1. Abnormal Psychology

2. Unit Overview Perspectives on Psychological Disorders Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Schizophrenia Personality Disorders Rates of Disorder Click on the any of the above hyperlinks to go to that section in the presentation.

3. 3 Psychological Disorders I felt the need to clean my room … would spend four to five hours at it… At the time I loved doing it. Then I didn't want to do it any more, but I couldn’t stop… The clothes hung… two fingers apart… I touched my bedroom wall before leaving the house… I had constant anxiety… I thought I might be nuts. Marc, diagnosed with obsessive-compulsive disorder (from Summers, 1996)

4. Introduction How should we define psychological disorders? How should we understand disorders? How should we classify psychological disorders?

5. Perspectives on Psychological Disorders

6. 6 Psychological Disorders People are fascinated by the exceptional, the unusual, & the abnormal. This fascination may be caused by two reasons: 1.During various moments we feel, think, & act like an abnormal individual. 2.Psychological disorders may bring unexplained physical symptoms, irrational fears, & suicidal thoughts.

7. 7 Psychological Disorders To study the abnormal is the best way of understanding the normal. 1.There are 450 million people suffering from psychological disorders (WHO, 2004). 2.Depression & schizophrenia exist in all cultures of the world. William James (1842-1910)

8. 8 Defining Psychological Disorders Definition of Disorders - Free Intro to Psychology Video Definition of Disorders - Free Intro to Psychology Video Definition of Disorders - Free Intro to Psychology Video Psychological Disorders - persistently harmful thoughts, feelings, & actions. behavior that is deviant, distressful, & dysfunctional Varies between cultures, over time, & must be more than just deviant, must be harmful (distressful) 1.Deviant behavior (going naked) in one culture may be considered normal, while in others it may lead to arrest. 2.Deviant behavior must accompany distress. 3.Behavior is harmful & dysfunctional it is clearly a disorder. Controversial & unclear at times: Attention deficit hyperactivity disorder (ADHD)Attention deficit hyperactivity disorder (ADHD) a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

9. Defining Psychological Disorders Psychological disorders - deviant, distressful, & dysfunctional patterns of thoughts, feelings, or behaviors.Psychological disorders –Deviant behavior –Distressful behavior –Harmful dysfunctional behavior Definition varies by context/culture Attention deficit hyperactivity disorder (ADHD)Attention deficit hyperactivity disorder (ADHD)

10. Understanding Psychological Disorders Understanding Psychological Disorders The Medical Model Until early 1800s mental illness- largely viewed as possession, evil, godly intervention Philippe Pinel- French, late 17–early 1800s REFORMER. Insisted these behaviors were a “sickness of the mind” often caused by severe stress & inhumane conditions Medical model –Mental illness (psychopathology)

11. 11 Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1.Etiology: Cause & development of the disorder. 2.Diagnosis: Identifying (symptoms) & distinguishing one disease from another. 3.Treatment: Treating a disorder in a psychiatric hospital. 4.Prognosis: Forecast about the disorder.

12. Understanding Psychological Disorders Understanding Psychological Disorders The Biopsychosocial Approach Today, psychologist contend that ALL behavior (normal/abnormal) arises from Interaction of nature & nurture But “mental illness” implies an internal problem or sickness. Current psychology considers the problem may be a growth-blocking difficulty in the person’s environment, current interpretation of events, or bad habits & poor social skills Influence of culture on disorders- may share underlying dynamic while differing in symptoms –Bulimia, Susto, Taijain-kyofusho Definition of Disorders - Free Intro to Psychology VideoDefinition of Disorders - Free Intro to Psychology Video

13. 13 The Biopsychosocial Approach Assumes that biological, socio-cultural, & psychological factors combine & interact to produce psychological disorders.

14. Classifying Psychological Disorders Classification and Diagnosis - Free Intro to Psychology Video Classification and Diagnosis - Free Intro to Psychology Video Classification and Diagnosis - Free Intro to Psychology Video Diagnostic & Statistical Manual of Mental Disorders (DSM) video\_Advanced Assessment & Diagnosis Using the DSM-IV-TR®..._ Seminar with Brooks Baer, MA, LCPC, CMHP.mp4 video\_Advanced Assessment & Diagnosis Using the DSM-IV-TR®..._ Seminar with Brooks Baer, MA, LCPC, CMHP.mp4 –DSM-IV-TRDSM-IV-TR –DSM-V - will appear in 2014 –Reliable across practitioners International Classification of Diseases (ICD-10) coordinated to develop DSM classifications used as diagnosis codes for insurance companies Criticisms of the DSM- creates labels that bias people / may lead to stigmatizing people

15. 15 How are Psychological Disorders Diagnosed? Multiaxial Classification pg 645 Are Psychosocial or Environmental Problems (school or housing issues) also present? Axis IV What is the Global Assessment of the person’s functioning? Axis V Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis III Is a Personality Disorder or Mental Retardation present? Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis I

16. Classifying Psychological Disorders

23. The Biopsychosocial Approach to Psychological Disorders

24. 24 Labeling Psychological Disorders 1.Critics of the DSM-IV argue that labels may stigmatize individuals. Rosenhan’s study Rosenhan’s study – “hearing voices,” saying “empty,” “hollow,” or “thud.” Otherwise gave good info…. All 8 diagnosed mentally ill. 2.Labels may be helpful for healthcare professionals when communicating with one another & establishing therapy. 3.“Insanity” labels raise moral & ethical questions about how society should treat people who have disorders & have committed crimes.

25. Labeling Psychological Disorders Rosenhan’s study – “hearing voices,” saying “empty,” “hollow,” or “thud.” Otherwise gave good info…. All 8 diagnosed mentally ill. Power of labels –Preconception can stigmatize Insanity label Stereotypes of the mentally ill Self-fulfilling prophecy

26. Anxiety Disorders

27. Anxiety Disorders video\217_Experiencing_Anxiety.mp4 video\217_Experiencing_Anxiety.mp4 Anxiety disorders- psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety Anxiety Disorders - Free Intro to Psychology VideoAnxiety disorders Anxiety Disorders - Free Intro to Psychology Video –Generalized anxiety disorderGeneralized anxiety disorder –Panic disorderPanic disorder –PhobiaPhobia –Obsessive-compulsive disorderObsessive-compulsive disorder –Post-traumatic stress disorderPost-traumatic stress disorder

28. Generalized Anxiety Disorder Generalized anxiety disorder - an anxiety disorder in which a person is continually tense, apprehensive, & in a state of autonomic nervous system arousal. (persistent)Generalized anxiety disorder –Unexplainably & continually tense, jittery & uneasy, muscle tension, sleeplessness & agitation, Feeling unfocused, out of control & negative –Physical symptoms (dizziness, sweating palms, heart palpitations, High BP, ulcers, etc) w/o any physical problem video\216_Anxiety_Disorders.mp4 video\216_Anxiety_Disorders.mp4 –2/3 women –Cause not Identifiable thus can not be dealt with »Free floating anxiety

29. Panic Disorder Panic disorder- an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror & accompanying chest pain, choking, or other frightening sensations.Panic disorder –Panic attacks- minutes long episode of intense fear that something horrible is about to happen. Usually involves physical symptoms. Smokers have a 2-4 X higher risk

30. Phobias Phobias an anxiety disorder marked by a persistent, irrational fear & avoidance of a specific object, activity, or situation.Phobias –Specific phobia – can lead to incapacitating efforts to avoid the feared situation –Social phobia – intense fear of being scrutinized by others –Agoraphobia- fear/avoidance of a situation in which escape might be difficult or help unavailable when panic strikes

31. Phobias

33. Obsessive-Compulsive Disorder Obsessive-compulsive disorder - an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions). video\219_OCD_Young Mother.mp4Obsessive-compulsive disorder video\219_OCD_Young Mother.mp4 –An obsession versus a compulsion –Checkers –Hand washers

34. Obsessive-Compulsive Disorder

39. Post-Traumatic Stress Disorder Post-traumatic stress disorder - an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience. video\THIS EMOTIONAL LIFE _ PTSD _ Treatment _ PBS.flvPost-traumatic stress disorder video\THIS EMOTIONAL LIFE _ PTSD _ Treatment _ PBS.flv –AKA: PTSD, “shellshock” or “battle fatigue” –Not just due to a war situation Post-traumatic growth

40. Understanding Anxiety Disorders The Learning Perspective Fear conditioning- general anxiety has been linked with classical conditioning of fear –Stimulus generalization –Reinforcement- avoidance, compulsions Observational learning –We can learn fear thru observing other’s fears

41. Understanding Anxiety Disorders The Biological Perspective Natural selection Genes –Anxiety gene –Twin studies support The Brain –scans reveal specific brain activity in OCD & depressed people –Anterior cingulate cortex- monitors our actions & checks for errors. Extremely active in OCD patients

42. Dissociative Disorders

43. Dissociative Disorders Dissociative Disorders Dissociative Disorders - Free Intro to Psychology Video Dissociative Disorders - Free Intro to Psychology Video Dissociative disorders- disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts,& feelings.Dissociative disorders –Fugue state- a patient completely forgets their personal identity (only temporarily) –Dissociate (become separated)

44. Dissociative Identity Disorder Dissociative identity disorder (DID) a rare dissociative disorder in which a person exhibits two or more distinct & alternating personalities.Dissociative identity disorder (DID) Formerly called multiple personality disorde –video\232_Multiple_Personality_Disorder.mp4video\232_Multiple_Personality_Disorder.mp4

45. Understanding Dissociative Identity Disorder Genuine disorder or not? DID rates 1930 2 cases a year to > 20,000 in the 1980s Therapist’s creation – shows up most with therapist who utilize hypnosis

46. Mood Disorders Phobias more common BUT…. Depression is the #1 reason to seek help & it’s the leading cause of disability

47. Mood Disorders Mood disorders psychological disorders characterized by emotional extremes. Mood Disorders - Free Intro to Psychology VideoMood disorders Mood Disorders - Free Intro to Psychology Video –Major depressive disorder mood disorder in which a person experiences, in the absence of drugs or a medical condition, 2 or more weeks of significantly depressed moods, feelings of worthlessness, & diminished interest or pleasure in most activities.Major depressive disorder –Bipolar disorder a mood disorder in which the person alternates btwn the hopelessness & lethargy of depression & the overexcited state of mania. (formerly called manic-depressive disorder.)Bipolar disorder

48. Major Depressive Disorder Major depressive disorder –Lethargy –Discouraged, dissatisfied, isolated –Unable to concentrate, eat or sleep –Feelings of worthlessness –Loss of interest in family & friends –Loss of interest in activities Dysthymic disorder- btwn normal sadness & major depression. Everyday > than 2 yrs

49. Major Depressive Disorder

52. Bipolar Disorder Bipolar Disorder - a mood disorder in which the person alternates between the hopelessness & lethargy of depression & the overexcited state of mania. (formerly named manic-depressive disorder)Bipolar Disorder –Mania (manic) Overtalkative, overactive, elated, little need for sleep, loud, flighty, reckless, poor judgement, etc.Mania –Bipolar disorder & creativity

53. Understanding Mood Disorders Many behavioral & cognitive changes accompany depression Depression is widespread, nearly ½ of depressed people have other disorders (anxiety, substance abuse) Compared with men, women are nearly twice as vulnerable to major depression Most major depressive episodes self-terminate Stressful events related to work, marriage & close relationships often precede depression With each new generation, depression is striking earlier & affecting more people

54. Understanding Mood Disorders

55. Genetic Influences Heritability- mood disorders run in families Linkage analysis- process of elimination Association studies- correlation btwn more specific DNA variation & population traits The depressed brain- Left Frontal Lobe. Genes act by directing biochemicals that down the line, influence behavior –Biochemical influences (key) Norepinephrine -increases arousal, boosts mood. scarce during depression, in overabundance during Mania Serotonin-scarce during Depression Understanding Mood Disorders The Biological Perspective video\225_Mood_Disorders.mp4 11 m video\225_Mood_Disorders.mp4

56. Understanding Mood Disorders The Biological Perspective

59. Understanding Mood Disorders Understanding Mood Disorders The Social-Cognitive Perspective Negative Thoughts & Moods Interact –Mind’s negative thoughts can influence biological events that can be a vicious cycle amplifying depression –Self-defeating beliefs Learned helplessness Overthinking –Explanatory style Stable, global, internal explanations –Cause versus indictor of depression? Bad moods feed on themselves –xxx

60. Understanding Mood Disorders Understanding Mood Disorders Explanatory Style

61. Understanding Mood Disorders Explanatory Style

70. Understanding Mood Disorders The Vicious Cycle of Depression

74. Biopsychosocial Approach to Depression

78. Understanding Mood Disorders Understanding Mood Disorders The Social-Cognitive Perspective Depression’s Vicious Cycle –Stressful experience –Negative explanatory style –Depressed mood –Cognitive & behavioral changes

79. Schizophrenia

80. Symptoms of Schizophrenia Symptoms of Schizophrenia Schizophrenia - Free Intro to Psychology Video Schizophrenia - Free Intro to Psychology Video Schizophrenia (split mind) a group of severe disorders characterized by disorganized & delusional thinking, disturbed perceptions, & inappropriate emotions & actions. video\229_Schizophrenia.mp4 -4:20 Not multiple personalitiesSchizophrenia video\229_Schizophrenia.mp4 –Positive symptoms –Negative symptoms

81. Symptoms of Schizophrenia Symptoms of Schizophrenia Disorganized Thinking Disorganized thinking –Delusions false beliefs, often of persecution or grandeur, that may accompany psychotic disordersDelusions Delusions of persecution (paranoid)\Word Salad –Breakdown in selective attention ability Disturbed perceptions –Hallucinations- no stimulus hearing voices Visual, smells, touch hallucinations are rare

82. Symptoms of Schizophrenia Symptoms of Schizophrenia Inappropriate Emotions & Actions Inappropriate Emotions –Flat affect – zombielike state of apparent apathy Inappropriate Actions –Catatonia- to remain motionless for hrs on end & then become agitated –Disruptive social behavior- disorganized thinking, disturbed perceptions & inappropriate emotions & actions

83. Types of Schizophrenia

89. Onset & Development Onset of the disease-early adulthood, 1 in 100 people Chronic (process) schizophrenia develops gradually, emerging from a long history of social inadequacy. Recovery in doubtful Acute (reactive) schizophrenia develops rapidly in response to particular life stresses. Recovery is much more likely

90. Understanding Schizophrenia Understanding Schizophrenia Brain Abnormalities video\229_Schizophrenia.mp4 4:20 - video\229_Schizophrenia.mp4 Dopamine Overactivity –Dopamine – D4 dopamine receptor: increased receptors for dopamine. –Dopamine blocking drugs Glutamate- impaired glutamate acitivity = another symptom Scans indicate abnormal activity in multiple brain areas. Out of sync neurons may disrupt the integrated functioning of t neural ntwks

91. Understanding Schizophrenia Understanding Schizophrenia Brain Abnormalities Abnormal Brain Activity & Anatomy –Frontal lobe & core brain activity abnormally low –Enlarged Fluid filled areas of the brain & a corresponding skrinkage of cerebral tissue –Thalamus tends to be smaller than normal – filtering sensory input & focusing attention C:\Users\mburt\Desktop\AP Psych\psych disorders\video\231_Schizophrenic_Brain.mp4 C:\Users\mburt\Desktop\AP Psych\psych disorders\video\231_Schizophrenic_Brain.mp4

92. Understanding Schizophrenia Brain Abnormalities Maternal Virus During Pregnancy –Studies on maternal activity & schizophrenia –Influence of the flu during mid pregnancy may impair fetal brain development

93. Understanding Schizophrenia Understanding Schizophrenia Genetic Factors Genetic predisposition- risks increases to in if a family member had/s schizophrenia & in 1 in 2 if an identical twin has/d it Twin studies & adoption studies confirm genetic connection Genetics & environmental influences- work together

94. Understanding Schizophrenia Psychological Factors video\227_Schizophrenia_Case_Study.mp4 video\227_Schizophrenia_Case_Study.mp4 Possible warning signs –Mother severely schizophrenic –Birth complications (low weight/oxygen deprivation) –Separation from parents –Short attention span –Poor muscle coordination –Disruptive or withdrawn behavior –Emotional unpredictability –Poor peer relations and solo play

95. Somatoform Disorders

96. Somatoform Disorder Somatoform Disorder Somatoform Disorders - Free Intro to Psychology Video Somatoform Disorders - Free Intro to Psychology Video Somatoform disorder - psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause.Somatoform disorder –Somatic (body) –Conversion disorderConversion disorder –HypochondriasisHypochondriasis

97. Personality Disorders

98. Personality disorders psychological disorders characterized by inflexible & enduring behavior patterns that impair social functioningPersonality disorders –Anxiety cluster- avoidant –Eccentric cluster- schizoid –Dramatic/impulsive cluster- histrionic & narcissistic –Personality Disorders - Free Intro to Psychology VideoPersonality Disorders - Free Intro to Psychology Video Most troubling of Personality Disorders: Antisocial Personality Disorder

99. Antisocial personality disorder a personality disorder in which the person (usually male) exhibits a lack of conscience for wrongdoing, even toward friends & family members. May be aggressive & ruthless or a clever con artist.Antisocial personality disorder -AKA Sociopath or psychopath Understanding antisocial personality disorder- brain scans reveal reduced activity in the frontal lobes (controls impulses) A genetic predisposition may interact with environ- mental influences to produce this disorder

100. Rates of Disorder Mental health statistics 1 in 6 or 7 consistently in studies. –Lowest rates – Shanghai –Highest rates- US

101. Rates of Disorder Poverty is a predictor Serious psychological disorders are doubly high among those below the poverty line Chicken or egg?Both Schizophrenia leads to poverty Kids in poverty exhibit more deviant & aggressive behavior When people move out of poverty these rates drop 40% Women in poverty= higher rates of substance abuse & depression Other factors Age –antisocial & phobias appear the earliest 8-10 OCD, alcohol abuse, bipolar, schizophrenia median 20 Major Depression median age 25

102. The End

103. Teacher Information Types of Files – This presentation has been saved as a “basic” Powerpoint file. While this file format placed a few limitations on the presentation, it insured the file would be compatible with the many versions of Powerpoint teachers use. To add functionality to the presentation, teachers may want to save the file for their specific version of Powerpoint. Animation – Once again, to insure compatibility with all versions of Powerpoint, none of the slides are animated. To increase student interest, it is suggested teachers animate the slides wherever possible. Adding slides to this presentation – Teachers are encouraged to adapt this presentation to their personal teaching style. To help keep a sense of continuity, blank slides which can be copied and pasted to a specific location in the presentation follow this “Teacher Information” section.

104. Teacher Information Hyperlink Slides - This presentation contain two types of hyperlinks. Hyperlinks can be identified by the text being underlined and a different color (usually purple). – Unit subsections hyperlinks: Immediately after the unit title slide, a page (slide #3) can be found listing all of the unit’s subsections. While in slide show mode, clicking on any of these hyperlinks will take the user directly to the beginning of that subsection. This allows teachers quick access to each subsection. – Bold print term hyperlinks: Every bold print term from the unit is included in this presentation as a hyperlink. While in slide show mode, clicking on any of the hyperlinks will take the user to a slide containing the formal definition of the term. Clicking on the “arrow” in the bottom left corner of the definition slide will take the user back to the original point in the presentation. These hyperlinks were included for teachers who want students to see or copy down the exact definition as stated in the text. Most teachers prefer the definitions not be included to prevent students from only “copying down what is on the screen” and not actively listening to the presentation. For teachers who continually use the Bold Print Term Hyperlinks option, please contact the author using the email address on the next slide to learn a technique to expedite the returning to the original point in the presentation.

105. Teacher Information Continuity slides – Throughout this presentation there are slides, usually of graphics or tables, that build on one another. These are included for three purposes. By presenting information in small chunks, students will find it easier to process and remember the concepts. By continually changing slides, students will stay interested in the presentation. To facilitate class discussion and critical thinking. Students should be encouraged to think about “what might come next” in the series of slides. Please feel free to contact me at kkorek@germantown.k12.wi.us with any questions, concerns, suggestions, etc. regarding these presentations.kkorek@germantown.k12.wi.us Kent Korek Germantown High School Germantown, WI 53022 262-253-3400 kkorek@germantown.k12.wi.us

106. Division title (green print) subdivision title ( blue print) xxx –xxx

107. Division title (green print) subdivision title ( blue print) Use this slide to add a table, chart, clip art, picture, diagram, or video clip. Delete this box when finished

108. Definition Slide = add definition here

109. Definition Slides

110. Psychological Disorder = deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors.

111. Attention-deficit Hyperactivity Disorder (ADHD) = a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms; extreme inattention, hyperactivity, and impulsivity.

112. Medical Model = the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured often through treatment in a hospital.

113. DSM-IV-TR = the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, updated as of 2000 “text revision”; a widely used system for classifying psychological disorders. describes 400 psychological disorders compared to 60 in the 1950s.

114. Anxiety Disorders = psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.

115. Generalized Anxiety Disorder = an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

116. Panic Disorder = an anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations.

117. Phobia = an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.

118. Obsessive-compulsive Disorder (OCD) = an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).

119. Post-traumatic Stress Disorder (PTSD) = an anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience.

120. Post-traumatic Growth = positive psychological changes as a result of struggling with extremely challenging circumstances and life crises.

121. Somatoform Disorder = psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause.

122. Conversion Disorder = a rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no psychological basis can be found.

123. Hypochondriasis = a somatoform disorder in which a person interprets normal physical sensations as symptoms of the disease.

124. Dissociative Disorders = disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.

125. Dissociative Identity Disorder (DID) = a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.

126. Mood Disorders = psychological disorders characterized by emotional extremes.

127. Major Depressive Disorder = a mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.

128. Mania = a mood disorder marked by a hyperactive, wildly optimistic state.

129. Bipolar Disorder = a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (formerly called manic- depressive disorder.)

130. Schizophrenia = a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions.

131. Delusions = false beliefs, often of persecution or grandeur, that may accompany psychotic disorders.

132. Personality Disorders = psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.

133. Antisocial Personality Disorder = a personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.