Personality

Stability vs. Situation?

Personality• Traits vs. States vs. Types• 18,000 personality terms to 32 traits to- • Big five:

– Extraversion (outgoing, sociable, positive)– Neuroticism (prone to negative emotions)– Conscientiousness (organized, efficient, disciplined)– Openness to experience (non-conventional,

curious)– Agreeableness (trusting & easygoing with others)

40 to 60% heritable

Situationism• Low correlations across situations

– Strong vs. weak situations– But-brain differences and heritability

• Introverts more sensitive to external stimuli• More reactive central nervous system• Low pain tolerance• Underactive Nor-epi system• Sensation seeking extraverts

Heritability: Big five correlations

• Identical twins vs. fraternal twins :

Identical Fraternal

• Reared together- .51 .23

• Reared apart- .50 .21

Personality Theories• Psychoanalytic

– Childhood experience, ucs influence, dynamics, conflict, defenses, development and identification

• Humanistic– Focus on self & self-actualization, existential

approach, flow & happiness

• Social-Cognitive Theory– Beliefs, thoughts & personal constructs shape

behavior

• Behavioral Theory– Learning history, self-perception theory, self-control

Defining Abnormality

• Medical approach

• Statistical approach

• Functional approach

These reflect two basic views of disorders

--brain based

--behavior/experience/situation based

The “two worlds” of psychiatry

DSM-IV• Axis 1: Syndromes (Scz, Depress, etc.)

• Axis 2: Retardation & Personality Disorders

• Axis 3: General Medical Condition

• Axis 4: Social/Environmental Problems

• Axis 5: Global Assessment & Coping

• Older classification (primarily of Axis 1 & 2) dichotomized: Neuroses & Psychoses

• Mood (Dep. Bipolar) vs. Thought (Scz) Disrdr

• Now replaced by highly elaborated DSM-V

Heritability of Psychosis: Schizophrenia

Scz incidence & poverty/residential area

Prevalence of Neurotic Disorders by Age

Prevalence of Neurosis by Age & Social Class

Prevalence of Psychosis by Age & Gender

Some Interim Conclusions

• Psychoses (focus on SCZ) is a disorder of heredity and/or prenatal environment

• But it’s also a disorder of poverty (and that may be bidirectional)!

• Another view of prevalence and recent dramatic changes in prevalence

Incidence & Prevalence

• Schizophrenia: approx. 1%

• Bipolar Disorder: approx. 1%

• Depression: approx. M 13% F 21%

Different Therapies for Different Conditions

• Medical: Brain targeted drug interventions examples: --SCZ: Dopamine receptor blockers (the better the block the more effective it is)

--Other neurotransmitters involved as well--Depression: ex. Norepinephrine uptake or release+, Serotonin release+, & a host of other neurotransmitter controls involved

-- Electro-convulsive shock therapy!

Psychological Therapies

• Psychoanalytic

• Behavioral

• Client-centered

• Cognitive-behavioral

• Existential

• Eclectic

• Situational

Commonalities• Just as there are some common underlying

aspects of disorders (chemical imbalance, brain disease, stress, social disconnection) there are commonalities of psychotherapy.

• Correcting the neurological imbalance can correct our thinking and so can working directly on our thinking and behavior.

• A two-pronged approach may be best.

One More Outcome Study

• In a recent meta-analysis comparing drug with psychotherapy approaches to treating depression, drugs resulted in a 55% improvement, psychotherapy 52% and a combination of the two 85%!! (New England J. of Medicine, 5-18-’00.)

• Mind and body interact, we shouldn’t be surprised!

Some Over-arching Issues

• Therapy works!

• Comparative studies

• It’s the therapist as much as the theory

• Meta analyses

• Cost is driving the system now!

What to do?• Keep wits about you & get recommendations from

knowledgeable people• Don’t try to tough it out--it’s not weakness!• Make sure therapist listens and understands• Realize that there are setbacks along the way and

that it takes time• Remember that heredity vs. environment isn’t

“either-or” but a set of interactions--so changing situations is important in any case

• Finally, remember that most people get better!