Abnormal Psychology: Psychophysiological and Dissociative Disorders

Psychophysiological Disorders

• Definition: Physiological disorders that are influenced by psychological factors.

  • Previously referred to as psychosomatic心理影響的 disorders.

  • Emphasizes the mind-body connection.

  • Psychological states influence physical well-being.

  • Often requires both medical treatment and psychotherapy.

• Types of Psychophysiological Disorders:

  1. Tissue Damage (e.g., Coronary Heart Disease)

  2. Disease Process (e.g., immune impairment)

  3. Physiological Dysfunction (e.g., asthma哮喘, migraine headaches)

Key Examples

1. Coronary Heart Disease (CHD) 冠狀動脈心臟病

   • Description: Narrowing of cardiac arteries leading to restricted blood flow and oxygen to the heart.

   • Mechanism: Stress triggers cortisol release, activating the sympathetic nervous system.

   • Symptoms:

     • Chest pain

     • Heart attack

     • Cardiac arrest

   • Risk Factors:

     • Work stress, depression, hostility

     • History of abuse in childhood

   • Case Example: 48-year-old stockbroker's vital signs spiked significantly during market stress.

2. Hypertension 高血壓

   • Definition: Chronic condition with blood pressure at or above 130/80.

   • Risk Factors:

     • Biological: High blood pressure, genetic factors

     • Psychological: Stress, anger

     • Social/Sociocultural: Crowded living conditions, stressful job environments

3. Headaches 頭痛

   • Common types: Migraine, tension, cluster.

   • Risk Factors:

     • Biological: Poor posture, eyestrain

     • Psychological: Stress, depression

     • Social/Sociocultural: Sexual harassment, triggering environmental factors

4. Asthma 哮喘

   • Definition: Chronic inflammatory disease affecting lung airways.

   • Risk Factors:

     • Biological: Allergies, genetic predisposition

     • Psychological: Depression, hostility

     • Social/Sociocultural: Family conflicts

Dissociative Disorders 解離症

• Definition of Dissociation: A mental process where a person feels disconnected from thoughts, feelings, memories, or identity.

  • Varies in severity from temporary daydreaming to persistent disorders affecting daily life.

Types of Dissociative Disorders

1. Depersonalization/Derealization Disorder 人格解體

   • Prevalence: Affected 1.0% - 2.0% of the general population; onset usually begins around age 16.

   • Characteristics:

     • Depersonalization: Detachment from self, feeling like an outside observer.

     • Derealization: Detachment from surroundings, feeling environments are unreal.

   • DSM-5 Criteria: Must exhibit persistent experiences causing distress; reality testing remains intact.

   • Case Study Example: College student perceiving changes in her own appearance and surroundings.

2. Dissociative Amnesia 解離失憶症

   • Description: Inability to recall important autobiographical information, typically around traumatic events.

   • Subtypes: Localized (specific events) vs. generalized (identity).

   • Criteria: Symptoms must cause distress and not be attributed to other medical conditions or substances.

   • Case Study Example: Woman failing to recall traumatic event surrounding a fire.

3. Dissociative Fugue 解離性漫遊症

   • Definition: Sudden travel away from home, inability to recall personal history, might assume a new identity.

   • Case Study Example: Agatha Christie’s disappearance and identity assumption during her fugue state.

4. Dissociative Identity Disorder (DID) 解離身份障礙

   • Characteristics: Presence of two or more distinct identities (alters); often coexists with dissociative amnesia失憶.

   • Prevalence: More common in females (9:1 ratio) with varying durations of alters' control.

   • DSM-5 Criteria: Identity disruption, recurrent memory gaps, significant distress, not attributable to cultural practices or substances.

Understanding Dissociative Disorder from a Multipath Perspective

• Biological Dimension:

  • Brain activation patterns differ between personalities.

  • Trauma-related reductions in hippocampus and amygdala volumes influence memory processing.

  • Temporal lobe involvement linked to altered consciousness states.

• Psychological Dimension:

  • Psychodynamic Perspective: Utilizes repression to protect individuals from painful memories.

  • Influenced by stress exposure and the individual's resilience.

• Social and Sociocultural Dimension:

  • Experiences of childhood abuse and lack of social support may contribute.

  • Sociocognitive Model suggests DID can arise in response to suggestive environments and therapy prompts rather than deception.

Treatments for Dissociative Disorders

• Medications: No specific medication for DID, but can treat associated anxiety or depression.

• Treatment Approach:

  1. Safety, stabilization, symptom reduction.

  2. Address underlying traumatic memories.

  3. Foster integration of the distinct identities.