Lesson 1: Clinical Disorders – Part B
| Site: | MoodleHUB.ca 🍁 |
| Course: | Abnormal Psychology 35 RVS |
| Book: | Lesson 1: Clinical Disorders – Part B |
| Printed by: | Guest user |
| Date: | Saturday, 13 September 2025, 8:01 PM |
Section/Lesson Objectives
The student will ...
• Understand and describe the general symptoms of the clinical disorders discussed in the course [This lesson]
• Discuss the possible causes of clinical disorders [This lesson]
• Understand and describe the general symptoms of the cognitive disorders discussed in the course
• Discuss the possible causes of cognitive disorders
• Understand and describe the general symptoms of mental retardation
• Discuss the possible causes of mental retardation
• Understand and describe the general symptoms of the personality disorders discussed in the course
• Discuss the possible causes of personality disorders
Introduction
In the lesson content you will come across some terms in maroon color that are bolded. Look them up in the course Glossary.
Factitious Disorders
There are three branches to the sub-group of clinical disorders referred to as factitious: Munchausen syndrome, malingering, and general factitious disorder. Please make note of the subtle differences among them.
Individuals with factitious disorder exaggerate complaints, induce symptoms, or pretend they have an illness. They do this to get noticed – to get attention from others and to lessen any expectations placed on them. Such individuals are not faking their disorders to get insurance money or drugs although this may result from their actions. Factitious disorders often resemble Munchausen syndrome as some patients consciously imitate specific symptoms of an illness by traumatizing their skin, injecting themselves with insulin, or causing an allergic reaction in themselves by purposefully being around or consuming a known allergen to which they are sensitive.
Individuals with factitious disorder seek medical attention, but they will sabotage their own treatment with self-induced or self-perpetuated disease. Such patients differ from individuals with Munchausen syndrome because they generally feign only one illness and act on this urge only during times of major psychosocial stress. Unlike individuals with Munchausen syndrome, those with factitious disorder do not tend to visit one hospital or physician after another.
PART B
Munchausen Syndrome
Individuals with Munchausen syndrome pretend to have a physical illness and go from hospital to hospital seeking treatment. Often patients are very convincing with their portrayal of their chosen disorder. They may cut themselves, break bones, and induce fever from bacterial cultures to produce specific symptoms. Although individuals with Munchausen syndrome seek medical attention for physical injuries or illnesses, their true problem is a psychiatric one.
Individuals suffering from Munchausen syndrome generally have severe emotional difficulties, have histrionic personality features, and are intelligent. Patients know how to imitate the symptoms of their chosen disease and are quite knowledgeable of medical practices. Many individuals with Munchausen syndrome have had childhoods riddled with emotional and physical abuse. Patients have problems surrounding their self-concept and identity. They also have poor impulse control, a deficient sense of reality, short psychotic episodes, and unstable interpersonal relationships. They have an irresistible need to be taken care of, yet they do not trust authority figures and, instead, manipulate and provoke them. A unique variation of Munchausen syndrome is Munchausen syndrome by proxy. In these situations another person, usually a child, is used as a “substitute” patient by another individual, often a parent. The child may be purposefully injured (e.g., drugged), or their urine and stool samples contaminated to simulate disease.
Such parents seek medical care for their child, fabricate their child’s medical history, and appear deeply concerned and protective. The child is often gravely ill, requires frequent hospitalization, and may even die. A Hollywood example of Munchausen syndrome by proxy can be seen in the movie, The Sixth Sense.
PART B
Malingerers
Malingerers have symptoms very much like those of factitious disorder. Individuals exaggerate, self-induce, or pretend they have an illness, not only to get attention from others, but also to earn some type of external reward such as disability payments, insurance money, drugs, or other items.
Video: Factiticious Disorder, Munchausen Syndrome and Malingerers
Video: A patient on the popular TV show Grey's Anatomy portrays an patient with factitious disorder in this clip:
DISEASE OR DECEPTION?
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THE MYSTERY OF FACTITIOUS DISORDERS Jenny (a pseudonym) was one of those “invisible” people we all know and overlook each day. A secretary for a manufacturing company, Jenny was as a diligent employee, but one who had not developed many friends at work. Nevertheless, she seemed to find all the companionship she needed in her relationship with her live-in boyfriend. Week in and week out, her world seemed never to change, and yet she seemed satisfied. Then one day, everything suddenly and quietly fell apart. Jenny’s boyfriend announced he was leaving her; he had fallen in love with another woman and was moving out. Horrified and adrift, with no one to call on for comfort, Jenny chose a remarkable way out of her loneliness. She mobilized an instant support network by showing up at work one day and announcing, “I’ve just been diagnosed with breast cancer. And it’s too late. It’s terminal.” It was also a lie. Jenny had found a remarkable and desperate way to mobilize an instant support network of sympathetic co-workers. Eventually she enrolled in a breast cancer support group, shaved her head to mimic the effects of chemotherapy, and dieted to lose 50 pounds all to keep the illusion alive. Jenny was suffering not only from a broken heart, but from an emotional ailment called “factitious disorder.” People with factitious disorder feign or actually induce illness in themselves, typically to garner the nurturance of others. In bizarre cases called “Munchausen syndrome by proxy,” they even falsify illness in another person (such as their own children) in order to garner attention and sympathy for themselves as the heroic caregiver. Desperate? Of course. Yet more common than you might think. Experts estimate that one percent of hospitalized patients are faking their ailments. The medical bills in one case alone amounted to $6 million. Clearly factitious disorders are sapping an already-burdened health care system. They also defy the imagination. Patients have bled themselves into anemia and then showed up at a doctor’s office stating they haven’t a clue about how they became so ill. Others have secretly taken laxatives to induce diarrhea, or mimicked seizures so convincingly that neurologists hospitalized them on the spot. The good news: this phenomenon is finally coming out of the closet. In recent months, newspapers, magazines, and TV news programs have all described cases of factitious disorder, helping both health professionals and the general public to become aware. At the same time, factitious disorder patients are recognizing that, twisted as their behaviour may seem even to themselves, help is available. In Jenny’s case, the ruse of cancer came crashing down when the leaders of the breast cancer support group discovered that she had lied about her medical care. Referred for psychiatric care, Jenny revealed feelings of overwhelming depression, and this deep depression had fueled her factitious behaviour. Treated with antidepressant medication and psychotherapy, Jenny ended her illness portrayals and moved on-- decisively--with her life. She has never resorted to factitious illness again. The first step for factitious disorder patients is to realize they cannot go it alone. Though this is a hurdle they inevitably find intimidating, they simply must reach out to a therapist. The therapist can help them realize why the feigned illnesses began in the first place: why had the need for sympathy become so intense? The therapist can also discover underlying emotional problems--as in Jenny’s case--that must be treated at once, and also provide the very caring these patients had previously had to go to extremes to elicit. Finally, the therapist can help teach the patient ways to get needs met without resorting to self-defeating, and even literally self-destructive, actions. Families who suspect that a loved one has factitious disorder are invariably hungry for education about it. Consulting with a knowledgeable professional or reading about the disorder are important steps to take before they actually confront the patient. Heavy-handed, punitive confrontation doesn’t work. Instead, we now know that factitious disorder is among the trickiest of psychological ailments to address, and intervention must be informed, carefully planned, and, above all, humane. |
PART B
Mood Disorders - BIPOLAR Disorder
Depression and bipolar disorder are two of the most common mood disorders in North America. With bipolar disorder, individuals experience extreme mood swings interspersed by periods of more balanced and stable moods and behaviour. There appears to be a genetic link to bipolar disorder because it tends to run in families. Typically, this disorder presents itself in the early twenties and continues throughout the life of the afflicted person. Without treatment (usually drug therapy), individuals with bipolar disorder may experience marital difficulties, job loss, substance abuse, and suicidal thought. Please see Table 3.1 for symptoms of bipolar disorder.
Table 3.1:
| Manic Phase | Depressive Phase |
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• increased energy and activity |
• fatigue |
Video: Depression and Bi-polar disorder
Video: Demi Lovato's speaks about her experience with Bipolar Disorder
Click on the link below to learn more about bipolar disorder:
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Teen Mental Health http://teenmentalhealth.org/learn/mental-disorders/bipolar-disorder/ |
*Please note: all names used in the following case studies have been changed to protect privacy.
PART B
Bipolar Disorder - Case Study 12
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Description Abigale, a 24 year-old copy editor who had just moved to a new city, sought help from a psychiatrist regarding her on-going treatment with lithium, a mood stabilizer. She told the doctor that three years ago, while attending college in her senior year, she began to experience depression and a loss of appetite that resulted in a weight loss of about ten pounds. Abigale explained that she had trouble falling asleep and often awakened too early - unable to sleep any longer. Before the onset of these symptoms, Abigale described herself as a happy person who did well at school and had many friends.
Abigale’s friends became alarmed at her change in behaviour and so took her to a hospital emergency room where she was admitted to the psychiatric ward after an evaluation. Further assessment of After about six weeks Abigale displayed none of the symptoms she had at the time of her admission, but she did note that she was sleeping a bit longer than normal (ten hours) and had a decrease in appetite. She was, however, found well enough to be discharged from the hospital to live with some friends. Unfortunately, after about eight months, Abigale was taken off of the lithium carbonate by the college psychiatrist only to have her symptoms reappear after a few months. She was admitted to the hospital again with almost identical symptoms of her first visit. She was placed back on her medication and has been doing well ever since. Her move to a new city because of a job promotion necessitated finding another psychiatrist to manage her treatment. As for Abigale’s familial history, her father had severe depression in his 40s. The depression was characterized by hypersomnia (sleeping too much), anorexia, a slowing of body movements, and suicidal thoughts. Her father’s mother (Abigale’s grandmother) also suffered from depression and had committed suicide during a major depressive episode. |
Diagnosis Abigale was functioning quite well before the onset of her unusual behaviour. Starting with the development of a depressive episode (depression, loss of appetite) and changing to a period of mania (elation, irritability, low sleep requirements, delusions-radar messages, auditory hallucinations), it became evident that Abigale was suffering from a mood disorder. Many of Abigale’s symptoms also characterize schizophrenia (delusions and hallucinations), but because they occurred only in the manic phase, schizophrenia was ruled out. A diagnosis of bipolar disorder was made because no organic cause was found and Abigale did not abuse any stimulants or other drugs that may produce similar symptoms. Because Abigale was symptom-free for over six months (still taking her medication) and functioned well in her day-to-day life, she was considered to be in “full remission” with a high GAF. Please see below for her full DSM diagnosis. Axis I: Bipolar Disorder, Manic, in Full Remission Axis II: No diagnosis or condition Axis III: None Axis IV: Psychosocial stressors: none Axis V: Current GAF: 80 Axis V: Current GAF: 80 |
She told the psychiatrist that the above symptoms lasted about two months only to be replaced by feelings of increased energy and a reduced need for sleep – from two to five hours per night. She noted that her thoughts would race during these “energetic” phases and that she would see symbolic meaning (especially sexual) in ordinary things. She began to imagine that comments on television shows were directed to her personally and she became increasingly ecstatic, irritable, and verbose (talkative). Abigale began to believe that radar messages were being sent to her through a hole in her head. The messages, from other people, were believed to be beyond her control and had power over her emotions and thoughts. She also believed that other people could read her thoughts at will. Abigale also heard voices that sometimes spoke to her in the third person. 
Abigale on the following day resulted in her being placed on three drugs (an antipsychotic, chlorpromazine, and lithium carbonate). Over the next month Abigale’s symptoms decreased rapidly and her medication was modified to consist of only lithium carbonate.
PART B
Mood Disorders - DEPRESSION
Video: Ellie's Depression
Depression is known to have many causes, including a possible genetic link. From the loss of a loved one, losing a job, and financial difficulties, to thyroid problems and nutritional deficiencies, depression is a complicated condition and can be difficult to treat. Unfortunately, the number of individuals suffering from depression has steadily increased over the past decade, especially in teenagers and young adults. This disorder, the most common of all psychiatric disorders, affects more women than men. It is characterized by decreased interest or pleasure in most activities (if not all) and a depressed mood for most of the day, every day, for more than two weeks. In addition to these symptoms, a person must present five or more of the following for a diagnosis of depression to be made.
Table 5.1:
Symptoms of Depression
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Symptom
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Mood:
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Thinking:
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Body Sensations:
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People with depression are at increased risk for suicide, especially if the depression is left untreated. Pay attention to your friend's/family's behavior and be aware of the warning signs that he or she may be contemplating suicide:
If you know someone that you think may be contemplating suicide, ask him or her about it and let him or her know you are concerned. Make sure they get professional help. |
A unique form of depression, referred to as seasonal affective disorder (SAD), is associated with seasonal changes in the amount of available daylight. Treatment for this type of depression usually involves having the patient spend time under special lamps that use full-spectrum emission bulbs, for a prescribed period of time each day. Individuals with a predisposition to SAD and who live in parts of the world with little sunlight during certain times of the year (such as the northern hemisphere) or with much cloud cover for weeks on end (such as Vancouver) are more likely to develop this type of depression.
Regarding the more pervasive forms of depression, treatment often involves cognitive-behavioral therapy and/or interpersonal therapy combined with medication, the three major types of which are tricyclics, selective serotonin re-uptake inhibitors (SSRIs), and monoamine oxidase inhibitors. These medications help depressed people by preventing the re-uptake of the neurotransmitters norepinephrine and serotonin in the brain. Individuals must be careful with antidepressant drugs, however, because they each can have adverse side effects.
It is important to note that most antidepressant drugs have not been widely tested on children and teenagers. Therefore, they must be prescribed with caution. What is known is that careful monitoring of depressed individuals is required – especially when patients begin treatment or when their medication is increased or decreased.
Video: Caet's experience with depression
When traditional treatments (medication and therapy) are not effective, clinicians may try electroconvulsive therapy (ECT). ECT involves applying a small amount of electricity (not enough to hurt the individual) to the scalp. The electricity is believed to stimulate important neurotransmitters in the brain that act to alleviate depression. ECT, while highly controversial, can be potentially life-saving when other therapies fail or when a person is seriously ill (mentally or psychologically) and/or unable to take medication.
Once depression is recognized, help can make a difference for 80% of people who are affected, allowing them to get back to their regular activities.
Refer to the web site below to learn more about depression.
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Teen Mental Health http://teenmentalhealth.org/learn/mental-disorders/depression/ |
PART B
Mood Disorders - DEPRESSION Part 2
The following article (reprinted with permission from the Edmonton Journal, 2004), details the experience of a courageous Edmonton resident with depression.
“During depression, the world disappears”
Kate Millett, author of The Loony-Bin Trip
“Last February I was treated for severe depression after my co-workers found me passed out and frozen to the ground in our Global parking lot,” Olivia Cheng wrote in an e-mail to ed editor Therese Kehler. “The event blew my dirty little secret out in the open after months of hiding the fact that I was losing my mind.” During her recovery, the 24-yearold Global Television reporter struggled to find out what was happening to her, only to find that there’s a sad lack of information available to young people. In hopes of changing that, she has written this very personal account of her slide into blackness… and her long journey back.
On February 19, 2003, my façade of normalcy was stripped away after months of hiding an illness I’d masked out of fear and ignorance. At the age of 23, I was denying the demons of depression because I was too proud to admit they’d sunk their claws into my mind.
I remember forcing myself out of bed that morning after another night of depression-induced insomnia. I insisted on going to work even though I could barely walk in a straight line. My parents tried to take my car keys away but in a stubborn daze, I swore at them and drove off.
I pulled up to the Global Television studio just before my nine o’clock shift as a news reporter, dreading the thought that, in mere minutes, I’d have to paste a smile on my face and assume the role of cheerful go-getter. Exhausted and light-headed, I stepped out of my car and then watched the snow-covered ground rush towards me as I passed out.
About an hour later, a co-worker spotted me lying between two cars, frozen to the ground.
‘My hair started turning white and falling out!’
I started staying away from my friends. Even though it made no sense, I felt isolated and disconnected from people I’d known for years. Plus, the slightest thing would trigger uncontrollable crying fits, or worse, frightening rages. My mood swings caused me to withdraw further.
I hated myself for not being able to “snap out of it.” And I didn’t want my friends to see how screwed up and neurotic I was becoming. The one person I didn’t hide anything from was my boyfriend who, like me, puzzled over what was happening.
Home offered no escape from pressure either.
Tensions ran high as my family struggled with major illnesses, loss of employment and other hardships. I felt under pressure to “fix things” for loved ones whose problems seemed so much bigger than mine. Trapped in the role of unwilling social worker and referee, my hair started turning white and falling out, while my neck and shoulders stiffened painfully with hard knots of tense muscles.
At this point, since I thought all my problems stemmed from lack of sleep, I walked into a medicentre to score some sleeping pills. When I made my request, the doctor drilled me with questions until he gently told me I was likely depressed.
My reaction was indignant. “No, Doctor, I’m not crazy. If I seem like I have depression, it’s only because I haven’t slept in days. Just give me some sleeping pills and I’ll be OK.”
The doctor urged me to go on anti-depressants, but I refused. I didn’t understand what depression was and I was insulted to be categorized with unstable people. I insisted on sleeping pills and left.
But the pills didn’t work. Nor did any of the different sleeping aids, tranquillizers or muscle relaxants I was given over the next few weeks. The drugs only left me in a zombie-like stupor. Or maybe I was just becoming a zombie from the mental drain of pretending everything was OK.
Two days before I passed out at work, I returned to the medicentre in a frantic state. I hadn’t slept for at least five days straight and I was desperate for a drug to knock me out. Unfortunately, there was a three-hour wait to see a doctor and I was in no state of mind to wait around.
I stumbled out of the medicentre and hid behind a dumpster as tears of anguish poured out of me. I stayed there until my boyfriend came to get me. The next day, I was devastated again to find out that it was my doctor’s day off. I crawled into bed that night hoping for sleep. I was helpless when it did not come.
You know what happens next.
Crisis hotline was a lifeline
Later that awful morning of February 19, doctors in the hospital ran numerous tests to check for heart conditions or other physical problems to explain my fainting. Twisted as it sounds, I secretly hoped something was wrong with my body, not my mind.
When I was able to get out of bed, I dragged my IV into the bathroom and was disgusted by my appearance in the mirror. A pair of bloodshot eyes ringed by dark circles stared back at me. My skin looked grey against the green hospital gown.
Worst of all was my expression. I looked lifeless.
After hours of tests, the doctor eventually told me what I already knew. Nothing was wrong with me in the physical sense. I was simply exhausted and had mixed too many sleeping pills. The hospital physician agreed with her counterpart at the medicentre: I was depressed.
Close to tears, I asked, “Now what?” but she had no advice to offer. I was given another prescription for sleeping pills and urged to go on anti-depressants.
Later that night, I lay curled up on the floor of my room feeling paralyzed and overwhelmed. I had to go back to work tomorrow, didn’t I? What would I say?
Even as I returned phone calls to concerned co-workers, I lied through my teeth about what was wrong. I was adamant they couldn’t find out I was losing it.
After I hung up the phone for what I thought would be the last time that night, I spotted it—a card stuffed behind some books with the phone number for Global’s confidential distress line. I called the number and was connected to a lifeline.
A kind counsellor explained what depression was, talked about how common an affliction it is and insisted on setting me up with emergency counseling.
Looking back, the day’s series of awful events turned out to be a blessing in disguise.
I was finally forced to make a crucial choice: accept the depression and deal with it or go on fooling myself and never get better.
I started taking anti-depressants the next day and was prescribed a two-month medical leave.
Support of friends a blessing
Two months. That’s how long it takes for anti-depressants to become fully effective.
The medication was awful at first. The initial dosage was too strong and I numbly watched the world float by. It took a couple of weeks to figure out what I could handle.
I also started going to counseling. I hated it. Talking to a stranger about my problems went against every Chinese cultural value I’d ever learned about saving face and staying stoic in the face of hardship.
Because my pride still proved to be the greatest obstacle to my recovery, my counselor, Marie, spent the first few sessions simply reinforcing that depression is a medical illness, not a product of a weak and damaged personality. When I stopped resisting her, Marie slowly helped me understand that I was no good to anyone if I didn’t admit that I needed help, too.
I also learned how people with my anally perfectionist, type-A personality are more prone to depression because of the impossible expectations we set for ourselves.
Sleep-wise, I was finally on a blue pill that offered me the rest that had eluded me for months.
However, as my mind cleared, being in Edmonton felt like a constant guilt trip. Reminders of my failure both at home and at work plagued me. It didn’t help when strangers recognized me and asked why I hadn’t been on TV for the last while.
On a whim to get out of a city that symbolized so much misery, I bought a one-way ticket to Seattle to visit a girlfriend. I only meant to stay a few days and ended up staying a month.
Gradually, the panic attacks, neck pain and headaches stopped. I found my sense of humor again and was taken aback when I laughed for the first time in a long time.
I started telling my friends in Edmonton about my depression. Their steadfast support was a huge relief. Many of them couldn’t believe I’d been too ashamed to tell them sooner.
Meanwhile, through the inevitable bad days, my wonderful boyfriend wouldn’t let me give up on myself. It meant the world to know he still loved me at my worst.
The slow, painful journey back
Once my two-month medical leave was up, I faced the frightening step of going back to the real world.
The thought of re-entering the fast-paced, high-stress world of news made me want to hide under my bed. How would I keep up? How would my co-workers treat me after all this time away? I had no scars, bandages or other tangible evidence to prove I’d really been sick. I dreaded their judgment.
However, to my genuine amazement, my Global family was extremely supportive and protective.
Many of my workmates guessed I’d been depressed and went out of their way to help me get back on my feet. My wonderful boss, Tim Spelliscy, scheduled me to come in a few hours a day, a few days a week to let me ease back into things. He even brought in reporters from Red Deer to cover my shifts. That eliminated the pressure to “hurry up and get better.”
Left to recover at my own pace, I stayed behind the scenes and filed small stories.
It took another two months for me to venture in front of the camera again.
Talk can end the taboo
I know how lucky I am. I’ve survived an illness that evokes shame, stigma and silence in too many of its sufferers. I don’t know if I can ever say I’m fully recovered because the fear of relapse always lurks in the shadows of my mind.
In researching depression, I’ve come across others who’ve permanently lost their livelihood, relationships and self-worth because they never received the help they needed. Sadly, there’s a sore lack of awareness when it comes to the “Black Dog,” as Winston Churchill named his own haunting depression. Maybe that’s why the mentally ill are so misunderstood.
But take a closer look at all the “normal people” around you. At least one of them has battled, or is battling, mental illness. They just don’t like to admit it, and can you blame them? A physical ailment produces stacks of get well-soon cards. Mental agonies are eclipsed by hushed whispers of “What’s wrong with them?”
I’m not trying to crack a bitter whip of holier-than-thou proportions here. I’m just trying to sound the alarms of a wake-up call, because the only way to tear down the taboo surrounding depression is to encourage people to talk about it.
Otherwise, the deafening silence will continue to drown out the cries of those chained to depression’s dark dungeon.
And if you really think you don’t know of someone who’s been to that hellhole… you do now.
Me.
Lesson Review
Lesson 1 Part B draws to a close. Fictitious Disorders are intriguing, don't you think?
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To summarize: • There are three branches to the sub-group of clinical disorders referred to as factitious: Munchausen syndrome, malingering, and general factitious disorder. • Individuals with Munchausen syndrome pretend to have a physical illness and go from hospital to hospital seeking treatment. Although individuals with Munchausen syndrome seek medical attention for physical injuries or illnesses, their true problem is a psychiatric one. • Malingerers have symptoms very much like those of factitious disorder. Individuals exaggerate, self-induce, or pretend they have an illness, not only to get attention from others, but also to earn some type of external reward such as disability payments, insurance money, drugs, or other items. • Individuals with factitious disorder exaggerate complaints, induce symptoms, or pretend they have an illness. They do this to get noticed – to get attention from others and to lessen any expectations placed on them. |
Assignment
Complete the S3L1A_BQuiz - You may refer to your lesson while you complete this quiz.