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 Reared apart

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

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!