abnormal psychology

Antisocial Personality Disorder VS Borderline Personality Disorder

According to the DSM -V, Antisocial Personality Disorder (ASPD) is a “pattern of disregard for, and violation of, the rights of others” (639).  Borderline Personality Disorder (BPD) is defined by the DSM-V as a “pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity” (639).  Both disorders carry the potential to co-exist with substance abuse and impulsive behaviors (Nolen-Hoeksema, 12/2013).  Aggressive behaviors, identity disturbance, and unstable interpersonal relationships are also similar symptoms of both BPD and ASPD (“Mayo Clinic”, 2016).  However, the differences lie in the context of manifestation of the symptoms.  Impulsive behavior in two potentially self-harming areas such as sex, spending, or substance abuse is consistent in BPD rather than planning failure as seen in ASPD (American Psychiatric Association, 2013).  The impulsivity of ASPD often leads to arrest as they fail to comply with social norms and disregard the safety of themselves and others (“Mayo Clinic”, 2016).  In ASPD, individuals typical target aggression toward others whereas individuals with BPD tend to partake in self-harm and suicidal ideations or tendencies.  Researchers report 75% of individuals attempt suicide and 10% of those actually commit the act (Nolen-Hoeksema, 12/2013).  Those with ASPD emit superiority and arrogance, but are rather deceitful to gain pleasure or personal profit at the expense of others (“Mayo Clinic”, 2016).  Those with BPD tend to have a negative sense of self leading to constant feelings of emptiness and being worthless and undesired (“Mayo Clinic”, 2016).  Additionally, treatment varies between both disorders.  Treating ASPD can be difficult as the individual typically feels that nothing is wrong and no help is needed.  Treatment is most beneficial through the use of teaching coping skills for anger and emotion control (Nolen-Hoeksema, 12/2013).  BPD has several successful treatments including medication, cognitive behavior therapy to help the individual see themselves in a positive manner, and dialectical behavior therapy helps teach individuals problem solving skills and emotion regulation (Nolen-Hoeksema, 12/2013).

Forensic Mental Health Professionals need to be able to identify the differences between the two disorders in order to identify which, if either, personality disorder is present.  The disorders are closely related and it is imperative to establish if motives are directed towards the self or others.  It is also important to establish if a psychotic disorder underlies the personality disorder or if it’s possible the disorder manifested from substance abuse.  In these disorders, individuals are unstable making the primary goal to stabilize mood and emotion which is achieved through developing a proper treatment plan which evolves from the identification of possible diagnoses.

The text implicated substance abuse as a piece of impulsive behavior associated with both disorders.  It also said individuals with these disorders may be victims of physical or sexual abuse.  Previously I learned that those who suffer from abuse, tend to bury the memory in an effort to escape it.  However, there are unidentified triggers that allow the memories to surface with no evidence, not even the actual physical memory, outside of behavior and emotional disturbances.  I think as individuals begin to understand they have something “abnormal” going on, they look for an escape, an easy one.  I believe this desired escape leads to substance abuse as it has a quick effect on the individual.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

Mayo Clinic. (2016). Retrieved from http://www.mayoclinic.org/

Nolen-Hoeksema, Susan. (12/2013). Abnormal Psychology, 6th Edition. [VitalSource Bookshelf Online]. Retrieved fromhttps://digitalbookshelf.argosy.edu/#/books/1259316335/

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Complex Relationship Between Mental and Physical Health

 

There is a stigmatizing attitude among society over mental health or psychological disorders.  When individuals fail to conform to the expected societal norm, he or she may be perceived as “insane, mad, lunatic, kooky (Nolen-Hoeksema, 12/2013), etc. causing them to not seek treatment for their self-diagnosed, abnormal behaviors, feelings, or thoughts.  On a personal level, I believe diagnosis is a double-edged sword because one does not want to deal with the stigma associated with mental illness in combination with the persistent symptoms.  I also believe, at times, the individual may be in denial because they have grown or dealt with the illness for so long, it is normal for them and altering a perceived normality could scare the individual.  Another issue with diagnosis is the potential for mis-diagnosis due to the overlap of symptoms into several disorders.  Additionally, people may feel anxiety towards therapy or medication due to cultural values and beliefs.  If an individual seeks help and receives a diagnosis, others may perceive them differently and begin to alter their treatment and reactions toward the individual in either a positive or negative manner, both of which could hinder treatment.

Three approaches to developing a diagnostic scheme include categorical, dimensional, and prototypical approaches.  The categorical approach, as found in the DSM, classifies symptoms biologically and medically into categories with one set of causative factors that do not overlap, creating a single category that each individual in the category should meet (Kreuger, Watson, & Barlow, 2005).  Due to only having to suffice a single subset of criteria for an individual to identify under a single category creates heterogeneity among the disorder and treatment (Kreuger, Watson, & Barlow, 2005).  Thus creating difficulties in treatment as no two people may identify mutually.  I believe the categorical approach would maintain stigma as the disorder is a generalization of a major category rather than a specific detriment.

The dimensional approach classifies disordered thought, affect, and behavior as multiple dimensions (Kreuger, Watson, & Barlow, 2005).  The dimensional approach measures the degree to which behaviors persist indicating variances of symptoms versus normative behavior reducing the possibility of comorbid disorders (Hudziak, Achenbach, Althoff, & Spine, 2007).  However, inconsistencies cause a void in the use of the yes or no treatment and diagnosis process and testing may have higher costs than traditional categorical diagnostic measures.  I think the dimensional approach may increase stigma as the degree of the behavior is scrutinized leaving the individual open for judgment on how “bad” off they appear.

The prototypical approach conceptualizes psychopathology into categories within the DSM (Kreuger, Watson, & Barlow, 2005).  This approach allows for a high heterogeneity within categories as individuals must only meet a certain number of symptoms to fall within a category and therefore, may qualify under more than one as several disorders share similar symptoms (Kreuger, Watson, & Barlow, 2005).  Prototypical approach opens the door for mis-diagnosis and co-existing disorders rather than a single unified diagnosis as the symptoms may be versatile among categories.  Treatment could turn into an unnecessary trial and error basis.   I think the prototypical approach may increase stigma as the diagnosis seems to be open to more error than the other approaches.  This allows for the individual to feel as if they may be untreatable.

References:

Hudziak, J. J., Achenbach, T. M., Althoff, R. R., & Spine, D.  S. (2007).  A dimensional approach to developmental psychopathology.  International Journal of Methods in Psychiatric Research 16(S1):  S16-S23.  http://doi.org/10.1002/mpr.217

Krueger, R. F., Watson, D., & Barlow, D. H. (2005). Introduction to the Special Section: Toward a Dimensionally Based Taxonomy of Psychopathology.  Journal of Abnormal Psychology114(4), 491–493. http://doi.org/10.1037/0021-843X.114.4.491

Nolen-Hoeksema, Susan.  (12/2013).  Abnormal Psychology, 6th Edition. [VitalSource Bookshelf Online].  Retrieved from https://digitalbookshelf.argosy.edu/#/books/1259316335/

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