Download 15. Personality Disorders

Psychological
Defence In
Different Age.
Deviative Behavior.
Defense mechanisms
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Defense mechanisms are helpful and, if used in a
proper manner, are healthy. Some disorders, such as
personality disorders and psychosis, may in fact be
caused in part by inadequate use of appropriate
defensce mechanisms. However, if misused, the
defense mechanisms may also be unhealthy.
The maladaptive use of defense mechanisms can
occur in a variety of cases, such as when they become
automatic and prevent individuals from realizing their
true feelings and thoughts or when they put the person
in actual danger. For example, someone who is in
denial about the possibility that a new sexual partner
could carry an STD may not take appropriate
precautions to protect their own sexual health.
Defense mechanisms
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Defense mechanisms can also be maladaptive when
they are continually used in a way that disrupts realitytesting. Repeated denial and paranoid projection use
can cause people to lose touch with the real world and
their surroundings and consequently isolate
themselves from it and dwell in a ‘created’ world of
their own design. For example, people with addictive
behaviour are known to misuse such defense
mechanisms as denial. Defense mechanisms can also
be harmful if:
There are too few defenses which can be employed in
coping with threats;
There is too much superego activity, which causes the
use of too many defenses.
List of defense
mechanisms
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Sigmund Freud was the first person to develop
the concept of defense mechanisms, however it
was his daughter Anna Freud who clarified and
conceptualized it.
She has described various different defense
mechanisms.
The list of particular defense mechanisms is
huge and there is no theoretical consensus on
the amount of defense mechanisms. It has
been attempted to classify defense
mechanisms according some of their properties
(ie. underlying mechanisms, similarities or
connexions with personality).
Compensation
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Compensation occurs when someone
takes up one behavior because one
cannot accomplish another behavior.
Denial
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An ego defense mechanism that
operates unconsciously to resolve
emotional conflict, and to reduce
anxiety by refusing to perceive the
more unpleasant aspects of external
reality.
Displacement
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An unconscious defense mechanism,
whereby the mind redirects emotion from a
‘dangerous’ object to a ‘safe’ object.
In psychoanalytic theory, displacement is a
defense mechanism that shifts sexual or
aggressive impulses to a more acceptable
or less threatening target; redirecting
emotion to a safer outlet.
Intellectualization

Concentrating on the intellectual
components of the situations as to
distance oneself from the anxiety
provoking emotions associated with
these situations
Projection
Attributing to others, one’s own
unacceptable or unwanted thoughts
and/or emotions.
 Projection reduces anxiety in the way
that it allows the expression of the
impulse or desire without letting the
ego recognize it.

Rationalization
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The process of constructing a logical
justification for a decision that was
originally arrived at through a different
mental process
Reaction formation
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The converting of unconscious wishes
or impulses that are perceived to be
dangerous into their opposites
Regression
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The reversion to an earlier stage of
development in the face of
unacceptable impulses
Repression
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The process of pulling thoughts into
the unconscious and preventing
painful or dangerous thoughts from
entering consciousness.
Sublimation
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The refocusing of psychic energy (which Sigmund
Freud believed was limited) away from negative outlets
to more positive outlets. These drives which cannot
find an outlet are rechanneled. In Freud’s classic
theory, erotic energy is only allowed limited expression
due to repression, and much of the remainder of a
given group’s erotic energy is used to develop its
culture and civilization.
Freud considered this defense mechanism the most
productive compared to the others that he identified.
Sublimation is the process of transforming libido into
‘social useful’ achievements, mainly art.
Psychoanalysts often refer to sublimation as the only
truly successful defense mechanism.
Undoing

A person tries to 'undo' a negative or
threatening thought by their actions.
Suppression
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The conscious process of pushing
thoughts into the preconscious.
Dissociation

Separation or postponement of a
feeling that normally would
accompany a situation or thought.
Humor.

Refocuses attention on the somewhat
comical side of the situation as to
relieve negative tension; similar to
comic relief.
Idealization

Form of denial in which the object of
attention is presented as "all good"
masking true negative feelings
towards the other.
Identification
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The unconscious modeling of one's
self upon another person's behavior.
Introjection

Identifying with some idea or object so
deeply that it becomes a part of that
person.
Inversion

Refocusing of aggression or emotions
evoked from an external force onto
one's self.
Somatization
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Manifestation of emotional anxiety into
physical symptoms.
Splitting

Primitive defense mechanism-when a
person sees external objects or
people as either "all good" or "all bad."
Substitution

When a person replaces one feeling
or emotion for another.
Introduction and History of Mental
Illness
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Our earliest explanation of what we now refer to as
psychopathology involved the possession by evil
spirits and demons. Many believed, even as late as
the sixteenth and seventeenth centuries that the
bizarre behavior associated with mental illness could
only be an act of the devil himself. To remedy this,
many individuals suffering from mental illness were
tortured in an attempt to drive out the demon.
Most people know of the witch trials where many
women were brutally murdered due to a false belief of
possession. When the torturous methods failed to
return the person to sanity, they were typically deemed
eternally possessed and were executed
The medical model
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By the eighteenth century we began to look at mental illness
differently. It was during this time period that "madness" began
to be seen as an illness beyond the control of the person rather
than the act of a demon. Because of this, thousands of people
confined to dungeons of daily torture were released to asylums
where medical forms of treatment began to be investigated.
Today, the medical model continues to be a driving force in the
diagnosing and treatment of psychopathology, although research
has shown the powerful effects that psychology has on a
person's behavior, emotion, and cognitions. This chapter will
discuss the various ways mental illness is classified as well as
the effects of mental illness on the individual and society.
Classifying
Psychopathology
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Mental illness is classified today according
to the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM IV),
published by the American Psychiatric
Association (1994).
The DSM uses a multiaxial or
multidimensional approach to diagnosing
because rarely do other factors in a
person's life not impact their mental
health. It assesses five dimensions as
described below:
The DSM
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Axis I: Clinical Syndromes
This is what we typically think of as the diagnosis (e.g.,
depression, schizophrenia, social phobia)
Axis II: Developmental Disorders and Personality
Disorders
Developmental disorders include autism and mental
retardation, disorders which are typically first evident in
childhood
Personality disorders are clinical syndromes which
have a more long lasting symptoms and encompass
the individual's way of interacting with the world. They
include Paranoid, Antisocial, and Borderline
Personality Disorders.
The DSM
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Axis III: Physical Conditions which play a role in the
development, continuance, or exacerbation of Axis I and II
Disorders
Physical conditions such as brain injury or HIV/AIDS that
can result in symptoms of mental illness are included here.
Axis IV: Severity of Psychosocial Stressors
Events in a persons life, such as death of a loved one,
starting a new job, college, unemployment, and even
marriage can impact the disorders listed in Axis I and
II. These events are both listed and rated for this axis.
Axis V: Highest Level of Functioning
On the final axis, the clinician rates the person's level of
functioning both at the present time and the highest level
within the previous year. This helps the clinician understand
how the above four axes are affecting the person and what
type of changes could be expected
Psychiatric Disorders
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Let's discuss the first two axes in more
detail now as these are what we typically
think of when we think of mental illness or
psychopathology.
The DSM IV (American Psychiatric
Association, 1994) identifies 15 general
areas of adult mental illness. We'll discuss
each one briefly. For more information
about a specific category, open Psychiatric
Disorders on the Main Menu and follow the
links provided.
1. Delirium, Dementia,
Amnestic, and Other
Cognitive Disorders
The primary symptoms of these
disorders include significant negative
changes in the way a person thinks
and/or remembers.
 All of these disorders have either a
medical or substance related cause
and are therefore not discussed in
detail in this chapter.
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2. Mental Disorders Due to
a Medical Condition
Like those above, all disorders in this
category are directly related to a
medical condition.
 If symptoms of anxiety, depression,
etc are a direct result of a medical
condition, this is the classification
used.
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3. Substance Related
Disorders
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There are two disorders listed in this category: Substance Abuse
and Substance Dependence. Both involve the ingestion of a
substance (alcohol, drug, chemical) which alters either
cognitions, emotions, or behavior.
Abuse refers to the use of the substance to the point that it has a
negative impact on the person's life. This can mean receiving a
DUI for drinking and driving, being arrested for public
intoxication, missing work or school, getting into fights, or
struggling with relationships because of the substance.
Dependence refers to what we typically think of as
'addicted.' This occurs when (a) the use of the substance is
increased in order to get the same effect because the person has
developed a tolerance, (b) the substance is taken more
frequently and in more dangerous situations such as drinking and
driving, or (c) the person continues to take the substance despite
negative results and/or the desire to quit, or (d) withdrawal
symptoms are present when the substance is stopped, such as
delirium tremors (DTs), amnesia, anxiety, headaches, etc.
4. Schizophrenia and other
Psychotic Disorders
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The major symptom of these disorders is psychosis, or delusions
and hallucinations. The major disorders include schizophrenia
and schizoaffective disorder.
Schizophrenia is probably the most recognized term in the study
of psychopathology, and it is probably the most
misunderstood. First of all, it does not mean that the person has
multiple personalities. The prefix 'schiz' does mean split, but it
refers to a splitting from reality. The predominant features of
schizophrenia include hallucinations and delusions and
disorganized speech and behavior, inappropriate affect, and
avolition. There is no known cure for schizophrenia and is
without doubt the most debilitating of all the mental illnesses.
Schizoaffective Disorder is characterized by a combination of the
psychotic symptoms such as in Schizophrenia and the mood
symptoms common in Major Depression and/or Bipolar
Disorder. The symptoms are typically not as severe although
when combined together in this disorder, they can be quite
debilitating as well.
5. Mood Disorders
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The disorders in this category include those where the
primary symptom is a disturbance in mood. The
disorders include Major Depression, Dysthymic
Disorder, Bipolar Disorder, and Cyclothymia.
Major Depression (also known as depression or
clinical depression) is characterized by depressed
mood, diminished interest in activities previously
enjoyed, weight disturbance, sleep disturbance, loss of
energy, difficulty concentrating, and often includes
feelings of hopelessness and thoughts of suicide.
5. Mood Disorders
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Dysthymia is often considered a lesser, but more
persistent form of depression. Many of the symptoms
are similar except to a lesser degree. Also, dysthymia,
as opposed to Major Depression is more steady rather
than periods of normal feelings and extreme lows.
Bipolar Disorder (previously known as ManicDepression) is characterized by periods of extreme
highs (called mania) and extreme lows as in Major
Depression. Bipolar Disorder is subtyped either I
(extreme or hypermanic episodes) or II (moderate or
hypomanic episodes).
Like Dysthymia and Major Depression, Cyclothymia is
considered a lesser form of Bipolar Disorder.
6. Anxiety Disorders
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Anxiety Disorders categorize a large number of disorders where
the primary feature is abnormal or inappropriate anxiety. The
disorders in this category include Panic Disorder, Agoraphobia,
Specific Phobias, Social Phobia, Obsessive-Compulsive
Disorder, Posttraumatic Stress Disorder, and Generalized Anxiety
Disorder.
Panic Disorder is characterized by a series of panic attacks. A
panic attack is an inappropriate intense feeling of fear or
discomfort including many of the following symptoms: heart
palpitations, trembling, shortness of breath, chest pain,
dizziness. These symptoms are so severe that the person may
actually believe he or she is having a heart attack. In fact, many,
if not most of the diagnoses of Panic Disorder are made by a
physician in a hospital emergency room.
6. Anxiety Disorders
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Agoraphobia literally means fear of the marketplace. It
refers to a series of symptoms where the person fears,
and often avoids, situations where escape or help
might not be available, such as shopping centers,
grocery stores, or other public place. Agoraphobia is
often a part of panic disorder if the panic attacks are
severe enough to result in an avoidance of these types
of places.
Specific or Simple Phobia and Social Phobia
represents an intense fear and often an avoidance of a
specific situation, person, place, or thing. To be
diagnosed with a phobia, the person must have
suffered significant negative consequences because of
this fear and it must be disruptive to their everyday life.
6. Anxiety Disorders
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Obsessive-Compulsive Disorder is
characterized by obsessions (thoughts
which seem uncontrollable) and
compulsions (behaviors which act to reduce
the obsession). Most people think of
compulsive hand washers or people with an
intense fear of dirt or of being infected.
These obsessions and compulsions are
disruptive to the person's everyday life, with
sometimes hours being spent each day
repeating things which were completed
successfully already such as checking,
counting, cleaning, or bathing.
6. Anxiety Disorders
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Posttraumatic Stress Disorder (PTSD)
occurs only after a person is exposed to a
traumatic event where their life or someone
else's life is threatened. The most common
examples are war, natural disasters, major
accidents, and severe child abuse.
Once exposed to an incident such as this,
the disorder develops into an intense fear of
related situations, avoidance of these
situations, reoccurring nightmares,
flashbacks, and heightened anxiety to the
point that it significantly disrupts their
everyday life.
6. Anxiety Disorders
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Generalized Anxiety Disorder is diagnosed
when a person has extreme anxiety in
nearly every part of their life. It is not
associated with just open places (as in
agoraphobia), specific situations (as in
specific phobia), or a traumatic event (as in
PTSD).
The anxiety must be significant enough to
disrupt the person's everyday life for a
diagnosis to be made.
7. Somatoform Disorders
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Disorders in this category include those where the symptoms
suggest a medical condition but where no medical condition can
be found by a physician. Major disorders in this category include
Somatization Disorder, Pain Disorder, Hypochondriasis.
Somatization Disorder refers to generalized or vague symptoms
such as stomach aches, sexual pain, gastrointestinal problems,
and neurological symptoms which have no found medical cause.
Pain Disorder refers to significant pain over an extended period
of time without medical support.
Hypochondriasis is a disorder characterized by significant and
persistent fear that one has a serious or life-threatening illness
despite medical reassurance that this is not true.
8. Factitious Disorder
Factitious Disorder is characterized by the
intentionally produced or feigned symptoms
in order to assume the 'sick role.'
 These people will often ingest medication
and/or toxins to produce symptoms and there
is often a great secondary gain in being
placed in the sick role and being either
supported, taken care of, or otherwise shown
pity and given special rights.
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9. Dissociative Disorders
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The main symptom cluster for dissociative disorders
include a disruption in consciousness, memory,
identity, or perception. In other words, one of these
areas is not working correctly causing significant
distress within the individual. The major diagnoses in
this category include Dissociative Amnesia,
Dissociative Fugue, Depersonalization Disorder, and
Dissociative Identity Disorder.
Dissociative Amnesia is characterized by memory
gaps related to traumatic or stressful events which are
too extreme to be accounted for by normal
forgetting. A traumatic event is typically a precursor to
this disorder and memory is often restored.
9. Dissociative Disorders
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Dissociative Fugue represents an illness where an individual,
after an extremely traumatic event, abruptly moves to a new
location and assumes a new identity. This disorder is very rare
and typically runs its course within a month.
Depersonalization Disorder, occurring after an extreme stressor,
includes feelings of unreality, that your body does not belong to
you, or that you are constantly in a dreamlike state.
Dissociative Identity Disorder (DID) is most widely known as
Multiple Personality Disorder or MPD. DID is the presence of
two or more distinct personalities within an individual. These
personalities must each take control of the individual at varying
times and there is typically a gap in memory between
personalities or "alters." This disorder is quite rare and a
significant trauma such as extended sexual abuse is usually the
precursor.
10. Sexual
Dysfunctions, Paraphilias, and
Gender Identity Disorders
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These disorders are all related to sexuality,
either in terms of functioning (Sexual
Dysfunctions), distressing and often
irresistible sexual urges (Paraphilias), and
gender confusion or identity (Gender
Identity Disorder.
It should be noted that for these, as well as
many other categories, a medical reason
should always be ruled out before making a
psychological diagnosis.
10. Sexual
Dysfunctions, Paraphilias, and
Gender Identity Disorders
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Sexual Dysfunctions include Hypoactive Sexual Desire
Disorder (deficiency or absence of sexual fantasies
and desire for sexual activity), Sexual Aversion
Disorder (persistent or recurring aversion to or
avoidance of sexual activity), Sexual Arousal and Male
Erectile Disorder (Inability to attain or maintain until
completion of sexual activity adequate lubrication (in
women) or erection (in men) in response to sexual
excitement),
Orgasmic Disorder [male] [female] (delay or absence
of orgasm following normal excitement and sexual
activity), and Premature Ejaculation (ejaculation with
minimal sexual stimulation before or shortly after
penetration and before the person wishes it).
10. Sexual
Dysfunctions, Paraphilias, and
Gender Identity Disorders
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Paraphilias include Exhibitionism (the intense urge to expose
oneself to an unsuspecting stranger), Voyeurism (the intense
urge to watch an unsuspecting person in various states of
undress or sexual activity), Fetishism (intense sexual fantasies,
urges, and behaviors involving an inanimate object), Pedophilia
(sexually arousing fantasies. urges, and behavior involving a
prepubescent child), Sexual Masochism (intense sexual
fantasies, urges, and behavior involving the act of being beaten,
humiliated, and/or bound), and Sexual Sadism (intense sexual
fantasies, urges, and behavior involving the infliction of pain
and/or humiliation on another person).
The final category, Gender Identity Disorder, is characterized by
a strong and persistent identification with the opposite sex and
the belief that one is actually the opposite sex due to an extreme
discomfort in one's present sexual identity.
11. Eating Disorders
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Eating disorders are characterized by disturbances in
eating behavior. There are two types: Anorexia
Nervosa and Bulimia Nervosa.
Anorexia is characterized by failure to maintain body
weight of at least 85% of what is expected, fear of
losing control over your weight or of becoming
'fat.' There is typically a distorted body image, where
the individual sees themselves as overweight despite
overwhelming evidence to the contrary.
The key characteristics of Bulimia include bingeing
(the intake of large quantities of food) and purging
(elimination of the food through artificial means such
as forced vomiting, excessive use of laxatives, periods
of fasting, or excessive exercise).
12. Sleep Disorders
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All sleep disorders involve abnormalities in sleep in one of
two categories, dysomnias and parasomnias.
Dysomnias are related to the amount, quality and/or timing
of sleep. Examples of sleep disorders include insomnia
(inability or reduced ability to sleep), hypersomnia
(excessive sleepiness and prolonged sleep without physical
justification), and narcolepsy (irresistible attacks of sleep).
Parasomnias refer to sleep disturbances related to
behavioral or physiological events related to
sleep. Disorders in this subcategory include nightmare
disorder (occurance of extremely frightening dreams which
result in awakening and resulting distress), sleep terror
disorder (similar to nightmare disorder but the fear is more
intense and the person is often unresponsive during the
episode), and sleepwalking disorder (walking or performing
tasks during sleep without recollection once awakened).
13. Impulse Control
Disorders
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Disorders in this category include the failure or
extreme difficulty in controlling impulses despite the
negative consequences.
Specific disorders include Intermittent Explosive
Disorder (failure to resist aggressive impulses resulting
in serious assaults or destruction of property),
Kleptomania (stealing objects which are not needed),
Pyromania (fire starting for pleasure or relief of
tension), Pathological Gambling (maladaptive
gambling behavior), and trichotillomania (pulling out of
one's own hair).
14. Adjustment Disorders
This category consists of an
inappropriate or inadequate
adjustment to a life stressor.
 Adjustment disorders can include
depressive symptoms, anxiety
symptoms, and/or conduct or
behavioral symptoms.

15. Personality Disorders
Personality Disorders are
characterized by an enduring pattern
of thinking, feeling, and behaving
which is significantly different from the
person's culture and results in
negative consequences.
 This pattern must be longstanding and
inflexible for a diagnosis to be made.
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15. Personality Disorders
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There are ten types of personality disorders, all of which result in
significant distress and/or negative consequences within the
individual: Paranoid (includes a pattern of distrust and
suspiciousness, Schizoid (pattern of detachment from social
norms and a restriction of emotions), Schizotypal (pattern of
discomfort in close relationships and eccentric thoughts and
behaviors), Antisocial (pattern of disregard for the rights of
others, including violation of these rights and the failure to feel
empathy), Borderline (pattern of instability in personal
relationships, including frequent bouts of clinginess and affection
and anger and resentment, often cycling between these two
extremes rapidly), Histrionic (pattern of excessive emotional
behavior and attention seeking), Narcissistic (pattern of
grandiosity, exaggerated self-worth, and need for admiration),
Avoidant (pattern of feelings of social inadequacies, low selfesteem, and hypersensitivity to criticism), and ObsessiveCompulsive (pattern of obsessive cleanliness, perfection, and
control).
Stigma, Stereotyping, and the
Mentally Ill
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Mental illness can have a devastating effect on an
individual, his or her family and friend, and on the
community in many ways. How it affects the individual
is obvious, reduced ability to care for oneself, strong
negative emotions, distorted thoughts, inappropriate
behavior, and reduced ability to maintain a relationship
are only a few possible outcomes.
On friends and family, it can be a major responsibility
to care for someone suffering from a mental illness,
the emotional and behavioral components of some
illnesses can be very difficult at times to understand
and to deal with. Mental illness also effects the
community due to the high incidence of homelessness
and unemployment in some serious disorders such as
schizophrenia.
Obvious effects of mental
illness
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These are the obvious effects of mental illness, but there are
less obvious effects due to the misperception of the mentally
ill. Not too long ago when people heard the term mentally
ill, many thought of severe cases and associated these
individuals with bizarre behavior, violence, and a lack of
caring about themselves and the world. In this sense,
people with mental illness were almost dehumanized. They
were avoided and feared.
This is changing now as people understand that mental
illness effects many people in many different ways. We as a
society are starting to see that depression doesn't mean
weakness, that anxiety doesn't mean fear, and that
schizophrenia doesn't mean violence. We are finally
understanding that needing help for mental or emotional
reasons does not represent a character flaw.
The early stages
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We are in the early stages of this enlightenment,
however, and many people continue to stereotype the
mentally ill population. The effects of this are
twofold. First, imagine being labeled as weak, fearful,
violent, or flawed. What would this do to your selfesteem? Certainly nothing positive.
These misguided beliefs can eventually reach the
individual suffering from a mental illness and cause a
drastic shift in their belief system. They may begin
saying to themselves "Everyone can't be wrong, I must
be a terrible person to let this happen." The results
are a deeper depression, increased anxiety, lower selfesteem, and isolation, to name only a few.
The groundwork for the cycle of
many mental illnesses
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Second, due to the stigma associated with
mental illness, many people do not seek out
help. This is especially true for mood and
anxiety disorders which, ironically, have
very well researched and successful
treatments available.
These two factors lay the groundwork for
the cycle of many mental illnesses to
continue and to strengthen. I'm a weak
person, I feel worse about myself and can
not possibly seek help because I would be
ridiculed, humiliated, and shamed.