psychological disorders

Psychological Disorders

OUTLINE OF RESOURCES

Introducing Psychological Disorders Lecture/Discussion Topic: Using Case Studies to Teach Psyhological Disorders (p. 917)

Student Project: Diagnosing a “Star” (p. 918)

Feature Films and TV: Introducing Psychological Disorders (p. 917)

Perspectives on Psychological Disorders

Defining Psychological Disorders Lecture/Discussion Topic/Lecture Break: The Self-Diagnosis Phenomenon (p. 918) NEW

Classroom Exercises: Introducing Psychological Disorders (p. 919) Defining Psychological Disorder (p. 920)

Student Project: Encounters With a “Mentally Ill” Person (p. 920)

Student Projects/Classroom Exercises: Adult ADHD Screening Test (p. 920) Normality and the Sexes (p. 921)

Worth Video Anthology: ADHD and the Family*

Understanding Psychological DisordersLecture/Discussion Topics: Tourette Syndrome (p. 921) UPDATED

Culture-Bound Disorders (p. 922)

Classroom Exercise: Multiple Causation (p. 922)

Classifying Psychological Disorders

Lecture/Discussion Topic: Mental Health as Flourishing (p. 924)

Lecture/Discussion Topic/Lecture Break: Revising the DSM (p. 923) NEW

Classroom Exercise: The Flourishing Scale (p. 925) NEW

Worth Video Anthology: Gender Identity Disorder*

PsychSim 5: Mystery Client (p. 925) (or could be used at the end of the psychological disorders discussion)

Labeling Psychological Disorders Classroom Exercise: The Effects of Labeling (p. 925)

Feature Film: In Cold Blood (p. 925)

Worth Video Anthology: Postpartum Psychosis: The Case of Andrea Yates*

Anxiety Disorders Classroom Exercise: Penn State Worry Questionnaire (p. 926)

Worth Video Anthology: Anxiety Disorders* NEW Three Anxiety Disorders* Experiencing Anxiety*

* Titles in the Worth Video Anthology are not described within the core resource unit. They are listed, with running times, in the Lecture Guides and described in detail in their Faculty Guide, which is available at www.worthpublishers.com/mediaroom.

915

916 Psychological Disorders

Generalized Anxiety Disorder Classroom Exercise: Taylor Manifest Anxiety Scale (p. 926)

Panic Disorder

Phobias Lecture/Discussion Topic: Discovery Health Channel Phobia Study (p. 927)

Classroom Exercises: Fear Survey (p. 927) Social Phobia (p. 928)

Obsessive-Compulsive Disorder Lecture/Discussion Topic: Obsessive Thoughts (p. 929)

Classroom Exercise: Obsessive-Compulsive Disorder (p. 928)

Feature Film: As Good As It Gets and OCD (p. 928)

Worth Video Anthology: Obessive-Compulsive Disorder: A Young Mother’s Struggle* Those Who Hoard*

Post-Traumatic Stress DisorderLecture/Discussion Topic: Concentration Camp Survival (p. 930)

Classroom Exercise: The Posttraumatic Cognitions Inventory (PTCI) (p. 930)

Worth Video Anthology: Post-Traumatic Stress Disorder: A Vietnam Combat Veteran* PTSD: Returning from Iraq*

Understanding Anxiety DisordersWorth Video Anthology: Fear, PTSD, and the Brain*

Mood Disorders

Major Depressive Disorder Classroom Exercises: Depression Scales (p. 931)

The Automatic Thoughts Questionnaire (p. 932) Depression and Memory (p. 932) Loneliness (p. 932)

Worth Video Anthology: Depression*

Bipolar Disorder Lecture/Discussion Topic: Bipolar Disorder (p. 933)

Understanding Mood Disorders Lecture/Discussion Topics: The Sadder-but-Wiser Effect (p. 934)

Cognitive Errors in Depression (p. 934) Commitment to the Common Good (p. 938)

Classroom Exercises: Attributions for an Overdrawn Checking Account (p. 935) The Body Investment Scale and Self-Mutilation (p. 936) Understanding Suicide (p. 936) The Expanded Revised Facts on Suicide Quiz (p. 937)

Worth Video Anthology: Mood Disorders* Suicide: Case of the “3-Star” Chef*

Schizophrenia

Symptoms of Schizophrenia Classroom Exercise: Magical Ideation Scale (p. 939)

Lecture/Discussion Topic: Infantile Autism (p. 940)

Student Project: The Eden Express and Schizophrenia (p. 939)PsychSim 5: Losing Touch With Reality (p. 939)

Worth Video Anthology: Schizophrenia* NEW Schizophrenia: Symptoms NEW John Nash: “A Beautiful Mind”*

Understanding Schizophrenia Worth Video Anthology: The Schizophrenic Brain*

Other Disorders Lecture/Discussion Topics: Factitious Disorder (p. 941)

Sensory Processing Disorder (p. 941) NEW

Dissociative Disorders Classroom Exercise: The Curious Experiences Inventory (p. 941)

Lecture/Discussion Topics: Psychogenic Versus Organic Amnesia (p. 942) The Dissociative Disorders Interview Schedule and Dissociative Identity Disorder (p. 942)

Worth Video Anthology: Multiple Personality Disorder*

Eating DisordersClassroom Exercise: Assessing Body Image (p. 942)

Motivations-to-Eat Scale (p. 942)

Worth Video Anthology: Beyond Perfection: Female Body Dysmorphic Disorder* Purging Food* Self-Image: Body Dissatisfaction Among Teenage Girls* Overcoming Anorexia Nervosa*

Personality Disorders Lecture/Discussion Topic: Narcissistic Personality Disorder (p. 943)

Classroom Exercises: Schizotypal Personality Questionnaire (p. 943) Antisocial Personality Disorder (p. 944)

Worth Video Anthology: Trichotillomania: Pulling Out One’s Hair* The Mind of the Psychopath*

Rates of Psychological DisordersLecture/Discussion Topic: The Commonality of Psychological Disorders (p. 944)

Psychological Disorders 917

RESOURCES

Introducing Psychological Disorders

Lecture/Discussion Topic: Using Case Studies to Teach Psychological DisordersYou can effectively teach psychological disorders using a case study approach. Robert L. Spitzer’s DSM-IV-TR Casebook provides an extremely useful resource for examples of all the major disorders. Each case is brief and is followed by a discussion of the DSM-IV-TR diagnostic issues raised. You can use them to introduce each major category of disorder. Alternatively, after students have read the text, the cases can be presented as puzzles to solve, either to your class as a whole or in small groups. The American Psychiatric Association is currently revising the DSM-IV-TR and will publish the DSM-5 in 2013. The DSM-5 will include major changes to the chapter structure for the diagnostic cat-egories in the DSM; some chapters have been deleted with the content distributed across other chapters. You can see a list of the most recent changes on the website for the DSM-5 Task Force at www.dsm5.org/Pages/RecentUpdates.aspx.

Spitzer, R. L. (Ed.). (2002). DSM-IV-TR casebook: A learning companion to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Arlington, VA: American Psychiatric Publishing.

Feature Films and TV: Introducing Psychological Disorders

Psychological disorders are frequently depicted in novels, short stories, television programs, and popular films. Amy Badura recommends several specific movie clips for introducing and stimulating student interest in the topic. All are very brief and illustrate different classes of disorders.

Before showing the clips you might ask students to watch with the following questions in mind: Where should we draw the line between normality and abnor-mality? How should we define psychological disorders? How should we understand disorders—as sicknesses that need to be diagnosed and cured or as natural responses to a troubling environment? After show-ing the clips and eliciting student responses, highlight the text definition. Many mental health workers label behavior as disordered when they judge it to be devi-ant, distressful, and dysfunctional. You may also want to identify the specific disorders illustrated by the clips or wait until you discuss each disorder more fully. Here are the films, scenes, specific disorders, and running times (from appearance of the production company’s full name to the start of the clip):

1. Con Air: voice-over introduction to John Malkovich’s character as he enters the airplane: antisocial personality disorder (0:15:16–0:15:57)


2. The English Patient: Juliette Binoche rides in a caravan with her patient, her best friend’s jeep hits a landmine, her reaction: acute stress disorder (0:10:45–0:14:52)

3. As Good As It Gets: Jack Nicholson visits Greg Kinnear’s apartment and finds him upset: major depressive disorder (0:58:14–1:00:41) (See page 928 for another use of this film.)

4. Primal Fear: Jailhouse interview in which Ed Norton displays personality switch for his attorney: dissociative identity disorder (1:12:00–1:15:41)

5. Copy Cat: Sigourney Weaver retrieves a newspaper from her apartment hallway: panic disorder with agoraphobia (0:19:11–0:20:39)

Television programs also provide a ready source of material for classroom presentation and student projects. You might have your students (individually or in small groups) identify examples from popular TV shows. For example, the popular, Emmy-winning com-edy Monk provides a good example of OCD (although the series ended in 2009, past seasons are available on DVD).

For more on the use of contemporary film in teach-ing psychological disorders, see Danny Wedding, Mary Ann Boyd, and Ryan Niemiec’s Movies and Mental Illness: Using Films to Understand Psychopathology 2nd ed. (2005, Hogrefe).

Wedding, Boyd, and Niemiec have also authored a 75-page resource guide titled Films Illustrating Psychopathology. The guide provides brief descrip-tions of hundreds of films that can be used to illustrate various psychological disorders. The films (each rated on a 5-point scale) are classified according to major category (e.g., anxiety disorders, mood disorders, substance-related disorders). This very helpful guide can be found at the Office of Teaching Resources in Psychology (sponsored by the Society for the Teaching of Psychology). See http://teachpsych.org/otrp/ resourc-es/dw08film.pdf.

Badura, A. S. (2002). Capturing students’ attention: Movie clips set the stage for learning in abnormal psy-chology. Teaching of Psychology, 29, 58–60.

Student Project: Diagnosing a “Star”

W. Brad Johnson describes a well-received student project that he has used for his abnormal psychology course; it can readily be adapted to the introductory course either as an individual or small-group project. It provides an excellent opportunity for students “to think like a psychologist” about psychological disorders. The assignment is for students to select any “star” or famous person (a musician, movie star, politician, historical figure, or criminal) who they believe has a clinical dis-order. Students should prepare an oral or written report on that person, including the identification of symptoms

that reflect one of the specific disorders covered in the text and some discussion of possible causes and treat-ment recommendations. Encourage students to use magazines, books, Internet sites, and even television interviews for making their case. It is important that their report be consistent with existing evidence about the person’s behavior and symptoms.

Johnson, W. B. (2004). Diagnosing the stars: A tech-nique for teaching diagnosis in abnormal psychology. Teaching of Psychology, 31, 275–277.

Perspectives on Psychological Disorders

Defining Psychological Disorders

Lecture/Discussion Topic/Lecture Break: The Self-Diagnosis Phenomenon

Before defining psychological disorders for your stu-dents, you will probably want to make some of the fol-lowing points. You can use these points as the basis for small-group discussions or lecture break topics, or you can create out-of-class assignments in which students expand on the basic points.

1. It is common for students who are studying psy-chological disorders to begin to wonder about their incidence among friends and families (or them-selves)! Although they are just beginning to learn about mental disorders, they often overconfidently “diagnose” the disorders in others or themselves; this can lead to some degree of distress, conflict, and anxiety among your students, their friends, and/or their family members.

This phenomenon is not limited to psychology students. It has been documented in the literature on medical student education and is known by a few different names (e.g., “medical students’ dis-ease,” “nosophobia,” “health anxiety,” “medical student syndrome,” or “medical student disorder”; see Thakur & Preunca, 2008).

It is a good idea to discuss this phenomenon prior to lecturing on the topic of psychopatholo-gies. You may also want to review some of the psychological reasons why students might begin to recognize symptoms of the disorders they are studying in themselves and others, or why they may be very confident in their “diagnoses.” You can discuss the confirmation bias, overconfidence, self-serving bias, the availability heuristic, and other sources of bias in our self- and other- perceptions. You might also consider asking your students to generate suggestions on how to combat this problem by drawing on what they have learned all semester from scientific psychology.

Thakur, N., & Preunca, B. (2008). Nosophobia presented as acute hypochondria. Timisoara Medical Journal, 56(2), 120.

2. In addition to the diagnostic criteria for specific psychopathologies, professionals look for the pres-ence of the “4 Ds” within an individual’s experi-ences in order to consider that person “abnormal.” Three of these—deviant, distressful, and dysfunc-tional—are the criteria applied by the text. Ronald Comer (2005) also includes dangerous. None of the Ds, in and of itself, is sufficient in its presence to make a diagnosis without the presence of the others. It is also useful to know whether there is a good justification or rational explanation for the set of symptoms a person is experiencing, and whether the symptoms occur on “more days than not.” Use the following definitions to expand on your discussion.

a. Deviance refers to a set of recurring behaviors, thoughts, or emotions that deviate from the nor-mative expectations of a society or are deemed unacceptable. However, eccentricity (or “being strange”) cannot be the sole basis for diagnosis for a psychological abnormality.

b. Distress refers to negative feelings that an individual may have toward him- or herself, or toward others. There is an overarching theme that things are not well.

c. Dysfunction describes the degree to which the individual displays maladaptive patterns of behavior, thought, or emotions. These pat-terns interfere with his or her ability to func-tion normally in important daily activities like work, school, social relationships, and personal hygiene or health status. Within the disorder, maladaptive behaviors or thoughts may achieve a specific end, but they are ultimately harmful to successful daily living.

d. Danger to self or others is another feature. For example, consider the behavior known as “cut-ting,” in which individuals literally injure them-selves (cutting into their own skin) when they experience anxiety, flooding, or other strong emotion. Such behaviors are often described as alleviating tension for the sufferer, which may positively reinforce the behaviors to continue or increase in frequency over time. Although the cutting behaviors serve a palliative role for the sufferer, they are, in the end, injurious and harmful to him or her.

e. Justification centers on the context for a set of behaviors, thoughts, or emotions. Can a good reason for the pattern be identified? Consider how cultural and religious values may provide different contexts or rationales for the same kinds of behaviors.

f. “More days than not” is an informal standard used by professionals to establish whether a reli-able pattern of problematic thoughts, emotions, or behaviors exists. Over some period (e.g., two weeks or two months), the number of days dur-ing which an individual displays symptoms is counted or estimated. In psychopathology, the number of symptom-present days will exceed the number of symptom-absent days.

Comer, R. J. (2010). Fundamentals of abnormal psychology (7th ed.). New York: Worth.

Classroom Exercise: Introducing Psychological Disorders

Steven M. Davis provides an effective exercise for introducing psychological disorders. Davis notes that, although the concept of “mental” or psychological dis-order is familiar to students, their beliefs about what constitutes a disorder are unexamined and may even be contradictory. Handout 1 (which Davis reports adapt-ing from a similar exercise designed by John Suler) challenges students to define psychological disorder, as well as confront any inconsistencies in their beliefs. The handout also serves to raise important political, cultural, and social issues concerning the definition of psychological disorders.

Before students have read the text definition of psychological disorder, have them read through the case studies quickly and decide whether the person has a “psychological disorder.” Then organize students into groups of four or five, and instruct each group to pretend that they are a committee that is advising the American Psychiatric Association on the writing of the DSM-5. They are to decide whether each case should be included as a psychological disorder in the DSM-5. They are to try to reach agreement and, most important, to keep track of the criteria they use for including or excluding each case.

After about 25 minutes, reconvene the entire class and consider each case in turn. Write on the chalkboard the criteria that each group identified for including or excluding each case. Note consistencies as well as con-tradictions between the small groups. Finally, introduce the text definition of psychological disorder.

Davis notes that this activity provides numerous learning opportunities for students. For example, stu-dents are often surprised to discover inconsistencies in how they define psychological disorders and are also surprised at the arbitrariness inherent in any “official” definition. Sometimes, students discover that they want to exclude all cases that have a clear biological etiol-ogy, as well as all cases that have a clear environmental origin—which theoretically leaves very few examples of psychological disorders. Issues surrounding stigma, labeling, the medical model, cultural relativism, and person-environment fit are also likely to arise.


Davis, S. M. (2003, January). Utilizing contradictions in students’ implicit definitions of “mental disorder” in an introductory psychology course. Poster presented at the 25th Annual National Institute on the Teaching of Psychology, St. Petersburg, FL, January 2003.

Classroom Exercise: Defining Psychological Disorder

As a simple alternative to the previous exercise, have students form small groups of four or five and come up with a definition for “psychological disorder.” Instruct them to be specific, identifying the criteria they would apply in drawing the line between normality and abnor-mality. After 20 to 30 minutes, have each group report its definition to the class. Inadequacies are certain to be pointed out, and the rest of the session can be spent in considering the difficulty of satisfactorily defining the term. The text indicates that behavior is considered disordered when it is deviant, distressful, and dysfunctional.

In highlighting each of these criteria, Larry Bates makes some important observations. First, what is considered deviant depends on the context or cultural setting. For example, should someone speak in an unfa-miliar language while standing, dancing, and finally fainting in front of class, the behavior might be consid-ered deviant (Bates suggests that should it occur in his class, he would probably call an ambulance!). Yet for some religious groups, such behavior is considered nor-mal, even laudatory.

In some cases, deviance may be extremely difficult to detect. Some people seem fine on the outside—smil-ing, joking, performing their work well each day, and putting their kids to bed every night. Unknown to us, however, they may cry themselves to sleep because they no longer find life enjoyable or meaningful. When they engage in the activities that once brought pleasure, they feel nothing. In such cases, internal distress more clearly characterizes the psychological disorder.

Finally, almost all disorders have a threshold they must cross that meets the requirements of a psychologi-cal disorder. If a person is terrified of flying but has no real reason to fly, the fear is probably not considered a psychological disorder. Only when this fear interferes with the person’s daily life—for example, if he or she is promoted to regional manager and must travel—is it considered dysfunctional and thus a psychological disorder.

Bates, L. (2007, January 3). Abnormal/atypical. Message posted to PSYCHTEACHER@ list.kennesaw.edu.

Student Project: Encounters With a “Mentally Ill” Person

Irwin and Barbara Sarason suggest an exercise you might use to introduce the topic of psychological dis-orders. As compared with 30 years ago, when most

chronic mental patients were institutionalized, it is now much more likely that students will have encountered a person with a chronic mental disorder in the super-market, at the shopping mall, on the bus, or on the street corner. Ask your students to recall one incident in which they have personally encountered a “mentally ill” person. Ask them to reflect on what happened, then write down the details of that encounter. What made them decide the person was mentally ill? Also ask them to indicate whether they felt comfortable or uncomfort-able, whether the person’s behavior seemed predictable or unpredictable, and whether the person seemed dan-gerous or nondangerous.

It may also be worth asking where the encoun-ter occurred, whether other people were present, and whether the mentally disordered person actually approached or spoke to them. Collect the accounts and tabulate the number of students who found the encoun-ters to be uncomfortable, unpredictable, and dangerous. As the Sarasons note, research on public attitudes has shown that most people feel uncomfortable with the mentally ill and find their behavior to be both unpre-dictable and dangerous. Did the students react that way? Did they observe similar reactions in others? If not, how might the setting, the presence or absence of other people, and the actions of the psychologically dis-ordered person change one or more of their reactions?

Use the students’ descriptions to define “psycho-logical disorder.” The students’ examples will illustrate how behavior is considered psychologically disordered when it is deviant, distressful, and dysfunctional.

Sarason, I., & Sarason, B. (2005). Abnormal psychology (11th ed.). Upper Saddle River, NJ: Prentice Hall.

Student Project/Classroom Exercise: Adult ADHD Screening Test

Handout 2, designed by the World Health Organization, can be used to help respondents recognize the signs of adult attention-deficit hyperactivity disorder (ADHD). The questionnaire is not meant to replace consultation with a trained professional—obviously, an accurate diagnosis can be made only through clinical evalu-ation—but respondents who checked “sometimes,” “often,” or “very often” four or more times may want to talk with a psychologist about being evaluated for ADHD.

Researchers estimate that as many as 4 to 5 per-cent of U.S. adults have ADHD, but perhaps only 20 percent of them are aware of it. Although ADHD was once considered to be only a childhood disorder that was outgrown, researchers now believe that between 35 and 60 percent of children with ADHD continue having symptoms in adulthood. Some people who did not have symptoms as children in school have difficulty multi-tasking in adulthood. Furthermore, because awareness


of the disorder is relatively recent, some adults now in their thirties and forties may have had the disorder as children but their symptoms were not recognized.

ADHD tends to run in families. Psychiatrist Lenard Adler of New York University suggests that if a child is diagnosed with ADHD, there is a 40 percent chance that one parent has it as well. Factors such as exposure to alcohol and tobacco in pregnancy are also linked with the condition. Although boys are more likely than girls to be diagnosed with the disorder, adult ADHD affects men and women equally. Some hypothesize that girls are less likely to be disruptive in the classroom, and thus teachers may be more likely to overlook it.

Adults with the disorder are easily distracted, fre-quently forget appointments, and constantly lose things. They may fidget, talk excessively, and feel an internal restlessness. Other symptoms include a failure to fol-low through on instructions or finish a task, difficulty organizing, and an inability to attend to details. “One of the tell-tale signs is when someone has a hard time staying in the conversation with you without interrupt-ing,” states Carol Gignoux, a Boston-based executive coach who specializes in working with people who have ADHD.

Adults with ADHD sometimes become worka-holics, using deadlines as the motivation to complete complex projects. The structure and routine of work becomes easier to deal with than their free time. However, ADHD can interfere with job performance as well as with interpersonal relationships. Those with the disorder are more likely to divorce, engage in substance abuse, and have more driving accidents. They are also more likely to suffer other psychological disorders, including depression.

ADHD raises fundamental questions about the nature and definition of psychological disorder. Like most disorders, attention disorder has a “spectrum diag-nosis” with widely varying symptoms. Is the problem with attention really disabling or within the parameters of being normal? “Where does the disorder begin?” asks Russell Barkley at the Medical University of South Carolina. “It begins where impairment begins. You may have a high degree of ADD symptoms, but it just means you have a sparkling personality because there is no impairment.”

The U.S. Food and Drug Administration (FDA) has approved adult use of drugs such as Adderall, a stimulant similar to Ritalin, which is widely prescribed to children diagnosed with the condition. The FDA has also approved Straterra, the first nonstimulant medica-tion for adults with the disorder. The success rate for treatment is considered very good, especially when cou-pled with coaching that provides organizing strategies.

Rubin, R. (2003, December 3). ADHD focuses on adults. USA Today, pp. 1D–2D.

Szegedy-Maszak, M. (2004, April 26). Driven to distrac-tion. U.S. News & World Report, 53–62.

Weaver, J. (2004, September 9). Are you an adult with ADHD? Message posted at http://msnbc.msc.com/ id/5889089.

Student Project/Classroom Exercise: Normality and the Sexes

In 1970, Inge Broverman and her associates found that mental health professionals (psychiatrists, psycholo-gists, and social workers) viewed the mature, healthy man differently from the mature, healthy woman. For example, the healthy man was more likely to be viewed as ambitious, adventurous, self-confident, logical, and independent, while the healthy woman was viewed as tactful, aware of others’ feelings, gentle, expressive of tender feelings, and in need of security. The research-ers further found that the characteristics they linked to a healthy adult person more closely resembled those of the healthy man than those of the healthy woman.

As either a student project or a classroom exer cise, have both male and female students complete Handout 3. Collect and tabulate the data. (Items, 1, 3, 6, 7, and 9 were more likely to be attributed to the healthy man in Broverman’s study; items 2, 4, 5, 8, and 10, to the healthy woman.)

Discuss the results in class. Do the earlier results still hold for students in the 2000s? Has sensitivity to the problem of sexism eliminated the double standard for nor mality, or does it still exist? Is the view of a healthy adult person still closer to the male than to the female ideal? If so, what does it mean for women who are taught that by being normal, competent people, they are not normal?

In fairness to mental health professionals, we should note that research suggests that they evaluate and treat men and women similarly. Sex-role stereo-types may have weakened, or they may become irrel-evant when clinicians are confronted with a particular individual.

Broverman, I. K., Broverman, D. M., Clarkson, R. E., Rosenkrantz, P. S., & Vogel, S. R. (1970). Sex role ste-reotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7.

Understanding Psychological Disorders

Lecture/Discussion Topic: Tourette Syndrome

A discussion of Tourette syndrome may give students a clearer picture of the different perspectives on psycho-logical disorders. Symptoms of this unusual disorder include involuntary twitching—facial grimacing, head jerking, finger snapping, whirling, hopping—and the making of unusual sounds—hooting, barking, screech-ing, grunting, even cursing uncontrollably. It is esti-mated that about 100,000 Americans suffer from the


more severe symptoms of Tourette syndrome and that 3 million others may have a milder form of the disorder. The first symptom may appear by age 7 and can be as insignificant as repeated eye-blinking or clearing of the throat. In a few instances, the person may simply echo another’s words. The movements and words seem to have no purpose or meaning. Although victims are unable to overcome the symptoms, many can temporar-ily suppress them, sometimes for hours.

Tourette syndrome was originally thought to be the work of the devil. Exorcism was the only cure. Psychoanalytic theorists have provided a variety of explanations for the disorder—from a defense against thumb-sucking to repressed aggression. It has now become clear that Tourette syndrome has physical causes. Many believe the disorder is hereditary. The most conclusive evidence comes from a study of Mennonite farmers in Alberta, Canada, in which 54 of the 136 family members have the syndrome or at least some of the minor symptoms, such as facial twitches and humming. A dominant gene has been implicated, although Tourette’s symptoms do not appear in every-one who inherits it. Virtually all men who have the gene show at least minor symptoms, but only two-thirds of the women do. Moreover, women who display its symptoms tend to show more obsessive-compulsive traits, for example, touching every lightpost on the street. Both dopamine, which helps control movement, and norepinephrine, which helps the body respond to stress, seem to be involved in Tourette syndrome. A satisfactory treatment has yet to be found. The antipsy-chotic haloperidol is effective in about three-quarters of all cases but often with adverse side effects, including depression and, paradoxically, violent muscle spasms. Another antipsychotic medication, risperidone, and the blood pressure medication clonidine also significantly reduce tics. Side effects include weight gain, fatigue, and dry mouth.

Most researchers have not found behavioral inter-vention to be effective in the treatment of Tourette syndrome. For example, 55 percent of medical profes-sionals believe that the tics cannot be controlled, and 77 percent believe that if they are suppressed, they will become even worse later. More recently, Douglas Woods and his research team have challenged those assumptions. Children between the ages of 8 and 11 were rewarded for every 10-second interval they did not exhibit a tic. The children significantly suppressed their tics. They expressed a tic during 16 percent of the 10-second intervals when they were rewarded as opposed to 50 percent of the intervals at the begin-ning of the experiment. Another study conducted by Raymond Miltenberger and his colleagues found no rebound effect for tic suppression in five people with Tourette syndrome, ranging in age from 7 to 20. Both

lines of research highlight the role that environmental factors may play in the expression of Tourette.

Currently, NIH-funded researchers are conducting several large-scale genetic studies. A research team led by Matthew State, an associate professor in the Child Study Center and in the departments of psychiatry and genetics at Yale University and co-director of the Yale Program on Neurogenetics, has been studying one fam-ily in which the father has Tourette and OCD, all eight children have Tourette, and two also have OCD. A gene, called HDC, is needed for producing histamine, a small molecule with many roles in the body, includ-ing signaling in the brain. Dr. State and his team found that all of the affected family members share a mutation in the HDC gene, which encodes an enzyme needed to produce histamine. The mutation reduces the activity of the enzyme.

Other promising research involves neuroimaging, neuropathology, and clinical trials, all providing impor-tant information about this difficult disorder.

Dingfelder, S. (2006). Nix the tics. Monitor on Psychology, 37, 18.

Himle, M. B., & Woods, D. G. (2005). An experimental evaluation of tic suppression and the tic rebound effect. Behavior Research and Therapy, 43, 1443–1451.

Miltenberger, R.G. (2005). Habit Reversal. In A. Gross & R. Drabman (Eds.), Encyclopedia of behavior modifi-cation and cognitive behavior therapy, Vol.II (pp. 873-877). Thousand Oaks, CA: Sage.

National Institute of Neurological Disorders and Stroke. (2010, September 14). Abnormalities in brain histamine may be key factor in Tourette syndrome. Retrieved September 29, 2011, from www.ninds.nih.gov/news_and_events/news_articles/Abnormalities%20in%20Brain%20Histamine%20may%20be%20Key%20Factor%20in%20Tourette%20Syndrome.htm.

Seligman, M., Walker, E., & Rosenhan, D. L. (2001). Abnormal psychology (4th ed.). New York: Norton.

West, S. (1987, November/December). The devil’s disor-der. Hippocrates, 66–71.

Woods, D. W., Walther, M. R., Bauer, C. C., Kemp, J. J., & Conelea. C. A. (2009). The development of stimu-lus control over tics: A potential explanation for con-textually-based variability in the symptoms of Tourette syndrome. Behavior Research and Therapy, 47, 41–47.

Classroom Exercise: Multiple Causation

Today’s psychologists argue that all behavior arises from the interaction of nature and nurture. The biopsy-chosocial approach recognizes that psychological dis-orders have multiple causes. Clearly, we ought to resist the pervasive temptation to expect simple explanations.

Handout 4 is Gregory Kimble’s classroom exercise to demonstrate the problems caused when we use sim-ple explanations. In brief, it asks students whether they


can remember events in their lives that were painful enough to bring on a mental breakdown. Most people can.

Give students 10 minutes or so to respond to the scenario in Handout 4. (If you want to give them more time and thus obtain more detailed responses, make it a homework assignment.) Also ask students to clearly indicate at the end of their response whether you may share it with the rest of the class. Between class peri-ods, review the responses and pick a few of the more poignant answers to share with the entire class.

Kimble suggests that everyone has a traumatic experience that can cause psychological disorder but that not everyone succumbs. Such single episodes do not qualify as causes of psychological disorders. Too often, Kimble notes, we think that behavioral phe-nomena are single entities that have single causes. The medical model of psychopathology falls into this trap. It promotes the myth that disorders are single maladies brought on by single causes such as a traumatic experi-ence. Although this perspective might be appropriate for certain medical conditions, it typically does not apply to psychological disorders, which may be full-blown or borderline and express an array of disposi-tions. Typically, psychological disorders involve faulty knowledge, inappropriate feelings, and disordered behavior. A single cause, suggests Kimble, of such multiple and varied symptoms is unlikely.

Kimble, G. (1996, August). Secondary school psychol-ogy: The challenge and the hope. Paper presented at the 104th Annual Convention of the American Psychological Association, Toronto.

Lecture/Discussion Topic: Culture-Bound Disorders

Evidence of environmental effects on psychological disorder comes from links between culture and disor-der. Although some disorders such as schizophrenia and depression are worldwide, others are not. For example, anorexia nervosa and bulimia nervosa are disorders that occur mostly in Western cultures. On the other hand, susto, marked by severe anxiety, restlessness, and a fear of black magic is a disorder found only in Latin America. You can expand on this disorder as well as other culture-bound disorders in class.

Susto is most likely to occur in infants and young children. In addition to anxiety and restlessness, the disorder is often marked by depression, loss of weight, weakness, and rapid heartbeat. Those within the culture claim that the susto is caused by contact with super-natural beings or with frightening strangers, or even by bad air from cemeteries. Treatment involves rubbing certain plants and animals against the skin.

Latah occurs among uneducated middle-aged or elderly women in Malaya. Unusual circumstances (such as hearing someone say “snake” or even being tickled) produce a fear response that is characterized by

repeating the words and actions of other people, utter-ing obscenities, and acting the opposite of what other people ask.

Koro is a pattern of anxiety found in Southeast Asian men. It involves the intense fear that one’s penis will withdraw into one’s abdomen, causing death. Tradition holds that koro is caused by an imbalance of “yin” and “yang,” two natural forces thought to be the fundamental components of life. In one form of treat-ment, the individual keeps a firm hold on his penis (often with the assistance of family members) until the fear subsides. Another is to clamp the penis to a wooden box.

Amok, a disorder found in the Philippines, Java, and certain parts of Africa, occurs more often in men than in women. Those suffering the affliction jump around violently, yell loudly, and attack objects and other people. These symptoms are often preceded by social withdrawal and a loss of contact with reality. The outburst is often followed by depression, then amnesia regarding the symptomatic behavior. Within the culture, it is thought that stress, shortage of sleep, alcohol con-sumption, and extreme heat are the primary causes.

Winigo, the intense fear of being turned into a can-nibal by a supernatural monster, was once common among Algonquin Indian hunters. Depression, lack of appetite, nausea, and sleeplessness were common symptoms. This disorder could be brought on by com-ing back from a hunting expedition empty-handed. Ashamed of his failure, the hunter might fall victim to deep and lingering depression. Some afflicted hunters actually did kill and eat members of their own households.

Comer, R. J. (2010). Abnormal psychology (7th ed.). New York: Worth.

Classifying Psychological Disorders

Lecture/Discussion Topic/Lecture Break: Revising the DSM

Efforts to revise the Diagnostic and Statistical Manual of Mental Disorders (DSM) are in full swing by the American Psychiatric Association and its working com-mittees. The structure, content, and (in some cases) definitions for mental disorders are all being revised and reconsidered for the new edition. This work began in earnest in 1999 and is still ongoing. Field trials are currently underway, and the anticipated publication date for the new DSM-5 is sometime in 2013.

Some of the changes to the DSM being proposed are substantial—for example:

• TheAPAnolongerwishestouseromannumeralsto denote edition. The new edition will be labeled the “DSM-5” instead of “DSM-V.”


• CollapseAxesI,II,&IIIofDSM-IV:theDSM-5will include one axis to capture all psychiatric and general medical diagnoses. The decision to do this was made to bring the DSM into closer alignment with the World Health Organization’s International Classification of Diseases.

• Standardizethedocumentationofsymptomsthat are not specific to any one specific disorder (e.g., malaise, fatigue, depressed mood) in an Assessment Instrument that labels a person’s pre-senting set of symptoms as “Level 1” (lowest risk) or “Level 2” (further questioning warranted).

• Addnewcategories:addictionandrelateddis-orders, autism spectrum disorders, binge eating disorder (the criteria for the category “other eating disorders” were revised), temper dysregulation with dysphoria, and others.

• Placegreateremphasisongender,race,andethnic-ity in the revision process to foster greater cultural sensitivity in diagnosis and treatment.

If you need to brush up on the specifics of the pro-cess used to revise the DSM, or want to dig deeper into the work conducted to reconsider specific diagnostic categories, you can check the APA’s press release web-site. You can find here a collection of excellent sum-maries of the review process and the specific changes being recommended: www.dsm5.org/ Newsroom/Pages/ PressReleases. aspx. More detailed descriptions of the proposed revisions in specific categories can be found at www.dsm5.org/Proposed Revisions/Pages/Default.aspx.

The revisions to the DSM have not been under-taken without controversy, of course. You and your stu-dents can get a good feel for the issues, the advocates for different positions on these issues, and how debate has influenced the revision process by reading a number of different blogs dedicated to the DSM-5 endeavor. Some good examples of discussions and blogs on spe-cific revision topics can be found at the following sites:

Jared DeFife’s review of the changes to the section(s) on personality disorders: www.psycholo-gytoday.com/ blog/the-shrink-tank/201002/dsm-v-offers-new-criteria-personality-disorders

Addictive disease category: www.jointogether. org/news/features/2010/dsm-v-draft-includes-major.html

DSM revision petition: www.thepetitionsite.com/1/ DSMrevisionpetition/

Wall Street Journal’s health blog about critics and counter critics of the DSM revision process: http://blogs.wsj.com/health/2009/01/08/psychiatrists-bash-back-at-critics-of-diagnostic-manual-revision/

An interesting argument for how DSM-5 revisions may affect the criminal justice system: http://blog.neulaw.org/?tag=temporary-insanity

Lecture/Discussion Topic: Mental Health as Flourishing

Corey L. M. Keyes argues that mental health is not merely the absence of mental illness but the presence of human flourishing. The key clusters and associated dimensions of human flourishing include the following:

Positive emotions (or emotional well-being) Positive affect (regularly cheerful, interested in life, in good spirits, happy, calm, peaceful, full of life)

Avowed quality of life (mostly or highly satisfied with life overall)

Positive psychological functioning (or psychological well-being)

Self-acceptance (holds positive attitudes toward self)

Personal growth (seeks challenge, has insight into own potential, feels a sense of continued development)

Purpose in life (finds own life has direction and meaning)

Environmental mastery (exercises ability to select, manage, and mold personal environs to suit needs)

Autonomy (is guided by own, socially accepted, internal standards and values)

Positive relations with others (has, or can form, warm, trusting interpersonal relationships)

Positive social functioning (or social well-being) Social acceptance (holds positive attitudes toward, acknowledges, and is accepting of human differences)

Social actualization (believes people, groups, and society have potential and can evolve or grow positively)

Social contribution (sees own daily activities val-ued by society and others)

Social coherence (interested in society and social life and finds them meaningful and somewhat intelligible)

Social integration (a sense of belonging to, and support from, a community)

According to Keyes, to be diagnosed as flourishing in life, a person must exhibit high levels on at least 1 of the 2 measures of emotional well-being and high levels on at least 6 measures of the 11 measures of positive functioning. Interestingly, the prevalence of flourish-ing is about 20 percent of the adult population. Keyes


suggests this low percentage highlights the need for a national program for mental health promotion that complements our long-standing efforts to prevent and treat mental illness.

The benefits of flourishing to individuals and soci-ety are reflected in research findings that indicate that completely mentally healthy adults miss the fewest days of work; have the lowest risk of cardiovascular disease, the lowest number of chronic physical diseases, and the fewest health limitations on activities of daily living; and are the least likely to use health care services.

Keyes et al. (2005) Mental illness and/or mental health? Investigations axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), Table 1, page 543. Copyright 2005. Adapted with permission by the American Psychological Association.

PsychSim 5: Mystery Client

This program is a review for those who have already read the text chapter on psychological disorders. The program includes six cases, one for each of the major diagnostic (DSM-IV-TR) categories mentioned in the text. The student is to try to guess the category from the description. The program randomly selects the order of cases but keeps track of them within a session so that cases are not repeated.

Classroom Exercise: The Flourishing Scale

The Emotion unit in these resources included Ed Diener and Robert Biswas-Diener’s recently published Flourishing Scale. If you did not use Handout 21 in that unit (p. 733) earlier, you may want to do so now.

Labeling Psychological Disorders

Classroom Exercise: The Effects of Labeling

Once a diagnostic label is attached to someone, we come to see that person differently. Labels create preconcep tions that can bias our interpretations and memories. One result is that erroneous diagnoses can sometimes be self-confirming, because clinicians will search for evidence in a client’s life history and hospital behavior that is consistent with the diagnosis. David Rosenhan, who conducted a controversial demonstra-tion of the biasing power of diagnostic labels, gives the example of one pseudopatient who told the interviewer that he

had a close relationship with his mother but was rather remote from his father during his early childhood. During adolescence and beyond, however, his father became a close friend, while his relationship with his mother cooled. His present relationship with his wife was characteristically close and warm. Apart from occa-sional angry ex changes, friction was minimal. The chil-dren had rarely been spanked.

Knowing the person was diagnosed as having schizo-phrenia, the clinician “explained” the problem in the following manner.

This white 39-year-old male . . . manifests a long his-tory of considerable ambivalence in close relationships, which begins in early childhood. A warm relationship with his mother cools during his adolescence. A distant relation ship to his father is described as becoming very intense. Affective stability is absent. His attempts to con-trol emotionality with his wife and children are punctu-ated by angry outbursts and, in the case of the children, spank ings. And while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships also.

To show how readily we can explain people’s per-sonalities in terms of an earlier sketch of their motives and behavior, present the top half of Handout 5 to small groups in your class, and the bottom half to the remaining groups. The sketch of Tom W. is adapted from a description prepared by Daniel Kahneman and Amos Tversky. Ask each group to read its answers to the questions to the class. Regardless of which outcome they have been given, the groups will have no difficulty identifying psychological indicators that pointed to Tom’s present status.

Kahneman, D., & Tversky, A. (1973). On the psychol-ogy of predictions. Psychological Review, 80, 237–251.

Feature Film: In Cold Blood

In Cold Blood provides an excellent introduction to the insanity defense. Or, you might prefer to show the film when you discuss antisocial personality disorder. Based on Truman Capote’s bestseller, it relates the true story of the personalities and events surrounding the murder of the Herbert Clutter family. Perry Smith and Richard Hickock, two former prison inmates, travel to Holcomb, Kansas, with the intent of robbing the Clutter farm. When they find no money, they systematically shoot the four defenseless family members.

As Capote relates in his book, the defendants’ attorneys entered an insanity plea, but under the M’Naghten rule (in criminal trials, an insanity defense is valid only if the defendant is shown not to have known what he or she was doing or did not know right from wrong), Smith and Hickock were convicted and sentenced to hang. While Richard Hickock’s criminal conduct might be attributed to an earlier head injury, a psychiatrist testified that Hickock knew the difference between right and wrong. Tests to determine whether brain damage was in fact present were never conducted.

You might ask students if they think the insan-ity plea is ever appropriate, and if so, what should be the criteria. In the 1950s, the Durham rule replaced M’Naghten in some courts. The Durham rule states that the “accused is not criminally responsible if his


unlawful act is the product of mental disease or defect.” David Bazelon, the presiding judge at the trial that first applied this criterion, believed that use of the general term “mental disease” would leave the profession of psychiatry free to apply its full knowledge. Forcing the jury to rely on expert but often conflicting testimony has not proved workable, however, so the Durham rule is no longer used in most jurisdictions.

Other alternatives to the insanity defense have been proposed, and in some cases adopted. For example, several states have adopted the verdict “guilty but men-tally ill.” While the person is held legally accountable for his action, his sentence involves psychotherapeutic treatment in a hospital or in jail. Treatment may focus on helping the convict take responsibility for his or her own actions. Another proposal has been the plea of diminished capacity, or diminished responsibility, whereby a defendant may be tried for a lesser crime if there is reason to suspect psychological disorder. Its advantage is that it does not create a separate category of prisoners (or patients). Moreover, it recognizes that responsibility exists along a continuum, with some peo-ple more responsible than others for their actions.

If you wish to discuss this later, the film provides much information about the personality and motives of Perry Smith. Through flashbacks, the viewer observes the role of early experience in the development of his aggressive behavior. After showing the film, you can discuss the possible factors that contribute to the antiso-cial personality.

Anxiety Disorders

Classroom Exercise: Penn State Worry Questionnaire

Handout 6, the Penn State Worry Questionnaire (PSWQ) designed by T. J. Meyer and his colleagues, provides a good introduction to the anxiety disorders. In scoring the scale, respondents should reverse their responses to items 1, 3, 8, 10, and 11 (1 = 5, 2 = 4, 3 = 3, 4 = 2, 5 = 1), then add the numbers in front of all 16 items. Total scores can range from 16 to 80, with higher scores reflecting a greater tendency to worry. The mean score of 405 introductory psychology students was 48.8 (mean for women = 51.2, for men, 46.1).

The authors note that generalized anxiety disorder is primarily defined by chronic worry, and the pro-cess of worry is pervasive throughout all the anxiety disorders. Thus, identifying the nature and functions of worry should significantly contribute to our under-standing of anxiety and its disorders. In research on the scale, Meyer and his colleagues report that PSWQ scores were linked to lower self-esteem but higher levels of perfectionism, time urgency, and self- handicapping. Worry as measured by the questionnaire

was also associated with more maladaptive levels of coping.

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28, 487–495.

Generalized Anxiety Disorder

Classroom Exercise: Taylor Manifest Anxiety Scale

Handout 7 is the Taylor Manifest Anxiety Scale, which attempts to assess level of anxiety. The average score for college students is about 14 or 15 answers that match the “true” answers below. An answer of “true” indicates anxiety related to that item.

1. F 18. F 35. T 2. T 19. T 36. T 3. F 20. F 37. T 4. F 21. T 38. F 5. T 22. T 39. T 6. T 23. T 40. T 7. T 24. T 41. T 8. T 25. T 42. T 9. F 26. T 43. T 10. T 27. T 44. T 11. T 28. T 45. T 12. F 29. F 46. T 13. T 30. T 47. T 14. T 31. T 48. T 15. F 32. F 49. T 16. T 33. T 50. F 17. T 34. T

Learning theorists have explained the develop-ment of anxiety in terms of classical conditioning. Rats given unpredictable shocks in the laboratory may become apprehensive whenever placed in the labora-tory environment; they may develop more specific phobias if a given object or activity is associated with shock. Researchers believe that a number of factors influence the conditioning process. Janet Taylor Spence has focused on individual differences in emotional responsiveness. She asked five clinical psychologists to judge which items from the Minnesota Multiphasic Person ality Inventory indicate chronic anxiety. Those on which the psychologists agreed were put through an item analysis, and the 50 surviving items constitute the present Manifest Anxiety Scale.

Psychodynamic theorists, of course, have a very different view of anxiety. Freud saw it as a product of unresolved conflict that occurs when defense mecha-nisms are weak. Karen Horney, a neo-Freudian, argues that an inadequate self-concept is the basis for anxiety. We presum ably construct an ego ideal that is designed


to gain the unconditional approval of our parents. This ideal self is too rigid and impossible to attain, so we consistently give ourselves a poor self-evaluation. Self-censure follows, which is the worst form of anxiety for it is the most difficult both to escape and to satisfy.

Existential theorists have yet a different view of anxiety. They suggest that it is based in our growing aware ness that we exist and that we are responsible for the choices we make. The accompanying realization of nonexis tence, or death, is particularly important in understanding the roots of anxiety. Our awareness of our inevitable death leads to deep concern over whether we are living a meaningful and fulfilling life.

Napoli, V., Kilbride, J., & Tebbs, D. (1995). Adjustment and growth in a changing world (5th ed.). St. Paul, MN: West Publishing.

Panic Disorder

Phobias

Lecture/Discussion Topic: Discovery Health Channel Phobia Study

What do people fear? In August 2000, Discovery Health Channel commissioned Penn, Schoen, & Berland Associates to conduct a nationally representa-tive telephone survey of 1000 Americans to answer that question (see http://health.discovery.com/centers/ mental/phobias/facts.html). Students will find the fol-lowing results interesting.

The top 10 fears (men and women combined) were the following: 1. Fear of snakes 2. Fear of being buried alive 3. Fear of heights 4. Fear of being bound or tied up 5. Fear of drowning 6. Fear of public speaking 7. Fear of hell 8. Fear of cancer 9. Fear of tornadoes and hurricanes 10. Fear of fire

Top 5 fears of men?

1. Fear of being buried alive 2. Fear of heights 3. Fear of snakes 4. Fear of drowning 5. Fear of public speaking

Top 5 fears of women?

1. Fear of snakes 2. Fear of being bound or tied up 3. Fear of being buried alive 4. Fear of heights 5. Fear of public speaking

The greatest difference between men and women was in the fear of being bound or tied up (women 27 percent versus men 2 percent). Results also indicated that we fear giving a speech (36 percent) more than meeting new people (12 percent), embarrassing our-selves in a sport (44 percent) more than asking someone for a date (35 percent), being stranded in the ocean (62 percent) more than being stranded in the desert (24 percent), and the IRS (57 percent) more than God (30 percent). The things we fear equally are rats and den-tists (58 percent), elevators and flying (52 percent), and public speaking and being alone in the woods (40 percent). While the pollsters found the level of fear in American society to be high, they also reported that few seek treatment. Among those who say they have a pho-bia or extreme fear, only 11 percent indicated that they sought professional help.

Classroom Exercise: Fear Survey

What do we fear? James Geer has devel oped a scale to measure fear. He asked 124 research participants to list their fears on an open-ended questionnaire. Fifty-one specific fears were mentioned two or more times; these were included in the survey in Handout 8. The following 11 fears received the highest intensity ratings: untimely or early death, death of a loved one, speak-ing before a group, snakes, not being a success, being self-conscious, illness or injury to loved ones, making mistakes, looking foolish, failing a test, suffocating. Students will be interested in compar ing their fears with those of their classmates, so you may wish to collect the surveys and report the overall results back to the class.

Psychiatrists and psychologists have labeled more than 700 specific fears and estimate that there are thou-sands more. When such fears are persistent and debili-tating, they are considered to be phobias. Among those specifically identified are the following, listed under their appropriate Greek or Latin name.

Acrophobia: Heights Aquaphobia: Water Gephyrophobia: Bridges Ophidiophobia: SnakesAerophobia: Flying Arachnophobia: Spiders Herpetophobia: Reptiles Ornithophobia: BirdsAgoraphobia: Open spaces Astraphobia: Lightning Mikrophobia: Germs Phonophobia: Speaking aloudAilurophobia: Cats Brontophobia: Thunder Murophobia: Mice Pyrophobia: FireAmaxophobia: Vehicles, driving Claustrophobia: Closed spacesNumerophobia: Numbers Thanatophobia: DeathAnthophobia: Flowers Cynophobia: Dogs Nyctophobia: Darkness Trichophobia: HairAnthropophobia: People Dementophobia: Insanity Ochlophobia: Crowds Xenophobia: Strangers

You might also ask students if they have heard of triskaidekaphobia (the number 13), uxoriphobia (one’s wife), Santa Claustrophobia (getting stuck in a chim-ney), panaphobia (everything), or phobophobia (fear itself).


Geer, J. H. (1965). The development of a scale to mea-sure fear. Behavior Research and Therapy, 3, 45–53.

Classroom Exercise: Social Phobia

Handout 9 is the Social Thoughts and Beliefs Scale (STABS), which was designed by Samuel Turner and his colleagues to assess the cognitions associated with social phobia. The disorder is marked by social timid-ity, social inhibition, the avoidance of social situa-tions, and, in many cases, extreme social debilitation. Students obtain a total score by adding the numbers they provided in response to all 21 items. Patients diagnosed with social phobia obtained a mean of 52.4, those with other anxiety disorders had a mean of 28.0, and controls without any psychiatric diagnosis had a mean score of 22.3. Factor analysis suggested that STABS points to two factors being involved in social phobia: social comparison, a belief that others are more socially competent and capable, and social ineptness, a belief that one will act awkwardly in social situations or appear anxious in front of others.

Turner and his colleagues note that while social phobia originally was thought to be a condition devel-oping in mid-adolescence, findings suggest that it can be diagnosed as early as 8 years of age. Research sug-gests that 6.8 percent of people in the United States and other Western countries experience a social phobia in any given year. It is more common among women than among men. About 12 percent develop this disorder at some point in their lives.

Socially anxious people seek to avoid potentially embarrassing social situations. If they cannot avoid contact, they often experience physical symptoms such as trembling, profuse perspiration, and nausea. For some, the greatest fear is that others will detect their signs of anxiety, such as blushing, tremors of the hand, and shaking voice. The earliest signs of social phobia often occur in late childhood or early adolescence, with fear of public speaking and eating in public being com-mon symptoms.

Irwin and Barbara Sarason note that phobias about interpersonal relationships often include fear of criticism and of making a mistake. Those who suffer social phobia may attempt to compensate by involv-ing themselves in school and work, never quite sure of their abilities or talents. When successful, they may be dismissive: “I was just lucky—being in the right place at the right time.” They may even feel like imposters, fearing that one day they will be discovered.

Among the self-help guidelines that therapists have provided for dealing with social phobia are the following:

1. In dealing with the symptoms of anxiety, respond with approach rather than avoidance.

2. Greet people with eye contact.

3. Create a list of possible topics of conversation and listen carefully to others.

4. Initiate conversation by asking questions. This strategy demonstrates that you want to speak but at the time focuses attention on the other person.

5. Speak clearly and without mumbling. 6. Be willing to tolerate some silences. 7. Wait for cues from others in deciding where to sit,

when to pick up a drink, and what to talk about. 8. Learn to tolerate criticism and be willing to intro-

duce a controversial topic at an appropriate point.

Comer, R. J. (2010). Abnormal psychology (7th ed). New York: Worth.

Hartman, L. M. (1984). Cognitive components of anxi-ety. Journal of Clinical Psychology, 40, 137–139.

Sarason, I., & Sarason, B. (2005). Abnormal behavior: The problem of maladaptive behavior (11th ed.). Upper Saddle River, NJ: Prentice Hall.

Turner, S. M., et al. (2003). The social thoughts and beliefs scale: A new inventory for assessing cognitions in social phobia. Psychological Assessment, 15, 384–391.

Obsessive-Compulsive Disorder

Feature Film: As Good As It Gets and OCD

As noted earlier, feature films can provide wonder-ful case studies in all of the psychological disorders covered in the text. As Good As It Gets, starring Jack Nicholson, was also mentioned. Following are some specifics about the film in relation to OCD. The film is about Melvin Udall, who displays numerous obsessions and compulsions. Perhaps the best single scene to show in class begins 3:34 minutes into the film and runs just 97 seconds. Udall locks and unlocks his apartment door exactly five times, turns lights on and off five times. Then, using multiple bars of soap stacked high in his medicine cabinet, he demonstrates his obsession with cleanliness, washing his hands with scalding water. The rest of the story finds him eating every day at the same table in the same restaurant. He insists on the same waitress, always orders the same meal, and brings his own paper-wrapped plastic flatware to avoid contami-nation. He wipes off door handles before opening doors and carefully avoids stepping on sidewalk cracks in his visits to his therapist’s office. If anything disrupts his routine, he becomes both angry and anxious.

Classroom Exercise: Obsessive-Compulsive Disorder

Handout 10, the Obsessive-Compulsive Inventory, was developed by Edna Foa and her colleagues. Total score is obtained by adding the numbers circled and can range from 0 to 72. In one study, patients with OCD obtained a mean score of 28.01; a sample of 477 psy-chology students at the University of Delaware scored


a mean of 18.82. The scale has six components that introduce common symptoms of OCD, including wash-ing (5, 11, 17), obsessing (6, 12, 18), hoarding (1, 7, 13), ordering (3, 9, 15), checking (2, 8, 14), and mental neutralizing (4, 10, 16).

Obsessive-compulsive disorder traps people in seemingly endless cycles of repetitive thoughts (obses-sions) and in feelings that they must repeat certain actions over and over (compulsions). Approximately 20 percent of those with OCD have only obsessions or only compulsions; all others experience both. Although Foa’s inventory does not provide separate scores for obsessive thoughts and compulsive behaviors, Richard Halgin and Susan Krauss Whitbourne provide good examples of obsessions and their closely related com-pulsions.

Obsession: A young woman is continuously ter-rified by the thought that cars might careen onto the sidewalk and run over her. Compulsion: She always walks as far from the street pavement as possible and wears red clothes so that she will be immediately visible to an out-of-control car.

Obsession: A mother is tormented by the concern that she might inadvertently contaminate food as she cooks dinner for her family. Compulsion: Every day she sterilizes all cooking utensils in boil-ing water, scours every pot and pan before placing food in it, and wears rubber gloves while handling food.

Obsession: A woman cannot rid herself of the thought that she might accidentally leave her gas stove turned on, causing her house to explode. Compulsion: Every day she feels the irresistible urge to check the stove exactly 10 times before leaving for work.

Obsession: A college student has the urge to shout obscenities while sitting through lectures in classes. Compulsion: Carefully monitoring his watch, he bites his tongue every 60 seconds in order to ward off the inclination to shout.

Obsession: A young boy worries incessantly that something terrible might happen to his mother while sleeping at night. Compulsion: On his way up to bed each night, he climbs the stairs according to a fixed sequence of three steps up, followed by two steps down in order to ward off danger.

An important reason that obsessions generate so much anxiety and have so much power over people is that their victims do not seem to “know” anything with certainty. Their own senses are unconvincing. For example, they may see that their hands look clean but wash anyway. In fact, they may have to repeat the

action 10, 20, or more times. Their doubt may lead them to believe that they are taking unbearable risks if they don’t perform their rituals. In other areas of their lives, sufferers of OCD may use the normal process of reasoning. Victims may even recognize that their obses-sion is “crazy” and receive no pleasure in what they are doing. Still, they cannot escape the hold the disorder has over them.

Until the 1980s, OCD was considered relatively rare. Now, some researchers estimate that about 4 mil-lion Americans have OCD at some time in their life. This makes OCD more common than panic disorder or even schizophrenia. Moreover, the disorder affects adults, teenagers, and even small children. It occurs across all social and economic levels. Generally, it appears before the age of 25. In fact, less than 15 per-cent of people develop the disorder after age 35. If it occurs early in life, it seems to be linked to a stressful event and affect boys more often than girls; if it occurs in the teen years, it affects male and female teens equal-ly and, in 80 percent of all cases, it involves washing rituals linked to contamination fears. If it appears first in adulthood, the incidence is slightly higher in women than in men.

OCD does tend to run in families, sometimes in two, three, or even four consecutive generations. About 15 to 20 percent of those with OCD come from families in which another immediate family member has the same problem. Although it was once thought that this might be the result of learning, researchers have found that when OCD occurs in the next generation, it often takes a different form. For example, a parent may be a “checker,” while the son or daughter is a compulsive washer. Many researchers now believe that there is a biological basis for OCD. What is transmitted is the predisposition to develop OCD symptoms under certain conditions, but not a specific obsession or compulsion.

Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, Hajcak, G., et al. (2002). The obsessive-compul-sive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496.

Gibb, G., Bailey, J., Best, R., & Lambirth, T. (1983). The measurement of the obsessive compulsive personal-ity. Educational and Psychological Measurement, 43, 1233–1237.

Halgin, R., & Whitbourne, S. (2008). Abnormal psychol-ogy: Clinical perspectives on psychological disorders (5th ed.) Boston: McGraw-Hill.

Lecture/Discussion Topic: Obsessive Thoughts

Typically, we deal with unwanted thoughts by trying to suppress them. Research by Daniel Wegner and his colleagues indicates that this strategy may backfire. The more we attempt to suppress obsessive ideas, the more likely we are to become preoccupied with them.


The researchers instructed college students not to think about white bears and then asked them to dic-tate their ongoing thoughts into a tape recorder. Each time a white bear came to mind they were to ring a bell. Results indicated that the students rang the bell or mentioned the bear more than once a minute dur-ing a 5-minute session. Not thinking about white bears proved very difficult. It seems that actively attempting to suppress a thought ironically makes us think of it more.

Wegner and his colleagues suggest a way to rid ourselves of obsessive thoughts. In a second experiment they told students to think about a red Volkswagen every time they thought of a white bear. The strategy worked. Using a single distracting thought helped students to avoid thinking of the dreaded white bear. Although more work needs to be done, the researchers believe the technique may be useful not only for elimi-nating obsessions but also in the treatment of addic-tions, such as smoking.

For students who want more information on obsessive-compulsive disorder, the International OCD Foundation offers advice, information, newsletters, and referrals to treatment centers. It even offers support groups to OCD sufferers and their families in all 50 states. Write International OCD Foundation, P.O. Box 961029, Boston, MA 02196, call 617-973-5801, or go to the website at www.ocfoundation.org.

Neath, J. (1987, December). Suppress now, obsess later. Psychology Today, 10.

Post-Traumatic Stress Disorder

Classroom Exercise: The Posttraumatic Cognitions Inventory (PTCI)

The Posttraumatic Cognitions Inventory (PTCI) designed by Edna B. Foa and her colleagues (Handout 11) may help students understand why some victims of traumatic experiences develop post-traumatic stress disorder (PTSD) while others do not. Completing and scoring the PTCI may also foster students’ appreciation for the cognitive perspective in explaining psychologi-cal disorders.

The inventory asks respondents to report their thoughts after experiencing traumatic stress—that is, experiencing or witnessing severely threatening, uncon-trollable events with a sense of fear, helplessness, or horror. If students report never having had such an experience, ask them to respond to the items in terms of their most upsetting life experience. The scoring key follows the inventory and is part of the handout.

Many theorists have argued that traumatic events can produce changes in victims’ thoughts and beliefs. Those changes account for the development of PTSD. Specifically, Foa and her colleagues proposed two basic dysfunctional cognitions that mediate the development

of PTSD: the world is completely dangerous and one’s self is totally incompetent. The researchers further sug-gested that there may be two distinct ways by which people acquire these dysfunctional cognitions. Those who enter the traumatic experience with the idea that the world is extremely safe and that they are extremely competent have difficulty in assimilating the experience and therefore overaccommodate their schemas about self and world. For others, particularly those who have experienced upsetting experiences throughout their lives, the traumatic experience primes existing sche-mas of the world as a dangerous place and oneself as incompetent. In short, the existence of rigid concepts about self and the world (positive or negative) renders people vulnerable to develop PTSD. Those who make finer distinctions about degrees of safety and compe-tence are better able to interpret the trauma as a unique experience that does not have general implications for the nature of the world and the nature of their ability to cope with it.

As the scoring key indicates, factor analyses of the items reveal three separate factors. These include nega-tive cognitions about self, negative cognitions about the world, and self-blame. Mean scores are obtained for each subscale and can range from 1 to 7, with higher scores reflecting greater acceptance of each factor. Items 13, 32, and 34 are experimental and thus are not included in the scoring. Foa and her colleagues report that each scale predicts PTSD severity, depression, and general anxiety in traumatized individuals. In fact, the ability of the PTCI to discriminate between traumatized individuals with and without PTSD was maintained even after controlling for depression and state anxiety, as well as for age, sex, race, and type of assault.

Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314.

Lecture/Discussion Topic: Concentration Camp Survival

Examining the coping skills used by Jews in concen-tration camps provides an intriguing case study that reinforces much of the literature on post-traumatic stress disorder. Research ers have identified seven major strategies that seem to have contributed to their sur-vival. They include the following, as reviewed by Chris Kleinke.

1. Differential focus on the good. Despite the horrible events that surrounded them, some inmates focused their attention on whatever good they could find—for example, seeing a sunset or finding a small car-rot in the field.

2. Survival for some purpose. Inmates continued to look for and find meaning in their existence. For


some, it was simply the determination to tell the world about what had happened.

3. Psychological distancing. Prisoners used a variety of strategies to distance themselves from the expe-riences in the camp. These included intellectualiz-ing (e.g., Bruno Bettelheim assumed the role of an observer who would study the situation and write about it), religious conviction (e.g., for some, reli-gious convictions made the suffering less personal and provided hope for some kind of existence after death), time focus (e.g., it was possible to distance oneself from the magnitude of the horror by liv-ing 1 day, 1 hour, or even 1 minute at a time), and finally, humor (e.g., in the most difficult of times, some prisoners were still able to laugh).

4. Mastery. Although opportunities were sharply lim-ited, there was still the challenge to use one’s mind, to devote oneself to helping others, and to maintain a sense of worthiness and self-esteem.

5. Will to live. Simply the human determination not to give up but to survive can be a powerful source of strength.

6. Hope. It often matters not how realistic the hope is so long as it is held and nurtured.

7. Social support. Some drew on social support from individual friendships and from simply being in groups of people who shared the same life situation.

Dimsdale, J. (1974). The coping behavior of Nazi concentration camp survivors. American Journal of Psychiatry, 131, 792–797.

Kleinke, C. (1998). Coping with life challenges (2nd ed.). Belmont, CA: Wadsworth.

Understanding Anxiety Disorders

Mood Disorders

Major Depressive Disorder

Classroom Exercise: Depression Scales

Handout 12, a short form of the Center for Epidemi-ological Studies—Depression Scale (CES-D), was developed by Jason Cole and his colleagues to be used as a screening tool in the general population. In scor-ing it, students should reverse the numbers placed in response to statements 3 and 6 (i.e., 0 = 3, 1 = 2, 2 = 1, 3 = 0), then add the numbers in front of all 10 items. Scores can range from 0 to 30, with higher scores reflecting greater distress. The authors do not provide specific norms but indicate that “most respon-dents score in the lower range.” The specific scale items introduce four important components of depression: Items 2 and 9 reflect the presence of negative affect; items 3 and 6 suggest the absence of positive affect;

items 7, 8, and 10 indicate interpersonal difficulty; and items 1, 4, and 5 assess “somatic” difficulties.

Handout 13, the Zung Self-Rating Depression Scale, is one of the most widely used measures of depression. In scoring, students should reverse their responses to items 2, 5, 6, 11, 12, 14, 16, 17, 18, and 20 (1 = 4, 2 = 3, 3 = 2, 4 = 1). They should then add all the numbers to obtain a total score, which can range from 20 to 80. Scores from 50 to 59 suggest mild to moderate depression, from 60 to 69 indicate moderate to severe depression, and 70 and above indicate severe depression.

An adapted version of this scale is published each year by Parade Magazine prior to National Depression Screening Day. National Depression Screening Day, created by Harvard psychiatrist Dr. Douglas G. Jacobs in 1991, has since been repeated every year in early October. (A toll-free number, which can be called to learn the closest screening site, is typically advertised by the media in late September.) Each year, the num-ber of sites staffed by mental health professionals has grown. The free screening includes completion of a self-rating depression scale; a 20-minute talk on the causes, symptoms, and treatment of the disorder, during which participants may ask questions; and 5 minutes alone with a mental health professional. Based on the scale scores and the clinician’s probing, participants learn if they need more evaluation. No diagnosis or treatment is provided.

Jacobs maintains that the effort has now saved hundreds of lives. He relates the story of a college student who appeared on the first screening day at McLean Hospital in Belmont, Massachusetts. “The student had been putting plastic bags over his head,” Jacobs recounts, “so his roommate suggested he go to the screening. He arrived and answered some questions: ‘Do you think of killing yourself?’ He said, ‘Yes.’ In 2 minutes, we had detected that he was at risk. In 10 min-utes, he was hospitalized, and treatment was begun. We saved his life.”

Aaron Beck, a leading investigator of depression, suggests that college students may be especially prone to psychological problems because they simul taneously experience all the transitions that are major stresses in adulthood. Entering college, they lose family, friends, and familiar surroundings and are provided no ready-made substitutes. Furthermore, while in high school, they were the most able students; in college, they must compare their own abilities with equally able students.

Research indicates that students who exhibit optimism as they enter college develop more social support and experience a lowered risk of depression. Moreover, students’ frequent misperception of these stresses may be as important a cause of depression as the stresses themselves. While they do not hallucinate


their problems of academic or social adjustment, they often inflate the importance of temporary setbacks and misjudge the severity of rejections. They may overesti-mate academic difficulties on the basis of one mediocre grade. They may grieve over their social isolation, even though they often have at least some caring and sup-portive friends. Their pessimism and dissatisfaction may lead to clinical depression that in turn interferes with actual performance. A vicious cycle is created in which mispercep tions of academic and social difficul-ties result in still poorer grades and greater social isolation.

Beck, A., & Young, J. (1978, September). College blues. Psychology Today, 80–92.

Cole, J. C., Rabin, A. S., Smith, T. L., & Kaufman, A. S. (2004). Development and validation of a Rasch-Derived CES-D Short Form. Psychological Assessment, 16, 360–372.

Ubell, E. (1993, September 26). Help for depression. Parade Magazine, 20.

Ubell, E. (1994, September 18). You can find help for depression. Parade Magazine, 22.

Classroom Exercise: The Automatic Thoughts Questionnaire

Philip Kendall and Steven Hollon designed the Auto-matic Thoughts Questionnaire (ATQ), Handout 14, to measure the frequency of automatic negative thoughts associated with depression and to “identify the covert self-statements reported by depressives as being repre-sentative of the kinds of cognitions that depressed per-sons experience.” Thus the ATQ, which was developed on a sample of undergraduates, provides a measure of depression and highlights some of its most important symptoms. Among the specific facets of depression it measures are personal maladjustment and desire for change (e.g., items 14 and 20), negative expectations (e.g., items 3 and 24), low self-esteem (e.g., items 17 and 18), and helplessness (e.g., items 29 and 30). Total scores range from 30 (little or no depression) to 150 (maximum depression). Mean scores of 79.6 and 48.6 were obtained for depressed and nondepressed samples, respectively.

Kendall, P., & Hollon, S. (1980). Cognitive self state-ments in depression: Development of an Automatic Thoughts Questionnaire. Cognitive Therapy and Research, 4, 383–395.

Classroom Exercise: Depression and Memory

When we are in a bad or sad mood, we are more likely to remember unpleasant events. Jerry Burger suggests a simple classroom replication of D. M. Clark and J. D. Teasdale’s study demonstrating this effect.

Have students take out a blank piece of paper. Tell them that you are going to read a series of individual

words and that after you have read each word they will have a few seconds to think of a past experience they associate with the word. They are to write down the experience in a sentence or two. Proceed to read the following list, which Clark and Teasdale used (shorten for efficiency if you like). Pause between each word, giving students time to respond: train, ice, wood, letter, house, race, shoe, window, sign, meeting, travel, read-ing, road, machine, rain, roam, water, tunnel.

After students have finished, have them indicate whether each recalled experience was pleasant or unpleasant. Finally, have them tally the total number of pleasant and unpleasant experiences they recalled. Have them reflect on their level of depression that day and how it may have affected the degree to which they gen-erated pleasant or unpleasant memories. As noted, when we are depressed, we remember more unpleasant than pleasant events. If you prefer to analyze the relationship between depression and memory more carefully, have students complete the Zung Self-Rating Depression Scale (Handout 13) before this exercise. Have them score both the scale and exercise before turning in the results. Between classes, calculate the correlation between depression scores and pleasantness ratings and report the outcome at the next class session.

Burger, J. M. (2008). Instructor’s manual for Burger’s Personality (7th ed.). Belmont, CA: Wadsworth.

Clark, D. M., & Teasdale, J. D. (1982). Diurnal varia-tions in clinical depression and accessibility of memo-ries of positive and negative experiences. Journal of Abnormal Psychology, 91, 87–95.

Classroom Exercise: Loneliness

You can extend your discussion of depression and sui-cide with Handout 15, the Revised UCLA Loneliness Scale. Scores should be reversed (1 = 4, 2 = 3, 3 = 2, 4 = 1) for items 1, 4, 5, 6, 9, 10, 15, 16, 19, 20. The sum of all 20 items then provides a total score, which can range from 20 to 80. Mean scores for men and women en rolled in undergraduate psychology courses were 37.06 and 36.06, respectively. Correlations rang-ing from .51 to .62 were found between loneliness scores and depression, as measured, for example, by the Beck Depression Inven tory.

Loneliness is a common and distressing problem for many people. In one national survey, 26 percent of Americans reported having felt “very lonely or remote from other people” during the previous few weeks. In a worldwide survey of adults in 18 countries, Italians and Japanese reported the most frequent feelings of loneli-ness and Danes reported the least. While we have a stereotype in our culture of the elderly as being lonely, research indicates adolescents and young adults are actually the most lonely. Married people are less lonely than the unmarried.


The problem of loneliness may be increasing. A relatively recent study found that, on average, Americans have only two close friends to confide in, down from an average of three in 1985. The percentage of people who reported no confidant rose from 10 per-cent to almost 25 percent; an additional 19 percent said they had only a single confidant (often their spouse).

Loneliness has both psychological and physical consequences. Studies at Carnegie Mellon University suggest that being lonely may make one physically ill. Students with few friends had a 16-percent-weaker immune response to a flu shot than did their counter-parts. Another study found that men who had the fewest social interactions every week had the highest levels of an inflammatory marker that seems to play a role in heart disease. Investigators suggest that loneliness may depress immune systems by increasing stress and decreasing the amount of sleep one gets. Other studies have found that social support and affiliation may actu-ally serve to protect people from stress and illness as well as speed recovery from illness or surgery.

While research does not indicate overall sex differ-ences in loneliness, Sharon Brehm and her colleagues report that gender inter acts with marital status in the following ways.

1. Married women report greater loneliness than do married men.

2. Among those never married, men report more lone-liness than do women.

3. Among the separated and divorced, men report greater loneliness than do women.

4. Among those whose spouse has died, men report greater loneliness than do women.

Brehm and her colleagues suggest that these find-ings indicate that men and women may differ in their vulnerability to two types of loneliness: social and emotional isolation. In social isolation, people are dis-satisfied and lonely because they lack a social network of friends and acquaintances. In emotional isolation, they are dissatisfied because they lack a single intense relationship. Research has found that marriage is more likely to reduce a woman’s social network than a man’s. For example, men are more likely to remain employed and seem to establish closer relationships with their relatives after marriage than they had before. Married women may forgo outside employment and also leave their relatives to be with their husbands. As a result, they suffer greater social isolation.

In contrast, women, married or single, are more likely to maintain some intimate ties with their friends. Men tend to have close emotional relationships only with their female partners. Hence, unmarried or roman-tically unattached men are likely to be emotionally isolated despite regular contact with people at work and during leisure activities.

What reasons do people give for being lonely? One survey sorted them into five major categories.

1. Being unattached: Having no spouse or sexual partner, particularly breaking up with a spouse or lover.

2. Alienation: Being misunderstood and feeling differ-ent; not being needed and having no close friends.

3. Being alone: Coming home to an empty house. 4. Forced isolation: Being hospitalized or house-

bound; having no transportation. 5. Dislocation: Being away from home; starting a

new job or school; traveling often.

How do people cope with loneliness? Rubenstein and Shaver have found four major strategies. “Sad passivity” includes sleeping, drinking, overeating, and watching TV. “Social contact” may involve calling a friend or visiting someone. “Active solitude” takes the form of studying, reading, exercising, or going to a movie. “Distrac tions” include spending money and going shopping.

Comer, R. (2010). Abnormal psychology (7th ed.). New York: Worth.

McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social isolation in America: Changes in core discussion networks over two decades. American Sociological Review, 71, 353–375.

Miller, R., Perlman, D., & Brehm, S. (2007). Intimate relationships (4th ed.). New York: McGraw-Hill.

Rubenstein, C. M., & Shaver, P. (1982). In search of intimacy. New York: Delacorte Press.

Bipolar Disorder

Lecture/Discussion Topic: Bipolar Disorder

To give students some idea of the manic state of a bipo-lar disorder, read the following account.

When I start going into a high, I no longer feel like an ordinary housewife. Instead, I feel organized and accom-plished, and I begin to feel I am my most creative self. I can write poetry easily. I can compose melodies without effort. I can paint. My mind feels facile and absorbs everything. I have countless ideas about improving the conditions of mentally retarded children, how a hospital for these children should be run, what they should have around them to keep them happy and calm and unafraid. I see myself as being able to accomplish a great deal for the good of people. I have countless ideas about how the environmental problem could inspire a crusade for the health and betterment of everyone. I feel able to accom-plish a great deal for the good of my family and others. I feel pleasure, a sense of euphoria or elation. I want it to last forever. I don’t seem to need much sleep. I’ve lost weight and feel healthy, and I like myself. I’ve just bought six new dresses, in fact, and they look quite good on me. I feel sexy and men stare at me. Maybe I’ll have


an affair, or perhaps several. I feel capable of speaking and doing good in politics. I would like to help people with problems similar to mine so they won’t feel hope-less. (Fieve, 1975, p. 17)

David Rosenhan, Elaine Walker, and Martin Seligman identify the following symptoms of mania.

1. Mood or emotional symptoms The mood is typi-cally euphoric, expansive, and elevated. In some cases, the dominant mood is irritability, particularly if the person with mania is thwarted. Even when euphoric, people with mania are close to tears and if frustrated burst out crying. This suggests that a strong depressive element coexists with mania.

2. Grandiose cognition People with mania believe they have no limits to their abilities and, what’s worse, do not recognize the painful consequences of trying to carry out their plans. They may have a flight of ideas in which ideas race through their mind faster than can be related or written down. Sometimes, they have delusional thoughts about themselves—for example, that they are messengers of God or are intimate friends with celebrities.

3. Motivational symptoms The hyperactivity of a person with mania has an intrusive, dominating, and domineering quality. In the manic state, some engage in compulsive gambling, reckless driving, or poor financial investment.

4. Physical symptoms With the hyperactivity comes a greatly lessened need for sleep. After a few days, however, exhaustion settles in, and the mania slows down.

Between 0.6 and 1.1 percent of the U.S. population will have bipolar disorder in their lifetime. It affects both sexes equally. Onset is sudden and, typically, no precipitating event is obvious. The first episode is usu-ally manic and occurs between ages 20 and 30. Bipolar illness tends to recur, but, surprisingly, not many epi-sodes occur more than 20 years after the initial onset.

Fieve, R. R. (1975). Mood swing. New York: Morrow.


Understanding Mood Disorders

Lecture/Discussion Topic: The Sadder-but-Wiser Effect

A number of studies have shown that depressed persons may see certain events more accurately than do those who are happy and optimistic. Lauren Alloy and Lyn Abrahamson, among the first to report this finding in 1979, initially labeled it the sadder-but-wiser effect. Today, it is also known as depressive realism.

In testing the learned helplessness theory of depression, Alloy and Abrahamson recruited groups of depressives and nondepressives. Research participants were individually placed behind a special arrangement

of lights and buttons and peri odically were given a choice whether to push one of the buttons. A light was programmed to come on every other time the choice was presented, regardless of the participant’s choice. Afterward, the experimenter asked participants to esti-mate how much control they had over the lights. From helplessness theory, Alloy and Abrahamson pre dicted that depressed subjects would underestimate their con-trol. In fact, however, the depressed participants were very accurate in their estimates, while those who were not depressed made mistakes by drastically exaggerat-ing the degree of control they thought they exercised.

Alloy and Abrahamson replicated this finding in other experiments. Nondepressives consistently overesti mated their control over positive events and underestimated their control over negative events. Other researchers reported similar results. For example, Peter Lewinsohn had participants interact with one other per-son or with a group and then asked them to rate their own social skills. In evaluating themselves, they noted the clarity of their com munication, their friendliness, and their ability to understand others. Observers on the opposite side of a one-way mirror also rated the partici-pants. While nondepressives perceived themselves more positively than did the observers, depressed participants gave themselves ratings that were very close to those of the observers.

What does all of this have to say about helping the depressed to see things more clearly? Alloy reports that one patient, after hearing these results, quit therapy on the basis that there was nothing wrong with him. In reflect ing later on her patient’s decision, the therapist states, “If I had been able to talk to him, I would have pointed out that to be realistic is not necessarily the same as being adaptive.”

Fred Hapgood suggests that depressed persons may feel as they do, not because of low ego defenses or learned helplessness, but because they see themselves as “lost in a society of cockeyed optimists who barge through life with little grasp of the consequences of their actions or words.” A depressing thought? Yes, suggests Hapgood, and possibly one more likely to be correct.

Hapgood, F. (1985, August). The sadder-but-wiser effect. Science, 85, 86–88.

Lecture/Discussion Topic: Cognitive Errors in Depression

Aaron Beck’s work with depressed patients convinced him that depression is primarily a disorder of think-ing rather than of mood. He argued that depression can best be described as a cognitive triad of negative thoughts about oneself, the situation, and the future. The depressed person misinterprets facts in a negative way, focuses on the negative aspects of any situation, and also has pessimistic expectations about the future.


The cognitive errors of depressed people include the following.

1. Overgeneralizing: Drawing global conclusions about worth, ability, or performance on the basis of a single fact.

2. Selective abstraction: Focusing on one insignifi-cant detail while ignoring the more important fea-tures of a situation.

3. Personalization: Incorrectly taking responsibility for bad events in the world.

4. Magnification and minimization: Gross evaluations of a situation in which small, bad events are magni-fied and large, good events are minimized.

5. Arbitrary inference: Drawing conclusions in the absence of sufficient evidence or of any evidence at all.

6. Dichotomous thinking: Seeing everything in one extreme or its opposite (black or white, good or bad).

Beck and others have noted that the thoughts of depressed people differ from those with anxiety dis-orders. Those suffering from anxiety typically focus on uncertainty and worry about the future. In contrast, depressed people focus on negative aspects of the past or reflect a negative outlook on what the future will bring. Whereas anxious people worry about what may happen and whether they will be able to deal with it, depressed people think about how terrible the future will be and how they will be unable to deal with it or improve it.

Sarason, I., & Sarason, B. (2005). Abnormal psychology (11th ed.). Upper Saddle River, NJ: Prentice Hall.

Classroom Exercise: Attributions for an Overdrawn Checking Account

Depressed people are more likely to explain bad events in terms of causes that are stable, global, and internal. More specifically, experiments have shown that either stable or global attributions can produce depression, but internal attributions seem to produce depression only when they are combined with stable and global components. Given the present popularity of the social-cognitive perspective, you may want to offer a specific illustration of the attributions most likely to be associ-ated with depression.

Ask students to imagine that they have just been notified by their bank that their checking account is overdrawn. After reflecting a bit on the possible reasons for the notification, have them write down in a sentence or two what they believe to be the single most impor-tant cause. Then, in thinking about what they have writ-ten, have them answer the following questions.

1. Does the cause you describe reflect more about you or something more about other people or circum-stances (internal or external)?

2. Is the cause something that is permanent or tempo-rary; that is, is the cause likely to be present in the future (stable or unstable)?

3. Is the cause something that influences other areas of your life or only your checking account balance (global or specific)?

Ask for volunteers to share some of their answers and reiterate that attributions for events that are internal, stable, and global are most likely to be associated with depression. Christopher Peterson and Martin Seligman give the following examples of attributions for the over-drawn checking account.


Examples of Causal Explanations for the Event “My Checking Account Is Overdrawn”

Explanation

Style Internal External

Stable Global “I’m incapable of doing anything right.” “All institutions chronically make mistakes.”

Specific “I always have trouble figuring my balance.” “This bank has always used antiquated techniques.”Unstable Global “I’ve had the flu for a week, and I’ve let everything “Holiday shopping demands that one throw slide.” oneself into it.”

Specific “The one time I didn’t enter a check is the one “I’m surprised—my bank has never made an time my account gets overdrawn.” error before.” Source: Peterson, C., et al. (1984). Causal explanations as a risk factor for depression: Theory and evidence. Psychological Review, 91, 347–374. Copyright © 1984 by the American Psychological Association. Reprinted by permission.

Classroom Exercise: The Body Investment Scale and Self-Mutilation

If you discuss non-suicidal self-injury, you may want to have students complete Handout 16, the Body Investment Scale designed by Israel Orbach and Mario Mikulincer. To obtain a total score, respondents need to reverse the numbers (1 = 5, 2 = 4, 4 = 2, 5 = 1) they place in front of items 2, 3, 5, 7, 9, 11, 13, 17, and 22 and then add up the numbers in front of all 24 state-ments. Scores can range from 24 to 120, with higher scores reflecting a more positive emotional investment in one’s body. Orbach and Mikulincer identified four separate aspects of the bodily self measured by their scale. Items 5, 10, 13, 16, 17, and 21 assess body image feelings and attitudes, items 2, 6, 9, 11, 20, and 23 mea-sure comfort in physical contact with others, items 1, 4, 8, 12, 14, and 19 reflect concern for body care, and items 3, 7, 15, 18, 22, and 24 assess investment in body protection.

Working primarily with adolescents and young adults between 13 and 19, the authors found their scale to be predictive of self-destructive behaviors, including suicidal tendencies. Those with higher scores reported higher self-esteem, as well as having experienced greater maternal care. Moreover, they were more likely to indicate a capacity to enjoy sensual and bodily plea-sures and were less likely to state that their parents had been overprotective.

You may want to extend the discussion of suicide to a consideration of research on self-mutilation. One survey of undergraduate students reported that 9.8 percent of the students indicated that they had purpose-fully cut or burned themselves on at least one occasion in the past. A 2003 study found a high prevalence of self-injury among 428 homeless and runaway youth (ages 16 to 19) with 72 percent of young men and 66 percent of young women reporting a past history of self-mutilation. More generally, research indicates self-injury is more frequent among women than men and typically begins in the teen years. Those who injure themselves are not usually seeking to end their lives but rather seem to use self-injury as a coping effort to relieve emotional pain. Before her tragic death, Princess Diana brought global attention to the disorder when she admitted in a television interview that she had inten-tionally injured her arms and legs: “You have so much pain inside yourself that you try to hurt yourself on the outside because you want help.”

Although some self-mutilators are suicidal, most cut themselves not to die but to cope with the stresses of staying alive. Many were sexually abused as chil-dren and learned to shield themselves from the trauma by dissociating themselves from their emotions. Some claim that cutting snaps them back into consciousness. One victim writes, “It proves I’m alive, I’m human, I

have blood coursing through my veins.” Others who suffer from anorexia or bulimia apparently self-mutilate to gain control over their bodies or to express their feelings about being abused. “They’re wearing a vis-ible symbol of the violation imposed on them,” claims Joseph Shrand, director of the Child and Adolescent Outpatient Clinic at McLean Hospital in Belmont, Massachusetts.

Whatever their childhood experience, almost all self-mutilators, according to experts, grew up in homes with poor communication between parent and child. Cutting often seems to be a replacement for absent lan-guage. Self-mutilators may have lived through a bitter divorce or were verbally demeaned as fat or lazy. As a result, they suffer self-loathing, not merely lower self-esteem. “Cutting is literally like letting out bad blood,” claims Marilee Strong, author of A Bright Red Scream, a book on self-mutilation.

Treatments include antidepressants and even the drug Naltrexone, commonly used to treat heroin addicts. Although traditional psychotherapy is often ineffective, some therapists report success using Marsha Linehan’s dialectical behavior therapy, which teaches skill in tolerating distress and controlling behavior. War, poverty, and unemployment may also be contrib-uting factors.

Some therapeutic efforts have successfully gener-ated alternative coping behaviors for sufferers who oth-erwise would engage in self-injury. For example, clients may be encouraged to journal, to participate in sports or exercise, or to seek social support in curbing the urge to harm themselves. Even safer methods of self-harm that do not lead to permanent injury— for example, the snapping of a rubber band on the wrist—may help calm the urge to engage in self-injury.

Kalb, C. (1998, November 9). An armful of agony. Newsweek, 82.

Orbach, I., & Mikulincer, M. (1998). The body invest-ment scale: Construction and validation of a body experi-ence scale. Psychological Assessment, 10, 415–425.

Tyler, K. A., Whitbeck, L. B., Hoyt, D. R., & Johnson, K. D. (2003). Self-mutilation and homeless youth: The role of family abuse, street experiences, and mental disorders. Journal of Research on Adolescence, 13, 457–474.

Vanderhoff, H., & Lynn, S. J. (2001). The assessment of self-mutilation: Issues and clinical considerations. Journal of Threat Assessment, 1, 91–109

Classroom Exercise: Understanding Suicide

Laura Madson and Corey J. Vas designed Handout 17 to help students understand the risk factors for suicide. You may want to use the exercise before students have read about mood disorders and suicide. Distribute a copy of the handout to each student. As the instructions


indicate, have students read the descriptions of the four fictional persons and, using their best judgment, rank them in terms of their risk for attempting or committing suicide.

After students have completed the rankings, engage the full class in a discussion of the “correct” rankings (initially, you could form small groups). The discussion will make it clear that these rankings are somewhat arbitrary and will highlight the uncertainty that surrounds suicide risk. The same event may have no effect on one person but may dramatically increase the risk for suicide in another person. In addition, the overwhelming majority of people who experience vari-ous risk factors do not become suicidal. As Madson and Vas conclude, “Predicting suicide is far more complex than compiling a laundry list of a person’s risk factors.”

In surveying the literature, Madson and Vas iden-tify a number of risk factors that are correlated with suicidal ideation (thinking about suicide) and behavior. Some, but not all, of these are also identified in the text. For example, suicidal behavior varies by gender, age, and marital status. Easy accessibility to firearms, mood disorders, substance abuse, and feelings of loneliness and hopelessness are also predictive.

Perhaps the strongest single predictor of suicidal behavior, particularly in adolescents, is previous suicide attempts. Among adolescents and young adults (under age 30), interpersonal loss; poor social adjustment; and problems surrounding love relationships, dating, and friends also act as precipitating factors. Rejection by a potential partner or loss of a romantic relationship may be a powerful predisposing event for under-graduates.

In terms of the rankings, Madson and Vas suggest that Person 2 is at greatest risk because she presents two of the strongest predictors of suicide (i.e., a previ-ous suicide attempt and the breakup of a long-term relationship). Person 4 may be second in terms of risk because he presents other leading predictors (i.e., he has a substance abuse problem, ready access to firearms, and recently began giving away his possessions). The last two persons present both risk factors (i.e., a young woman who is depressed and ostracized by her fam-ily because she is lesbian, and a father who recently lost his job), but they also show protective factors that decrease risk (i.e., she is currently in treatment for her depression, and he has his family to provide social sup-port). The article authors rank persons 3 and 1 in posi-tions 3 and 4, respectively.

Finally, the brevity of the descriptions represents a challenge. Clinicians who do careful evaluations of

clients have much greater detail about the person’s current mental state and his or her past behavior. You might ask students what additional information they would want in order to make more informed judgments. For example, the person at most risk has “taken a few pills” in her past, so therapists would certainly want more information including the type of medication and quantity. If you like, you can expand the fictional accounts as well as vary the risk factors across cases. Madson and Vas note that students find the exercise valuable and those who participate do perform better on exam questions testing knowledge of the suicide literature, particularly of risk factors. They also observe that, because suicide is an unsettling topic, you should be ready to provide support in helping students process any negative emotions. At a minimum, they suggest being ready to provide referral to your institution’s counseling center.

Madson, L., & Vas, C. J. (2003). Learning risk fac-tors for suicide: A scenario-based activity. Teaching of Psychology, 30, 123–126.

Classroom Exercise: The Expanded Revised Facts on Suicide Quiz

Handout 18, the Expanded Revised Facts on Suicide (ERFOS) quiz, designed by John McIntosh and Richard Hubbard, is a useful tool for introducing classroom discussion of research on suicide. The information com-municated in the answers to the questions goes well beyond that presented in the text, so the quiz is useful, even if students have already completed the text read-ing assignment. The quiz contains 25 true–false and 25 multiple-choice items. In addition to basic demographic questions about suicide (e.g., age, sex, race/ethnicity), the quiz touches on a number of clinically relevant issues. For those who used an earlier version of the instrument, this expanded revised version includes new items selected to represent emerging issues in suicidol-ogy, including questions on suicide in later life. The correct answers are provided on the next page; beside each is the percentage of 373 undergraduates in general or abnormal psychology classes who correctly answered that question. (Note: In a personal communication, John McIntosh states, “The only question that still remains tenuous is #37 related to suicide rates and specific race/ethnicity. Although at the time we presented and col-lected data for ERFOS rates were highest for Native Americans (slightly higher than for Whites), more recent data has been the opposite again.”


1. F (40.9%) 2. T (45.5%) 3. T (27.3%) 4. F (70.5%) 5. F (95.5%) 6. F (77.3%) 7. T (52.3%) 8. F (50.0%) 9. T (18.2%) 10. F (84.1%)

11. F (59.1%) 12. T (31.8%) 13. F (25.0%) 14. T (54.5%) 15. F (70.5%) 16. F (18.2%) 17. T (61.4%) 18. T (36.4%) 19. F (11.4%) 20. F (29.5%)

21. T (88.6%) 22. T (27.3%) 23. T (40.9%) 24. T (29.5%) 25. F (38.6%) 26. a (38.6%) 27. c (6.8%) 28. b (47.7%) 29. a (18.2%) 30. b (70.5%)

31. a (84.1%) 32. b (25.0%) 33. c (6.8%) 34. a (50.0%) 35. c (56.8%) 36. a (47.7%) 37. c (11.4%) 38. c (81.8%) 39. b (18.2%) 40. b (56.8%)

41. a (68.2%) 42. b (68.2%) 43. c (20.5%) 44. c (54.5%) 45. b (36.4%) 46. b (31.8%) 47. a (72.7%) 48. c (56.8%) 49. a (63.6%) 50. b (27.3%)


The mean score for all students was 24.1, and no sex differences were found.

Earlier, Richard Hubbard and John McIntosh had noted that students’ increasing interest in the topic of suicide may in part be due to its personal relevance. Studies suggest that perhaps 40 to 50 percent of stu-dents have suicidal thoughts at one time or another and that as many as 15 percent may have actually attempted suicide.

Depending on time, you may want to present Edwin Schneidman’s 10 common characteristics of suicidal people. Schneidman presents the following in the belief that knowledge of these characteristics may help the general public and mental health professionals reduce suicide rates.

1. Unendurable psychological pain. Suicide is not an act of hostility or revenge but a way of switching off unendurable and inescapable pain. If you reduce their level of suffering, even just a little, suicidal people will choose to live.

2. Frustrated psychological needs. Needs for secu-rity, achievement, trust, and friendship are among the important ones not being met. Address these psychological needs and the suicide will not occur. Although there are pointless deaths, there is never a “needless” suicide.

3. The search for a solution. Suicide is never done without purpose. It is a way out of a problem or cri-sis and seems to be the only answer to the question: “How do I get out of this?”

4. An attempt to end consciousness. Suicide is both a movement away from pain and a movement to end consciousness. The goal is to stop awareness of a painful existence.

5. Helplessness and hopelessness. Underneath all the shame, guilt, and loss of effectiveness is a sense of powerlessness. There is the feeling that no one can help and nothing can be done except to commit suicide.

6. Constriction of options. Instead of looking for a variety of answers, suicidal people see only two alternatives: a total solution or a total cessation. All other options have been driven out by pain. The goal of the rescuer should be to broaden the sui-cidal person’s perspective.

7. Ambivalence. Some ambivalence is normal, but for the suicidal person ambivalence is only between life and death. In the typical case, a person cuts his or her own throat and calls for help simultaneously. The rescuer can use this ambivalence to shift the inner debate to the side of life.

8. Communication of intent. About 80 percent of suicidal people give family and friends clear clues about their intention to kill themselves.

9. Departure. Quitting a job, running away from home, leaving a spouse are all departures, but sui-cide is the ultimate escape. It is a plan for a radical, permanent change of scene.

10. Lifelong coping patterns. To spot potential suicides, one must look to earlier episodes of disturbance, to the person’s style of enduring pain, and to a general tendency toward “either/or” thinking. Often, there has been a style of problem solving that might be characterized as “cut and run.”

Hubbard, R. W., & McIntosh, J. L. (2003, April 25). The Expanded Revised Facts on Suicide Quiz. Paper presen-tation at the annual meeting of the American Association of Suicidology, Santa Fe, NM.

Hubbard, R., & McIntosh, J. (1992). Integrating suicidol-ogy into abnormal psychology classes: The Revised Facts on Suicide Quiz. Teaching of Psychology, 19, 163–166.

McIntosh, J. L., & Hubbard, R. W. (2004, April 16). A Facts on Suicide Quiz: Reliability and Validity. Paper presentation at the annual meeting of the American Association of Suicidology, Santa Fe, NM.

Schneidman, E. (1987, March). At the point of no return. Psychology Today, 54–58.

Lecture/Discussion Topic: Commitment to the Common Good

Martin Seligman argues that the present epidemic of depression stems in part from a rise in individualism and a decline in commitment to religion and family, and, more generally, to a decline in commitment to close-knit relationships and the common good. While Seligman believes that depression follows from a pes-simistic way of thinking about failure, and that learning to think more optimistically provides one strategy for short-circuiting depression, he does not believe that learned optimism alone will stop the tide of depression

on a societal basis. It has to be coupled with a renewed commitment to the common good. Seligman observes, “Optimism is a tool to help the individual achieve the goals he has set for himself. It is in the choice of the goals themselves that meaning—or emptiness—resides. When learned optimism is coupled with a renewed commitment to the common good, our epidemic of depression and meaninglessness may end.”

Seligman suggests that we begin thinking of this renewed commitment to the common good as a kind of moral jogging in which a little daily self-denial is exchanged for long-term self-enhancement. In our own self-interest, we must begin to reduce our investment in ourselves and heighten our investment in the common good. Some of his specific suggestions follow:

— Give 5 percent of last year’s income away. Do it personally, not through a charity. Advertise among potential recipients in a charitable field of interest that you are giving, say, $2000 away. Interview applicants, give out the money, and fol-low its use to a successful conclusion.

— Give up eating out once a week, shopping for new shoes, watching a rented movie on Tuesday night, and spend the time promoting the well-being of others. Help in a soup kitchen, visit AIDS patients, clean the public park, raise funds for your alma mater.

— Visit areas where you will encounter the home-less. Talk to beggars and judge as well as you can whether they will use any money you give them for nondestructive purposes. Spend three hours a week doing this.

— When you read of particularly virtuous or evil acts, write letters. Compose fan letters to people who could use your praise, “mend-your-ways” letters to people and organizations you dislike. Follow up with letters to elected officials who can act directly. Again, spend three hours weekly in this activity.

— Teach your children to give things away. Suggest they set aside one-fourth of their allowance to give to a needy person or project. Further suggest that they do this personally.

Some items on the list are likely to generate a live-ly discussion. Ask students to consider alternatives that might produce similar results without putting the person “in the hole” financially.

You might also ask your class to reflect on the psychological benefits of bipartisan efforts to promote the common good through volunteer service. And what might be the psychological payoff for those who par-ticipate in community-sponsored “random acts of kind-ness” days or weeks?

Seligman, M. (1990). Learned optimism. New York: Knopf.

Schizophrenia

Symptoms of Schizophrenia

PsychSim 5: Losing Touch With Reality

This activity explains the symptoms of schizophrenia and the brain changes that accompany schizophrenia. Students learn about the types of schizophrenia and the main symptoms, view video clips of individuals with schizophrenia, and are asked to identify the symptoms displayed by each individual.

Student Project: The Eden Express and Schizophrenia

Michael Gorman reports a highly successful student project in which students were asked to read Mark Vonnegut’s The Eden Express and relate it to the psy-chological literature on schizophrenia. The book is an autobiographical account of the author’s schizophrenic breakdown and eventual recovery. Vonnegut describes his thoughts and feel ings while hallucinating, his attempts to commit suicide, and his struggle to recover. He attributes his cure primarily to the use of Thorazine, but certainly other factors contributed to his recovery. The book is also relevant to a discussion of therapy.

While Gorman had students write papers discussing how different theoretical perspectives would account for the cause and cure of Vonnegut’s schizophrenia, you might simply assign the book as outside reading; this in itself will provide students with new insight into the nature of schizophrenia.

Gorman, M. (1984). Using The Eden Express to teach introductory psychology. Teaching of Psychology, 11(1), 39–40.

Classroom Exercise: Magical Ideation Scale

Handout 19 is Mark Eckblad and Loren Chapman’s 30-item true–false scale to assess “magical thinking.” The scale is based on the idea that schizophrenia-prone people often show a belief in magical influences. Most of the items inquire about respondents’ interpretations of their own experiences rather than their belief in the theoretical possibility of magical forms of causation. Of more than 1500 college students who completed the scale, men and women had mean scores of 8.56 and 9.69, respectively. The scoring key follows.

1. T 11. T 21. T 2. T 12. F 22. F 3. T 13. F 23. F 4. T 14. T 24. T 5. T 15. T 25. T 6. T 16. F 26. T 7. F 17. T 27. T 8. T 18. F 28. T 9. T 19. T 29. T 10. T 20. T 30. T


The scale is part of a larger project aimed at developing “measures of deviant functioning to iden-tify young adults who may be psychosis prone.” Participants who scored very high on the Magical Ideation Scale were inter viewed extensively. Compared with a control group, they reported “more schizotypical experiences, more affective symptoms, and more dif-ficulties in concentration.”

Eckblad, M., & Chapman, L. (1983). Magical ideation as an indicator of schizotypy. Journal of Consulting and Clinical Psychology, 51, 215–225.

Lecture/Discussion Topic: Infantile Autism

You can extend your discussion of schizophrenia to include a consideration of infantile autism (if you did not discuss autism as part of your coverage of devel-opment). The autistic condition appears similar to schizophrenia, in that social withdrawal is a prominent characteristic of both. There are, how ever, important differences. For example, autism is usually diagnosed at an early age, sometimes within the first 6 months after birth, and always by age 3. The usual age for diagnosis of schizophrenia is between 15 and 30 years. Although the incidence of schizophrenia in men and women is about equal, autism occurs mostly in men. Finally, schizophrenia tends to run in families, whereas autism does not.

James Kalat identifies nine characteristic behaviors of the child with autism.

1. Social isolation. The child ignores others, even par-ents, and retreats into a world of his (or her) own.

2. Stereotyped behaviors. The child rocks back and forth, bites his hands, stares at some object, engag-es in repetitive behaviors.

3. Resistance to any change in routine. 4. Abnormal responses to sensory stimuli. Sometimes,

the child ignores visual and auditory stimuli; at other times, he shows a “startle reaction” to very mild stimuli.

5. Insensitivity to pain. The child is remarkably insen-sitive to cuts, burns, and other sources of pain.

6. Inappropriate emotional expression. Sometimes the child may have sudden bouts of fear without obvi-ous reason. In other cases, he may show absolute fearlessness and unprovoked laughter.

7. Disturbances of movement. These vary from hyper-activity to prolonged inactivity.

8. Poor development of speech. Some never develop any spoken language, whereas others begin to develop it and then lose it.

9. Specific, limited intellectual problems. Many autis-tic children do well on some intellectual tasks but very poorly on others. It is nearly impossible to

estimate their general intelligence because they fail to follow the directions of a standard IQ test.

Prognosis for the autistic child is not good. Many drugs have been tried but none has proved to be reli-ably helpful. Therapy involving operant conditioning techniques has occasionally been useful. More recently, some encouraging results have been reported for large doses of vitamins and minerals, including vitamin B and magnesium.

Some theorists have suggested that parental lack of emotional warmth is the cause of autism, but others reject the bad-parent theory. They point to the fact that in most cases, siblings are completely normal. It also seems impossible to alleviate autism by merely provid-ing a great deal of emotional warmth and love.

One puzzling characteristic of some children with autism is that they tend to huddle around radiators and other heat sources, as if they felt cold. Even more surprising, some children with autism behave almost normally when they have a fever, showing better atten-tion to their surroundings and improved communication with other people.

James Kalat and others have speculated on the pos-sible biological basis of autism. Insensitivity to pain, which characterizes the child with autism, can also be produced by morphine or other opiate drugs. The brain uses some peptide synaptic transmitters, called endor-phins and enkephalins, with effects similar to those of morphine. If for some unknown reason the brain some-times produced huge amounts of enkephalins and at other times small amounts, the behavioral effect would resemble that of a child who occasionally took mor-phine, and would be very much like that of a child with autism.

Eric Courchesne and Rachel Yeung-Courchesne have linked autism to underdevelopment of the cerebel-lum. They have used an advanced imaging technique to show precisely where autism-linked damage may occur. The location of the damage suggests that it occurs dur-ing the fetal stage or during the first two years of life and may be caused by genetic abnormality or exposure to a virus or harmful chemicals.

Elias, M. (1988, May 26). Autism may be caused by brain damage. USA Today, p. 10.

Kalat, J. (2009). Biological psychology (10th ed.). Pacific Grove, CA: Wadsworth.

Courchesne, E., et al. (1988). Hypoplasia of cerebel-lar vermal lobules VI and VII in autism. New England Journal of Medicine, 318, 1349–1354.

Understanding Schizophrenia


Other Disorders

Lecture/Discussion Topic: Factitious Disorder

People with factitious disorder purposefully produce or fake physical symptoms in order to assume a patient’s role. In some cases, they may take extreme measures to create the appearance of illness. For example, they may inject drugs to cause bleeding. In contrast, high fevers are relatively easy to produce. Those with fac-titious disorder are often very knowledgeable about their ailments, including possible treatments. If chal-lenged about the reality of their illness, they are likely to change doctors. The disorder usually begins in early adulthood and seems to be more common among women than men. However, men tend to show more severe forms of the disorder.

Factitious disorder seems to be more common among those who received extensive medical treatment for a true physical disorder in childhood; experienced abuse in childhood; carry a grudge against the medical profession; have worked as a nurse, laboratory techni-cian, or medical aide; or have an underlying personality problem such as extreme dependence. Typically, they are socially isolated, enjoying little social support or family life. The extreme and long-term form of facti-tious disorder is called Munchausen syndrome.

In Munchausen syndrome by proxy, parents fake or actually produce physical illnesses in their children that may lead to painful diagnostic tests, medication, and surgery. Typically, the parent (most often the mother) is emotionally needy and craves attention and praise for her devoted care of her sick child. This disorder, first identified in 1977, is often viewed as a crime by law enforcement authorities. The caregiver may have administered drugs, contaminated a feeding tube, or may even have attempted to smother the child. Ronald Comer makes the important observation that parents who resort to such actions are obviously experiencing serious psychological disturbance and in need of thera-peutic intervention.

The child’s illnesses may take almost any form but the more common symptoms are bleeding, seizures, comas, diarrhea, fevers, and infections. Between 6 and 30 percent of victims die and 8 percent are permanently disfigured or physically impaired. The disorder is dif-ficult to diagnose because the parent seems so devoted and caring. Yet when child and parent are separated, the physical problems disappear.

Comer, R. (2010). Abnormal psychology (7th ed.). New York: Worth.

Lecture/Discussion Topic: Sensory Processing Disorder

The Sensation and Perception unit in these resources describes sensory processing disorder (SPD), a disorder involving difficulties in sensory processing (see p. 308).

SPD is associated with a wide range of behavioral, lan-guage, neurological, and psychiatric symptoms and is thought to be related to autism spectrum disorder and other disorders in which sensory processing is disrupted (e.g., disorders involving vestibular, motor, or periph-eral or central nervous system problems). If you did not discuss it earlier, you may want to do so now.

Dissociative Disorders

Classroom Exercise: The Curious Experiences Inventory

Dissociation is often defined as an incapacity to inte-grate one’s thoughts, feelings, or experiences into one’s present consciousness. Dissociative symptoms have been implicated in such diverse conditions as amnesia, fugue states, dissociative identity disorder, and even post-traumatic stress disorder. Handout 20 represents the shortened version of Lewis R. Goldberg’s The Curious Experiences Survey, which measures self-reported dissociative experiences. Total score is simply the sum of the numbers placed before the 17 items. Thus, scores can range from 17 to 85, with higher scores reflecting more experience with dissociation.

An analysis of the full-length 31-item scale revealed the presence of three factors in dissociation: depersonalization (“Had the experience of feeling that my body did not belong to me”), self-absorption (“Find that I sometimes sit staring off in space, thinking of nothing, and am not aware of the passage of time”), and amnesia (“Found evidence that I had done things that I did not remember doing”).

The frequency of self-reported dissociation was positively correlated with measures of neuroticism (par-ticularly depression) and imagination, and negatively related to conscientiousness (particularly dutifulness), agreeableness, and, to a lesser extent, age. No relation-ships were found with gender, educational level, intel-ligence, vocational skills, or self-reported skills. Behav-ioral acts that were most highly positively correlated with dissociative experiences included the following:

Spent an hour at a time daydreamingStayed away from a social event in order to finish some workHad a nightmareAte until I felt sickDrove faster than normal because I was angryBorrowed moneyReceived public assistance (such as food stamps or welfare)Borrowed something and lost it, broke it, or never returned itStayed up all nightDid something I thought I would never doDiscussed sexual matters with a male friendSmashed a vase or other object in anger or frustration


Goldberg, L. R. (1999). The Curious Experiences Survey, a revised version of the Dissociative Experiences Scale: Factor structure, reliability, and relations to demographic and personality variables. Psychological Assessment, 11, 134–145.

Lecture/Discussion Topic: Psychogenic Versus Organic Amnesia

Dissociative amnesia is a type of dissociative disor-der. Students are likely to be aware that amnesia may be either physically or psychologically based. For example, a blow to the head, alcohol dependency, stroke, or Alz heimer’s disease may impair memory, just as marital, financial, or career stress may do so. Dissociative amnesia is often referred to as psychogenic amnesia and has four characteristics that distinguish it from organic amnesia. First, psychogenic amnesics lose memory for both the distant and recent past. For example, they cannot remember the number of siblings they have. Organic amnesics, on the other hand, lose memory for the recent past but remember the distant past well. Second, psychogenic amnesics lose their per-sonal identity—name, address, occupation—but their store of general knowledge remains intact. For example, they remember the date, the name of the President, the capital of Illinois. Organic amnesics, however, lose both personal and general knowledge. Third, psychogenic amnesics have no anterograde amnesia; that is, they remember well events happening after the amnesia starts. In contrast, organic amnesics experi-ence severe anterograde amnesia, which is often their primary symptom; that is, they recall very little about events after the organic damage. For example, they may not remember the name of the physician treating them for the head injury. Finally, psychogenic amnesia often reverses itself very abruptly, ending within a few hours or days of its onset. Within a day, a person may even recall the traumatic event that set off the memory loss. In the case of organic amnesia, on the other hand, memory only gradually returns for retrograde memo-ries and hardly ever returns for anterograde memories following organic treatment. Memory of the trauma is never revived.


Lecture/Discussion Topic: The Dissociative Disorders Interview Schedule and Dissociative Identity Disorder

Colin Ross and his colleagues developed the Disso-ciative Disorders Interview Schedule to refine and stan-dardize the diagnosis of dissociative identity disorder (formerly known as multiple personality). Presenting some of its key questions in class will provide students with further insight into the nature of the symptoms associated with this disorder. Yes responses to the fol-

lowing would be rated in the direction of a high disso-ciative identity disorder score.

1. Have you ever walked in your sleep? 2. Did you have imaginary playmates as a child? 3. Were you physically abused as a child or

adolescent? 4. Were you sexually abused as a child or adolescent?

(Sexual abuse includes rape or any type of unwant-ed sexual touching or fondling that you may have experienced.)

5. Have you ever noticed that things are missing from your personal possessions or where you live?

6. Have you ever noticed that things appear where you live, but you don’t know where they came from or how they got there (e.g., clothes, jewelry, books, furniture)?

7. Do people ever talk to you as if they know you but you don’t know them, or only know them faintly?

8. Do you ever speak about yourself as “we” or “us”? 9. Do you ever feel that there is another person or

persons inside you? 10. If there is another person inside you, does he or she

ever come out and take control of your body?

The controversy surrounding this disorder led the authors of the DSM-IV-TR to attempt to increase the precision of diagnosis. Perhaps most important, to fit the diagnosis of dissociative identity disorder, the person must have had the experience of amnesia, an inability to remember important personal information. It is hoped that more stringent conditions will reduce the number of false diagnoses.

Ross, C. A., Miller, S. D., Reagor, P., Bjornson, L., Fraser, G. A., & Anderson, G. (1990). Structured inter-view data on 102 cases of multiple personality disorder from four centers. American Journal of Psychiatry, 147, 596–601.

Eating Disorders

Classroom Exercise: Assessing Body ImageHandout 21, Assessing Your Body Image, provides a good introduction to your discussion of how research shows dramatic increases in the number of women who have a poor body image. For a total score, students should simply add up the numbers they place in front of the 12 items. As Bryan Strong and his colleagues indicate, the lowest possible score is 0 and suggests a positive body image. The highest possible score is 36 and indicates an unhealthy body image. A score above 14 suggests a need to develop a healthier body image.

Classroom Exercise: Motivations-to-Eat Scale

Handout 8 (p. 652) in the Motivation and Work unit represents the Motivations-to-Eat Scale designed by


Benita Jackson and her colleagues. If you did not use it to introduce the psychology of eating, you may want to use it now in relation to eating disorders. As noted on page 614, the scale recognizes that psychological moti-vations can play an important role in the initiation of both healthy and disordered eating.

Personality Disorders

Lecture/Discussion Topic: Narcissistic Personality Disorder

Narcissistic personality disorder provides a good exam-ple of a personality disorder. Ask your students whether they agree with the following statements:

1. I think I am a special person. 2. I expect a great deal from other people. 3. I am envious of other people’s good fortune. 4. I will never be satisfied until I get all that I

deserve. 5. I really like to be the center of attention.

All the statements are drawn from Robert Raskin and Calvin Hall’s Narcissistic Personality Inventory and reflect some of the disorder’s primary features. The narcissistic personality has a strong need to be admired, has a grandiose sense of self-importance, and demon-strates a lack of insight into other people’s feelings.

This sense of superiority is accompanied by feel-ings of entitlement. That is, narcissists believe they should receive special privileges and respect—get the best job, obtain admission to the best university—although they have done nothing to earn such favorable treatment. Moreover, the world should be their fan club. When they come to a party, they expect to be welcomed with great fanfare. Many narcissists prefer friends who are weak or unpopular, so they will not compete for attention.

Randy Larsen and David Buss identify the narcis-sistic paradox—narcissists appear to have high self-esteem, but it is actually quite fragile. They appear self- confident but are in desperate and continuing need for others to verify their worth. Ironically, without others, they are nothing; at the same time, they disdain others. In an interview with Gear magazine in October 2000, entertainer Roseanne Barr stated (hopefully tongue-in-cheek): “I hate every human being on earth. I feel everyone is beneath me, and I feel they should all wor-ship me.”

Narcissists have difficulty in their interpersonal relations because of an inability to recognize the needs or desires of others. They talk mostly about themselves. In fact, research finds that they tend to use first-person pronouns in everyday conversation significantly more often than does the average person. Narcissists are also prone to envy. They tend to disparage the success and

accomplishments of others. Appearing snobbish, they may attempt to hide their strong feelings of envy and rage over the success of others. Their fragile sense of self-worth becomes apparent when others are critical of them. They either fly into a rage or experience a period of depression, shame, and self-doubt.

Larsen, R. J., & Buss, D. M. (2008). Personality psy-chology: Domains of knowledge about human nature (3rd ed.). Boston: McGraw-Hill.

Raskin, R., & Hall, C. S. (1979). A narcissistic personal-ity inventory. Psychological Reports, 45, 590.

Sedikes, C., Campbell, W. K., Reeder, G. D., Elliot, A. J., & Gregg, A. P. (2002). Do others bring out the worst in narcissists? The “others exist for me” illusion. In Y. Kashima, M. Foddy, & M. Platow (Eds.), Self and identity (pp. 103–124). Mahwah, NJ: Erlbaum.

Classroom Exercise: Schizotypal Personality Questionnaire

You can extend your discussion of personality disorders with Handout 22, Adrian Raine’s schizotypal personal-ity questionnaire. It will introduce the key characteris-tics of a fascinating personality disorder that is closely tied to the study of schizophrenia. Students score their responses by adding all their yes responses. Total mean score for 220 male and female undergraduates was 9.6.

Three subscales help to describe the essential char-acteristics of this disorder. The cognitive-perceptual factor is assessed by items 2, 4, 5, 9, 10, 12, 16, and 17. The mean score for undergraduates was 3.6. The items suggest that the disorder is often marked by unusual perceptual experiences, magical thinking, and odd beliefs and ideas of reference. The interpersonal factor is measured by items 1, 7, 11, 14, 15, 18, 21, and 22. The mean undergraduate score was also 3.6. Schizo-typal personality is marked by social anxiety, few close friends, and constricted affect. The “disorganized” fac-tor is assessed by items 3, 6, 8, 13, 19, and 20, and the mean score for undergraduates was 2.5. The personal-ity disorder is marked by odd behavior, including odd speech.

Schizoptypal personality disorder falls within the “eccentric” cluster of personality disorders (the other clusters include the “erratic” cluster, which covers antisocial, borderline, histrionic, and narcissistic disor-ders, and the “anxious” cluster, which covers avoidant, dependent, and obsessive-compulsive personality disorders.)

Those suffering schizoptypal personality disorder report unusual perceptions that border on hallucina-tions. They may feel that other people are looking at them or hear murmurs that sound like their names. It is not unusual for them to hold many superstitious beliefs, including an acceptance of ESP and other psychic phe-nomena. They may believe in magic, such as in their own ability to control others with their thoughts.


Schizotypal people are very uncomfortable in social situations, especially those that involve strangers. They feel that they are different from others and simply don’t fit in. Importantly, they become more, rather than less, anxious as they interact. They are suspicious of others and thus unable to invest trust in them.

Schizotypal persons have disorganized thoughts that are expressed in difficulty communicating, vague speech, and odd nonverbal behavior. They often fail to make eye contact in conversation and are viewed as eccentric. They often wear clothes that are unkempt or that clash.

Raine, A., & Benishay, D. (1995). The SPQ-B: A brief screening instrument for schizotypal personality disorder. Journal of Personality Disorders, 9, 346–355.

Classroom Exercise: Antisocial Personality Disorder

Many regard Hervey Cleckley’s The Mask of Sanity to be the classic work on antisocial personality disorder. Recasting Cleckley’s clinical criteria for the disorder in the form of self-referential or opinion statements, Michael Levenson designed Handout 23 to assess this antisocial posture. He attempted to remove the negative connotations of the original criteria so that the items would suggest to antisocial persons that antisocial traits are not necessarily undesirable. A point is scored for each “true” response. If you use the scale, you should note that the items have been employed strictly for research, not for diagnostic purposes, and that you are using the scale to introduce Cleckley’s portrayal of the antisocial personality. When Levenson included the scale in a study of risk taking and personality, he obtained a mean score of 8.33 for residents in a long-term drug treatment facility, a mean of 6.06 for skilled rock climbers, and a mean of 5.15 for police officers/ firefighters who had been commended for bravery in the line of duty. All participants were male.

Cleckley identifies the following characteristics of antisocial personality.

1. Superficial charm and good intelligence. 2. Poise, rationality, absence of neurotic anxiety. 3. Lack of a sense of personal responsibility. 4. Untruthfulness, insincerity, callousness,

manipulativeness. 5. Antisocial behavior without regret or shame. 6. Poor judgment and failure to learn from

experience. 7. Inability to establish lasting, close relationships

with others. 8. Lack of insight into personal motivations.

Cleckley, H. (1976). The mask of sanity (5th ed.). St. Louis: Mosby.

Levenson, M. (1990). Risk taking and personality. Journal of Personality and Social Psychology, 58, 1073–1080.

Rates of Psychological Disorders

Lecture/Discussion Topic: The Commonality of Psychological DisordersThe results of a federally funded study headed by Ronald Kessler of the University of Michigan’s Institute for Social Research and released in early 1994 suggested that nearly half of people ages 15 to 54 have experienced at least one bout with a psychiatric disorder, and about one in three have had such an epi-sode over the last year. Psychological disorder peaks between the ages of 25 and 34. Affluent, well-educated people seem to suffer less anxiety than others, perhaps, Kessler suggests, because “they’re not as scared about their future, and can afford to buy psychological help.” Despite the high lifetime rates of emotional problems, only one out of four people have ever received help. Kessler notes that many mental disorders are mild, and people recover from them without help.

The study found that the most common disorders were these:

1. Major depressive episode, which constitutes at least two weeks of symptoms such as low mood and loss of pleasure. More than 17 percent have suffered an episode in their lives, more than 10 percent in the last year.

2. Alcohol dependence, with more than 14 percent experiencing it in their lifetime, 7.2 percent in the last year.

3. Social phobia, a persistent fear of feeling scruti-nized or embarrassed in social situations, with 13 percent experiencing it, almost 8 percent in the last year.

4. Simple phobia, or a persistent fear of objects such as animals, insects, or blood, or of situations such as closed spaces, heights, or air travel, with more than 11 percent experiencing it in their lifetime, almost 9 percent in the last year.

Kessler and his colleagues have released another report based on a nationally representative face-to-face household survey conducted between February 2001 and April 2003. It extends earlier findings. The researchers used the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview in assessing 9282 English-speaking respondents. Perhaps of greatest interest is that one-quarter of all Americans met the criteria for having a mental illness within the prior year, and fully a quarter of those had a “serious” disorder that significantly disrupted their ability to function day to day. Although comparable studies in 27 other countries are not yet complete, the research-ers conclude that these new numbers suggest that the United States is poised to rank No. 1 globally for


mental illness. Other important findings include the following:

• AbouthalfofAmericanswillmeetthecriteriaforaDSM-IV-TR disorder sometime in their lifetime.

• Byage75,thelifetimeprobabilityofananxietydisorder (including phobias) is 32 percent, of mood disorders (including depression) is 28 percent, of impulse control disorders is 25 percent, of alcohol abuse is 15 percent, and of drug abuse is 9 percent.

• Medianageofonsetismuchearlierforanxiety(11 years) and impulse-control (11 years) disor-ders than for substance abuse (20 years) and mood disorders (30 years). Half of all cases start by 14 years and three-fourths by 24 years.

• Ratesofmentalillnesshaveflattenedinthepast15years after steadily rising from the 1950s.

• 41percentofthosehavingadisorderwentfortreatment in the prior year which is up from 25 per-cent a decade ago. Younger adults are more likely to seek prompt care, so the stigma of mental illness may be waning.

• Becauseschizophrenia,autism,andsomeothersevere disorders were not surveyed, the researchers conclude that the prevalence of psychological dis-orders is even higher than their statistics suggest.

Elias, M. (1994, January 14). Many adults have glitches in mental health. USA Today, p. 4D.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.


HANDOUT 1

Defining Psychological Disorders

Instructions: Read through the case studies that follow. After you read each one, decide whether you think that the individual described is displaying a psychological disorder. Go with your initial “gut” instinct for now.

Andrew has led a turbulent life. As a young child, he skipped school more often than he attended. When he did attend, he was a frequent behavior problem, often getting into fights with other boys. He was finally expelled from school altogether after stabbing another student in his high school class. Since then he has not held a job for any length of time. Soon after his expulsion, he began supplementing his income by breaking into homes and stealing whatever he could get his hands on. However, he appears to feel no guilt about this behavior. Although he has never been in a committed relationship, he has several children, whom he never sees, due partly to the fact that he frequent-ly moves from town to town. Despite these characteristics, Andrew is a colorful and entertaining person and has a certain charm. If asked, he will tell you that he is quite happy with his current life-style.

Has a Psychological Disorder Does Not Have a Psychological Disorder

Barbara was generally a happy child and had many friends in high school. She made very good grades and decided to go on to college and then to law school. After her first year of law school, she began to notice periods of “feeling down.” At first she ignored this, but after a year or so, these episodes began to get worse. When she started paying more attention, she noticed that the episodes usually began about a week before her period and ended a few days after her period began. In addition to feeling depressed during that time, she also was overly sensitive to criticism. Often, her appetite would increase, and she would especially crave sweets. Sometimes she found it difficult to concentrate on her studies during this time, and she often lacked the energy to do much of anything except watch television.


Charles is the third of seven children. He attended school in the suburbs of a large city, where he made average grades. He dated a bit in high school and had several close friends. During vacations, he worked in his father’s garage, learning all he could about automobiles. After high school, Charles took a job as a mechanic in the garage. However, Charles was beginning to feel different from his co-workers. He began to realize that he was attracted to one of his customers, a man with whom he had gone to school. When Charles realized this, he became very confused and felt angry with himself for having such feelings. Although he tried to convince himself that the feelings would go away over time, they did not, and Charles finally admitted to himself that he was a homosexual. Currently, he is in a monogamous relationship with another man but is afraid to admit his sexual orientation to friends or family, for fear of their reaction. He often finds himself preoccupied with trying to find ways to hide his orientation from them.



HANDOUT 1 (continued)

Diane is the only child of two professional parents. She did well in high school and had several close friends. However, her grades suffered when she got to college, and she spent one semester on probation before she gradu-ated. While in college, she met Don, and the two married soon after graduation and had two children of their own. Diane and Don decided that she would stay home until the children were in school, since his job with a prestigious accounting firm would allow him to support the family. Three months ago, however, Don came home from work and announced that he had met another woman and was having an affair and that he had decided to leave Diane. The divorce proceeded quickly, and, while Diane retained custody of the children, she had to move to a smaller apartment. She began looking for work but found that it was difficult to find a job, and eventually took a job she disliked. Diane often finds herself thinking about how quickly her life has changed in the last few months. She becomes very sad and will sometimes lie in bed crying after the children are asleep. She finds her-self eating a lot more than she used to, and sometimes, she has difficulty getting to sleep at night.


Eric was born in a rural town in the Midwest. He made average grades in school and decided after graduation to purchase a farm in the area and raise corn. He very much enjoyed this lifestyle and did quite well. One day, while working in the field, an accident with a combine caused Eric to be rushed to the hospital. While doctors were able to save his life, they were not able to save his legs. Eric is now confined to a wheelchair. It has been a year since the accident and he is in a great deal of pain, which is partially controlled by morphine, which his doctor has prescribed. However, his thinking remains quite rational, and he has been able to do some work helping with the books at his parents’ store. He does not enjoy this work and misses his previous activity. Recently, he con-fided in his doctor that he does not feel that his new life is worth living, and he has decided that he would like to end it all.


Source: Davis, S. M. (2003, January). Utilizing contradictions in students’ implicit definitions of “mental disorder” in an introductory psychology course. Poster presented at the 25th Annual National Institute on the Teaching of Psychology, St. Petersburg, FL, January 2003.


HANDOUT 2

Adult ADHD Self-Report Scale Symptom Checklist

Please answer the questions below, rating yourself on each of the criteria using the following scale. As you answer each question, describe how you have felt and conducted yourself over the past 6 months.

0 = never 1 = rarely 2 = sometimes 3 = often 4 = very often

1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

2. How often do you have difficulty getting things in order when you have to do a task that requires organization?

3. How often do you have problems remembering appointments or obligations?

4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?

6. How often do you feel overly active and compelled to do things, like you were driven by a motor?

Source: Reprinted by permission of the World Health Organization.


HANDOUT 3

The Healthy Adult

Circle the five characteristics that best describe a mature, healthy, and socially competent adult male.

1. ambitious 6. self-confident2. tactful 7. logical3. adventurous 8. gentle4. aware of others’ feelings 9. independent5. need for security 10. expresses tender feelings

Circle the five characteristics that best describe a mature, healthy, and socially competent adult female.


Circle the five characteristics that best describe a mature, healthy, and socially competent adult person.


Source: Broverman, I. K., et al. (1970). Sex role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology, 34, 1–7. Copyright © 1970 by the American Psychological Association. Adapted by permission.


HANDOUT 4

Suppose, without your knowledge, just before you came to class today, someone put a drug into your drink that soon will make you behave as though you were psychotic. This afternoon, a classmate finds you wandering the halls mut-tering nonsense and takes you to the Dean’s office. The Dean notifies your parents of your “illness” and they send you to a psychiatric clinic where you fill out a questionnaire that asks about events in your past that might have caused your “breakdown.” Take some time now, during a short break, to think about it. Can you remember happen-ings in your own life that might explain your “psychopathological” condition? Jot down anything that comes to mind. Don’t sign them but be prepared to hand in your notes when class resumes.

Source: Kimble, G. A. (1996, August). Secondary school psychology: The challenge and the hope (table 2). Paper presented at the 104th Annual Convention of the American Psychological Association, Toronto.


HANDOUT 5

Pretend the following description of Tom W. was written by a clinical psychologist 5 years ago, when Tom was a senior in high school. Please read it carefully before responding to the question below.

Tom W. is of high intelligence, although lacking in true creativity. He has a need for order and clarity, and for neat and tidy systems in which every detail finds its appropriate place. His writing is rather dull and mechanical, occasionally enlivened by somewhat corny puns and flashes of imagination of the sci-fi type. He has a strong drive for competence. He seems to have little feeling and little sympathy for other people and does not enjoy interacting with others. Self-centered, he nonetheless has a deep moral sense.

Today, Tom is a mental patient in a state hospital. Might that outcome have been predicted when Tom was a senior in high school? On what basis?

Source: Bolt, M. (1999). Instructor’s manual to accompany Social Psychology (6th ed., p. 478). Copyright © 1996 by McGraw-Hill. Reproduced by permission of The McGraw-Hill Companies. Adapted from Kahneman, D., & Tversky, A. (1973). On the psychology of predictions. Psychological Review, 80, 237–251. Copyright © 1973 by the American Psychological Association. Reprinted with permission.


HANDOUT 5

Pretend the following description of Tom W. was written by a clinical psychologist 5 years ago, when Tom was a senior in high school. Please read it carefully before responding to the question below.

Tom W. is of high intelligence, although lacking in true creativity. He has a need for order and clarity, and for neat and tidy systems in which every detail finds its appropriate place. His writing is rather dull and mechanical, occasionally enlivened by somewhat corny puns and flashes of imagination of the sci-fi type. He has a strong drive for competence. He seems to have little feeling and little sympathy for other people and does not enjoy interacting with others. Self-centered, he nonetheless has a deep moral sense.

Today, Tom is a graduate student in the School of Education in a state university and hopes to work eventually with handicapped children. Might that outcome have been predicted when Tom was a senior in high school? On what basis?

Source: Bolt, M. (1999). Instructor’s manual to accompany Social Psychology (6th ed., p. 478). Copyright © 1996 by McGraw-Hill. Reproduced by permission of The McGraw-Hill Companies. Adapted from Kahneman, D., & Tversky, A. (1973). On the psychology of predictions. Psychological Review, 80, 237–251. Copyright © 1973 by the American Psychological Association. Reprinted with permission.


HANDOUT 6

Penn State Worry Questionnaire

Using a scale from 1 = “not at all typical of me” to 5 = “very typical of me” respond to each of the following items:

1. If I do not have enough time to do everything, I do not worry about it.

2. My worries overwhelm me.

3. I do not tend to worry about things.

4. Many situations make me worry.

5. I know I should not worry about things, but I just cannot help it.

6. When I am under pressure I worry a lot.

7. I am always worrying about something.

8. I find it easy to dismiss worrisome thoughts.

9. As soon as I finish one task, I start to worry about everything else I have to do.

10. I never worry about anything.

11. When there is nothing more I can do about a concern, I do not worry about it any more.

12. I have been a worrier all my life.

13. I notice that I have been worrying about things.

14. Once I start worrying, I cannot stop.

15. I worry all the time.

16. I worry about projects until they are all done.

Source: Meyer et. al. Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28, 487–495. Copyright 1990. Reprinted by permission of Elsevier.


HANDOUT 7

Taylor Manifest Anxiety Scale

Circle the items that are true of you.

1. I do not tire quickly. 2. I am troubled by attacks of nausea. 3. I believe I am no more nervous than most others. 4. I have very few headaches. 5. I work under a great deal of tension. 6. I cannot keep my mind on one thing. 7. I worry over money and business. 8. I frequently notice my hand shakes when I try to do something. 9. I blush no more often than others. 10. I have diarrhea once a month or more. 11. I worry quite a bit over possible misfortunes. 12. I practically never blush. 13. I am often afraid that I am going to blush. 14. I have nightmares every few nights. 15. My hands and feet are usually warm. 16. I sweat very easily even on cool days. 17. Sometimes when embarrassed, I break out in a sweat. 18. I hardly ever notice my heart pounding and I am seldom short of breath. 19. I feel hungry almost all the time. 20. I am very seldom troubled by constipation. 21. I have a great deal of stomach trouble. 22. I have had periods in which I lost sleep over worry. 23. My sleep is fitful and disturbed. 24. I dream frequently about things that are best kept to myself. 25. I am easily embarrassed. 26. I am more sensitive than most other people. 27. I frequently find myself worrying about something. 28. I wish I could be as happy as others seem to be. 29. I am usually calm and not easily upset. 30. I cry easily. 31. I feel anxiety about something or someone almost all the time. 32. I am happy most of the time. 33. It makes me nervous to have to wait. 34. I have periods of such great restlessness that I cannot sit long in a chair. 35. Sometimes I become so excited that I find it hard to get to sleep. 36. I have sometimes felt that difficulties were piling up so high that I could not overcome them. 37. I must admit that I have at times been worried beyond reason over something that really did not matter. 38. I have very few fears compared to my friends. 39. I have been afraid of things or people that I know could not hurt me. 40. I certainly feel useless at times. 41. I find it hard to keep my mind on a task or job. 42. I am usually self-conscious. 43. I am inclined to take things hard. 44. I am a high-strung person. 45. Life is a trial for me much of the time. 46. At times I think I am no good at all. 47. I am certainly lacking in self-confidence. 48. I sometimes feel that I am about to go to pieces. 49. I shrink from facing a crisis of difficulty. 50. I am entirely self-confident.

Source: Reprinted by permission of Janet T. Spence from Taylor, J. A. (1953). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology, 48, 285–290.


HANDOUT 8

Measuring Fear

Using the key below, rate each item on the intensity of fear you associate with that object or event.

1 2 3 4 5 6 7 no fear very little a little some much great terror fear fear fear fear fear

1. Sharp objects 27. Being with drunks

2. Being a passenger in a car 28. Illness or injury to loved one

3. Dead bodies 29. Being self-conscious

4. Suffocating 30. Driving a car

5. Failing a test 31. Meeting authority

6. Looking foolish 32. Mental illness

7. Being a passenger in an airplane 33. Closed places

8. Worms 34. Boating

9. Arguing with parents 35. Spiders

10. Rats and mice 36. Thunderstorms

11. Life after death 37. Not being a success

12. Hypodermic needles 38. God

13. Being criticized 39. Snakes

14. Meeting someone for the first time 40. Cemeteries

15. Roller coasters 41. Speaking before a group

16. Being alone 42. Seeing a fight

17. Making mistakes 43. Death of a loved one

18. Being misunderstood 44. Dark places

19. Death 45. Strange dogs

20. Being in a fight 46. Deep water

21. Crowded places 47. Being with a member of the opposite sex

22. Blood 48. Stinging insects

23. Heights 49. Untimely or early death

24. Being a leader 50. Losing a job

25. Swimming alone 51. Auto accidents

26. Illness

Source: Geer. The development of a scale to measure fear. Behavior Research and Therapy. Copyright 1965. Reprinted by permission of Elsevier.


HANDOUT 9

Rate the degree to which the thoughts or beliefs below are typical of your thinking when anticipating or participating in a social encounter. Use the following scale:

1 = never characteristic 2 = rarely characteristic 3 = sometimes characteristic 4 = often characteristic 5 = always characteristic

1. When I am in a social situation, I appear clumsy to other people.

2. If I am with a group of people and I have an opinion, I am likely to chicken out and not say what I think.

3. I feel as if other people sound more intelligent than I do.

4. When I am with other people, I am not good at standing up for myself.

5. I am a coward when it comes to interacting with other people.

6. I feel unattractive when I am with other people.

7. I would never be able to make a speech in public.

8. Other people are more comfortable in social situations than I am.

9. Other people are more socially capable than I am.

10. No matter what I do, I will always be uncomfortable in social situations.

11. My mind is very likely to go blank when I am talking in a social situation.

12. I am not good at small talk.

13. Other people are bored when they are around me.

14. When speaking in a group, others will think what I am saying is stupid.

15. If I am around someone I am interested in, I am likely to get panicky or do something to embarrass myself.

16. I do not know how to behave when I am in the company of others.

17. If something went wrong in a social situation, I would not be able to smooth it over.

18. When I am with other people they usually don’t think I am very smart.

19. When other people laugh it feels as if they are laughing at me.

20. People can easily see when I am nervous.

21. If there is a pause during a conversation, I feel as if I have done something wrong.

Source: From Turner and Beidel. (2003). The social thoughts and beliefs scale: A new inventory for assessing cognitions in social phobia. Psychological Assessment, 15, 384 –391 (Scale appears as Appendix, p. 391). Copyright © 2003. Reprinted by permission of the authors.


HANDOUT 10

The following statements refer to experiences that many people have in their everyday lives. Circle the number that best describes HOW MUCH that experience has DISTRESSED or BOTHERED you during the PAST MONTH. The numbers refer to the following verbal labels:

0 1 2 3 4 Not at all A little Moderately A lot Extremely

1. I have saved up so many things that they get in the way. 0 1 2 3 4

2. I check things more often than necessary. 0 1 2 3 4

3. I get upset if objects are not arranged properly. 0 1 2 3 4

4. I feel compelled to count while I am doing things. 0 1 2 3 4

5. I find it difficult to touch an object when I know it has been touched 0 1 2 3 4 by strangers or certain people.

6. I find it difficult to control my own thoughts. 0 1 2 3 4

7. I collect things I don’t need. 0 1 2 3 4

8. I repeatedly check doors, windows, drawers, etc. 0 1 2 3 4

9. I get upset if others change the way I have arranged things. 0 1 2 3 4

10. I feel I have to repeat certain numbers. 0 1 2 3 4

11. I sometimes have to wash or clean myself simply because I feel contaminated. 0 1 2 3 4

12. I am upset by unpleasant thoughts that come into my mind against my will. 0 1 2 3 4

13. I avoid throwing things away because I am afraid I might need them later. 0 1 2 3 4

14. I repeatedly check gas and water taps and light switches after turning them off. 0 1 2 3 4

15. I need things to be arranged in a particular order. 0 1 2 3 4

16. I feel that there are good and bad numbers. 0 1 2 3 4

17. I wash my hands more often and longer than necessary. 0 1 2 3 4

18. I frequently get nasty thoughts and have difficulty getting rid of them. 0 1 2 3 4

Source: Foa, E. F., et al. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. Scale appears in the Appendix, p. 486. Reprinted by permission of the author.


HANDOUT 11

Psychological Disorder

We are interested in the kinds of thoughts you may have had after a traumatic experience. Below are a number of statements that may or may not be representative of your thinking. Please read each statement carefully and tell us how much you AGREE or DISAGREE with each statement. People react to traumatic events in many different ways. There are no right or wrong answers to these statements.

1 = Totally disagree 2 = Disagree very much 3 = Disagree slightly 4 = Neutral 5 = Agree slightly 6 = Agree very much 7 = Totally agree

1. The event happened because of the way I acted.

2. I can’t trust that I will do the right thing.

3. I am a weak person.

4. I will not be able to control my anger and will do something terrible.

5. I can’t deal with even the slightest upset.

6. I used to be a happy person but now I am always miserable.

7. People can’t be trusted.

8. I have to be on guard all the time.

9. I feel dead inside.

10. You can never know who will harm you.

11. I have to be especially careful because you never know what can happen next.

12. I am inadequate.

13. I will not be able to control my emotions, and something terrible will happen.

14. If I think about the event, I will not be able to handle it.

15. The event happened to me because of the sort of person I am.

16. My reactions since the event mean that I am going crazy.

17. I will never be able to feel normal emotions again.

18. The world is a dangerous place.

19. Somebody else would have stopped the event from happening.

20. I have permanently changed for the worse.

21. I feel like an object, not like a person.

22. Somebody else would not have gotten into this situation.

23. I can’t rely on other people.

24. I feel isolated and set apart from others.

25. I have no future.

26. I can’t stop bad things from happening to me.

27. People are not what they seem.

28. My life has been destroyed by the trauma.

29. There is something wrong with me as a person.

30. My reactions since the event show that I am a lousy coper.



31. There is something about me that made the event happen.

32. I will not be able to tolerate my thoughts about the event, and I will fall apart.

33. I feel like I don’t know myself anymore.

34. You never know when something terrible will happen.

35. I can’t rely on myself.

36. Nothing good can happen to me anymore.

Scoring Key for the Posttraumatic Cognitions Inventory (PTCI)

Negative Cognitions Negative Cognitions about Self about the World Self-Blame

2 ______ 7 ______ 1 ______

3 ______ 8 ______ 15 ______

4 ______ 10 ______ 19 ______

5 ______ 11 ______ 22 ______

6 ______ 18 ______ 31 ______

9 ______ 23 ______

12 ______ 27 ______ Sum C ______

14 ______ divided by 5 = ______ (Score)

16 ______ Sum B ______

17 ______ divided by 7 = _______ (Score)

20 ______

21 ______

24 ______

25 ______

26 ______ Total Score

28 ______ Sum A ______

29 ______ Sum B ______

30 ______ Sum C ______

33 ______

35 ______ Sum of A, B, C = _______ (Score)

36 ______

Sum A ______ divided by 21 = ______ (Score)

Note. Items 13, 32, and 34 are experimental and therefore not included in subscales.

Source: Foa, E. B., et al. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314. Copyright © 1999 by the American Psychological Association and the authors. Reprinted by permission.


HANDOUT 12

Depression Scale

Using a scale from: 0 = rarely/none to 3 = most of the time, indicate how often the following were true for you over the past 2 weeks:

1. I was bothered by things that usually don’t bother me.

2. I felt that I could not shake off the blues even with the help from my friends or family.

3. I felt that I was just as good as other people.

4. I had trouble keeping my mind on what I was doing.

5. I felt that everything I did was an effort.

6. I felt hopeful about the future.

7. I felt my life had been a failure.

8. I felt fearful.

9. I felt lonely.

10. People were unfriendly.

Source: Cole, J. C., et al. (2004). Development and validation of a Rasch-Derived CES-D Short Form. Psychological Assessment, 16, 360–372. (Scale items appear in Table 1, p. 363).


HANDOUT 13

Instructions: Read each statement carefully. Use the following scale to indicate how often you have felt that way dur-ing the past two weeks. (If you are on a diet, respond to statements 5 and 7 as though you were not on a diet.)

1 = none or a little of the time 2 = some of the time 3 = good part of the time 4 = most or all of the time

1. I feel down-hearted, blue, and sad.

2. Morning is when I feel the best.

3. I have crying spells or feel like it.

4. I have trouble sleeping through the night.

5. I eat as much as I used to.

6. I enjoy looking at, talking to, and being with attractive women/men.

7. I notice that I am losing weight.

8. I have trouble with constipation.

9. My heart beats faster than usual.

10. I get tired for no reason.

11. My mind is as clear as it used to be.

12. I find it easy to do the things I used to do.

13. I am restless and can’t keep still.

14. I feel hopeful about the future.

15. I am more irritable than usual.

16. I find it easy to make decisions.

17. I feel that I am useful and needed.

18. My life is pretty full.

19. I feel that others would be better off if I were dead.

20. I still enjoy the things I used to do.

Source: Zung, W. K. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63–70. Copyright 1965, American Medical Association.


HANDOUT 14

Automatic Thoughts Questionnaire

Listed below are a variety of thoughts that pop into people’s heads. Please read each thought and indicate how fre-quently, if at all, the thought occurred to you over the last week. Please read each item carefully and fill in the blank with the appropriate number, using the following scale:

1 = not at all 2 = sometimes 3 = moderately often 4 = often 5 = all the time

1. I feel like I’m up against the world.

2. I’m no good.

3. Why can’t I ever succeed?

4. No one understands me.

5. I’ve let people down.

6. I don’t think I can go on.

7. I wish I were a better person.

8. I’m so weak.

9. My life’s not going the way I want it to.

10. I’m so disappointed in myself.

11. Nothing feels good anymore.

12. I can’t stand this anymore.

13. I can’t get started.

14. What’s wrong with me?

15. I wish I were somewhere else.

16. I can’t get things together.

17. I hate myself.

18. I’m worthless.

19. Wish I could just disappear.

20. What’s the matter with me?

21. I’m a loser.

22. My life is a mess.

23. I’m a failure.

24. I’ll never make it.

25. I feel so helpless.

26. Something has to change.

27. There must be something wrong with me.

28. My future is bleak.

29. It’s just not worth it.

30. I can’t finish anything.

Source: Kendall, P., & Hollon, S. (1980). Cognitive self statements in depression: Development of an Automatic Thoughts Questionnaire. Cognitive Therapy and Research, 4, 383–395. Copyright © 1989 Philip C. Kendall. Reprinted by permission.


HANDOUT 15

The Revised UCLA Loneliness Scale

Directions: Indicate how often you feel the way described in each of the following statements. Circle one number for each.

Statement Never Rarely Sometimes Often_________________________________________________________________________________________________________________________________________________________

1. I feel in tune with the people around me 1 2 3 4

2. I lack companionship 1 2 3 4

3. There is no one I can turn to 1 2 3 4

4. I do not feel alone 1 2 3 4

5. I feel part of a group of friends 1 2 3 4

6. I have a lot in common with the people around me 1 2 3 4

7. I am no longer close to anyone 1 2 3 4

8. My interests and ideas are not shared by those around me 1 2 3 4

9. I am an outgoing person 1 2 3 4

10. There are people I feel close to 1 2 3 4

11. I feel left out 1 2 3 4

12. My social relationships are superficial 1 2 3 4

13. No one really knows me well 1 2 3 4

14. I feel isolated from others 1 2 3 4

15. I can find companionship when I want it 1 2 3 4

16. There are people who really understand me 1 2 3 4

17. I am unhappy being so withdrawn 1 2 3 4

18. People are around me but not with me 1 2 3 4

19. There are people I can talk to 1 2 3 4

20. There are people I can turn to 1 2 3 4_________________________________________________________________________________________________________________________________________________________

Source: Russell, D., et al. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480. Copyright © 1980 by the American Psychological Association. Reprinted by permission.


HANDOUT 16

The Body Investment Scale (BIS)

Instructions for Participants: The following is a list of statements about one’s experience, feelings, and attitudes of his/her body. There are no right or wrong answers. We would like to know what your experience, feelings, and atti-tudes of your body are. Please read each statement carefully and evaluate how it relates to you by checking the degree to which you agree or disagree with it. If you do not agree at all: circle (1). If you do not agree: circle (2). If you are undecided: circle (3). If you agree: circle (4). If you strongly agree: circle (5). Try to be as honest as you can. Thank you for your time and cooperation.

1. I believe that caring for my body will improve my well-being. 1 2 3 4 5

2. I don’t like it when people touch me. 1 2 3 4 5

3. It makes me feel good to do something dangerous. 1 2 3 4 5

4. I pay attention to my appearance. 1 2 3 4 5

5. I am frustrated with my physical appearance. 1 2 3 4 5

6. I enjoy physical contact with other people. 1 2 3 4 5

7. I am not afraid to engage in dangerous activities. 1 2 3 4 5

8. I like to pamper my body. 1 2 3 4 5

9. I tend to keep a distance from the person with whom I am talking. 1 2 3 4 5

10. I am satisfied with my appearance. 1 2 3 4 5

11. I feel uncomfortable when people get too close to me physically. 1 2 3 4 5

12. I enjoy taking a bath. 1 2 3 4 5

13. I hate my body. 1 2 3 4 5

14. In my opinion it is very important to take care of the body. 1 2 3 4 5

15. When I am injured, I immediately take care of the wound. 1 2 3 4 5

16. I feel comfortable with my body. 1 2 3 4 5

17. I feel anger toward my body. 1 2 3 4 5

18. I look in both directions before crossing the street. 1 2 3 4 5

19. I use body care products regularly. 1 2 3 4 5

20. I like to touch people who are close to me. 1 2 3 4 5

21. I like my appearance in spite of its imperfections. 1 2 3 4 5

22. Sometimes I purposely injure myself. 1 2 3 4 5

23. Being hugged by a person close to me can comfort me. 1 2 3 4 5

24. I take care of myself whenever I feel a sign of illness. 1 2 3 4 5

Source: Orbach, I., & Mikulincer, M. (1998). The body investment scale: Construction and validation of a body experience scale. Psychological Assessment, 10, 425. Copyright © 1998 Israel Orbach. Reprinted with permission.


HANDOUT 17

Suicide

Read each of the scenarios below and indicate which person you think is at greatest risk for attempting/committing suicide by writing a “1” in the space. Indicate which person you think is at the next greatest risk by writing a “2” in the space, and so on. In short, rank the descriptions with 1 being the person at the greatest risk and 4 being the person at the least risk.

Person 1:

Joe is a 35-year-old man who just found out that he has been laid off from his job as a computer pro-grammer after working at the same company for 7 years. He has no idea how he is going to tell his wife and their 5-year-old girl that daddy just lost his job. Money is tight and looks to be getting even tighter. Joe finds himself thinking that his family would be better off if he were dead and they could collect on the insurance money.

Person 2:

Maria is a 22-year-old college student who just broke up with her boyfriend of 2 years. Much of Maria’s self-concept was based on her idea of a future with her boyfriend primarily because she had such a difficult time adjusting to her parents’ divorce. At age 13, following her parents’ first separation, Maria took “a few pills,” but nothing serious happened and she never told anyone about it.

Person 3:

Amy is a 19-year-old female who just told her family that she is a lesbian. Disowned by her father and ostracized by the rest of her family, Amy now finds herself on her own trying to pay for school. Amy’s counselor has noted disturbing changes in her behavior, especially that she isn’t sleeping or eating, she can’t concentrate on schoolwork, and she has stopped doing things with her friends. Amy reluctantly followed her counselor’s advice and saw a doctor about beginning medication.

Person 4:

Alex is a 57-year-old man who has been divorced three times, the last divorce costing him his house and his status in the community. As if that weren’t enough, the economy has led to poor commissions at his high-pressure sales job so he hasn’t made his alimony and child support payments for the last few months. After work, he often goes to the shooting club to shoot a few rounds with his favorite gun as a way to blow off steam and then has a few beers “to help him relax.” The other day, after shooting and drinking several rounds, he unexpectedly gave his favorite gun to his best friend.

Source: Madson, L., & Vas, C. J. (2003). Learning risk factors for suicide: A scenario-based activity. Teaching of Psychology, 30, 123–126. Copyright 2003. Reprinted by permission of Laura Madson.


HANDOUT 18

Expanded Revised Facts on Suicide Quiz

Circle the answer you feel is most correct for each question. “T” (true), “F” (false), or “?” (don’t know)

T F ? 1. People who talk about suicide rarely commit suicide.

T F ? 2. No tendency toward suicide is genetically (i.e., biologically) inherited and passed on from one generation to another.

T F ? 3. The suicidal person neither wants to die nor is fully intent on dying.

T F ? 4. If they were assessed by a psychiatrist, everyone who commits suicide would be diag-nosed as depressed.

T F ? 5. If you ask someone directly “Do you feel like killing yourself?” it will likely lead them to make a suicide attempt.

T F ? 6. A suicidal person will always be suicidal and entertain thoughts of suicide.

T F ? 7. Suicide rarely happens without warning.

T F ? 8. A person who commits suicide is mentally ill.

T F ? 9. A time of high suicide risk in depression is at the time when the person begins to improve.

T F ? 10. Nothing can be done to stop a person from making the attempt once they have made up their mind to kill themself.

T F ? 11. Motives and causes of suicide are readily established.

T F ? 12. Women’s suicide rates are generally highest in midlife.

T F ? 13. Suicide is among the top four causes of death in the U.S.

T F ? 14. Most people who attempt suicide fail to kill themselves.

T F ? 15. Those who attempt suicide do so only to manipulate others and attract attention to themselves.

T F ? 16. Oppressive weather (e.g., rain, etc.) has been found to be very related to suicidal behavior.

T F ? 17. There is a strong correlation between alcoholism and suicide.

T F ? 18. Suicide seems unrelated to moon phases.

T F ? 19. Special treatment techniques are needed in dealing with the depressed/suicidal elderly.

T F ? 20. On average each year more people die from homicides than suicides.

T F ? 21. More teenagers die from suicide than from AIDS.

T F ? 22. Elderly suicide rates have declined for several decades.

T F ? 23. Suicide rates for young African American males significantly increased over the last two decades.

T F ? 24. By age, race, and sex, the grouping at highest risk for death by suicide is elderly white males.

T F ? 25. Older adults are much less likely than younger adults to use firearms as a method of suicide.



For questions 26–50, select your single answer from among choices a, b, or c.:

26. What percent of suicides leaves a suicide note?

a. 15–25% b. 40–50% c. 65–75%

27. Suicide rates for the U.S. as a whole are for the young.

a. lower than b. higher than c. the same as

28. With respect to sex differences in suicide attempts:

a. Males and females attempt at similar levels.

b. Females attempt more often than males.

c. Males attempt more often than females.

29. Suicide rates among the young are those for the old.

a. lower than b. higher than c. the same as

30. Men kill themselves in numbers those for women.

a. similar to b. higher than c. lower than

31. Suicide rates for the young since the 1950s have:

a. increased b. decreased c. changed little

32. The most common method employed to kill oneself in the U.S. is:

a. hanging b. firearms c. drugs and poisons

33. The season of highest suicide risk is:

a. Winter b. Fall c. Spring

34. The day of the week on which the most suicides occur is:

a. Monday b. Wednesday c. Saturday

35. Suicide rates for non-Whites are those for Whites.

a. higher than b. similar to c. lower than

36. Which marital status category has the lowest rates of suicide?

a. married b. widowed c. single, never married

37. The ethnic/racial group with the highest suicide rate is:

a. Whites b. African American c. Native Americans

38. The risk of death by suicide for a person who has attempted suicide in the past is someone who has never attempted.

a. lower than b. similar to c. higher than

39. Compared to other Western nations, the U.S. suicide rate is:

a. among the highest b. moderate c. among the lowest

40. The most common method in attempted suicide is:

a. firearms b. drugs and poisons c. cutting ones wrists

41. On the average, when a young person makes a suicide attempt they are to die compared to an elderly person.

a. less likely b. just as likely c. more likely

42. If we place the ways people die in rank order for young people and for the nation as a whole, suicide ranks ____ for the young when compared to the nation as a whole.

a. the same b. higher c. lower



43. The region of the U.S. with the highest suicide rates is:

a. Eastern b. Midwestern c. Western

44. Most older adults who complete suicide:

a. did not have a physician at the time of their death.

b. have not seen a physician in the year before their death.

c. have seen a physician in the month before their death

45. Currently, ____ states have legalized physician assisted suicides.

a. 0 b. 1 c. 3

46. According to government surveys of American high school students (grades 9 to 12), reported they had made a suicide attempt in the past year.

a. 1 in 5 b. 1 in 12 c. 1 in 25

47. Individuals with HIV or AIDS appear to have a suicide risk compared to undiagnosed populations.

a. higher b. lower c. similar

48. The risk of suicide is highest among:

a. alcoholics/substance abusers b. schizophrenics c. depressed individuals

49. The age group most likely to make a non fatal suicide attempt is:

a. young b. middle aged c. old

50. On average approximately Americans die from suicide each day:

a. 40–50 b. 80–90 c. 120–130

Source: Hubbard, R. W., & McIntosh, J. L. (2003, April 25). The expanded revised facts on suicide quiz. Paper presented at the annual meeting of the American Association of Suicidology, Santa Fe, NM. Reprinted by permission of John L. McIntosh.


HANDOUT 19

True–False Scale

Circle the items with which you agree, that is, those you consider “true.”

1. Some people can make me aware of them just by thinking about me.

2. I have had the momentary feeling that I might not be human.

3. I have sometimes been fearful of stepping on sidewalk cracks.

4. I think I could learn to read others’ minds if I wanted to.

5. Horoscopes are right too often for it to be a coincidence.

6. Things sometimes seem to be in different places when I get home, even though no one has been there.

7. Numbers like 13 and 7 have no special powers.

8. I have occasionally had the silly feeling that a TV or radio broadcaster knew I was listening to him.

9. I have worried that people on other planets may be influencing what happens on earth.

10. The government refuses to tell us the truth about flying saucers.

11. I have felt that there were messages for me in the way things were arranged, like in a store window.

12. I have never doubted that my dreams are the products of my own mind.

13. Good luck charms don’t work.

14. I have noticed sounds on my records [CDs] that are not there at other times.

15. The hand motions that strangers make seem to influence me at times.

16. I almost never dream about things before they happen.

17. I have had the momentary feeling that someone’s place has been taken by a look-alike.

18. It is not possible to harm others merely by thinking bad thoughts about them.

19. I have sometimes sensed an evil presence around me, although I could not see it.

20. I sometimes have a feeling of gaining or losing energy when certain people look at me or touch me.

21. I have sometimes had the passing thought that strangers are in love with me.

22. I have never had the feeling that certain thoughts of mine really belong to someone else.

23. When introduced to strangers, I rarely wonder whether I have known them before.

24. If reincarnation were true, it would explain some unusual experiences I have had.

25. People often behave so strangely that one wonders if they are part of an experiment.

26. At times, I perform certain little rituals to ward off negative influences.

27. I have felt that I might cause something to happen just by thinking too much about it.

28. I have wondered whether the spirits of the dead can influence the living.

29. At times I have felt that a professor’s lecture was meant especially for me.

30. I have sometimes felt that strangers were reading my mind.

Source: Eckblad, M. et al. (1983). Magical ideation as an indicator of schizotypy. Journal of Consulting and Clinical Psychology, 51, 216–217. Copyright © 1983 by the American Psychological Association. Reprinted by permission.


HANDOUT 20

The Curious Experiences Survey

Here are some experiences that people have in their daily lives. We are interested in how often you have these experiences (when you are not under the influence of alcohol or drugs). Please use the following scale for your responses.

1 = This never happens to me. 2 = This occasionally happens to me. 3 = This sometimes happens to me. 4 = This frequently happens to me. 5 = This is almost always happening to me.

1. Had the experience of feeling as though I was standing next to myself, or watching myself as if I were look at a different person.

2. Had the experience of looking in a mirror and not recognizing myself.

3. Had the experience of feeling that other people, objects, and the world around me were not real.

4. Had the experience of feeling that my body did not belong to me.

5. Had the experience of remembering a past event so vividly that it felt like I was reliving that event.

6. Had the experience of not being sure whether things I remember happening really did happen or whether I just dreamed them.

7. Had the experience of being in a familiar place but finding it strange and unfamiliar.

8. Feeling that I became so involved in a fantasy or daydream that it felt like it was really happening to me.

9. Find that I sometimes sit staring off in space, thinking of nothing, and am not aware of the pas-sage of time.

10. Find that in one situation I act so differently from when I’m in another situation that I felt almost as if I were two different people.

11. Find that in certain situations I am able to do things with amazing ease and spontaneity that would usually be difficult for me.

12. Found that I could not remember whether I had done something or had just thought about doing that thing.

13. Found evidence that I had done things that I did not remember doing.

14. Found that I hear voices inside my head that told me to do things or that commented on things that I was doing.

15. Felt as though I was looking at the world through a fog so that people or objects appeared far away or unclear.

16. Felt like I was dreaming when I was awake.

17. Felt like I was disconnected from my body.

Source: Goldberg, L. R. (1999). The Curious Experiences Survey, a revised version of the Dissociative Experiences Scale: Factor structure, reliability, and relations to demographic and personality variables. Psychological Assessment, 11, 134–145. (Scale items appear on p. 145.) Copyright © 1999 by the American Psychological Association. Reprinted by permission.


HANDOUT 21

Assessing Your Body Image

Respond to each item by using the following scale:

0 = never 1 = sometimes 2 = often 3 = always

1. I dislike seeing myself in mirrors. 2. When I shop for clothing, I am more aware of my weight problem, and consequently I find shopping for

clothes somewhat unpleasant. 3. I am ashamed to be seen in public. 4. I prefer to avoid engaging in sports or public exercise because of my appearance. 5. I feel somewhat embarrassed by my body in the presence of someone of the other sex. 6. I think my body is ugly. 7. I feel that other people must think my body is unattractive. 8. I feel that my family or friends may be embarrassed to be seen with me. 9. I find myself comparing my body with other people to see if they are heavier than I am. 10. I find it difficult to enjoy activities because I am self-conscious about my physical appearance. 11. Feeling guilty about my weight problem preoccupies most of my thinking. 12. My thoughts about my body and physical appearance are negative and self-critical.

Source: Strong et al. THE RESOURCE BOOK; A TEACHER’S TOOL KIT TO ACCOMPANY HUMAN SEXUALITY. Copyright 1999. Reprinted by permission of The McGraw-Hill Companies.


HANDOUT 22

Please answer each item by checking Yes or No. Answer all items even if you’re unsure of your answer.

Yes No

1. People sometimes find me aloof and distant.

2. Have you ever had the sense that some person or force is around you, even though you cannot see anyone?

3. People sometimes comment on my unusual mannerisms and habits.

4. Are you sometimes sure that other people can tell what you are thinking?

5. Have you ever noticed a common event or object that seemed to be a special sign for you?

6. Some people think that I am a very bizarre person.

7. I feel I have to be on my guard even with friends.

8. Some people find me a bit vague and elusive during a conversation.

9. Do you often pick up hidden threats or put-downs from what people say or do?

10. When shopping do you get the feeling that other people are taking notice of you?

11. I feel very uncomfortable in social situations involving unfamiliar people.

12. Have you had experiences with astrology, seeing the future, UFOs, ESP or a sixth sense?

13. I sometimes use words in unusual ways.

14. Have you found that it is best not to let other people know too much about you?

15. I tend to keep in the background on social occasions.

16. Do you ever suddenly feel distracted by distant sounds that you are not normally aware of?

17. Do you often have to keep an eye out to stop people from taking advantage of you?

18. Do you feel that you are unable to get “close” to people?

19. I am an odd, unusual person.

20. I find it hard to communicate clearly what I want to say to people.

21. I feel very uneasy talking to people I do not know well.

22. I tend to keep my feelings to myself.

Source: Raine, A., and Benishay, D. (1995). The SPQ-B: A brief screening instrument for schizotypal personality disor-der. Journal of Personality Disorders, 9, 346–355.


HANDOUT 23

Personality Inventory

Indicate your agreement or disagreement with each of the following items by circling T (True) or F (False).

T F Love is just a four-letter word.

T F People find me very charming.

T F About the only thing that ever makes me nervous is being cooped up.

T F People who never lie are suckers.

T F Feeling guilty is a waste of time.

T F If I don’t feel like doing something, I just don’t do it.

T F I often do things just for the hell of it.

T F I’ve fallen in and out of love dozens of times.

T F Most of my problems are due to the fact that people just don’t understand me.

T F As far as people go, I can take them or leave them.

T F One of my chief amusements is pulling people’s strings.

T F I have never been able to understand how anyone could pursue one goal for a long time.

T F I keep finding myself in the same difficulties time after time.

Source: Levenson, M. (1990). Risk taking and personality. Journal of Personality and Social Psychology, 58, 1080. Copyright © 1990 by the American Psychological Association. Reprinted by permission.


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