Abnormal psychology Case Studies
obsessive-compulsive disorder (OCD)
A successful executive who, for various reasons, hated the responsibility of marriage and fatherhood. He was obsessed many times a day with the idea that his two children were "somehow in danger", although he knew them to be safe in a well run private day school to which he himself brought them every morning. As a result, he felt impelled to interrupt his office routine three times a day by personal calls to the school principal who, incidently, after several months began to question the sincerity of the patient's fatherly concerns. Similarly, the patient could not return home at night without misgivings unless he brought some small present to his wife and children, although, significantly, it was always something they did not want.
Schizophrenia
A young man believed that he was destined to become Emperor of the United States. "I could do a lot for the world," he said, "The U.S. has presidents, will it ever have an emperor? I'll bet you think I'm nuts to ask about that. I must have the morning paper to keep track of world affairs. If the people of the United States want me to rule them, I'm willing to do so; but no one has been to see me and tell me. I'll be glad to lead them." Later he spoke of hearing public announcements that he was to be crowned emperor. "It's been heard all over the country... The world is in chaos. Thousands will be killed. I'm not a god or a devil, but I'm a supernatural being." All nations will be under his rule but Egypt. Along with these delusional convictions, the patient believed that attempts to kill him were repeatedly being made so that he lived, like Damocles, in constant danger.
Obsessive-Compulsive Disorder
Bill is an extremely orderly, clean, stubborn, and stingy person. He expects everything in the house to be spotless at all times. He insists that every chair, napkin, ashtray, and book be in its proper place. His wife loves him but finds it very difficult to keep the house in the rigid order he demands. He tends to have some time consuming rituals connected with dressing and personal care, such as arranging his toilet articles in a particular order, rinsing his face exactly five times after shaving, laying out all of his clothes in a fixed sequence and making sure that he puts them on in that order.
multiple personality disorder
Brian appears to be a mild-mannered 20-something, but he sometimes believes he is a teenage female named "Suzy" who is a member of a high school dance team. At these times, he dresses in various matching outfits, carries pom-poms, and practices various dance routines. Brian is confused about why he sometimes awakens dressed in strange clothing.
Bi-Polar Disorder
Don goes through periods when he feels he just can't lose. He goes on gambling sprees, launches new get-rich-quick schemes, and engages in promiscuous behavior. At other times, he feels so down that he can't even get out of bed. Life seems purposeless.
Phobic Disorder (Phobia)
Edna, age 20, a sophomore in college, had a pronounced fear of being left alone with a man, whether a fellow student, professor, relative, or acquaintance. She refused all dates and never allowed herself to be placed in situations where it was necessary for her to go home with someone of the opposite sex. She could give no good reason for this fear, bur recognized her problem; yet there seemed to be nothing that she could do about it. Recently when it appeared inevitable that she must go home from a party with a boy, she trembled, her hands became clammy, and she became very faint. As a result her hostess invited her to remain for the night.
Schizophrenia
Examiner: How do you feel today? Patient: Fine. Examiner: When did you come here? Patient: 1416, you remember doctor. Examiner: Do you know why you are here? Patient: Well, in 1951 I changed into two men. President Truman was judge at my trial. I was convicted and hung. My brother and I were given back our normal bodies 5 years ago. I am a policeman. I keep a dictaphone concealed on my person. Examiner: Can you tell me the name of this place? Patient: I have not been a drinker of 16 years. I am taking a mental rest after an assignment. You know a penwrap. I had contracts with Warner Brothers and Mike protested. I am made of flesh and blood. Examiner: Are you married? Patient: No. I am not attracted to women. I have a companionship arrangement with my brother. I am a loner.
panic disorder
For the past 15 years, a 35-year-old man has suffered from palpitations of the heart and faintness. The symptoms have increased and in the last few days the patient has stopped working because of the distress. At any time and without warning, he suddenly feels he is about to faint and fall down. If standing he cringes and clutches at the nearest wall or chair. If driving he pulls over to the curb and waits for the feelings to pass before resuming his journey. He has become afraid of walking alone in the street or driving his car for fear that the episodes would be triggered. The attacks could come on at any time of day or night.
Bipolar Disorder
He dressed in flashy pajamas and loud bathrobes, and, was otherwise immodest and careless about his personal appearance. He neglected his meals and rest hours, and was highly irregular, impulsive and distractable in his adaptations to ward routine. Without apparent intent to be annoying or disturbing he sang, whistled, told pointless off color stories, visited indiscriminately and flirted crudely with the nurses and female patients. Superficially he appeared to be in high spirits, and yet one day when he was being gently chided over some particularly irresponsible act he suddenly slumped in a chair, covered his face with his hands, began sobbing and cried, "for Pete's sake, Doc, let me be. Can't you see that I've just got to act happy?" This reversal of mood was transient and his seeming buoyancy returned in a few moments; nevertheless during treatment his defense euphoria disappeared again when he revealed his fear that his wife was unfaithful to him.
social phobia (social anxiety disorder)
Heather, a 19 year old college junior, has an intense fear of speaking to people she does not know very well. During her first and second years, she chose large lecture courses, which allowed her to hide in the back of the lecture hall and not speak to other students or to participate in the class discussions. Heather received high marks in all of her courses, earning a place on the dean's list and the honor roll. In her third year, Heather is now required to take some smaller upper level courses in which class participation and small-group discussions are mandatory. She is sure that she will do something embarrassing, such as vomit, and others will judge negatively. Because of these fears, Heather has trouble sleeping at night and is considering dropping out of school.
agoraphobia
Leonard has a fear of going more than a few blocks away from his home and the university. For years his fear kept him a virtual prisoner in this small geographical area. Although he knew of his fear, he did not know its underlying cause. During the course of therapy he was able to remember a frightening incident in his childhood. He had wandered away from his home and gone over to the railroad tracks, and a passing train scalded him with steam. This incident was the origin of his fear. His real motive for staying home was the fear acquired in this incident. The fear was so powerful that it dominated his whole life. It was never completely eradicated even though he recognized it's source and could be objective enough to write a book about it.
Social Anxiety Disorder
Walt has always been a loner. He has had a few friends, but never felt really close with any peers. In new situations, he seems shy and withdrawn. His parents have tried everything they know to encourage him to be more outgoing. Like many people, Walt feels nervous when he has to speak in front of a crowd, though his fears often give way to panic. Walt usually does not complete his projects or speeches because he would rather say he didn't do the work than try to explain his panic to his teacher. He has been labeled a "slacker" by fellow students and an "under-achiever" by teachers. Walt is sure that everyone will just be waiting for him to mess up his speech and that he will never live it down. He is distressed by his distorted beliefs in the cafeteria, too, where he is sure that he will do something stupid to make everyone will laugh at him. School has become so stressful to Walt that some days he stays in bed and tells his mother he has a stomach ache.
post-traumatic stress disorder (PTSD)
While she was on a visit to the Midwest, Samantha's residence was demolished by a tornado. Ever since, she has been plagued by terrible nightmares and occasional flashbacks.
obessive-compulsive disorder (OCD)
A 34 year old woman describes the ordeal of some of her weekly activities. "Once I have attained control of the car, I have the burden of getting into it and getting in going. This can be a big project some days, locking and unlocking the doors, rolling up and down the power windows, putting on and off the seat belts, some times countlessly . . . Sometimes while driving I must do overtly good deeds, like letting cars out of streets in front of me, or stopping to let people cross. These are things everyone probably should do, but things I must do. . . . My trip in the car may take us to the grocery store. Inside I have certain rituals I must perform. I am relatively subtle about how I do them to avoid drawing attention to myself. Certain foods must have their packages read several times before I am allowed to purchase them. Some things need to be touched repetitively. There are certain tiles on the floor must be stepped on by my family and myself. I'll find myself having to go from one end of an aisle to the other and back again, just to make everything all right. I fear being accused of shoplifting sometimes because of the way I behave and the way I am always looking around to see if people have noticed my actions.
panic disorder
A 35-year-old mathematician gave a history of episodic palpitations and faintness over the previous 15 years. There had been periods of remission of up to 5 years, but in the past year the symptoms had increased and in the last few days the patient had stopped working because of the distress. His chief complaints were that at any time and without warning, he might suddenly feel that he was about to faint and fall down, or tremble and experience palpitations, and if standing would cringe and clutch at the nearest wall or chair. If he was driving a car at the time he would pull up at the curbside and wait for the feelings to pass off before he resumed his journey. He was becoming afraid of walking alone in the street or of driving his car for fear that these episodes would be triggered by it and was loath to travel by public transport. Although he felt safer when accompanied, this did not abolish his symptoms. The attacks could come on at any time of day or night.
obsessive-compulsive disorder (OCD)
A boy in high school was supplied with some second hand books. He began to doubt the accuracy of them, for, as they were not new, he thought they might be out of date and what he read might not be the truth. Before long he would not read a book unless he could satisfy himself that it was new and the writer of it an authority. Even then he was assailed with doubts. For he felt uncertain as to whether he understood what he read. If, for example, he came across a word of which he was not sure of the exact meaning, he could not go on until he had looked up the word in the dictionary. But likely as not, in the definition of the word there would be another word with which he was not entirely familiar and he would have to look that up, so at times a half an hour or more would be taken up in reading a single page, and even then he would feel doubtful as to whether he had gotten the exact truth.
specific phobia
A man had fear of the number thirteen. At first he controlled his fear by staying in bed on the thirteenth of each month, thus avoiding contact with the calendar and newspaper dates. One day he realized that the word twenty seventh had thirteen letters, and he began spending two days a month in bed. Later he avoided passing a sign which had thirteen letters in it that hung on his normal route to work; he began to hop over the thirteenth step in each flight of stairs. Finally all his actions revolved around his fear.
panic disorder
A married woman, whose life was complicated by her mother's living in the home, complained that she felt tense and irritable most of the time. She suffered from occasional attacks in which her heart pounded, and she could not seem to get her breath. Often she broke out in a profuse perspiration. Her mouth seemed always dry, even though she drank a great deal of water.
Generalized Anxiety Disorder
A married woman, whose life was complicated by her mother's living in their home, complained that she felt tense and irritable most of the time. She was apprehensive for fear that something would happen to her mother, her husband, her children, or herself. She has no definite idea what it was that she fears might happen. She suffers from occasional attacks in which her heart pounds with irregular beats; she can not seem to catch her breath when this happens. Often she breaks out in a profuse perspiration. Her mouth seems to be always dry, even though she drinks a great deal of water, and because of this and her diffuse anxiety she cannot sleep.
social anxiety disorder
A student won't attend her university classes on the first day because she knows that in some classes the professor will instruct them to go around the room and introduce themselves. Just thinking about sitting there, waiting to introduce herself to a roomful of strangers who will be staring at her makes her feel nauseous. She knows she won't be able to think clearly because her anxiety will be so high, and she is sure she will leave out important details. Her voice might even quaver and she would sound scared and tentative. The anxiety is just too much to bear -- so she skips the first day of class to avoid the possibility of having to introduce herself in public.
Generalized Anxiety Disorder (GAD)
Amy, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries that she worries so much and isn't always sure what it is that she is worried about. She can't let her husband or children leave the house without making them call her regularly to reassure her that they are okay. Her husband is growing weary of her fretting. Her children can't understand what all the fuss is about. Their impatience with her only makes her worry more.
obsessive-compulsive disorder (OCD)
An 11-year boy instituted the following ceremonial before going to bed. He did not sleep until he has told his mother every last minute detail of the events that occurred that day; there must be no scraps of paper or other rubbish on the carpet of the bedroom; the bed must be pushed right to the wall; three chairs must stand by it and the pillows must lie in a particular way. In order to get to sleep he must first kick out a certain number of time with both legs and then lie on his side.
Bipolar Disorder
An individual had provided the following description of how they have been feeling over the last several months. "There is a particular a kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high, it's tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the ability to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feeling of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one's marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption upon friends' faces are replaced by fear and concerns. Everything previously moving with the grain is not against - you are irritably, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end for madness carves its own reality."
No Diagnosis - Too soon
Lenore has been feeling very sad since her husband died 12 days ago. She has eaten very little, and has difficulty sleeping. She is weepy most of the time. Lenore is preoccupied with thoughts of her dead husband and does not want to do much other than thinking about him. She has declined all invitations by friends and spends most of her time alone.
Body Dysmorphic Disorder (BDD)
In an interview a 30 year woman sits and describes her unhealthy fascination with her looks. "I sat in front of my mirror several times today and picked at my face. Matt, my husband saw my red puffy face and got upset. He only cares but he does not understand that it is not a conscious decision to sit there for an hour and pick at my face. And is it really that abnormal to stare at your breasts for ten minutes and go over and over in your head that they are not the same size? I am so tired of feeling compelled to look in the mirror whenever I pass by one. I hate that I cannot not look in the rear view mirror at myself while driving. I have to know what I look like no matter what I am doing. I hate that I think of my bulging stomach over 30 times a day. I hate always thinking about my nose and chin and my eyebrows, my hair, my boobs, my stomach, do I smell? Is my hair frizzy today? Can anyone else tell that my right boob is bigger than my left? Great, I picked at my face and now I have to go back to work red and puffy. I have to make sure and do my eyeliner so that my right eye doesn't look so much smaller than my left. I am so tired of bathing with several different soaps in one shower and then using a good smelling lotion and body powder. I am sick of washing my face two or three times at once. It feels better to get it all out."
Major Depressive Disorder (MDD)
It takes the greatest effort to get out of bed in the morning. I am tired all day, yet when night comes, sleep evades me. I stare at the ceiling, wondering what has happened to my life, and what will become of me. Nothing is getting doneat work. I have projects to complete, but I can't think. I try to focus on my work, and I get lost. I keep wondering when the boss will discover how little I have accomplished. My wife does not understand. She keeps telling me to "snap out of it." I'm irritable all the time, and yell at the kids, then I feel terrible later. Nothing is fun any more. I can't read, and the music I used to enjoy so much does nothing for me. I am bored, but I feel like doing nothing. There are times, when I'm alone, that I think that life is hopeless and meaningless, and I can't go on much longer.
Bipolar Disorder
John, a patient at the state mental hospital, appears to be happy and elated. He frequently makes humorous remarks, laughs at them himself, and is successful in making others laugh too. In expressing his thoughts he jumps from one topic to another without following any particular course. If, while he is talking about his family, the psychologist suddenly interjects a comment about the weather, John immediately switches his conversation to the weather or any other topic the psychologist introduces. Furthermore, he is hyperactive. He is either drumming with his fingers, playing with a pencil, or engaging others with his rapid talk. His present illness will probably be followed by several years of "normal" behavior.
post-traumatic stress disorder (PTSD)
Josh, a 27 year-old male, recently moved back in with his parents after his fiancée was killed walking across a busy intersection. He vividly remembers the horrific scene as the drunk driver ran the red light, hitting his fiancée right before his eyes. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident. Since the accident, Josh has been plagued with nightmares about the accident. He quit his job because the office was located right next to where he was meeting his fiancée the day she died. The few times he attempted to return to work were unbearable for him. He has since avoided that entire area of town. Normally an outgoing, fun-loving guy, Josh has become increasingly withdrawn, "jumpy", and irritable. He's stopped working out, playing his guitar, or playing basketball with his friends - all activities he once really enjoyed. His parents worried how detached and emotionally flat he's become.
obsessive-compulsive disorder (OCD)
Ken is plagued by constant worries that what he has planned will not occur as scheduled. He makes hundreds of to-do lists each day and often checks these lists to make sure they are correct. Ken incessantly reminds his colleagues of upcoming deadlines, sometimes 15 or 20 times each day.
social phobia
Keshona is terrified of speaking in public. Although highly knowledgeable and competent, whenever she has to address a gathering of adults, her heart pounds, and her mouth gets dry.
obsessive-compulsive disorder (OCD)
Lonnie, a 38 year-old chemical engineer for a large pharmaceutical company, sought a consultation at the urging of his wife, Maria. He told the psychologist that Maria had grown exasperated over "his little behavioral quirks." It seems that Lonnie was a compulsive checker. When ever the two of them would leave their apartment, he would insist on returning to check and reached that the gas jets were turned off, the windows were shut, the door was securely locked, and the refrigerator door was tightly shut. Sometimes he'd get as far as the garage before the compulsion to return to the apartment would strike. He would apologize to Maria and leave her fuming. When retiring to bed a night, he performed an elaborate ritual of checking and rechecking to see that everything was secure. But even then, he would often bolt out of bed to check everything again, which would disturb Maria's sleep. Leaving for vacation was especially troublesome, as it required checking rituals that consumed the better part of the morning. Yet he would still be bothered by nagging doubts that would plague him throughout his trip. Lonnie recognized that his compulsive behavior was wrecking his marriage and causing him emotional distress. However, he feared that giving in them up would leave him defenseless against the anxieties they help to ease.
dissociative identity disorder (DID)
Margaret explained to her therapist that she often "hears a voice telling her to say things and do things." It was, she said, "a terrible voice" that sometimes threatened to "take over completely." When it was finally suggested to Margaret that she let the voice "take over," she closed her eyes, clenched her fists, and grimaced for a few moments during which she was out of contact with those around her. Suddenly she opened her eyes and one was in the presence of another person. Her name, she said, was "Harriet." Whereas Margaret had been paralyzed, and complained of fatigue, headache and backache, Harriet felt well, and she at once proceeded to walk unaided around the interviewing room. She spoke scornfully of Margaret's religiousness, her invalidism, and her puritanical life, professing that she herself liked to drink and "go partying" but that Margaret was always going to church and reading the Bible. "But," she said impishly and proudly, "I make her miserable - I make her say and do things she doesn't want to." At length, at the interviewer's suggestion, Harriet reluctantly agreed to "bring Margaret back," and after more grimacing and fist clenching, Margaret reappeared, paralyzed, complaining of her headache and backache, and completely amnesiac for the brief period of Harriet's release from prison.
bipolar disorder
Midge become depressed and asked to return to the hospital where she had been a patient. She then become overactive and exuberant in spirits and visited her friends, to whom she outlined her plans for reestablishing different forms of lucrative businesses. She purchased many clothes, bought furniture, pawned her rings, and wrote checks without funds. For a period thereafter she was depressed. In a little less than a year, she again become overactive, played her radio until late in the night, smoked excessively, took out insurance on a car that she had not yet bought. Contrary to her usual habits, she swore frequently and loudly, created a disturbance in a club to which she did not belong, and instituted divorce proceedings. On the day prior to her second admission to the hospital she purchased 57 hats.
obessive-compulsive disorder (OCD)
Mike, a 32 year-old man, performed many acts that were preceded by a fear of harming other people. When driving, he had to stop the car often and return to check whether he had run over people, particularly babies. Before flushing the toilet, he had to check to be sure that a live insect had not fallen into the toilet, because he did not want to be responsible for killing a living thing. At home he repeatedly checked to see that the doors, stoves, lights, and windows were shut or turned off. . . . Mike performed theses and many other checking behaviors for an average of 4 hours a day.
Narcissistic Personality
Mr. A, an extremely intelligent, shy but arrogant 25-year-old man, was a college student and came for therapy because he had suffered from depression for several years. Although an exceptionally competent student, he constantly felt unappreciated. He tended to devote his time in lectures to "giving the teachers and professors a hard time" by criticizing them, and asking "impossible" questions in order to prove their incompetence and make them embarrass themselves in public. He described himself as extraordinarily superior with feelings of disdain and confusion toward people he experienced as different from himself-people who he felt had lower standards and different values than he. He also described himself as intellectually unique, stressing his specific theoretical and philosophical perspectives and high academic standards. He had several close friends among his male peers, but admitted that he experienced severe problems in relating to young women, had difficulty connecting, and felt shy and insecure. Mr. A came from a very competitive and successful family background. His father was a famous lawyer in his early 60s, and Mr. A described having a complicated relationship, with mixed feelings toward the father. On the one hand he highly admired and idealized his father; on the other hand he despised the father's demands, values and expectations, and tended to take every opportunity to protest against him. While he envied his father and fantasized about becoming as successful, Mr. A also felt inferior, and believed that he would never become as successful as his father. Often he felt deeply misunderstood by his father. After successfully graduating from college, Mr. A decided to work as a pizza deliverer, a decision that he considered to be unusually risky but in line with his "unique approach" to life.
Generalized Anxiety Disorder (GAD)
Mr. D. was a married man, 30 years of age. He had had a severe anxiety attack and after became chronically and so intensely anxious that he was admitted to the hospital. He seemed perpetually afraid and complained that he had the feeling that something terrible was going to happen. Over and over again he would repeat, "I'm afraid of something happening, and I don't know just what." He was always tense, irritable, and restless. He had difficulty getting to sleep. He had headaches and sweated excessively. His appetite was poor.
Major Depressive Disorder
Mr. S. would spend most of his time sitting on a chair by the side of his bed, moaning and wringing his hands. His facial expression was one of deepest dejection and his eyes were reddened from weeping. As a rule Mr. S. would not speak unless spoken to, but occasionally he would address another patient or a member of the ward staff. At such times he would usually blame himself in the harshest terms for having "ruined my family", saying that he did not deserve to live.
Schizophrenia
Mrs. Kames was a nurse, but began to get the idea that she was being spied upon by her neighbors, that men were hiding in her attic at night with a view of seducing her, "an honorable woman". She is a great inventress, having invented a powderless, triggerless, shell-less, reportless, barrel-less gun - in fact a peace gun. She has sold it to the government, but spies are everywhere in the institution and the superintendent is in league with them. She has the idea that there may be some spies in the class, so she asked everyone to raise their right hand and say, "God Save America". Then she is satisfied and continues with her harangue, hinting that even greater inventions are coursing through her mind. She switches to religion, telling what a pure righteous woman she is. She was "monkied" with ten years ago and is to give birth to five monkeys. She says her term is a long one because hers is a Caesarian Case. When the doctor says, "All right Mrs Kames, you may go back now," she becomes quarrelsome, accusing him of not wanting these boys and girls to know that he is keeping her, a perfectly sane woman, in this place. She is edged out of the room but slips a piece of paper to a girl sitting near the door. It says, "This is a house of ill repute, you had better get out of it while you have the chance."
panic disorder
My breathing starts getting very shallow. I feel I'm going to stop breathing. The air feels like it gets thinner. I feel the air is not coming up through my nose. I take short rapid breaths. Then I see an image of myself gasping for air and remember what happened in the hospital. I think that I will start grasping. I get very dizzy and disoriented. I cannot sit or stand still. I start pacing. Then I start shaking and sweating. If feel I'm losing my mind and I will flip out and hurt myself or someone else. My heart starts beating fast and I start getting pains in my chest. My chest tightens up. I become very frightened. I get afraid that these feelings will not go away. Then I get really upset. If feel no one will be able to help me. I get very frightened I will die. I want to run to some place safe but I don't know where.
Generalized Anxiety Disorder (GAD)
No matter what he is doing, Ikimba always feels a little tense. The apprehension has no apparent cause. Even during weekends and vacations, he experiences constant uneasiness.
Social Anxiety Disorder
Professional football player and Heisman Trophy-winning running back Ricky Williams could play football in front of thousands of fans but struggled being interviewed by the press, talking to a fan, or even going to the mall where some might recognize him. Many times after a game he would keep his helmet on when talking to the press. He dreaded going anywhere he might encounter a fan or someone wanting to talk with him. After being diagnosed and treated Williams now takes his helmet off after games, goes shopping and out to restaurants.
obsessive-compulsive disorder (OCD)
Rocky Prater went to college only because of pressure from his older brother. Unfortunately, he got into several courses he hated, so that the entire school day seemed difficult and dull. Shortly before midterms, Rocky developed a thought that he had not set his alarm clock. He would lean out of bed to check, but it was always set. Sometimes he would wake up in the middle of the night with the terrible feeling that the alarm was not set, but it always was. Still he continued to go through this alarm checking ritual at least once every night and often more frequently. Finally his counselor helped him realize that his recurring thought was based on his desire to sleep through his morning classes, and that the behavior was his method of counter-acting these unrecognized feelings. After his talk with the counselor his behavior began to fade away.
obessive-compulsive disorder (OCD)
Ruth Langely was 30 years old when she sought help from a therapist after experiencing long-standing fears of contamination. She stated that she became intensely uncomfortable with any dirt on herself or in her immediate environment. After noticing any dirt, she felt compelled to carry out elaborate and time-consuming cleaning procedures. This usually involved thoroughly washing her hands and arms. Moreover, if she found dirt in her apartment, she was compelled to scrub her apartment methodically, in addition to showering in a very regimented manner. Her cleaning rituals have severely restricted her life. She now washes her hands at least four or five times an hour, showers six or seven times a day, and thoroughly cleans her apartment at least twice a day.
Body Dysmorphic Disorder
Sandra is a twenty-three-year-old college student who believes she has blemishes that make her very unattractive; she also despises her curly hair and "droopy" eyes. One day, on a break, she broke down and told her parents that she couldn't continue school. Her parents were shocked. Sandra hadn't revealed her concerns to them and rarely spoke of her appearance. She did not wish to appear vain or conceited; however, unknown to her family, while at school, she had been spending hours straightening her hair and using foundations and concealers to hide her blemishes until she could her ensure her appearance was "perfect," even though her flaws were unnoticeable to others. She had even tried many products to attempt to lighten the skin under her eyes. The anxiety and stress of this constant quest for perfection was taking its toll on Sandra's ability to lead a normal life.
Schizophrenia
Steve was admitted to the hospital from the city jail, where he had been serving a sentence for peddling without a license. The jail physician recommended psychiatric observation after the patient told him a story of being the Swedish ambassador to the United States who was traveling around the country in disguise to study conditions. In appearance, Steve was untidy and disheveled, a small man who appeared to be about forty five years of age. He stated his own age to be six thousand and twelve and said that he was the owner of the whole continent of Sweden under God. He claimed that the medicine he was selling from door to door was made from the inner most private essences of time without end, amen. For over a thousand years, according to the patient, evil men had been trying to get his secret of perpetual life and even now were operating on him. He said that he had discovered a super-radio with which he could tell where his enemies were and that at the proper time he would order the armies into action and give his whole fortune of several billion dollars to the support of genuine Swedish Christianity. He maintained that he was not bothered by being placed in jail or being taken to the hospital, because his superordered powers would enable him to walk through the thickest walls at any time he chose.
Schizophrenia
Susan was a young woman placed by her school in a class for the emotionally disturbed. She talked at length about her interests and occupations. She said she made a robot in the basement that ran amok and was about to cause a great deal of damage, but she was able to stop it by remote control. She claims to have built the robot from spare computer parts, which she acquired from the local museum. When pressed on details of how this worked, she became increasingly vague, and when asked to draw a picture of one of her inventions, drew a picture of an overhead railway and went into what appeared to be complex mathematical calculations to substantiate the structural details, but which in fact consisted of meaningless repetitions of symbols (eg: plus, minus, divide, multiply). When the interviewer expressed some gentle incredulity, she blandly replied that many people did not believe that she was a super genius. She also talked about her unusual ability to hear things other people cannot hear, and said she was in communication with some sort of creature. She thought she might be haunted, or perhaps the creature was a being from another planet. She could hear his voice talking to her and asking her questions.
Major Depressive Disorder
The patient lies in bed hardly moving. He does not look at anyone passing by his bed. His facial expression is empty and unchanging. He is thin and pale and looks physically ill. He refused to eat and has to be fed by a stomach tube. He cannot control urination or defecation. Occasionally he mutters a few words like "Sin...Sinners...Hell" apparently preoccupied completely with his thoughts of sin and punishment. We are quite sure he does not know where he is - he may believe he is in hell.
OC (Obsessive Compulsive Disorder)
This pattern is illustrated by the case of a 13 year old boy who was constantly preoccupied with the thought that he wanted to hurt other people. Whenever he saw someone asleep, he was struck by the thought that he had killed them. In his religious observances he felt compelled to make the sign of the cross three times instead of once as other people did. He refused to watch deaths portrayed in movies and television because he thought they were real. He also was afraid of bumping and hurting other people and for this reason he avoided crowds and all the usual boyhood sports.
antisocial personality disorder (APD)
Tuan has been arrested on numerous occasions for disturbing the peace and for illegally producing and selling alcohol and drugs to minors. Although a number of his clients have died from overdoses, he feels no remorse.
