Psychology 110 Module #32 – Dissociative, Schizophrenic and
Personality Disorders
2015-2016
Essential Question: What does it mean to disconnect from reality?
Student Outcomes – Upon completion of this module, students will be able to:
1. Identify the symptoms and causes of dissociative disorders.
2. Describe the delusions, hallucinations and inappropriate emotions or behaviours
that are common to schizophrenic disorders
3. Analyze the biological factors and the psychological factors that interact to
produce schizophrenia.
4. Examine the different types of personality disorders.
Introduction – Read page 569
Dissociative Disorders
If a person has a dissociative disorder, his sense of self has become separated
(dissociated) from his memories, thoughts, or feelings. Dissociative disorders are quite
rare and usually represent a response to overwhelming stress.
3 Specific Forms of Dissociative Disorders Are:
1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity disorder
1. Dissociative Amnesia
Amnesia is memory loss, and any number of factors such as drug use, too much
alcohol, head injury, fatigue and physical disorders such as Alzheimer’s disease
can cause amnesia. To qualify as dissociative amnesia, the memory loss must be
a reaction to a traumatic event, such as serious personal threats, war, or surviving
natural disasters.
2. Dissociative Fugue
Dissociative fugue is an extended form of dissociative amnesia characterized by
loss of identity and travel to a new location. The word fugue comes from the
same root as fugitive. A dissociative fugue state can be short, lasting only a few
hours, or long, lasting months or even years. The person may develop a new
identity, form new friendships, or even enter a new line of work. As with other
dissociative disorders, the development of a fugue state is an unconscious
response to extreme stress.
*Discussion: Have you ever wanted to pick up, move, and start over somewhere else?
Why? What would be the advantages and disadvantages?
3. Dissociative Identity Disorder
Have you ever felt like a different person? Have you ever said, “I have no idea
why I did that”? Magnified to an extreme, these feelings are central features to
dissociative identity disorder (formerly known as multiple personality
disorder) – a rare and controversial disorder in which an individual exhibits two
or more distinct and alternating personalities. These subpersonalities reportedly
can differ in age, sex and self-perception of physical characteristics. Some
researchers have even reported changes in brain function, or handedness as a
patient switches from one personality to another. Sometimes subpersonalities
seem to be aware of one another and sometimes they do not.
Diagnosed cases of dissociative identity disorder have increased dramatically in
recent years. Before the 1970’s, fewer than 100 cases had ever been reported. In
the 1980’s alone, reports of more than 20,000 diagnosed cases of dissociated
identity disorder appeared, almost all of them in North America. The average
number of subpersonalities has also increased – from 3 to 12. BUT psychologists
debate whether dissociate identity disorder even really exists!
*Discussion: Do you behave differently in different situations? Have people ever
accused you of having multiple personalities?
Schizophrenic Disorders
Schizophrenia is perhaps the most frightening and most misunderstood
psychological disorder.
- Schizophrenia is not one disorder; it is a family of severe disorders
characterized by disorganized and delusional thinking, disturbed perceptions
and inappropriate emotions and behaviours.
- Schizophrenia is not “split personality”. Schiz does come from a word that
means “split”, but the split represents a break from reality, not a division of
personality (there is no psychological disorder called split personality).
- Schizophrenia occurs in about 1% of the world’s population. It typically
develops in late adolescence or early adulthood and strikes men at a slightly
greater rate than it strikes women.
Symptoms of Schizophrenia
A variety of symptoms characterize schizophrenia. No one will experience them all, but
everyone with the disorder will experience some of them. Common symptoms include
delusions, hallucinations and inappropriate emotions or behaviours.
1. Delusions – A delusion is a false belief. We all believe false things sometimes,
but the delusions of schizophrenia are more extensive, more complex, and often
longer term.
4 categories of delusions:
A. Delusions of grandeur – are false beliefs that you are more important than
you really are. People with schizophrenia may actually believe they are
someone else, such as Abraham Lincoln or Jesus.
B. Delusions of persecution – are false beliefs that people are out to get you.
Example, a person may believe that she is being followed or that the CIA is
engaging in an elaborate plot to capture her.
C. Delusions of sin or guilt – are false beliefs of being responsible for some
misfortune. For instance, a person might believe he is responsible for a plane
crash because he failed to brush his teeth one morning.
D. Delusions of influence – are false beliefs of being controlled by outside
forces: “The devil made me do it.”
*The Referential Thinking Scale (Handout 31-4)
2. Hallucinations – A hallucination is a false perception. The hallucinations people
with schizophrenia experience differ:
A. Auditory – report hearing voices and sometimes the voices tell them what to
do. This type is most common.
B. Visual – the person sees nonexistent objects or distorted images of items or
people.
C. Tactile – occur when people feel skin stimulation, such as tingling or burning
or touch that is not real.
D. Hallucinations can also distort taste or smell
Note the difference: Delusions are beliefs with no logical basis; hallucinations are
perceptions with no outside stimulation. But hallucinations often provide
“evidence” for delusions – it’s quite logical to believe someone is plotting to kill
you if you taste poison in your food.
3. Inappropriate Emotions or Behaviours – Many specific symptoms fit into the
broad category of inappropriate emotions or behaviours.
- wildly inappropriate emotions, example – laughing uncontrollably when
sadness is called for
- flat emotions (showing no emotion at all)
- some may not speak
-
-
others may produce word salad (nonsense talk)
act in inappropriate ways, example – speaking too loudly or engaging in odd
mannerisms or being completely inactive
waxy flexibility – a state in which you could place the person’s arm, as you
would place a doll’s arm, in some position of your choice and the person
would hold that position for hours
withdraw from the affairs of the world, effecting their knowledge of current
events and social skills
Types of Schizophrenia
1. Paranoid Schizophrenia – is characterized by delusions, particularly delusions
of grandeur and persecution. Auditory and other hallucinations often support the
delusions.
2. Catatonic schizophrenia – is characterized largely by variations in voluntary
movements. A person with catatonic schizophrenia alternates between 2 phases –
catatonic excitement – consisting of rapid movements, delusions and
hallucinations and catatonic stupor – with little activity or speech, flat emotion
and waxy flexibility.
3. Disorganized schizophrenia – is characterized by bizarre behaviour, delusions
and hallucinations. They are visibly disturbed. In historical time they were
thought to have “gone mad.” (Describes Emilio)
4. Undifferentiated schizophrenia – is characterized by symptoms that are
disturbed but are not clearly consistent with the other types of schizophrenia.
They do show clear evidence of the symptoms of schizophrenia, however.
Causes of Schizophrenia
1. Biological Factors
There is so much research to support biological causes of schizophrenia that
some experts say we are wrong to call it a “psychological disorder.”
Genetics – the likelihood of developing schizophrenia increases from 1% to 10%
if you have a parent or sibling with schizophrenia and 50% if you have an
identical twin with schizophrenia. However, there is no gene or set of genes that
can “cause” schizophrenia; there are many other factors.
Brain Structure – Schizophrenia is often associated with smaller amounts of
brain tissue and larger fluid-filled spaces around that tissue. For example, the
thalamus, which is responsible for the routing of our incoming sensory
information, is smaller when schizophrenia is present and may hinder the
person’s ability to focus their attention.
Brain function – PET scans have shown that the frontal lobe, the centre of our
most advanced thinking abilities, is less active when schizophrenia is present.
Brains of people with schizophrenia can have as many as 6 times the normal
number of dopamine receptor sites. Medications that block these receptor sites
reduce symptoms associated with schizophrenia, including delusions and
hallucinations. Researchers are now working on a medication that adjusts
glutamate (a different neurotransmitter) levels.
Prenatal viruses – A viral infection during the middle of pregnancy may
contribute to schizophrenia. The evidence is circumstantial but persuasive. Rates
of schizophrenia rise for individuals who were born a few months after a flu
epidemic. And the riskiest birth months in general follow the flu season.
2. Psychological Factors – The 2 areas that seem the most significant are stress
and disturbed family communication patterns. Stress can sometimes act as the
trigger that sets it off. Disturbed family communications are correlated with
the development of schizophrenia; but right now, it’s impossible to tell whether
they contribute to the cause of schizophrenia or develop as a result of
schizophrenia.
Personality Disorders
Personality disorders are lasting, rigid behaviour patterns that disrupt social
functioning. The DSM-IV-TR divides personality disorders into 3 clusters:
personality disorders related to anxiety, personality disorders with odd or
eccentric behaviour, and personality disorders with dramatic or impulsive
behaviour. Specific personality disorders are often difficult to diagnose because there
is a lot of overlap between them. The behaviour patterns are usually evident by
adolescence and obvious to others, but the person with the personality disorder often
does not recognize the problem exists, which can make treatment difficult.
1. Personality Disorders Related to Anxiety:
Avoidant Personality: People with an avoidant personality are overly sensitive
to rejection, and they fear starting relationships or anything new. They have a
strong desire for affection and acceptance but avoid intimate relationships and
social situations for fear of disappointment and criticism. Unlike those with a
schizoid personality, they are openly distressed by their isolation and inability to
relate comfortably to others. Unlike those with a borderline personality, they do
not respond to rejection with anger; instead, they withdraw and appear shy and
timid. Avoidant personality is similar to generalized social phobia.
Dependent Personality: People with a dependent personality routinely
surrender major decisions and responsibilities to others and permit the needs of
those they depend on to supersede their own. They lack self-confidence and feel
intensely insecure about their ability to take care of themselves. They often
protest that they cannot make decisions and do not know what to do or how to
do it. This behavior is due partly to a reluctance to express their views for fear of
offending the people they need and partly to a belief that others are more
capable. People with other personality disorders often have traits of a dependent
personality, but the dependent traits are usually hidden by the more dominant
traits of the other disorder. Sometimes adults with a prolonged illness or physical
handicap develop a dependent personality.
Obsessive-Compulsive Personality: People with an obsessive-compulsive
personality are preoccupied with orderliness, perfectionism, and control. They are
reliable, dependable, orderly, and methodical, but their inflexibility makes them
unable to adapt to change. Because they are cautious and weigh all aspects of a
problem, they have difficulty making decisions. They take their responsibilities
seriously, but because they cannot tolerate mistakes or imperfection, they often
have trouble completing tasks. Unlike the mental health disorder called
obsessive-compulsive disorder, obsessive-compulsive personality does not
involve repeated, unwanted obsessions and ritualistic behavior.
People with an obsessive-compulsive personality are often high achievers,
especially in the sciences and other intellectually demanding fields that require
order and attention to detail. However, their responsibilities make them so
anxious that they can rarely enjoy their successes. They are uncomfortable with
their feelings, with relationships, and with situations in which they lack control or
must rely on others or in which events are unpredictable.
2. Personality Disorders with Odd or Eccentric Behaviours:
Paranoid Personality: People with a paranoid personality are distrustful and
suspicious of others. Based on little or no evidence, they suspect that others are
out to harm them and usually find hostile or malicious motives behind other
people's actions. Thus, people with a paranoid personality may take actions that
they feel are justifiable retaliation but that others find baffling. This behavior
often leads to rejection by others, which seems to justify their original feelings.
They are generally cold and distant in their relationships.
People with a paranoid personality often take legal action against others,
especially if they feel righteously indignant. They are unable to see their own role
in a conflict. They usually work in relative isolation and may be highly efficient
and conscientious.
Sometimes people who already feel alienated because of a defect or handicap
(such as deafness) are more likely to suspect that other people have negative
ideas or attitudes toward them. Such heightened suspicion, however, is not
evidence of a paranoid personality unless it involves wrongly attributing malice
to others.
Schizoid Personality: People with a schizoid personality are introverted,
withdrawn, and solitary. They are emotionally cold and socially distant. They are
most often absorbed with their own thoughts and feelings and are fearful of
closeness and intimacy with others. They talk little, are given to daydreaming,
and prefer theoretical speculation to practical action. Fantasizing is a common
coping (defense) mechanism.
Schizotypal Personality: People with a schizotypal
personality, like those with a schizoid personality, are socially and emotionally
detached. In addition, they display oddities of thinking, perceiving, and
communicating similar to those of people with schizophrenia. Although
schizotypal personality is sometimes present in people with schizophrenia before
they become ill, most adults with a schizotypal personality do not develop
schizophrenia.
Some people with a schizotypal personality show signs of magical thinking that
is, they believe that their thoughts or actions can control something or someone.
For example, people may believe that they can harm others by thinking angry
thoughts. People with a schizotypal personality may also have paranoid ideas.
3. Personality Disorders with Dramatic or Impulsive Behaviours:
Histrionic (Hysterical) Personality: People with a histrionic personality
conspicuously seek attention, are dramatic and excessively emotional, and are
overly concerned with appearance. Their lively, expressive manner results in easily
established but often superficial and transient relationships. Their expression of
emotions often seems exaggerated, childish, and contrived to evoke sympathy or
attention (often erotic or sexual) from others.
People with a histrionic personality are prone to sexually provocative behavior or
to sexualizing nonsexual relationships. However, they may not really want a
sexual relationship; rather, their seductive behavior often masks their wish to be
dependent and protected. Some people with a histrionic personality also are
hypochondriacal and exaggerate their physical problems to get the attention
they need.
Narcissistic Personality: People with a narcissistic personality have a sense of
superiority, a need for admiration, and a lack of empathy. They have an
exaggerated belief in their own value or importance, which is what therapists call
grandiosity. They may be extremely sensitive to failure, defeat, or criticism. When
confronted by a failure to fulfil their high opinion of themselves, they can easily
become enraged or severely depressed. Because they believe themselves to be
superior in their relationships with other people, they expect to be admired and
often suspect that others envy them. They believe they are entitled to having
their needs met without waiting, so they exploit others, whose needs or beliefs
they deem to be less important. Their behavior is usually offensive to others, who
view them as being self-centred, arrogant, or selfish. This personality disorder
typically occurs in high achievers, although it may also occur in people with few
achievements.
Antisocial Personality: People with an antisocial personality (previously called
psychopathic or sociopathic personality), most of whom are male, show callous
disregard for the rights and feelings of others. Dishonesty and deceit permeate
their relationships. They exploit others for material gain or personal gratification
(unlike narcissistic people, who exploit others because they think their superiority
justifies it).
Characteristically, people with an antisocial personality act out their conflicts
impulsively and irresponsibly. They tolerate frustration poorly, and sometimes
they are hostile or violent. Often they do not anticipate the negative
consequences of their antisocial behaviors and, despite the problems or harm
they cause others, do not feel remorse or guilt. Rather, they glibly rationalize
their behavior or blame it on others. Frustration and punishment do not motivate
them to modify their behaviors or improve their judgment and foresight but,
rather, usually confirm their harshly unsentimental view of the world.
People with an antisocial personality are prone to alcoholism, drug addiction,
sexual deviation, promiscuity, and imprisonment. They are likely to fail at their
jobs and move from one area to another. They often have a family history of
antisocial behavior, substance abuse, divorce, and physical abuse. As children,
many were emotionally neglected and physically abused. People with an
antisocial personality have a shorter life expectancy than the general population.
The disorder tends to diminish or stabilize with age.
Borderline Personality: People with a borderline personality, most of whom are
women, are unstable in their self-image, moods, behavior, and interpersonal
relationships. Their thought processes are more disturbed than those of people
with an antisocial personality, and their aggression is more often turned against
the self. They are angrier, more impulsive, and more confused about their identity
than are people with a histrionic personality. Borderline personality becomes
evident in early adulthood but becomes less common in older age groups.
People with a borderline personality often report being neglected or abused as
children. Consequently, they feel empty, angry, and deserving of nurturing. They
have far more dramatic and intense interpersonal relationships than people with
anxiety related personality disorders. When they fear being abandoned by a
caring person, they tend to express inappropriate and intense anger. People with
a borderline personality tend to see events and relationships as black or white,
good or evil, but never neutral.
When people with a borderline personality feel abandoned and alone, they may wonder
whether they actually exist (that is, they do not feel real). They can become desperately
impulsive, engaging in reckless promiscuity, substance abuse, or self-mutilation. At times they
are so out of touch with reality that they have brief episodes of psychotic thinking, paranoia,
and hallucinations.
People with a borderline personality commonly visit primary care doctors. Borderline personality
is also the most common personality disorder treated by therapists, because people with the
disorder relentlessly seek someone to care for them. However, after repeated crises, vague
unfounded complaints, and failures to comply with therapeutic recommendations, caretakers
including doctors often become very frustrated with them and view them erroneously as people
who prefer complaining to helping themselves.
**Activity – Matching activity on personality disorders