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ABNORMAL PSYCHOLOGY

Functional and personality disorders

            The population of mental hospitals peaked in the 1950s with 0.38% of Americans institutionalized. There were more people in hospitals for mental disorders than for all other medical causes combined.

            By the 1970s, the old mental retardation classification system had been replaced. Formerly, 75% were classified as morons (IQ 50-70, mental age 7-12); 20% imbeciles (IQ 30-50, mental age 4-7); and 5% idiots (IQ 0-30, mental age 0-4).         

            Current statistics

           Some psychiatrists have adopted the habit of scanning a checklist of symptoms, then writing a prescription to save time. An adequate evaluation must include psychosocial context, pervasiveness, and their time course in order to distinguish them from simple reactivity to life’s experiences.

            According to the National Institute for Mental Health (NIMH), at any given time, 26.2% of Americans suffers a mental disorder, and over a lifetime, half of us; yet only 10% of us are in psychotherapy. Men and women suffer equally in numbers, but with different symptoms. Blacks have 30% less mental illness than whites.

            80% of the patients report that the treatment was effective, 47% of the patients received medication without therapy, 34% received both, and 19% received therapy but no medication. Mental disorders are more common than heart disease, cancer, or diabetes, and account for half of all causes of disability.

            Because of deinstitutionalization (replacing hospital confinement with drug therapy) that began in the 1960s, only 10% of the mental hospital beds of the 1950s remain today. The population has doubled since then, and there are three times as many mentally ill persons in jails than in hospitals. Most incarcerations are for minor offenses like public urination or creating a public disturbance. People with severe mental illness commit only 5% of violent crimes.

            Comorbidity: 45% of the population suffers from more than one mental disorder at a given time; depression tends to accompany substance abuse and anxiety disorders.

            Over 90% of suicides are committed by persons with a mental disorder, usually depression or substance abuse.  Globally, there are 3000 suicides a day, or a million a year, and rising steadily. 1% of the U.S. population is suicidal with the highest rates among the 18-29 age group. More women than men consider it, but more men than women do it. One of every 25 attempts is successful, men by guns, women by prescription drugs.

            On the other hand, the thin line between normal and abnormal personalities suggests that that “normal” people have varying degrees of quirkiness that define the individuals’ personalities. For example, symptoms seen in a variety of psychiatric disorders as well as in normal people under stress include impulsivity, irritability, aggression, hostility and rage, moodiness and sudden mood changes, agitation, poor concentration, and disorganization.

            We have a tendency to generalize, readily name-calling “neurotic” and “paranoid” when such disorders are actually syndromes—clusters of clinically-defined symptoms. Even then, individuals who are inflicted may not display all of the characteristic symptoms.

            Not all personality displays are indicative of pathology; a loud-mouth at a party isn’t necessarily a narcissist, but may be merely compensating for a feeling of inferiority – or may be drunk!

 

WHAT IS NORMAL?

“Normal” must have a reference for the particular group or culture. Assuming there is a baseline for acceptable behavior, or a bell curve for general behavior, children vary wildly up and down from that center line, gradually moderating with age and experience. While constant motion of children may be distracting to adults, it’s necessary for their physical growth.

 

            PERSONALITY TRAITS OF NORMAL ADULTS (Model by Costa and McCrae)

(Note: In each of the five cases, the category and its oppositional characteristic are both normal)

1. Extroversion: A preference for social interaction and a tendency to be active, talkative, optimistic, and affectionate. Introverts, on the other hand, tend to prefer solitude and are less active than extroverts; they appear sober, aloof, quiet, task-oriented, and have less need for stimulation.

2. Openness: Interested in new experiences, receptive to new activities, creative, curious, untraditional; closed minds are typically more interested in practical, concrete pursuits, set in their ways and are emotionally unresponsive.

3. Emotional stability: the ability to remain calm during stressful situations, as opposed to neuroticism, the tendency to experience negative emotions such as anxiety, anger, and depression, accompanied by disruptions of behavior and distressed thinking.

4. Agreeableness: Taking a compassionate interest in others; trusting and tender-hearted; generous and caring, often putting others’ needs before themselves and even appearing gullible; disagreeable personalities are likely to be competitive, manipulative, cynical, skeptical, hostile and rude.

5. Conscientiousness: Well-organized dedication to work, ambitious, persistent, strive for perfection; low conscientious individuals are less demanding of themselves and others, unreliable and careless.

 

            Defining “abnormal” is a challenge. It must be remembered that normal people display many of these symptoms at times, but disordered types are rigid in their malfunctions, consequently losing friendships and jobs.

While smoking, drinking, high productivity and genius may be “abnormal,” they aren’t considered a mental health problem unless they cause discomfort, unhappiness, or affect others. Maladaptiveness—the inability to reach goals, adapt to the demands of life, or function among others—is the key, exhibited with four distinct characteristics:

Long Periods of Discomfort

It is normal to experience discomfort from stress or grief, but this diminishes with time. Persistent discomfort has no reality basis and is abnormal.

Impaired Functioning

Everyone has periods of inefficiency and moods, but a very brilliant person who consistently fails classes and tasks, or changes jobs for no apparent reason may need help.

Bizarre Behavior

Young people experiment with their individuality – piercings, dress style, tattoos, hair coloring – but bizarre behavior like hallucinations (baseless sensory perceptions) or delusions (provably-false beliefs) suggests confusion.

Disruptive Behavior

Impulsive and apparently uncontrollable behavior disrupts the lives of others or deprives them of their human rights.

 

Lying

          According to Dr. Phil, the average man lies six times a day and the average woman three times. He suggests looking for the following clues to spot a liar:

 

1) Too much or too little eye contact. Liars tend to avoid looking people in the eye, but if they are staring you down, they may be working hard at lying.

 

2) Over-emphasizes details or picks some obscure point to emphasize instead of focusing on the key issue.

 

3) Fidgeting. Is the person you're talking to very fidgety? Kids do this when they're telling a tale.

 

4) Frequent touching of the nose, face, ear, mouth, throat.

 

5) Mouth pursed (lips tight).

 

6) Throat clearing, stuttering, hesitating, or other stalling techniques.

 

7) Looking up or down (stalling for time).

 

8) Answers questions not asked or provide information not needed to defend themselves.

 

9) Excessive blinking, dilated pupils, voice pitch changes, less smiling, shrugging shoulders, crossed arms.

 

10) Shaking head while making a point [I doubt this; Dr. Phil does it, too!]

 

11) Too rehearsed. They've got a story and they'll repeat key phrases over and over and over.

 

12) They don't like saying “I” or “me” because they don't want to own the lie, so they'll say “It didn't happen” instead of “I didn't go there.”

 

14) liars are also repetitive. When you ask, “Did you drive over there last night?”' he or she will answer, “I did not drive over there last night.”

 

15) Liars often avoid contractions in their speech and are overly emphatic: “I did not do that!”.

 

 

 

ADD/ADHD

            Attention Deficit (Hyperactivity) Disorder is a cluster of symptomatic subsets which often include three primary characteristics:

 

Inattention: Disorganized, bored, easily distracted, often lost in daydreams. Makes careless mistakes; doesn’t follow instructions. Underestimates time to do tasks, leading to procrastination and lateness. Often appears aloof or arrogant because of inattentiveness. May show obsessive interest in interesting subject like cars, video games, music, sports, but cannot be motivated to pay attention to uninteresting subjects.

 

Impulsivity: Restless, fidgety hands and feet, incessant talking and switching subjects; feels overwhelmed.

 

Hyperactivity: impatient, irritable, reactive, outspoken, interruptive. Hyperactivity is not shown in all cases.

 

These subsets must have existed for at least six months, may have started by the age of seven (in some cases symptoms don’t occur until adulthood), have been observable in more than one setting (classroom, playground, social, home, community), and must be impairing. Only one in seven adults with diagnosable ADD is aware he has it. Adult ADD is the same as juvenile ADD, and pharmaceutical treatment improves 80% of the cases.

            The cause may be chemical imbalance between neurons, unable to fire in the messaging system unless intense interest is present.

            It is the most commonly studied and diagnosed psychiatric disorder in children (5% in the U.S., 0.5% in France). At least half of these children will continue with their symptoms into adulthood.

            Close observation is required for accurate diagnosis since similar symptoms can be triggered by depression, death or divorce in the family, lack of sleep, abuse, hearing loss, learning disability, or seizures. While American child psychiatrists embrace the biological causes, French psychotherapists believe it is social and situational and treat it with counseling.

           

Overmedication of children

            The diagnosis of ADHD in children is rapidly increasing. Globally, the market for psychotropic drugs for children, like antidepressants, antipsychotics and sedatives, is growing 10% per year, with $20.7 billion sales for antipsychotics alone. In publishing the initial 1952 DSM-1, the American Psychiatric Association recognized 106 diagnoses for mental disorders; only 1 was for children: Adjustment Reaction of Childhood/Adolescence. Today at least 8 million children receive prescriptions for ADD, ADHD, bipolar disorder, autism, depression, schizophrenia and dozens of other listings in the DSM-3.

            A 2005 New York Times study revealed that doctors who accepted payments from pharmaceutical companies for prescribing their drugs were five times more likely to recommend such drugs for children than doctors who didn’t.

            French child psychiatrists do not use the DSM; they use the CFTMEA (French Classification for Mental Issues in Children and Adolescents). They feel that Americans pathologize what is really normal childish behavior.

            French children are more rigidly brought up compared to American children. Meals are at specific times with no snacking between meals; French babies are allow to “cry it out” at night rather than being coddled; behavior limits are enforced, and ”no” means exactly that.  French parents are in charge of their children, the opposite of what many American families practice.

           Types of Mental Disorders (Showing approximate percent in U.S. adult population )

       Acute stress disorder

      Adjustment disorder (distress resulting from exposure to an event)

       Alcoholism (6%; young men 21%)

       Amnesia

       Anxiety disorders (18.1% of adults)

       Separation anxiety  lasting more than six months

Panic disorder (2.7% of adults)

Phobias (10.5% of adults)

Post-traumatic stress disorder (PTSD) (3.5% of adults; 20-30% of veterans)

Selective mutism  

       General anxiety disorder (3.1% of adults)

       Behavioral disorders

Attention deficit hyperactivity disorder (ADHD) (4.1% of adults))

Conduct disorder

       Oppositional defiant disorder

Communication disorders

       Language disorder (receptive-expressive language disorder)

       Speech sound disorder (formerly called phonological disorder)

       Childhood-onset fluency disorder (stuttering)

       Social-pragmatic communication disorder (difficulties in verbal and non-verbal communication)

Developmental disorders

Intellectual disability (formerly called mental retardation)

Learning disorders

Autism (0.91%) (4:1 boys:girls; Asperger syndrome 10:1 boys:girls)

 Dissociative disorders

Dissociative amnesia

Dissociative identity disorder (DID) (formerly called multiple personality)

Eating disorders (4%)

Anorexia nervosa (0.6% of adults)

Bulimia (1% of adults)

Binge eating disorder (2.8% of adults)

Pica and rumination disorder 

      Gender identity disorder

     Homosexuality

     Transvestism

     Transexuality

     Hermaphrodism

     Pseudohermaphrodism

     Asexuality

Impulse control disorders

Kleptomania

Pyromania

Gambling addiction

Intermittent explosive disorder

      Trichotillomania (hair pulling)

Mood disorders (9.5% of adults)

            Major depressive disorder, excluding bvereavement (formerly called nervous breakdown; 6.7% of    adults)

Dysthymic disorder (Mild, chronic depression) (1.5% of adults) 

Bipolar disorder (formerly called manic depressive) (2.6% of adults)

       Cyclothymic disorder

      Motor disorders

     Developmental coordination disorder

     Stereotypic movement disorder

                Tourette’s disorder (0.8%)

     Tic disorder

Neurocognitive disorders

       Dementia and amnesia

Obsessive-compulsive disorder

       Body dysmorphic disorder  (preoccupied with flaws in appearance)

       Hoarding disorder

       Excoriation (skin picking) disorder

Paraphilias

Pedophilia

Voyeurism

Exhibitionism

Fetishism

Frotteurism

Sexual masochism

Sexual sadism

Transvestitism

 Personality disorders (9.1% of adults)

Paranoid personality disorder (5%)

Schizoaffective disorder

Schizoid  personality disorder (3%)

Schizotypal personality disorder (3%)

Antisocial personality disorder (psychopathy, sociopathy) (1% of adults)

Borderline personality disorder (2% of adults, mostly young women)

Histrionic personality disorder (2%)

Narcissistic personality disorder (3% age 65+, 10% age 20s)

Avoidant personality disorder (5% of adults)

Dependent personality disorder (0.5%)

Psychotic disorders (2%-3%)

Schizophrenia (1.1% of adults)

Brief psychotic disorder

Delusional disorder

Shared psychotic disorder

Substance-induced psychotic disorder

Sleep disorders (13%)

Insomnia

Narcolepsy

Hypersomnia

Somatoform disorders

Somatization disorder

Conversion disorder

Pain disorder

Undifferentiated somatoform disorder

       Illness anxiety disorder (formerly called hypochondriasis)

      Suicide (.01% of adults, 90% of whom have a mental disorder, usually depression or substance abuse)

 

“Quirky” personalities

            With such variability in personalities, it’s hard to pinpoint abnormality. Is the “enforcer” abnormal? He could be a vigilante, a law enforcement officer, or a hall monitor.

            The drama queen (or king) can create quite a scene for no apparent reason at all. The hoarder just can’t throw anything away. And the shopaholic can’t resist a shopping mall.

Neurosis or Psychosis? A neurotic individual recognizes that he has a problem; often possesses nervous habits like severe tics, excessive smoking or drinking, obsessive/compulsive behavior, phobias or panic. Psychotic symptoms, on the other hand, involve altered perceptions, thoughts or consciousness (delusions or hallucinations) arising from disordered thinking. Their “reality” is actually a fantasy.

Psychoses common to organic brain disorders: Delirium or shock-like symptoms include frequent breaks in the attention, memory impairment, and incoherent speech, and may even have a distorted sense of time and space.

Psychoses associated with alcohol and drug abuse: Chronic use of hallucinatory or psychotropic drugs, and also “uppers” (stimulants) like methamphetamine (“Speed”) will bring on psychotic symptoms like disordered thought, extreme anxiety, hallucinations, and paranoia. Some of these symptoms can be attributed to lack of sufficient sleep over extended periods. Chronic alcoholics also display psychosis when extremely intoxicated or when withdrawing from drinking (delirium tremens).

Psychoses seen in bi-polar disorder (formerly manic depressive): In the manic state, a person displays unrealistic optimism—unobtainable plans or goals. Delusions of grandeur and a distinct lack of judgment result in inappropriate public behavior such as untoward sexual advances, dominating conversations, excessive drinking or drug use. While manic, the individual requires little sleep.

Psychoses associated with schizophrenia: Hallucinations (especially auditory) and delusions are characteristic. This mental disorder normally starts in childhood and is chronic, worsening over time. People suffering from schizophrenia have a difficult time processing information correctly.

Schizophrenia (formerly dementia praecox): A psychotic condition affecting 1% of the population (47% of siblings of a schizophrenic), 3 million Americans who live in an imaginary world, dissociated from reality. 50% of hospitalized mental care patients have schizophrenia, 1-1/2 times more men than women. Historically called “mad,” “loony,” “crazy,” “insane,” or “maniac” (not manic). Children as young as 6 can have all the symptoms.

            Schizophrenia as an illness is not violent; the odds of being murdered by a schizophrenic stranger is 1 in 14.3 million, 1/3 the likelihood of being killed by lightning.

 

(NOTE: DSM-V suggests schizophrenia spectrum and other psychotic disorders include schizophrenia, schizoaffective disorder, schizotpal personality disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder, substance-induced psychotic disorder, psychotic disorder, and catatonic disorder.)

 Symptoms

            Delusion: Misperception of reality

            Illusions: Misperception of a stimulus or sense as in “optical (visual) illusion.”                                            Hallucinations: Imagined excitation of any of the senses, most typically auditory (hearing                        voices that comment on or urge behavior, issue orders, or accuse of terrible actions. A non-psychotic                    form may be dissociation, a psychological phenomenon in which a person separates from a reality that is too painful to process by conscious means, and retreats into an imaginary world.

            Disordered speech: Written or spoken language that shifts to unrelated topics

            Disorganized, bizarre speech and behavior: Sudden, unpredictable, inappropriate actions unrelated to the surroundings due to fragmentary delusions or hallucinations.

            Flat affect: (no eye contact, expressionless, apathy, monotone, unemotional); poverty of speech                           (short response, slow speech); loss of directedness (slow movement, unable to initiate, non-            socialization)

            Catatonic: Motor immobility or excessive, purposeless mobility; resists instructions to move or                             speak, but may be manually positioned; repeats words or movements of others.

            Undifferentiated: Meets general schizophrenic definition, but not the subtypes.

            Residual: Episodic schizophrenia; no prominent positive symptoms, but does exhibit odd             behavior and hold eccentric beliefs.

            Schizoaffective: A mix of major mood disorder complicated by psychosis.

 

GENESIS OF DISORDERS

Mental disorders may be functional (psychogenic or pyschosocial), arising from experiences, attitudes or social roles, or organic (amentia) if present at birth. The latter may be hereditary (genetogenic) as exaggerated by inbreeding; congenital if it develops after conception; chemogenic if it arises from an imbalance in body chemistry like hormones; or somatogenic if anatomically induced by tumors, injury, structure or illness.

 

SEASONAL EFFECTS

Because of the shorter time of daylight as measured by our biological clocks, people born in winter months have a higher risk of a number of neurological disorders including winter depression (seasonal affective disorder), bipolar depression and schizophrenia.

 

PHENOTYPES (Appearance)

Down’s syndrome (Mongolism): Body stocky and squat, eyes slanted, protruding thick tongue, short fingers, thumb separated, toes spread. IQ 50-70, life span typically to middle adolescence, extra 21st chromosome. Mother usually had a late pregnancy.

Cretin: Short, dwarf-like with a thyroid deficiency.

Hydrocephalic (“water on the brain”): Fluid compresses the brain, damaging its development; skull is expanded, exhibiting a very large head.

Microcephalic (“pinhead”): Underdeveloped brain.

 

TREATMENTS FOR MENTALLY AFFLICTED INDIVIDUALS

Euthanasia: “Mercy killing” of the insane, criminals, aged, non-self-sufficient.

Sterilization: Sexual neutering to prevent passing on hereditary characteristics.

Institutionalization: Assign the afflicted to wards, prisons and medical institutions.

Rehabilitation: Education and training to enhance skills.

Surgery: Correction of physical disorder.

Chemotherapy: Medication to treat the disorder.

Counseling: Cognitive therapy, especially helpful if the disorder is not organic.

The Rorschach Test

            Rorschach developed his test in 1921 using hundreds of random ink blots of various shapes and colors which he showed to 300 mental patients and 100 normal control subjects, recording their interpretations. He finally settled  on the best ten which showed the greatest consistency in responses from the control group and variability among the mental subjects.

            Rorschach originally intended his test to diagnose schizophrenia, but its use has grown for its variety of diagnostic indicators. Each card looks for specific responses from the subject, and different cultures see different things. Accurate interpretation by an analyst can take years of clinical experience. 

                                                       THE POLYGRAPH

               A polygraph is a combination of instruments that collect physiological data from at least three systems in the human body. Flexible tubes (pneumograph) and leads are placed over the examinee's chest and abdominal area to monitor respiratory activity. Two small metal plates, attached to the fingers, are used to monitor sweat gland activity (electrodermal; galvanic skin response). A blood pressure cuff (sphygmomanometer) or similar device monitors cardiovascular activity. Questions are spaced in 20 second intervals for 2-3 hours.

 

PHYSIOLOGICAL MEASUREMENTS USED TO ASSESS RESPONSES TO QUESTIONS

Skin conductivity: Galvanic Skin Response (GSR), psychological stress evaluator (PSE), psycholgalvanometer, or Skin Resistance Response (SSR); commonly attached to two fingers or the index finger and thumb. Look for amplitude, recovery time, burst frequency. Resistance ranges from 5k to 25 k ohms, although my tests show about 100k ohms. Resistance drops under tension-induced sweating, and rises under relaxation. Lag is about 2-3 seconds after stimulus, gradually reversing after 10-15 seconds. Highest reliability.

Blood volume: Chance or slightly above chance as an indicator

Blood pressure: Systolic/diastolic BP

Pulse rate: 72 beats per minute is normal

Respiration: Amplitude and frequency; chance or slightly above chance

Eye blink: Frequency

Finger pulse: Volume

Voice Stress Analysis (VSA): The original device was published in the April 1980 issue of Popular Electronics. The concept is that all muscles in the body, including the vocal chords, vibrate in the 8 to 12 Hz range. As explained in the Scientific American Article "Psychological Tremor" Vol. 224, No. 3, 1971, in moments of stress, like when you tell a lie that you mustn’t be caught at, the body prepares its fight-or-flight reaction by increasing the readiness of its muscles to spring into action. The vibration increases from the relaxed 8 to 9 Hz, to the stressful 11 to 12 Hz. Software available: TVSA3.

            Over a 20-year period (1970-1990), at least 15 studies showed no results better than chance, yet there are still many proponents, especially those who market a computerized VSA (CVSA) for $10,000!

Brain Waves: Electroencephalograph (EEG): High beta waves (above 18 Hz) indicate stress, anxiety, agitation.

            A typical polygraph examination is composed of three periods--a pre-test, a chart collection phase and a test data analysis phase. In the pre-test, the polygraph examiner completes required paperwork and talks with the examinee about the test. During this period, the examiner discusses the questions to be asked and familiarizes the examinee with the testing procedure. During the chart collection phase, the examiner administers and collects a number of polygraph charts. The examiner subsequently analyzes the charts and renders his opinion as to the truthfulness of the person taking the test. The examiner may offer the examinee an opportunity to explain physiological responses to any questions asked during the test.

            During the control question test (CQT), physiological responses to questions are compared to a baseline. The subject (examinee) is asked a series of questions that include control, irrelevant and relevant questions. A control question is one to which the subject will lie or respond physiologically to: "Have you ever stolen anything?" Irrelevant questions, based on true and obvious statements of fact, are also asked: “Is your address ……,” “Are you wearing…” to establish a low-response baseline. Each response will be marked one of three ways: Deception Indicated (DI), No Deception Indicated (NDI), or Inconclusive.

Deceptive Countermeasures

Some deceptive subjects use deliberate techniques to appear non-deceptive, including: (a) Physical countermeasures (biting the tongue, constricting anal muscles, pressing toes against the floor or against a sharp object within a shoe); and (2) Mental countermeasures (thoughts that are stimulating or disturbing, or a difficult mathematical calculation).

Using these countermeasures, it is possible to achieve a response level to the control questions that is greater than the response level to the relevant questions, giving a "Non-Deception Indicated" result or, if the response level to the relevant questions is similar to the response level to the control questions, the test results are “Inconclusive.”

 A typical polygraph examination will include a pre-test, a chart collection phase, and a test data analysis phase. In the pre-test, the polygraph examiner will complete required paperwork and talk with the examinee, answering questions to be asked and familiarizing the examinee with the testing procedure. During the chart collection phase, the examiner will administer the test and collect a number of polygraph charts. Following this, the examiner will analyze the charts and render his opinion. The examiner, when appropriate, will offer the examinee an opportunity to explain physiological responses in relation to one or more questions asked during the test.

 

AUTISM SPECTRUM DISORDER (As redefined in DSM-V)

Warning signs in babies:

By age 6 months they don’t smile; by 12 months they don’t point, wave, or babble; and by 16 months they speak no words at all. Frequency: 1 in 54 boys; less in girls. There is no credible evidence that autism is on the increase, only that previously-misidentified symptoms are now being assigned to autism spectrum disorder.

 

Autistic children typically:

            1. Won’t respond to their name

            2. Don’t wave “bye-bye.”

            3. Tune people out rather than integrate with them

            4. Are uninterested in other children

            5. Have poor eye contact

             

Must meet these criteria from early childhood:

 

A. Persistent deficits in relationships for their age as displayed by abnormal or lack of social approach and failure of normal back and forth conversation. Poor nonverbal communication like eye contact, body language, facial expression, and gestures. Disability in making and keeping friendships due  to an apparent absence of interest in people

           

B.    Repetitive patterns of behavior, speech, interests, or activities; displayed as motor movements, use of objects, immediate repetition of words used by others (echolalia), tenacious adherence to routines and rejection of change, ritualized verbal or nonverbal behavior. Intensely fixated interests in unusual subjects or objects. Hyper-or hypo-reactive senses: pain, heat/cold, specific sounds or textures, excessive smelling or touching of objects. Fascination with lights or spinning objects.

 

 Autism runs in families and may be detected as young as one year old. Autistic individuals lack empathy and they don’t understand people, but they are good at making sense out of the physical world which they view with detachment. Those with lower IQ may exhibit obsession, often staring for long periods at something that has captured their attention, or memorizing license plates or posted schedules.

            Poor motor control – timed movements – results in poor handwriting in autistic children. Character size, alignment, and spacing are normal, but coordination for forming letters is deficient. Autistic children throw long temper tantrums as a result of their inability to communicate. They scream instead of talk and become increasingly violent.  

            In general, a normal one-year-old when presented with a new toy will typically eye it with interest, raise his eyebrows and face the adult, then reach out and ask for it with a short vocalization. In general, the autistic child will stare at the toy, but won’t reach for it or look at the adult. If given a toy they will home in on it, playing with it endlessly.

           

ASPERGER’S  SYNDROME (Now combined as an autistic trait in DSM-V)

            High-intellect autism may present as Asperger’s Syndrome (AS) with high systemization skills while still having difficulty with social skills, communication, motor skills, and sensory responses. Obsessively driven in a narrow, detailed focus, “Aspies” are often considered “nerds” or “geeks” who, from an early age, relentlessly pursue science, mathematics, engineering, computer software writing, mechanics, art, or writing and can become very competent. Many scientists, computer programmers, and academics are thought to have AS. 

            They consider language an informational exchange, not a social contact, so they often monopolize long-winded conversations as  well as postal or email even if the listener or recipient tries to change the subject, or they may not talk at all. Choice of words or delivery may seem inappropriately formal or informal, and delivered monotonously, rigid, or unusually fast.         

            Since they are autistic, Asperger’s subjects lack eye contact or facial expression; often move awkwardly, clumsily bumping into things. They appear not to understand or empathize with others' feelings and have a difficult time "reading" other people or understanding humor. They don’t easily take redirection by others.

            Sensory systems are often over- or under-sensitive; an AS subject may become very agitated in crowds, and react to lighting, smell and taste differently from other people.

            The cause of autism is unknown; it affects only 0.2% of the population, and is far more prevalent in boys than girls (10:1 for Asperger’s). This gender ratio may be a clue, since males are more direct and physical, while females are more indirect and verbal, and they have better social skills as well. 

  

SAVANT SYNDROME  (formerly “Idiot” savant)

This syndrome is assigned to a person with below-normal intelligence who displays a special talent or ability in a specific area, usually mathematics, music, and visual arts. Social and communicative skills are retarded, often severely. The symptoms usually show up by ages 5-6.

Roughly 50% of children who display this are autistic. 10% of autistic children are savants. The physical cause is not known, although one theory is that damage to the left hemisphere of the brain is being overcompensated by the right hemisphere.

            The most common skill is extraordinary memory of data such sports statistics, population figures, and historical or biographical data. A popularized display of this is being able to quickly associate the day of the week for a particular historical or future date. The skill generally improves with age and practice.

            Mathematical savant Daniel Tammet can recite pi to over 20,000 decimal places.

Musical savants often have perfect pitch and can play a piece perfectly after hearing it performed just once.        

 

STOCKHOLM SYNDROME

In Stockholm, Sweden, in 1973, a bank employee became romantically attached to a robber who held her hostage. This occurs in long-term abductions as well. Intimidation, threats, even brutality forces a victim to hold a perpetual state of fear, thus becoming obsessed with pacifying and pleasing the captor. Constant obedience out of fear and dependence induces a dominant/submissive sort of relationship that can engender affection for survival, both physically and emotionally.

 

MUNCHAUSEN SYNDROME (“Hospital Addiction,” “Hospital Hopper,” “Malingering”)

This contrived disorder is characterized by an individual who feigns an illness or injury in order to draw attention or sympathy.

 

Munchausen Syndrome by ProxyMost commonly a mother (occasionally a health-care provider) feigns sickness in a healthy child in order to draw attention or sympathy. She might lie about symptoms, contaminate a (urine) test, falsify medical records, or induce symptoms by poisoning, suffocating, starving, or infecting.

 

Warning signs: Perpetrators will often be very friendly, cooperative, and overly-concerned with the patient who has had many hospitalizations; a strange set of symptoms, reportedly worse or different from those observed by medical personnel; other similar illnesses in the family; improvement in the hospital but recurrent symptoms at home; non-matching blood samples provided; signs of chemicals in the blood, stool or urine. 

 

KORSAKOFF’S SYNDROME     

A memory loss produced by chronic alcoholism resulting in a reduction of vitamin B1 (thiamin) and consequently  damage or destruction of nerve cells as displayed by dementia, psychosis, and unsteady movements similar to drunkenness.

 

PHOBIAS: Irrational or exaggerated, specific fears

PARAPHILIAS: SEXUAL ARROUSAL THROUGH DEVIANCE

            While sexual gratification among men and women is a normal biological mechanism for perpetuation of the species, deviance from this natural attraction is not. Examples include:

 

Fetishism: Use of a non-living object for gratification, including transvestism (cross-dressing).

Sadism and masochism: Giving or receiving painful humiliation.

Voyeurism: Spying on others who may be naked or engaging in sex.

Frotteurism: Rubbing up against others in a crowd, unnoticed.

Exhibitionist: Males who expose their genitals in public.

Pedophilia: Sexual contact with children.

 

GENDER DISORDERS

Homosexuality: Sexual preference for partners of the same gender; may or may not dress in drag

Transvestism: Cross-dressing heterosexual fetish; a paraphilia

Transsexuality (transgender): Surgical reversal of gender; not homosexuality

Hermaphrodism: Anatomical presence of both male and female genitalia.

Asexual (“gender queer”): Doesn’t feel either male or female roles and stereotypes, including dress

Pseudohermaphrodism: Deficiency of the hormone 17-B-hydroxysteroid dehydrogenase (17-B-HSD) during pregnancy leaves male reproductive organs deformed and buried deep within their abdomens. At birth, misidentified as girls because genitalia appear to be female; but at puberty, bodies generate testosterone, resulting in facial hair and increasingly masculine features. Gender transformation surgery is applied. Extremely rare; more common in Gaza because of traditional intermarriage.

Asexuality: Feels no sexual attraction to either gender, or has no desire to act on such feelings.

Hypersexuality: Has an overwhelming desire for sex.  

 Impulse Control Disorder (ICD): Anxiety can only be relieved by some behavior pattern

    Intermittent explosive disorder: "Hot-headedness"

    Pathological gambling: persistent and recurrent maladaptive gambling behavior that disrupts personal, family, or vocational pursuits

    Kleptomania: Must steal an item even though it isn't needed or wanted

    Eating Disorders: Bulimia, anorexia, binge eating. The annual death rate from anorexia among young women (ages 15-24) is twelve times that of all other causes.          

    Tics: A habit which is repetitive, stereotyped, apparently purposeful, irresistible, and gives a feeling of satisfaction; universally common. Examples: tongue and lip movements, sighing, yawning, throat clearing, biting a lip or inside cheek, sniffing, fiddling, crossing legs, nail biting, nose picking, blinking, shuffling feet, scratching and picking, stretching eyelids, hair twirling/pulling/chewing. Usually representative of emotional conflicts, but harmless.

 

BIPOLAR DISORDER (Formerly manic-depressive disorder): Extreme high/low mood swings last for days and typically beginning at age 19, and prevalence is growing among the young. Without long-term observation, roughly 50% of BPD cases are misdiagnosed as depression, schizophrenia, borderline personality disorder, or substance abuse. When manic, may have 1000 great ideas a minute, must tell everybody. Uncontrollably ebullient (or irritable) and self-important, he has an exaggerated self-image of power and ability, with grandiose solutions to the world’s problems. Restless and euphoric. Thinks that friends and relatives who don’t acknowledge his wisdom and agree with him are traitors and enemies. When the mood switches to deep depression, diminished drive, guilt and despair, he may be suicidal. Best treated with psychotherapy, although antipsychotic drugs and mood stabilizers can stabilize anxiety and reactivity during the manic and depressive states.

 

DISSOCIATIVE IDENTITY DISORDER (DID)  Formerly multiple personality disorder (MPD)

            Popularly known as “split personality disorder,” often blamed on a traumatic childhood experience from which they “dissociate” (remove from conscience), these individuals assume alternative identities which may or may not be aware of each other. Each identity may even have its own emotions, pulse, blood pressure, and blood flow to the brain. The alternative personalities may have totally different wardrobes, possessions, interests, religions, ages, sexual orientation, value systems, speech patterns and accents, and even right- or left-handedness.

            Affecting about 3% of the population, and nine times more women than men, the fact that not all victims have suffered childhood trauma, and many normal individuals have been unaffected by childhood trauma, that symptoms in children are much different from those in adults, and that U.S. cases far outnumber other countries, lead some therapists to question whether DID actually exists or is a culture-based myth, merely excessive suggestibility. As an example, individuals who may benefit legally or emotionally sometimes pretend to have it.

            Inaccurately-portrayed dramas like The Three Faces of Eve and Sybil complicate the clinical symptoms which include:

            Dissociation (lapses in memory from significant life events, like birthdays, wedding, or birth of a child;

            Blackouts in time, resulting in finding oneself in places but not recalling how one traveled there;

            Frequent accusations of lying when being told of things they did but do not recall;

            Finding items in one's possession but not recalling how they were acquired;

            Being called by names they don’t recognize;

            Finding writings they have done, but in handwriting other than their own;

            Hearing voices inside their head that are not their own;

            Not recognizing themselves in the mirror;

            Derealization (feeling unreal);

            Feeling like they are watching themselves move through life rather than living their own life; and

            Feeling like more than one person.

 

 

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NOTE:  Five current personality disorders are being considered for dropping from the DSM5, including narcissism. The new dimensional approach consists of making an overall, general diagnosis of personality disorder for a given patient, and then selecting particular traits from a long list in order to best describe that specific patient. This is in contrast to the prototype approach that has been used for the past 30 years: the narcissistic syndrome is defined by a cluster of related traits, and the clinician matches patients to that profile.

                           PERSONALITY DISORDERS

NOTE: All current personality disorders are being reformulated for the DSM-V edition (May, 2013)

            While functional disorders like mood, anxiety or delusion affect the afflicted individual, personality disorders affect others as well. The difference is often a matter of degree and rigidity. There are some professions in which personality disorders are actually advantageous, such as the narcissistic celebrity.

            Approximately 10% of the adult population and 30% of mental health patients exhibit one or more of the ten recognized personality disorders -- long-standing patterns of maladaptive behavior, improper or immature responses to problems or situations. These inflexible patterns of perceiving, reacting, and relating to other people and events impairs their ability to function socially. Since these individuals do not feel like they are doing anything wrong, they see no reason to change their behavior.       

Cluster A: Odd or eccentric personality disorder (withdrawn; often reclusive, cold, suspicious, irrational)

Paranoid: Afflicted with paranoia--distrusting, suspects malevolent motives from others; preoccupied with unjustified doubts including fidelity of spouse; excessively trusts his own knowledge and abilities to avoid close relationships. Reads hidden, demeaning or threatening messages in innocent remarks; presents as cold, distant; Shifts blame to others and persistently bears grudges; humorless.

Schizoid: Loner who is solitary and friendless by preference; avoids relationships; frigid emotionally and sexually; indifferent to praise or criticism and does not desire popularity; seeks jobs requiring little social contact; appear humorless and distant.

Schizotypal: Possibly a mild case of, or precursor of schizophrenia. Cold and aloof; consistently odd behavior, beliefs (like magical thinking), appearance, thinking, speech (overly elaborate, difficult to follow); may exhibit paranoia, excessive social anxiety, belief in having supernatural powers, and thinks that unrelated events somehow do relate to them. Lacks close friends; has difficulty concentrating for long periods. May experience hallucinations, illusions, and delusions.

Cluster B: Dramatic, emotional or erratic personality disorder (attention seeking; unpredictable, noticeable behavior)

Antisocial Personality Disorder (APD): Characterized by lack of empathy or conscience, a difficulty controlling impulses and manipulative behaviors. Also called psychopathy or sociopathy, but Antisocial Personality Disorder is the clinical terminology used for diagnosis. (See below for an expansive overview)

Borderline Personality Disorder (BPD): Thinks in black-and-white terms—no gray areas; has intense but unstable, stormy, conflict-ridden relationships with friends, family, and romantic partners. Quick to anger when expectations aren’t met. 75% are women with separation anxiety (terrified of being abandoned), needing presence of others for self-definition. Inappropriately hostile, dysfunctional, verbally abusive, depressed, lonely, with drastic mood swings which can last for hours, and bouts of anger which can spiral out of control and result in self-mutilation or rarely suicide. Self-loathing, self-destructive, often manipulatively suicidal behavior over minor incidents. Impulsive buying, gambling, substance abuse, sex, driven. Chronic boredom, emptiness. Transient stress-related paranoia and dissociative symptoms.

Histrionic Personality Disorder (HPD): Excessively shallow emotionally, these drama queens can be very theatrical in action and speech, using flowery language to describe everyday events. Mostly female and common among actresses constantly seek attention, they can’t really connect. They need to be the center of attention, often interrupting others to dominate the conversation. They require excessive reassurance and approval, and exhibit temper outbursts if ignored. Attractive appearance is important and they may dress seductively. Exaggerated feelings and illnesses to gain attention. Serial romances, exaggerated interpretation of friendships, belief that everyone loves them. Manipulative, superficial, naïve, insincere, highly suggestible.

Narcissistic Personality Disorder (NPD): Like the mythological Greek Narcissus who fell in love with his own reflection in a pond, the narcissist is in love only with his reflection, not himself. He feels entitled to special treatment and adulation because he exists and is unique.

            The groom wouldn't let his fiancée's overweight friend be a bridesmaid because he didn't want to be seen near her in the wedding pictures. A woman so confident in her great taste routinely redecorated her daughter's home without asking.  (See below for an expansive overview)

           

Cluster C: Anxious, fearful

Avoidant Personality Disorder: While most people are understandably cautious, the avoidant personality goes to the extreme to shun closeness to avert rejection, and avoid risk-taking to escape the humiliation of failure. Social inhibition and anxiety create feelings of inadequacy—low self-esteem and repressed self-confidence; neutral or slightly-negative interpersonal experiences are exaggerated; jobs with little social contact are preferred; potential difficulties of new situations are exaggerated to rationalize avoiding them. Yearns for close friends, but unwilling to get involved unless certain of being liked; may fantasize to avoid the real world.

                       

Dependent Personality Disorder: Needs to be taken care of and is indecisive without help, letting others make decisions for them. Usually women over 40, probably over-protected as children. They appear meek, submissive, agreeable, clinging, affectionate, and admiring in order to hold on to others, even abusive ones, and quickly acquire a new relationship at the termination of a former one. Have difficulty initiating projects, making decisions, and expressing disagreement; preoccupied with fear of being left alone and may be suicidal when rejected, feeling helpless and depressed; excessively solicit help.  

           

Obsessive Compulsive Disorder (OCD): (Obsessive is thought, compulsive is behavior)

            Orderliness, perfectionism suppress flexibility and efficiency.  

            Preoccupation with details, rules, lists, schedules and organization interferes with task completion; avoid making decisions for fear of making mistakes. Caught in details, they miss the big picture. Excessive devotion to work without leisure activity; reluctance to delegate without exact compliance.

            Conscientious worker but not a team player, considers others incompetent or careless. Often sets unreasonably high standards for themselves and others, highly critical when not met. Inflexible about morality, values, or ethics. Miserly, rigid and stubborn. Lacks emotional warmth and is stiff, formal, serious. 

            Compulsive (ritualistic) behavior or obsessive (overpowering) thoughts rule their lives. Minor symptoms earn their reputation as being a “perfectionist” or “anal.”

            The neat freak constantly sorts and arranges items, showing an extreme preoccupation with order. A misplaced sock, a spot on a shirt, a scrambled pile of papers or magazines, a picture tilted on a wall; all must be immediately corrected to prevent uneasiness or even anger.

            The control freak must do an activity repetitively and/or in a certain way. Don’t step on a crack on the sidewalk; turn the lights on and off an exact number of times; check the door locks over and over.

            Phobias may be magnified by OCD. The germophobe continually cleans and washes his hands and dreads doorknobs, keyboards, handrails, and library books. He won’t touch anyone nor does he want to be touched. He wears gloves constantly to avoid germs and can’t go out in public without covering his nose and mouth.

 

Hoarding Disorder:

            The hoarder can’t bear to throw anything away; he/she might need it someday. Piles of newspapers and magazines, clothes, cans of food, even pets accumulate in huge, unmanageable lots. Hoarders can actually be perfectionists and neat freaks as well and are paralyzed by the thought that they can’t overcome it. There is evidence of abnormal brain activity in the hoarder. At least four million Americans fully qualify for this diagnosis.

 

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Narcissistic Personality Disorder

Normal baseline: Healthy, well-balanced sense of self worth

Hubris (excessive self pride, arrogance), conceit (excessively favorable opinion of one’s own ability)

Egotist (megalomaniac, egoist, egocentric, self centered, arrogantly conceited)

Egomaniac (extreme egotism, obsessively self-appreciative, narcissist)

            It is easy to confuse narcissism with extraversion. Both can display charm, self assurance, and friendly facial expressions, warmth, and humor.

            Ted Turner commented, "If I only had a little humility, I'd be perfect." It’s been said of the founder of Oracle software, "The difference between Larry Ellison and God is that God doesn't think he's Larry Ellison."

            A psychologist recently observed, Perhaps narcissism isn't too dissimilar from a compulsive behavior that gives the "user" a high despite the fallout with others. If nothing else, this helps explain Charlie Sheen, most of the rest of Hollywood, and about 60% of everyone running for office.”

            A recent NIMH study reveals that 3% of the population aged over 65, 10% of those in their 20s, exhibit narcissism. Narcissism tends to peak in adolescence and decline with age.

            Milder narcissists are happy, less stress-inclined, rarely depressed, sad or anxious, and rate their well-being highly. They feel invulnerable, able to handle whatever life throws at them. Their extreme self-confidence seems charming and attractive, and they feel pretty good about themselves.

            While realistic self-appreciation is normal and healthy, allowing a person to bolster his sense of self worth, narcissists need validation of their self worth by being admired, the center of attention, not just liked. They feel entitled to special treatment and are easily offended, harboring grudges. Their relationships can be tumultuous--few people can tolerate them for long.

            Narcissists don’t feel self-doubt; while most people are willing to share blame for failure, narcissists will blame someone else.

            Narcissists love the sound of their own voice, but they don't always sound pretty to others. In order to stay in power, they are more argumentative, curse more, and use more sexual language than their more modest counterparts.

            They brag, refocus discussion topics, make exaggerated hand movements, talk loudly, and show disinterest by “glazing over” when others are speaking.

            Since a narcissist appears to have high self-regard, you wouldn't suspect him or her to be so defensive and needy. But they are revealed by temper tantrums, unreasonable expectations, extreme selfishness, and inability to engage in teamwork.

 

 The four facets of narcissism: Leadership and authority, self-absorption and self-admiration, superiority and arrogance, exploitiveness and entitlement.

          Malignant narcissism is more pathological, exhibiting paranoid traits and ego-satisfying aggression. He lacks empathy and caring for others and is envious, exploitive, hurtful, and destructive. If he is humiliated, he reacts with indignation and often rage. He blames others for his explosive behavior, accusing them of provoking him, and believes that they should be punished for their misbehavior, expecting those apologies to be accompanied by humiliation.

            As long as others are instrumental in achieving his goals, the narcissist holds them in high regard, but if they cease to function in his expectations, they are subjected to a reign of terror for their insubordination. He belittles and humiliates them, and may display aggression and violence. Such rapid transitions from idealized overvaluation to abhorrent devaluation make long-term interpersonal relationships with a narcissist all but impossible.

            Situational narcissism is a form of malignant narcissism prevalent among high profile performers. It is fueled by anger and frustration over lack of recognition of their greatness, exemplified by publicized fits of rage exhibited by actors like Alec Baldwin, Russell Crowe, Mel Gibson, and Charlie Sheen. Narcissists in the news include former governor Rod Blagojevich and Sarah Palin, financial swindler Bernie Madoff, and talk-show hosts Rush Limbaugh and Glenn Beck.

            The artificiality of “stardom” can cause considerable psychological harm to inexperienced youths when televised singing, dancing and beauty competitions breed unrealistic illusions of success, talent, and fame which are soon dashed by reality.

             Religious narcissists (clergymen, evangelists, cult leaders) pretend to love and follow God because that association confers authority upon them, thus allowing them to indulge their urges. Preying upon their gullible flocks who provide continuous narcissistic supply (“NS”), they are likely to humiliate and chastise their followers, and abuse them spiritually and sexually.

            The religious narcissist vicariously becomes God by observing His commandments and instructions, loving and obeying Him, communicating with Him, seemingly merging with Him. Conversely, he may even defy Him since the bigger the narcissist’s enemy, the more grandiose the narcissist feels.    

            Such malignant narcissists include Reverend Jim Jones of the People’s Temple whose personality characteristics matched 8 of the 9 criteria for NPD. Others include David Koresh, and Charles Manson.

     Political narcissism is widespread, although there are rare examples of altruistic statesmanship.

 The Narcissist as a partner

            Most anyone can be seduced by the narcissist; our society admires take-charge personalities. But narcissists make lousy partners. Their initial self-confidence and charm are very appealing, but their over-concern about their appearance and their ability to turn the charm on and off at will soon become apparent.

            They are users who shun commitment and cheat since romantic relationships are just another way to pump up their own self-image. Narcissists look for mates with very high social status, good looks or acknowledged success to complement their inflated sense of self. If your partner has had a string of relationships, constantly talks about how people admire him, and is easily angered when he doesn't get what he wants, he’s a narcissist.

            As one reporter observed, “Perhaps if narcissists could simply date each other, each could have a self-confident, impressive and shallow mate, leaving the rest of us in peace.”

 The Cause and the Cure

            Genetics may play a role, and overly-permissive parents who lavish their children with endless praise, thus depriving them of a normal coping mechanism in the real world, may also contribute. If you think you're the greatest, why would you want to change? Narcissists most often show up for counseling with a spouse or relative who is who is having trouble with them, or they show up because of feelings of emptiness.

 

The Narcissism Checklist (The “smartest, most talented, all-around, best person in the world” test). The following checklist is a combination from Albert J. Bernstein, Ph.D., and the DSM-IV.

Five or more starred items (*1-*9) comprise a key indication of narcissism

*1. Displays arrogant, haughty behavior or attitude.

*2. Preoccupied with fantasies of unlimited success, fame, power, brilliance, beauty, or idealized love.

*3. Has a grandiose sense of self-importance, firmly convinced that he is better, smarter, more talented, or better looking than other people.

*4. Has a sense of entitlement; expects special treatment or automatic compliance with his expectations.

*5. Is a name dropper to imply his association with famous or important people.

*6. Is interpersonally exploitative, taking advantage of others to achieve his or her own goals.

*7. Lacks empathy, unwilling to recognize or identify with the feelings and needs of others.

*8. Belief that he is special and can only be understood by, or should associate with, other special or high-status people or institutions, and feels it’s very important to live in the right place.

*9. Is often envious of others or believes that others are envious of him/her; and that their criticism of him is motivated by jealousy.

10. Has achieved more than most people of his age. 

11. Loves competition, but hates losing.

12. Is only interested in what other people are thinking or feeling if he wants something from them.

13. Usually manages to be in a category by himself.

14. Feels put upon if asked to take care of his responsibilities to family, friends and coworkers.

15. Regularly disregards rules, or expects them to be changed because he is special.

16. Becomes irritated when others don’t automatically do what he asks, even if compliance isn’t a good idea.

17. Reviews sports, art, literature and other’s works by saying how he would have done it instead.

18. Is rarely able to recognize his mistakes, and then the slightest error can precipitate a major depression.

19. Often insists that people who are better known than he are really not all that great.

20. Often complains of being mistreated or misunderstood.

21. Is either loved or hated by other people.

22. Is really intelligent and talented in spite of his over-inflated self image.

 

Antisocial Personality Disorder (APD: The psychopath and the sociopath)

            “He will choose you, disarm you with his words, and control you with his presence. He will delight you with his wit and his plans. He will show you a good time, but you will always get the bill. He will smile and deceive you, and he will scare you with his eyes. And when he is through with you—and he will be through with you—he will desert you, taking with him your innocence and your pride. You will be left much sadder but not a lot wiser, and for a long time you will wonder what happened and what you did wrong.” (From Without Conscience - The Disturbing World of the Psychopaths among Us by Dr. Robert Hare)

            News item: December 18, 2010, Brazil. At the height of a happy wedding party, the new groom announced to the crowd that he had a surprise for them. He revealed that he was a sociopath who had fooled everyone;, and then he proceeded to shoot and kill his new bride, his best man, and himself.  

 Serial killers and mass murderers

            While it is futile to ascribe a narrowly-defined profile to all such killers, they commonly display social isolation, schizophrenia, delusion, and paranoia. They avoid intimacy and are generally unsociable, blaming their problems on others and seeking to resolve their issues by an onslaught against those whom they perceive as rejecting and belittling them.

 Rearing a Psychopath

            In a recent year, 29 children under age 14 committed homicides in the U.S. One of these was Christian Fernandez, born to a 12-year-old mother who was sexually assaulted. He was found as a naked and dirty two-year old wandering a Florida street as his caretaker grandmother was holed up with cocaine in a messy motel room.

            By age eight he had been sexually assaulted by his father and his cousin, and beaten by his stepfather. He had also killed a kitten and simulated sex acts with other students at school. He once told a counselor, “You got to suck up feelings and get over it.”

            At age 11, left alone at home with his two half brothers, he sexually assaulted the five-year old and broke the two-year-old’s leg. Two weeks later, left alone with them again, he beat the two-year-old to death.

            Upon returning home and finding the dying child, his grandmother looked up “unconsciousness” on line, then spent the next 8-1/2 hours texting friends. She was sentenced to 30 years in prison for aggravated manslaughter.

            During Christian’s prison interviews he openly discussed his life and was unemotional while detailing his crimes.

 

Therapy

            Psychopaths love to intellectualize with their half-baked understanding of rules, but their reasoning cannot handle cognition and emotion. When interviewed about their crime, they tend to imply that it had to be done, using words like “because,” “since,” and “so that.”

            They refer twice as much to physical needs like food, sex, or money than do non-psychopaths who refer to social needs like family, religion, and spirituality. 

            When institutionalized, they will attempt to escape, create a nuisance and a danger to staff, be a disruptive influence on other patients or inmates, and fake symptoms to get transferred, bouncing back and forth between institutions.

            PET scans of murderers show that brain activity in the prefrontal cortex is lower than normal, a condition that is associated with risk taking, rule breaking, aggression, impulsivity, and violence. Their lack of compassion and empathy is like those of frontal-lobe-injured individuals.

           

 APD or Narcissism?  It’s the magnitude of the pathology

(1) APDs are usually unwilling or unable to control impulses. Narcissists may exhibit self control.

(2) APDs lack empathy, compassion, conscience, guilt, remorse, and usually anxiety as well. Narcissists may display some feelings and empathy toward others, and feel initial guilt for misconduct, but they immediately rationalize their behavior and shift the blame.

(3) APDs rarely form long-term, interpersonal relationships. Narcissists often do.

(4) APDs totally disregard society’s rules, laws, ethics, morals and conventions, and brag about their infractions. Narcissists recognize the conventions of society and don’t intentionally cause harm.

The APD’s continuous display of chronic conduct disorder under age 15 grows into an adult disregard for, and violation of, the rights of others which may develop into crime and violence.

APDs are not psychotic and are capable of rational thinking. Because they know what society calls right and wrong, yet they choose their non-compliant behavior, APD criminals are not eligible for an insanity defense.

Characteristics: Rather than the dark, sinister figures of TV crime shows who stalk and prey their victims, the majority are successful, adapted and non-violent. They seem rather normal as relatives, friends, co-workers, neighbors, or chance encounters. Fewer than half of them have significant criminal records.

Many psychopathic traits like fearlessness, confidence, charisma, lack  of empathy, and persistent focus are attributes in professions like surgery.

Male APDs are likely to emphasize intellect, power, aggression, money, and social status. Females are more likely to emphasize feminine stereotypes with looks, charm, sexuality, homemaking, and child rearing. Despite all their outward bravado, many APDs describe themselves as empty, dark, and void.

Hand gestures are used excessively by APDs, perhaps to help integrate their fragmented thinking as they typically change subjects or go off on tangents, disjointing their story line. This erratic, superficial thinking often causes slips of the tongue and the making up of words (neologisms), abbreviations, and sayings. They commonly avoid direct, thought-out responses to questions, preferring pat answers.

Statistics: A 2004 poll of 43,000 Americans revealed that 3.6% (11 million, or 1 in every 30) show APD tendencies (3:1 men to women); they are twice as often found in inner cities than in small towns or rural areas. At any one time it is estimated that there are 30-50 active serial killers in the U.S.

APD tendencies are shown by up to 75% of prison inmates, but only 10-15% of them are psychopathic (15%-25% of the men and 7%-15% of the women). The majority of all violent crimes, including nearly half of the murders of on-duty law-enforcement officers, are committed by APDs.

The real-life Hannibal Lecter (Silence of the Lambs) was Britain’s Robert Maudsley (“Hannibal the Cannibal”) who bashed in the skull of a fellow prison inmate and ate his brain with a spoon.   

Notorious psychopaths include: Aurora, CO movie theater killer of 11, James Holmes; Columbine High School shooters Eric David Harris and Dylan Bennet Klebold; Chicago mass murderer Richard Speck, who killed eight nursing students; Texas tower mass murderer Charles Whitman, who murdered 16; Norwegian killer Anders Behring Breivik, who murdered 77 people; Virginia Tech mass murderer Seung-Hui Cho, who killed 32 people; Fort Hood Islamic terrorist Major Nidal Malik Hasan, who murdered 13.

Historically we’ve had Charles Manson, Ted Bundy, Jeffrey Dahmer, Gary Gilmore, David Berkowitz, Richard Kuklinski (The Iceman), John Wayne Gacey Jr., Dennis Rader (The BTK Killer—bind, torture, kill), Edward Teach (Blackbeard the pirate), William Bonney (Billy the Kid), John Dillinger, Reverend Jim Jones (Jonestown), David Koresh (Branch Davidians), Gary Ridgeway (The Green River Killer) holds the U.S. record for serial killings: 48 prostitutes within 20 years. In England, Jack the Ripper.

Then there are the world-class tyrants responsible for the needless deaths of more than 100 million people: National Socialist Adolph Hitler, Chinese communist chairman Mao Tse-tung, Soviet communist leader Josef Stalin, Cambodian communist leader Pol Pot, and Iraq’s notorious Saddam Hussein.

Serial pedophiles like Penn State coach Jerry Sandusky is also suspect.

 

Childhood precursors

APD is not normally diagnosed in children or adolescents, often by law. Psychopathic tendencies are instead diagnosed as conduct disorder which fails to consider the traits of egocentricity and lack of remorse, empathy or guilt. Approximately 30%-40% of ADHD and conduct-disorder children are APD.

Same-sex identical twins are more likely to exhibit psychopathic behavior than fraternal twins. As callous-unemotional (“CU”) children, they display extreme antisocial behavior — fighting, bullying, lying, cheating, and stealing.

Precursor traits (The first three are “red flags”):

    * An extended period of bedwetting past the preschool years not due to any medical problem.   * Precocious sadism, usually profound animal abuse.
    * Pathological, deliberate setting of destructive fires with utter disregard for the property and lives of others. Not to be confused with playing with matches which is common for preschoolers.

PSYCHOPATHY CHECKLIST: Dr. Hare’s Psychopathy Checklist must be applied by a qualified technician, and includes in-depth interviews with the subject, family, acquaintances, business associates, police, social workers, and others.

DIRECTIONS: For each trait, score 2 if the subject matches fully, 1 if partially, or 0 if not at all. At least three of the highly-indicative, bold-numbered characteristics must be present. A total score above 25 suggests strong psychopathic tendencies.

1. Unstable, predatory relationships:

APDs tend to become involved with unstable partners; one study revealed that 75% of female felons had married APDs. Women who are attracted to male APDs often have a hysteric or histrionic personality and feel empowered when attached to the APD, or even have sado-masochistic tendencies, wanting to be dominated and take part in the sadism of the APD.

APDs never remain attached to anyone or anything, preventing commitment to a long-term relationship. They live a “predatory” lifestyle, often attracting women by bragging and bravado, lying to bolster their image and feigning false emotions to create empathy. They will often profess profound, moving experiences, even though most of them remain untouched and uncompassionate. 

To manipulate a woman, he will choose someone gullible, but to destroy a woman, he will choose one who can see through him. He will play mind games with her, instilling hope, and then betray her to destroy that hope. Most often he will attack her self-esteem with false accusations and questioning her honesty, fidelity, sanity, judgment. He may leave, without a word, only after he has done as much damage as possible to make the victim feel like a punished child.

Divorcing an APD can be extremely dangerous; since his entire goal is to keep her under control to build up his low self-esteem, he may try to bleed his wife as dry as possible or cause harm to their children.

Female APDs flaunt their gender -- a charming "southern belle" schemer who appears to be a damsel in distress—helpless, needy, pitiful, inept or emotional. This parasite lures her target’s protector/provider instincts with her sexuality. But she won’t give reasonable answers to reasonable questions, and when her mask comes off, she is cunning, ruthless, predatory and loveless.

APDs frequent singles bars, social clubs, resorts, cruise ships and foreign airports looking for lonely or homesick victims eager for excitement or companionship. Although they don’t always get along well, two may pair up like Leopold and Loeb and the Menendez brothers, often as an interchangeable team with one being a “talker” and the other a “doer.”

2. Manipulation and control: The APD views everything and everyone as an object; preoccupation with weapons, money, goods, and people (viewed as objects), is a classic hallmark.  They spend their lives seeking power through money and material goods, and by manipulation of people. They are driven by a need to prove their superiority, while suspicious of others who may harm or humiliate them.

Deception is used to cheat, con, or defraud. Found in all echelons of society, they gravitate toward professions which guarantee abundant narcissistic supply for authority, advantage or superiority, eliciting their automatic admiration and affirmation; failing that, they exert their power for fear and obedience.

An APD professional can masterfully fake his abilities and credentials, ascending to regional and national leadership roles during social distress like wars, economic breakdown, epidemics, and political conflict.

Most people are instinctively trusting and are incredulous to discover that an acquaintance or even a powerful and reputable individual like a CEO or a political leader could be a psychopath. They can inflict far more damage in sub-criminal positions of power like lawyers, politicians, military heroes, trade union leaders, teachers, journalists, evangelists, most cult leaders, unscrupulous businessmen, physicians and psychotherapists, hype-prone stock brokers, and boiler-room operators.

Criminal types often include serial killers, rapists, thieves, swindlers, con men and scammers, gangsters, child and spouse abusers, pimps, sadists, white-collar criminals, biker gang members, drug barons, professional gamblers, terrorists, and organized crime figures.

The APD is exploitive and must be in absolute control, often suspicious and paranoid. He backstabs his way to high position, ruthlessly abusing his power, showing bad judgment, placing others in precarious or failure situations. Those who see through the arrogance and perceive the empty shell are subject to elimination. The retribution can be brutal if the APD happens to be the boss.

The APD seems unable to believe that people have valid opinions different from theirs. Inferior, unworthy humans need to be convinced, punished or extinguished. Social interaction is a contest of wills, and there can be only one winner.

When needing to manipulate a female, the APD targets the “dumb blonde” stereotype who exudes naiveté and nurture, often unaware of her own sexuality and innocence. Often Pollyanna-like and not too bright, they always see a silver lining in every cloud. When dealing with an APD, that can prove a deadly combination.

On-line “cyberpaths” invent a persona to prey on confused, helpless, gullible, sympathetic, vulnerable targets. The unwillingness of an on-line correspondent to meet in person or talk on the telephone is a giveaway.

3. Pathological lying: They are pathological, unskilled liars, often for the sheer pleasure of it ("duping delight"), even if it’s outrageously unbelievable, inconsistent and contradictory. They may use aliases or just con others. If they forget the lies they’ve told and are caught, they are seldom embarrassed, they simply deny the inconsistency and change their stories, often confusing the listener. If you try to pin him down, he will avoid answering your questions directly.

4. Arrogance: The APD is self-impressed by his grandiose demeanor, coming across as a self-assured, opinionated, cocky braggart. Despite frequent failure, he views himself as an important, entitled, disdainful and patronizing, superior being who is justified in living according to his own rules. He is viewed by others as full of himself.

5. Absence of remorse or guilt: Their unfeeling emotional poverty render APDs cold, contemptuous, inconsiderate and tactless. They lack empathy for, and are indifferent to, the losses, pain and suffering of others, and even show disdain for their victims. Their lack of remorse or guilt is rationalized by denying responsibility for their shocking actions. Usually they have handy excuses for their behavior and, in some cases, deny that it even happened. Caught red-handed, they feign remorse to get away with it.

6. Superficial, exaggerated charm: Charismatic APDs tend to be smooth, charming, fast talking, persuasive liars. They appear fun filled, the life of the party--intelligent, talented, captivating companions with considerable social presence and good verbal fluency. They are entertaining and convincing conversationalists and storytellers who typically attempt to appear familiar with sociology, psychiatry, medicine, psychology, philosophy, poetry, literature, art or law. But they usually won’t let you get a word in edgewise, often flitting from topic to topic to avoid depth of conversation or a straight answer.

7. Need for constant stimulation: An excessive need for novel, thrilling and exciting stimulation. APDs often have a low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time or finish tasks that they consider dull or routine.

8. Lack of emotion: Primary APDs do not respond to punishment, apprehension, stress or disapproval. They seem to be unable to experience any genuine emotion and are unresponsive to kindness. Normal experimental subjects show mounting anxiety when anticipating an electric shock; APDs don’t even sweat. Emotionally-charged words like "rape" and "cancer" trigger brain-wave jolts in normal subjects, APDs show no response. To the APD a word is just a word.

The APD may refer to himself and others in the third person or as a machine. He has no familiarity with personal values or feelings and takes no interest in tragedy, grief, or the humanity found in art and literature, and isn’t moved by beauty, ugliness, love, horror, or even humor. He may say he understands without knowing that he doesn’t understand. As psychologists J. H. Johns and H. C. Quay say, the psychopath “knows the words but not the music.” Even that statement would be meaningless to the APD.

At lower levels of the pathology, bordering more on narcissism, some APDs can cry real tears and are even emotionally "touched" by sunsets, laughing children and beautiful music. However, like narcissists, they don’t share the depth of feeling of mainstream society. But by reading a lot, and communicating with people who experience emotions, the APD can predict and adjust to people's behavior.

9. Impulsiveness and risk taking: They are incapable of considering the consequences of foolhardy, unpredictable, reckless behavior, often endangering themselves and others. They act impetuously and can’t delay immediate pleasure.   

10. Refusal to accept blame: Their failure to accept responsibility for their actions is a result of low conscientiousness and absence of sense of duty; thus, they shift the blame (projection).

11. Teenage misbehavior: APD traits are visible by adolescence, and are legally diagnosable by age 18. These  traits include a pervasive disregard for rules and violation of the rights of others; the torturing or killing animals—even a general dislike of animals; vandalism and fire setting; frequent lying and cheating; repetitive truancy; theft; bullying and fighting with school mates; precocious sexual experimentation; glue sniffing and alcohol use; immunity to pain in themselves and indifference to pain in others; unresponsiveness to discipline; defiance of parental and teacher authority; and running away from home.   

12. Parasitic, freeloading lifestyle: Intentional exploitation of, and financial dependence on others.

13. Poor temper control: “Distempered” APDs, if challenged, easily fly into a red-faced rage or even a frenzy resembling an epileptic fit. They have low tolerance for frustration; when things are not going their way, they are brash, arrogant, and resentful. They perceive casual remarks as attacks, thereby justifying their outbursts as a reasonable defense.

14. Sexual promiscuity: Numerous brief, superficial affairs with casually-selected sexual partners are common, as well as maintaining several simultaneous relationships, and attempting to coerce others into sexual activity. Sexual attitudes are inappropriate or perverse; they tend to say sexually-inappropriate things to people they barely know, bragging about their sexuality and how many partners they’ve had.

15. Belligerent bullying: APDs are often  irritable, confrontational, and intimidating, often resulting in fights or assaults. Many people report the particular stare of the APD—an intense, relentless gaze described as “predatory” or “reptilian,” as if he is directing all of his intensity and hatred through his eyes. One wife described this malevolent foreboding as a feeling of “being eaten” by her APD husband.

16. Lack of realistic planning: Long-term plans and goals are elusive to the APD; they lead a nomadic, impulsive, aimless existence, living in the present, unable to plan for the future.

17. Lack of empathy and conscience: Although APD is a composite of symptoms, the absence of empathy, conscience, compassion and guilt feelings is central. He doesn’t acknowledge the feelings and needs of others.

18. Irresponsibility: APDs repeatedly fail to meet obligations and commitments, ignore bills, default on loans, perform sloppy work, are absent or late to work, break promises, and fail to honor contractual agreements. They disregard the consequences of their behavior.

19. Generally poor behavior: For all the reasons cited above, APDs are often called obnoxious or hateful. They don’t observe society’s niceties or courtesies. Nearly half of them have significant and frequent arrest records, mostly with business associates, traffic offenses, and severe marital difficulties like domestic violence. They tend to invade people’s space; if you are alone in a room, they might suddenly intrude and give you the stare, watching your reaction. Some women misread that look-over as sexuality.

 

                                                             TAKE-HOME POINTS

Typically, psychology students recognize many symptoms in themselves and in others, but occasional off-beat thoughts and quirkiness are normal. To be pathological, they must be pervasive, and a valid diagnosis requires training and experience.  

While it’s true that narcissists and psychopaths can be charismatic and display leadership, not all charismatic people or strong leaders are narcissists; they may be truly altruistic.

Movies and television depictions of psychological pathologies are maximized and dramatized to draw viewership. Every mean character is a sadistic, psychopathic, serial killer. But in real life such predators are very rare; that’s why they make the news.

Having a psychopathic trait doesn’t make someone a psychopath, which is a syndrome of anti-social traits.

The inexperience of youth presents a wide range of behavior; that range narrows with maturity.

There’s a big gap between a symptom and a diagnosis. Having a cough doesn’t mean you have lung cancer, and having occasional weird thoughts, or displaying an inappropriate action, doesn’t make anyone a mental case.