变态心理学讲义(北大钱铭怡)

(AbnormalPsychology)psychologicaldisordersmentaldisordermentalillnessinsanityCCMD-3DSM-IVICD-10ChineseClassificationandDiagnosticCriteriaofMentalDisorders(2001)DiagnosticandStatisticalManualofMentalDisorders,DSM-VI(19942000)AxisIClinicaldisordersAxisIIPersonalitydisorders,mentalretardationAxisIIIGeneralmedicalconditionsAxisIVPsychosocialandenvironmentalproblemsAxisVGlobalassessmentoffunctioningInternationalStatisticalClassificationofDiseasesandRelatedProblemsICD-10(1992)CCMDICDHippocratesGalenwitchcraft“”“”(exorism)(heroicmedicine)有关心理异常的理论模型(Thetheoreticalmodelsofabnormalpsychology)有关心理异常的理论模型生物学模型心理学模型生物学模型遗传的影响中枢神经系统外周神经系统内分泌系统对生物学模型的评价遗传的影响基因遗传不仅影响人的身体特点，也影响行为由许多基因交互作用控制，同时也受躯体化学因素以及经验的影响中枢神经系统包括大脑和脊髓大脑的结构中枢神经系统基本功能是储存和传递信息当中枢神经系统出现问题时，可能引起行为、人格的巨大的改变神经递质传递冲动对心理病理过程起着重要作用的神经递质:乙酰胆碱、多巴胺、内啡肽、GABA（r-氨基丁酸）、去甲肾上腺素、五羟色胺等外周神经系统外周神经系统包括躯体神经系统植物神经系统内分泌系统指挥中心：下丘脑产物：激素，通过内分泌腺释放入血液影响：性功能、食欲、睡眠、生长和发育、能量的利用、情感的反应激素可能与某些特定的心理障碍有关对于生物学模型的评价对于病因的解释遗传、神经生化、内分泌、神经系统等诊断系统治疗方法医学治疗方法、药物心理学模型心理动力学模型认知行为模型人本主义模型社会和人际间关系的观点心理动力学模型S.Freud观点：意识、前意识、无意识人格构成：本我－遵循快乐原则自我－遵循现实原则超我－遵循至善原则焦虑与心理防御机制性心理发展的不同阶段病因心理发展的固着、退行无意识中欲望和冲突以症状形式表现出来治疗自由联想、释梦、解释等新弗洛伊德流派强调自我强调客体关系病因客体关系问题等治疗方法对于阻抗和移情的分析对心理动力学的评价首次运用心理学原理解释异常现象其理论、概念、方法等至今具有影响力心理动力学理论的局限认知行为模型行为治疗理论观点认知治疗理论观点行为治疗理论观点经典的条件作用(Classicalconditioning)原理操作性条件作用(Operantconditioning)原理模仿学习(Modeling)原理病因行为异常是通过条件反射、模仿学习、错误强化等习得的治疗行为治疗－学习新的行为方式，消退旧的行为方式，建立新的适宜反应方法各种行为治疗方法对行为治疗理论的评价实验室研究、客观性行为治疗理论的局限认知治疗理论观点情绪、行为是受认知影响的认知的歪曲、非理性信念是心理障碍产生的原因病因：歪曲的认知、不良思维方式、认知图式治疗方法：认知重建、认知行为矫正等对认知治疗理论的评价目前具有很强的影响力注重认知对人的情绪与行为的影响认知治疗理论的局限人本主义模型人本学派强调成长和自我实现，而不是治愈疾病或缓解障碍病因个体具有的指向健康和个人成长的自然倾向受到了阻碍或歪曲，无法发挥作为人所具有的潜能治疗提供良好的成长环境，使个体朝着具有社会建设性和个人自我实现的方向发展对人本主义治疗观点的评价强调人类具有对自己负完全责任的能力，以全新的角度来理解异常行为人本主义观点的局限社会和人际间关系的观点病因生活变动、都市化、环境因素、人际交往等影响或问题改变预防上述有害因素或对其进行干预对于社会和人际关系的观点的评价这个方面一直没有得到与心理或生物影响一样的重视，但研究已开始证明社会影响是强大和深远的(schizophrenia),0.07-0.52‰:0.24‰:0.9-17.4‰:5.8‰(WHO):19937:5.31‰:6.55‰(1.6:1)„„CCMD-31DSM-IV6()„„„„(paranoidschizophrenia)(catatonicschizophrenia)(hebephrenicschizophrenia)(paranoidschizophrenia)(catatonicschizophrenia)„„„„„(hebephrenicschizophrenia)CCMD3(simpleschizophrenia)1(CCMD-3)6(DSM-IV)Mooddisordersandsuicide\\\\(Affectivedisorders)DSM-III-R(1987)ICD-10(1992)CCMD-3(2001)()„Š19937„0.52‰„0.83‰„ƒ5.2%5.9-7%()ƒ3%ƒ3600¾¾¾¾¾¾„(unipolar)(DSM-IV)--(depression)„(bipolar)(DSM-IV)--(mania)--¾¾¾¾¾¾¾¾¾--16-353„„„„„„„„„„ICD10„„„vs.vs.1(Dysthymia)„„CCMD2(Cyclothymia)„12„„„(suicide)]]]]1025/10:„14.7/10,19.6/10,17.07/10(1989)„1534200312“”3(Poeldinger,1983)„„123414P(4Pmodel)23(Anxietydisorders)••••••¾¾¾•18••2050•1980DSMIII••CCMD••CCMD-3–()•,–•–DSM-6CCMD-33••phobia•••••–•11.1%15.5%Magee1996•11%7%16%Keller1994•5.3%75%Keller1994–•120.059‰(1986(agoraphobia)•––•123(socialphobias)––––(specificphobias)•––••––––••––––•(panicdisorder)•••••–3.5%–2590––––––––––––•––l0–2030–1–12•–13–1CCMD-3•–50%20%–•–••–––––•–•II(Anxietydisorders)(generalizedanxietydisorder,GAD)•••••2%-5%1.48‰1986•–()–ƒƒƒƒƒƒ•••••(obsessive-compulsivedisorder,OCD)•••••(1984)5–2.5%–61.6%•198612–0.030%••(obsessions)•compulsion•–•–••III(Anxietydisorders)(Posttraumaticstressdisorder,PTSD)•••••–6–•–1.0%-2.6%Hrlzoretal.,1987–3%-58%–•–––••–––•–––•(Conversionanddissociativedisorders)„„(Hysteria)„„18„19„1980DSMIII(neurosis)“”„„1%30%„„3.55‰1986„CCMD3—DSM-IVCCMD3()—DSM-IV()CCMD-3[()]DSMIVconversiondisorders„„„„„„„„„„„„„„„„„„DissociativeDisorder„„„„„„„„„(depersonalizaiondisorder)„„(dissociativeamnesia)„,„„„localizedamnesia„selectiveamnesia„generalizedamnesia„continuousamnesia„systematizedamnesia(dissociativefugue)„„(dissociativeidentitydisorder,DID„2„multiplepersonalitydisorder„DID15„DID9„„„„„„„DIDPTSD„„(EatingDisorders)DSM-„AnorexiaNervosaAN„BulimiaNervosaBN1:8-10(BulimiaNervosa)„90—95%„1619„:1%DSM-IV1-3%„„„purging„DSM-IV„„„(AnorexiaNervosa)„90%—95%„13„:0.28%„DSM-IV:0.5-1.0%DSM-„restrictingtype„/binge-eating/purgingtype„85%„„„3„„„„„„„„„„—„„12„„„(Substance-relateddisorders)„——psychoactivesubstance„:„–CCMD-3„„–DSM-IV„substanceabuse„substancedependence+++++++++-++++++++++++++++++++LSD++1.+?1993%8000.1413300.23141202.4530200.5225500.44218203.781999„:„1984-2004114.04„79.1„80%„„––„„„„„„„(cannabis)“”„„marijuana/marihuana„–„––„„„–198610–1986319910.14‰0.29‰,0.05‰„––„„–––„„„„——„„„(personalitydisorders)¾¾¾¾„CCMD3„„()„DSMIV„„„6-9%Kathleen1986„0.13‰1986„DSM-IV103„A„B„CclusterAclusterBclusterC(paranoidPD)„„„„„„„„„„„„„„„(SchizoidPD)„„„„PDQSCID0.71.6„„„„„„„„„„„(schizotype)„„„„„„„„„„„(HistrionicPD)„„„„„„PDQSCID1.33.0„2„„„„„(NarcissisticPD)„„„„„00.4„„„„„„„„(AntisocialPD)„„„„„Vaillant&Perry(1985):0.05-15%„„„„„„„„„„„„„„(BorderlinePD)„„„„„0.2-4.6„„„„„„„„„„„„„„„(AvoidantPD)„„„„„0.4-1.6„„„„„„„„„„„„„„„„(DependentPD)„(inadequate)„„„„„0.3-6.7„„„„„„„„(Obsessive-CompulsivePD)„„„„1.7-6.4„„„„„„„„„(Sexualandgenderidentitydisorders)““DSM-IV“ICD10“CCMD-3Homosexuality“Homosexuality““50“(1974)DSM-II“DSMIII1980“DSMIV1994“WHO1992“CCMD32001“CCMD3“19923.6%“19924.1%“34360048002000“““““““““disordersofsexualpreference“Paraphilias““““““““()“““““““““““genderidentitydisorders““1/370001/103000“1/340001/108000““““““““““““”se