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Eye on Psi Chi: Winter 2012
Christmas Spirit:
A (Tongue-in-Cheek) Proposal for an Addition to the DSM-V

Kelsey Connell, Jordan Bradford, Taylor Baldwin,
and Heather A. Haas, PhD, LaGrange College (GA)

122.50 Christmas Spirit

Diagnostic Features
The essential feature of Christmas Spirit is a recurrent pattern of cheery, festive, and altruistic behavior, accompanied by an obsessive focus on Christmas topics and activities, that persists for at least two weeks (Criterion A) and that exceeds normative seasonal reactions of individuals of comparable ages and developmental levels. Manifestations of the disorder are generally persistently present in all settings but occur exclusively during the last two months of the calendar year (Criterion B). By definition, the symptoms are attributed by the individual to the holiday season (Criterion C). Individuals with Christmas Spirit are typically proud of their behavioral differences and attempt to flaunt their symptoms, which often remit suddenly on December 25 or 26. The symptoms negatively impact academic and occupational functioning (Criterion D), although the impairment may be negligible if, as is often the case, fellow students and coworkers are similarly affected. Social functioning is not generally negatively impacted and, in fact, often improves during fits of Christmas Spirit. These symptoms are not due to the direct physiological effects of a substance or a general medical condition (Criterion E). The predominant mood during an episode of Christmas Spirit is hypomanic (Criterion A1), although giddiness approaching mania may occur when engaged in activities directly related to the Christmas season, especially if inebriated. This elevated mood state, often described as being "merry” or "jolly,” may be evident in the person’s subjective report. The heightened mood may also be noticeable to others who report high levels of smiling and laughing, frequent wishes of "Merry Christmas” and "Happy Holidays,” and sudden interjections of "Ho Ho Ho!” by those afflicted.

Marked increases in altruism, generally in the form of gift-giving, are also a key feature of Christmas Spirit (Criterion A2). A great deal of time is spent making lists of gifts to buy, finding or making gifts, wrapping gifts, and standing in lines to mail gifts. This feature is often one of the earliest indicators of the Christmas Spirit. High levels of altruism may also be manifested in helpful acts such as volunteering (e.g., to stand in front of grocery or department store doors repeatedly ringing a bell) or in making donations to charitable causes (e.g., donating turkeys, hams, or, in the Southeastern United States, boxes of macaroni and cheese to community Christmas dinner drives). Significantly, in the most prototypical cases of Christmas Spirit, altruism and gift-giving are not restricted to family and friends but extend to those who are strangers as well.

Compulsive and extravagant "over-the-top” decorating almost always characterizes those with Christmas Spirit (Criterion A3). This is most likely to involve decorating an evergreen tree with lights and ornaments and placing disproportionately sized stockings along a mantle. In severe cases, however, entire houses and even offices may be entirely transformed in a matter of days. In many cases, the compulsive redecorating is thematic. Color themes (especially red and green, but also silver, gold, white, and occasionally blue) are common. Other common themes are nativity scenes, angels, Santa Claus, elves, snowmen, stars, candy canes, reindeer, and sleds or sleighs. In addition to the one or more evergreens (or artificial evergreens), holly, mistletoe, poinsettias, and wreaths made from various organic substances may also be brought into the home. Although less common, the outside of the house may also be decorated, generally with lights. Decorating may also require the individual to spend hours stringing popcorn, building gingerbread houses, or making snowmen. These activities are often completed while listening to Christmas music or singing or humming Christmas themed songs.

Individuals with Christmas Spirit also often choose to adorn themselves in ways that match their newly redecorated homes,showing a strong preference for red and green apparel often similarly adorned with Christmas symbols or characters (Criterion A4). This is particularly common among women, who are especially likely to select Christmas-themed sweaters, jewelry, and, in some cases, socks. This symptom is generally less common and less extreme among men, although men too may suddenly elect to wear Christmas-themed T-shirts, ties, and boxer shorts not worn at any point during the first 10 months of the year. In the most extreme cases, people may also dress their families and pets in Christmas-related outfits or costumes, sometimes matching, and force them to be photographed this way.

Over-consumption of cookies, eggnog, and gingerbread (Criterion A5) may occur at any point during the course of the episode but is especially likely to occur during the frequent partying and drinking episodes (Criterion A6) that also typify this syndrome, although the two sets of activities do not necessarily occur together. People who have consumed copious amounts of mulled wine or other Christmas spirits may also develop a love of standing under the mistletoe, diagnostically known as Phoradendronphilia.

The most serious cases of Christmas Spirit are also marked by delusions (Criterion A7). Children are particularly likely to report a paranoid belief that Santa is always watching and making a list of who’s been naughty and who’s been nice. In adults, delusions of grandeur are more common and generally manifested in the protestations that one is Santa Claus, Mrs. Claus, or an elf.

Associated Features and Disorders

Associated descriptive features and mental disorders. Individuals affected by Christmas Spirit are generally characterized as being excessively cheery, jovial, exuberant, active, and energetic. This hypomanic mood state is often also accompanied by other symptoms of a hypomanic episode including racing thoughts and difficulty concentrating, distractibility, increased sociability, and goal-directed activity (e.g., hypergraphic episodes during which dozens of envelopes may be addressed and cards written in a single evening), and involvement in pleasurable activities that may have painful long-term consequences (e.g., impulsive spending and extremely generous charitable donations).

In some instances, individuals with Christmas Spirit also show obsessive and compulsive symptoms. For example, tree lights and tinsel may need to be hung in perfect symmetry, and specific foods may need to be prepared according to specific recipes and served for specific meals, using specific serving dishes. Although these compulsions may be attributed to family traditions, individuals overcome with Christmas Spirit may experience significant anxiety, distress, and hostility if the rituals are not performed perfectly, leading to disharmony within the family.

Children high in Christmas Spirit may nonetheless also experience episodes of intense Santaphobia. (See Watson & Rayner, 1920, for a case study of Santaphobia in the absence of Christmas Spirit). Episodes of Santaphobia are usually particularly intense while the child is sitting in a mall Santa’s lap and when relatives are trying to record the occasion photographically.

It appears that Christmas Spirit may also be a precursor to another disorder, Post Holiday Stress Disorder. When the season suddenly ends, some individuals— particularly those who have overspent or gained a great deal of weight—may experience a dysphoric state that may persist for days or weeks after the holidays have ended.

Associated laboratory findings. Although little laboratory research has been performed, anecdotal reports suggest that Christmas Spirit does cause physiological changes. Most well-validated is the Grinch Effect, an enlargement of the heart directly attributable to the rapid and dramatic increase of positive feelings due to the Christmas season and all that it entails. For more information on the Grinch Effect, see Seuss (1957).

Associated physical examination findings and general medical conditions. Levels of Christmas Spirit are positively correlated with levels of alcohol consumption and weight gain, but individuals with Christmas Spirit appear to be in normal physical condition when examined. The most notable physical marker of Christmas Spirit is a smile that does not fade. In some extremely rare but noteworthy cases, the presence of a bright red nose, Rudolph’s Syndrome, has been observed. It is important, though, to differentiate a true case of Rudolph’s Syndrome from more temporary seasonal causes of red noses that may also occur during the same time of year. Red noses from exposure to the cold (e.g., while sledding, building snowmen, or decorating the house) are much more common in northern climates and generally remit within an hour of returning indoors. Red noses may also accompany cold or flu symptoms, but Rudolph’s Syndrome is not associated with the coughs, sneezes, fevers, and sniffles of these other disorders.

Specific Culture, Age, and Gender Features
Christmas Spirit occurs only among those who celebrate Christmas, but because Christmas can be celebrated as a secular holiday, it does occur among people who self-report identification with a variety of religious faith traditions. Rates of Christmas Spirit do not vary by race, gender, or socioeconomic class. Whether rates of Christmas Spirit vary with age is unclear, with different researchers reporting strikingly different results.

Prevalence
Many reports suggest that rates of Christmas Spirit are decreasing every year. Defining symptoms of the syndrome also seem to be changing over time, with garish and gaudy outdoor decorations increasing in frequency and religiously themed manifestations decreasing in frequency.

Course
Although some symptoms may occur earlier, cases of Christmas Spirit generally increase dramatically after Thanksgiving, with shopping symptoms often peaking on Black Friday, at least in the United States. Symptoms generally persist until Christmas Day. Severity of the symptoms generally increases steadily throughout this time with the symptoms reaching the peak of severity on Christmas Eve or early on Christmas Day. Symptoms generally begin to subside during the afternoon or evening of Christmas Day and typically completely disappear by the day after Christmas. In some cases, symptoms, particularly those involving gift-buying, may persist at a subclinical level throughout the year.

The number of prior episodes of Christmas Spirit predicts the likelihood of subsequent episodes. Almost everyone who experiences one episode of Christmas Spirit will experience at least one more episode at some point in his or her life, and a sizeable majority experience at least subclinical episodes every year.

Familial Pattern
Anecdotal reports suggest that a diagnosis of Christmas Spirit is more likely to occur if close family members, not necessarily biological, show symptoms of the disorder. The incidence of Christmas Spirit is dramatically reduced among those who are not able to be home with their families, friends, and loved ones for the holidays.

Differential Diagnosis
Although the symptoms of Christmas Spirit may resemble the symptoms of a Hypomanic Episode, a Substance- Abuse Disorder, or Attention-Deficit/ Hyperactivity Disorder, these syndromes can be distinguished from Christmas Spirit on the basis of their course (with the onset of Christmas Spirit symptoms coming in November and sudden remission in late December). Furthermore, individuals with Christmas Spirit must, by definition, attribute the cause of their symptoms to the holiday season.

The obsessions and compulsions associated with episodes of Christmas Spirit can be distinguished from those defining Obsessive-Compulsive Disorder in two ways. First, in episodes of Christmas Spirit, the obsessions and compulsions are clearly related to Christmas activities and traditions. Second, the individual generally derives pleasure from the "compulsive” ritualistic Christmas behaviors, whereas this is not the case in Obsessive-Compulsive Disorder.

Although the two disorders share a number of features, course and theme considerations also help to distinguish Christmas Spirit from Obsessive-Compulsive Personality Disorder. As is true in Obsessive- Compulsive Personality Disorder, those experiencing Christmas Spirit may be highly perfectionistic, unable to delegate responsibility unless the task is done precisely according to their instructions, rigid, stubborn, and preoccupied with details, lists, organization, schedules, and order. However, Christmas Spirit is not associated with the miserly spending style that often characterizes Obsessive-Compulsive Personality Disorder or the devotion to work to the exclusion of friendship and leisure activities. In contrast, Christmas Spirit is defined by altruistic acts, socializing, and partying. In other cases, apparently similar behavioral symptoms occur for different reasons in episodes of Christmas Spirit than in the context of Obsessive Compulsive Disorder. First, although the individual experiencing Christmas Spirit may be overly conscientious and scrupulous, that is generally attributed to a concern that "Santa is watching.” Second, although the person experiencing high levels of Christmas Spirit may be unable to discard worn-out or useless objects (e.g., old Christmas cards and letters, old presents, and broken ornaments made by kindergarteners who now have children of their own), the reasons for retaining the items are clearly sentimental.


Kelsey Hunter Connell is a sophomore chemistry major with a psychology minor who is planning a career in pharmacy.

Jordan Bradford, the president of the LaGrange College chapter of Psi Chi, is a psychology major and history minor and is currently applying to graduate programs in clinical psychology.

Taylor Baldwin is a sophomore psychology major with a math minor. Dr. Heather A. Haas is now an associate professor of psychology at the University of Montana Western in Dillon, Montana.

Copyright 2012 (Volume 16, Issue 2) by Psi Chi, the International Honor Society in Psychology



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