Psychological Disorders

OUTLINE OF RESOURCES

Introducing Psychological Disorders Lecture/Discussion Topic: Using Case Studies to Teach Psyhological Disorders (p. 917) Student Project: Diagnosing a “Star” (p. 918) Feature Films and TV: Introducing Psychological Disorders (p. 917) Perspectives on Psychological Disorders Defining Psychological Disorders Lecture/Discussion Topic/Lecture Break: The Self-Diagnosis Phenomenon (p. 918) NEW Classroom Exercises: Introducing Psychological Disorders (p. 919) Defining Psychological Disorder (p. 920) Student Project: Encounters With a “Mentally Ill” Person (p. 920) Student Projects/Classroom Exercises: Adult ADHD Screening Test (p. 920) Normality and the Sexes (p. 921) Worth Video Anthology: ADHD and the Family* Understanding Psychological Disorders Lecture/Discussion Topics: Tourette Syndrome (p. 921) UPDATED Culture-Bound Disorders (p. 922) Classroom Exercise: Multiple Causation (p. 922) Classifying Psychological Disorders Lecture/Discussion Topic: Mental Health as Flourishing (p. 924) Lecture/Discussion Topic/Lecture Break: Revising the DSM (p. 923) NEW Classroom Exercise: The Flourishing Scale (p. 925) NEW Worth Video Anthology: Gender Identity Disorder* PsychSim 5: Mystery Client (p. 925) (or could be used at the end of the psychological disorders discussion) Labeling Psychological Disorders Classroom Exercise: The Effects of Labeling (p. 925) Feature Film: In Cold Blood (p. 925) Worth Video Anthology: Postpartum Psychosis: The Case of Andrea Yates* Anxiety Disorders Classroom Exercise: Penn State Worry Questionnaire (p. 926) Worth Video Anthology: Anxiety Disorders* NEW Three Anxiety Disorders* Experiencing Anxiety* *Titles in the Worth Video Anthology are not described within the core resource unit. They are listed, with running times, in the Lecture Guides and described in detail in their Faculty Guide, which is available at www.worthpublishers.com/mediaroom. 915 916 Psychological Disorders

Generalized Anxiety Disorder Classroom Exercise: Taylor Manifest Anxiety Scale (p. 926) Panic Disorder Phobias Lecture/Discussion Topic: Discovery Health Channel Phobia Study (p. 927) Classroom Exercises: Fear Survey (p. 927) Social Phobia (p. 928) Obsessive-Compulsive Disorder Lecture/Discussion Topic: Obsessive Thoughts (p. 929) Classroom Exercise: Obsessive-Compulsive Disorder (p. 928) Feature Film: As Good As It Gets and OCD (p. 928) Worth Video Anthology: Obessive-Compulsive Disorder: A Young Mother’s Struggle* Those Who Hoard* Post-Traumatic Stress Disorder Lecture/Discussion Topic: Concentration Camp Survival (p. 930) Classroom Exercise: The Posttraumatic Cognitions Inventory (PTCI) (p. 930) Worth Video Anthology: Post-Traumatic Stress Disorder: A Vietnam Combat Veteran* PTSD: Returning from Iraq* Understanding Anxiety Disorders Worth Video Anthology: Fear, PTSD, and the Brain* Mood Disorders Major Depressive Disorder Classroom Exercises: Depression Scales (p. 931) The Automatic Thoughts Questionnaire (p. 932) Depression and Memory (p. 932) Loneliness (p. 932) Worth Video Anthology: Depression* Bipolar Disorder Lecture/Discussion Topic: Bipolar Disorder (p. 933) Understanding Mood Disorders Lecture/Discussion Topics: The Sadder-but-Wiser Effect (p. 934) Cognitive Errors in Depression (p. 934) Commitment to the Common Good (p. 938) Classroom Exercises: Attributions for an Overdrawn Checking Account (p. 935) The Body Investment Scale and Self-Mutilation (p. 936) Understanding Suicide (p. 936) The Expanded Revised Facts on Suicide Quiz (p. 937) Worth Video Anthology: Mood Disorders* Suicide: Case of the “3-Star” Chef* Schizophrenia Symptoms of Schizophrenia Classroom Exercise: Magical Ideation Scale (p. 939) Lecture/Discussion Topic: Infantile Autism (p. 940) Student Project: The Eden Express and Schizophrenia (p. 939) PsychSim 5: Losing Touch With Reality (p. 939) Worth Video Anthology:Schizophrenia* NEW Schizophrenia: Symptoms NEW John Nash: “A Beautiful Mind”* Understanding Schizophrenia Worth Video Anthology: The Schizophrenic Brain* Psychological Disorders 917

Other Disorders Lecture/Discussion Topics: Factitious Disorder (p. 941) Sensory Processing Disorder (p. 941) NEW Dissociative Disorders Classroom Exercise: The Curious Experiences Inventory (p. 941) Lecture/Discussion Topics: Psychogenic Versus Organic Amnesia (p. 942) The Dissociative Disorders Interview Schedule and Dissociative Identity Disorder (p. 942) Worth Video Anthology: Multiple Personality Disorder* Eating Disorders Classroom Exercise: Assessing Body Image (p. 942) Motivations-to-Eat Scale (p. 942) Worth Video Anthology: Beyond Perfection: Female Body Dysmorphic Disorder* Purging Food* Self-Image: Body Dissatisfaction Among Teenage Girls* Overcoming Anorexia Nervosa* Personality Disorders Lecture/Discussion Topic: Narcissistic Personality Disorder (p. 943) Classroom Exercises: Schizotypal Personality Questionnaire (p. 943) Antisocial Personality Disorder (p. 944) Worth Video Anthology: Trichotillomania: Pulling Out One’s Hair* The Mind of the Psychopath* Rates of Psychological Disorders Lecture/Discussion Topic: The Commonality of Psychological Disorders (p. 944) RESOURCES Feature Films and TV: Introducing Psychological Disorders Introducing Psychological Disorders Psychological disorders are frequently depicted in Lecture/Discussion Topic: Using Case Studies to Teach novels, short stories, television programs, and popular Psychological Disorders films. Amy Badura recommends several specific movie You can effectively teach psychological disorders using clips for introducing and stimulating student interest a case study approach. Robert L. Spitzer’s DSM-IV-TR in the topic. All are very brief and illustrate different Casebook provides an extremely useful resource for classes of disorders. examples of all the major disorders. Each case is brief Before showing the clips you might ask students and is followed by a discussion of the DSM-IV-TR to watch with the following questions in mind: Where diagnostic issues raised. You can use them to introduce should we draw the line between normality and abnor- each major category of disorder. Alternatively, after mality? How should we define psychological disorders? students have read the text, the cases can be presented How should we understand disorders—as sicknesses as puzzles to solve, either to your class as a whole or that need to be diagnosed and cured or as natural in small groups. The American Psychiatric Association responses to a troubling environment? After show- is currently revising the DSM-IV-TR and will publish ing the clips and eliciting student responses, highlight the DSM-5 in 2013. The DSM-5 will include major the text definition. Many mental health workers label changes to the chapter structure for the diagnostic cat- behavior as disordered when they judge it to be devi- egories in the DSM; some chapters have been deleted ant, distressful, and dysfunctional. You may also want with the content distributed across other chapters. You to identify the specific disorders illustrated by the clips can see a list of the most recent changes on the website or wait until you discuss each disorder more fully. Here for the DSM-5 Task Force at www.dsm5.org/Pages/ are the films, scenes, specific disorders, and running RecentUpdates.aspx. times (from appearance of the production company’s full name to the start of the clip): Spitzer, R. L. (Ed.). (2002). DSM-IV-TR casebook: A learning companion to the Diagnostic and Statistical 1. Con Air: voice-over introduction to John Manual of Mental Disorders (4th ed.). Arlington, VA: Malkovich’s character as he enters the airplane: American Psychiatric Publishing. antisocial personality disorder (0:15:16–0:15:57) 918 Psychological Disorders

2. The English Patient: Juliette Binoche rides in a that reflect one of the specific disorders covered in the caravan with her patient, her best friend’s jeep text and some discussion of possible causes and treat- hits a landmine, her reaction: acute stress disorder ment recommendations. Encourage students to use (0:10:45–0:14:52) magazines, books, Internet sites, and even television 3. As Good As It Gets: Jack Nicholson visits Greg interviews for making their case. It is important that Kinnear’s apartment and finds him upset: major their report be consistent with existing evidence about depressive disorder (0:58:14–1:00:41) (See page the person’s behavior and symptoms. 928 for another use of this film.) Johnson, W. B. (2004). Diagnosing the stars: A tech- 4. Primal Fear: Jailhouse interview in which Ed nique for teaching diagnosis in abnormal psychology. Norton displays personality switch for his attorney: Teaching of Psychology, 31, 275–277. dissociative identity disorder (1:12:00–1:15:41) 5. Copy Cat: Sigourney Weaver retrieves a newspaper Perspectives on Psychological Disorders from her apartment hallway: panic disorder with agoraphobia (0:19:11–0:20:39) Defining Psychological Disorders Television programs also provide a ready source Lecture/Discussion Topic/Lecture Break: The Self- of material for classroom presentation and student Diagnosis Phenomenon projects. You might have your students (individually Before defining psychological disorders for your stu- or in small groups) identify examples from popular TV dents, you will probably want to make some of the fol- shows. For example, the popular, Emmy-winning com- lowing points. You can use these points as the basis for edy Monk provides a good example of OCD (although small-group discussions or lecture break topics, or you the series ended in 2009, past seasons are available on can create out-of-class assignments in which students DVD). expand on the basic points. For more on the use of contemporary film in teach- 1. It is common for students who are studying psy- ing psychological disorders, see Danny Wedding, Mary chological disorders to begin to wonder about their Ann Boyd, and Ryan Niemiec’s Movies and Mental incidence among friends and families (or them- Illness: Using Films to Understand Psychopathology selves)! Although they are just beginning to learn 2nd ed. (2005, Hogrefe). about mental disorders, they often overconfidently Wedding, Boyd, and Niemiec have also authored “diagnose” the disorders in others or themselves; a 75-page resource guide titled Films Illustrating this can lead to some degree of distress, conflict, Psychopathology. The guide provides brief descrip- and anxiety among your students, their friends, tions of hundreds of films that can be used to illustrate and/or their family members. various psychological disorders. The films (each rated This phenomenon is not limited to psychology on a 5-point scale) are classified according to major students. It has been documented in the literature category (e.g., anxiety disorders, mood disorders, on medical student education and is known by a substance-related disorders). This very helpful guide few different names (e.g., “medical students’ dis- can be found at the Office of Teaching Resources in ease,” “nosophobia,” “health anxiety,” “medical Psychology (sponsored by the Society for the Teaching student syndrome,” or “medical student disorder”; of Psychology). See http://teachpsych.org/otrp/ resourc- see Thakur & Preunca, 2008). es/dw08film.pdf. It is a good idea to discuss this phenomenon Badura, A. S. (2002). Capturing students’ attention: prior to lecturing on the topic of psychopatholo- Movie clips set the stage for learning in abnormal psy- gies. You may also want to review some of the chology. Teaching of Psychology, 29, 58–60. psychological reasons why students might begin to recognize symptoms of the disorders they are Student Project: Diagnosing a “Star” studying in themselves and others, or why they W. Brad Johnson describes a well-received student may be very confident in their “diagnoses.” You project that he has used for his abnormal psychology can discuss the confirmation bias, overconfidence, course; it can readily be adapted to the introductory self-serving bias, the availability heuristic, and course either as an individual or small-group project. It other sources of bias in our self- and other- provides an excellent opportunity for students “to think perceptions. You might also consider asking your like a psychologist” about psychological disorders. The students to generate suggestions on how to combat assignment is for students to select any “star” or famous this problem by drawing on what they have learned person (a musician, movie star, politician, historical all semester from scientific psychology. figure, or criminal) who they believe has a clinical dis- Thakur, N., & Preunca, B. (2008). Nosophobia presented order. Students should prepare an oral or written report as acute hypochondria. Timisoara Medical Journal, on that person, including the identification of symptoms 56(2), 120. Psychological Disorders 919

2. In addition to the diagnostic criteria for specific f. “More days than not” is an informal standard psychopathologies, professionals look for the pres- used by professionals to establish whether a reli- ence of the “4 Ds” within an individual’s experi- able pattern of problematic thoughts, emotions, ences in order to consider that person “abnormal.” or behaviors exists. Over some period (e.g., two Three of these—deviant, distressful, and dysfunc- weeks or two months), the number of days dur- tional—are the criteria applied by the text. Ronald ing which an individual displays symptoms is Comer (2005) also includes dangerous. None of counted or estimated. In psychopathology, the the Ds, in and of itself, is sufficient in its presence number of symptom-present days will exceed to make a diagnosis without the presence of the the number of symptom-absent days. others. It is also useful to know whether there is a Comer, R. J. (2010). Fundamentals of abnormal good justification or rational explanation for the set psychology (7th ed.). New York: Worth. of symptoms a person is experiencing, and whether the symptoms occur on “more days than not.” Use Classroom Exercise: Introducing Psychological the following definitions to expand on your Disorders discussion. Steven M. Davis provides an effective exercise for a. Deviance refers to a set of recurring behaviors, introducing psychological disorders. Davis notes that, thoughts, or emotions that deviate from the nor- although the concept of “mental” or psychological dis- mative expectations of a society or are deemed order is familiar to students, their beliefs about what unacceptable. However, eccentricity (or “being constitutes a disorder are unexamined and may even be strange”) cannot be the sole basis for diagnosis contradictory. Handout 1 (which Davis reports adapt- for a psychological abnormality. ing from a similar exercise designed by John Suler) challenges students to define psychological disorder, b. Distress refers to negative feelings that an as well as confront any inconsistencies in their beliefs. individual may have toward him- or herself, or The handout also serves to raise important political, toward others. There is an overarching theme cultural, and social issues concerning the definition of that things are not well. psychological disorders. c. Dysfunction describes the degree to which Before students have read the text definition of the individual displays maladaptive patterns psychological disorder, have them read through the of behavior, thought, or emotions. These pat- case studies quickly and decide whether the person terns interfere with his or her ability to func- has a “psychological disorder.” Then organize students tion normally in important daily activities like into groups of four or five, and instruct each group to work, school, social relationships, and personal pretend that they are a committee that is advising the hygiene or health status. Within the disorder, American Psychiatric Association on the writing of the maladaptive behaviors or thoughts may achieve DSM-5. They are to decide whether each case should a specific end, but they are ultimately harmful to be included as a psychological disorder in the DSM-5. successful daily living. They are to try to reach agreement and, most important, to keep track of the criteria they use for including or d. Danger to self or others is another feature. For excluding each case. example, consider the behavior known as “cut- After about 25 minutes, reconvene the entire class ting,” in which individuals literally injure them- and consider each case in turn. Write on the chalkboard selves (cutting into their own skin) when they the criteria that each group identified for including or experience anxiety, flooding, or other strong excluding each case. Note consistencies as well as con- emotion. Such behaviors are often described as tradictions between the small groups. Finally, introduce alleviating tension for the sufferer, which may the text definition of psychological disorder. positively reinforce the behaviors to continue Davis notes that this activity provides numerous or increase in frequency over time. Although learning opportunities for students. For example, stu- the cutting behaviors serve a palliative role for dents are often surprised to discover inconsistencies in the sufferer, they are, in the end, injurious and how they define psychological disorders and are also harmful to him or her. surprised at the arbitrariness inherent in any “official” e. Justification centers on the context for a set of definition. Sometimes, students discover that they want behaviors, thoughts, or emotions. Can a good to exclude all cases that have a clear biological etiol- reason for the pattern be identified? Consider ogy, as well as all cases that have a clear environmental how cultural and religious values may provide origin—which theoretically leaves very few examples different contexts or rationales for the same of psychological disorders. Issues surrounding stigma, kinds of behaviors. labeling, the medical model, cultural relativism, and person-environment fit are also likely to arise. 920 Psychological Disorders

Davis, S. M. (2003, January). Utilizing contradictions chronic mental patients were institutionalized, it is now in students’ implicit definitions of “mental disorder” in much more likely that students will have encountered an introductory psychology course. Poster presented at a person with a chronic mental disorder in the super- the 25th Annual National Institute on the Teaching of market, at the shopping mall, on the bus, or on the Psychology, St. Petersburg, FL, January 2003. street corner. Ask your students to recall one incident in which they have personally encountered a “mentally Classroom Exercise: Defining Psychological Disorder ill” person. Ask them to reflect on what happened, then As a simple alternative to the previous exercise, have write down the details of that encounter. What made students form small groups of four or five and come up them decide the person was mentally ill? Also ask them with a definition for “psychological disorder.” Instruct to indicate whether they felt comfortable or uncomfort- them to be specific, identifying the criteria they would able, whether the person’s behavior seemed predictable apply in drawing the line between normality and abnor- or unpredictable, and whether the person seemed dan- mality. After 20 to 30 minutes, have each group report gerous or nondangerous. its definition to the class. Inadequacies are certain to be It may also be worth asking where the encoun- pointed out, and the rest of the session can be spent in ter occurred, whether other people were present, considering the difficulty of satisfactorily defining the and whether the mentally disordered person actually term. The text indicates that behavior is considered approached or spoke to them. Collect the accounts and disordered when it is deviant, distressful, and tabulate the number of students who found the encoun- dysfunctional. ters to be uncomfortable, unpredictable, and dangerous. In highlighting each of these criteria, Larry Bates As the Sarasons note, research on public attitudes has makes some important observations. First, what is shown that most people feel uncomfortable with the considered deviant depends on the context or cultural mentally ill and find their behavior to be both unpre- setting. For example, should someone speak in an unfa- dictable and dangerous. Did the students react that miliar language while standing, dancing, and finally way? Did they observe similar reactions in others? If fainting in front of class, the behavior might be consid- not, how might the setting, the presence or absence of ered deviant (Bates suggests that should it occur in his other people, and the actions of the psychologically dis- class, he would probably call an ambulance!). Yet for ordered person change one or more of their reactions? some religious groups, such behavior is considered nor- Use the students’ descriptions to define “psycho- mal, even laudatory. logical disorder.” The students’ examples will illustrate In some cases, deviance may be extremely difficult how behavior is considered psychologically disordered to detect. Some people seem fine on the outside—smil- when it is deviant, distressful, and dysfunctional. ing, joking, performing their work well each day, and Sarason, I., & Sarason, B. (2005). Abnormal psychology putting their kids to bed every night. Unknown to us, (11th ed.). Upper Saddle River, NJ: Prentice Hall. however, they may cry themselves to sleep because they no longer find life enjoyable or meaningful. When Student Project/Classroom Exercise: Adult ADHD they engage in the activities that once brought pleasure, Screening Test they feel nothing. In such cases, internal distress more clearly characterizes the psychological disorder. Handout 2, designed by the World Health Organization, Finally, almost all disorders have a threshold they can be used to help respondents recognize the signs of must cross that meets the requirements of a psychologi- adult attention-deficit hyperactivity disorder (ADHD). cal disorder. If a person is terrified of flying but has no The questionnaire is not meant to replace consultation real reason to fly, the fear is probably not considered a with a trained professional—obviously, an accurate psychological disorder. Only when this fear interferes diagnosis can be made only through clinical evalu- with the person’s daily life—for example, if he or she ation—but respondents who checked “sometimes,” is promoted to regional manager and must travel—is it “often,” or “very often” four or more times may want considered dysfunctional and thus a psychological to talk with a psychologist about being evaluated for disorder. ADHD. Researchers estimate that as many as 4 to 5 per- Bates, L. (2007, January 3). Abnormal/atypical. Message cent of U.S. adults have ADHD, but perhaps only 20 posted to PSYCHTEACHER@ list.kennesaw.edu. percent of them are aware of it. Although ADHD was once considered to be only a childhood disorder that Student Project: Encounters With a “Mentally Ill” was outgrown, researchers now believe that between 35 Person and 60 percent of children with ADHD continue having Irwin and Barbara Sarason suggest an exercise you symptoms in adulthood. Some people who did not have might use to introduce the topic of psychological dis- symptoms as children in school have difficulty multi- orders. As compared with 30 years ago, when most tasking in adulthood. Furthermore, because awareness Psychological Disorders 921 of the disorder is relatively recent, some adults now in Szegedy-Maszak, M. (2004, April 26). Driven to distrac- their thirties and forties may have had the disorder as tion. U.S. News & World Report, 53–62. children but their symptoms were not recognized. Weaver, J. (2004, September 9). Are you an adult with ADHD tends to run in families. Psychiatrist Lenard ADHD? Message posted at http://msnbc.msc.com/ Adler of New York University suggests that if a child id/5889089. is diagnosed with ADHD, there is a 40 percent chance that one parent has it as well. Factors such as exposure Student Project/Classroom Exercise: Normality and the to alcohol and tobacco in pregnancy are also linked Sexes with the condition. Although boys are more likely than In 1970, Inge Broverman and her associates found that girls to be diagnosed with the disorder, adult ADHD mental health professionals (psychiatrists, psycholo- affects men and women equally. Some hypothesize that gists, and social workers) viewed the mature, healthy girls are less likely to be disruptive in the classroom, man differently from the mature, healthy woman. For and thus teachers may be more likely to overlook it. example, the healthy man was more likely to be viewed Adults with the disorder are easily distracted, fre- as ambitious, adventurous, self-confident, logical, and quently forget appointments, and constantly lose things. independent, while the healthy woman was viewed as They may fidget, talk excessively, and feel an internal tactful, aware of others’ feelings, gentle, expressive of restlessness. Other symptoms include a failure to fol- tender feelings, and in need of security. The research- low through on instructions or finish a task, difficulty ers further found that the characteristics they linked to organizing, and an inability to attend to details. “One a healthy adult person more closely resembled those of of the tell-tale signs is when someone has a hard time the healthy man than those of the healthy woman. staying in the conversation with you without interrupt- As either a student project or a classroom exercise,­ ing,” states Carol Gignoux, a Boston-based executive have both male and female students complete Handout coach who specializes in working with people who 3. Collect and tabulate the data. (Items, 1, 3, 6, 7, and have ADHD. 9 were more likely to be attributed to the healthy man Adults with ADHD sometimes become worka- in Broverman’s study; items 2, 4, 5, 8, and 10, to the holics, using deadlines as the motivation to complete healthy woman.) complex projects. The structure and routine of work Discuss the results in class. Do the earlier results becomes easier to deal with than their free time. still hold for students in the 2000s? Has sensitivity to However, ADHD can interfere with job performance as the problem of sexism eliminated the double standard well as with interpersonal relationships. Those with the for normality,­ or does it still exist? Is the view of a disorder are more likely to divorce, engage in substance healthy adult person still closer to the male than to the abuse, and have more driving accidents. They are also female ideal? If so, what does it mean for women who more likely to suffer other psychological disorders, are taught that by being normal, competent people, they including depression. are not normal? ADHD raises fundamental questions about the In fairness to mental health professionals, we nature and definition of psychological disorder. Like should note that research suggests that they evaluate most disorders, attention disorder has a “spectrum diag- and treat men and women similarly. Sex-role stereo- nosis” with widely varying symptoms. Is the problem types may have weakened, or they may become irrel- with attention really disabling or within the parameters evant when clinicians are confronted with a particular of being normal? “Where does the disorder begin?” individual. asks Russell Barkley at the Medical University of South Carolina. “It begins where impairment begins. You Broverman, I. K., Broverman, D. M., Clarkson, R. E., Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex role ste- may have a high degree of ADD symptoms, but it just reotypes and clinical judgments of mental health. Journal means you have a sparkling personality because there is of Consulting and Clinical Psychology, 34, 1–7. no impairment.” The U.S. Food and Drug Administration (FDA) Understanding Psychological Disorders has approved adult use of drugs such as Adderall, a stimulant similar to Ritalin, which is widely prescribed Lecture/Discussion Topic: Tourette Syndrome to children diagnosed with the condition. The FDA has A discussion of Tourette syndrome may give students a also approved Straterra, the first nonstimulant medica- clearer picture of the different perspectives on psycho- tion for adults with the disorder. The success rate for logical disorders. Symptoms of this unusual disorder treatment is considered very good, especially when cou- include involuntary twitching—facial grimacing, head pled with coaching that provides organizing strategies. jerking, finger snapping, whirling, hopping—and the Rubin, R. (2003, December 3). ADHD focuses on adults. making of unusual sounds—hooting, barking, screech- USA Today, pp. 1D–2D. ing, grunting, even cursing uncontrollably. It is esti- mated that about 100,000 Americans suffer from the 922 Psychological Disorders more severe symptoms of Tourette syndrome and that 3 lines of research highlight the role that environmental million others may have a milder form of the disorder. factors may play in the expression of Tourette. The first symptom may appear by age 7 and can be as Currently, NIH-funded researchers are conducting insignificant as repeated eye-blinking or clearing of several large-scale genetic studies. A research team led the throat. In a few instances, the person may simply by Matthew State, an associate professor in the Child echo another’s words. The movements and words seem Study Center and in the departments of psychiatry and to have no purpose or meaning. Although victims are genetics at Yale University and co-director of the Yale unable to overcome the symptoms, many can temporar- Program on Neurogenetics, has been studying one fam- ily suppress them, sometimes for hours. ily in which the father has Tourette and OCD, all eight Tourette syndrome was originally thought to be children have Tourette, and two also have OCD. A the work of the devil. Exorcism was the only cure. gene, called HDC, is needed for producing histamine, Psychoanalytic theorists have provided a variety of a small molecule with many roles in the body, includ- explanations for the disorder—from a defense against ing signaling in the brain. Dr. State and his team found thumb-sucking to repressed aggression. It has now that all of the affected family members share a mutation become clear that Tourette syndrome has physical in the HDC gene, which encodes an enzyme needed to causes. Many believe the disorder is hereditary. The produce histamine. The mutation reduces the activity of most conclusive evidence comes from a study of the enzyme. Mennonite farmers in Alberta, Canada, in which 54 of Other promising research involves neuroimaging, the 136 family members have the syndrome or at least neuropathology, and clinical trials, all providing impor- some of the minor symptoms, such as facial twitches tant information about this difficult disorder. and humming. A dominant gene has been implicated, Dingfelder, S. (2006). Nix the tics. Monitor on although Tourette’s symptoms do not appear in every- Psychology, 37, 18. one who inherits it. Virtually all men who have the Himle, M. B., & Woods, D. G. (2005). An experimental gene show at least minor symptoms, but only two-thirds evaluation of tic suppression and the tic rebound effect. of the women do. Moreover, women who display its Behavior Research and Therapy, 43, 1443–1451. symptoms tend to show more obsessive-compulsive Miltenberger, R.G. (2005). Habit Reversal. In A. Gross traits, for example, touching every lightpost on the & R. Drabman (Eds.), Encyclopedia of behavior modifi- street. Both dopamine, which helps control movement, cation and cognitive behavior therapy, Vol.II (pp. 873- and norepinephrine, which helps the body respond to 877). Thousand Oaks, CA: Sage. stress, seem to be involved in Tourette syndrome. A National Institute of Neurological Disorders and satisfactory treatment has yet to be found. The antipsy- Stroke. (2010, September 14). Abnormalities in brain chotic haloperidol is effective in about three-quarters of histamine may be key factor in Tourette syndrome. all cases but often with adverse side effects, including Retrieved September 29, 2011, from www.ninds.nih. depression and, paradoxically, violent muscle spasms. gov/news_and_events/news_articles/Abnormalities%20 Another antipsychotic medication, risperidone, and the in%20Brain%20Histamine%20may%20be%20Key%20 blood pressure medication clonidine also significantly Factor%20in%20Tourette%20Syndrome.htm. reduce tics. Side effects include weight gain, fatigue, Seligman, M., Walker, E., & Rosenhan, D. L. (2001). and dry mouth. Abnormal psychology (4th ed.). New York: Norton. Most researchers have not found behavioral inter- West, S. (1987, November/December). The devil’s disor- vention to be effective in the treatment of Tourette der. Hippocrates, 66–71. syndrome. For example, 55 percent of medical profes- Woods, D. W., Walther, M. R., Bauer, C. C., Kemp, J. sionals believe that the tics cannot be controlled, and J., & Conelea. C. A. (2009). The development of stimu- 77 percent believe that if they are suppressed, they lus control over tics: A potential explanation for con- will become even worse later. More recently, Douglas textually-based variability in the symptoms of Tourette Woods and his research team have challenged those syndrome. Behavior Research and Therapy, 47, 41–47. assumptions. Children between the ages of 8 and 11 were rewarded for every 10-second interval they did Classroom Exercise: Multiple Causation not exhibit a tic. The children significantly suppressed Today’s psychologists argue that all behavior arises their tics. They expressed a tic during 16 percent of from the interaction of nature and nurture. The biopsy- the 10-second intervals when they were rewarded as chosocial approach recognizes that psychological dis- opposed to 50 percent of the intervals at the begin- orders have multiple causes. Clearly, we ought to resist ning of the experiment. Another study conducted by the pervasive temptation to expect simple explanations. Raymond Miltenberger and his colleagues found no Handout 4 is Gregory Kimble’s classroom exercise rebound effect for tic suppression in five people with to demonstrate the problems caused when we use sim- Tourette syndrome, ranging in age from 7 to 20. Both ple explanations. In brief, it asks students whether they Psychological Disorders 923 can remember events in their lives that were painful repeating the words and actions of other people, utter- enough to bring on a mental breakdown. Most people ing obscenities, and acting the opposite of what other can. people ask. Give students 10 minutes or so to respond to the Koro is a pattern of anxiety found in Southeast scenario in Handout 4. (If you want to give them more Asian men. It involves the intense fear that one’s penis time and thus obtain more detailed responses, make it will withdraw into one’s abdomen, causing death. a homework assignment.) Also ask students to clearly Tradition holds that koro is caused by an imbalance of indicate at the end of their response whether you may “yin” and “yang,” two natural forces thought to be the share it with the rest of the class. Between class peri- fundamental components of life. In one form of treat- ods, review the responses and pick a few of the more ment, the individual keeps a firm hold on his penis poignant answers to share with the entire class. (often with the assistance of family members) until the Kimble suggests that everyone has a traumatic fear subsides. Another is to clamp the penis to a experience that can cause psychological disorder but wooden box. that not everyone succumbs. Such single episodes do Amok, a disorder found in the Philippines, Java, not qualify as causes of psychological disorders. Too and certain parts of Africa, occurs more often in men often, Kimble notes, we think that behavioral phe- than in women. Those suffering the affliction jump nomena are single entities that have single causes. The around violently, yell loudly, and attack objects and medical model of psychopathology falls into this trap. other people. These symptoms are often preceded by It promotes the myth that disorders are single maladies social withdrawal and a loss of contact with reality. The brought on by single causes such as a traumatic experi- outburst is often followed by depression, then amnesia ence. Although this perspective might be appropriate regarding the symptomatic behavior. Within the culture, for certain medical conditions, it typically does not it is thought that stress, shortage of sleep, alcohol con- apply to psychological disorders, which may be full- sumption, and extreme heat are the primary causes. blown or borderline and express an array of disposi- Winigo, the intense fear of being turned into a can- tions. Typically, psychological disorders involve faulty nibal by a supernatural monster, was once common knowledge, inappropriate feelings, and disordered among Algonquin Indian hunters. Depression, lack behavior. A single cause, suggests Kimble, of such of appetite, nausea, and sleeplessness were common multiple and varied symptoms is unlikely. symptoms. This disorder could be brought on by com- Kimble, G. (1996, August). Secondary school psychol- ing back from a hunting expedition empty-handed. ogy: The challenge and the hope. Paper presented at the Ashamed of his failure, the hunter might fall victim 104th Annual Convention of the American Psychological to deep and lingering depression. Some afflicted Association, Toronto. hunters actually did kill and eat members of their own households. Lecture/Discussion Topic: Culture-Bound Disorders Comer, R. J. (2010). Abnormal psychology (7th ed.). Evidence of environmental effects on psychological New York: Worth. disorder comes from links between culture and disor- der. Although some disorders such as schizophrenia and Classifying Psychological Disorders depression are worldwide, others are not. For example, anorexia nervosa and bulimia nervosa are disorders that Lecture/Discussion Topic/Lecture Break: Revising the occur mostly in Western cultures. On the other hand, DSM susto, marked by severe anxiety, restlessness, and a Efforts to revise the Diagnostic and Statistical Manual fear of black magic is a disorder found only in Latin of Mental Disorders (DSM) are in full swing by the America. You can expand on this disorder as well as American Psychiatric Association and its working com- other culture-bound disorders in class. mittees. The structure, content, and (in some cases) Susto is most likely to occur in infants and young definitions for mental disorders are all being revised children. In addition to anxiety and restlessness, the and reconsidered for the new edition. This work began disorder is often marked by depression, loss of weight, in earnest in 1999 and is still ongoing. Field trials are weakness, and rapid heartbeat. Those within the culture currently underway, and the anticipated publication date claim that the susto is caused by contact with super- for the new DSM-5 is sometime in 2013. natural beings or with frightening strangers, or even by Some of the changes to the DSM being proposed bad air from cemeteries. Treatment involves rubbing are substantial—for example: certain plants and animals against the skin. Latah occurs among uneducated middle-aged or • The APA no longer wishes to use roman numerals elderly women in Malaya. Unusual circumstances (such to denote edition. The new edition will be labeled as hearing someone say “snake” or even being tickled) the “DSM-5” instead of “DSM-V.” produce a fear response that is characterized by 924 Psychological Disorders

• Collapse Axes I, II, & III of DSM-IV: the DSM-5 An interesting argument for how DSM-5 revisions will include one axis to capture all psychiatric and may affect the criminal justice system: http://blog. general medical diagnoses. The decision to do this neulaw.org/?tag=temporary-insanity was made to bring the DSM into closer alignment with the World Health Organization’s International Lecture/Discussion Topic: Mental Health as Classification of Diseases. Flourishing Corey L. M. Keyes argues that mental health is not • Standardize the documentation of symptoms merely the absence of mental illness but the presence that are not specific to any one specific disorder of human flourishing. The key clusters and associated (e.g., malaise, fatigue, depressed mood) in an dimensions of human flourishing include the following: Assessment Instrument that labels a person’s pre- senting set of symptoms as “Level 1” (lowest risk) Positive emotions (or emotional well-being) or “Level 2” (further questioning warranted). Positive affect (regularly cheerful, interested in life, • Add new categories: addiction and related dis- in good spirits, happy, calm, peaceful, full of life) orders, autism spectrum disorders, binge eating Avowed quality of life (mostly or highly satisfied disorder (the criteria for the category “other eating with life overall) disorders” were revised), temper dysregulation with dysphoria, and others. Positive psychological functioning (or psychological • Place greater emphasis on gender, race, and ethnic- well-being) ity in the revision process to foster greater cultural Self-acceptance (holds positive attitudes toward sensitivity in diagnosis and treatment. self) Personal growth (seeks challenge, has insight If you need to brush up on the specifics of the pro- into own potential, feels a sense of continued cess used to revise the DSM, or want to dig deeper into development) the work conducted to reconsider specific diagnostic categories, you can check the APA’s press release web- Purpose in life (finds own life has direction and site. You can find here a collection of excellent sum- meaning) maries of the review process and the specific changes Environmental mastery (exercises ability to select, being recommended: www.dsm5.org/ Newsroom/Pages/ manage, and mold personal environs to suit needs) PressReleases. aspx. More detailed descriptions of the Autonomy (is guided by own, socially accepted, proposed revisions in specific categories can be found internal standards and values) at www.dsm5.org/Proposed Revisions/Pages/Default. Positive relations with others (has, or can form, aspx. warm, trusting interpersonal relationships) The revisions to the DSM have not been under- taken without controversy, of course. You and your stu- Positive social functioning (or social well-being) dents can get a good feel for the issues, the advocates Social acceptance (holds positive attitudes toward, for different positions on these issues, and how debate acknowledges, and is accepting of human has influenced the revision process by reading a number differences) of different blogs dedicated to the DSM-5 endeavor. Some good examples of discussions and blogs on spe- Social actualization (believes people, groups, and cific revision topics can be found at the following sites: society have potential and can evolve or grow positively) Jared DeFife’s review of the changes to the Social contribution (sees own daily activities val- section(s) on personality disorders: www.psycholo- ued by society and others) gytoday.com/ blog/the-shrink-tank/201002/dsm-v- offers-new-criteria-personality-disorders Social coherence (interested in society and social life and finds them meaningful and somewhat Addictive disease category: www.jointogether. org/ intelligible) news/features/2010/dsm-v-draft-includes-major. Social integration (a sense of belonging to, and html support from, a community) DSM revision petition: www.thepetitionsite.com/1/ According to Keyes, to be diagnosed as flourishing DSMrevisionpetition/ in life, a person must exhibit high levels on at least 1 of Wall Street Journal’s health blog about critics and the 2 measures of emotional well-being and high levels counter critics of the DSM revision process: http:// on at least 6 measures of the 11 measures of positive blogs.wsj.com/health/2009/01/08/psychiatrists- functioning. Interestingly, the prevalence of flourish- bash-back-at-critics-of-diagnostic-manual-revision/ ing is about 20 percent of the adult population. Keyes Psychological Disorders 925 suggests this low percentage highlights the need for Knowing the person was diagnosed as having schizo- a national program for mental health promotion that phrenia, the clinician “explained” the problem in the complements our long-standing efforts to prevent and following manner. treat mental illness. This white 39-year-old male . . . manifests a long his- The benefits of flourishing to individuals and soci- tory of considerable ambivalence in close relationships, ety are reflected in research findings that indicate that which begins in early childhood. A warm relationship completely mentally healthy adults miss the fewest with his mother cools during his adolescence. A distant days of work; have the lowest risk of cardiovascular relation­ship to his father is described as becoming very disease, the lowest number of chronic physical diseases, intense. Affective stability is absent. His attempts to con- and the fewest health limitations on activities of daily trol emotionality with his wife and children are punctu- living; and are the least likely to use health care ated by angry outbursts and, in the case of the children, services. spank­ings. And while he says that he has several good friends, one senses considerable ambivalence embedded Keyes et al. (2005) Mental illness and/or mental health? in those relationships also. Investigations axioms of the complete state model of To show how readily we can explain people’s per- health. Journal of Consulting and Clinical Psychology, sonalities in terms of an earlier sketch of their motives 73(3), Table 1, page 543. Copyright 2005. Adapted with permission by the American Psychological Association. and behavior, present the top half of Handout 5 to small groups in your class, and the bottom half to the PsychSim 5: Mystery Client remaining groups. The sketch of Tom W. is adapted This program is a review for those who have already from a description prepared by Daniel Kahneman and read the text chapter on psychological disorders. The Amos Tversky. Ask each group to read its answers to program includes six cases, one for each of the major the questions to the class. Regardless of which outcome diagnostic (DSM-IV-TR) categories mentioned in the they have been given, the groups will have no difficulty text. The student is to try to guess the category from the identifying psychological indicators that pointed to description. The program randomly selects the order of Tom’s present status. cases but keeps track of them within a session so that Kahneman, D., & Tversky, A. (1973). On the psychol- cases are not repeated. ogy of predictions. Psychological Review, 80, 237–251. Classroom Exercise: The Flourishing Scale The Emotion unit in these resources included Ed Feature Film: In Cold Blood Diener and Robert Biswas-Diener’s recently published In Cold Blood provides an excellent introduction to Flourishing Scale. If you did not use Handout 21 in that the insanity defense. Or, you might prefer to show the unit (p. 733) earlier, you may want to do so now. film when you discuss antisocial personality disorder. Based on Truman Capote’s bestseller, it relates the true Labeling Psychological Disorders story of the personalities and events surrounding the murder of the Herbert Clutter family. Perry Smith and Classroom Exercise: The Effects of Labeling Richard Hickock, two former prison inmates, travel to Once a diagnostic label is attached to someone, we Holcomb, Kansas, with the intent of robbing the Clutter come to see that person differently. Labels create farm. When they find no money, they systematically preconcep­tions that can bias our interpretations and shoot the four defenseless family members. memories. One result is that erroneous diagnoses can As Capote relates in his book, the defendants’ sometimes be self-confirming, because clinicians will attorneys entered an insanity plea, but under the search for evidence in a client’s life history and hospital M’Naghten rule (in criminal trials, an insanity defense behavior that is consistent with the diagnosis. David is valid only if the defendant is shown not to have Rosenhan, who conducted a controversial demonstra- known what he or she was doing or did not know right tion of the biasing power of diagnostic labels, gives the from wrong), Smith and Hickock were convicted and example of one pseudopatient who told the interviewer sentenced to hang. While Richard Hickock’s criminal that he conduct might be attributed to an earlier head injury, a had a close relationship with his mother but was rather psychiatrist testified that Hickock knew the difference remote from his father during his early childhood. between right and wrong. Tests to determine whether During adolescence and beyond, however, his father brain damage was in fact present were never conducted. became a close friend, while his relationship with his You might ask students if they think the insan- mother cooled. His present relationship with his wife ity plea is ever appropriate, and if so, what should be was characteristically close and warm. Apart from occa- the criteria. In the 1950s, the Durham rule replaced sional angry exchanges,­ friction was minimal. The chil- M’Naghten in some courts. The Durham rule states dren had rarely been spanked. that the “accused is not criminally responsible if his 926 Psychological Disorders unlawful act is the product of mental disease or defect.” was also associated with more maladaptive levels of David Bazelon, the presiding judge at the trial that first coping. applied this criterion, believed that use of the general Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, term “mental disease” would leave the profession of T. D. (1990). Development and validation of the Penn psychiatry free to apply its full knowledge. Forcing the State Worry Questionnaire. Behavior Research and jury to rely on expert but often conflicting testimony Therapy, 28, 487–495. has not proved workable, however, so the Durham rule is no longer used in most jurisdictions. Generalized Anxiety Disorder Other alternatives to the insanity defense have been proposed, and in some cases adopted. For example, Classroom Exercise: Taylor Manifest Anxiety Scale several states have adopted the verdict “guilty but men- Handout 7 is the Taylor Manifest Anxiety Scale, which tally ill.” While the person is held legally accountable attempts to assess level of anxiety. The average score for his action, his sentence involves psychotherapeutic for college students is about 14 or 15 answers that treatment in a hospital or in jail. Treatment may focus match the “true” answers below. An answer of “true” on helping the convict take responsibility for his or indicates anxiety related to that item. her own actions. Another proposal has been the plea of diminished capacity, or diminished responsibility, 1. F 18. F 35. T whereby a defendant may be tried for a lesser crime if 2. T 19. T 36. T there is reason to suspect psychological disorder. Its 3. F 20. F 37. T advantage is that it does not create a separate category 4. F 21. T 38. F of prisoners (or patients). Moreover, it recognizes that 5. T 22. T 39. T responsibility exists along a continuum, with some peo- 6. T 23. T 40. T ple more responsible than others for their actions. 7. T 24. T 41. T If you wish to discuss this later, the film provides 8. T 25. T 42. T much information about the personality and motives of 9. F 26. T 43. T Perry Smith. Through flashbacks, the viewer observes 10. T 27. T 44. T the role of early experience in the development of his 11. T 28. T 45. T aggressive behavior. After showing the film, you can 12. F 29. F 46. T discuss the possible factors that contribute to the antiso- 13. T 30. T 47. T cial personality. 14. T 31. T 48. T 15. F 32. F 49. T Anxiety Disorders 16. T 33. T 50. F 17. T 34. T Classroom Exercise: Penn State Worry Questionnaire Handout 6, the Penn State Worry Questionnaire Learning theorists have explained the develop- (PSWQ) designed by T. J. Meyer and his colleagues, ment of anxiety in terms of classical conditioning. provides a good introduction to the anxiety disorders. Rats given unpredictable shocks in the laboratory may In scoring the scale, respondents should reverse their become apprehensive whenever placed in the labora- responses to items 1, 3, 8, 10, and 11 (1 = 5, 2 = 4, tory environment; they may develop more specific 3 = 3, 4 = 2, 5 = 1), then add the numbers in front of phobias if a given object or activity is associated with all 16 items. Total scores can range from 16 to 80, shock. Researchers believe that a number of factors with higher scores reflecting a greater tendency to influence the conditioning process. Janet Taylor Spence worry. The mean score of 405 introductory psychology has focused on individual differences in emotional students was 48.8 (mean for women = 51.2, for men, responsiveness. She asked five clinical psychologists 46.1). to judge which items from the Minnesota Multiphasic The authors note that generalized anxiety disorder Person­ality Inventory indicate chronic anxiety. Those is primarily defined by chronic worry, and the pro- on which the psychologists agreed were put through an cess of worry is pervasive throughout all the anxiety item analysis, and the 50 surviving items constitute the disorders. Thus, identifying the nature and functions present Manifest Anxiety Scale. of worry should significantly contribute to our under­ Psychodynamic theorists, of course, have a very standing of anxiety and its disorders. In research on different view of anxiety. Freud saw it as a product of the scale, Meyer and his colleagues report that PSWQ unresolved conflict that occurs when defense mecha- scores were linked to lower self-esteem but higher nisms are weak. Karen Horney, a neo-Freudian, argues levels of perfectionism, time urgency, and self- that an inadequate self-concept is the basis for anxiety. handicapping. Worry as measured by the questionnaire We presumably­ construct an ego ideal that is designed Psychological Disorders 927 to gain the unconditional approval of our parents. This The greatest difference between men and women ideal self is too rigid and impossible to attain, so we was in the fear of being bound or tied up (women 27 consistently give ourselves a poor self-evaluation. Self- percent versus men 2 percent). Results also indicated censure follows, which is the worst form of anxiety for that we fear giving a speech (36 percent) more than it is the most difficult both to escape and to satisfy. meeting new people (12 percent), embarrassing our- Existential theorists have yet a different view of selves in a sport (44 percent) more than asking someone anxiety. They suggest that it is based in our growing for a date (35 percent), being stranded in the ocean (62 aware­ness that we exist and that we are responsible for percent) more than being stranded in the desert (24 the choices we make. The accompanying realization percent), and the IRS (57 percent) more than God (30 of nonexistence,­ or death, is particularly important in percent). The things we fear equally are rats and den- understanding the roots of anxiety. Our awareness of tists (58 percent), elevators and flying (52 percent), our inevitable death leads to deep concern over whether and public speaking and being alone in the woods (40 we are living a meaningful and fulfilling life. percent). While the pollsters found the level of fear in American society to be high, they also reported that few Napoli, V., Kilbride, J., & Tebbs, D. (1995). Adjustment seek treatment. Among those who say they have a pho- and growth in a changing world (5th ed.). St. Paul, MN: bia or extreme fear, only 11 percent indicated that they West Publishing. sought professional help. Panic Disorder Classroom Exercise: Fear Survey Phobias What do we fear? James Geer has developed­ a scale to measure fear. He asked 124 research participants to Lecture/Discussion Topic: Discovery Health Channel list their fears on an open-ended questionnaire. Fifty- Phobia Study one specific fears were mentioned two or more times; What do people fear? In August 2000, Discovery these were included in the survey in Handout 8. The Health Channel commissioned Penn, Schoen, & following 11 fears received the highest intensity ratings: Berland Associates to conduct a nationally representa- untimely or early death, death of a loved one, speak- tive telephone survey of 1000 Americans to answer that ing before a group, snakes, not being a success, being question (see http://health.discovery.com/centers/ self-conscious, illness or injury to loved ones, making mental/phobias/facts.html). Students will find the fol- mistakes, looking foolish, failing a test, suffocating. lowing results interesting. Students will be interested in comparing­ their fears with The top 10 fears (men and women combined) were those of their classmates, so you may wish to collect the the following: surveys and report the overall results back to the class. 1. Fear of snakes Psychiatrists and psychologists have labeled more 2. Fear of being buried alive than 700 specific fears and estimate that there are thou- 3. Fear of heights sands more. When such fears are persistent and debili- 4. Fear of being bound or tied up tating, they are considered to be phobias. Among those 5. Fear of drowning specifically identified are the following, listed under 6. Fear of public speaking their appropriate Greek or Latin name. 7. Fear of hell Acrophobia: Heights Aquaphobia: Water 8. Fear of cancer Gephyrophobia: Bridges Ophidiophobia: Snakes 9. Fear of tornadoes and hurricanes Aerophobia: Flying Arachnophobia: Spiders 10. Fear of fire Herpetophobia: Reptiles Ornithophobia: Birds Agoraphobia: Open spaces Astraphobia: Lightning Top 5 fears of men? Mikrophobia: Germs Phonophobia: Speaking aloud Ailurophobia: Cats Brontophobia: Thunder 1. Fear of being buried alive Murophobia: Mice Pyrophobia: Fire 2. Fear of heights Amaxophobia: Vehicles, driving Claustrophobia: Closed spaces 3. Fear of snakes Numerophobia: Numbers Thanatophobia: Death 4. Fear of drowning Anthophobia: Flowers Cynophobia: Dogs Nyctophobia: Darkness Trichophobia: Hair 5. Fear of public speaking Anthropophobia: People Dementophobia: Insanity Top 5 fears of women? Ochlophobia: Crowds Xenophobia: Strangers 1. Fear of snakes You might also ask students if they have heard of 2. Fear of being bound or tied up triskaidekaphobia (the number 13), uxoriphobia (one’s 3. Fear of being buried alive wife), Santa Claustrophobia (getting stuck in a chim- 4. Fear of heights ney), panaphobia (everything), or phobophobia (fear 5. Fear of public speaking itself). 928 Psychological Disorders

Geer, J. H. (1965). The development of a scale to mea- 3. Create a list of possible topics of conversation and sure fear. Behavior Research and Therapy, 3, 45–53. listen carefully to others. 4. Initiate conversation by asking questions. This Classroom Exercise: Social Phobia strategy demonstrates that you want to speak but at Handout 9 is the Social Thoughts and Beliefs Scale the time focuses attention on the other person. (STABS), which was designed by Samuel Turner and 5. Speak clearly and without mumbling. his colleagues to assess the cognitions associated with 6. Be willing to tolerate some silences. social phobia. The disorder is marked by social timid- 7. Wait for cues from others in deciding where to sit, ity, social inhibition, the avoidance of social situa- when to pick up a drink, and what to talk about. tions, and, in many cases, extreme social debilitation. 8. Learn to tolerate criticism and be willing to intro- Students obtain a total score by adding the numbers duce a controversial topic at an appropriate point. they provided in response to all 21 items. Patients Comer, R. J. (2010). Abnormal psychology (7th ed). New diagnosed with social phobia obtained a mean of 52.4, York: Worth. those with other anxiety disorders had a mean of 28.0, and controls without any psychiatric diagnosis had Hartman, L. M. (1984). Cognitive components of anxi- a mean score of 22.3. Factor analysis suggested that ety. Journal of Clinical Psychology, 40, 137–139. STABS points to two factors being involved in social Sarason, I., & Sarason, B. (2005). Abnormal behavior: phobia: social comparison, a belief that others are more The problem of maladaptive behavior (11th ed.). Upper socially competent and capable, and social ineptness, a Saddle River, NJ: Prentice Hall. belief that one will act awkwardly in social situations or appear anxious in front of others. Turner, S. M., et al. (2003). The social thoughts and Turner and his colleagues note that while social beliefs scale: A new inventory for assessing cognitions in phobia originally was thought to be a condition devel- social phobia. Psychological Assessment, 15, 384–391. oping in mid-adolescence, findings suggest that it can be diagnosed as early as 8 years of age. Research sug- Obsessive-Compulsive Disorder gests that 6.8 percent of people in the United States and Feature Film: As Good As It Gets and OCD other Western countries experience a social phobia in As noted earlier, feature films can provide wonder- any given year. It is more common among women than ful case studies in all of the psychological disorders among men. About 12 percent develop this disorder at covered in the text. As Good As It Gets, starring Jack some point in their lives. Nicholson, was also mentioned. Following are some Socially anxious people seek to avoid potentially specifics about the film in relation to OCD. The film is embarrassing social situations. If they cannot avoid about Melvin Udall, who displays numerous obsessions contact, they often experience physical symptoms such and compulsions. Perhaps the best single scene to show as trembling, profuse perspiration, and nausea. For in class begins 3:34 minutes into the film and runs just some, the greatest fear is that others will detect their 97 seconds. Udall locks and unlocks his apartment door signs of anxiety, such as blushing, tremors of the hand, exactly five times, turns lights on and off five times. and shaking voice. The earliest signs of social phobia Then, using multiple bars of soap stacked high in his often occur in late childhood or early adolescence, with medicine cabinet, he demonstrates his obsession with fear of public speaking and eating in public being com- cleanliness, washing his hands with scalding water. The mon symptoms. rest of the story finds him eating every day at the same Irwin and Barbara Sarason note that phobias table in the same restaurant. He insists on the same about interpersonal relationships often include fear of waitress, always orders the same meal, and brings his criticism and of making a mistake. Those who suffer own paper-wrapped plastic flatware to avoid contami- social phobia may attempt to compensate by involv- nation. He wipes off door handles before opening doors ing themselves in school and work, never quite sure of and carefully avoids stepping on sidewalk cracks in his their abilities or talents. When successful, they may be visits to his therapist’s office. If anything disrupts his dismissive: “I was just lucky—being in the right place routine, he becomes both angry and anxious. at the right time.” They may even feel like imposters, fearing that one day they will be discovered. Classroom Exercise: Obsessive-Compulsive Disorder Among the self-help guidelines that therapists have provided for dealing with social phobia are the Handout 10, the Obsessive-Compulsive Inventory, following: was developed by Edna Foa and her colleagues. Total score is obtained by adding the numbers circled and can 1. In dealing with the symptoms of anxiety, respond range from 0 to 72. In one study, patients with OCD with approach rather than avoidance. obtained a mean score of 28.01; a sample of 477 psy- 2. Greet people with eye contact. chology students at the University of Delaware scored Psychological Disorders 929 a mean of 18.82. The scale has six components that action 10, 20, or more times. Their doubt may lead introduce common symptoms of OCD, including wash- them to believe that they are taking unbearable risks if ing (5, 11, 17), obsessing (6, 12, 18), hoarding (1, 7, they don’t perform their rituals. In other areas of their 13), ordering (3, 9, 15), checking (2, 8, 14), and mental lives, sufferers of OCD may use the normal process of neutralizing (4, 10, 16). reasoning. Victims may even recognize that their obses- Obsessive-compulsive disorder traps people in sion is “crazy” and receive no pleasure in what they are seemingly endless cycles of repetitive thoughts (obses- doing. Still, they cannot escape the hold the disorder sions) and in feelings that they must repeat certain has over them. actions over and over (compulsions). Approximately Until the 1980s, OCD was considered relatively 20 percent of those with OCD have only obsessions or rare. Now, some researchers estimate that about 4 mil- only compulsions; all others experience both. Although lion Americans have OCD at some time in their life. Foa’s inventory does not provide separate scores for This makes OCD more common than panic disorder obsessive thoughts and compulsive behaviors, Richard or even schizophrenia. Moreover, the disorder affects Halgin and Susan Krauss Whitbourne provide good adults, teenagers, and even small children. It occurs examples of obsessions and their closely related com- across all social and economic levels. Generally, it pulsions. appears before the age of 25. In fact, less than 15 per- Obsession: A young woman is continuously ter- cent of people develop the disorder after age 35. If it rified by the thought that cars might careen onto occurs early in life, it seems to be linked to a stressful the sidewalk and run over her. Compulsion: She event and affect boys more often than girls; if it occurs always walks as far from the street pavement as in the teen years, it affects male and female teens equal- possible and wears red clothes so that she will be ly and, in 80 percent of all cases, it involves washing immediately visible to an out-of-control car. rituals linked to contamination fears. If it appears first in adulthood, the incidence is slightly higher in women Obsession: A mother is tormented by the concern than in men. that she might inadvertently contaminate food OCD does tend to run in families, sometimes in as she cooks dinner for her family. Compulsion: two, three, or even four consecutive generations. About Every day she sterilizes all cooking utensils in boil- 15 to 20 percent of those with OCD come from families ing water, scours every pot and pan before placing in which another immediate family member has the food in it, and wears rubber gloves while handling same problem. Although it was once thought that this food. might be the result of learning, researchers have found Obsession: A woman cannot rid herself of the that when OCD occurs in the next generation, it often thought that she might accidentally leave her gas takes a different form. For example, a parent may be a stove turned on, causing her house to explode. “checker,” while the son or daughter is a compulsive Compulsion: Every day she feels the irresistible washer. Many researchers now believe that there is a urge to check the stove exactly 10 times before biological basis for OCD. What is transmitted is the leaving for work. predisposition to develop OCD symptoms under certain conditions, but not a specific obsession or compulsion. Obsession: A college student has the urge to shout obscenities while sitting through lectures in classes. Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, Hajcak, G., et al. (2002). The obsessive-compul- Compulsion: Carefully monitoring his watch, he sive inventory: Development and validation of a short bites his tongue every 60 seconds in order to ward version. Psychological Assessment, 14, 485–496. off the inclination to shout. Gibb, G., Bailey, J., Best, R., & Lambirth, T. (1983). Obsession: A young boy worries incessantly that The measurement of the obsessive compulsive personal- something terrible might happen to his mother ity. Educational and Psychological Measurement, 43, while sleeping at night. Compulsion: On his way 1233–1237. up to bed each night, he climbs the stairs according Halgin, R., & Whitbourne, S. (2008). Abnormal psychol- to a fixed sequence of three steps up, followed by ogy: Clinical perspectives on psychological disorders two steps down in order to ward off danger. (5th ed.) Boston: McGraw-Hill.

An important reason that obsessions generate so Lecture/Discussion Topic: Obsessive Thoughts much anxiety and have so much power over people is that their victims do not seem to “know” anything Typically, we deal with unwanted thoughts by trying with certainty. Their own senses are unconvincing. to suppress them. Research by Daniel Wegner and his For example, they may see that their hands look clean colleagues indicates that this strategy may backfire. The but wash anyway. In fact, they may have to repeat the more we attempt to suppress obsessive ideas, the more likely we are to become preoccupied with them. 930 Psychological Disorders

The researchers instructed college students not to of PTSD: the world is completely dangerous and one’s think about white bears and then asked them to dic- self is totally incompetent. The researchers further sug- tate their ongoing thoughts into a tape recorder. Each gested that there may be two distinct ways by which time a white bear came to mind they were to ring a people acquire these dysfunctional cognitions. Those bell. Results indicated that the students rang the bell who enter the traumatic experience with the idea that or mentioned the bear more than once a minute dur- the world is extremely safe and that they are extremely ing a 5-minute session. Not thinking about white bears competent have difficulty in assimilating the experience proved very difficult. It seems that actively attempting and therefore overaccommodate their schemas about to suppress a thought ironically makes us think of it self and world. For others, particularly those who have more. experienced upsetting experiences throughout their Wegner and his colleagues suggest a way to rid lives, the traumatic experience primes existing sche- ourselves of obsessive thoughts. In a second experiment mas of the world as a dangerous place and oneself as they told students to think about a red Volkswagen incompetent. In short, the existence of rigid concepts every time they thought of a white bear. The strategy about self and the world (positive or negative) renders worked. Using a single distracting thought helped people vulnerable to develop PTSD. Those who make students to avoid thinking of the dreaded white bear. finer distinctions about degrees of safety and compe- Although more work needs to be done, the researchers tence are better able to interpret the trauma as a unique believe the technique may be useful not only for elimi- experience that does not have general implications for nating obsessions but also in the treatment of addic- the nature of the world and the nature of their ability to tions, such as smoking. cope with it. For students who want more information on As the scoring key indicates, factor analyses of the obsessive-compulsive disorder, the International OCD items reveal three separate factors. These include nega- Foundation offers advice, information, newsletters, and tive cognitions about self, negative cognitions about the referrals to treatment centers. It even offers support world, and self-blame. Mean scores are obtained for groups to OCD sufferers and their families in all 50 each subscale and can range from 1 to 7, with higher states. Write International OCD Foundation, P.O. Box scores reflecting greater acceptance of each factor. 961029, Boston, MA 02196, call 617-973-5801, or go Items 13, 32, and 34 are experimental and thus are not to the website at www.ocfoundation.org. included in the scoring. Foa and her colleagues report that each scale predicts PTSD severity, depression, and Neath, J. (1987, December). Suppress now, obsess later. Psychology Today, 10. general anxiety in traumatized individuals. In fact, the ability of the PTCI to discriminate between traumatized Post-Traumatic Stress Disorder individuals with and without PTSD was maintained even after controlling for depression and state anxiety, Classroom Exercise: The Posttraumatic Cognitions as well as for age, sex, race, and type of assault. Inventory (PTCI) Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & The Posttraumatic Cognitions Inventory (PTCI) Orsillo, S. M. (1999). The Posttraumatic Cognitions designed by Edna B. Foa and her colleagues (Handout Inventory (PTCI): Development and validation. 11) may help students understand why some victims Psychological Assessment, 11, 303–314. of traumatic experiences develop post-traumatic stress disorder (PTSD) while others do not. Completing and Lecture/Discussion Topic: Concentration Camp scoring the PTCI may also foster students’ appreciation Survival for the cognitive perspective in explaining psychologi- Examining the coping skills used by Jews in concen- cal disorders. tration camps provides an intriguing case study that The inventory asks respondents to report their reinforces much of the literature on post-traumatic thoughts after experiencing traumatic stress—that is, stress disorder. Researchers­ have identified seven major experiencing or witnessing severely threatening, uncon- strategies that seem to have contributed to their sur- trollable events with a sense of fear, helplessness, or vival. They include the following, as reviewed by Chris horror. If students report never having had such an Kleinke. experience, ask them to respond to the items in terms of their most upsetting life experience. The scoring key 1. Differential focus on the good. Despite the horrible follows the inventory and is part of the handout. events that surrounded them, some inmates focused Many theorists have argued that traumatic events their attention on whatever good they could find— can produce changes in victims’ thoughts and beliefs. for example, seeing a sunset or finding a small car- Those changes account for the development of PTSD. rot in the field. Specifically, Foa and her colleagues proposed two basic 2. Survival for some purpose. Inmates continued to dysfunctional cognitions that mediate the development look for and find meaning in their existence. For Psychological Disorders 931

some, it was simply the determination to tell the items 7, 8, and 10 indicate interpersonal difficulty; and world about what had happened. items 1, 4, and 5 assess “somatic” difficulties. 3. Psychological distancing. Prisoners used a variety Handout 13, the Zung Self-Rating Depression of strategies to distance themselves from the expe- Scale, is one of the most widely used measures of riences in the camp. These included intellectualiz- depression. In scoring, students should reverse their ing (e.g., Bruno Bettelheim assumed the role of an responses to items 2, 5, 6, 11, 12, 14, 16, 17, 18, and observer who would study the situation and write 20 (1 = 4, 2 = 3, 3 = 2, 4 = 1). They should then add about it), religious conviction (e.g., for some, reli- all the numbers to obtain a total score, which can range gious convictions made the suffering less personal from 20 to 80. Scores from 50 to 59 suggest mild to and provided hope for some kind of existence after moderate depression, from 60 to 69 indicate moderate death), time focus (e.g., it was possible to distance to severe depression, and 70 and above indicate severe oneself from the magnitude of the horror by liv- depression. ing 1 day, 1 hour, or even 1 minute at a time), and An adapted version of this scale is published each finally, humor (e.g., in the most difficult of times, year by Parade Magazine prior to National Depression some prisoners were still able to laugh). Screening Day. National Depression Screening Day, 4. Mastery. Although opportunities were sharply lim- created by Harvard psychiatrist Dr. Douglas G. Jacobs ited, there was still the challenge to use one’s mind, in 1991, has since been repeated every year in early to devote oneself to helping others, and to maintain October. (A toll-free number, which can be called to a sense of worthiness and self-esteem. learn the closest screening site, is typically advertised 5. Will to live. Simply the human determination not by the media in late September.) Each year, the num- to give up but to survive can be a powerful source ber of sites staffed by mental health professionals has of strength. grown. The free screening includes completion of a 6. Hope. It often matters not how realistic the hope is self-rating depression scale; a 20-minute talk on the so long as it is held and nurtured. causes, symptoms, and treatment of the disorder, during 7. Social support. Some drew on social support from which participants may ask questions; and 5 minutes individual friendships and from simply being in alone with a mental health professional. Based on the groups of people who shared the same life scale scores and the clinician’s probing, participants situation. learn if they need more evaluation. No diagnosis or treatment is provided. Dimsdale, J. (1974). The coping behavior of Nazi concentration camp survivors. American Journal of Jacobs maintains that the effort has now saved Psychiatry, 131, 792–797. hundreds of lives. He relates the story of a college student who appeared on the first screening day at Kleinke, C. (1998). Coping with life challenges (2nd McLean Hospital in Belmont, Massachusetts. “The ed.). Belmont, CA: Wadsworth. student had been putting plastic bags over his head,” Jacobs recounts, “so his roommate suggested he go to Understanding Anxiety Disorders the screening. He arrived and answered some questions: ‘Do you think of killing yourself?’ He said, ‘Yes.’ In 2 Mood Disorders minutes, we had detected that he was at risk. In 10 min- Major Depressive Disorder utes, he was hospitalized, and treatment was begun. We saved his life.” Classroom Exercise: Depression Scales Aaron Beck, a leading investigator of depression, Handout 12, a short form of the Center for Epidemi- suggests that college students may be especially prone ological Studies—Depression Scale (CES-D), was to psychological problems because they simultaneously­ developed by Jason Cole and his colleagues to be used experience all the transitions that are major stresses in as a screening tool in the general population. In scor- adulthood. Entering college, they lose family, friends, ing it, students should reverse the numbers placed in and familiar surroundings and are provided no ready- response to statements 3 and 6 (i.e., 0 = 3, 1 = 2, made substitutes. Furthermore, while in high school, 2 = 1, 3 = 0), then add the numbers in front of all 10 they were the most able students; in college, they must items. Scores can range from 0 to 30, with higher compare their own abilities with equally able students. scores reflecting greater distress. The authors do not Research indicates that students who exhibit provide specific norms but indicate that “most respon- optimism as they enter college develop more social dents score in the lower range.” The specific scale items support and experience a lowered risk of depression. introduce four important components of depression: Moreover, students’ frequent misperception of these Items 2 and 9 reflect the presence of negative affect; stresses may be as important a cause of depression as items 3 and 6 suggest the absence of positive affect; the stresses themselves. While they do not hallucinate 932 Psychological Disorders their problems of academic or social adjustment, they words and that after you have read each word they will often inflate the importance of temporary setbacks and have a few seconds to think of a past experience they misjudge the severity of rejections. They may overesti- associate with the word. They are to write down the mate academic difficulties on the basis of one mediocre experience in a sentence or two. Proceed to read the grade. They may grieve over their social isolation, even following list, which Clark and Teasdale used (shorten though they often have at least some caring and sup- for efficiency if you like). Pause between each word, portive friends. Their pessimism and dissatisfaction giving students time to respond: train, ice, wood, letter, may lead to clinical depression that in turn interferes house, race, shoe, window, sign, meeting, travel, read- with actual performance. A vicious cycle is created in ing, road, machine, rain, roam, water, tunnel. which misperceptions­ of academic and social difficul- After students have finished, have them indicate ties result in still poorer grades and greater social whether each recalled experience was pleasant or isolation. unpleasant. Finally, have them tally the total number of Beck, A., & Young, J. (1978, September). College blues. pleasant and unpleasant experiences they recalled. Have Psychology Today, 80–92. them reflect on their level of depression that day and how it may have affected the degree to which they gen- Cole, J. C., Rabin, A. S., Smith, T. L., & Kaufman, A. S. (2004). Development and validation of a Rasch-Derived erated pleasant or unpleasant memories. As noted, when CES-D Short Form. Psychological Assessment, 16, we are depressed, we remember more unpleasant than 360–372. pleasant events. If you prefer to analyze the relationship between depression and memory more carefully, have Ubell, E. (1993, September 26). Help for depression. Parade Magazine, 20. students complete the Zung Self-Rating Depression Scale (Handout 13) before this exercise. Have them Ubell, E. (1994, September 18). You can find help for score both the scale and exercise before turning in depression. Parade Magazine, 22. the results. Between classes, calculate the correlation Classroom Exercise: The Automatic Thoughts between depression scores and pleasantness ratings and Questionnaire report the outcome at the next class session. Philip Kendall and Steven Hollon designed the Auto­ Burger, J. M. (2008). Instructor’s manual for Burger’s matic Thoughts Questionnaire (ATQ), Handout 14, to Personality (7th ed.). Belmont, CA: Wadsworth. measure the frequency of automatic negative thoughts Clark, D. M., & Teasdale, J. D. (1982). Diurnal varia- associated with depression and to “identify the covert tions in clinical depression and accessibility of memo- self-statements reported by depressives as being repre- ries of positive and negative experiences. Journal of sentative of the kinds of cognitions that depressed per- Abnormal Psychology, 91, 87–95. sons experience.” Thus the ATQ, which was developed Classroom Exercise: Loneliness on a sample of undergraduates, provides a measure of depression and highlights some of its most important You can extend your discussion of depression and sui- symptoms. Among the specific facets of depression it cide with Handout 15, the Revised UCLA Loneliness measures are personal maladjustment and desire for Scale. Scores should be reversed (1 = 4, 2 = 3, 3 = 2, change (e.g., items 14 and 20), negative expectations 4 = 1) for items 1, 4, 5, 6, 9, 10, 15, 16, 19, 20. The (e.g., items 3 and 24), low self-esteem (e.g., items 17 sum of all 20 items then provides a total score, which and 18), and helplessness (e.g., items 29 and 30). Total can range from 20 to 80. Mean scores for men and scores range from 30 (little or no depression) to 150 women enrolled­ in undergraduate psychology courses (maximum depression). Mean scores of 79.6 and 48.6 were 37.06 and 36.06, respectively. Correlations rang- were obtained for depressed and nondepressed samples, ing from .51 to .62 were found between loneliness respectively. scores and depression, as measured, for example, by the Beck Depression Inventory.­ Kendall, P., & Hollon, S. (1980). Cognitive self state- Loneliness is a common and distressing problem ments in depression: Development of an Automatic for many people. In one national survey, 26 percent of Thoughts Questionnaire. Cognitive Therapy and Americans reported having felt “very lonely or remote Research, 4, 383–395. from other people” during the previous few weeks. In a worldwide survey of adults in 18 countries, Italians and Classroom Exercise: Depression and Memory Japanese reported the most frequent feelings of loneli- When we are in a bad or sad mood, we are more likely ness and Danes reported the least. While we have a to remember unpleasant events. Jerry Burger suggests stereotype in our culture of the elderly as being lonely, a simple classroom replication of D. M. Clark and J. D. research indicates adolescents and young adults are Teasdale’s study demonstrating this effect. actually the most lonely. Married people are less lonely Have students take out a blank piece of paper. Tell than the unmarried. them that you are going to read a series of individual Psychological Disorders 933

The problem of loneliness may be increasing. What reasons do people give for being lonely? One A relatively recent study found that, on average, survey sorted them into five major categories. Americans have only two close friends to confide in, 1. Being unattached: Having no spouse or sexual down from an average of three in 1985. The percentage partner, particularly breaking up with a spouse or of people who reported no confidant rose from 10 per- lover. cent to almost 25 percent; an additional 19 percent said 2. Alienation: Being misunderstood and feeling differ- they had only a single confidant (often their spouse). ent; not being needed and having no close friends. Loneliness has both psychological and physical 3. Being alone: Coming home to an empty house. consequences. Studies at Carnegie Mellon University 4. Forced isolation: Being hospitalized or house- suggest that being lonely may make one physically bound; having no transportation. ill. Students with few friends had a 16-percent-weaker 5. Dislocation: Being away from home; starting a immune response to a flu shot than did their counter- new job or school; traveling often. parts. Another study found that men who had the fewest social interactions every week had the highest levels How do people cope with loneliness? Rubenstein of an inflammatory marker that seems to play a role and Shaver have found four major strategies. “Sad in heart disease. Investigators suggest that loneliness passivity” includes sleeping, drinking, overeating, and may depress immune systems by increasing stress and watching TV. “Social contact” may involve calling decreasing the amount of sleep one gets. Other studies a friend or visiting someone. “Active solitude” takes have found that social support and affiliation may actu- the form of studying, reading, exercising, or going to ally serve to protect people from stress and illness as a movie. “Distractions”­ include spending money and well as speed recovery from illness or surgery. going shopping. While research does not indicate overall sex differ- Comer, R. (2010). Abnormal psychology (7th ed.). New ences in loneliness, Sharon Brehm and her colleagues York: Worth. report that gender interacts­ with marital status in the following ways. McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social isolation in America: Changes in 1. Married women report greater loneliness than do core discussion networks over two decades. American married men. Sociological Review, 71, 353–375. 2. Among those never married, men report more lone- Miller, R., Perlman, D., & Brehm, S. (2007). Intimate liness than do women. relationships (4th ed.). New York: McGraw-Hill. 3. Among the separated and divorced, men report Rubenstein, C. M., & Shaver, P. (1982). In search of greater loneliness than do women. intimacy. New York: Delacorte Press. 4. Among those whose spouse has died, men report greater loneliness than do women. Bipolar Disorder Brehm and her colleagues suggest that these find- Lecture/Discussion Topic: Bipolar Disorder ings indicate that men and women may differ in their vulnerability to two types of loneliness: social and To give students some idea of the manic state of a bipo- emotional isolation. In social isolation, people are dis- lar disorder, read the following account. satisfied and lonely because they lack a social network When I start going into a high, I no longer feel like an of friends and acquaintances. In emotional isolation, ordinary housewife. Instead, I feel organized and accom- they are dissatisfied because they lack a single intense plished, and I begin to feel I am my most creative self. I relationship. Research has found that marriage is can write poetry easily. I can compose melodies without more likely to reduce a woman’s social network than effort. I can paint. My mind feels facile and absorbs a man’s. For example, men are more likely to remain everything. I have countless ideas about improving the employed and seem to establish closer relationships conditions of mentally retarded children, how a hospital for these children should be run, what they should have with their relatives after marriage than they had before. around them to keep them happy and calm and unafraid. Married women may forgo outside employment and I see myself as being able to accomplish a great deal for also leave their relatives to be with their husbands. As a the good of people. I have countless ideas about how the result, they suffer greater social isolation. environmental problem could inspire a crusade for the In contrast, women, married or single, are more health and betterment of everyone. I feel able to accom- likely to maintain some intimate ties with their friends. plish a great deal for the good of my family and others. Men tend to have close emotional relationships only I feel pleasure, a sense of euphoria or elation. I want it with their female partners. Hence, unmarried or roman- to last forever. I don’t seem to need much sleep. I’ve tically unattached men are likely to be emotionally lost weight and feel healthy, and I like myself. I’ve just isolated despite regular contact with people at work and bought six new dresses, in fact, and they look quite good during leisure activities. on me. I feel sexy and men stare at me. Maybe I’ll have 934 Psychological Disorders

an affair, or perhaps several. I feel capable of speaking of lights and buttons and periodically­ were given a and doing good in politics. I would like to help people choice whether to push one of the buttons. A light was with problems similar to mine so they won’t feel hope- programmed to come on every other time the choice less. (Fieve, 1975, p. 17) was presented, regardless of the participant’s choice. David Rosenhan, Elaine Walker, and Martin Afterward, the experimenter asked participants to esti- Seligman identify the following symptoms of mania. mate how much control they had over the lights. From helplessness theory, Alloy and Abrahamson predicted­ 1. Mood or emotional symptoms The mood is typi- that depressed subjects would underestimate their con- cally euphoric, expansive, and elevated. In some trol. In fact, however, the depressed participants were cases, the dominant mood is irritability, particularly very accurate in their estimates, while those who were if the person with mania is thwarted. Even when not depressed made mistakes by drastically exaggerat- euphoric, people with mania are close to tears and ing the degree of control they thought they exercised. if frustrated burst out crying. This suggests that a Alloy and Abrahamson replicated this finding strong depressive element coexists with mania. in other experiments. Nondepressives consistently 2. Grandiose cognition People with mania believe overesti­mated their control over positive events and they have no limits to their abilities and, what’s underestimated their control over negative events. Other worse, do not recognize the painful consequences researchers reported similar results. For example, Peter of trying to carry out their plans. They may have Lewinsohn had participants interact with one other per- a flight of ideas in which ideas race through their son or with a group and then asked them to rate their mind faster than can be related or written down. own social skills. In evaluating themselves, they noted Sometimes, they have delusional thoughts about the clarity of their communication,­ their friendliness, themselves—for example, that they are messengers and their ability to understand others. Observers on the of God or are intimate friends with celebrities. opposite side of a one-way mirror also rated the partici- 3. Motivational symptoms The hyperactivity of a pants. While nondepressives perceived themselves more person with mania has an intrusive, dominating, positively than did the observers, depressed participants and domineering quality. In the manic state, some gave themselves ratings that were very close to those of engage in compulsive gambling, reckless driving, the observers. or poor financial investment. What does all of this have to say about helping 4. Physical symptoms With the hyperactivity comes the depressed to see things more clearly? Alloy reports a greatly lessened need for sleep. After a few days, that one patient, after hearing these results, quit therapy however, exhaustion settles in, and the mania slows on the basis that there was nothing wrong with him. In down. reflect­ing later on her patient’s decision, the therapist Between 0.6 and 1.1 percent of the U.S. population states, “If I had been able to talk to him, I would have will have bipolar disorder in their lifetime. It affects pointed out that to be realistic is not necessarily the both sexes equally. Onset is sudden and, typically, no same as being adaptive.” precipitating event is obvious. The first episode is usu- Fred Hapgood suggests that depressed persons ally manic and occurs between ages 20 and 30. Bipolar may feel as they do, not because of low ego defenses or illness tends to recur, but, surprisingly, not many epi- learned helplessness, but because they see themselves sodes occur more than 20 years after the initial onset. as “lost in a society of cockeyed optimists who barge Fieve, R. R. (1975). Mood swing. New York: Morrow. through life with little grasp of the consequences of Seligman, M., Walker, E., & Rosenhan, D. L. (2001). their actions or words.” A depressing thought? Yes, Abnormal psychology (4th ed.). New York: Norton. suggests Hapgood, and possibly one more likely to be correct. Understanding Mood Disorders Hapgood, F. (1985, August). The sadder-but-wiser effect. Science, 85, 86–88. Lecture/Discussion Topic: The Sadder-but-Wiser Effect A number of studies have shown that depressed persons Lecture/Discussion Topic: Cognitive Errors in may see certain events more accurately than do those Depression who are happy and optimistic. Lauren Alloy and Lyn Aaron Beck’s work with depressed patients convinced Abrahamson, among the first to report this finding in him that depression is primarily a disorder of think- 1979, initially labeled it the sadder-but-wiser effect. ing rather than of mood. He argued that depression Today, it is also known as depressive realism. can best be described as a cognitive triad of negative In testing the learned helplessness theory of thoughts about oneself, the situation, and the future. depression, Alloy and Abrahamson recruited groups of The depressed person misinterprets facts in a negative depressives and nondepressives. Research participants way, focuses on the negative aspects of any situation, were individually placed behind a special arrangement and also has pessimistic expectations about the future. Psychological Disorders 935

The cognitive errors of depressed people include the Classroom Exercise: Attributions for an Overdrawn following. Checking Account 1. Overgeneralizing: Drawing global conclusions Depressed people are more likely to explain bad events about worth, ability, or performance on the basis of in terms of causes that are stable, global, and internal. a single fact. More specifically, experiments have shown that either 2. Selective abstraction: Focusing on one insignifi- stable or global attributions can produce depression, cant detail while ignoring the more important fea- but internal attributions seem to produce depression tures of a situation. only when they are combined with stable and global 3. Personalization: Incorrectly taking responsibility components. Given the present popularity of the social- for bad events in the world. cognitive perspective, you may want to offer a specific 4. Magnification and minimization: Gross evaluations illustration of the attributions most likely to be associ- of a situation in which small, bad events are magni- ated with depression. fied and large, good events are minimized. Ask students to imagine that they have just been 5. Arbitrary inference: Drawing conclusions in the notified by their bank that their checking account is absence of sufficient evidence or of any evidence overdrawn. After reflecting a bit on the possible reasons at all. for the notification, have them write down in a sentence 6. Dichotomous thinking: Seeing everything in one or two what they believe to be the single most impor- extreme or its opposite (black or white, good or tant cause. Then, in thinking about what they have writ- bad). ten, have them answer the following questions. Beck and others have noted that the thoughts of 1. Does the cause you describe reflect more about you depressed people differ from those with anxiety dis- or something more about other people or circum- orders. Those suffering from anxiety typically focus stances (internal or external)? on uncertainty and worry about the future. In contrast, 2. Is the cause something that is permanent or tempo- depressed people focus on negative aspects of the past rary; that is, is the cause likely to be present in the or reflect a negative outlook on what the future will future (stable or unstable)? bring. Whereas anxious people worry about what may 3. Is the cause something that influences other areas happen and whether they will be able to deal with it, of your life or only your checking account balance depressed people think about how terrible the future (global or specific)? will be and how they will be unable to deal with it or Ask for volunteers to share some of their answers improve it. and reiterate that attributions for events that are internal, Sarason, I., & Sarason, B. (2005). Abnormal psychology stable, and global are most likely to be associated with (11th ed.). Upper Saddle River, NJ: Prentice Hall. depression. Christopher Peterson and Martin Seligman give the following examples of attributions for the over- drawn checking account.

Examples of Causal Explanations for the Event “My Checking Account Is Overdrawn” Explanation Style Internal External Stable Global “I’m incapable of doing anything right.” “All institutions chronically make mistakes.” Specific “I always have trouble figuring my balance.” “This bank has always used antiquated techniques.” Unstable Global “I’ve had the flu for a week, and I’ve let everything “Holiday shopping demands that one throw slide.” oneself into it.” Specific “The one time I didn’t enter a check is the one “I’m surprised—my bank has never made an time my account gets overdrawn.” error before.”

Source: Peterson, C., et al. (1984). Causal explanations as a risk factor for depression: Theory and evidence. Psychological Review, 91, 347–374. Copyright © 1984 by the American Psychological Association. Reprinted by permission. 936 Psychological Disorders

Classroom Exercise: The Body Investment Scale and have blood coursing through my veins.” Others who Self-Mutilation suffer from anorexia or bulimia apparently self-mutilate If you discuss non-suicidal self-injury, you may want to gain control over their bodies or to express their to have students complete Handout 16, the Body feelings about being abused. “They’re wearing a vis- Investment Scale designed by Israel Orbach and Mario ible symbol of the violation imposed on them,” claims Mikulincer. To obtain a total score, respondents need Joseph Shrand, director of the Child and Adolescent to reverse the numbers (1 = 5, 2 = 4, 4 = 2, 5 = 1) they Outpatient Clinic at McLean Hospital in Belmont, place in front of items 2, 3, 5, 7, 9, 11, 13, 17, and 22 Massachusetts. and then add up the numbers in front of all 24 state- Whatever their childhood experience, almost all ments. Scores can range from 24 to 120, with higher self-mutilators, according to experts, grew up in homes scores reflecting a more positive emotional investment with poor communication between parent and child. in one’s body. Orbach and Mikulincer identified four Cutting often seems to be a replacement for absent lan- separate aspects of the bodily self measured by their guage. Self-mutilators may have lived through a bitter scale. Items 5, 10, 13, 16, 17, and 21 assess body image divorce or were verbally demeaned as fat or lazy. As a feelings and attitudes, items 2, 6, 9, 11, 20, and 23 mea- result, they suffer self-loathing, not merely lower self- sure comfort in physical contact with others, items 1, esteem. “Cutting is literally like letting out bad blood,” 4, 8, 12, 14, and 19 reflect concern for body care, and claims Marilee Strong, author of A Bright Red Scream, items 3, 7, 15, 18, 22, and 24 assess investment in body a book on self-mutilation. protection. Treatments include antidepressants and even Working primarily with adolescents and young the drug Naltrexone, commonly used to treat heroin adults between 13 and 19, the authors found their scale addicts. Although traditional psychotherapy is often to be predictive of self-destructive behaviors, including ineffective, some therapists report success using Marsha suicidal tendencies. Those with higher scores reported Linehan’s dialectical behavior therapy, which teaches higher self-esteem, as well as having experienced skill in tolerating distress and controlling behavior. greater maternal care. Moreover, they were more likely War, poverty, and unemployment may also be contrib- to indicate a capacity to enjoy sensual and bodily plea- uting factors. sures and were less likely to state that their parents had Some therapeutic efforts have successfully gener- been overprotective. ated alternative coping behaviors for sufferers who oth- You may want to extend the discussion of suicide erwise would engage in self-injury. For example, clients to a consideration of research on self-mutilation. One may be encouraged to journal, to participate in sports or survey of undergraduate students reported that 9.8 exercise, or to seek social support in curbing the urge percent of the students indicated that they had purpose- to harm themselves. Even safer methods of self-harm fully cut or burned themselves on at least one occasion that do not lead to permanent injury— for example, the in the past. A 2003 study found a high prevalence of snapping of a rubber band on the wrist—may help calm self-injury among 428 homeless and runaway youth the urge to engage in self-injury. (ages 16 to 19) with 72 percent of young men and 66 Kalb, C. (1998, November 9). An armful of agony. percent of young women reporting a past history of Newsweek, 82. self-mutilation. More generally, research indicates self- Orbach, I., & Mikulincer, M. (1998). The body invest- injury is more frequent among women than men and ment scale: Construction and validation of a body experi- typically begins in the teen years. Those who injure ence scale. Psychological Assessment, 10, 415–425. themselves are not usually seeking to end their lives but rather seem to use self-injury as a coping effort to Tyler, K. A., Whitbeck, L. B., Hoyt, D. R., & Johnson, relieve emotional pain. Before her tragic death, Princess K. D. (2003). Self-mutilation and homeless youth: The Diana brought global attention to the disorder when she role of family abuse, street experiences, and mental disorders. Journal of Research on Adolescence, 13, admitted in a television interview that she had inten- 457–474. tionally injured her arms and legs: “You have so much pain inside yourself that you try to hurt yourself on the Vanderhoff, H., & Lynn, S. J. (2001). The assessment outside because you want help.” of self-mutilation: Issues and clinical considerations. Although some self-mutilators are suicidal, most Journal of Threat Assessment, 1, 91–109 cut themselves not to die but to cope with the stresses of staying alive. Many were sexually abused as chil- Classroom Exercise: Understanding Suicide dren and learned to shield themselves from the trauma Laura Madson and Corey J. Vas designed Handout 17 by dissociating themselves from their emotions. Some to help students understand the risk factors for suicide. claim that cutting snaps them back into consciousness. You may want to use the exercise before students have One victim writes, “It proves I’m alive, I’m human, I read about mood disorders and suicide. Distribute a copy of the handout to each student. As the instructions Psychological Disorders 937 indicate, have students read the descriptions of the four clients have much greater detail about the person’s fictional persons and, using their best judgment, rank current mental state and his or her past behavior. You them in terms of their risk for attempting or committing might ask students what additional information they suicide. would want in order to make more informed judgments. After students have completed the rankings, For example, the person at most risk has “taken a few engage the full class in a discussion of the “correct” pills” in her past, so therapists would certainly want rankings (initially, you could form small groups). The more information including the type of medication discussion will make it clear that these rankings are and quantity. If you like, you can expand the fictional somewhat arbitrary and will highlight the uncertainty accounts as well as vary the risk factors across cases. that surrounds suicide risk. The same event may have Madson and Vas note that students find the exercise no effect on one person but may dramatically increase valuable and those who participate do perform better the risk for suicide in another person. In addition, the on exam questions testing knowledge of the suicide overwhelming majority of people who experience vari- literature, particularly of risk factors. They also observe ous risk factors do not become suicidal. As Madson and that, because suicide is an unsettling topic, you should Vas conclude, “Predicting suicide is far more complex be ready to provide support in helping students process than compiling a laundry list of a person’s risk factors.” any negative emotions. At a minimum, they suggest In surveying the literature, Madson and Vas iden- being ready to provide referral to your institution’s tify a number of risk factors that are correlated with counseling center. suicidal ideation (thinking about suicide) and behavior. Madson, L., & Vas, C. J. (2003). Learning risk fac- Some, but not all, of these are also identified in the text. tors for suicide: A scenario-based activity. Teaching of For example, suicidal behavior varies by gender, age, Psychology, 30, 123–126. and marital status. Easy accessibility to firearms, mood disorders, substance abuse, and feelings of loneliness Classroom Exercise: The Expanded Revised Facts on and hopelessness are also predictive. Suicide Quiz Perhaps the strongest single predictor of suicidal Handout 18, the Expanded Revised Facts on Suicide behavior, particularly in adolescents, is previous suicide (ERFOS) quiz, designed by John McIntosh and Richard attempts. Among adolescents and young adults (under Hubbard, is a useful tool for introducing classroom age 30), interpersonal loss; poor social adjustment; and discussion of research on suicide. The information com- problems surrounding love relationships, dating, and municated in the answers to the questions goes well friends also act as precipitating factors. Rejection by beyond that presented in the text, so the quiz is useful, a potential partner or loss of a romantic relationship even if students have already completed the text read- may be a powerful predisposing event for under­ ing assignment. The quiz contains 25 true–false and 25 graduates. multiple-choice items. In addition to basic demographic In terms of the rankings, Madson and Vas suggest questions about suicide (e.g., age, sex, race/ethnicity), that Person 2 is at greatest risk because she presents the quiz touches on a number of clinically relevant two of the strongest predictors of suicide (i.e., a previ- issues. For those who used an earlier version of the ous suicide attempt and the breakup of a long-term instrument, this expanded revised version includes new relationship). Person 4 may be second in terms of risk items selected to represent emerging issues in suicidol- because he presents other leading predictors (i.e., he has ogy, including questions on suicide in later life. The a substance abuse problem, ready access to firearms, correct answers are provided on the next page; beside and recently began giving away his possessions). The each is the percentage of 373 undergraduates in general last two persons present both risk factors (i.e., a young or abnormal psychology classes who correctly answered woman who is depressed and ostracized by her fam- that question. (Note: In a personal communication, John ily because she is lesbian, and a father who recently McIntosh states, “The only question that still remains lost his job), but they also show protective factors that tenuous is #37 related to suicide rates and specific race/ decrease risk (i.e., she is currently in treatment for her ethnicity. Although at the time we presented and col- depression, and he has his family to provide social sup- lected data for ERFOS rates were highest for Native port). The article authors rank persons 3 and 1 in posi- Americans (slightly higher than for Whites), more tions 3 and 4, respectively. recent data has been the opposite again.” Finally, the brevity of the descriptions represents a challenge. Clinicians who do careful evaluations of 938 Psychological Disorders

1. F (40.9%) 11. F (59.1%) 21. T (88.6%) 31. a (84.1%) 41. a (68.2%) 2. T (45.5%) 12. T (31.8%) 22. T (27.3%) 32. b (25.0%) 42. b (68.2%) 3. T (27.3%) 13. F (25.0%) 23. T (40.9%) 33. c (6.8%) 43. c (20.5%) 4. F (70.5%) 14. T (54.5%) 24. T (29.5%) 34. a (50.0%) 44. c (54.5%) 5. F (95.5%) 15. F (70.5%) 25. F (38.6%) 35. c (56.8%) 45. b (36.4%) 6. F (77.3%) 16. F (18.2%) 26. a (38.6%) 36. a (47.7%) 46. b (31.8%) 7. T (52.3%) 17. T (61.4%) 27. c (6.8%) 37. c (11.4%) 47. a (72.7%) 8. F (50.0%) 18. T (36.4%) 28. b (47.7%) 38. c (81.8%) 48. c (56.8%) 9. T (18.2%) 19. F (11.4%) 29. a (18.2%) 39. b (18.2%) 49. a (63.6%) 10. F (84.1%) 20. F (29.5%) 30. b (70.5%) 40. b (56.8%) 50. b (27.3%)

The mean score for all students was 24.1, and no 7. Ambivalence. Some ambivalence is normal, but for sex differences were found. the suicidal person ambivalence is only between Earlier, Richard Hubbard and John McIntosh had life and death. In the typical case, a person cuts his noted that students’ increasing interest in the topic of or her own throat and calls for help simultaneously. suicide may in part be due to its personal relevance. The rescuer can use this ambivalence to shift the Studies suggest that perhaps 40 to 50 percent of stu- inner debate to the side of life. dents have suicidal thoughts at one time or another and 8. Communication of intent. About 80 percent of that as many as 15 percent may have actually attempted suicidal people give family and friends clear clues suicide. about their intention to kill themselves. Depending on time, you may want to present 9. Departure. Quitting a job, running away from Edwin Schneidman’s 10 common characteristics of home, leaving a spouse are all departures, but sui- suicidal people. Schneidman presents the following in cide is the ultimate escape. It is a plan for a radical, the belief that knowledge of these characteristics may permanent change of scene. help the general public and mental health professionals 10. Lifelong coping patterns. To spot potential suicides, reduce suicide rates. one must look to earlier episodes of disturbance, to the person’s style of enduring pain, and to a general 1. Unendurable psychological pain. Suicide is not an tendency toward “either/or” thinking. Often, there act of hostility or revenge but a way of switching has been a style of problem solving that might be off unendurable and inescapable pain. If you reduce characterized as “cut and run.” their level of suffering, even just a little, suicidal people will choose to live. Hubbard, R. W., & McIntosh, J. L. (2003, April 25). The 2. Frustrated psychological needs. Needs for secu- Expanded Revised Facts on Suicide Quiz. Paper presen- rity, achievement, trust, and friendship are among tation at the annual meeting of the American Association of Suicidology, Santa Fe, NM. the important ones not being met. Address these psychological needs and the suicide will not occur. Hubbard, R., & McIntosh, J. (1992). Integrating suicidol- Although there are pointless deaths, there is never a ogy into abnormal psychology classes: The Revised Facts “needless” suicide. on Suicide Quiz. Teaching of Psychology, 19, 163–166. 3. The search for a solution. Suicide is never done McIntosh, J. L., & Hubbard, R. W. (2004, April 16). A without purpose. It is a way out of a problem or cri- Facts on Suicide Quiz: Reliability and Validity. Paper sis and seems to be the only answer to the question: presentation at the annual meeting of the American “How do I get out of this?” Association of Suicidology, Santa Fe, NM. 4. An attempt to end consciousness. Suicide is both a Schneidman, E. (1987, March). At the point of no return. movement away from pain and a movement to end Psychology Today, 54–58. consciousness. The goal is to stop awareness of a painful existence. Lecture/Discussion Topic: Commitment to the Common 5. Helplessness and hopelessness. Underneath all the Good shame, guilt, and loss of effectiveness is a sense of Martin Seligman argues that the present epidemic of powerlessness. There is the feeling that no one can depression stems in part from a rise in individualism help and nothing can be done except to commit and a decline in commitment to religion and family, suicide. and, more generally, to a decline in commitment to 6. Constriction of options. Instead of looking for a close-knit relationships and the common good. While variety of answers, suicidal people see only two Seligman believes that depression follows from a pes- alternatives: a total solution or a total cessation. All simistic way of thinking about failure, and that learning other options have been driven out by pain. The to think more optimistically provides one strategy for goal of the rescuer should be to broaden the sui- short-circuiting depression, he does not believe that cidal person’s perspective. learned optimism alone will stop the tide of depression Psychological Disorders 939 on a societal basis. It has to be coupled with a renewed Schizophrenia commitment to the common good. Seligman observes, Symptoms of Schizophrenia “Optimism is a tool to help the individual achieve the goals he has set for himself. It is in the choice of the PsychSim 5: Losing Touch With Reality goals themselves that meaning—or emptiness—resides. This activity explains the symptoms of schizophrenia When learned optimism is coupled with a renewed and the brain changes that accompany schizophrenia. commitment to the common good, our epidemic of Students learn about the types of schizophrenia and the depression and meaninglessness may end.” main symptoms, view video clips of individuals with Seligman suggests that we begin thinking of this schizophrenia, and are asked to identify the symptoms renewed commitment to the common good as a kind displayed by each individual. of moral jogging in which a little daily self-denial is exchanged for long-term self-enhancement. In our own Student Project: The Eden Express and Schizophrenia self-interest, we must begin to reduce our investment in Michael Gorman reports a highly successful student ourselves and heighten our investment in the common project in which students were asked to read Mark good. Some of his specific suggestions follow: Vonnegut’s The Eden Express and relate it to the psy- —Give 5 percent of last year’s income away. Do chological literature on schizophrenia. The book is an it personally, not through a charity. Advertise autobiographical account of the author’s schizophrenic among potential recipients in a charitable field breakdown and eventual recovery. Vonnegut describes of interest that you are giving, say, $2000 away. his thoughts and feelings­ while hallucinating, his Interview applicants, give out the money, and fol- attempts to commit suicide, and his struggle to recover. low its use to a successful conclusion. He attributes his cure primarily to the use of Thorazine, —Give up eating out once a week, shopping for new but certainly other factors contributed to his recovery. shoes, watching a rented movie on Tuesday night, The book is also relevant to a discussion of therapy. and spend the time promoting the well-being While Gorman had students write papers discussing of others. Help in a soup kitchen, visit AIDS how different theoretical perspectives would account patients, clean the public park, raise funds for for the cause and cure of Vonnegut’s schizophrenia, your alma mater. you might simply assign the book as outside reading; —Visit areas where you will encounter the home- this in itself will provide students with new insight into less. Talk to beggars and judge as well as you can the nature of schizophrenia. whether they will use any money you give them Gorman, M. (1984). Using The Eden Express to teach for nondestructive purposes. Spend three hours a introductory psychology. Teaching of Psychology, 11(1), week doing this. 39–40. —When you read of particularly virtuous or evil acts, write letters. Compose fan letters to people Classroom Exercise: Magical Ideation Scale who could use your praise, “mend-your-ways” Handout 19 is Mark Eckblad and Loren Chapman’s letters to people and organizations you dislike. 30-item true–false scale to assess “magical thinking.” Follow up with letters to elected officials who can The scale is based on the idea that schizophrenia-prone act directly. Again, spend three hours weekly in people often show a belief in magical influences. Most this activity. of the items inquire about respondents’ interpretations —Teach your children to give things away. Suggest of their own experiences rather than their belief in the they set aside one-fourth of their allowance to theoretical possibility of magical forms of causation. give to a needy person or project. Further suggest Of more than 1500 college students who completed the that they do this personally. scale, men and women had mean scores of 8.56 and Some items on the list are likely to generate a live- 9.69, respectively. The scoring key follows. ly discussion. Ask students to consider alternatives that 1. T 11. T 21. T might produce similar results without putting the person 2. T 12. F 22. F “in the hole” financially. 3. T 13. F 23. F You might also ask your class to reflect on the 4. T 14. T 24. T psychological benefits of bipartisan efforts to promote 5. T 15. T 25. T the common good through volunteer service. And what 6. T 16. F 26. T might be the psychological payoff for those who par- 7. F 17. T 27. T ticipate in community-sponsored “random acts of kind- 8. T 18. F 28. T ness” days or weeks? 9. T 19. T 29. T Seligman, M. (1990). Learned optimism. New York: 10. T 20. T 30. T Knopf. 940 Psychological Disorders

The scale is part of a larger project aimed at estimate their general intelligence because they fail developing “measures of deviant functioning to iden- to follow the directions of a standard IQ test. tify young adults who may be psychosis prone.” Prognosis for the autistic child is not good. Many Participants who scored very high on the Magical drugs have been tried but none has proved to be reli- Ideation Scale were interviewed­ extensively. Compared ably helpful. Therapy involving operant conditioning with a control group, they reported “more schizotypical techniques has occasionally been useful. More recently, experiences, more affective symptoms, and more dif- some encouraging results have been reported for large ficulties in concentration.” doses of vitamins and minerals, including vitamin B Eckblad, M., & Chapman, L. (1983). Magical ideation and magnesium. as an indicator of schizotypy. Journal of Consulting and Some theorists have suggested that parental lack Clinical Psychology, 51, 215–225. of emotional warmth is the cause of autism, but others reject the bad-parent theory. They point to the fact that Lecture/Discussion Topic: Infantile Autism in most cases, siblings are completely normal. It also You can extend your discussion of schizophrenia to seems impossible to alleviate autism by merely provid- include a consideration of infantile autism (if you did ing a great deal of emotional warmth and love. not discuss autism as part of your coverage of devel- One puzzling characteristic of some children with opment). The autistic condition appears similar to autism is that they tend to huddle around radiators schizophrenia, in that social withdrawal is a prominent and other heat sources, as if they felt cold. Even more characteristic of both. There are, however,­ important surprising, some children with autism behave almost differences. For example, autism is usually diagnosed at normally when they have a fever, showing better atten- an early age, sometimes within the first 6 months after tion to their surroundings and improved communication birth, and always by age 3. The usual age for diagnosis with other people. of schizophrenia is between 15 and 30 years. Although James Kalat and others have speculated on the pos- the incidence of schizophrenia in men and women is sible biological basis of autism. Insensitivity to pain, about equal, autism occurs mostly in men. Finally, which characterizes the child with autism, can also be schizophrenia tends to run in families, whereas autism produced by morphine or other opiate drugs. The brain does not. uses some peptide synaptic transmitters, called endor- James Kalat identifies nine characteristic behaviors phins and enkephalins, with effects similar to those of of the child with autism. morphine. If for some unknown reason the brain some- times produced huge amounts of enkephalins and at 1. Social isolation. The child ignores others, even par- other times small amounts, the behavioral effect would ents, and retreats into a world of his (or her) own. resemble that of a child who occasionally took mor- 2. Stereotyped behaviors. The child rocks back and phine, and would be very much like that of a child with forth, bites his hands, stares at some object, engag- autism. es in repetitive behaviors. Eric Courchesne and Rachel Yeung-Courchesne 3. Resistance to any change in routine. have linked autism to underdevelopment of the cerebel- 4. Abnormal responses to sensory stimuli. Sometimes, lum. They have used an advanced imaging technique to the child ignores visual and auditory stimuli; at show precisely where autism-linked damage may occur. other times, he shows a “startle reaction” to very The location of the damage suggests that it occurs dur- mild stimuli. ing the fetal stage or during the first two years of life 5. Insensitivity to pain. The child is remarkably insen- and may be caused by genetic abnormality or exposure sitive to cuts, burns, and other sources of pain. to a virus or harmful chemicals. 6. Inappropriate emotional expression. Sometimes the child may have sudden bouts of fear without obvi- Elias, M. (1988, May 26). Autism may be caused by ous reason. In other cases, he may show absolute brain damage. USA Today, p. 10. fearlessness and unprovoked laughter. Kalat, J. (2009). Biological psychology (10th ed.). Pacific 7. Disturbances of movement. These vary from hyper- Grove, CA: Wadsworth. activity to prolonged inactivity. 8. Poor development of speech. Some never develop Courchesne, E., et al. (1988). Hypoplasia of cerebel- lar vermal lobules VI and VII in autism. New England any spoken language, whereas others begin to Journal of Medicine, 318, 1349–1354. develop it and then lose it. 9. Specific, limited intellectual problems. Many autis- Understanding Schizophrenia tic children do well on some intellectual tasks but very poorly on others. It is nearly impossible to Psychological Disorders 941

Other Disorders SPD is associated with a wide range of behavioral, lan- Lecture/Discussion Topic: Factitious Disorder guage, neurological, and psychiatric symptoms and is thought to be related to autism spectrum disorder and People with factitious disorder purposefully produce or other disorders in which sensory processing is disrupted fake physical symptoms in order to assume a patient’s (e.g., disorders involving vestibular, motor, or periph- role. In some cases, they may take extreme measures eral or central nervous system problems). If you did not to create the appearance of illness. For example, they discuss it earlier, you may want to do so now. may inject drugs to cause bleeding. In contrast, high fevers are relatively easy to produce. Those with fac- Dissociative Disorders titious disorder are often very knowledgeable about their ailments, including possible treatments. If chal- Classroom Exercise: The Curious Experiences lenged about the reality of their illness, they are likely Inventory to change doctors. The disorder usually begins in Dissociation is often defined as an incapacity to inte- early adulthood and seems to be more common among grate one’s thoughts, feelings, or experiences into one’s women than men. However, men tend to show more present consciousness. Dissociative symptoms have severe forms of the disorder. been implicated in such diverse conditions as amnesia, Factitious disorder seems to be more common fugue states, dissociative identity disorder, and even among those who received extensive medical treatment post-traumatic stress disorder. Handout 20 represents for a true physical disorder in childhood; experienced the shortened version of Lewis R. Goldberg’s The abuse in childhood; carry a grudge against the medical Curious Experiences Survey, which measures self- profession; have worked as a nurse, laboratory techni- reported dissociative experiences. Total score is simply cian, or medical aide; or have an underlying personality the sum of the numbers placed before the 17 items. problem such as extreme dependence. Typically, they Thus, scores can range from 17 to 85, with higher are socially isolated, enjoying little social support or scores reflecting more experience with dissociation. family life. The extreme and long-term form of facti- An analysis of the full-length 31-item scale tious disorder is called Munchausen syndrome. revealed the presence of three factors in dissociation: In Munchausen syndrome by proxy, parents fake or depersonalization (“Had the experience of feeling that actually produce physical illnesses in their children that my body did not belong to me”), self-absorption (“Find may lead to painful diagnostic tests, medication, and that I sometimes sit staring off in space, thinking of surgery. Typically, the parent (most often the mother) nothing, and am not aware of the passage of time”), and is emotionally needy and craves attention and praise amnesia (“Found evidence that I had done things that I for her devoted care of her sick child. This disorder, did not remember doing”). first identified in 1977, is often viewed as a crime by The frequency of self-reported dissociation was law enforcement authorities. The caregiver may have positively correlated with measures of neuroticism (par- administered drugs, contaminated a feeding tube, or ticularly depression) and imagination, and negatively may even have attempted to smother the child. Ronald related to conscientiousness (particularly dutifulness), Comer makes the important observation that parents agreeableness, and, to a lesser extent, age. No relation- who resort to such actions are obviously experiencing ships were found with gender, educational level, intel- serious psychological disturbance and in need of thera- ligence, vocational skills, or self-reported skills. Behav­ peutic intervention. ioral acts that were most highly positively correlated The child’s illnesses may take almost any form but with dissociative experiences included the following: the more common symptoms are bleeding, seizures, Spent an hour at a time daydreaming comas, diarrhea, fevers, and infections. Between 6 and Stayed away from a social event in order to finish some 30 percent of victims die and 8 percent are permanently work disfigured or physically impaired. The disorder is dif- Had a nightmare ficult to diagnose because the parent seems so devoted Ate until I felt sick and caring. Yet when child and parent are separated, the Drove faster than normal because I was angry physical problems disappear. Borrowed money Comer, R. (2010). Abnormal psychology (7th ed.). New Received public assistance (such as food stamps or York: Worth. welfare) Borrowed something and lost it, broke it, or never Lecture/Discussion Topic: Sensory Processing Disorder returned it The Sensation and Perception unit in these resources Stayed up all night describes sensory processing disorder (SPD), a disorder Did something I thought I would never do involving difficulties in sensory processing (see p. 308). Discussed sexual matters with a male friend Smashed a vase or other object in anger or frustration 942 Psychological Disorders

Goldberg, L. R. (1999). The Curious Experiences lowing would be rated in the direction of a high disso- Survey, a revised version of the Dissociative Experiences ciative identity disorder score. Scale: Factor structure, reliability, and relations to demographic and personality variables. Psychological 1. Have you ever walked in your sleep? Assessment, 11, 134–145. 2. Did you have imaginary playmates as a child? 3. Were you physically abused as a child or Lecture/Discussion Topic: Psychogenic Versus Organic adolescent? Amnesia 4. Were you sexually abused as a child or adolescent? Dissociative amnesia is a type of dissociative disor- (Sexual abuse includes rape or any type of unwant- der. Students are likely to be aware that amnesia may ed sexual touching or fondling that you may have be either physically or psychologically based. For experienced.) example, a blow to the head, alcohol dependency, 5. Have you ever noticed that things are missing from stroke, or Alzheimer’s­ disease may impair memory, your personal possessions or where you live? just as marital, financial, or career stress may do so. 6. Have you ever noticed that things appear where Dissociative amnesia is often referred to as psychogenic you live, but you don’t know where they came amnesia and has four characteristics that distinguish from or how they got there (e.g., clothes, jewelry, it from organic amnesia. First, psychogenic amnesics books, furniture)? lose memory for both the distant and recent past. For 7. Do people ever talk to you as if they know you but example, they cannot remember the number of siblings you don’t know them, or only know them faintly? they have. Organic amnesics, on the other hand, lose 8. Do you ever speak about yourself as “we” or “us”? memory for the recent past but remember the distant 9. Do you ever feel that there is another person or past well. Second, psychogenic amnesics lose their per- persons inside you? sonal identity—name, address, occupation—but their 10. If there is another person inside you, does he or she store of general knowledge remains intact. For example, ever come out and take control of your body? they remember the date, the name of the President, The controversy surrounding this disorder led the capital of Illinois. Organic amnesics, however, the authors of the DSM-IV-TR to attempt to increase lose both personal and general knowledge. Third, the precision of diagnosis. Perhaps most important, to psychogenic amnesics have no anterograde amnesia; fit the diagnosis of dissociative identity disorder, the that is, they remember well events happening after the person must have had the experience of amnesia, an amnesia starts. In contrast, organic amnesics experi- inability to remember important personal information. It ence severe anterograde amnesia, which is often their is hoped that more stringent conditions will reduce the primary symptom; that is, they recall very little about number of false diagnoses. events after the organic damage. For example, they Ross, C. A., Miller, S. D., Reagor, P., Bjornson, L., may not remember the name of the physician treating Fraser, G. A., & Anderson, G. (1990). Structured inter- them for the head injury. Finally, psychogenic amnesia view data on 102 cases of multiple personality disorder often reverses itself very abruptly, ending within a few from four centers. American Journal of Psychiatry, 147, hours or days of its onset. Within a day, a person may 596–601. even recall the traumatic event that set off the memory loss. In the case of organic amnesia, on the other hand, Eating Disorders memory only gradually returns for retrograde memo- ries and hardly ever returns for anterograde memories Classroom Exercise: Assessing Body Image following organic treatment. Memory of the trauma is Handout 21, Assessing Your Body Image, provides a never revived. good introduction to your discussion of how research shows dramatic increases in the number of women who Seligman, M., Walker, E., & Rosenhan, D. L. (2001). have a poor body image. For a total score, students Abnormal psychology (4th ed.). New York: Norton. should simply add up the numbers they place in front Lecture/Discussion Topic: The Dissociative Disorders of the 12 items. As Bryan Strong and his colleagues Interview Schedule and Dissociative Identity Disorder indicate, the lowest possible score is 0 and suggests a Colin Ross and his colleagues developed the Disso­ positive body image. The highest possible score is 36 ciative Disorders Interview Schedule to refine and stan- and indicates an unhealthy body image. A score above dardize the diagnosis of dissociative identity disorder 14 suggests a need to develop a healthier body image. (formerly known as multiple personality). Presenting some of its key questions in class will provide students Classroom Exercise: Motivations-to-Eat Scale with further insight into the nature of the symptoms Handout 8 (p. 652) in the Motivation and Work unit associated with this disorder. Yes responses to the fol- represents the Motivations-to-Eat Scale designed by Psychological Disorders 943

Benita Jackson and her colleagues. If you did not use it accomplishments of others. Appearing snobbish, they to introduce the psychology of eating, you may want to may attempt to hide their strong feelings of envy and use it now in relation to eating disorders. As noted on rage over the success of others. Their fragile sense of page 614, the scale recognizes that psychological moti- self-worth becomes apparent when others are critical of vations can play an important role in the initiation of them. They either fly into a rage or experience a period both healthy and disordered eating. of depression, shame, and self-doubt. Larsen, R. J., & Buss, D. M. (2008). Personality psy- Personality Disorders chology: Domains of knowledge about human nature Lecture/Discussion Topic: Narcissistic Personality (3rd ed.). Boston: McGraw-Hill. Disorder Raskin, R., & Hall, C. S. (1979). A narcissistic personal- ity inventory. Psychological Reports, 45, 590. Narcissistic personality disorder provides a good exam- ple of a personality disorder. Ask your students whether Sedikes, C., Campbell, W. K., Reeder, G. D., Elliot, A. they agree with the following statements: J., & Gregg, A. P. (2002). Do others bring out the worst in narcissists? The “others exist for me” illusion. In Y. Kashima, M. Foddy, & M. Platow (Eds.), Self and 1. I think I am a special person. identity (pp. 103–124). Mahwah, NJ: Erlbaum. 2. I expect a great deal from other people. 3. I am envious of other people’s good fortune. Classroom Exercise: Schizotypal Personality 4. I will never be satisfied until I get all that I Questionnaire deserve. You can extend your discussion of personality disorders 5. I really like to be the center of attention. with Handout 22, Adrian Raine’s schizotypal personal- ity questionnaire. It will introduce the key characteris- All the statements are drawn from Robert Raskin and tics of a fascinating personality disorder that is closely Calvin Hall’s Narcissistic Personality Inventory and tied to the study of schizophrenia. Students score their reflect some of the disorder’s primary features. The responses by adding all their yes responses. Total mean narcissistic personality has a strong need to be admired, score for 220 male and female undergraduates was 9.6. has a grandiose sense of self-importance, and demon- Three subscales help to describe the essential char- strates a lack of insight into other people’s feelings. acteristics of this disorder. The cognitive-perceptual This sense of superiority is accompanied by feel- factor is assessed by items 2, 4, 5, 9, 10, 12, 16, and 17. ings of entitlement. That is, narcissists believe they The mean score for undergraduates was 3.6. The items should receive special privileges and respect—get the suggest that the disorder is often marked by unusual best job, obtain admission to the best university— perceptual experiences, magical thinking, and odd although they have done nothing to earn such favorable beliefs and ideas of reference. The interpersonal factor treatment. Moreover, the world should be their fan club. is measured by items 1, 7, 11, 14, 15, 18, 21, and 22. When they come to a party, they expect to be welcomed The mean undergraduate score was also 3.6. Schizo­ with great fanfare. Many narcissists prefer friends who typal personality is marked by social anxiety, few close are weak or unpopular, so they will not compete for friends, and constricted affect. The “disorganized” fac- attention. tor is assessed by items 3, 6, 8, 13, 19, and 20, and the Randy Larsen and David Buss identify the narcis- mean score for undergraduates was 2.5. The personal- sistic paradox—narcissists appear to have high self- ity disorder is marked by odd behavior, including odd esteem, but it is actually quite fragile. They appear self- speech. confident but are in desperate and continuing need for Schizoptypal personality disorder falls within the others to verify their worth. Ironically, without others, “eccentric” cluster of personality disorders (the other they are nothing; at the same time, they disdain others. clusters include the “erratic” cluster, which covers In an interview with Gear magazine in October 2000, antisocial, borderline, histrionic, and narcissistic disor- entertainer Roseanne Barr stated (hopefully tongue- ders, and the “anxious” cluster, which covers avoidant, in-cheek): “I hate every human being on earth. I feel dependent, and obsessive-compulsive personality everyone is beneath me, and I feel they should all wor- disorders.) ship me.” Those suffering schizoptypal personality disorder Narcissists have difficulty in their interpersonal report unusual perceptions that border on hallucina- relations because of an inability to recognize the needs tions. They may feel that other people are looking at or desires of others. They talk mostly about themselves. them or hear murmurs that sound like their names. It is In fact, research finds that they tend to use first-person not unusual for them to hold many superstitious beliefs, pronouns in everyday conversation significantly more including an acceptance of ESP and other psychic phe- often than does the average person. Narcissists are also nomena. They may believe in magic, such as in their prone to envy. They tend to disparage the success and own ability to control others with their thoughts. 944 Psychological Disorders

Schizotypal people are very uncomfortable in Rates of Psychological Disorders social situations, especially those that involve strangers. Lecture/Discussion Topic: The Commonality of They feel that they are different from others and simply Psychological Disorders don’t fit in. Importantly, they become more, rather than The results of a federally funded study headed by less, anxious as they interact. They are suspicious of Ronald Kessler of the University of Michigan’s others and thus unable to invest trust in them. Institute for Social Research and released in early Schizotypal persons have disorganized thoughts 1994 suggested that nearly half of people ages 15 to 54 that are expressed in difficulty communicating, vague have experienced at least one bout with a psychiatric speech, and odd nonverbal behavior. They often fail disorder, and about one in three have had such an epi- to make eye contact in conversation and are viewed as sode over the last year. Psychological disorder peaks eccentric. They often wear clothes that are unkempt or between the ages of 25 and 34. Affluent, well-educated that clash. people seem to suffer less anxiety than others, perhaps, Raine, A., & Benishay, D. (1995). The SPQ-B: A brief Kessler suggests, because “they’re not as scared about screening instrument for schizotypal personality disorder. their future, and can afford to buy psychological help.” Journal of Personality Disorders, 9, 346–355. Despite the high lifetime rates of emotional problems, Classroom Exercise: Antisocial Personality Disorder only one out of four people have ever received help. Many regard Hervey Cleckley’s The Mask of Sanity to Kessler notes that many mental disorders are mild, and be the classic work on antisocial personality disorder. people recover from them without help. Recasting Cleckley’s clinical criteria for the disorder The study found that the most common disorders in the form of self-referential or opinion statements, were these: Michael Levenson designed Handout 23 to assess this 1. Major depressive episode, which constitutes at least antisocial posture. He attempted to remove the negative two weeks of symptoms such as low mood and loss connotations of the original criteria so that the items of pleasure. More than 17 percent have suffered an would suggest to antisocial persons that antisocial traits episode in their lives, more than 10 percent in the are not necessarily undesirable. A point is scored for last year. each “true” response. If you use the scale, you should 2. Alcohol dependence, with more than 14 percent note that the items have been employed strictly for experiencing it in their lifetime, 7.2 percent in the research, not for diagnostic purposes, and that you are last year. using the scale to introduce Cleckley’s portrayal of 3. Social phobia, a persistent fear of feeling scruti- the antisocial personality. When Levenson included nized or embarrassed in social situations, with 13 the scale in a study of risk taking and personality, he percent experiencing it, almost 8 percent in the last obtained a mean score of 8.33 for residents in a long- year. term drug treatment facility, a mean of 6.06 for skilled 4. Simple phobia, or a persistent fear of objects such rock climbers, and a mean of 5.15 for police officers/ as animals, insects, or blood, or of situations such firefighters who had been commended for bravery in as closed spaces, heights, or air travel, with more the line of duty. All participants were male. than 11 percent experiencing it in their lifetime, Cleckley identifies the following characteristics of almost 9 percent in the last year. antisocial personality. Kessler and his colleagues have released another 1. Superficial charm and good intelligence. report based on a nationally representative face-to- 2. Poise, rationality, absence of neurotic anxiety. face household survey conducted between February 3. Lack of a sense of personal responsibility. 2001 and April 2003. It extends earlier findings. The 4. Untruthfulness, insincerity, callousness, researchers used the fully structured World Health manipulativeness. Organization World Mental Health Survey version of 5. Antisocial behavior without regret or shame. the Composite International Diagnostic Interview in 6. Poor judgment and failure to learn from assessing 9282 English-speaking respondents. Perhaps experience. of greatest interest is that one-quarter of all Americans 7. Inability to establish lasting, close relationships met the criteria for having a mental illness within the with others. prior year, and fully a quarter of those had a “serious” 8. Lack of insight into personal motivations. disorder that significantly disrupted their ability to Cleckley, H. (1976). The mask of sanity (5th ed.). St. function day to day. Although comparable studies in Louis: Mosby. 27 other countries are not yet complete, the research- Levenson, M. (1990). Risk taking and personality. ers conclude that these new numbers suggest that the Journal of Personality and Social Psychology, 58, United States is poised to rank No. 1 globally for 1073–1080. Psychological Disorders 945 mental illness. Other important findings include the • 41 percent of those having a disorder went for following: treatment in the prior year which is up from 25 per- cent a decade ago. Younger adults are more likely • About half of Americans will meet the criteria for a to seek prompt care, so the stigma of mental illness DSM-IV-TR disorder sometime in their lifetime. may be waning. • By age 75, the lifetime probability of an anxiety • Because schizophrenia, autism, and some other disorder (including phobias) is 32 percent, of mood severe disorders were not surveyed, the researchers disorders (including depression) is 28 percent, of conclude that the prevalence of psychological dis- impulse control disorders is 25 percent, of alcohol orders is even higher than their statistics suggest. abuse is 15 percent, and of drug abuse is 9 percent. • Median age of onset is much earlier for anxiety Elias, M. (1994, January 14). Many adults have glitches (11 years) and impulse-control (11 years) disor- in mental health. USA Today, p. 4D. ders than for substance abuse (20 years) and mood disorders (30 years). Half of all cases start by 14 Kessler, R. C., Berglund, P., Demler, O., Jin, R., years and three-fourths by 24 years. Merikangas, K. R., & Walters, E. E. (2005) Lifetime • Rates of mental illness have flattened in the past 15 prevalence and age-of-onset distributions of DSM- IV Disorders in the National Comorbidity Survey years after steadily rising from the 1950s. Replication. Archives of General Psychiatry, 62, 593–602. 946 Psychological Disorders

HANDOUT 1

Defining Psychological Disorders

Instructions: Read through the case studies that follow. After you read each one, decide whether you think that the individual described is displaying a psychological disorder. Go with your initial “gut” instinct for now.

Andrew has led a turbulent life. As a young child, he skipped school more often than he attended. When he did attend, he was a frequent behavior problem, often getting into fights with other boys. He was finally expelled from school altogether after stabbing another student in his high school class. Since then he has not held a job for any length of time. Soon after his expulsion, he began supplementing his income by breaking into homes and stealing whatever he could get his hands on. However, he appears to feel no guilt about this behavior. Although he has never been in a committed relationship, he has several children, whom he never sees, due partly to the fact that he frequent- ly moves from town to town. Despite these characteristics, Andrew is a colorful and entertaining person and has a certain charm. If asked, he will tell you that he is quite happy with his current life-style.

Has a Psychological Disorder Does Not Have a Psychological Disorder

Barbara was generally a happy child and had many friends in high school. She made very good grades and decided to go on to college and then to law school. After her first year of law school, she began to notice periods of “feeling down.” At first she ignored this, but after a year or so, these episodes began to get worse. When she started paying more attention, she noticed that the episodes usually began about a week before her period and ended a few days after her period began. In addition to feeling depressed during that time, she also was overly sensitive to criticism. Often, her appetite would increase, and she would especially crave sweets. Sometimes she found it difficult to concentrate on her studies during this time, and she often lacked the energy to do much of anything except watch television.

Has a Psychological Disorder Does Not Have a Psychological Disorder

Charles is the third of seven children. He attended school in the suburbs of a large city, where he made average grades. He dated a bit in high school and had several close friends. During vacations, he worked in his father’s garage, learning all he could about automobiles. After high school, Charles took a job as a mechanic in the garage. However, Charles was beginning to feel different from his co-workers. He began to realize that he was attracted to one of his customers, a man with whom he had gone to school. When Charles realized this, he became very confused and felt angry with himself for having such feelings. Although he tried to convince himself that the feelings would go away over time, they did not, and Charles finally admitted to himself that he was a homosexual. Currently, he is in a monogamous relationship with another man but is afraid to admit his sexual orientation to friends or family, for fear of their reaction. He often finds himself preoccupied with trying to find ways to hide his orientation from them.

Has a Psychological Disorder Does Not Have a Psychological Disorder Psychological Disorders 947

HANDOUT 1 (continued)

Diane is the only child of two professional parents. She did well in high school and had several close friends. However, her grades suffered when she got to college, and she spent one semester on probation before she gradu- ated. While in college, she met Don, and the two married soon after graduation and had two children of their own. Diane and Don decided that she would stay home until the children were in school, since his job with a prestigious accounting firm would allow him to support the family. Three months ago, however, Don came home from work and announced that he had met another woman and was having an affair and that he had decided to leave Diane. The divorce proceeded quickly, and, while Diane retained custody of the children, she had to move to a smaller apartment. She began looking for work but found that it was difficult to find a job, and eventually took a job she disliked. Diane often finds herself thinking about how quickly her life has changed in the last few months. She becomes very sad and will sometimes lie in bed crying after the children are asleep. She finds her- self eating a lot more than she used to, and sometimes, she has difficulty getting to sleep at night.

Has a Psychological Disorder Does Not Have a Psychological Disorder

Eric was born in a rural town in the Midwest. He made average grades in school and decided after graduation to purchase a farm in the area and raise corn. He very much enjoyed this lifestyle and did quite well. One day, while working in the field, an accident with a combine caused Eric to be rushed to the hospital. While doctors were able to save his life, they were not able to save his legs. Eric is now confined to a wheelchair. It has been a year since the accident and he is in a great deal of pain, which is partially controlled by morphine, which his doctor has prescribed. However, his thinking remains quite rational, and he has been able to do some work helping with the books at his parents’ store. He does not enjoy this work and misses his previous activity. Recently, he con- fided in his doctor that he does not feel that his new life is worth living, and he has decided that he would like to end it all.

Has a Psychological Disorder Does Not Have a Psychological Disorder

Source: Davis, S. M. (2003, January). Utilizing contradictions in students’ implicit definitions of “mental disorder” in an introductory psychology course. Poster presented at the 25th Annual National Institute on the Teaching of Psychology, St. Petersburg, FL, January 2003. 948 Psychological Disorders

HANDOUT 2

Adult ADHD Self-Report Scale Symptom Checklist

Please answer the questions below, rating yourself on each of the criteria using the following scale. As you answer each question, describe how you have felt and conducted yourself over the past 6 months.

0 = never 1 = rarely 2 = sometimes 3 = often 4 = very often

1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? 2. How often do you have difficulty getting things in order when you have to do a task that requires organization? 3. How often do you have problems remembering appointments or obligations? 4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started? 5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? 6. How often do you feel overly active and compelled to do things, like you were driven by a motor?

Source: Reprinted by permission of the World Health Organization. Psychological Disorders 949

HANDOUT 3

The Healthy Adult

Circle the five characteristics that best describe a mature, healthy, and socially competent adult male.

1. ambitious 6. self-confident 2. tactful 7. logical 3. adventurous 8. gentle 4. aware of others’ feelings 9. independent 5. need for security 10. expresses tender feelings

Circle the five characteristics that best describe a mature, healthy, and socially competent adult female.

1. ambitious 6. self-confident 2. tactful 7. logical 3. adventurous 8. gentle 4. aware of others’ feelings 9. independent 5. need for security 10. expresses tender feelings

Circle the five characteristics that best describe a mature, healthy, and socially competent adult person.

1. ambitious 6. self-confident 2. tactful 7. logical 3. adventurous 8. gentle 4. aware of others’ feelings 9. independent 5. need for security 10. expresses tender feelings

Source: Broverman, I. K., et al. (1970). Sex role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7. Copyright © 1970 by the American Psychological Association. Adapted by permission. 950 Psychological Disorders

HANDOUT 4

Suppose, without your knowledge, just before you came to class today, someone put a drug into your drink that soon will make you behave as though you were psychotic. This afternoon, a classmate finds you wandering the halls mut- tering nonsense and takes you to the Dean’s office. The Dean notifies your parents of your “illness” and they send you to a psychiatric clinic where you fill out a questionnaire that asks about events in your past that might have caused your “breakdown.” Take some time now, during a short break, to think about it. Can you remember happen- ings in your own life that might explain your “psychopathological” condition? Jot down anything that comes to mind. Don’t sign them but be prepared to hand in your notes when class resumes.

Source: Kimble, G. A. (1996, August). Secondary school psychology: The challenge and the hope (table 2). Paper presented at the 104th Annual Convention of the American Psychological Association, Toronto. Psychological Disorders 951

HANDOUT 5

Pretend the following description of Tom W. was written by a clinical psychologist 5 years ago, when Tom was a senior in high school. Please read it carefully before responding to the question below.

Tom W. is of high intelligence, although lacking in true creativity. He has a need for order and clarity, and for neat and tidy systems in which every detail finds its appropriate place. His writing is rather dull and mechanical, occasionally enlivened by somewhat corny puns and flashes of imagination of the sci-fi type. He has a strong drive for competence. He seems to have little feeling and little sympathy for other people and does not enjoy interacting with others. Self-centered, he nonetheless has a deep moral sense.

Today, Tom is a mental patient in a state hospital. Might that outcome have been predicted when Tom was a senior in high school? On what basis?

Source: Bolt, M. (1999). Instructor’s manual to accompany Social Psychology (6th ed., p. 478). Copyright © 1996 by McGraw-Hill. Reproduced by permission of The McGraw-Hill Companies. Adapted from Kahneman, D., & Tversky, A. (1973). On the psychology of predictions. Psychological Review, 80, 237–251. Copyright © 1973 by the American Psychological Association. Reprinted with permission.

Psychological Disorders 951

HANDOUT 5

Pretend the following description of Tom W. was written by a clinical psychologist 5 years ago, when Tom was a senior in high school. Please read it carefully before responding to the question below.

Tom W. is of high intelligence, although lacking in true creativity. He has a need for order and clarity, and for neat and tidy systems in which every detail finds its appropriate place. His writing is rather dull and mechanical, occasionally enlivened by somewhat corny puns and flashes of imagination of the sci-fi type. He has a strong drive for competence. He seems to have little feeling and little sympathy for other people and does not enjoy interacting with others. Self-centered, he nonetheless has a deep moral sense.

Today, Tom is a graduate student in the School of Education in a state university and hopes to work eventually with handicapped children. Might that outcome have been predicted when Tom was a senior in high school? On what basis?

Source: Bolt, M. (1999). Instructor’s manual to accompany Social Psychology (6th ed., p. 478). Copyright © 1996 by McGraw-Hill. Reproduced by permission of The McGraw-Hill Companies. Adapted from Kahneman, D., & Tversky, A. (1973). On the psychology of predictions. Psychological Review, 80, 237–251. Copyright © 1973 by the American Psychological Association. Reprinted with permission. 952 Psychological Disorders

HANDOUT 6

Penn State Worry Questionnaire

Using a scale from 1 = “not at all typical of me” to 5 = “very typical of me” respond to each of the following items:

1. If I do not have enough time to do everything, I do not worry about it. 2. My worries overwhelm me. 3. I do not tend to worry about things. 4. Many situations make me worry. 5. I know I should not worry about things, but I just cannot help it. 6. When I am under pressure I worry a lot. 7. I am always worrying about something. 8. I find it easy to dismiss worrisome thoughts. 9. As soon as I finish one task, I start to worry about everything else I have to do. 10. I never worry about anything. 11. When there is nothing more I can do about a concern, I do not worry about it any more. 12. I have been a worrier all my life. 13. I notice that I have been worrying about things. 14. Once I start worrying, I cannot stop. 15. I worry all the time. 16. I worry about projects until they are all done.

Source: Meyer et. al. Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28, 487–495. Copyright 1990. Reprinted by permission of Elsevier. Psychological Disorders 953

HANDOUT 7

Taylor Manifest Anxiety Scale

Circle the items that are true of you. 1. I do not tire quickly. 2. I am troubled by attacks of nausea. 3. I believe I am no more nervous than most others. 4. I have very few headaches. 5. I work under a great deal of tension. 6. I cannot keep my mind on one thing. 7. I worry over money and business. 8. I frequently notice my hand shakes when I try to do something. 9. I blush no more often than others. 10. I have diarrhea once a month or more. 11. I worry quite a bit over possible misfortunes. 12. I practically never blush. 13. I am often afraid that I am going to blush. 14. I have nightmares every few nights. 15. My hands and feet are usually warm. 16. I sweat very easily even on cool days. 17. Sometimes when embarrassed, I break out in a sweat. 18. I hardly ever notice my heart pounding and I am seldom short of breath. 19. I feel hungry almost all the time. 20. I am very seldom troubled by constipation. 21. I have a great deal of stomach trouble. 22. I have had periods in which I lost sleep over worry. 23. My sleep is fitful and disturbed. 24. I dream frequently about things that are best kept to myself. 25. I am easily embarrassed. 26. I am more sensitive than most other people. 27. I frequently find myself worrying about something. 28. I wish I could be as happy as others seem to be. 29. I am usually calm and not easily upset. 30. I cry easily. 31. I feel anxiety about something or someone almost all the time. 32. I am happy most of the time. 33. It makes me nervous to have to wait. 34. I have periods of such great restlessness that I cannot sit long in a chair. 35. Sometimes I become so excited that I find it hard to get to sleep. 36. I have sometimes felt that difficulties were piling up so high that I could not overcome them. 37. I must admit that I have at times been worried beyond reason over something that really did not matter. 38. I have very few fears compared to my friends. 39. I have been afraid of things or people that I know could not hurt me. 40. I certainly feel useless at times. 41. I find it hard to keep my mind on a task or job. 42. I am usually self-conscious. 43. I am inclined to take things hard. 44. I am a high-strung person. 45. Life is a trial for me much of the time. 46. At times I think I am no good at all. 47. I am certainly lacking in self-confidence. 48. I sometimes feel that I am about to go to pieces. 49. I shrink from facing a crisis of difficulty. 50. I am entirely self-confident. Source: Reprinted by permission of Janet T. Spence from Taylor, J. A. (1953). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology, 48, 285–290. 954 Psychological Disorders

HANDOUT 8

Measuring Fear

Using the key below, rate each item on the intensity of fear you associate with that object or event.

1 2 3 4 5 6 7 no fear very little a little some much great terror fear fear fear fear fear

1. Sharp objects 27. Being with drunks 2. Being a passenger in a car 28. Illness or injury to loved one 3. Dead bodies 29. Being self-conscious 4. Suffocating 30. Driving a car 5. Failing a test 31. Meeting authority 6. Looking foolish 32. Mental illness 7. Being a passenger in an airplane 33. Closed places 8. Worms 34. Boating 9. Arguing with parents 35. Spiders 10. Rats and mice 36. Thunderstorms 11. Life after death 37. Not being a success 12. Hypodermic needles 38. God 13. Being criticized 39. Snakes 14. Meeting someone for the first time 40. Cemeteries 15. Roller coasters 41. Speaking before a group 16. Being alone 42. Seeing a fight 17. Making mistakes 43. Death of a loved one 18. Being misunderstood 44. Dark places 19. Death 45. Strange dogs 20. Being in a fight 46. Deep water 21. Crowded places 47. Being with a member of the opposite sex 22. Blood 48. Stinging insects 23. Heights 49. Untimely or early death 24. Being a leader 50. Losing a job 25. Swimming alone 51. Auto accidents 26. Illness

Source: Geer. The development of a scale to measure fear. Behavior Research and Therapy. Copyright 1965. Reprinted by permission of Elsevier. Psychological Disorders 955

HANDOUT 9

Rate the degree to which the thoughts or beliefs below are typical of your thinking when anticipating or participating in a social encounter. Use the following scale:

1 = never characteristic 2 = rarely characteristic 3 = sometimes characteristic 4 = often characteristic 5 = always characteristic 1. When I am in a social situation, I appear clumsy to other people. 2. If I am with a group of people and I have an opinion, I am likely to chicken out and not say what I think. 3. I feel as if other people sound more intelligent than I do. 4. When I am with other people, I am not good at standing up for myself. 5. I am a coward when it comes to interacting with other people. 6. I feel unattractive when I am with other people. 7. I would never be able to make a speech in public. 8. Other people are more comfortable in social situations than I am. 9. Other people are more socially capable than I am. 10. No matter what I do, I will always be uncomfortable in social situations. 11. My mind is very likely to go blank when I am talking in a social situation. 12. I am not good at small talk. 13. Other people are bored when they are around me. 14. When speaking in a group, others will think what I am saying is stupid. 15. If I am around someone I am interested in, I am likely to get panicky or do something to embarrass myself. 16. I do not know how to behave when I am in the company of others. 17. If something went wrong in a social situation, I would not be able to smooth it over. 18. When I am with other people they usually don’t think I am very smart. 19. When other people laugh it feels as if they are laughing at me. 20. People can easily see when I am nervous. 21. If there is a pause during a conversation, I feel as if I have done something wrong.

Source: From Turner and Beidel. (2003). The social thoughts and beliefs scale: A new inventory for assessing cognitions in social phobia. Psychological Assessment, 15, 384–391­ (Scale appears as Appendix, p. 391). Copyright © 2003. Reprinted by permission of the authors. 956 Psychological Disorders

HANDOUT 10

The following statements refer to experiences that many people have in their everyday lives. Circle the number that best describes HOW MUCH that experience has DISTRESSED or BOTHERED you during the PAST MONTH. The numbers refer to the following verbal labels:

0 1 2 3 4 Not at all A little Moderately A lot Extremely

1. I have saved up so many things that they get in the way. 0 1 2 3 4 2. I check things more often than necessary. 0 1 2 3 4 3. I get upset if objects are not arranged properly. 0 1 2 3 4 4. I feel compelled to count while I am doing things. 0 1 2 3 4 5. I find it difficult to touch an object when I know it has been touched 0 1 2 3 4 by strangers or certain people. 6. I find it difficult to control my own thoughts. 0 1 2 3 4 7. I collect things I don’t need. 0 1 2 3 4 8. I repeatedly check doors, windows, drawers, etc. 0 1 2 3 4 9. I get upset if others change the way I have arranged things. 0 1 2 3 4 10. I feel I have to repeat certain numbers. 0 1 2 3 4 11. I sometimes have to wash or clean myself simply because I feel contaminated. 0 1 2 3 4 12. I am upset by unpleasant thoughts that come into my mind against my will. 0 1 2 3 4 13. I avoid throwing things away because I am afraid I might need them later. 0 1 2 3 4 14. I repeatedly check gas and water taps and light switches after turning them off. 0 1 2 3 4 15. I need things to be arranged in a particular order. 0 1 2 3 4 16. I feel that there are good and bad numbers. 0 1 2 3 4 17. I wash my hands more often and longer than necessary. 0 1 2 3 4 18. I frequently get nasty thoughts and have difficulty getting rid of them. 0 1 2 3 4

Source: Foa, E. F., et al. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. Scale appears in the Appendix, p. 486. Reprinted by permission of the author. Psychological Disorders 957

HANDOUT 11

Psychological Disorder

We are interested in the kinds of thoughts you may have had after a traumatic experience. Below are a number of statements that may or may not be representative of your thinking. Please read each statement carefully and tell us how much you AGREE or DISAGREE with each statement. People react to traumatic events in many different ways. There are no right or wrong answers to these statements.

1 = Totally disagree 2 = Disagree very much 3 = Disagree slightly 4 = Neutral 5 = Agree slightly 6 = Agree very much 7 = Totally agree

1. The event happened because of the way I acted. 2. I can’t trust that I will do the right thing. 3. I am a weak person. 4. I will not be able to control my anger and will do something terrible. 5. I can’t deal with even the slightest upset. 6. I used to be a happy person but now I am always miserable. 7. People can’t be trusted. 8. I have to be on guard all the time. 9. I feel dead inside. 10. You can never know who will harm you. 11. I have to be especially careful because you never know what can happen next. 12. I am inadequate. 13. I will not be able to control my emotions, and something terrible will happen. 14. If I think about the event, I will not be able to handle it. 15. The event happened to me because of the sort of person I am. 16. My reactions since the event mean that I am going crazy. 17. I will never be able to feel normal emotions again. 18. The world is a dangerous place. 19. Somebody else would have stopped the event from happening. 20. I have permanently changed for the worse. 21. I feel like an object, not like a person. 22. Somebody else would not have gotten into this situation. 23. I can’t rely on other people. 24. I feel isolated and set apart from others. 25. I have no future. 26. I can’t stop bad things from happening to me. 27. People are not what they seem. 28. My life has been destroyed by the trauma. 29. There is something wrong with me as a person. 30. My reactions since the event show that I am a lousy coper. 958 Psychological Disorders

HANDOUT 11 (continued)

31. There is something about me that made the event happen. 32. I will not be able to tolerate my thoughts about the event, and I will fall apart. 33. I feel like I don’t know myself anymore. 34. You never know when something terrible will happen. 35. I can’t rely on myself. 36. Nothing good can happen to me anymore.

Scoring Key for the Posttraumatic Cognitions Inventory (PTCI) Negative Cognitions Negative Cognitions about Self about the World Self-Blame 2 ______7 ______1 ______3 ______8 ______15 ______4 ______10 ______19 ______5 ______11 ______22 ______6 ______18 ______31 ______9 ______23 ______12 ______27 ______Sum C ______14 ______divided by 5 = ______(Score) 16 ______Sum B ______17 ______divided by 7 = ______(Score) 20 ______21 ______24 ______25 ______26 ______Total Score 28 ______Sum A ______29 ______Sum B ______30 ______Sum C ______33 ______35 ______Sum of A, B, C = ______(Score) 36 ______Sum A ______divided by 21 = ______(Score) Note. Items 13, 32, and 34 are experimental and therefore not included in subscales.

Source: Foa, E. B., et al. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314. Copyright © 1999 by the American Psychological Association and the authors. Reprinted by permission. Psychological Disorders 959

HANDOUT 12

Depression Scale

Using a scale from: 0 = rarely/none to 3 = most of the time, indicate how often the following were true for you over the past 2 weeks:

1. I was bothered by things that usually don’t bother me. 2. I felt that I could not shake off the blues even with the help from my friends or family. 3. I felt that I was just as good as other people. 4. I had trouble keeping my mind on what I was doing. 5. I felt that everything I did was an effort. 6. I felt hopeful about the future. 7. I felt my life had been a failure. 8. I felt fearful. 9. I felt lonely. 10. People were unfriendly.

Source: Cole, J. C., et al. (2004). Development and validation of a Rasch-Derived CES-D Short Form. Psychological Assessment, 16, 360–372. (Scale items appear in Table 1, p. 363). 960 Psychological Disorders

HANDOUT 13

Instructions: Read each statement carefully. Use the following scale to indicate how often you have felt that way dur- ing the past two weeks. (If you are on a diet, respond to statements 5 and 7 as though you were not on a diet.)

1 = none or a little of the time 2 = some of the time 3 = good part of the time 4 = most or all of the time

1. I feel down-hearted, blue, and sad. 2. Morning is when I feel the best. 3. I have crying spells or feel like it. 4. I have trouble sleeping through the night. 5. I eat as much as I used to. 6. I enjoy looking at, talking to, and being with attractive women/men. 7. I notice that I am losing weight. 8. I have trouble with constipation. 9. My heart beats faster than usual. 10. I get tired for no reason. 11. My mind is as clear as it used to be. 12. I find it easy to do the things I used to do. 13. I am restless and can’t keep still. 14. I feel hopeful about the future. 15. I am more irritable than usual. 16. I find it easy to make decisions. 17. I feel that I am useful and needed. 18. My life is pretty full. 19. I feel that others would be better off if I were dead. 20. I still enjoy the things I used to do.

Source: Zung, W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70. Copyright 1965, American Medical Association. Psychological Disorders 961

HANDOUT 14

Automatic Thoughts Questionnaire

Listed below are a variety of thoughts that pop into people’s heads. Please read each thought and indicate how fre- quently, if at all, the thought occurred to you over the last week. Please read each item carefully and fill in the blank with the appropriate number, using the following scale:

1 = not at all 2 = sometimes 3 = moderately often 4 = often 5 = all the time

1. I feel like I’m up against the world. 2. I’m no good. 3. Why can’t I ever succeed? 4. No one understands me. 5. I’ve let people down. 6. I don’t think I can go on. 7. I wish I were a better person. 8. I’m so weak. 9. My life’s not going the way I want it to. 10. I’m so disappointed in myself. 11. Nothing feels good anymore. 12. I can’t stand this anymore. 13. I can’t get started. 14. What’s wrong with me? 15. I wish I were somewhere else. 16. I can’t get things together. 17. I hate myself. 18. I’m worthless. 19. Wish I could just disappear. 20. What’s the matter with me? 21. I’m a loser. 22. My life is a mess. 23. I’m a failure. 24. I’ll never make it. 25. I feel so helpless. 26. Something has to change. 27. There must be something wrong with me. 28. My future is bleak. 29. It’s just not worth it. 30. I can’t finish anything.

Source: Kendall, P., & Hollon, S. (1980). Cognitive self statements in depression: Development of an Automatic Thoughts Questionnaire. Cognitive Therapy and Research, 4, 383–395. Copyright © 1989 Philip C. Kendall. Reprinted by permission. 962 Psychological Disorders

HANDOUT 15

The Revised UCLA Loneliness Scale

Directions: Indicate how often you feel the way described in each of the following statements. Circle one number for each.

Statement Never Rarely Sometimes Often ______

1. I feel in tune with the people around me 1 2 3 4 2. I lack companionship 1 2 3 4 3. There is no one I can turn to 1 2 3 4 4. I do not feel alone 1 2 3 4 5. I feel part of a group of friends 1 2 3 4 6. I have a lot in common with the people around me 1 2 3 4 7. I am no longer close to anyone 1 2 3 4 8. My interests and ideas are not shared by those around me 1 2 3 4 9. I am an outgoing person 1 2 3 4 10. There are people I feel close to 1 2 3 4 11. I feel left out 1 2 3 4 12. My social relationships are superficial 1 2 3 4 13. No one really knows me well 1 2 3 4 14. I feel isolated from others 1 2 3 4 15. I can find companionship when I want it 1 2 3 4 16. There are people who really understand me 1 2 3 4 17. I am unhappy being so withdrawn 1 2 3 4 18. People are around me but not with me 1 2 3 4 19. There are people I can talk to 1 2 3 4 20. There are people I can turn to 1 2 3 4 ______

Source: Russell, D., et al. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480. Copyright © 1980 by the American Psychological Association. Reprinted by permission. Psychological Disorders 963

HANDOUT 16

The Body Investment Scale (BIS)

Instructions for Participants: The following is a list of statements about one’s experience, feelings, and attitudes of his/her body. There are no right or wrong answers. We would like to know what your experience, feelings, and atti- tudes of your body are. Please read each statement carefully and evaluate how it relates to you by checking the degree to which you agree or disagree with it. If you do not agree at all: circle (1). If you do not agree: circle (2). If you are undecided: circle (3). If you agree: circle (4). If you strongly agree: circle (5). Try to be as honest as you can. Thank you for your time and cooperation.

1. I believe that caring for my body will improve my well-being. 1 2 3 4 5 2. I don’t like it when people touch me. 1 2 3 4 5 3. It makes me feel good to do something dangerous. 1 2 3 4 5 4. I pay attention to my appearance. 1 2 3 4 5 5. I am frustrated with my physical appearance. 1 2 3 4 5 6. I enjoy physical contact with other people. 1 2 3 4 5 7. I am not afraid to engage in dangerous activities. 1 2 3 4 5 8. I like to pamper my body. 1 2 3 4 5 9. I tend to keep a distance from the person with whom I am talking. 1 2 3 4 5 10. I am satisfied with my appearance. 1 2 3 4 5 11. I feel uncomfortable when people get too close to me physically. 1 2 3 4 5 12. I enjoy taking a bath. 1 2 3 4 5 13. I hate my body. 1 2 3 4 5 14. In my opinion it is very important to take care of the body. 1 2 3 4 5 15. When I am injured, I immediately take care of the wound. 1 2 3 4 5 16. I feel comfortable with my body. 1 2 3 4 5 17. I feel anger toward my body. 1 2 3 4 5 18. I look in both directions before crossing the street. 1 2 3 4 5 19. I use body care products regularly. 1 2 3 4 5 20. I like to touch people who are close to me. 1 2 3 4 5 21. I like my appearance in spite of its imperfections. 1 2 3 4 5 22. Sometimes I purposely injure myself. 1 2 3 4 5 23. Being hugged by a person close to me can comfort me. 1 2 3 4 5 24. I take care of myself whenever I feel a sign of illness. 1 2 3 4 5

Source: Orbach, I., & Mikulincer, M. (1998). The body investment scale: Construction and validation of a body experience scale. Psychological Assessment, 10, 425. Copyright © 1998 Israel Orbach. Reprinted with permission. 964 Psychological Disorders

HANDOUT 17

Suicide

Read each of the scenarios below and indicate which person you think is at greatest risk for attempting/committing suicide by writing a “1” in the space. Indicate which person you think is at the next greatest risk by writing a “2” in the space, and so on. In short, rank the descriptions with 1 being the person at the greatest risk and 4 being the person at the least risk.

Person 1:

Joe is a 35-year-old man who just found out that he has been laid off from his job as a computer pro- grammer after working at the same company for 7 years. He has no idea how he is going to tell his wife and their 5-year-old girl that daddy just lost his job. Money is tight and looks to be getting even tighter. Joe finds himself thinking that his family would be better off if he were dead and they could collect on the insurance money.

Person 2:

Maria is a 22-year-old college student who just broke up with her boyfriend of 2 years. Much of Maria’s self-concept was based on her idea of a future with her boyfriend primarily because she had such a difficult time adjusting to her parents’ divorce. At age 13, following her parents’ first separation, Maria took “a few pills,” but nothing serious happened and she never told anyone about it.

Person 3:

Amy is a 19-year-old female who just told her family that she is a lesbian. Disowned by her father and ostracized by the rest of her family, Amy now finds herself on her own trying to pay for school. Amy’s counselor has noted disturbing changes in her behavior, especially that she isn’t sleeping or eating, she can’t concentrate on schoolwork, and she has stopped doing things with her friends. Amy reluctantly followed her counselor’s advice and saw a doctor about beginning medication.

Person 4:

Alex is a 57-year-old man who has been divorced three times, the last divorce costing him his house and his status in the community. As if that weren’t enough, the economy has led to poor commissions at his high-pressure sales job so he hasn’t made his alimony and child support payments for the last few months. After work, he often goes to the shooting club to shoot a few rounds with his favorite gun as a way to blow off steam and then has a few beers “to help him relax.” The other day, after shooting and drinking several rounds, he unexpectedly gave his favorite gun to his best friend.

Source: Madson, L., & Vas, C. J. (2003). Learning risk factors for suicide: A scenario-based activity. Teaching of Psychology, 30, 123–126. Copyright 2003. Reprinted by permission of Laura Madson. Psychological Disorders 965

HANDOUT 18

Expanded Revised Facts on Suicide Quiz

Circle the answer you feel is most correct for each question. “T” (true), “F” (false), or “?” (don’t know) T F ? 1. People who talk about suicide rarely commit suicide. T F ? 2. No tendency toward suicide is genetically (i.e., biologically) inherited and passed on from one generation to another. T F ? 3. The suicidal person neither wants to die nor is fully intent on dying. T F ? 4. If they were assessed by a psychiatrist, everyone who commits suicide would be diag- nosed as depressed. T F ? 5. If you ask someone directly “Do you feel like killing yourself?” it will likely lead them to make a suicide attempt. T F ? 6. A suicidal person will always be suicidal and entertain thoughts of suicide. T F ? 7. Suicide rarely happens without warning. T F ? 8. A person who commits suicide is mentally ill. T F ? 9. A time of high suicide risk in depression is at the time when the person begins to improve. T F ? 10. Nothing can be done to stop a person from making the attempt once they have made up their mind to kill themself. T F ? 11. Motives and causes of suicide are readily established. T F ? 12. Women’s suicide rates are generally highest in midlife. T F ? 13. Suicide is among the top four causes of death in the U.S. T F ? 14. Most people who attempt suicide fail to kill themselves. T F ? 15. Those who attempt suicide do so only to manipulate others and attract attention to themselves. T F ? 16. Oppressive weather (e.g., rain, etc.) has been found to be very related to suicidal behavior. T F ? 17. There is a strong correlation between alcoholism and suicide. T F ? 18. Suicide seems unrelated to moon phases. T F ? 19. Special treatment techniques are needed in dealing with the depressed/suicidal elderly. T F ? 20. On average each year more people die from homicides than suicides. T F ? 21. More teenagers die from suicide than from AIDS. T F ? 22. Elderly suicide rates have declined for several decades. T F ? 23. Suicide rates for young African American males significantly increased over the last two decades. T F ? 24. By age, race, and sex, the grouping at highest risk for death by suicide is elderly white males. T F ? 25. Older adults are much less likely than younger adults to use firearms as a method of suicide. 966 Psychological Disorders

HANDOUT 18 (continued)

For questions 26–50, select your single answer from among choices a, b, or c.:

26. What percent of suicides leaves a suicide note? a. 15–25% b. 40–50% c. 65–75% 27. Suicide rates for the U.S. as a whole are for the young. a. lower than b. higher than c. the same as 28. With respect to sex differences in suicide attempts: a. Males and females attempt at similar levels. b. Females attempt more often than males. c. Males attempt more often than females. 29. Suicide rates among the young are those for the old. a. lower than b. higher than c. the same as 30. Men kill themselves in numbers those for women. a. similar to b. higher than c. lower than 31. Suicide rates for the young since the 1950s have: a. increased b. decreased c. changed little 32. The most common method employed to kill oneself in the U.S. is: a. hanging b. firearms c. drugs and poisons 33. The season of highest suicide risk is: a. Winter b. Fall c. Spring 34. The day of the week on which the most suicides occur is: a. Monday b. Wednesday c. Saturday 35. Suicide rates for non-Whites are those for Whites. a. higher than b. similar to c. lower than 36. Which marital status category has the lowest rates of suicide? a. married b. widowed c. single, never married 37. The ethnic/racial group with the highest suicide rate is: a. Whites b. African American c. Native Americans 38. The risk of death by suicide for a person who has attempted suicide in the past is someone who has never attempted. a. lower than b. similar to c. higher than 39. Compared to other Western nations, the U.S. suicide rate is: a. among the highest b. moderate c. among the lowest 40. The most common method in attempted suicide is: a. firearms b. drugs and poisons c. cutting ones wrists 41. On the average, when a young person makes a suicide attempt they are to die compared to an elderly person. a. less likely b. just as likely c. more likely 42. If we place the ways people die in rank order for young people and for the nation as a whole, suicide ranks ____ for the young when compared to the nation as a whole. a. the same b. higher c. lower Psychological Disorders 967

HANDOUT 18 (continued)

43. The region of the U.S. with the highest suicide rates is: a. Eastern b. Midwestern c. Western 44. Most older adults who complete suicide: a. did not have a physician at the time of their death. b. have not seen a physician in the year before their death. c. have seen a physician in the month before their death 45. Currently, ____ states have legalized physician assisted suicides. a. 0 b. 1 c. 3 46. According to government surveys of American high school students (grades 9 to 12), reported they had made a suicide attempt in the past year. a. 1 in 5 b. 1 in 12 c. 1 in 25 47. Individuals with HIV or AIDS appear to have a suicide risk compared to undiagnosed populations. a. higher b. lower c. similar 48. The risk of suicide is highest among: a. alcoholics/substance abusers b. schizophrenics c. depressed individuals 49. The age group most likely to make a non fatal suicide attempt is: a. young b. middle aged c. old 50. On average approximately Americans die from suicide each day: a. 40–50 b. 80–90 c. 120–130

Source: Hubbard, R. W., & McIntosh, J. L. (2003, April 25). The expanded revised facts on suicide quiz. Paper presented at the annual meeting of the American Association of Suicidology, Santa Fe, NM. Reprinted by permission of John L. McIntosh. 968 Psychological Disorders

HANDOUT 19

True–False Scale

Circle the items with which you agree, that is, those you consider “true.”

1. Some people can make me aware of them just by thinking about me. 2. I have had the momentary feeling that I might not be human. 3. I have sometimes been fearful of stepping on sidewalk cracks. 4. I think I could learn to read others’ minds if I wanted to. 5. Horoscopes are right too often for it to be a coincidence. 6. Things sometimes seem to be in different places when I get home, even though no one has been there. 7. Numbers like 13 and 7 have no special powers. 8. I have occasionally had the silly feeling that a TV or radio broadcaster knew I was listening to him. 9. I have worried that people on other planets may be influencing what happens on earth. 10. The government refuses to tell us the truth about flying saucers. 11. I have felt that there were messages for me in the way things were arranged, like in a store window. 12. I have never doubted that my dreams are the products of my own mind. 13. Good luck charms don’t work. 14. I have noticed sounds on my records [CDs] that are not there at other times. 15. The hand motions that strangers make seem to influence me at times. 16. I almost never dream about things before they happen. 17. I have had the momentary feeling that someone’s place has been taken by a look-alike. 18. It is not possible to harm others merely by thinking bad thoughts about them. 19. I have sometimes sensed an evil presence around me, although I could not see it. 20. I sometimes have a feeling of gaining or losing energy when certain people look at me or touch me. 21. I have sometimes had the passing thought that strangers are in love with me. 22. I have never had the feeling that certain thoughts of mine really belong to someone else. 23. When introduced to strangers, I rarely wonder whether I have known them before. 24. If reincarnation were true, it would explain some unusual experiences I have had. 25. People often behave so strangely that one wonders if they are part of an experiment. 26. At times, I perform certain little rituals to ward off negative influences. 27. I have felt that I might cause something to happen just by thinking too much about it. 28. I have wondered whether the spirits of the dead can influence the living. 29. At times I have felt that a professor’s lecture was meant especially for me. 30. I have sometimes felt that strangers were reading my mind. Source: Eckblad, M. et al. (1983). Magical ideation as an indicator of schizotypy. Journal of Consulting and Clinical Psychology, 51, 216–217. Copyright © 1983 by the American Psychological Association. Reprinted by permission. Psychological Disorders 969

HANDOUT 20

The Curious Experiences Survey

Here are some experiences that people have in their daily lives. We are interested in how often you have these experiences (when you are not under the influence of alcohol or drugs). Please use the following scale for your responses.

1 = This never happens to me. 2 = This occasionally happens to me. 3 = This sometimes happens to me. 4 = This frequently happens to me. 5 = This is almost always happening to me.

1. Had the experience of feeling as though I was standing next to myself, or watching myself as if I were look at a different person. 2. Had the experience of looking in a mirror and not recognizing myself. 3. Had the experience of feeling that other people, objects, and the world around me were not real. 4. Had the experience of feeling that my body did not belong to me. 5. Had the experience of remembering a past event so vividly that it felt like I was reliving that event. 6. Had the experience of not being sure whether things I remember happening really did happen or whether I just dreamed them. 7. Had the experience of being in a familiar place but finding it strange and unfamiliar. 8. Feeling that I became so involved in a fantasy or daydream that it felt like it was really happening to me. 9. Find that I sometimes sit staring off in space, thinking of nothing, and am not aware of the pas- sage of time. 10. Find that in one situation I act so differently from when I’m in another situation that I felt almost as if I were two different people. 11. Find that in certain situations I am able to do things with amazing ease and spontaneity that would usually be difficult for me. 12. Found that I could not remember whether I had done something or had just thought about doing that thing. 13. Found evidence that I had done things that I did not remember doing. 14. Found that I hear voices inside my head that told me to do things or that commented on things that I was doing. 15. Felt as though I was looking at the world through a fog so that people or objects appeared far away or unclear. 16. Felt like I was dreaming when I was awake. 17. Felt like I was disconnected from my body.

Source: Goldberg, L. R. (1999). The Curious Experiences Survey, a revised version of the Dissociative Experiences Scale: Factor structure, reliability, and relations to demographic and personality variables. Psychological Assessment, 11, 134–145. (Scale items appear on p. 145.) Copyright © 1999 by the American Psychological Association. Reprinted by permission. 970 Psychological Disorders

HANDOUT 21

Assessing Your Body Image

Respond to each item by using the following scale:

0 = never 1 = sometimes 2 = often 3 = always

1. I dislike seeing myself in mirrors. 2. When I shop for clothing, I am more aware of my weight problem, and consequently I find shopping for clothes somewhat unpleasant. 3. I am ashamed to be seen in public. 4. I prefer to avoid engaging in sports or public exercise because of my appearance. 5. I feel somewhat embarrassed by my body in the presence of someone of the other sex. 6. I think my body is ugly. 7. I feel that other people must think my body is unattractive. 8. I feel that my family or friends may be embarrassed to be seen with me. 9. I find myself comparing my body with other people to see if they are heavier than I am. 10. I find it difficult to enjoy activities because I am self-conscious about my physical appearance. 11. Feeling guilty about my weight problem preoccupies most of my thinking. 12. My thoughts about my body and physical appearance are negative and self-critical.

Source: Strong et al. THE RESOURCE BOOK; A TEACHER’S TOOL KIT TO ACCOMPANY HUMAN SEXUALITY. Copyright 1999. Reprinted by permission of The McGraw-Hill Companies. Psychological Disorders 971

HANDOUT 22

Please answer each item by checking Yes or No. Answer all items even if you’re unsure of your answer.

Yes No

1. People sometimes find me aloof and distant.

2. Have you ever had the sense that some person or force is around you, even though you cannot see anyone?

3. People sometimes comment on my unusual mannerisms and habits.

4. Are you sometimes sure that other people can tell what you are thinking?

5. Have you ever noticed a common event or object that seemed to be a special sign for you?

6. Some people think that I am a very bizarre person.

7. I feel I have to be on my guard even with friends.

8. Some people find me a bit vague and elusive during a conversation.

9. Do you often pick up hidden threats or put-downs from what people say or do?

10. When shopping do you get the feeling that other people are taking notice of you?

11. I feel very uncomfortable in social situations involving unfamiliar people.

12. Have you had experiences with astrology, seeing the future, UFOs, ESP or a sixth sense?

13. I sometimes use words in unusual ways.

14. Have you found that it is best not to let other people know too much about you?

15. I tend to keep in the background on social occasions.

16. Do you ever suddenly feel distracted by distant sounds that you are not normally aware of?

17. Do you often have to keep an eye out to stop people from taking advantage of you?

18. Do you feel that you are unable to get “close” to people?

19. I am an odd, unusual person.

20. I find it hard to communicate clearly what I want to say to people.

21. I feel very uneasy talking to people I do not know well.

22. I tend to keep my feelings to myself.

Source: Raine, A., and Benishay, D. (1995). The SPQ-B: A brief screening instrument for schizotypal personality disor- der. Journal of Personality Disorders, 9, 346–355. 972 Psychological Disorders

HANDOUT 23

Personality Inventory

Indicate your agreement or disagreement with each of the following items by circling T (True) or F (False).

T F Love is just a four-letter word. T F People find me very charming. T F About the only thing that ever makes me nervous is being cooped up. T F People who never lie are suckers. T F Feeling guilty is a waste of time. T F If I don’t feel like doing something, I just don’t do it. T F I often do things just for the hell of it. T F I’ve fallen in and out of love dozens of times. T F Most of my problems are due to the fact that people just don’t understand me. T F As far as people go, I can take them or leave them. T F One of my chief amusements is pulling people’s strings. T F I have never been able to understand how anyone could pursue one goal for a long time. T F I keep finding myself in the same difficulties time after time.

Source: Levenson, M. (1990). Risk taking and personality. Journal of Personality and Social Psychology, 58, 1080. Copyright © 1990 by the American Psychological Association. Reprinted by permission.