Theoretical Perspectives on Maladaptive Behavior

DEFENSE MECHANISMS

Freud believed that the ego was not helpless in the face of the demands of the id, the outside world, and the superego. anxiety alerts the individual to danger, such as the presence of an intense unconscious conflict or unacceptable wish. if this anxiety cannot be managed by direct action, so that the wish can be gratified, the ego initiates unconscious defenses in order to ward off awareness of the conflict. a variety of defensive responses to perceived danger are possible. since everyone experiences danger, the use of these responses, called defense mechanisms, clearly is not a special characteristic of maladaptive behavior. defense mechanisms are used by all people, either singly or in combination, at one or another. the level of adaptive behavior depends on the repertory of defenses available to the individual under study.

The most important and basic of the defense mechanisms is repression. Freud called it the cornerstone on which psychoanalysis rests. repression, like other defenses, is directed at both external dangers, such as fear-arousing events, and internal dangers, such as wishes, impulses. and emotions that cry out for gratification bur arouse fault. repression reduces anxiety by keeping anxiety-laden thoughts and impulses out of the person's consciousness. sometimes repressed thoughts and wishes leak out and are expressed indirectly.

Repression is often described as motivated forgetting. it is necessary to distinguish between two kinds of forgetting" forgetting neutral mental content such as an unimportant telephone number is not the same as forgetting a traumatic childhood experience. the other main categories of defense mechanism are as follows:

Displacement- A shift of feelings and attitudes from one object to another, more acceptable substitute. example: a man is criticized by his boss and then feels angry. He comes home and yells at his his wife. (yelling at his boss might be too dangerous)

Intellectualization- dealing with problems as interesting events which can be explained rationally and which have no anxiety or emotional content attached to them. example: a woman whose husband has just died discusses the inadequacy of America's mourning rituals, rather than her anger at her husband for leaving her.

Reaction formation- Expressing an unacceptable impulse by transforming it into its opposite. example: a mother who feels angry and rejecting toward her child checks many times to see if the child is all right during the night and worries excessively about her safety on the way to and from school.

denial-

refusal to acknowledge the anxiety-arousing aspects of the environment. the denial may be related only to the emotions connected to an idea or event or it may involve failure to acknowledge the event itself. denial is most often seen in psychosis. example: a student who has to take a final exam on material she doesn't understand, tells herself the exam is really not important and goes to a movie instead of studying the material with which she is having trouble.

projection-

characteristics or impulses that arouse anxiety are externalized by attributing them to others. psychotics are particularly likely to use projection. exam;le: Nazis in Germany who started World War II insisted that they did so because of aggressive threats from other countries.

regression-

going back to earlier ways of behaving that were characteristic of a previous development level. typical of people who go to pieces under stress. example: a wife goes home to her mother every time she and her husband have a quarrel.

sublimation-

a socially useful course of action developed when more direct forms of gratification are blocked. example: an adolescent with strong aggressive feelings expresses them without danger by becoming a football player.

PERSONALITY DISORDERS

paranoid personality disorder-

people with paranoid personality disorders have three outstanding characteristics: unwarranted feelings of suspiciousness and mistrust of other people, hypersensitivity and restricted emotional response. it is very difficult for such people to have close relationships with others because they are constantly expecting treachery.

paranoid individuals rarely seek clinical help. they are also hypersensitive to criticism, making is especially difficult for them to function in subordinate positions. they have a strong fear of losing independence and the power to shape events.

people with paranoid personality disorders often seem cold, humorless, devious, and scheming. perhaps because people with this kind of personality keep to themselves and rarely become intimate with others, many of their unusual ideas remain unnoticed. their performance is often impaired, however, because their preoccupation with searching for hidden motives and special meanings limits their ability to consider and understand who situations. when problems occur,

schizoid personality disorder-

individuals with schizoid personality disorders are reserved, socially withdrawn, and seclusive. they prefer solitary work activities and hobbies and rarely express their feelings directly. they often have poor social skills, lack a sense of humor and seem detached from their environment.

as this disorder advances in severity, changes in speech patterns may become evident. things that they say in conversation often are not understood because they either use unusual words and phrases or use common words in unusual ways. much of the time they seem suspicious, superstitious, and aloof.

histrionic personality disorder-

for people with histrionic personality disorders, getting the attention of others is a high priority. these people strike others as vain and immature and tend to speak in dramatic, exaggerated, and gushing manner. this classification is used in cases that are marked by exaggerated expressions of emotion, stormy interpersonal relationships, a self=centered attitude, and manipulativeness. the manipulativeness might manifest itself in suicidal gestures, threats, or attempts, as well as in other attention-getting behaviors such as dramatic physical complaints. histrionic individuals often react too quickly to situations that require some analysis and thought. they don't always focus their attention long enough to perceive the details of a situation, and as a result they tend to respond with emotionally tinged generalities. when people with histrionic personalities are asked to describe something, they generally respond with impressions rather than facts.

histrionic individuals often operate on hunches and tend to stop at the obvious. not only are they suggestible and easily influenced by the opinions of others, but they are also easy to distract. their attention is easily captured and just as easily turned toward something else. these problems of attention also lead histrionic people to appear incredibly naive about many commonplace things.

histrionic people may also feel unlovable and may react to this feeling by trying to make themselves sexually irresistible. women in particular may dress and behave seductively yet not really desire intimate sexual activity. women are more likely than men to be diagnosed as histrionic.

narcissistic personality disorder-

narcissistic personality disorders are characterized by an extreme sense of self-importance and the expectation of special favors, a need for constant attention, fragile self-esteem and lack of empathy or caring for others. people with a narcissistic personality disorder are often preoccupied with fantasies of unlimited success and brilliance, power, beauty and ideal love relationships. they may think of their problems as unique and feel that only other equally special people are able to understand them.

borderline personality disorder-

borderline individuals tend to have intense and unstable interpersonal relationships. a person may be valued as a wonderful friend one day and suddenly cut off the next. often there is a manipulative quality to these relationships. borderline individuals are also likely to engage impulsively in a variety of self-damaging behaviors. these may include gambling, shoplifting, overeating, and sexual exploits as well as suicidal gestures, self-mutilation or fighting.

self-destructiveness is the characteristic of borderline individuals that generates the most discomfort in those who attempt to help them. marked emotional instability with sudden shifts to anxiety, continued depression, or irritability, which may last only a few hours and never more than a few days, are typical of borderline personality disorder. borderline individuals also show disturbance in their concepts of identity: uncertainty about self-image, gender identity. values, loyalties, and goals. they may have chronic feelings of emptiness or boredom and be unable to tolerate being alone.

antisocial personality disorder-

antisocial personality disorder is associated with crime, violence, and delinquency. the essential characteristics of this disorder include a history of continuous and chronic behavior that violates the rights of others.

psychopathic personality disorder-

this disorder is a more severe form of the antisocial personality disorder. the characteristics of psychopaths are superficial charm and good intelligence often exhibiting poise, rationality and an absence of neurotic anxiety. beneath this veneer is a lack of a sense of personal responsibility utilizing untruthfulness, insincerity, callousness, manipulativeness without regret or shame. there is also evidence of poor judgement and a failure to learn from experience and a lack of insight into personal motivations. psychopaths tend to be "sensation seekers" but, paradoxically, show little anxiety when in a dangerous situation.

avoidant personality disorder-

the two most outstanding characteristics of avoidant personality disorder are extreme sensitivity to rejection or humiliation and low self-esteem. people with this disorder deep away from personal attachments and won't enter into relationships unless the other person provides unusually strong guarantees of uncritical acceptance.

the seclusiveness of avoidant personalities differs from that of people with schizoid personality disorders because avoidant people, unlike schizoids, do want to enter into relationships. the conflict they feel is over wanting affection and, at the same time, doubting their acceptance by others. they cannot seem to rid themselves of the belief that any overtures of friendship will end in pain and disillusion. some of these feelings come from doubts about their own competence. the primary goal of people in this group is to protect themselves from pain. they are caught between wanting human contact and dreading it.

one coping mechanism that those with avoidant personality disorder are likely to use is hypervigilance. they continuously assess all their human contacts for signs of deception, humiliation, and deprecation. as a result, they are able to detect the most minute traces of indifference or annoyance. they literally make mountains out of molehills. this technique of constantly scanning the environment is a self-defeating one, however, because it increases the likelihood that they will pick up just the kind of negative response they expect. in addition, their nervousness can result in making their companions uncomfortable, which can further damage the quality of their relationships with others.

another maneuver that avoidant personalities use is to narrow their range of activities in order to cut off upsetting stimuli. someone with an avoidant personality disorder may patronize only a small number of shops and restaurants so as to avoid encountering unfamiliar people or situations, or may even even avoid shopping and other everyday activities because they seem too tiring or uncomfortable. such people may also exaggerate the potential dangers of certain situations; for example, they may refuse to use buses or trains even though others do not doubt their safety. the lives of people with avoidant personality disorders are controlled by fears of looking foolish or being embarrassed or by concern about becoming anxious or crying in public.

dependant personality disorder-

people with dependent personality disorder have two basic characteristics. first, they passively allow other people to make all the important decisions in their lives because they lack confidence and feel that they are unable to function independently. second, to ensure that they will not lose this dependent position, such people subordinate their own needs to the needs and demands of others.

dependent individuals try to make themselves so pleasing that no one could possibly wish to abandon them. they are self-effacing, ever agreeable, and continually ingratiating. if left on their own, they feel empty, extremely anxious, and unable to function. they may feel anxiety even when the dependent relationship is intact because of the pervasive worry that the dominant figure might be lost in some way- for example, through death or divorce.

dependent individuals feel that they must act meek and obedient in order to hold onto other people. the also behave affectionately and admiringly toward their protectors. the dominant individual may tire of the constant need to demonstrate affection and support and begin to behave abusively.

obsessive compulsive personality disorder-

compulsive people have been described as "living machines". an obsessive compulsive personality disorder has several characteristics. one is the lack of ability to express many warm and tender emotions. instead, a person with this disorder seems stiff, formal, and unusually serious. such an individual is likely to be overly conscientious and inflexible about matters of morality. extreme perfectionism is also a problem because it focuses on small details, lists, and rulemaking rather than o getting the job done. they usually insist that their way of doing things be followed, without any awareness of the feelings this creates in other people. another characteristic of the compulsive personality is excessive concentration on work and productivity and even pleasure can become work when obsessive compulsives try hard to become "spontaneous".

finally, obsessive compulsive personality disorder is characterized by indecisiveness. individuals with this disorder have great difficulty making decisions because they might be wrong. some compulsives cannot bear to throw away anything- even things without sentimental value. their inability to make decisions can be so extreme that they can accomplish relatively little. pleasure comes from planning a job, not from doing it.

passive aggressive personality disorder-

people with passive aggressive personality disorder habitually resist demands for adequate performance both on the job and in their social life. although they have the skills to behave more effectively, they sabotage their accomplishments through procrastination, intentional inefficiency, stubbornness, and forgetfulness. people with passive aggressive personalities resent the demands that are made on them, but rather than expressing these feelings directly, they express their anger through passive resistance. for example, if a supervisor comes in at quitting time and requests a complex report by early the next morning, a passive-aggressive person would be more likely to mislay some of the needed data than to directly tell the supervisor that the request in unreasonable.

passive aggressive individuals seem to have no awareness of how their own behavior contributes to the situation. the behavior of passive aggressive individuals might be compared to a situation that is often found in childrearing. the child pushes the parents to the limits of their control and then backs off just in time to prevent retaliation. like the child, the passive aggressive individual is extremely sensitive to the limits of others and goes that far and no farther. interacting with a passive aggressive person can be immobilizing because it requires one either to give in or to violate one's own beliefs.

SCHIZOPHRENIC DISORDERS

delusions-

it is clear that people who are labeled as schizophrenic do not perceive situations in the same way that most other people do. schizophrenic individuals become so preoccupied with internal events that they no longer distinguish between objective reality and fantasy images. these people may experience two characteristic signs of schizophrenia: delusions and hallucinations.

a delusion is essentially a faulty interpretation of reality that cannot be shaken despite clear evidence to the contrary. the delusions that occur in different disorders tend to have different content. delusions of being controlled by others, delusions of being persecuted and continuing delusion that are not reflected in the person's mood, combined with auditory hallucinations in which voices are heard but are al likely to occur together and can be used as a way to distinguish individuals with schizophrenic disorders from others.

delusions can result in violent behavior that harms others. at other times the behavior, although is is based on delusional thinking, is highly organized and requires immense concentration. there is the case of a 22 year old male student who performed surgery deep in his abdomen, in his college dormitory room and carried out the operation with a precision that astonished surgeons. he had spent months preparing for the surgery, which, he said, was intended to 'denervate his adrenal glands." he had read surgical texts and acquired instruments. before the operation he sterilized his dormitory room, anesthetized himself with barbiturates, donned a sterile mask and gloves, and draped his body in sheets. lying down and looking into strategically placed mirrors to obtain an optimum view, he sterilized his abdomen and made an incision with a scalpel and used retractors to hold open the incision. after eight hours he had had a minimal blood loss but was unable to obtain adequate exposure to enter the retroperitoneal space because of the unexpected pain in retracting his liver. exhausted, he bandaged his wound, cleaned up his room, and called the police for transport to the hospital because of a "rupture".

hallucinations-

hallucinations are projections of internal impulses and experiences onto perceptual images in the external world. although they may occur in other disorders, only in schizophrenia do hallucinations occur when the person is in a clear, conscious state. hallucinations can be associated with any of the senses. many schizophrenics report voices either issuing orders or accusing them of terrible crimes or actions. not all hallucinations are accusatory or unpleasant. sometimes voices provide comfort and companionship.

schizophrenic individuals may be highly intelligent, not at all confused, and very painstaking in working out logical solutions to problems. however, their thought processes do not lead to conclusions based on reality or universal logic.

hebephrenia-

the extreme forms of hebephrenic schizophrenia are among the most bizarre varieties of psychosis. profuse delusions and hallucinations, grimacing, and gesturing mark the hebephrenic's behavior. hebephrenics show a childish disregard for social conventions and may resist wearing clothes, urinate or defecate at inappropriate times, and eat with their fingers. they behave actively but aimlessly and display emotional responses that are inappropriate to the circumstances. giggling, silly mannerisms and inexplicable gestures are common.

catatonia-

disturbance in motor activity is the major symptom of the catatonic schizophrenia. people with this disorder may remain stiffly immobile or may be extremely agitated. waxy flexibility is an extreme form of immobility in which the catatonic's arm or leg remains passively in the position in which it is placed. at the opposite extreme, the agitated catatonic shows extreme psychomotor excitement, talking and shouting almost continuously. patients who experience prolonged catatonic excitement may be very destructive and violent toward others. as with manic excitement, there is danger of personal injury or collapse due to exhaustion.

PARANOID DISORDERS

paranoid delusions-

everyone engages in paranoid thinking at one time or another. you could probably think of at least one occasion when you have felt that you were being discriminated against or talked about or were suspicious of someone else's motives without adequate proof that such things had actually occurred. we can consider paranoid thinking to be a kind of cognitive style. people vary in how frequently they use it and in how much they let reality influence what they perceive. paranoid thinking thus can be expressed as a kind of continuum extending from the everyday type to severe delusional thinking that affects all of a person's life.

paranoid delusions usually fall into one of several categories" the feeling of being persecuted by others, unwarranted jealousy and suspicion of sexual unfaithfulness by one's lover or mate, the feeling that another person has fallen in love with one when there is no evidence for this, and delusions of illness when none exists.

folie a deux-

probably the most interesting kind of paranoia is the shared paranoia disorder that is sometimes called folie a deux. in such cases one person is dominant, with fixed delusions, and the other is a suggestible person who adopts the delusional beliefs when the two are together. usually the suggestible person gives up the belief when the two are separated. two sisters, a husband and wife, or a mother and her child are the most common pairs involved. in some cases more than two people may take part in the delusion. the following case illustrates folie a deux:

a 34-year old student was admitted to the hospital after threatening to kill his graduate advisor for perceived discrimination. the student, a Vietnam combat veteran, believed that his professor was turning the college faculty against him because of his war experiences. when contacted by the hospital social worker, the student's widowed mother emphatically insisted that her son's beliefs were correct. a family session revealed that the mother, a passive and ineffectual lady, was completely dominated by her son ...when would agree, without hesitation, to his tirades against the university. he had influenced the mother to write numerous letters to the university president, the city's mayor, the chief of police, and the state governor protesting perceived actions of the university. she had written to the mayor after her son convinced her that his tardiness was secondary to a university plot to slow the bus service from the home to school. her letters to the police chief asserted that the advisor had influenced her son's classmates to pelt him with snowballs. she wrote to the university president to report her son's allegations that his advisor gave better grades to the women in the class because of their sexual favors to him. her detailed letters to the governor railed against the university for discriminating against her son, the Vietnam veteran, after her son had been hospitalized for several weeks, she began to realize that his thinking was disturbed. she entered psychotherapy to deal with the separation anxiety engendered by her son's absence.