Adult Psychopathology Case Studies / Edition 1

by Irving B. Weiner

Overview

A unique case study book, Adult Psychopathology Case Studies presents adult client case studies that describe the ways in which people with psychological disorders are likely to think, feel, and act. Written by experienced clinicians and well-known authorities in their respective specialties, it brings together the work of an international group of contributors who address the nature, origin, development, manifestations, course, and prognosis of a diverse range of adult psychopathological conditions.

Close examination is given to the clinical, personal, contextual, theoretical, ethical, and legal dimensions of case studies, along with insightful, real-world focus on overlapping themes, such as culture, substance abuse, domestic violence, and sexual abuse. Authors illustrate rational case formulation, but stop short of exhaustive or doctrinaire analyses that would discourage alternative opinions on how and why a disturbance occurred or its likely outcome-giving students an opportunity to apply their own knowledge to each case and providing instructors with material that will spark lively classroom discussion and debate.

The contributors also bring a broad range of theoretical perspectives to the diverse array of case studies, including psychoanalytic, psychodynamic-interpersonal, cognitive, and cognitive-behavioral conceptualizations of psychopathology and psychotherapeutic methods.

Adult Psychopathology Case Studies includes thirteen full-length case studies in the following categories:
* Personality disorders
* Anxiety and somatoform disorders
* Identity disorders
* Habit disorders
* Serious or psychotic disorders


Also included are six brief case studies covering:
* Adjustment disorder
* Dependent personality disorder
* Schizotypal personality disorder
* Generalized anxiety disorder
* Polysubstance dependence
* Depressive disorder


Adult Psychopathology Case Studies offers an engaging and perceptive look into the real world of adult psychopathology and provides students with an enriching "hands-on" learning experience as they apply their knowledge and techniques to each of the unique case studies provided in this book.

Product Details

ISBN-13:	9780471273400
Publisher:	Wiley
Publication date:	10/15/2003
Edition description:	Older Edition
Pages:	336
Product dimensions:	6.16(w) x 9.31(h) x 0.87(d)

About the Author

IRVING B. WEINER, PhD, PA, is Clinical Professor of Psychiatry and Behavioral Medicine at the University of South Florida and is in the practice of clinical and forensic psychology in Tampa, FL. He is Editor-in-Chief of the twelve-volume Handbook of Psychology (Wiley).

Read an Excerpt

Adult Psychopathology Case Studies

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John Wiley & Sons

Copyright © 2003

Irving B. Weiner
All right reserved.


ISBN: 0-471-27340-6

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Chapter One

Defining and Classifying Psychopathology

Irving B. Weiner

Learning about psychopathology through case studies begins with
identifying the nature of abnormal psychological functioning and
determining how it differs from normal behavior. This is not a simple
matter because normality has traditionally been defined in various
ways and from different perspectives. Experts have also disagreed
about whether psychologically normal and abnormal conditions are
continuous phenomena involving similar dimensions of personality or
whether they constitute distinctive states of mind that require separate
sets of concepts if they are to be described adequately. The first
two sections of this chapter discuss alternative ways of defining psychological
normality and some implications of considering it continuous
or discontinuous with abnormal functioning. The third section of
the chapter addresses the utility of a classification system in grouping
and distinguishing among different types of psychological disorders,
and the fourth section indicates the basis for choosing the topics of the
case studies presented in Chapters 2 through 19.

Identifying Psychological Normality

Psychologicalnormality has most often been defined either as an average,
an ideal, or a level of adjustment. Normality as an average is a
statistical definition that identifies the typical or most common behaviors
among a group of people as being normal for that group. This
average perspective on what it means to be normal is what someone
means when he or she says to another person, "Why can't you be like
everyone else?" or "Get with the program!"

Identifying some large middle percentage of a group of persons as
showing normal behavior has the benefit of providing a precise criterion
for deciding whom to consider abnormal, namely, those who fall outside
this middle range. Attention to typical patterns of behavior also promotes
cultural sensitivity and helps clinicians avoid seeing psychopathology
where none exists. Cultural sensitivity in this regard consists of recognizing
that what is normal for a person depends in part on the attitudes
and behavior patterns that are valued in the groups to which the person
belongs. Being aware of respects in which normality is relative to the
customs, traditions, and expectations in a person's sociocultural context
helps observers avoid inferring psychological disturbance from seemingly
strange characteristics that may be common or even advantageous
in a subculture with which the observers are unfamiliar.

Although useful for selecting "normal" comparison groups in experimental
studies and for minimizing cultural bias in clinical evaluations,
a statistical perspective on normality also has some disadvantages.
When being normal is defined as being average, highly intelligent as well
as intellectually limited people are considered abnormal, as are extremely
happy people as well as those who are despondent, and highly
creative as well as unproductive persons. Likewise, in a situation of mass
panic or mob violence, the many who are acting impulsively or irrationally
are considered normal, while the few who remain calm and
clearheaded despite the crisis are labeled abnormal. Thus, being different
does not necessarily mean being abnormal, as the statistical approach
would imply. Moreover, it is unwise to assume that people who become
acutely upset in a traumatic situation have no need for mental health assistance
simply because most of the people around them are showing
similar signs of distress.

As an alternative to defining normality in statistical terms as what
is average or typical, normality defined as an ideal refers to a state of
perfection that people aspire to but seldom attain. This utopian perspective,
as reflected in the expression "Nobody's perfect," assumes
that all people struggle with psychological limitations of one kind or
another that prevent them from being as happy and successful as they
would like to be. Regarding normality as an ideal way of being avoids
statistical decisions that label unusually intelligent, happy, or productive
people as abnormal. In addition, by calling attention to the potential
for people to become more than what they are, the ideal perspective
on normality encourages striving toward self-improvement and the active
pursuit of greater happiness and success.

On the other hand, by implying that almost everyone is disturbed
to some extent, normality as an ideal is a difficult concept to apply.
Scientifically, it provides little help in separating normal from abnormal
groups of people for research purposes. Practically, unless you
take the questionable stance that everyone is more or less in need of
therapy, it provides little help in determining whether a person's psychological
limitations call for professional mental health attention.

Level of adjustment as a criterion for normality refers to whether
people can cope reasonably well with their experiences in life, particularly
with respect to being able to establish enjoyable interpersonal relationships
and work constructively toward self-fulfilling goals. When
normality is defined in these terms, abnormality becomes a state of mind
or way of acting that prevents people from dealing adequately with the
social and occupational demands of their daily lives. The adjustment
approach to normality is more useful than either the average or the ideal
perspective in determining which conditions psychopathologists should
study and clinicians should treat. For this reason, normality defined as
reasonably good adjustment serves the purposes of this book by providing
a clear frame of reference for identifying the presence and severity
of psychological disturbance.

Continuity and Discontinuity in
Conceptualizing Psychopathology

Normal and abnormal behavior can be regarded as either continuous or
discontinuous phenomena. From a continuity perspective, differences
between disturbed and well-adjusted persons are quantitative. A quantitative
approach conceives normal and abnormal behaviors as deriving
from the same psychological dimensions or traits, with maladjusted
individuals having more or less than the optimum amount of these
traits. For example, a moderate amount of self-control contributes to
good adjustment, whereas too little self-control can lead to pathological
impulsivity and too much self-control, to pathological inhibition
and rigidity. Similarly, a moderate capacity to reflect on yourself and
your experiences tends to promote good adjustment, whereas insufficient
reflection can lead to limited self-awareness, and excessive reflection
can lead to paralyzing self-consciousness.

From a continuity perspective, every aspect of a disturbed person's
behavior constitutes an exaggeration of normal ways of thinking,
feeling, or acting. Any normal person can be expected on occasion to
think, feel, or act the way disturbed people do, but the key consideration
is one of degree. Normal people show maladaptive exaggerations
of behavioral traits less frequently, to a lesser extent, and for shorter
periods of time than people who are psychologically disturbed.

From a discontinuity perspective, by contrast, differences between
normal and abnormal behavior are considered qualitative, that is, as
differences in kind rather than degree. A qualitative approach emphasizes
the study of abnormal psychology in its own right, rather than as
an extension of normal psychology, to focus on the unique circumstances
that give rise to psychological disturbance and on the special
kinds of care and treatment that disturbed persons require.

Both of these approaches to the relationship between psychological
normality and abnormality serve useful purposes. The continuity
perspective helps mental health professionals and the general public
avoid regarding disturbed persons as "different" from the rest of us.
Being able to think of psychologically disordered people as having
more or less of certain characteristics that we all have, instead of being
in an entirely different dimension, fosters understanding of their problems
and enlightened and sympathetic efforts to help them overcome
these problems. By contrast, the discontinuity perspective has at times
resulted in psychologically disturbed people being viewed as alien and
unfathomable, with the regrettable consequence of relegating them to
places where they are out of sight and out of mind and treating them
with little regard for their humanity.

The continuity perspective on psychopathology also brings with it
some downside, however, particularly with respect to minimizing the
implications of apparent psychological disorder. Perceiving manifestations
of disorder as being only an extension of normal behavior and as
something we all have may be a prelude for insensitive advice ("Snap
out of it"; "Pull yourself together"), unwarranted expectations ("He'll
be okay in a few days"; "She just needs a good vacation, and she'll be
fine"), and failure to recommend or seek needed professional care. In
this regard, the discontinuity perspective can be very helpful by virtue
of its stress on the uniqueness of psychopathology. A qualitative approach
has the benefit of increasing the likelihood that disturbed people,
their family and friends, and mental health professionals who
evaluate them will recognize and respond to their needs for help.

Accordingly, the problems of psychologically disturbed persons and
the case presentations in the chapters that follow are best viewed from
both continuity and discontinuity perspectives. To what extent can the
adjustment problems of these people be seen and understood as exaggerations
(too much or too little) of characteristics common to all people?
At the same time, to what extent have these tendencies to think,
feel, and act in certain ways become sufficiently exaggerated to warrant
a diagnostic classification and a treatment recommendation, both of
which qualitatively distinguish these persons from most people?

Using a Classification System

Classification of disorders serves important purposes in research and
clinical practice. To study the origins and effects of a condition and
its course over time, researchers must be able to identify people who
have that condition and would be appropriate participants in such studies.
To draw on their experience and cumulative knowledge concerning
treatment methods that are helpful to people with certain kinds of
disorders, practitioners must be able to identify which disorders their
patients have. Whether a particular classification system serves these
research and practical purposes well depends on how reliable and valid
the system is. A reliable classification is one in which (1) the individual
categories are reasonably distinct from one another, and (2) knowledgeable
professionals can agree reasonably well on which category
best describes a patient's disorder. A valid classification is one in which
the characteristics used to describe and differentiate among disorders
have been confirmed by research findings to be in fact associated with
these disorders.

With respect to classifying psychological disorders, the best known
and most widely used system is the Diagnostic and Statistical Manual
of Mental Disorders (DSM) published by the American Psychiatric Association.
The DSM first appeared in 1952 and is now in its fourth edition.
DSM-IV was published in 1994 and was followed in 2000 by a
text revision, DSM-IV-TR, which lists the same categories of disorders
as DSM-IV but includes some changes in how these categories are described.
A key feature of the DSM is a multiaxial approach, in which
a person being evaluated can be described on each of five separate
axes, according to the following guidelines:

Axis I is used for reporting clinical disorders, which are conditions
defined mainly by the kinds of symptoms people present. Symptoms
in this context refer to maladaptive ways of thinking, feeling,
or acting that are causing people to feel distressed, that are not a
natural or welcome part of themselves, and that they would like to
be rid of.

Axis II is used for designating personality disorders and mental
retardation, which are conditions defined by the way people are
and have been, rather than by symptoms they have developed and
that come and go. The maladaptive characteristics of people with
personality disorders consist of well-entrenched traits and behavioral
dispositions that they are comfortable with and see no need to
change, regardless of whatever difficulties may be resulting from
them. Personality-disordered individuals would like to see the
world change to accommodate their style and preferences, whereas
symptom-disordered individuals would like to change themselves
to fit more happily and productively into the world around them.

Axis III of the DSM is used for reporting any general medical
conditions that may be relevant to understanding or treating a
patient's mental disorder (e.g., cancer, seizure disorder, ulcerative
colitis).

Axis IV is used to report psychosocial and environmental problems
that have a bearing on the person's treatment needs and prognosis
(e.g., family disruption, stressful work situation, homelessness).

Axis V is used for rating the overall adequacy of a patient's level
of functioning from 1 to 100 according to criteria specified in a
Global Assessment of Functioning (GAF) scale.

Despite its popularity and the years of effort that have gone into
preparing and revising it, the DSM has some notable shortcomings.
First, many of the criteria that are provided for individual categories
of disorders are overlapping rather than discrete. Because some symptoms
and personality traits characterize two or more of the disorders
classified in the DSM, clinicians may have difficulty agreeing in their
differential diagnosis of these disorders. To minimize this difficulty,
the DSM recognizes that a person's disorder may meet criteria for
more than one Axis I or Axis II condition, in which case all of the conditions
that seem present should be diagnosed. This flexibility takes appropriate
account of the fact that most psychological disorders are
complex and multifaceted. However, it does not resolve the reliability
issue, nor does it resolve how people should be selected for a research
sample or some form of treatment on the basis of their diagnosed condition
when they have been diagnosed with multiple conditions.

A second shortcoming of the DSM resides in its calling for categorical
classification. Each DSM disorder comes with a list of criteria and
instructions to diagnose the condition as present if a certain number of
these criteria are met.

Continues...

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Copyright © 2003 by Irving B. Weiner.
Excerpted by permission.
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Table of Contents

Contributors.

Preface.

PART ONE: NORMALITY, ABNORMALITY, AND ADJUSTMENT DISORDER.

1. Defining and Classifying Psychopathology (I. Weiner).

2. Adjustment Disorder (T. Millon).

PART TWO: DISORDERS OF PERSONALITY.

3. Dependent Personality Disorder (R. Bornstein).

4. Borderline Personality Disorder (C. Swenson and M. Linehan).

5. Antisocial Personality Disorder (C. Gacono).

6. Schizotypal Personality Disorder (D. Bernstein).

7. Paranoid Personality Disorder (J. Kleiger).

PART THREE: ANXIETY AND SOMATOFORM DISORDERS.

8. Panic Disorder with Agoraphobia (R. McCabe and M. Antony).

9. Obsessive-Compulsive Disorder (D. Roth and E. Foa).

10. Posttraumatic Stress Disorder (J. Armstrong and J. High).

11. Generalized Anxiety Disorder (I. Weiner).

12. Pain Disorder (J. Lackner).

PART FOUR: IDENTITY DISORDERS.

13. Dissociative Identity Disorder (P. Lerner).

14. Gender Identity Disorder (K. Zucker).

PART FIVE: HABIT DISORDERS.

15. Polysubstance Dependence (P. Nathan).

16. Bulimia Nervosa (P. Hendricks and J. Thompson).

PART SIX: MOOD DISORDERS AND SCHIZOPHRENIA.

17. Depressive Disorder (N. Hamilton and R. Ingram).

18. Bipolar Disorder (C. Newman).

19. Schizophrenia (M. Harrow, et al.).

Author Index.

Subject Index.