Psy/410 - Antisocial Personality Disorder

Antisocial Personality Disorder

            Antisocial Personality Disorder is considered to be a type of chronic mental condition, characterized by the patient having unique and destructive ways of thinking. Individuals suffering from antisocial personality disorder usually have no regard for the wishes and feelings of those around them, and cannot differentiate right from wrong. Although this disorder begins in childhood, symptoms are usually more evident in early adulthood (Meloy, 1998). This study intends to analyze and explain the main causes and symptoms in patients with antisocial personality disorder while analyzing the case of Theodor Bundy.

Case Overview

            Theodor Bundy was born illegitimately in 1946, on November 24 in Burlington, Vermont. Bundy never knew his father, but remembered and adored his grandfather during his first three years of life while in Philadelphia. He was upset when he and his mother moved in with his uncles in Tacoma, Washington at four-years-old. Bundy also became upset and jealous when his mother became involved with Johnnie Bundy, a military base cook. Bundy’s mother and Johnnie married and by 1952 they had their first of three children. Bundy recalls that his mother went through immense pain during labor, and he related that with her pregnancies and with Johnnie (Myer, Chapman, & Weaver, 2009).

            Bundy looked up to his teacher in first grade and was upset when she was no longer present because of having her baby. On the other hand, he disliked his teacher in second grade. He remembers when he punched a child in school, and she hit his hands with a ruler. Bundy recognized at seven years old that he felt a strange feeling of a growing entity inside. He explained the feelings as uneasy and disturbing (Myer, Chapman, & Weaver, 2009).

            Throughout school, Bundy did well. He received A’s and credited his mother to his achievement. However, she never talked with him about sex or opened up with him. He said his mother was not social and never brought up her childhood. Her incited resentment of Bundy’s father caused Bundy to feel troubled about his illegitimate status during life (Myer, Chapman, & Weaver, 2009).

            Bundy attended Sunday school and studied the Bible weekly while in high school, but according to him, he did not retain it. He was aware of politics and would talk to his mother about the hypocrisy involved in Christianity. Bundy’s parents did not smoke or drink alcohol, but his stepfather was violent (Myer, Chapman, & Weaver, 2009).

            Beginning early, Bundy regularly opted to be solo. He was fascinated with radio and music. Later in life, he had a hard time socializing. As a child, he probed through garbage cans looking for photos of nude women. Although he tried to involve himself in sports, he did not pursue it because it was too serious, his mother did not want to pay for sports, and his stepfather did not want to attend to watch. Because he failed to get on a team, he was traumatized, and took up skiing (Myer, Chapman, & Weaver, 2009).

            Bundy was infatuated with material items and dreamed of becoming adopted by Roy Rogers and Dale Evans, and receiving a pony from them. He was embarrassed of his own family’s car and viewed his childhood as empty because he believed he was ignored (Myer, Chapman, & Weaver, 2009).

            Bundy had a few friends in junior high school and went to some parties, but he did not learn proper social skills and in high school became an introvert and very shy. He did not get into trouble. He dated once in high school, and felt incompetent with girls. Bundy thought he was poor in comparison to others who were wealthy. By senior year, Bundy participated in a political race and accomplished many political efforts where he was able to make more friends (Myer, Chapman, & Weaver, 2009).

            Bundy expressed having an entity inside and called it the “malignant being” that wanted him to commit murder. He insisted that the murders he committed were not because of his craving to kill, but because he wanted complete control over his target. He asserted that he kept the victims from feeling pain and the sex was not extreme. Meyer, Weaver, and Chapman (2009) say, “The ‘entity’ grew slowly within him, becoming stronger, and more powerful after every deviant act”.

            Bundy first attempt at killing was in 1974, in Seattle. For no reason, he smashed the head of a stranger, Sharon Clarke with a rod, but she survived. After a few weeks, Lynda Ann Healy, a neighbor of Sharon’s, disappeared along with many other women over seven months time. Janis Ott was another never to be seen after an encounter with Bundy and on the same day a woman vanished from a public restroom near the same lake he met Janis at. Both remains were discovered nearby. Bundy’s murdering spree went on for months. The victims were attractive, with long parted hair, white, and in college. Bundy made several attempts in a day. By 1975, he started killing women in Colorado. Women began to go missing one after another until Bundy’s arrest in August 16, 1975. A hair was found in his car that matched that of one of his murder victims, and he was tried for murder (Myer, Chapman, & Weaver, 2009).

            Bundy was charming, smart, witty, and handsome, which helped convince people into getting his way. He finagled his way out of a library window and escaped captivity. However, he was recaptured eight days later and guarded with more care (Myer, Chapman, & Weaver, 2009).

            Bundy bear witnessed that he was not guilty and was a victim of circumstance, insisting there was no clear evidence. He argued also that his description was like the one of many other men. His legal abilities enabled him to delay his case, which allowed him to escape again. He travelled to Tallahassee, Florida, where there were nearby sorority houses that housed students from Florida State University. In 1978 five girls from a sorority house were beaten badly and raped, two did not survive. A month passed and a 12-year-old went missing after school. She was later found dead with mutilated sexual organs and was strangled (Myer, Chapman, & Weaver, 2009).

            On February 15, 1978, Bundy was arrested again, but did not go without a fight. Again, he insisted he was innocent, but evidence showed that his teeth matched teeth marks on one of his victims. Bundy went to trial in Florida, where he again tried to use his charm and legal skills. He admitted to 23 murders in a teasing way, but kept himself from death for 10 more years using his talents and charm. He was proposed to many times and even had a child while in prison. However, on January 24, 1989, he was executed by electric chair in Florida, and people cheered (Myer, Chapman, & Weaver, 2009).

            According to Meyer and Weaver (2009), “Bundy is a classic case of a high Factor 1 psychopath (see following discussion)—that is, high on the indices of true psychopathy.” Ann Rule, his biographer told a story of Bundy at about age 14, when an eight-year-old went missing in the neighborhood he lived in. He knew the girl and delivered her newspaper. When in jail, Bundy was asked if he killed her, he said no as he smirked and grinned (Myer, Chapman, & Weaver, 2009).

Biological Perspective

            There are several theories that have been made about how people get antisocial personality disorder. One such theory is that people with antisocial personality disorder have alpha waves that do not function the same as most peoples. For instance, when individuals get arrested, they may feel nervous, tense and even scared perhaps. In this situation, that person’s alpha waves would be traveling at an increased rate than usual. A person with antisocial personality disorder were in the same situation, their alpha waves would be traveling at about the same rate as usual, and would therefore be able to remain quite calm. This also explains why someone with antisocial personality disorder can do some of the things that they do, and are seemingly not affected by it at all.

            Modern research supports the idea that biological factors, especially those that are derived genetically, influence the production of criminality, antisocial personality disorder, and especially psychopathy (Meyer, Chapman, & Weaver, 2009). It is unclear as to how biological factors translate into specific behaviors, there are possibilities that include deficits in specific types of intelligence skills, brain dysfunctions, neurohormonal disorders, and so on (Meyer, Chapman, & Weaver, 2009). Some characteristics of someone with antisocial personality disorder are as follows: failure to conform to social norms, deceitfulness, impulsivity, aggressiveness, and a disregard for safety to themselves as well as to others at times, irresponsibility, and a lack of remorse.

            According to Meyer, Chapman, and Weaver, the most influential modern conceptualization has viewed psychopathy as composed of two main factors, the first is affective-cognitive instability and the second is behavioral-social deviance. The following characteristics contribute to affective-cognitive instability: glibness, a grandiose sense of self, pathological lying, conning-manipulative behaviors, lack of remorse, shallow affect, callousness, and lack of empathy as well as failure to accept responsibility (Meyer, Chapman, & Weaver, 2009). Characteristics that contribute to behavioral-social deviance are a higher need for stimulation, a parasitic lifestyle, poor behavioral controls, early behavior problems, lack of realistic goals, impulsivity, irresponsibility, having been adjudicated delinquent, and a history of violating supervision (Meyer, Chapman, & Weaver, 2009).

Cognitive Perspective

Cognitive psychology is, at heart, the study of how people’s thoughts and interpretations color their behavior and reactions (Kowalski & Westen, 2011). In the Case of Ted Bundy there is a wealth of help and insight that can be gained from this branch of psychology in understanding how this individual became so disturbed. Bundy was a pathological liar and this is the stand out in terms of cognition. When someone lies to everyone around them all the time, the question becomes: does that individual know the truth? For a man to kill so many women in such a cavalier way he had to have a horrible opinion of women, he had to justify his behavior in a way that makes it non-threatening to himself and his ego and this can be accomplished through pathologically lying to himself about his true nature and the nature of the women he killed. In the case study, Bundy claims to be innocent, and maybe he thinks that he was innocent of wrong doing, because he was doing a service. In cognitive psychology the focus is not on reality, objectively reviewing facts, but rather on the thought process of a person and the automatic thoughts that they repeat in their mind constantly (Kowalski & Westen, 2011).

Behavioral Perspective

             Concepts of behavioral theory can be used to explain and treat antisocial personality disorder.  Theodore Bundy’s actions throughout his life are congruent with the definition of antisocial personality disorder; mainly because he had a complete disregard for other people’s rights and focused on his own interests at the expense of the women he killed (Hansell & Damour, 2008, p. 420).  Studies have shown that Bundy was very likely to be antisocial as an adult because his parents were as well (Meyer, Chapman, & Weaver, 2009, p. 210).  His mother resented the fact that he was an illegitimate child with no father present, plus the fact that she did not like to socialize, meant that as a toddler and young child he did not have the opportunity to experience social play and development.  This lack of early exposure to other children may have been another reason why Bundy found it difficult to integrate socially during his adult life. 

Feelings of inadequacy prevented him from participating in sports as a child; a lack of social interaction, especially from his mother and stepfather, caused him to be obsessed with possessions. This also left him with plenty of time to fantasize about how his life could be.  His family’s low income made him feel inferior to the other children in his high school, and he felt overlooked and disregarded by his parents who gave all their attention to his younger siblings (Meyer, Chapman, & Weaver, 2009, p. 210). 

            It seems Bundy modeled his outbursts of aggression (during the murders) after his stepfather who was relatively calm except for an easily triggered temper.  Other than that, his mother’s resentment and his stepfather’s other priorities led to Bundy developing during those early years with a very inconsistent parent-child relationship.  His family’s low income status in addition to the unreliable parenting resulted in unstable interpersonal relationships and an insecure attachment to possessions.  Consistent with this analysis, Bundy claims that his desire to kill was driven by his need to possess the victim (Meyer, Chapman, & Weaver, 2009, p. 210).  Bundy may have gravitated towards killing multiple women because those actions fulfilled both his need for more possessions as well as his need for an interpersonal relationship, albeit brief.

            Some have theorized that the lack of early psychopathic evidence from Bundy’s past was because his mother probably covered for some of his deviant acts (Meyer, Chapman, & Weaver, 2009, p. 212).  Behavioral theorists emphasize that antisocial traits are reinforced when parents reward manipulative or abusive behavior, which very well may have been what Bundy’s mother was covering up.  Behavioral interventions that aim to teach responsible behavior through the use of consistent punishments for inappropriate behavior and rewards for positive behavior have been found to be effective for some people with antisocial personality disorder (Hansell & Damour, 2008, p. 423).

                                    Psychodynamic Perspective

Antisocial personality disorder is mainly characterized by the sufferer’s flagrant disregard of other individuals’ rights. (Hansel & Damour, 2008). In other words, people with antisocial personality disorder are insensitive to other people’s feelings and interests; instead they solely focus on their own interests and feelings alone. Individuals with this disorder do not feel remorse or guilt for their wrong doings. The Psychodynamic application and treatment of antisocial personality disorder is linked with the assumption that the sufferers are born into dysfunctional families with physical abuse tendencies, cruel, and are emotionally turbulent (Akhtar, 1992). Consequentially, children that are born into this type of aforementioned family setting may experience helplessness feelings especially when their parents are unleashing barrages of anger and violence on them. As a result, such child may resort into using defense mechanism of identification with the aggressor, whereby the individual will want to cause others to experience the same feelings of helplessness, powerlessness, and victimization they experienced as a child).

Part of psychodynamic treatment of antisocial disorder includes psychotherapy whereby the clinician will discuss early childhood experience with the sufferer. People with antisocial disorder will act instead of feel; they find it difficult to talk about their personal emotional experiences. The feelings of helpless and a scared victim during childhood stage makes them want to scare and victimize others when they grow up (Hansel & Damour, 2008). Furthermore, the psychodynamic aspect also delves into analyzing early childhood attachments of individuals with antisocial personality disorder. Gabbard (2000) stated that “normal parent-child attachment paves the way for the internalization of a morally guiding superego and the ability to empathize with others. People with antisocial personality disorder show abnormal superego functioning and a lack of empathic ability to imagine how others feel, presumably due to disrupted parent-child relationships” (Hansel & Damour, 2008, p. 422).

Conclusion

            In conclusion, all the theories presented above offer different perspectives in explaining how antisocial personality disorder can impact the lives of not only the suffering patients, but also those around them, since psychopathy can be associated with the disorder. In fact, a report presented by the FBI in 1992 showed that most psychopathic killers met the criteria for the diagnose of antisocial personality disorder (Hare, 1996). Antisocial personality disorder can be considered as one of the most difficult disorders to treat, since it is rare that patients will seek treatment on their own. However, behavioral treatments with appropriate behavior gratification can be effective in making sure those patients are well-adjusted and safe for life in society.

References

Akhtar, S. (1992). Broken structures: Severe personality disorders and their treatment. Northvale, NJ: Jason Aronson.

Hansell, J. & Damour, L. (2008). Abnormal psychology (2nd ed.). Hoboken, NJ: Wiley.

Hare, R.D. (1996). Psychopathy and antisocial personality disorder. Retrieved from http://www.psychiatrictimes.com/antisocial-personality-disorder/psychopathy-and-antisocial-personality-disorder-case-diagnostic-confusion-0

Kowalski, R., & Westen, D. (2011). Psychology (6th ed.). Hoboken, NJ: Wiley.

Meloy, J. (1998). The psychology of stalking: clinical and forensic perspectives. San Diego: Academic Press.

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8th      ed.). Boston, MA: Pearson/Allyn & Bacon.

Psy/410 - Anxiety Case Study

Anxiety Case Study

            According to Hansell and Damour (2008, p. 123), “Obsessive-compulsive disorder (OCD) is a condition involving repetitive, unwanted, anxiety-producing thoughts and compulsive rituals intended to protect against anxiety”. Obsessions in this case of psychology, are upsetting thoughts that are not wanted, and compulsions basically are the rituals irrationally used repeatedly to neutralize or control the anxious feelings that the obsessions create. OCD is an anxiety disorder, and someone with OCD will experience unwanted thoughts and compulsions, which will interfere significantly with that person’s everyday life. OCD can develop through a person’s fears, repeated doubts, or even trauma (Hansell & Damour, 2008). The case of Bess explains more about OCD. An overview of Bess’s case will be addressed as well as how biological, psychodynamic, cognitive, and behavioral theories can be applied to developing her treatment to her disorder.

Case Overview

            Bess is 27, she is attractive, lives in an upper class apartment in the nicest part of town, but does not have many friends. An ordinary evening for Bess would entail a late workday, dinner, reading or television, a sleeping pill, and an alcoholic beverage prior to going to bed and falling asleep. Bess is an accountant at a manufacturing company. She is quite successful because of the many hours she spends at work. Bess is a perfectionist, which is an advantage to her field of work.

            Bess’s parents divorced when she was 10, she had no brothers or sisters. She was raised mostly by her mother and saw her father only occasionally. Her mother was affectionate, but Bess hardly remembers the time spent with her mother other than when she encouraged Bess to improve and regularly enrolled her in lessons, where they would argue about how much effort Bess put into those lessons. Bess’s mother regularly stressed the importance of keeping clean and neat, which was something else they argued over. Bess’s mother nagged her regularly if her room was not cleaned up, and she would clean it up, but as soon as her mother turned away she would let her room get messy. Bess’s mother repeatedly stressed that this behavior would be trouble when she grew up, but failed to explain how. Her mother displayed excessive distress over cleanliness and ensured Bess thoroughly washed her hands every time she used the bathroom or touched her genitals for any reason. Bess’s mother was disgusted by bathroom smells and used various candles and deodorizers to control the smells. At times, Bess felt unhappy, but when she told her mother, she would try to change Bess’s feelings right away. She would ask Bess how she could be unhappy considering the amount of time she spent with her. Her mother would appear upset if Bess continued to show her unhappiness.

            Bess visited her father and enjoyed her time with him because he was more relaxed. However, he was not successful and could not keep a steady job. Her father was usually happy and took good care of Bess when she visited, but her mother was not happy with Bess visiting her father and tried to sabotage the visits when she could. Bess’s mother would mention how her father was lazy and did not support the family efficiently enough.

            Bess lived the way her mother insisted, although she resisted at times, she did well in school and worked hard and meticulously on assignments. Bess was successful in school but was not popular and did not involve herself in activities. She spent her time mostly preparing for assignments and doing household chores instead. Bess was an active Methodist because her mother raised her that way, and although it was positive, there were times when she became upset and confused about being a sinner or being saved. Bess would drown herself in schoolwork or church activities to avoid the conflicted feelings. When Bess entered adolescence she became overwhelmed with erotic fantasies. Bess believed this could be against her religion and tried to manage her fantasies and distract her attention from them by drowning herself in other activities, such as crosswords and jigsaw puzzles to stay occupied for a length of time. However, her erotic fantasies continued to arise, and she began to have orgiastic sessions of masturbating.

            Bess interacted with male friends easily, but did not know how to handle sexual or romantic issues. Therefore, Bess rarely date. As a senior, she was charmed by a boy who regularly wanted to have sex, but she refused to. However, on a drunken night, she agreed, and continued to on a regular basis until she became pregnant and was forced by her mother to abort the child. Her mother took her away to Europe and when Bess returned, she discovered that her boyfriend had met someone else.

            Bess involved herself into school, became a top student, received honors, and obtained a career where she was successful and spent the majority of her time. Vague anxieties continued with Bess, including worry over dating, marriage, and family. She dealt with these anxieties by continuing to throw herself into work. However, she simultaneously experienced cleanliness symptoms similar to those displayed as a child. Her concerns turned into rituals of thorough cleanings. Bess’s rituals would start with her touching her anal or genital area. Bess’s ritual involved her taking off her clothes in a specific sequence. She laid each piece of clothing out in certain areas of her bed and inspects each piece to ensure they were clean. If an article of clothing appeared dirty, it was put in the laundry and replaced with another piece of clean clothing. Bess would scrub her body from her feet upward using specific washcloths for specific areas. Bess would redress in the reverse order from which they were taken off. If something was not right in her mind, she would begin the sequence again, doing this four or five time some days.

            Eventually Bess acquired other rituals and thoughts that were obsessive. These obsessions and rituals generally were associated with using the bathroom, sexual issues, or coming across dirtiness in public areas. Bess’s functioning in her daily life became affected as her rituals increase. Her time and energy is spent on rituals and Bess becomes aware of the absurdness of her behavior. However, Bess feels bound to continue with the rituals and finally seeks help for her behavior.

Biological Perspective

            Obsessive Compulsive disorder is an anxiety disorder as classified by the DSM-IV-TR. One of the criteria for this classification is the obsessive need to perform a task, in which are known to the person as a ritual they feel the need to complete. From a biological perspective, using a PET scan, researchers have found that the four brain structures work together in unison and become overactive as a result in a person that has Obsessive Compulsive Disorder (Meyer, Chapman, & Weaver, 2009). As studied in previous classes, the orbital frontal cortex operates as a person’s error detection circuit, this section of the brain alerts the rest of the brain when something is wrong and needs to be taken care of.  In a person that has obsessive compulsive disorder, this part of the brain is hyperactive, so this person will keep fixing what they think is wrong such as making sure the door is locked or the stove is shut off (Meyer, Chapman, & Weaver, 2009). Another section deep in the core of the brain signal that there is something very wrong is the caudate nucleus and the cingulate gyrus. These parts of the brain will make a person’s heart pound and give the feelings of anxiety (Meyer, Chapman, & Weaver, 2009). The section of the brain in which the sensory information is processed within the thalamus will also work in unison with the other sections of the brain. When a person with obsessive compulsive disorder becomes more active metabolically, the other structure do as well, which is not the case in a healthy person (Meyer, Chapman, & Weaver, 2009).

            A person with Obsessive Compulsive disorder have a tendency of learning these behaviors from their parents or the people they are around as a child, as in the case with Bess, she was taught to be obsessive compulsive about keeping her room clean and studying hard by her mother. Since Bess was raised by a single mother who had very little contact with her father, Bess was influenced heavily by her mother and how and what she had been taught growing up.

Psychodynamic Perspective

            Since obsessive compulsive disorder can be difficult to treat, there is a very wide variety of treatments available in which psychoanalysts have had some success (Meyer, Chapman, & Weaver, 2009). There is also a danger in this treatment as an obsessive compulsive individual has a history of using intellectualization as a defense mechanism, and the technique of free association in psychoanalysis can be easily abused by intellectualization (Meyer, Chapman, & Weaver, 2009).

            Studies have also shown that cognitive behavior modification can be effective in the treatment of obsessive compulsive disorder. In these studies, Schwartz and his colleagues have shown that cognitive behavioral modification can reverse the obsessive compulsive physiological “locking up” of the brain and the four sections that seem to work in unison with the obsessive compulsive individual (Meyer, Chapman, & Weaver, 2009).

            As in the case with Bess, her treatment started with cognitive behavior modification as well as thought stopping or response prevention (Meyer, Chapman, & Weaver, 2009). Her therapist set a regiment of thought stopping, Bess was trained to stop the obsessive behavior as she shouted “stop” and to evaluate her consciousness. As she did this there was an electric shock that reminded her that her obsessive thoughts were being disturbed. This thought stopping process integrated to Bess that her obsessive compulsive behavior could be changed or controlled, which gave light to being trained in a new way with positive behaviors.

Cognitive Explanations

            Many cognitive formulations have been created to explain obsessions and compulsions like OCD, especially by psychologists like Clark (2002), Salkovskis (1985, 1989, 1998), and Rachman (1997, 1998). Although their ideas presented different components, they all had the common underlying assumptions about the cognitive roots of OCD, such as the explanations that most obsessions have their origin in intrusive, distressing, and unwanted thoughts, impulses, and images. Although these are present in most individual’s minds, some individuals lack control over them, which results in obsessions (Frost & Steketee, 2002).

            In the case of Bess, as it happens to most individuals who suffer from OCD, it is possible to observe the common feature of an enlarged and inflated sense of responsibilities over outcomes. In other words, patients tend to think that their actions will eventually lead to harm to themselves or others. In this case, Bess had a ritual of making sure her body and her clothes were impeccably clean, by fear of being “contaminated”.

            A very effective treatment for patients like Bess is Cognitive-behavior modification, which can actually reverse the OCD symptoms. By learning to relabel their urges, and calling them for what they were (for example, instead of saying “I need to wash my clothes again”, saying “I’m having a compulsion again”), patients would learn to swift their attention to another activity and regain control of their thoughts (Meyer, Chapman, & Weaver, 2009).

Behaviorist Perspective

            Behaviorists believe that all behavior can be explained in terms of rewards and punishments (Kowlaski & Westen, 2011). Therefore Bess is being rewarded by her environment by performing her rituals and being overly clean and tidy. When you consider the way that Bess’s mom expressed her love to her as a child, and when she withheld her love it follows that Beth would do her best to do things that make her mother love and accept her and avoid behaviors that result in painful censure. When she was clean and orderly, her mother Bess praised Bess. When her room or her environment were not clean then she was punished. To gain the rewarding feeling of her mother’s love Bess cleans and tries to be as orderly as possible.

Behaviorists also talk about the importance of modeling and learned behavior (Decker, 2010). Bess did not learn how to cope in a vacuum, rather she watched her mom deal with everyday stress and chronic stress by cleaning and in being orderly. When the house was a mess her mother was unhappy and Bess saw that. Cleanliness brought her mother joy, so Bess would learn this as a coping strategy and use it when she felt lost and out of control.

            In conclusion, all the theories presented above offer alternatives to significantly change Bess’ reality of OCD. By analyzing her past experiences with her mother, having a doctor analyze her brain, and even try to learn new thought processes, Bess and other patients suffering from OCD can finally change their behaviors and thoughts and learn to live a normal life. Obsessive Compulsive disorder is much more common that originally perceived, and it has no cultural boundaries. Each of the approaches presented has its own specific advantages to target different cases and challenges. Different theoretical perspectives can be integrated, allowing therapists and physicians to have an even broader spectrum of possibilities to help patients.

References

Deckers, L. (2010). Motivation: Biological, psychological, and environmental (3^rd ed). Boston:      Pearson/Allyn &Bacon.

Frost, Randy O., and Gail Steketee. Cognitive Approaches to Obsessions and Compulsions:          Theory, Assessment, and Treatment. Amsterdam: Pergamon, 2002. Print.

Hansell, J., & Damour, L. (2008). Abnormal psychology (2nd ed.). Hoboken, NJ: Wiley.

Kowalski, R., & Westen, D. (2011). Psychology (6th ed.). Hoboken, NJ: Wiley.

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8^th       ed.). Boston: Pearson/Allyn & Bacon.

Psy/410 - Schizophrenia Case Analysis

Schizophrenia Case Analysis

            Schizophrenia is a disorder displaying prominent symptoms of psychosis or lost touch with reality, hallucinations, and possibly delusions, along with declining adaptive functions. A subtype of schizophrenia is Undifferentiated Schizophrenia (Hansell & Damour, 2008, p. 454). The case of Sally explains common behavior of an individual with undifferentiated schizophrenia. An overview of Sally’s case will be addressed as well as how biological, psychodynamic, cognitive, and behavioral theories can be applied to developing her treatment to her disorder.

Case Overview

            Sally’s start in life was quite poor. During her mother’s pregnancy, she smoked two packs of cigarettes per day, despite her doctor’s warnings against it. During the fifth month of her mother’s pregnancy, she caught the flu. There were also reasons to think Sally inherited schizophrenia. Her mother’s father was thought to suffer from mental instability and was referred to as eccentric, nuts, or crazy. Compared to most, Sally developed slowly. She talked later than most children and walked later than most children. Sally was overly active but not considered by her doctor to be hyperactive.

            When Sally was only two, her parents were separated for about 10 months, but got back together to continue their struggling marriage. Her parent’s marriage was not peaceful nor was it consistent. They tried to be good parents to Sally, because they could not have more children. Her father played with her often despite his job’s requirement to travel. However, at times he was extremely critical because he believed she was behind. Sally’s mother on the other hand, had a deep relationship with her.

            Sally withdrew from studying and displayed fantasy behavior despite that she was smarter than average and her mother strongly encouraged her. She showed to be below average in many subjects, as if her thinking was not normal. Sally had few friends because her mother was overprotective, and Sally’s odd behaviors did not allow her to keep friends or establish deep relationships with the friends she did have. Because she did not get the feedback within friendships, or have an active social life, she began to establish additional unusual mannerisms and interests, which resulted in even more distance to social activity.

            When Sally completed high school, her parents let her board at a collage nearby, but the new environment caused her stress, and she began talking to herself. Her counselor witnessed her odd behavior. She was unresponsive, sitting in her room, staring at the ground. When the counselor tried to move her arms, the limbs stayed in place. In this catatonic state, called waxy flexibility, Sally had to be put in the hospital, but her condition quickly returned to normal. Upon her return to school, she skipped class. Therefore, her mother took her back home so she could look after her. Sally’s condition only worsened, and she began to show patterns of unresponsive behavior with bouts of rocking and laughing. Sally’s father was persistent in getting Sally admitted to a hospital, but they released her once she showed improvement, and her mother did not follow through with the doctor’s orders of aftercare.

            Eventually, Sally obtained a part-time job in a small store nearby, as a clerk. She spent her time off at home, mostly in her room. At this time, her father died of a heart attack, and her mother became more dependent on Sally. She began to wander around on her way from work back home, likely to avoid her mother. Sally’s behaviors became even stranger, and a police officer found her in a park, walking around in a shallow pond, talking to herself. He took her into the hospital once again. Sally was transferred to a mental hospital.

            Sally experienced many relapses. She was diagnosed with Undifferentiated Schizophrenia and given a poor prognosis for a cure. Sally was likely to continue this pattern and be admitted and released from hospitals repeatedly with recommendations of treatment to follow so that she could cope.

Biological Theory

            The biological perspective or genetic aspect of schizophrenia has been the most researched. Researchers believe there is a biological process at work in schizophrenia development. Researchers have linked genetic predisposition with occurrences of stress in late adolescence and early adulthood. Researchers have proposed that schizophrenia is inherited and in Sally’s case, her grandfather was thought to have schizophrenia but was never properly diagnosed.

            Within the last decade, scanning techniques have shown that type II schizophrenic people have a larger brain cavity and cerebrospinal fluid and smaller temporal lobes, frontal lobes, and an abnormal blood flow to specific parts of the brain. There is other research that indicates other genetic factors as well such as complications at birth, immune reactions, fetal development, and toxins may play a role in the development of schizophrenia. In the case of Sally, during her mother’s pregnancy, she had a severe case of the flu. Researchers have proven that trauma from a virus in the second trimester of pregnancy can increase the risk of the unborn child developing schizophrenia. The theory is that when pregnant in the second trimester, a severe virus can disrupt the migration of cells resulting from the breaking up of the neural sub-plate (Hansell & Damour, 2008). Any potential brain disorder such as genetic problems, birth disorder, and trauma, viral or infectious disorder may be contributing factors in displaying symptoms of schizophrenia (Hansell & Damour, 2008).

            In Sally’s case, her treatment was given to her after the third time she was hospitalized, thus her treatment was not effectively treated until late in the process of her disorder, which is not uncommon with schizophrenic’s (Hansell & Damour, 2008). Her treatment included medication, which was Thorazine, Sally also went to inpatient group therapy as well as talking to a psychiatrist twice a week. With the exception of counseling for families with known high risks of schizophrenic offspring, no preventative measures are currently available. There are somatic treatments that are available, it is also noted that biological treatments work best when they are combined with psychosocial intervention (Wyatt, Apud, & Potkin, 1996).

Psychodynamic Theory

            The psychodynamic theory focuses on unconscious motivation, struggles between the id, ego, the superego, and the importance of the first few years of life in determining lifelong behavior (Feist & Feist, 2009).  If Sally were to see a psychoanalyst, her therapist would focus on Sally’s relationship with her parents. Her mother’s overdependence on Sally and her father’s rejection both work together to create feelings of hostility in Sally. 

            It is understandable to a person observing that Sally would feel angry at her mother for depending on Sally, not allowing her to be a child with friends, not taking care of herself when pregnant with Sally, and for not protecting Sally from her emotionally abusive father. Sally would repress these feelings because after all her mother is the only person she can depend on. Anger toward her mother might alienate the one companion she has, so she directs the anger inward. Her disorder functions as a constant punishment for things that she may have done wrong while having the dual purpose of punishing her mother, and allowing her to avoid the next stage in life because she never mastered the earliest stages.

            If Sally were well, she would have to deal with many of life’s stressors, such a paying her own bills, finding a potential life partner, and raising children, all of which Sally has been poorly prepared for. Her sickness prevents her from having to participate in the real-world and has a function because she can escape the chaotic nature of emotion, such as the emotion she had to endure watching from her parents when they fought during her childhood. She never has to make choices, fall in love or be a prisoner of love like her parents because she is unwell. Her id, remains unseen, and unacknowledged, but continues to influence her thought process and allows her to embrace conflicting ideas, she is sick, but it serves a purpose and protects her from the harsher alternative (Feist &Feist, 2009).

Cognitive Theory

            Cognitive psychology tries to understand how individuals process information, react to stimuli, and create responses. In other words, this theory focuses on the many variables that can outcome from the relationship between stimulus/input and response/output. Internal processes like perception, language, attention, thinking, and memory are part of this theory’s focus. The cognitive theory suggests that most disorders are consequences of negative thoughts and behaviors, which are commonly based on false assumptions made by the patient. This approach tries to understand how psychological disorders are affected by the individual’s thoughts, reasoning, and perceptions (Meyer & Weaver, 2009).

            In the case of Sally, as in most schizophrenia cases, many cognitive symptoms can be listed, as cognitive functioning is always impaired in patients, either moderately or severely. These symptoms include poor executive functioning, or in other words, the individual’s ability to make decisions based on his or her interpretation of information; inability to pay attention in certain situations for long periods; inability to store recently learned information and use it right away (Keefe & Harvey, 2012).

            Researchers from the University of Pennsylvania discovered that cognitive therapy can improve the daily functioning and the life quality of those patients suffering from schizophrenia, even the lowest-functioning cases. Cognitive therapy, which was introduced by Aaron Beck in the 1970s, tries to help patients by identifying and changing disruptive thinking as well as dysfunctional behavior and emotional responses. It was originally developed as a method to provide treatment for residual symptoms. The technique involves emphasis on the normal processes of dealing with adversity, the use of over learning, stimulation, and role playing, the practice of behavioral coping skills, and other techniques to promote the well-being and mental stability of patients dealing with schizophrenia (Paulette, 2009).

Behavioral Theory

            Behaviorism believes that most individuals are born without any knowledge, and acquire new skills and learn new behaviors throughout live through classical conditioning and operant conditioning processes, which assimilate stimuli and provoke learning. This approach also believes that most psychological disorders are results to maladaptive learning. For instance, classical conditioning, which involves learning by association, can explain the cause for most phobias; operant conditioning, on the other hand can explain abnormal behaviors like eating disorders because it is based on an intricate system of rewards and punishments (Meyer & Weaver, 2009).

            In the case presented above, the behavioral theory would explain that although researchers suggest neurological factors contribute to schizophrenia, Sally may have learned many abnormal behaviors from her inconsistent parents. Because of the instability in her house growing up, Sally became more sensitive to the influences from the environment that normal. However, the behavioral approach believes that the same way behaviors can be learned and unlearned.

            As a treatment, behavioral therapy could help Sally tremendously in the way of living with her disease and adapting to it. Therapy could not cure Sally’s schizophrenia, but it would teach her to focus on current behaviors and problems instead of on the underlying causes of her disorder. Following the premise that behavior is learned, by using methods like systematic desensitization, Sally could learn to remove the fear factor from her responses and focus on relaxation methods to walk her through unpleasant episodes (McLeod, 2010).

            In conclusion, the theories addressed can be applied to the treatment of Sally’s disorder. The biological theory is the genetic aspect and believed to be a strong link to how schizophrenia is developed. In Sally’s case genetics is thought to be significant to her treatment process. The psychodynamic theory involves struggles in early years. Had Sally received treatment sooner, this theory would suggest therapy that focuses on the impact of issues with her parent’s marriage, her mother’s extreme dependence on Sally, and her father’s criticalness. The cognitive theory suggests that treatment involving the understanding of how Sally processes information, reacts to stimuli, and creates responses. Cognitive therapy is said to help improve the lives of schizophrenics by identifying and changing certain thinking, dysfunctional behavior, and emotional responses. The behavioral theory says that Sally could have learned her way to abnormality because of her upbringing and her environment growing up. Therefore, this theory would indicate that treatment should include unlearning undesired behaviors. Sally’s treatment came late and was not as effective as wanted. Medication was used along with group therapy and seeing a psychiatrist weekly. Sally was given a poor prognosis for a complete cure and was likely to continue her pattern of repeated hospitalizations. However, treatment will help Sally learn to live with her disease and arm her with techniques in adapting.

References

Feist, J., & Feist, G. (2009). Theories of personality (7^th ed.). New York: McGraw Hill.

Hansell, J. & Damour, L. (2008). Abnormal Psychology (2^nd ed.). Hoboken, NJ: Wiley

McLeod, S. A. (2010). Behavioral Therapy - Simply Psychology. Retrieved from             http://www.simplypsychology.org/behavioral-therapy.html

Meyer, R., Chapman, L. K., & Weaver, C. M. (2009). Case studies in abnormal behavior. (8^th       ed.). Boston: Pearson/Allyn & Bacon.

Paulette, M. (2009). Cognitive behavior therapy for people with schizophrenia. Retrieved from             http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/

Wyatt; Apud; Potkin. Interpersonal and biological Processes, Vol 59(4), Nov. 1996, 357-370