - like calorie restriction etc. o BUT: culture isnt acting isnt the sole risk factor, and there is data indicating that eating disorders can develop in the absence of thin-idealization ! so: what were looking at with the eating disorders is pretty typical of the rest of psychopathology. A complex and multifactorial etiology. We can probably think about risk for eating disorders like we do everything else - as the product of an interplay between genetic and environmental factors that interacts with cultural messages to shape susceptibility. o Eating disorders heritable, but whats being inherited is more about general personality traits like negative affect, reward sensitivity, and perfectionism - than about weightspecific issues. o greater striatal reward response to underweight cues in anorexic women. o anorexic women have heightened striatal responses to food cues that they report not liking OBESITY: define obesity has having a body mass index of greater than 30. Behaviorally, we conceptualize obesity as the compulsive consumption of food, coupled with an inability to restrain from eating, despite a desire to do so. some have argued that each of the DSM-IV criteria for addiction has a match, a partner in obesity Addiction and obesity overlap significantly with respect to neurobiology. both food and drugs of abuse stimulate DA release in the nucleus accumbens, and both !

food and drug cues stimulate DA release in the human ventral striatum when we look at PET imaging. o if you show cocaine-addicted subjects pictures of cocaine, their brains flood with dopamine, and the amount thats released is directly correlated with how much they crave cocaine. Well, the same things happen when you show anyone a picture of a big mac or a piece of cake - theres massive DA release in the same regions, and the amount of release predicts how much they crave that food item Obesity is heritable, and many of the same heritable personality traits that you see in substance abuse - like impulsivity and novelty seeking - are also seen in obesity. o genetic data suggests that obesity and addiction arent entirely distinct disorders - that we can think about them as being along the same continuum of disorders, as just different manifestations of the same basic underlying psychopathology. Which, in this case, would be something like poor impulse control or disinhibition Leptin: its a thing