Availability of Psychological Disorders--论文代写范文精选

选择的症状也影响个人。例如与医学领域相关学科,更容易开发复杂的疾病,PBT包含了精神分析认为不可接受的冲动在神经症发挥重要的作用。选择是有意识的和理性的,病人看重效果与成本。下面的essay代写范文进行详述。

The second principle that affects the choice of symptoms is availability. The symptom is selected from experiential resources that become salient in attention through the individuals specific coping needs and environmental cues. These resources can be classified into a number of categories, as specified below.

   Somatic defects: Patients often utilize their physiological defects to develop neurotic disorders when appropriate to their pathological coping needs. For example, not only is there a strong relationship between conversion disorder and organic defects, but even the  selection of a specific type of symptomatology appears to be determined by the patients own past experiences with illness or injury (Carden & Schramnel 1966, p. 27). Availability may also account for the significant relationship between respiratory diseases (e.g., asthma) or a cardiac malfunction of mitral valve prolapse and panic disorder (see review by Rofé 2000, pp. 141-143).

Behavioral repertoire: Sometimes bizarre behaviors are a deliberate exaggeration of routine behaviors. For example, a significant relationship exists between dieting and eating disorders (Rofé 2000, pp. 143-144).  Accordingly, the higher prevalence of eating disorders among women may be partly due to the fact that women are more preoccupied with weight and dieting (e.g., Stice 1994). Likewise, both homosexual males, who place a higher value on their appearance (e.g., Carlat, Camargo, & Herzog 1997) and men whose occupation demands strict weight control and a thin appearance, such as dancers, actors, models, and athletes (e.g., Stice 1994), are at a higher risk for developing eating disorders. Both groups utilize their dieting repertoire to develop eating disorders when a need for a pathological coping mechanism arises. The increased availability of dieting practices and the quest for a slim appearance may partly account for the dramatic increase of eating disorders in modern times (e.g., Polivy & Herman 1987). 

   The effect of behavioral repertoire is also evident in OCD. For example, the high rate of compulsive cleaning among women was attributed to the fact that in our culture most women are responsible for running the household (Emmelkamp 1982, p. 167). Similarly, it is likely that the over representation of religious individuals among OCD patients (e.g., Rasmussen & Eisen 1992) is the result of the increases availability of rituals in their behavioral repertoire.

   Family history: Modeling of family members is an important source of availability. For example, Mucha and Reinhardt (1970) found that 70% of conversion disorder patients had parents who suffered from illness in the same organ system affected by their hysterical symptoms. Similarly, Dell and Eisenhower (1990) reported that 73% of patients with MPD had at least one parent who suffered from a diagnosable dissociative disorder and 36% of the mothers had MPD. Modeling of family members was also observed with respect to eating disorders and OCD (see review by Rofé 2000, pp. 148-150).

   Peer group: As demonstrated in several cases of mass hysteria, peers who display deviant behaviors may serve as models for imitation when the symptoms satisfy the individuals coping needs (e.g., see Nandi et al. 1985). This effect is evident in other psychiatric disorders as well. For example, as pointed out by Striegel-Moor et al. (1986), a college woman who purges almost always knows another female student who purges, whereas a woman who does not purge rarely knows someone who does (p. 256).

   Mass media: Numerous studies show that increased exposure to eating disorders and MPD through mass media may account for the dramatic increase in the prevalence of these disorders in more developed countries and fluctuations in their distribution among different sex and socio-economic groups (see review by Rofé 2000, pp. 151-153). For example, Andersen and DiDomenico (1992), upon examining the underlying causes of sex differences in eating disorders, found that womens magazines contained 10.5 times more articles and advertisements promoting weight loss than mens magazines.

   Education: Choice of symptom is also affected by the individuals training (see Rofé 2000, pp. 153-154). For example, subjects associated with the field of medicine, such as physicians, nurses, and medical secretaries, are more likely to develop complicated hysterical diseases (e.g., Ziegler et al. 1960). Accordingly, a significant percentage of MPD patients had training in the mental health field (17%), aspired to become mental health professionals (17%) or had extensive psychiatric or medical knowledge (28%; see Spanos 1996, p. 242).

   Suggestion: Pre-neurotic patients, preoccupied by the need to develop a bizarre symptom, may be motivated to choose a particular disorder, such as MPD (e.g., Spanos 1996), following suggestions by an authoritative person, such as a therapist or religious mentor (see Rofé 2000, pp. 154-155). For example, Spanos et al. (1985) reviewed clinical data showing that therapists sometimes encourage patients to adopt the multiple role, provide them with information about how to enact that role convincingly, and perhaps, most important, provide official validation for the different identities that their patients enact(p. 363). 

Unique personal experiences: In the aforementioned categories of availability, the symptom was not unique to the individual, as other patients display similar behaviors (e.g., anorexia nervosa). However, there are cases in which the symptom is idiosyncratic and constitutes a deliberate exaggeration of a personal aversive experience, that the patient has or has had toward a certain stimulus, to a bizarre level. The stimulus becomes salient in the individuals attention when facing unbearable stress, due to its environmental or symbolic relationship with the stressor. For example, Brandt and Mackenzie (1987) reported a case study of a woman who, as a child, saw a rat in the family garage while being sexually abused by her brother for the first time. 

Years later, at age 26, she developed an intrusive fear of contamination, accompanied by compulsive hand-washing, upon discovering that her husband had been engaged in an extramarital affair. The symptoms were exacerbated during pregnancy and she would not allow her husband to touch her. Thus, feeling sexually abused once again, the familiar feelings of revulsion associated with the rat incident, which may have symbolically represented her disgusted attitude toward her husband, were inflated to a bizarre level for the purpose of pathological coping. As in the psychoanalytic case of Little Hans (Freud 1909/1964), instead of focusing on her husbands stress-provoking behavior, the woman chose to alienate herself from the painful situation by directing her feelings of disgust toward the available representative of her sexual mistreatment (i.e., the rat).

Cost-benefit analysis
In the decision-making process, patients weigh the coping benefit of distraction and controllability of an available symptom as against the expected cost, mainly concerning social stigma and impact on overall adjustment. As a rule, a specific symptom, or other modes of coping, is only likely to be adopted if it reduces the patients emotional distress and they can absorb the cost. 

   As with suicide (e.g., Sanborn 1990) and drug abuse (Robbins 1989), cost-benefit analysis can also account for sex differences in neuroses. Socialization processes encourage men not to be sissies (Sanborn 1990, p. 151) and to avoid inappropriate feminine coping strategies (Eisler & Blalock 1991). Additionally, numerous studies show that unemployment has a much stronger aversive impact on mens well being than on womens (see review by Rofé 2000, p. 163). Consequently, men tend to avoid neurotic disorders, such as agoraphobia, panic disorder, MPD, and conversion disorder, because of the higher cost of both social stigma and damage to work ability (see Rofé 2000, pp. 162-163).

   OCD is the only neurotic disorder that is equally prevalent between the two sexes, due to its equal cost to both men and women (see review by Rofé 2000, pp. 28-29). Social embarrassment is relatively low for OCD patients as they have the freedom to avoid symptoms when inconvenient, without being perceived as malingerers. As noted by Rachman and Hodgson (1980), without any effort a compulsive cleaner or checker can abbreviate, extend, curtail or postpone a compulsive act (p.15). Additionally, several case studies indicate that OCD poses a minimal threat of unemployment for working individuals (Rachman & Hodgson 1980, pp. 60-61).

   The cost-benefit principle may also account for age differences in the prevalence of neurotic disorder. Conversion disorder is relatively more common than other neurotic disorders among children (e.g., Proctor 1958), not only because of their higher familiarity with physical illnesses than other psychiatric symptoms, but also because it enables an easy escape from scholastic stressors and solicits attention from parents and teachers (e.g., Clarizio & McCoy 1983).

   Similarly, children prefer to develop school phobia (e.g., Last & Francis 1988), rather than agoraphobia and panic disorder, which are rare among children (e.g., Wittchen & Essau 1993), as it provides more control over their scholastic stressors. However, after the school years, when cost-benefit considerations have changed, the school phobia might develop into agoraphobia if the need for a bizarre coping strategy persists (e.g., Deltito & Hahn 1993).

   Sometimes, a stressor may motivate the selection of a particular disorder as a result of cost-benefit analysis. Accordingly, patients tend to choose OCD as a coping mechanism against unacceptable impulses (e.g., Miller 1983) as its symptoms provide an effective measure of control (see controllability) at a relatively low cost in terms of social embarrassment and damage to work ability.

   When two symptoms provide equal benefit, the least costly will be chosen. For example, conversion symptoms are more frequently found on the left side of the body than on the right. While psychoanalysts attributed these findings to the right hemisphere, which they posited as the location of the unconscious, Kihlstrom (1984), who rejected this claim, noted that a more parsimonious explanation is that the symptoms are lateralized where they will do the least harm (p. 160).

   In conclusion, controllability, availability and cost-benefit analysis account for the variability in the distribution of neurotic disorders, such as sex, age, socio-economic differences and diagnostic fluctuations (e.g., the rising prevalence of MPD and eating disorders), thus synthesizing a vast amount of data from different schools of thought. While the choice of symptoms is determined by current stressors, PBT incorporates the psychoanalytic idea that unacceptable impulses play a major role in neuroses. This choice is also affected by the patients biological weaknesses, behavioral repertoire, cognitive knowledge available from various channels of communications or as a consequence of childhood traumatic experiences.  Yet, this choice is conscious and rational, as the patient weighs the benefit versus the cost involved in the decision process.（essay代写)

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