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Stress, Health and Coping What is Stress? Stress is any circumstance that threatens or is perceived to threaten one’s well-being and tax one’s coping abilities. Stress can interfere with neurogenesis, the formation of new neurons in the brain. The Biopsychosocial Model The Biopsychosocial Health model holds that physical illness is caused by a complex interaction of biological, psychological and sociocultural factors. Health Psychologists Health Psychologists are concerned with how psychosocial conflicts relate to the promotion and maintenance of health and determine the causation, prevention, and treatment of illness. Four Types of Stress Frustration is experienced when you want something you cannot have. Conflict is experienced when two or more choices are available. Approach-Approach conflict is when two attractive goals are presented. Avoidance-Avoidance conflict is when two unattractive goals are presented. Approach-Avoidance conflict is when a single goal has both attractive and unattractive aspects. Four Types of Stress Change is experienced when there are alterations in one’s living circumstances that require readjustment. Pressure is experienced when there are expectations or demands that a person respond or behave in a certain way. Social Readjustment Rating Scale Major Life Events Research by Psychiatrists Dr. Thomas Holmes and Dr. Richard Rahe revealed a list of common causes of stress that most people would find stressful. They called this scale the Holmes and Rahe Social Readjustment Scale. The scale is a list of 45 stressors each given a number of points, with the most stressful at the top of the list (death of a spouse) and the least stressful at the bottom of the scale (a minor violation of the law). The research indicates that if your total score is more than 150 points the chances are that it could have an impact on your health. A score of over three hundred points in one year indicates that you have a high risk of developing a stress related health problem. Social Readjustment Rating Scale One of the weaknesses of the Holmes and Rahe Social Readjustment scale is that it doesn’t take into account the individual’s personality, their perception of how difficult the stressor is, nor does it take into account how long the stressor continues for; the scale just gives a single number for each stressor. However, it s known that the longer a stressor continues, then the more likely it is to cause stress and that the individuals perception of an event is the key to whether they will find a situation stressful or not. Social Readjustment Rating Scale Richard Lazarus and Daily Hassels of Stress The majority of causes of stress that we face on a day-to- day basis are not as extreme as life events. The day-to-day causes of stress are called daily hassles. They are those daily, minor irritations such as misplacing our car keys, traffic jams, minor arguments with family, friends, or coworkers. Research by Richard Lazarus (1984), at the University of California, indicated that it was the daily hassles rather than the major life events that affected us the most. Life events do not occur every day, but daily hassles do; it’s the constant, daily frustration caused by these hassles that cause us the most stress, because they occur so regularly and therefore can undermine our health. Richard Lazarus and Daily Hassels of Stress “Stress resides neither in the situation nor in the person; it depends on a transaction between the two.” –Dr. Richard Lazarus We tend to think that stress is solely caused by external events, situations and people, yet this is not strictly correct. Research has found that the Transactional Model of Stress is more accurate. This model says that stress is caused by a transaction, there is an interaction between the stressor, our view of the stressor and our perceived ability to cope with it. It’s our own internal beliefs, attitudes, interpretations, perceptions and other factors, in combination with the external events that tend to create stress. Internal factors which influence how we perceive stress include· Beliefs · Expectations · Locus of control · Low assertion · Low self esteem · People pleasing · Perception · Perfectionism · Personality Barbara Fredrickson’s Positivity Ratio Barbara has done pioneering work that demonstrates how developing positive emotions can improve our lives. Twenty years of research into emotions culminated in her best selling book Positivity. People who have positive emotions in a ratio of 3:1 in relation to negative emotions are more likely to flourish. Barbara believes in humanity’s ability to shape a successful future, but she is a scientist, rather than a self-help guru. Her work is based on rigorous interviewing and testing. So would you like to know your own Positivity Ratio? Here is a link to the Positivity Self Test. One key point: this invites you to focus on your emotions today. Barbara and others recommend that you try it over a period of a month to get a realistic reading. http://www.positivityratio.com/single.php Barbara Fredrickson’s Broaden-and Build Theory of Positive Emotions Potentially Stressful Objective Events Subjective Cognitive Appraisal Emotional Response Physiological Response Behavioral Response Hans Selye’s General Adaptation Syndrome (G.A.S.) In 1936, Hans Selye created the stress model "General Adaptation Syndrome", which thoroughly explains the stress response and how aging and disease are caused by chronic exposure to stress. “Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older.”- Hans Selye (1907-1982) Hans Selye’s General Adaptation Syndrome (G.A.S.) Alarm Stage- in this phase, the initial reaction of the body to stress is that it labels the stressor as a threat or danger to balance, that is why it immediately activates its fight or flight response system, and releases the “stress” hormones such as adrenaline, noradrenaline and cortisol. These hormones enable you to perform activities that you don’t usually do. Hans Selye’s General Adaptation Syndrome (G.A.S.) Resistance Stage- After the body has responded to the stressor, it is more likely that the stress level has been eradicated, or simply reduced. What happens next to the fight or flight response is that you body’s defenses become weaker, as it needs to allocate energy to the repair of damaged muscle tissues and lower the production of the stress hormones. Although the body has shifted to this second phase of stress response, it remains on-guard, particularly when the stressors persist and the body is required to fight them continuously, although not as stronger as it could during the initial response. Hans Selye’s General Adaptation Syndrome (G.A.S.) Exhaustion Stage- During this phase, the stress has been persistent for a longer period. The body starts to lose its ability to combat the stressors and reduce their harmful impact because the adaptive energy is all drained out. The exhaustion stage can be referred to as the gate towards burnout or stress overload, which can lead to health problems if not resolved immediately. All in all, the General Adaptation Syndrome model by Hans Selye presents a clear biological explanation of how the body responds and adapts to stress. Brain-Body Pathway in Response to Stress Brain-Body Pathway in Response to Stress STRESS Pituitary Gland Hypothalamus ACTH (Adrenocorticotropic Hormone) and ANS (Autonomic Nervous System) Adrenal Cortex Adrenal Medulla Secretion of Corticosteroids Catecholamine's Brain-Body Pathway in Response to Stress The major communication center for brain-body interaction, the hypothalamus works with the pituitary gland to regulate your body’s hormones. When you have a “stress response,” these two structures throw the adrenal glands into high gear for “fight or flight.” Brain-Body Pathway in Response to Stress When the brain perceives a stress stimulus, it immediately releases adrenaline from the adrenal glands, and corticotrophin-releasing hormone (CRH) from nerve cells in the hypothalamus. CRH travels to the pituitary gland, where it triggers the release of adrenocorticotrophic hormone (ACTH), which then stimulates the production of cortisol in the adrenal glands. Cortisol sustains energy, but it also curbs the surge of adrenaline and turns off CRH. Coping and Stress Coping is efforts to master, reduce, or tolerate the demands of stress. Defensive Coping is using aggressive or addictive behaviors to deal with stress. In defensive coping, defense mechanisms are used to protect a person from unpleasant emotions, such as anxiety and guilt. Constructive Coping are healthy efforts that people make to deal with stressful events. Ways to deal with Stress using Constructive Coping Confront problems directly. Have a realistic understanding of resources available to cope with stress. Recognize disruptive emotional reactions to stress. Make efforts to ensure that your body is not especially vulnerable to the damaging effects of stress. Three Factors which contribute to Illness from Stress Personality – Type A or Type B Depression Immune Responses Health Problems linked to Stress Stroke, hypertension, diabetes, heart disease, cancer, chronic back pain, common cold, epileptic seizures, rheumatoid arthritis, ulcers, infections, PMS, asthma, appendicitis and AIDS. Three Factors Moderating the Impact of Stress Social Support Optimism Conscientiousness Health-Impairing Behavior which affects Stress Smoking Poor Nutritional habits Lack of Exercise Drinking Alcohol Drug Use Albert Ellis (1913-2007) Albert Ellis, Ph.D., was born in Pittsburgh on September 27, 1913, and raised in New York City. He holds M.A. and Ph.D. degrees in clinical psychology from Columbia University, and has held many important psychological positions, including chief psychologist of the State of New Jersey and adjunct professorships at Rutgers and other universities. He is the founder of Rational Emotive Behavior Therapy (REBT), the first of the now popular Cognitive Behavioral Therapies (CBT). Albert Ellis (1913-2007) Albert Ellis, Ph.D., was born in Pittsburgh on September 27, 1913, and raised in New York City. He holds M.A. and Ph.D. degrees in clinical psychology from Columbia University, and has held many important psychological positions, including chief psychologist of the State of New Jersey and adjunct professorships at Rutgers and other universities. He is the founder of Rational Emotive Behavior Therapy (REBT), the first of the now popular Cognitive Behavioral Therapies (CBT). Albert Ellis (1913-2007) The Albert Ellis Institute (AEI), a world-renowned psychotherapy training institute established in 1959, committed to promoting emotional well-being through the research and application of effective, short-term therapy with long-term results. AEI’s therapeutic approach is based on rational emotive behavior therapy (REBT), the pioneering form of cognitive behavior therapy. REBT is an action-oriented psychotherapy that teaches individuals to identify, challenge, and replace their self-defeating thoughts and beliefs with healthier thoughts that promote emotional well-being and goal achievement. REBT was developed in 1955 by Dr. Albert Ellis. Dr. Ellis has been considered the second most influential psychotherapist in history. Prior to this death in 2007, Psychology Today described him as the “greatest living psychologist.” Rational Emotive Behavior Therapy Ellis suggested that people mistakenly blame external events for unhappiness. He argued, however, that it is our interpretation of these events that truly lies at the heart of our psychological distress. To explain this process, Ellis developed what he referred to as the ABC Model: A – Activating Event: Something happens in the environment around you. B – Beliefs: You hold a belief about the event or situation. C – Consequence: You have an emotional response to your belief. Rational Emotive Behavior Therapy Activating Event Beliefs- Irrational and Rational Appraisal ConsequencesEmotional Turmoil or Emotional Calm The Basic Steps in Rational Emotive Behavior Therapy 1. Identifying the underlying irrational thought patterns and beliefs. The very first step in the process is to identify the irrational thoughts, feelings, and beliefs that lead to psychological distress. In many cases, these irrational beliefs are reflected as absolutes, as in "I must," "I should," or "I cannot." According to Ellis, some of the most common irrational beliefs include: Feeling excessively upset over other people's mistakes or misconduct. Believing that you must be 100 percent competent and successful in everything to be valued and worthwhile. Believing that you will be happier if you avoid life's difficulties or challenges. Feeling that you have no control over your own happiness; that your contentment and joy are dependent upon external forces. By holding such unyielding beliefs, it becomes almost impossible to respond to situations in a psychologically healthy way. Possessing such rigid expectations of ourselves and others only leads to disappointment, recrimination, regret, and anxiety. The Basic Steps in Rational Emotive Behavior Therapy 2. Challenging the irrational beliefs. Once these underlying feelings have been identified, the next step is to challenge these mistaken beliefs. In order to do this, the therapist must dispute these beliefs using very direct and even confrontational methods. Ellis suggested that rather than simply being warm and supportive, the therapist needs to be blunt, honest, and logical in order to push people toward changing their thoughts and behaviors. The Basic Steps in Rational Emotive Behavior Therapy 3. Gaining Insight and Recognizing Irrational Thought Patterns As you might imagine, REBT can be a daunting process for the client. Facing irrational thought patterns can be difficult, especially because accepting these beliefs as unhealthy is far from easy. Once the client has identified the problematic beliefs, the process of actually changing these thoughts can be even more difficult. While it is perfectly normal to feel upset when you make a mistake, the goal of REBT is to help people respond rationally to such situations. When faced with this type of situation in the future, the emotionally healthy response would be to realize that while it would be wonderful to be perfect and never make mistakes, it is not realistic to expect success in every endeavor. You made a mistake. But that's okay because everyone makes mistakes. All you can do is learn from the situation and move on. REBT can be effective in the treatment of a range of psychological disorders including anxiety disorders and phobias as well as specific behaviors such as severe shyness and excessive approval seeking. Ways to Reduce Stress Humor or Laughing Release pent up emotions- Catharsis Forgive others Learn to relax Yoga What Is Catharsis? A catharsis is an emotional release. According to psychoanalytic theory, this emotional release is linked to a need to release unconscious conflicts. For example, experiencing stress over a work-related situation may cause feelings of frustration and tension. Rather than vent these feelings inappropriately, the individual may instead release these feelings in another way, such as through physical activity or another stress relieving activity. Psychological Disorders Psychological Disorders Psychological Disorders are diagnosed by psychologists by first determining if a behavior is deviant, maladaptive and causes personal distress. This is done through a diagnosis, (determining the illness), etiology, (cause of illness) and prognosis (probable cause of illness in the future). This is done using the Axis System within the DSM-IV. This is a reference book of about 300 disorders that psychologists can use to determine what illness a patient has, if any. DSM-IV , TR Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition. Better known as the DSM-IV, the manual is published by the American Psychiatric Association and covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches. Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd party payers (e.g., insurance) understand the needs of the patient. The book is typically considered the ‘bible’ for any professional who makes psychiatric diagnoses in the United States and many other countries. Much of the diagnostic information on these pages is gathered from the DSM IV. The DSM IV is published by the American Psychiatric Association. Much of the information from the Psychiatric Disorders pages is summarized from the pages of this text. Should any questions arise concerning incongruencies or inaccurate information, you should always default to the DSM as the ultimate guide to mental disorders. DSM-IV , TR The DSM-IV, TR uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health. It assesses five dimensions as described below: Axis I: Clinical Syndromes This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia) Axis II: Developmental Disorders and Personality Disorders Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood Personality disorders are clinical syndromes which have a more long lasting symptoms and encompass the individual's way of interacting with the world. They include Paranoid, Antisocial, and Borderline Personality Disorders. DSM-IV , TR Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here. Axis IV: Severity of Psychosocial Stressors Events in a persons life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II. These events are both listed and rated for this axis. Axis V: Highest Level of Functioning On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year. This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected. Anxiety Disorders Anxiety is a familiar emotion to all of us- the feeling of tension, apprehension, and worry that often hits during personal crisis and everyday conflicts. In Anxiety Disorders, the anxiety is maladaptive (inhibit a person’s ability to adjust to particular situations.) disrupting activities, moods, and thought processes. Three features distinguish normal anxiety from pathological anxiety. Pathological anxiety is ; irrational, uncontrollable, and disruptive. Anxiety Disorders Generalized Anxiety Disorder (GAD) Global, persistent, chronic and ongoing anxiety is the main feature of GAD. Normal anxiety quickly dissipates when a threatening situation is resolved. In GAD, when one source of worry is removed, another quickly take it’s place. The anxiety can be attached to any object or person or none at all. GAD is often referred as “free-floating anxiety”. Anxiety Disorders Panic Disorder In panic disorder, the anxiety is sudden, intense and short-lived. A Panic Attack is a sudden episode of extreme anxiety that rapidly escalates in intensity. The most common symptoms of a panic attack are a pounding heart, rapid breathing, breathlessness, and a choking situation. When panic attacks occur frequently and unexpectedly, the person is said to suffer from panic disorder. Anxiety Disorders Phobias A phobia is a strong irrational fear of something, usually a specific object or situation. Having a phobia does not mean a person has a psychological disorder. People with a Specific Phobia have an irrational fear of a specific object or situation that interferes with the ability to function in everyday life. People with Social Phobia or Social Anxiety Disorder have an extreme or irrational fear of being embarrassed, judged or scrutinized in social situations. Social Phobia is far more debilitating than everyday shyness. People with social phobia are intensively fearful of being watched and judged by others. Even in everyday activities, such as eating with friends in a restaurant, can cause unbearable anxiety. Phobias can partly be explained by; classical conditioning, operant conditioning, and observational learning. Anxiety Disorders Agoraphobia This is a type of phobia that deserves special attention. Agoraphobia is an extreme and irrational fear of experiencing a panic attack in a public situation and being unable to escape or get help. Agoraphobia means “fear of the marketplace”. Although agoraphobia and panic disorder are characterized by panic attacks, not everyone with panic disorder develops agoraphobia. Many people with agoraphobia will become prisoners in their own homes, unable to go out the door. Anxiety Disorders Posttraumatic Stress Disorder (PTSD) PTSD is a long-lasting anxiety disorder that develops in response to an extreme physical or psychological trauma. Extreme traumas are events that produce intense feelings of horror and helplessness, such as a serious physical injury or threat of injury to yourself or to loved ones. PTSD was originally associated with direct experiences of military combat. However, it now know n that PTSD can develop in survivors of other sorts of extreme traumas, such as natural disasters, physical or sexual assault, random shooting sprees, or terrorist attacks. Anxiety Disorders Obsessive- Compulsive Disorder (OCD) OCD is characterized by symptoms of anxiety which are triggered by intrusive, repetitive thoughts and urges to perform certain actions. A deficiency in the neurotransmitter serotonin seems to be associated with OCD. Obsessions are repeated, intrusive, uncontrollable thoughts or mental images that cause a person great worry and distress. One common obsession is an irrational fear of dirt, germs, and other forms of contamination. Another common theme is the pathological doubt about having accomplished a simple task, such as shutting off appliances or locking a door. Compulsions are repetitive behaviors that a person feels driven to perform, Typically, compulsions are ritual behaviors that must be carried out in a certain process or sequence. Compulsions may be overt physical behaviors, such as repeated hand washing, checking doors and windows. Other compulsions may be covert mental behaviors, such as counting or reciting certain phrases to yourself. If a person tries to resist performing the ritual, unbearable tension, anxiety and distress. Many people with OCD have the irrational belief that failure to perform the ritual action will lead to catastrophic or disastrous outcome. Mood Disorders Mood Disorders are a category of mental disorders in which significant and persistent disruptions in mood or emotions cause impaired cognitive, behavioral, and physical functioning; also called affective (affect is another word for “emotion or mood”) disorders. The DSM-IV-TR defines a mood disorder as a serious, persistent disturbance in a person’s emotions that cause psychological discomfort which impairs the ability to function or both. Mood Disorders Major Depression Major Depression is characterized by extreme and persistent feelings of despondency, worthlessness, and hopelessness causing impaired emotional, cognitive, behavioral, and physical functioning. It is often triggered by traumatic and stressed events. In Major Depression, there is a loss of pleasure in almost all activities, feelings of emptiness, excessive guilt, preoccupation with death or suicidal thoughts, difficulty sleeping, dimished ability to think, concentrate or make decisions, and diminished appetite and significant weight loss. Mood Disorders Dysthymic Disorder In contrast to major depression, which significantly impairs a person’s ability to function, some people experience a less severe form of depression called dysthymic disorder. Dysthymic Disorder is chronic, low-grade depression. It is characterized by many symptoms of depression, but the symptoms are less intense. Although the person functions adequately, they have a chronic case of “the blues” that can continue for years. Mood Disorders Seasonal Affective Disorder (SAD) SAD is repeated episodes of depression in the changing seasons of the onset of autumn to winter. In the most common form of SAD, episodes of depression recur in the fall and winter months when there is the least amount of sunlight. Mood Disorders Bipolar Disorder Bipolar Disorder involves periods of depression alternating with periods of extreme euphoria and excitement (Mania). A person with Bipolar Disorder experience extreme mood swings During manic episodes, the person’s thoughts often rapidly shift from topic to topic. This is often referred to as a “flight of ideas”. For most people with Bipolar Disorders, a manic episode immediately precedes or follows a bout with major depression. However, according to the DSM-IV-TR , a small percentage of people experience only manic episodes. Mood Disorders Cyclothymic Disorder Cyclothymic Disorder is characterized by moderate but frequent mood swings, which last two years or more that are not severe enough to qualify as bipolar disorder. Personality Disorders Personality Disorders are inflexible, maladaptive patterns of thoughts, emotions, behaviors, and interpersonal functioning that are stable over time and across situations, and deviate from the expectations of the individuals culture. Personality traits are consistent over time and across situations, but they are not etched in stone. A psychologically well-adjusted person possesses a fair degree of flexibility and adaptiveness. Based on our experiences with others, we are able to modify are behaviors and how we display our personality traits. In contrast, someone with personality disorder has personality traits that are inflexible and maladaptive across a broad range of situations. Personality Disorders Paranoid Personality Disorder is characterized by pervasive distrust and suspiciousness of the motives of other without sufficient basis. About 3% of the general population display this disorder, which occurs more frequently in men. These individuals are constantly on guard because they think that other people are out to exploit, harm, or dupe them. Personality Disorders Antisocial Personality Disorder is characterized by a pervasive pattern of disregarding and violating the rights of others. These people are often referred to as “psychopaths or sociopaths”. These people have the ability to lie, steal, cheat, and otherwise manipulate and harm other people. Evidence of this personality trait can be seen in childhood or early adolescence. In many cases, the child has repeated run-ins with the law or school authorities. Behaviors that draw the attention of authorities can include; cruelty to animals, attacking or harming adults or other children, theft, setting fires, and destroying property. This pattern of behavior is typically diagnosed as conduct disorder. Personality Disorders Borderline Personality Disorder is characterized by instability of interpersonal relationships, self-image, and emotions, and marked impulsivity. This is the most commonly diagnosed personality disorder, of 10 million Americans diagnosed with personality disorder, about 75% are women. The person has extreme mood swings and angry outbursts are common. They often have feelings of emptiness and are afraid of abandonment. There sense of self is just as unstable and just as chaotic as their external world, partly because their identity is so fragile. Some researchers believe that a disruption in attachment relationships in early childhood is an important cause. Personality Disorders Schizoid Personality Disorder Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. For example, a person suffering from schizoid personality is more of a daydreamer than a practical action taker. Personality Disorders Schizotypal Personality Disorder A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common. People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. They also display signs of “magical thinking” by saying they can see into the future or read other people’s minds. Personality Disorders Narcissistic Personality Disorder People with narcissistic personality have an exaggerated sense of self-importance, are absorbed by fantasies of unlimited success, and seek constant attention. The narcissistic personality is oversensitive to failure and often complains of multiple somatic symptoms. Prone to extreme mood swings between self-admiration and insecurity, these people tend to exploit interpersonal relationships. Personality Disorders Avoidant Personality Disorder Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are fearful of saying something considered foolish by others; worry they will blush or cry in front of others; and are very hurt by any disapproval by others. People with avoidant personality disorder may have no close relationships outside of their family circle, although they would like to, and are upset at their inability to relate well to others. Personality Disorders Dependent Personality Disorder People with dependent personality disorder may exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They require excessive reassurance and advice, and are easily hurt by criticism or disapproval. They feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends. They have a strong fear of rejection. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males. Personality Disorders Obsessive-Compulsive Personality Disorder Obsessive-Compulsive personalities are conscientious and have high levels of aspiration, but they also strive for perfection. Never satisfied with their achievements, people with compulsive personality disorder take on more and more responsibilities. They are reliable, dependable, orderly, and methodical, but their inflexibility often makes them incapable of adapting to changed circumstances. People with compulsive personality are highly cautious, weigh all aspects of a problem, and pay attention to every detail, making it difficult for them to make decisions and complete tasks. When their feelings are not under strict control, events are unpredictable, or they must rely on others, compulsive personalities often feel a sense of isolation and helplessness. Somatoform Disorders Somatoform Disorders are physical ailments that cannot be fully explained by organic conditions and are largely due to psychological factors. Somatization Disorder is marked by a history of diverse physical complaints that appear to be psychological in origin. Hypochondriasis is characterized by an excessive preoccupation with one’s own health and worry about developing a physical illness. Conversion Disorder is characterized by a significant loss of physical function usually in a single organ system, with no organic basis. Eating Disorders Anorexia nervosa involves intense fear of gaining weight, disturbed body image, refusal to maintain normal weight, and used dangerous measures to lose weight. Bulimia nervosa involves engaging in out-of-control overeating followed by unhealthy compensatory efforts. Dissociative Disorders Dissociative Disorders are a category of psychological disorders in which extreme and frequent disruptions of awareness, memory, and personal identity impair and function. Dissociative experience is one in which a person’s awareness, memory, and personal identity become separated or divided. While that may sound weird, dissociative experiences are not inherently pathological. Mild dissociative experiences are quite common and completely normal. In Dissociative Disorders, the dissociative experiences are more extreme and frequent and severely disruptive in everyday functioning. Dissociative Disorders Dissociative Fugue Dissociative Fugue is a closely related disorder to dissociative amnesia. In dissociative fugue, the person outwardly appears completely normal. However, the person has extensive amnesia and is confused about his identity. While in the fugue state, they suddenly and inexplicably travels from their home, wandering to other cities or even countries. In some cases, people in a fugue state adopt a completely new identity. It is thought to be associated with traumatic events or stressful periods. Dissociative Disorders Dissociative Identity Disorder (DID) Dissociative Identity Disorder (DID) among all dissociative disorders is more fascinating- or controversial than any other, formerly known as multiple personality disorder. It involves extensive memory disruptions for personal information with the presence of two or more distinct identities or “personalities” within a single person. Typically, each personality has its own name and is experienced as if it has its own history and selfimage. These alternate personalities are often called alters or alter egos, each of which may have different ages and genders. In order to explain dissociative identity disorder, research has shown that a very high percentage of DID patients report having suffered extreme physical or sexual abuse in childhood- over 90% in most surveys. Schizophrenia Schizophrenia according to the DSM-IV-TR is a disorder characterized by impaired functioning by severely distorted beliefs, perceptions, and thought processes. Schizophrenia can be described in terms of two broad categories: positive and negative symptoms. Schizophrenia is an extremely complex disorder also called psychosis, which is a characterized by a loss of contact with reality. There are enormous individual variability in the onset, symptoms, duration, and recovery from schizophrenia. According to the dopamine hypothesis, schizophrenia is related to excessive activity of the neurotransmitter dopamine in the brain. There is also strong evidence that shows there is genetic involvement . Schizophrenia Positive Symptoms of Schizophrenia Delusions are false beliefs that persists in spite of contradictory evidence. Delusions of Reference occur when a person convinced that other people are constantly talking about them and everything that is related to them in some way. They believe the person on the radio is speaking to them. Delusions of Grandeur are when a person believes they are extremely powerful, wealthy, or important. They believe they are the president of the United States or Jesus. Delusions of Persecution are when a person believes other people are plotting against them to harm them or someone important to them. A person may believe that “terrorist forces” are going to attack them in their own home. Hallucinations are false or distorted perceptions that seem vividly real. The content of hallucinations is often tied to the person’s delusional beliefs. Hallucinations include; visual, smell or taste, touch or tactile and the most common type of hallucination which is auditory. Schizophrenia Negative Symptoms of Schizophrenia Negative Symptoms of Schizophrenia include; social withdrawal, loss of motivation, very limited speech, slowed movements, poor hygiene, poor problemsolving abilities and a distorted sense of time. Some people may exhibit a flat affect, showing practically no emotional response at all, even though they may report feeling emotional. Schizophrenia Four Types of Schizophrenia Paranoid Schizophrenia is the most common type of schizophrenia with symptoms of delusions and hallucinations. Disorganized Schizophrenia is the most serious type marked by extreme social withdrawal, hallucinations, delusions and inapproiate behavior. Catatonic Schizophrenia is characterized by bizarre postures or grimacing or echoing words spoken by another person. Undifferentiated Schizophrenia is when the symptoms do not conform to one type of schizophrenia. Therapies Psychoanalytic Therapy Psychoanalytic Therapy or Psychoanalysis is a form of therapy developed by Sigmund Freud. Psychotherapy can be described as the use of psychological techniques to increase understanding and treat emotional, behavioral and interpersonal problems. All forms of psychotherapy share the assumption that psychological factors play a significant role in problematic emotions, behaviors and thoughts. Psychoanalysis is a form of therapy based on dream interpretation, transference and resistance. Transference refers to a patient responding to the therapist as though the therapist was a significant person in their life. Resistance refers to patients unconscious attempts to block repressed memories and conflicts. Behavior Therapy Behavior therapy, also called Behavior Modification is to modify a specific problem behavior, not to change the entire personality. Behavior therapy use techniques of learning and conditioning to change behavior. Mary Cover Jones was the first behavior therapist who developed was the first behavior therapist who developed counterconditioning- the learning of a new response that is incompatible with a previously learned response. Humanistic Therapy- “Client-Centered Therapy” The humanistic perspective has exerted a strong influence on psychotherapy. The most influential of the humanistic psychotherapies is client-centered therapy, also called person-centered therapy developed by Carl Rogers. Carl Rogers believed to promote self-awareness, psychological growth and self-directed change the three qualities important of a therapist are; genuineness, unconditional positive regard and empathic understanding. Cognitive Therapies Cognitive therapies is based on the assumption that psychological problems are due to maladaptive patterns of thinking, treatment techniques focus on recognizing and altering these unhealthy thinking patterns. Albert Ellis developed rational-emotional therapy (RET) which promotes psychologically healthier thought process by disputing irrational beliefs and replacing them with more rational interpretations of events. “ABC” Model- (A) Activating Event (B) Beliefs and (C) Consequences Cognitive-Behavioral Therapy Cognitive-Behavioral Therapy (CBT) integrates cognitive and behavioral techniques and based on the assumption that thoughts, moods, and behaviors are interrelated.