Egocentrism
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In psychology, egocentrism is defined as
* the incomplete differentiation of the self and the world, including other people and
* the tendency to perceive, understand and interpret the world in terms of the self.
The term derives from the Greek and Latin egô / ego, meaning "I," "me," and "self". An egocentric person cannot fully empathize, i.e. "put himself in other peoples' shoes," and believes everyone sees what she/he sees (or that what he/she sees, in some way, exceeds what others see).
It appears that this egocentric stance towards the world is present mostly in younger children. They are unable to separate their own beliefs, thoughts and ideas from others. For example, if a child sees that there is candy in a box, he assumes that someone else walking into the room also knows that there is candy in that box. He implicitly reasons that "since I know it, you should too". As stated previously this may be rooted in the limitations in the child's theory of mind skills. However, it does not mean that children are unable to put themselves in someone else's shoes. As far as feelings are concerned, it is shown that children exhibit empathy early on and are able to cooperate with others and be aware of their needs and wants.
Jean Piaget (1896-1980) claimed that young children are egocentric. This does not mean that they are selfish, but that they do not have the mental ability to understand that other people may have different opinions and beliefs from themselves. With his colleague Barbel Inhelder, Piaget did a test to investigate egocentrism called the three mountains problem (Piaget & Inhelder 1948/1956). He put children in front of a simple plaster mountain range and then asked them to pick from four pictures the view that he, Piaget, would see. Younger children before age 7, during the so-called pre-operational stage, picked the picture of the view they themselves saw and were therefore found to lack the ability to appreciate a viewpoint different from their own. In other words, their way of reasoning was egocentric. Only when entering the so-called concrete-operational stage at age 7-12, children became capable of de-centering and could appreciate viewpoints other than their own. In other words, they were capable of cognitive perspective-taking.
However, the mountains test has been criticized for judging only the child's visuo-spatial awareness, rather than egocentrism. A follow up study involving police dolls showed that even young children were able to correctly say what the interviewer would see. It is thought that Piaget overestimated the levels of egocentrism in children.
Egocentrism is thus the child's inability to see other peoples' viewpoints. The child at this stage of cognitive development assumes that their view of the world is the same as other people's, e.g. a little girl covers her eyes and says 'daddy you can't see me now, can you?'
The behaviors of an egocentric person are much of the time compulsive. "Without ropes they bind themselves" said Lao Tzu. They see themselves in competition with others and since the ego is so vulnerable and sensitive they are compelled towards defensiveness and self justification. They are compelled to impress others with their talents- meaning their looks, machismo, charm-much more so than someone who is focused on external things such as a helping profession. The egocentric is shallow, often lacking the staying power to achieve long range goals. Defensive, easily angered, jealous, they suffer living in the comparatively small world of fragile ego.
ADDICTION
Addiction is a term widely used to indicate any type of excessive
repetitive involvement with an activity or substance,
and it is applied as readily to exercise, reading, and
television viewing as to alcohol, cocaine, or heroin use. Such
broad use of the term detracts from its technical value, and
in this entry the term will be used to refer only to substance
use. When considering problematic patterns of use, two distinct
patterns, abuse and dependence, are described (American
Psychiatric Association, 1994). Substance Abuse refers
to life problems from substance use—use in situations in
which it is physically dangerous, use interfering with occupational
roles or with family and other social relationships,
or use resulting in legal difficulties. In contrast, Substance
Dependence is more syndromal. Physiological components
of dependence may include tolerance—the need for increasing
amounts of the substance to attain the same behavioral
and subjective effects—or withdrawal, a physical
syndrome activated by cessation of use of the substance.
Behavioral components include using larger amounts of the
substance over longer periods of times than intended;
spending excessive amounts of time obtaining, using, and
recovering from use of the substance; or using instead of
engaging in other recreational and social pursuits. Psychological
components include continued use despite knowledge
of medical or psychological conditions caused or worsened
by substance use, and desire or actual attempts to cut
down or stop using the substance. Use of a range of substances,
including alcohol, other sedative/hypnotic/anxiolytic
drugs, cocaine, other stimulants, heroin, cannabis,
hallucinogens, inhalants, and nicotine, can lead to Substance
Abuse or Dependence. A withdrawal syndrome is
associated only with alcohol, sedative/hypnotic/anxiolytic
drugs, heroin, and nicotine.
Epidemiology
Use of alcohol is common; regular use or abuse of other
drugs is less common (Grant & Dawson, 1999). At some
time in their adult lives two thirds of Americans have been
regular drinkers (consumed at least 12 drinks in a year). In
contrast, just under 16% of Americans are regular drug
users (illicit use of a drug at least 12 times in a year) at
some point in their lives. The lifetime prevalence of Substance
Abuse and Dependence varies by substance, with
different prevalence rates for men and women. Alcohol
Abuse or Dependence is most common, with a lifetime
prevalence for men of 25.5% and for women of 11.4%. In
contrast, 8.1% of men and 4.2% of women have had any
form of drug abuse or dependence at some time in their
lives. The most common drug of abuse or dependence is
cannabis, followed by prescription drugs, cocaine, amphetamines,
hallucinogens, opiates, and sedatives.
Etiology
The causes of addiction are complex and involve an interplay
among three dimensions—the biological, the psychological,
and the social. The relative importance of each dimension
varies with the specific substance of abuse and
with the individual user. Considerable research has attempted
to identify the causes of dependence at the cellular
or molecular level. A number of different neuronal
changes have been suggested as causing Alcohol Dependence,
including changes in neuronal membranes, changes
in the excitability and function of nerve cells mediated
through the calcium and GABAreceptor/chloride channels,
changes in the activity of excitatory neurotransmitter systems,
and changes in second messenger systems (Moak &
Anton, 1999). Research on opiate dependence has failed to
find changes in opiate receptors associated with addiction.
However, at the subcellular level, chronic exposure to opiates
has been demonstrated to lead to long-term changes in
specific G protein subunits (Stine & Kosten, 1999).
Substance use disorders run in families, and research
has attempted to distinguish genetic from familial aspects
of etiology. Both twin and adoption studies suggest a heritable
component to Alcohol Dependence. With other drugs,
some studies are suggestive of genetic elements, such as evidence
of common drug preferences in monozygotic twins,
and increased risk for drug dependence in families (Hesselbrock,
Hesselbrock, & Epstein, 1999). The relationship
between family history and the development of alcohol or
other substance dependence, however, is not absolute—the
majority of offspring from families with Alcohol Abuse or
Dependence do not develop problems, and the majority of
those with Alcohol Abuse or Dependence do not have a clear
family history (Fingarette, 1988).
ADDICTION 9
Among those with familial alcohol or drug problems, the
mechanisms by which inherited risk is expressed are not
clear. The most common mechanism appears to be through
specific temperament or personality—persons high in sensation
seeking, low in harm avoidance, and low in reward
dependence. Consequently, those with inherited risk for alcohol
or drug dependence are at greater risk for Conduct
Disorder or Antisocial Personality Disorder.
Psychological research has demonstrated the importance
of interactions between the individual and environment.
Repeated exposure to drug use situations can lead to
conditioned physiological responses to the situations that
are similar to physiological responses to the actual drug
(Rohsenow et al., 1994). The development of strong positive
expectancies about the effects of certain drugs can also contribute
to continued use (Brown, Christiansen, & Goldman,
1987). Individuals may use substances to enhance positive
moods as well as to cope with negative emotions, and those
with other psychological problems are at particularly high
risk for the development of substance use disorders as well.
Alcohol and drug use occurs in a social context. Introduction
to alcohol and drug use most commonly occurs with
either peers or family members. Individuals who are at
high risk for using drugs and for other problem behaviors
often join with peers of a similarly high risk level, and these
peer groups then may influence those within the group to
continue to use or experiment with other substances and
other high-risk behaviors.
Prevention
Prevention of addiction has taken many forms, including
broad-brush prevention programs in schools; prevention
targeted at specific populations, such as pregnant women;
and environmentally focused interventions that change
laws and policies, decrease access to the substance, and increase
penalties. Individually and environmentally focused
interventions have been successful in preventing or delaying
the onset of use, decreasing use among those already using,
and decreasing harmful consequences to the individual
or to others.
Treatment
Treatment efforts include both psychological and pharmacological
approaches. A number of psychological therapies
are effective in the treatment of Substance Abuse or Dependence.
Brief, motivationally focused interventions are
effective for individuals with milder problems, and they also
may enhance treatment outcomes when combined with ongoing
treatments (Bien, Miller, & Tonigan, 1993). Cognitivebehavioral
therapies, including community reinforcement
treatment, relapse prevention, social skills training, and
behavioral couples therapy, have good support for their effectiveness
in treating Alcohol Dependence (McCrady &
Langenbucher, 1996). Community reinforcement combined
with the use of vouchers (Higgins et al., 1994), and family
therapy (Liddle & Dakof, 1995) are effective in treating
drug dependence. Outcomes for those who complete longterm
treatment in therapeutic communities are good, but
dropout rates are high (Simpson & Curry, 1997). Treatments
to facilitate involvement with self-help groups such
as Alcoholics Anonymous or Narcotics Anonymous also are
effective (Project MATCH Research Group, 1997), and continued
active participation in self-help groups is correlated
with better outcomes.
Separate from medications for withdrawal, effective
pharmacotherapies to treat substance use disorders are
somewhat limited in number. Naltrexone, acamprosate,
and disulfiram have evidence supporting their use in the
treatment of alcohol dependence. Methadone, LAAM (1-aacetylmethadol),
and buprenorphine have strong evidence
of effectiveness in the treatment of opioid dependence.
Nicotine replacement products are effective in the initial
phases of treatment for nicotine dependence, and bupropion
appears to be effective for longer-term pharmacotherapy
(Barber & O’Brien, 1999).
Conclusions
The term addiction is overused, but it is useful in referring
to a range of substance use problems. Etiology of these
problems is complex, with multiple biological, psychological,
and social factors contributing. Prevention is possible,
and a number of effective treatments are available.
ADHD (ATTENTION-DEFICIT/
HYPERACTIVITY DISORDER)
Description
Attention-Deficit/Hyperactivity Disorder (ADHD) is most
commonly characterized by persistent and chronic inattention
and/or excessive motor restlessness and impulsive behavior.
Earlier names for ADHD included Minimal Brain
Dysfunction, Hyperkinetic Impulse Disorder, and Attention
Deficit Disorder with or without Hyperactivity. Since the
1994 publication of the fourth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV), ADHD
has been reorganized into three subtypes: predominantly inattentive
(ADHD-I), predominantly hyperactive-impulsive
(ADHD-HI), and combined (ADHD-C). The inattentive subtype
requires six or more symptoms of inattention and five
or fewer hyperactive-impulsive symptoms. The hyperactiveimpulsive
subtype consists of six or more symptoms of
hyperactivity-impulsivity and five or fewer inattentive
symptoms. The combined subtype requires six or more out
of nine symptoms from both the inattentive and hyperactiveimpulsive
categories. Symptoms on the inattentive list are
related to poor attention and organizational skills, forgetfulness,
and distractibility. Symptoms on the hyperactiveimpulsive
list refer to restlessness, excessive talking, and
interrupting. According to DSM-IV, the symptoms must be
present for at least 6 months and observable by 7 years of
age. For the purpose of diagnosis, symptom manifestation
should be developmentally inappropriate and exhibited in
two or more settings (e.g., home and school).
Prevalence
Prevalence rates of ADHD in the childhood population
vary, with expert opinion most often citing an incidence of
approximately 3–5% (American Psychiatric Association,
1994). Prevalence rates in adults are more speculative, but
are estimated to be about 4.7% (Barkley, 1998). The disorder
is more common in males, with Barkley (1998) citing
three males to one female for nonreferred samples.
Diagnosis
The diagnosis of ADHD remains difficult, with no single
test to assess it and a heavy reliance on subjective measures.
A comprehensive evaluation of ADHD in adults or
children should assess the presence or absence of symptomatology,
differential diagnosis from other disorders that
mimic ADHD, and the possibility of comorbid psychiatric
disorders. At a minimum, the evaluation should include a
clinical interview, a medical evaluation conducted within
the past year, standardized behavior rating scales from parents
and teachers, and direct observation of the patient.
The evaluation for both children and adults includes a
family history as well as documentation regarding developmental,
social, and academic functioning. An evaluation
for adults should also include information regarding
their childhood via academic records and transcripts and
retrospective-childhood ratings by the adult patient and a
parent or another individual who knew the patient as a
child. Common conditions that may coexist with ADHD and
warrant screening include Oppositional Defiant Disorder,
Conduct Disorder, Bipolar Disorder, Antisocial Personality
Disorder (for adults), and learning disorders. An assessment
of intellectual, academic, neuropsychological, and attentional
functioning is desirable for purposes of differential
diagnosis, as well as for pointing out individual strengths
and weaknesses. Psychoeducational testing can also be useful
when a low level of intellectual functioning or a learning
disability mimics or coexists with ADHD.
Treatment
Treatment of ADHD should be individualized depending
upon the presenting concerns. Treatment approaches may
include behavioral interventions combined with medica-
ADHD (ATTENTION-DEFICIT/HYPERACTIVITY DISORDER) 11
tion. Interventions begin with education about ADHD, its
etiology, and its treatment. Behavioral interventions for
children include social skills training, school interventions,
and parent training in contingency management. Behavioral
treatments for adults often focus on developmentally
appropriate self-monitoring techniques (e.g., a selfprescribed
reward for completing a goal), time management
skills, organizational skills, social skills, and vocational
counseling. Adults may also choose to have an individual
therapist or coach to monitor daily progress.
The use of pharmacological interventions is warranted
if the symptoms are interfering significantly with functioning
at home, school, or work. Psychostimulant medications
(e.g., methylphenidate and dextroamphetamine) are
considered safe and effective treatments for ADHD and are
used to treat children as well as adults whose diagnoses
have been confirmed. Stimulants, typically considered the
first line of defense, can produce improvements in impulse
control, attention, on-task behavior, and social behavior. A
number of new delivery systems for psychostimulant medications
have become available that have the potential to
reduce dosing from the older regimen of two to three times
a day to once a day.
Other medications, including bupropion and tricyclic antidepressants,
are considered when there are concerns regarding
substance abuse or coexisting depression, or when
the stimulants produce significant side effects. There are
several new nonstimulant compounds under development
for the disorder. These compounds target the norepinephrinergic,
histaminergic, and dopaminergic systems.
Neurobiologic Bases of ADHD
The etiology of ADHD is unknown, although the disorder is
now considered a disorder of the brain and development.
There has been a wave of recent genetic studies that suggest
that a substantial genetic component contributes to
the disorder. Most of the genetic research has focused on
candidate genes involved in dopaminergic transmission.
Dysfunction in both dopaminergic and norepinephrinergic
neurotransmitter systems are implicated in
ADHD. Both clinical and preclinical pharmacological studies
support the role of these neurotransmitters in ADHD,
with additional confirmation for the role of catecholamine’s
involvement arising from the observation that compounds
known to improve ADHD symptoms affect catecholamine
transmission. Neuroimaging research into brain structure
and the function of ADHD in children and adults has shown
significant differences between subjects with ADHD and
controls in frontal, basal ganglia, and cerebellar anatomy
and function. A number of functional imaging studies
demonstrate decreased neuronal activity in the anterior
cingulate and associated projection areas in subjects with
ADHD. A combination of methods using behavioral, imaging,
and genetic techniques should increase our understanding
of the etiology of the disorder in the future.
