Descriptive Psychopathology: The Signs and Symptoms of ...

145 Chapter 6: Psychopathology of everyday behavior and general appearanceIn addition to antipsychotic medication and lithium for her mood disorderand “psychosis”, she had been receiving therapy for her “identity disorder”.Other than having substantial extrapyramidal side effects from rispiridoneand mild circumstantiality, the patient was without psychopathology onexamination. She seemed to be a mild-mannered, dependent and easily influencedperson. Anticonvulsant and adjunct management strategies for seizuredisorder were recommended and the patient made a slow recovery over thenext several months.Grooming, hygiene and dressAlthough the degree of grooming and hygiene and what a person wears isinfluenced by social class, and culture, appearance may also reflect personalitydeviation and brain disease. The histrionic person dresses more flamboyantly andsexually provocatively. The person with antisocial personality disorder may wearthe intimidating black leather, metal-studded costume of “the biker”. Elaboratetattoos, body piercing and complicated hair design (e.g. the Apache with brightlycolored spikes) reflect at a minimum high novelty seeking and non-conformity. 42Perfectly lacquered finger and toe nails, carefully applied facial make-up, highlystyled hair-do, all-year tan take substantial time and effort to accomplish andrepresent at best vanity and self-absorption. The sloppiness of Oscar Madison andthe neatness of Felix Unger, the characters in Neil Simon’s The Odd Couple,represent their deviant personality traits. 43Being reasonably clean and neat is an accepted norm in many societies. A lossof this standard implies disease. When a person no longer adequately self-groomsand cleans despite the means, general medical functioning, and visual acuity todo so, the most likely cause is poor executive functioning and self-monitoring.The disheveled and unclean patient has lost interest or the ability to attend to thetask and the recognition of the problem. Severe and chronic mood disorder, braindamage from trauma and illicit drug use, and dementing conditions are commoncauses. Unilateral grooming and hygiene problems indicate contralateral braindisease. A patient with a right parietal lobe lesion failed to shave the left side ofhis face. He first denied any asymmetry in his beard. When pressed to explain it,he said “I’m letting my sideburns grow”. When shown that only one side of hisface was involved he became irritable and uncooperative.Persons with substantial perseverative behaviors may collect debris and otheritems, hoarding them on their person – pockets bulging, shopping bags filled tothe bursting with useless items. In the 1950s in New York City, the homelesswomen of that era were called “shopping bag ladies”. Playing with, smearing, oringesting feces (coprophagia) is seen in patients with severe mood disorder,psychosis, dementia, or mental retardation.