DSM-IV Evaluation of Case Studies

Case Study 1 (Schizoid Personality Disorder)

Schizoid personality disorder (SPD) is characterized by a lack of emotional response, social relationships, and sexual interest. The causes of this personality disorder fall entirely in the realm of the environment, rather than any genetic or biologic considerations. The psychodynamic approach theorizes that an unaccepting or abusive parent-child relationship might be at the heart of SPD resulting in an unfulfilled desire for human contact (Nevid & Rathus, 2005). Conversely, the cognitive theory explains that SPD is mostly caused by a person’s lack of emotional sensitivity; that they have problems picking up on emotional signals from others. Likewise, the cognitive approach to the treatment of SPD entails addressing these deficits by changing the way that these people think about human interaction. Cognitive treatments can include both lists of emotions for the client to think about and having a client write down pleasurable memories of social experiences. On the other hand, behaviorists treat SPD by using role-playing, homework assignments, and exposure techniques. Also, group therapy sometimes opens the door for those with SPD by allowing social contact in a controlled environment. Lastly, drug therapy has had only limited success in treating SPD.

Case Study 2 (Narcissistic Personality Disorder)

Narcissistic personality disorder (NPD) is described as a grandiose self-image typified by a need for admiration and a lack of empathy for the thoughts and feelings of others. Again, the psychodynamic approach points to cold, rejecting parents as a causal factor in the development of this personality disorder. They hypothesize that because of this relationship a person feels like they always have to prove themselves in order to convince themselves of their self-sufficiency and independence from the need for personal relationships. However, the cognitive/behaviorist approach maintains that NPD is caused by parents or guardians that are too positive towards the child, as in the case of only children or first children. Furthermore, the sociocultural theorists explain that NPD is a result of decaying family values as a result of Western culture. In response to this breakdown, they theorize, a generation of self-centered youth is produced. Moreover, the treatment of NPD according to the psychodynamic approach entails little more than highlighting a person’s basic insecurities and defenses. On the other hand, cognitive therapists attempt to treat NPD by, “…redirecting the clients’ focus onto the opinions of others, teach[ing] them to interpret criticism more rationally, increase[ing] their ability to empathize, and chang[ing] their all-or-nothing style of thinking” (Nevid & Rathus, 2005, p. 406).

Case Study 3 (Conversion Disorder, specifically glove anesthesia)

This disorder is basically a conversion of a psychosocial conflict into a physical impairment of some type. Conversion disorder (CD) is usually caused by an extremely stressful or traumatic event or the anticipation of an extremely stressful or traumatic event. Glove anesthesia is a specific type of CD which is characterized by numbness of the hands without actual neurological damage. Moreover, Freud hypothesized that CD is caused by the conversion of underlying emotional conflicts into bodily symptoms. Specifically, in women, he suggested that an unresolved Electra complex brings about sexual anxiety translated into physical symptoms. On the other hand, behaviorist emphasizes that psychologically caused physical symptoms can sometimes bring rewards. In this way, the behavior is positively reinforced. Conversely, cognitive theorists maintain that conversion symptoms are actually a form of emotional communication. Furthermore, there are five main ways in which conversion disorders are treated: insight, suggestion, reinforcement, confrontation, and drug therapy. The insight approach runs along psychodynamic lines and seeks to address the underlying anxiety-arousing conflicts which lead to the conversion. Suggestion simply seeks to inform patients persuasively that their physical symptoms will soon disappear. Reinforcement, which pulls from the behaviorist traditions, is an attempt to increase rewards for proper behavior and negatively reinforce the conversion behavior. Confrontation is where a clinician tries to straightforwardly tell a patient that their symptoms have no biological explanation. Lastly, antidepressants work in some cases to alleviate pain or anxiety.

Case Study 4 (Dissociative Localized Amnesia)

Dissociative localized amnesia (DLA) is characterized by a loss of memory (amnestic episode) during a finite period of time which is usually brought on by extremely traumatic or stressful events. Of course, the psychodynamic model explains DLA as an excessive repression of memory in order to shelter the conscious mind. The behaviorist approach emphasizes that operant conditioning might be at work in those that suffer from DLA. Behaviorists claim that the temporary relief obtained by the amnesia positively reinforces further amnestic episodes. Also, some form of state-dependent learning or self-hypnosis might be at work in the onset of DLA. Furthermore, psychodynamic therapists use free association to treat DLA by brining the forgotten episodes into consciousness. Likewise, hypnotherapy seeks to use hypnosis to help patients remember forgotten events. Lastly, several types of barbiturates (truth serums) have been used to alleviate anxiety and tension thereby allowing patients to more freely express the repressed memories.

Case Study 5 (Paranoid Schizophrenia)

Schizophrenia appears to be predisposed through genetic/biological factors and brought on through extremely stressful events, bouts with depression, and/or hallucinations/delusions. According to the psychodynamic model, schizophrenia is caused by a cycle of regression to primary narcissism and the restoration of ego control/connection with reality. On the other hand, the biological perspective maintains that schizophrenia is caused chiefly by biochemical abnormalities, abnormal brain structure, and viral problems. Also, the cognitive approach explains schizophrenia as an attempt to compute the delusions and hallucinations that are usually associated with the onset of the disorder. The sociocultural model sees schizophrenia as a result of family dysfunction and social labeling. Furthermore, treatment options for schizophrenia include milieu therapy which entails expecting a patient to make their own decisions within the framework of an institutional organization. Also, the token economy model seeks to reward (positively reinforce) normal behavior through the use of tokens that can actually buy things or coveted activities. Antipsychotic drugs, specifically atypical antipsychotics, have shown some success when used in conjunction with psychotherapy. Some other programs which have met with measured success are family therapy, family support groups, short-term hospitalization, supervised residences, occupational training, and insight therapy.

References

Nevid, J.S., & Rathus, S.A. (2005). Psychology and the challenges of life: Adjustment in the new millennium (9th ed.). Hoboken, NJ: John Wiley & Sons.

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