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One problem with the Freudian view is that it does not explain how energies left over from unconscious conflicts become transformed into physical symptoms (E medications prescribed for migraines 50mg thorazine for sale. The ancient Greek physician Hippocrates believed that hysterical symptoms were Miller symptoms 4dpo buy thorazine with paypal, 1987) symptoms 8 weeks cheap thorazine online visa. Might he have changed his mind had he the They allow the person to achieve primary gains and secondary gains medicinebg 100 mg thorazine visa. The person is aware of the physical symptom but not of the conflict prevented them from carrying out dangerous it represents. For example, the hysterical paralysis of an arm might symbolize and also prevent the individual from acting out on repressed unacceptable sexual. Repression occurs unconsciously, so the individual remains unaware of the underlying conflicts. From the psychodynamic perspective, conversion disorders, like dissociative disorders, serve a purpose. Secondary gains from the symptoms are those that allow the individual to avoid burdensome responsibilities and to gain the support-rather than condemnation-of those around them. For example, soldiers sometimes experience sudden "paralysis" of their hands, which prevents them from firing their guns in battle. The symptoms in such cases are not considered contrived, as would be the case in malingering. In the psychodynamic view, their "blindness" may have achieved a primary gain of shielding them from guilt associated with dropping bombs on civilian areas. It may also have achieved a secondary purpose of helping them avoid dangerous missions. Learning Theory Theoretical formulations including both psychodynamic theory and learning theory, focus on the role of anxiety in explaining conversion disorders. Psychodynamic theorists, however, seek the causes of anxiety in unconscious conflicts. Learning theorists focus on the more direct reinforcing properties of the symptom and its secondary role in helping the individual avoid or escape anxiety-evoking situations. Dissociative and Somatoform Disorders From the learning perspective, the symptoms in conversion and other somatoform disorders may also carry the benefits, or reinforcing properties, of the "sick role. See Tying it Together on page 226 for a schematic representation of the psychodynamic and learning theory conceptualizations of conversion disorder. Differences in learning experiences may explain why conversion disorders were historically more often reported among women than men. It may be that women in Western culture are more likely than men to be socialized to cope with stress by enacting a sick role (Miller, 1987). We are merely pointing out that people may learn to adopt roles that lead to reinforcing consequences, regardless of whether they deliberately seek to enact these roles. In hypochondriasis, people are bothered by obsessive, anxiety-inducing thoughts about their health. Running from doctor to doctor may be a form of compulsive behavior that is reinforced by the temporary relief from anxiety that patients experience when doctors assure them that their fears are unwarranted. Similarly, with body dysmorphic disorder, the constant grooming and pruning in the attempt to "fix" the perceived physical defect may offer partial relief from anxiety, but the "fix" is never quite good enough to completely erase the underlying concerns. In other cases, diverting attention to physical complaints can serve as a means of avoiding thinking about other life problems. People who develop hypochondriasis have a tendency to exaggerate the significance of minor physical complaints (Barsky et al. They misinterpret benign symptoms as signs of a serious illness, which creates anxiety, which leads them to chase down one doctor after another in an attempt to uncover the dreaded disease they fear they have. The anxiety itself may lead to unpleasant physical symptoms, which are likewise exaggerated in importance, leading to more worrisome cognitions. Cognitive theorists speculate that hypochondriasis and panic disorder, which often occur together, may share a common cause: a distorted way of thinking that leads the person to misinterpret minor changes in bodily sensations as signs of pending catastrophe (Salkovskis & Clark, 1993). Differences between the two disorders may hinge on whether the misinterpretation of bodily cues carries a perception of an imminent threat that leads to a rapid spiraling of anxiety (panic disorder) or of a longer-range threat that leads to a fear of an underlying disease process (hypochondriasis). Given the role of anxiety in hypochondriasis and somatization disorder, investigators question whether these disorders should continue to be classified as distinct forms of somatoform disorders (Creed & Barsky, 2004). Evidence shows a high rate of cooccurrence (comorbidity) of hypochondriasis and somatization disorder with both anxiety and depressive disorders (Creed & Barsky, 2004; de Waal et al.
For instance treatment 5th metatarsal shaft fracture buy cheap thorazine online, a biological male child with gender identity disorder may be ostracized or made fun of by children or even teachers for consistently "playing girl games"-and thus the child feels distress because of the reactions of others medicine in ukraine generic 50 mg thorazine with mastercard. Most adolescents and adults with gender identity disorder report having had symptoms of the disorder in childhood (even though most people who had gender identity disorder in childhood do not have it later in life) shinee symptoms buy 50mg thorazine mastercard, like the person in Case 11 holistic medicine discount 50 mg thorazine fast delivery. My conviction, by the way, had nothing to do with a desire to be feminine, but it had everything to do with being female. Most commonly, individuals with gender identity disorder are heterosexual relative to their gender identification. For instance, biological men who see themselves as women tend to be attracted to men, and thus feel as if they are heterosexual (Blanchard, 1989, 1990; Zucker & Bradley, 1995). Others are homosexual relative to their gender identification; a biological woman who sees herself as a man may be sexually attracted to men. However, some people with gender identity disorder are asexual-they have little or no interest in any type of sex. One explanation for this difference is that in Western cultures, females have a wider range of acceptable "masculine" behavior and dress than males do of acceptable "feminine" behavior and dress. Bob Barkany/Getty Images United Artists/Photofest Gender and Sexual Disorders 4 7 7 Table 11. Source: Unless otherwise noted, information is from American Psychiatric Association, 2000. Understandably, the person might then experience distress or impaired functioning. Critics also argue that the concept of "appropriate" behavior (especially for males) is too constrained. Understanding Gender Identity Disorder We now know that the brains of adults with gender identity disorder are different in some respects from the brains of people who do not have the disorder. Moreover, various psychological and social factors are associated with gender identity disorder. In the following sections we examine these neurological, psychological, and social factors. Neurological Factors Researchers know little about neurological factors that contribute to gender identity disorder. However, they have begun to document differences in specific brain structures in people who have the disorder versus those who do not, and have evidence that hormones during fetal development play a role in producing this disorder. N P S Brain Systems and Neural Communication the brains of transsexuals differ from typical brains in ways consistent with their gender identity. In particular, Kruijver and colleagues (2000) examined a specific type of neuron in a brain structure called the bed nucleus of the stria terminalis (which is often regarded as an extension of the amygdala). In this study, the number of these neurons in the brains of male-to-female transsexuals was in the range typically found in female brains, and the number in the brains of female-to-male transsexuals was in the range typically found in male brains. Research suggests that prenatal exposure to hormones may affect later gender identity (Bradley & Zucker, 1997; Wallien et al. In particular, maternal stress during pregnancy could produce hormones that predispose a person to gender identity disorder (Zucker & Bradley, 1995). In rats, maternal stress raises the level of cortisol in both the pregnant rat and any male pups she is carrying. Such an increase in cortisol can disrupt the timing of prenatal developmental events in a way that leads to low levels of androgen in the fetus and changes certain brain areas (Ward, 1992; Zucker & Bradley, 1995, p. One study found similar results in humans but with a different hormone, testosterone (which underlies many male sexual characteristics): Fetal levels of testosterone-measured from amniotic fluid-were positively associated with later stereotypical "male" play behavior in girls and, to a lesser extent, in boys; the higher the level of testosterone in the fluid, the more "male" play the children exhibited when they were between 6 and 10 years old (Auyeung et al. Genetics A hint that genetic factors contribute to gender identity disorder was reported by Sadeghi and Fakhrai (2000). These researchers described two 18-year-old female identical twins, both of whom had requested sex reassignment surgery. These young women had cross-dressed since childhood and had the hallmarks of gender identity disorder.
In some cases symptoms irritable bowel syndrome discount thorazine 50 mg online, panic attacks are cued-they are associated with particular objects medications made from plasma buy discount thorazine, situations medicine mountain scout ranch thorazine 100mg visa, or sensations symptoms cervical cancer discount thorazine american express. Although panic attacks are occasionally cued by Panic attack A specific period of intense dread, fear, or a sense of imminent doom, accompanied by physical symptoms of a pounding heart, shortness of breath, shakiness, and sweating. For example, grocery shopping in the winter-with the heat and stuffiness that comes from being under layers of clothing while inside of a store-may remind a person of sensations associated with a previous panic attack, which can lead to anxiety about having another panic attack. In other cases, panic attacks are uncued-they are spontaneous-they feel as though they come out of the blue, and are not associated with a particular object or situation. Panic attacks can occur at any time, even while sleeping (referred to as nocturnal panic attacks, which Campbell experienced). Infrequent panic attacks are not unusual; they affect 30% of adults at some point in their lives. Recurrent panic attacks may interfere with daily life (for example, if they occur on a bus or at work) and cause the individual to leave the situation to return home or seek medical help. The symptoms of a panic attack are so unpleasant that people who suffer from this disorder may try to prevent another attack by avoiding environments and activities that increase their heart rates (hot places, crowded rooms, elevators, exercise, sex, mass transportation, or sporting events). And the last thing you want to accept is the idea of living the rest of your life with panic. This condition caused me to shut myself up in the my house, where I would sit in the dark, frustrated, crying, afraid to go out. To mental health clinicians, panic disorder is marked by frequent, unexpected panic attacks, along with fear of further attacks and possible restrictions of behavior in order to prevent such attacks (see Table 7. Panic disorder the anxiety disorder characterized by frequent, unexpected panic attacks, along with fear of further attacks and possible restrictions of behavior in order to prevent such attacks. S had experienced her first panic attack approximately 1 year prior to the time of the initial assessment. Her father had died 3 months before her first panic attack; his death was unexpected, the result of a stroke. In addition to grieving for her father, S became extremely concerned about the possibility of herself having a stroke. Following her first panic attack, S was highly vigilant for tingling sensation in her scalp, pain around her eyes, and numbness in her arms and legs. Moreover, because her concerns became more generalized, she began to fear any signs of impending panic, such as shortness of breath and palpitations. Her concerns led to significant changes in her lifestyle [and she avoided] unstructured time in the event she might dwell on "how she felt" and, by so doing, panic. S felt that her life revolved around preventing the experience of panic and stroke. For example, among Cambodian refugees, symptoms of panic disorder include a fear that "wind-and-blood pressure" (referred to as wind overload) may increase to the point of bursting the neck area, and patients may complain of a sore neck, along with headache, blurry vision, and dizziness (Hinton, Um, & Ba, 2001). In some cultures, people experience symptoms that are similar-but not identical- to the classic symptoms of a panic attack. In the Caribbean, Puerto Rico, and some areas of Latin America, an anxiety-related problem called ataque de nervios can occur (usually in women). The most common symptoms are uncontrollable screaming and crying attacks, together with palpitations, shaking, and numbness. Both (1) and (2): (1) recurrent unexpected Panic Attacks (2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following: (a) persistent concern about having additional attacks (b) worry about the implications of the attack or its consequences. The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia. The two Axis I disorders mostly commonly associated with panic disorder are depression (up to 65% of cases) and substance abuse (up to 30% of cases) (Biederman et al. Panic attacks that are part of panic disorder tend not to have such an obvious situational trigger. Panic disorder, as well as ataque de nervios and other anxiety disorders, is diagnosed in at least twice as often in women as in men (American Psychiatric Association, 2000).
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Syndromes
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Pedagogy All abnormal psychology textbooks cover a lot of ground: Students must learn new concepts x medications purchase 50mg thorazine with mastercard, facts medicine nelly cheap generic thorazine canada, and theories medications used to treat fibromyalgia order thorazine 100 mg with visa. We want to make that task easier medications and grapefruit interactions purchase 100mg thorazine with visa, to help students consolidate the material they learn and to come to a deeper understanding of the material. The icon specifies which types of factors and feedback loops are directly implicated by a particular study, set of findings, or theory ("N" for neurological, "P" for psychological, and "S" for social). For instance, in the margin here is the icon we use to note specific evidence or theory that implicates psychological and social factors-and the feedback loop between them-as contributing to a particular psychological disorder. Social Factors: Modeling N P S Sometimes, simply seeing other people exhibit fear of a particular stimulus is enough to make the observer become afraid of that stimulus (Mineka, Cook, & Miller, 1984). For example, if as a young child, you saw your older cousin become agitated and anxious when a dog approached, you might well learn to do the same. Similarly, repeated warnings about the dangers of a stimulus can increase the risk of developing a specific phobia of that stimulus (Antony & Barlow, 2002). In addition, an arrow points to the type of factor that is the direct target of relevant treatment. When patients successfully respond differently to a feared stimulus, this mastery over the compulsion gives them hope and motivates them to continue to perform the new behaviors. Examples of these sections are Feedback Loops in Action: Understanding Panic Disorder and Feedback Loops in Treatment: Panic Disorder. It is only when neurological, biological, and psychological factors interact that panic disorder develops (Bouton, Mineka, & Barlow, 2001). Indeed, such stressors may lead an individual to be aroused (neurological factor), but he or she then misinterprets the cause of this arousal (psychological factor). In fact, the dose should be gradually decreased so that the patient can experience enough anxiety to be increasingly able to make use of cognitive-behavioral methods. In addition to transcripts of therapy sessions and brief first-person descriptions of particular symptoms, the textbook includes three types of clinical material: a story woven through each chapter, traditional third-person cases (From the Outside), and first-person accounts (From the Inside). Chapter Stories: Illustration and Integration Each chapter opens with a story about an individual (or, in some cases, several individuals) who has symptoms of psychological distress or dysfunction. Observations about the person or people described in the opening story are then woven throughout the chapter. These chapter stories illustrate the common threads that run throughout the chapter (and thereby integrate the material), serve as retrieval cues for later recall of the material, and show students how the theories and research presented in each chapter apply to real people in the real world; the stories humanize the clinical descriptions and discussions of research presented in the chapters. However, he also suffered periods when he was immobilized by depression, and he generally had trouble regulating his emotions. I would read the same passage over and over again only to realize that I had no memory at all for what I had just read. The category of psychological disorders called mood disorders encompasses prolonged and marked disturbances in mood that affect how people feel, what they believe and expect, how they think and talk, and how they interact with others. Thus, we ask the student to see situations from the point of view of clinicians and researchers, who must sift through the available information to develop hypotheses about possible diagnoses and then obtain more information to confirm or disconfirm these hypotheses. The chapter stories in subsequent chapters focus on different examples of symptoms of psychological disorders, drawn from the lives of other people. For example, in Chapter 7, we discuss the reclusive billionaire Howard Hughes and the football star Earl Campbell, both of whom suffered from symptoms of anxiety; in Chapter 12, we discuss the Genain quadruplets-all four of whom were diagnosed with schizophrenia. The chapter begins like this: Rachel Reiland wrote a memoir called Get Me Out of Here, about living with a personality disorder. From the Outside the feature called From the Outside provides third-person accounts (typically case presentations by mental health clinicians) of disorders or particular symptoms of disorders. These accounts provide an additional opportunity for memory consolidation of the material, an additional set of retrieval cues, a further sense of how symptoms and disorders affect real people; these cases also serve to expose students to professional case material. The From the Outside feature covers an array of disorders, including cyclothymic disorder (Case 6. Often several From the Outside cases are included in a chapter; for instance, in Chapter 8, we include From the Outside cases on dissociative amnesia (Case 8. His mother reports that he stopped taking his medication about a month ago and has since begun to hear voices and to look and act more bizarrely.