abnormal psychology, Maladaptive psychology, Uncategorized

Pedophilic Disorder

Pedophilic disorder is a diagnosis found in Paraphilic Disorders in the DSM-5 (American Psychiatric Association, 2013).  Pedophilia requires the presence of a paraphilia that causes significant distress or impairment to the individual or harm to another (Patricelli, 1995-2016).  Paraphilia involves intense sexual interest centered around children, non-humans, or harming oneself or another individual during sexual activity (Patricelli, 1995-2016).  The sexual interest may focus on the individuals erotic or sexual activities or it may focus on the target of the sexual interest (Patricelli, 1995-2016).

In order for an individual to be diagnosed with pedophilic disorder, there must be a period of six months in which “recurrent, intense sexually arousing fantasies,” urges, or sexually oriented behaviors with a prepubescent child(ren), with prepubescent declared as under the age of thirteen, has occurred (American Psychiatric Association, 2013).  The individual must have at some point acted on the sexually natured urges or fantasies or exclaimed a marked distress / interpersonal difficulty due to the urges or fantasies (American Psychiatric Association, 2013).  Additionally, the individual must be five years older than the child(ren), be of at least sixteen years old, and void of an ongoing sexual relationship with a twelve or thirteen-year-old (American Psychiatric Association, 2013).

Pedophilic Disorder should be classified as exclusive type (attracted solely to children) or nonexclusive type (attracted to children and adults) in addition to a specifier including sexually attracted to male, sexually attracted to female, sexually attracted to both, or limited to incest, if a specifier can be established (Patricelli, 1995-2016).   According to the DSM-5, the diagnostic criteria can apply to those who disclose a paraphilia or to those who deny it despite substantial evidence (2013).  If an individual denies current Paraphilia, but has a proven history or evidence of meeting criteria A over a six-month period may still be diagnosed with Pedophilic Disorder (American Psychiatric Association, 2013).  Also noted is that if an individual claims their sexual attraction to children causes psychosocial difficulties, a diagnosis of Pedophilic Disorder may be given as well (American Psychiatric Association, 2013).  However, an individual who has never acted on their impulses, legal history is clear of acting on the impulses, is void of guilt, shame, and/or anxiety, and is not limited in functioning, he or she retains Pedophilic Sexual Orientation, not the disorder (American Psychiatric Association, 2013).

The extended commitment of individuals with pedophilia appears to be pretty controversial.  An article on the NCBI website claims there are supporters for and against extended commitment.  Critics argue that providers tend to use a “catch-all” diagnosis as justification to deprive the individual of liberty and unethical commitment (extended incarceration in this case) should not be utilized for the purpose of public safety (Testa & West, 2010).    On the other hand, those in support of extended commitment claim ‘abberant’ sexual disorders remain largely untreatable which causes the individual to pose a risk to innocent citizens (Testa, 2010).  The article says supporters claim that no matter how great the treatment, the potential of recidivism is still present to some degree (Testa, 2010).  However, a study indicates that with treatment, recidivism decreased by thirty percent over a seven-year period (Testa, 2010).  I think that extending a sentence past the maximum is unethical despite the crime.  Although with this thinking, there is bound to be backlash, there are other options to in-house commitment, that ensures treatment and seems to still protect society at large.  Testa and West explain outpatient civil commitment as a way to allow the individual back into society, but mandates continued treatment (2010).  Outpatient Civil Commitment allows the state to continue to monitor the individual while in our community and the mandated treatment ensures the individual does not become harmful to others or themselves (Testa & West, 2010).  Additionally, with this type of commitment does allow easier hospitalization commitment at the earliest stage of deterioration or if the individual fails to comply with mandated orders.  I believe each individual, despite the crime or circumstance has the right to liberty and ethical treatment and it is important to approach topics like this with an open mind and positivity.  I think if we extend punishment, we may create a resentment in the individual that holds potential for the individual to become worse or even develop new symptoms or disorders, and therefore, we as a society, must act ethically in the favor all individuals.

 

 

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

Patricelli, MA, K. (1995-2016). Behvioral connections. Retrieved from http://www.behavioralconnections.org/poc/view_doc.php?type=doc&id=571

Testa, M., & West, S. G. (2010). Civil Commitment in the United States.Psychiatry (Edgmont), 7(10), 30–40.  Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392176/

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Maladaptive psychology, Uncategorized

Scizophrenia

According to the DSM-V, the overall symptoms of Schizophrenia include positive symptoms such as delusions (surreal beliefs), hallucinations (seeing or hearing things which are nonexistent), disorganized speech (impaired communication or answers to questions are unrelated), or catatonic or grossly disorganized behavior (a range of silliness to agitation and may include abnormal motor behavior) (American Psychiatric Association, 2013).  Schizophrenia also includes negative symptoms such as avolition which includes diminished emotional expression, lack of eye contact, monotone speech, neglecting personal hygiene, social withdraw, etc.(American Psychiatric Association, 2013).  According to the Mayo Clinic website, Schizophrenia occurs in men typically in early to mid twenties, in women in late twenties, but rarely in individuals after age forty-five (2014).  Although rare,Schizophrenia has been founded in children as young as five years old (Mayo Clinic, 2014).  Often times, it is difficult to diagnose teens because symptoms such as social withdraw, irritability, sleep disturbance, drop in grades, and lock of motivation are typical of development in teens (Mayo Clinic, 2014).    The DSM-V declares two or more symptoms must be present for the majority of a one month period and one of the symptoms must be delusions, hallucinations, or disorganized speech (American Psychiatric Association, 2013). Level of functioning in one or more areas of life must have a marked decrease that lasts for at least six months and during one month symptoms must be present (American Psychiatric Association, 2013).

Violent behavior in individuals with Schizophrenia is sometimes witnessed when positive symptoms and depression present concurrently, but this only increases the chance of aggressive behavior (Hodgins, 2008).  There tends to be a lack of aggression when the individual presents with singular psychosis, or positive symptoms (Hodgins, 2008).  According to Hodgins study, aggressive behavior is associated with interpersonal skills or a lack of psycho-social functioning (2008).  In her study, Hodgins found that predictors of aggressive behavior included past substance abuse and level of education as well as lack of anti-psychotic medications, depression, and victimization experiences (2008).   In a psychiatric hospital setting individuals committed against their will tend to be more aggressive, however, in society, aggression is associated with thought disorder (Hodgins, 2008).  This information leads me to believe that individuals are more likely to experience aggression at times when negative symptoms are present.  During negative symptoms, individuals experience catatonia, disorganized behavior, and avolition.  Avolition cases the individual to neglect themselves and create isolation from society, but their thoughts are disorganized and the individual may react without thinking because thoughts are all over the place.  Popularly, people believe aggressive behavior is most persistent during delusions which is understandable, but only if the delusion is a negative one.  For instance, another post referred to the individual acting on the desires of the voices.

Although I sympathize with forcing medication as a violation of rights, I do believe that enforcing medication when it is truly in the best interest of the individual is acceptable.  The Answered Patient video claimed that individuals can recover from Schizophrenia after years of medication combined with psychotherapy and group support.  Therefore, it is possible for the individual to rehabilitate and live a positive life, however, medication is necessary (2015).  The video also claimed that Schizophrenia is controllable with medication (The Answered Patient, 2015).  I believe that an individual who is not of a complete and sound mind is not able to decipher what is best for them.  Their thoughts should be taken into consideration, but sometimes, someone is better suited to make the call.  In a sense, I don’t feel that this is any different than a parent choosing medication for their child.  The parent makes the choice because it is perceived as the best interest of the child who cannot make that decision for themselves.  The same goes for an individual who is unable to maintain a solid though process based in reality.

Instructor:  When you state that it is comparable as to a parent choosing medication for a child this negates that fact that an adult with schizophrenia is their own legal guardian.  If we take away their right to choose medication, can we also take away their other rights and treat them as a child or ward of the state?

I think we have to recognize and embrace their limitations.  There are pros cons to every scenario and we have lean toward highest weight.  The medication balances the individual brain decreasing the symptoms allowing the individual to function according to the societal norm or standard.  However, if the individual negates the meds, symptoms return along with the behavior and at that point, do they have the ability to make rational choices based on reality?  For instance, medicated, an individual still shows signs of the disorder, but he or she is “down to earth” and aggression is minimal.  When waiting for a refill or simply refuses meds the hallucinations and delusions return.. the paranoid state heightens and she becomes extremely aggressive.   The research i found in my original post suggests individuals can recover with meds, psychotherapy, and group… this gives hope that if the individual is forced medication for a period of time they have potential to recover and will no longer require the meds.
Instructor:  But then, just to be the devil’s advocate, should we force treatment on other people who have destructive behaviors, like substance abusers or self-mutilators?

“If we take away their right to choose medication, can we also take away other rights and treat them as a child or ward of the state?”  Forcing medication does not necessarily ensure taking away rights or alter their treatment, per say.  According to the “Treatment Advocacy Center”, there are several options for individuals with severe mental illness, all of which have documented improvement in the individuals behavior and compliance with medication (2014).  Although the individuals are ward of the state or under some type of guardianship, they maintain their rights as an independent adult.  For instance, Assisted Outpatient Treatment court mandates an individual to comply with an outpatient treatment plan such as California’s Laura’s Law and New York’s Kendra’s Law, or the individual is returned to the hospital (“Treatment Advocacy Center”, 2014).  Conditional Release court mandates that an individual must take their medication or they return to the hospital (“Treatment Advocacy Center”, 2014). Research conducted on the outcomes of both programs indicates an increase in compliance and a decrease in negative behavior, incarceration, victimization, and violent episodes (“Treatment Advocacy Center”, 2014).  Additionally, a study conducted in Australia using the “ward of state” conditional release medication enforcement indicated a 14% reduction in the death rate of those on conditional release (“Treatment Advocacy Center”, 2014).  Everything above proves that forcing medication and rehabilitation services has the potential to produce a positive outcome for the individual without stripping the individual of their other rights.  However, from what I gather, these options are implemented once and individual commits a crime, becomes a threat to themselves or others and after hospitalization, and minors.   It seems as if these options (and there are several others listed on the website) were developed to ensure independent living and recovery from and “error” made while not medicated.  I also believe it is a way to keep the individual from having to serve a jail sentence when acting “abnormally” due to a mental health issue.  The infamous Stanford Prison Experiment, although unethical (personal opinion) exposed how rapidly incarceration could alter an individuals way of thinking in a short period (this just seemed appropriate here, but not trying to debate the experiment).  If an individual suffers from a mental health issue/ illness/ disorder, the potential to heighten the symptoms is greatly increased especially in confinement.  If the individual is sentenced to a jail / prison term, wouldn’t that set them up for failure or the potential of symptoms worsening throughout the course of confinement also setting them up to be forced medication because chances of them being sent to psych are probably high as well?  If the individual is forced to medicate, chances of incarceration and hospitalization is greatly decreased and the individual has opportunity to complete an outpatient treatment program that holds promise for the future of the individual.  A child who is ward of the state (at least in California) has the medications paid for by the state, even medications atypical of the  child’s age and development group if deemed medically necessary to ensure “normal” functioning in education, social aspects, familial aspects, and work.  Although it is difficult to get the medications and the process of filling is prolonged because the pharmacy has to jump through loops and work with the psychiatrist to have exact coding and diagnosis which is difficult when the psychiatrist is avoiding a definitive diagnosis. Although the examples are of individuals who are ward of the state, I found an article on the APA website which explains new hope for Schizophrenia which integrates psychosocial rehabilitation, or a model consisting of the combination of medication, maintenance, and stabilization , to teach those with schizophrenia self-sufficiency via work skills, social integration via coping techniques that lead them to rehabilitation in their illness (MacGuire, 2000).  There is so much research I came across that claims the importance of medication in rehabilitation of Schizophrenia, it kind of seems as if all those who suffer should be forced the treatment programs because the outcome is so great versus no medications.  That it just my though.  Another thing tht stood out to me was that researchers found that many suffering do not have the knowledge necessary to understand Schizophrenia and perceive the illness as a doom or never ending battle (MacGuire, 2000) making me wonder.. if the knowledge is not there, how can the individual decide on a medication regimen?

Instructor:  I agree that treatment can be beneficial, but I also recognize that the end can not always justify the means.  I do not know if you are familiar with the clubhouse model?

I was not familiar with the Clubhouse Model.  It made me wonder if supportive services are more beneficial than what we are led to believe.  The program appears to have highly positive outcomes, which is what most people look for.  The model, an empowerment approach, brings hope, decreases stigma, and teaches the individual their competence allowing members to realize they have full potential in life, despite adversity.  The Model seems very similar to the psychosocial model discussed earlier.  However, the Clubhouse model incorporates a supportive, accepting, family-like atmosphere as opposed to the clinical atmosphere I gathered from the psychosocial model explanation.  I did gain an understanding, that even if the individual does not achieve full rehabilitation, there are other ways in which he or she can learn to accept and cope with the illness and still lead a successful life.  On another note, I like the fact that the members feel independent and self sufficient and the family has the option to incorporate themselves into the model as well.  A lot of the research I found claims those with mental health issues often feel as if they have no support and no one understands.

MacGuire, P. A. (2000, February). New hope for people with schizophrenia. American Psychological Association, 31(2), 24. http://www.apa.org/monitor/feb00/schizophrenia.aspx

Treatment Advocacy Center. (2014). Retrieved from http://www.treatmentadvocacycenter.org/about-us/reports-studies-backgrounders/2530
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Hodgins, S. (2008, August 12). Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. The Royal Society Publishing, 363(1503), 2505-2518. doi:10.1098/rstb.2008.0034

Mayo Clinic. (2014). Retrieved from http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/symptoms/con-20021077

The Answered Patient (2015 ).  Schizophrenia overview [Video file]. Retrieved from BehaveNet.com website: http://behavenet.com/schizophrenia

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Maladaptive psychology, Uncategorized

Dysfunctional Mood Deregulation Disorder vs Bipolar Disorder

DMDD is a disorder new to the DSM-V which is described as severe and recurrent temper outbursts that go beyond what is necessary for the situation in intensity and duration.  The outbursts must occur three or more times a week and occur in the home as well as other settings such as school and in public.  The symptoms must be recurrent for a year without remission for more than two months (Copeland, Angold, Costello, & Egger, 2013).  The article I found compares studies of other mental health disorders, but found a consistent co-occurrence between DMDD and other disorders, as it tends to co-occur with all common psychiatric disorders such as ODD and Depressive disorders, as well as other behavior and emotional disorders (Copeland, et al., 2013).  The difference between BPD and DMDD seems to be that DMDD  onset tends to be in early childhood, between ages 4-10 and the diagnosis can not be utilized in a person over 18 (Copeland, et al., 2013), implying it is strictly a childhood disorder.  However, BPD is not generally diagnosed before the age of 18.  This makes me wonder, is DMDD a precursor for BPD?  And does that mean that even though the individual was diagnosed with DMDD, once they are 18, are they reassessed and rediagnosed with a different disorder or does the co-existing disorder take the primary diagnosis?

Copeland, W. E., Angold, A., Costello, E. J., & Egger, H. (2013). Prevalence, Comorbidity and Correlates of DSM-5 Proposed Disruptive Mood Dysregulation Disorder. The American Journal of Psychiatry170(2), 173–179. http://doi.org/10.1176/appi.ajp.2012.12010132

 

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Maladaptive psychology, Uncategorized

Diagnostic Scheme

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 Psychology, 114(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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abnormal psychology, Criminal Behavioral Psychology, Maladaptive psychology, Uncategorized

Juvenile Homicide

The most serious type of crime, Criminal Homicide or Murder, is the “unlawful taking of the life of another” and regarded as the most dangerous type of crime (“HG”, 1995-2016).  Two-thirds of the United States have adopted a penal code system that breaks murder down into separate degrees (“HG”, 1995-2016).   Murder is the most serious type of criminal homicide and includes varying degrees:  First Degree (Premeditated), Second Degree (Intentional, not premeditated), Manslaughter (death is due to unintentional actions), Justifiable Homicide (self- protection), and other homicide (“HG”, 1995-2016).  Other homicide includes felony murder in which the murder was a direct result of involvement in a crime that led to the death (“HG”, 1995-2016).  Within these categories lies juvenile homicide.

According to the “Office of Juvenile Justice and Delinquency Prevention (OJJDP)” Statistical Briefing Book, juvenile homicide peaked in the 1980’s and had drastically declined throughout the 1990’s and currently (“Office of Juvenile Justice and Delinquency Prevention”, 2015).  However, juvenile homicide is a phenomenon we often hear in our communities.  According to the OJJDP, Juvenile homicide is committed most often by males between the ages of fifteen and seventeen and of American Indian decent (“Office of Juvenile Justice and Delinquency Prevention”, 2015).   Although juvenile homicide rates are on the decline, it remains a serious problem within communities.  Post-incarceration studies implicate the necessity of prevention and intervention strategies.

 

Development and Origins

Juvenile homicide offenders murder for various reasons:  Psychological disorders, neurological impairments, history of family violence, substance abuse, early onset of aggressive and antisocial behaviors, or learning disabilities (Khachatryan, 2015).  Motivations of offenders include orientations of conflict, crime, parricide, psychotic episode, and sexually driven (Khachatryan, 2015).  Understanding the motivation and triggers of the offender gives more incite critical for proper intervention and prevention of juvenile homicide.

Focus

Research indicates the majority of juvenile homicide occurs by males between the age of fifteen and seventeen, but several were committed as early as ten years old (“Office of Juvenile Justice and Delinquency Prevention”, 2015).  Statistics dictate an urgency in the intervention of children who possess risk factors associated with potential violence in the future.  Targeting youth exposed to certain risk factors such as poverty, familial abuse patterns, issues with peers, and other social, familial, peer, and educational risk factors will help deter behavior potentiating homicidal ideations and tendencies before they take effect in the youth (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).

Prevention

Preventing homicidal behavior begins with recognizing the risk factors associated with the development of the behavior.  The risk factors discussed above are alarms that indicate a child in need of intervention.  Familial risk factors should be recognized as the foundation of the children begins in the home and creates the acceptable behaviors the child exhibits in society (Bartol & Bartol, 2014).  Familial risk factors include faulty or inadequate parenting, sibling influences, and child maltreatment or abuse (Bartol & Bartol, 2014).  According to the U.  S.  Department of Justice, family structure (parenting skills, size, home discord, treatment of children, and antisocial parents) is linked with juvenile offending (Shader).  A study indicated predictors of violent offending including harsh discipline, lack of supervision from parents, and parental conflict and aggression within the home (Shader).

Interventions

School-based interventions for at-risk youth including competence training for children and training for educators and parents to encourage proper socialization and interaction with peers proved effective in reducing aggressive behavior, substance abuse, and sexual activity in addition to increasing academic performance for the Seattle Social Development Project (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).   In addition to in-school interventions, after school programs deter self-alienation and promote socialization while introducing self-protective factors through the promotion of prosocial and leisure activities such as sports and studying (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).

Mentoring programs in which adults act as role models providing a positive and supportive atmosphere for youth raised in a single parent home (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).   Although these programs have not proven highly beneficial as a simple big brother / big sister opportunity, it was found when the mentor incorporates cognitive behavioral techniques in the time spent with the child, academic success increased, truancy reduced, and behavior became more confident when rewards were offered (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).   Mentoring programs also prove beneficial in increasing the child’s perception of self-ability and self-esteem (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999) which promotes a positive outlook on personal potential.

Media intervention techniques may also prove beneficial.  Running campaigns that promote acceptable positive behavior as an attempt to change the societal attitude and educate the community (Catalano, Ph. D., Loeber, Ph. D., & McKinney, Ph. D., 1999).   Rather than ads and movies that promote and glorify the “thug” life, ads that deter their behavior may cause a child not to desire the life of the streets.  Promoting individuals who have defeated the odds and didn’t fall to a statistic by not following those negative behaviors may allow a child to have hope and begin dreaming of a better future. Additionally, allowing reformed offenders to advocate youth their experience may lead to behavior modification because the youth may develop a fear of the consequence or a desire to be upstanding to avoid the harsh reality of the road they are currently at risk to endure.

 

Bartol, C. R., & Bartol, A. M. (2014). Criminal behavior: A psychological approach (10th ed.). Retrieved from https://digitalbookshelf.argosy.edu/#/books/9781323121146

Catalano, Ph. D., R. F., Loeber, Ph. D., R., & McKinney, Ph. D., K. C. (1999, October). School and community interventions to prevent serious and violent offending. Juvenile Justice Bulletin, (), 1-12. Retrieved from https://www.ncjrs.gov/pdffiles1/ojjdp/177624.pdf

  1. (1995-2016). Retrieved from https://www.hg.org/murder.html

Khachatryan, Norair, “Thirty Year Follow-Up of Juvenile Homicide Offenders” (2015). Graduate Theses and Dissertations. Retrieved from http://scholarcommons.usf.edu/etd/5822

Office of juvenile justice and delinquency prevention. (2015). Retrieved from http://www.ojjdp.gov/ojstatbb/crime/JAR_Display.asp?ID=qa05262

Shader, M. U. S. Department of Justice. Retrieved from https://www.ncjrs.gov/pdffiles1/ojjdp/frd030127.pdf

 

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abnormal psychology, Maladaptive psychology, Uncategorized

Cyberbullying

Cyberbullying appears to have increased over time as technological advances take effect.  An article found in The Guelph Mercury claims unlike traditional bullying, cyberbully is difficult to escape making it unavoidable and inescapable as one can no longer retreat to their home and seek refuge because technology is everywhere (“Cyberbullying requires a balanced approach”, 2013).  Due to the nature of the abuse, the victim is forced to endure repeat suffering as it is easy to constantly recirculate the bullying across social media outlets (“Cyberbullying requires a balanced approach”, 2013).  Additionally, often times, the victim becomes the bully because the anonymity and ease of bullying from the privacy of one’s home without having to face the victim is a retaliatory act one may subject themselves to (“Cyberbullying requires a balanced approach”, 2013).  Although laws are developed to protect individuals from cyberbullying, and enact criminalization and punishment for the perpetrator, early intervention is a cooperative effort of schools and home to ensure the safety of victims or potential victims (“Cyberbullying requires a balanced approach”, 2013).

Many theorists claim people are not responsible for their behavior including psychological problems.  However, Glasser stood in opposition with his Choice Theory claiming behavior is directed by internal factors and the source of behavior problems is individuals own choice (Tanrikulu, 2014).  The theory claims it is human nature to solve issues with others by changing the other’s behavior through power and control, but in reality, one can only change their own behavior (Tanrikulu, 2014).   The focus of Choice Theory is successful identity in which one takes responsibility for their behavior and accepts consequences of their behavior, realities as they are, and behaves accordingly (Tanrikulu, 2014).  However unsuccessful identity may lead to abnormal behaviors including cyberbullying (Tanrikulu, 2014).

Choice theory contains five motives including survival and reproduction, belonging, power, freedom, and fun which pertains to life elements including basic needs, “Quality World”, total behavior, and (un)successful identity (Tanrikulu, 2014).  According to Tanrikulu, cyberbullies behavior is explained as avenues of fun (38% of cyberbullies), 25% seeking revenge, 6% of cyberbullying is due to a bad mood, and the remainder have no explanation as to why they do it (2014).  According to Choice Theory, behavior aims to meet the basic needs of life (Tanrikulu, 2014), but sometimes barriers hinder the process of achieving goals.  Relationship problems during puberty causes wants to be unmet creating anger and rage that triggers rebellion (problematic behavior such as bullying) (Tanrikulu, 2014).  Research attributes authoritative and oppressive parental attitude as predictors for cyberbullying behavior in their children (Tanrikulu, 2014).  These parental attitudes indicate potential experiences of violence and aggression that steer the child toward aggressive solutions (Tanrikulu, 2014).  Additionally, the parenting attitudes above may lead to feelings of restrain and the inability to present individual potential to cope with obstacles which leads to discipline problems in school causing lack of success and not meeting basic needs (Tanrikulu, 2014).

Glasser defines “Quality World” as the most important part of life as it is the individual’s perception and pictures of what one wants in order to exist in the real world (Tanrikulu, 2014).  However, when the perceived world and real worlds differ, the individual develops problematic behavior (cyberbullying) in an attempt to remove the difference exhibiting a need for power and entertainment (Tanrikulu, 2014).  In this respect, parenting attitude holds a huge effect as the individual’s perception begins forming from birth (Tanrikulu, 2014).

Total behavior consists of all aspects (doing, thinking, feeling, physiology) panning into behavior that is always under the individuals control (Tanrikulu, 2014).  The doing element implicates the behavior is enacted as a way of doing harm (Tanrikulu, 2014).  Cyberbullies often exhibit hostile feelings of loneliness, being unsafe, revenge, and boredom (Tanrikulu, 2014) which drive the negative behaviors as unrealistic expectations and cognitive distortions of the real world are unmet (Tanrikulu, 2014).

(Un)Successful identity, as explained above, occurs in conjunction with relationships.  Those who cannot maintain relationships have a high sense of ego, low self-esteem, worthlessness, and low self-confidence implicating difficulty in social relationships significant of unsuccessful identification which leads to cyberbullying (Tanrikulu, 2014).

I originally thought that cyberbullying was due to a lack of parenting or an adjustment problem in adolescence.  However, I found an article on Glasser’s Choice Theory and came to the understanding that cyberbullying develops from the interaction of biological forces and environmental impact on an individual.  I do believe the individual does have control over choices and remain mixed on the impulsivity behind cyberbullying.  I agree with Glasser that there is some type of hindrance in social development that causes the individual to behave negatively, but I am stuck as to why the behavior occurs in private rather than in person.  I believe it is easier to hide and let aggression out, but with little about the home life and history of the bully, it is difficult to say what caused this individuals behavior.  Interventions I would recommend are also up in the air.  I believe criminalizing will just heighten the aggression in the bully and the bullying will continue.  We can remove the bully, but the fact of the matter is that the problem still has potential because they can continue from the comfort of their home.  Additionally, the victim may become the bully as she now has aggression to get out.  It could turn into a cycle which probably explains why we hear so much of it today.  Maybe educating the entire school on cyberbullying and its effects is a good place to start.  I also believe it is necessary to combine the efforts of the school, parents, and general community in educating about the potentials.  Not only should intervention contain education, but also prevention and reduction of the behaviors.  Tanrikulu brought up the potential of reality therapy that can be utilized to analyze cyberbully behaviors to create intervention programs (2014).  I think maybe reconditioning the individuality to perceive the real world as reality and abate cognitive distortions and somehow accept what they have as valuable.  For the victim, teaching positive coping techniques and ways to avert pent up shame, depression, and anger will avoid the victim becoming the bully.

 

Cyberbullying requires a balanced approach. (2013, May 21). The Guelph Mercury Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/1353330392?accountid=34899

Tanrikulu, T. (2014). Cyberbullying from the perspective of choice theory.Educational Research and Reviews, 9(18), 660-665. doi:http://dx.doi.org/10.5897/ERR2014.1761

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abnormal psychology, clinical psychology, Cognitive psychology, Cross-Cultural Psychology, Environmental Psychology, Maladaptive psychology, social psychology, Uncategorized

Case Study: Borderline Personality Disorder

Diagnosis:  Borderline Personality Disorder

Background

  • Outline the major symptoms of this disorder.
    • The DSM – V describes Borderline Personality Disorder (BPD) as a disorder that manifests in early adulthood as a pattern of instability in “relationships, self-image, and affects, and impulsivity” (p. 663).  Criteria for BPD includes, the individual portrays aggressive effort to avoid real or imagined abandonment, convey an identity disturbance, reveal suicidal ideation or self-mutilating behaviors, and maintain feelings of emptiness (American Psychiatric Association, 2013).  Additionally, an individual exhibits patterns of instability in interpersonal relationships via extreme devaluation and idealization, and affect due to reactivity of mood (American Psychiatric Association, 2013).  Individuals must portray two potentially self-damaging impulsive behaviors such as sex, spending, or substance abuse as well as exhibit intense anger or the inability to control anger (American Psychiatric Association, 2013).
  • Briefly outline the client’s background (age, race, occupations, etc.).
    • Becky is a 24-year-old college student who lives with her father, who was diagnosed with muscular dystrophy when she was three, in a one-bedroom apartment and sleeps in the dining room.  She lives with her father while trying to attain financial and emotional stability so she can support herself better.  She currently takes two medications (600mg/day) and has never thought of herself as mentally well. Becky is the oldest of five children born over six years.  Raised in a Mormon Church, she now repudiates, she left the church at 15 years old and began attending a Baptist church with her friends searching for a sense of belonging.  However, she claims she was not her “true self.” She expresses self-doubt and feels as if others are dishonestly praising her.  She also deals with a personal internal conflict which manifests through self-mutilation. Becky experiences severe panic attacks if she becomes the center of attention or separated from a person.  Upon uniting, she exhibits verbal rage.  However, she recognizes her irrational behavior and apologizes after she calms down (McGraw Hill Higher Education,  2007).
    • Becky experiences severe anxiety attacks relieved through “cutting”, self- mutilation practice that has progressively worsened over time.  Her first experience of cutting came about when she was left home alone for the weekend in the home she shared with a roommate.  The episode was triggered by a television program that made her cry due to sadness.  She attempted to distract herself and accidently sliced her arm which brought pain and further distraction.  She now uses the technique as a way to punish herself for irrational behavior.  Although Becky claims she is intelligent and possesses the good work ethic and empathy for others, her perception of self is negative as she views herself as unworthy of love and fake to society.  She fears if others find out her true self, they will abandon her (McGraw Hill Higher Education,  2007).

 

    • Becky has found peace with her therapist and views him as a positive and understanding support in her life.  She is proud to say she has had a male friend for five years, the longest ever, leading me to believe her friend is her therapist as she did not expose any further information about the friend or time in therapy. Becky maintains a negative view of the world claiming the human race is stupid, mean, horrible and cruel.  Due to this and biological factors, Becky does not want children (McGraw Hill Higher Education, 2007).

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    •  Although Becky claims to experience panic when she is in the limelight, she volunteered to do the interview to help her overcome her troubles, which seems contradictory.  She claims she wants to finish college and be free of medication and therapy and use her personal experience to help children like her (McGraw Hill Higher Education, 2007).

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  • Describe any factors in the client’s background that might predispose him or her to this disorder.
    • According to the DSM, premature parental loss, neglect, and violent conflict are two features associated with BPD (American Psychiatric Association, 2013). Although Becky has not experienced a parental loss, per se, she is coping with a father who is terminally ill and has been since she was only three years old.  She does not expose how ill her father is or if he suffers from limitations, but she has been living with the possibility of losing him.  Additionally, the violent altercations between her and her family members also support this feature of the DSM.  Becky shared that she did not receive the love and attention she needed in childhood.  She claims that she cried for attention and affection and even went to extreme measures to gain it, but she never received it which implies feelings of neglect.  Additionally, Becky claimed in the interview that mental health problems run in her family, which creates a predisposition to mental illness (Nolen-Hoeksema, 2013).  Another thing that stood out in the interview was Becky claiming that her mother would take all of her frustrations out on her and use her as her confidant even for inappropriate conversation.  Her mother’s behavior in conjunction with possible feelings of spousal abandonment or neglect, and dealing with childhood sexual abuse memories may be symptomatic of an undisclosed or undiagnosed mental health issue that predisposed Becky to her disorder.  In high school. Becky fell in love with a guy who made her feel as if here was potential in a relationship between them. However, he married her best friend.  The incident seems as if it reinforced her unworthiness of love she felt from her mother which holds the potential to cause Becky to exhibit the inability to maintain interpersonal relationships and continually “phase out” relationships she deems as having the potential to leave her feeling abandoned (McGraw Hill Higher Education, 2007).

 

Observations

  • Throughout the course of the interview, Becky often looks away, making little eye contact, and many facial expressions. She also takes long pauses between thoughts.  Becky talks with her hands and smiles often.  When speaking of sleeping arrangements, she snickers as if embarrassed at having to admit her arrangement.  At the beginning of the interactive, the narrator stated his crew thought she was not genuine, but he disagreed.  The pauses imply that she had to think about a response, at some points, she paused for an extended period which seemed as if she was fabricating a scenario or thought.  However, other times she was clear and concise right to the point, leading one to believe she was speaking truth.  She rarely made eye contact specifically during the pauses; rather her eyes wandered, and she talked to the side.  Assuming the interviewer was in front of her, this implies dishonesty or simply shame of the events she recalled.  It was noted her thoughts remained mostly consistent and attentive to the question at hand.
  • Describe any symptoms that you have observed that support the diagnosis. You can include direct quotes or behaviors that you may have observed.
    • Becky recalled a trip to the grocery store in which she and her friend became separated.  The separation created a severe panic attack that caused her to lash out yelling at her friend.  Her behavior is consistent with avoiding abandonment criteria listed in the DSM.  Additionally, Becky disclosed she practices cutting to punish herself for irrational behaviors and rubs the scars as a reminder of the pain she endured from her behavior.  She views herself as worthless and fake to the general public and fears people will not like her if they learn who she is.  Her negative self-perception is evident when speaking interpersonal relationships.  Becky feels she needs to break up by two years because by then people will learn how she actually deals with life and it is better to be unhappy by losing a friend she chose to cut off than feeling abandoned because they discovered the “real” Becky.  Additionally, Becky disclosed she had had impulsive spending behaviors in the past (McGraw Hill Higher Education, 2007).

 

  • Describe any symptoms or behaviors that are inconsistent with the diagnosis.
    • Becky claims that she did not get mean towards her friends, rather would turn cold and phase them out of her life or just never talk to them again when she began to fear that the individual would learn her unmasked identity.  The behavior is inconsistent with the DSM claiming devaluation and idealization as the cause of the dissociation of relationships (American Psychiatric Association, 2013).  For Becky, I believe it was the fear of the potential outcome of abandonment.
  • Provide any information that you have about the development of this disorder.
    • According to the National Alliance on Mental Illness (NAMI) website, genetic factors such as first degree relatives support hereditary as a factor in the development of BPD (2016).  Although Becky did not disclose anyone in her family has the same illness, she did state that her family has a history of mental illness.  She also recalled hearing of her mother’s traumatic childhood, the dysfunction within her household as a child, her parent’s separation, and her father’s terminal disease.  The “NAMI” website claims childhood trauma increases the risk for developing BPD (2016).  Brain function, specifically the centers that control emotions and decision making may have a communication barrier that produces extreme behaviors and thoughts in individuals (“NAMI”, 2016).

Diagnosis

  • Did you observe any evidence of general medical conditions that might contribute to the development of this disorder?
    • Becky did not disclose any medical conditions that may contribute to the development of her disorder.  However, it seems as if her disorder is attributed to biological and environmental factors.
  • Did you observe any evidence of psychosocial and environmental problems that might contribute to this disorder?
    • Becky claims her manipulative mother is the root of her problem established through therapy. Becky’s mother learned of her childhood sexual abuse via flashbacks after a traumatic experience.  Her mother discussed in detail the sexual abuse her sisters endured from their father when Becky was a young child of 5 years. Additionally, Becky claims she was her mother’s confidant, and she would take her frustrations out on Becky.  In the interview, Becky often reverted to the conversation surrounding some sexual abuse which caused for questioning if she fabricated her experience from conversations shared with her mother or if she was genuine in her personal experience.  Her parents didn’t talk to each other.  However, the NIH website reports that individuals with BPD are more likely to subject themselves to violence and rape (“NIH”) causing one to believe that she is speaking from experience.  Additionally, Becky recalled physically violent altercations with family which resorted to her breaking dishes as she threw them screaming until she could calm down which implies that her family was dysfunctional and correlates with the National Institute of Mental Health’s report that she is at risk of developing BPD (“NIH”).
  • As per your observations, what is the client’s overall level of safety regarding the potential harm to self or others (suicidality or homicidality)?
    • Becky exhibits progressive self-mutilation.  She began on her arms, abdomen, and currently on her thighs as she has so much scarring from her actions.  Cutting is Becky’s coping skill for anxiety and panic triggered by minor experiences such as being called on in a class or a television program (McGraw Hill Higher Education, 2007).

According to the National Institute of Mental Health, eighty percent of individuals with BPD experience suicidal ideations and four to four percent commit suicide (“NIH”) placing Becky in a bracket of suicide risk.  Although she claims she is not suicidal, self-mutilation rituals have become a typical and expected behavior of Becky and the wounds created have potential to become life threatening.  Therefore, Becky’s safety should be regarded as highly at-risk to herself.

  • What cross-cultural issues, if any, affect the differential diagnosis?
    • According to the DSM, individuals exhibiting identity problems including existential dilemmas, emotional instability, and anxiety-provoked decisions, among others may mislead a diagnosis of BPD, especially when substance abuse is involved (American Psychiatric Association, 2013).  The three symptoms are identified in Becky. However, there is no evidence of substance abuse outside of her prescription medications.  Dependent Personality Disorder is clarified by the individual becoming submissive and appeasing and immediately seeks replacement relationships when things turn negative (American Psychiatric Association, 2013) is also consistent with Becky’s description of her abandonment dilemmas and therefore holds potential for co-occurring disorders.  However, the DSM also reports that BPD is established by a pattern of intense and unstable relationships (2013) indicative of Becky’s recorded history.

Therapeutic Intervention

  • In your opinion, what are the appropriate short-term goals of this intervention?
    • Self-mutilation seems to be overtaking Becky at this point.  It is imperative that she learn skills to cope with stressful events that cause anxiety and panic.  Self-mutilation can become deadly and should be the top priority.  Becky also needs to learn that she is worthy of positive relationships and should be treated as if she has a place in the world.  Additionally, Becky has only spoken of her therapist as a positive support.  She needs to develop a support system or reinstate her familial ties as they are not spoken about outside of childhood.  It seems as if she only has her father, but embracing her family in its entirety may prove beneficial in her circumstance.
  • In your opinion, what are the appropriate long-term goals of this intervention?
    • Becky appears to have unresolved issues with her mother.  It is important for Becky to acknowledge and work through these issues to achieve peace with her past and move on to live in the present.  Becky has a very negative worldview that needs to be turned around.  As she realizes her self-worth, she should also realize that it is good in the world.  Another long-term goal is to complete college and secure employment where she feels she does not have to mask herself.  This will allow her financial stability that will lead her to independence and having her bedroom door back.
  • Which therapeutic strategy seems the most appropriate in this case? Why?
    • Psychotherapy via Dialectical Behavior Therapy (DBT) seems to be the most promising in treating Becky.  DBT aims to help individuals better regulate emotional responses by accepting the issue they are facing (Johnson, Gentile, & Correll, 2010).  It is believed that self-harm is a way to reduce discomfort from affect (Johnson, Gentile, & Correll, 2010).  CBT begins by reducing the treatment-disruptive behavior, in Becky’s case, cutting, to effectively teach coping for emotional regulation and interpersonal relatedness skills (Johnson, et al., 2010). Additionally, talk therapy should be utilized to resolve the issues between Becky and her family.  Although the root cause is known at this time, talk therapy can help Becky effectively process her childhood experiences and grow from them.   According to the treatment section of the interactive, it is vital that therapists should “maintain open communication” to develop trust between themselves and the Becky.  Becky stated that she is fond of her therapist because he is open and honest and has shared personal experiences with her that relate to an experience she had.   However, a behavioral contract should be included to protect the therapist and Becky safety throughout the course of treatment.  It seems at this point; the self-mutilation has increased even with treatment implying Becky is in need of intensive therapeutic services.  The interactive also claimed it is beneficial for therapists to practice splitting during treatment.  This would allow Becky two therapists who swap out in the event Becky became angry with one.  Splitting would allow Becky to remain comfortable in sessions and also a collaborative approach to reconditioning negative thoughts and behavior.
  • Which therapeutic modality seems the most appropriate in this case? Why?
    • Pharmacotherapy such as serotonin reuptake inhibitors helps deter and regulate dangerous and impulsive behavior.  Becky exhibits increasing self-harm techniques and has admitted to impulsive behavior and major mood swings.  Additionally, she suffers panic and anxiety attacks in situations that bring focus to her.  The attacks are triggers for self-mutilation which in turn brings feelings of relief, but also emptiness and worthlessness.  Becky relates her mental state to others that result in death such as AIDs, which implies that she could be worse off by dying.  Becky’s ideations and professed feelings lead one to believe she would benefit from anxiety and depression medications as well.  Additionally, through DBT, Becky will learn healthy patterns of thinking about herself and the world, positive self-image, non-destructive coping skills and adaptive interpersonal skills.  Reversing the pessimism brings about a positive change necessary for Becky to establish a successful and independent life.

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

Dick, Ph. D., D. M., & Agrawal, Ph. D., A. (2008). The genetics of alcohol and other drug dependence. Alcohol Research and Health, 3(2), 111- 118. Retrieved from http://pubs.niaaa.nih.gov/publications/arh312/111-118.pdf

Johnson, A. B., Gentile, J. P., & Correll, T. L. (2010). Accurately diagnosing and treating borderline personality disorder: a psychotherapeutic case. Psychiatry (Edgmont)7(4), 21–30.

McGraw Hill Higher Education. (2007). Faces of abnormal psychology interactive [Multimedia]. Retrieved from McGraw Hill Higher Education, Maladaptive Behavior & Psychopathology | FP6005 A01 website.

NAMI. (2016). Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder

NIH. (2012). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/behavioral-therapiesNIH. Retrieved from http://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

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

Zickler, P. (2002, April). Childhood sex abuse increases risk for drug dependence in adult women. NIDA, 17(1),. Retrieved from http://archives.drugabuse.gov/NIDA_Notes/NNVol17N1/Childhood.html

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