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Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

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Nội dung chi tiết: Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2tion with the interest in post traumatic stress disorder (PTSD) and responses to trauma in general. Psychoanalytic thinking traditionally focused on u

nconscious needs, wishes, and drives in concert with the defenses against them. Intrapsychic fantasy played a greater role than external trauma. Disso Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ciative disorders and PTSD have leveled the playing field so that contemporary psychodynamic clinicians now give equal weight to the pathogenetic infl

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

uences of real events. The growing body of research on reactions to trauma has led to new categorizations in the DSM-5 system (American Psychiatric As

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2 disorder, and reactive attachment disorder into a new category designated as trauma- and stressor-related disorders. A greater understanding of PTSD

and acute stress disorder has broadened the array of responses to adverse events such that there is no longer a requirement that a subjective specific Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

response to the adverse event must be one of fear or helplessness or horror. Large numbers of people numb themselves during an adverse event that is

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

experienced directly or indirectly and begin to have symptoms after a period of282PSYCHODYNAMIC PSYCHIATRY IN CLINICAL PRACTICErequires all of the DSM

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 25. Dissociative fugue has been included as a specifier of dissociative amnesia, so it is no longer listed as a separate diagnosis. The definition of d

issociative identity disorder has been altered to emphasize the intrusive nature of the dissociative symptoms as disruptions in consciousness, includi Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ng an experience of possession as an alteration of identity, and an awareness that amnesia for everyday events, not merely traumatic events, is typica

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

l. Finally, derealization is no longer separate from depersonalization disorder.In this chapter, 1 include both trauma- and stressor-related disorders

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2ma is virtually a universal experience, with 89.6% of Americans having been exposed to a traumatic event in their lifetime (Breslau 2009). PTSD itself

afflicts approximately 6.8% of Americans (Kessler Ct al. 2005). Almost 40% of individuals who receive the diagnosis of PTSD continue to have signific Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ant symptoms a decade after onset (Kessler Ct al. 1995), and many have significant work impairment (Davidson 2001). As noted in Chapter 1, there is so

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

me thought that genetic vulnerability interacts with adult traumatic events and childhood adversity to increase the risk of PTSD. A study of acute and

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2rve as a useful predictor of risk for PTSD-related symptoms in the weeks and months following trauma. It is also clear from numerous studies that chil

d abuse itself provides significant risk liability for the development of adult PTSD. Child abuse increases the vulnerability by altering the hypothal Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

amic-pit uitary-adrenal axis functioning and by altering the nature of the attachment profile of the young child. In addition, child abuse appears to

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

interact with genetic factors. In a study involving highly traumatized inner city individuals (Binder et al. 2008), four single nucleotide polymorphis

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2interac-Trauma- and Stressor-Related Disorders and Dissociative Disorders 283Certain types of children seem to be more vulnerable to ultimately develo

ping PTSD symptoms. Prospective studies of children exposed to trauma show that traumatic events are fairly common and do not often result in a full-b Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

lown picture of PTSD. However, children who have preexisting anxiety and/or depression appear to be a greater risk for the development of PTSD followi

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ng trauma exposure (Copeland et al. 2007; Storr et al. 2007).Whereas the severity of posttraumatic symptoms was once thought to be directly proportion

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2ore experiencing the trauma (Schnydcr et al. 2001). Events that seem to be relatively low in severity may trigger PTSD in certain individuals because

of the subjective meaning assigned to the event. Old traumas may be reawakened by present-day circumstances. One investigation of 51 burn patients (Pe Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

rry Ct al. 1992) showed that PTSD was predicted by smaller burns, by less perceived emotional support, and by greater emotional distress. More severe

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

or extensive injury did not predict posttraumatic symptoms. The findings of this study are in keeping with the growing consensus that PTSD is perhaps

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2 severity of the stressor.Psychotherapy is generally the treatment of choice for PTSD, and a number of psychological treatments may be useful, includi

ng cognitive-behavioral, interpersonal, dynamic, and eclectic approaches (Youngncr et al. 2014). Reviews of the literature suggest that PTSD is most e Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ffectively treated with trauma-focused therapy, with meta-analyses demonstrating strong responses to cognitive-behavioral therapy (CBT; Bradley et al.

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

2005). CBT techniques generally focus on having the patient confront rather than avoid his or her traumatic memories while also confronting distorted

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2vidence from clinical trials (Forbes et al. 2010).Psychodynamic approaches that emphasize the careful building of a therapeutic alliance may be useful

in many cases. As noted earlier, a dissociative subtype of PTSD has been added to DSM-5. Lanius Ct al. (2010) identified neurobiological features of Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

dissociative PTSD that differentiate it from the more traditional subtype involving hyperarousal symptoms. The nondis-sociative subtype of PTSD, chara

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

cterized by reexperiencing and hyperarousal. is regarded as a form of emotion dvsreeulation that involves284PSYCHODYNAMIC PSYCHIATRY IN CLINICAL PRACT

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2ation, thus reducing treatment effectiveness (Lanius et al. 2010). In a study of borderline personality disorder (Kleindienst et al. 2011), levels of

dissociation served as an important negative predictor of response to behavioral and exposure treatments. Hence, dissociative symptoms must be careful Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

ly assessed before proceeding to an exposure-based treatment for PTSD patients. These patients require a phase-based intervention that includes identi

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

fying and modifying attachment schemas and developing mood regulation skills.Brom et al. (1989) compared patients receiving dynamic therapy, hypnother

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2eved greater reduction in avoidant symptoms but had less impact on intrusive symptoms. The desensitization and hypnotherapy group showed the reverse p

attern. Behavioral techniques have proven to be effective, but the relaxation necessary for behavioral modalities may be difficult for PTSD patients t Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

o achieve because of their impaired self-soothing abilities.Lindy Ct al. (1983) used a manualized brief dynamic therapy consisting of 6-12 sessions. I

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

n a well-controlled study of this treatment with survivors of fires, these investigators demonstrated significant improvement in the 30 patients who p

CHAPTER 10TRAUMA- AND STRESSOR-RELATED DISORDERS AND DISSOCIATIVE DISORDERSIn recent years, psychiatric interest in dissociation has grown in conjunct

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2 treatment used, individual psychotherapy must be highly personalized for patients with PTSD. Dropout rates as high as 50% and nonresponse are fairly

common in the literature on PTSD treatment (Schottenbaucr et al. 2008). A significant subgroup of patients will be overwhelmed by the reconstruction o Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

f the trauma and will react with clinical deterioration. The integration of split-off traumatic experiences must be titrated in keeping with the parti

Ebook Psychodynamic psychiatry in clinical practice (5/E): Part 2

cular patients capacity for such integration. The therapist must be willing to contain projected aspects of the traumatized self until the patient is

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