Dissociative, Schizophrenic, and 32 Personality Disorders

Lesson PLanning CaLendar

Use this Lesson Planning Calendar to determine how much time to allot for each topic. Schedule Day One Day Two Day Three Traditional Period (50 minutes) Dissociative Disorders Schizophrenic Disorders Personality Disorders Block schedule (90 minutes) Dissociative Disorders Schizophrenic Disorders (continued) Schizophrenic Disorders Personality Disorders

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B2E3e_book_ATE.indb 1 3/19/12 10:51 AM 32 MODULE 32 aCTiviTy PLanner From The TeaCher’s resourCe maTeriaLs Dissociative, Schizophrenic,

Use this Activity Planner to bring active learning to your daily lessons. and Personality Disorders Topic Activities dissociative disorders Getting Started: Critical Thinking Activity: Fact or Falsehood? (10 min.) Dissociative Disorders ● Dissociative Digital Connection: The Brain (2nd ed.), Module 23: “Multiple Personality” (10 min.) ● Dissociative Fugue Analysis Activity: Questionnaire of Experiences of Dissociation (30 min.) ● Dissociative Identity Disorder Building Vocabulary/Graphic Organizer: Crossword Puzzle (15 min.) Schizophrenic Disorders Enrichment Lesson: Psychogenic Versus Organic Amnesia (15 min.) ● Symptoms of Enrichment Lesson: The Dissociative Disorders Interview Schedule and Multiple Personality (15 min.) ● Types of Schizophrenia Digital Connection: DVD: Lost in the Mirror (30 min.) ● Causes of Schizophrenia schizophrenic disorders Digital Connection: The Brain (2nd ed.), Module 26: “Schizophrenia: Symptoms” (10 min.) Personality Disorders Digital Connection: The Brain (2nd ed.), Module 27: “Schizophrenia: Etiology” (10 min.) ● Personality Disorders Related to Anxiety Demonstration Activity: The Referential Thinking Scale (15 min.) ● Personality Disorders With Odd or Eccentric Demonstration Activity: Magical Ideation Scale (20 min.) Is it possible to be two different people? Can you really split from reality? Serious Behaviors psychological disorders are the topic of this module. ● Personality Disorders Digital Connection: DVD: Full of Sound and Fury: Living With Schizophrenia (60 min.) With Dramatic or Impulsive Behaviors Digital Connection: The Brain (2nd ed.), Module 29: “” (13 min.) Enrichment Lesson: Infantile Autism (15 min.) Consider Gene Saunders. Gene was a manager at a manufacturing company. Work had become a struggle, with missed production goals, criticism from his supervisor, Digital Connection: Film: Silent Snow, Secret Snow (17 min.) and disappointment when an expected promotion didn’t come through. The at work led to additional problems at home, including a violent argument with his teen- Personality disorders Digital Connection: The Mind (2nd ed.), Module 35: “The Mind of the Psychopath” (10 min.) age son. Two days after the argument, Gene disappeared. A year and a half later, Demonstration Activity: Antisocial (25 min.) police in a town hundreds of miles away picked up a drifter who had been working as a short- order cook. The drifter’s name was Burt Tate, and although Burt knew what Portfolio Project: Exploring Psychological Disorders on the World Wide Web town he was in, he had no knowledge of his life before arriving in town. There were no physical or drug problems that would account for the loss. You guessed it— Gene and Burt were the same person (Spitzer et al., 1989). Consider Emilio. His twelfth hospitalization occurred when he was 40 because his mother, with whom he lived, feared him. He dressed in a ragged old coat and bedroom slippers, with several medals around his neck. Much of what he said was simply nonsense. When interviewed, he claimed he had been “eating wires and light- ing fires.” He alternated from being angry toward his mother to childlike giggling, and he heard nonexistent voices. Emilio had been unable to hold a job since his first hospitalization at age 16 (Spitzer et al., 1989, 2002).

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B2E3e_book_ATE.indb 2 3/19/12 10:51 AM 32 MODULE 32 inTroduCe The moduLe

Dissociative, Schizophrenic, Getting Started TRM and Personality Disorders The disorders featured in this module are the ones most commonly associ-associ ated with having a mental illness. Have Dissociative Disorders students consider what it means to ● Dissociative Amnesia lose touch with reality. What behaviors ● Dissociative Fugue would people exhibit if they lost touch ● Dissociative Identity with reality? Disorder You may wish to use Critical Schizophrenic Thinking Activity: Fact or False- Disorders hood? as a prereading strategy to ● Symptoms of evaluate what students already know Schizophrenia about dissociative, schizophrenic, ● Types of Schizophrenia and personality disorders. The activ-activ ● Causes of Schizophrenia ity, along with its results, will prime students to note terms and concepts Personality Disorders in the text that confirm or dispel their ● Personality Disorders Related to Anxiety preconceptions about these disorders. ● Personality Disorders With Odd or Eccentric Building Vocabulary TRM Is it possible to be two different people? Can you really split from reality? Serious Behaviors Help students understand how the psychological disorders are the topic of this module. ● Personality Disorders terms in this module are related With Dramatic or by having them complete Building Impulsive Behaviors Vocabulary/Graphic Organizer: Consider Gene Saunders. Gene was a manager at a manufacturing company. Work Crossword Puzzle. had become a struggle, with missed production goals, criticism from his supervisor, and disappointment when an expected promotion didn’t come through. The stress at work led to additional problems at home, including a violent argument with his teen- age son. Two days after the argument, Gene disappeared. A year and a half later, police in a town hundreds of miles away picked up a drifter who had been working as a short- order cook. The drifter’s name was Burt Tate, and although Burt knew what town he was in, he had no knowledge of his life before arriving in town. There were no physical or drug problems that would account for the memory loss. You guessed it— Gene and Burt were the same person (Spitzer et al., 1989). Consider Emilio. His twelfth hospitalization occurred when he was 40 because his mother, with whom he lived, feared him. He dressed in a ragged old coat and bedroom slippers, with several medals around his neck. Much of what he said was simply nonsense. When interviewed, he claimed he had been “eating wires and light- ing fires.” He alternated from being angry toward his mother to childlike giggling, and he heard nonexistent voices. Emilio had been unable to hold a job since his first hospitalization at age 16 (Spitzer et al., 1989, 2002).

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resourcer mmanager Activities TE Web/Multimedia TE Film/Video TE Analysis 571 Digital Connection 575 Lost in the Mirror 570 Critical Thinking 569, 582 The Brain (2nd ed.), Module 23 572 Demonstration 574, 581 The Brain (2nd ed.), Module 27 574, 577, 578 Enrichment 571, 572, 575 Full of Sound and Fury: Living With Schizophrenia 574 Graphic Organizer 569 The Brain (2nd ed.), Module 26 575 Portfolio Project 582 The Brain (2nd ed.), Module 29 575 Vocabulary 569 Silent Snow, Secret Snow 576 The Mind (2nd ed.), Module 35 581

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B2E3e_book_ATE.indb 569 3/19/12 10:51 AM 32 570 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 571 Consider Mary. She was 26 years old when referred for hospitalization by her dissociative disorders Disor- Dissociative Amnesia ders in which the sense of self therapist because she had urges to cut herself with a razor. For more than 10 years, TeaCh has become separated (dissoci- Mary struggled with issues related to religion and philosophy. Her academic perfor- Can you remember the meaning of the word amnesia? ated) from previous , thoughts, or feelings. mance in college dropped when she began experimenting with a variety of drugs. Amnesia is memory loss, and any number of factors, FYI TRM When Mary entered therapy, she became both hostile and demanding, sometimes including drug use, can cause it. Drinking too much alco- insisting on two therapy sessions a day. She did not exhibit stability in her moods or hol, for example, can lead to a blackout of all memories The DSM- IV- TR lists 14 dif- relationships (Spitzer et al., 1989). of the drinking episode. Head injury, fatigue, and physi- ferent categories of disorders. Gene, Emilio, and Mary suffer from psychological disorders we discuss in this cal disorders such as Alzheimer’s disease can also cause Disorders that aren’t discussed in module. These disorders are not nearly as common as anxiety disorders (such as amnesia. To qualify as dissociative amnesia, however, detail in this textbook include the ) and mood disorders (such as ), but they represent an interest- the memory loss must be a reaction to a traumatic event.

ing sample of the types of disturbances that can plague people. Keep in mind that in Serious personal threats are the most common causes of es nelson/Getty ImaG scott following: Memory and Your this text we do not come even close to examining all disorders—the American Psy- Sense of Self dissociative amnesia. Combat soldiers may report los- ● Disorders first diagnosed in chiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth ing their memory for hours or days (van der Hart et al., Trauma and Amnesia infancy, childhood, or adoles- We often joke about forget- edition, text revision (DSM-IV- TR), lists more than 200 specific mental disorders. 1999). Survivors of natural disasters, such as floods or wildfires, sometimes fulness, but the dissociative Several of the people you read about in this module have lost some aspect of their cence, such as mental retarda- experience similar losses (Kihlstrom et al., 1993). People under extreme disorders all involve serious tion, learning disorders, and sense of self like Gene (dissociative disorders). Others have lost contact with real- In one case of dissociative amnesia, an 18-year- old man lost his memory of stress, such as soldiers in disruption of memory. ity like Emilio (schizophrenic disorders). And still others have developed lasting and tic disorders (that is, Tourette’s sailing with friends off the coast of Florida. A storm had come up, and only he combat, may experience counterproductive patterns of behavior like Mary (personality disorders). dissociative amnesia. syndrome) had the foresight to put on a life jacket and tie himself to the boat. His friends ● , , amnesia, were swept overboard in the high waves. Because of the emotional trauma, the young man lost all memory of the tragic storm and the several days he and other cognitive disorders, spent hoping to be rescued (Spitzer et al., 1989). including Alzheimer’s disease Dissociative Disorders and organic amnesia ● Mental disorders due to a gen- WHAT’S THE POINT? Dissociative Fugue eral medical condition ● Substance- related disorders 32-1 What are the symptoms and causes of Dissociative fugue is an extended form of dissociative amnesia character- ● Fictitious disorders, including dissociative disorders? ized by loss of identity and travel to a new location. (The word fugue comes from the same root as fugitive.) A dissociative fugue state can be short, last-

Munchausen’s syndrome and www.cartoonstock.com ing only a few hours, or long, lasting months or even years. The person may malingering Dissociate is the opposite of associate (to make connections). If a person has a , his sense of self has become separated (dissociated) develop a new identity, form new friendships, or even enter a new line of ● Sexual and gender identity dis- from his memories, thoughts, or feelings. Dissociative disorders are quite work. As with other dissociative disorders, the development of a fugue state orders, such as sexual dysfunc- rare and usually represent a response to overwhelming stress. Three specific is an unconscious response to extreme stress. The case of Gene Saunders at tion and forms are dissociative amnesia, fugue, and identity disorder (see Figure 32.1). the beginning of this module represents dissociative fugue. His stressful work ● Eating disorders and home situations led to his disappearance, and even he was not aware of ● Sleep disorders the history behind his transformation into Burt Tate. ● Impulse control disorders, such Figure 32.1 as , pathological Dissociative Disorders Dissociative Disorders Loss of self Dissociative Identity Disorder gambling, and Three dissociative disorders ● are dissociative amnesia, dissociative amnesia A dis- Adjustment disorders Have you ever felt like a different person? Have you ever said, “I have no dissociative fugue, and dis- sociative disorder characterized by loss of memory in reaction to At this point, you may want to Dissociative Identity idea why I did that”? Magnified to an extreme, these feelings are central sociative identity disorder. Dissociative Amnesia a traumatic event. watch Lost in the Mirror. Disorder features of dissociative identity disorder (formerly known as multiple Loss of memory of dissociative fugue A dissocia- Two or more personality disorder)— a rare and controversial disorder in which an indi- a traumatic event tive disorder characterized by distinct personalities vidual exhibits two or more distinct and alternating personalities. These loss of identity and travel to a subpersonalities reportedly can differ in age, sex, and self-perception of new location. dissociative identity disorder Dissociative Fugue physical characteristics. Some researchers have even reported changes in brain function (Elzinga et al., 2007; Putnam, 1991) or handedness (Hen- A rare and controversial dis- Loss of identity and sociative disorder in which travel to a new location ninger, 1992) as a patient switches from one personality to another. Some- an individual exhibits two or times subpersonalities seem to be aware of one another, and sometimes more distinct and alternating personalities. they do not.

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B2E3e_book_ATE.indb 570 3/19/12 10:51 AM 570 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 571 32 Consider Mary. She was 26 years old when referred for hospitalization by her dissociative disorders Disor- Dissociative Amnesia ders in which the sense of self therapist because she had urges to cut herself with a razor. For more than 10 years, has become separated (dissoci- Mary struggled with issues related to religion and philosophy. Her academic perfor- Can you remember the meaning of the word amnesia? TeaChingTea TiP TRM ated) from previous memories, thoughts, or feelings. mance in college dropped when she began experimenting with a variety of drugs. Amnesia is memory loss, and any number of factors, Students should understand that dis-dis When Mary entered therapy, she became both hostile and demanding, sometimes including drug use, can cause it. Drinking too much alco- sociation is not the same as . insisting on two therapy sessions a day. She did not exhibit stability in her moods or hol, for example, can lead to a blackout of all memories Dissociation involves breaking away relationships (Spitzer et al., 1989). of the drinking episode. Head injury, fatigue, and physi- from the sense of self, either by losing Gene, Emilio, and Mary suffer from psychological disorders we discuss in this cal disorders such as Alzheimer’s disease can also cause memory and identity or by adding per-per module. These disorders are not nearly as common as anxiety disorders (such as amnesia. To qualify as dissociative amnesia, however, phobias) and mood disorders (such as depression), but they represent an interest- sonalities. Psychosis involves a break the memory loss must be a reaction to a traumatic event. with reality, believing things that are ing sample of the types of disturbances that can plague people. Keep in mind that in Serious personal threats are the most common causes of es nelson/Getty ImaG scott Memory and Your this text we do not come even close to examining all disorders—the American Psy- untrue, or having hallucinations about Sense of Self dissociative amnesia. Combat soldiers may report los- chiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth ing their memory for hours or days (van der Hart et al., things that aren’t there. At this point, Trauma and Amnesia We often joke about forget- edition, text revision (DSM-IV- TR), lists more than 200 specific mental disorders. 1999). Survivors of natural disasters, such as floods or wildfires, sometimes you may want to use Analysis Activ- fulness, but the dissociative Several of the people you read about in this module have lost some aspect of their experience similar losses (Kihlstrom et al., 1993). People under extreme ity: Questionnaire of Experiences of disorders all involve serious sense of self like Gene (dissociative disorders). Others have lost contact with real- In one case of dissociative amnesia, an 18-year- old man lost his memory of stress, such as soldiers in Dissociation. disruption of memory. ity like Emilio (schizophrenic disorders). And still others have developed lasting and sailing with friends off the coast of Florida. A storm had come up, and only he combat, may experience counterproductive patterns of behavior like Mary (personality disorders). had the foresight to put on a life jacket and tie himself to the boat. His friends dissociative amnesia. Differentiation TRM were swept overboard in the high waves. Because of the emotional trauma, There are two types of amnesia: the young man lost all memory of the tragic storm and the several days he ● occurs when spent hoping to be rescued (Spitzer et al., 1989). Dissociative Disorders old memories are lost. This is the most common type of amnesia. WHAT’S THE POINT? Dissociative Fugue Memories for experiences that occurred in the time surrounding an 32-1 What are the symptoms and causes of Dissociative fugue is an extended form of dissociative amnesia character- event fall under this type of amnesia. dissociative disorders? ized by loss of identity and travel to a new location. (The word fugue comes ● Anterograde amnesia occurs when from the same root as fugitive.) A dissociative fugue state can be short, last- www.cartoonstock.com the ability to form new memories is Dissociate is the opposite of associate (to make connections). If a person has ing only a few hours, or long, lasting months or even years. The person may lost. This form is less common, but a dissociative disorder, his sense of self has become separated (dissociated) develop a new identity, form new friendships, or even enter a new line of from his memories, thoughts, or feelings. Dissociative disorders are quite work. As with other dissociative disorders, the development of a fugue state some instances of head trauma or rare and usually represent a response to overwhelming stress. Three specific is an unconscious response to extreme stress. The case of Gene Saunders at brain disease can affect a person’s forms are dissociative amnesia, fugue, and identity disorder (see Figure 32.1). the beginning of this module represents dissociative fugue. His stressful work ability to form new memories. and home situations led to his disappearance, and even he was not aware of At this point, you may want to use the history behind his transformation into Burt Tate. Figure 32.1 Enrichment Lesson: Psychogenic Versus Organic Amnesia. Dissociative Disorders Dissociative Disorders Loss of self Dissociative Identity Disorder Three dissociative disorders are dissociative amnesia, dissociative amnesia A dis- FYI Have you ever felt like a different person? Have you ever said, “I have no dissociative fugue, and dis- sociative disorder characterized by loss of memory in reaction to Dissociative Identity idea why I did that”? Magnified to an extreme, these feelings are central sociative identity disorder. Dissociative Amnesia a traumatic event. The Latin root of the word fugue Disorder features of dissociative identity disorder (formerly known as multiple Loss of memory of dissociative fugue A dissocia- means “flight,” which makes this Two or more personality disorder)— a rare and controversial disorder in which an indi- a traumatic event tive disorder characterized by an appropriate name for the dis- distinct personalities vidual exhibits two or more distinct and alternating personalities. These loss of identity and travel to a order dissociative fugue. subpersonalities reportedly can differ in age, sex, and self-perception of new location. dissociative identity disorder Dissociative Fugue physical characteristics. Some researchers have even reported changes in brain function (Elzinga et al., 2007; Putnam, 1991) or handedness (Hen- A rare and controversial dis- Loss of identity and sociative disorder in which Beyond the Classroom TRM travel to a new location ninger, 1992) as a patient switches from one personality to another. Some- an individual exhibits two or times subpersonalities seem to be aware of one another, and sometimes more distinct and alternating Bellringers Use the following prompts personalities. they do not. as discussion starters: ● Have you ever wanted to pick up, move, and start over somewhere else? Why? What would be the advantages and disadvantages of ActIve LeArnIng TRM such a move? ● Do you behave differently in dif- Dissociative Amnesia ferent situations? Have people ever A famous case of dissociative amnesia concerns the daughter of the last Russian czar, accused you of having different Nicholas II. In 1920, people believed that an amnesiac woman named Anna Anderson was personalities? How did that make Anastasia, the youngest daughter of the czar. Have students research the Romanov family you feel? and the conflicting evidence surrounding Anna Anderson. At this point, you may want to use ● Why did Anna arouse suspicions concerning her identity? Enrichment Lesson: The Dissocia- ● What evidence supports Anna’s claims? What evidence disputes them? tive Disorders Interview Schedule ● What means can researchers use to verify claims like Anna’s? and Multiple Personality. At this point, you may want to use Enrichment Lesson: Psychogenic Versus Organic Amnesia.

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Psychology in THE REAL WORLD Beyond the Classroom TRM Analyze Dissociative identity disorder is so controversial partly because the Mind and Body in Psychological Disorders claims of patients are so difficult to confirm. Typically, it is not diagnosed The relationship between mind and body has fas- be sick to avoid responsibility or to gain attention also until later in life when evidence of past cinated psychologists since this science was born. does not qualify as . abuse or trauma may no longer be Psychological disorders are a good place to look Another somatoform disorder, present. for this interaction, because such disorders almost (formerly called hysteria), takes its name from its main always have both psychological and physical com- symptom— the change, or conversion, of a psychologi- ● Does the difficulty of confirming ponents. This is most dramatic in the somatoform cal factor (typically anxiety) into an actual loss of physi-

evidence necessarily deny patients’ John sprInGer collectIon/corbIs the everett collectIon disorders, in which the symptoms take a bodily form cal function. A person with conversion disorder might claims? without apparent physical cause and the reasons suddenly experience blindness, laryngitis, or paralysis ● How do investigators prove claims behind many visits to the doctor are “medically un- that has no physical cause. Have you ever been so The Media and Diagnosed cases of dissociative identity disorder increased dramatically explained” (Johnson, 2008). (Somatic comes from a frightened you momentarily lost the ability to move, or of abuse that happened long ago? Mental Disorders in the final decades of the twentieth century. Before the 1970s, fewer than Greek word for “body.”) so stunned you momentarily lost the ability to speak? At this point, you may want to use 100 cases had ever been reported in professional journals. Then, in the 1980s The controversy about dis- You’re probably already familiar with one of these Then you’ve experienced, on a minor, short- term level, The Brain (2nd ed.), Module 23: sociative identity disorder alone, reports of more than 20,000 diagnosed cases of dissociative identity disorders, hypochondriasis, which you may know as the core requirement of conversion disorder—loss of “Multiple Personality.” has been partially fueled disorder appeared, almost all of them in North America (McHugh, 1995). hypochondria, a somatoform disorder characterized function for psychological reasons. Although some by the public’s interest in The average number of subpersonalities also increased—from 3 to 12 (Goff & by imagined symptoms of illness (see Figure 32.2). disorders, such as major depression, appear to be the disorder. Two classic TeaChing TiP Simms, 1993). In some cases, dozens of personalities were reported. People with hypochondriasis experience symptoms increasing in modern times, conversion disorder has films—The Three Faces of Psychologists debate whether dissociative identity disorder really exists. If you show any of the popular films Eve (left) and Sybil (right)— of physical illness, such as headaches and fleeting become quite rare. Are clinicians simply more knowledgeable about and willing to make the that depict dissociative identity disor- have showcased “multiple joint pains, but medical exams reveal nothing physi- The symptoms of hypochondriasis and conversion diagnosis? Are better diagnostic rules reducing the number of cases that der, help students watch with a critical personality.” Some are con- cally wrong with their bodies. The disorder is, quite disorder have no real physical basis. But sometimes cerned that these kinds of in the past were misdiagnosed as other disorders, such as schizophrenia? literally, all in the mind. People with hypochondriasis psychological factors can lead to or aggravate real eye. The goal of movies is not to depict films and other media atten- Skeptics believe the power of suggestion has been at work here. Clinicians, suffer, however, because they believe they are sick. medical conditions. Stress, for example, contributes to tion lead to false diagnoses reality but to entertain and tell a com-- who now have read a great deal about these fascinating cases, may unin- All of us occasionally have hypochondriacal feelings, asthma, ulcers, headaches, and high blood pressure. of this disorder. pelling story. The facts might not be tentionally suggest multiple personalities to their clients (Kihlstrom, 2005). worrying that we may be sick but then turning out to Such conditions, called psychophysiological or psy- an accurate depiction of what actually Questions such as “Have you ever felt another part of you is in control?” be fine. Athletes, who must be tuned in to their bod- chosomatic disorders, involve a more complete inter- happened. may lead the patient (who has also read about the disorder or seen depic- ies, may experience these worries frequently— but not action of mind and body. With these disorders, as with tions on television) to construct subpersonalities in an effort to please the usually to the extent seen in this mind- body disorder. other somatoform disorders, it’s not mind or body— it’s Beyond the Classroom therapist by responding to perceived expectations. This, of course, is also And let’s be clear about one more thing: Pretending to mind and body interacting to produce trouble. Explore profession- unintentional. als have only recently begun treating Sybil Dorsett’s famous case of dissociative identity disorder was the sub- ject of a book, Sybil, and a made- for- TV movie of the same name in 1976 Figure 32.2 female patients as having character- (remade in 2007). However, after the death of Sybil’s psychiatrist, a different Mind-Body Problems Somatoform istics different from male patients. picture emerged. After reading her recently released records, some experts Disorders Freud and his contemporaries believed have come to believe that Sybil’s multiple personalities were the result of Psychophysiological Somatoform disorders that women who attended college had her therapist’s suggestions. By giving names to Sybil’s emotional states and Hypochondriasis Disorders include hypochon- shrunken ovaries because they did not asking her to take on these roles as part of the therapeutic process, the psy- Imagined illness Medical condition produced driasis, conversion bear as many children as their less chiatrist could have led Sybil to believe that she possessed multiple personali- by psychological factors disorder, and psycho- educated sisters. Also, illnesses such as ties. (Other problems that originate in the mind can have physical results, as physiological disorders. somatoform disorders Psy- discussed in Psychology in the Real World: Mind and Body in Psychological dissociative and somatoform disorders chological disorders in which Conversion Disorder Disorders.) were often only reported in women. the symptoms take a bodily form Anxiety producing a without apparent physical cause. Have students explore old stereotypes loss of physical function hypochondriasis A somato- Pause Now or Move oN and new advances in women’s health. form disorder characterized by imagined symptoms of illness. Turn to page 582 to review and apply what you’ve learned. ● What were some other common beliefs about women’s health issues? ● What kind of influence did Freud and others have on the study of women’s health? ● When did women’s health issues start to get serious notice as being ActIve LeArnIng TRM distinct from men’s health issues? ● What advances have been made in Mental Illness on Film recent years that have made wom- Have students research the lives of Chris Sizemore and Sybil Dorsett. Ask: en’s health issues better understood? ● What abuse did they say they experienced? ● What types of relationships did they have with their therapists? ● What was the result of their therapy sessions? Did they experience personality integra- tion? Why or why not? ● What impact did the movie versions of their lives have on them? Use Enrichment Lesson: The Dissociative Disorders Interview Schedule and Mul- tiple Personality.

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Psychology in THE REAL WORLD FYI

Mind and Body in Psychological Disorders Hypochondriacs aren’t people who fake sickness to get atten- The relationship between mind and body has fas- be sick to avoid responsibility or to gain attention also tion. They truly believe they are cinated psychologists since this science was born. does not qualify as hypochondriasis. sick from an illness that doc- Psychological disorders are a good place to look Another somatoform disorder, conversion disorder tors haven’t diagnosed yet. They for this interaction, because such disorders almost (formerly called hysteria), takes its name from its main switch doctors seeking a diagnosis always have both psychological and physical com- symptom— the change, or conversion, of a psychologi- that will confirm their condi- ponents. This is most dramatic in the somatoform cal factor (typically anxiety) into an actual loss of physi- tion. Malingering is a disorder John sprInGer collectIon/corbIs the everett collectIon disorders, in which the symptoms take a bodily form cal function. A person with conversion disorder might without apparent physical cause and the reasons suddenly experience blindness, laryngitis, or paralysis in which patients fake illness to behind many visits to the doctor are “medically un- that has no physical cause. Have you ever been so avoid trouble or to achieve gain. The Media and Diagnosed cases of dissociative identity disorder increased dramatically explained” (Johnson, 2008). (Somatic comes from a frightened you momentarily lost the ability to move, or Mental Disorders in the final decades of the twentieth century. Before the 1970s, fewer than Greek word for “body.”) so stunned you momentarily lost the ability to speak? 100 cases had ever been reported in professional journals. Then, in the 1980s Beyond the Classroom The controversy about dis- You’re probably already familiar with one of these Then you’ve experienced, on a minor, short- term level, sociative identity disorder alone, reports of more than 20,000 diagnosed cases of dissociative identity disorders, hypochondriasis, which you may know as the core requirement of conversion disorder—loss of Guest Speaker Invite a doctor to has been partially fueled disorder appeared, almost all of them in North America (McHugh, 1995). hypochondria, a somatoform disorder characterized function for psychological reasons. Although some discuss the procedures to follow when by the public’s interest in The average number of subpersonalities also increased—from 3 to 12 (Goff & by imagined symptoms of illness (see Figure 32.2). disorders, such as major depression, appear to be confronted with a suspected hypo-hypo the disorder. Two classic Simms, 1993). In some cases, dozens of personalities were reported. People with hypochondriasis experience symptoms increasing in modern times, conversion disorder has chondriac. Ask: films—The Three Faces of Psychologists debate whether dissociative identity disorder really exists. Eve (left) and Sybil (right)— of physical illness, such as headaches and fleeting become quite rare. Are clinicians simply more knowledgeable about and willing to make the ● have showcased “multiple joint pains, but medical exams reveal nothing physi- The symptoms of hypochondriasis and conversion Does the American Medical Associa- personality.” Some are con- diagnosis? Are better diagnostic rules reducing the number of cases that cally wrong with their bodies. The disorder is, quite disorder have no real physical basis. But sometimes tion (AMA) have a particular proto- cerned that these kinds of in the past were misdiagnosed as other disorders, such as schizophrenia? literally, all in the mind. People with hypochondriasis psychological factors can lead to or aggravate real col for dealing with such patients? films and other media atten- Skeptics believe the power of suggestion has been at work here. Clinicians, suffer, however, because they believe they are sick. medical conditions. Stress, for example, contributes to ● Do doctors share medical informa- tion lead to false diagnoses who now have read a great deal about these fascinating cases, may unin- All of us occasionally have hypochondriacal feelings, asthma, ulcers, headaches, and high blood pressure. tion to keep track of these patients? of this disorder. tentionally suggest multiple personalities to their clients (Kihlstrom, 2005). worrying that we may be sick but then turning out to Such conditions, called psychophysiological or psy- ● Do doctors prescribe placebos to Questions such as “Have you ever felt another part of you is in control?” be fine. Athletes, who must be tuned in to their bod- chosomatic disorders, involve a more complete inter- patients they suspect are hypochon- may lead the patient (who has also read about the disorder or seen depic- ies, may experience these worries frequently— but not action of mind and body. With these disorders, as with driacs? Why or why not? tions on television) to construct subpersonalities in an effort to please the usually to the extent seen in this mind- body disorder. other somatoform disorders, it’s not mind or body— it’s therapist by responding to perceived expectations. This, of course, is also And let’s be clear about one more thing: Pretending to mind and body interacting to produce trouble. unintentional. FYI Sybil Dorsett’s famous case of dissociative identity disorder was the sub- ject of a book, Sybil, and a made- for- TV movie of the same name in 1976 Figure 32.2 Other somatoform disorders Mind-Body Problems (remade in 2007). However, after the death of Sybil’s psychiatrist, a different Somatoform include the following: picture emerged. After reading her recently released records, some experts Disorders have come to believe that Sybil’s multiple personalities were the result of ● , Psychophysiological Somatoform disorders her therapist’s suggestions. By giving names to Sybil’s emotional states and Hypochondriasis Disorders include hypochon- or a preoccupation with bodily asking her to take on these roles as part of the therapeutic process, the psy- Imagined illness Medical condition produced driasis, conversion imperfections chiatrist could have led Sybil to believe that she possessed multiple personali- by psychological factors disorder, and psycho- ● Pain disorder, or complaints ties. (Other problems that originate in the mind can have physical results, as physiological disorders. of severe pain in the absence of somatoform disorders Psy- discussed in Psychology in the Real World: Mind and Body in Psychological chological disorders in which Conversion Disorder any attributable condition or the symptoms take a bodily form Disorders.) Anxiety producing a malingering without apparent physical cause. loss of physical function ● hypochondriasis A somato- Pause Now or Move oN , in form disorder characterized by which a person exhibits a imagined symptoms of illness. Turn to page 582 to review and apply what you’ve learned. variety of unexplained physi- cal symptoms; typically found in individuals under 30 years of age

Differentiation MuLtIcuLturAL connectIons People with conversion disorder will typically suffer problems with parts of Research their bodies that directly relate to the Are somatoform disorders common in non- Western cultures? Have students research the stress they are under. For example, a incidence of hypochondriasis and conversion disorder in different cultures and in men quarterback for a football team might and women. lose sensation in his throwing hand ● Are certain cultures more likely to report such conditions? Why or why not? before the big game. However, he may ● Are these disorders more common among women or men? Why? report feeling fine and not admit to having stress about the event.

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B2E3e_book_ATE.indb 573 3/19/12 10:51 AM 32 574 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 575 appropriate environmental stimuli. Instead, their attention may be captured schizophrenia A group of hallucinations False per- severe disorders characterized Schizophrenic Disorders by insignificant things, or they may not notice important ones (Reichenberg ceptions that are symptoms of Beyond the Classroom TRM by disorganized and delusional & Harvey, 2007). fall into several broad categories: schizophrenia and other serious thinking, disturbed perceptions, psychological disorders. Field Trip Conduct a field trip to a and inappropriate emotions and WHAT’S THE POINT? ● Delusions of grandeur are false beliefs that you are more important behaviors. local mental health care facility to 32-2 What are the symptoms, types, and causes of than you really are. People with schizophrenia may actually believe learn more about the most common delusions False beliefs that they are someone else, such as a famous political leader (Abraham are symptoms of schizophrenia schizophrenic disorders? illnesses mental institutions encounter. and other serious psychological Lincoln, for example) or religious figure (Jesus). Arrange for students to tour the facility disorders. ● Delusions of persecution are false beliefs that people are out to get Schizophrenia is perhaps the most frightening and most misunderstood psy- and meet with staff psychologists or you. A person may believe that she is being followed or that the CIA chological disorder. Here are some facts to help dispel the myths: psychiatrists to learn more about treat-treat- is engaging in an elaborate plot to capture her. ● Schizophrenia is not one disorder. It is a family of severe disorders ments for schizophrenia. If permis- ● Delusions of sin or guilt are false beliefs of being responsible for some characterized by disorganized and delusional thinking, disturbed per- misfortune. For instance, a person might believe he is responsible for a sible, students may bring donations of ceptions, and inappropriate emotions and behaviors. clothing, personal hygiene products, plane crash because he failed to brush his teeth one morning. ● Schizophrenia is not “split personality.” Schiz does come from a word and games for patients to use as they ● Delusions of influence are false beliefs of being controlled by outside that means “split,” but the split represents a break from reality, not a forces: “The devil made me do it.” stay in the facility. division of personality. (There is no psychological disorder called split At this point, you may want to personality. Dissociative identity disorder, discussed earlier in this mod- watch Full of Sound and Fury: Living ule, comes closest.) Hallucinations A hallucination is a false perception. The With Schizophrenia. ● Schizophrenia occurs in about 1 percent of the world’s population hallucinations people with schizophrenia most often experience (World Health Organization, 2008c). Schizophrenia typically devel- are auditory. Many report hearing voices, and sometimes the TeaChing TiP TRM ops in late adolescence or early adulthood and strikes men at a slightly voices tell them what to do. If the hallucination is visual, then the Schizophrenia typically manifests greater rate than it strikes women (Aleman et al., 2003; Picchioni & person sees nonexistent objects or distorted images of items or during the late teen and early adult Murray, 2007). people. Tactile hallucinations occur when people feel skin stim- years, but children as young as 12 have ulation, such as a tingling or burning or touch that is not real. developed symptoms of the illness. Hallucinations can also distort taste and smell. Note the differ- ence: Delusions are beliefs with no logical basis; hallucinations Full- blown psychotic episodes, in Symptoms of Schizophrenia are perceptions with no outside stimulation. But hallucinations which patients lose touch with reality, often provide “evidence” for delusions— it’s quite logical to believe may not occur until the patient is out A variety of symptoms characterize schizophrenia (see Figure 32.3). No one will experience them all, but everyone with the disorder will experience some someone is plotting to kill you if you can taste poison in your

on his or her own, away from family works ImaGe UnIversal stUdIos/dreamworks/topham/the of them. Common symptoms include delusions, hallucinations, and inappro- food. Life becomes unimaginably difficult if we can’t trust the and friends who previously provided priate emotions or behaviors. input from our own senses. support. At this point, you may want to use Hallucinations Delusions A is a false belief. We all believe false things some- Inappropriate Emotions or Behaviors Many specific symptoms fit The Brain (2nd ed.), Module 27: times, but the delusions of schizophrenia are more extensive, more complex, into the broad category of inappropriate emotions or behaviors. Schizo- John Nash, the Nobel Prize– “Schizophrenia: Etiology.” and often longer term. It may be that these delusions develop initially because phrenia can produce wildly inappropriate emotions. A patient might laugh winning mathematician featured in the 2001 movie individuals with schizophrenia have trouble focusing their attention on uncontrollably when sadness is called for. Another sufferer might have flat Differentiation TRM emotions, showing little or no emotional response. Inappropriate behaviors A Beautiful Mind, suffered many classic symptoms of may be verbal or physical. Some people may not speak. Others may pro- Schizophrenic patients will exhibit schizophrenia, including other striking symptoms of their duce word salad, nonsense talk characteristic of some types of schizophrenia. disturbing hallucinations. In disorder: Figure 32.3 (Remember Emilio at the beginning of this module? His claim of “eating wires this photo, Nash (played by Symptoms of Schizophrenia and lighting fires” is one of several symptoms of schizophrenia he exhibits. Russell Crowe) is seeing ● Symptoms of things that are not there. Loose associations occur in Schizophrenia Can you identify the others? After you have tried, check your answers in the patients with disorganized schizo- next paragraph.) People with schizophrenia may act in inappropriate ways phrenia as they tie together events It would be unusual for a Delusions Inappropriate Behavior (examples include speaking too loudly or engaging in odd mannerisms) or and memories that don’t seem to person with schizophrenia be almost completely inactive. In rare cases, waxy flexibility occurs, a state in to experience all of these which you could place the person’s arm, as you would place a doll’s arm, in logically fit. symptoms, but some of Hallucinations Inappropriate Emotion some position of your choice. The person would hold that position for hours. ● Neologisms are words that patients them will be present. Quite often, people with schizophrenia withdraw from the affairs of the real create, usually as part of the “word salad” symptom. They will make up words that make no logical sense. At this point, you may want to use Demonstration Activity: The Refer- ential Thinking Scale and Demon- stration Activity: Magical Ideation Scale.

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B2E3e_book_ATE.indb 574 3/19/12 10:51 AM 574 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 575 32 appropriate environmental stimuli. Instead, their attention may be captured schizophrenia A group of hallucinations False per- severe disorders characterized Schizophrenic Disorders by insignificant things, or they may not notice important ones (Reichenberg ceptions that are symptoms of by disorganized and delusional & Harvey, 2007). Delusions fall into several broad categories: schizophrenia and other serious DIgItAL connectIon thinking, disturbed perceptions, psychological disorders. and inappropriate emotions and WHAT’S THE POINT? ● Delusions of grandeur are false beliefs that you are more important behaviors. 32-2 What are the symptoms, types, and causes of than you really are. People with schizophrenia may actually believe Access a free online computer delusions False beliefs that they are someone else, such as a famous political leader (Abraham simulation available through UC are symptoms of schizophrenia schizophrenic disorders? and other serious psychological Lincoln, for example) or religious figure (Jesus). Davis that simulates hallucina- disorders. ● Delusions of persecution are false beliefs that people are out to get tions schizophrenics might experi- Schizophrenia is perhaps the most frightening and most misunderstood psy- you. A person may believe that she is being followed or that the CIA ence: www.ucdmc.ucdavis.edu/ais/ chological disorder. Here are some facts to help dispel the myths: is engaging in an elaborate plot to capture her. virtualhallucinations. ● Schizophrenia is not one disorder. It is a family of severe disorders ● Delusions of sin or guilt are false beliefs of being responsible for some characterized by disorganized and delusional thinking, disturbed per- misfortune. For instance, a person might believe he is responsible for a ceptions, and inappropriate emotions and behaviors. plane crash because he failed to brush his teeth one morning. Differentiation TRM ● Schizophrenia is not “split personality.” Schiz does come from a word ● Delusions of influence are false beliefs of being controlled by outside Autism and Schizophrenia Extend the that means “split,” but the split represents a break from reality, not a forces: “The devil made me do it.” discussion of schizophrenia to include division of personality. (There is no psychological disorder called split personality. Dissociative identity disorder, discussed earlier in this mod- autism. James Kalat identifies nine ule, comes closest.) Hallucinations A hallucination is a false perception. The behaviors of the autistic child: ● Schizophrenia occurs in about 1 percent of the world’s population hallucinations people with schizophrenia most often experience ● Social isolation (World Health Organization, 2008c). Schizophrenia typically devel- are auditory. Many report hearing voices, and sometimes the ● Stereotypical behaviors, such as ops in late adolescence or early adulthood and strikes men at a slightly voices tell them what to do. If the hallucination is visual, then the rocking back and forth, biting person sees nonexistent objects or distorted images of items or greater rate than it strikes women (Aleman et al., 2003; Picchioni & hands, and staring people. Tactile hallucinations occur when people feel skin stim- Murray, 2007). ● ulation, such as a tingling or burning or touch that is not real. Resistance to any change in routine Hallucinations can also distort taste and smell. Note the differ- ● Abnormal, often extreme, responses ence: Delusions are beliefs with no logical basis; hallucinations to sensory stimuli Symptoms of Schizophrenia are perceptions with no outside stimulation. But hallucinations ● Insensitivity to pain often provide “evidence” for delusions— it’s quite logical to believe ● A variety of symptoms characterize schizophrenia (see Figure 32.3). No one Inappropriate emotional expression will experience them all, but everyone with the disorder will experience some someone is plotting to kill you if you can taste poison in your ● Disturbances of movement of them. Common symptoms include delusions, hallucinations, and inappro- food. Life becomes unimaginably difficult if we can’t trust the works ImaGe UnIversal stUdIos/dreamworks/topham/the ● Poor development of speech priate emotions or behaviors. input from our own senses. ● Specific, limited intellectual Hallucinations problems Inappropriate Emotions or Behaviors Many specific symptoms fit Delusions A delusion is a false belief. We all believe false things some- Autism is diagnosed by age 3, into the broad category of inappropriate emotions or behaviors. Schizo- John Nash, the Nobel Prize– times, but the delusions of schizophrenia are more extensive, more complex, whereas schizophrenia is not diag-diag and often longer term. It may be that these delusions develop initially because phrenia can produce wildly inappropriate emotions. A patient might laugh winning mathematician featured in the 2001 movie individuals with schizophrenia have trouble focusing their attention on uncontrollably when sadness is called for. Another sufferer might have flat nosed until a patient is between 15 and emotions, showing little or no emotional response. Inappropriate behaviors A Beautiful Mind, suffered 30 years of age. Autism is prevalent many classic symptoms of may be verbal or physical. Some people may not speak. Others may pro- schizophrenia, including in males, while schizophrenia affects duce word salad, nonsense talk characteristic of some types of schizophrenia. disturbing hallucinations. In males and females at similar rates. Figure 32.3 (Remember Emilio at the beginning of this module? His claim of “eating wires this photo, Nash (played by At this point, you may want to use Symptoms of Schizophrenia and lighting fires” is one of several symptoms of schizophrenia he exhibits. Russell Crowe) is seeing Symptoms of The Brain (2nd ed.), Module 29: Can you identify the others? After you have tried, check your answers in the things that are not there. Schizophrenia “Autism” and Enrichment Lesson: next paragraph.) People with schizophrenia may act in inappropriate ways It would be unusual for a Delusions Inappropriate Behavior (examples include speaking too loudly or engaging in odd mannerisms) or Infantile Autism. person with schizophrenia be almost completely inactive. In rare cases, waxy flexibility occurs, a state in Source: Kalat, J. (1998). Biological psychology to experience all of these which you could place the person’s arm, as you would place a doll’s arm, in symptoms, but some of Hallucinations Inappropriate Emotion (9th ed.). Pacific Grove, CA: Brooks/Cole. them will be present. some position of your choice. The person would hold that position for hours. Quite often, people with schizophrenia withdraw from the affairs of the real

ActIve LeArnIng TRM

Research Some famous murderers have claimed that voices told them to commit their crimes. They also held ideas that would be considered delu- sional. Have students research the following cases: ● David Berkowitz (the Son of Sam): He claimed that a dog was possessed by Satan and instructed him to kill. He confessed to a yearlong murder spree in New York City, during which he killed six individuals and injured another seven. ● John Hinckley, Jr.: In 1981, he attempted to assassinate President Ronald Reagan in Washington, DC. Hinckley was motivated by a desire to attract the attention of Jodie Foster, the Hollywood actress and director. ● Mark David Chapman: In 1980, he killed former Beatles band member John Lennon in New York City. Chapman claimed that the “Little People,” a group of imaginary beings he talked to since childhood, told him to kill Lennon. At this point, you may want to use The Brain (2nd ed.), Module 26: “Schizophrenia: Symptoms.”

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B2E3e_book_ATE.indb 575 3/19/12 10:51 AM 32 576 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 577 world. This withdrawal further limits their knowledge of current events and Causes of Schizophrenia their social skills. FYI Emilio exhibits several symptoms of schizophrenia. We’ve already estab- Complex disorders have complicated causes, and there is probably no psycho- lished that he is speaking in word salad. His bizarre dress is inappropriate logical disorder more complex than schizophrenia. As is often the case, biologi- Paranoid schizophrenia is the behavior. His mood swings are inappropriate emotion. Finally, the voices he cal factors and psychological factors seem to interact to produce schizophrenia. most widely recognizable form hears are auditory hallucinations. of the disorder. Movies depict- Biological Factors The biological approach to schizophrenia has received ing paranoids as either bumbling so much research support in recent years that some experts say we are wrong oddballs or psychopathic killers Types of Schizophrenia to call it a psychological disorder. Rather, it is a brain disorder that produces changes in a person’s mind. Let’s examine the biological factors in more detail. reinforce stereotypes of these The family of disorders known as schizophrenia is broken into four major ● patients. types—paranoid, catatonic, disorganized, and undifferentiated (see Figure 32.4): Genetics—The risk of schizophrenia increases substantially if relatives have the disorder (see Figure 32.5). Although roughly 1 percent of the gen- ● Paranoid schizophrenia is characterized by delusions, particularly delu- eral population has schizophrenia, the risk rises to about 10 percent if a sions of grandeur and persecution. Auditory and other hallucinations TRM parent or sibling has the disorder. These odds are even higher—almost 50 Differentiation often support the delusions. Remind students that a genetic pre- percent—if the relative with schizophrenia is an identical twin (Plomin ● disposition toward schizophrenia does Catatonic schizophrenia is characterized largely by variations in vol- et al., 1997). Notice that this evidence shows that, while genetics is an untary movements. A person with catatonic schizophrenia alternates important factor, there is no single gene or set of genes not guarantee that one will develop the between two phases— catatonic excitement, consisting of rapid move- that guarantees schizophrenia will develop. If there disorder. Environmental and behav- ment, delusions, and hallucinations, and catatonic stupor, with little were, the risk for an identical twin whose co-twin had Figure 32.5 ioral influences play a significant role activity or speech. Flat emotion and waxy flexibility often are part of the disorder would be 100 percent, because identical Genetics and Schizophrenia: in the development of the illness. the stupor phase. twins have identical genes. Instead, genetics seems The Genain Quadruplets At this point, you may want to to produce a predisposition for schizophrenia—an ● Disorganized schizophrenia is characterized by bizarre behavior, delu- Nora, Iris, Myra, and Hester Genain, identical increased likelihood that the disorder will develop. The watch Silent Snow, Secret Snow. sions, and hallucinations. Individuals with disorganized schizophrenia quadruplets, have all developed schizophrenia. If search is on for the specific genes that might combine are visibly disturbed. In historical times, they were thought to have they had been randomly selected, the probability to alter the brain in a way that produces schizophrenia of this would be 1 in 100 million. We can assume “gone mad.” The case of Emilio from the beginning of this module (Marx, 2007; Millar et al., 2005; Williams et al., 2007). that no single gene or set of genes is directly illustrates disorganized schizophrenia. Other factors, as you will see, determine whether the responsible for schizophrenia, however. If such a direct cause existed, the figure for identical ● Undifferentiated schizophrenia is characterized by symptoms that are increased likelihood will lead to a full-fledged disorder. twins, who are genetically identical, would be 100 disturbed but are not clearly consistent with the paranoid, catatonic, A similar situation exists for various kinds of heart percent. Because two of the sisters have more or disorganized types of schizophrenia. Nevertheless, individuals with disease. Genetics may put a person at risk, but factors serious forms of schizophrenia, it is likely that both undifferentiated schizophrenia show clear evidence of the symptoms of such as exercise, diet, and smoking play a critical role heredity and environment— nature and nurture— schizophrenia. in determining whether the disease will develop. are involved. (Adapted from Gottesman, 2001.)

Figure 32.4 Lifetime risk, Types of Schizophrenia Types of Schizophrenia per 100 people, 40% Schizophrenia risk of developing increases with Schizophrenia is a family of schizophrenia genetic closeness to relatives with related disorders. for relatives of 30 a person with schizophrenia schizophrenia Paranoid Undifferentiated 20 Delusions of persecution Symptoms that don’t and grandeur clearly fit one of the other types 10 ly of GenaIn famI coUrtesy Disorganized Catatonic 0 Bizarre behavior, General Sibling Child Fraternal Child of two Identical Excitement and population twin parents with twin delusions, and stupor phases schizophrenia hallucinations Relationship to person with schizophrenia

cross- currIcuLAr connectIon

Literature Michael Gorman reports on a successful student project involving the book The Eden Express by Mark Vonnegut (son of the famous author Kurt Vonnegut). In this book, the author documents the hallucinations and suicide attempts he experienced during his schizophrenic breakdown. Later he describes his recovery, which he largely attributes to the drug Thorazine. Have students complete one of the following projects: ● An analysis of the depiction of schizophrenia in light of modern knowledge ● A reflective paper focusing on the student’s reaction to Vonnegut’s story ● A creative story based on Vonnegut’s account

Source: Gorman, M. (1984). Using The Eden Express to teach introductory psychology. Teaching of Psychology, 11(1), 39– 40.

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B2E3e_book_ATE.indb 576 3/19/12 10:51 AM 576 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 577 32 world. This withdrawal further limits their knowledge of current events and Causes of Schizophrenia their social skills. Emilio exhibits several symptoms of schizophrenia. We’ve already estab- Complex disorders have complicated causes, and there is probably no psycho- FYI lished that he is speaking in word salad. His bizarre dress is inappropriate logical disorder more complex than schizophrenia. As is often the case, biologi- behavior. His mood swings are inappropriate emotion. Finally, the voices he cal factors and psychological factors seem to interact to produce schizophrenia. The names of the quadruplets fea- hears are auditory hallucinations. tured in Figure 32.5 were changed Biological Factors The biological approach to schizophrenia has received to protect their privacy because so much research support in recent years that some experts say we are wrong they became recurrent research Types of Schizophrenia to call it a psychological disorder. Rather, it is a brain disorder that produces subjects. They have the unique changes in a person’s mind. Let’s examine the biological factors in more detail. The family of disorders known as schizophrenia is broken into four major distinction of being the only set of ● types—paranoid, catatonic, disorganized, and undifferentiated (see Figure 32.4): Genetics—The risk of schizophrenia increases substantially if relatives multiples who share this mental have the disorder (see Figure 32.5). Although roughly 1 percent of the gen- ● Paranoid schizophrenia is characterized by delusions, particularly delu- illness, and all were diagnosed by eral population has schizophrenia, the risk rises to about 10 percent if a sions of grandeur and persecution. Auditory and other hallucinations age 25. They also share a history parent or sibling has the disorder. These odds are even higher—almost 50 often support the delusions. of a nightmarish family life: Their percent—if the relative with schizophrenia is an identical twin (Plomin father— who also suffered from ● Catatonic schizophrenia is characterized largely by variations in vol- et al., 1997). Notice that this evidence shows that, while genetics is an untary movements. A person with catatonic schizophrenia alternates important factor, there is no single gene or set of genes schizophrenia— was a strict dis- between two phases— catatonic excitement, consisting of rapid move- that guarantees schizophrenia will develop. If there ciplinarian, and their mother was ment, delusions, and hallucinations, and catatonic stupor, with little were, the risk for an identical twin whose co-twin had Figure 32.5 overly protective of them. activity or speech. Flat emotion and waxy flexibility often are part of the disorder would be 100 percent, because identical Genetics and Schizophrenia: the stupor phase. twins have identical genes. Instead, genetics seems The Genain Quadruplets to produce a predisposition for schizophrenia—an ● Disorganized schizophrenia is characterized by bizarre behavior, delu- Nora, Iris, Myra, and Hester Genain, identical ActIve LeArnIng TRM increased likelihood that the disorder will develop. The sions, and hallucinations. Individuals with disorganized schizophrenia quadruplets, have all developed schizophrenia. If search is on for the specific genes that might combine are visibly disturbed. In historical times, they were thought to have they had been randomly selected, the probability Mental Illness and Heredity to alter the brain in a way that produces schizophrenia of this would be 1 in 100 million. We can assume “gone mad.” The case of Emilio from the beginning of this module Have students examine the prob- (Marx, 2007; Millar et al., 2005; Williams et al., 2007). that no single gene or set of genes is directly illustrates disorganized schizophrenia. ability of inheriting mental ill- Other factors, as you will see, determine whether the responsible for schizophrenia, however. If such a direct cause existed, the figure for identical ● Undifferentiated schizophrenia is characterized by symptoms that are increased likelihood will lead to a full-fledged disorder. nesses other than schizophrenia. twins, who are genetically identical, would be 100 Consider the following conditions: disturbed but are not clearly consistent with the paranoid, catatonic, A similar situation exists for various kinds of heart percent. Because two of the sisters have more or disorganized types of schizophrenia. Nevertheless, individuals with disease. Genetics may put a person at risk, but factors serious forms of schizophrenia, it is likely that both ● Mood disorders, such as undifferentiated schizophrenia show clear evidence of the symptoms of such as exercise, diet, and smoking play a critical role heredity and environment— nature and nurture— depression and schizophrenia. in determining whether the disease will develop. are involved. (Adapted from Gottesman, 2001.) ● Anxiety disorders ● Somatoform disorders Figure 32.4 ● Substance- related disorders Lifetime risk, Types of Schizophrenia ● Types of Schizophrenia per 100 people, 40% Schizophrenia risk Personality disorders of developing increases with Schizophrenia is a family of schizophrenia genetic closeness At this point, you may want to to relatives with related disorders. for relatives of 30 a person with schizophrenia use The Brain (2nd ed.), Module schizophrenia 27: “Schizophrenia: Etiology.” Paranoid Undifferentiated 20 Delusions of persecution Symptoms that don’t and grandeur clearly fit one of the other types 10 ly of GenaIn famI coUrtesy Disorganized Catatonic 0 Bizarre behavior, General Sibling Child Fraternal Child of two Identical Excitement and population twin parents with twin delusions, and stupor phases schizophrenia hallucinations Relationship to person with schizophrenia

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B2E3e_book_ATE.indb 577 3/19/12 10:51 AM 32 578 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 579

Are there any psychological factors that do appear important? The two personality disorders Psy- Figure 32.6 areas that seem most significant are stress and disturbed family communi- chological disorders character- FYI Schizophrenia and cation patterns. Recall that the major genetic contribution to schizophre- ized by rigid and lasting behavior Brain Structure patterns that disrupt social nia seems to be a predisposition— a tendency to develop the disorder. Stress functioning. may be the trigger that sets off the series of events that converts schizophre- Recent research using brain- These two brain scans are In the braIns nia from a possibility into a reality. Disturbed family communications are imaging techniques has shed from identical twins, one Imh/nsc some light on the biological basis who has schizophrenia and also correlated with the development of schizophrenia, but at this point it’s of schizophrenia. one who does not. Note that for Ic twIns dIscordant impossible to tell whether they are a cause of schizophrenia or a result of the the open space (actually, a disorder. One study did find that young people who developed schizophrenia ● People who develop schizophre- cavity in the brain filled with were more likely to be socially withdrawn and to exhibit odd behavior before fluid) is larger for the twin from sUddath, rIchard l., et al. (1990). from sUddath, abnormalItI es anatomIcal ot of monozyG The New eNglaNd JourNal of schIzophrenIa. the massachUsetts MediciNe 322, 12. © 1990 by of danIel coUrtesy photo medIcal socIety. r. weInberGer, m.d., nIh- n becoming schizophrenic (Johnstone et al., 2005). nia later in life have abnormal with schizophrenia (Sud- Schizophrenia No schizophrenia brain activity before the onset dath et al., 1990). Because The bizarre world of schizophrenia has puzzled and fascinated students of of symptoms, showing that identical twins have identical human behavior for centuries. We are making progress both in understand- ● it may be a developmental genes, this difference must Brain structure—The brain structure of people with schizophrenia dif- ing and in effectively treating this devastating disorder. It seems to result have been caused by some fers markedly from normal brain structure (see Figure 32.6). Brain scans from a complex interaction of biological and psychological factors. To be disorder. environmental factor, such as show that schizophrenia is often associated with smaller amounts of effective, treatment must address both of these components. ● a virus. MRI studies show that gray brain tissue and larger, fluid-filled spaces around that tissue (Wright et matter in the brains of schizo- al., 2000). Particular brain structures may be affected by schizophrenia. Pause Now or Move oN phrenic patients is markedly For example, the thalamus, responsible for the routing of incoming sen- Turn to page 582 to review and apply what you’ve learned. less dense than in patients with- sory information, is smaller when schizophrenia is present and may hin- out the disorder. der the person’s ability to focus attention (Andreasen et al., 1994). ● Studies have also shown that ● Brain function— Positive emission tomography (PET) scans, which patients who have auditory hal- show the parts of the brain that are active during particular tasks, reveal lucinations experience temporal that the brain of a person with schizophrenia operates differently than Personality Disorders lobe activation, which indi- does the brain of someone without the disorder. One difference appears cates that they actually do hear in the frontal lobes—the center of our most advanced thinking abilities— WHAT’S THE POINT? voices that aren’t really there. which show less activity when schizophrenia is present (Morey et al., 2005; Resnick, 1992). Brain chemistry also differs for a person with schizophre- 32-3 What kinds of personality disorders are known? nia. Researchers have discovered as many as six times the normal number Personality disorders are lasting, rigid behavior patterns that disrupt social Differentiation TRM of receptor sites for the neurotransmitter dopamine when they examined the brains of people with schizophrenia after death (Seeman et al., 1993). This functioning. The DSM- IV- TR lists 10 personality disorders divided into Link the discussion of dopamine abnormally high number of receptors may explain the delusions and three clusters— related to anxiety, odd or eccentric behaviors, and dramatic to Module 4’s discussion of neu- hallucinations associated with schizophrenia. Medication that blocks or impulsive behaviors (see Figure 32.7). The specific personality disorders rotransmitters and their functions. these receptor sites reduces such symptoms. Researchers are working on The chemical structure of dopamine medications for another neurotransmitter, glutamate, in an attempt to

is similar to that of cocaine, which diminish other symptoms of schizophrenia (Javitt & Coyle, 2004). Personality Disorders Figure 32.7 Clusters of Personality explains why abusers of the drug expe-expe- ● Prenatal viruses— A maternal viral infection during pregnancy may Lasting, rigid patterns of Disorders rience schizophrenic- like symptoms. cause schizophrenia (Patterson, 2007). The evidence for this is circum- behavior that seriously diminish functioning In addition, Parkinson’s disease is stantial but persuasive. Rates of schizophrenia rise for individuals who The main clusters of per- thought to result from a lack of dopa- were born a few months after a flu epidemic (Mednick et al., 1994), and sonality disorders relate to mine channels in the brain. Patients the riskiest birth months in general follow the flu season (Torrey et al., Related to Anxiety Dramatic or Impulsive Behaviors anxiety, odd or eccentric 1997). In the Southern Hemisphere, where the seasons are reversed, behaviors, and dramatic or who take medicine to treat schizophre-schizophre- Avoidant personality disorder Borderline personality disorder impulsive behaviors. nia usually develop symptoms, such the high- risk months are reversed as well (McGrath & Welham, 1999). Dependent personality disorder Antisocial personality disorder as hand tremors, that are common in Psychological Factors For many years, explanations of schizophrenia Parkinson’s patients. Odd or Eccentric Behaviors focused mainly on psychological factors. Sigmund Freud targeted the rela- At this point, you may want to use Paranoid personality disorder tionship between mother and child as the primary cause of the disorder. He The Brain (2nd ed.), Module 27: Schizoid personality disorder mistakenly thought that mothers who were cold, domineering, and selfish “Schizophrenia: Etiology.” caused schizophrenia in their children (Fromm- Reichmann, 1948).

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B2E3e_book_ATE.indb 578 3/19/12 10:51 AM 578 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 579 32

Are there any psychological factors that do appear important? The two personality disorders Psy- Figure 32.6 areas that seem most significant are stress and disturbed family communi- chological disorders character- Schizophrenia and cation patterns. Recall that the major genetic contribution to schizophre- ized by rigid and lasting behavior Beyond the Classroom Brain Structure patterns that disrupt social nia seems to be a predisposition— a tendency to develop the disorder. Stress functioning. Discuss Personality disorders are dif- may be the trigger that sets off the series of events that converts schizophre- These two brain scans are ficult to diagnose and treat because the In the braIns nia from a possibility into a reality. Disturbed family communications are from identical twins, one Imh/nsc behaviors are enduring and rigid. Have who has schizophrenia and also correlated with the development of schizophrenia, but at this point it’s students discuss why people may be one who does not. Note that for Ic twIns dIscordant impossible to tell whether they are a cause of schizophrenia or a result of the unable to recognize that someone has the open space (actually, a disorder. One study did find that young people who developed schizophrenia a personality disorder. cavity in the brain filled with were more likely to be socially withdrawn and to exhibit odd behavior before fluid) is larger for the twin from sUddath, rIchard l., et al. (1990). from sUddath, abnormalItI es anatomIcal ot of monozyG The New eNglaNd JourNal of schIzophrenIa. the massachUsetts MediciNe 322, 12. © 1990 by of danIel coUrtesy photo medIcal socIety. r. weInberGer, m.d., nIh- n becoming schizophrenic (Johnstone et al., 2005). ● with schizophrenia (Sud- Schizophrenia No schizophrenia Where should the line be drawn dath et al., 1990). Because The bizarre world of schizophrenia has puzzled and fascinated students of between being eccentric, anxious, identical twins have identical human behavior for centuries. We are making progress both in understand- or odd and having a personality genes, this difference must ● Brain structure—The brain structure of people with schizophrenia dif- ing and in effectively treating this devastating disorder. It seems to result disorder? have been caused by some fers markedly from normal brain structure (see Figure 32.6). Brain scans from a complex interaction of biological and psychological factors. To be environmental factor, such as ● How might treatment for a personal- show that schizophrenia is often associated with smaller amounts of effective, treatment must address both of these components. a virus. ity disorder be difficult? brain tissue and larger, fluid-filled spaces around that tissue (Wright et al., 2000). Particular brain structures may be affected by schizophrenia. Pause Now or Move oN For example, the thalamus, responsible for the routing of incoming sen- Turn to page 582 to review and apply what you’ve learned. Beyond the Classroom sory information, is smaller when schizophrenia is present and may hin- Guest Speaker Invite a psychologist to der the person’s ability to focus attention (Andreasen et al., 1994). class to discuss treatment options for ● Brain function— Positive emission tomography (PET) scans, which people with personality disorders. Ask: show the parts of the brain that are active during particular tasks, reveal ● How can people be treated for per- that the brain of a person with schizophrenia operates differently than Personality Disorders sonality disorders? does the brain of someone without the disorder. One difference appears ● in the frontal lobes—the center of our most advanced thinking abilities— WHAT’S THE POINT? How successful is treatment for which show less activity when schizophrenia is present (Morey et al., 2005; these conditions? Resnick, 1992). Brain chemistry also differs for a person with schizophre- 32-3 What kinds of personality disorders are known? ● Are personality disorders normally nia. Researchers have discovered as many as six times the normal number identified in conjunction with other of receptor sites for the neurotransmitter dopamine when they examined the Personality disorders are lasting, rigid behavior patterns that disrupt social disorders? Why or why not? brains of people with schizophrenia after death (Seeman et al., 1993). This functioning. The DSM- IV- TR lists 10 personality disorders divided into abnormally high number of receptors may explain the delusions and three clusters— related to anxiety, odd or eccentric behaviors, and dramatic Beyond the Classroom hallucinations associated with schizophrenia. Medication that blocks or impulsive behaviors (see Figure 32.7). The specific personality disorders Bellringers Use the following prompts these receptor sites reduces such symptoms. Researchers are working on as discussion starters: medications for another neurotransmitter, glutamate, in an attempt to ● Do you feel you would qualify for diminish other symptoms of schizophrenia (Javitt & Coyle, 2004). Personality Disorders Figure 32.7 Clusters of Personality a personality disorder? Why or ● Prenatal viruses— A maternal viral infection during pregnancy may Lasting, rigid patterns of Disorders cause schizophrenia (Patterson, 2007). The evidence for this is circum- behavior that seriously why not? diminish functioning ● stantial but persuasive. Rates of schizophrenia rise for individuals who The main clusters of per- Have you known someone that you were born a few months after a flu epidemic (Mednick et al., 1994), and sonality disorders relate to might suspect has a personality dis- the riskiest birth months in general follow the flu season (Torrey et al., Related to Anxiety Dramatic or Impulsive Behaviors anxiety, odd or eccentric order? What behaviors would lead 1997). In the Southern Hemisphere, where the seasons are reversed, behaviors, and dramatic or Avoidant personality disorder Borderline personality disorder impulsive behaviors. you to this conclusion? the high- risk months are reversed as well (McGrath & Welham, 1999). Dependent personality disorder Antisocial personality disorder Differentiation Psychological Factors For many years, explanations of schizophrenia Create a graphic organizer using the Odd or Eccentric Behaviors focused mainly on psychological factors. Sigmund Freud targeted the rela- handout for Figure 32.7. Students who Paranoid personality disorder tionship between mother and child as the primary cause of the disorder. He Schizoid personality disorder may have trouble with this portion of mistakenly thought that mothers who were cold, domineering, and selfish the module can complete the handout caused schizophrenia in their children (Fromm- Reichmann, 1948). on their own or with a tutor. You can also use a transparency of this figure during class to reinforce your discus-discus sion of personality disorders.

MuLtIcuLturAL connectIons

Personality Disorders Have students investigate the incidence of personality disorders in other cultures. Are these disorders more common in Western cultures such as the United States? Why or why not?

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B2E3e_book_ATE.indb 579 3/19/12 10:51 AM 32 580 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 581 are often difficult to diagnose because there is a lot of overlap among them. Because of the difficulties that mental health professionals have had in using Figure 32.8 TeaChing TiP the current categories of personality disorders, it is quite likely that this area The Criminal Brain The paranoid and schizoid personality will undergo significant change in the DSM- 5, the new edition of the official Biological factors may help explain the criminal disorders differ from schizophrenia diagnostic and classification system that is expected in 2013 (American Psy- behavior of individuals with antisocial person- only by a matter of degree. Schizo- chiatric Association, 2010; Clark, 2007; Widiger & Trull, 2007). The behavior ality disorder. These PET scans show reduced phrenia involves psychotic episodes patterns are usually evident by adolescence and obvious to others, but the activity (less red) in the frontal lobes of a with an associated break with reality, person with the personality disorder often does not recognize the problem murderer. This may result in a lack of judgment exists, which can make treatment difficult. Let’s take a look at the three clus- and less ability to control impulsive or aggres- whereas paranoid and schizoid per- sive tendencies. (From Raine, 1999.) sonality disorders do not. People with ters of personality disorders and a sample of the specific disorders included these disorders exhibit odd, eccentric, in each cluster. coUrtesy of adrIan raIne, coUrtesy UnIversIty of soUthern calIfornIa Normal Murderer and disturbing behaviors, but their daily lives are not impaired to the Personality Disorders Related to Anxiety People with antisocial personality disorder (also known as psycho- same extent as the lives of people with antisocial personality dis- pathic or sociopathic personality disorder) show a lack of conscience for order A personality disorder schizophrenia. Individuals with avoidant personality disorder are so sensitive about being wrongdoing and a lack of respect for the rights of other people. Antisocial in which the person (usually a rejected that personal relationships become difficult. Those with dependent man) shows a lack of conscience personality disorder is the most dramatic and troubling of all personality for wrongdoing and a lack of personality disorder behave in clingy, submissive ways and display a strong ActIve LeArnIng disorders. Because of this lack of conscience, people with this disorder are respect for the rights of others. need to have others take care of them. Juanita, for example, is a 28-year- old willing to engage in wide-ranging criminal behaviors about which they show Exploring Case Studies with dependent personality disorder. She still lives with her mother and feels no remorse (see Figure 32.8). This disorder is more likely to occur in males unable to live in her own apartment because she has trouble making deci- Divide students into small groups than in females, and it usually develops by adolescence (Cale & Lilienfeld, sions about day- to-day life. She needs constant reassurance from her mother 2002). People with the disorder are often charming and clever, which helps and provide them with case and is afraid to disagree with her parent because she wants to avoid criticism. them get away with their misdeeds. In extreme forms, antisocial personal- studies of people who possess ity disorder may manifest itself in serial killing, where the murderer has no different personality disorders. regard for the victims (think of Hannibal Lecter in the 1991 film The Silence After they read each case study, Personality Disorders With of the Lambs). Vicious crimes are committed for trivial reasons and dismissed have them decide which disorder Odd or Eccentric Behaviors with such excuses as “Once I’ve done a crime, I just forget it” or “I think of is described. Then have students killing like smoking a cigarette, like another habit” (Darrach & Norris, 1984). come together to see if they all Individuals with paranoid personality disorder (which is different from para- The horribly counterproductive behavior patterns of antisocial personality agreed on the diagnosis. They noid schizophrenia) show deep distrust of other people. This suspiciousness are caused by a combination of biological, psychological, and social factors. may also come up with their own gets in the way of personal relationships. Those with schizoid personality dis- Once in place, the disorder is extremely difficult to treat effectively. As you can imagine, people with antisocial personality disorder often end up in jail case studies to see if other stu- order are detached from social relationships. They are the true hermits, pre- instead of in treatment. dents can correctly diagnose the ferring the life of the loner and avoiding intimate interactions with others at all costs. Henry is such a person. He does most of his shopping online because disorders. Pause Now or Move oN he doesn’t like having to talk to clerks in stores. He has always lived on his own and does not attend any family holiday celebrations despite repeated Turn to page 582 to review and apply what you’ve learned. invitations from relatives. He does not own a telephone.

Dissociative disorders, schizophrenic disorders, and personality disorders Personality Disorders With Dramatic help us understand that abnormal functioning is as varied as normal func- tioning and that the reasons for it are just as complex. Just as psychology or Impulsive Behaviors can help us understand and promote productive behavior and mental pro- cesses, it can also help us comprehend the fascinating and sometimes fright- Those with borderline personality disorder exhibit, above all else, instability— ening world of mental disorders. This is the first step on the road to effective of emotions, self-image, behavior, and relationships. Mary, whose story is one treatment. of the cases that opens this module, is an example of a person with borderline personality disorder. Her academic struggles in college, inability to resolve religious and philosophical issues, unrealistic demands, and self- cutting all add up to a life filled with instability.

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B2E3e_book_ATE.indb 580 3/19/12 10:51 AM 580 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 581 32 are often difficult to diagnose because there is a lot of overlap among them. Because of the difficulties that mental health professionals have had in using Figure 32.8 the current categories of personality disorders, it is quite likely that this area The Criminal Brain FYI TRM will undergo significant change in the DSM- 5, the new edition of the official Biological factors may help explain the criminal diagnostic and classification system that is expected in 2013 (American Psy- behavior of individuals with antisocial person- Harvey Cleckley identifies these chiatric Association, 2010; Clark, 2007; Widiger & Trull, 2007). The behavior ality disorder. These PET scans show reduced characteristics of antisocial per- patterns are usually evident by adolescence and obvious to others, but the activity (less red) in the frontal lobes of a sonality disorder: person with the personality disorder often does not recognize the problem murderer. This may result in a lack of judgment ● exists, which can make treatment difficult. Let’s take a look at the three clus- and less ability to control impulsive or aggres- Superficial charm and sive tendencies. (From Raine, 1999.) ters of personality disorders and a sample of the specific disorders included intelligence in each cluster. ● Poise, rationality, and the

coUrtesy of adrIan raIne, coUrtesy UnIversIty of soUthern calIfornIa Normal Murderer absence of neurotic anxiety ● The lack of a sense of personal Personality Disorders Related to Anxiety People with antisocial personality disorder (also known as psycho- antisocial personality dis- responsibility pathic or sociopathic personality disorder) show a lack of conscience for order A personality disorder ● Untruthfulness, insincerity, cal- Individuals with avoidant personality disorder are so sensitive about being wrongdoing and a lack of respect for the rights of other people. Antisocial in which the person (usually a man) shows a lack of conscience lousness, and manipulativeness rejected that personal relationships become difficult. Those with dependent personality disorder is the most dramatic and troubling of all personality for wrongdoing and a lack of ● Antisocial behavior without personality disorder behave in clingy, submissive ways and display a strong disorders. Because of this lack of conscience, people with this disorder are respect for the rights of others. regret or shame need to have others take care of them. Juanita, for example, is a 28-year- old willing to engage in wide-ranging criminal behaviors about which they show ● with dependent personality disorder. She still lives with her mother and feels no remorse (see Figure 32.8). This disorder is more likely to occur in males Poor judgment and failure to unable to live in her own apartment because she has trouble making deci- than in females, and it usually develops by adolescence (Cale & Lilienfeld, learn from experience sions about day- to-day life. She needs constant reassurance from her mother 2002). People with the disorder are often charming and clever, which helps ● The inability to establish last- and is afraid to disagree with her parent because she wants to avoid criticism. them get away with their misdeeds. In extreme forms, antisocial personal- ing, close relationships with ity disorder may manifest itself in serial killing, where the murderer has no others regard for the victims (think of Hannibal Lecter in the 1991 film The Silence ● The lack of insight into per- Personality Disorders With of the Lambs). Vicious crimes are committed for trivial reasons and dismissed sonal motivations Odd or Eccentric Behaviors with such excuses as “Once I’ve done a crime, I just forget it” or “I think of killing like smoking a cigarette, like another habit” (Darrach & Norris, 1984). At this point, you may want Individuals with paranoid personality disorder (which is different from para- The horribly counterproductive behavior patterns of antisocial personality to use Demonstration Activity: noid schizophrenia) show deep distrust of other people. This suspiciousness are caused by a combination of biological, psychological, and social factors. Antisocial Personality Disorder. gets in the way of personal relationships. Those with schizoid personality dis- Once in place, the disorder is extremely difficult to treat effectively. As you order are detached from social relationships. They are the true hermits, pre- can imagine, people with antisocial personality disorder often end up in jail Source: Cleckley, H. (1976). The mask ferring the life of the loner and avoiding intimate interactions with others at instead of in treatment. of sanity (5th ed.). St. Louis, MO: all costs. Henry is such a person. He does most of his shopping online because Mosby. Pause Now or Move oN he doesn’t like having to talk to clerks in stores. He has always lived on his own and does not attend any family holiday celebrations despite repeated Turn to page 582 to review and apply what you’ve learned. invitations from relatives. He does not own a telephone. ActIve LeArnIng TRM

Dissociative disorders, schizophrenic disorders, and personality disorders Research help us understand that abnormal functioning is as varied as normal func- Personality Disorders With Dramatic While all serial killers are anti- tioning and that the reasons for it are just as complex. Just as psychology or Impulsive Behaviors can help us understand and promote productive behavior and mental pro- social, not all people who are cesses, it can also help us comprehend the fascinating and sometimes fright- antisocial are serial killers. Have Those with borderline personality disorder exhibit, above all else, instability— ening world of mental disorders. This is the first step on the road to effective students explore the lives and of emotions, self-image, behavior, and relationships. Mary, whose story is one treatment. crimes of these serial killers, all of the cases that opens this module, is an example of a person with borderline of whom are believed to have or personality disorder. Her academic struggles in college, inability to resolve have had antisocial personality religious and philosophical issues, unrealistic demands, and self- cutting all add up to a life filled with instability. disorder: ● Ted Bundy ● Kenneth Bianchi (one of the “Hillside Stranglers”) ● Jeffrey Dahmer ● Aileen Wuornos (America’s only known female serial killer) At this point, you may want to use The Mind (2nd ed.), Module 35: “The Mind of the Psychopath.”

FYI

The terms psychopath and socio- path are synonymous. They are legal terms and are not used to diagnose psychological disorders.

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B2E3e_book_ATE.indb 581 3/19/12 10:51 AM 32 SuMMArY AnD ForMAT ive ASSe SSMenT MODULE 32 Apply What You Know 6. Individuals with a deep distrust of others might 5. True or False: Personality disorders usually be diagnosed with ______personality assess Thinking About Dissociative, Schizophrenic, involve patterns of behavior that are obvious to disorder. and Personality Disorders others by the time an individual is a teenager. a. paranoid Check for Understanding TRM b. avoidant ● At this point, you may wish to review Dissociative Disorders Schizophrenic disorders include symptoms of c. borderline and confirm concepts about these delusions, hallucinations, and inappropriate d. antisocial disorders with Critical Thinking WHAT’S THE POINT? emotions or behaviors. Activity: Fact or Falsehood? Suggest 32-1 What are the symptoms and causes of ● The main types of schizophrenia are paranoid that students complete the handout in dissociative disorders? schizophrenia, catatonic schizophrenia, disor- Key Terms small groups, taking the time to look ganized schizophrenia, and undifferentiated ● Dissociative amnesia is memory loss caused by a up information in the text so they can schizophrenia. dissociative disorders, p. 570 somatoform disorders, p. 573 hallucinations, p. 575 reaction to a traumatic event. respond correctly to questions. Have ● The risk of schizophrenia increases substantially dissociative amnesia, p. 571 hypochondriasis, p. 573 personality disorders, p. 579 ● all the groups meet to review the hand-hand- Dissociative fugue is an extended form of disso- if biological relatives have the disorder, indicat- dissociative fugue, p. 571 schizophrenia, p. 574 antisocial personality disorder, ciative amnesia characterized by loss of identity out, again asking students to use the ing a genetic predisposition for the development dissociative identity disorder, delusions, p. 574 p. 581 and travel to a new location. text to support their responses. of schizophrenia. Brain structure, brain function, p. 571 ● Dissociative identity disorder (formerly known and maternal viral infection during pregnancy as multiple personality disorder) is a rare and may also contribute to schizophrenia. CLose controversial disorder in which an individual ● The psychological factors of stress and disturbed exhibits two or more distinct and alternating family communication patterns may be triggers Reteach personalities. for the underlying biological factors that cause a Have students ponder the following ● Dissociative disorders are usually a response to person to manifest schizophrenic symptoms. questions about dissociative, schizo- overwhelming stress. They cause individuals to phrenic, and personality disorders: lose their sense of self and separate (dissociate) Apply What You Know from their memories, thoughts, or feelings. 3. Delusions of persecution and grandeur charac- ● How much of a role would you say terize ______schizophrenia. biology has in contributing to the Apply What You Know 4. Briefly describe two biological factors that incidence of these types of disor- 1. Psychologists skeptical about the increase in are associated with the development of ders? Why? the number of people diagnosed with dissocia- schizophrenia. ● How much of a role would you say tive identity disorder believe the increase is environment has in contributing to likely due to these disorders? Why? a. better diagnostic criteria. Personality Disorders ● How can knowledge of what con- b. an increase in severe child abuse. tributes to these disorders lead to c. genetic factors that may trigger the disorder. WHAT’S THE POINT? greater compassion for those who d. therapists who “cause” the disorder through 32-3 What kinds of personality disorders are suggestion. suffer from them? known? 2. True or False: Dissociative amnesia is often caused by drug use or head injuries. ● Personality disorders are lasting, rigid behavior answers Dissociative Disorders: Apply patterns that disrupt social functioning. What You Know Schizophrenic Disorders ● Personality disorders are divided into three clus- 1. (d) ters related to anxiety, to odd or eccentric behav- 2. False WHAT’S THE POINT? iors, and to dramatic or impulsive behaviors. ● 32-2 What are the symptoms, types, and Antisocial personality disorder involves a lack of answers Schizophrenic Disorders: causes of schizophrenic disorders? conscience and a lack of respect for the rights of other people. Apply What You Know 3. paranoid 4. The correct answer will provide 582 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 583 one- or two- sentence descrip- tions of the role of genetics, brain structure, brain function, or pre- natal viruses. PortFoLIo Project TRM Exploring Psychological Disorders on the World Wide Web Students can search the web for information on different disorders presented in Modules 30 through 32. Assign each student or group of students a disorder and have them gather information on it, creating a presentation to share with the class, school, or community. Some presentation options include the following: ● A formal research paper ● A poster presentation ● A public awareness campaign to educate people about the illness ● A documentary about someone with the disorder that educates people about the day-to- day life of people with the illness Please refer to Alternative Assessment/Portfolio Project: Exploring Psychological Disorders on the World Wide Web for helpful websites and rubrics to aid in evaluating your students’ projects. 582

B2E3e_book_ATE.indb 582 3/19/12 10:51 AM SuMMArY AnD ForMAT ive ASSe SSMenT 32 Apply What You Know 6. Individuals with a deep distrust of others might MODULE 32 be diagnosed with ______personality 5. True or False: Personality disorders usually Using the Test Bank Thinking About Dissociative, Schizophrenic, involve patterns of behavior that are obvious to disorder. The Test Bank that accompanies this and Personality Disorders others by the time an individual is a teenager. a. paranoid b. avoidant textbook offers a wide variety of ques-ques ● Dissociative Disorders Schizophrenic disorders include symptoms of c. borderline tions in different formats and levels delusions, hallucinations, and inappropriate d. antisocial of complexity. Use the software to WHAT’S THE POINT? emotions or behaviors. construct whole tests or to integrate 32-1 What are the symptoms and causes of ● The main types of schizophrenia are paranoid standardized questions into teacher- dissociative disorders? schizophrenia, catatonic schizophrenia, disor- Key Terms made tests. ganized schizophrenia, and undifferentiated ● Dissociative amnesia is memory loss caused by a schizophrenia. dissociative disorders, p. 570 somatoform disorders, p. 573 hallucinations, p. 575 answersa Personality Disorders: Apply reaction to a traumatic event. ● The risk of schizophrenia increases substantially dissociative amnesia, p. 571 hypochondriasis, p. 573 personality disorders, p. 579 What You Know ● Dissociative fugue is an extended form of disso- if biological relatives have the disorder, indicat- dissociative fugue, p. 571 schizophrenia, p. 574 antisocial personality disorder, ciative amnesia characterized by loss of identity 5. True ing a genetic predisposition for the development dissociative identity disorder, delusions, p. 574 p. 581 and travel to a new location. of schizophrenia. Brain structure, brain function, p. 571 6. (a) ● Dissociative identity disorder (formerly known and maternal viral infection during pregnancy as multiple personality disorder) is a rare and may also contribute to schizophrenia. controversial disorder in which an individual ● The psychological factors of stress and disturbed exhibits two or more distinct and alternating family communication patterns may be triggers personalities. for the underlying biological factors that cause a ● Dissociative disorders are usually a response to person to manifest schizophrenic symptoms. overwhelming stress. They cause individuals to lose their sense of self and separate (dissociate) Apply What You Know from their memories, thoughts, or feelings. 3. Delusions of persecution and grandeur charac- terize ______schizophrenia. Apply What You Know 4. Briefly describe two biological factors that 1. Psychologists skeptical about the increase in are associated with the development of the number of people diagnosed with dissocia- schizophrenia. tive identity disorder believe the increase is likely due to a. better diagnostic criteria. Personality Disorders b. an increase in severe child abuse. c. genetic factors that may trigger the disorder. WHAT’S THE POINT? d. therapists who “cause” the disorder through 32-3 What kinds of personality disorders are suggestion. known? 2. True or False: Dissociative amnesia is often caused by drug use or head injuries. ● Personality disorders are lasting, rigid behavior patterns that disrupt social functioning. Schizophrenic Disorders ● Personality disorders are divided into three clus- ters related to anxiety, to odd or eccentric behav- WHAT’S THE POINT? iors, and to dramatic or impulsive behaviors. ● 32-2 What are the symptoms, types, and Antisocial personality disorder involves a lack of causes of schizophrenic disorders? conscience and a lack of respect for the rights of other people.

582 ITS IndI v I dual v arI atI ons ITS Psychological Disorders Dissociative, Schizophrenic, and Personality Disorders STI Module 32 STI 583

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B2E3e_book_ATE.indb 583 3/19/12 10:51 AM