Biopsychologic and Psychobiologic Interactions
The state of the body may result in changes in the mind; body affects mind, while the state of the mind may result in changes in the body; mind affects body.
| Biological State | Resulting Psychological State |
|---|---|
| Increased Blood Pressure | Mood Changes, Anxiety, Depression |
| Severe Pain | Reduced Concentration and Attention, Anxiety |
| Chronic Illness | Depression, Emotional Instability, Mood Changes, Anxiety, Altered Perception and Cognition |
| Brain Chemistry Imbalances | Alteration in Thinking, Behavior, Moods, and Cognitive Functions |
| Endocrine Dysfunction | Lethargy, Mood Changes, Anxiety |
| Psychological State | Resulting Biological State |
|---|---|
| Unpleasant Emotions | Irritability, Insomnia, Headaches, etc. |
| Stress | Headache, Tachycardia, Appetite Changes, Digestive Distress, Higher frequency of infections or sickness |
| Anxiety | Palpitations, Chest Pain, Headache, Increase risk for Hypertension and Heart Disease |
| Emotional Conflicts | Peptic Ulcers, Ulcerative Colitis, etc. |
| Deep Thinking | Physical Strain; Alteration in Sleeping and Eating Patterns, Fatigability |
Bases of Behavior
Biological Basis
Behavior is influenced by biology (biophysical basis of behavior). There is a genetic basis for all behaviors and variance in what we think and feel. Most behavior has an adaptive or evolutionary function, and have their origins in specific locations of the brain.
Heritability is also a factor, where some traits are more readily inherited through genetics than other traits. As such, the “nature” aspect of some traits are demonstrated in identical twins (identical genetics) than in fraternal twins (same level of similarity as normal siblings). Inversely, some traits may differ even in identical twins as they may have different habits, friends, schools, etc. This highlights the “nurture” aspect of growth and development.
Mental disorders may also be heritable. Among the most commonly inherited disorders is schizophrenia with ~80% heritability.
| Disorder | Heritability |
|---|---|
| Schizophrenia | 80% |
| Alcoholism | 50% |
| Antisocial Behavior | 41% |
| Panic Attacks | 30% to 40% |
| Anxiety Disorders | 30% |
| Phobias | 20% to 40% |
Environmental Basis
All influences outside of genetics fall under the “Environment” (environmental basis of behavior). It starts right after conception until death, covering social, moral, economical, political, physical, and intellectual factors. The negative environment of children living in poverty almost always played a greater role in their future success than genetics. For children in middle or upper-class homes, genetics were vital for future success.
Psychological Basis
Psychological traits such as personality types result in different actions and behaviors to given situations depending on psychological development and cultural setting.
Family Dynamics
The functioning of a family in good and bad situations. This involves decision-making, problem solving, and sharing feelings. There are various types of family structures:
- Nuclear: parents and children
- Single Parent Families: one parent and children
- Extended Family: the same as nuclear + non-first degree relatives
- Childless Family
- Grandparent Family: grandparents take care of grandchildren
- Stepfamily
The culture of the family, with an emphasis on family values (traditions, habits, practices, values) and identity, can affect family dynamics. It is very important for families to acknowledge cultural differences within their own dynamic systems, such as age, geography, gender roles, personality types, and family strengths.
It is theorized that birth order also affects family dynamics, as stated by Alfred Adler:
- Single Children: tend to receive full attention, may be overprotected and spoiled.
- They become attached to being the center of attention, preferring adult company, and have difficulty in sharing with others.
- Eldest Children: tend to be required to learn how to share. Expectations are often high, causing a trend towards authoritarian and strict approaches.
- They feel powerful and often require encouragement to be helpful.
- Youngest Children: may see every other sibling as a surrogate mother or father figure. Their role as the obedient follower, following what they are told to do and when, is never removed.
- This may cause the child to want to “grow up” faster and make big plans that may never come true.
- Middle Child: due to eldest children receiving responsibility, and the youngest potentially being spoiled, middle children may feel like they don’t get enough attention.
- They fight for significance and privilege, creating a “black-and-white” attitude. They are even-tempered and fight to protect the social justice of others, but may feel lonely.
- Twins: one twin often gets a higher standing than the other; they may be more active, and becomes a “leader” while the other becomes a “follower”.
- There may be some identity problems.
- Ghost Child: children born to families where the first child died before they were born. This may cause over-protectiveness, most often for the oldest child.
- These children often become rebellious or exploitative of the protection for personal gain.
- Adopted Child: often receives the same level of attention an only child receives, as parents attempt to compensate for the child’s loss of biological parents.
- The child may become demanding, lacking in self-confidence, and may even resent their family.
Needs and Behavior
“Needs” are internal motives that energize, direct, and sustain behavior. These are strivings necessary for the maintenance of life e.g. physiological needs and for the promotion of growth and wellbeing.
Abraham Harold Maslow’s Hierarchy of Needs
- Physiological: breathing, food, water, sex, sleep, homeostasis, excretion
- Safety: security of body, of employment, of resources, of morality, of the family, of health, and of property.
- Love/Belonging: friendship, family, and sexual intimacy.
- Esteem: self-esteem, confidence, achievement, respect of others and by others.
- Self-Actualization: morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts.
- Self actualization is a person’s motivation to reach his or her full potential. Previous needs must be met before self-actualization can be achieved.
Conflicts and Frustrations
“Conflict” is a painful emotional state that results from tension, opposition, and contradiction (Douglas, Holland). It is brought by the presence of two or more opposing desires in an individual (Barney, Lehner). There are various sources in differing environments:
- Home: faulty upbringing, unhealthy relationships, overprotection
- School: teachers, faulty teaching methodology, denial of self-expression, classmates
- Occupation: improper working environment, unsatisfactory relationships, dissatisfactory working conditions
“Frustration” refers to emotional tension resulting from non-fulfillment of desires or needs. (Good, 1959). It may be caused by failure to satisfy basic needs because of internal or external obstacles (Barney, Lehner)
- External Factors: physical (natural calamities, accidents, injury), societal (norms and values that may restrict individual needs), economic and financial (unemployment, lack of money)
- Internal Factors: physical abnormality or defects, conflicting desires, morality and high ideals, level of aspirations (inability to meet one’s aspirations). This often falls into five main triggers:
- Desire: something the character wants.
- Need: something the character requires for survival.
- Duty: some obligation the character feels is right or necessary.
- Fear or worry that drives the character.
- Expectation: the character feels they are obligated to something because of someone else.
Anxiety and Anxiety Responses
“Anxiety” is a vague, unpleasant feeling of apprehension. It may be a response to unknown and non-specific threats. It normally motivates a person to take action for resolving a problem or crisis. It may become abnormal when excessive, chronic, and results in impairment of major functioning e.g. panic without reason, phobias, and uncontrollable repetitive actions. Hildegard Peplau outlined four types of anxiety: mild, moderate, severe, and panic.
Types of Anxiety
- Mild Anxiety: a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems, taking in all available stimuli (perceptual field)
- Perception: increased
- Behavior: alert, energetic, attentive
- Physiologic Changes: slight discomfort, restlessness, “butterflies in my stomach”, difficulty sleeping.
- Coping: adaptive
- Nursing Management: none
- Moderate Anxiety: decreased perceptual field (only able to focus on the immediate task); assistance is required to learn new behaviors or solve problems.
- Perception: decreased, selective
- Behavior: difficulty in concentration, easily distracted, pacing
- Physiologic Changes: clammy hands, diaphoresis, muscle tension, GI distress, headache, xerostomia, frequent urination
- Coping: palliative; the use of any defense mechanism available.
- Nursing Management: refocus attention; supervise in problem solving and learning. When talking, keep it short and simple (KISS).
- Medical Management: oral anxiolytics
- Severe Anxiety: feelings of dread and terror. Redirection to a task by another individual is not possible. Their focus is on scattered details and physiologic symptoms of tachycardia, diaphoresis, and chest pain occur (They may go to the emergency room believing they are having a heart attack).
- Perception: distorted perception
- Behavioral: impaired rational, decision-making, problem solving, judging, concentration, and ability. Confusion and disorientation.
- Physiologic Changes: increased BP, RR, CR, chest pain, severe headache, nausea and vomiting, diarrhea, tremors, dilated pupils.
- Coping: excessive, maladaptive defense mechanisms.
- Nursing Management: relaxation techniques, decrease environmental stimuli, stay or walk with the patient, and listen attentively.
- Medical Management: intramuscular anxiolytics
- Panic Anxiety: loss of rational thought; delusions, hallucinations, and complete physical immobility and mutism may occur. The person may bolt and run aimlessly, leading to injury.
- Perception: disorganized
- Behavioral: immobilization, hysterical or mute, irrational reasoning, overwhelmed and helpless - suicidal, potential hallucination or delusions.
- Physiological: same as severe anxiety, shortness of breath, and hyperventilation.
- Coping: dysfunctional use of defense mechanisms.
- Nursing Management: provide safety, reduce environmental stimuli, continuously talk with the patient, use touch judiciously, and stay with the person during their panic attack (5 to 30 minutes).
| Type | Perception | Behavioral | Coping | Nursing Management | Medical Management |
|---|---|---|---|---|---|
| Mild | Widened | Alert, Energetic, Attentive | Adaptive | None | N/A |
| Moderate | Narrowed | Distracted, Pacing | Palliative | Refocus, Supervision, KISS | PO Anxiolytic |
| Severe | Distorted | Impaired thinking, Confusion, Disorientation | Excessive, Maladaptive | Relaxation, Less Stimuli, Presence, Listening | IM Anxiolytic |
| Panic | Disorganized | Immobilization, Mute/Hysterical, Irrational, Overwhelmed (Suicidal), Potential Hallucination/Delusion | Dysfunctional | Safety, Less Stimuli, Presence (judicious touch) | N/A |
Underlying Causes of Anxiety
- Interpersonal Factors: fear of interpersonal rejection; traumatic or dysfunctional relationships.
- Behavioral Factors: exposure to early negative life circumstances and learned responses to frustration.
- Psychoanalytic Factor: conflicts between the Id and the Superego.
Adaptation and Coping Mechanisms
“Adaptation” is the physical or behavioral characteristic of an organism that helps an organism to survive better in the surrounding environment. Adaptation occurs in various levels:
- Adaptive: facing and finding solutions to situations
- Less Adaptive: temporary use of defense mechanisms
- Maladaptive: excessive use of defense mechanisms
- Dysfunctional: ineffective use of defense mechanisms; results in negative ADL and social impact.
Coping Mechanisms
“Coping” is any effort done to reduce stress responses. It may be constructive; task-oriented (direct problem solving) or defense-oriented (regulate stress via defense mechanisms), or destructive, where the individual often avoid the problem.
“Defense Mechanisms” also known as “ego defense mechanisms” or “protective defenses” are patterns of behavior or thought utilized to protect oneself from threatening internal or external aspects. It allows an individual to maintain control, safety, self-esteem, lessen discomfort, cope with stress, and decrease anxiety.
Normal and Adaptive Mechanism
Persons who effectively utilize these mechanisms are perceived as virtuous. These mechanisms enhance the individual’s feeling of mastery and pleasure.
- Anticipation: planning ahead for realistic expectations.
- Compensation: making up for imagined or actual handicaps or deficiency.
- Compromise: give-and-take dynamics; often seen in relationships.
- Sublimation: channeling socially unacceptable behavior to a socially acceptable one. It is the most constructive defense mechanism.
- Humor: seeing the lighter side of the situation.
Narcissistic Defense Mechanism
The most primitive mechanism often utilized by children. These mechanisms eliminate the need to cope with reality.
- Denial: refusal to acknowledge reality.
- Projection: blaming others for unacceptable deeds or thoughts.
- Fantasy: gratification of wishes through imagination.
Immature Defense Mechanism
Often seen in adolescents and some non-psychotic individuals; it lessens distress and anxiety-provoking situations. Excessive use of these defenses are seen as socially undesirable (immature, difficulty, out-of-touch).
- Conversion: transferring emotional conflict into physical symptoms.
- Malingering: fabrication of ailments.
- Fixation: psychosocial development ceases to advance.
- Regression: returning to previous developmental stages.
- Identification: unconscious attempts to change oneself as another, admired person.
- Introjection: sub-type of identification in which a person incorporates traits or values of other individuals into themselves.
- Intellectualization: excessive reasoning to obscure feelings.
- Suppression: forgetting thoughts or feelings voluntarily.
- Isolation: blocking feelings associated with unpleasant experiences; may be physical or emotional.
- Symbolism: conscious use of an alternate idea or object to represent another idea or object.
Neurotic Defense Mechanisms
Often seen in obsessive-compulsive, hysterical individuals and adults under stress. These are advantageous in short-term coping situations, but can cause long-term problems in relationships and life if used as a primary coping method.
Link to original
- Displacement: releasing anger in a less threatening way.
- Dissociation: blocking off events from the conscious mind e.g. amnesia.
- Substitution: replacing original goals or desires with something else.
- Rationalization: justification of behavior to make them acceptable.
- Reaction Formation: reacting in a way that is opposite of what is felt.
- Repression: involuntary forgetfulness of unacceptable thoughts.
- Undoing: engaging in behaviors opposite of previous unacceptable actions.
Crisis
When events causing anxiety becomes overwhelming and usual coping patterns become suspended. These may involve man-made and natural disasters, interpersonal events, traumatic experiences, etc.
- Maturational Crisis: occuring as a normal part of growth and development e.g. leaving home for the first time, completing school, marriage, childbirth and rearing, beginning a career, etc. The successful resolution of these crises result in positive character development.
- Situational Crisis: sudden or unpredicted events that threaten an individual’s integrity (physical, emotional, societal, economic, etc.).
- Adventitious Crisis: unexpected unusual events that can affect an individual or a multitude of people; a social crisis e.g. natural disasters; societal injustices like racism, kidnapping, terrorism; violent crimes.
Stages of Crisis
- Denial: an initial reaction of shock or disbelief.
- Increased Tension: the recognition of the crisis; initial functioning remains adequate.
- Disorganization: preoccupation with the crisis affects the individual’s functioning.
- Attempts to Reorganize: the utilization of old and new coping mechanisms.