Schizophrenia and Personality
Disorders
Chapter 16
Psychological Disorders
Schizophrenia
 Nearly 1 in 100 people will develop it, joining
the 24 million across the world who have it.
 One of humanity’s most dreaded disorders –
the cancer of psychological disorders.
 Typically strikes young people just entering adulthood.
 Knows no national boundaries.
 Affects both males and females – though men seem to be
struck earlier, more severely, and slightly more often.
the
Schizophrenia means “split mind”
Symptoms of Schizophrenia
 Disorganized Thinking
 Fragmented (word salad) – Jumping from one idea to another may occur
even within sentences.
 Bizarre
 Distorted with false beliefs (delusions).
 Paranoid tendencies – prone to delusions of persecution.
 Different psychologists believe disorganized thoughts result from:
 A breakdown in selective attention
 Deficiencies in clearing the working memory of distracting info
 Disturbed perceptions
 May perceive things that are not there (hallucinations).
 Usually auditory and often take the form of voices making insulting statements
or giving orders.
 Less common – see, feel, taste, or smell things that are not there.
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Mary Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
(Sheehan, 1982)
Other
forms of delusions
delusions
of
This
monologue
illustratesinclude,
fragmented,
bizarre
persecution
is following
me”) or
thinking
with (“someone
distorted beliefs
called delusions
grandeur
(“I am
a king”).
(“I’m Mary
Poppins”).
Example of a Word Salad
 One young man begged for “a little more
allegro in the treatment,” and suggested that
“liberationary movement with a view to the
widening of the horizon” will “ergo extort
some wit in lectures.”
Many psychologists believe disorganized thoughts result from a breakdown in selective
attention.
• We normally have a remarkable capacity for selective attention.
• Those with schizophrenia cannot do this.
• Thus, an irrelevant stimulus or an extraneous part of the preceding thought easily
distracts them.
• Minute stimuli, such as the grooves on a brick or the inflections of a voice, may
distract their attention from the whole scene or the speaker’s meaning.
Hallucinations – Hearing Voices
Delusions – distorted, false beliefs
Symptoms (cont.)
 Inappropriate emotions and Actions
 May laugh when inappropriate, become angry for no apparent
reason, or cry when others laugh.
 Some lapse into a flat affect – zombielike state of apparent apathy.
 Motor behavior may also be inappropriate
 Senseless, compulsive acts (rocking or rubbing an arm)
 Catatonia – motionless for hours on end, then become agitated.
 Supportive environment – some eventually recover to live
normal lives, some have bouts intermittently, others remain
withdrawn and isolated.
Rarely is schizophrenia a one-time
Types of Schizophrenia
 Not a single disorder
Positive Symptoms
(presence of inappropriate behaviors)
Hallucinations
Delusional
Disorganized speech
Inappropriate emotions
Negative Symptoms
(absence of appropriate behaviors)
Toneless voices
Expressionless faces
Mute
Rigid bodies
 May develop gradually or from long history of social inadequacy*.
 Called chronic (or process) schizophrenia – recovery is doubtful
 Often exhibit the negative symptom of withdrawal
 Other times, it appears suddenly – reaction to stress
 Called acute (or reactive) schizophrenia – recovery more likely
 Men:
 On average develops 4 years earlier than women
 More often exhibit negative symptoms and chronic schizophrenia
Subtypes of Schizophrenia
 Paranoid
 Residual
Preoccupation with delusions
or hallucinations, often with
themes of persecution or
grandiosity
Withdrawal, after
hallucinations and delusions
have disappeared
 Catatonic
Immobility (or excessive,
purposeless movement),
extreme negativism, and/or
parrot-like repeating of
another’s speech or
movements
 Disorganized
Disorganized speech or
behavior, or flat or
inappropriate emotion
 Undifferentiate
d
Many and varied
Understanding Schizophrenia
Brain Abnormalities
Dopamine Overactivity
Imbalances in brain
chemistry might
underlie schizophrenia.
(“mad as a hatter”)
Six-fold excess of the D4
dopamine receptors found
in some schizophrenic
brains after death.
(Mad as a hatter refers to
the psychological
deterioration of the British
hatmakers whose brains, it
was later discovered, were
slowly poisoned as they
moistened the brims of
mercury-laden felt hats
with their lips.)
Excess dopamine may
intensify brain signals –
creating positive symptoms,
such as hallucinations and
paranoia.
Drugs that block lessen
symptoms; drugs that
increase levels (amph. &
cocaine) may intensify—
reason for overreaction to
irrelevant stimuli.
Impaired Glutamate
Activity
(a neurotransmitter that
directs neurons to pass
along an impulse)—It
appears to be another
source of symptoms.
Drugs that interfere with
these receptors can
produce negative
symptoms.
Medications that
neutralize these drugs
seem to alleviate negative
symptoms.
 Abnormal Brain Activity and Anatomy
 Schizophrenia involves not one isolated brain
abnormality but problems with several brain regions and
their interconnections.
 Low brain activity in the frontal lobes (reasoning, planning, problem solving)
 Decline in brain waves that reflect synchronized neural firing in frontal lobes
 PET scan studies while hallucinating – brains vigorously overactive in several
core regions, including the thalamus.
 Enlarged, fluid-filled areas and a corresponding shrinkage of cerebral tissue
seem characteristic, esp. in men.
 What causes these abnormalities
 Problem during prenatal development or delivery
 Low birth weight and oxygen deprivation are risk factors
 Famine is a suspect (Dutch wartime famine / eastern China)
 Maternal Virus during Midpregnancy
 Impaired fetal brain development
 How to test – studying questions
 Flu epidemic?
 Densely populated areas – viral diseases spread more easily?
 Born during winter and spring after fall/winter flu season?
 Southern hemisphere – are births similarly reversed?
 Mothers sick with flu during pregnancy more likely?
 Blood drawn from pregnant women whose children develop it shows evidence of
viral infections?
 98% of women that catch the flu during 2nd trimester do not have
children with schizophrenia, but still a flu shot is recommended.
 Why might flu during pregnancy be a cause?
 Virus itself?
 Mother’s immune response to it?
 Medications taken?
 Infection weakens brain’s supportive glial cells – reduced synaptic connections?
 Genetic Factors
 Inherit predisposition to certain brain abnormalities?
 Evidence says yes, some do.
 The 1 in 100 odds of any person being diagnosed with schizophrenia becomes 1 in
10 if a sibling or parent has it (twins with separate placentas) and 1 in 2 if an
identical twin has it.
 Adopted children of a parent who gets schizophrenia do not get it – risk goes up if
biological parent has it.
 But remember, not all identical twins both get it
 So genetics may not be enough
 Maybe, there is a predisposition
 Maybe, viral infections, lack of oxygen during birth, etc. are factors as well.
So what happens if researchers develop
genetic tests that reveal who is at risk?
Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 2001).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
You cannot “catch” schizophrenia
 Psychological Factors
 No environmental causes have been discovered that will invariably,
or even with moderate probability, produce schizophrenia in
persons who are not related to a person with schizophrenia.
 Psychologists long ago ceased blaming parents.
 If genes predispose some people to react to particular experiences
by developing schizophrenia, then there must be identifiable
triggering experiences.
 Can stress trigger schizophrenia?
 Can difficulties in family communications be a contributing factor?
 The answer is a strong maybe – psychological triggers have proved elusive,
partly because they vary with the type and speed of its onset.
Early Warning Signs
 Mother whose schizophrenia was severe and long-lasting
 Birth complications
 Separation from parents
 Short attention span and poor muscle coordination
 Disruptive or withdrawn behavior
 Emotional unpredictability
 Poor peer relations and solo play
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicol & Gottesman,
1983).
Courtesy of Genain Family
Genain Sisters
The genetically identical
Genain
sisters suffer from
schizophrenia. Two more than
others, thus there are
contributing environmental
factors.
Personality Disorders
Personality Disorders
 Inflexible and enduring patterns of behavior that impair one’s social
functioning.
 Avoidant personality disorder
 Expresses anxiety, such as fearful sensitivity to rejection (can become withdrawn)
 Schizoid personality disorder
 Expresses eccentric behaviors, such as emotional disengagement
 Histrionic personality disorder
 Displays shallow, attention-getting emotions and goes to great lengths to gain
others’ praise and reassurance
 Narcissistic personality disorder
 Self-focused – exaggerate their own importance – aided by success fantasies
 Find criticism hard to accept, often reacting with rage or shame.
 Borderline personality disorder
 Unstable identity (sense of self), unstable relationships, and unstable and impulsive
emotions
Charles Manson and Jeffrey Dahmer
Antisocial Personality Disorder
 Formerly called sociopath or psychopath.
 Typically male whose lack of conscience
becomes plain before age 15
 begins to steal, lie, fight, display unrestrained sexual behavior
 About ½ of those children become antisocial adults
 Cannot hold a job
 Irresponsible as a spouse and parent
 Assaultive or otherwise criminal
 Combine antisocial personality with keen intelligence
and amorality – charming and clever con artist or worse.
 Example: Ted Bundy
 Most criminals do not fit this description, because they show
responsible concern for family and friends.
 Antisocials feel and fear little and show little regret over violating
others’ rights.
 Example: Henry Lee Lucas
Henry Lee Lucas and Otis Toole
Adam Walsh
 Henry Lee Lucas - At age 13, he strangled a woman who refused





to have sex with him.
At one time confessed to having bludgeoned, suffocated, stabbed,
shot, or mutilated some 360 women, men and children during
his 32 years of crime.
During the last 6 years of his reign of terror, he teamed with
Elwood Toole, who reportedly slaughtered about 50 people he
“didn’t think was worth living anyhow.”
It ended when Lucas confessed to stabbing and dismembering his
15-year-old common-law wife, who was Toole’s niece.
Lucas said, “Once I’ve done a crime, I just forget it.”
Toole was equally matter-of-fact: “I think of killing like smoking
a cigarette, like another habit.”
 PET scans of 41 murderers’ brains and a follow-up:
 Reduced activity in frontal lobes (impulse control)
 Violent repeat offenders – 11% less frontal lobe tissue
 Helps explain why they exhibit marked deficits in frontal lobe cognitive
functions, such as planning, organization, and inhibition.
Figure 12.3 Murderous minds
Myers: Psychology in Everyday Life, First Edition
Copyright © 2009 by Worth Publishers
Understanding APD
 Woven of both biological and psychological strands.
 Their genetic vulnerability appears as a fearless approach to life. When
awaiting aversive events, such as electric shocks or loud noises, they
show little autonomic nervous system arousal.
 As youngsters, before committing any crime, the react with lower levels of
stress hormones than do others their age.
 Have detected signs as early as 3 to 6 years old.
 Twin and adoption studies
 Biological relatives of those with APS are at risk
 Helps explain the reunion of long-separated sisters Joyce Lott (27) and
Mary Jones (29) in a South Carolina prison where both went on drug
charges. After a newspaper story about the reunion, their long-lost half
brother Frank Strickland called. He too was in jail on drugs/burglary, and
larceny charges.
 May start out as fearless, impulsive, uninhibited, low in
anxiety, unconcerned with social rewards.
 Channeled properly can lead to heroes or star athletes
 Unchanneled may lead to con artist or killer.
 Sociocultural Factors
 1997 comparison to 1960
 Twice as likely to be murdered
 4 times as likely to be robbed or raped
 5 times as likely to be assaulted
The gene pool hasn’t changed
 One quarter-century study followed 1037 children:
 Two combined factors predicted antisocial problems
 Childhood maltreatment
 A gene that altered neurotransmitter balance
 Genes predisposed some children to be more sensitive to maltreatment.
 With antisocial behavior, as with so much else, nature and nurture
interact.
Predictors of Psychological Disorders
One predictor of mental disorder is poverty.
 The incidence of serious psychological disorders
is doubly high among those below the poverty
line.
 Does poverty cause disorders – OR – do
disorders cause poverty?
 It is both, though the answer varies with the
disorder.
 Schizophrenia understandably leads to poverty.
 Yet, the stresses and demoralization of poverty
can also precipitate disorders, esp. depression in
women and substance abuse in men.
Age Factors
 Those who experience a psychological disorder usually do so by
early adulthood.
 The symptoms of antisocial personality disorder and of phobias are
among the earliest to appear, at a median age of 8 and 10,
respectively.
 Symptoms of alcohol abuse, OCD, bipolar disorder, and
schizophrenia appear at a median age near 20.
 Major depression often hits somewhat later, at a median age of 25.
The bewilderment, fear, and sorrow caused by psychological
disorders are real; but, as Chapter 17 shows, hope, too, is real.
Resources
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