Recognizing and Managing Student Psychopathology

electronic mail from a student

In order to maintain an effective and appropriate learning environment, the community college professor must be prepared to recognize and manage student psychopathology. This article will provide clear guidelines for identifying common categories of psychopathology (mental disorders) and straightforward strategies for managing psychopathological behaviors.

It is apparent that I don’t know right from wrong concerning boundaries and that I’m not ‘normal’ after all. That must be why I’m crying, too. I feel very disappointed in myself.

electronic mail from a student

As professors, we’ve all had at least one student in class who just didn’t seem "right." But we couldn’t quite put our finger on what was wrong and didn’t know what to call it. Psychopathology is the generic term psychologists use to describe abnormal behavior - behavior that is maladaptive or causes subjective discomfort. A mental disorder is similarly conceptualized as a syndrome or pattern of behavior that causes distress or impairment (American Psychiatric Association, 1994). Political, sexual, or religious deviance, in and of itself, however, is not sufficient to diagnose a mental disorder unless such deviance is a symptom of some particular dysfunction (American Psychiatric Association, 1994).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994) classifies and describes psychopathology or mental disorders in 16 major diagnostic classes. This article will address two of the 16 diagnostic classes most frequently encountered by the author in my role as both professor and psychotherapist: schizophrenic and other psychotic/mood disorders.

Several other of the remaining 14 major diagnostic classes (for example, Personality Disorders, Anxiety Disorders, and Substance-Related Disorders) are relevant to the community college population but are beyond the scope of this article.

The symptoms and behaviors described for each disorder are based on the criteria delineated in the Diagnostic and Statistical Manual of Mental Disorders (hereafter referred to as the DSM). Examples, quotations, and some of the symptoms described in this article come from the author’s experience with psychotherapy clients and college students.

I was scared because I was having weird thoughts¯ex., [sic] that cameras were watching me in the school.

electronic mail from a student

Schizophrenic and other psychotic disorders involve a loss of contact with reality. Most psychotic disorders include many or all of the following symptoms:delusions, hallucinations, disturbance in emotions, disturbance in thought, and disturbance in behavior

Delusions

Delusions are rigidly held false beliefs. Students will continue in their beliefs despite reasonable attempts to convince them that their beliefs are false or illogical. Delusional students will often misconstrue ordinary comments or class activities as having special significance or meaning intended just for them (ideas of reference). For example, I once mentioned to my class that I study the martial art of Tae Kwon Do. A student who had already expressed concern about the meaning of a particular class activity sent me the following electronic mail message:

I wonder if you know about [a previous conflict with another professor]. And if you know, are you concerned at having such a student in your class. You tell us you know Tae Kwon Do, and I wonder if you’re telling me specifically.

This student believed that I feared her and therefore that I was covertly trying to intimidate her during class. Another man bragged that he had received "a perfect score on my PSAT, SAT, GRE, LSAT, and MCAT and I speak English, Spanish, German, Russian, Latin, and Greek." These false beliefs are called grandiose delusions (also known as "delusions of grandeur") and are characterized by an inflated sense of ability, importance, or accomplishment.

Other delusions include thought broadcast (the belief that one’s thoughts are being broadcast from one’s head so that others can hear them); thought insertion (other people’s thoughts are being inserted into one’s own mind); thought withdrawal (one’s thoughts are being withdrawn from one’s head); delusions of influence (outside forces or people are controlling one’s behavior and thoughts); persecutory or paranoid delusions (the belief that one is being spied on, maligned, or plotted against); and somatic delusions (beliefs that one’s body is disfigured, misshapen or infested, for example that there are snakes crawling in one’s stomach).

Hallucinations

Hallucinations are false sensory experiences that occur in the absence of stimulation in any of the five sense modalities, i.e., seeing, hearing, feeling, tasting, and smelling things that aren’t really there. Auditory hallucinations are the most common type of hallucination. Students may appear distracted, upset, or confused as they attend to voices commentating, (a "blow by blow" description of what is happening around them), command hallucinations telling the student what to do, or sounds, such as humming or buzzing. One student found it difficult to concentrate on lecture and reading assignments because she frequently heard voices cursing at her and putting her down.

Other distracting or disturbing hallucinations involve the perception of tingling or burning sensations (tactile hallucinations) or sensations of rats, for example, clawing at one’s skin (somatic hallucinations). Less commonly experienced hallucinations are visual, olfactory, and gustatory hallucinations (seeing, smelling, and tasting, respectively).

Disturbance in Emotions

Psychotic students may exhibit an absence of apparent emotion (flat effect) or report that they have no emotions. Such students will have a monotonous tone of voice and few if any facial expressions. Other psychotic students might demonstrate inappropriate emotions, where their displayed emotions are incongruent with the situation or their stated emotions. For example, when told they have failed your class, the student may laugh hysterically. Sudden changes in emotion, such as angry outbursts, may also occur.

Disturbance in Thought

Attention to the psychotic student’s speech and/or written work reveals ample evidence of a disturbance in thought not due to low intelligence ("formal thought disorder"). Jumping from topic to topic, the psychotic student’s loose associations and flight of ideas contribute to a loss of clarity in speech or writing. Neologisms (made up words) and clanging (words that are selected based only on how they sound or because they rhyme, without regard for meaning or syntax) can be so severe that speech or writing becomes incomprehensible (referred to as "word salad").

I once had a student who made an oral presentation that lasted the required duration of time but which exhibited a poverty of content. Using excessively vague, repetitive, and abstract speech, he spoke for ten minutes, but not much was actually said.

Disturbance in Behavior

Severely psychotic students may display odd, stereotyped, or purposeless gestures and mannerisms and/or rigid or bizarre postures.

Sometimes I feel like I am invisible, a silhouette which can not be touched or touch in return, for that matter, and at times that seems maddening to me…I can catch hints enough to know I do not really belong…You don’t have to be afraid of me or anything crazy like that, and I am not mentally ill. Just alone.

electronic mail from a student

Mood disorders are classified as depressive disorders and bipolar disorders. The essential feature of a depressive disorder is an episode of depressed mood, while bipolar disorder requires a manic episode.

Depression

Students who are depressed report or display a wide array of symptoms that can be observed inside or outside the classroom. Most notably, the students will appear sad or state that they are depressed. They may also report feelings of helplessness, hopelessness, guilt, and worthlessness. These feelings manifest themselves in behaviors such as tearfulness, (often unexplained), decline in appearance or grooming, frequent apologies, and lack or appropriate eye contact and volume when conversing with others. Depression can also cause a person to become irritable, restless, or agitated.

A depressed student frequently finds it difficult to concentrate and may be easily distracted during class or exhibit a decline in course performance. Depressed students may also report or exhibit fatigue or a loss of energy, which would be particularly apparent in a physical education or speech/drama class. Depression-induced fatigue makes it difficult for students to get to class on time, exhibit enthusiasm in class discussions, and complete at-home assignments.

Fatigue is often exacerbated by the depressed student’s sleep disturbance. Hypersomnia (excessive sleeping and sleepiness) and insomnia (difficulty sleeping ) are common symptoms of depression that interfere with the student’s productivity and attentiveness in class. Another physical (or "vegetative") symptom of depression is appetite disturbance (eating too much, very little, or not at all). Appetite disturbance ultimately manifests itself in apparent weight gain or weight loss.

Finally, a student who was previously active in different organizations of clubs, or who was especially zealous about your class, may experience anhedonia, a loss of interest or pleasure in previously enjoyed activities. This student’s demeanor may become bland and disinterested,and he or she may suddenly "drop out of the picture."

Not every depressed person becomes suicidal, but certainly depressed students should be monitored carefully for signs of suicidal behavior. There are several "red flags" for suicide, that is, behaviors that should never be ignored. The most obvious red flag is when a student expresses indirectly or verbalizes directly thoughts or intent to hurt himself. A student might write a poem , essay, or story about death or suicide that may be a disguised "cry for help." Or a student many confide in you directly that she has thoughts of hurting herself.

Another red flag should be raised if, when expressing suicidal thoughts, the student has a specific plan with a lethal, accessible method. For example, a student casually saying, "I’m so embarrassed, I wish I were dead," is quite a different case than a student who says, "Over spring break I am going to take my father’s shot gun into the woods and blow my head off while my parents are at work."

Another red flag disclosure is disclosure of a previous suicide attempt. Someone who has attempted suicide in the past (or who, for that matter, has a friend or relative who has committed suicide) has fewer inhibitions about trying again. These student may disclose this fact as part of a class assignment or confide in you during office hours. Taken with other previously mentioned symptoms, this should certainly capture your concern.

Finally, giving away prized possessions or "putting affairs in order" are frequently seen when a person is suicidal. One student might present you with her favorite book or a personal object, while another might indicate that he is trying to tie up loose ends in his life without indicating why. The steps to take when confronted with a suicidal student will be outlined below.

Mania

A manic episode is characterized by a euphoric mood. Some manic students become irritable, but generally their mood is one of elation. They may be excessively talkative, exhibit a pressure to keep talking (pressured speech), and demonstrate flight of ideas. They will seem hyper and be very busy, engaging in multiple tasks or activities.

Manic students will report (or brag) that they have a decreased need for sleep, with some sleeping only three or four hours over the course of several days. During a manic episode, students may appear grandiose; for example, they may be over-confident about their successful performance in your class in the absence of demonstrated ability. Other students may describe excessive pleasure seeking that is often self destructive such as promiscuous sex or spending sprees.

Eventually, often as a result of non-stop activity and self-destructive pleasure seeking, many manic students experience a downward spiral ending in a state of depression (commonly referred to as "manic depression"). One student who exhibited many manic symptoms during the beginning of the semester suddenly stopped coming to class. He later telephoned to inform me that he had been hospitalized after a manic episode.

Strategies for Managing Student Psychopathology

It is important to note that the presence of any one symptom described in the preceding pages is not sufficient to diagnose a mental disorder. There must be a pattern of symptoms, and in fact, DSM criteria typically require the presence of several symptoms before the disorder can be diagnosed.

The "menu" of symptoms provided here should simply serve as a guide to assist the professor in differentiating between unusual (albeit "normal") behavior and "bona fide" student psychopathology. Because of our own uncertainties and fears, however, we are sometimes reluctant to act decisively when a student’s behavior is bizarre, erratic, or self-destructive. Recognizing that such behavior might legitimately be classified as a mental disorder helps the professor to be clear about his or her role and when and how to intervene.

What to Do

I was so enraged and hurt by (blank) that I cut my arm; this was a compromise and brought relief. Until I saw myself bleeding, terrible thoughts were going through my mind. Making the superficial cuts was better than hurting someone or killing myself.

note from a student

Dealing with Suicidal Students

Dealing With Aggression

Conclusion

Students sometimes experience subjective discomfort and exhibit maladaptive behaviors that interfere with their ability to learn and your ability to teach. As community college professors, I believe we have an obligation to intervene within the limits of our role and expertise. Simply asking a student, "Are you OK today?" if you notice behavior that is out of character or unusual can sometimes make a difference to that student, as the following message illustrates:

This is a personal message not really pertaining to school. I realize this is not part of your job description, but I appreciate the fact that you did notice my mood Thursday in class . . .

electronic mail from a student

This article provides information and tools that will enable you to more effectively recognize and manage student psychopathology, and ultimately enhance students’ educational experience and personal well being.

References