PSY 408 – ABNORMAL PSYCHOLOGY

(Durand, Barlow, & Hofmann, 2019)

(Durand, Barlow, & Hofmann, 2019, p. 476)
(Durand, Barlow, & Hofmann, 2019, p. 476, 516)
Durand, V. M., Barlow, D. H., & Hofmann, S. G. (2019). Essentials of Abnormal Psychology. Cengage.
UNIT ESSAY EXAM (WRITING ASSIGNMENT) #4

CHAPTER 12: SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS (PG. 444-475)
1. Which of the symptom types of schizophrenia might be most distressing or debilitating? Explain.

Schizophrenia is a highly stigmatized, undoubtedly complex, and severe mental illness that profoundly impacts
and disrupts nearly every aspect of an individual’s daily functioning and the lives of those around them. This psychotic
disorder encompasses a broad spectrum of different presentations and combinations of symptoms, including positive
symptoms (active presentations of delusions and hallucinations), negative symptoms (deficits in normal behaviors and
abilities), and disorganized symptoms (erratic behaviors affecting speech, emotive reactions, and motor functions)
(Durand, Barlow, & Hofmann, 2019). While all symptom types can be distressing and debilitating and their presence (or
absence) can vary in occurrence, positive symptoms of schizophrenia, in particular, are significantly detrimental to an
individual's requisite functioning and overall quality of life.

Positive symptoms of schizophrenia are the more obvious features that characterize this debilitating psychotic
disorder. This symptom type encompasses the active manifestations of abnormal behavior, including hallucinations,
delusions, or both; with a reported 50-70% of people with this diagnosis experiencing these defining features (Durand,
Barlow, & Hofmann, 2019). Positive symptoms can be particularly distressing due to their intrusive and often frightening
nature. Hallucinations, especially auditory, where individuals hear voices that others cannot, can create significant
emotional distress and confusion. If fact, a reported 70% of experience this phenomenon, making it the most common
imagined perceptual disturbance among individuals with schizophrenia (Durand, Barlow, & Hofmann, 2019). Delusions,
another hallmark of positive symptoms, are fixed false beliefs that can cause individuals to feel paranoid and anxious,
leading to a profound impact on their daily life and interactions. While the text lists several types of unusual beliefs,
including delusions of grandeur (a conflated sense of undue fame or power), Capgras syndrome (being replaced by a
double), and Cotard’s syndrome (the belief that he or she is dead), the most common and perhaps most disturbing, are
delusions of persecution (Durand, Barlow, & Hofmann, 2019). This particular delusion reinforces the paranoia and distrust
that makes it truly detrimental for afflicted individuals throughout their daily lives, social interactions, and ultimately,
seeking and maintaining proper treatment. Any combination of positive symptoms, coupled with the fact that most of these
individuals lack insight, a genuine self-awareness of their condition, perpetuates their lack of receptiveness and non-
compliance to established treatment plans, making this particular symptom type one of the more distressing and
debilitating (Durand, Barlow, & Hofmann, 2019).

Negative symptoms, marked by the absence or attenuation of normal behaviors and expressive normalities, can
also be highly debilitating and distressing. Approximately 25% of individuals with schizophrenia display this secondary
symptom type, including avolition (or apathy), alogia (relative absence of speech), anhedonia (lack of pleasure), asociality
(reduced interest in social engagement), and affective flatting (demeanor and speech devoid of emotion), which is present
within ¼ of individuals with this diagnosis (Durand, Barlow, & Hofmann, 2019). Symptoms like social withdrawal, flattened
affect, and lack of motivation can make it challenging for individuals to engage in daily activities, such as retaining gainful
employment or maintaining relationships. Moreover, the absence of motivation and social engagement can perpetuate
feelings of loneliness and despair, further impacting their quality of life and the likelihood of exacerbating comorbidity and
compromising treatment adherence. Fortunately, after a decades-long innovative longitudinal study observing the
expression of affect within high-risk, genetically-predisposed children, researchers deduced that emotional expression is a
predictive indicator of the disorder during our formative years (Durand, Barlow, & Hofmann, 2019).

While symptoms are most commonly distinguished as either positive or negative in a clinical setting, this tertiary
subtype of schizophrenic symptoms proves to be an integral aspect characterizing this disorder (Durand, Barlow, &
Hofmann, 2019). One could infer that the prevalence of these behaviors is unclear because they are the least studied and
least understood of the aforementioned symptoms (Durand, Barlow, & Hofmann, 2019). Disorganized symptoms, the
categorically least studied and understood of the symptom types, describe a variety of erratic behaviors that include
disorganized speech and inappropriate affect. As typified by the patient-therapist dialogue carried throughout chapter 12,
David’s (the patient) response illustrates the tangential prose synonymous with the condition and characteristic of the
symptom type’s namesake (Durand, Barlow, & Hofmann, 2019). The text also recognizes the loose association or
derailment exhibited by David’s inability to provide a relevant response to the therapist’s question (Durand, Barlow, &
Hofmann, 2019). As with the previous aforementioned symptom types, the behaviors encompassed by the disorganized
category make it understandably difficult to communicate on any meaningful level. Another disorganized symptom
includes inappropriate affect, defined as an “active” behavior where an individual engages in otherwise unusual behaviors.
This can manifest into episodes of catatonia (inability to move normally), noted as one of the most curious symptoms of
the disorder; evolve into catatonic immobility (holding unusual postures), which can include waxy flexibility (resistance to
mobility, as if positioned by someone else), engaging in hoarding, and exhibiting inappropriate affect (improper emotional
display) (Durand, Barlow, & Hofmann, 2019). Despite the elusiveness of this particular symptom type, early interventional
strategies and a multi-dimensional approach comprised of neuroleptics, psychosocial modalities that reinforce appropriate
behaviors elicited through token economies, and other integrative treatment approaches that span across employment
and environmental efforts prove most effective in assisting these individuals achieve higher levels of quality of life
(Durand, Barlow, & Hofmann, 2019).

In conclusion, schizophrenia is a complex mental disorder marked by a broad spectrum of various presentations
and combinations of both distressing and debilitating symptoms. While positive symptoms, marked by active
presentations of delusions and hallucinations, can be distressing, negative symptoms, characterized by deficits in normal
behaviors and abilities, can be incredibly debilitating as well. Additionally, disorganized symptoms, comprised of erratic
behaviors, can also greatly interfere with daily functioning and the ability to live a productive life. The presence or absence
of these characteristic features, coupled with the stigmatization, comorbidity, societal costs, and other variables, make this
life-long disorder especially critical to understand the impact and challenges associated with these symptoms to best
support afflicted individuals in their recovery journeys.

References:

Durand, V. M., Barlow, D. H., & Hofmann, S. G. (2019). Essentials of Abnormal Psychology. Cengage.