SLK 310 Chapter 9 Personality Disorders PDF

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CHAPTER 9Personality Disorders Your personality affects your daily life constantly It determines how you perceive the events of your day, how you feels and how you interact with others A core aspect of your personality is your sense of self or identity Personality: Enduring patterns of perceiving, f...

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CHAPTER 9

Personality Disorders •Yourper sonal i t yaffect syourdai l yl i f econst ant l y •I tdet er mi neshowyouper cei vet heevent sofyourday ,howyouf eel sandhowy oui nt er actwi t h ot her s •Acor easpectofy ourper sonal i t yi sy oursenseofs el fori dent i t y •Per sonal i t y:Endur i ngpat t er nsofper cei vi ng,f eel i ng,t hi nki ngaboutandr el at i ngt oones el fand t heenvi r onment •Aper sonal i t yt r ai ti sapr omi nentaspectofy ourper sonal i t yt hati sr el at i v el yc ons i s t entacr oss t i meandac r osssi t uat i ons,suchasbei ngout goi ng,car i ngandcompas si onat e-expl oi t i v eor hos t i l e-i mpul si v eorunst abl e •Fi v ef act ormodel 1

-Adi mensi onalper spect i vet hatposi t st hatever yone' sper sonal i t yi sor gani z edal ong5br oad per sonal i t yt r ai t sorf act or s

-Thesef act or sar eof t enr ef er r edt oast heBi g5 1.Negat i v eemot i onal i t y

2.Ex t r av er si on 3.Opennesst oexper i ence 4.Agr eeabl eness 5.Consci ent i ousness 2

•Per sonal i t yt r ai t sar est r ongl yi nfl uencedbygenet i cs •DSM5i ncl udes2model sofper sonal i t ydi sor der

-Thefir stmodel=Cat egor i calmodel-defi nes10di ffer entper sonal i t ydi sor der si nt er msof di st i nctcr i t er i aset s .Thec at egor i c almodeli si nt endedf orcl i ni caluse

-Thesecondmodel=Al t er nat i vemodel-wasdev el opedf orDSM5.I tmak esuseofa cont i nuum modelofper sonal i t ydi sor der ssuchast hatr epr esent edi nt hebi g5model .I t assumest hatnor mal andabnor mal per sonal i t yf al lonani nt egr at edc ont i nuum ofper sonal i t y

General Definition of Personality Disorders (Categorical Model)

•Cat egor i calper spect i v ewasfi r s test abl i s hedi nkDSMI I Ii n1980

•Ani ndi vper sonal i t ypat t er nmus tbeper v asi veandi nflexi bl eacr osss i t uat i ons,best abl eov er t i me,hav eanonseti nadol es cenceorear l yadul t hoodandl eadt osi gni ficantdi st r essor f unct i onal i mpai r ment •Ani ndi vl ongt er m pat t er noff unct i oni ngal soc annotbeexpl ai nedasamani f es t at i onor consequenceofanot herment al ,subst anceuseormedi caldi sor der •Forper sonal i t ydi sor dert obedi agnosedi nani ndi vy oungert han18y ear s-t heper sonal i t y pat t er nsmusthavebeenpr esentf oratl east1y ear •Mos tcl i ni ci answi l lt husacces st hest abi l i t yofper sonal i t yt r ai t sov ert i meandacr ossdi ffer ent si t uat i ons ,t aki ngi nt oaccountet hni c,cul t ur alandsoci albackgr oundi nfl uencesandt aki ngcar e t odi st i ngui sht heper sonal i t yt r ai t st hatdefinet heper sonal i t ydi sor der sf r om char act er i st i cst hat emer gei nr esponset os i t uat i onalst r essor sormor et r ansi entment al st at esl i k emood,anxi et yor subst anceusedi sor der •Manypeopl eexper i enceanot hercl i ni cal di sor derats omet i mei nt hei rl i f e 3

•TheDSM5gr oups10di st i nctper sonal i t ydi sor der si nt o3cl ust er sbasedont hei rdesc r i pt i v e si mi l ar i t i es •Thi scl ust er i ngs y st em i sl i mi t ed,hasnotbeenconsi st ent l yv al i dat edandf ai l st oaccountf ort he f actt hati ndi vof t ens howcooccur r i ngper sonal i t ydi sor der sf r om di ffer entcl ust er s •Di sor der s

-Cl ust erA 1.Char act er i z edbyodd,eccent r i cbehavi our sandt hi nk i ng 2.Par anoi dper s onal i t ydi sor der 3.Sc hi z oi dper sonal i t ydi sor der 4.Sc hi z ot ypalper sonal i t ydi s or der

-Cl ust erB 1.Char act er i z edbydr amat i c ,er r at i coremot i onal behavi ourandi nt er per sonalr el at i onshi ps 2.Ant i soci alper sonal i t ydi sor der 3.Hi st r i oni cper sonal i t ydi sor der 4.Bor der l i neper sonal i t ydi sor der 5.Nar ci ss i st i cper s onal i t ydi s or der

-Cl ust erC 1.Char act er i z edbyanxi ousandf ear f ulemot i onsandc hr oni csel f doubt 2.Def endantper s onal i t ydi sor der 3.Av oi dantper sonal i t ydi sor der 4.Obsessi vec ompul si veper sonal i t ydi sor der

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Cluster A •Si mi l art ot hatofpeopl ewi t hschi zophr eni abutar enotoutoft ouchwi t hr eal i t y •Theymaybepar anoi d,speaki noddandec cent r i cway st hatmaket hem di fficul tt ounder s t and, hav edi fficul t yr el at i ngt oot herpeopl eandhav eunusual bel i ef sorper cept ualexper i enc est hat f al ls hor tofdel usi onsandhal l uci nat i ons •Thesedi sor der sf al lpar toft heschi z ophr eni as pect r um

Par anoi dPer sonal i t yDi s or der • Par anoi dPer sonal i t yDi sor der :Apat t er nofper v asi vedi st r ustands uspi c i ousnessofot her s sucht hatt hei rmot i v esar ei nt er pr et edasmal ev ol ent •Peopl edi agnosedwi t ht hi sdi sor derbel i ev et hatot herpeopl ear echr oni cal l yt r yi ngt odecei v eor expl oi tt hem andt heyar epr eoccupi edwi t hconcer nsaboutbei ngvi ct i mi z edormi s t r eat edby ot her s •Theyar ehyper vi gi l antf orevi denceconfi r mi ngt hei rsuspi ci ons •Theyspendagr eatdealoft i met r y i ngt odec i phersuchcl uest oot herpeopl e' si nt ent i ons •Theyar eal sover ysensi t i v eandangr i l yr eact i vet or ealorper cei v edcr i t i c i sm andt endt obear gr udges •Theyt endt omi s i nt er pr etsi t uat i onsi nl i newi t ht hei rsus pi ci ons

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•Thesepeopl ear er esi st antt or at i onalar gument sagai ns tt hei rsuspi ci onsandmayconsi dert he f actt hatanot herper soni sar gui ngwi t ht hem asevi dencet hatt heper soni spar toft he conspi r ac yagai ns tt hem •Somear esec r et i v eandwi t hdr awf r om ot herpeopl ei nanat t emptt opr ot ectt hemsel ves ,but ot her sbecomehost i l eandar gument at i v e,sur et hatt hei rwayofl ooki ngatt hewor l di sr i ghtand super i orandt hatt hebestdef enseagai ns tt heconspi r i ngofot her si sagoodoffense •0. 75. 1% oft hepopul at i oncanbedi agnosedwi t ht hi sdi sor der •I ncr easedr i skf orcooccur r i ngdi s or der s( maj ordepr essi vedi sor der ,anxi et ydi sor der s, subst anceabuseandpsy chot i cepi sodes) •Theyar edi fficul tt ogetal ongwi t handt hei ri nt er per sonalr el at i onshi pst endt obeunst abl e •Sy mpt omsi nt ensi f yunderst r ess

Theor i esofPar anoi dper sonal i t ydi sor der •Mor ecommoni nf ami l i eswi t hs chi z ophr eni a •Theher i t abi l i t yoft hi sdi sor deri s. 50

Tr eat mentofPar anoi dPer sonal i t yDi sor der •Comei nt ocont actofcl i ni ci ansonl ywhent heyar ei ncr i si s •Theymayseekt r eat mentf ors ev er es ympt omsofdepr essi onoranx i et ybutt heyof t endonotf eel aneedf ort r eat mentoft hei rpar anoi a •Thei rguar dedandsuspi ci onsst yl ewi l lof t enunder cutt hedev el opmentofat r ust i ngt her apeut i c r el at i onshi p •Tr eat i ngwi l lbedi fficul tbecaus et heyar enott r ust i ng •I nor dert ogai nt het r ust ,t het her api s tmustbec al m,r espect f ul l yandext r emel yst r ai ght f or war d. Thet her api stcannotdi r ect l yconf r ontt hecl i ent spar anoi dt hi nki ng •Byt r ust i ngt het her api st ,t hehopei st hatt hepat i entwi l lbeabl et ot r ustot her sabi tmor eand t husdev el opssomei mpr ov edi nt er per s onalr el at i onshi ps •Cogni t i vet her apy-f ocus esoni ncr eas i ngt hei rsens eofsel feffici encyi ndeal i ngwi t hdi fficul t si t uat i onst hi sdecr easi ngt hei rf earandhost i l i t yt owar dot her s •Thet her api stshoul dnotchal l enget hepat i ent ssenseofbel i ef sbutr at hert r yt or educ et hei r senseofdanger

Sc hi z oi dPer sonal i t yDi s or der

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•Schi zoi dPer sonal i t yDi sor der :Showaper vas i v epat t er nofdet achmentf r om soci al r el at i onshi psandar est r i ct edr angeofemot i onal expr ess i oni nt hei ri nt er act i onswi t hot her s •Theyseem i ndi ffer entt ooppor t uni t i est odev el opcl os er el at i onshi psandder i v el i t t l e,i fany , pl easur ef r om f ami l yorsoci ali nt er act i ons •Theyar edescr i bedasemot i onal l yal oof ,bl and,uni nt er est i ngorcol d •Theyar eof t eni ndi ffer entt oot her spr ai seorcr i t i ci sm,andt heyt ak epl easur ei nf ewact i vi t i es •Theyt endt ovi ewr el at i onshi pswi t hot her sasunr ewar di ng,mess yandi nt r usi v e •E. g.Roywoul dbedi agnos edwi t hSchi zoi dbecauseofhi sl ongt er m st andi ngav oi danceofcl ose r el at i onshi pswi t hf ami l ymember s •0. 81. 7% ofadul t smani f est i ngt hi sdi sor deratsomet i medur i ngt hei rl i f e •Mor ecommoni nmal es

Theor i esi fsc hi z oi dper s onal i t ydi s or der •I ncr easedr at eofsc hi z oi dper sonal i t ydi s or deri nt her el at i v esofper sonswi t hschi zophr eni a,but t hel i nkbet weent he2di sor der si snotc l ear •Theseper s onal i t yt r ai t smaybepar t i al l yi nher i t edbutt heev i dencef orher i t abi l i t yi sonl yi ndi r ect

Tr eat mentofsc hi z oi dper sonal i t ydi sor der •Notv er ymot i vat edf ort r eat mentandt hei nt er per sonalcl osenessoft her apymaybeexper i enced asst r essf ul i nst eadofs uppor t i ve •Tr eat ment sf ocusoni ncr easi ngt heper son’ sawar enessofhi sorherownf eel i ngs,aswel las i ncr easi nghi sorhersoci als ki l l sandsoci alcont act s •Thet her api stmaymodel t heexpr essi onoff eel i ngsf ort hecl i entandhel pt hecl i enti dent i f yand expr es shi sorherownf eel i ngs •Soci als ki l l st r ai ni ng,donet hr oughr ol epl ayi ngwi t ht het her api standhomewor kassi gnment si n whi cht hecl i entt r i esoutnewsoci alski l l swi t hot herpeopl e,i sani mpor t antcomponentof cogni t i vet her api es •Somet her api st sr ecommendgr oupt her apy •Thegr oupmember scanmodeli nt er per sonal ,r el at i onshi ps,andeac hper sonwi t hschi z oi d per sonal i t ydi sor dercanpr act i cenewsoci al ski l l sdi r ect l ywi t hot hergr oupmember s

Sc hi z ot ypalPer sonal i t yDi s or der

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•Schi zot ypalPer sonal i t yDi sor der :Shows ympt omssi mi l art ot hoseofschi z ophr eni abuti n mi l derf or m •Peopl ewi t ht hi sdi sor dert endt obesoci al l yi sol at ed,havear est r i c t edr angeofemot i onsandt o beuncomf or t abl ei ni nt er per sonali nt er act i ons •Aschi l dr ent heyar epassi ve,soci al l yusengagedandhyper sensi t i v et oc r i t i ci sm andt heymay at t r actt easi ng •Thedi s t i ngui shi ngc har act er i st i csofSc hi z ot ypalper sonal i t ydi sor derar et hecogni t i v eand per cept ual di st or t i onsandoddandecc ent r i cbehav i or s .Thesechar act er i st i csgener al l yf al li nt o4 cat egor i es: 1.Par anoi aorsus pi ci ousness( per cei veot herpeopl easdecei t f ul andhost i l e) 2.I deasofr ef er ence( t endt obel i ev et hatr andom ev ent sorci r cumst anceshav eapar t i cul ar meani ngj us tf ort hem) 3.Oddbel i ef sandmagi calt hi nki ng( t heymaybel i ev et hatot her sknowwhatt heyar et hi nki ng) 4.I l l usi onst hatar ej ustshor tofhal l uc i nat i ons( t heymays eepeopl ei nt hepat t er nsofwal l paper ) •I naddi t i ont odemons t r at i ngc ogni t i v eandper cept ual ,peopl edi agnosedwi t hSc hi z ot ypal per sonal i t ydi sor der st endt ohav espeecht hati st angent i al ,ci r cums t ant i al ,vagueor ov er el abor at e •Theymaybeeasi l ydi st r act edormayfix at eonanobj ectf oral ongper i odoft i me,l osti nt hought orf ant asy •Thepr ev al encei nt hegener alpopul at i oni s3. 9% •Mor ecommoni nmak est hanf emal es •I ncr easedr i skf ordepr essi onandf orsc hi zophr eni aori sol at edps ychot i cepi sodes •Foraper sont obedi agnosedwi t hSc hi z ot ypal per sonal i t ydi sor dert hei roddoreccent r i c t hought scannotbepar tofc ul t ur albel i ef s ,suchasc ul t ur albel i ef si nmagi corspeci fi c super st i t i ons 8

•St i l lsomeps y chol ogi s t shav ear guedt hatpeopl eofcol orar emor eof t endi agnosedwi t hcl us t er Adi sor der sbecausec l i ni ci ansof t enmi si nt er pr etcul t ur al l yboundbel i ef sasevi denceof Sc hi z ot ypalt hi nki ng •Af r i canAmer i cansar emor el i kel yt obeexposedt ocondi t i onst hatenhanc eabi ol ogi cal vul ner abi l i t yt os chi z ophr eni al i k edi sor der s .Thesecondi t i onsi ncl udeur banl i vi ngandl owSES

Theor i esofSchi z ot y pal per sonal i t ydi sor der •Fami l yhi st or y ,adopt i onandt wi nst udi esal lsuggestt hatSc hi z ot ypalper sonal i t ydi sor deri sal l t r ansmi t t edgenet i cal l y •Her i t abi l i t yi sf oundt obe. 81 •Muc hmor ec ommoni nfir stdegr eer el at i vesofpeopl ewi t hs chi zophr eni at hani nr el at i v esof ei t herps ychi at r i cpat i ent sorheal t hycont r olgr oups •Agenet hatr egul at est heNMDAr ecept orsy st em hasbeenassoci at edwi t hbot hschi z ophr eni a andSc hi z ot ypal per sonal i t ydi sor der •Sc hi z ot ypalandschi z ophr eni apat i ent sshowmanyoft hesamec ogni t i v edefi ci t s,i ncl udi ng di fficul t i esi nver balfl uenc y ,i ni nhi bi t i ngi nf or mat i onwhenat askc al l sf ori t ,andi nmemor y .Then al soshowdy sr egul at i onoft heneur ot r ansmi t t erdopami nei nt hebr ai n.Theyal s ohav e abnor mal l yhi ghl ev el sofdopami nel evel si nsomear easoft hebr ai n •Sc hi z ot ypalabnor mal i t i est endt obel esssev er et hanpat i ent swi t hschi zophr eni a •Peopl ewi t hbot hdi sor der sshowgr eymat t err educt i onsi nar easoft het empor al l obeoft hebr ai n compar edt ocont r ol s,butt her educt i onswer el essi npeopl ewi t hSchi zot ypalper sonal i t y di sor der s •Peopl ewi t hSc hi z ot ypal per sonal i t ydi sor derdonott endt oshowt heabnor mal i t i esi nt he pr ef r ont al ar easoft hebr ai nshownbypeopl ewi t hschi z ophr eni a •Peopl ewi t hSc hi z ot ypal per sonal i t ydi sor deral s ot endt ohav emor ef r equenthi st or i esofawi de r angeofchi l dhoodadver si t i escompar edt ot hegener alpopul at i on,i ncl udi ngphys i cal ,emot i on andsexualabuseandhavi ngapar entwhowasbat t er ed,abusedsubst ancesors pentt i mei nj ai l

Tr eat mentofSchi z ot ypalper sonal i t ydi s or der •Tr eat edwi t ht hesamedr ugsusedt ot r eatschi z ophr eni aj us tatal owerdose,i ncl udi ngt r adi t i onal neur ol ept i css uchas

-Hal oper i dol -Thi ot hi x ene -At ypi calant i psy c hot i cs-ol anzapi ne •Thesedr ugsappeart or el i eveps y chot i cl i k es ympt oms,whi chi ncl udeddi st or t edi deasof r ef er ence,magi cal t hi nki ngandi l l usi ons

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•I nps y chot her apy ,i ti sespeci al l yi mpor t antf ort het her api stt ofi r stest abl i s hagoodr el at i onshi p wi t ht hecl i ent ,becauset hesecl i ent st ypi c al l yhavef ewcl oser el at i onshi psandt endt os t r uggl e wi t hpar anoi dt hought sandex cessi v esoci alanxi et y •Thenex tst epi nt her apyi st ohel pt hecl i enti ncr eas es oci alc ont act sandl ear nsoci al l yt hr ough appr opr i at ebehavi our st hr oughsoci al ski l l st r ai ni ng •Gr oupt her apy=ver ygood •Thecr uc i alcomponenti ncogni t i vet her apyi st eachi ngt hem t ol ookf orobj ec t i veevi denc ei nt he envi r onmentt osuppor tt hei rt hought sandt odi sr egar dbi zar r et hought s

Cluster B: Dramatic-Emotional Personality Disorder ( Supposet osayCl us t erBPer sonal i t yDi sor der s,butt het ext bookgoti twr ong) •Engagei nbehavt hatar edr amat i candi mpul s i v e,andt heyof t enshowl i t t l er egar df ort hei rown saf et yort hesaf et yofot her s •Theymayacti nhost i l e,evenvi ol entway sagai ns tot her s

Bor der l i nePer sonal i t yDi sor der

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•Sy mpt omsi nv ol v e:

-Outofcont r ol emot i onst hatcannotbesmoot hed -Ahyper sensi t i vi t yt oabandonment -At endenc yt ocl i ngt oot i ght l yt oot her s -Ahi st or yofhur t i ngt hems el ves •Thedi s or deri schar act er i z edbyf undament al defici t si ni dent i t yandi ni nt er per sonalr el at i onshi ps •Sel f concept=v er yunst abl e,wi t hper i odsofext r emesel f doubtal t er nat i ngwi t hper i odsof gr andi oses el f i mpor t anc eandaccompani edbyaneedf orot her st osuppor tt hei rsel f est eem •Pat i ent sar epr onet odi ssoci at i vest at es,i nwhi cht heyf eelunr eal ,l oset r ackoft i meandmay evenf or getwhot heyar e •Thei ri nt er per sonalr el at i onshi psar eext r emel yunst abl e-t heycanswi t chf r om i deal i zi ngot her s t odespi si ngt hem wi t houtpr ov ocat i on •Theyof t endescr i beanempt i nesst hatl eadst hem t ocl i ngt onewac quai nt anc esort her api st si n anat t emptt ofil lt hev oi d •Theywor r yaboutabandonmentandmi si nt er pr etot herpeopl e' sever ydayact i onsasdes er t i onor r ej ec t i on •Ex ampl e-Thet her api s tneedst ocancelt hei rsessi onbecauset heyar esi ck ,abor der l i ne per sonal i t ydi sor derpat i entmi ghti nt er pr ett hi sasr ej ect i onandbecomever yangr yand depr es sed

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•Themoodofpeopl ewi t hbor der l i neper sonal i t ydi sor deri sunst abl e,wi t hbout sofsev er e depr es si on,anxi et yorangerseemi ngt oar i sef r equent l y ,of t enwi t houtcause •St r ongt endenc yt oengagei ni mpul si ve,sel f damagi ngbehav ,i ncl udi ngsel f mut i l at i onorsui ci dal behav •Thei rvar i et yofsympt omsandt hei rshi f t i ngnat ur emakei tacompl exdi sor dert odi agnoseand t r eat •Fr equent l yal sodi agnosedwi t hot herment al di sor der s-anxi et y ,subst anceani se,depr essi on, agor aphobi a,as i mpl ephobi a •75% ofpeopl ewi t hbor der l i neper sonal i t ydi sor derat t emptsui ci deand10% di eofs ui ci de •Thegr eat estr i skf orsui ci deappear st obei nt hefir s tort woy ear sofdi agnosi s,pr obabl ybecause peopl ear eof t ennotdi agnosedunt i lacr i si sbr i ngst hem t ot heat t ent i onoft hement al heal t h s yst em •Mor eof t eni nwoment hanmen •Commonl ydi agnosedi npeopl eofcol ort hani nwhi t e,andi npeopl eofal owerSES •Hi spani csmor eof t ent hanwhi t esorAf r i canAmer i cans,t hi si sbecausef act or st hatcont r i but et o t hedi sor der ,suchasext r emest r essar emor ecommentamongHi spani csorc l i ni ci ansdonot t ak ei nt oaccountHi spani ccul t ur alnor mst hatper mi tgr eat erexpr ess i onofst r ongemot i onssuch asanger ,aggr essi v enessandsexualat t r act i on •85% ofpeopl ewi t ht hi sdi sor derhav eshownr emi ssi onofsympt omswi t hi n1015y ear s •St r essf ul l i f eev ent sandl ackofsoci alsuppor tar et r i gger sf orr el apsei ni ndi vi dual swhose s ympt omshav er emi t t ed

Theor i esofbor der l i neper sonal i t ydi s or der •Peopl ewi t ht hi sdi sor derhav ef undament al defici t sr egul at i ngt hei remot i onsaswel lasgr eat er v ar i abi l i t yi nt hei rmoods,par t i cul ar l ywi t hr egar dt of ear ,host i l i t yandsadness •Cogni t i vel y-peopl ewi t hbor der l i neper sonal i t ydi sor derar ehyper act i vet i met onegat i ve emot i onal s t i mul ii nt heenvi r onment ,t hei rmemor i est endt obemor enegat i v eandt heyt endt o makenegat i vel ybi asedi nt er pr et at i onsofsi t uat i ons •Fr equent l yt r yt osuppr esst hei rnegat i v et hought s,t hei rat t empt susual l yar eunsucces sf ul •Repor tachi l dhoodmar kedbyi nst abi l i t y ,negl ectandpar ent al psy chopat hol ogy-of t enhavea hi st or yofs exualorphysi calabusedur i ngchi l dhood •Theyr el yonot her st ohel pt hem copewi t hdi fficul tsi t uat i onsbutdonothaveenoughsel f confidencet oas kf orhel pi nmat ur eways •Theybecomemani pul at i veandi ndi r ecti nt hei rat t emptt ogai nsuppor tf r om ot her s,andt hei r ext r emeemot i onalr eact i onst osi t uat i onsl eadt oi mpul si v eact i ons •Peopl ewi t hbor der l i neper sonal i t ydi sor dernev erl ear nedf ul l yt odi ffer ent i at et hei rvi ewof t hemsel vesf r om t hei rv i ewofot her s,maki ngt hem ext r emel yr eact i v et oot her sopi ni onsof t hemsel vesandmayengagei nsel f puni shmentorsel f mut i l i z at i on

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•Spl i t t i ng:Theyt endt oseet hems el v esandot her sasei t heral lgoodoral lbadandt ov aci l l at e bet weent heset wovi ews

-Thei nst abi l i t yi nt hei remot i onsandi nt er per s onalr el at i onshi psi sduet osuchs pl i t t i ng, r efl ect i ngt hei rv aci l l at i onbet weent heal l goodandt heal l badsel fandt heal l goodandal l badot her •Theamy gdal aandhi ppocampusofpeopl ewi t hbor der l i near esmal l eri nv ol umet hant hoseof peopl ewi t houtt hedi sor der .Theyal sohav egr eat err egul at i onoft heamy gdal ai nr esponset o pi ct ur esofemot i onal f aces,whi chmaypar t l yexpl ai nt hedi fficul t yt heyh...