Transcript 正向心理学

Some Mental Disorders
Shulin Chen, MD & PhD
Zhejiang University
Hangzhou Mental Health Center
Outline
• Stress
• Anxiety and OCD
• Somatoform and Dissociative
disorders
Stress-Related Disorders
Categories of Stressors
• Frustrations
• Conflicts
– Approach-avoidance
– Double approach
– Double avoidance
• Pressures
– internal and external
Factors Predisposing a Person to
Stress - Stressor characteristics
• Duration (acute versus chronic)
• Number of stressors
• Severity (“size” of the stressor)
Psychological Moderators of Stress
• Self-efficacy
• Psychological hardiness
– commitment; high in challenge
• Sense of humor
• Predictability and controllability
• Social support
• Task oriented versus defense oriented coping
Effects of Stress
• Physical effects
• Physiological effects
– General Adaptation Syndrome
• Alarm stage
• Resistance stage
• Exhaustion state
Stress-Related Disorders:
Adjustment Disorders
• Adjustment Disorders
– Mild
– A maladaptive reaction to an identifiable
psychosocial stressor
– Typical sources of stress:
• unemployment
• relocation
Disaster Syndrome
• Characterizes the initial reactions of many
victims to catastrophes
• Stages:
– Shock
– Suggestible
– Recovery
Acute Stress Disorder and Post
Traumatic Stress Disorder
• Similar symptoms, but “time-frame” of
symptoms differ.
• Both occur in reaction to traumatic events
(e.g., natural disasters, rape, assault, war,
etc).
• Acute stress disorder, if it lasts past one
month, will turn into a diagnosis of PTSD.
PTSD:
General Categories of Symptoms
• Reexperiencing of the traumatic event
• Avoidance of stimuli associated with the
event.
• Numbing of general responsiveness
• Increased arousal
PTSD:
Vulnerability Factors
• Premorbid personality
– pre-existing psychological problems, low self-esteem,
social skill deficits, external locus of control.
• Severity of trauma
• Conditioned fear
• Childhood factors
– Poverty, early divorce or separation, family history of
mental disorders, history of sexual/physical abuse
• Social support
PTSD- Types of Trauma
• Rape
– Anticipatory phase, impact phase, posttraumatic
recoil phase, and reconstitution phase
• Military combat
Treatment
• Immediate treatment (if possible)
• Stress innoculation training
– provide information about the stressful situation
– rehearse adaptive self-statements
– practice self-statements while expose to various
stressors
• Exposure
Anxiety Disorders and OCD
Who is afraid of ?
• small insect
• animal, reptile
• speaking to a large audience
• speaking in front of a small group of familiar people
• meeting new people
• attending social gatherings
Anxiety as a Normal
and an Abnormal Response
• Some amount of anxiety is “normal” and is
associated with optimal levels of functioning.
• Only when anxiety begins to interfere with
social or occupational functioning is it
considered “abnormal.”
Bell Curve
The Fear and Anxiety Response
Patterns
•
•
•
•
Fear
Panic
Anxiety
Anxiety Disorder
Phobia Disorders
• Phobias
– Specific phobias
– Social phobia
– Agoraphobia
Specific Phobias
Specific Phobias
• Psychosocial causal factors
• Genetic and temperamental causal
factors
• Preparedness and the nonrandom
distribution of fears and phobias
• Treating specific phobias
Social Phobia
• General characteristics
Fear of being in social situations in
which one will be embarrassed or
humiliated
Social Phobia
• Interaction of psychosocial and biological
causal factors
– Social phobias as learned behavior
– Social fears and phobias in an evolutionary
context
– Preparedness and social phobia
Social Phobia
• Interaction of psychosocial and biological
causal factors
– Genetic and temperamental factors
– Perceptions of uncontrollability
– Cognitive variables
Panic Disorder With and Without
Agoraphobia
•
•
•
•
Panic disorder
Panic versus anxiety
Agoraphobia
Agoraphobia without panic
Panic Disorder
•
•
•
•
Prevalence and age of onset
Comorbidity with other disorders
Biological causal factors
The role of Norepinephrine and
Serotonin
Panic and the Brain
Panic Disorder
• Genetic factors
• Cognitive and behavioral causal factors
• Interoceptive fears
Panic Disorder: The Cognitive
Theory of Panic
Panic Disorder: The Cognitive
Theory of Panic
• Perceived control and safety
• Anxiety sensitivity as a vulnerability factor
for panic
• Safety behaviors and the persistence of
panic
• Cognitive biases and the maintenance of
panic
Treating Panic Disorder and
Agoraphobia
• Medications
• Behavioral and
cognitive-behavioral
treatments
Generalized Anxiety Disorder
• General characteristics
• Prevalence and age of onset
• Comorbidity with other disorders
Generalized Anxiety Disorder:
Psychosocial Causal Factors
• The psychoanalytic viewpoint
• Classical conditioning to many stimuli
• The role of unpredictable and
uncontrollable events
• A sense of mastery: immunizing against
anxiety
Generalized Anxiety Disorder:
Biological Causal Factors
• Genetic factors
• A functional deficiency of GABA
• Neurobiological differences between
anxiety and panic
Obsessive-Compulsive Disorder
• Obsessions- repetitive unwanted ideas that
the person recognizes are irrational
• Compulsions- repetitive, often ritualized
behavior whose behavior serves to diminish
anxiety caused by obsessions
Obsessive-Compulsive Disorder
•
•
•
•
Prevalence and age of onset
Characteristics of OCD
Types of compulsions
Comorbidity with other disorders
Obsessive-Compulsive Disorder:
Psychosocial Causal Factors
•
•
•
•
Psychoanalytic viewpoint
Behavioral viewpoint
The role of memory
Attempting to suppress obsessive thoughts
Obsessive-Compulsive Disorder:
Biological Causal Factors
• Genetic influences
• Abnormalities in brain
function
• The role of serotonin
Somatoform and Dissociative
Disorders
I. Somatoform Disorders
A. Sick Role
• Have you ever “played sick” in order to get
out of something? How did that work out
(did you get what you wanted)?
• Sick  attention (friends, family, medical) =
secondary gains
• Likely link between secondary gains and
somatoform disorders
• Some medical condition may actually exist
B. Somatization Disorder
1. Historical perspective
•
•
•
•
In the medical/clinical nomenclature since the
mid-1600’s
Known as “Hysteria,” “hypochondriasis,” and
“melancholia” until 1800’s when mental
disorders were differentiated
Briquet’s syndrome, named for the French
physician who initially defined it in 1859
Term “somatization disorder” was first used in
DSM-III (1980)
B. Somatization (cont.)
2. DSM-IV criteria (p. 174)
A. History of many physical complaints
beginning before age 30 occurring over
several years resulting in treatment being
sought or significant impairment in
functioning
2. DSM-IV criteria (cont.)
B. Each of the following met at some point
during disorder:
1) 4 pain symptoms
2) 2 gastrointestinal symptoms
3) 1 sexual symptom
4) 1 pseudoneurological symptom
2. DSM-IV criteria (cont.)
C. Either:
1) symptoms in Criterion B cannot be fully
explained by a known GMC
or 2) when a GMC does exist, the
symptoms in Criterion B are in excess of
what would be expected based on medical
facts
D. Symptoms not intentionally feigned or
produced
B. Somatization (cont.)
3. Additional descriptive information
•
•
•
Report of symptoms usually colorful or
exaggerated; factual info usually lacking
Lab findings do not support somatic complaints
Treatment sought from several doctors at once
 hazardous mix of treatments
3. Additional info (cont.)
• Primary relationships are with doctors; personal
relationships usually have problems
• Often seem indifferent about what symptoms
represent
– Concerned with individual symptoms, not what
symptoms might indicate in terms of a disease
• Physical symptoms become part of their identity
(ego syntonic)
B. Somatization (cont.)
4. Statistics and course
– Lifetime prevalence:
•
•
•
0.2 – 2% in women
less than 0.2% in men
Rates affected by rater, method of assessment, and
demographic variables:
– Non-physicians diagnose it less frequently
– In primary medical care settings, rate is 4.4 – 20%
– Typical demographic is lower SES unmarried woman
4. Statistics and course (cont.)
• Onset is usually before 25 (must have
symptoms before 30)
• Course is chronic and rarely remits completely
B. Somatization (cont.)
5. Causes
a) familial/genetic
•
•
Clear link between somatization and antisocial personality
disorder
Genetic influence (30-50%) on somatization symptoms
b) Social learning
•
•
Parents may reinforce somatic complaints in children  gain
attention (sick role)
Research shows somatization features and help seeking for
illness in parents of somatizing children
5. Causes (cont.)
c) Cultural
– Cultural differences in type of symptoms
– Different rates across cultures
– Possible differences in the use of somatic
references in communication (not a disorder, just
differences in communication?)
d) Societal
– More acceptance of medical vs. psychological
problems
B. Somatization (cont.)
6. Treatment
– No treatment shown to be effective
– Behavioral approach  limit doctor visits
•
Use a gatekeeper physician
– Train patient to relate to others without using
physical complaints
Somatoform and Dissociative
Disorders
II. Dissociative Disorders
Overview
• Disorders are marked by disruption in the
usually integrated functions of consciousness,
memory, identity, or perception of the
environment
• What are some “normal” dissociative
experiences that people have sometimes?
A. Common Features of Dissociative
Disorders
1. Depersonalization = distortion in perception
such that a sense of reality is lost
2. Derealization = losing a sense of the
external world
•
e.g., things change size or shape
B. Dissociative Identity Disorder (DID)
•
Formerly known as multiple personality
disorder
1. DSM-IV criteria (p.192)
A. presence of 2 or more distinct identities
or personality states
B. At least 2 identities/personalities
recurrently take control of the person’s
behavior
1. DSM-IV criteria (cont.)
C. Inability to recall important personal
information (goes beyond ordinary
forgetfulness)
D. Not due to effects of a substance or GMC;
in children, symptoms not attributable to
imaginary playmates or fantasy play
Additional descriptive info
• Alter = identity or personality in DID
– Many have at least 1 impulsive alter
– Alters of the opposite gender are common
• Host = identity that seeks treatment and tries
to keep other identities integrated
• Switch = transition to another identity
B. DID (cont.)
2. Course and statistics
- 3-9 times more common among women
- ratio may be more even in children
- number of identities varies:
- women average about 15
- men average about 8
- course is chronic; dissociation can be spurred
by stress
B. DID (cont.)
3. Causes
- almost every DID case has history of severe
sexual or physical abuse  dissociation
seems to be a defense
- may be extreme form of PTSD
- biological influences not clear
- very few twin studies  suggest
environment is more influential than
genes
3. Causes (cont.)
• Most are highly suggestible; easily hypnotized
B. DID (cont.)
4. Treatment
- similar to treatment of PTSD
- exposure to traumatic memories; goal
is desensitization and prevention of
response (dissociation)
Summary
• Somatoform disorders involve a focus on
physical symptoms that are either not real or
are exaggerated
• Dissociative disorders involve a disturbance in
normally integrated functions (memory,
identity, etc.)
• Course is usually chronic
• Causes for most are unknown
Thanks
and
Question Welcome