Maeda H
Department of Neuropsychiatry, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Jpn J Psychiatry Neurol. 1993 Dec;47(4):743-51. doi: 10.1111/j.1440-1819.1993.tb01823.x.
Pathogenetic mechanisms of "neuroses" were reconsidered based on a behavioristic framework which includes not only the traditional stimulus-response learning theory but also the concept of conflict proposed by Lewin. Most of the subtypes of "neuroses"--with the exception of panic disorder--were divided into two categories: conditioned fear-related disorders and conflict-related disorders. Phobias have been suggested to be caused by an escape or avoidance behavior motivated by an unconditioned or conditioned fear and obsessive compulsive disorder by an avoidance behavior motivated by a conditioned fear, while such disorders as posttraumatic disorder or hypochondriasis (nosophobia) were considered to be direct manifestations of conditioned fear. Generalized anxiety and depersonalization disorders were suggested to be caused by conflicts, but these conflicts seemed to persist even after the appearance of the symptoms. In contrast, appearances of conversion, somatization, somatoform pain, psychogenic fugue, or psychogenic amnesia were suggested to result in a temporary attenuation of the causative conflicts.
基于行为主义框架重新审视了“神经症”的发病机制,该框架不仅包括传统的刺激-反应学习理论,还包括勒温提出的冲突概念。“神经症”的大多数亚型——除惊恐障碍外——分为两类:条件性恐惧相关障碍和冲突相关障碍。恐惧症被认为是由无条件或条件性恐惧激发的逃避或回避行为所致,强迫症则是由条件性恐惧激发的回避行为所致,而创伤后应激障碍或疑病症(疾病恐怖症)等障碍被认为是条件性恐惧的直接表现。广泛性焦虑和人格解体障碍被认为是由冲突引起的,但这些冲突似乎在症状出现后仍持续存在。相比之下,转换、躯体化、躯体形式疼痛、心因性神游或心因性遗忘的出现被认为会导致致病冲突的暂时缓解。