Self-control of polydipsia in a long-stay patient

Abstract

The patient was referred because excessive water drinking had seriously depleted his serum sodium levels. The Polydipsia was viewed as an adjunctive behaviour generated by deprivation. Deprivation was described as lack of opportunity to negotiate personal schedules of reinforcment in a back ward of a large institution. Unreinforced behaviour has a low probability of occurring. The repertoire becomes characterised by missing items. This even further reduces the ability of the individual to activate sources of reinforcment himself. Dependency on the control asserted by the ward becomes an essential factor of the maintenance of the status quo. The treatment fostered self-control of the polydipsic drinking to the extent that the patient was able to choose to engage in highly reinforcing activities, away from the ward,in his personal workshop. These behaviours were able to successfully compete with the drinking away from the stimulus control in the ward of the maladaptive behaviour. When the patient was moved to another environment which contained features of both the ward and the workshop stimulus control appeared to reassert itself. Sodium levels returned to their original low level. The lack of choice appeared to be the most significant change in this last environment. Choice assures that the engaged in activity is reinforcing.