Author: hibernatorslibrary

Homemaker, Reader, Blogger

Stress and Your Body: An introduction

Great Courses: Stress and Your Body, by Professor Robert Saplosky,
narrated by Robert Saplosky
Robert Saplosky is a professor of biological sciences, neurology, and neurosurgery at Stanford University. His lab focuses on how stress affects the nervous system. He also has extensive field work, studying a particular population of wild baboons in East Africa – where he examines how social rank, personality, and sociality affect vulnerability to stress-related disease. He is a fantastic lecturer, and if you get the chance to watch a YouTube video of him lecturing, go for it. 



Saplosky and The Teaching Company developed the course Stress and Your Body to teach us about the detrimental effects of stress on our health. The primary textbook is his own Why Don’t Zebras Get Ulcers? Which, as far as I can tell from chapter 1 versus lecture 1, is pretty much verbatim with his lectures.  


Remember that time you were lying in bed, worrying about the big exam, presentation, or event that might make-or-break you the next day? You couldn’t sleep because you were ruminating about the fact that if you couldn’t sleep, you’d do terribly the next day. Then you noticed some minor symptom that’s been troubling you lately. Your head’s been aching. Oh no! You have a brain tumor! Now not only can you not sleep because of your event the next day, but you’re worried about your health.

This is the type of stress that often happens to humans. We worry about things that might happen in the future, rather than worrying about things that are happening now. Thus, our stress is generally long-lasting rather than immediate and acute. 

Animals biologically respond to stressors in very similar ways to ourselves, but their reasons for being stressed vary significantly from ours. A zebra might be munching contentedly on grass until suddenly he spots a lion. His fight-or-flight response ramps up. A part of his autonomic nervous system (responsible for controlling unconscious bodily functions) called the sympathetic nervous system is activated. His body goes into energy saving mode: it turns off all the functions that are unnecessary for fight-or-flight, and turns on the ones that are. 

He saves energy. That means his stomach stops digesting, he stops producing semen, his immune system – which requires a huge amount of energy – slows way down. Tissue repair – also another drain on energy – halts.  The rate of his heart and glucose metabolism increases so that oxygen and energy flows to the limbs for fight or flight. 

He runs.

This is a very helpful response to an immediate stressor like a lion. As soon as the zebra escapes the lion, the stress is gone and the zebra contentedly starts munching on the grass again. His parasympathetic nervous system activates, reversing all the bodily changes outlined above. He’s now in rest-and-digest mode. 

When humans experience long-term stress, many of the same pathways as short-term stress are activated, leading to chronically increased blood pressure, poor digestion, dysfunctional glucose metabolism, and heightened susceptibility to infection (among many other things). Such effects on the body will be discussed in detail as we explore Saplosky’s course. 

References:
Saplosky, Robert. (2004) Chapter 1: Why Don’t Zebras Get Ulcers? Why Don’t Zebras Get Ulcers? Third edition. (Nook ebook pp. 13-30). Holt, Henry & Company, Inc.

Saplosky, Robert. (2010) Lecture 1: Why Don’t Zebras get Ulcers? Why Do We? Stress and Your Body. The Teaching Company, The Great Courses.

Black Five, by J. Lynn Bailey

Black Five, by J. Lynn Bailey
In exchange for a fair and honest review,
I received an advanced release copy of this book through NetGalley
in exchange for a fair and honest review. 

Penelope Jackson has had a hard life. Her earliest memories were living with her crack-addicted adopted mother – who died when she was 8. Scarred by horrible memories of that time, Penelope moved to live with her aunt JoAnne. Life for the next almost-10-years went pretty calmly. She wasn’t popular in school, but she had her couple of good friends, and her loving aunt. But then everything changed. She found out that she’d been lied to her whole life. That she was a special immortal being called a “black five.” She was the only one who could save the world from an evil tyrant. 

I think this book would appeal to its target audience – perhaps 12-15 year old girls. Penelope is a unique, charming, and engaging character. The two romantic interests are handsome, powerful, masculine, mysterious, and totally enamored by her. This is also a nice story because the main character is a girl; but a loving, strong-willed, powerful one. Flawed, as well, which makes her likable. Most stories like this feature a boy as the magical-one-who-will-save-the-world (e.g. Harry Potter). Or if it’s a girl, she’s either a weak, needy one (yeah, I’m thinking Bella Swann); or a hard, unempathetic one (e.g. Tris or Katniss). I’m thinking of this book as sort of a mix between Harry Potter and Twilight. It’s young, it’s clean, it’s magical, and it’s got that love triangle. So, yes, if you’ve got a 12-15 year old girl who loves this type of book, it’s definitely appropriate and enjoyable.  

Now I get to the part that’s harder to say, but this is a “fair and honest review” after all. This book was not for me. I doubt it’s really for many adults at all. Love triangles? Ick. Not only do they give me the willies because I feel like the girl likes one guy and leads on the other, but they always seem to be leading on the guy that I think is better (so it always comes with disappointment in the end). Oh, and the Edward Cullen creepiness factor? It’s in this one too. Except – oh change-up! – it’s in the guy that I actually like. 🙂 Another problem I had with this book is the lengthy journal section. The hand-writing was atrocious. The writer even admitted that his writing was atrocious. It was an incredible struggle for me to read. 

Ok. So here’s what I think. This book wasn’t for me, but it’s a great book for 12-year-old girls. Therefore, I think it’s fair-and-honest to give the book 4 stars with the disclaimer: this is a book for young girls. 🙂

4 stars for appropriateness, likable characters, and magical story

Nonfiction in Audiobooks

The discussion post for the third week of Nonfiction November is to discuss “nontraditional nonfiction.” I admit, I’m a really slow reader and by the time I’m relaxing at home with a book, I’d rather be reading fiction. Therefore, my “traditional” nonfiction reading is pretty much at a snail’s pace. But I get a lot of nonfiction read through audiobook. In fact, I alternate fiction with non-fiction when I’m listening, so I get a lot of nonfiction “read” this way. I can’t recommend a specific book, because there are just too many, and I’m  not all that picky – as long as the reader is reasonably good, I’m happy. 

Instead, let me tell you about why I started listening to audiobooks. When I was younger, I never listened in class. My teachers in middle school used to accuse me of “staring off into space instead of listening,” which I really didn’t think I was doing. By the time I got to high school, I knew I didn’t listen – my chemistry teacher used to always praise me about how I’d discovered a new way to solve his problems. Well, the reason I didn’t do it his way is because I never listened to a word he said. I had no idea how he told us to solve the problems. I didn’t tell him that. Then in college, I had a rather shocking experience. I was sitting with a group of students discussing a class. One of them mentioned something the professor said. I was floored. People actually hear what the professor says? 

After that, I tried. The rest of my undergraduate career I tried really hard to pay attention. It didn’t work. During the first couple of years of grad school, I tried chanting in my head “you must listen, you must listen, you must listen.” Somehow I managed to continue that chant in my head while thinking of other things. I even tried yoga. No luck. I just couldn’t listen to what people said. I decided I was audibly challenged. As in, low auditory comprehension, not poor hearing.

That’s when I tried out audiobooks. I figured I could practice listening to auditory stimulation while I was exercising and stuff. I specifically picked books that I wouldn’t otherwise have read – because I didn’t want to miss something that I actually wanted to read. For instance, I listened to the entire Twilight series. 🙂 

It worked! Now I am able to listen to books that I want to read, and I do it all the time. I like audio for non-fiction, because it doesn’t make my eyes blur over when I’m tired, like written non-fiction can. (Though maybe if I stopped reading books that “read like textbooks” I’d not have this problem – but I like those books!)

Less importantly, I’m better able to listen in classes now. So, thank God for audiobooks!


The Biological Effects of Anxiety on the Body

Stress and anxiety can wreak havoc upon your body. It can lead to problems with childhood physical development, and affect the immune, endocrine, gastrointestinal, and cardiovascular systems. It can exacerbate diabetes. Stress affects the mind as well, a tragic example being PTSD, where an individual might relive a traumatic event over and over. 

Stress can be either good or bad event – such as marriage or a divorce. Low levels of stress can actually be a good thing – for instance, a small amount of stress might help you prepare for an upcoming exam better than you otherwise would have. But sometimes stress becomes overwhelming, and biological systems in your body that would usually only slightly increase during “good stress,” go into overdrive – potentially on a long-term basis. 

In order to understand why long-term stress can be bad, we need to understand what immediate effect stress has on our bodies. Under stress, the hypothalamus-pituitary-adrenal system (HPA axis) is activated. The hypothalamus releases corticotrophin-releasing-hormone (CRH). CRH stimulates the pituitary gland. The pituitary then secretes adrenocorticotrophic hormone (ACTH). The Adrenal cortex then produces the stress hormone cortisol in humans. 

Anatomy of hypothalamus-pituitary-adrenal system
Top left, the pituitary gland is red
Top right, the hypothalamus and pituitary glands are connected
Bottom left, the adrenal glands are bright red
Bottom right, the adrenal glands are the yellow cones on the kidneys

Cortisol activates the fight-or-flight response. The sympathetic nervous system shuts down anything that your body doesn’t need during a traumatic event where you might need to fight or run away from a threat. That means your stomach stops digesting, you stop producing semen / ovulating, your immune system – which requires a huge amount of energy – slows way down. Tissue repair – also another drain on energy – halts.  Activation of the sympathetic nervous system leads to release of the adrenaline (epinephrine) and noradrenaline (norepinephrine). These hormones circulate through the body and increase rate of the heart and of glucose metabolism – that gets the oxygen and energy flowing so you can use your limbs for fight or flight. 

Cortisol is the hormone that prepares the body for fight-or-flight; thus, it is a good hormone to have around in an immediate danger. However, if stress continues, and cortisol is not turned off, the long term effects of suppression of vital bodily functions is quite detrimental to the body. Usually, after immediate stress, the cortisol has a feedback inhibition mechanism, in which it signals to slow its own production. However, if the stress continues for too long, cortisol’s feedback inhibition loop can be deactivated; thus allowing the adrenal cortex to continue pumping out cortisol and keeping the physiological effects of the sympathetic nervous system still active. 

Since the immune system is inhibited by the sympathetic nervous system, individuals experiencing long-term stress are susceptible to infection by viruses and bacteria. 


The best known physical side effect of stress is cardiovascular problems. As mentioned earlier in this post, the sympathetic nervous system increases heart-rate so that blood pumps more quickly throughout the body. Not only can this increase blood pressure directly, but it can also lead to damage of the blood vessel walls. The high blood pressure leads to tiny tears in the blood vessel walls. These tears are susceptible to accumulating circulating “junk” such as particles of fat and cholesterol. This accumulation – pictured n yellow above – can decrease blood flow through the vessel, or completely block flow as seen above. When the heart doesn’t get enough oxygen, then a heart attack may occur. Another problem with decreased blood flow is that if the brain doesn’t get enough oxygen, this can cause a stroke. 

As you can see, stress can have a huge impact on your health. Doesn’t that stress you out?


This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 5: Stress and Physical and Mental Health. Abnormal Psychology, sixteenth edition (pp. 129-161). Pearson Education Inc.

Women’s Classic Literature Event 2016

Women’s Classic Literature Event
Hosted by the Classics Club
Ok. I’ve broken down and decided to join the Women’s Classic Literature Event with the Classics Club. “Why do you say ‘broken down'” You ask? Because I’m trying to only join events that will supplement my personal reading goals or introduce me to bloggers with common interests. After thinking about it, I’ve decided that this challenge fits those needs. I’m starting today. 

I hate making lists of books to read, because I will not stick to it – in fact, writing my Classics Club list was stressful enough. But here are the books (8 of 54 – oh sad, sad day; I’m embarrassed) on my Classics Club list that are by female authors – I will try to focus on them this year as much as feasible. 

  1. Persuasion, Jane Austen
  2. The Bell Jar, Sylvia Plath
  3. The Collected Poems of Sylvia Plath
  4. Ten Days in a Mad-House, Nellie Bly
  5. North and South, Elizabeth Gaskell
  6. Middlemarch, George Elliot
  7. Jane Eyre, Charlotte Bronte
  8. Cotillion, Georgette Heyer
Furthermore, Ali @heavenali is maybe hosting a Woolf-a-long through 2016, though its structure is still a little up in the air. I told her that the books by Woolf that I am interested in reading are: Mrs Dalloway, To the Lighthouse, Orlando, The Waves, and Between the Acts.

The Gilgamesh Epic and Old Testament Parallels, by Alexander Heidel

This classic book published in 1946 begins with a short introduction to The Epic of Gilgamesh, gives Heidel’s translation of the Epic, and finally provides a comparison of the Epic of Gilgamesh, and other Mesopotamian tablets with similar stories. Heidel’s translation is organized into tablet format, with fragments and unsure translations represented with an ellipsis and brackets.
Heidel begins his comparison with a chapter about death and the afterlife. In Mesopotamian literature, gods can die, evil was innate because humans were formed from the blood of a “bad” god, and there was an afterlife in which a person carried the objects buried with him into the afterlife. In Hebrew tradition, the one God can not die – he lives forever. However, there is a concept of original sin, similar to the Mesopotamian belief of innate evil. There seems to be some contradiction about whether Hebrews believed that there was an afterlife or not – most likely because of different beliefs of different sects.
The Mesopotamians partook in ancestor worship, which suggested that the ancestors could somehow intercede on behalf of their descendants. On the other hand, in Hebrew culture, there doesn’t seem to be any contact between the spirits of the dead and the living people.
The second, and final, chapter of Heidel’s book compares the Utnapishtim’s flood story that took place in the Epic of Gilgamesh with Noah’s flood story that took place in the Old Testament. There are obvious similarities. Utnapishtim and Noah both built ships to save them from a massive flood that the gods (or God) unleashed on the earth. They collected a male and female of every animal so that they could repopulate the earth. And at the end they released birds to let them know if the flood had subsided. Both the gods and the one God promised never to kill off humanity with such a calamity again.
But there were some interesting differences. First of all, Utnapishtim was not directly told of the flood. Nobody was meant to be told. But a god that favored Utnapishtim whispered to him through the wall of his home while Utnapishtim was sleeping. He told Utnapishtim to lie to the people around him – saying that one of the gods hated him, and that in order to save the entire community, he must leave in a ship. If the community helped Utnapishtim build the ship, they would be rewarded with a season of plenty, which would start with a “wheat-rain.” The community built the ship. Utnapishtim loaded on his family and his entire household of servants. At the end of the story, not all of humanity had died – just most of them. Some had survived the flood.
In the Old Testament, Noah was told directly by God to build a ship. He was asked to warn the community – telling them they must repent. The community did not repent. Noah built the ship and took only his family with him. All of humanity died.
Finally, Heidel discussed arguments of whether the Old Testament story had been derived directly from the Gilgamesh Epic, or if they had the same origins from a different source. He also wrote an interesting, though incredibly theoretical discussion about whether the flood really did happen, and what could have caused such a flood.
In the end, this book was very interesting, though I was hoping for a little more from it. However, I’m not quite certain what I expected, or why I expected it. After all, it delivered what was promised in the title. I think part of my higher expectations came from the fact that pretty much every list of references for studying the Gilgamesh Epic included this book.
Besides the rather silly overly-detailed theoretical discussions about the origins of the flood, one other thing I found annoying about this book was his over-use of the word “obviously.” These points were certainly not obvious to me, so why did he keep using that word? Perhaps his target audience was nothing like me.
3.5 stars for excellent research and being a classic reference book for Gilgamesh Epic.

Personality Disorders – Cluster C

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters -A, B, and C. This post will discuss cluster C. People with these disorders tend to be  anxious and fearful.

Avoidant Personality Disorder is characterized by extreme social inhibition and introversion, which lead to few friends and a tendency to avoid social interactions. Unlike schizoid personalities, people with avoidant personality disorder want to have friends, but they are too afraid of rejection to attempt social interaction.  They do not enjoy being alone, and are often bored. They generally have low self-esteem and high self-consciousness. 

In order to be diagnosed with avoidant personality disorder, the individual must have four or more of the following characteristics, which create clinically significant problems in functioning: 1) avoids occupations that involve interpersonal contact; 2) unwilling to get involved with people unless certain of being liked; 3) shows restraint within intimate relationships for fear of being shamed or ridiculed; 4) preoccupied with criticism and rejection; 5) inhibited in new interpersonal situations; 6) views self as socially inept, unappealing, and inferior; 7) does not take personal risks or engage in new activities for fear of embarrassment. 

Dependent personality disorder is characterized by extreme need to be taken care of. They tend to find one person to cling to, and they ask that person for advice on everyday decisions. They are terrified of separation from the person they are dependent upon. They sacrifice their own needs in order to please their chosen person, and often agree to do unpleasant things. They often remain in physically and emotionally abusive relationships. When their relationship is broken off, they desperately seek another person immediately, and often choose an inappropriate partner because of their fear that they are unable to take care of themselves. 

In order to be diagnosed with dependent personality disorder, the individual must have five or more of the following traits, leading to clinically significant impairment of function: 1) difficulty making everyday decisions without excessive advice; 2) needs others to assume responsibility for most major areas of life; 3) has difficulty disagreeing with others; 4) has difficulty initiating projects or of doing things alone; 5) goes to excessive lengths to obtain nurturance and support of others; 6) feels uncomfortable or helpless when alone; 7) urgently seeks another relationship when his source of care is broken off; 8) is terrified of being left alone to take care of himself. 

I met someone like this at a party once. He asked the entire group if anyone wanted to go wine tasting with a “bunch” of friends the next weekend, and I agreed. Within a day, he was asking me what to wear, how much money he should bring, and how early I thought we should be. He also told me that his wife had made him convert to Lutheran, and he felt extreme guilt over his conversion and wanted to be Catholic again – but he felt uncomfortable going to Mass alone. I naively volunteered to go to Mass with him a few times until he got used to the new church. “A few times” ended up to be every week. He began depending on me for every small decision in his life. Wanted to be around me every day. Said that he couldn’t eat alone and couldn’t exercise alone, so: could I come over and do those things with him? I was unemployed at the time (lots of time) and have an overly agreeable personality, so I got stuck helping him out way too much. I kept telling him I wasn’t interested in an intimate relationship, but he seemed not to understand this concept. (That may have been my fault for helping him out so much.) 

Finally, I got sick of him and said that I couldn’t spend that much time helping him. He needed to learn to be independent. I even suggested that he had dependent personality disorder and ought to seek help. That was mean, perhaps, but I was annoyed. It was a sign of his dysfunctional inability to disagree that he agreed I was right: he must have dependent personality disorder.

Anyway, dependent personality disorder is one of the disorders that will be dropped if diagnosis switches over to the dimensional rather than cluster approach. Which I think is unfortunate since I’ve met someone who clearly has those features. 

People with obsessive-compulsive personality disorder are the type of people that Freud would call “anally retentive.” They have an incredible need for symmetry, order, and perfection. They have specific rules and schedules and get very upset when those rules and schedules are broken by themselves or others. They tend to be dysfunctional because they are so obsessed with perfectionism that they aren’t able to finish projects. Unlike people with obsessive-compulsive disorder, they do not have true compulsive rituals like excessively washing hands. 

In order to be diagnosed with obsessive-compulsive personality disorder, an individual must have at least four of the following traits, which cause clinically significant impairment of function: 1) preoccupation with details, rules, lists, order, organization, or schedules; 2) perfectionism that interferes with task completion; 3) excessively devoted to work and productivity to the exclusion of leisure activities; 4) overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values; 5) unable to discard worn-out or worthless objects even when they have no sentimental value; 6) reluctant to delegate tasks or to work with others unless they follow his instructions perfectly; 7) has miserly spending style towards self or others; 8) shows rigidity and stubbornness.

What do you know? I know someone like this, too! But I won’t discuss him on my blog. 🙂 Some of my readers know who he is, though. 
This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics

Suicide – An Overview

References:


Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 10: Personality Disorders. Abnormal Psychology, sixteenth edition (pp. 328-366). Pearson Education Inc.

The Martian, by Andy Weir

The Martian, by Andy Weir, narrated by R. C. Bray
When a team of Mars explorers runs into some problems while on Mars, they think that astronaut Mark Watney has died. The rest of the crew avoid the storm by immediately heading back home to Earth. Unknown to them, Watney is still alive and must survive on Mars alone with meager supplies left behind by the Mars expedition. With his extraordinary resourcefulness, he manages to survive while desperately hoping that Earth will realize that he’s still alive and come to rescue him. 

This book was as fantastic as everyone says it is. Watney’s struggle to survive is fascinating, and the action moves forward at a steady pace. Yeah, there’s a lot of technical language, which made the book a little slower than I would have liked at times, but it was never so slow that I wanted to stop listening. It was more of an “ok, I get that you’re doing awesome technical stuff, let’s move on.” But those scenes were only paragraph-long. I was a little amused at how much money and time America was willing to put in to save Watney. After all, he was only one person and there are so many people on earth that could have benefited greatly from that money. They could have helped thousands of people instead of just one. I get it. He’s a hero. But he also made the choice to go on a dangerous adventure. The homeless and hungry in America and around the world did not make the choice to starve. Shouldn’t they be helped first?

The narration in the audiobook was also excellent. The humorous parts were so well executed that I had to laugh out loud on numerous occasions. 

I can’t wait to see this movie. I plan on going with my boyfriend next Tuesday. 🙂
4.5 stars for interest level and superb execution

Personality Disorders – Cluster B

As mentioned in my opening post about personality disorders, personality disorders are split into three clusters -A, B, and C. This post will discuss cluster B. People with these disorders tend to be dramatic, emotional, and erratic. 

Patients with histrionic personality disorder are characterized by self-dramatization, over-concern with attractiveness, tendency to irritability, and temper outbursts if attention-seeking is frustrated. These patients often manipulate their partners with seductive behavior, but they are also tend to be very dependent on the partners’ attention. They are generally considered self-centered, vain, shallow, and insincere. These traits are much more commonly seen in women than in men – probably because many of the characteristics (like over-concern with appearance) tend to be “women’s traits.” In fact, some argue that histrionic personality disorder is just another form of anti-social personality disorder, which is much more prevalent in men. 

In order to be diagnosed with histrionic personality disorder, the patient must have 5 or more of the following traits: 1) she is uncomfortable in situations in which she is not the center of attention; 2) her interactions with others are often characterized by inappropriate sexually seductive or provocative behaviors; 3) she displays rapidly shifting and shallow expression of emotions; 4) she consistently uses physical appearance to draw attention to herself; 5) she has a style of speech that is excessively impressionistic and lacking in detail; 6) she shows self-dramatization, theatricality, and exaggerated expression of emotion; 7) she is suggestible (i.e. easily influenced by others or circumstances); 8) she considers relationships to be more intimate than they actually are. 

This is one of the personality disorders that will be dispensed with if the next DSM moves towards a dimensional model of diagnosis, as mentioned in my earlier post. 

Narcissistic personality disorder is characterized by grandiosity, preoccupation with receiving attention, self-promoting, and lack of empathy. There are two types: grandiosity and vulnerable narcissism. In the former, the patient is convinced of their superiority; in the latter the patient expresses superiority defensively due to a low self-esteem. Narcissistic personality disorder is observed more often in men than in women. 

In order to be diagnosed with narcissistic personality disorder, the patient must meet five or more of the following traits: 1) he has a grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior); 2) he is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love; 3) he believes that he is “special” and unique and can only be understood by, or should associate with, other special people; 4) he requires excessive admiration; 5) he has a sense of entitlement; 6) he is interpersonally exploitative; 7) he lacks empathy and is unwilling to recognize or identify with the feelings or needs of others; 8) he is often envious of others or believes that others are envious of him; 9) he shows arrogant, haughty behaviors. 

Now, I doubt my ex-boyfriend had a personality disorder, but he did have quite a few of these traits – possibly exacerbated by a lifetime of alcoholism which he had only recently given up when I’d met him. In fact, at one point in our relationship, he went to a neurologist to be checked for long-term side-effects of a past concussion, and he returned with a psychological assessment which said he had “narcissistic personality traits.” At the time, I had laughed it off, but later I began to see it. 

This guy thought that he was incredibly smart, good looking, and absolutely amazing at his job. He was always bragging about the quality of his work; however, I saw some of his work a couple of times and found it lacking (which I didn’t say, of course). He was always talking about the future – how he had so many offers for jobs (he was unemployed) and how he’d be making well over $300,0000 a year in no time. He surrounded himself with people that he saw as superior (yes, that includes myself – he was always bragging to everyone about how smart and beautiful I was. It was rather embarrassing and over-the-top.) He also showed a surprising lack of empathy – he felt that anxiety was a sign of weakness in others, but when he had anxiety attacks he felt it was uncontrollable rather than a weakness.

Narcissistic personality disorder is one of the disorders that would be dropped if the diagnosis switched to a dimensional rather than cluster approach. 

Because there is a lot of public interest in borderline personality disorder and antisocial / psychopathy, I will mention those Cluster B disorders in another post. 


This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links: 

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:


Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 10: Personality Disorders. Abnormal Psychology, sixteenth edition (pp. 328-366). Pearson Education Inc.

The Biology of Desire, by Marc Lewis

The Biology of Desire, by Marc Lewis, narrated by Don Hagen
Neuroscientist and former addict Marc Lewis writes an engaging study of the biological changes that occur in an addicted brain, complete with personal stories about himself and several addicts that he interviewed. Lewis points out that there are two major models for addiction – the disease model and the choice model – and argues why he believes the disease model has outlived its use and is now harming rather than helping addicts. 

The disease model of addiction is highly accepted by clinicians, psychologists, and insurance companies right now. It posits that the more an addict uses a substance, the more his brain changes, and the more he needs the drug. Furthermore, some people have a biological preinclination for addiction – it doesn’t mean that they will become addicts, but the genetic preinclination raises their chance of becoming an addict under the right environmental stimulus. The combination of genetic factors and changes in the brain suggest to clinicians that addiction is a disease. A lot of money, therapy, and medication currently goes into treating addiction as a disease – often successfully.

Lewis argues, though, that changes in the brain and genetic preinclination do-not-a-disease-make. After all, every experience changes your brain – and some events, like falling in love, change your brain in much the same way addiction changes it. Furthermore, much as people have a preinclination for addiction, they also have a preinclination to temperament. For instance, an introverted, agreeable parent is more likely to have an introverted, agreeable child. Despite this heritability, temperament is not considered a disease. So why do we pick-and-choose which heritable brain-changing habits are a disease?

My answer is that addiction is considered a disease whereas in-love and temperament are not considered diseases because in-love and temperament do not generally cause clinically significant impairment in an individual’s ability to function in the workplace and social interactions. And when they do inhibit the individual’s ability to function, then they are considered a disease. 

Instead of the disease model, Lewis supports the “choice” model. People choose to abuse substances in the first place, and continue to make that choice. And when they give up the substance abuse, it is generally because they have chosen that now is the right time to give it up. 

Lewis spends the great part of this book describing why he feels viewing addiction as a disease is harmful to addicts as well as unhelpful for treatment. When an addict views his problem as a disease, then he might feel helpless to make his situation better. Whereas if he views it as a choice, he recognizes that he has power over this problem. You might notice that this is in stark contrast to the first step of AA in which the addict accepts that he is powerless over his addiction. In fact, in the stories of Lewis’ interviewees, none of them mentioned AA or NA as a helpful tool for stopping their addiction. 

Lewis also points out that although medication and therapy generally help the individual to give up alcohol to begin with, there is a very high relapse rate. And that is because although the individual doesn’t want the negative effects of his addiction, he has not yet accepted the choice to give up the drug.

Lewis claims that many people view the choice model and the disease model as mutually exclusive, but he believes that they are not. I would tend to agree with him on this. I don’t see the harm in viewing addiction as a disease – in fact, I think this model would be very helpful to a certain subset of addicts – it provides them a reason to say “this is not my fault, I have a disease, and I need to live as healthy a life as I can in order to not let it ruin my life.” But I also think the choice model is helpful to another subset of addicts – it provides them the ability to say “I have the power to choose not to use. I am not powerless.”