You are on page 1of 40

Research 1:

The Homunculus

Scientists can map which parts of the brain control various parts of the body. The mapping is done by stimulating the sensory or motor cortex with a weak electric current. The stimulation often produces tingling or movement in part of the body. Humans put great emphasis on speech and manipulation of objects by the hands, so humans have large amounts of cortex devoted to mouth, tongue, and hands. Different species have different patterns. Rats get a lot of information from their whiskers, so they have large amounts of sensory cortex devoted to their whiskers. The following diagram represents a slice of cortex near the fissure of Rolando, running from the top of the head down toward the ear. The diagram indicates the location and amount of cortex devoted to each part of the body. At location #22, for example (just above the lateral fissure by the ear), stimulation produces a swallowing reflex. A location #3, at the top of the head, stimulation results in toe movement. Altogether, the map of brain connections to the body in this particular strip of cortex looks like this, with the amount of cortical tissue represented by the size of the body part in the diagram: How is the homunculus mapped out?

The Homunculus, based on Penfield's classic diagram

The diagram looks a bit like a grotesque little man, so it is called the homunculus (ho-MUN-q-lus) which means "little man" in Latin. The first homunculus diagram was drawn by Wilder Penfield in the 1940s and looks similar to the one above. Notice that the hands, lips, and tongue are large, because of the large areas of cortex devoted to these areas of the body in humans. What sort of humorous references to the homunculus are common?

The homunculus is a textbook diagram, certainly is not a self or center of consciousness in the brain. However, humorous references to the homunculus as a little person in the head are common among psychologists. One psychologist might say to another, "But how exactly is this mental activity carried out? Does the homunculus do it?" This is a way of saying, "You have not given us an adequate explanation!" What is evidence that cortical mapping can change with experience? Actually there are many homunculi in the brain, if the word refers to an area of cortex where body surfaces are mapped. Such maps can change with experience. People who read Braille (which is done with an index finger) develop large areas responsive to stimulation from the index finger. A homunculus mapped on the motor cortex of such a person would have a huge index finger. This flexibility in the brain inspired some therapies for brain-damaged patients. In one study, people who suffered partial paralysis of an arm after a stroke were able to regain full use of the arm by having the other (good) arm immobilized (prevented from moving). This encouraged development of the cortex that controlled the "bad" arm, resulting in partial recovery of the patient's ability to move that arm (see "Behavioral Treatment of Pain").

Figure 8.8 Somatotopic order in the human primary somatic sensory cortex. (A) Diagram showing the region of the human cortex from which electrical activity is recorded following mechanosensory stimulation of different parts of the body. The patients in the study were undergoing neurosurgical procedures for which such mapping was required. Although modern imaging methods are now refining these classical data, the human somatotopic map first defined in the 1930s has remained generally valid. (B) Diagram along the plane in (A) showing the somatotopic representation of body parts from medial to lateral. (C) Cartoon of the homunculus constructed on the basis of such mapping. Note that the amount of somatic sensory cortex devoted to the hands and face is much larger than the relative amount of body surface in these regions. A similar disproportion is apparent in the primary motor cortex, for much the same reasons (see Chapter 17). (After Penfield and Rasmussen, 1950, and Corsi, 1991.) (Source: Neuroscience 3rd edition (e-version) Dale Purves P.205)

(Source: Neurology of Neurology, Neurosurgery and Psychiatry)

Research 2:

Laterization of Brain Function

A longitudinal fissure separates the human brain into two distinct cerebral hemispheres, connected by the corpus callosum. The sides resemble each other and each hemisphere's structure is generally mirrored by the other side. Yet despite the strong anatomical similarities, the functions of each cortical hemisphere are managed differently. For example, the lateral sulcus generally is longer in the left hemisphere than in the right hemisphere. Broad generalizations are often made in popular psychology about one side or the other having characteristic labels such as "logical" for the left side or "creative" for the right. These labels need to be treated carefully; although a lateral dominance is measurable, these characteristics are in fact existent in both sides,[1] and experimental evidence provides little support for correlating the structural differences between the sides with functional differences.[2] The extent of any modularity, or specialization of brain function by area, remains under investigation. If a specific region of the brain or even an entire hemisphere[3] is either injured or destroyed, its functions can sometimes be assumed by a neighboring region, even in the opposite hemisphere, depending upon the area damaged and the patient's age. When injury interferes with pathways from one area to another, alternative (indirect) connections may come to exist to communicate information with detached areas, despite the inefficiencies. While functions are lateralized, these are only a tendency. The trend across many individuals may also vary significantly as to how any specific function is implemented. The areas of exploration of this causal or effectual difference of a particular brain function include its gross anatomy, dendritic structure, and neurotransmitter distribution. The structural and chemical variance of a particular brain function, between the two hemispheres of one brain or between the same hemisphere of two different brains, is still being studied. Short of having undergone a hemispherectomy (removal of a cerebral hemisphere), no one is a "left-brain only" or "right-brain only" person.[4] Brain function lateralization is evident in the phenomena of right- or left-handedness and of right or left ear preference[citation needed], but a person's preferred hand is not a clear indication of the location of brain function. Although 95% of right-handed people have left-hemisphere dominance for language, 18.8% of left-handed people have right-hemisphere dominance for language function. Additionally, 19.8% of the left-handed have bilateral language functions.[5] Even within various language functions (e.g., semantics, syntax, prosody), degree (and even hemisphere) of dominance may differ.

(MRI of the brain at the level of the the caudate nuclei emphasizing corpus callosum.)

(Source 1)

Left Brain, Right Brain: Fact and Fiction

by Elizabeth Hampson, PhD


The left brain, right brain concept of brain function has become a recent fad in popular magazines and among some laymen and teachers. To what extent are the ideas we hear about really based on scientific evi-dence? This concept has been over-simplified and over-generalized in the popular press, leading to confusion and some mistaken ideas about hemispheric specialization (as it is known in scientific circles). Modern researchers have many techniques available to them to study hemispheric specialization. We can examine people who have brain damage limited to one hemisphere. Or we can monitor patterns of blood flow and glucose use, or patterns of electrical activity in the brain while people are working on different kinds of tasks. In the 1960s, Nobel Prize winner Roger Sperry and his co-workers studied a special group of people who had had a brain operation to control epilepsy, which in-volved cutting the band of nerve fibres that normally inter-connects the two hemispheres and allows them to communicate. Following surgery, each half of the brain functioned on its own; so it became possible for the first time to study the capabilities of each hemisphere independently. We know from studies like these that the left and right sides of the brain are equivalent at analyzing basic sensory information or generating sim-ple movements. But the two hemispheres are not equally proficient at some other functions, including the ability to generate speech and perform compli-cated visual-perceptual analyses. From popular magazines, you might have the impression that the left hemisphere is completely responsible for language, while the right hemisphere is the one that controls visual perception. This impression is over-simplified in three ways. First of all, the specializations of the two hemispheres are not lim-ited to these two areas. Secondly, for most functions, the division of la-bour between the hemispheres is not really this black-and-white. Hemispheric specialization means that one side of the brain is more adept than the other. It does not necessarily mean that the other side can-not perform a function at all or is not routinely involved in a particular activity. Thirdly, specializations tend to be for skills that are much more specific and circumscribed than language or perception as a whole. The most radical division of labour between the hemispheres, as far as we know, occurs for speech production, which is mainly controlled by the left side of the brain, at least in most people who are right-handed. This left hemisphere predominance is the reason that people who have strokes, for example, may have problems speaking afterward, if the left side of the brain is seriously affected. Even for language, however, spe-cialization is a lot more complicated and incomplete than the popular press would have us believe. Sperrys split-brain studies, as well as studies of adults with reading problems acquired as a result of brain damage (in a previously-normal reader) have shown that the right hemi-sphere has some language comprehension abilities. This may be espe-cially true in females. Furthermore, even for spoken language, the right hemisphere may routinely be involved in aspects of speech comprehen-sion, such as decoding the meaning of the changes in tone of voice that occur during normal speaking. There is even evidence that the right side of the brain is important in drawing inferences understanding connected discourse and in appreciating non-literal parts of speech such as idioms and metaphors. Therefore, not all aspects of language are exclusively controlled by the left hemisphere. The right hemisphere, too, has its own specialization. We often hear that drawing is an activity governed by the right side of the brain. But actually drawing and other constructional activities, such as building things out of blocks, require both hemispheres. The notion that the right hemisphere is the only one active when people draw probably came from the fact that the right hemisphere is particularly adept at understanding some kinds of spatial relations among objects or in diagrams. But even here, the evidence suggests that the left hemisphere is not incapable of such a function, only that it is less competent than the right. I know of no convincing scientific evidence that the right hemisphere has any particu-lar specialization for a number of abstract functions often attributed to it, including intuition and creativity. The split-brain studies of Sperry and his co-workers showed what each hemisphere can do when severed from its mate; however, the two hemispheres normally dont operate independently. In normal people, the corpus callosum is usually abuzz with communications being trans-mitted between the two hemispheres. This sort of left- and right-brain interaction is routine for most activities, and especially for complex thought processes, which typically require integrating many kinds of in-formation. This brings us to another popular notion: does it make any sense to classify people as left-brained or rightbrained? It is a mistake to think that any normal person uses one side of the brain selectively for thinking. If a child is intuitive, not verbally-adept and excels at express-ing himself in pictures rather than words, the child may be

especially proficient at some abilities and less proficient at others, but it does not mean that this child relies on only one hemisphere. Virtually all behav-iours and modes of thinking require both hemispheres working together. Organization for Quality Education, December 1994 Lets consider some recent magazine articles with titles like Are you a left- or right-brained lover? (Glamour), or Are you left-brained or right-brained?(Teen Magazine). Here are a few examples from a quiz that Teen Magazine claims will tell you whether you are left- or right-brained: Im pretty good at math, I always wear a watch, If someone asks me a question, I generally turn my head to the right, When I talk, I gesture a lot, I like to draw, Ive considered becoming a poet, politician, architect or dancer. Although it might be fun and entertaining to do these kinds of quizzes, the questions are not scientifically valid, and your answers probably reveal more about your personality or how you were raised than which side of the brain you rou-tinely use. It is just plan untrue that some of us tend to use only one side of our brains. Hemispheric specialization is a reputable scien-tific concept, but interested readers need to look beyond popular maga-zines to get a realistic idea of what left-brain, right-brain is all about. (Source 2) Specialization of the Two Hemispheres

There are two hemispheres in your brain, the right and the left. At first glance, these hemispheres appear to be mirror images of one another, but closer examination reveals that they are highly specialized regions that serve differing functions. The left hemisphere governs our ability to express ourselves in language. In over 95% of right-handed people the left hemisphere is dominant for speech. The figure is somewhat lower for left handers, approximately 70%, but still highly significant. The left hemisphere is better than the right at recognizing sequences of words and letters. It controls our logic, our reasoning, and our analytical thought processes. It can focus on details, however it has difficulty comprehending the whole picture. The perceptual functions of the right hemisphere are more specialized for the analysis of space and geometrical shapes and forms, elements that are all present at the same time (not so sequential like language). The right hemisphere is the creative half; it can "see" the whole out of parts, thus allowing us to connect puzzle parts together. The right hemisphere also plays and important role in the comprehension of emotion. In an experiment where subjects were shown pictures of a faces with strong facial expression, the right hemisphere was able to discern the expression more accurately then the left hemisphere. In addition, an experiment was done where subjects listened to verbal messages said with different emotions. The messages were presented to each ear separately. When presented to the left hemisphere, the subject was more accurate with regards to the verbal content of the message. However the right hemisphere was more accurate at identifying the emotional tone of the voice. Ehrenwald (1984: 16) has classified important differences between the hemispheres as follows: Table 1: General Left-right brain attributes
Hemisphere Thinking Cognitive style Language Executive capacity Specialized functions Time experience Spatial orientation Psychoanalytic aspects Ideal prototype Left Abstract, linear, analytic Rational, logical Rich vocabulary, good grammar and syntax; pose Introspection, will, initiative, sense of self, focus on trees Reading, writing, arithmetic, sensory-motor skills; inhibits psi Sequentially ordered, measured Relatively poor Secondary process, ego functions, consciousness; superego? Aristotle, Appollonian mode, Marx, Freud, Koestler's Commissar Right Concrete, holistic Intuitive, artistic no grammar, syntax; prosody, poor vocabulary metaphoric, verse Low sense of self, low initiative, focus on forest Three i's, music, rich dream imagery, good face and gestalt recognition, open to psi "Lived" time, primitive time sense Superior, also for shapes, wire figures Primary process, dream-work, free assoc. hallucinations? Plato, Dionysian mode, Nietzsche, Jung Koestler's Yogi

(Source 3)

from Psychology - The Search for Understanding by Janet A. Simons, Donald B. Irwin and Beverly A. Drinnien West Publishing Company, New York, 1987

Abraham Maslow developed a theory of personality that has influenced a number of different fields, including education. This wide influence is due in part to the high level of practicality of Maslow's theory. This theory accurately describes many realities of personal experiences. Many people find they can understand what Maslow says. They can recognize some features of their experience or behavior which is true and identifiable but which they have never put into words. Maslow is a humanistic psychologist. Humanists do not believe that human beings are pushed and pulled by mechanical forces, either of stimuli and reinforcements (behaviorism) or of unconscious instinctual impulses (psychoanalysis). Humanists focus upon potentials. They believe that humans strive for an upper level of capabilities. Humans seek the frontiers of creativity, the highest reaches of consciousness and wisdom. This has been labeled "fully functioning person", "healthy personality", or as Maslow calls this level, "self-actualizing person." Maslow has set up a hierarchic theory of needs. All of his basic needs are instinctoid, equivalent of instincts in animals. Humans start with a very weak disposition that is then fashioned fully as the person grows. If the environment is right, people will grow straight and beautiful, actualizing the potentials they have inherited. If the environment is not "right" (and mostly it is not) they will not grow tall and straight and beautiful. Maslow has set up a hierarchy of five levels of basic needs. Beyond these needs, higher levels of needs exist. These include needs for understanding, esthetic appreciation and purely spiritual needs. In the levels of the five basic needs, the person does not feel the second need until the demands of the first have been satisfied, nor the third until the second has been satisfied, and so on. Maslow's basic needs are as follows:

Physiological Needs These are biological needs. They consist of needs for oxygen, food, water, and a relatively constant body temperature. They are the strongest needs because if a person were deprived of all needs, the physiological ones would come first in the person's search for satisfaction. Safety Needs When all physiological needs are satisfied and are no longer controlling thoughts and behaviors, the needs for security can become active. Adults have little awareness of their security needs except in times of emergency or periods of disorganization in the social structure (such as widespread rioting). Children often display the signs of insecurity and the need to be safe. Needs of Love, Affection and Belongingness When the needs for safety and for physiological well-being are satisfied, the next class of needs for love, affection and belongingness can emerge. Maslow states that people seek to overcome feelings of loneliness and alienation. This involves both giving and receiving love, affection and the sense of belonging. Needs for Esteem When the first three classes of needs are satisfied, the needs for esteem can become dominant. These involve needs for both self-esteem and for the esteem a person gets from others. Humans have a need for a stable, firmly based, high level of self-respect, and respect from others. When these needs are satisfied, the person feels self-confident and valuable as a person in the world. When these needs are frustrated, the person feels inferior, weak, helpless and worthless. Needs for Self-Actualization When all of the foregoing needs are satisfied, then and only then are the needs for self-actualization activated. Maslow describes self-actualization as a person's need to be and do that which the person was "born to do." "A musician must make music, an artist must paint, and a poet must write." These needs make themselves felt in signs of restlessness. The person feels on edge, tense, lacking something, in short, restless. If a person is hungry, unsafe, not loved or accepted, or lacking selfesteem, it is very easy to know what the person is restless about. It is not always clear what a person wants when there is a need for self-actualization. The hierarchic theory is often represented as a pyramid, with the larger, lower levels representing the lower needs, and the upper point representing the need for self-actualization. Maslow believes that the only reason that people would not move well in direction of self-actualization is because of hindrances placed in their way by society. He states that education is one of these hindrances. He recommends ways education can switch from its usual person-stunting tactics to person-growing approaches. Maslow states that educators should respond to the potential an individual has for growing into a self-actualizing person of his/her own kind. Ten points that educators should address are listed: 1. We should teach people to be authentic, to be aware of their inner selves and to hear their innerfeeling voices. 2. We should teach people to transcend their cultural conditioning and become world citizens. 3. We should help people discover their vocation in life, their calling, fate or destiny. This is especially focused on finding the right career and the right mate. 4. We should teach people that life is precious, that there is joy to be experienced in life, and if people are open to seeing the good and joyous in all kinds of situations, it makes life worth living. 5. We must accept the person as he or she is and help the person learn their inner nature. From real knowledge of aptitudes and limitations we can know what to build upon, what potentials are really there. 6. We must see that the person's basic needs are satisfied. This includes safety, belongingness, and esteem needs. 7. We should refreshen consciousness, teaching the person to appreciate beauty and the other good things in nature and in living. 8. We should teach people that controls are good, and complete abandon is bad. It takes control to

improve the quality of life in all areas. 9. We should teach people to transcend the trifling problems and grapple with the serious problems in life. These include the problems of injustice, of pain, suffering, and death. 10. We must teach people to be good choosers. They must be given practice in making good choices.

Maslow's Levels Detailed Self Actualization -Fulfillment Needs This is the rare level where people have need of purpose, personal growth and realization of their potentials. This is the point where people start to become fully functional, acting purely on their own volition and having a healthy personality. Ego -Self Esteem Needs We need to believe in ourselves and have healthy pride. At this level we need selfrespect, and respect from others. Social - Love and Belongingness Needs At this level the needs of love from family and friends are important. Security - Safety Needs Here we might include living in a safe area away from threats. This level is more likely to be found in children as they have a greater need to feel safe. Body -Physiological Needs On this level are the very basic needs for air, warmth, food, sleep, stimulation and activity. People can die due to lack of biological needs and equilibrium (homeostasis).

Relation with Revolutions


The lower down on Maslows pyramid a dysfunctional regime effects the populace, t he deeper the impact, and the more likely the effected people will rebel. In other words, when a government fails to meet the basic human needs of its people, the people rise up.

Looking back in history for examples of how food and government are connected at the hip, our eyes come to rest on the Roman empire. Though the causes of the fall of Rome are debated still, one thing is certain: As the Roman empire devolved into the latestage Bread and Circuses phase, once the farm system failed and the bread ran out, the rulers quickly lost the support of the people. The party was over.

Sleep
Sleep remains one of the great mysteries of modern neuroscience. We spend nearly one-third of our lives asleep, but the function of sleep still is not known. Fortunately, over the last few years researchers have made great headway in understanding some of the brain circuitry that controls wake-sleep states. Scientists now recognize that sleep consists of several different stages; that the choreography of a nigh ts sleep involves the interplay of these stages, a process that depends upon a complex switching mechanism; and that the sleep stages are accompanied by daily rhythms in bodily hormones, body temperature and other functions. Sleep disorders are among the nations most common health problems, affecting up to 70 million people, most of whom are undiagnosed and untreated. These disorders are one of the least recognized sources of disease, disability and even death, costing an estimated $100 billion annually in lost productivity, medical bills and industrial accidents. Research holds the promise for devising new treatments to allow millions of people to get a good nights sleep. The Stages of Sleep Sleep appears to be a passive and restful time when the brain is less active. In fact, this state actually involves a highly active and well-scripted interplay of brain circuits to produce the stages of sleeping. The stages of sleep were discovered in the 1950s in experiments examining the human brain waves or electroencephalogram (EEG) during sleep. Researchers also measured movements of the eyes and the limbs during sleep. They found that over the course of the first hour or so of sleep each night, the brain progresses through a series of stages during which the brain waves progressively slow down. The period of slow wave sleep is accompanied by relaxation of the muscles and the eyes.Heart rate, blood pressure and body temperature all fall. If awakened at this time, most people recall only a feeling or image, not an active dream. Sleep SLEEP PATTERNS. During a night of sleep, the brain waves of a young adult recorded by the electroencephalogram (EEG) gradually slow down and become larger as the individual passes into deeper stages of slow wave sleep. After about an hour, the brain re-emerges through the same series of stages, and there is usually a brief period of REM sleep (on dark areas of graph), during which the EEG is similar to wakefulness. The body is completely relaxed, the person is deeply unresponsive and usually is dreaming. The cycle repeats over the course of the night, with more REM sleep, and less time spent in the deeper stages of slow wave sleep as the night progresses.

THE WAKING AND SLEEPING BRAIN.Wakefulness is maintained by activity in two systems of brainstem neurons. Nerve cells that make the neurotransmitter acetylcholine stimulate the thalamus, which activates the cerebral cortex (red pathway). Full wakefulness also requires cortical activation by other neurons that make monoamine neurotransmitters such as norepinephrine, serotonin and histamine (blue pathway). During slow wave sleep, when the brain becomes less active, neuron activity in both pathways slows down. During rapid eye movement sleep, in which dreaming occurs, the neurons using acetylcholine fire rapidly, producing a dreaming state, but the monoamine cells stop firing altogether.

Over the next half hour or so, the brain emerges from the deep slow wave sleep as the EEG waves become progressively faster. Similar to during waking, rapid eye movements emerge, but the bodys muscles become almost completely paralyzed (only the muscles that allow breathing remain active). This state is often called rapid eye movement (REM) sleep. During REM sleep, there is active dreaming. Heart rate, blood pressure and body temperature become much more variable. Men often have erections during this stage of sleep. The first REM period usually lasts ten to 15 minutes. Over the course of the night, these alternative cycles of slow wave and REM sleep alternate, with the slow wave sleep becoming less deep, and the REM periods more prolonged, until waking occurs. Over the course of a lifetime, the pattern of sleep cycles changes. Infants sleep up to 18 hours per day, and they spend much more time in deep slow wave sleep. As children mature, they spend less time asleep, and less time in deep slow wave sleep. Older adults may sleep only six to seven hours per night, often complain of early wakening that they cannot avoid, and spend very little time in slow wave sleep.

Sleep disorders Periodic limb movements of sleep are The most common sleep disorder, and the one intermittent jerks of the legs or arms, which most people are familiar with, is insomnia. occur as the individual enters slow wave sleep,

Some people have difficulty falling asleep initially, but other people fall asleep, and then awaken part way through the night, and cannot fall asleep again. Although there are a variety of short-acting sedatives and sedating antidepressant drugs available to help, none of these produces a truly natural and restful sleep state because they tend to suppress the deeper stages of slow wave sleep. Excessive daytime sleepiness may have many causes. The most common are disorders that disrupt sleep and result in inadequate amounts of sleep, particularly the deeper stages. These are usually diagnosed in the sleep laboratory. Here, the EEG, eye movements and muscle tone are monitored electrically as the individual sleeps. In addition, the heart, breathing, and oxygen content of the blood can be monitored. Obstructive sleep apnea causes the airway muscles in the throat to collapse as sleep deepens. This prevents breathing, which causes arousal, and prevents the sufferer from entering the deeper stages of slow wave sleep. This condition can also cause high blood pressure and may increase the risk of heart Cerebral cortex Thalamus Pons Spinal cord 24 attack. There is also an increased risk of daytime accident, especially automobile accidents, which may prevent driving. Treatment is complex and may include a variety of attempts to reduce airway collapse during sleep. While simple things like losing weight, avoiding alcohol and sedating drugs prior to sleep, and avoiding sleeping on ones back can sometimes help, most people with sleep apnea require positive airway pressure to keep the airway open. This can be provided by fitting a small mask over the nose that provides an air stream under pressure during sleep. In some cases, surgery is needed to correct the airway anatomy.

and can cause arousal from sleep. Other people have episodes in which their muscles fail to be paralyzed during REM sleep, and they act out their dreams. This REM behavior disorder can also be very disruptive to a normal nights sleep. Both disorders are more common in people with Parkinsons disease, and both can be treated with drugs that treat Parkinsons, or with an anti-epileptic drug called clonazepam. Narcolepsy is a relatively uncommon condition (one case per 2,500 people) in which the switching mechanism for REM sleep does not work properly. Narcoleptics have sleep attacks during the day, in which they suddenly fall asleep. This is socially disruptive, as well as dangerous, for example, if they are driving. They tend to enter REM sleep very quickly as well, and may even enter a dreaming state while still awake, a condition nown as hypnagogic hallucinations. They also have attacks during which they lose muscle tone, similar to what occurs during REM sleep, but while they are awake. Often, this occurs while they are falling asleep or just waking up, but attacks of paralysis known as cataplexy can be triggered by an emotional experience or even hearing a funny joke. Recently, insights into the mechanism of narcolepsy have given major insights into the processes that control these mysterious transitions between waking, slow wave and REM sleep states.

How is sleep regulated? During wakefulness, the brain is kept in an alert state by the interactions of two major systems of nerve cells. Nerve cells in the upper part of the pons and in the midbrain, which make acetylcholine as their neurotransmitter, send inputs to the thalamus, to activate it.When the thalamus is activated, it in turn activates the cerebral cortex, and produces a waking EEG pattern. However, that is not all there is to wakefulness. As during monoamine neurons. In experiments in which the gene for the neurotransmitter orexin was experimentally removed in mice, the animals became narcoleptic. Hormones and other bodily functions. The suprachiasmatic nucleus also receives an input directly from the retina, and the clock can be reset by light, so that it remains linked to the outside worlds day-night cycle. The suprachiasmatic nucleus provides a signal to the ventrolateral preoptic nucleus and probably the orexin neurons. Similarly, in two dog strains with naturally occurring narcolepsy, an abnormality was discovered in the gene for the type 2 orexin receptor. Recent studies show that in humans with narcolepsy, the orexin levels in the brain and spinal fluid are abnormally low. Thus, orexin appears to play a critical role in activating the monoamine system, and preventing abnormal transitions, particularly into REM sleep. Two main signals control this circuitry. First, there is homeostasis, or the bodys need to seek a natural equilibrium. There is an intrinsic need for a certain amount of sleep each day. The mechanism for accumulating sleep need is not yet clear. Some people think that a chemical called adenosine may accumulate in the brain during prolonged wakefulness, and that it may drive sleep homeostasis. Interestingly, the drug caeine, which is widely used to prevent sleepiness, acts as an adenosine blocker, to prevent its eects. If an individual does not get enough sleep, the sleep debt progressively accumulates, and leads to a degradation of mental function. When the opportunity comes to sleep again, the individual will sleep much more, to repay the debt, and the slow wave sleep debt is usually paid o first.

The other major influence on sleep cycles is the bodys circadian clock, the suprachiasmatic nucleus. This small group of nerve cells in the hypothalamus contains clock genes, which go through a biochemical cycle of almost exactly 24 hours, setting the pace for daily cycles of activity, sleep,

What is a Multiaxial Diagnosis?


Multiaxial diagnosis of DSM is one of two systems for the classification of illnesses and disorders (the second is ICD). In simple terms, a multiaxial diagnosis is a system used to organize, prioritize, and classify illnesses and mental disorders. In a multiaxial diagnostic evaluation there are 5 levels of assessment that allow the clinical team an overview of a persons problems and potential issues. These problems and potential issues include factors interconnected to the patients psychology, neurochemistry, physiology and global level of functioning related to their drug abuse, chemical dependency and social issues. Multiaxial diagnostic assessments are embodied by a system of evaluation protocols defined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, commonly referred to as the DSM-IV-TR. This manual is developed and updated periodically by the American Psychiatric Association.
The underlying framework of the multiaxial system developed in recent years for diagnosis in Psychiatry indicates its relevance to the psychosomatic model.

The five levels of the DSM are called axes and are defined as follows: AXIS I Axis I is reserved for clinical disorders, along with developmental and learning disorders. Some examples of disorders that may be present on Axis I are:

Panic Disorder Generalized Anxiety Disorder Social Phobia Obsessive-Compulsive Disorder Post traumatic Stress Disorder Specific Phobia

This is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes).

AXIS II Axis II is reserved for personality disorders or mental handicaps. Some examples of disorders that may be present on Axis II are:

Borderline Personality Disorder Histrionic Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder

Axis II is the assesment of personality disorders and intellectual disabilities. These disorders are usually life-long problems that first arise in childhood.

AXIS III

Axis III is reserved for medical and/or physical conditions and disorders. Some examples of conditions or disorders that may be present on Axis III are:

Hyperthyroidism Mitral Valve Prolapse (MVP)

Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue which may lead to a depressive episode.

AXIS IV Axis IV is reserved for factors contributing, or affecting, the current psychiatric disorder and treatment outcomes. Some examples of factors that may be present on Axis IV are:

Lack of an adequate support system Social issues Educational problems Problems with work Financial difficulties Legal problems Other psychosocial and environmental problems

Axis IV identifies recent psychosocial stressors - a death of a loved one, divorce, losing a job, etc. - that may affect the diagnosis, treatment, and prognosis of mental disorders.

AXIS V Axis V is reserved for the GAF scale. GAF stands for global assessment functioning. This is a 100 point scale that the clinical team uses to describe and define each persons overall performance level in usual daily activities and social, occupational, academic and interpersonal functioning.

Axis V
The final Axis, V, is designated to provide a Global Assessment of Functioning. The exact scale used is a petty detail. What is clear is that this represents an effort to quantify the effectiveness of adaptation at given relevant points in time. The time chosen is of some importance. When DSM-III was created, it was decided that the assessment was to be made of the highest level of adaptive functioning (for at least a few months) during the past year. The choice of a year was arbitrary and somewhat controversial, but the intent is clear. This was to be a measure of the preexisting level of effectiveness of adaptedness, that is, that level present before the acute maladaptation of the Axis I disorder. It was to represent the baseline of function, which included the effects of enduring (Axis II) disabilities, and offered a realistic goal for treatment outcome. With DSM-III-R, the decision was made to include a second occasion, the time period of the acute illness (and this became the sole focus of DSM-IV). What was thus also quantified was the extent of the acute maladaptation. From our standpoint, the dual inclusion is ideal, because it provides a quantification of both the prior level of adaptedness as well as that reached during the impact of the illness.

Axis V - Global Assessment of Functioning Scale


Axis V is part of the DSM "multiaxial" system for assessment. The five axis model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that account for a patient's mental health. This page explains DSM Axis V

Axis V is for Global Assessment of Functioning (GAF), a reflection of the evaluating clinician's judgement of a patient's ability to function in daily life. The 100 point scale measures psychological, social and occupational functioning. From a diagnostic perspective, the GAF takes a practical view of a patient's mental health. GAF ratings are not only applied to the time the patient enters the doctor's office but are applied over time to monitor progress; ratings are given for different time frames such as "current" or "past week" along with relative ratings such as "highest level in past year." From a healthcare management perspective, the GAF provides quantifiable information that is used to measure eligibility for treatment programs, insurance benefits, disability benefits, etc.

Range of Axis V GAF ratings


The 100 point scale regardes the top rating level of 91-100 as "superior functioning," which essentially identifies a person without symptoms. At the middle of the scale, a rating of 41-50 is for symptoms that lead to antisocial behavior (kleptomania) or social dysfunction (inability to keep a job). The bottom of the scale, 1-10, rates those who pose a threat to themselves or others, who cannot maintain their personal hygiene, or who are suicidal - these patients are mostly dysfunctional on a daily basis and in need of serious help.

An example of a Five axis diagnosis


Axis V is only one of five axes used in a DSM assessment. Here is an example of a five-axis diagnosis (from Substance Abuse Assessment and Diagnosis: A Comprehensive Guide for Counselors and Helping Professionals by Gerald A. Juhnke, Routledge, 2002)

Axis I: Adjustment Disorder with Depressed Mood, Alcohol Abuse, Cannabis Abuse Axis II: No Diagnosis of Axis II Axis III: Hypothyroidism Axis IV: None Axis V: GAF = 50 (on admission), GAF = 62 (on discharge)

From Wikipedia, the free encyclopedia Jump to: navigation, search The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-inliving. The scale is presented and described in the DSM-IV-TR on page 34. The score is often given as a range, as outlined below: 91 - 100 No symptoms. Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. 81 - 90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members). 71 - 80 If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). 61 - 70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

51 - 60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). 41 - 50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). 31 - 40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed adult avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 21 - 30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment, in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends) 11 - 20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communicat ion (e.g., largely incoherent or mute). 1 - 10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death. 0 (Not currently defined.)

References: http://www.psyweb.com/DSM_IV/jsp/Axis_V.jsp Wikipedia Oxford Handbook of Psychiatry

Mechanism of Defence
Table 2: From Defense Mechanisms in Psychology Today American Psychologist, June 2000 (Phebe Cramer, William College)

________________________________________________________________________________________________ ___ In every human being, intrapsychic conflicts are bound to occur. Usually, (or maybe hopefully), these conflicts are resolved by themselves in a short amount of time; however sometimes this is not the case. Every now and then, our internal conflicts can last for long periods of times, and can potentially cause us great harm. Oftentimes anxiety can wear and tear at us, and should not be underestimated. Fortunately, our body has defense mechanisms to defend us from unpleasant emotions and feelings, such as anxiety. These are 7 of them: 1. Rationalization Rationalization is something that every human being does, probably on a daily basis. Rationalization is defined as Creating false but plausible excuses to justify unacceptable behavior. An example of this would be a student stealing money from a wealthy friend of his, telling himself Well he is rich, he can afford to lose it. 2. Identification Identification is defined as Bolstering self-esteem by forming an imaginary or real alliance with some person or group. This is a fairly common method of attempting to forget about ones troubles, happens fairly often, especia lly in insecure people. A person joining a sports team, fraternity, social clique or even subcultures are all examples of this. 3. Displacement Displacement is defined as Diverting emotional feelings (usually anger) from their original source to a substitute target. This frequently occurs in families, where we often see the father getting mad at the mother. The mother then takes her anger out on her son, the son in turn yells at his little sister, the little sister kicks the dog, and the dog bites the cat. Another example would obviously be a boxer taking out his frustration on a punching bag or an opponent. 4. Projection Projection is defined as Attributing ones own thoughts, feelings, or motives to another. This characteristic is not uncommon, and we have probably all witnessed it. An angry man might accuse others of being hostile and

antagonistic. Another example might be a con-artist might be under the impression that everyone else is trying to con him or her.

5. Regression Regression is defined as A reversion to immature patterns of behavior. There are plenty of examples of this (and we all know a couple we are guilty of). One of the more obvious examples might be a teenager not allowed to go on a trip for spring break, so he or she might throw a temper tantrum and scream and cry at his or her parents. Conversely, a teenager might revert back to infant behavior to receive sympathy from his or her parents. 6. Reaction Formation Reaction formation is one of the odder defense mechanisms, as it entails behaving completely contrary to how one truly feels. It is defined as Behaving in a way that is exactly the opposite of ones true feelings. We see this all the time in relationships, where I despise him becomes I love him. Similarly, a b oss might give an employee who he is frustrated with a raise. 7. Repression Repression underlies all the others, and it is possibly the oddest of them all. Repression is defined by Keeping distressing thoughts and feelings buried in the unconscious. There has been much controversy over repressed memories, and many court cases as a result of this. A little girls memory of being molested when she was a toddler might become a repressed memory. The little girl will completely forget about this experience, until the memory might resurface years later. The trouble is, there have been various accounts of memories resurfacing that have no truth or bearing to them. Repressed memories then are unreliable and oftentimes untrue. Conversely; there have been several cases of repressed memories being accurate; one must simply take an account of a repressed memory with a grain of salt. Source: Weiten, Wayne. Psychology: Themes and Variations. Thomson Wadsworth. Source 3:
Why do we need Ego defenses? Memories banished to the unconscious, or unacceptable drives or urges do not disappear. They continue to exert a powerful influence on behavior. The forces, which try to keep painful or socially undesirable thoughts and memories out of the conscious mind, are termed defense mechanisms. There is a perpetual battle between the wish (repressed into the id) and the defense mechanisms. We use defense mechanisms to protect ourselves from feelings of anxiety or guilt, which arise because we feel threatened, or because our id or superego becomes too demanding. They are not under our conscious control, and are non-voluntaristic. With the ego, our unconscious will use one or more to protect us when we come up against a stressful situation in life. Ego-defense mechanisms are natural and normal. When they get out of proportion, neuroses develop, such as anxiety states, phobias, obsessions, or hysteria. Examples of Defenses Mechanisms There are a large number of defense mechanisms; the main ones are summarized below. * Identification with the Aggressor A focus on negative or feared traits. I.e. if you are afraid of someone, you can practically conquer that fear by becoming more like them. An extreme example of this is the Stockholm Syndrome where hostages identify with the terrorists. E.g. Patty Hearst and the Symbionese Liberation Army. Patty was abused and raped by her captors, yet she joined their movement and even took part in one of their bank robberies. At her trial she was acquitted because she was a victim suffering from Stockholm Syndrome.

* Repression This was the first defense mechanism that Freud discovered, and arguably the most important. Repression is an unconscious mechanism employed by the ego to keep disturbing or threatening thoughts from becoming conscious. Thoughts that are often repressed are those that would result in feeling of guilt from the superego. For example, in the Oedipus complex aggressive thoughts about the same sex parents are repressed. * Projection This involves individuals attributing their own thoughts, feeling and motives to another person. Thoughts most commonly projected onto another are ones that would cause guilt such as aggressive and sexual fantasies or thoughts. For instance, you might hate someone, but your superego tells you that such hatred is unacceptable. You can 'solve' the problem by believing that they hate you. * Displacement Displacement is the redirection of an impulse (usually aggression) onto a substitute target. If the impulse, the desire, is okay with you, but the person you direct that desire towards is too threatening, you can displace to someone or something that can serve as a symbolic substitute. Someone who feels uncomfortable with their sexual desire for a real person may substitute a fetish. Someone who is frustrated by his or her superiors may go home and kick the dog, beat up a family member, or engage in cross-burnings. * Sublimation This is similar to displacement, but takes place when we manage to displace our emotions into a constructive rather than destructive activity. This might for example be artistic many great artists and musicians have had unhappy lives and have used the medium of art of music to express themselves. Sport is another example of putting our emotions (e.g. aggression) into something constructive. Sublimation for Freud was the cornerstone of civilized life, arts and science are all sublimated sexuality. (NB. this is a value laden concept, based on the aspirations of a European society at the end of the 1800 century). * Denial Denial involves blocking external events from awareness. If some situation is just too much to handle, the person just refuses to experience it. As you might imagine, this is a primitive and dangerous defense - no one disregards reality and gets away with it for long! It can operate by itself or, more commonly, in combination with other, more subtle mechanisms that support it. For example, smokers may refuse to admit to themselves that smoking is bad for their health. * Regression This is a movement back in psychological time when one is faced with stress. When we are troubled or frightened, our behaviors often become more childish or primitive. A child may begin to suck their thumb again or wet the bed when they need to spend some time in the hospital. Teenagers may giggle uncontrollably when introduced into a social situation involving the opposite sex. * Rationalization Rationalization is the cognitive distortion of "the facts" to make an event or an impulse less threatening. We do it often enough on a fairly conscious level when we provide ourselves with excuses. But for many people, with sensitive egos, making excuses comes so easy that they never are truly aware of it. In other words, many of us are quite prepared to believe our lies. * Reaction formation This is where a person goes beyond denial and behaves in the opposite way to which he or she thinks or feels. By using the reaction formation the id is satisfied while keeping the ego in ignorance of the true motives. Conscious feelings are the opposite of the unconscious. Love - hate. Shame - disgust and moralizing are reaction formation against sexuality. Usually a reaction formation is marked by showiness and compulsiveness. For example, Freud claimed that men who are prejudice against homosexuals are making a defense against their own homosexual feelings by adopting a harsh anti-homosexual attitude which helps convince them of their heterosexuality. Other examples include:

* The dutiful daughter who loves her mother is reacting to her Oedipus hatred of her mother. * Anal fixation usually leads to meanness, but occasionally a person will react against this (unconsciously) leading to overgenerosity. McLeod, S. A. (2009). Defense Mechanisms. Retrieved from http://www.simplypsychology.org/defense-mechanisms.html

Source 4

Defense Mechanisms Defense mechanisms protect us from being consciously aware of a thought or feeling which we cannot tolerate. The defense only allows the unconscious thought or feeling to be expressed indirectly in a disguised form. Let's say you are angry with a professor because he is very critical of you. Here's how the various defenses might hide and/or transform that anger: Denial: You completely reject the thought or feeling. "I'm not angry with him!" Suppression: You are vaguely aware of the thought or feeling, but try to hide it. "I'm going to try to be nice to him." Reaction Formation: You turn the feeling into its opposite. "I think he's really great!" Projection: You think someone else has your thought or feeling. "That professor hates me." "That student hates the prof." Displacement: You redirect your feelings to another target.. "I hate that secretary." Rationalization: You come up with various explanations to justify the situation (while denying your feelings). "He's so critical because he's trying to help us do our best." Intellectualization: A type of rationalization, only more intellectualized. "This situation reminds me of how Nietzsche said that anger is ontological despair." Undoing: You try to reverse or undo your feeling by DOING something that indicates the opposite feeling. It may be an "apology" for the feeling you find unacceptable within yourself. "I think I'll give that professor an apple." Isolation of affect: You "think" the feeling but don't really feel it. "I guess I'm angry with him, sort of." Regression: You revert to an old, usually immature behavior to ventilate your feeling. "Let's shoot spitballs at people!" Sublimation: You redirect the feeling into a socially productive activity. "I'm going to write a poem about anger." ** Defenses may hide any of a variety of thoughts or feelings: anger, fear, sadness, depression, greed, envy, competitiveness, love, passion, admiration, criticalness, dependency, selfishness, grandiosity, helplessness. Your Group's Role play: In your small group, develop a role play that you can peform in front of the class. In it demonstrate several defense mechanisms. Try to give everyone in the group a part to play. Good role plays usually spend a minute or so to develop the scene, the characters, and the situation at hand. At that point start to introduce the defenses into the scene. The whole role play should last about 3-5 minutes. After you finish the scene, the class will try to guess which defense mechanisms you were demonstrating.

Mental Disorders Classification


Classification of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). Categorical description of symptoms - person meets all or some of symptoms for a period of time (almost 400 disorders 5 axes primary problem, personality, medical condition, social and environmental stressors, global assessment Problems over diagnosis, problems with labels, distinction between serious mental disorders and normal problems

Anxiety Disorders

Anxiety - apprehension, dread, worry, muscle tension, sweating, increased breathing and heart rate. Phobia - Excessive, irrational fear Simple phobia - Fear of a specific object Social phobia - Fear of social settings involving evaluation, embarrassment, looking foolish Agoraphobia - Fear of being in public places. Often associated with panic disorder. Panic Disorder - Sudden, overwhelming, intense anxiety, fear, terror. Lasts for a short time period. May include shortness of breath, dizziness, fear of dying or going crazy.

Simple phobias Bugs, mice, snakes, bats; heights; water; storms; closed places

Obsessive-Compulsive Disorder Obsession - Intrusive, irrational, recurrent, unwanted thoughts, images, or impulses Compulsion - Repetitive, ritualistic behavior, feel compelled to perform, irresistible urge. Anxiety builds up from obsession and compulsion helps relieve anxiety Most common: Cleaning (hand washing) and Checking. (everything unplugged, locked) Also counting and touching

Mood Disorders

Major Depressive Disorder Several possible symptoms (does not need to have ALL symptoms to be diagnosed): Chronic, extreme sadness, unhappiness. Little interest or pleasure in usual activities. Sleeps more or less than usual. Eats more or less than usual. Little energy or enthusiasm. Feelings of worthlessness; self-blame and despair. Difficulty concentrating, making decisions. Thoughts of dying or suicide. Bipolar Disorder: - Periods of mania and depression Mania characterized by: Euphoric or irritable mood Restlessness, pacing. Distractibility

Little need for sleep Inflated self-esteem; grandiose plans Reckless sexual and/or financial behavior Extreme talkativeness.

Emotional behavior MANIA - elation, euphoria, extreme sociability, expansiveness, impatience, DEPRESSIVE gloominess, hopelessness, social withdrawal, irritability, indecisiveness Cognitive characteristics MANIA - distractibility, desire for action, impulsiveness, talkativeness, grandiosity, inflated self esteem, DEPRESSION slowness of thought, obsessive worrying about death, negative self image, delusions of guilt, difficulty concentrating Motor characteristics MANIA hyperactivity, decreased need for sleep, sexual indiscretion, fluctuating appetite, DEPRESSIVE decreased motor activity, fatigue, difficulty sleeping, decreased sex drive, decreased appetite

Seasonal Affective disorder - winter Crave carbohydrates, overeat, oversleep Light

Somatoform Disorders

Physical symptoms in the absence of any physical cause. Hypochondriasis - Excessive, unwarranted concern/preoccupation for personal health. Minor pains and other symptoms are overblown, convinced have serious disorder Not done to get attention - not "faking" or Munchausen syndrome Conversion Disorder - Serious physical symptoms (motor or sensory function) without physical cause but may solve psychological problem ( Paralysis, blindness) o La belle indifference - Nonchalance , lack of concern Body Dysmorphic disorder - imagined ugliness to the point of obsession (not the same as anorexia or bulimia)

Dissociative Disorders

Dissociation - loss of ability to integrate all components of self into coherent representation of ones identity Dissociative Amnesia - Sudden inability to recall personal info ( name, parents, profession, address). Also known as repressed memory. o Usually occurs after severe stress or trauma. Dissociative Fugue (to flee) - Memory loss and wander or move to a new place (New identity, job, home, family, and personality). Often resolve spontaneously with no memory of what happened Dissociative Identity Disorder (multiple personality) - 2 or more personalities, each with distinct traits, names, memories, speech patterns, hair style, sex. Traumatic incident usually precedes split Dissociative disorders (repression, multiple personality disorder) are on the rise, large amount of controversy

Schizophrenia

Severe, debilitating, often chronic. Loss of contact with reality, inappropriate affect, disturbances in thought and/or other behavior Many kinds of symptoms Agitation Hallucinations

Delusions Disruptions in cognition/speech Social withdrawal Problems in emotional expression

Descriptions of Symptoms

Positive abnormal behavior is present Hallucinations - Sensory experiences without sensory stimulus - Usually auditory Delusions - False belief, Cant be convinced its not true. Grandeur one is famous or has power Persecution someone is out to get them Reference materials refer to them personally Influence something influencing their behavior Formal thought disorder- Problems in the organization of ideas & speech Loose associations Negative symptoms loss or deficiency Social withdrawal, problems in emotional expression (flat affect), limited speech, poor hygience

Types of Schizophrenia

Paranoid type - Elaborate delusions (grandeur, persecution), suspicious, argumentative Disorganized type - Bizarre, inappropriate speech & behavior, flat or inappropriate affect, silliness, grotesque mannerisms, bizarre behavior. Catatonic type Catatonic Excitement - Restlessness, pacing & purposeless, repetitive movements Catatonic Stupor - Almost never talks, barely moves, Waxy flexibility(assume posture and remain in same position for long periods of time)

Childhood Disorders

Autism - oblivious to others, unresponsive, preference for nonsocial object (social isolation) Abnormal response to stimuli or change mute or talk in parrot-like fashion Self stimulating behavior (hand wringing, rocking, etc.) Attention Deficit Disorder - hyperactivity inability to attend, focus attention in sustained way impulsive, distractible, aggressive Ritalin (stimulant) or new one - ephinephrine

Eating Disorders

Fear of getting fat Anorexia Nervosa - abnormal concern with weight and body image, extreme measures to lose weight, excessively thin Bulimia Nervosa - binge eating followed by purging - remain normal in weight

The Notion of Insanity - legal


Insanity as incompetence to stand trial. Not able to participate in own defense. May be placed in a mental hospital or forced treatment Insanity as a criminal defense Varies from state to state

Model Penal code: Not responsible for crime if as result of mental disorder cannot appreciate wrongfulness of conduct or conform to law o Alternative: Guilty but Mentally Ill Only used in 1% of cases, 2 in 1000 acquitted, 3 in 10,000 set free

The Notion of Insanity - legal


Insanity as a condition of involuntary commitment A danger to self or others or inability to care for self. Emergency vs. formal commitment

Statistics: Percent of Americans ever experiencing psychological disorders Alcohol men 23.8%, women 4.6%, total 13.8% Phobic disorder men 10.4%, women 17.7%, total 14.3% Mood disorder men 5.2%, women 10.2%, total 7.8% Schizophrenic disorder men 1.2%, women 1.7%, total 1.5%

The Five Stages of Loss and Grief


The stages of mourning are universal and are experienced by people from all walks of life. Mourning occurs in response to an individuals own terminal illness or to the death of a valued being, human or animal. There are five stages of normal grief. They were first proposed by Elsabeth Kubler-Ross in her 1969 book On Death and Dying. In our bereavement, we spend different lengths of time working through each step and express each stage more or less intensely. The five stages do not necessarily occur in order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief. The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges. As long as there is life, there is hope. As long as there is hope, there is life. Many people do not experience the stages in the order listed below, which is okay. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, its more helpful to look at them as guides in the grieving process it helps you understand and put into context where you are. 1. Denial and Isolation The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain. 2. Anger As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry. Remember, grieving is a personal process that has no time limit, nor one right way to do it. The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them. Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved ones illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time. 3. Bargaining The normal reaction to feelings of helplessness and vulnerability is often a need to regain control

If only we had sought medical attention sooner If only we got a second opinion from another doctor

If only we had tried to be a better person toward them

Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality. 4. Depression Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug. 5. Acceptance Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression. Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us. Coping with loss is a ultimately a deeply personal and singular experience nobody can help you go through it more easily or understand all the emotions that youre going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.
APA Reference Axelrod, J. (2012). The 5 Stages of Loss and Grief. Psych Central. Retrieved on October 7, 2012, from http://psychcentral.com/lib/2006/the-5-stages-of-loss-and-grief/

From Wikipedia

The Kbler-Ross model, commonly known as The Five Stages of Grief, includes denial, anger, bargaining, depression, and acceptance. In no defined sequence, most of these stages occur when a person is faced with the reality of their impending death and applies to survivors of a loved one's death as well. The hypothesis was first introduced by Elisabeth Kbler-Ross[1] in her book On Death and Dying, which was inspired by her work with terminally ill patients. Kbler-Ross was inspired by the lack of curriculum in medical schools that addressed death and dying, so she started a project about death when she became an instructor at the University of Chicago medical school. This evolved into a series of seminars; those interviews, along with her previous research, led to her book. Her work revolutionized how the medical field took care of the terminally ill. Her five stages of grief have now become widely accepted. Kbler-Ross noted that these stages are not meant to be complete nor chronological. Her hypothesis also holds that not everyone who experiences a life-threatening or life-altering event feels all five of the responses nor

will everyone who does experience them do so in any particular order. The hypothesis is that the reactions to illness, death, and loss are as unique as the person experiencing them. The stages, popularly known by the acronym DABDA, include:[2]
1. Denial "I feel fine."; "This can't be happening, not to me." Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death. Denial can be conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism and some people can become locked in this stage. 2. Anger "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?" Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief. 3. Bargaining "I'll do anything for a few more years."; "I will give my life savings if..." The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..." People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. 4. Depression "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?" During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed. Depression could be referred to as the dress rehearsal for the 'aftermath'. It is a kind of acceptance with emotional attachment. It's natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation. 5. Acceptance "It's going to be okay."; "I can't fight it, I may as well prepare for it." In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. This stage varies according to the person's situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief.

Kbler-Ross originally applied these stages to people suffering from terminal illness. She later expanded this theoretical model to apply to any form of catastrophic personal loss (job, income, freedom). Such losses may also include significant life events such as the death of a loved one, major rejection, end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or chronic illness, an infertility diagnosis, as well many tragedies and disasters. As stated before, the Kbler-Ross Model can be used for multiple situations where people are experiencing a significant loss. We explain how the model is applied differently in a few specific situations below. These are just some of the many examples that Kbler-Ross wanted her model to be used for.
Children grieving in divorce Denial Children feel the need to believe that their parents will get back together or they will change their mind about the divorce. Example: Mom or Dad will change their mind Anger Children feel the need to blame someone for their sadness and loss. Example: I hate dad for leaving us Bargaining - In this stage, children feel as if they have some say in the situation if they bring a bargain to the table. This helps them keep focused on the positive that the situation might change and less focused on the negative, the sadness theyll experience after the divorce. Example: If I do all of my chores maybe Mom wont leave Dad

Depression - This involves the child experiencing sadness when they know there is nothing else to be done and they realize they cannot stop the divorce. The parents need to let the child experience this process of grieving because if they do not it will only show their inability to cope with the situation. Example: Im sorry that I cannot fix this situation for you. Acceptance This does not necessarily mean that the child is completely happy again. The acceptance is just moving past the depression and starting to accept the divorce. The sooner the parents start to move on from the situation the sooner the kids can begin to accept the reality of it. [3]

Stress
III. STRESS AND ILLNESS Stress has powerful effects on mental functioning, mental and physical performance, interpersonal encounters, and physical well-being. In the Principles of Internal Medicine (Harrison) it was reported that 50-80% of all physical disorders have psychosomatic or stress related origins.

A. Psychosomatic Illness Many people assume erroneously that a psychosomatic illness is a fake illness or something that someone is simply imagining. That is NOT true.Definition - a Psychosomatic Illness is a condition in which the state of mind (psyche) either causes or mediates a condition of actual, measurable damage in the body (soma). Examples include : ulcers, asthma, migraine headaches, arthritis, and even cancer. We discussed the differences between distress & eustress, but there is an additional "type" of stress called PSYCHOPHYSIOLOGICAL STRESS (it is not a category like distress...) that can be defined as mental upset that triggers a physiological stress response. Thus, it is stress that leads to psychosomatic illness. In our culture, psychophysiological stress is the most common type of stress AND is the major factor in the onset of psychosomatic illness. Since we have been discussing the fact that stress can lead to illness via the psychosomatic model, we now need to discuss what this model is and what steps are involved.

B. The Psychosomatic Model The idea behind creating and understanding a model of stress related illness is that by knowing the steps that lead to illness, we can intervene at any of these steps to break the cycle and thwart the onset of illness. The model works like a stage theory - you must progress from one stage (or step) to the next in the proper order for the model to work. The steps in the Model are: 1) Sensory Stimulus - is also referred to as the STRESSOR, which can be any mental or physical demand put upon our body our mind. This can be anything from a loud noise to an exam or work load to physical activity or the in-laws coming into town. For example, if you are stuck in a traffic jam, what is the stress and what is the stressor? Stressor = traffic jam Stress = mental and physical response to the stressor 2) Perception - the active process of bringing an external stimulus to the CNS (especially the brain) for interpretation.

A stressor is often an external event...but for a stressor to affect a human it must get into the mind-body system. It is through perception that this occurs. 3) Cognitive Appraisal - process of analyzing and processing information as well as categorizing and organizing it. Recall the section on memory - at the cognitive appraisal level we put labels on things - good, bad, dangerous, pleasant, etc. Thus, for most situations, it is the LABEL that we give to the information that determines whether it will be deemed stressful and trigger a physiological response. In addition, appraisal is influenced by personal history, personal beliefs, morals, etc. *** I will claim that it is this labeling processes that is the key component. We all make personal appraisals of situations and it is these labels that determine our stress level and stress response . For example, my father becomes outraged while sitting in traffic while I have no problem with it. He labels traffic as a very bad and, in his words "infuriating". I think traffic is simply a part of driving in a city...I can't do anything about it, so why label it as a "bad" thing? 4) Emotional Arousal - If we classify/label something as stressful, it then produces a bodily/physiological response. Remember, anytime a subjective experience of emotion occurs, it is followed by a change in autonomic physiology. So, at this stage, we simply experience an emotion...nothing else at this point, just the production (or beginning) of an emotion. So, any emotion we experience, be it joy, fear, excitement, anger, etc., will elicit a stress response in the body. At a physiological level, we cannot differentiate between positive and negative emotions. 5) Mind-Body Connection - here the emotional arousal is changed into a bodily change so that you may adapt to the situation and respond appropriately. Now, the emotional arousal BEGINS TO BE CONVERTED into that bodily response or change we have addressed. This change will/can occur at two levels: a) nervous system - sympathetic and parasympathetic systems. Short-term changes occur and work on an electrical level. For example: you are afraid and your bodily response is to tremble. b) endocrine system - produces slower, longer lasting responses using chemicals, hormones, and glands. *emotional arousal stimulates the hypothalamus which sends messages through the sympathetic nervous system to the appropriate organ. *in addition the pituitary gland is stimulated and results in hormone production 6) Physical Arousal - Once the mind-body connection has been made and the bodily changes occur, these changes are called physical arousal. 7) Physical Effects - Now the internal organs begin to be affected by the physical arousal. For example, increased heart rate, blood pressure, dilation of the pupils, etc., Sound familiar??? Like the Fight-or-flight response.

8) Disease - If the physical effects continue for a sustained period of time (this varies) the imbalance of functioning can result in disease. One or more organ can become exhausted and work inefficiently or not at all. At this point, we would say that the person has a psychosomatic disease. But, we give them a specific name: PSYCHOGENIC DISEASE - physical disease that have a change in mental state as the major cause. Other diseases which may be influenced by stress/the mind, but do not have them as the MAJOR CAUSE are not psychogenic (e.g., cancer, diabetes, etc.). *this model is an EXACERBATION CYCLE - arousal, tension, and disease can breed further stress responses and thus become even more intense. For example, how would you respond if a doctor told you today that you have cancer? IV. MAJOR TYPES/SOURCES OF STRESS Although we know that almost anything can be a source of stress, we have 4 major classifications or types of stress: A) FRUSTRATION - stress due to any situation in which the pursuit of some goal is thwarted. Frustration is usually short-lived, but some frustrations can be source of major stress: 1) failures - we all fail. But, if we set unrealistic goals, or place too much emphasis on obtaining certain successes, failure can be devastating. 2) Losses - deprivation of something that you once had and considered a "part" of your life. Can result in tremendous stress. B) CONFLICT - two or more incompatible motivations or behavioral impulses compete for expression. When faced with multiple motivations or goals, you must chose and this is where the problems/conflict arise. Studies have indicated that the more conflict a person experiences, the greater the likelihood for anxiety, depression, and physical symptoms. There are 3 major types of conflicts: 1) Approach-Approach: a choice must be made between two attractive goals. You may want both, but can only have one. For example, "Since I don't have to work today, should I play basketball or golf? Do I go out for pizza or Chinese food?" Mmmmm...pizza! This type of conflict is the least demanding and least damaging. You rarely collapse at a restaurant because you can't decide between the lobster and the steak. 2) Avoidance-Avoidance: a choice must be made between two unattractive goals. "Caught between a rock and a hard place." These conflicts are usually very unpleasant and highly stressful. 3) Approach-Avoidance: choice must be made to pursue a single goal that has both positive and negative aspects. For example, asking someone on a date. This type of conflict often produces VACILLATION: going and back and forth in decision making.

Studies have shown that even animals vacillate. Miller (1959) concluded, "in trying to resolve an approach-avoidance conflict, one should focus more on decreasing avoidance motivation than on increasing approach motivation." So, if you have a friend who is vacillating over whether to ask someone on a date, you should downplay the negative aspects of possible rejection rather than dwelling on how much fun the date could be if only... C) CHANGE - life changes are noticeable alterations in one's living circumstances that require adjustment. 1) Holmes & Rahe (1967) - developed the Social Readjustment Rating Scale (SRRS) to measure life changes. They found that, after interviewing thousands of people, while BIG changes like death of a loved one are very stressful, small life changes have tremendous effects. Studies using the SRRS have indicated that people with higher scores tend to be more vulnerable to many different physical and psychological illnesses. Further studies have found that the scale measures a wide range of experiences that may result in stress as opposed to just measuring "life-changes". D) Pressure - expectations or demands that one must behave in a certain way. For example, I am under pressure to perform in very specific ways when I am in front of a class as the "teacher". Surprisingly, pressure has only recently been examined in terms of psychological and physical effects due to stress. Studies have found the Pressure inventory (created in the 80's) is more highly correlated with psychological problems than the SRRS.

________________________________________ V. STRESS & PSYCHOLOGICAL FUNCTIONING A) IMPAIRED TASK PERFORMANCE - Baumeister (1984) found that stress interferes with attention and therefore, performance. 1) increased stress = increased distractibility 2) increased stress = over thinking on tasks that should be "automatic". For example: a free throw at "crunch time" B) BURNOUT - physical, emotional, and mental exhaustion due to work-related stress. Cause is not sudden, but prolonged exposure to stress. Increases the more "jobs/tasks" placed upon you. For example, having multiple roles such as parent, student, spouse, etc. C) POSTTRAUMATIC STRESS DISORDER - disturbed behavior that is attributed to a major stressful event, but emerges after the event has ended (often years later). Very common in the 70's - Vietnam war veterans had symptom usually 9-60 months later.

Occurs in general population as well: 1) most common - rape 2) seeing someone die or severely injured 3) close brush with death Symptoms include - nightmares, sleep disturbances, jumpiness, etc. D) Psychological Problems/Disorders - usually the result of prolonged stress: insomnia, nightmares, poor academic performance, sexual dysfunctions, anxiety, schizophrenia, depression, eating disorders, and lots more. What can you do about it??? There are many techniques to reduce stress and the progression through the Psychosomatic Model. For example, there are relaxation techniques such as Meditation, Progressive Neuromuscular Relaxation, exercise, biofeedback, and Selective Awareness, just to name a few.

Source: http://www.alleydog.com/101notes/stress&health.html#ixzz28dUuSONT

Holmes and Rahe


Holmes and Rahe (1967) developed a questionnaire called the Social Readjustment Rating Scale (SRRS) for identifying major stressful life events. Each one of the 43 stressful life events was awarded a Life Change Unit depending on how traumatic it was felt to be by a large sample of participants. A total value for stressful life events can be worked out by adding up the scores for each event experienced over a 12 month period. If a person has less the 150 life change units they have a 30% chance of suffering from stress. 150 - 299 life change units equates to a 50% chance of suffering from stress. Over 300 life units means a person has an 80% chance of developing a stress related illness.

Social Readjustment Rating Scale - SRRS

Evaluation of the SRRS


Individual Difference: The SRRS assumes that each stressor affects people the same way. Not necessarily true e.g. divorce can be amicable or even a relief. Most 43 life changes in the SRRS arent everyday events. Kanner et al (1981) has designed a Hassles Scale which are more common, e.g. losing things, traffic jams, arguments, disappointments, weight and physical appearance.

Reference

McLeod, S. A. (2010). SRRS - Stress of Life Events. Retrieved from http://www.simplypsychology.org/SRRS.html

IMPORTANT TERMS

Life Stress - external changes that occur in people's lives requiring them to make major internal, psychological adjustments

THEORETICAL PROPOSITIONS
Do you believe in a clear connection between stress and illness? Most people would answer "Yes." However, just until 20 to 30 years ago, people were not aware of the fact that stress affected our health conditions. As defined above, life stress is stress that bring big changes to our lives, such as moving to a new school, or losing your job. Of course, scientifically it is impossible to precisely measure these life stresses, because it's not like the psychologists can stuff people into a room and expose them to long term stressful events. Therefore, Holmes and Rahe developed a written scale to measure life stress, and what effect it has on a person's health.

METHOD

Holmes and Rahe first came up with a list of 43 life stresses that causes a person to make adjustments in their lives. Then, they showed the list to 394 subjects and asked them to determine how much stress each event brings. They also asked the subjects to assign a point value to each event, in which marriage had been given an arbitrary value of 500 points. Then, if the subjects saw an event that cause more changes than marriage, they would give that event more than 500 points, and if it was less, they would give it less than 500 points. These scores were averaged and then divided by 10 to arrive at a score for the individual items.

RESULTS
As you can see, the death of spouse was ranked the most stressful event and minor violation of law was ranked as the least. To make the result consistent to all subjects, Holmes and Rahe divided the subjects into several subgroups (such as male vs female, higher socioeconomic vs lower socioeconomic, etc) and correlated their ratings of the items.
Score of 300+: At risk of illness. Score of 150-299: Risk of illness is moderate. (reduced by || 30% from the above risk) Score <150: Slight risk of illness.

CRITICISMS
Holmes' and Rahe's SRRS have been criticized mostly for its lack of accuracy, for the scale includes both positive and negative life events as well as events that are in your control and events that are out of your control in the same scale. This is inaccurate because events that are sudden, negative and out of your control are much more predictive of illness than are positive, controllable life changes. Furthermore, the scale also does not take into consideration each person's interpretation of a stressful event. For example, retirement may mean for a person, the end of a career and being forced out of pasture, while for another person, it may mean freedom and leisure time.

RECENT APPLICATIONS

There have been many new tools for measuring stress, however, the SRRS is still chosen frequently by researchers as the most useful tool. Recently, a study incorporating the SRRS examined the relationship between life stress and coping abilities to the increased chance of serious injury in elderly individuals. The results showed that there was a clear connection between the number of life-change events with hip-fracture injuries. Furthermore, there also has been a study with the SRRS to examine the link between drug abuse and stress among white collar workers in Quebec. This also showed that there was a statistically significant association between psychotropic (i.e, marijuana, cocaine) drug use and job stress. Lastly, there was an important cross-cultural study that sought the validity of applying Western definitions and theories about stress to other diverse cultures. This study showed that for example in India, the word stress cannot be clearly translated, which is a problem for researchers in non-Western cultures. Furthermore, people in different cultures see different events as stressful events, which may not be included in the scale.

CONCLUSION

Several factors in life effect illness, and among them is stress. Though in the past it has been ignored, nowadays, people realize that successful treatment of illness must involve the entier person: mind and body.

PERSONALITY DISORDERS
By definition, personality disorders are considered a group of personality traits that are relatively persistent through adulthood. However, the concept of personality disorders persisting throughout the lifespan contradicts widespread clinical belief that they become less severe with ageing. For example, DSM-IV(1) notes that some types of personality disorders...tend to become less evident or remit with age'. Detailed descriptions of each of the 10 personality disorder diagnoses can be found in the DSM-IV. However, because we believe that the clearest linkages between personality disorders and physiology may lie at the level of symptoms and their inter-relationships rather than at the level of existing diagnoses, we will focus more on these symptoms that comprise the diagnoses rather than on the diagnoses themselves. The 10 personality disorders listed in the DSM-IV can be grouped into 3 clusters on the basis of similar symptoms. Specifically, people diagnosed with a personality disorder in cluster A (paranoid, schizoid, or schizotypal) tend to show odd and eccentric behavior. Interpersonally, they are often reclusive and suspicious. People diagnosed with a personality disorder in cluster B (histrionic, narcissistic, borderline, or antisocial) tend to show dramatic, emotional. and impulsive behavior. People diagnosed with a personality disorder in cluster C (avoidant. dependent, and obsessive-compulsive) tend to show anxious or fearful behavior (see Table 5.1). Since personality disorders are difficult to diagnose reliably, incidence data are rare and variable. According to a recent review, current U.S. population estimates for any personality disorder (PD) based on DSM-III-R criteria ranged from 6.7 to 33.1 percent, with the authors concluding that lifetime prevalence of at least one personality.
Table 1 Weighted prevalence (%) of DSM-III personality disorders in a large community study

Books@Ovid Copyright 2000 Oxford University Press Michael G. Gelder, Juan J. Lpez-Ibor Jr, Nancy C. Andreasen New Oxford Textbook of Psychiatry

From Wikipedia:

Personality disorders are a class of personality types and enduring behaviors associated with significant distress or disability, which appear to deviate from social expectations particularly in relating to other humans. [1][2][3] Personality disorders are included as mental disorders on Axis II of the Diagnostic manual of the American Psychiatric Association, and in the mental and behavioral disorders section of the ICD manual of the World Health Organization. Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. In general, personality disorders are diagnosed in 40-60 percent of psychiatric patients, making them the most frequent of all psychiatric diagnoses.[4] These behavioral patterns in personality disorders are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress or depression. [5] The onset of these patterns of behavior can typically be traced back to early adolescence and the beginning of adulthood and, in some instances, childhood. [1] Because the theory and diagnosis of personality disorders stem from prevailing cultural expectations, their validity is contested by some experts on the basis of invariable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.

Personality disorders
Cluster A (odd)

Paranoid Schizoid Schizotypal

Cluster B (dramatic)

Antisocial Borderline Histrionic Narcissistic

Cluster C (anxious)

Avoidant Dependent Obsessivecompulsive

Not specified

Depressive Passive aggressive

Sadistic

Self-defeating

You might also like