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

(BQ) Part 2 book “Psychodynamic psychiatry in clinical practice” has contents: Paraphilias and sexual dysfunctions, neurodevelopmental and neurocognitive disorders, hysterical and histrionic personality disorders, cluster a personality disorders - paranoid, schizoid, and schizotypal, and other contents. | C H A P T E R 10 TRAUMA- AND STRESSORRELATED DISORDERS AND DISSOCIATIVE DISORDERS I n recent years, psychiatric interest in dissociation has grown in conjunction with the interest in posttraumatic stress disorder (PTSD) and responses to trauma in general. Psychoanalytic thinking traditionally focused on unconscious needs, wishes, and drives in concert with the defenses against them. Intrapsychic fantasy played a greater role than external trauma. Dissociative disorders and PTSD have leveled the playing field so that contemporary psychodynamic clinicians now give equal weight to the pathogenetic influences of real events. The growing body of research on reactions to trauma has led to new categorizations in the DSM-5 system (American Psychiatric Association 2013). Although PTSD was formerly included among the anxiety disorders, the revision in DSM-5 groups acute stress disorder, PTSD, adjustment 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 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 experienced directly or indirectly and begin to have symptoms after a period of time. PTSD now includes four distinct symptom clusters: reexperiencing, avoidance, persistent negative alterations in mood, and cognition and arousal. Finally, the new dissociative subtype has been added to PTSD that 281 282 PSYCHODYNAMIC PSYCHIATRY IN CLINICAL PRACTICE requires all of the DSM-5 PTSD symptoms plus depersonalization and/or derealization. Changes have also occurred in the conceptualization of the dissociative disorders in DSM-5. Dissociative fugue has been included as a specifier of dissociative amnesia, so it is no longer listed as a