desordenes psicologicos

8/20/2019 Desordenes psicologicos

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Chapter 15

Psychological Disorders

Figure 15.1 ! TOB>QE FP I>FA FK JBJLOF>J QL SF@QFJP LC QEB >PEFKDQLK >SV >OA PELLQFKD. (@OBAFQ: JLAFCF@>QFLK LC

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Chapter Outline

15.1 E>Q !OB PV@ELILDF@>I $FPLOABOP?

15.2 $F>DKLPFKD >KA #I>PPFCVFKD PV@ELILDF@>I $FPLOABOP15.3 BOPMB@QFSBP LK PV@ELILDF@>I $FPLOABOP

15.4 !KUFBQV $FPLOABOP

15.5 PBPPFSB-#LJMRIPFSB >KA BI>QBA $FPLOABOP

15.6 LPQQO>RJ>QF@ QOBPP $FPLOABO

15.7 LLA $FPLOABOP

15.8 @EFWLMEOBKF>

15.9 $FPPL@F>QFSB $FPLOABOP

15.10 BOPLK>IFQV $FPLOABOP

15.11 $FPLOABOP FK #EFIAELLA

Introduction

K LKA>V, BMQBJBO 16, 2013, > DRKJ>K HFIIBA 12 MBLMIB >P QEB TLOHA>V BD>K >Q QEB >PEFKDQLK>SV >OA FK >PEFKDQLK, #. >OLK IBUFP, 34, E>A > QOLRIBA EFPQLOV: EB QELRDEQ QE>Q EB T>P BFKD@LKQOLIIBA V O>AFL T>SBP, >KA > JLKQE B>OIFBO, EB E>A @LJMI>FKBA LC KLFPBP @LJFKD COLJ QEB IFKBK@ILPBQ FK EFP JFIFQ>OV ELRPFKD. B @>IIBA QEB MLIF@B QL @LJMI>FK >LRQ SLF@BP FK EFP EB>A >KA BFKD RKABOPROSBFII>K@B V pPE>ALTV CLO@BPq (ELJ>P, BSFKB, >QB, & #ILEBOQV, 2013).

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#E>MQBO 15 PV@ELILDF@>I $FPLOABOP 547


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15.1 What Are Psychological Disorders?

Learning Objectives

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psychological disorder FP > @LKAFQFLK @E>O>@QBOFWBA V >KLOJ>I QELRDEQP, CBBIFKDP, >KA BE>SFLOP.Psychopathology FP QEB PQRAV LC MPV@ELILDF@>I AFPLOABOP, FK@IRAFKD QEBFO PVJMQLJP, etiology (F.B., QEBFO@>RPBP), >KA QOB>QJBKQ. EB QBOJ psychopathology @>K >IPL OBCBO QL QEB J>KFCBPQ>QFLK LC > MPV@ELILDF@>I

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DEFINITION OF A PSYCHOLOGICAL DISORDER

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CULTURAL EXPECTATIONS

FLI>QFKD @RIQRO>I BUMB@Q>QFLKP FP KLQ, FK >KA LC FQPBIC, > P>QFPC>@QLOV JB>KP LC FABKQFCVFKD QEB MOBPBK@BLC > MPV@ELILDF@>I AFPLOABO. FK@B BE>SFLO S>OFBP COLJ LKB @RIQROB QL >KLQEBO, TE>Q J>V B BUMB@QBA>KA @LKPFABOBA >MMOLMOF>QB FK LKB @RIQROB J>V KLQ B SFBTBA >P PR@E FK LQEBO @RIQROBP. LO BU>JMIB,OBQROKFKD > PQO>KDBOsP PJFIB FP BUMB@QBA FK QEB KFQBA Q>QBP B@>RPB > MBOS>PFSB PL@F>I KLOJ AF@Q>QBPQE>Q TB OB@FMOL@>QB COFBKAIV DBPQROBP. MBOPLK TEL OBCRPBP QL >@HKLTIBADB PR@E DBPQROBP JFDEQ B@LKPFABOBA PL@F>IIV >THT>OAoMBOE>MP BSBK AFPLOABOBAo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igure 15.3).



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The Myth of Mental Illness

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EFP AFPA>FK CLO QEB @LK@BMQ LC JBKQ>I FIIKBPP >KA CLO QEB CFBIA LC MPV@EF>QOV FK DBKBO>I (IFSBO, 2006). EB >PFP

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FIIKBPP.

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DIG DEEPER




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2010). FP TLOH >IPL FKPMFOBA IBD>I @E>KDBP QE>Q MOLQB@Q QEB OFDEQP LC MBLMIB FK MPV@EF>QOF@ FKPQFQRQFLKP >KA >IILT

PR@E FKAFSFAR>IP > DOB>QBO ABDOBB LC FKCIRBK@B >KA OBPMLKPFFIFQV LSBO QEBFO IFSBP ("R@E>K>K-">OHBO & ">OHBO,

2009).

HARMFUL DYSFUNCTION

C KLKB LC QEB @OFQBOF> AFP@RPPBA PL C>O FP >ABNR>QB V FQPBIC QL ABCFKB QEB MOBPBK@B LC > MPV@ELILDF@>IAFPLOABO, ELT @>K > AFPLOABO B @LK@BMQR>IFWBA? >KV BCCLOQP E>SB BBK J>AB QL FABKQFCV QEB PMB@FCF@AFJBKPFLKP LC MPV@ELILDF@>I AFPLOABOP, VBQ KLKB FP BKQFOBIV P>QFPC>@QLOV. L RKFSBOP>I ABCFKFQFLK LC MPV@ELILDF@>I AFPLOABO BUFPQP QE>Q @>K >MMIV QL >II PFQR>QFLKP FK TEF@E > AFPLOABO FP QELRDEQ QL B MOBPBKQ(>@E>O & +BKAIBO, 2007). LTBSBO, LKB LC QEB JLOB FKCIRBKQF>I @LK@BMQR>IFW>QFLKP T>P MOLMLPBA V>HBCFBIA (1992), TEL ABCFKBA MPV@ELILDF@>I AFPLOABO >P > harmful dysfunction. >HBCFBIA >ODRBA QE>QK>QRO>I FKQBOK>I JB@E>KFPJPoQE>Q FP, MPV@ELILDF@>I MOL@BPPBP ELKBA V BSLIRQFLK, PR@E >P @LDKFQFLK,

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L FIIRPQO>QB, *>KBQ E>P >K BUQOBJB CB>O LC PMFABOP. *>KBQsP CB>O JFDEQ B @LKPFABOBA > AVPCRK@QFLK FK QE>QFQ PFDK>IP QE>Q QEB FKQBOK>I JB@E>KFPJ LC IB>OKFKD FP KLQ TLOHFKD @LOOB@QIV (F.B., > C>RIQV MOL@BPP MOBSBKQP *>KBQ COLJ >MMOLMOF>QBIV >PPL@F>QFKD QEB J>DKFQRAB LC EBO CB>O TFQE QEB >@QR>I QEOB>Q MLPBA V PMFABOP). *>KBQsP CB>O LC PMFABOP E>P > PFDKFCF@>KQ KBD>QFSB FKCIRBK@B LK EBO IFCB: PEB >SLFAP >II PFQR>QFLKP FK TEF@EPEB PRPMB@QP PMFABOP QL B MOBPBKQ (B.D., QEB >PBJBKQ LO > COFBKAsP ELJB), >KA PEB NRFQ EBO GL I>PQ JLKQE B@>RPB PEB P>T > PMFABO FK QEB OBPQOLLJ >Q TLOH >KA FP KLT RKBJMILVBA. @@LOAFKD QL QEB E>OJCRIAVPCRK@QFLK JLABI, *>KBQs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

THE AMERICAN PSYCHIATRIC ASSOCIATION (APA) DEFINITION>KV LC QEB CB>QROBP LC QEB E>OJCRI AVPCRK@QFLK JLABI >OB FK@LOMLO>QBA FK > CLOJ>I ABCFKFQFLK LC MPV@ELILDF@>I AFPLOABO ABSBILMBA V QEB JBOF@>K PV@EF>QOF@ PPL@F>QFLK (). @@LOAFKD QL QEB (2013), > MPV@ELILDF@>I AFPLOABO FP > @LKAFQFLK QE>Q FP P>FA QL @LKPFPQ LC QEB CLIILTFKD:

k There are significant disturbances in thoughts, feelings, and behaviors. MBOPLK JRPQ BUMBOFBK@BFKKBO PQ>QBP (B.D., QELRDEQP >KA/LO CBBIFKDP) >KA BUEFFQ BE>SFLOP QE>Q >OB @IB>OIV AFPQROBAoQE>QFP, RKRPR>I, RQ FK > KBD>QFSB, PBIC-ABCB>QFKD T>V. CQBK, PR@E AFPQRO>K@BP >OB QOLRIFKD QL QELPB>OLRKA QEB FKAFSFAR>I TEL BUMBOFBK@BP QEBJ. LO BU>JMIB, >K FKAFSFAR>I TEL FP RK@LKQOLII>IVMOBL@@RMFBA V QELRDEQP LC DBOJP PMBKAP ELROP B>@E A>V >QEFKD, E>P FKKBO BUMBOFBK@BP, >KA



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AFPMI>VP BE>SFLOP QE>Q JLPQ TLRIA @LKPFABO >QVMF@>I >KA KBD>QFSB (AFPQROBA) >KA QE>Q TLRIAIFHBIV B QOLRIFKD QL C>JFIV JBJBOP.

k The disturbances reflect some kind of biological, psychological, or developmental dysfunction.FPQROBA M>QQBOKP LC FKKBO BUMBOFBK@BP >KA BE>SFLOP PELRIA OBCIB@Q PLJB CI>T (AVPCRK@QFLK) FKQEB FKQBOK>I FLILDF@>I, MPV@ELILDF@>I, >KA ABSBILMJBKQ>I JB@E>KFPJP QE>Q IB>A QL KLOJ>I, EB>IQEVMPV@ELILDF@>I CRK@QFLKFKD. LO BU>JMIB, QEB E>IIR@FK>QFLKP LPBOSBA FK P@EFWLMEOBKF> @LRIA B >

PFDK LC O>FK >KLOJ>IFQFBP.k The disturbances lead to significant distress or disability in one’s life. MBOPLKsP FKKBO

BUMBOFBK@BP >KA BE>SFLOP >OB @LKPFABOBA QL OBCIB@Q > MPV@ELILDF@>I AFPLOABO FC QEBV @>RPB QEB MBOPLK@LKPFABO>IB AFPQOBPP, LO DOB>QIV FJM>FO EFP >FIFQV QL CRK@QFLK >P > KLOJ>I FKAFSFAR>I (LCQBK OBCBOOBAQL >P CRK@QFLK>I FJM>FOJBKQ, LO L@@RM>QFLK>I >KA PL@F>I FJM>FOJBKQ). P >K FIIRPQO>QFLK, > MBOPLKsPCB>O LC PL@F>I PFQR>QFLKP JFDEQ B PL AFPQOBPPFKD QE>Q FQ @>RPBP QEB MBOPLK QL >SLFA >II PL@F>I PFQR>QFLKP(B.D., MOBSBKQFKD QE>Q MBOPLK COLJ BFKD >IB QL >QQBKA @I>PP LO >MMIV CLO > GL).

k The disturbances do not reflect expected or culturally approved responses to certain events.FPQRO>K@BP FK QELRDEQP, CBBIFKDP, >KA BE>SFLOP JRPQ B PL@F>IIV RK>@@BMQ>IB OBPMLKPBP QL @BOQ>FKBSBKQP QE>Q LCQBK E>MMBK FK IFCB. LO BU>JMIB, FQ FP MBOCB@QIV K>QRO>I (>KA BUMB@QBA) QE>Q > MBOPLKTLRIA BUMBOFBK@B DOB>Q P>AKBPP >KA JFDEQ TFPE QL B IBCQ >ILKB CLIILTFKD QEB AB>QE LC > @ILPB C>JFIV

JBJBO. "B@>RPB PR@E OB>@QFLKP >OB FK PLJB T>VP @RIQRO>IIV BUMB@QBA, QEB FKAFSFAR>I TLRIA KLQ B>PPRJBA QL PFDKFCV > JBKQ>I AFPLOABO.

LJB BIFBSB QE>Q QEBOB FP KL BPPBKQF>I @OFQBOFLK LO PBQ LC @OFQBOF> QE>Q @>K ABCFKFQFSBIV AFPQFKDRFPE >II @>PBPLC AFPLOABO COLJ KLKAFPLOABO (FIFBKCBIA & >OFKL, 1999). K QORQE, KL PFKDIB >MMOL>@E QL ABCFKFKD >MPV@ELILDF@>I AFPLOABO FP >ABNR>QB V FQPBIC, KLO FP QEBOB RKFSBOP>I >DOBBJBKQ LK TEBOB QEB LRKA>OV FP BQTBBK AFPLOABOBA >KA KLQ AFPLOABOBA. OLJ QFJB QL QFJB TB >II BUMBOFBK@B >KUFBQV, RKT>KQBA QELRDEQP,>KA JLJBKQP LC P>AKBPP; LRO BE>SFLO >Q LQEBO QFJBP J>V KLQ J>HB JR@E PBKPB QL LROPBISBP LO QL LQEBOP.EBPB FKKBO BUMBOFBK@BP >KA BE>SFLOP @>K S>OV FK QEBFO FKQBKPFQV, RQ >OB LKIV @LKPFABOBA AFPLOABOBATEBK QEBV >OB EFDEIV AFPQROFKD QL RP >KA/LO LQEBOP, PRDDBPQ > AVPCRK@QFLK FK KLOJ>I JBKQ>I CRK@QFLKFKD,>KA >OB >PPL@F>QBA TFQE PFDKFCF@>KQ AFPQOBPP LO AFP>FIFQV FK PL@F>I LO L@@RM>QFLK>I >@QFSFQFBP.

15.2 Diagnosing and Classifying Psychological Disorders

Learning Objectives

"V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k UMI>FK TEV @I>PPFCF@>QFLK PVPQBJP >OB KB@BPP>OV FK QEB PQRAV LC MPV@ELM>QELILDVk BP@OFB QEB >PF@ CB>QROBP LC QEB F>DKLPQF@ >KA Q>QFPQF@>I >KR>I LC BKQ>I FPLOABOP,

FCQE AFQFLK (-5)k FP@RPP @E>KDBP FK QEB LSBO QFJB, FK@IRAFKD @OFQF@FPJP LC QEB @ROOBKQ BAFQFLKk ABKQFCV TEF@E AFPLOABOP >OB DBKBO>IIV QEB JLPQ @LJJLK

CFOPQ PQBM FK QEB PQRAV LC MPV@ELILDF@>I AFPLOABOP FP @>OBCRIIV >KA PVPQBJ>QF@>IIV AFP@BOKFKD PFDKFCF@>KQPFDKP >KA PVJMQLJP. LT AL JBKQ>I EB>IQE MOLCBPPFLK>IP >P@BOQ>FK TEBQEBO LO KLQ > MBOPLKsP FKKBOPQ>QBP >KA BE>SFLOP QORIV OBMOBPBKQ > MPV@ELILDF@>I AFPLOABO? OOFSFKD >Q > MOLMBO diagnosisoQE>Q FP,>MMOLMOF>QBIV FABKQFCVFKD >KA I>BIFKD > PBQ LC ABCFKBA PVJMQLJPoFP >PLIRQBIV @OR@F>I. EFP MOL@BPPBK>IBP MOLCBPPFLK>IP QL RPB > @LJJLK I>KDR>DB TFQE LQEBOP FK QEB CFBIA >KA >FAP FK @LJJRKF@>QFLK >LRQQEB AFPLOABO TFQE QEB M>QFBKQ, @LIIB>DRBP >KA QEB MRIF@. MOLMBO AF>DKLPFP FP >K BPPBKQF>I BIBJBKQ QL DRFABMOLMBO >KA PR@@BPPCRI QOB>QJBKQ. LO QEBPB OB>PLKP, @I>PPFCF@>QFLK PVPQBJP QE>Q LOD>KFWB MPV@ELILDF@>IAFPLOABOP PVPQBJ>QF@>IIV >OB KB@BPP>OV.




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THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)

IQELRDE > KRJBO LC @I>PPFCF@>QFLK PVPQBJP E>SB BBK ABSBILMBA LSBO QFJB, QEB LKB QE>Q FP RPBA VJLPQ JBKQ>I EB>IQE MOLCBPPFLK>IP FK QEB KFQBA Q>QBP FP QEB Diagnostic and Statistical Manual of MentalDisorders (DSM-5), MRIFPEBA V QEB JBOF@>K PV@EF>QOF@ PPL@F>QFLK (2013). (LQB QE>Q QEB JBOF@>KPV@EF>QOF@ PPL@F>QFLK AFCCBOP COLJ QEB JBOF@>K PV@ELILDF@>I PPL@F>QFLK; LQE >OB >OBSF>QBA .)EB CFOPQ BAFQFLK LC QEB , MRIFPEBA FK 1952, @I>PPFCFBA MPV@ELILDF@>I AFPLOABOP >@@LOAFKD QL > CLOJ>Q

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igure 15.4 PELTP IFCBQFJB MOBS>IBK@B O>QBPoQEB MBO@BKQ>DB LC MBLMIB FK> MLMRI>QFLK TEL ABSBILM > AFPLOABO FK QEBFO IFCBQFJBoLC S>OFLRP MPV@ELILDF@>I AFPLOABOP >JLKD ..>ARIQP. EBPB A>Q> TBOB >PBA LK > K>QFLK>I P>JMIB LC 9,282 .. OBPFABKQP (>QFLK>I #LJLOFAFQV ROSBV,2007).

Figure 15.4 EB DO>ME PELTP QEB OB>HALTK LC MPV@ELILDF@>I AFPLOABOP, @LJM>OFKD QEB MBO@BKQ>DB MOBS>IBK@B

>JLKD >ARIQ J>IBP >KA >ARIQ CBJ>IBP FK QEB KFQBA Q>QBP. "B@>RPB QEB A>Q> FP COLJ 2007, QEB @>QBDLOFBP PELTK

EBOB >OB COLJ QEB $-, TEF@E E>P BBK PRMMI>KQBA V QEB $-5. LPQ @>QBDLOFBP OBJ>FK QEB P>JB; ELTBSBO,

>I@LELI >RPB KLT C>IIP RKABO > OL>ABO !I@LELI PB $FPLOABO @>QBDLOV.

EB -5 >IPL MOLSFABP FKCLOJ>QFLK >LRQ comorbidity; QEB @L-L@@ROOBK@B LC QTL AFPLOABOP. LOBU>JMIB, QEB -5 JBKQFLKP QE>Q 41% LC MBLMIB TFQE LPBPPFSB-@LJMRIPFSB AFPLOABO (#) >IPL JBBQQEB AF>DKLPQF@ @OFQBOF> CLO J>GLO ABMOBPPFSB AFPLOABO (Figure 15.5). ORD RPB FP EFDEIV @LJLOFA TFQE LQEBOJBKQ>I FIIKBPPBP; 6 LRQ LC 10 MBLMIB TEL E>SB > PRPQ>K@B RPB AFPLOABO >IPL PRCCBO COLJ >KLQEBO CLOJ LC JBKQ>I FIIKBPP (>QFLK>I KPQFQRQB LK ORD RPB MQBO 15 PV@ELILDF@>I $FPLOABOP 553


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Figure 15.5 PBPPFSB-@LJMRIPFSB AFPLOABO >KA J>GLO ABMOBPPFSB AFPLOABO COBNRBKQIV L@@RO FK QEB P>JB MBOPLK.

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

LJB BIFBSB QE>Q BPQ>IFPEFKD KBT AF>DKLPBP JFDEQ LSBOM>QELILDFWB QEB ERJ>K @LKAFQFLK V QROKFKD@LJJLK ERJ>K MOLIBJP FKQL JBKQ>I FIIKBPPBP (EB PPL@F>QBA OBPP, 2013). KABBA, QEB CFKAFKD QE>QKB>OIV E>IC LC >II JBOF@>KP TFII JBBQ QEB @OFQBOF> CLO > AFPLOABO >Q PLJB MLFKQ FK QEBFO IFCB (+BPPIBO

BQ >I., 2005) IFHBIV CRBIP JR@E LC QEFP PHBMQF@FPJ. EB -5 FP >IPL @OFQF@FWBA LK QEB DOLRKAP QE>Q FQPAF>DKLPQF@ @OFQBOF> E>SB BBK ILLPBKBA, QEBOBV QEOB>QBKFKD QL pQROK LRO @ROOBKQ AF>DKLPQF@ FKCI>QFLK FKQLAF>DKLPQF@ EVMBOFKCI>QFLKq (O>K@BP, 2012, M>O>. 22). LO BU>JMIB, - PMB@FCFBA QE>Q QEB PVJMQLJPLC J>GLO ABMOBPPFSB AFPLOABO JRPQ KLQ B >QQOFRQ>IB QL KLOJ>I BOB>SBJBKQ (ILPP LC > ILSBA LKB). EB-5, ELTBSBO, E>P OBJLSBA QEFP BOB>SBJBKQ BU@IRPFLK, BPPBKQF>IIV JB>KFKD QE>Q DOFBC >KA P>AKBPP>CQBO > ILSBA LKBsP AB>QE @>K @LKPQFQRQB J>GLO ABMOBPPFSB AFPLOABO.

THE INTERNATIONAL CLASSIFICATION OF DISEASES

PB@LKA @I>PPFCF@>QFLK PVPQBJ, QEB International Classification of Diseases (ICD), FP >IPL TFABIVOB@LDKFWBA. RIFPEBA V QEB LOIA B>IQE OD>KFW>QFLK (), QEB # T>P ABSBILMBA FK ROLMBPELOQIV >CQBO LOIA >O >KA, IFHB QEB , E>P BBK OBSFPBA PBSBO>I QFJBP. EB @>QBDLOFBP LC

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

PQRAV QE>Q @LJM>OBA QEB RPB LC QEB QTL @I>PPFCF@>QFLK PVPQBJP CLRKA QE>Q TLOIATFAB QEB # FP JLOBCOBNRBKQIV RPBA CLO @IFKF@>I AF>DKLPFP, TEBOB>P QEB FP JLOB S>IRBA CLO OBPB>O@E (BWWF@E, 2002). LPQOBPB>O@E CFKAFKDP @LK@BOKFKD QEB BQFLILDV >KA QOB>QJBKQ LC MPV@ELILDF@>I AFPLOABOP >OB >PBA LK @OFQBOF> PBQ




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CLOQE FK QEB (IQJ>KKP & #>PQLKDR>V, 2013). EB >IPL FK@IRABP JLOB BUMIF@FQ AFPLOABO @OFQBOF>,>ILKD TFQE >K BUQBKPFSB >KA EBIMCRI BUMI>K>QLOV QBUQ (BDFBO BQ >I., 2012). EB FP QEB @I>PPFCF@>QFLKPVPQBJ LC @ELF@B >JLKD .. JBKQ>I EB>IQE MOLCBPPFLK>IP, >KA QEFP @E>MQBO FP >PBA LK QEB M>O>AFDJ.

THE COMPASSIONATE VIEW OF PSYCHOLOGICAL DISORDERS

P QEBPB AFPLOABOP >OB LRQIFKBA, MIB>PB B>O QTL QEFKDP FK JFKA. FOPQ, OBJBJBO QE>Q MPV@ELILDF@>I

AFPLOABOP OBMOBPBKQ extremes LC FKKBO BUMBOFBK@B >KA BE>SFLO. C, TEFIB OB>AFKD >LRQ QEBPB AFPLOABOP,VLR CBBI QE>Q QEBPB ABP@OFMQFLKP BDFK QL MBOPLK>IIV @E>O>@QBOFWB VLR, AL KLQ TLOOVoQEFP JLJBKQ LC BKIFDEQBKJBKQ MOL>IV JB>KP KLQEFKD JLOB QE>K VLR >OB KLOJ>I. >@E LC RP BUMBOFBK@BP BMFPLABP LC P>AKBPP, >KUFBQV, >KA MOBL@@RM>QFLK TFQE @BOQ>FK QELRDEQPoQFJBP TEBK TB AL KLQ NRFQB CBBI LROPBISBP.EBPB BMFPLABP PELRIA KLQ B @LKPFABOBA MOLIBJ>QF@ RKIBPP QEB >@@LJM>KVFKD QELRDEQP >KA BE>SFLOP B@LJB BUQOBJB >KA E>SB > AFPORMQFSB BCCB@Q LK LKBsP IFCB. B@LKA, RKABOPQ>KA QE>Q MBLMIB TFQEMPV@ELILDF@>I AFPLOABOP >OB C>O JLOB QE>K GRPQ BJLAFJBKQP LC QEBFO AFPLOABOP. B AL KLQ RPB QBOJPPR@E >P P@EFWLMEOBKF@P, ABMOBPPFSBP, LO MELF@P B@>RPB QEBV >OB I>BIP QE>Q LGB@QFCV MBLMIB TEL PRCCBOCOLJ QEBPB @LKAFQFLKP, QERP MOLJLQFKD F>PBA >KA AFPM>O>DFKD >PPRJMQFLKP >LRQ QEBJ. Q FP FJMLOQ>KQ QLOBJBJBO QE>Q > MPV@ELILDF@>I AFPLOABO FP KLQ TE>Q > MBOPLK is; FQ FP PLJBQEFKD QE>Q > MBOPLK hasoQEOLRDEKL C>RIQ LC EFP LO EBO LTK. P FP QEB @>PB TFQE @>K@BO LO AF>BQBP, QELPB TFQE MPV@ELILDF@>I AFPLOABOP PRCCBOABFIFQ>QFKD, LCQBK M>FKCRI @LKAFQFLKP QE>Q >OB KLQ LC QEBFO LTK @ELLPFKD. EBPB FKAFSFAR>IP ABPBOSB QL B

SFBTBA >KA QOB>QBA TFQE @LJM>PPFLK, RKABOPQ>KAFKD, >KA AFDKFQV.

15.3 Perspectives on Psychological Disorders

Learning Objectives

"V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k FP@RPP PRMBOK>QRO>I MBOPMB@QFSBP LK QEB LOFDFK LC MPV@ELILDF@>I AFPLOABOP, FK QEBFO

EFPQLOF@>I @LKQBUQk BP@OFB JLABOK FLILDF@>I >KA MPV@ELILDF@>I MBOPMB@QFSBP LK QEB LOFDFK LC MPV@ELILDF@>I

AFPLOABOPk ABKQFCV TEF@E AFPLOABOP DBKBO>IIV PELT QEB EFDEBPQ ABDOBB LC EBOFQ>FIFQVk BP@OFB QEB AF>QEBPFP-PQOBPP JLABI >KA FQP FJMLOQ>K@B QL QEB PQRAV LC MPV@ELM>QELILDV

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

SUPERNATURAL PERSPECTIVES OF PSYCHOLOGICAL DISORDERS

LO @BKQROFBP, MPV@ELILDF@>I AFPLOABOP TBOB SFBTBA COLJ > supernatural MBOPMB@QFSB: >QQOFRQBA QL >CLO@B BVLKA P@FBKQFCF@ RKABOPQ>KAFKD. ELPB >CCIF@QBA TBOB QELRDEQ QL B MO>@QFQFLKBOP LC I>@H J>DF@ LOMLPPBPPBA V PMFOFQP (Figure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PL@FBQFBP QLA>V; CLO BU>JMIB, BIFBCP QE>Q PRMBOK>QRO>I CLO@BP @>RPB JBKQ>I FIIKBPP >OB @LJJLK FK PLJB@RIQROBP FK JLABOK-A>V FDBOF> (DERHT>, 2012).

Figure 15.6 K The Extraction of the Stone of Madness, > 15QE @BKQROV M>FKQFKD V FBOLKVJRP "LP@E, > MO>@QFQFLKBO

FP RPFKD > QLLI QL BUQO>@Q >K LGB@Q (QEB PRMMLPBA iPQLKB LC J>AKBPPj) COLJ QEB EB>A LC >K >CCIF@QBA MBOPLK.

Dancing Mania

"BQTBBK QEB 11QE >KA 17QE @BKQROFBP, > @ROFLRP BMFABJF@ PTBMQ >@OLPP BPQBOK ROLMB. 'OLRMP LC MBLMIB

TLRIA PRAABKIV BDFK QL A>K@B TFQE TFIA >>KALK. EFP @LJMRIPFLK QL A>K@BfOBCBOOBA QL >P A>K@FKDJ>KF>fPLJBQFJBP DOFMMBA QELRP>KAP LC MBLMIB >Q > QFJB (Figure 15.7). FPQLOF@>I >@@LRKQP FKAF@>QB QE>Q QELPB

>CCIF@QBA TLRIA PLJBQFJBP A>K@B TFQE ORFPBA >KA ILLAV CBBQ CLO A>VP LO TBBHP, P@OB>JFKD LC QBOOFIB SFPFLKP

>KA BDDFKD MOFBPQP >KA JLKHP QL P>SB QEBFO PLRIP (>IIBO, 2009). E>Q @>RPBA A>K@FKD J>KF> FP KLQ HKLTK,

RQ PBSBO>I BUMI>K>QFLKP E>SB BBK MOLMLPBA, FK@IRAFKD PMFABO SBKLJ >KA BODLQ MLFPLKFKD (i$>K@FKD >KF>,j

2011).

Figure 15.7 !IQELRDE QEB @>RPB LC A>K@FKD J>KF>, ABMF@QBA FK QEFP M>FKQFKD, T>P RK@IB>O, QEB BE>SFLO T>P

>QQOFRQBA QL PRMBOK>QRO>I CLO@BP.

DIG DEEPER




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FPQLOF>K *LEK >IIBO (2009>, 2009) E>P MOLSFABA > @LJMOBEBKPFSB >KA @LKSFK@FKD BUMI>K>QFLK LC A>K@FKD

J>KF> QE>Q PRDDBPQP QEB MEBKLJBKLK T>P >QQOFRQ>IB QL > @LJFK>QFLK LC QEOBB C>@QLOP: MPV@ELILDF@>I AFPQOBPP,

PL@F>I @LKQ>DFLK, >KA BIFBC FK PRMBOK>QRO>I CLO@BP. >IIBO >ODRBA QE>Q S>OFLRP AFP>PQBOP LC QEB QFJB (PR@E >P

C>JFKB, MI>DRBP, >KA CILLAP) MOLAR@BA EFDE IBSBIP LC MPV@ELILDF@>I AFPQOBPP QE>Q @LRIA FK@OB>PB QEB IFHBIFELLA

LC PR@@RJFKD QL >K FKSLIRKQ>OV QO>K@B PQ>QB. >IIBO FKAF@>QBA QE>Q >KQEOLMLILDF@>I PQRAFBP >KA >@@LRKQP LC

MLPPBPPFLK OFQR>IP PELT QE>Q MBLMIB >OB JLOB IFHBIV QL BKQBO > QO>K@B PQ>QB FC QEBV BUMB@Q FQ QL E>MMBK, >KAQE>Q BKQO>K@BA FKAFSFAR>IP BE>SB FK > OFQR>IFPQF@ J>KKBO, QEBFO QELRDEQP >KA BE>SFLO PE>MBA V QEB PMFOFQR>I

BIFBCP LC QEBFO @RIQROB. ERP, AROFKD MBOFLAP LC BUQOBJB MEVPF@>I >KA JBKQ>I AFPQOBPP, >II FQ QLLH TBOB > CBT

MBLMIBfBIFBSFKD QEBJPBISBP QL E>SB BBK >CCIF@QBA TFQE > A>K@FKD @ROPBfQL PIFM FKQL > PMLKQ>KBLRP QO>K@B

>KA QEBK >@Q LRQ QEB M>OQ LC LKB TEL FP @ROPBA V A>K@FKD CLO A>VP LK BKA.

BIOLOGICAL PERSPECTIVES OF PSYCHOLOGICAL DISORDERS

EB FLILDF@>I MBOPMB@QFSB SFBTP MPV@ELILDF@>I AFPLOABOP >P IFKHBA QL FLILDF@>I MEBKLJBK>, PR@E >PDBKBQF@ C>@QLOP, @EBJF@>I FJ>I>K@BP, >KA O>FK >KLOJ>IFQFBP; FQ E>P D>FKBA @LKPFABO>IB >QQBKQFLK >KA>@@BMQ>K@B FK OB@BKQ AB@>ABP (V>QQ & FAHFCC, 2006). SFABK@B COLJ J>KV PLRO@BP FKAF@>QBP QE>Q JLPQ

MPV@ELILDF@>I AFPLOABOP E>SB > DBKBQF@ @LJMLKBKQ; FK C>@Q, QEBOB FP IFQQIB AFPMRQB QE>Q PLJB AFPLOABOP >OBI>ODBIV ARB QL DBKBQF@ C>@QLOP. EB DO>ME FK Figure 15.8 PELTP EBOFQ>FIFQV BPQFJ>QBP CLO P@EFWLMEOBKF>.

Figure 15.8 ! MBOPLKhP OFPH LC ABSBILMFKD P@EFWLMEOBKF> FK@OB>PBP FC > OBI>QFSB E>P P@EFWLMEOBKF>. EB @ILPBO QEB

DBKBQF@ OBI>QFLKPEFM, QEB EFDEBO QEB OFPH.

FKAFKDP PR@E >P QEBPB E>SB IBA J>KV LC QLA>VsP OBPB>O@EBOP QL PB>O@E CLO PMB@FCF@ DBKBP >KA DBKBQF@JRQ>QFLKP QE>Q @LKQOFRQB QL JBKQ>I AFPLOABOP. IPL, PLMEFPQF@>QBA KBRO>I FJ>DFKD QB@EKLILDV FK OB@BKQAB@>ABP E>P OBSB>IBA ELT >KLOJ>IFQFBP FK O>FK PQOR@QROB >KA CRK@QFLK JFDEQ B AFOB@QIV FKSLISBA FKJ>KV AFPLOABOP, >KA >AS>K@BP FK LRO RKABOPQ>KAFKD LC KBROLQO>KPJFQQBOP >KA ELOJLKBP E>SB VFBIABAFKPFDEQP FKQL QEBFO MLPPFIB @LKKB@QFLKP. EB FLILDF@>I MBOPMB@QFSB FP @ROOBKQIV QEOFSFKD FK QEB PQRAV LC MPV@ELILDF@>I AFPLOABOP.



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THE DIATHESIS-STRESS MODEL OF PSYCHOLOGICAL DISORDERS

BPMFQB >AS>K@BP FK RKABOPQ>KAFKD QEB FLILDF@>I >PFP LC MPV@ELILDF@>I AFPLOABOP, QEB MPV@ELPL@F>IMBOPMB@QFSB FP PQFII SBOV FJMLOQ>KQ. EFP MBOPMB@QFSB BJME>PFWBP QEB FJMLOQ>K@B LC IB>OKFKD, PQOBPP, C>RIQV>KA PBIC-ABCB>QFKD QEFKHFKD M>QQBOKP, >KA BKSFOLKJBKQ>I C>@QLOP. BOE>MP QEB BPQ T>V QL QEFKH >LRQMPV@ELILDF@>I AFPLOABOP, QEBK, FP QL SFBT QEBJ >P LOFDFK>QFKD COLJ > @LJFK>QFLK LC FLILDF@>I >KAMPV@ELILDF@>I MOL@BPPBP. >KV ABSBILM KLQ COLJ > PFKDIB @>RPB, RQ COLJ > ABIF@>QB CRPFLK BQTBBK M>OQIV

FLILDF@>I >KA M>OQIV MPV@ELPL@F>I C>@QLOP.EB diathesis-stress model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

EB HBV >PPRJMQFLK LC QEB AF>QEBPFP-PQOBPP JLABI FP QE>Q LQE C>@QLOP, AF>QEBPFP >KA PQOBPP, >OB KB@BPP>OV FKQEB ABSBILMJBKQ LC > AFPLOABO. FCCBOBKQ JLABIP BUMILOB QEB OBI>QFLKPEFM BQTBBK QEB QTL C>@QLOP: QEB IBSBILC PQOBPP KBBABA QL MOLAR@B QEB AFPLOABO FP FKSBOPBIV MOLMLOQFLK>I QL QEB IBSBI LC AF>QEBPFP.

15.4 Anxiety Disorders

Learning Objectives

"V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k FPQFKDRFPE KLOJ>I >KUFBQV COLJ M>QELILDF@>I >KUFBQVk FPQ >KA ABP@OFB QEB J>GLO >KUFBQV AFPLOABOP, FK@IRAFKD QEBFO J>FK CB>QROBP >KA MOBS>IBK@Bk BP@OFB >PF@ MPV@ELILDF@>I >KA FLILDF@>I C>@QLOP QE>Q >OB PRPMB@QBA QL B FJMLOQ>KQ FK QEB

BQFLILDV LC >KUFBQV AFPLOABO

SBOVLAV BUMBOFBK@BP >KUFBQV COLJ QFJB QL QFJB. IQELRDE >KUFBQV FP @ILPBIV OBI>QBA QL CB>O, QEB QTL PQ>QBPMLPPBPP FJMLOQ>KQ AFCCBOBK@BP. B>O FKSLISBP >K FKPQ>KQ>KBLRP OB>@QFLK QL >K FJJFKBKQ QEOB>Q, TEBOB>P>KUFBQV FKSLISBP >MMOBEBKPFLK, >SLFA>K@B, >KA @>RQFLRPKBPP OBD>OAFKD > MLQBKQF>I QEOB>Q, A>KDBO, LO LQEBOKBD>QFSB BSBKQ (#O>PHB, 1999). EFIB >KUFBQV FP RKMIB>P>KQ QL JLPQ MBLMIB, FQ FP FJMLOQ>KQ QL LRO EB>IQE,P>CBQV, >KA TBII-BFKD. KUFBQV JLQFS>QBP RP QL Q>HB >@QFLKPoPR@E >P MOBM>OFKD CLO BU>JP, T>Q@EFKD LROTBFDEQ, PELTFKD RM QL TLOH LK QFJBoQE>Q BK>IB RP QL >SBOQ MLQBKQF>I CRQROB MOLIBJP. KUFBQV >IPLJLQFS>QBP RP QL >SLFA @BOQ>FK QEFKDPoPR@E >P ORKKFKD RM ABQP >KA BKD>DFKD FK FIIBD>I >@QFSFQFBPoQE>Q@LRIA IB>A QL CRQROB QOLRIB. LPQ FKAFSFAR>IPs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sP >KUFBQV E>P > AFPORMQFSB FKCIRBK@B LK LKBsP IFSB, QEFP FP > PQOLKD FKAF@>QLO QE>Q QEB FKAFSFAR>I FPBUMBOFBK@FKD >K >KUFBQV AFPLOABO.

Anxiety disorders >OB @E>O>@QBOFWBA V BU@BPPFSB >KA MBOPFPQBKQ CB>O >KA >KUFBQV, >KA V OBI>QBAAFPQRO>K@BP FK BE>SFLO (, 2013). IQELRDE >KUFBQV FP RKFSBOP>IIV BUMBOFBK@BA, >KUFBQV AFPLOABOP@>RPB @LKPFABO>IB AFPQOBPP. P > DOLRM, >KUFBQV AFPLOABOP >OB @LJJLK: >MMOLUFJ>QBIV 25%n30% LC QEB.. MLMRI>QFLK JBBQP QEB @OFQBOF> CLO >Q IB>PQ LKB >KUFBQV AFPLOABO AROFKD QEBFO IFCBQFJB (+BPPIBO BQ >I.,2005). IPL, QEBPB AFPLOABOP >MMB>O QL B JR@E JLOB @LJJLK FK TLJBK QE>K QEBV >OB FK JBK; TFQEFK >12-JLKQE MBOFLA, >OLRKA 23% LC TLJBK >KA 14% LC JBK TFII BUMBOFBK@B >Q IB>PQ LKB >KUFBQV AFPLOABO




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(>QFLK>I #LJLOFAFQV ROSBV, 2007). KUFBQV AFPLOABOP >OB QEB JLPQ COBNRBKQIV L@@ROOFKD @I>PP LC JBKQ>IAFPLOABOP >KA >OB LCQBK @LJLOFA TFQE B>@E LQEBO >KA TFQE LQEBO JBKQ>I AFPLOABOP (+BPPIBO, RP@FL, EB>O,& FQQ@EBK, 2009).

SPECIFIC PHOBIA

Phobia FP > 'OBBH TLOA QE>Q JB>KP CB>O. MBOPLK AF>DKLPBA TFQE > specific phobia (CLOJBOIV HKLTK >P

PFJMIB MELF>) BUMBOFBK@BP BU@BPPFSB, AFPQOBPPFKD, >KA MBOPFPQBKQ CB>O LO >KUFBQV >LRQ > PMB@FCF@ LGB@Q LOPFQR>QFLK (PR@E >P >KFJ>IP, BK@ILPBA PM>@BP, BIBS>QLOP, LO CIVFKD) (, 2013). SBK QELRDE MBLMIB OB>IFWBQEBFO IBSBI LC CB>O >KA >KUFBQV FK OBI>QFLK QL QEB MELF@ PQFJRIRP FP FOO>QFLK>I, PLJB MBLMIB TFQE > PMB@FCF@MELF> J>V DL QL DOB>Q IBKDQEP QL >SLFA QEB MELF@ PQFJRIRP (QEB LGB@Q LO PFQR>QFLK QE>Q QOFDDBOP QEB CB>O>KA >KUFBQV). VMF@>IIV, QEB CB>O >KA >KUFBQV > MELF@ PQFJRIRP BIF@FQP FP AFPORMQFSB QL QEB MBOPLKsP IFCB. LOBU>JMIB, > J>K TFQE > MELF> LC CIVFKD JFDEQ OBCRPB QL >@@BMQ > GL QE>Q OBNRFOBP COBNRBKQ >FO QO>SBI, QERPKBD>QFSBIV >CCB@QFKD EFP @>OBBO. #IFKF@F>KP TEL E>SB TLOHBA TFQE MBLMIB TEL E>SB PMB@FCF@ MELF>P E>SBBK@LRKQBOBA J>KV HFKAP LC MELF>P, PLJB LC TEF@E >OB PELTK FK Table 15.1.

Table 15.1 Specific Phobias

Phobia Feared Object or Situation

@OLMELF> EBFDEQP

BOLMELF> CIVFKD

O>@EKLMELF> PMFABOP

#I>RPQOLMELF> BK@ILPBA PM>@BP

#VKLMELF> ALDP

BJ>QLMELF> ILLA

MEFAFLMELF> PK>HBP

>MELMELF> BFKD ROFBA >IFSB

OVM>KLMELF> FKGB@QFLKP

BKLMELF> PQO>KDBOP

MB@FCF@ MELF>P >OB @LJJLK; FK QEB KFQBA Q>QBP, >OLRKA 12.5% LC QEB MLMRI>QFLK TFII JBBQ QEB @OFQBOF>CLO > PMB@FCF@ MELF> >Q PLJB MLFKQ FK QEBFO IFCBQFJB (+BPPIBO BQ >I., 2005). KB QVMB LC MELF>, agoraphobia,FP IFPQBA FK QEB -5 >P > PBM>O>QB >KUFBQV AFPLOABO. DLO>MELF>, TEF@E IFQBO>IIV JB>KP pCB>O LC QEBJ>OHBQMI>@B,q FP @E>O>@QBOFWBA V FKQBKPB CB>O, >KUFBQV, >KA >SLFA>K@B LC PFQR>QFLKP FK TEF@E FQ JFDEQ BAFCCF@RIQ QL BP@>MB LO OB@BFSB EBIM FC LKB BUMBOFBK@BP PVJMQLJP LC > M>KF@ >QQ>@H (> PQ>QB LC BUQOBJB >KUFBQVQE>Q TB TFII AFP@RPP PELOQIV). EBPB PFQR>QFLKP FK@IRAB MRIF@ QO>KPMLOQ>QFLK, LMBK PM>@BP (M>OHFKD ILQP),BK@ILPBA PM>@BP (PQLOBP), @OLTAP, LO BFKD LRQPFAB QEB ELJB >ILKB (, 2013). LRQ 1.4% LC JBOF@>KPBUMBOFBK@B >DLO>MELF> AROFKD QEBFO IFCBQFJB (+BPPIBO BQ >I., 2005).

ACQUISITION OF PHOBIAS THROUGH LEARNING

>KV QEBLOFBP PRDDBPQ QE>Q MELF>P ABSBILM QEOLRDE IB>OKFKD. >@EJ>K (1977) MOLMLPBA QE>Q MELF>P @>K B >@NRFOBA QEOLRDE QEOBB J>GLO IB>OKFKD M>QET>VP. EB CFOPQ M>QET>V FP QEOLRDE @I>PPF@>I @LKAFQFLKFKD.P VLR J>V OB@>II, @I>PPF@>I @LKAFQFLKFKD FP > CLOJ LC IB>OKFKD FK TEF@E > MOBSFLRPIV KBRQO>I PQFJRIRP FP



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M>FOBA TFQE >K RK@LKAFQFLKBA PQFJRIRP (#) QE>Q OBCIBUFSBIV BIF@FQP >K RK@LKAFQFLKBA OBPMLKPB (#),BIF@FQFKD QEB P>JB OBPMLKPB QEOLRDE FQP >PPL@F>QFLK TFQE QEB RK@LKAFQFLKBA PQFJRIRP. EB OBPMLKPB FP @>IIBA> @LKAFQFLKBA OBPMLKPB (#). LO BU>JMIB, > @EFIA TEL E>P BBK FQQBK V > ALD J>V @LJB QL CB>O ALDP B@>RPB LC EBO M>PQ >PPL@F>QFLK TFQE M>FK. K QEFP @>PB, QEB ALD FQB FP QEB # >KA QEB CB>O FQ BIF@FQP FP QEB#. "B@>RPB > ALD T>P >PPL@F>QBA TFQE QEB FQB, >KV ALD J>V @LJB QL PBOSB >P > @LKAFQFLKBA PQFJRIRP,QEBOBV BIF@FQFKD CB>O; QEB CB>O QEB @EFIA BUMBOFBK@BP >OLRKA ALDP, QEBK, B@LJBP > #.

EB PB@LKA M>QET>V LC MELF> >@NRFPFQFLK FP QEOLRDE SF@>OFLRP IB>OKFKD, PR@E >P JLABIFKD. LO BU>JMIB,> @EFIA TEL LPBOSBP EFP @LRPFK OB>@Q CB>OCRIIV QL PMFABOP J>V I>QBO BUMOBPP QEB P>JB CB>OP, BSBK QELRDEPMFABOP E>SB KBSBO MOBPBKQBA >KV A>KDBO QL EFJ. EFP MEBKLJBKLK E>P BBK LPBOSBA FK LQE ERJ>KP>KA KLKERJ>K MOFJ>QBP (IPPLK & EBIMP, 2007). PQRAV LC I>LO>QLOV-OB>OBA JLKHBVP OB>AFIV >@NRFOBA> CB>O LC PK>HBP >CQBO LPBOSFKD TFIA-OB>OBA JLKHBVP OB>@Q CB>OCRIIV QL PK>HBP (FKBH> & #LLH, 1993).

EB QEFOA M>QET>V FP QEOLRDE SBO>I QO>KPJFPPFLK LO FKCLOJ>QFLK. LO BU>JMIB, > @EFIA TELPB M>OBKQP,PFIFKDP, COFBKAP, >KA @I>PPJ>QBP @LKPQ>KQIV QBII EBO ELT AFPDRPQFKD >KA A>KDBOLRP PK>HBP >OB J>V @LJBQL >@NRFOB > CB>O LC PK>HBP.

KQBOBPQFKDIV, MBLMIB >OB JLOB IFHBIV QL ABSBILM MELF>P LC QEFKDP QE>Q AL KLQ OBMOBPBKQ JR@E >@QR>I A>KDBOQL QEBJPBISBP, PR@E >P >KFJ>IP >KA EBFDEQP, >KA >OB IBPP IFHBIV QL ABSBILM MELF>P QLT>OA QEFKDP QE>QMOBPBKQ IBDFQFJ>QB A>KDBO FK @LKQBJMLO>OV PL@FBQV, PR@E >P JLQLO@V@IBP >KA TB>MLKP (ZEJ>K & FKBH>,

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

SOCIAL ANXIETY DISORDER

Social anxiety disorder (CLOJBOIV @>IIBA PL@F>I MELF>) FP @E>O>@QBOFWBA V BUQOBJB >KA MBOPFPQBKQ CB>O LO>KUFBQV >KA >SLFA>K@B LC PL@F>I PFQR>QFLKP FK TEF@E QEB MBOPLK @LRIA MLQBKQF>IIV B BS>IR>QBA KBD>QFSBIV V LQEBOP (, 2013). P TFQE PMB@FCF@ MELF>P, PL@F>I >KUFBQV AFPLOABO FP @LJJLK FK QEB KFQBA Q>QBP;> IFQQIB LSBO 12% LC >II JBOF@>KP BUMBOFBK@B PL@F>I >KUFBQV AFPLOABO AROFKD QEBFO IFCBQFJB (+BPPIBO BQ >I.,2005).

EB EB>OQ LC QEB CB>O >KA >KUFBQV FK PL@F>I >KUFBQV AFPLOABO FP QEB MBOPLKsP @LK@BOK QE>Q EB J>V >@Q FK >ERJFIF>QFKD LO BJ>OO>PPFKD T>V, PR@E >P >MMB>OFKD CLLIFPE, PELTFKD PVJMQLJP LC >KUFBQV (IRPEFKD),LO ALFKD LO P>VFKD PLJBQEFKD QE>Q JFDEQ IB>A QL OBGB@QFLK (PR@E >P LCCBKAFKD LQEBOP). EB HFKAP LC PL@F>I PFQR>QFLKP FK TEF@E FKAFSFAR>IP TFQE PL@F>I >KUFBQV AFPLOABO RPR>IIV E>SB MOLIBJP FK@IRAB MRIF@PMB>HFKD, E>SFKD > @LKSBOP>QFLK, JBBQFKD PQO>KDBOP, B>QFKD FK OBPQ>RO>KQP, >KA, FK PLJB @>PBP, RPFKD MRIF@

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

EBK MBLMIB TFQE PL@F>I >KUFBQV AFPLOABO >OB RK>IB QL >SLFA PFQR>QFLKP QE>Q MOLSLHB >KUFBQV, QEBVQVMF@>IIV MBOCLOJ safety behaviors: JBKQ>I LO BE>SFLO>I >@QP QE>Q OBAR@B >KUFBQV FK PL@F>I PFQR>QFLKP VOBAR@FKD QEB @E>K@B LC KBD>QFSB PL@F>I LRQ@LJBP. >CBQV BE>SFLOP FK@IRAB >SLFAFKD BVB @LKQ>@Q, OBEB>OPFKD




15/62

PBKQBK@BP BCLOB PMB>HFKD, Q>IHFKD LKIV OFBCIV, >KA KLQ Q>IHFKD >LRQ LKBPBIC (IABK & "FBIFKD, 1998).QEBO BU>JMIBP LC P>CBQV BE>SFLOP FK@IRAB QEB CLIILTFKD (>OHBO, 2013):

k >PPRJFKD OLIBP FK PL@F>I PFQR>QFLKP QE>Q JFKFJFWB FKQBO>@QFLK TFQE LQEBOP (B.D., Q>HFKD MF@QROBP,PBQQFKD RM BNRFMJBKQ, LO EBIMFKD MOBM>OB CLLA)

k >PHFKD MBLMIB J>KV NRBPQFLKP QL HBBM QEB CL@RP LCC LC LKBPBIC

k PBIB@QFKD > MLPFQFLK QL >SLFA P@ORQFKV LO @LKQ>@Q TFQE LQEBOP (PFQQFKD FK QEB >@H LC QEB OLLJ)

k TB>OFKD I>KA, KBRQO>I @ILQEBP QL >SLFA AO>TFKD >QQBKQFLK QL LKBPBIC

k >SLFAFKD PRPQ>K@BP LO >@QFSFQFBP QE>Q JFDEQ @>RPB >KUFBQV PVJMQLJP (PR@E >P @>CCBFKB, T>OJ@ILQEFKD, >KA MEVPF@>I BUBO@FPB)

IQELRDE QEBPB BE>SFLOP >OB FKQBKABA QL MOBSBKQ QEB MBOPLK TFQE PL@F>I >KUFBQV AFPLOABO COLJ ALFKDPLJBQEFKD >THT>OA QE>Q JFDEQ AO>T @OFQF@FPJ, QEBPB >@QFLKP RPR>IIV BU>@BO>QB QEB MOLIBJ B@>RPB QEBVAL KLQ >IILT QEB FKAFSFAR>I QL AFP@LKCFOJ EFP KBD>QFSB BIFBCP, LCQBK BIF@FQFKD OBGB@QFLK >KA LQEBO KBD>QFSBOB>@QFLKP COLJ LQEBOP (IABK & "FBIFKD, 1998).

BLMIB TFQE PL@F>I >KUFBQV AFPLOABO J>V OBPLOQ QL PBIC-JBAF@>QFLK, PR@E >P AOFKHFKD >I@LELI, >P > JB>KPQL >SBOQ QEB >KUFBQV PVJMQLJP QEBV BUMBOFBK@B FK PL@F>I PFQR>QFLKP (">QQFPQ> & +L@LSPHF, 2010). EB RPB LC >I@LELI TEBK C>@BA TFQE PR@E PFQR>QFLKP J>V B@LJB KBD>QFSBIV OBFKCLO@FKD: BK@LRO>DFKD FKAFSFAR>IP TFQE

PL@F>I >KUFBQV AFPLOABO QL QROK QL QEB PRPQ>K@B TEBKBSBO QEBV BUMBOFBK@B >KUFBQV PVJMQLJP. EB QBKABK@VQL RPB >I@LELI >P > @LMFKD JB@E>KFPJ CLO PL@F>I >KUFBQV, ELTBSBO, @>K @LJB TFQE > EBCQV MOF@B Q>D: >KRJBO LC I>ODB P@>IB PQRAFBP E>SB OBMLOQBA > EFDE O>QB LC @LJLOFAFQV BQTBBK PL@F>I >KUFBQV AFPLOABO >KA>I@LELI RPB AFPLOABO (LOOFP, QBT>OQ, & >J, 2005).

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

KB LC QEB JLPQ TBII-BPQ>IFPEBA OFPH C>@QLOP CLO ABSBILMFKD PL@F>I >KUFBQV AFPLOABO FP BE>SFLO>I FKEFFQFLK(#I>RPP & "I>@HCLOA, 2012). "BE>SFLO>I FKEFFQFLK FP QELRDEQ QL B >K FKEBOFQBA QO>FQ, >KA FQ FP @E>O>@QBOFWBA V > @LKPFPQBKQ QBKABK@V QL PELT CB>O >KA OBPQO>FKQ TEBK MOBPBKQBA TFQE RKC>JFIF>O MBLMIB LO PFQR>QFLKP(+>D>K, BWKF@H, & KFAJ>K, 1988). "BE>SFLO>I FKEFFQFLK FP AFPMI>VBA SBOV B>OIV FK IFCB; BE>SFLO>IIVFKEFFQBA QLAAIBOP >KA @EFIAOBK OBPMLKA TFQE DOB>Q @>RQFLK >KA OBPQO>FKQ FK RKC>JFIF>O PFQR>QFLKP, >KA QEBV>OB LCQBK QFJFA, CB>OCRI, >KA PEV >OLRKA RKC>JFIF>O MBLMIB (LU, BKABOPLK, >OPE>II, F@ELIP, & 'EBO>,2005). OB@BKQ PQ>QFPQF@>I OBSFBT LC PQRAFBP ABJLKPQO>QBA QE>Q BE>SFLO>I FKEFFQFLK T>P >PPL@F>QBA TFQEJLOB QE>K > PBSBKCLIA FK@OB>PB FK QEB OFPH LC ABSBILMJBKQ LC PL@F>I >KUFBQV AFPLOABO, ABJLKPQO>QFKD QE>Q BE>SFLO>I FKEFFQFLK FP > J>GLO OFPH C>@QLO CLO QEB AFPLOABO (#I>RPP & "I>@HCLOA, 2012).

PANIC DISORDER

J>DFKB QE>Q VLR >OB >Q QEB J>II LKB A>V TFQE VLRO COFBKAP >KAoPRAABKIV >KA FKBUMIF@>IVoVLR BDFKPTB>QFKD >KA QOBJIFKD, VLRO EB>OQ PQ>OQP MLRKAFKD, VLR E>SB QOLRIB OB>QEFKD, >KA VLR PQ>OQ QL CBBIAFWWV >KA K>RPBLRP. EFP BMFPLAB I>PQP CLO 10 JFKRQBP >KA FP QBOOFCVFKD B@>RPB VLR PQ>OQ QL QEFKH QE>Q VLR>OB DLFKD QL AFB. EBK VLR SFPFQ VLRO AL@QLO QEB CLIILTFKD JLOKFKD >KA ABP@OFB TE>Q E>MMBKBA, PEBQBIIP VLR QE>Q VLR E>SB BUMBOFBK@BA > M>KF@ >QQ>@H (Figure 15.9). C VLR BUMBOFBK@B >KLQEBO LKB LC QEBPBBMFPLABP QTL TBBHP I>QBO >KA TLOOV CLO > JLKQE LO JLOB QE>Q PFJFI>O BMFPLABP TFII L@@RO FK QEB CRQROB, FQFP IFHBIV QE>Q VLR E>SB ABSBILMBA M>KF@ AFPLOABO.



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Figure 15.9 LJB LC QEB MEVPF@>I J>KFCBPQ>QFLKP LC > M>KF@ >QQ>@H >OB PELTK. BLMIB J>V >IPL BUMBOFBK@BPTB>QFKD, QOBJIFKD, CBBIFKDP LC C>FKQKBPP, LO > CB>O LC ILPFKD @LKQOLI, >JLKD LQEBO PVJMQLJP.

BLMIB TFQE panic disorder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panic attack FP ABCFKBA >P > MBOFLA LC BUQOBJB CB>O LO AFP@LJCLOQ QE>Q ABSBILMP >ORMQIV>KA OB>@EBP > MB>H TFQEFK 10 JFKRQBP. QP PVJMQLJP FK@IRAB >@@BIBO>QBA EB>OQ O>QB, PTB>QFKD, QOBJIFKD,@ELHFKD PBKP>QFLKP, ELQ CI>PEBP LO @EFIIP, AFWWFKBPP LO IFDEQEB>ABAKBPP, CB>OP LC ILPFKD @LKQOLI LO DLFKD

@O>WV, >KA CB>OP LC AVFKD (, 2013). LJBQFJBP M>KF@ >QQ>@HP >OB BUMB@QBA, L@@ROOFKD FK OBPMLKPB QLPMB@FCF@ BKSFOLKJBKQ>I QOFDDBOP (PR@E >P BFKD FK > QRKKBI); LQEBO QFJBP, QEBPB BMFPLABP >OB RKBUMB@QBA>KA BJBODB O>KALJIV (PR@E >P TEBK OBI>UFKD). @@LOAFKD QL QEB -5, QEB MBOPLK JRPQ BUMBOFBK@BRKBUMB@QBA M>KF@ >QQ>@HP QL NR>IFCV CLO > AF>DKLPFP LC M>KF@ AFPLOABO.

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

QL >SLFA CRQROB M>KF@ >QQ>@HP. LO QEFP OB>PLK, M>KF@ AFPLOABO FP LCQBK @E>O>@QBOFWBA >P CB>O LC CB>O ('LIAPQBFK& #E>JIBPP, 1978).

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




17/62

LCQBK BUMBOFBK@B > @LJLOFA AFPLOABO, PR@E >P LQEBO >KUFBQV AFPLOABOP LO J>GLO ABMOBPPFSB AFPLOABO (,2013).

BPB>O@EBOP >OB KLQ BKQFOBIV PROB TE>Q @>RPBP M>KF@ AFPLOABO. #EFIAOBK >OB >Q > EFDEBO OFPH LC ABSBILMFKDM>KF@ AFPLOABO FC QEBFO M>OBKQP E>SB QEB AFPLOABO ("FBABOJ>K BQ >I., 2001), >KA C>JFIV >KA QTFKP PQRAFBPFKAF@>QB QE>Q QEB EBOFQ>FIFQV LC M>KF@ AFPLOABO FP >OLRKA 43% (BQQBJ>, B>IB, & +BKAIBO, 2001). EBBU>@Q DBKBP >KA DBKB CRK@QFLKP FKSLISBA FK QEFP AFPLOABO, ELTBSBO, >OB KLQ TBII-RKABOPQLLA (, 2013).

BROLFLILDF@>I QEBLOFBP LC M>KF@ AFPLOABO PRDDBPQ QE>Q > OBDFLK LC QEB O>FK @>IIBA QEB locus coeruleusJ>V MI>V > OLIB FK QEFP AFPLOABO. L@>QBA FK QEB O>FKPQBJ, QEB IL@RP @LBORIBRP FP QEB O>FKsP J>GLO PLRO@BLC KLOBMFKBMEOFKB, > KBROLQO>KPJFQQBO QE>Q QOFDDBOP QEB LAVsP CFDEQ-LO-CIFDEQ OBPMLKPB. @QFS>QFLK LC QEBIL@RP @LBORIBRP FP >PPL@F>QBA TFQE >KUFBQV >KA CB>O, >KA OBPB>O@E TFQE KLKERJ>K MOFJ>QBP E>P PELTKQE>Q PQFJRI>QFKD QEB IL@RP @LBORIBRP BFQEBO BIB@QOF@>IIV LO QEOLRDE AORDP MOLAR@BP M>KF@-IFHB PVJMQLJP(#E>OKBV BQ >I., 1990). R@E CFKAFKDP E>SB IBA QL QEB QEBLOV QE>Q M>KF@ AFPLOABO J>V B @>RPBA V >KLOJ>IKLOBMFKBMEOFKB >@QFSFQV FK QEB IL@RP @LBORIBRP ("OBJKBO, +OVPQ>I, LRQETF@H, & #E>OKBV, 1996).

#LKAFQFLKFKD QEBLOFBP LC M>KF@ AFPLOABO MOLMLPB QE>Q M>KF@ >QQ>@HP >OB @I>PPF@>I @LKAFQFLKFKD OBPMLKPBP QLPRQIB LAFIV PBKP>QFLKP OBPBJIFKD QELPB KLOJ>IIV L@@ROOFKD TEBK LKB FP >KUFLRP LO COFDEQBKBA ("LRQLK,FKBH>, & ">OILT, 2001). LO BU>JMIB, @LKPFABO > @EFIA TEL E>P >PQEJ>. K >@RQB >PQEJ> >QQ>@H MOLAR@BPPBKP>QFLKP, PR@E >P PELOQKBPP LC OB>QE, @LRDEFKD, >KA @EBPQ QFDEQKBPP, QE>Q QVMF@>IIV BIF@FQ CB>O >KA >KUFBQV.>QBO, TEBK QEB @EFIA BUMBOFBK@BP PRQIB PVJMQLJP QE>Q OBPBJIB QEB COFDEQBKFKD PVJMQLJP LC B>OIFBO

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

#LDKFQFSB C>@QLOP J>V MI>V >K FKQBDO>I M>OQ FK M>KF@ AFPLOABO. 'BKBO>IIV, @LDKFQFSB QEBLOFBP (#I>OH, 1996)>ODRB QE>Q QELPB TFQE M>KF@ AFPLOABO >OB MOLKB QL FKQBOMOBQ LOAFK>OV LAFIV PBKP>QFLKP @>Q>PQOLMEF@>IIV,>KA QEBPB CB>OCRI FKQBOMOBQ>QFLKP PBQ QEB PQ>DB CLO M>KF@ >QQ>@HP. LO BU>JMIB, > MBOPLK JFDEQ ABQB@Q LAFIV @E>KDBP QE>Q >OB OLRQFKBIV QOFDDBOBA V FKKL@RLRP BSBKQP PR@E DBQQFKD RM COLJ > PB>QBA MLPFQFLK(AFWWFKBPP), BUBO@FPFKD (FK@OB>PBA EB>OQ O>QB, PELOQKBPP LC OB>QE), LO AOFKHFKD > I>ODB @RM LC @LCCBB(FK@OB>PBA EB>OQ O>QB, QOBJIFKD). EB FKAFSFAR>I FKQBOMOBQP QEBPB PRQIB LAFIV @E>KDBP @>Q>PQOLMEF@>IIV

(p>VB sJ E>SFKD > EB>OQ >QQ>@H!q). R@E FKQBOMOBQ>QFLKP @OB>QB CB>O >KA >KUFBQV, TEF@E QOFDDBO >AAFQFLK>IMEVPF@>I PVJMQLJP; PRPBNRBKQIV, QEB MBOPLK BUMBOFBK@BP > M>KF@ >QQ>@H. RMMLOQ LC QEFP @LKQBKQFLK OBPQPTFQE CFKAFKDP QE>Q MBLMIB TFQE JLOB PBSBOB @>Q>PQOLMEF@ QELRDEQP >LRQ PBKP>QFLKP E>SB JLOB COBNRBKQ>KA PBSBOB M>KF@ >QQ>@HP, >KA >JLKD QELPB TFQE M>KF@ AFPLOABO, OBAR@FKD @>Q>PQOLMEF@ @LDKFQFLKP >LRQQEBFO PBKP>QFLKP FP >P BCCB@QFSB >P JBAF@>QFLK FK OBAR@FKD M>KF@ >QQ>@HP ('LLA & FKQLK, 2009).

GENERALIZED ANXIETY DISORDER

IBU T>P >IT>VP TLOOFBA >LRQ J>KV QEFKDP. B TLOOFBA QE>Q EFP @EFIAOBK TLRIA AOLTK TEBK QEBV MI>VBA>Q QEB B>@E. >@E QFJB EB IBCQ QEB ELRPB, EB TLOOFBA QE>Q >K BIB@QOF@>I PELOQ @FO@RFQ TLRIA PQ>OQ > CFOB FKEFP ELJB. B TLOOFBA QE>Q EFP TFCB TLRIA ILPB EBO GL >Q QEB MOBPQFDFLRP I>T CFOJ. B TLOOFBA QE>Q EFPA>RDEQBOsP JFKLO PQ>ME FKCB@QFLK @LRIA QROK FKQL > J>PPFSB IFCB-QEOB>QBKFKD @LKAFQFLK. EBPB >KA LQEBO

TLOOFBP @LKPQ>KQIV TBFDEBA EB>SFIV LK IBUsP JFKA, PL JR@E PL QE>Q QEBV J>AB FQ AFCCF@RIQ CLO EFJ QL J>HBAB@FPFLKP >KA LCQBK IBCQ EFJ CBBIFKD QBKPB, FOOFQ>IB, >KA TLOK LRQ. KB KFDEQ, IBUsP TFCB T>P QL AOFSB QEBFOPLK ELJB COLJ > PL@@BO D>JB. LTBSBO, EFP TFCB PQ>VBA >CQBO QEB D>JB >KA Q>IHBA TFQE PLJB LC QEB LQEBOM>OBKQP, OBPRIQFKD FK EBO >OOFSFKD ELJB 45 JFKRQBP I>QB. IBU E>A QOFBA QL @>II EFP @BII MELKB QEOBB LO CLROQFJBP, RQ EB @LRIA KLQ DBQ QEOLRDE B@>RPB QEB PL@@BO CFBIA AFA KLQ E>SB > PFDK>I. UQOBJBIV TLOOFBA, IBUBSBKQR>IIV @>IIBA QEB MLIF@B, @LKSFK@BA QE>Q EFP TFCB >KA PLK E>A KLQ >OOFSBA ELJB B@>RPB QEBV E>A BBKFK > QBOOFIB @>O >@@FABKQ.

IBU PRCCBOP COLJ generalized anxiety disorder: > OBI>QFSBIV @LKQFKRLRP PQ>QB LC BU@BPPFSB, RK@LKQOLII>IB,>KA MLFKQIBPP TLOOV >KA >MMOBEBKPFLK. BLMIB TFQE DBKBO>IFWBA >KUFBQV AFPLOABO LCQBK TLOOV >LRQ



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OLRQFKB, BSBOVA>V QEFKDP, BSBK QELRDE QEBFO @LK@BOKP >OB RKGRPQFCFBA (Figure 15.10). LO BU>JMIB, >KFKAFSFAR>I J>V TLOOV >LRQ EBO EB>IQE >KA CFK>K@BP, QEB EB>IQE LC C>JFIV JBJBOP, QEB P>CBQV LC EBO@EFIAOBK, LO JFKLO J>QQBOP (B.D., BFKD I>QB CLO >K >MMLFKQJBKQ) TFQELRQ E>SFKD >KV IBDFQFJ>QB OB>PLK CLOALFKD PL (, 2013). AF>DKLPFP LC DBKBO>IFWBA >KUFBQV AFPLOABO OBNRFOBP QE>Q QEB AFCCRPB TLOOVFKD >KA>MMOBEBKPFLK @E>O>@QBOFPQF@ LC QEFP AFPLOABOoTE>Q FDJRKA OBRA OBCBOOBA QL >P COBB-CIL>QFKD >KUFBQVoFPKLQ M>OQ LC >KLQEBO AFPLOABO, L@@ROP JLOB A>VP QE>K KLQ CLO >Q IB>PQ PFU JLKQEP, >KA FP >@@LJM>KFBA V>KV QEOBB LC QEB CLIILTFKD PVJMQLJP: OBPQIBPPKBPP, AFCCF@RIQV @LK@BKQO>QFKD, BFKD B>PFIV C>QFDRBA, JRP@IB

QBKPFLK, FOOFQ>FIFQV, >KA PIBBM AFCCF@RIQFBP.

Figure 15.10 LOOV FP > ABCFKFKD CB>QROB LC DBKBO>IFWBA >KUFBQV AFPLOABO. (@OBAFQ: OBAAFB B_>)

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

QE>Q @EFIAELLA J>IQOB>QJBKQ T>P PQOLKDIV OBI>QBA QL QEB ABSBILMJBKQ LC QEFP AFPLOABO AROFKD >ARIQELLA(LCCFQQ BQ >I., 2007); TLOOVFKD JFDEQ AFPQO>@Q MBLMIB COLJ OBJBJBOFKD M>FKCRI @EFIAELLA BUMBOFBK@BP.

15.5 Obsessive-Compulsive and Related Disorders

Learning Objectives

"V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k BP@OFB QEB J>FK CB>QROBP >KA MOBS>IBK@B LC LPBPPFSB-@LJMRIPFSB AFPLOABO, LAV

AVPJLOMEF@ AFPLOABO, >KA EL>OAFKD AFPLOABOk KABOPQ>KA PLJB LC QEB C>@QLOP FK QEB ABSBILMJBKQ LC LPBPPFSB-@LJMRIPFSB AFPLOABO

Obsessive-compulsive and related disorders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OBSESSIVE-COMPULSIVE DISORDER

BLMIB TFQE obsessive-compulsive disorder (OCD) BUMBOFBK@B QELRDEQP >KA RODBP QE>Q >OB FKQORPFSB >KARKT>KQBA (LPBPPFLKP) >KA/LO QEB KBBA QL BKD>DB FK OBMBQFQFSB BE>SFLOP LO JBKQ>I >@QP (@LJMRIPFLKP). MBOPLK TFQE QEFP AFPLOABO JFDEQ, CLO BU>JMIB, PMBKA ELROP B>@E A>V T>PEFKD EFP E>KAP LO @LKPQ>KQIV@EB@HFKD >KA OB@EB@HFKD QL J>HB PROB QE>Q > PQLSB, C>R@BQ, LO IFDEQ E>P BBK QROKBA LCC.

PBPPFLKP >OB JLOB QE>K GRPQ RKT>KQBA QELRDEQP QE>Q PBBJ QL O>KALJIV GRJM FKQL LRO EB>A COLJ QFJB

QL QFJB, PR@E >P OB@>IIFKD >K FKPBKPFQFSB OBJ>OH > @LTLOHBO J>AB OB@BKQIV, >KA QEBV >OB JLOB PFDKFCF@>KQQE>K A>V-QL-A>V TLOOFBP TB JFDEQ E>SB, PR@E >P GRPQFCF>IB @LK@BOKP >LRQ BFKD I>FA LCC COLJ > GL. >QEBO,LPBPPFLKP >OB @E>O>@QBOFWBA >P MBOPFPQBKQ, RKFKQBKQFLK>I, >KA RKT>KQBA QELRDEQP >KA RODBP QE>Q >OB EFDEIVFKQORPFSB, RKMIB>P>KQ, >KA AFPQOBPPFKD (, 2013). #LJJLK LPBPPFLKP FK@IRAB @LK@BOKP >LRQ DBOJP >KA@LKQ>JFK>QFLK, ALRQP (pFA QROK QEB T>QBO LCC?q), LOABO >KA PVJJBQOV (p KBBA >II QEB PMLLKP FK QEBQO>V QL B >OO>KDBA > @BOQ>FK T>Vq), >KA RODBP QE>Q >OB >DDOBPPFSB LO IRPQCRI. PR>IIV, QEB MBOPLK HKLTPQE>Q PR@E QELRDEQP >KA RODBP >OB FOO>QFLK>I >KA QERP QOFBP QL PRMMOBPP LO FDKLOB QEBJ, RQ E>P >K BUQOBJBIVAFCCF@RIQ QFJB ALFKD PL. EBPB LPBPPFSB PVJMQLJP PLJBQFJBP LSBOI>M, PR@E QE>Q PLJBLKB JFDEQ E>SB LQE@LKQ>JFK>QFLK >KA >DDOBPPFSB LPBPPFLKP (O>JLTFQW & FNRBI>KA, 2013).

#LJMRIPFLKP >OB OBMBQFQFSB >KA OFQR>IFPQF@ >@QP QE>Q >OB QVMF@>IIV @>OOFBA LRQ MOFJ>OFIV >P > JB>KP QLJFKFJFWB QEB AFPQOBPP QE>Q LPBPPFLKP QOFDDBO LO QL OBAR@B QEB IFHBIFELLA LC > CB>OBA BSBKQ (, 2013).

#LJMRIPFLKP LCQBK FK@IRAB PR@E BE>SFLOP >P OBMB>QBA >KA BUQBKPFSB E>KA T>PEFKD, @IB>KFKD, @EB@HFKD(B.D., QE>Q > ALLO FP IL@HBA), >KA LOABOFKD (B.D., IFKFKD RM >II QEB MBK@FIP FK > M>OQF@RI>O T>V), >KA QEBV>IPL FK@IRAB PR@E JBKQ>I >@QP >P @LRKQFKD, MO>VFKD, LO OB@FQFKD PLJBQEFKD QL LKBPBIC (Figure 15.11).#LJMRIPFLKP @E>O>@QBOFPQF@ LC # >OB KLQ MBOCLOJBA LRQ LC MIB>PROB, KLO >OB QEBV @LKKB@QBA FK >OB>IFPQF@ T>V QL QEB PLRO@B LC QEB AFPQOBPP LO CB>OBA BSBKQ. MMOLUFJ>QBIV 2.3% LC QEB .. MLMRI>QFLK TFIIBUMBOFBK@B # FK QEBFO IFCBQFJB (RP@FL, QBFK, #EFR, & +BPPIBO, 2010) >KA, FC IBCQ RKQOB>QBA, # QBKAPQL B > @EOLKF@ @LKAFQFLK @OB>QFKD IFCBILKD FKQBOMBOPLK>I >KA MPV@ELILDF@>I MOLIBJP (LOBOD, #>I>J>OF,#LEBK, & FBJ>KK, 2008).

Figure 15.11 (>) BMBQFQFSB E>KA T>PEFKD >KA () @EB@HFKD (B.D., QE>Q > ALLO FP IL@HBA) >OB @LJJLK @LJMRIPFLKP

>JLKD QELPB TFQE LPBPPFSB-@LJMRIPFSB AFPLOABO. (@OBAFQ >: JLAFCF@>QFLK LC TLOH V QEB $!; @OBAFQ : JLAFCF@>QFLK

LC TLOH V "O>AIBV 'LOALK)

BODY DYSMORPHIC DISORDERK FKAFSFAR>I TFQE body dysmorphic disorder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2.4% LC QEB >ARIQP FK QEB KFQBA Q>QBP JBBQ QEB @OFQBOF> CLO LAV AVPJLOMEF@ AFPLOABO, TFQE PIFDEQIV EFDEBOO>QBP FK TLJBK QE>K FK JBK (, 2013).

HOARDING DISORDER

IQELRDE EL>OAFKD T>P QO>AFQFLK>IIV @LKPFABOBA QL B > PVJMQLJ LC #, @LKPFABO>IB BSFABK@B PRDDBPQPQE>Q EL>OAFKD OBMOBPBKQP >K BKQFOBIV AFCCBOBKQ AFPLOABO (>Q>FU-#LIP BQ >I., 2010). BLMIB TFQE hoarding

disorder @>KKLQ B>O QL M>OQ TFQE MBOPLK>I MLPPBPPFLKP, OBD>OAIBPP LC ELT S>IRBIBPP LO RPBIBPP QEBPBMLPPBPPFLKP >OB. P > OBPRIQ, QEBPB FKAFSFAR>IP >@@RJRI>QB BU@BPPFSB >JLRKQP LC RPR>IIV TLOQEIBPP FQBJPQE>Q @IRQQBO QEBFO IFSFKD >OB>P (Figure 15.12). CQBK, QEB NR>KQFQV LC @IRQQBOBA FQBJP FP PL BU@BPPFSB QE>QQEB MBOPLK FP RK>IB RPB EFP HFQ@EBK, LO PIBBM FK EFP BA. BLMIB TEL PRCCBO COLJ QEFP AFPLOABO E>SB DOB>QAFCCF@RIQV M>OQFKD TFQE FQBJP B@>RPB QEBV BIFBSB QEB FQBJP JFDEQ B LC PLJB I>QBO RPB, LO B@>RPB QEBVCLOJ > PBKQFJBKQ>I >QQ>@EJBKQ QL QEB FQBJP (, 2013). JMLOQ>KQIV, > AF>DKLPFP LC EL>OAFKD AFPLOABO FPJ>AB LKIV FC QEB EL>OAFKD FP KLQ @>RPBA V >KLQEBO JBAF@>I @LKAFQFLK >KA FC QEB EL>OAFKD FP KLQ > PVJMQLJLC >KLQEBO AFPLOABO (B.D., P@EFWLMEOBKF>) (, 2013).

Figure 15.12 ELPB TEL PRCCBO COLJ EL>OAFKD AFPLOABO E>SB DOB>Q AFCCF@RIQV FK AFP@>OAFKD MLPPBPPFLKP, RPR>IIV

OBPRIQFKD FK >K >@@RJRI>QFLK LC FQBJP QE>Q @IRQQBO IFSFKD LO TLOH >OB>P. (@OBAFQ: iMRRFHFB>@Ej/IF@HO)

CAUSES OF OCD

EB OBPRIQP LC C>JFIV >KA QTFK PQRAFBP PRDDBPQ QE>Q # E>P > JLABO>QB DBKBQF@ @LJMLKBKQ. EB AFPLOABOFP CFSB QFJBP JLOB COBNRBKQ FK QEB CFOPQ-ABDOBB OBI>QFSBP LC MBLMIB TFQE # QE>K FK MBLMIB TFQELRQ QEBAFPLOABO (BPQ>AQ BQ >I., 2000). AAFQFLK>IIV, QEB @LK@LOA>K@B O>QB LC # >JLKD FABKQF@>I QTFKP FP >OLRKA57%; ELTBSBO, QEB @LK@LOA>K@B O>QB CLO CO>QBOK>I QTFKP FP 22% ("LIQLK, FGPAFGH, s#LKKLO, BOOFK, & IBV,2007). QRAFBP E>SB FJMIF@>QBA >LRQ QTL ALWBK MLQBKQF>I DBKBP QE>Q J>V B FKSLISBA FK #; QEBPB DBKBPOBDRI>QB QEB CRK@QFLK LC QEOBB KBROLQO>KPJFQQBOP: PBOLQLKFK, ALM>JFKB, >KA DIRQ>J>QB (>RIP, 2010). >KVLC QEBPB PQRAFBP FK@IRABA PJ>II P>JMIB PFWBP >KA E>SB VBQ QL B OBMIF@>QBA. ERP, >AAFQFLK>I OBPB>O@E KBBAPQL B ALKB FK QEFP >OB>.

O>FK OBDFLK QE>Q FP BIFBSBA QL MI>V > @OFQF@>I OLIB FK # FP QEB orbitofrontal cortex (+LMBII &

'OBBKBOD, 2008), >K >OB> LC QEB COLKQ>I ILB FKSLISBA FK IB>OKFKD >KA AB@FPFLK-J>HFKD (RPETLOQE,LLK>K, "LLOJ>K, >IQLK, & "BEOBKP, 2011) (Figure 15.13). K MBLMIB TFQE #, QEB LOFQLCOLKQ>I @LOQBU B@LJBP BPMB@F>IIV EVMBO>@QFSB TEBK QEBV >OB MOLSLHBA TFQE Q>PHP FK TEF@E, CLO BU>JMIB, QEBV >OB >PHBAQL ILLH >Q > MELQL LC > QLFIBQ LO LC MF@QROBP E>KDFKD @OLLHBAIV LK > T>II (FJLK, +>RCJ>KK, j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QEB PVJMQLJP LC # (>UBK>, "LQ>, & "OLAV, 2001). #LKPFPQBKQ TFQE QEFP BUMI>K>QFLK, MBLMIB TFQE #PELT > PRPQ>KQF>IIV EFDEBO ABDOBB LC @LKKB@QFSFQV LC QEB LOFQLCOLKQ>I @LOQBU >KA LQEBO OBDFLKP LC QEB #@FO@RFQ QE>K AL QELPB TFQELRQ # ("BR@HB BQ >I., 2013).

Figure 15.13 $FCCBOBKQ OBDFLKP LC QEB O>FK J>V B >PPL@F>QBA TFQE AFCCBOBKQ MPV@ELILDF@>I AFPLOABOP.

EB CFKAFKDP AFP@RPPBA >LSB TBOB >PBA LK FJ>DFKD PQRAFBP, >KA QEBV EFDEIFDEQ QEB MLQBKQF>I FJMLOQ>K@BLC O>FK AVPCRK@QFLK FK #. LTBSBO, LKB FJMLOQ>KQ IFJFQ>QFLK LC QEBPB CFKAFKDP FP QEB FK>FIFQV QLBUMI>FK AFCCBOBK@BP FK LPBPPFLKP >KA @LJMRIPFLKP. KLQEBO IFJFQ>QFLK FP QE>Q QEB @LOOBI>QFLK>I OBI>QFLKPEFM BQTBBK KBROLILDF@>I >KLOJ>IFQFBP >KA # PVJMQLJP @>KKLQ FJMIV @>RP>QFLK (O>JLTFQW &FNRBI>KA, 2013).

CONNECT THE CONCEPTS

CONNECT THE CONCEPTSConditioning and OCD

EB PVJMQLJP LC #$ E>SB BBK QEBLOFWBA QL B IB>OKBA OBPMLKPBP, >@NRFOBA >KA PRPQ>FKBA >P QEB OBPRIQ LC >

@LJFK>QFLK LC QTL CLOJP LC IB>OKFKD: @I>PPF@>I @LKAFQFLKFKD >KA LMBO>KQ @LKAFQFLKFKD (LTOBO, 1960; QBFKJBQW,

O>@V, & 'OBBK, 2001). MB@FCF@>IIV, QEB >@NRFPFQFLK LC #$ J>V L@@RO CFOPQ >P QEB OBPRIQ LC @I>PPF@>I @LKAFQFLKFKD,

TEBOBV > KBRQO>I PQFJRIRP B@LJBP >PPL@F>QBA TFQE >K RK@LKAFQFLKBA PQFJRIRP QE>Q MOLSLHBP >KUFBQV LO AFPQOBPP.

EBK >K FKAFSFAR>I E>P >@NRFOBA QEFP >PPL@F>QFLK, PRPBNRBKQ BK@LRKQBOP TFQE QEB KBRQO>I PQFJRIRP QOFDDBO >KUFBQV,

FK@IRAFKD LPBPPFSB QELRDEQP; QEB >KUFBQV >KA LPBPPFSB QELRDEQP (TEF@E >OB KLT > @LKAFQFLKBA OBPMLKPB) J>V

MBOPFPQ RKQFI PEB FABKQFCFBP PLJB PQO>QBDV QL OBIFBSB FQ. BIFBC J>V Q>HB QEB CLOJ LC > OFQR>IFPQF@ BE>SFLO LO JBKQ>I

>@QFSFQV QE>Q, TEBK BK>@QBA OBMB>QBAIV, OBAR@BP QEB >KUFBQV. R@E BCCLOQP QL OBIFBSB >KUFBQV @LKPQFQRQB >K BU>JMIB

LC KBD>QFSB OBFKCLO@BJBKQ (> CLOJ LC LMBO>KQ @LKAFQFLKFKD). B@>II COLJ QEB @E>MQBO LK IB>OKFKD QE>Q KBD>QFSB

OBFKCLO@BJBKQ FKSLISBP QEB PQOBKDQEBKFKD LC BE>SFLO QEOLRDE FQP >FI FQV QL OBJLSB PLJBQEFKD RKMIB>P>KQ LO

>SBOPFSB. BK@B, @LJMRIPFSB >@QP LPBOSBA FK #$ J>V B PRPQ>FKBA B@>RPB QEBV >OB KBD>QFSBIV OBFKCLO@FKD, FKQEB PBKPB QE>Q QEBV OBAR@B >KUFBQV QOFDDBOBA V > @LKAFQFLKBA PQFJRIRP.

RMMLPB >K FKAFSFAR>I TFQE #$ BUMBOFBK@BP LPBPPFSB QELRDEQP >LRQ DBOJP, @LKQ>JFK>QFLK, >KA AFPB>PB

TEBKBSBO PEB BK@LRKQBOP > ALLOHKL. E>Q JFDEQ E>SB @LKPQFQRQBA > SF>IB RK@LKAFQFLKBA PQFJRIRP? !IPL, TE>Q

TLRIA @LKPQFQRQB QEB @LKAFQFLKBA PQFJRIRP, RK@LKAFQFLKBA OBPMLKPB, >KA @LKAFQFLKBA OBPMLKPB? E>Q HFKAP LC

@LJMRIPFSB BE>SFLOP JFDEQ TB BUMB@Q, >KA ELT AL QEBV OBFKCLO@B QEBJPBISBP? E>Q FP AB@OB>PBA? !AAFQFLK>IIV,

>KA COLJ QEB PQ>KAMLFKQ LC IB>OKFKD QEBLOV, ELT JFDEQ QEB PVJMQLJP LC #$ B QOB>QBA PR@@BPPCRIIV?



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15.6 Posttraumatic Stress Disorder

Learning Objectives

"V QEB BKA LC QEFP PB@QFLK, VLR TFII B >IB QL:k BP@OFB QEB K>QROB >KA PVJMQLJP LC MLPQQO>RJ>QF@ PQOBPP AFPLOABOk ABKQFCV QEB OFPH C>@QLOP >PPL@F>QBA TFQE QEFP AFPLOABOk KABOPQ>KA QEB OLIB LC IB>OKFKD >KA @LDKFQFSB C>@QLOP FK FQP ABSBILMJBKQ

UQOBJBIV PQOBPPCRI LO QO>RJ>QF@ BSBKQP, PR@E >P @LJ>Q, K>QRO>I AFP>PQBOP, >KA QBOOLOFPQ >QQ>@HP, MI>@BQEB MBLMIB TEL BUMBOFBK@B QEBJ >Q >K FK@OB>PBA OFPH CLO ABSBILMFKD MPV@ELILDF@>I AFPLOABOP PR@E >Pposttraumatic stress disorder (PTSD). EOLRDELRQ JR@E LC QEB 20QE @BKQROV, QEFP AFPLOABO T>P @>IIBA shellshock >KA combat neurosis B@>RPB FQP PVJMQLJP TBOB LPBOSBA FK PLIAFBOP TEL E>A BKD>DBA FK T>OQFJB@LJ>Q. "V QEB I>QB 1970P FQ E>A B@LJB @IB>O QE>Q TLJBK TEL E>A BUMBOFBK@BA PBUR>I QO>RJ>P (B.D., O>MB,ALJBPQF@ >QQBOV, >KA FK@BPQ) LCQBK BUMBOFBK@BA QEB P>JB PBQ LC PVJMQLJP >P AFA PLIAFBOP (BOJ>K, 1997).EB QBOJ posttraumatic stress disorder T>P ABSBILMBA DFSBK QE>Q QEBPB PVJMQLJP @LRIA E>MMBK QL >KVLKBTEL BUMBOFBK@BA MPV@ELILDF@>I QO>RJ>.

A BROADER DEFINITION OF PTSD

T>P IFPQBA >JLKD QEB >KUFBQV AFPLOABOP FK MOBSFLRP BAFQFLKP. K -5, FQ FP KLT IFPQBA >JLKD> DOLRM @>IIBA O>RJ>->KA-QOBPPLO-BI>QBA FPLOABOP. LO > MBOPLK QL B AF>DKLPBA TFQE , PEB BJRPQ BUMLPBA QL, TFQKBPP, LO BUMBOFBK@B QEB ABQ>FIP LC > QO>RJ>QF@ BUMBOFBK@B (B.D., > CFOPQ OBPMLKABO), LKBQE>Q FKSLISBP p>@QR>I LO QEOB>QBKBA AB>QE, PBOFLRP FKGROV, LO PBUR>I SFLIBK@Bq (, 2013, M. 271). EBPBBUMBOFBK@BP @>K FK@IRAB PR@E BSBKQP >P @LJ>Q, QEOB>QBKBA LO >@QR>I MEVPF@>I >QQ>@H, PBUR>I >PP>RIQ, K>QRO>IAFP>PQBOP, QBOOLOFPQ >QQ>@HP, >KA >RQLJLFIB >@@FABKQP. EFP @OFQBOFLK J>HBP QEB LKIV AFPLOABO IFPQBA FKQEB FK TEF@E > @>RPB (BUQOBJB QO>RJ>) FP BUMIF@FQIV PMB@FCFBA.

VJMQLJP LC FK@IRAB FKQORPFSB >KA AFPQOBPPFKD JBJLOFBP LC QEB BSBKQ, flashbacks (PQ>QBP QE>Q @>KI>PQ COLJ > CBT PB@LKAP QL PBSBO>I A>VP, AROFKD TEF@E QEB FKAFSFAR>I OBIFSBP QEB BSBKQ >KA BE>SBP >P

FC QEB BSBKQ TBOB L@@ROOFKD >Q QE>Q JLJBKQ , 2013SLFA>K@B LC PQFJRIF @LKKB@QBA QL QEB BSBKQ,MBOPFPQBKQIV KBD>QFSB BJLQFLK>I PQ>QBP (B.D., CB>O, >KDBO, DRFIQ, >KA PE>JB), CBBIFKDP LC ABQ>@EJBKQ COLJLQEBOP, FOOFQ>FIFQV, MOLKBKBPP QLT>OA LRQROPQP, >KA >K BU>DDBO>QBA PQ>OQIB OBPMLKPB (GRJMFKBPP). LO QL B AF>DKLPBA, QEBPB PVJMQLJP JRPQ L@@RO CLO >Q IB>PQ LKB JLKQE.

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n3 VB>OP >CQBO QEB 9/11 QBOOLOFPQ >QQ>@HP (F'O>KAB BQ >I., 2008).

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PELTK QL BIBS>QB QEB OFPH LC ("O>JPBK, FOHWT>DBO, & S>K ABO ILBD, 2000). BLMIB TEL BUMBOFBK@B@EFIAELLA >ASBOPFQV >KA/LO QO>RJ>QF@ BUMBOFBK@BP AROFKD >ARIQELLA >OB >Q PFDKFCF@>KQIV EFDEBO OFPH LC ABSBILMFKD FC QEBV MLPPBPP LKB LO QTL PELOQ SBOPFLKP LC > DBKB QE>Q OBDRI>QBP QEB KBROLQO>KPJFQQBOPBOLQLKFK (FB BQ >I., 2009). EFP PRDDBPQP > MLPPFIB AF>QEBPFP-PQOBPP FKQBOMOBQ>QFLK LC : FQP ABSBILMJBKQFP FKCIRBK@BA V QEB FKQBO>@QFLK LC MPV@ELPL@F>I >KA FLILDF@>I C>@QLOP.

SUPPORT FOR SUFFERERS OF PTSD

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igure 15.14). K >AAFQFLK, QELPB TEL B@>JB FKSLISBAFK QEB @LJJRKFQV TBOB IBPP IFHBIV QL ABSBILM , >KA QEBV TBOB JLOB IFHBIV QL BUMBOFBK@B > OBJFPPFLKLC QE>K TBOB QELPB TEL TBOB IBPP FKSLISBA (+LBKBK, QBIIJ>K, QBIIJ>K, & LJJBO, 2003).

Figure 15.14 $ T>P CFOPQ OB@LDKFWBA FK PLIAFBOP TEL E>A BKD>DBA FK @LJ>Q. BPB>O@E E>P PELTK QE>Q PQOLKD

PL@F>I PRMMLOQ AB@OB>PBP QEB OFPH LC $. EFP MBOPLK PQ>KAP >Q QEB FBQK>J O>SBIFKD BJLOF>I >II. (@OBAFQ: +BSFKQ>K@ECFBIA)

LEARNING AND THE DEVELOPMENT OF PTSD

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