PSYC 2002 -

ABNORMAL PSYCHOLOGY

STUDY
GUIDE
SPRING 2017
ANXIETY DISORDERS
Introduction ongoing societal conditions that are dangerous.
Studies have found that people in highly threatening
Anxiety disorders include disorders that share features environments are indeed more likely to develop the
of excessive fear and anxiety and related behavioral general feelings of tension, anxiety, and fatigue and
disturbances. Fear is the emotional response to the sleep disturbances found in this disorder. For
real or perceived imminent threat, whereas anxiety example, people without financial means are likely to
is anticipation of future threat. Although these live in rundown communities with high crime rates,
two states overlap, they also differ, with fear more have fewer educational and job opportunities, and
often associated with surges of autonomic arousal run a greater risk for health problems, which would
necessary for fight or flight, thoughts of immediate increase their risk for GAD. The psychodynamic
danger, and escape behaviors, and anxiety more perspective posits that children who do not develop
often associated with muscle tension and vigilance effective ego defense mechanisms are susceptible to
in preparation for future danger, and cautious or GAD, while the cognitive perspective suggests that
avoidant behaviors. Sometimes the level of fear or GAD is caused by dysfunctional ways of thinking.
anxiety is reduced by pervasive avoidance behaviors. Biological theorists believe that GAD is caused chiefly
Anxiety disorders differ from developmentally by biological factors, including GABA deficiencies.
normative fear or anxiety by being excessive or
persisting beyond developmentally appropriate Psychological interventions for GAD include free
periods. Anxiety disorders are the most common association and the therapist’s interpretations of
mental disorders in the United States, with around transference, resistance, and dreams, in an effort
18 percent of the adult population suffering from one to help anxious patients identify and settle the
or another of the anxiety disorders identified by DSM- childhood relationship problems that continue to
5 in any given year, while close to 29 percent of all produce anxiety in adulthood. Cognitive therapies
people develop one of the disorders at some point in help patients to change the maladaptive assumptions
their lives. that characterize their disorder, by helping them to
understand the special role that worrying may play
Generalized Anxiety Disorder in their disorder and to change their views about
People with generalized anxiety disorder (GAD) and reactions to worrying. The leading biological
experience excessive anxiety under most treatment for GAD is drug therapy, which includes the
circumstances and worry about practically anything. use of benzodiazepines, or antianxiety drugs, such as
They typically feel restless, keyed up, or on edge; Lorazepam (Ativan), which work to bind to GABA-A
tire easily; have difficulty concentrating; suffer neuron receptors to increase the ability of GABA to
from muscle tension; and have sleep problems. The bind to them as well, and so improve GABA’s ability to
symptoms last at least 6 months, however, most stop neuron firing and reduce anxiety.
people with the disorder are able, although with Social Anxiety Disorder
some difficulty, to carry on social relationships and
job activities. GAD is common in Western society, People with social anxiety disorder, by contrast, have
and altogether, more than 6 percent of all people severe, persistent, and irrational anxiety about social
or performance situations in which they may face
develop it sometime during their lives. It may emerge
scrutiny by others and possibly feel embarrassment.
at any age, but usually it first appears in childhood
or adolescence. Women diagnosed with the disorder The social anxiety may be narrow, such as a fear of
talking in public or eating in front of others, or it may
outnumber men 2 to 1. A variety of factors have been
cited to explain the development of this disorder.be broad, such as a general fear of functioning poorly
in front of others. In both forms, people repeatedly
According to sociocultural theorists, GAD is most judge themselves as performing less competently
likely to develop in people who are faced with than they actually do.
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Social anxiety disorder can interfere greatly with can also employ the use of medication, in the form
one’s life. A person who cannot interact with others of antidepressant drugs such as Zoloft in treatment
or speak in public may fail to carry out important of social anxiety disorder. At the same time, several
responsibilities, and may become socially isolated types of psychotherapy have proved to be at least as
due to their perceived snobbery, lack of interest, or effective as medication at reducing social fears, and
hostility. Surveys reveal that 7.4 percent of people people helped by such psychological treatments
in the United States and other Western countries appear less likely to relapse than those treated with
(around 60 percent of them female) experience social medications alone At the same time, several types
anxiety disorder in any given year. It tends to begin in of psychotherapy, including exposure therapy, have
late childhood or adolescence and may continue into proved to be at least as effective as medication at
adulthood. reducing social fears, and people helped by such
Although varied causes have been uncovered by psychological treatments appear less likely to relapse
researchers, including genetic predispositions, trait than those treated with medications alone.
tendencies, biological abnormalities, traumatic Separation Anxiety Disorder
childhood experiences, and overprotective parent-
child interactions during childhood, the leading Separation anxiety disorder, one of the most common,
explanation for social anxiety disorder has been but not unique, childhood anxiety disorders, begins
proposed by cognitive theorists and researchers who as early as the preschool years, and at least 4 percent
contend that people with this disorder hold a group of all children experience it. Sufferers feel extreme
of social beliefs and expectations that consistently anxiety, often panic, whenever they are separated
work against them. These include unrealistically high from home or a parent. They have enormous trouble
social standards and the belief that they must perform traveling away from their family, and they often refuse
perfectly in social situations; the view of themselves to visit friends’ houses, go on errands, or attend camp
as unattractive social beings, who are unskilled or school. Many cannot even stay alone in a room
and inadequate; and the belief that they have no and cling to their parent around the house. Some
control over feelings of anxiety that emerge in social also have temper tantrums, cry, or plead to keep their
situations. Because of these beliefs, people with parents from leaving them. The children may fear that
social anxiety disorder keep anticipating that social they will get lost when separated from their parents or
disasters will occur, and they repeatedly perform that the parents will meet with an accident or illness.
“avoidance” and “safety” behaviors to help prevent Of the psychodynamic, cognitive-behavioral, family,
or reduce such disasters. Beset by such beliefs and and group therapies available, separately or in
expectations, people with social anxiety disorder find combination, cognitive-behavioral therapy has fared
that their anxiety levels increase as soon as they enter the best across a number of studies. Such treatments
into a social situation. Moreover, because they are parallel adult anxiety approaches but they are
convinced that their social flaws are the cause of the tailored to fit the child’s cognitive abilities, unique
anxiety, certain that they do not have the social skills life situation, and limited control over his or her
to deal with the situation, and concerned that they life. Clinicians may offer psychoeducation, provide
cannot contain their negative arousal, they become parent training, and arrange school interventions
filled with anxiety. Later, after the social event has to treat anxious children, in addition to prescribing
taken place, the individuals repeatedly review the not only antianxiety drugs, but antidepressant and
details of the event. They overestimate how poorly antipsychotic drugs as well.
things went and what negative results may take
place. These persistent thoughts actually keep the Specific Phobias
event alive and further increase the individuals’ fears
A specific phobia is a persistent fear of a specific
about future social situations.
object or situation. When sufferers are exposed to
Armed with this insight, clinicians now treat social the object or situation, they typically experience
anxiety disorder by trying to reduce social fears, by immediate fear. Common specific phobias are intense
providing training in social skills, or both. Therapists fears of specific animals or insects, heights, enclosed
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spaces, thunderstorms, and blood. Each year around reasoning, and coaxing to get clients to confront
12 percent of all people in the United States have the outside world. Exposure therapy for people with
the symptoms of a specific phobia, with women agoraphobia often includes the use of support groups
outnumbering men by at least 2 to 1. and home-based self-help programs to motivate
Behaviorists believe that people with phobias first clients to work hard at their treatment.
learn to fear certain objects, situations, or events Panic Disorder
through conditioning. Once the fears are acquired,
the individuals avoid the dreaded object or situation, In panic disorder, the individual experiences recurrent
permitting the fears to become all the more unexpected panic attacks — abrupt surges of intense
entrenched. Another way of acquiring a fear reaction fear or intense discomfort that reach a peak within
is through modeling, that is, through observation minutes, accompanied by physical and/or cognitive
and imitation. A person may observe that others are symptoms — and is persistently concerned or worried
afraid of certain objects or events and develop fears about having more panic attacks, or changes his or her
of the same things. behavior in maladaptive ways because of the panic
attacks (e.g., avoidance of exercise or of unfamiliar
Every theoretical model has its own approach to locations). Around 2.4 percent of all people in the
treating phobias, but behavioral techniques have United States suffer from panic disorder, which tends
proven to be more effective, and are more widely to develop in late adolescence or early adulthood and
used than the rest, particularly for specific phobias. is at least twice as common among women as among
The major behavioral approaches to treating them are men.
systematic desensitization, flooding, and modeling,
all exposure treatments that expose sufferers to the The search for a cause of panic disorder has led
objects or situations they dread. cognitive theorists to believe that panic-prone people
may be very sensitive to certain bodily sensations;
Agoraphobia when they unexpectedly experience such sensations,
People with agoraphobia are afraid of being in they misinterpret them as signs of a medical
public places or situations where escape might be catastrophe Rather than understanding the probable
difficult or help unavailable, should they experience cause of their sensations, those prone to panic grow
panic or become incapacitated. This is a pervasive increasingly upset about losing control, fear the
and complex phobia, which affects 1.7 percent of worst, lose all perspective, and rapidly plunge into
the population; women twice as frequently as men. panic. For example, many people with panic disorder
The disorder also is twice as common among poor seem to “overbreathe,” or hyperventilate, in stressful
people as wealthy people. It is typical of people situations. The abnormal breathing makes them think
with agoraphobia to avoid entering crowded streets that they are in danger of suffocation, so they panic.
or stores, driving in parking lots or on bridges, and In the area of treatment, researchers discovered that
traveling on public transportation or in airplanes. If certain antidepressant drugs, such as Xanax, could
they venture out of the house at all, it is usually only
prevent panic attacks or reduce their frequency, by
in the company of close relatives or friends. Some restoring proper activity of norepinephrine in the
insist that family members or friends stay with them parts of the panic brain circuit. Cognitive therapists
at home, but even at home and in the company of try to correct people’s misinterpretations of their
others they may continue to feel anxious. In severe bodily sensations in hope of educating clients
cases, people become virtual prisoners in their own about the general nature of panic attacks, the actual
homes. Their social life dwindles, they cannot hold a causes of bodily sensations, and the tendency of
job, and may also become depressed. clients to misinterpret their sensations. In view of the
Behaviorists have developed a variety of exposure effectiveness of both cognitive and drug treatments,
approaches to treat agoraphobia. Therapists typically many clinicians have tried combining them.
help clients to venture farther and farther from their
homes and to gradually enter outside places, one
step at a time. Sometimes the therapists use support,
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PERSONALITY DISORDERS
Introduction them harm, they shun close relationships, although
People with a personality disorder display an their trust in their own ideas and abilities can be
enduring, rigid pattern of Inner experience and excessive. Always on guard and cautious, and seeing
outward behavior that impairs their sense of self, threats everywhere, people with PPD continually
emotional experiences, goals, capacity for empathy, expect to be the targets of some trickery. They find
and/or capacity for intimacy. Put another way, they “hidden” meanings, which are usually belittling or
have personality traits that are much more extreme threatening, in everything. Quick to challenge the
and dysfunctional than those of most other people loyalty or trustworthiness of acquaintances, people
in their culture, leading to significant problems and with PPD remain cold and distant. For example, a
psychological pain for themselves or others. The woman might avoid confiding in anyone, for example,
symptoms of personality disorders last for years and for fear of being hurt; or a husband might, without
typically become recognizable in adolescence or early any justification, persist in questioning his spouse’s
adulthood, although some start during childhood. faithfulness. People with this disorder are critical of
These disorders are among the most difficult weakness and fault in others, particularly at work.
psychological disorders to treat. Many people with They are unable to recognize their own mistakes,
the disorders are not even aware of their personality though, and are extremely sensitive to criticism. They
problems and fail to trace their difficulties to their often blame others for the things that go wrong in
maladaptive style of thinking and behaving. Surveys their lives, and they repeatedly bear grudges. As
indicate that between 10 and 15 percent of adults in many as 4.4 percent of adults in the United States
the United States have a personality disorder. DSM-5, experience this disorder, which is more common in
identifies 10 personality disorders, each characterized men than in women.
by a group of problematic personality symptoms, Psychodynamic theories, posits the origins of PPD to
and separated into three groups, or clusters. Cluster early interactions with demanding parents, particularly
A, marked by odd or eccentric behavior, consists of distant, rigid fathers and over-controlling, rejecting
the paranoid, schizoid, and schizotypal personality mothers. According to another psychodynamic
disorders. Cluster B features dramatic behavior and view, some people come to view their environment
consists of the antisocial, borderline, histrionic, and as hostile as a result of their parents’ persistently
narcissistic personality disorders. The final cluster, C,unreasonable demands. They must always be on the
features a high degree of anxiety and includes the alert because they cannot trust others, and they are
avoidant, dependent, and obsessive-compulsive likely to develop feelings of extreme anger. They also
personality disorders. project these feelings onto others and, as a result, feel
Cluster A - “Odd” increasingly persecuted. Similarly, some cognitive
theorists suggest that people with PPD generally hold
The cluster of “odd” personality disorders consists of broad maladaptive assumptions, such as “People are
the paranoid, schizoid, and schizotypal personality evil” and “People will attack you if given the chance.”
disorders. People with these disorders typically have
odd or eccentric behaviors that are similar to but not Because people with PPD do not typically see
as extensive as those seen in schizophrenia, including themselves as needing help, and few come to
extreme suspiciousness, social withdrawal, and treatment willingly, therapy for this disorder has
peculiar ways of thinking and perceiving things. limited effect and moves very slowly. Cognitive and
behavioral techniques have been used to treat people
Paranoid Personality Disorder with PPD, and are often combined into an integrated
People with paranoid personality disorder (PPD) cognitive-behavioral approach. On the behavioral
deeply distrust other people and are suspicious of their side, therapists help clients to master anxiety-
motives. Because they believe that everyone intends reduction techniques and to improve their skills at
solving interpersonal problems. On the cognitive
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side, therapists guide the clients to develop more Cognitive-behavioral therapists have sometimes
realistic interpretations of other people’s words and been able to help people with this disorder
actions and to become more aware of other people’s experience more positive emotions and more
points of view. satisfying social interactions. On the cognitive end,
their techniques include presenting clients with lists
Schizoid Personality Disorder of emotions to think about or having them write
People with schizoid personality disorder (SPD) down and remember pleasurable experiences. On
persistently avoid and are removed from social the behavioral end, therapists have sometimes had
relationships and demonstrate little in the way of success teaching social skills to such clients, using
emotion. Like people with paranoid personality role-playing, exposure techniques, and homework
disorder, they do not have close ties with other assignments as tools. Group therapy is apparently
people. The reason they avoid social contact, useful when it offers a safe setting for social contact,
however, has nothing to do with paranoid feelings although people with schizoid personality disorder
of distrust or suspicion; it is because they genuinely may resist pressure to take part.
prefer to be alone. People with SPD, often described
as “loners,” make no effort to start or keep friendships, Schizotypal Personality Disorder
take little interest in having sexual relationships, and People with schizotypal personality disorder (SPD)
even seem indifferent to their families. They seek display a range of interpersonal problems marked by
out jobs that require little or no contact with others. extreme discomfort in close relationships, very odd
When necessary, they can form work relations to a patterns of thinking and perceiving, and behavioral
degree, but they prefer to keep to themselves. Many eccentricities. Anxious around others, they seek
live by themselves as well, resulting in weak social isolation and have few close friends. Some feel
skills. If they marry, their lack of interest in intimacy intensely lonely. This disorder is more severe than
may create marital or family problems. People with the paranoid and schizoid personality disorders. The
SPD focus mainly on themselves and are generally thoughts and behaviors of people with SPD can be
unaffected by praise or criticism. They rarely show noticeably disturbed. These symptoms may include
any feelings, expressing neither joy nor anger. They ideas of reference — beliefs that unrelated events
seem to have no need for attention or acceptance; pertain to them in some important way — and
are typically viewed as cold, humorless, or dull; and bodily illusions, such as sensing an external “force” or
generally succeed in being ignored. This disorder is presence. A number of people with this disorder see
present in 3.1 percent of the adult population. Men themselves as having special extrasensory abilities,
are slightly more likely to experience it than are and some believe that they have magical control
women, and men may also be more impaired by it. over others. Examples of schizotypal eccentricities
Many psychodynamic theorists propose that SPD has include repeatedly arranging cans to align their
its roots in an unsatisfied need for human contact. labels, organizing closets extensively, or wearing an
The parents of people with this disorder, like those odd assortment of clothing. The emotions of these
of people with paranoid personality disorder, are individuals may be inappropriate, flat, or humorless.
believed to have been unaccepting or even abusive People with SPD often have great difficulty keeping
of their children. Whereas people with paranoid their attention focused. Correspondingly, their
symptoms react to such parenting chiefly with distrust, conversation is typically digressive and vague, even
those with SPD are left unable to give or receive love. sprinkled with loose associations. They tend to drift
They cope by avoiding all relationships. Cognitive aimlessly and lead an idle, unproductive life. They
theorists propose that people with SPD suffer from are likely to choose undemanding jobs in which they
deficiencies in their thinking. Their thoughts tend to can work below their capacity and are not required
be vague, empty, and without much meaning, and to interact with other people. Surveys suggest that
they have trouble scanning the environment to arrive 3.9 percent of adults—slightly more males than
at accurate perceptions. Unable to pick up emotional females—display schizotypal personality disorder.
cues from others, they simply cannot respond to Researchers have found that schizotypal symptoms,
emotions. like schizophrenic patterns, are often linked to
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family conflicts and to psychological disorders in 5 stipulates that a person must be at least 18 years
parents. They have also learned that defects in old to receive this diagnosis; however, most people
attention and short-term memory may contribute with ASPD displayed some patterns of misbehavior
to schizotypal personality disorder, just as they before they were 15, including truancy, running away,
apparently do to schizophrenia. Researchers have cruelty to animals or people, and destroying property.
also linked SPD to some of the same biological People with ASPD lie repeatedly. Many cannot work
factors found in schizophrenia, such as high activity consistently at a job; they are absent frequently and
of the neurotransmitter dopamine, enlarged brain are likely to quit their jobs altogether. Usually they are
ventricles, smaller temporal lobes, and loss of gray also careless with money and frequently fail to pay
matter. The disorder also has been linked to disorders their debts. They are often impulsive, taking action
of mood, with more than half of people with SPD also without thinking of the consequences. They may be
suffering from major depressive disorder at some irritable, aggressive, and quick to start fights. Many
point in their lives. travel from place to place. Recklessness is another
In treating SPD, most therapists agree on the need to common trait: people with ASPD have little regard
help clients “reconnect” with the world and recognize for their own safety or for that of others, even their
the limits of their thinking and their powers. Using children. They are self-centered as well, and are likely
cognitive interventions, they try to teach clients to have trouble maintaining close relationships.
to evaluate their unusual thoughts or perceptions Usually they develop a knack for gaining personal
objectively and to ignore the inappropriate ones. profit at the expense of other people. Lacking a moral
Therapists may keep track of clients’ odd or magical conscience, they think of their victims as weak and
predictions, for example, and later point out their deserving of being conned, robbed, or even physically
inaccuracy. When clients are speaking and begin harmed. Surveys indicate that 3.6 percent of adults
to digress, the therapists might ask them to sum in the United States meet the criteria ASPD, with the
up what they are trying to say. In addition, specific disorder as much as four times more common among
behavioral methods, such as speech lessons, social men than women.
skills training, and tips on appropriate dress and Explanations of ASPD come from the psychodynamic,
manners, have sometimes helped clients learn to behavioral, cognitive, and biological models.
blend in better with and be more comfortable around Psychodynamic theorists propose that ASPD begins
others. Antipsychotic drugs have been given to with an absence of parental love during infancy,
people with SPD, because of the disorder’s similarity leading to a lack of basic trust. In this view, some
to schizophrenia. children—the ones who develop antisocial personality
disorder—respond to the early inadequacies by
Cluster B - “Dramatic” becoming emotionally distant, and they bond with
The cluster of “dramatic” personality disorders others through the use of power and destructiveness.
includes the antisocial, borderline, histrionic, and Many behavioral theorists have suggested that
narcissistic personality disorders. The behaviors antisocial symptoms may be learned through
of people with these problems are so dramatic, modeling, or imitation. Other behaviorists have
emotional, or erratic that it is almost impossible for suggested that some parents unintentionally teach
them to have relationships that are truly giving and antisocial behavior by regularly rewarding a child’s
satisfying. These personality disorders are more aggressive behavior. When the child misbehaves or
commonly diagnosed than the others. becomes violent in reaction to the parents’ requests
or orders, for example, the parents may give in to
Antisocial Personality Disorder restore peace. Without meaning to, they may be
Sometimes described as“psychopaths”or“sociopaths,” teaching the child to be stubborn and perhaps even
people with antisocial personality disorder (ASPD) violent. The cognitive view says that people with
persistently disregard and violate others’ rights. Aside ASPD hold attitudes that trivialize the importance
from substance use disorders, this is the disorder of other people’s needs; they further propose that
most closely linked to adult criminal behavior. DSM- people with this disorder have genuine difficulty
recognizing points of view or feelings other than
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their own. Studies also suggest that biological factorsalso may violate the boundaries of relationships.
may play an important role in ASPD. Researchers Thinking in black-and-white terms, they quickly feel
have found that antisocial people, particularly those rejected and become furious when their expectations
who are highly impulsive and aggressive, have lower are not met; yet they remain very attached to the
serotonin activity than other people. relationships. In fact, they have recurrent fears of
Treatments for people with ASPD are typically impending abandonment and frequently engage in
ineffective as major obstacles to treatment include frantic efforts to avoid real or imagined separations
the individuals’ lack of conscience, desire to change, from important people in their lives. They typically
or respect for therapy. Some cognitive therapists have dramatic identity shifts. Because of this unstable
try to guide clients with ASPD to think about moral sense of self, their goals, aspirations, friends, and
issues and about the needs of other people. Clinicians even sexual orientation may shift rapidly. They may
have also used psychotropic medications, particularly also occasionally have a sense of dissociation, or
atypical antipsychotic drugs, to treat people with detachment, from their own thoughts or bodies. 5.9
ASPD. percent of the adult population display BPD and close
to 75 percent who receive the diagnosis are women.
Borderline Personality Disorder Psychodynamic theorists have looked to early parental
People with borderline personality disorder (BPD) relationships to explain the disorder proposing that
display great instability, including major shifts in an early lack of acceptance by parents may lead to
mood, an unstable self-image, and impulsivity. These a loss of self-esteem, increased dependence, and
characteristics combine to make their relationships an inability to cope with separation. Research has
very unstable as well. People with BPD swing in and found that the early childhoods of people with BPD
out of very depressive, anxious, and irritable states that were often marked by multiple parent substitutes,
last anywhere from a few hours to a few days or more. divorce, death, or traumas such as physical or sexual
Their emotions seem to be always in conflict with abuse. BPD also has been linked to certain biological
the world around them. They are prone to bouts of abnormalities, such as an overly reactive amygdala,
anger, which sometimes result in physical aggression the brain structure that is closely tied to fear and other
and violence. Just as often, however, they direct their negative emotions, and an underactive prefrontal
impulsive anger inward and inflict bodily harm on cortex, the brain region linked to planning, self-
themselves. Many seem troubled by deep feelings of control, and decision making.
emptiness. Their impulsive, self-destructive activities Psychotherapy can eventually lead to some degree of
may range from alcohol and substance abuse to improvement for people with BPD, and antidepressant,
delinquency, unsafe sex, and reckless driving. Many anti-bipolar, antianxiety, and antipsychotic drugs
engage in self-injurious or self-mutilation behaviors, have helped calm the emotional and aggressive
such as cutting or burning themselves or banging storms of some people with borderline personality
their heads, behaviors which typically cause immense disorder.
physical suffering, but those with BPD often feel
as if the physical discomfort offers relief from their Histrionic Personality Disorder
emotional suffering. It may serve as a distraction from People with histrionic personality disorder (HPD) are
their emotional or interpersonal upsets, “snapping” extremely emotional—they are typically described
them out of an “emotional overload.” Many try as “emotionally charged”—and continually seek
to hurt themselves as a way of dealing with their to be the center of attention. People with HPD are
chronic feelings of emptiness, boredom, and identity always “on stage,” using theatrical gestures and
confusion. Scars and bruises also may provide them mannerisms and grandiose language to describe
with a kind of concrete evidence of their emotional ordinary everyday events. Like chameleons, they
distress. People with BPD frequently form intense, keep changing themselves to attract and impress an
conflict-ridden relationships in which their feelings audience, and in their pursuit they change not only
are not necessarily shared by the other person. They their surface characteristics—according to the latest
may come to idealize another person’s qualities fads—but also their opinions and beliefs. In fact, their
and abilities after just a brief first encounter. They
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speech is actually scanty in detail and substance, expecting others to recognize them as superior,
and they seem to lack a sense of who they really are. and often appear arrogant. They are very choosy
Approval and praise are their lifeblood; they must about their friends and associates, believing that
have others present to witness their exaggerated their problems are unique and can be appreciated
emotional states. Vain, self-centered, demanding, and only by other “special,” high-status people. Because
unable to delay gratification for long, they overreact of their charm, they often make favorable first
to any minor event that gets in the way of their impressions, yet they can rarely maintain long-term
quest for attention. Some make suicide attempts, relationships. People with NPD are seldom interested
often to manipulate others. People with HPD may in the feelings of others. They may not even be
draw attention to themselves by exaggerating their able to empathize with such feelings. Many take
physical illnesses or fatigues. They may also behave advantage of other people to achieve their own ends,
very provocatively and try to achieve their goals perhaps partly out of envy; at the same time they
through sexual seduction. Most obsess over how they believe others envy them. Though grandiose, some
look and how others will perceive them, often wearing react to criticism or frustration with bouts of rage,
bright, eye-catching clothes. They exaggerate the humiliation, or embitterment. Others may react with
depth of their relationships, considering themselves cold indifference. And still others become extremely
to be the intimate friends of people who see them pessimistic and filled with depression. They may
as no more than casual acquaintances. Often they have periods of zest that alternate with periods of
become involved with romantic partners who may be disappointment. As many as 6.2 percent of adults
exciting but who do not treat them well. 1.8 percent display NPD, up to 75 percent of them men.
of adults have this personality disorder, with males Psychodynamic theorists propose that the problem
and females equally affected. begins with cold, rejecting parents, and argue that
Most psychodynamic theorists believe that as children, some people with this background spend their
people with this disorder had cold and controlling lives defending against feeling unsatisfied, rejected,
parents who left them feeling unloved and afraid of unworthy, ashamed, and wary of the world. They
abandonment. To defend against deep-seated fears do so by repeatedly telling themselves that they are
of loss, the children learned to behave dramatically, actually perfect and desirable, and also by seeking
inventing crises that would require other people to admiration from others. A number of cognitive-
act protectively. Cognitive theorists see these people behavioral theorists propose that NPD may develop
as becoming less and less interested in knowing when people are treated too positively rather than too
about the world at large because they are so self- negatively in early life. They hold that certain children
focused and emotional. Sociocultural, particularly acquire a superior and grandiose attitude when their
multicultural, theorists believe that HPD is produced “admiring or doting parents” teach them to “overvalue
in part by cultural norms and expectations. their self worth,” repeatedly rewarding them for minor
Cognitive therapists have tried to help people with this accomplishments or for no accomplishment at all.
disorder to change their belief that they are helplessNarcissistic personality disorder is one of the most
and also to develop better, more deliberate ways difficult personality patterns to treat because the
of thinking and solving problems. Psychodynamic clients are unable to acknowledge weaknesses, to
therapy and various group therapy formats have also appreciate the effect of their behavior on others,
been used. or to incorporate feedback from others, however,
psychodynamic therapists seek to help people with
Narcissistic Personality Disorder this disorder recognize and work through their basic
People with narcissistic personality disorder (NPD) insecurities and defenses, while cognitive therapists,
are generally grandiose, need much admiration, and focusing on the self-centered thinking of such
feel no empathy with others. Convinced of their own individuals, try to redirect the clients’ focus onto the
great success, power, or beauty, they expect constant opinions of others, teach them to interpret criticism
attention and admiration from those around them. more rationally, increase their ability to empathize,
They exaggerate their achievements and talents, and change their all-or-nothing notions.
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Cluster C - “Anxious” Beyond building trust, therapists tend to treat people
The cluster of “anxious” personality disorders includes with avoidant personality disorder much as they treat
the avoidant, dependent, and obsessive-compulsive people with social anxiety disorder and other anxiety
personality disorders. People with these patterns disorders. Psychodynamic therapists try to help clients
typically display anxious and fearful behavior. recognize and resolve the unconscious conflicts that
may be operating. Cognitive therapists help them
Avoidant Personality Disorder change their distressing beliefs and thoughts, carry
People with avoidant personality disorder (APD) are on in the face of painful emotions, and improve their
very uncomfortable and inhibited in social situations, self-image. Behavioral therapists provide social skills
overwhelmed by feelings of inadequacy, and training as well as exposure treatments that require
extremely sensitive to negative evaluation. They are people to gradually increase their social contacts.
so fearful of being rejected that they give no one an Antianxiety and antidepressant drugs are sometimes
opportunity to reject them—or to accept them either. useful in reducing the social anxiety of people with
Because of their dread of criticism, disapproval, or the disorder, although the symptoms may return
rejection, people with APD actively avoid occasions when medication is stopped.
for social contact, and are often timid and hesitant in Dependent Personality Disorder
social situations, afraid of saying something foolish
or of embarrassing themselves by blushing or acting People with dependent personality disorder (DPD)
nervous. Even in intimate relationships they express have a pervasive, excessive need to be taken care of.
themselves very carefully, afraid of being shamed or As a result, they are clinging and obedient, fearing
ridiculed. They believe themselves to be unappealing separation from their parent, spouse, or other person
or inferior to others. They exaggerate the potential with whom they are in a close relationship. They
difficulties of new situations, so they seldom take rely on others so much that they cannot make the
risks or try out new activities. They usually have few smallest decision for themselves. Those with DPD
or no close friends, though they actually yearn for constantly need assistance with even the simplest
intimate relationships, and frequently feel depressed matters and have extreme feelings of inadequacy
and lonely. As a substitute, some develop an inner and helplessness. Afraid that they cannot care for
world of fantasy and imagination. Around 2.4 percent themselves, they cling desperately to friends or
of adults have avoidant personality disorder, men as relatives. In contrast to people with APD, who have
frequently as women. difficulty initiating relationships, people with DPD
have difficulty with separation, and feel completely
Psychodynamic theorists focus mainly on the general helpless and devastated when a close relationship
sense of shame that people with APD feel. Some trace ends, and they quickly seek out another relationship
the shame to childhood experiences such as early to fill the void. Many cling persistently to relationships
bowel and bladder accidents. If parents repeatedly with partners who physically or psychologically abuse
punish or ridicule a child for having such accidents, them. Lacking confidence in their own ability and
the child may develop a negative self-image. This may judgment, people with this disorder seldom disagree
lead to the child’s feeling unlovable throughout life with others and allow even important decisions to be
and distrusting the love of others. Similarly, cognitive made for them. For example, they may depend on a
theorists believe that harsh criticism and rejection in parent or spouse to decide where to live, what job
early childhood may lead certain people to assume to have, and which neighbors to befriend. Because
that others in their environment will always judge they so fear rejection, they are overly sensitive to
them negatively. These people come to expect disapproval and keep trying to meet other people’s
rejection, misinterpret the reactions of others to fit wishes and expectations, even if it means volunteering
that expectation, discount positive feedback, and for unpleasant or demeaning tasks. Many people
generally fear social involvements—setting the stage with DPD feel distressed, lonely, and sad; often they
for APD. Behavioral theorists suggest that people dislike themselves. Thus they are at risk for depressive,
with APD typically fail to develop normal social skills, anxiety, and eating disorders. Their fear of separation
a failure that helps maintain the disorder. and their feelings of helplessness may leave them
9
particularly prone to suicidal thoughts, especially to be rigid and stubborn, particularly in their morals,
when they believe that a relationship is about to end. ethics, and values. They live by a strict personal code
Surveys suggest that fewer than 1 percent of the and use it as a yardstick for measuring others. They
population experience DPD, with men and women may have trouble expressing much affection, and
equally affected. their relationships are sometimes stiff and superficial.
Psychodynamic explanations for DPD say that In addition, they are often stingy with their time or
early parental loss or rejection may prevent normal money. Some cannot even throw away objects that
experiences of attachment and separation, leaving are worn out or useless. According to surveys, as
some children with fears of abandonment that persist many as 7.9 percent of the adult population display
throughout their lives. Behaviorists propose that OCPD, with white, educated, married, and employed
parents of people with DPD unintentionally rewarded people receiving the diagnosis most often; men are
their children’s clinging and “loyal” behavior, while twice as likely as women to display the disorder.
at the same time punishing acts of independence, Freudian theorists suggest that people with OCPD are
perhaps through the withdrawal of love. At the same anal retentive. That is, because of overly harsh toilet
time, some parents’ own dependent behaviors may training during the anal stage, they become filled
have served as models for their children. with anger, and they remain fixated at this stage.
Cognitive-behavioral therapists combine behavioral To keep their anger under control, they persistently
and cognitive interventions to help the clients take resist both their anger and their instincts to have
control of their lives. On the behavioral end, the bowel movements. In turn, they become extremely
therapists often provide assertiveness training to orderly and restrained; many become passionate
help the individuals better express their own wishes collectors. Other psychodynamic theorists suggest
in relationships. On the cognitive end, the therapists that any early struggles with parents over control and
also try to help the clients challenge and change their independence may ignite the aggressive impulses
assumptions of incompetence and helplessness. at the root of this personality disorder. Cognitive
Antidepressant drug therapy has been helpful for theorists say little about the origins of OCPD, but
people whose personality disorder is accompanied they do propose that illogical thinking processes
by depression. help keep it going. They point, for example, to
dichotomous thinking, which may produce rigidity
Obsessive-Compulsive Personality Disorder and perfectionism. Similarly, they note that people
People with obsessive-compulsive personality with this disorder tend to misread or exaggerate the
disorder (OCPD) are so preoccupied with order, potential outcomes of mistakes or errors.
perfection, and control that they lose all flexibility, People with OCPD do not usually believe there is
openness, and efficiency; their concern for doing anything wrong with them, and are therefore not
everything “right” impairs their productivity. likely to seek treatment unless they are also suffering
Those who have OCPD may become so focused on from another disorder. When in treatment, people
organization and details that they fail to grasp the with OCPD often respond well to psychodynamic or
point of the activity. As a result, their work is often cognitive therapy. Psychodynamic therapists typically
behind schedule (some seem unable to finish any try to help these clients recognize, experience, and
job), and they may neglect leisure activities and accept their underlying feelings and insecurities,
friendships. People with this personality disorder and perhaps take risks and accept their personal
set unreasonably high standards for themselves and limitations. Cognitive therapists focus on helping
others. Their behaviors extend well beyond the realm the clients to change their dichotomous—“all or
of conscientiousness. They can never be satisfied with nothing”—thinking, perfectionism, indecisiveness,
their performance, but they typically refuse to seek procrastination, and chronic worrying.
help or to work with a team, convinced that others
are too careless or incompetent to do the job right.
Because they are so afraid of making mistakes, they
may be reluctant to make decisions. They also tend
10
MOOD DISORDERS
Introduction

We all have moods that come and go. Feelings of

elation or sadness are understandable reactions to
daily events and do not affect the lives of most people
greatly. However, the moods of certain people last a
long time, affecting all of their interactions with the
world and even interfering with normal functioning.
Such people struggle in particular with depression,
mania, or both. Depression is a low, sad state in which
life seems dark and its challenges overwhelming.
Mania, the opposite of depression, is a state of
breathless euphoria, or at least frenzied energy, in
which people may have an exaggerated belief that the
world is theirs for the taking. Mood problems of these
kinds are at the center of two groups of disorders—
depressive disorders and bipolar disorders. These
groups are examined in this chapter. People with
depressive disorders suffer only from depression,
a pattern called unipolar depression. They have no
history of mania and return to a normal or nearly
normal mood when their depression lifts. In contrast,
those with bipolar disorders have periods of mania
that alternate with periods of depression.
Major Depressive Disorder

The diagnostic criteria for major depressive disorder

require that the person exhibit more symptoms than
are required for dysthymia and that the symptoms
be more persistent (not interwoven with periods
of normal mood). To receive a diagnosis of major
depressive disorder, a person must be in a major
depressive episode and never have had a manic,
hypomanic, or mixed episode. An affected person
must experience either markedly depressed moods
or marked loss of interest in pleasurable activities
most of every day, nearly every day, for at least two
consecutive weeks. In addition to showing one or
both of these symptoms, the person must experience
additional symptoms during the same period (for a
total of at least five symptoms.

11
EXAM QUESTIONS
Section A on themselves, such as cutting or burning themselves or
banging their heads, behaviors which typically cause
QUESTION: The DSM has attempted to retain a diagnostic immense physical suffering, but those with BPD often
classification called Personality Disorders. feel as if the physical discomfort offers relief from their
emotional suffering. It may serve as a distraction from their
a. List the clusters and explain the important features
emotional or interpersonal upsets, “snapping” them out of
of each cluster that differentiates one cluster from
an “emotional overload.” Many try to hurt themselves as a
the other.
way of dealing with their chronic feelings of emptiness,
DSM-5 identifies 10 personality disorders, each boredom, and identity confusion. Scars and bruises also
characterized by a group of problematic personality may provide them with a kind of concrete evidence of
symptoms, and separated into three groups, or clusters. their emotional distress.
Cluster A, marked by odd or eccentric behavior, consists
Many seem troubled by deep feelings of emptiness. Their
of the paranoid, schizoid, and schizotypal personality
impulsive, self-destructive activities may range from
disorders. People with these disorders typically have
alcohol and substance abuse to delinquency, unsafe
odd or eccentric behaviors that are similar to but not
sex, and reckless driving. People with BPD frequently
as extensive as those seen in schizophrenia, including
form intense, conflict-ridden relationships in which their
extreme suspiciousness, social withdrawal, and peculiar
feelings are not necessarily shared by the other person.
ways of thinking and perceiving things.
They may come to idealize another person’s qualities
Cluster B features dramatic behavior and consists of and abilities after just a brief first encounter. They also
the antisocial, borderline, histrionic, and narcissistic may violate the boundaries of relationships. Thinking
personality disorders. The behaviors of people with these in black-and-white terms, they quickly feel rejected and
problems are so dramatic, emotional, or erratic that it is become furious when their expectations are not met; yet
almost impossible for them to have relationships that are they remain very attached to the relationships. In fact,
truly giving and satisfying. These personality disorders are they have recurrent fears of impending abandonment
more commonly diagnosed than the others. and frequently engage in frantic efforts to avoid real or
The final cluster, C, features a high degree of anxiety imagined separations from important people in their lives.
and includes the avoidant, dependent, and obsessive- They typically have dramatic identity shifts. Because of this
compulsive personality disorders. People with these unstable sense of self, their goals, aspirations, friends, and
patterns typically display anxious and fearful behavior. even sexual orientation may shift rapidly. They may also
occasionally have a sense of dissociation, or detachment,
b. List the personality disorders in Cluster B. from their own thoughts or bodies. 5.9 percent of the
Cluster B, the cluster of “dramatic” personality disorders adult population display BPD and close to 75 percent who
includes the antisocial, borderline, histrionic, and receive the diagnosis are women.
narcissistic personality disorders. Psychotherapy can eventually lead to some degree of
improvement for people with BPD, and antidepressant,
c. Name one disorder in Cluster B and explain how the anti-bipolar, antianxiety, and antipsychotic drugs have
features of that disorder make it different from the helped calm the emotional and aggressive storms of some
other disorders in that Cluster. people with borderline personality disorder.
People with borderline personality disorder (BPD)
display great instability, including major shifts in mood, an Section B
unstable self-image, and impulsivity. These characteristics QUESTION 1: Anxiety is a term used by many people, but
combine to make their relationships very unstable as well. Generalized Anxiety Disorder is a mental Disorder.
People with BPD swing in and out of very depressive,
anxious, and irritable states that last anywhere from a few a. Give a definition of Generalized Anxiety Disorder
hours to a few days or more. Their emotions seem to be and how it is classified in the DSM.
always in conflict with the world around them. They are Generalized Anxiety Disorder is a disorder marked by
prone to bouts of anger, which sometimes result in physical persistent and excessive feelings of anxiety and worry
aggression and violence. Just as often, however, they about numerous events and activities. It is classified as an
direct their impulsive anger inward and inflict bodily harm Anxiety Disorder in the DSM-5.
12
b. List the main symptoms that must be present for the To receive a diagnosis of major depressive disorder, a person
diagnosis to be made. must be in a major depressive episode and never have had
People with generalized anxiety disorder (GAD) a manic, hypomanic, or mixed episode. An affected person
experience excessive anxiety under most circumstances must experience five or more symptoms, including either
and worry about practically anything. They typically feel markedly depressed moods or marked loss of interest in
restless, keyed up, or on edge; tire easily; have difficulty pleasurable activities most of every day, nearly every day,
concentrating; suffer from muscle tension; and have for at least two consecutive weeks; significant weight
sleep problems. The symptoms last at least 6 months, loss or gain when not dieting; insomnia or hypersomnia;
however, most people with the disorder are able, although observable psychomotor agitation or retardation; fatigue
with some difficulty, to carry on social relationships and or loss of energy, feelings of worthlessness or excessive
job activities. GAD is common in Western society, and or inappropriate guilt; and, diminished ability to think or
altogether, more than 6 percent of all people develop it concentrate, or recurrent thoughts of death. In addition,
sometime during their lives. It may emerge at any age, but the symptoms must cause clinically significant distress
usually it first appears in childhood or adolescence. or impairment in social, occupational, or other important
areas of functioning, and must not be attributable to the
c. How is Generalized Anxiety Disorder managed? physiological effects of a substance or to another medical
condition.
Psychological interventions for GAD include free
c. Outline a management plan for this woman and
association and the therapist’s interpretations of
explain why you chose this approach.
transference, resistance, and dreams, in an effort to
help anxious patients identify and settle the childhood In designing a management plan for this client suffering
relationship problems that continue to produce anxiety in from major depressive disorder, I would adopt a
adulthood. combination of cognitive-behavioral therapy and
Cognitive therapies help patients to change the antidepressant drugs.
maladaptive assumptions that characterize their disorder, The behavioral approach would reintroduce the client to
by helping them to understand the special role that pleasurable events and activities, while helping them to
worrying may play in their disorder and to change their improve their social skills, while the cognitive approach
views about and reactions to worrying. would primarily help her to recognize and change her
The leading biological treatment for GAD is drug therapy, negative cognitive processes and thus improve her mood.
which includes the use of benzodiazepines, or antianxiety The pharmacological component would involve the
drugs, such as Lorazepam (Ativan), which work to bind to use of a selective serotonin reuptake inhibitor (SSRI)
GABA-A neuron receptors to increase the ability of GABA such as prozac, which would increase serotonin activity
to bind to them as well, and so improve GABA’s ability to specifically, without affecting norepinephrine or other
stop neuron firing and reduce the anxiety. neurotransmitters. SSRIs have become the mode of choice
due to the fact that it is harder to overdose on them than
QUESTION 2: A forty-two year old woman was brought the other antidepressants. In addition, they do not pose
to a clinical psychologist and was diagnosed as suffering the dietary problems of the MAO inhibitors or produce
from a Mood Disorder. some of the unpleasant effects of the tricyclics, such as dry
mouth and constipation.
a. List four Disorders that are classified under Mood
Disorders in the DSM-5.
Section C
Four disorders classified in DSM-5 as Depressive Disorders
are Major Depressive Disorder, Persistent Depressive QUESTION: A 75 year old female was diagnosed with
Disorder, Disruptive Mood Dysregulation Disorder, and Dementia of the Alzheimer’s Type two years ago. She lives
Premenstrual Dysphoric Disorder. alone and has been consuming alcohol, and causing a
disturbance to her neighbors over the past 2 weeks.
b. List the main symptoms of one of the four listed
above. a. List and explain the features of the Dementia that
The diagnostic criteria for major depressive disorder may be contributing to the problem.
require that the person exhibit more symptoms than are Classified as a major Neurocognitive Disorder—in which
required for dysthymia and that the symptoms be more the decline in cognitive functioning is substantial and
persistent (not interwoven with periods of normal mood). interferes with a person’s ability to be independent —
13
Alzheimer’s disease is a gradually progressive disease They may lose almost all knowledge of the past and fail
in which memory impairment is the most prominent to recognize the faces of even close relatives. They also
cognitive dysfunction. Technically, sufferers receive a become increasingly uncomfortable at night and take
DSM-5 diagnosis of mild neurocognitive disorder due to frequent naps during the day.
Alzheimer’s disease during the early and mild stages of
the syndrome and major neurocognitive disorder due to b. List the main features of alcohol intoxication that
Alzheimer’s disease during the later, more severe stages. might be contributing to the problem.
Alzheimer’s disease sometimes appears in middle age
Due to her alcohol consumption, the woman may be
(early onset), but in the vast majority of cases it occurs after
displaying behaviors consistent with alcohol intoxication,
the age of 65 (late onset). It is the most common cause of
which is a disturbance in behavior or mental function
dementia.
during or after alcohol consumption, marked by slurred
It usually begins with mild memory problems, lapses of speech, incoordination, and mood and behavior changes.
attention, and difficulties in language and communication.
As symptoms worsen, the person has trouble completing c. Explain the importance in distinguishing between
complicated tasks or remembering important these two disorders in further management of this
appointments. Eventually sufferers also have difficulty with case.
simple tasks, forget distant memories, and have changes
in personality that often become very noticeable. For Research has shown that alcohol abuse does not increase
example, a gentle man may become uncharacteristically the risk of Alzheimer’s, however, the symptoms of both
aggressive. People with Alzheimer’s disease may at first Alzheimer’s and alcohol intoxication include cognitive
deny that they have a problem, but they soon become impairments such as amnesia, mental confusion and
anxious or depressed about their state of mind; many also unresponsiveness, behavioral features such as aggression
become agitated. and lack of restraint and poor judgement; psychological
conditions such as depression and euphoria; and
As the neurocognitive symptoms intensify, people with psychomotor problems with coordination, rapid
Alzheimer’s disease show less and less awareness of their involuntary eye movement, or slurred speech. It would
limitations. They may withdraw from others during the therefore be very important for a clinician to accurately
late stages of the disorder, become more confused about distinguish between the two disorders, to be able to
time and place, wander, and show very poor judgment. design an effective treatment plan for an elderly person.
Eventually they become fully dependent on other people.

14
DEFINITIONS
Delusions - classified as positive symptoms of Anhedonia - an affective manifestation of schizophrenia
schizophrenia, and defined as ideas that a person may or depression that may manifest as a loss of interest
believe wholeheartedly, but that have no basis in fact. in or a lessening of the experience of pleasure. Those
• The quantity, range and effect of the delusion may who experience Anhedonia typically lose interest in
vary per person; some may feel empowered by it, recreational activities and social relationships, or have
while others may be left in a state of confusion. a decreased ability to experience tactile pleasure from
physical sensations, such as taste and touch.
• Others may hold a single delusion that dominates
their lives and behavior, while others may subscribe to Two types of pleasure experiences in the anhedonia
multiple delusional beliefs. construct:

The four most common delusions which may be present in 1. Consummatory pleasure - refers to the amount
a schizophrenia are: of pleasure experienced in-the-moment or in the
presence of something pleasurable. For example, The
1. Delusions of persecution - the affected individual amount of pleasure you experience as you are eating
believes that they are being plotted or discriminated your favorite meal.
against, spied on, slandered, threatened, attacked, or
deliberately victimized; 2. Anticipatory pleasure - refers to the pleasure amount
you experience in expectation or anticipation of
2. Delusions of reference - the individual attaches special future events or activities. For example, the amount of
meaning to the actions of others or to various objects pleasure you expect to receive from going to the bar
or events; after a hard day at work.
3. Delusions of grandeur - individuals believe themselves
to possess superior qualities such as genius, fame, Thought Disorder - manifests itself in a number of
omnipotence, or wealth; speech-related ways which involves the tendency to say
things that don’t make sense.
4. Delusions of control - they believe that their feelings,
thoughts and actions are being controlled by other 1. Derailment - speech may be disorganized by loose
people. associations, in which the person rapidly shifts from
one topic to another, believing that their incoherent
Hallucinations - the experiencing of sights, sounds, statements make sense. For example, a single, perhaps
smells, and other perceptions that occur in the absence unimportant word in one sentence becomes the focus
of external stimuli. Also present in people with depressed of the next.
moods, but most prevalent in cases of schizophrenia. 2. Neologisms - made-up words that typically have
1. Auditory hallucinations - patients hear sounds and meaning only to the person using them.
voices that seem to come from outside their heads. The 3. Perseveration - in which they repeat their words and
voices may talk directly to the hallucinator, perhaps statements again and again.
giving commands or warning of dangers, or they may
be experienced as overheard voices. 4. Clang - or rhyme, to think or express themselves. For
example, in response to the question of how he is
2. Tactile hallucinations - may take the form of tingling, feeling, a patient may reply, “Well, hell, it’s well to tell.”
burning, or electric-shock sensations.
3. Somatic hallucinations - they feel as if something is Depersonalization/derealization disorder - the person’s
happening inside their body, such as a snake or bug perception of the self or surroundings is disconcertingly
crawling inside their stomach. and disruptively altered.

4. Visual hallucinations - produce vague perceptions of 1. Depersonalization - People rather suddenly lose their
colors or clouds or distinct visions of people or objects. sense of self. This involves unusual sensory experiences,
where their limbs may seem drastically changed in size
5. Gustatory hallucinations - people with regularly find or their voices may sound strange to them. They may
that their food or drink tastes strange. have the impression that they are outside their bodies,
6. Olfactory hallucinations - people smell odors that no viewing themselves from a distance. Sometimes they
one else does, such as the smell of poison or smoke. feel mechanical, as though they are robots.
15
2. Derealization - Characterized by the persistent or complete, although it takes varying amounts of time.
recurrent feeling that the external world has become After recovery, people are fully able to remember the
unreal or strange. details of their life and experiences, except for those
events that took place during the fugue.
Amnesia - the partial or complete loss of recall for
particular events or for a particular period of time. Can Affect - the pattern of observable behaviors, such as facial
occur after a person has experienced some severe stress, expression, voice pitch, and hand and body movements,
such as marital discord, personal rejection, financial or that are associated with subjective states of feeling such
occupational difficulties, war service, or a natural disaster, as sadness, happiness, and anger. The manifestation of
but not all amnesias seem to immediately follow trauma. emotions.
1. Dissociative Amnesia - inability to recall important 1. Appropriate or ideal affect – the full range of normal
autobiographical information that 1) should be emotional states that a person ideally wants to feel.
successfully stored in memory and 2) ordinarily would 2. Inappropriate affect - emotions that are unsuited to
be readily remembered. the situation. For example, someone may smile when
2. Localized Amnesia - a person loses all memory of making a somber statement or on being told terrible
events that took place within a limited period of time, news, or they may become upset in situations that
almost always beginning with some very disturbing should make them happy.
occurrence. For example a soldier may awaken a week 3. Blunted affect - refers to a reduction in outward
after a horrific combat battle and be unable to recall expression of emotion. The person may stare vacantly,
the battle or any of the events surrounding it. He may the eyes lifeless. They are neither happy nor sad,
remember everything that happened up to the battle, and they appear to be completely indifferent to
and may recall everything that has occurred over the their surroundings. The faces of blunted patients are
past several days, but the events in between remain a apathetic and expressionless. When spoken to, the
total blank. person may answer in a flat and toneless voice and
3. Selective or Systematized Amnesia, the second most not look at his or her conversational partner. Events in
common form of dissociative amnesia, remember their environment hold little consequence for them,
some, but not all, events that took place during a and they may demonstrate a complete lack of concern
period of time. For example, the combat soldier might for themselves and for others.
remember certain interactions or conversations that 4. Flat affect – Refers to a lack of emotions at all. The
occurred during the battle, but not more disturbing faces of people with flat affect are still, with poor eye
events such as the death of a friend or the screams of contact, and monotonous voice.
enemy soldiers.
4. Generalized Amnesia, the loss of memory extends Disorientation - the inability to identify oneself and/or
back to times long before the upsetting period. For the current time, place, or situation.
example, in addition to forgetting battle-linked events, Cyclothymic disorder - A disorder marked by numerous
the soldier may not remember events that occurred periods of hypomanic symptoms and mild depressive
earlier in his life, and in extreme cases, might not even symptoms. The symptoms of this milder form of bipolar
recognize relatives and friends. disorder continue for two or more years, interrupted
5. Continuous Amnesia - forgetting continues into the occasionally by normal moods that may last for only days
present. For example, the soldier might forget new or weeks.
and ongoing experiences as well as what happened
before and during the battle.
6. Dissociative Fugue - memory loss is more extensive,
with the person not only becoming totally amnesic
but suddenly leaving home and work and assuming
a new identity, establishing a new home and job in
a new location, and even a new set of personality
characteristics. The person may even succeed in
establishing a fairly complex social life. More often
than not, the fugue is of relatively brief duration,
and as in other forms of amnesia, recovery is usually

16
©2015 Trevor A. Charles