Descriptive Psychopathology: The Signs and Symptoms of ...

147 Chapter 6: Psychopathology of everyday behavior and general appearanceuntypical of their usual dress. The semi-nudity is associated with inappropriatesexual advances to staff and other patients. One manic-depressive physician cameto work only in her white coat and high heels. Patients who suddenly remove alltheir clothes without apparent sexual intent, however, are more likely to be deliriousor demented, or in a post-ictal state.When ill, manic patients cannot give a clear reason for the change in theirappearance. They may cite a delusional belief or become irritable and threatening.An early sign of treatment response is the attempt to normalize the decorativechanges made during the height of the mania. Manic men who shave one side oftheir head or beard suddenly shave the other side. When asked about the changetoward norm they often respond “It looked silly”.Body size and shapeA person’s body build may communicate personality traits and disease. The bodybuilder’s exaggerated musculature conveys histrionic traits. The skeletal look ofthe anorectic is defining. Bulimic and manic-depressive patients tend towardobesity; the latter may also be large-framed and big-boned (endomorphic). 44 Therounded “moon face” and fatty deposit at the base of the neck (“buffalo hump”)characterizes Cushing’s disease. A wasted musculature and large abdomen suggestschronic alcoholism. Developmental and genetic disorders such as Down’ssyndrome (short stocky stature, thick neck, wide-spaced eyes with an epicanthicfold), fragile-X syndrome (long, narrow face, prominent ears, other large facialfeatures, velvety skin and large gonads), 45 Marfan’s syndrome (long thin skeletonwith disproportionately long arm span, and large hands and feet), XYY syndrome(unusually tall man with acne), and many others have been associated withbehavioral syndromes. Dysplastic features (disproportionate size of body partssuch as limbs too long or short for the torso, small head circumference, ectopicfeatures such as low-set ears and wide-spaced eyes) are associated with developmentalproblems and behavioral symptoms emerging in childhood.Examination of the patient’s skin is also important. Scars may indicate violence,surgery, self-harm and IVor subcutaneous drug use. Abnormal tanning is associatedwith Addison’s disease. Jaundice is associated with liver dysfunction. Lyme disease,syphilis, and other infectious agents produce tell-tale lesions. Dry skin, brittle nails,and sticky hair suggest depression or hypothyroidism. Palmar erythema, brokennasal blood vessels and rhinophyma, and spider angiomata indicate alcoholism.Assessing for minor physical anomalies is also revealing. These mostly cosmeticreflections of either a genetic or gestational perturbation are recognized in infancyand are stable over the person’s lifetime. Many non-ill persons exhibit one ortwo. The presence of four or more, however, suggests that an adverse obstetricalevent occurred that may have contributed to the present psychopathology.