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What Are Psychological Disorders? I. Defining Abnormality A. Deviation from Normality 1. Abnormality is any deviation from the average or from the majority. a. Has serious limitations i. If most people cheat on their income-tax returns, are honest taxpayers abnormal? ii. Different cultural norms must also be taken into consideration. B. Adjustment 1. Normal people are able to get along in the world – physically, emotionally and socially. Abnormal people are the ones who fail to adjust. a. They may experience so much anxiety that they can’t eat or sleep or they may be lethargic and cannot hold a job. b. Cultural context must also be taken into consideration (ethnicity, gender, socio-economic status) C. Psychological Health 1. Just as there is an ideal way for people to function physically, there is also an ideal way for people to function psychologically. 2. Determining what is ideal is somewhat arbitrary and can lead to mislabeling a person. (homosexuals) D. Caution should be taken when diagnosing someone as mentally ill. E. Mild psychological disorders are common and only when a psychological problem becomes severe enough to disrupt everyday life that it is though of as abnormal. II. Classifying psychological disturbances A. Categorizing psychological problems is difficult because the causes, symptoms and cures are rarely obvious or clear-cut. B. In 1952, the APA created a system for classifying abnormal symptoms called the Diagnostic and Statistical Manual of mental Disorders or DSM. The book has been revised 4 times and its current edition DSM-IV was published in 1994. The DSM-V is scheduled to be released in May 2013. C. Within each diagnostic category of the DSM-IV, the following descriptions are included: 1. Essential features – characteristics that define the disorder 2. Associated features – additional features that are usually present 3. Differential diagnosis – info on how to distinguish the disorder from other disorders with which it might be confused 4. Diagnostic criteria – a list of symptoms, taken from the essential & associated features, that must be present for a patient to be given a particular diagnosis. D. In early editions, it was difficult to give a patient more than one label but the DSM-III and now the DSM-IV overcame this problem by using five major dimensions, or axes, to describe a person’s mental functioning. Each axis reflects a different aspect of a person’s case. 1. Axis I – used to classify current symptoms into explicitly defined categories. Major disorders of Axis I 2. Axis II – used to describe developmental disorders and long-standing personality disorders or maladaptive traits such as compulsiveness, overdependency or aggressiveness. Can also be used to describe specific developmental disorders for children, adolescents and adults such as learning disorders, mental retardation, autism or speech problems. (It is possible for a person to have a disorder on Axis I & II) 3. Axis III – used to describe physical disorders or general medical conditions that are potentially relevant to understanding or caring for a person (brain damage or a chemical imbalance) 4. Axis IV – a measurement of the current stress level at which the person is functioning. The rating is based on what the person has experienced in the last year. 5. Axis V – used to describe the highest level of adaptive functioning present within the past year. Global Assessment Functioning – 100 point scale based on: a. Social relations – quality of a person’s relationships b. Occupational functioning – functions as a worker, student or homemaker & the quality of the work accomplished. c. Use of leisure time – recreational activities or hobbies & the degree of involvement & pleasure a person has in them. 6. Example Diagnosis Patient #1 Axis I: 296.84 Bipolar Disorder, Early Onset. Axis II: 301.6 Dependent Personality Disorder Axis III: None Axis IV: Child abuse victim, unemployment Axis V: 28 Patient #2 Axis I Axis II Axis III Axis IV Axes V Patient #3 Axis I: Axis II: Axis III: Axis IV: Axis V: 309.00 Adjustment Disorder with Depressed Mood Alcohol Abuse Cannabis Abuse No Diagnosis of Axis II Hypothyroidism 305.00 305.20 V71.09 244.9 None GAF = 50 (on admission) GAF = 62 (on discharge) V71.09 No diagnosis V62.89 Borderline Intellectual Functioning Fetal Alcohol Syndrome by history Occupational and Educational problems GAF=75 The 5 part diagnosis may be extremely helpful to researchers trying to discover connections among psychological disorders & other factors such as stress & physical illness. Also, it is important to note that many people develop a disorder listed in the DSM-IV at some point in their lifetime but most will be temporary. Anxiety Disorders Anxiety is a general state of dread or uneasiness that a person feels in response to a real or imagined danger. Anxiety disorders are the most common type of mental illness in the US, affecting 19 million annually. The main types of anxiety disorders are Panic Disorder, Specific Phobias, Generalized Anxiety Disorder, Post-tramatic Stress Disorder, Obsessive-compulsive Disorder. 1. PANIC DISORDER • A problem characterized by recurrent panic attacks. • Symptoms of a panic attack 1. palpitations, pounding heart, or accelerated heart rate 2. sweating 3. trembling or shaking 4. sensations of shortness of breath or smothering 5. feeling of choking 6. chest pain or discomfort 7. nausea or abdominal distress 8. feeling dizzy, unsteady, lightheaded or faint 9. derealization (feeling of unreality) or depersonalization (being detached from oneself) 10. fear of losing control or going crazy 11. fear of dying 12. numbness or tingling sensations 13. chills or hot flushes • A panic attack usually lasts only a few minutes, but such attacks may recur for no apparent reason. A single incident of a panic attack is NOT considered a panic disorder. It’s when the person has them over and over, that a diagnosis of panic disorder is made. • Panic attacks leave the sufferer with a dread of having another panic attack that may cause them to develop agoraphobia (the fear of open places). Sufferers will avoid any circumstance that might cause anxiety and cling to people or situations that help keep them calm. 2. SPECIFIC PHOBIA • An intense, paralyzing fear of something that perhaps should be feared, but the fear is excessive and unreasonable. • The fear in a specific phobia is so great that it leads the person to avoid routine or adaptive activities and thus interferes with life functioning. 3. GENERALIZED ANXIETY DISORDER • Prolonged vague but intense fears that are not attached to any particular object or circumstance. • Symptoms 1. restlessness or feeling keyed up or on edge 2. being easily fatigued 3. difficulty concentrating or mind going blank 4. irritability 5. muscle tension 6. sleep disturbances 7. person finds it difficult to control the worry 4. POSTTRAUMATIC STRESS DISORDER • Occurs when a person experiences, witnesses or is confronted with some type of traumatic event and their response involves intense fear, helplessness or horror • Symptoms 1. recurrent distressing recollections or dreams of the event 2. acting or feeling as if the traumatic event were recurring 3. avoid thought, feelings, conversations, activities, places or people that arouse recollections of the trauma 4. inability to recall an important aspect of the trauma 5. feeling of detachment or estrangement from others 6. restricted range of affect 7. difficulty falling or staying asleep 8. irritability or outbursts of anger 9. difficulty concentrating 10. hypervigilance 11. exaggerated startle response • Usually occurs in people involved in war, rape victims or natural disasters. 5. OBSESSIVE-COMPULSIVE DISORDER • Obsessions – involuntary thoughts or ideas that keep recurring despite the person’s attempts to stop them • Compulsions – repetitive, ritualistic behaviors that a person feels compelled to perform • A person can have obsession without compulsions but NOT VICE VERSA • Generally, a person’s obsessions are so severe that they are compelled to do some type of repetitive behavior in an effort to rid themselves of the obsession. • With OCD, the person realizes that the obsessions and compulsions are unreasonable but are still unable to stop them. CAUSES OF ANXIETY DISORDERS • Heredity – there is a genetic factor that predisposes some people to these disorders. • Personality - Researchers believe that personality may play a role in the development of an anxiety disorder, noting that people who have low self esteem and poor coping skills may be more prone. • Life experiences - Researchers believe that the relationship between anxiety disorders and long-term exposure to abuse, violence, or poverty is an important area for further study, as life experiences may affect an individual's susceptibility to these disorders. TREATMENTS • Medication Anti-depressants, anti-anxiety medication • Therapy – cognitive/behavioral therapy, exposure therapy Somatoform and Dissociative Disorders Somatoform Disorders Anxiety can create a wide variety of physical symptoms for which no physical cause is apparent. These are known as somatoform disorders. The main types of somatoform disorders are Somatization Disorder, Conversion Disorder, Hypochondria & Body Dysmorphic Disorder. 1. SOMATIZATION DISORDER • Experiences of vague, recurring physical symptoms for which medical attention has been sought repeatedly but no organic cause is found. • Common complaints are back pains, dizziness, partial paralysis, abdominal pains, sexual problems and sometimes anxiety and depression 2. CONVERSION DISORDER • Involves complaints of far more bizarre symptoms, such as paralysis, blindness, deafness, seizures, loss of feeling or false pregnancy • Conversion disorder comes from the notion that psychological problems are “converted” into physical illness • An example may be if a person witnesses a traumatic event and then suddenly goes blind and there is not medically explanation for the blindness. 3. HYPOCHONDRIA • A person interprets some small symptom as a sign of a serious disease. The symptom may actually exist, but there is not evidence that the serious illness does. • Repeated assurances that there is no serious problem has little effect and the person is likely to visit one doctor after another in search of someone who will validate their “illness” 4. BODY DYSMORPHIC DISORDER • Imagined ugliness – people become so preoccupied with their appearance that they cannot lead a normal life. CAUSES OF SOMATOFORM DISORDERS • Behavior may have been learned, in that, symptomatic behavior was rewarded, thereby reinforced. • Freud would say that the physical symptoms are often related to traumatic experiences buried in the patient’s past. TREATMENT • Medication Anti-depressants • Therapy – cognitive/behavioral & psychoanalytic to deal with symptoms Dissociative Disorders Dissociation means that part of an individual’s personality is separated, or dissociated, from the rest, and for some reason the person cannot reassemble the pieces. Main types are Dissociative Identity Disorder, Dissociative Amnesia & Dissociative Fugue 1. DISSOCIATIVE IDENTITY DISORDER (multiple personalities) • In a true multiple personality, the various personalities are distinct people, with their own names, identities, memories, mannerisms, speaking voices and even IQ’s • Sometimes the “personalities” are unaware of each other and at other times they acknowledge the existence of the other “personalities” and will even make disparaging remarks about them. • Typically, the personalities will contrast sharply with each other. The personalities will represent different aspects of a single person (one is nice, one is mean) • In 75% of DID cases, the patient has reported a history of child abuse, thus leading researchers to believe that this is the main cause and it’s supported by the fact that in most cases once of the personalities is a child. 2. DISSOCIATIVE AMNESIA • Loss of memory without an organic cause • People often block out an event or a period of their lives that has been extremely stressful. 3. DISSOCIATIVE FUGUE • Occurs in addition to dissociative amnesia, however, the person will also flee from home and assume an entirely new identity. CAUSES OF DISSOCIATIVE DISORDERS • As stated before, dissociative identity disorder is mainly caused by the person being abused as a child and other types of dissociative disorders are related to some type of traumatic event TREATMENT • Generally some form of therapy is used to try and integrate the multiple parts of the person’s personality or to help them remember their past. Schizophrenia and Mood Disorders SCHIZOPHRENIC DISORDERS Schizophrenic disorders are severe conditions marked by disordered thoughts and communications, inappropriate emotions and bizarre behavior that last for months, even years. They are out of touch with reality and suffer from hallucinations (false sensory perceptions – visual, tactile or olfactory) and delusions (false beliefs about reality with no factual basis) Main types are disorganized, catatonic and paranoid. 1. DISORGANIZED SCHIZOPHRENIA • Symptoms a. Disorganized thinking. Disorganized thinking causes illogical, nonsensical thought patterns. May not be able to stay on track in a conversation, instead jumping from one unrelated idea to another. Making up words is common. Written communications also are very disorganized. b. Grossly disorganized behavior. Bathing, dressing appropriately or preparing meals may be impossible. Other common issues include confronting others without logical reason, wearing many layers of clothing on a warm day, having a very messy appearance or engaging in sexual behavior in public. c. Absent or inappropriate emotional expression. A person who lacks emotional expression (flat affect) has a blank face and doesn't make eye contact or use common body language. Emotions inappropriate to the situation also are common, such as acting silly or laughing loudly during a serious event. 2. CATATONIC SCHIZOPHRENIA • Symptoms a. Physical immobility. May be completely unable to move or speak, or may stare, hold body in a rigid position and seem to be unaware of surroundings (catatonic stupor). May also have a form of immobility known as waxy flexibility; for example, if the arm is moved into a certain position, it will stay in that position for hours. b. Excessive mobility. Rather than being unable to move, may move in an excited manner that appears to have no purpose. May pace in a frenzy, turn in circles, flail arms or make loud noises. c. Extreme resistance. May not respond to instructions, may resist any attempt to be moved or may not speak at all. d. Peculiar movements. May have inappropriate or unusual postures, grimace for long periods or use strange mannerisms. May also mechanically repeat certain behaviors (stereotyped behaviors), such as repeating words, obsessively following a routine or always arranging objects exactly the same way. e. Mimicking speech or movement. May repeatedly say a word just spoken by someone else or repeatedly copy a gesture or movement made by someone else. 3. PARANOID SCHIZOPHRENIA • Symptoms - Delusions and hallucinations are the symptoms that make paranoid schizophrenia most distinct from other types of schizophrenia. a. Delusions. In paranoid schizophrenia, a common delusion is that you're being singled out for harm. For instance, you may believe that the government is monitoring every move you make. You may also have delusions of grandeur — the belief that you can fly, that you're famous or that you have a relationship with a famous person. You hold on to these false beliefs despite evidence to the contrary. Delusions can result in aggression or violence if you believe you must act in self-defense against those who want to harm you. b. Auditory hallucinations. An auditory hallucination is the perception of sound — usually voices — that no one else hears. The sounds may be a single voice or many voices. These voices may talk either to you or to each other. The voices are usually unpleasant. They may make ongoing criticisms of what you're thinking or doing, or make cruel comments about your real or imagined faults. Voices may also command you to do things that can be harmful to yourself or to others. When you have paranoid schizophrenia, these voices seem real. You may talk to or shout at the voices. CAUSE OF SCHIZOPHRENIA • There is no single cause of schizophrenia but there are several theories • Genetic - Schizophrenia runs in some families. The risk for inheriting schizophrenia is 10 percent in those who have an immediate family member with the illness, and 40 percent if the illness affect both parents or an identical twin. • Brain chemistry - Many researchers believe that people with schizophrenia are either very sensitive to a brain chemical called dopamine, or produce too much of it. • Abnormality with the brain • Complications during pregnancy or birth that may increase the chance of developing schizophrenia. TREATMENT • Medication Anti-psychotics/anti-depressants • Therapy (although may have limitations) • Electroshock therapy Mood Disorders The DSM-IV distinguishes between two forms of depression – Major Depression & Dysthymia 1. MAJOR DEPRESSIVE DISORDER • Episode of intense sadness that may last for several months and may be caused by a difficult life event. • Symptoms a. Depressed mood most of the day, nearly ever day, as indicated by reports by self or by others. In children or adolescents, it may be an irritable mood. b. Diminished interest or pleasure in all, or almost all, activities. c. Significant weight loss or weight gain d. Insomnia or hypersomnia e. Restlessness or lethargic f. Feelings of worthlessness or excessive or inappropriate guilt g. Diminished ability to think or concentrate, or indecisiveness h. Recurrent thoughts of death, suicidal ideation or a suicide attempt 2. DYSTHYMIA • Involves less intense sadness & related symptoms but persists with little relief for a period of 2 years or more. Another mood disorder, less common than depression is MANIA and when this is mixed with a depressive mood it’s called BIPOLAR DISORDER 1. MANIA • Symptoms 1. Inflated self-esteem or grandiosity 2. Decrease need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of ideas or feels that thoughts are racing 5. Distractibility 6. Increase in goal-directed activity 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (buying sprees, sexual indiscretions or foolish business investments) 2. BIPOLAR DISORDER • Bipolar I disorder - Mood swings with bipolar I cause significant difficulty in job, school or relationships. Manic episodes can be severe and dangerous. • Bipolar II disorder - Less severe than bipolar I. May have an elevated mood, irritability and some changes in functioning, but generally can carry on with normal daily routine. Manic period is less severe (hypomania). Periods of depression typically last longer than manic periods. • Cyclothymia - Cyclothymia is a mild form of bipolar disorder. Highs and lows are not as severe as they are with other types of bipolar disorder. CAUSES OF MOOD DISORDERS • Mood disorders result from a combination of risk factors. a. Biological factors – genetics, chemical imbalances in the brain. b. Psychological factors – cognitive distortions (maladaptive response to early negative life events) c. Social factors – difficulties in interpersonal relationships TREATMENTS • Medication Anti-depressants, Lithium (bi-polar disorder) • Therapy – cognitive/behavioral, psychoanalytic Personality Disorders and Drug Addiction PERSONALITY DISORDERS Personality disorders are where some people develop inflexible and maladaptive ways of thinking and behaving that are so exaggerated and rigid that they cause serious distress to themselves or problems to others. 1. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER • A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control • Symptoms 1. preoccupied with details, rules, lists, order, organization or schedules to the extent that the major point of the activity is lost 2. shows perfectionism that interferes with task completion 3. excessively devoted to work & productivity to the exclusion of leisure activities & friendships 4. over conscientious, scrupulous and inflexible about matters of morality, ethics or values 5. unable to discard worn-out or worthless objects even when they have not sentimental value 6. reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things • OC Personality disorder is different than OCD because with the personality disorder, the person does not recognize that the obsession/compulsions are unreasonable 2. BORDERLINE PERSONALITY DISORDER • Pattern of instability of interpersonal relationships, self-image and affects • Symptoms 1. frantic efforts to avoid real or imagined abandonment 2. pattern of unstable and intense interpersonal relationship characterized by alternating between extremes of idealization and devaluation 3. identity disturbance 4. impulsivity in at least two areas that are potentially self-damaging 5. recurrent suicidal behavior, gestures, threats or self-mutilating behavior 6. instability of affect 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger 3. HISTRIONIC PERSONALITY DISORDER • Pattern of excessive emotionality and attention seeking • Symptoms 1. uncomfortable in situations in which they are not center of attention 2. interaction with others is often characterized by inappropriate sexually seductive or provocative behavior 3. displays rapidly shifting and shallow expression of emotions 4. consistently uses physical appearance to draw attention to self 5. has a style of speech that is excessively impressionistic and lacking in detail 6. is suggestible or easily influenced by others 7. shows self-dramatizations, theatricality & exaggerated expression of emotion 8. considers relationship to be more intimate than they actually are 4. NARCISSISTIC PERSONALITY DISORDER • Pattern of grandiosity, need for admiration and lack of empathy • Symptoms 1. has a grandiose sense of self-importance 2. preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love 3. believes that they are “special” and unique and can only be understood by or should associate with other special or high-status people 4. requires excessive admiration 5. has a sense of entitlement 6. is interpersonally exploitative (takes advantage of others to achieve their own ends) 7. lack empathy 8. is often envious of others or believes that others are envious of them 5. PARANOID PERSONALITY DISORDER • Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent • Symptoms 1. suspects, with reason, that others are exploiting, harming or deceiving them. 2. preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. is reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them. 4. reads hidden demeaning or threatening meanings into benign remarks or events 5. persistently bears grudges 6. perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack 7. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner 6. AVOIDANT PERSONALITY DISORDER • Pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation • Symptoms 1. avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval or rejection 2. is unwilling to get involved with people unless certain of being liked 3. shows restraint within intimate relationships because of the fear of being shamed or ridiculed 4. is preoccupied with being criticized or rejected in social situations 5. is inhibited in new interpersonal situations because of feelings of inadequacy 6. views self as socially inept, personally unappealing or inferior to others 7. is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing 7. DEPENDENT PERSONALITY DISORDER • Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation • Symptoms 1. difficulty making everyday decisions without an excessive amount of advice and reassurance from others 2. needs others to assume responsibility for most major areas of his or her life. 3. has difficulty expressing disagreement with others because of fear of loss of support or approval 4. has difficulty initiating projects or doing things on their own 5. goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant 6. feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves 7. urgently seeks another relationship as a source of care and support when a close relationship ends 8. is unrealistically preoccupied with fears of being left to take care of themselves 8. ANTISOCIAL PERSONALITY DISORDER • Pattern of disregard for and violation of the rights of others • Symptoms 1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3. impulsivity or failure to plan ahead 4. irritability and aggressiveness, as indicated by repeated physical fights or assaults 5. reckless disregard for safety of self or others 6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations 7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another 9. SCHIZOTYPAL PERSONALITY DISORDER • Pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. • Symptoms 1. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms 2. unusual perceptual experiences, including bodily illusions 3. odd thinking and speech 4. suspiciousness or paranoid ideation 5. behavior or appearance that is odd, eccentric, or peculiar 6. inappropriate or constricted affect 7. lack of close friends or confidants other than first-degree relatives 8. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self 10. SCHIZOID PERSONALITY DISORDER • Pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings • Symptoms 1. neither desires nor enjoys close relationships, including being part of a family 2. almost always chooses solitary activities 3. has little, in any, interest in having sexual experiences with another person 4. takes pleasure in few, in any, activities 5. lacks close friends or confidants other than first-degree relatives 6. appears indifferent to the praise or criticism of others 7. shows emotional coldness, detachment or flattened affectivity CAUSES OF PERSONALITY DISORDERS • Most personality disorders result from a combination of biological predisposition, adverse psychological experiences and an unhealthy social environment TREATMENT • Therapy – different forms of therapy are generally used to help treat personality disorders but have little success • Medication – used to treat symptoms because there is no medication to treat personality disorders ...imagine a party where all the people had Personality Disorders Donna danced into the party and immediately became the center of attention. With sweeping gestures of her arms and dramatic displays of emotion, she boasted about her career as an actress in a local theater group. During a private conversation, a friend inquired about the rumors that she was having some difficulties in her marriage. In an outburst of anger, she denied any problems and claimed that her marriage was “as wonderful and charming as ever.” Shortly thereafter, while drinking her second martini, she fainted and had to be taken home. William wandered into the party, but didn’t stay long. The “negative forces” in the room were unsettling to his “psychic soul-spot.” The few guests he spoke to felt somewhat uneasy being with this aloof “space cadet.” Sherry paraded into the party drunk and continued to drink throughout the night. Laughing and giggling, she flirted with many of the men and to two of them expressed her “deep affection.” Twice during the evening she disappeared for almost half an hour, each time with a different man. After a violent argument with one of them, because he took “too long” to get her a drink, she locked herself into the bathroom and attempted to swallow a bottle of aspirin. Her friends encouraged her to go home, but she was afraid to be alone in her apartment. Winston spent most of the time talking about his trip to Europe, his new Mercedes, and his favorite French restaurants. People seemed bored being around him, but he kept right on talking. When he made a critical remark about how one of the woman was dressed - and hurt her feelings - he could not apologize for his obvious blunder. He tried to talk his way around it, and even seemed to be blaming her for being upset. Peter arrived at the party exactly on time. He made a point of speaking to every guest for five minutes. He talked mostly about technology and finance, and avoided any inquiries about his feelings or personal life. He left precisely at 10 PM because he had work to do at home. Before entering, Doreen watched the party for several minutes from outside through the window. Once she went in, she seemed very uncomfortable. When people tried to be nice to her, she looked guarded and distrustful. People quickly became uncomfortable with her habit of finding fault with everything little thing you said or did. She seemed to be picking fights with people. She didn’t stay very long at the party. Margie didn’t come to the party, even though she promised the hostess that she would bring the ice. The hostess was very upset that everyone had warm drinks. Harold wasn’t invited to the party. No one really knows him very well because he rarely talks. In fact, he spends most of his time alone at home reading. Gary arrived at the party alone. Charming and sociable, he carried on conversations with several people, who clearly enjoyed his company. Midway through the party, he sneaks into the host’s bedroom and steals her most expensive jewelry. He feels no remorse and rejoins the party.