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Case Studies in Abnormal Behavior
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ISBN 978-1-29202-795-1 o
n
Robert G. Meyer Christopher M. Weaver
Ninth Edition
9 781292 027951
Pearson New International Edition
Case Studies in Abnormal Behavior
Robert G. Meyer Christopher M. Weaver
Ninth Edition
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ISBN 13: 978-1-292-02795-1
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P E A R S O N C U S T O M L I B R AR Y
Table of Contents
1. Concepts of Abnormality
Robert G. Meyer/Christopher M. Weaver 1
2. Theories and Techniques
Robert G. Meyer/Christopher M. Weaver 13
3. The Anxiety Disorders
Robert G. Meyer/Christopher M. Weaver 29
4. The Dissociative and Sleep Disorders
Robert G. Meyer/Christopher M. Weaver 57
5. The Somatoform Disorders
Robert G. Meyer/Christopher M. Weaver 71
6. The Schizophrenic and Delusional (or Paranoid) Disorders
Robert G. Meyer/Christopher M. Weaver 85
7. The Affective (or Mood) Disorders and Suicide
Robert G. Meyer/Christopher M. Weaver 103
8. The Psychosexual Disorders
Robert G. Meyer/Christopher M. Weaver 127
9. The Substance Use Disorders
Robert G. Meyer/Christopher M. Weaver 161
10. The Eating Disorders: Anorexia Nervosa and Bulimia Nervosa
Robert G. Meyer/Christopher M. Weaver 181
11. The Personality Disorders
Robert G. Meyer/Christopher M. Weaver 197
12. Disorders of Impulse Control
Robert G. Meyer/Christopher M. Weaver 229
13. Disorders with Violence
Robert G. Meyer/Christopher M. Weaver 241
I
223359139313
14. Disorders of Childhood and Adolescence
Robert G. Meyer/Christopher M. Weaver 259
15. Organic Mental Disorders and Mental Retardation
Robert G. Meyer/Christopher M. Weaver 293
16. References
Robert G. Meyer/Christopher M. Weaver 311
Index 333
II
Concepts of Abnormality
Adultery: Consensual non-monogamy.
Corrupt: Morally challenged.
Looters: Nontraditional shoppers.
Drug addicts/alcoholics: People of stupor.
Sadomasochists: The differently pleasured.
A Few Entries from Henry
Beard and Christopher Cerf,
The Official Politically Correct
Dictionary and Handbook
T
he case of O. J. Simpson, discussed later, dramatically highlights some of the problems
in merely defining abnormal behavior. A traditional method of defining abnormal
behavior has been to use statistical norms (Kring, Johnson, Davidson, & Neale, 2010).
However, this only establishes extremes and does not per se discriminate between positive
and negative patterns or characteristics. To address this lack of dimensionality, this approach
has also been combined with evaluations of impairment, given that the relationship between
level of impairment and abnormality may help to determine what is psychopathological and
what is not (Markon, 2010). Unfortunately, even utilizing this method, some widespread pat-
terns (e.g., drunk driving, anxiety) may be labeled as normal because of their commonness.
Defining abnormality as the absence of optimal or ideal characteristics is another
possibility. The problem, however, is then simply shifted: What is “optimal” and who decides
(Meyer & Weaver, 2006; Schneider & Leitner, 2002)? Also, most normal individuals are not
that close to “ideal.”
In any case, most people will generally agree that abnormal behavior is behavior that
significantly differs from some consensually agreed-upon norm and that is in some way harmful to
From Chapter 1 of Case Studies in Abnormal Behavior, Ninth Edition. Robert G. Meyer, Christopher M.
Weaver. Copyright © 2013 by P earson Education, Inc. All rights reserved.
1
Concepts of Abnormality
the differently behaving person or to others (Stein & Foltz, 2009). More specifically, components
of a judgment of abnormality often include the f ollowing descriptors:
Deviant Deviant refers to behavior that d iffers markedly from socially accepted
standards of conduct. In many cases, the word has negative connotations
(Crane & Platow, 2010).
Different Different also suggests behavior that varies significantly, at least
statistically, from the accepted norm, but it does not usually have negative
connotations.
Disordered Disordered implies a lack of integration in behaviors; the result may be
impairment of a person’s ability to cope in various situations.
Bizarre Bizarre suggests behavior that d iffers extremely from socially accepted
norms. In addition, it c onnotes i nadequate coping patterns and d isintegration
of behavioral patterns.
One phenomenon that results from the continuum issue, commonly known as “interns’ d isease,”
is that students who first study mental health diagnoses become convinced that they and e veryone
around them has a mental disorder. Of course, this is highly unlikely.
If we like a man’s dream, we call him a reformer; if we don’t like his dream we call him a crank.
—William Dean Howells,
Writer (1837–1920)
The DSMs
Even though there are valid criticisms of the DSMs (Flaskerud, 2010; Greenberg, Shuman, &
Meyer, 2004), it is the official document of the American Psychiatric Association, it is approved
by the American Psychological Association, and it is well respected by all v arieties of mental
health workers, both nationally and internationally. The first DSM was published in 1952,
DSM-II in 1968, DSM-III in 1980, and DSM-III-Revised in 1987. There were numerous changes
from DSM-III-R to DSM-IV-TR, published in 1994, with further changes in DSM-IV-TR in 2000
(American Psychiatric Association, 1994, 2000). Indeed, the simple listing of changes took
up 28 pages in the DSM-IV-TR book. A concise list of some of the more important changes
is as follows: Only the Personality Disorders and Mental Retardation remain on Axis II;
Rett’s Disorder, Childhood Disintegrative Disorder, and Asperger’s Disorder have
been added as Childhood Disorders; there is no separate category of Attention Deficit
Disorder, it is subsumed under ADHD; there is now a separate overall category of Eating
Disorders; there are now two separate Bipolar Disorders, with Bipolar Disorder I referring to
2
Concepts of Abnormality
the traditional, severe form, where both recurrent manic and depressive patterns are observed;
the phrase “outside the range of normal human experience” has been deleted as a criteria for
PTSD, and the related category of Acute Stress Disorder has been added; the term Multiple
Personality Disorder has been changed to Dissociative Identity Disorder; Passive-Aggressive
Personality Disorder has been deleted as an Axis II Personality Disorder but has been
retained in revised form as a “Criteria Set . . . for further study”; two new patterns in “other
conditions that may be a focus of clinical a ttention” are “Religious or Spiritual Problem” and
“Acculturation Problem.”
RaTes of MenTal DisoRDeRs
There have been numerous efforts over the last several decades to effectively apply
definitions of abnormality to determine overall rates of mental disorder. Earlier endeavors
provided some useful data. However, the first major study is known as the Epidemiologic
Catchment Area (ECA) study wherein researchers interviewed 17,000 individuals in
five different cities/areas. They found a 33 percent lifetime prevalence rate, with anxiety
disorders as the most common disorder type. They also looked at rate differential among
different geographic areas: Schizophrenia, organic brain disorder, alcohol and drug abuse,
and antisocial personality disorder were highest in the central city, less so in the suburbs,
and lowest in rural areas; depression was somewhat evenly distributed; and somatization
disorders, panic disorders, and some affective disorders were a bit higher in rural/small town
areas. The only disorder more common in the suburbs was obsessive-compulsive disorder
(Robins & Regier, 1990).
A subsequent set of two studies, the National Comorbidity Study (NCS) and the NCS-
Replication (NCS-R), was even more extensive than the ECA. They had numerous
methodological improvements and “sampled” the entire U.S. population (Kessler, Berglund,
Demler, Jin, & Walters, 2005). They c oncluded that the l ifetime prevalence rate of having
any DSM-IV-TR disorder is a pproximately 45 p ercent. However, because they did not include
schizophrenia, eating disorders, autism, or several of the personality disorders in this specific
assessment, it is reasonable to infer that the lifetime prevalence rate of mental disorders is over
50 percent. Because these were b etter-designed studies than the EPA study, one has to give
more credibility to the 50 percent figure. In the NCS and NCS-R studies, anxiety disorders
are the most prevalent c ategory, and the most common specific disorders are major depression,
specific phobias, and a lcohol abuse. Of course, some of the disordered individuals included in
these statistics manifested the d isorder only briefly and/or mildly. These s tudies also found a
high but variable level of comorbidity (two or more disorders in the same person at the same
time). Half of those with a severe disorder had a comorbid disorder, while only 7 percent of
those with a mild disorder had a comorbid disorder.
In general, all of the major studies s uggest that overall median age of onset is less than
25 years of age. There has been an i ncreasing prevalence of emotional disorder in persons born
after World War I, especially for a ffective disorders (Reinecke, Washburn, & Becker-Weidman,
2008). Also, it is estimated that about 20 to 30 percent of those diagnosable as mentally ill
never receive any treatment. And only about 20 percent of these receive care from mental health
specialists; most receive it from medical p ractitioners other than psychiatrists.
Matters relevant to these points, issues, and statistics will occur throughout this book, and
several are especially evident in this first case of O. J. Simpson.
3
Concepts of Abnormality
“Is Adolf Hitler crazy?” Bohner asked eventually—the sort of damn-fool question too many people ask as soon
as they hear a man is a psychologist.
—Len Deighton,
Goodbye, Mickey Mouse (1982, p. 136)
a PResuMably noRMal PeRson PoTenTially VieweD
as PaThological
The famous, or infamous, case of O. J. Simpson highlights many of the conceptual and diagnostic
dilemmas that often confront mental health professionals. What sort of psychopathology, if any,
led to his behavior within the episode of June 17, 1994? Was he a psychopath? Did he deteriorate
into some sort of psychotic state at some point? On what dimension(s) is he reasonably construed
as normal or abnormal?
CASE
STUDY
The Case of o. J. simpson
O. J. Simpson literally and figuratively ran to the perception of O. J. Simpson, in addition to
forefront of the American consciousness. We first appreciation of his substantial athletic talent, was
knew him as a dazzling running back at the of an easygoing, articulate individual—that is, as
University of Southern California (USC), where he normal, if not much more normal, as a nyone in
won the Heisman Trophy. Then he went to the pros the public eye. After that date, information kept
with the Buffalo Bills and the San Francisco accumulating to suggest a very different picture.
49ers where he was the first r unning back to gain O. J. was born on July 9, 1947, and was named
2,000 yards in one season and was named to the Orenthal James Simpson, the name Orenthal
Pro Football Hall of Fame in 1985. We next saw coming from an obscure French actor. His
him running through airports in Hertz Rent-A-Car early childhood appears to have been r elatively
commercials, during the time when he also had unremarkable, although his father had abandoned
some previously forgettable roles in movies such the family when O. J. was just a toddler. A reac-
as The Towering Inferno and The Naked Gun and tion against his awareness that his father was both
was a commentator on ABC Sports’ Monday Night gay and dysfunctional may in part explain O. J.’s
Football. However, he had b ecome an American alleged “macho” patterns. His mother, Eunice, a
icon, or, as one television executive commented, strong and supportive figure throughout his life,
“He was Michael Jordan before Michael Jordan.” raised O. J. and his three siblings by working as
Tragically, his running that most people now an orderly on a psychiatric ward.
remember was when we saw him r unning on Ironically, the boy who was to grow up to be
Friday night, June 17, 1994, when the nation one of the greatest running backs in football history
watched the police pursue him in his white Ford was called “Pencil Legs” as a child and had to
Bronco, along with his friend Al Cowlings, in wear leg braces until age 5 because of a diagnosed
an almost funereal march down a Los Angeles case of rickets along with a c alcium deficiency.
freeway. In sum, until June 17, 1994, the p ublic’s He remained pigeon-toed and bowlegged, and
4
Concepts of Abnormality
his deformed extremities contrasted with his He reportedly had a drug problem. He clearly
large head, subjugating him to taunts such as did use marijuana. A Buffalo television station
“Headquarters” and “Waterhead.” reported that the owner of a bar that Simpson
However, as O. J. developed into adolescence, frequented stated that O. J. had been snorting
he moved from defense to offense. Although he coke during his years with the Bills and twice
was probably never a hard-core delinquent, he came very close to being busted. In any case, O. J.
came close. In junior high school, he became a was believed—at least by the NFL. He told
bully, and at age 14, he joined a “fighting gang,” Playboy magazine that he had experimented with
the Persian Warriors. He received his sexual drugs (marijuana) only once, as an adolescent,
initiation from the gang’s “ladies auxiliary,” and but that he “just pretended to take a hit.” Even
also managed to get caught stealing from a local President Bill Clinton didn’t try to say he “only
liquor store. The myth is that a talk with baseball pretended,” just that he didn’t inhale. Clinton
legend Willie Mays pushed him back onto a was not believed; O. J. was.
positive path. Reality is that his mother’s directing In the most publicized abuse incident, on New
him toward a small private Catholic school placed Year’s Eve of 1989, during his second m arriage,
him with a much more positive peer group and a hysterical and severely bruised Nicole came
also allowed him to attain a more positive identity out of the bushes in a bra and underpants to
by demonstrating his emerging athletic skills. He report “He’s going to kill me” to the officers
did so, leading the city in s coring his senior year. responding to a 911 call. When O. J. came out,
Recruiters came flocking. But, contrary to his he said, “I got two women and I don’t want that
image, O. J. was never overly bright, nor was he a woman anymore,” shouted at the officers, and
good student, and he didn’t have adequate grades drove off. But Nicole later refused to testify, and
for a major college. So he enrolled in the City charges were dropped. O. J. told Frank Olsen,
College of San Francisco. He starred in football and the CEO for Hertz (who paid O. J. a great deal as
was able to get grades that were at least a dequate its advertising spokesperson), and the public that
(and, in those days, adequate wasn’t much) to it was only an argument and was “no big deal
accept a scholarship at USC. There, he became an and there was nothing to it.” Olsen, Hertz, and
All-American, won the Heisman Trophy in 1968, the public believed. We all wanted to believe,
and gained “polish.” He learned to dress well, to and our behavior may be a form of abnormal
talk well, and to communicate an amiable and behavior, as it is certainly maladaptive.
easy-going image. However, he was not a student- O. J. had met his second wife, Nicole Brown,
scholar and dropped out before earning his degree. then 18 years old, in June 1977 at a nightclub
But he went on to stardom while a pro and then where she was waitressing. This was just before
gradually developed into an American icon, a celebrating his tenth wedding anniversary with
beloved and almost universally recognized hero. Marguerite, who was carrying their third child.
O. J.’s private life was less admirable. He was O. J. and Nicole were quickly involved, but O. J.
reputed as a chronic womanizer, but he told us and Marguerite were not divorced until later, in
that his devout Baptist wife “brings the Lord into 1980. The relationship with Nicole was stormy
our house and helps me when I sway” (and he from the beginning, as he was very controlling
swayed a lot). Although he stayed married for 11 (and she no doubt contributed in some f ashion)
years to Marguerite, the marriage was marked by and was easily made j ealous, although he was
several separations and by O. J.’s womanizing. reportedly already consistently unfaithful to her.
He also reportedly abused Marguerite. He denied When Nicole became pregnant in 1985, they
this. He was believed, as was often the case worked out a complex prenuptial agreement
(Kubany, McCaig, & Laconsay, 2004). and were married. The child was born on October
(Continued)
5
