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Abnormal Psychology
OUTLINE OF RESOURCES
I. Introducing Abnormal Psychology
Introductory Exercise: Fact or Falsehood? (p. 4) Lecture/Discussion Topic: Using Case Studies to
Teach Psychological Disorders (p. 4) Student Project: Diagnosing a “Star” (p. 4) Feature Films
and TV: Introducing Psychological Disorders (p. 4)
II. Perspectives on Psychological Disorders
A. Defining Psychological Disorders
Classroom Exercises: Introducing Psychological Disorders (p. 5)
Defining Psychological Disorder (p. 5) Student Project: Encounters with a
“Mentally Ill” Person (p. 6) Student Projects/Classroom Exercises: Adult ADHD Screening Test (p.
6)
Normality and the Sexes (p. 7) Psychology
Video Tool Kit: ADHD and the Family*
B. Understanding Psychological Disorders
Lecture/Discussion Topics: Tourette Syndrome (p. 7)
Culture Bound Disorders (p. 8) Classroom Exercise: Multiple Causation
(p. 8) Video: Scientific American Frontiers, 2nd ed., Segment 33: Cop Psychiatrists*
C. Classifying Psychological Disorders
PsychSim 5: Mystery Client (p. 9) (or might be used after the unit has been read)
D. Labeling Psychological Disorders
Classroom Exercise: The Effects of Labeling (p. 9) Lecture/Discussion Topic: Mental Health as
Flourishing (p. 9) Psychology Video Tool Kit: Postpartum Psychosis:The Case of Andrea Yates*
III. Anxiety Disorders
Classroom Exercise: Penn State Worry Questionnaire (p. 10) Video: Psychology: The Human
Experience, Module 37: Three Anxiety Disorders* ActivePsych: Digital Media Archive, 2nd ed.:
Experiencing Anxiety*
*Video, ActivePsych, and Psychology Video Tool Kit titles followed by an asterisk are not repeated within
the core resource unit. They are listed, with running times, in the Preface of these resources and
described in detail in their Faculty Guides, which are available at www.worthpublishers.com/mediaroom.
A. Generalized Anxiety Disorder
Classroom Exercises: Taylor Manifest Anxiety Scale (p. 10) The Posttraumatic Cognitions
Inventory (PTCI) (p. 11)
B. Panic Disorder
C. Phobias
Lecture/Discussion Topic: Discovery
Health Channel Phobia Study (p. 11)
Classroom Exercises: Fear Survey (p.
12) Social Phobia (p. 12) Video:
Scientific American Frontiers, 2nd ed.,
Segment 32: Arachnophobia*
D. Obsessive Compulsive Disorder
Lecture/Discussion Topic: Obsessive Thoughts (p. 14) Classroom Exercise: Obsessive
Compulsive Disorder (p. 13) Feature Film: As Good As It Gets and OCD (p. 13) Video:
Psychology: The Human Experience, Module 36: Obsessive Compulsive Disorder* Psychology
Video Tool Kit: Obessive Compulsive Disorder: A Young Mother’s Struggle*
Those Who Hoard*
E. Post Traumatic Stress Disorder
Lecture/Discussion Topic: Concentration Camp
Survival (p. 15) Psychology Video Tool Kit: Post
Traumatic Stress Disorder: A Vietnam Combat
Veteran* PTSD: Returning from Iraq*
F. Understanding Anxiety Disorders
Psychology Video Tool Kit: Fear, PTSD, and the Brain*
IV. Somatoform Disorders
Lecture/Discussion Topic: Factitious Disorder (p. 15) Psychology Video Tool Kit: Beyond
Perfection: Female Body Dysmorphic Disorder*
V. Dissociative Disorders
Classroom Exercise: The Curious Experiences Inventory (p. 16) Lecture/Discussion Topic:
Psychogenic Versus Organic Amnesia (p. 16)
A. Dissociative Identity Disorder
Lecture/Discussion Topic: The Dissociative Disorders Interview Schedule and Dissociative
Identity Disorder
(p. 17)
Videos: The Brain, 2nd ed., Module 23: Multiple Personality* Digital Media Archive: Psychology,
1st ed., Video Clip 31: Multiple Personality Disorder*
B. Understanding Dissociative Identity Disorder
VI. Mood Disorders
A. Major Depressive Disorder
Classroom Exercises: Depression Scales (p. 17) The Automatic Thoughts Questionnaire (p. 18)
Depression and Memory (p. 18) Loneliness (p. 18)
Video: Psychology: The Human Experience, Module 38: Mood Disorders: Major Depression and Bipolar
Disorder* Psychology Video Tool Kit: Depression*
B. Bipolar Disorder
Lecture/Discussion Topic: Bipolar Disorder (p. 19) Video: The Mind, 2nd ed., Module 31: Mood
Disorders: Mania and Depression*
C. Understanding Mood Disorders
Lecture/Discussion Topics: The Sadder but Wiser Effect (p. 20) Cognitive Errors in Depression
(p. 21) Commitment to the Common Good (p. 25)
Classroom Exercises: Attributions for an Overdrawn Checking Account (p. 21) The Body
Investment Scale and Self Mutilation (p. 22) Understanding Suicide (p. 23)
The Expanded Revised Facts on Suicide Quiz (p. 24)
Videos: The Mind, 2nd ed., Module 32: Mood Disorders: Hereditary
Factors* Digital Media Archive: Psychology, 1st ed., Video Clip 33:
Mood Disorders* Psychology Video Tool Kit: Suicide: Case of the
“3 Star” Chef*
VII. Schizophrenia
A. Symptoms of Schizophrenia
Classroom Exercise: Magical Ideation Scale (p. 26) Lecture/Discussion Topic: Infantile Autism (p.
26) Student Project: The Eden Express and Schizophrenia (p. 26) Videos: The Brain, 2nd ed.,
Module 26: Schizophrenia: Symptoms*
Psychology: The Human Experience, Module 39: Schizophrenia*
The Brain, 2nd ed., Module 29: Autism* PsychSim 5: Losing Touch With Reality (p. 26)
ActivePsych: Digital Media Archive, 2nd ed.: Schizophrenia: New Definitions, New Therapies*
Overcoming Schizophrenia: John Nash’s Beautiful
Mind* Psychology Video Tool Kit: John Nash: “A Beautiful Mind”*
B. Onset and Development of Schizophrenia
C. Understanding Schizophrenia
Videos: The Brain, 2nd ed., Module 27: Schizophrenia: Etiology* Digital Media Archive:
Psychology, 1st ed., Video Clip 29: The Schizophrenic Brain*
VIII. Personality Disorders
Lecture/Discussion Topic: Narcissistic Personality Disorder (p. 27) Classroom Exercise:
Schizotypal Personality Questionnaire (p. 28) Psychology Video Tool Kit: Trichotillomania: Pulling
Out One’s Hair*
A. Antisocial Personality Disorder
Classroom Exercise: Antisocial Personality Disorder (p. 28) Feature Film: In Cold Blood (p. 29)
B. Understanding Antisocial Personality Disorder
Videos: The Mind, 2nd ed., Module 35: The Mind of the Psychopath* Digital Media Archive:
Psychology, 1st ed., Video Clip 30: The Mind of the Psychopath*
IX. Rates of Psychological Disorders
Lecture/Discussion Topic: The Commonality of Psychological Disorders (p. 29)
UNIT OUTLINE
I. Introducing Abnormal Psychology
(pp. 561–562)
Introductory Exercise: Fact or Falsehood?
The correct answers to Handout 12–1, as shown below, can be confirmed on the listed text pages.
1
2
3
4
5
F (p. 562) 6. F (p. 578)
F (p. 568) 7. T (p. 583)
F (p. 568) 8. T (p. 584)
T (p. 569) 9. T (pp. 594–595)
T (p. 575) 10. T (p. 599)
Lecture/Discussion Topic: Using Case Studies to Teach Psychological Disorders
You can effectively teach psychological disorders using a case study approach. Beyond those presented
in the text, Robert L. Spitzer’s DSM IV TR Case Book pro vides an extremely useful resource for
examples of all the major disorders. Each case is brief and is followed by a discussion of the DSM IV TR
diagnostic issues raised. You can use them to introduce each major cate gory of disorder. Alternatively,
after students have read the text, the cases can be presented as puzzles to solve, either to your class as
a whole or in small groups.
Spitzer, R. L. (Ed). (2002). DSM IV TR casebook: A learning companion to the Diagnostic and Statistical
Manual of Mental Disorders (4e). Arlington, VA: American Psychiatric Publishing.
Feature Films and TV: Introducing Psychological Disorders
Psychological disorders are frequently depicted in nov els, short stories, television programs, and popular
films. Amy Badura recommends several specific movie clips for introducing and stimulating student
interest in the topic. All are very brief and illustrate different class es of disorders.
Before showing the clips you might ask students to watch with the following questions in mind: Where
should we draw the line between normality and abnor mality? How should we define psychological
disorders? How should we understand disorders—as sicknesses that need to be diagnosed and cured or
as natural responses to a troubling environment? After showing the clips and eliciting student responses,
highlight the text definition. Many mental health workers label behavior as disordered when they judge it
to be deviant, distressful, and dysfunctional. You may also want to identify the specific disorders
illustrated by the clips or wait until you discuss each disorder more fully. Here are the films, scenes,
specific disorders, and running times (from appearance of the production company’s full name to the start
of the clip):
1
Con Air: voice over introduction to John Malkovich’s character as he enters the airplane:
antisocial personality disorder (0:15:16–0:15:57)
2
The English Patient: Juliette Binoche rides in a car avan with her patient, her best friend’s jeep
hits a landmine, her reaction: acute stress disorder (0:10:45– 0:14:52)
3
As Good As It Gets: Jack Nicholson visits Greg Kinnear’s apartment and finds him upset: major
depressive disorder (0:58:14–1:00:41) (See also later discussion of use of this film.)
4
Primal Fear: Jailhouse interview in which Ed Norton displays personality switch for his attorney:
dissociative identity disorder (1:12:00–1:15:41)
5
Copy Cat: Sigourney Weaver retrieves a newspaper from her apartment hallway: panic disorder
with agoraphobia (0:19:11–0:20:39)
Television programs also provide a ready source of material for classroom presentation and student proj
ects. You might have your students (individually or in small groups) identify examples from popular TV
shows. For example, the popular, Emmy winning come dy Monk provided a good example of OCD (all
seasons are available on DVD).
For more on the use of contemporary film in teach ing psychological disorders, see Danny Wedding, Mary
Ann Boyd, and Ryan Niemiec’s Movies and Mental Illness: Using Films to Understand Psychopathology
2nd ed. (2005, Hogrefe).
Recently, Wedding, Boyd, and Niemiec also authored a 75 page resource guide titled Films Illustrating
Psychopathology. The guide provides brief descriptions of hundreds of films that can be used to illustrate
various psychological disorders. The films (each rated on a 5 point scale) are classified according to
major category (e.g., anxiety disorders, mood disor ders, substance use disorders). This very helpful
guide can be found at the Office of Teaching Resources in Psychology (sponsored by the Society for the
Teaching of Psychology). See http://teachpsych.org/otrp/ resources/dw08film.pdf
Badura, A. S. (2002). Capturing students’ attention: Movie clips set the stage for learning in abnormal psy
chology. Teaching of Psychology, 29, 58–60.
Student Project: Diagnosing a “Star”
W. Brad Johnson describes a well received student proj ect that he has used for his abnormal psychology
course; it can readily be adapted to the introductory course either as an individual or small group project.
It provides an excellent opportunity for students “to think like a psychologist” in applying this unit’s subject
mat ter. The assignment is for students to select any “star” or famous person (a musician, movie star,
politician, historical figure, or criminal) whom they believe has a clinical disorder. Students should prepare
an oral or written report on that person, including the identifica tion of symptoms that reflect one of the
specific disor ders covered in the text and some discussion of possible causes and treatment
recommendations. Encourage stu dents to use magazines, books, Internet sites, and even television
interviews for making their case. It is impor tant that their report be consistent with existing evi dence
about the person’s behavior and symptoms.
Johnson, W. B. (2004). Diagnosing the stars: A technique for teaching diagnosis in abnormal psychology. Teaching
of Psychology, 31, 275–277.
II. Perspectives on Psychological Disorders
(pp. 562–568)
A. Defining Psychological Disorders (pp. 562–563)
Classroom Exercise: Introducing Psychological Disorders
Steven M. Davis provides an effective exercise for introducing psychological disorders. Davis notes that,
although the concept of “mental” or psychological dis order is familiar to students, their beliefs about what
constitutes a disorder are unexamined and may even be contradictory. Handout 12–2 (which Davis
reports adapting from a similar exercise designed by John Suler) challenges students to define
psychological dis order as well as confront any inconsistencies in their beliefs. The handout also serves to
raise important polit ical, cultural, and social issues concerning the defini tion of psychological disorders.
Before students have read the text definition of psychological disorder, have them read through the
case studies quickly and decide whether the person has a “psychological disorder.” Then organize
students into groups of four or five, and instruct each group to pre tend that they are a committee that is
advising the American Psychiatric Association on the writing of the DSM V. They are to decide whether
each case should be included as a psychological disorder in the DSM V. They are to try to reach
agreement and, most important ly, to keep track of the criteria they use for including or excluding each
case.
After about 25 minutes, reconvene the entire class and consider each case in turn. Write on the
chalkboard the criteria that each group identified for including or excluding each case. Note consistencies
as well as con tradictions between the small groups. Finally, introduce the text definition of psychological
disorder.
Davis notes that this activity provides numerous learning opportunities for students. For example, stu
dents are often surprised to discover inconsistencies in how they define psychological disorders and are
also surprised at the arbitrariness inherent in any “official” definition. Sometimes, students discover that
they want to exclude all cases that have a clear biological etiology as well as all cases that have a clear
environmental ori gin—which theoretically leaves very few examples of psychological disorders. Issues
surrounding stigma, labeling, the medical model, cultural relativism, and person environment fit are also
likely to arise.
Davis, S. M. (2003, January). Utilizing contradictions in students’ implicit definitions of “mental disorder” in an
introductory psychology course. Poster presented at the 25th Annual National Institute on the Teaching of
Psychology, St. Petersburg, FL, January 2003.
Classroom Exercise: Defining Psychological Disorder
As a simple alternative to the previous exercise, have students form small groups of four or five and come
up with a definition for “psychological disorder.” Instruct them to be specific, identifying the criteria they
would apply in drawing the line between normality and abnor mality. After 20 to 30 minutes, have each
group report its definition to the class. Inadequacies are certain to be pointed out, and the rest of the
session can be spent in considering the difficulty of satisfactorily defining the term. The text. indicates that
behavior is considered disordered when it is deviant, distressful, and dysfunctional.
In highlighting each of these criteria, Larry Bates makes some important observations. First, what is con
sidered deviant depends on the context or cultural set ting. For example, should someone speak in an
unfamil iar language while standing, dancing, and finally faint ing in front of class, the behavior might be
considered deviant (Bates suggests that should it occur in his class, he would probably call an
ambulance!). Yet for some religious groups, such behavior is considered normal, even laudatory.
In some cases, deviance may be extremely difficult to detect. Some people seem fine on the outside—
smil ing, joking, performing their work well each day, and putting their kids to bed every night. Unknown to
us, however, they may cry themselves to sleep because they no longer find life enjoyable or meaningful.
When they engage in the activities that once brought pleasure, they feel nothing. In such cases, internal
distress more clear ly characterizes the psychological disorder.
Finally, almost all disorders have a threshold they must cross that meets the requirements of a
psychologi cal disorder. If a person is terrified of flying but has no real reason to fly, the fear is probably
not considered a psychological disorder. Only when this fear interferes with the person’s daily life—for
example, if he or she is promoted to regional manager and must travel—is it considered dysfunctional
and thus a psychological disorder.
Bates, L. (2007, January 3). Abnormal/atypical. Message posted to PSYCHTEACHER@ list.kennesaw.edu.
Student Project: Encounters with a “Mentally Ill” Person
Irwin and Barbara Sarason suggest an exercise you might use to introduce the topic of psychological
disor ders. As compared with 30 years ago, when most chron ic mental patients were institutionalized, it is
now much more likely that students will have encountered a person with a chronic mental disorder in the
supermarket, at the shopping mall, on the bus, or on the street corner. Ask your students to recall one
incident in which they have personally encountered a chronic “mentally ill” person. Ask them to reflect on
what happened, then write down the details of that encounter. What made them decide the person was
mentally ill? Also ask them to indicate whether they felt comfortable or uncomfort able, whether the
person’s behavior seemed predictable or unpredictable, and whether the person seemed dan gerous or
nondangerous.
It may also be worth asking where the encounter occurred, whether other people were present, and
whether the mentally disordered person actually approached or spoke to them. Collect the accounts and
tabulate the number of students who found the encoun ters to be uncomfortable, unpredictable, and
dangerous. As the Sarasons note, research on public attitudes has shown that most people feel
uncomfortable with the mentally ill and find their behavior to be both unpre dictable and dangerous. Did
the students react that way? Did they observe similar reactions in others? If not, how might the setting,
the presence or absence of other people, and the actions of the psychologically disor dered person
change one or more of their reactions?
Use the students’ descriptions to define “psycho logical disorder.” The students’ examples will
illustrate how behavior is considered psychologically disordered when it is deviant, distressful, and
dysfunctional.
Sarason, I., & Sarason, B. (2005). Abnormal psychology (11th ed.). Upper Saddle River, NJ: Prentice Hall.
Student Project/Classroom Exercise: Adult ADHD Screening Test
Handout 12–3, designed by the World Health Organization, can be used to help respondents recognize
the signs of adult attention deficit hyperactivity disor der (ADHD) (see the Thinking Critically box for a
good introduction to the disorder). The questionnaire is not meant to replace consultation with a trained
profession al—obviously, an accurate diagnosis can be made only through clinical evaluation—but
respondents who checked “sometimes,” “often,” or “very often” four or more times may want to talk with a
psychologist about being evaluated for ADHD.
Researchers estimate that as many as 4 to 5 percent of U.S. adults have ADHD, but perhaps only 20
percent of them are aware of it. Although ADHD was once con sidered to be only a childhood disorder
that was out grown, researchers now believe that between 35 and 60 percent of children with ADHD
continue having symp toms in adulthood. Some people who did not have symptoms as children in school
do have difficulty mul titasking in adulthood. Furthermore, because awareness of the disorder is relatively
recent, some adults now in their thirties and forties may have had the disorder as children but their
symptoms were not recognized.
ADHD tends to run in families. Psychiatrist Lenard Adler of New York University suggests that if a child is
diagnosed with ADHD, there is a 40 percent chance that one parent has it as well. Factors such as
exposure to alcohol and tobacco in pregnancy are also linked with the condition. Although boys are more
likely than girls to be diagnosed with the disorder, adult ADHD affects men and women equally. Some
hypothesize that girls are less likely to be disruptive in the classroom, and thus teachers may be more
likely to overlook it.
Adults with the disorder are easily distracted, fre quently forget appointments, and constantly lose things.
They may fidget, talk excessively, and feel an internal restlessness. Other symptoms include a failure to
follow through on instructions or finish a task, difficulty organizing, and an inability to attend to details.
“One of the tell tale signs is when someone has a hard time stay ing in the conversation with you without
interrupting,” states Carol Gignoux, a Boston based executive coach who specializes in working with
people who have ADHD.
Adults with ADHD sometimes become worka holics, using deadlines as the motivation to complete
complex projects. The structure and routine of work becomes easier to deal with than their free time.
However, ADHD can interfere with job performance as well as with interpersonal relationships. Those with
the disorder are more likely to divorce, engage in substance abuse, and have more driving accidents.
They are also more likely to suffer other psychological disorders, including depression.
As the text indicates, ADHD raises fundamental questions about the nature and definition of
psychologi cal disorder. Like most disorders, attention disorder has a “spectrum diagnosis” with widely
varying symptoms. Is the problem with attention really disabling or within the parameters of being normal?
“Where does the disor der begin?” asks Russell Barkley at the Medical University of South Carolina. “It
begins where impair ment begins. You may have a high degree of ADD symptoms, but it just means you
have a sparkling per sonality because there is no impairment.”
The U.S. Food and Drug Administration (FDA) has approved adult use of drugs such as Adderall, a
stimu lant similar to Ritalin, which is widely prescribed to children diagnosed with the condition. The FDA
has also approved Straterra, the first nonstimulant medica tion for adults with the disorder. The success
rate for treatment is considered very good, especially when cou pled with coaching that provides
organizing strategies.
Rubin, R. (2003, December 3). ADHD focuses on adults. USA Today, pp. 1D–2D.
Szegedy Maszak, M. (2004, April 26). Driven to distrac tion. U.S. News & World Report, 53–62.
Weaver, J. (2004, September 9). Are you an adult with ADHD? Message posted at http://msnbc.msc.com/
id/5889089.
Student Project/Classroom Exercise: Normality and the Sexes
In 1970, Inge Broverman and her associates found that mental health professionals (psychiatrists,
psycholo gists, and social workers) viewed the mature, healthy male differently from the mature, healthy
female. For example, the healthy male was more likely to be viewed as ambitious, adventurous, self
confident, logical, and independent, while the healthy female was viewed as tactful, aware of others’
feelings, gentle, expressive of tender feelings, and in need of security. The researchers further found that
the characteristics they linked to a healthy adult person more closely resembled those of the healthy male
than those of the healthy female.
As either a student project or a classroom exercise, have both male and female students complete
Handout 12–4. Collect and tabulate the data. (Items, 1, 3, 6, 7, and 9 were more likely to be attributed to
the healthy male in Broverman’s study; items 2, 4, 5, 8, and 10, to the healthy female.)
Discuss the results in class. Do the earlier results still hold for students in the 2000s? Has sensitivity
to the problem of sexism eliminated the double standard for normality, or does it still exist? Is the view of
a healthy adult person still closer to the male than to the female ideal? If so, what does it mean for women
who are taught that by being normal, competent people, they are not normal?
In fairness to mental health professionals, we should note that research suggests that they evaluate
and treat men and women similarly. Sex role stereo types may have weakened, or they may become
irrele vant when clinicians are confronted with a particular individual.
Broverman, I. K., Broverman, D. M., Clarkson, R. E., Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex role
stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7.
B. Understanding Psychological Disorders
(pp. 564–565)
Lecture/Discussion Topic: Tourette Syndrome
A discussion of Tourette syndrome may give students a clearer picture of the different perspectives on
psycho logical disorders. Symptoms of this unusual disorder include involuntary twitching—facial
grimacing, head jerking, finger snapping, whirling, hopping—and the making of unusual sounds—hooting,
barking, screech ing, grunting, even cursing uncontrollably. It is estimat ed that about 100,000 Americans
suffer from the more severe symptoms of Tourette syndrome and that 3 mil lion others may have a milder
form of the disorder. The first symptom may appear by age 7 and can be as insignificant as repeated eye
blinking or clearing of the throat. In a few instances, the person may simply echo another’s words. The
movements and words seem to have no purpose or meaning. Although victims are unable to overcome
the symptoms, many can temporari ly suppress them, sometimes for hours.
Tourette syndrome was originally thought to be the work of the devil. Exorcism was the only cure.
Psychoanalytic theorists have provided a variety of explanations for the disorder—from a defense against
thumb sucking to repressed aggression. It has now become clear that Tourette syndrome has physical
causes. Many believe the disorder is hereditary. The most conclusive evidence comes from a study of
Mennonite farmers in Alberta, Canada, in which 54 of the 136 family members have the syndrome or at
least some of the minor symptoms, such as facial twitches and humming. A dominant gene has been
implicated, although Tourette’s symptoms do not appear in every one who inherits it. Virtually all males
who have the gene show at least minor symptoms, but only two thirds of the females do. Moreover,
females who display its symptoms tend to show more obsessive compulsive traits, for example, touching
every lightpost on the street. Both dopamine, which helps control movement, and norepinephrine, which
helps the body respond to stress, seem to be involved in Tourette syndrome. A sat isfactory treatment
has yet to be found. The antipsy chotic haloperidol is effective in about three quarters of all cases but
often with adverse side effects, including depression and, paradoxically, violent muscle spasms. Another
antipsychotic medication, risperidone, and the blood pressure medication clonidine also significantly
reduce tics. Side effects include weight gain, fatigue, and dry mouth.
Most researchers have not found behavioral inter vention to be effective in the treatment of Tourette
syn drome. For example, 55 percent of medical profession als believe that the tics cannot be controlled,
and 77 percent believe that if they are suppressed, they will become even worse later. Recently, Douglas
Woods and his research team have challenged those assumptions. Children between the ages of 8 and
11 were rewarded for every 10 second interval they did not exhibit a tic. The children significantly
suppressed their tics. They expressed a tic during 16 percent of the 10 second intervals that they were
rewarded as opposed to 50 per cent of the intervals at the beginning of the experiment. Another study
conducted by Raymond Miltenberger and his colleagues found no rebound effect for tic suppres sion in
five people with Tourette syndrome, ranging in age from 7 to 20. Both lines of research highlight the role
that environmental factors may play in the expres sion of Tourette.
Dingfelder, S. (2006). Nix the tics. Monitor on
Psychology, 37, 18.
Himle, M. B., & Woods, D. G. (2005). An experimental
evaluation of tic suppression and the tic rebound effect.
Behavior Research and Therapy, 43, 1443–1451.
Miltenberger, R.G. (2005). Habit Reversal. In A. Gross &
R. Drabman (Eds.), Encyclopedia of behavior modifica tion and cognitive behavior therapy, Vol.II (pp. 873 877).
Thousand Oaks, CA: Sage.
Seligman, M., Walker, E., & Rosenhan, D. L. (2001). Abnormal psychology (4th ed.). New York: Norton.
West, S. (1987, November/December). The devil’s disor der. Hippocrates, 66–71.
Woods, D. W., Walther, M. R., Bauer, C. C., Kemp, J. J., & Conelea. C. A. (2009). The development of stimulus
control over tics: A potential explanation for contextual ly based variability in the symptoms of Tourette syn
drome. Behavior Research and Therapy, 47, 41–47.
Classroom Exercise: Multiple Causation
As the text notes, today’s psychologists argue that all behavior arises from the interaction of nature and
nur ture. The biopsychosocial approach recognizes that psy chological disorders have multiple causes.
Clearly, we ought to resist the pervasive temptation to expect simple explanations.
Handout 12–5 is Gregory Kimble’s classroom exer cise to demonstrate the problems caused when
we use simple explanations. In brief, it asks students whether they can remember events in their lives that
were painful enough to bring on a mental breakdown. Most people can.
Give students 10 minutes or so to respond to the scenario in Handout 12–5. (If you want to give them
more time and thus obtain more detailed responses, make it a homework assignment.) Also ask students
to clearly indicate at the end of their response whether you may share it with the rest of the class.
Between class periods, review the responses and pick a few of the more poignant answers to share with
the entire class.
Kimble suggests that everyone has a traumatic experience that can cause psychological disorder but that
not everyone succumbs. Such single episodes do not qualify as causes of psychological disorders. Too
often, Kimble notes, we think that behavioral phenome na are single entities that have single causes. The
med ical model of psychopathology falls into this trap. It promotes the myth that disorders are single
maladies brought on by single causes such as a traumatic experi ence. Although this perspective might
be appropriate for certain medical conditions, it typically does not apply to psychological disorders, which
may be full blown or borderline and express an array of dispositions. Typically, psychological disorders
involve faulty knowl edge, inappropriate feelings, and disordered behavior. A single cause, suggests
Kimble, of such multiple and varied symptoms is unlikely.
Kimble, G. (1996, August). Secondary school psycholo gy: The challenge and the hope. Paper presented at the
104th Annual Convention of the American Psychological Association, Toronto.
Lecture/Discussion Topic: Culture Bound Disorders
The text indicates that evidence of environmental effects on psychological disorder comes from links
between culture and disorder. Although some disorders such as schizophrenia and depression are
worldwide, others are not. For example, anorexia nervosa and bulimia nervosa are disorders that occur
mostly in Western cultures. On the other hand, susto, marked by severe anxiety, restlessness, and a fear
of black magic is a disorder found only in Latin America. You can expand on this disorder as well as other
culture bound disorders in class.
Susto is most likely to occur in infants and young children. In addition to anxiety and restlessness, the dis
order is often marked by depression, loss of weight, weakness, and rapid heartbeat. Those within the
culture claim that the susto is caused by contact with supernat ural beings or with frightening strangers, or
even by bad air from cemeteries. Treatment involves rubbing certain plants and animals against the skin.
Latah occurs among uneducated middle aged or elderly women in Malaya. Unusual circumstances
(such as hearing someone say “snake” or even being tickled) produce a fear response that is
characterized by repeating the words and actions of other people, utter ing obscenities, and acting the
opposite of what other people ask.
Koro is a pattern of anxiety found in Southeast Asian men. It involves the intense fear that one’s penis
will withdraw into one’s abdomen, causing death. Tradition holds that koro is caused by an imbalance of
“yin” and “yang,” two natural forces thought to be the fundamental components of life. In one form of treat
ment, the individual keeps a firm hold on his penis (often with the assistance of family members) until the
fear subsides. Another is to clamp the penis to a wooden box.
Amok, a disorder found in the Philippines, Java, and certain parts of Africa. occurs more often in men
than in women. Those suffering the affliction jump around violently, yell loudly, and attack objects and
other people. These symptoms are often preceded by social withdrawal and a loss of contact with reality.
The outburst is often followed by depression, then amnesia regarding the symptomatic behavior. Within
the culture, it is thought that stress, shortage of sleep, alcohol con sumption, and extreme heat are the
primary causes.
Winigo, the intense fear of being turned into a can nibal by a supernatural monster, was once
common among Algonquin Indian hunters. Depression, lack of appetite, nausea, and sleeplessness were
common symp toms. This disorder could be brought on by coming back from a hunting expedition empty
handed. Ashamed of his failure, the hunter might fall victim to deep and lingering depression. Some
afflicted hunters actually did kill and eat members of their own households.
Comer, R. J. (2007). Abnormal psychology (6th ed.). New York: Worth.
C. Classifying Psychological Disorders
(pp. 565–567)
PsychSim 5: Mystery Client
This program is a review for those who have already read the text unit. The program includes six cases,
one for each of the major diagnostic (DSM IV) categories mentioned in the text. The student is to try to
guess the category from the description. The program randomly selects the order of cases but keeps
track of them within a session so that cases are not repeated.
D. Labeling Psychological Disorders (pp. 567–568)
Classroom Exercise: The Effects of Labeling
Once a diagnostic label is attached to someone, we come to see that person differently. Labels create
preconceptions that can bias our interpretations and memories. One result is that erroneous diagnoses
can sometimes be self confirming, because clinicians will search for evidence in a client’s life history
and hospital behavior that is consistent with the diagnosis. David Rosenhan, whose controversial
demonstration of the biasing power of diagnostic labels is reported in the text, gives the example of
one pseudopatient who told the interviewer that he
had a close relationship with his mother but was rather remote from his father during his early childhood. During
adolescence and beyond, however, his father became a close friend, while his relationship with his mother
cooled. His present relationship with his wife was characteristically close and warm. Apart from occasional angry
exchanges, friction was minimal. The children had rarely been spanked.
Knowing the person was diagnosed as having schizo phrenia, the clinician “explained” the problem in
the following manner.
This white 39 year old male . . . manifests a long history of considerable ambivalence in close relationships,
which begins in early childhood. A warm relationship with his mother cools during his adolescence. A distant
relation ship to his father is described as becoming very intense. Affective stability is absent. His attempts to
control emo tionality with his wife and children are punctuated by angry outbursts and, in the case of the children,
spank ings. And while he says that he has several good friends, one senses considerable ambivalence
embedded in those relationships also.
To show how readily we can explain people’s per sonalities in terms of an earlier sketch of their motives
and behavior, present the top half of Handout 12–6 to small groups in your class, and the bottom half to
the remaining groups. The sketch of Tom W. is adapted from a description prepared by Daniel Kahneman
and Amos Tversky. Ask each group to read its answers to the questions to the class. Regardless of which
outcome they have been given, the groups will have no difficulty identifying psychological indicators that
pointed to Tom’s present status.
Kahneman, D., & Tversky, A. (1973). On the psychology of predictions. Psychological Review, 80, 237–251.
Lecture/Discussion Topic: Mental Health as Flourishing
Corey L. M. Keyes argues that mental health is not merely the absence of mental illness but the presence
of human flourishing. The key clusters and associated dimensions of human flourishing include the
following:
Positive emotions (or emotional well being) Positive affect (regularly cheerful, interested in life, in
good spirits, happy, calm, peaceful, full of life)
Avowed quality of life (mostly or highly satisfied with life overall) Positive psychological functioning
(or psychological well being) Self acceptance (Holds positive attitudes toward self)
Personal growth (Seeks challenge, has insight into own potential, feels a sense of continued
development)
Purpose in life (Finds own life has direction and
meaning) Environmental mastery (Exercises ability to select, manage, and mold personal environs to
suit needs)
Autonomy (Is guided by own, socially accepted,
internal standards and values) Positive relations with others (Has, or can form, warm, trusting
interpersonal relationships)
Positive social functioning (or social well being) Social acceptance (Holds positive attitudes toward,
acknowledges, and is accepting of human differences)
Social actualization (Believes people, groups, and society have potential and can evolve or grow
positively)
Social contribution (Sees own daily activities val
ued by society and others) Social coherence (Interested in society and social life and finds them
meaningful and somewhat intelligible)
Social integration (A sense of belonging to, and support from, a community)
According to Keyes, to be diagnosed as flourishing in life, a person must exhibit high levels on at
least 1 of the 2 measures of emotional well being and high levels on at least 6 measures of the 11
measures of positive functioning. Interestingly, the prevalence of flourishing is about 20 percent of the
adult population. Keyes sug gests this low percentage highlights the need for a national program for
mental health promotion that com plements our long standing efforts to prevent and treat mental illness.
The benefits of flourishing to individuals and soci ety are reflected in research findings that indicate
that completely mentally healthy adults miss the fewest days of work; have the lowest risk of
cardiovascular disease, the lowest number of chronic physical diseases, and the fewest health limitations
on activities of daily living; and are the least likely to use health care services.
Keyes et al. (2005) Mental illness and/or mental health? Investigations axioms of the complete state model of
health. Journal of Consulting and Clinical Psychology, 73(3), Table 1, page 543. Copyright 2005 Adapted for
permission by the American Psychological Association.
III. Anxiety Disorders (pp. 569–576)
Classroom Exercise: Penn State Worry Questionnaire
Handout 12–7, the Penn State Worry Questionnaire (PSWQ) designed by T. J. Meyer and his colleagues,
provides a good introduction to the anxiety disorders. In scoring the scale, students should reverse their
responses to items 1, 3, 8, 10, and 11 (1 = 5, 2 = 4, 3 = 3, 4 = 2, 5 = 1), then add the numbers in front of
all 16 items. Total scores can range from 16 to 80, with higher scores reflecting a greater tendency to
worry. The mean score of 405 psychology students was 48.8 (mean for females = 51.2, for males, 46.1).
The authors note that generalized anxiety disorder is primarily defined by chronic worry, and the process
of worry is pervasive throughout all the anxiety disor ders. Thus, identifying the nature and functions of
worry should significantly contribute to our under standing of anxiety and its disorders. In research on the
scale, Meyer and his colleagues report that PSWQ scores were linked to lower self esteem but higher
levels of perfectionism, time urgency, and self handicapping. Worry as measured by the questionnaire
was also associated with more maladaptive levels of coping.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec,
T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and
Therapy, 28, 487–495.
A. Generalized Anxiety Disorder (p. 570)
Classroom Exercise: Taylor Manifest Anxiety Scale
Handout 12–8 is the Taylor Manifest Anxiety Scale, which attempts to assess level of anxiety. The
average score for college students is about 14 or 15 answers that match the “true” answers at the top of
the next page. If you have your students complete the scale, you might want to compare the average for
college students with that of your students. An answer of “true” indicates anxiety related to that item.
Learning theorists have explained the development of anxiety in terms of classical conditioning. Rats
given unpredictable shocks in the laboratory may become apprehensive whenever placed in the
laboratory envi ronment; they may develop more specific phobias if a given object or activity is associated
with shock. Researchers believe that a number of factors influence the conditioning process. Janet Taylor
Spence has focused on individual differences in emotional respon siveness. She asked five clinical
psychologists to judge which items from the Minnesota Multiphasic Person ality Inventory indicate chronic
anxiety. Those on which the psychologists agreed were put through an item analysis, and the 50
surviving items constitute the pres ent Manifest Anxiety Scale.
1. F 18. F 35. T
2. T 19. T 36. T
3. F 20. F 37. T
4. F 21. T 38. F
5. T 22. T 39. T
6. T 23. T 40. T
7. T 24. T 41. T
8. T 25. T 42. T
9. F 26. T 43. T
10. T 27. T 44. T
11. T 28. T 45. T
12. F 29. F 46. T
13. T 30. T 47. T
14. T 31. T 48. T
15. F 32. F 49. T
16. T 33. T 50. F
17. T 34. T
Psychoanalysts, of course, have a very different view of anxiety. Freud saw it as a product of
unresolved conflict that occurs when defense mechanisms are weak. Karen Horney, a neo Freudian,
argues that an inadequate self concept is the basis for anxiety. We presumably construct an ego ideal
that is designed to gain the unconditional approval of our parents. This ideal self is too rigid and
impossible to attain, so we consistently give ourselves a poor self evaluation. Self censure follows, which
is the worst form of anxiety for it is the most difficult both to escape and to satisfy.
Existential theorists have yet a different view of anxiety. They suggest that it is based in our growing
awareness that we exist and that we are responsible for the choices we make. The accompanying
realization of nonexistence, or death, is particularly important in understanding the roots of anxiety. Our
awareness of our inevitable death leads to deep concern over whether we are living a meaningful and
fulfilling life.
Napoli, V., Kilbride, J., & Tebbs, D. (1995). Adjustment and growth in a changing world (5th ed.). St. Paul, MN:
West Publishing.
Classroom Exercise: The Posttraumatic Cognitions Inventory (PTCI)
The Posttraumatic Cognitions Inventory (PTCI) designed by Edna B. Foa and her colleagues (Handout
12–9) may help students understand why some victims of traumatic experiences develop post traumatic
stress disorder (PTSD) while others do not. Completing and scoring the PTCI may also foster students’
appreciation for the cognitive perspective in explaining psychologi cal disorders.
The inventory asks respondents to report their thoughts after experiencing traumatic stress—that is,
experiencing or witnessing severely threatening, uncon trollable events with a sense of fear,
helplessness, or horror. If students report never having had such an experience, ask them to respond to
the items in terms of their most upsetting life experience. The scoring key follows the inventory and is part
of the handout.
Many theorists have argued that traumatic events can produce changes in victims’ thoughts and beliefs.
Those changes account for the development of PTSD. Specifically, Foa and her colleagues proposed two
basic dysfunctional cognitions that mediate the development of PTSD: the world is completely dangerous
and one’s self is totally incompetent. The researchers further sug gested that there may be two distinct
ways by which people acquire these dysfunctional cognitions. Those who enter the traumatic experience
with the idea that the world is extremely safe and that they are extremely competent have difficulty in
assimilating the experience and therefore overaccommodate their schemas about self and world. For
others, particularly those who have experienced upsetting experiences throughout their lives, the
traumatic experience primes existing schemas of the world as a dangerous place and oneself as incom
petent. In short, the existence of rigid concepts about self and the world (positive or negative) renders
people vulnerable to develop PTSD. Those who make finer dis tinctions about degrees of safety and
competence are better able to interpret the trauma as a unique experi ence that does not have general
implications for the nature of the world and the nature of their ability to cope with it.
As the scoring key indicates, factor analyses of the items reveal three separate factors. These include
nega tive cognitions about self, negative cognitions about the world, and self blame. Mean scores are
obtained for each subscale and can range from 1 to 7, with higher scores reflecting greater acceptance of
each factor. Items 13, 32, and 34 are experimental and thus are not included in the scoring. Foa and her
colleagues report that each scale predicts PTSD severity, depression, and general anxiety in traumatized
individuals. In fact, the ability of the PTCI to discriminate between traumatized individuals with and without
PTSD was maintained even after controlling for depression and state anxiety, as well as for age, sex,
race, and type of assault.
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The Posttraumatic Cognitions
Inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314.
B. Panic Disorder (p. 570)
C. Phobias (p. 571)
Lecture/Discussion Topic: Discovery Health Channel Phobia Study
What do people fear? In August 2000, Discovery Health Channel commissioned Penn, Schoen, &
Berland Associates to conduct a nationally representative tele phone survey of 1000 Americans to
answer that ques tion. Students will find the following results interesting.
The top 10 fears (men and women combined) were the following:
1. Fear of snakes
2. Fear of being buried alive
3. Fear of heights
4. Fear of being bound or tied up
5. Fear of drowning
6. Fear of public speaking
7. Fear of hell
8. Fear of cancer
9. Fear of tornadoes and hurricanes
10. Fear of fire Top 5 fears of men?
1
2
3
4
5
Fear of being buried alive
Fear of heights
Fear of snakes
Fear of drowning
Fear of public speaking Top 5 fears of women?
1
2
3
4
5
Fear of snakes
Fear of being bound or tied up
Fear of being buried alive
Fear of heights
Fear of public speaking
The greatest difference between men and women was in the fear of being bound or tied up (women
27 percent versus men 2 percent). Results also indicated that we fear giving a speech (36 percent) more
than meeting new people (12 percent), embarrassing our selves in a sport (44 percent) more than asking
someone for a date (35 percent), being stranded in the ocean (62 percent) more than being stranded in
the desert (24 percent), and the IRS (57 percent) more than God (30 percent). The things we fear equally
are rats and den tists (58 percent), elevators and flying (52 percent), and public speaking and being alone
in the woods (40 per cent). While the pollsters found the level of fear in American society to be high, they
also reported that few seek treatment. Among those who say they have a phobia or extreme fear, only 11
percent indicated that they sought professional help.
Classroom Exercise: Fear Survey
What do we fear? James Geer has developed a scale to measure fear, which is provided in Handout 12–
10. He asked 124 research participants to list their fears on an open ended questionnaire. Fifty one
specific fears were mentioned two or more times; these were included in the survey in Handout 12–10.
The following 11 received the highest intensity ratings: untimely or early death, death of a loved one,
speaking before a group, snakes, not being a success, being self conscious, ill ness or injury to loved
ones, making mistakes, looking foolish, failing a test, suffocating. Students will be interested in comparing
their fears with those of their classmates, so you may wish to collect the surveys and report the overall
results back to the class.
Psychiatrists and psychologists have labeled over 700 specific fears and estimate that there are
thousands more. When such fears are persistent and debilitating, they are considered to be phobias.
Among those specifi cally identified are the following, listed under their appropriate Greek or Latin name.
Acrophobia: Heights Aquaphobia: Water Gephyrophobia: Bridges Ophidiophobia: Snakes Aerophobia: Flying Arachnophobia:
Spiders Herpetophobia: Reptiles Ornithophobia: Birds Agoraphobia: Open spaces Astraphobia: Lightning Mikrophobia: Germs
Phonophobia: Speaking aloud Ailurophobia: Cats Brontophobia: Thunder Murophobia: Mice Pyrophobia: Fire Amaxophobia:
Vehicles, driving Claustrophobia: Closed spaces Numerophobia: Numbers Thanatophobia: Death Anthophobia: Flowers
Cynophobia: Dogs Nyctophobia: Darkness Trichophobia: Hair Anthropophobia: People Dementophobia: Insanity Ochlophobia:
Crowds Xenophobia: Strangers
You might also ask students if they have heard of triskaidekaphobia (the number 13), uxoriphobia
(one’s wife), Santa Claustrophobia (getting stuck in a chim ney), panaphobia (everything), or
phobophobia (fear itself).
Geer, J. H. (1965). The development of a scale to meas ure fear. Behavior Research and Therapy, 3, 45–53.
Classroom Exercise: Social Phobia
Handout 12–11, the Social Thoughts and Beliefs Scale (STABS), was designed by Samuel Turner and
his col leagues to assess cognitions associated with social pho bia. The disorder is marked by social
timidity, social inhibition, the avoidance of social situations, and, in many cases, extreme social
debilitation. Students obtain a total score by adding the numbers they provided in response to all 21
items. Patients diagnosed with social phobia obtained a mean of 52.4, those with other anxi ety disorders
had a mean of 28.0, and controls without any psychiatric diagnosis had a mean score of 22.3. Factor
analysis suggested that STABS points to two fac tors being involved in social phobia: social comparison,
a belief that others are more socially competent and capable, and social ineptness, a belief that one will
act awkwardly in social situations or appear anxious in front of others.
Turner and his colleagues note that while social phobia originally was thought to be a condition
devel oping in mid adolescence, findings suggest that it can be diagnosed as early as 8 years of age.
Research sug gests that 6.8 percent of people in the United States and other Western countries
experience a social phobia in any given year. It is more common among women than among men.
About 12 percent develop this disorder at some point in their lives.
As the text indicates, socially anxious people seek to avoid potentially embarrassing social situations.
If they cannot avoid contact, they often experience physi cal symptoms such as trembling, profuse
perspiration, and nausea. For some, the greatest fear is that others will detect their signs of anxiety, such
as blushing, tremors of the hand, and shaking voice. The earliest signs of social phobia often occur in late
childhood or early adolescence, with fear of public speaking and eat ing in public being common
symptoms.
Irwin and Barbara Sarason note that phobias about interpersonal relationships often include fear of
criti cism and of making a mistake. Those who suffer social phobia may attempt to compensate by
involving them selves in school and work, never quite sure of their abil ities or talents. When successful,
they may be dismis sive: “I was just lucky—being in the right place at the right time.” They may even feel
like imposters, fearing that one day they will be discovered.
Among the self help guidelines that therapists have provided for dealing with social phobia are the
following:
1
In dealing with the symptoms of anxiety, respond with approach rather than avoidance.
2
Greet people with eye contact.
3
Create a list of possible topics of conversation and listen carefully to others.
4
Initiate conversation by asking questions. This strategy demonstrates that you want to speak but
at the time focuses attention on the other person.
5
Speak clearly and without mumbling.
6
Be willing to tolerate some silences.
7
Wait for cues from others in deciding where to sit, when to pick up a drink, and what to talk about.
8
Learn to tolerate criticism and be willing to intro duce a controversial topic at an appropriate point.
Comer, R. J. (2007). Abnormal psychology (6th ed). New York: Worth.
Hartman, L. M. (1984). Cognitive components of anxi ety. Journal of Clinical Psychology, 40, 137–139.
Sarason, I., & Sarason, B. (2005). Abnormal behavior: The problem of maladaptive behavior (11th ed.). Upper
Saddle River, NJ: Prentice Hall.
Turner, S. M., et al. (2003). The social thoughts and beliefs scale: A new inventory for assessing cognitions in
social phobia. Psychological Assessment, 15, 384–391.
D. Obsessive Compulsive Disorder (pp. 571–572)
Feature Film: As Good As It Gets and OCD As noted earlier, feature films can provide wonderful case
studies in all of the psychological disorders cov ered in the text. As Good As It Gets, starring Jack
Nicholson, was also mentioned. Following are some specifics about the film in relation to OCD. The film is
about Melvin Udall, who displays numerous obsessions and compulsions. Perhaps the best single scene
to show in class begins 3:34 minutes into the film and runs just 97 seconds. Udall locks and unlocks his
apartment door exactly five times, turns lights on and off five times. Then, using multiple bars of soap
stacked high in his medicine cabinet, he demonstrates his obsession with cleanliness, washing his hands
with scalding water. The rest of the story finds him eating every day at the same table in the same
restaurant. He insists on the same waitress, always orders the same meal, and brings his own paper
wrapped plastic flatware to avoid contamina tion. He wipes off door handles before opening doors and
carefully avoids stepping on sidewalk cracks in his visits to his therapist’s office. If anything disrupts his
routine, he becomes both angry and anxious.
Classroom Exercise: Obsessive Compulsive Disorder
Handout 12–12, the Obsessive Compulsive Inventory, was developed by Edna Foa and her colleagues.
Total score is obtained by adding the numbers circled and can range from 0 to 72. In one study, patients
with OCD obtained a mean score of 28.01; a sample of 477 psy chology students at the University of
Delaware scored a mean of 18.82. The scale has six components that intro duce common symptoms of
OCD, including washing (5, 11, 17), obsessing (6, 12, 18), hoarding (1, 7, 13), ordering (3, 9, 15),
checking (2, 8, 14), and mental neu tralizing (4, 10, 16).
Obsessive compulsive disorder traps people in seemingly endless cycles of repetitive thoughts (obses
sions) and in feelings that they must repeat certain actions over and over (compulsions). Approximately
20 percent of those with OCD have only obsessions or only compulsions; all others experience both.
While the OCI does not provide separate scores for obsessive thoughts and compulsive behaviors,
Richard Halgin and Susan Krauss Whitbourne provide good examples of obsessions and their closely
related compulsions.
Obsession: A young woman is continuously terri fied by the thought that cars might careen onto the
sidewalk and run over her. Compulsion: She always walks as far from the street pavement as
possible and wears red clothes so that she will be immedi ately visible to an out of control car.
Obsession: A mother is tormented by the concern that she might inadvertently contaminate food as
she cooks dinner for her family. Compulsion: Every day she sterilizes all cooking utensils in boil ing
water, scours every pot and pan before placing food in it, and wears rubber gloves while handling
food.
Obsession: A woman cannot rid herself of the thought that she might accidentally leave her gas
stove turned on, causing her house to explode. Compulsion: Every day she feels the irresistible
urge to check the stove exactly 10 times before leaving for work.
Obsession: A college student has the urge to shout obscenities while sitting through lectures in
classes. Compulsion: Carefully monitoring his watch, he bites his tongue every sixty seconds in order
to ward off the inclination to shout.
Obsession: A young boy worries incessantly that something terrible might happen to his mother while
sleeping at night. Compulsion: On his way up to bed each night, he climbs the stairs according to a
fixed sequence of three steps up, followed by two steps down in order to ward off danger.
An important reason that obsessions generate so much anxiety and have so much power over people
is that their victims do not seem to “know” anything with certainty. Their own senses are unconvincing.
For exam ple, they may see that their hands look clean but wash anyway. In fact, they may have to
repeat the action 10, 20, or more times. Their doubt may lead them to believe that they are taking
unbearable risks if they don’t per form their rituals. In other areas of their lives, sufferers of OCD may use
the normal process of reasoning. Victims may even recognize that their obsession is “crazy” and receive
no pleasure in what they are doing. Still, they cannot escape the hold the disorder has over them.
Until the 1980s, OCD was considered relatively rare. Now, some researchers estimate that about 4
mil lion Americans have OCD at some time in their life. This makes OCD more common than panic
disorder or even schizophrenia. Moreover, the disorder affects adults, teenagers, and even small
children. It occurs across all social and economic levels. Generally, it appears before the age of 25. In
fact, less than 15 per cent of people develop the disorder after age 35. If it occurs early in life, it seems
to be linked to a stressful event and affect boys more often than girls; if it occurs in the teen years, it
affects males and females equally and, in 80 percent of all cases, it involves washing ritu als linked to
contamination fears. If it appears first in adulthood, the incidence is slightly higher in women than in men.
OCD does tend to run in families, sometimes in two, three, or even four consecutive generations. About
15 to 20 percent of those with OCD come from families in which another immediate family member has
the same problem. Although it was once thought that this might be the result of learning, researchers
have found that when OCD occurs in the next generation, it often takes a different form. For example, a
parent may be a “checker,” while the son or daughter is a compulsive washer. Many researchers now
believe that there is a biological basis for OCD. What is transmitted is the predisposition to develop OCD
symptoms under certain conditions, but not a specific obsession or compulsion.
Foa, E. F., et al. (2002). The obsessive compulsive inven tory: Development and validation of a short version.
Psychological Assessment, 14, 485–496.
Gibb, G., Bailey, J., Best, R., & Lambirth, T. (1983). The measurement of the obsessive compulsive personality.
Educational and Psychological Measurement, 43,
1233–1237.
Halgin, R., & Whitbourne, S. (2008). Abnormal psychol ogy: Clinical perspectives on psychological disorders
(5th ed.) Boston: McGraw Hill.
Lecture/Discussion Topic: Obsessive Thoughts
Typically, we deal with unwanted thoughts by trying to suppress them. Research by Daniel Wegner and
his col leagues indicates that this strategy may backfire. The more we attempt to suppress obsessive
ideas, the more likely we are to become preoccupied with them.
The researchers instructed college students not to think about white bears and then asked them to dictate
their ongoing thoughts into a tape recorder. Each time a white bear came to mind they were to ring a bell.
Results indicated that the students rang the bell or men tioned the bear more than once a minute during a
5 minute session. Not thinking about white bears proved very difficult. It seems that actively attempting to
sup press a thought ironically makes us think of it more.
Wegner and his colleagues suggest a way to rid ourselves of obsessive thoughts. In a second experi
ment, they told students to think about a red Volkswagen every time they thought of a white bear. The
strategy worked. Using a single distracting thought helped students to avoid thinking of the dreaded white
bear. Although more work needs to be done, the researchers believe the technique may be useful not
only for eliminating obsessions but also in the treatment of addictions, such as smoking.
For students who want more information on obsessive compulsive disorder, the OCD Foundation
offers advice, information, newsletters, and referrals to treatment centers. It even offers “support
groups” to OCD sufferers and their families in all 50 states. Write OCD Foundation, P.O. Box 961029,
Boston, MA 02196 or go to the website at www.ocfoundation.org.
Neath, J. (1987, December). Suppress now, obsess later. Psychology Today, 10.
E. Post Traumatic Stress Disorder (pp. 572–574)
Lecture/Discussion Topic: Concentration Camp Survival
In the discussion of post traumatic stress disorder, the text describes the productive lives of American
Jews who survived the Holocaust trauma. Examining the coping skills they used in the concentration
camps pro vides an intriguing case study that reinforces much of the literature of this unit. Researchers
have identified seven major strategies that seem to have contributed to their survival. They include the
following, as reviewed by Chris Kleinke.
1
Differential focus on the good. Despite the horrible events that surrounded them, some inmates
focused their attention on whatever good they could find— for example, seeing a sunset or finding a small
car rot in the field.
2
Survival for some purpose. Inmates continued to look for and find meaning in their existence. For
some, it was simply the determination to tell the world about what had happened.
3
Psychological distancing. Prisoners used a variety of strategies to distance themselves from the
expe riences in the camp. These included intellectualiz ing (e.g., Bruno Bettelheim assumed the role of an
observer who would study the situation and write about it), religious conviction (e.g., for some, reli gious
convictions made the suffering less personal and provided hope for some kind of existence after death),
time focus (e.g., it was possible to distance oneself from the magnitude of the horror by living 1 day, 1
hour, or even 1 minute at a time), and finally, humor (e.g., in the most difficult of times, some prisoners
were still able to laugh).
4
Mastery. Although opportunities were sharply lim ited, there was still the challenge to use one’s
mind, to devote oneself to helping others, and to maintain a sense of worthiness and self esteem.
5
Will to live. Simply the human determination not to give up but to survive can be a powerful
source of strength.
6
Hope. It often matters not how realistic the hope is so long as it is held and nurtured.
7
Social support. Some drew on social support from individual friendships and from simply being in
groups of people who shared the same life situation.
Dimsdale, J. (1974). The coping behavior of Nazi con centration camp survivors. American Journal of
Psychiatry, 131, 792–797.
Kleinke, C. (1998). Coping with life challenges (2nd ed.). Belmont, CA: Wadsworth.
F. Understanding Anxiety Disorders (pp. 574–576)
IV. Somatoform Disorders (pp. 576–577)
Lecture/Discussion Topic: Factitious Disorder
People with factitious disorder purposefully produce or fake physical symptoms in order to assume a
patient’s role. In some cases, they may take extreme measures to create the appearance of illness. For
example, they may inject drugs to cause bleeding. In contrast, high fevers are relatively easy to produce.
Those with factitious dis order are often very knowledgeable about their ail ments, including possible
treatments. If challenged about the reality of their illness, they are likely to change doctors. The disorder
usually begins in early adulthood and seems to be more common among women than men. However,
men tend to show more severe forms of the disorder.
Factitious disorder seems to be more common among those who received extensive medical treatment
for a true physical disorder in childhood; experienced abuse in childhood; carry a grudge against the
medical profession; have worked as a nurse, laboratory techni cian, or medical aide; or have an
underlying personality problem such as extreme dependence. Typically, they are socially isolated,
enjoying little social support or family life. The extreme and long term form of faciti tious disorder is call
Munchausen syndrome.
In Munchausen syndrome by proxy, parents fake or actually produce physical illnesses in their children
that may lead to painful diagnostic tests, medication, and surgery. Typically, the parent (most often the
mother) is emotionally needy and craves attention and praise for her devoted care of her sick child. This
disorder, first identified in 1977, is often viewed as a crime by law enforcement authorities. The caregiver
may have admin istered drugs, contaminated a feeding tube, or may even have attempted to smother the
child. Ronald Comer makes the important observation that parents who resort to such actions are
obviously experiencing serious psychological disturbance and in need of therapeutic intervention.
The child’s illnesses may take almost any form but the more common symptoms are bleeding,
seizures, comas, diarrhea, fevers, and infections. Between 6 and 30 percent of victims die and 8 percent
are permanently disfigured or physically impaired. The disorder is diffi cult to diagnose because the
parent seems so devoted and caring. Yet when child and parent are separated, the physical problems
disappear.
Comer, R. (2007). Abnormal psychology (6th ed.). New York: Worth.
V. Dissociative Disorders (pp. 577–579)
Classroom Exercise: The Curious Experiences Inventory
Dissociation is often defined as an incapacity to inte grate one’s thoughts, feelings, or experiences into
one’s present consciousness. Dissociative symptoms have been implicated in such diverse conditions
as amnesia, fugue states, dissociative identity disorder, and even post traumatic stress disorder.
Handout 12–13 repre sents the shortened version of Lewis R. Goldberg’s The Curious Experiences
Survey, which measures self reported dissociative experiences. Total score is simply the sum of the
numbers placed before the 17 items. Thus, scores can range from 17 to 85, with higher scores reflecting
more experience with dissociation.
An analysis of the full length 31 item scale revealed the presence of three factors in dissociation:
depersonalization (“Had the experience of feeling that my body did not belong to me”), self absorption
(“Find that I sometimes sit staring off in space, thinking of nothing, and am not aware of the passage of
time”), and amnesia (“Found evidence that I had done things that I did not remember doing”).
The frequency of self reported dissociation was positively correlated with measures of neuroticism
(par ticularly depression) and imagination, and negatively related to conscientiousness (particularly
dutifulness), agreeableness, and, to a lesser extent, age. No relation ships were found with gender,
educational level, intelli gence, vocational skills, or self reported skills. Behav ioral acts that were most
highly positively correlated with dissociative experiences included the following:
Spent an hour at a time daydreaming Stayed away from a social event in order to finish some
work Had a nightmare Ate until I felt sick Drove faster than normal because I was angry Borrowed
money Received public assistance (such as food stamps or
welfare) Borrowed something and lost it, broke it, or never
returned it Stayed up all night Did something I thought I would never do Discussed sexual matters with
a male friend Smashed a vase or other object in anger or frustration
Goldberg, L. R. (1999). The Curious Experiences Survey, a revised version of the Dissociative Experiences
Scale: Factor structure, reliability, and relations to demographic and personality variables. Psychological
Assessment, 11, 134–145.
Lecture/Discussion Topic: Psychogenic Versus Organic Amnesia
Dissociative amnesia is a dissociative disorder that is not discussed in the text. Students are likely to be
aware that amnesia may be either physically or psychological ly based. For example, a blow to the head,
alcohol dependence, stroke, or Alzheimer’s disease may impair memory, just as marital, financial, or
career stress may do so. Dissociative amnesia is often referred to as psy chogenic amnesia and has four
characteristics that dis tinguish it from organic amnesia. First, psychogenic amnesics lose memory for
both the distant and recent past. For example, they cannot remember the number of siblings they have.
Organic amnesics, on the other hand, lose memory for the recent past but remember the dis tant past
well. Second, psychogenic amnesics lose their personal identity—name, address, occupation—but their
store of general knowledge remains intact. For example, they remember the date, the name of the
President, the capital of Illinois. Organic amnesics, however, lose both personal and general knowledge.
Third, psychogenic amnesics have no anterograde amnesia; that is, they remember well events
happening after the amnesia starts. In contrast, organic amnesics experience severe anterograde
amnesia, which is often their primary symptom; that is, they recall very little about events after the organic
damage. For example, they may not remember the name of the physician treat ing them for the head
injury. Finally, psychogenic amnesia often reverses itself very abruptly, ending with in a few hours or days
of its onset. Within a day, a per son may even recall the traumatic event that set off the memory loss. In
the case of organic amnesia, on the other hand, memory only gradually returns for retro grade memories
and hardly ever returns for anterograde memories following organic treatment. Memory of the trauma is
never revived.
Seligman, M., Walker, E., & Rosenhan, D. L. (2001). Abnormal psychology (4th ed.). New York: Norton.
A. Dissociative Identity Disorder (p. 578)
Lecture/Discussion Topic: The Dissociative Disorders Interview Schedule and Dissociative Identity
Disorder
Colin Ross and his colleagues developed the Disso ciative Disorders Interview Schedule to refine and
stan dardize the diagnosis of dissociative identity disorder (formerly known as multiple personality).
Presenting some of its key questions in class will provide students with further insight into the nature of
the symptoms associated with this disorder. “Yes” responses to the fol lowing would be rated in the
direction of a high disso ciative identity disorder score.
1. Have you ever walked in your sleep?
2. Did you have imaginary playmates as a child?
3. Were you physically abused as a child or adolescent?
4. Were you sexually abused as a child or adolescent? (Sexual abuse includes rape or any type of
unwant ed sexual touching or fondling that you may have experienced.)
5. Have you ever noticed that things are missing from your personal possessions or where you live?
6. Have you ever noticed that things appear where you live, but you don’t know where they came from or
how they got there (e.g., clothes, jewelry, books, furniture)?
7. Do people ever talk to you as if they know you but you don’t know them, or only know them faintly?
8. Do you ever speak about yourself as “we” or “us”?
9. Do you ever feel that there is another person or persons inside you?
10. If there is another person inside you, does he or she ever come out and take control of your body?
The controversy surrounding this disorder led the authors of the DSM IV to attempt to increase the
preci sion of diagnosis. Perhaps most important, to fit the diagnosis of dissociative identity disorder, the
person must have had the experience of amnesia, an inability to remember important personal
information. It is hoped that more stringent conditions will reduce the number of false diagnoses.
Ross, C. A., et al. (1990). Structured interview data on 102 cases of multiple personality disorder from four cen
ters. American Journal of Psychiatry, 147, 596–601.
B. Understanding Dissociative Identity Disorder
(pp. 578–579)
VI. Mood Disorders (pp. 579–589)
A. Major Depressive Disorder (p. 580)
Classroom Exercise: Depression Scales
Handout 12–14, a short form of the Center for Epidemiological Studies—Depression scale (CES D),
was developed by Jason Cole and his colleagues to be used as a screening tool in the general
population. In scoring it, students should reverse the numbers placed in response to statements 3 and 6
(i.e., 0 = 3, 1 = 2, 2 = 1, 3 = 0), then add the numbers in front of all 10 items. Scores can range from 0
to 30, with higher scores reflecting greater distress. The authors do not provide specific norms but
indicate that “most respon dents score in the lower range.” The specific scale items introduce four
important components of depression: Items 2 and 9 reflect the presence of negative affect; items 3 and
6 suggest the absence of positive affect; items 7, 8, and 10 indicate interpersonal difficulty; and items 1,
4, and 5 assess “somatic” difficulties.
Handout 12–15, the Zung Self Rating Depression Scale, is one of the most widely used measures of
depression. In scoring, students should reverse their responses to items 2, 5, 6, 11, 12, 14, 16, 17, 18,
and 20 (1 = 4, 2 = 3, 3 = 2, 4 = 1).They should then add all the numbers to obtain a total score, which can
range from 20 to 80. Scores from 50 to 59 suggest mild to moder ate depression, from 60 to 69 indicate
moderate to severe depression, and 70 and above indicate severe depression.
An adapted version of this scale is published each year by Parade Magazine prior to National Depression
Screening Day. National Depression Screening Day, created by Harvard psychiatrist Dr. Douglas G.
Jacobs in 1991, has since been repeated every year in early October. (A toll free number, which can be
called to learn the closest screening site, is typically advertised by the media in late September.) Each
year, the number of sites staffed by mental health professionals has grown. The free screening includes
completion of a self rating depression scale; a 20 minute talk on the causes, symptoms, and treatment of
the disorder, during which participants may ask questions; and 5 minutes alone with a mental health
professional. Based on the scale scores and the clinician’s probing, participants learn if they need more
evaluation. No diagnosis or treatment is provided.
Jacobs maintains that the effort has now saved hun dreds of lives. He relates the story of a college
student who appeared on the first screening day at McLean Hospital in Belmont, Massachusetts. “The
student had been putting plastic bags over his head,” Jacobs recounts, “so his roommate suggested he
go to the screening. He arrived and answered some questions: ‘Do you think of killing yourself?’ He said,
‘Yes.’ In 2 minutes, we had detected that he was at risk. In 10 min utes, he was hospitalized, and
treatment was begun. We saved his life.”
Aaron Beck, a leading investigator of depression, suggests that college students may be especially
prone to psychological problems because they simultaneously experience all the transitions that are
major stresses in adulthood. Entering college, they lose family, friends, and familiar surroundings and
are provided no ready made substitutes. Furthermore, while in high school, they were the most able
students; in college they must compare their own abilities with equally able students.
As the text notes, research indicates that students who exhibit optimism as they enter college
develop more social support and experience a lowered risk of depression. Moreover, students’ frequent
misperception of these stresses may be as important a cause of depres sion as the stresses
themselves. While they do not hallu cinate their problems of academic or social adjustment, they often
inflate the importance of temporary setbacks and misjudge the severity of rejections. They may over
estimate academic difficulties on the basis of one mediocre grade. They may grieve over their social
isola tion, even though they often have at least some caring and supportive friends. Their pessimism and
dissatisfac tion may lead to clinical depression that in turn inter feres with actual performance. A vicious
cycle is creat ed in which misperceptions of academic and social dif ficulties result in still poorer grades
and greater social isolation.
Beck, A., & Young, J. (1978, September). College blues. Psychology Today, 80–92.
Cole, J. C., et al. (2004). Development and validation of a Rasch Derived CES D Short Form. Psychological
Assessment, 16, 360–372.
Ubell, E. (1993, September 26). Help for depression. Parade Magazine, 20.
Ubell, E. (1994, September 18).You can find help for depression. Parade Magazine, 22.
Classroom Exercise: The Automatic Thoughts Questionnaire
Philip Kendall and Steven Hollon designed the Auto matic Thoughts Questionnaire, Handout 12–16, to
measure the frequency of automatic negative thoughts associated with depression and to “identify the
covert self statements reported by depressives as being repre sentative of the kinds of cognitions that
depressed per sons experience.” Thus the ATQ, which was developed on a sample of undergraduates,
provides a measure of depression and highlights some of its most important symptoms. Among the
specific facets of depression it measures are personal maladjustment and desire for change (e.g., items
14 and 20), negative expectations (e.g., items 3 and 24), low self esteem (e.g., items 17 and 18), and
helplessness (e.g., items 29 and 30). Total scores range from 30 (little or no depres sion) to 150
(maximum depression). Mean scores of
79.6 and 48.6 were obtained for depressed and nonde pressed samples, respectively.
Kendall, P., & Hollon, S. (1980). Cognitive self state ments in depression: Development of an Automatic
Thoughts Questionnaire. Cognitive Therapy and Research, 4, 383–395.
Classroom Exercise: Depression and Memory
The text notes that when we are in a bad or sad mood, we are more likely to remember unpleasant
events. Jerry Burger suggests a simple classroom replication of
D. M. Clark and J. D. Teasdale’s study demonstrating this effect.
Have students take out a blank piece of paper. Tell them that you are going to read a series of individual
words and that after you have read each word they will have a few seconds to think of a past experience
they associate with the word. They are to write down the experience in a sentence or two. Proceed to
read the fol lowing list, which Clark and Teasdale used (shorten for efficiency if you like). Pause between
each word, giving students time to respond: train, ice, wood, letter, house, race, shoe, window, sign,
meeting, travel, reading, road, machine, rain, roam, water, tunnel.
After students have finished, have them indicate whether each recalled experience was pleasant or
unpleasant. Finally, have them tally the total number of pleasant and unpleasant experiences they
recalled. Have them reflect on their level of depression that day and how it may have affected the degree
to which they gen erated pleasant or unpleasant memories. As noted, when we are depressed, we
remember more unpleasant than pleasant events. If you prefer to analyze the relationship between
depression and memory more carefully, have students complete the Zung Self Rating Depression Scale
(Handout 12–15) before this exercise. Have them score both the scale and exercise before turning in the
results. Between classes, calculate the correlation between depression scores and pleasantness ratings
and report the outcome at the next class session.
Burger, J. M. (2007). Instructor’s manual for Burger’s Personality (7th ed.). Belmont, CA: Wadsworth.
Clark, D. M., & Teasdale, J. D. (1982). Diurnal variations in clinical depression and accessibility of memories of
positive and negative experiences. Journal of Abnormal Psychology, 91, 87–95.
Classroom Exercise: Loneliness
You can extend the text discussion of depression and suicide with Handout 12–17, the Revised UCLA
Loneliness Scale. Scores should be reversed (1 = 4, 2 = 3, 3 = 2, 4 = 1) for items 1, 4, 5, 6, 9, 10, 15, 16,
19, 20. The sum of all 20 items then provides a total score, which can range from 20 to 80. Mean scores
for males and females enrolled in undergraduate psycholo gy courses were 37.06 and 36.06,
respectively. Correlations ranging from .51 to .62 were found between loneliness scores and depression,
as measured, for example, by the Beck Depression Inventory.
Loneliness is a common and distressing problem for many people. In one national survey, 26 percent
of Americans reported having felt “very lonely or remote from other people” during the previous few
weeks. In a worldwide survey of adults in 18 countries, Italians and Japanese reported the most frequent
feelings of loneli ness and Danes reported the least. While we have a stereotype in our culture of the
elderly as being lonely, research indicates adolescents and young adults are actually the most lonely.
Married people are less lonely than the unmarried.
The problem of loneliness may be increasing. A recent study found that, on average, Americans have
only two close friends to confide in, down from an average of three in 1985. The percentage of people
who reported no confidant rose from 10 percent to almost 25 percent; an additional 19 percent said they
had only a single confidant (often their spouse).
Loneliness has both psychological and physical consequences. Relatively recent studies at Carnegie
Mellon University suggest that being lonely may make one physically ill. Students with few friends had a
16 percent weaker immune response to a flu shot than did their counterparts. Another study found that
men who had the fewest social interactions every week had the highest levels of an inflammatory marker
that seems to play a role in heart disease. Investigators suggest that loneliness may depress immune
systems by increasing stress and decreasing the amount of sleep one gets. Other studies have found that
social support and affilia tion may serve to protect people from stress and illness as well as speed
recovery from illness or surgery.
While research does not indicate overall sex differ ences in loneliness, Sharon Brehm and her
colleagues reports that gender interacts with marital status in the following ways.
1
Married females report greater loneliness than do married males.
2
Among those never married, males report more loneliness than do females.
3
Among the separated and divorced, males report greater loneliness than do females.
4
Among those whose spouse has died, males report greater loneliness than do females.
Brehm and her colleagues suggest that these find ings indicate that men and women may differ in
their vulnerability to two types of loneliness: social and emo tional isolation. In social isolation, people are
dissatis fied and lonely because they lack a social network of friends and acquaintances. In emotional
isolation, they are dissatisfied because they lack a single intense rela tionship. Research has found that
marriage is more like ly to reduce a woman’s social network than a man’s. For example, men are more
likely to remain employed and seem to establish closer relationships with their relatives after marriage
than they had before. Married women may forgo outside employment and also leave their rela tives to be
with their husbands. As a result, they suffer greater social isolation.
In contrast, women, married or single, are more likely to maintain some intimate ties with their friends.
Men tend to have close emotional relationships only with their female partners. Hence, unmarried or
roman tically unattached males are likely to be emotionally isolated despite regular contact with people at
work and during leisure activities.
What reasons do people give for being lonely? One survey sorted them into five major categories.
1
Being unattached: Having no spouse or romantic partner, particularly breaking up with a spouse
or partner.
2
Alienation: Being misunderstood and feeling differ ent; not being needed and having no close
friends.
3
Being alone: Coming home to an empty house.
4
Forced isolation: Being hospitalized or house bound; having no transportation.
5
Dislocation: Being away from home; starting a new job or school; traveling often.
How do people cope with loneliness? Rubenstein and Shaver have found four major strategies. “Sad
pas sivity” includes sleeping, drinking, overeating, and watching TV. “Social contact” may involve calling
a friend or visiting someone. “Active solitude” takes the form of studying, reading, exercising, or going to
a movie. “Distractions” include spending money and going shopping.
Comer, R. (2007). Abnormal psychology (6th ed.). New
York: Worth.
McPherson, M., Smith Lovin, L., & Brashears, M. E.
(2006). Social isolation in America: Changes in core dis
cussion networks over two decades. American
Sociological Review, 71, 353–375.
Miller, R., Perlman, D., & Brehm, S. (2007). Intimate
relationships (4th ed.). New York: McGraw Hill. Rubenstein, C. M., & Shaver, P. (1982). In search of inti macy.
New York: Delacorte Press.
B. Bipolar Disorder (p. 581)
Lecture/Discussion Topic: Bipolar Disorder
To give students some idea of the manic state of a bipo lar disorder, read the following account.
When I start going into a high, I no longer feel like an ordinary housewife. Instead, I feel organized and accom
plished, and I begin to feel I am my most creative self. I can write poetry easily. I can compose melodies without
effort. I can paint. My mind feels facile and absorbs everything. I have countless ideas about improving the
conditions of mentally retarded children, how a hospital for these children should be run, what they should have
around them to keep them happy and calm and unafraid. I see myself as being able to accomplish a great deal
for the good of people. I have countless ideas about how the environmental problem could inspire a crusade for
the health and betterment of everyone. I feel able to accom plish a great deal for the good of my family and
others. I feel pleasure, a sense of euphoria or elation. I want it to last forever. I don’t seem to need much sleep.
I’ve lost weight and feel healthy, and I like myself. I’ve just bought six new dresses, in fact, and they look quite
good on me. I feel sexy and men stare at me. Maybe I’ll have an affair, or perhaps several. I feel capable of
speaking and doing good in politics. I would like to help people with problems similar to mine so they won’t feel
hope less. (Fieve, 1975, p. 17)
David Rosenhan and Martin Seligman identify the following symptoms of mania.
1
Mood or emotional symptoms The mood is typical ly euphoric, expansive, and elevated. In some
cases, the dominant mood is irritability, particularly if the manic person is thwarted. Even when euphoric,
manic people are close to tears and if frustrated burst out crying. This suggests that a strong depres sive
element coexists with mania.
2
Grandiose cognition Manic people believe they have no limits to their abilities and, what’s worse,
do not recognize the painful consequences of trying to carry out their plans. They may have a flight of
ideas in which ideas race through their mind faster than can be related or written down. Sometimes manic
people have delusional thoughts about them selves—for example, that they are special messen gers of
God or are intimate friends with celebrities.
3
Motivational symptoms The manic person’s hyperactivity has an intrusive, dominating, and
domineering quality. In the manic state, some engage in compulsive gambling, reckless driving, or poor
financial investment.
4
Physical symptoms With the hyperactivity comes a greatly lessened need for sleep. After a few
days, however, exhaustion settles in, and the mania slows down.
Between 0.6 and 1.1 percent of the U.S. population will have bipolar disorder in their lifetime. It
affects both sexes equally. Onset is sudden and, typically, no precipitating event is obvious. The first
episode is usu ally manic and occurs between ages 20 and 30. Bipolar illness tends to recur but
surprisingly not many episodes occur more than 20 years after the initial onset.
Fieve, R. R. (1975). Mood swing. New York: Morrow.
Seligman, M., Walker, E., & Rosenhan, D. L. (2001). Abnormal psychology (4th ed.). New York: Norton.
C. Understanding Mood Disorders (pp. 582–586)
Lecture/Discussion Topic: The Sadder but Wiser Effect
A number of studies have shown that depressed persons may see certain events more accurately than
do those who are happy and optimistic. Lauren Alloy and Lyn Abrahamson, among the first to report this
finding in 1979, initially labeled it the sadder but wiser effect. Today it is also known as depressive
realism.
In testing the learned helplessness theory of depres sion, Alloy and Abrahamson recruited groups of
depres sives and nondepressives. Research participants were individually placed behind a special
arrangement of lights and buttons and periodically were given a choice whether or not to push one of the
buttons. A light was programmed to come on every other time the choice was presented, regardless of
the participant’s choice. Afterwards, the experimenter asked participants to esti mate how much control
they had over the lights. From helplessness theory, Alloy and Abrahamson predicted that depressed
subjects would underestimate their con trol. In fact, however, the depressed participants were very
accurate in their estimates, while those who were not depressed made mistakes by drastically exaggerat
ing the degree of control they thought they exercised.
Alloy and Abrahamson replicated this finding in other experiments. Nondepressives consistently
overestimated their control over positive events and underestimated their control over negative events.
Other researchers reported similar results. For example, Peter Lewinsohn had participants interact with
one other per son or with a group and then asked them to rate their own social skills. In evaluating
themselves, they noted the clarity of their communication, their friendliness, and their ability to understand
others. Observers on the opposite side of a one way mirror also rated the partici pants. While
nondepressives perceived themselves more positively than did the observers, depressed participants
gave themselves ratings that were very close to those of the observers.
What does all of this have to say about helping the depressed to see things more clearly? Alloy reports
that one patient, after hearing these results, quit therapy on the basis that there was nothing wrong with
him. In reflecting later on her patient’s decision, the therapist states, “If I had been able to talk to him, I
would have pointed out that to be realistic is not necessarily the same as being adaptive.”
Fred Hapgood suggests that depressed persons may feel as they do, not because of low ego
defenses or learned helplessness, but because they see themselves as “lost in a society of cockeyed
optimists who barge through life with little grasp of the consequences of their actions or words.” A
depressing thought? Yes, sug gests Hapgood, and possibly one more likely to be correct.
Hapgood, F. (1985, August). The sadder but wiser effect. Science, 85, 86–88.
Lecture/Discussion Topic: Cognitive Errors in Depression
Aaron Beck’s work with depressed patients convinced him that depression is primarily a disorder of
thinking rather than of mood. He argued that depression can best be described as a cognitive triad of
negative thoughts about oneself, the situation, and the future. The depressed person misinterprets facts
in a negative way, focuses on the negative aspects of any situation, and also has pessimistic
expectations about the future. The cognitive errors of depressed people include the following.
1
Overgeneralizing: Drawing global conclusions about worth, ability, or performance on the basis of
a single fact.
2
Selective abstraction: Focusing on one insignificant detail while ignoring the more important
features of a situation.
3
Personalization: Incorrectly taking responsibility for bad events in the world.
4
Magnification and minimization: Gross evaluations of a situation in which small, bad events are
magni fied and large, good events are minimized.
5
Arbitrary inference: Drawing conclusions in the absence of sufficient evidence or of any evidence
at all.
6
Dichotomous thinking: Seeing everything in one extreme or its opposite (black or white, good or
bad).
Beck and others have noted that the thoughts of depressed people differ from those with anxiety
disor ders. Those suffering from anxiety typically focus on uncertainty and worry about the future. In
contrast, depressed people focus on negative aspects of the past or reflect a negative outlook on what
the future will bring. Whereas anxious people worry about what may happen and whether they will be
able to deal with it, depressed people think about how terrible the future will be and how they will be
unable to deal with it or improve it.
Sarason, I., & Sarason, B. (2005). Abnormal psychology (11th ed.). Upper Saddle River, NJ: Prentice Hall.
Classroom Exercise: Attributions for an Overdrawn Checking Account
The text reports that depressed people are more likely to explain bad events in terms of causes that are
stable, global, and internal. More specifically, experiments have shown that either stable or global
attributions can produce depression, but internal attributions seem to produce depression only when
they are combined with stable and global components. Given the present popu larity of the social
cognitive perspective, you may want to offer a specific illustration of the attributions most likely to be
associated with depression.
Ask students to imagine that they have just been notified by their bank that their checking account is
overdrawn. After reflecting a bit on the possible reasons for the notification, have them write down in a
sentence or two what they believe to be the single most impor tant cause. Then, in thinking about what
they have writ ten, have them answer the following questions.
1
Does the cause you describe reflect more about you or something more about other people or
circum stances (internal or external)?
2
Is the cause something that is permanent or tempo rary; that is, is the cause likely to be present
in the future (stable or unstable)?
3
Is the cause something that influences other areas of your life or only your checking account
balance (global or specific)?
Ask for volunteers to share some of their answers and reiterate that attributions for events that are
internal, stable, and global are most likely to be associated with depression. Christopher Peterson and
Martin Seligman give the examples on the next page of attributions for the overdrawn checking account.
2
2
Unit
12
Abnormal Psychology
Examples of Causal Explanations for the Event “My Checking Account Is Overdrawn”
Explanation
Style
Stable Global
Specific Unstable
Global
Specific
Internal
“I’m incapable of doing anything
right.”
“I always have trouble figuring my
balance.” “I’ve had the flu for a
week, and I’ve let everything slide.”
“The one time I didn’t enter a
check is the one time my account
gets overdrawn.”
External
“All institutions chronically
make mistakes.”
“This bank has always used
antiquated techniques.”
“Holiday shopping demands
that one throw oneself into
it.”
“I’m surprised—my bank has
never made an error before.”
Source: Peterson et al. (1984). Casual explanations as a risk factor for depression: Theory and evidence.
Psychological Review,
91. Copyright © 1984 by the American Psychological Association. Adapted by permission.
Classroom Exercise: The Body Investment Scale and Self-Mutilation
You can extend the text Close Up on suicide with Handout 12–18, the Body Investment Scale designed
by Israel Orbach and Mario Mikulincer. To obtain a total score, respondents need to reverse the numbers
(1 = 5, 2 = 4, 4 = 2, 5 = 1) they place in front of items 2, 3, 5, 7, 9, 11, 13, 17, and 22 and then add up the
numbers in front of all 24 statements. Scores can range from 24 to 120, with higher scores reflecting a
more positive emo tional investment in one’s body. Orbach and Mikulincer identified four separate
aspects of the bodily self-measured by their scale. Items 5, 10, 13, 16, 17, and 21 assess body image
feelings and attitudes, items 2, 6, 9, 11, 20, and 23 measure comfort in physical contact with others, items
1, 4, 8, 12, 14, and 19 reflect concern for body care, and items 3, 7, 15, 18, 22, and 24 assess investment
in body protection.
Working primarily with adolescents and young adults between 13 and 19, the authors found their
scale to be predictive of self destructive behaviors, including suicidal tendencies. Those with higher
scores reported higher self esteem as well as having experienced greater maternal care. Moreover, they
were more likely to indi cate a capacity to enjoy sensual and bodily pleasures and were less likely to state
that their parents had been overprotective.
You may want to extend the discussion of suicide to a consideration of research on self mutilation.
One survey of undergraduate students reported that 9.8 per cent of the students indicated that they had
purposefully cut or burned themselves on at least one occasion in the past. A 2003 study found a high
prevalence of self injury among 428 homeless and runaway youth (ages 16 to 19) with 72 percent of
males and 66 percent of females reporting a past history of self mutilation. More generally, research
indicates self injury is more frequent among women than men and typically begins in the teen years.
Those who injure themselves are not usually seeking to end their lives but rather seem to use self injury
as a coping effort to relieve emotional pain. Before her tragic death, Princess Diana brought global
attention to the disorder when she admitted in a televi sion interview that she had intentionally injured her
arms and legs: “You have so much pain inside yourself that you try to hurt yourself on the outside
because you want help.”
Although some self mutilators are suicidal, most cut themselves not to die but to cope with the stresses of
staying alive. Many were sexually abused as children and learned to shield themselves from the trauma
by dissociating themselves from their emotions. Some claim that cutting snaps them back into
consciousness. One victim writes, “It proves I’m alive, I’m human, I have blood coursing through my
veins.” Others who suffer from anorexia or bulimia apparently self mutilate to gain control over their
bodies or to express their feel ings about being abused. “They’re wearing a visible symbol of the violation
imposed on them,” claims Joseph Shrand, director of the Child and Adolescent Outpatient Clinic at
McLean Hospital in Belmont, Massachusetts.
Whatever their childhood experience, almost all self-mutilators, according to experts, grew up in
homes with poor communication between parent and child. Cutting often seems to be a replacement for
absent language. Self-mutilators may have lived through a bitter divorce or were verbally demeaned as
fat or lazy. As a result, they suffer self-loathing, not merely lower self-esteem. “Cutting is literally like
letting out bad blood,” claims Marilee Strong, author of A Bright Red Scream, a book on self-mutilation.
Treatments include antidepressants and even the drug Naltrexone, commonly used to treat heroin
addicts. Although traditional psychotherapy is often ineffective, some therapists report success using
Marsha Linehan’s dialectical behavior therapy, which teaches skill in tolerating distress and controlling
behavior. War, poverty, and unemployment may also be contributing factors.
Some therapeutic efforts have successfully generat ed alternative coping behaviors for sufferers who
other wise would engage in self injury. For example, clients may be encouraged to journal, to participate
in sports or exercise, or to seek social support in curbing the urge to harm themselves. Even safer
methods of self harm that do not lead to permanent injury— for example, the snapping of a rubber band
on the wrist—may help calm the urge to engage in self injury.
Kalb, C. (1998, November 9). An armful of agony. Newsweek, 82.
Orbach, I., & Mikulincer, M. (1998). The body invest ment scale: Construction and validation of a body experi
ence scale. Psychological Assessment, 10, 415–425.
Tyler, K. A., et al. (2003). Self mutilation and homeless youth: The role of family abuse, street experiences, and
mental disorders. Journal of Research on Adolescence, 13, 457–474.
Vanderhoff, H., & Lynn, S. J. (2001). The assessment of self mutilation: Issues and clinical considerations.
Journal of Threat Assessment, 1, 91–109
Classroom Exercise: Understanding Suicide
Laura Madson and Corey J. Vas designed Handout 12–19 to help students understand the risk factors for
suicide. You may want to use the exercise before stu dents have read the text material on mood
disorders and the Close Up on suicide. Distribute a copy of the hand out to each student. As the
instructions indicate, have students read the descriptions of the four fictional per sons and, using their
best judgment, rank them in terms of their risk for attempting or committing suicide.
After students have completed the rankings, engage the full class in a discussion of the “correct”
rankings (initially, you could form small groups). The discussion will make it clear that these rankings are
somewhat arbitrary and will highlight the uncertainty that sur rounds suicide risk. The same event may
have no effect on one person but may dramatically increase the risk for suicide in another person. In
addition, the overwhelm ing majority of people who experience various risk fac tors do not become
suicidal. As Madson and Vas con clude, “Predicting suicide is far more complex than compiling a laundry
list of a person’s risk factors.”
In surveying the literature, Madson and Vas identi fy a number of risk factors that are correlated with sui
cidal ideation and behavior. Some, but not all, of these are also identified in the text. For example,
suicidal behavior varies by gender, age, and marital status. Easy accessibility to firearms, mood
disorders, substance abuse, and feelings of loneliness and hopelessness are also predictive.
Perhaps the strongest single predictor of suicidal behavior, particularly in adolescents, is previous suicide
attempts. Among adolescents and young adults (under age 30), interpersonal loss; poor social
adjustment; and problems surrounding love relationships, dating, and friends also act as precipitating
factors. Rejection by a potential partner or loss of a romantic relationship may be a powerful predisposing
event for under graduates.
In terms of the rankings, Madson and Vas suggest that Person 2 is at greatest risk because she presents
two of the strongest predictors of suicide (i.e., a previous suicide attempt and the breakup of a long term
relation ship). Person 4 may be second in terms of risk because he presents other leading predictors (i.e.,
he has a sub stance abuse problem, ready access to firearms, and recently began giving away his
possessions). The last two persons present both risk factors (i.e., a young woman who is depressed and
ostracized by her family because she is lesbian, and a father who recently lost his job), but they also
show protective factors that decrease risk (i.e., she is currently in treatment for her depression, and he
has his family to provide social sup port). The article authors rank persons 3 and 1 in posi tions 3 and 4,
respectively.
Finally, the brevity of the descriptions represents a challenge. Clinicians who do careful evaluations of
clients have much greater detail about the person’s cur rent mental state and his or her past behavior.
You might ask students what additional information they would want in order to make more informed
judgments. For example, the person at most risk has “taken a few pills” in her past, so therapists would
certainly want more information including the type of medication and quan tity. If you like, you can expand
the fictional accounts as well as vary the risk factors across cases. Madson and Vas note that students
find the exercise valuable and those who participate do perform better on ques tions testing knowledge of
the suicide literature, partic ularly of risk factors. They also observe that, because suicide is an unsettling
topic, you should be ready to provide support in helping students process any negative emotions. At a
minimum, they suggest being ready to provide referral to your institution’s counseling center.
Madson, L., & Vas, C. J. (2003). Learning risk factors for suicide: A scenario based activity. Teaching of
Psychology, 30, 123–126.
Classroom Exercise: The Expanded Revised Facts on Suicide Quiz
Handout 12–20, the Expanded Revised Facts on Suicide Quiz, designed by John McIntosh and Richard
Hubbard, is a useful tool for introducing class discussion of research on suicide. The information
communicated in the answers to the questions goes well beyond that pre sented in the text, so the quiz is
useful, even if students have already completed the unit. The quiz contains 25
1. F (40.9%) 18. T (36.4%)
2. T (45.5%) 19. F (11.4%)
3. T (27.3%) 20. F (29.5%)
4. F (70.5%) 21. T (88.6%)
5. F (95.5%) 22. T (27.3%)
6. F (77.3%) 23. T (40.9%)
7. T (52.3%) 24. T (29.5%)
8. F (50.0%) 25. F (38.6%)
9. T (18.2%) 26. a (38.6%)
10. F (84.1%) 27. c (6.8%)
11. F (59.1%) 28. b (47.7%)
12. T (31.8%) 29. a (18.2%)
13. F (25.0%) 30. b (70.5%)
14. T (54.5%) 31. a (84.1%)
15. F (70.5%) 32. b (25.0%)
16. F (18.2%) 33. c (6.8%)
17. T (61.4%) 34. a (50.0%)
The mean score for all students was 24.1, and no sex differences were found.
Earlier, Richard Hubbard and John McIntosh had noted that students’ increasing interest in the topic
of suicide may in part be due to its personal relevance. Studies suggest that perhaps 40 to 50 percent of
stu dents have suicidal thoughts at one time or another and that as many as 15 percent may have
actually attempted suicide.
Depending on time, you may want to present Edwin Schneidman’s 10 common characteristics of sui
cidal people. Schneidman presents the following in the belief that knowledge of these characteristics
may help the general public and mental health professionals reduce suicide rates.
1. Unendurable psychological pain. Suicide is not an act of hostility or revenge but a way of switching off
unendurable and inescapable pain. If you reduce their level of suffering, even just a little, suicidal
people will choose to live.
true–false and 25 multiple choice items. Besides basic demographic questions about suicide (e.g., age,
sex, race/ethnicity, methods), the quiz touches on a number of clinically relevant issues. For those who
used an ear lier version of the instrument, this expanded revised version includes new items selected to
represent emerg ing issues in suicidology, including questions on suicide in later life. The correct answers
are provided below; beside each is the percentage of 373 undergraduates in general or abnormal
psychology classes who correctly answered that question. [Note: In a personal communi cation, John
McIntosh stated, “The only question that still remains tenuous is #37 related to suicide rates and specific
race/ethnicity. Although at the time we present ed and collected data for ERFOS rates were highest for
Native Americans (slightly higher than for Whites), more recent data has been the opposite again.”]
35. c (56.8%)
36. a (47.7%)
37. c (11.4%)
38. c (81.8%)
39. b (18.2%)
40. b (56.8%)
41. a (68.2%)
42. b (68.2%)
43. c (20.5%)
44. c (54.5%)
45. b (36.4%)
46. b (31.8%)
47. a (72.7%)
48. c (56.8%)
49. a (63.6%)
50. b (27.3%)
1. Frustrated psychological needs. Needs for security, achievement, trust, and friendship are among
the important ones not being met. Address these psy chological needs and the suicide will not
occur. Although there are pointless deaths, there is never a “needless” suicide.
2. The search for a solution. Suicide is never done without purpose. It is a way out of a problem or
crisis and seems to be the only answer to the ques tion: “How do I get out of this?”
3. An attempt to end consciousness. Suicide is both a movement away from pain and a movement
to end consciousness. The goal is to stop awareness of a painful existence.
4. Helplessness and hopelessness. Underneath all the shame, guilt, and loss of effectiveness is a
sense of powerlessness. There is the feeling that no one can help and nothing can be done
except to commit suicide.
5. Constriction of options. Instead of looking for a variety of answers, suicidal people see only two
alternatives: a total solution or a total cessation. All other options have been driven out by pain.
The goal of the rescuer should be to broaden the suici dal person’s perspective.
6. Ambivalence. Some ambivalence is normal, but for the suicidal person ambivalence is only
between life and death. In the typical case, a person cuts his or her own throat and calls for help
simultaneously. The rescuer can use this ambivalence to shift the inner debate to the side of life.
7. Communication of intent. About 80 percent of sui cidal people give family and friends clear clues
about their intention to kill themselves.
8. Departure. Quitting a job, running away from home, leaving a spouse are all departures, but sui
cide is the ultimate escape. It is a plan for a radical, permanent change of scene.
9. Lifelong coping patterns. To spot potential suicides, one must look to earlier episodes of
disturbance, to the person’s style of enduring pain, and to a general tendency toward “either/or”
thinking. Often, there has been a style of problem solving that might be characterized as “cut and
run.”
Hubbard, R. W., & McIntosh, J. L. (2003, April 25). The Expanded Revised Facts on Suicide Quiz. Paper presen
tation at the annual meeting of the American Association of Suicidology, Santa Fe, NM.
Hubbard, R., & McIntosh, J. (1992). Integrating suicidol ogy into abnormal psychology classes: The Revised
Facts on Suicide Quiz. Teaching of Psychology, 19, 163–166.
McIntosh, J. L., & Hubbard, R. W. (2004, April 16). A Facts on Suicide Quiz: Reliability and Validity. Paper
presentation at the annual meeting of the American Association of Suicidology, Santa Fe, NM.
Schneidman, E. (1987, March). At the point of no return. Psychology Today, 54–58.
Lecture/Discussion Topic: Commitment to the Common Good
Martin Seligman argues that the present epidemic of depression stems in part from a rise in individualism
and a decline in commitment to religion and family, and, more generally, to a decline in commitment to
close knit relationships and the common good. While Seligman believes that depression follows from a
pes simistic way of thinking about failure, and that learning to think more optimistically provides one
strategy for short circuiting depression, he does not believe that learned optimism alone will stop the tide
of depression on a societal basis. It has to be coupled with a renewed commitment to the common good.
Seligman observes,
Unit 12 Abnormal Psychology 25
“Optimism is a tool to help the individual achieve the goals he has set for himself. It is in the choice of the
goals themselves that meaning—or emptiness—resides. When learned optimism is coupled with a
renewed commitment to the common good, our epidemic of depression and meaninglessness may end.”
Seligman suggests that we begin thinking of this renewed commitment to the common good as a kind of
moral jogging in which a little daily self denial is exchanged for long term self enhancement. In our own
self interest, we must begin to reduce our investment in ourselves and heighten our investment in the
common good. Some of his specific suggestions follow:
—Give 5 percent of last year’s income away. Do it personally, not through a charity. Advertise
among potential recipients in a charitable field of interest that you are giving, say, $2000 away.
Interview applicants, give out the money, and follow its use to a successful conclusion.
—Give up eating out once a week, shopping for new shoes, watching a rented movie on Tuesday
night, and spend the time promoting the well being of others. Help in a soup kitchen, visit AIDS
patients, clean the public park, raise funds for your alma mater.
—Visit areas where you will encounter the homeless. Talk to beggars and judge as well as you can
whether they will use the money for nondestruc tive purposes. Spend three hours a week doing this.
—When you read of particularly virtuous or evil acts, write letters. Compose fan letters to people who
could use your praise, “mend your ways” let ters to people and organizations you dislike. Follow up
with letters to elected officials who can act directly. Again, spend three hours weekly in this activity.
—Teach your children to give things away. Suggest they set aside one fourth of their allowance to
give to a needy person or project. Further suggest that they do this personally.
Some items on the list are likely to generate a live ly discussion. Ask students to consider alternatives that
might produce similar results without putting the person “in the hole” financially.
You might also ask your class to reflect on the psy chological benefits of bipartisan efforts to promote the
common good through volunteer service. And what might be the psychological payoff for those who
partici pate in community sponsored “random acts of kind ness” days or weeks?
Seligman, M. (1990). Learned optimism. New York: Knopf.
VII. Schizophrenia (pp. 589–596)
A. Symptoms of Schizophrenia (pp. 590–591)
PsychSim 5: Losing Touch With Reality
This activity explains the symptoms of schizophrenia and the brain changes that accompany
schizophrenia. Students learn about the types of schizophrenia and the main symptoms, view video clips
of individuals with schizophrenia, and are asked to identify the symptoms displayed by each individual.
Student Project: The Eden Express and Schizophrenia Michael Gorman reports a highly successful
student project in which students were asked to read Mark Vonnegut’s The Eden Express and relate it to
the psy chological literature on schizophrenia. The book is an autobiographical account of the author’s
schizophrenic breakdown and eventual recovery. Vonnegut describes his thoughts and feelings while
hallucinating, his attempts to commit suicide, and his struggle to recover. He himself attributes his cure
primarily to the use of Thorazine, but certainly other factors contributed to his recovery. The book is also
relevant to the discussion of therapy in Unit 13.
While Gorman had students write papers dis cussing how different theoretical perspectives would
account for the cause and cure of Vonnegut’s schizo phrenia, you might simply assign the book as
outside reading; this in itself will provide students with new insight into the nature of schizophrenia.
Gorman, M. (1984). Using The Eden Express to teach introductory psychology. Teaching of Psychology, 11(1),
39–40.
Classroom Exercise: Magical Ideation Scale
Handout 12–21 is Mark Eckblad and Loren Chapman’s 30 item true false scale to assess “magical
thinking.” The scale is based on the idea that schizophrenia prone people often show a belief in magical
influences. Most of the items inquire about respondents’ interpretations of their own experiences rather
than their belief in the theoretical possibility of magical forms of causation. Of more than 1500 college
students who completed the scale, males and females had mean scores of 8.56 and 9.69, respectively.
The scoring key appears at the top of the next column.
The scale is part of a larger project aimed at devel oping “measures of deviant functioning to identify
young adults who may be psychosis prone.” Participants who scored very high on the Magical Ideation
Scale were interviewed extensively. Compared to a control group, they did report “more schizotypical
experiences, more affective symptoms, and more difficulties in concentration.”
1. T 16. F
2. T 17. T
3. T 18. F
4. T 19. T
5. T 20. T
6. T 21. T
7. F 22. F
8. T 23. F
9. T 24. T
10. T 25. T
11. T 26. T
12. F 27. T
13. F 28. T
14. T 29. T
15. T 30. T
Eckblad, M., & Chapman, L. (1983). Magical ideation as an indicator of schizotypy. Journal of Consulting and
Clinical Psychology, 51, 215–225.
Lecture/Discussion Topic: Infantile Autism
You can extend the text discussion of schizophrenia to include a consideration of infantile autism (see
also text Unit 9). The autistic condition appears similar to schiz ophrenia, in that social withdrawal is a
prominent char acteristic of both. There are, however, important differ ences. For example, autism is
usually diagnosed at an early age, sometimes within the first 6 months after birth, and always by age 3.
The usual age for diagnosis of schizophrenia is between 15 and 30 years. Although the incidence of
schizophrenia in males and females is about equal, autism occurs mostly in males. Finally, schizophrenia
tends to run in families, whereas autism does not.
James Kalat identifies nine characteristic behaviors of the autistic child.
1. Social isolation. The child ignores others, even par ents, and retreats into a world of his (or her)
own.
2. Stereotyped behaviors. The child rocks back and forth, bites his hands, stares at some object,
engages in repetitive behaviors.
3. Resistance to any change in routine.
4. Abnormal responses to sensory stimuli. Sometimes the child ignores visual and auditory stimuli;
at other times, he shows a “startle reaction” to very mild stimuli.
5. Insensitivity to pain. The child is remarkably insensitive to cuts, burns, and other sources of pain.
6. Inappropriate emotional expression. Sometimes the child may have sudden bouts of fear without
obvious reason. In other cases, he may show absolute fearlessness and unprovoked laughter.
7. Disturbances of movement. These vary from hyper activity to prolonged inactivity.
8. Poor development of speech. Some never develop any spoken language, whereas others begin
to develop it and then lose it.
9. Specific, limited intellectual problems. Many autis tic children do well on some intellectual tasks
but very poorly on others. It is nearly impossible to estimate their general intelligence because
they fail to follow the directions of a standard IQ test.
Prognosis for the autistic child is not good. Many drugs have been tried but none has proved to be
reliably helpful. Therapy involving operant conditioning tech niques (see Unit 13) has occasionally been
useful. More recently, some encouraging results have been reported for large doses of vitamins and
minerals, including vita min B and magnesium.
Some theorists have suggested that parental lack of emotional warmth is the cause of autism, but
others reject the bad parent theory. They point to the fact that in most cases, siblings are completely
normal. It also seems impossible to alleviate autism by merely provid ing a great deal of emotional
warmth and love.
One puzzling characteristic of some autistic chil dren is that they tend to huddle around radiators and
other heat sources, as if they felt cold. Even more sur prising, some autistic children behave almost
normally when they have a fever, showing better attention to their surroundings and improved
communication with other people.
James Kalat and others have speculated on the pos sible biological basis of autism. Insensitivity to
pain, which characterizes the autistic child, can also be pro duced by morphine or other opiate drugs. The
brain uses some peptide synaptic transmitters, called endor phins and enkephalins, with effects similar to
those of morphine. If for some unknown reason the brain some times produced huge amounts of
enkephalins and at other times small amounts, the behavioral effect would resemble that of a child who
occasionally took mor phine, and would be very much like that of a child with autism.
Eric Courchesne and Rachel Yeung Courchesne have linked autism to underdevelopment of the
cerebel lum. They have used an advanced imaging technique to show precisely where autism linked
damage may occur. The location of the damage suggests that it occurs dur ing the fetal stage or during
the first 2 years of life and may be caused by genetic abnormality or exposure to a virus or harmful
chemicals.
Elias, M. (1988, May 26). Autism may be caused by brain damage. USA Today, p. 10.
Kalat, J. (2007). Biological psychology (9th ed.). Pacific Grove, CA: Wadsworth.
Courchesne, E., et al. (1988). Hypoplasia of cerebellar vermal lobules VI and VII in autism. New England
Journal of Medicine, 318, 1349–1354.
B. Onset and Development of Schizophrenia
(pp. 591–592)
C. Understanding Schizophrenia (pp. 592–596)
VIII. Personality Disorders (pp. 596–599)
Lecture/Discussion Topic: Narcissistic Personality Disorder
Narcissistic personality disorder provides a good exten sion of the brief review of personality disorders in
the text. Ask your students whether they agree with the fol lowing statements:
1
2
3
4
5
I think I am a special person.
I expect a great deal from other people.
I am envious of other people’s good fortune.
I will never be satisfied until I get all that I deserve.
I really like to be the center of attention.
All the statements are drawn from Robert Raskin and Calvin Hall’s Narcissistic Personality Inventory and
reflect some of the disorder’s primary features. The nar cissistic personality has a strong need to be
admired, has a grandiose sense of self importance, and demon strates a lack of insight into other
people’s feelings.
This sense of superiority is accompanied by feel ings of entitlement. That is, narcissists believe they
should receive special privileges and respect—get the best job, obtain admission to the best university—
although they have done nothing to earn such favorable treatment. Moreover, the world should be their
fan club. When they come to a party, they expect to be welcomed with great fanfare. Many narcissists
prefer friends who are weak or unpopular, so they will not compete for attention.
Randy Larsen and David Buss identify the narcis sistic paradox—narcissists appear to have high self
esteem, but it is actually quite fragile. They appear self confident but are in desperate and continuing
need for others to verify their worth. Ironically, without others, they are nothing; at the same time, they
disdain others. In an interview with Gear magazine in October 2000, entertainer Roseanne Barr stated
(hopefully tongue in cheek): “I hate every human being on earth. I feel everyone is beneath me, and I feel
they should all wor ship me.”
Narcissists have difficulty in their interpersonal relations because of an inability to recognize the
needs or desires of others. They talk mostly about themselves. In fact, research finds that they tend to
use first person pronouns in everyday conversation significantly more often than does the average
person. Narcissists are also prone to envy. They tend to disparage the success and accomplishments of
others. Appearing snobbish, they may attempt to hide their strong feelings of envy and rage over the
success of others. Their fragile sense of self worth becomes apparent when others are critical of them.
They either fly into a rage or experience a period of depression, shame, and self doubt.
Larsen, R. J., & Buss, D. M. (2008). Personality psychol ogy: Domains of knowledge about human nature (3rd
ed.). Boston: McGraw Hill.
Raskin, R., & Hall, C. S. (1979). A narcissistic personali ty inventory. Psychological Reports, 45, 590.
Sedikes, C., et al. (2002). Do others bring out the worst in narcissists? The “others exist for me” illusion. In
Y. Kashima, M. Foddy, & M. Platow (Eds.), Self and identity (pp. 103–124). Mahwah, NJ: Erlbaum.
Classroom Exercise: Schizotypal Personality Questionnaire
You can extend the text discussion of personality disor ders with Handout 12–22, Adrian Raine’s
schizotypal personality questionnaire. It will introduce the key char acteristics of a fascinating personality
disorder that is closely tied to the study of schizophrenia. Students score their responses by adding all
their “yes” respons es. Total mean score for 220 male and female under graduates was 9.6.
Three subscales help to describe the essential char acteristics of this disorder. The cognitive
perceptual fac tor is assessed by items 2, 4, 5, 9, 10, 12, 16, and 17. The mean score for undergraduates
was 3.6. The items suggest that the disorder is often marked by unusual perceptual experiences, magical
thinking, and odd beliefs and ideas of reference. The interpersonal factor is measured by items 1, 7, 11,
14, 15, 18, 21, and 22. The mean undergraduate score was also 3.6. Schizotypical personality is marked
by social anxiety, few close friends, and constricted affect. The “disorga nized” factor is assessed by
items 3, 6, 8, 13, 19, and 20, and the mean score for undergraduates was 2.5. The personality disorder is
marked by odd behavior, including odd speech.
Schizoptypal personality disorder falls within the “eccentric” cluster of personality disorders (the
other clusters include the “erratic” cluster, which covers anti social, borderline, histrionic, and narcissistic
disorders, and the “anxious” cluster, which covers avoidant, dependent, and obsessive compulsive
personality disorders.)
Those suffering schizoptypal personality disorder report unusual perceptions that border on
hallucina tions. They may feel that other people are looking at them or hear murmurs that sound like
their names. It is not unusual for them to hold many superstitious beliefs, including an acceptance of
ESP and other psychic phe nomena. They may believe in magic such as in their own ability to control
others with their thoughts.
Schizotypal people are very uncomfortable in social situations, especially those that involve strangers.
They feel that they are different from others and simply don’t fit in. Importantly, they become more, rather
than less, anxious as they interact. They are suspicious of others and thus unable to invest trust in them.
Schizotypal persons have disorganized thoughts that are expressed in difficulty communicating, vague
speech, and odd nonverbal behavior. They often fail to make eye contact in conversation and are viewed
as eccentric. They often wear clothes that are unkempt or that clash.
Raine, A., & Benishay, D. (1995). The SPQ B: A brief screening instrument for schizotypal personality disorder.
Journal of Personality Disorders, 9, 346–355.
A. Antisocial Personality Disorder (p. 597)
Classroom Exercise: Antisocial Personality Disorder Many regard Hervey Cleckley’s The Mask of Sanity
to be the classic work on antisocial personality disorder. Recasting Cleckley’s clinical criteria for the
disorder in the form of self referential or opinion statements, Michael Levenson designed Handout 12–23
to assess this antisocial posture. He attempted to remove the neg ative connotations of the original
criteria so that the items would suggest to antisocial persons that antisocial traits are not necessarily
undesirable. A point is scored for each “true” response. If you use the scale, it would be wise to note that
the items have been employed strictly for research, not for diagnostic purposes, and that you are using
the scale to introduce Cleckley’s por trayal of the antisocial personality. When Levenson included the
scale in a study of risk taking and person ality, he obtained a mean score of 8.33 for residents in a long
term drug treatment facility, a mean of 6.06 for skilled rock climbers, and a mean of 5.15 for police
officers/fire fighters who had been commended for bravery in the line of duty. All participants were male.
Cleckley identifies the following characteristics of antisocial personality.
1.
2.
3.
4.
5.
6.
7.
8.
Superficial charm and good intelligence.
Poise, rationality, absence of neurotic anxiety.
Lack of a sense of personal responsibility.
Untruthfulness, insincerity, callousness, manipulativeness.
Antisocial behavior without regret or shame.
Poor judgment and failure to learn from experience.
Inability to establish lasting, close relationships with others.
Lack of insight into personal motivations.
Cleckley, H. (1976). The mask of sanity (5th ed.). St. Louis: Mosby.
Levenson, M. (1990). Risk taking and personality.
Journal of Personality and Social Psychology, 58,
1073–1080.
Feature Film: In Cold Blood In Cold Blood provides an excellent introduction to per sonality disorders.
Based on Truman Capote’s best seller, it relates the true story of the personalities and events
surrounding the murder of the Herbert Clutter family. Perry Smith and Richard Hickock, two former
prison inmates, travel to Holcomb, Kansas, with the intent of robbing the Clutter farm. When they find
no money, they systematically shoot the four defenseless family members. The film focuses on the
personality and motives of Perry Smith. Through flashbacks, the viewer observes the role of early
experience in the development of his aggressive behavior. After showing the film, you can discuss
the possible factors that con tribute to the antisocial personality. You can also use this film to
introduce a discussion of the insanity defense. As Capote relates in his book, the defendants’
attorneys entered an insanity plea, but under the M’Naghten rule (in criminal trials, an insanity
defense is valid only if the defendant is shown not to have known what he or she was doing or did not
know right from wrong). Smith and Hickock were convicted and sentenced to hang. While Richard
Hickock’s crimi nal conduct might be attributed to an earlier head injury, a psychiatrist testified that
Hickock knew the difference between right and wrong. Tests to determine whether brain damage was
in fact present were never conducted. You might ask students if they think the insanity plea is ever
appropriate, and if so, what should be the criteria. In the 1950s, the Durham rule replaced M’Naghten
in some courts. The Durham rule states that the “accused is not criminally responsible if his unlaw ful
act is the product of mental disease or defect.” David Bazelon, the presiding judge at the trial that first
applied this criterion, believed that use of the general term “mental disease” would leave the
profession of psychiatry free to apply its full knowledge. Forcing the jury to rely on expert but often
conflicting testimony has not proved workable, however, so the Durham rule is no longer used in
most jurisdictions. Other alternatives to the insanity defense have been proposed, and in some cases
adopted. For example, sev eral states have adopted the verdict “guilty but mentally ill.” While the
person is held legally accountable for his action, his sentence involves psychotherapeutic treat
ment in a hospital or in jail. Treatment may focus on helping the convict take responsibility for his or her
own actions. Another proposal has been the plea of diminished capacity, or diminished responsibility,
whereby a defendant may be tried for a lesser crime if there is reason to suspect psychological disorder.
Its advantage is that it does not create a separate category of prisoners (or patients). Moreover, it
recognizes that responsibility exists along a continuum, with some peo ple more responsible than others
for their actions.
B. Understanding Antisocial Personality Disorder
(pp. 597–598)
IX. Rates of Psychological Disorders
(pp. 599–600)
Lecture/Discussion Topic: The Commonality of Psychological Disorders
The results of a federally funded study headed by Ronald Kessler of the University of Michigan’s Institute
for Social Research and released in early 1994 suggest ed that nearly half of people ages 15 to 54 have
experi enced at least one bout with a psychiatric disorder, and about one in three have had such an
episode over the last year. Psychological disorder peaks between the ages of 25 and 34. Affluent, well
educated people seem to suffer less anxiety than others, perhaps, Kessler sug gests, because “they’re
not as scared about their future, and can afford to buy psychological help.” Despite the high lifetime rates
of emotional problems, only one out of four people have ever received help. Kessler notes that many
mental disorders are mild, and people recover from them without help.
The study found that the most common disorders were these:
1
Major depressive episode, which constitutes at least two weeks of symptoms such as low mood
and loss of pleasure. More than 17 percent have suffered an episode in their lives, more than 10 percent
in the last year.
2
Alcohol dependence, with more than 14 percent experiencing it in their lifetime, 7.2 percent in the
last year.
3
Social phobia, a persistent fear of feeling scruti nized or embarrassed in social situations, with 13
percent experiencing it, almost 8 percent in the last year.
4
Simple phobia, or a persistent fear of objects such as animals, insects, or blood, or of situations
such as closed spaces, heights, or air travel, with more than 11 percent experiencing it in their lifetime,
almost 9 percent in the last year.
Kessler and his colleagues have released another report based on a nationally representative face
to face household survey conducted between February 2001 and April 2003. It extends earlier findings.
The researchers used the fully structured World Health Organization World Mental Health Survey
version of the Composite International Diagnostic Interview in assessing 9282 English speaking
respondents. Perhaps of greatest interest is that one quarter of all Americans met the criteria for having
a mental illness within the prior year, and fully a quarter of those had a “serious” disorder that
significantly disrupted their ability to function day to day. Although comparable studies in 27 other
countries are not yet complete, the researchers conclude that these new numbers suggest that the
United States is poised to rank No. 1 globally for mental illness. Other important findings include the
following:
•
About half of Americans will meet the criteria for a DSM IV disorder sometime in their lifetime.
•
By age 75, the lifetime probability of an anxiety disorder (including phobias) is 32 percent, of
mood disorders (including depression) is 28 percent, of impulse control disorders is 25 percent, of alcohol
abuse is 15 percent, and of drug abuse is 9 percent.
•
Median age of onset is much earlier for anxiety (11 years) and impulse control (11 years)
disorders than for substance abuse (20 years) and mood dis orders (30 years). Half of all cases start by
14 years and three fourths by 24 years.
•
Rates of mental illness have flattened in the past 15 years after steadily rising from the 1950s.
•
41 percent of those having a disorder went for treatment in the prior year which is up from 25 per
cent a decade ago. Younger adults are more likely to seek prompt care, so the stigma of mental illness
may be waning.
•
Because schizophrenia, autism, and some other severe disorders were not surveyed, the
researchers conclude that the prevalence of psychological dis orders is even higher than their statistics
suggest.
Elias, M. (1994, January 14). Many adults have glitches in mental health. USA Today, p. 4D.
Kessler, R. C., et al. (2005) Lifetime prevalence and age of onset distributions of DSM IV Disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
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