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PSYCH1000 Textbook Notes Ch 14 - 17.docx

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Psychology 1000

CH. 14 – PERSONALITY WHAT IS PERSONALITY? Personality – the distinctive and relatively enduring ways of thinking, feeling, and acting that characterize a person’s responses to life situation. 1. Components of identity 2. Perceived internal cause 3. Perceived organization and structure THE PSYCHODYNAMIC PERSPECTIVE Freud’s Psychoanalytic Theory Conversion hysteria – physical symptoms such as paralysis and blindness appeared suddenly with no apparent physical cause. (Jean Charcot) - Led Freud to begin experimenting various techniques to access the unconscious mind, including hypnosis, free association (saying whatever came to mind), and dream analysis). Psychic energy – powers the mind and constantly presses for either direct or indirect release. Freud divided personality in three separate but interacting structures 1. Id – exists totally within the unconscious mind - innermost core of the personality, the only structure present at birth, and source of all psychic energy - No direct contact with reality and functions in a totally irrational manner - Operates according to the pleasure principle (seeks immediate gratification or release, regardless of rational considerations and environmental realities…”want…take!” 2. Ego – functions primarily at a conscious level, and it operates according to the reality principle (tests reality to decide when and under what conditions the Id can safely discharge its impulses and satisfy its needs. 3. Superego – last to develop, approx. at the age of 4 or 5. - Moral arm of personality - Completely tries to block gratification of Id. Defense mechanisms – deny or distort reality. 1. Repression – the ego uses some of its energy to prevent anxiety-arousing memories, feelings, and impulses from entering consciousness - A person who was sexually abused in childhood develops amnesia for the event 2. Sublimation – A repressed impulse is released in the form of a socially acceptable or even admired behaviour. - A man with strong hostile impulses becomes an investigative reporter who ruins political careers 3. Displacement – An unacceptable or dangerous impulse is repressed, and then directed at a safe substitute target - A man who is harassed by his boss experiences no anger at, but then goes home and abuses his wife and children 4. Intellectualization – The emotion connected with an upsetting event is repressed, and the situation is dealt with as an intellectually interesting event. 5. Projection – An unacceptable impulse is repressed, and then attributed to (projected onto) other people 6. Rationalization – A person constructs a false but plausible explanation or excuse for an anxiety- arousing behaviour or event that has already occurred. - A woman with strong repressed desires to have an affair continually accuses her husband of being unfaithful to her 7. Reaction formation – An anxiety-arousing impulse is repressed, and its psychic energy finds release in an exaggerated expression of the opposite behaviour. - A mother who harbors feelings of hatred for her child represses them and becomes overprotective of the child Freud’s Stages of Psychosexual Development - We develop our personality as we pass through a series of discrete developmental stages each defined by an erogenous zone (pleasure-sensitive areas of body). - If there is excessive or inadequate gratification at a particular stage, then fixation at that stage occurs and adult personality is affected. 1. Oral (0 – 2 years old) – mouth – weaning 2. Anal (2 – 3 years old) – anus – toilet training 3. Phallic (4 – 6 years old) – genitals – resolving Oedipus complex 4. Latency (7 – puberty) – none – developing social relationships 5. Genital (puberty and n) – genitals – developing mature social and sexual relationships - Major shortcoming, many concepts are ambiguous and difficult to operationally define and measure. Evaluating Psychoanalytic Theory - Freud’s theory was reject by many due to having no scientific grounds, his emphasis on unconscious was scorned by a Victorian society that emphasized rationality and was condemned as unscientific by generations of personality psychologists with a behaviorist orientation. Neoanalysts – psychoanalysts who disagreed with certain aspects of Freud’s thinking and developed their owner theories - believed Freud did not give social and cultural factors a sufficiently important role - stressed infantile sexuality too much - too much emphasis on the events of childhood as determinants of adult personality o Neoanalysts Erik Erikson believed that personality development continues throughout the lifespan as individuals confront challenges that are specific to particular phases in their lives. - Alfred Adler insisted that humans are inherently social begins who are motived by social interest (as opposed to how Freud views them) o General motive of striving for superiority (drives people to compensate for real or imagined defects – inferiority complex) and to strive to be ever more competent in life. Analytic psychology (Carl Jung) – expansion of Freud’s notion of the unconscious; Jung believed that humans possess not only a personal unconscious based on their life experiences, but also a collective unconscious that consists of memories accumulated throughout the entire history of the human race. Archetypes – inherited tendencies to interpret experience in symbols, myths, and beliefs that appear across may cultures, such as the image of a god and the quest for self-unity and completed-ness. Object relations – focus on the images of mental representations that people form of themselves and other people as a result of early experience with caregivers. (Melanie Klein, Otto Kernberg, Margaret Mahler, and Heinz Kohut) THE HUMANISTIC PERSPECTIVE - Embraces a positive view that affirms the inherent dignity and goodness of the human spirit. Emphasizes the central role of conscious experience, as well as the individual’s creative potential and inborn striving for self-actualization. Carl Roger’s Self Theory – behaviour is not a reaction to unconscious conflicts but a response to our immediate conscious experience of self and environment. - Believed that the forces that direct behaviour are within us and that, when they are distorted or blocked by our environment, they can be trusted to direct us towards self- actualization. Self – an organized, consistent set of perceptions of and beliefs about oneself. Self-consistency – an absence of conflict among self-perceptions Congruence – consistency between self-perceptions and experience “Problems in living” – Denying or distorting ones experiences to remove the incongruence. - If there is a significant degree of incongruence between self and experience, and the experiences are forceful enough, the defences used to deny and distort reality may collapse, resulting in extreme anxiety and a temporary disorganization of the self-concept. Need for positive regard – acceptance, sympathy, and love from others. o Essential for healthy development. Unconditional positive regard – communicates that the child is inherently worth of love. Conditional positive regard – dependent on how the child behaves. In the extreme cases love and acceptance are given to the child only when the child behaves as the parents want. Need for positive self-regard – we all want to feel good about ourselves Conditions of worth – dictate when we approve or disapprove of ourselves. After achieving self-actualization, as Rogers viewed them, fully functioning persons do not hide behind masks or adopt artificial roles. They feel a sense of inner freedom, self-determination, and choice in the direction of their growth. They have no fear of behaving spontaneously, freely, and creatively. Self-esteem – refers to how positively or negatively we feel about ourselves, and it is a very important aspect of personal well-bring, happiness, and adjustment. Self-verification – people are motivated to preserve their self-concept by maintaining self- consistency and congruence. Self-enhancement – people have a need to regard themselves positively. Gender schemas – organized mental structures that contain our understanding of the attributes and behaviours that are appropriate and expected for males and females - Carl Rogers’s most notable contributions were a series of groundbreaking studies on the process of self-growth that can occur in psychotherapy. o Measured discrepancies between ideal self and perceived self. TRAIT AND BIOLOGICAL PERSPECTIVES The trait theorist’s goal is to condense all behavioural descriptors into a manageable number of basic traits that can capture personal individuality. - Gordon Allport went through the English dictionary and recorded every word that could be used to describe a particular trait and ended up with 17,953 words Two major approaches have been taken to define “the building blocks of personality” 1. Propose traits (e.g. dominance, friendliness, or self-esteem) on the basis of intuition or a theory of personality. 2. Factor analysis – to identify clusters of specific behaviours that are correlated with one another so highly that they can be viewed as reflecting a basic dimension, or trait, on which people vary Introversion-extraversion – behavioural patterns define a general factor or dimension. At one end of the dimension are highly introverted behaviours, and at the other end are highly extraverted behaviours Cattell’s Sixteen Personality Factors - Cattell asked thousands of people to rate themselves on numerous behavioural characteristics and also obtained ratings from people who knew the participants well o Was able to identify 16 basic behaviour clusters, or factors  Reserved • Trusting  Less intelligent • Practical  Affected by feelings • Forthright  Submissive • Self-assured  Serious • Conservative  Expedient • Group-dependent  Timid • Uncontrolled  Tough-minded • Relaxed o Using this information, he developed a widely used personality test called the 16 Personality Factor Questionnaire (16PF) to measure individual differences on each of the dimensions and provide a comprehensive personality description o Developed personality profile for individuals and groups of people. Eysenck’s Extraversion-Stability Model - Eysenck propose surprising few basic traits. o Called his original basic dimensions of personality Introversion-Extraversion and Stability-Instability (which he referred to as Stability-Neuroticism). o Argued that personality within the normal range could be understood with only these two dimensions. o He later added a third factor, Psychoticism-Self Control.  Psychoticism – creative and had a tendency toward nonconformity, impulsivity, and social deviance, not meaning developing some type of psychosis. - He was one of the first modern theorists to suggest a biological basis for major personality traits. He linked Introversion-Extraversion and Stability-Instability to differences in individuals’ normal patterns of arousal within the brain. o Extreme introverts are chronically over aroused; their brains are too electrically active, so they try to minimize stimulation to reduce arousal to get down to their optimal arousal level, or comfort zone. This is opposite for extraverts. o Stability-Instability represents the suddenness with which shifts in autonomic nervous system arousal occur. The Five Factor Model - The “Big Five” factors help better capture the basic structure of personality. - O.C.E.A.N. – Openness, Conscientious, Extraversion, Agreeableness, and Neuroticism - Measures of the Big Five factors and real life behavioural outcome seldom show correlations beyond 0.20 – 0.30. o Therefore the Big Five Model now includes six subcategories of facets under each of the five major factors. - The most important personality test to measure the Big Five is the NEO Personality Inventory (NEO-PI). o Provides scores on each of the facets as well as corresponding major factor. Cloninger has attempted to link three broad personality traits - novelty-seeking (related to dopamine levels), harm avoidance, and reward dependence – to differences in the functioning of specific neurotransmitter systems. The Life Orientation Test is used by personality researchers to measure the disposition to be optimistic or pessimistic. Self-monitoring – tendency to tailor one’s behaviour to what is called for by the situation. SOCIAL COGNITIVE THEORIES Social cognitive theorists – combine the behavioural and cognitive perspectives into an approach to personality that stresses the interaction of a thinking human with a social environment that provides learning experiences. - Julian Rotter, Albert Bandura and Walter Mischel Reciprocal determinism – the person, the person’s behaviour, and the environment all influence one another in a pattern of two-way causal links. Julian Rotter: Expectancy, Reinforcement Value, and Locus of Control According to Rotter, the likelihood that we will engage in a particular behaviour in a given situation is influenced by two factors: expectancy and reinforcement value. - Expectancy is our perception of how likely it is that certain consequences will occur if we engage in a particular behaviour within a specific situation. - Reinforcement value is how much we desire or dread the outcome that we expect the behaviour to produce. - Internal-external locus of control – an expectancy concerning the degree of personal control we have in our lives o Internal believe that life outcomes are largely under personal control and depend on their own behaviour o External believe that their fate has less to do with their own efforts than with the influence of external factors, such as luck, chance, and powerful others. o Locus of control is called a generalized expectancy because it is thought to apply across many life domains. Albert Bandura: The Social Cognitive Perspective and Self-Efficacy The idea of human agency is the idea that humans are active agents in their own lives. - It is a process that includes four aspects: internationality, forethought, self-reactiveness, and self-reflectiveness. A key factor in the way people regulate their lives is their sense of self-efficacy, which is their beliefs concerning their ability to perform the behaviours needed to achieve desired outcomes. - Four important determinants have been identified but the two important ones are; performance attainments and observational learning, Walter Mischel: The Consistency Paradox and If… Then... Behaviour Consistencies Consistency paradox – we expect and perceive a high level of consistency in people’s behaviour, the actual level of consistency is surprisingly low. Cognitive-affective personality system (CAPS) – both the person and the situation matter that accounts for behaviour If… then… behaviour consistencies – suggest that there is consistency in behaviour, but it is found within similar situations. The strength of the social cognitive approach is it strong scientific base, which brings together two perspectives, the behavioural and the cognitive. It helps to resolve an apparent contradiction between the central assumption that personality produces stability in behaviour and research findings that people’s behaviour is no very consistent across different situation. PERSONALITY ASSESSMENT Various measures used to access personality are; interview data, personality scales and self-ratings, responses on projective tests, physiological measures, and behavioural assessment. Structural interviews – frequently used to collect research data or make a psychiatric diagnosis, contain a set of specific questions that are administered to every participant. Behavioural assessment – psychologists devise an explicit coding system that contains the behavioural categories of interest. Remote behaviour sampling – researchers and clinicians can collect samples of behaviour from respondents as they live their daily lives. o Useful in studying interactions between the person and the situation Personality scales and inventories are widely used but are considered objective measures. o Rational approach – items are based on the theorist’s conception of the personality trait to be measured.  The rational approach was used to develop the NEO-PI o Empirical approach – items are chosen not because their content seems relevant to the traits on rational grounds, but because previous research has shown that the items were answered differently by groups of people know to differ in personality characteristic of interest.  The empirical approach was used to develop the Minnesota Multiphasic Personality Inventory (MMPI), the most widely used personality inventory.  The revised MMPI-2 has 10 clinical scales (originally intended to measure severe personality deviations such as schizophrenia, depression, and psychopathic personality, and they do) and three validity scales (used to detect tendencies to either present an overly positive picture or exaggerate the degree of psychological disturbance)  Also used as a screening device in industrial and military settings o Favoured by trait theorists who want to measure specific personality traits and by behaviour geneticists who want to estimate genetic contributions to traits through twin or adoption studies o Projective tests – when a person is presented with an ambiguous stimulus whose meaning is not clear, the interpretation attached to the stimulus will have to come partly from within.  Rorschach inkblots  Favored by psychodynamic theorists interest in the unconscious interactions o Thematic Appreception Test (TAT) – consists of a series of pictures derived from paintings, drawings, and magazine illustrations.  Objective measures of personality have generally been found to have better reliability and validity than projective measures. CH. 15 – STRESS, COPING, AND HEALTH THE NATURE OF STRESS Psychologists have viewed stress in three different ways; as a stimulus, a response, and an organism-environment interaction. Stressor – eliciting stimuli or events that place strong demand on us. Stress has also been viewed as a response that has cognitive, physiological, and behavioural components. - The greater the imbalance between demand and resources, the more stressful - Micro-stressors – daily hassles and everyday annoyances we encounter - Catastrophic events – occur unexpectedly and typically affect large numbers of people - Major negative events – such as being the victim of a major crime. - In general, events which occur suddenly and unpredictably, and which affect a person over a long period of time seem to take the greatest toll on physical and psychological well-being. Stress combines the stimulus and response definitions into a more inclusive model here it is viewed as a person-situation interaction, or as a transaction between the organism and the environment. Stress – a pattern of cognitive appraisals, physiological responses, and behavioural tendencies that occurs in response to a perceived imbalance between situational demands and the resources needed to cope with them Life event scales – quantify the amount of life stress that a person has experienced over a given period of time - Early theorists believed that any life event that requires adaptation, whether negative or positive in nature is a stressor. The Stress Response 1. Appraisal of the demands of the situation (primary appraisal) 2. Appraisal of the resources available to cope with it (secondary appraisal) 3. Judgments of what the consequences of the situation could be 4. Appraisal of the personal meaning, that is, what the outcome might imply about us. - Distortions and mistaken appraisal can occur at any of the four points in the process, causing inappropriate stress responses. Chronic Stress and the Gas General adaption syndrome (GAS, Hans Selye) – a physiological response pattern to strong and prolonged stressors Stage 1 – Alarm Reaction - Alarm reaction – sudden activation of the sympathetic nervous system and the release of stress hormones by the endocrine system. During the period of stress, the cortisol is most important - It triggers an increase in blood sugars, in part by acting on the liver - Suppresses the immune system and inflammation from injuries - Persistent secretion of cortisol is associated with a number of serious clinical conditions, such as depression and anxiety disorders. - Sympathetic nervous system activation and hormonal response help deal with stressors Stage 2 – Resistance - Body’s resource continue to be mobilized so that the person can function despite the presence of the stressor - If the stressor is intense and persist for too long, the body may reach the stage of exhaustion. Stage 3 – Exhaustion - Body’s resources are dangerously depleted - The person may develop diseases related to immune system dysfunction or show evidence of weakened immune function STRESS AND HEALTH Stress and Psychological Well-being Rape trauma syndrome – the aftermath trauma of rape can be nearly as stressful as the incident itself Neuroticism – maladaptive behaviour with tendency to experience negative emotions and get into stressful situations Post-Traumatic Stress Disorder (PTSD) Post-traumatic stress disorder – is a severe anxiety disorder that is caused by exposure to trauma life events. Four major groups of symptoms occur with PTSD; 1. Severe anxiety, physiological arousal (stress response), and distress 2. Painful, uncontrollable reliving of the vent(s) in flashbacks, dreams ,and fantasies 3. Emotional numbing and avoidance of stimuli associated with the trauma 4. Intense “survivor guilt” - Some show self-destructive and impulsive behaviour - Likelihood of developing PTSD is influence by the victim’s social support, personality factors, coping strategies, and pre-existing psychological conditions. VULNERABILITY AND PROTECTIVE FACTORS Vulnerability factors – increase people’s susceptibility to stressful events Protective factors – environmental or personal resources that help people cope more effectively with stressful events Emotional purging helps to enhance immune system functioning Cognitive Protective Factors: The Importance of Beliefs Hardiness – three beliefs that constituted a stress-protective factor. - Commitment, control (strongest in buffering stress), and challenge Coping self-efficacy – the conviction that we can perform the behaviours necessary to copy successfully, is an important protective factor Optimism – positive affect is linked to better health and longer life, and a critical aspect of positive affect is our view of the future. Personality factors – Type A and Type B - Type A – people tend to live under great pressure and are demanding of themselves and others - Type B – people who are more relaxed, more agreeable, and have far less sense of time urgency Physiological Reactivity Physiological toughness – a particular stress hormone pattern that appears to be a protective factor involves relations between two classes of hormones secreted by the adrenal glands in the face of stress. Catecholamines (includes epinephrine and norepinephrine) Corticosteroids (particularly cortisol) – arousal effects last much longer and seem to be more damaging than those produced by the catecholamine’s (unless they are secreted at high levels over a long period of time) Physiological toughness consists of: 1. Low resting level of cortisol, low levels of cortisol secretion in response to stressors, and a quick return to baseline level of cortisol after the stress is over 2. Low resting level of catecholamines but a quick and strong catecholamine response when the stressor occur, followed by a quick decline in catecholamine secretion and arousal when the stressor is over - This hormonal pattern provides maximum short-term mobilization of resources needed to deal with the stressor but prevents the eventual depletion of catecholamines and the wear and tear on the body from the exhaustion phase of GAS. - Increased vulnerability to bodily breakdowns occurs when the person responds to stress with high levels of cortisol instead of catecholamines COPING WITH STRESS Strategies can be divided into three broad classes; 1. Problem-focused coping – attempts to confront and deal directly with the demands of the situation, or to change the situation so that it is no longer stressful. o Considered a favorable adjustment to stressors o Men favor this strategy 2. Emotional-focused coping – attempts to manage the emotional responses that result from it, typically avoidance of acceptance of it o Predicted depression and poorer adjustment o This strategy better reduced stress in low personal control situations -> no strategy is best, depends on circumstances o Women more likely to use this method than men 3. Seeking social support – turning to others for assistance and emotional support in times of stress. o Considered a favorable adjustment to stressors o Women favor this strategy - People flexible with emotional expression and suppression were less distress HEALTH PROMOTION AND ILLNESS PREVENTION Health psychology – recognition of the crucial role that behaviour plays in health maintenance has added impetus. Health related behaviours fall into two main categories - Health-enhancing behaviours – serve to maintain or increase health (ex. Exercise) - Health-comprising behaviours – promote the development of illness (ex. Smoking) How People Change: The Transtheoretical Model Transtheoretical model – identifies six major stages in the change process 1. Pre-contemplation – problem unrecognized or unacknowledged 2. Contemplation – recognition of problem; contemplating change 3. Preparation – preparing to try to change behaviour 4. Action – implementing change strategies 5. Maintenance – behaviour change is being maintained 6. Termination – permanent change no maintenance efforts required - Psychologists have developed ways of determining what stage people are in so that they can apply stage-matched interventions designed to move the person toward the action, maintenance, and termination stages. Increasing Behaviours That Enhance Health Exercise - Aerobic exercise – sustained activity, such as jogging, swimming, and bicycling, that elevate the heart rate and increases the body’s need for oxygen. Weight control - Yo-yo dieting – increase accumulation of abdominal fat and results in big up-and-down weight fluctuations. o Such dieting markedly increases the risk of dying from cardiovascular disease. - Bad (LDL) cholesterol and good (HDL) cholesterol Reducing behaviours that impair health Approach to cultural attitude change was inspired by Bandura’s social-cognitive-theory (the theory that saved a million lives). It involves the use of modeling procedures to change attitudes and behaviour in some of the poorest and most hopeless parts of the world. The strategy is to produce highly engage “entertainment-education” radio dramas to increase awareness and counteract false beliefs. Bandura found that people learn from role models whose behaviour they admire, and designed it to have a compelling storyline with a purpose to encourage protected sex and reduce soaring population growth. - Program featured three types of characters; positive role models whose behaviours have positive consequences, negative role models whose behaviours lead to disaster, and transitional models who start out behaving negatively and then change for the better and enjoy the positive outcomes. COMBATING SUBSTANCE ABUSE Alcohol abuse affects not just the drinker: For every person who has a problem with alcohol, an average of four other people’s lives is adversely affected on a daily basis. Treatment of substance abuse has point the way to cognitive-behavioural approaches, which have proven to be more cost-effective and successful in reducing abuse. Motivational interviewing – leads people to their own conclusions by asking questions that focus on discrepancies between the current state of affairs and individuals’ ideal self-images, desired behaviours, and desired outcomes. Multimodal treatments – often include biological measures (e.g., the use of nicotine patches), together with psychological measures such as o Aversion therapy – undesired behaviour associated with aversive stimulus o Relaxation and stress management training – helps the person adapt to and deal with stressful situations (a procedure called mindfulness meditation has become an important tool in the treatment of addictive behaviours o Self-monitoring procedures – help the person identify the antecedents and consequences of the abuse behaviours o Coping and social skills training – dealing with high-risk situations that trigger abuse o Marital and family counseling – reduce conflicts and increase social support for change o Positive reinforcement procedures – strengthens change The AA program seems to be moderately effective in reducing drinking if people remain in the program and adhere to its procedures - Only 10% remain in it, become abstinent, and remain abstinent for a year - Aversion therapy programs, such as Antabuse treatment, suffer from the same dropout problem 80% of people who quit smoking relapse within a year New Year’s resolutions are maintain for more than four months by only 40-45% of people Relapse – return to the undesirable behaviour pattern - Tends to occur after the person had suffered a lapse (a one-time “slip”) when confronted with a high-risk situation - Abstinence violation effect – the person becomes upset and self-blaming over the failure to remain abstinent and viewed the lapse as proof they would never be strong enough to resist temptation - Relapse prevention has the same overall effectiveness equal to the AA program Harm reduction – a prevention strategy that is designed not to eliminate behaviour, but rather reduce the harmful effects of a behaviour when it occurs. CH. 16 – PSYCHOLOGICAL DISORDERS THE SCOPE AND NATURE OF PSYCHOLOGICAL DISORDERS 26% of the population suffers from a diagnosable mental disorder Nearly half of all North Americans between the ages of 15-54 will experience a psychological disorder at some point in their lives Psychological disorders are the second leading cause of disability, exceeding physical illness and accidents One adolescent commits suicide every 90 seconds Medications used to treat anxiety and depressions are among the most frequently described drugs in North America Each year, more than a million students withdraw from universities in North America because of emotional problems 1 in 4 North Americans will have a substance abuse disorder during his/her lifetime. The loss to North American businesses is over $120 billion annually, much of which stems from the sharp decline in job productivity In developed economics, psychological disorders account for over 15% of the financial burden of illness, more than the burden caused by all cancers. Measures for normalness 1. The personal values of a given diagnostician 2. The expectations of the culture in which a person currently lives 3. The expectations of the person’s culture of origin 4. General assumption about human nature 5. Statistical deviation from the norm 6. Harmfulness, suffering, and impairment - Many people would not find criteria 1 and 5 satisfactory bases for judging a person to be disordered. Criteria 1, the diagnosis could depend on arbitrary and unusual beliefs of the person making the judgments. Criteria 5, an extremely well adjusted or highly intelligent person would be judged abnormal - Criteria 2-4 reflect cultural or even more widespread beliefs about what is appropriate, so that judgments about what is normal and what is abnormal can differ depending on the time and the culture. - Regarding Criteria 6 (judgment of abnormality – distress, deviant, and dysfunctional), personal distress is neither necessary nor sufficient to define abnormality. Second, most behaviours judged abnormal are dysfunctional either for the individual or for society. Thirdly, concerning deviance, related to conduct within every society where norms are regulated. - Abnormal behaviour – behaviour that is personally distressing, personally dysfunctional, and/or so culturally deviant. Historical Perspectives on Deviant Behaviour - King Saul’s mad rages and terrors - Mozart developed marked paranoid symptoms and was convinced his was poisoned during the time he was composing his Requiem. - Abraham Lincoln suffered recurrent bouts of depression through his life. - Winston Churchill suffered from severe depression, referring to it as his “black dog” - Howie Mendel and Cameron Diaz and their obsession with germs - Trephination – bizarre behaviour reflected an evil spirit’s attempt to escape from a person’s body and a sharp tool was used to chisel a hole into the skulls. It successfully eliminated abnormal behaviour by putting an end to the patient’s life. - In medieval Europe, the demonological model of abnormality held that disturbed people either were possessed involuntarily by the devil or had voluntarily made a pact with the forces of darkness - Based on the notion that impurities float to the surface, a women who floated was a witch. - Hippocrates suggested that mental illnesses were diseases and the site of mental illness was the brain - General paresis – a disorder characterized in its advanced stages by mental deterioration and bizarre behaviour, resulted from massive brain deterioration caused by syphilis. o First demonstration that a psychological disorder was caused by an underlying physically malady. - Vulnerability-stress model (diathesis-stress model) – each of us has some degree of vulnerability for developing a psychological disorder, given sufficient stress. o Vulnerability factors and stressors include  Genetic factors • Economic adversity  Biological characteristics • Environmental trauma  Psychological traits • Interpersonal stresses or losses  Previous maladaptive learning • Occupational setbacks or demands  Low social support Diagnosing Psychological Disorders Reliability – means that clinicians using the system should show high levels of agreement in their diagnostic decisions Validity – means that the diagnostic categories should accurately capture the essential features of the various disorders The DSM-IV-TR is the most widely used diagnostic classification system in North America. - Over 350 diagnostic categories and detailed lists of observable behaviours that must be present in order for a diagnosis to be made. - Allows diagnostic information to be represented along five dimensions or axes, that take both the person and his/her life situation into account o Axis I – primary diagnosis o Axis II – personality/developmental disorders o Axis III – relevant physical disorders o Axis IV – severity of psychosocial stressors o Axis V - global assessment of level of functioning - The current classification system is a categorical system, in which people are placed within specific diagnostic categories  Highly specific behavioural criteria diagnostic categories have improved Axis I reliability over earlier versions  Criteria are so detailed and specific that many people (50%) don’t fit into the categories.  People who receive the same diagnosis may share only certain symptoms and look very different from one another  Categorical system does not provide a way of capturing the severity of the person’s disorder, nor can it capture symptoms that are adaptively important but not severe enough to meet the behavioural criteria for the disorder - An alternative (or supplement) to the categorical system is a dimensional system, in which relevant behaviours are rated along a severity measure. o Based on the assumption that psychological disorders are extensions different in degree, rather than kind, from normal personality functioning.  Personality trait dimensions  Negative Emotionality • Introversion  Schizotypy • Antagonism  Disinhibition • Compulsivity  One beneficial consequence of the proposed DSM-V approach to the diagnosis of personality disorders is that it helps to link normal and abnormal personality functioning. Critical Issues in Diagnostic Labelling Beyond their clinical and scientific utility, diagnostic labels can have important personal, social, and legal consequences for the people who receive them Social and Personal Implications - Once a diagnostic label is attached to a person, it becomes all too easy to accept the label as an accurate description of the individual rather than of the behaviour Legal Consequences - Competency – refers to a defendant’s state of mind at the time of a judicial hearing (not at the time the crime was committed). - Insanity – a far more controversial issue, relates to the presumed state of mind of the defendant at the time the crime was committed -> may be declared “not guilt due to insanity” o Not criminally responsible on account of mental disorder Medical students’ disease – When people read descriptions of disorders, whether physical or psychological, they often see some of those symptoms or characteristics in themselves. Anxiety Disorders – the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life. Anxiety responses have four components 1. A subjective-emotional component, including feelings of tension and apprehension 2. A cognitive component, including subjective feelings of apprehension, a sense of impending danger, and a feeling of inability to cope 3. Physiological responses, including increased heart rate and blood pressure, muscle tension, rapid breathing, nausea, dry mouth, diarrhea, and frequent urination 4. Behaviour responses, such as avoidance of certain situations and impaired task performance Phobias – are strong and irrational fears of certain objects or situations Agoraphobia – a fear of open and public places Social phobias – excessive fear of situations in which the person might be evaluated and possibly embraced Specific phobias – such as fears of dogs, snakes, spiders, or death Animal fears are common to women and fear of heights, among men Phobias can develop at any point in life, but many of them develop during childhood, adolescence, and early adulthood. Many social phobias evolve out of extreme shyness during childhood Generalized Anxiety Disorder – a chronic state of diffuse or “free floating” anxiety that is not attached to specific situations or objects - 5% of people between the ages 15-45 reported having experience the symptoms of GAD. - Onset tends to occur in childhood and adolescence Panic disorder – occur suddenly and unpredictably and they are much more intense - Opposite to the generalized anxiety disorder - Formal diagnosis of a panic disorder requires recurrent attacks that do not seem tied to environmental stimuli, followed by psychological or behavioural problems o In a survey of Canadian students, 34% reported having had at least one unexpected panic attack within the previous year, during periods of extreme stress.  Under DSM-IV criteria, these students would not be diagnosed as having a panic disorder unless they developed an inordinate fear of having future attacks. Obsessive-compulsive disorder (OCD) – consists of two components, one cognitive and the other behavioural, although either can occur alone Obsessions – repetitive and unwelcome thoughts, images, or impulses that invade consciousness, are often abhorrent to the person, and are very difficult to dismiss or control Compulsions – are repetitive behavioural responses o Appears to reduce anxiety and be strengthened through a process of negative reinforcement because they allow a person to avoid anxiety Causal Factors in Anxiety Disorders Biological factors - Genetic factors may create a vulnerability to anxiety disorders - Clinical levels of anxiety, twins have a concordance rate of 40% and fraternal twins with 4% o Far from 100%, indicating the significance of psychological and environmental factors - 61% of the population variance in panic disorder and 44% of agoraphobia variance is genetically influenced - David Barlow suggests that such vulnerability may take the form of an autonomic nervous system that overreacts to perceived threat, creating high levels of physiological arousal o Hereditary factors may cause over-reactivity of neurotransmitter system involved in emotional responses - Other evidence suggest that trauma-produced over-activity in the emotional system of the right hemisphere (negative emotions) may produce vulnerability to PTSD o When experiencing anxiety associated with PTSD, it is primarily the right hemisphere that is activated - GABA (inhibitory transmitter) reduces neural activity in the amygdala and other brain structures that stimulate physiological arousal o Abnormally low levels of GABA in these arousal areas may cause people to have highly reactive nervous systems that quickly produce anxiety responses in response to stressors  Therefore might be more susceptible to classically conditioned phobias because they already have a strong unconditioned arousal response in place  Patients with a history of panic attacks had 22% lower concentration of GABA in the occipital cortex than age-matched controls without panic disorder - Serotonin may be involved in anxiety disorders - Peter Lewinsohn and co-workers found that sex difference emerges as early as 7 years of age o Suggests a sex-linked biological predisposition for anxiety disorders and gender discrimination, reason why women are more likely than men to have anxiety disorders - Evolutionary theorists believe that biological preparedness makes it easier for us to learn to fear certain stimulus, and may explain why phobias seem to center on certain classes of “primal” stimuli and not on more modern ones (ex. Guns, electrical power stations, etc.) Psychodynamic factors Neurotic anxiety – occurs when unacceptable impulses threaten to overwhelm the ego’s defenses and explode into action o How ego’s defense mechanism deals with neurotic anxiety determines the form of the anxiety disorder - Freud believed that in phobic disorders, neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to the underlying conflict - Obsessions (symbolically related to underlying impulse) and compulsions (“taking back”) are also ways of handling anxiety - Generalized anxiety and panic attacks are thought to occur when one’s defenses are not strong enough to control or contain anxiety, but are strong enough to hide the underlying conflict - Not enough research support Cognitive Factors - Cognitive theorists stress the role of maladaptive thought patterns and beliefs in anxiety disorders - Anxiety-disordered people “catastrophize” about demands and magnify them into threats. o Anticipate the worse and feel powerless to cope effectively - Edna Foa and co-workers asked social phobics 1. How likely it was that they would embarrass themselves in a social situation 2. How serious and costly the consequences of performing poorly would be for them o Costs much high in social phobics than non-social phobics and indifferent in social situations - According to David Barlow, panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms, such as heart palpitations, dizziness, and breathlessness o Appraises these as signs that a heart attack or a psychological loss of control is about to occur, creating more anxiety until it produces a full-blown state of panic. o Replacing these danger appraisals with more benign interpretations of their bodily symptoms results in a marked reduction in panic attack Behavioural Factors - Anxiety disorders result from emotional conditioning - Fears are acquired as a result of traumatic experiences that produce a classically conditioned fear response (ex. Fear of heights (CR) because the high place (CS) associated with pain and trauma of the fall (UCS) o But many phobics have never had a traumatic experience with the phobic object of situation that they now fear  Acquired through observational learning  Due to biological disposition (towards intense fear) and cognitive factors - Anxiety may be triggered by environmental cues (ex. phobic reactions) or internal cues (images and thoughts, ex. panic attacks) - Successful avoidance, while producing an immediate positive benefit, prolongs the problem in the long run (prevents anxiety response from being extinguished, which is by constant exposure) Sociocultural factors Culture-bound disorders – occur only in certain places - Koro is a Southeast Asian anxiety disorder in which a man fears that his penis is going to retract into his abdomen and kill him - Taijin Kyofushu are pathologically fearful of offending others by emitting offensive odours, blushing, staring inappropriately, or having a blemish or improper facial expression o Attributed to the Japanese cultural value of extreme interpersonal sensitivity and to cultural prohibitions against expression negative emotions - Windigo is an anxiety disorder from among certain North American Indians, fear of being possessed by monsters who will turn them into homicidal cannibals - Anorexia nervosa is the fear of getting fat Eating Disorders Anorexia nervosa – an intense fear of being fat and severely restrict their food intake to the point of self-starvation - Causes menstruation to stop, strains the heart, produces bone loss, and increases the risk of death (death of Karen Carpenter) Bulimia nervosa – are overly concerned with becoming fat, but instead of self-starvation they binge eat and then purge the food, usually by inducing vomiting or using laxatives - Consume about 2,000-4,000 calories during binges, and up to 20,000 in a day - Are of normal body weight, but repeated purging can produce severe physical consequences, including gastric problems and badly eroded teeth Causes of Anorexia and Bulimia - General eating regulation seems to lie in a combination of environmental, psychological, and biological factors - Cultural norms alone cannot account for eating disorders, because only a small percentage of women within a particular culture are anorexic or bulimic - Personality may be a factor, anorexics are perfectionists; high achievers who often strive ot live up to lofty self-standard - Monique Smeets’ experiment showed the anorexics set harsher standards for their own and other women’s bodies - Anorexics face more stressful events related to their parents due to their high standards - Bulimics, tend to be depressed and anxious, exhibit low impulse control, and seem to lack a stable sense of personal identity and self-sufficiency o Bingeing is often triggered by life stress, and guilt and self-contempt follow it o Purging may be a means of reducing depression and anxiety triggered by the bingeing - Anorexics and bulimics exhibit abnormal activity of serotonin and other body chemicals that help to regular eating o Due to being correlated, it is not clear whether it helps to cause eating disorders, or are a reaction to self-starvation and binge-purge eating o Many researchers believe that these physiological changes initially are a response to abnormal eating patterns; but, once started, they perpetuate eating and digestive irregularities  Leptin rebound effect  Vomiting causes bulimics to lose taste sensitivity, making the normally unpleasant taste of vomit more tolerable - Treating eating disorders is difficult and takes many years, only half fully recover Mood (Affective) Disorders Mood disorders – involve depression and mania (excessive excitement) - Anxiety and mood disorders have a high comorbidity (co-occurrence) - Half of all depressed people also experience an anxiety disorder Depression 25-30% of university undergraduates are expecting mild depression Major depression – leaves people unable to function effectively in their lives - Occurs in 16.6% of Americans during their lifetimes - In Canada, about 10% of those over the age of 18 will suffer major depression in their lifetimes Dysthymia – less intense form of depression with less dramatic effects on personal and occupational functioning - More chronic and long-lasting form of misery, occurring for years on end with intervals of normal mood that never last more than a few weeks of months Although depression is primarily a disorder of mood, there are three other types of symptoms: cognitive symptoms, motivational symptoms, and somatic (physical) symptoms Negative mood state is the core feature of depression - Depressed people most commonly report sadness, misery, and loneliness - Anxiety disordered people retain their capacity to experience pleasure, depressed people lose it Cognitive symptoms are also a central part of depression o Difficulty concentrating and making decisions, and low-self esteem o View the future with great pessimism and hopelessness Motivational symptoms involve an inability to get started and perform behaviours that might produce pleasure or accomplishment o Unable to get out of bed, let alone go to class of study o Movements slow down and the person walks or talks slowly with excruciating effort Somatic symptoms often include loss of appetite and weight loss in moderate and severe depression - Sleep disturbances (insomnia and weight loss lead to fatigue and weakness, adding to depressed feelings - May lose sexual desire and responsiveness and weight gain sometimes occurs as a person eats compulsively Bipolar Disorder Unipolar depression – a person experiences only depression Bipolar disorder – depression (dominant state) alternates with periods of main (high excitement) - Manic people can become very irritable and aggressive when their momentary goals are frustrated in any way. - In a manic state, speed is often rapid or pressured - Manic people may go several days without sleeping, until exhaustion inevitably sets in and the mania slow down - Ex. Robert B, a dentist who tried to treat as many patients as possible with his idea, but the interminable delays made him frustrated and he became destructive. Prevalence and Course of Mood Disorders 1 in 20 North Americans is severely depressed and having a depressive episode of clinical proportions at least once in your lifetime is about 1 in 5 - Appears in infants as young as six months who have been separated from their mothers for prolonged periods - Rate of depressive symptoms in children and adolescents is as high as the adult rate - Depression increasing dramatically in 15 -19 year olds - People born after 1960 are 10 times more likely to experience depression than are their grandparents - Women appear to be about twice as likely as men to suffer unipolar depression o Most likely to suffer their first episode of depression in their 20s, men in their 40s o Biological theories suggest that genetic factors, biochemical different in the nervous system, or the monthly premenstrual depression that many women experience could increase vulnerability to depressive disorders o Traditional sex roles and culture - Most people who suffer depressive episodes never seek treatment o Depression tends to dissipate with time o Lasts an average of 5-10 months when untreated  Half of all cases of depression will never recur  Recovery with recurrence and becomes shorter every time this cycle continues  10% of people who have a major depressive episode will not recover and will remain chronically depressed - Manic episodes, though less common, are far more likely to recur o Fewer than 1% of population experience mania, but more than 90% who do have a recurrence Casual Factors in Mood Disorders Biological Factors - Both genetic and neurochemical factors have been linked to depression - Identical twins have a concordance rate of 67% for experiencing clinical depression, compared with a rate of only 15% for fraternal twins - Biological relatives were found to be 8 times more likely than adoptive relatives to also suffer from depression - What is likely inherited is a predisposition to develop a depressive disorder, given certain kinds of environmental factors such as significant losses and low social support - The behavioral inhibition system (neuroticism) and the behavioural activation system (extraversion) are heavily involved in the development of mood disorders o Behavioural activation system (BAS) is reward-oriented and activated by cues that predict future pleasure, whereas the behavioural inhibition system (BIS) is pain- avoidant and generates fear and anxiety  Depression is predict by high BIS sensitivity and low BAS activity  Mania is linked to BAS and scores on the personality variable of extraversion (tied heavily to the BAS) predicts the future development of bipolar mania  Cues connoting potential reward, achievement gratification, and goal attainment triggers BAS activation, leading to the manic person’s elevated positive emotions and expectations, high activity level, and self-confidence  With clear failure, BAS deactivation can cause a flip-flop into feelings of depression - One influential theory holds that depression is a disorder of motivation caused by under- activity in a family of neurotransmitter that include norepinephrine, dopamine, and serotonin, which are involved in BAS - Several highly effective antidepressant drugs operate by increasing the activity of these neurotransmitter, thereby further stimulating the neural systems that underlie positive mood and goal-directed behaviour o Proven in Lescia Tremblay’s experiment and supports the hypothesis of “pleasure deficit” o Ian Gotlib’s experiment showed that people with depression showed no neural activity when showed a sad or happy scene -> accounting for the “emptiness” - Stronger genetic basis than unipolar depression - Women who suffer from postpartum depression can lose the capacity to experience pleasure while interacting with their babies - The chance of developing bipolar disorder is just below 1% o 50% of patients with bipolar disorder have a parent, grandparent, or child with this disorder o 5 times higher in identical twins than fraternal twins, suggesting genetic link - Manic disorders may stem from an overproduction of the same neurotransmitters that are underactive in depression o Lithium chloride, the drug most frequently used to calm manic disorders, works by decreasing the activity of these transmitters in the brain’s motivational/pleasure activation system Psychological Factors - Early traumatic losses or rejections create vulnerability for later depression by triggering a grieving and rage process that becomes part of the individual’s personality - Subsequent losses and rejection reactivate the original loss and cause a reaction not only to the current event, but also the unresolved loss from the past - Brown and Harrison interviewed women and found that those who experience another severe recent loss was almost 3 times higher than the rate of depression among women who only experience one loss. - This generation’s overemphasis on individuality and person control brought about depression o Define their self-worth in terms of individual attainment and have lesser commitment to traditional values of family, religion, and the common good, they are likely to react much more strong to failure to view negative events, as reflection their own inadequacies, and to experience a sense of meaninglessness in their lives - According to Aaron Beck, depressed people victimize themselves through their own beliefs that they are defective, worthless, and inadequate -> leading up to pessimism Depressive cognitive triad – of negative thoughts concerning (1) the world, (2) oneself, and (3) the future seems to pop into consciousness automatically, and many depressed people report that they cannot control or suppress the negative thoughts - Depressed people recall most of their failures and focus more on perceived inadequacies o A perceptual and memory sensitivity to the negative and more likely to distort memories of negative events Depressive attribution pattern (Beck) – Interpreting successes or other positive events as being due to factors outside the self, while attributing negative outcomes to personal factors o Low self-esteem predicted later depressive episodes Learned helplessness theory – holds that depression occurs when people expect that bad events will occur and that there is nothing they can do to prevent or cope with them o Chronic and intense depression occurs as the result of negative attributions for failure that are person, stable, and global - Lauren Alloy’s experiment found that cognition involving autonomy (a focus on individualistic achievement and self-sufficiency), high performance standards, and a tendency toward self-criticism when goals are not obtained -> predicted not only bipolar group membership but also the occurs of future hypomanic episodes - Peter Lewinsohn believe that depression is usually triggered by a loss, some other punishing event, or by a drastic decrease in the amount of positive reinforcement that the person receives from the environment o People stop performing behaviour that previous provided reinforcement (hobbies and socializing) o Generate additional negative life events through negative moods, pessimism, and reduced functioning o Make those who come in contact with them feel anxious, depressed, and hostile o Longitudinal studies show that reductions in social support are a good predictor of subsequent depression o Environmental factors may explain why depression tends to run in families, depressed parents often experience poor parenting and many stressful experiences as they grow up -> fail to develop good coping skills and positive self-concept  Children of depressed parents exhibit a significantly higher incidence of depression and other disorders as adolescents and young adults Sociocultural Factors - Prevalence, symptom pattern, and causes of depression reflect cultural variation - Western nations have higher prevalence of depression because in Hong Kong and Taiwan , connections to family and other groups help to reduce the negative impact of loss and disappointments and provide strong social support when they occur - Feelings of guilt and personal inadequacy seem to predominate in North American and western European countries, whereas somatic symptoms of fatigue, loss of appetite, and sleep difficulties are more often reported in Latin, Chinese, and African cultures - Sex difference in developing depression is not found in developing countries - Manipulation and a desire to escape distress are the two major motives for suicide. The risk of suicide increases in the person depressed and has a lethal plan and a past history of parasuicide Somatoform Disorders – involve physical complaints or disabilities that suggest a medical problem, but which have no known biological cause and are produced voluntarily by the person Hypochondriasis – people become unduly alarmed about any physical symptom they detect and are convinced that they have or are about to have a serious illness Pain disorder – experience intense pain that either is out of proportion to whatever medical condition they have or for which no physical basis can be found - Somatoform disorders differ from psychophysiological disorders, in which psychological factors cause or contribute to a real medical condition, such as ulcer, asthma, hypertension (chronic high blood pressure), or a cardiac problem o In peptic ulcers, a stress-produced outpouring of peptic acid into the stomach produces an actual lesion in the stomach wall. The resulting pain is therefore caused by the actual physical damage. In a somatoform disorder, no physical basis for the pain would be found Conversion disorder – serious neurological symptoms, such as paralysis, loss of sensation, blindness suddenly occur o Electrophysiological recordings and brain imaging indicate that sensory and motor pathways in the brain are intact o Often exhibit la belle indifference, a strange lack of concern about their symptom and its implications  In some cases, physiologically impossible such as “glove anaesthesia” in which a person loses all sensation below the wrist -> the hand is served by nerves that also provide sensory input above the hand, making it impossible o Relatively rare, occurrence is 3 in 1,000 North Americans during peacetime, but such disorders occur more frequently under wartime conditions o “Psychogenic blindness” is quite rare, there are Cambodian refugees who escaped their country and settled in Long Beach. These are survivors of the “killing fields” and were subjected to unspeakable horror. More than 150 of them are functionally blind, even though their eyes appear intact and electrophysiological monitoring shows that visual stimuli “register” in their visual cortex  Occurred suddenly after witnessing traumatic scenes of murder  To Freud, such symptoms were a symbolic expression of an underlying conflict that aroused so much anxiety that the ego kept the conflict in the unconscious by converting the anxiety into a physical symptom that in some way symbolized the conflict - A predisposition to somatoform disorders may involve a combination of biological and psychological vulnerabilities - Tends to run in families -> not clear about genetic and environmental factors - People may experience internal sensations more vividly than others or may focus more attention on them o Results in a person being self-absorbed in their own body sensations, it could set the stage for increased apprehension about the body - Somatoform patients are also very suggestible - Incidence of this tends to be much higher in cultures that discourage open discussion of emotions of that stigmatize psychological disorders o In this setting, somatic symptoms may be the only acceptable outlet for emotional distress o Some may be so emotionally constricted, they cannot acknowledge their emotions of verbally communicate them to others Dissociative Disorders – involve a breakdown of this normal integration, resulting in significant alterations in memory or identity. Three forms that such disorders can take are; Psychogenic amnesia – a person response to a stressful event with extensive but selective memory loss Psychogenic fugue – a more profound dissociative disorder in which a person loses all sense of personal identity gives up their customary life, wanders to a new faraway location, and establishes a new identity - Triggered by a highly stressful event or trauma, and it may last from a few hours or days to several years o Some adolescent runaways are found to be in fugue state - Fugue ends when the person suddenly recovers their original identity and wakes up mystified and distressed at being in a strange place. Dissociative identity disorder (DID) – formerly, multiple personality disorder, is the most striking and widely publicized; it is also the most controversial - A primary, or host personality appears more often than the others (alters), but each personality has its own integrated set of memories and behaviours o They may or may not know the existence of the others o Differs in age and gender, and personality can differ mentally, behaviorally, and physiologically What Causes Dissociative Identity Disorder? According to Frank Putman’s trauma-dissociation theory, the development of new personalities occur in response to severe stress - Beings in early childhood, in response to physical or sexual abuse -> occur during the time childhood identity is not well established. - Putman believes that in response to the trauma and their helplessness to resist it, children may engage in something akin to self-hypnosis and dissociate from reality - Create an alternate identity to transfer what is happening to someone else who can handle it, and to blunt the pain - Over time, the protective functions served by the new personality remain separate in the form of an alternate personality rather than being integrated into the host personality. Schizophrenia – is a psychotic disorder that involves severe disturbances n thinking, speech, perception, emotion, and behaviour - Bleuler intended to suggest that certain psychological functions such as thought, language, and emotion, which are joined together in normal people, are somehow split apart or disconnected in schizophrenia - Misinterprets reality and exhibits disordered attention, thought, or perception. In addition, withdrawal from social interaction is common, communication is strange or inappropriate, personal grooming may be neglected and behaviour may become disorganized Delusions – false beliefs that are sustained in the face of evidence that normally would be sufficient to destroy them o Delusion of persecution and delusion of grandeur Hallucinations – false perceptions that have a compelling sense of reality o Primarily auditory hallucination Blunted affect – manifesting less sadness, joy, and anger than most people Flat affect – showing almost no emotion at all, voice is monotonous, and face impassive Subtypes of Schizophrenia - Paranoid Type – Delusions of persecution, in which people believe that others mean to harm them, and delusions of grandeur, in which they believe they are enormously important. Suspicion, anxiety, or anger may accompany the delusions, and hallucinations may also occur in this subtype - Disorganized type – Primarily confusion and incoherence, together with severe deterioration of adaptive behaviour. Thought disorganization often is so extreme that it is difficult to communicate with them. Their behaviour often appears silly and childlike, and their emotional responses are highly inappropriate. These people are usually unable to function on their own. - Catatonic type – Shows striking motor disturbances, ranging from muscular rigidity to random or repetitive movements. Sometimes alternate between stuporous states in which they seem oblivious to reality and agitated excitement during which they can be dangerous to others. While in a stuporous state, they may exhibit a waxy flexibility in which their limbs can be moulded by another person into grotesque positions that they will then maintain for hours. - Undifferentiated type – for people who exhibit some of the symptoms and thought disorders of the above but do not
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