Somatic and Dissociative Disorders
Somatic and Dissociative Disorders PSYC 40111-002
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This 5 page Class Notes was uploaded by Amy Turk on Sunday April 17, 2016. The Class Notes belongs to PSYC 40111-002 at Kent State University taught by Dr. Fresco in Spring 2016. Since its upload, it has received 12 views. For similar materials see Abnormal Psychology in Psychlogy at Kent State University.
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Date Created: 04/17/16
SOMATIC & DISSOCIATIVE DISORDERS Somatic Disorders ● Soma = meaning body ○ Overly preoccupied with their health or body appearance ● No identifiable medical condition causing the physical complaints ● Types ○ Conversion disorder = a change in sensory motor function ○ Somatic symptom disorder = recurrent, multiple somatic complaints ○ Body dysmorphic disorder = a preoccupation with an imagined physical defect ○ Illness anxiety disorder = (hypochondriasis) a preoccupation with disease Conversion Disorder ● Involves sensory or motor symptoms ● Not related to known physiology of the body ○ Ex. glove anesthesia ● Conversion symptoms appear suddenly ● Related to stress ● Person shows la belle indifference ● Retain most normal functions, but without awareness of this ability ● Glove anesthesia = numbness in hand ○ Actual damage to ulnar nerve ● Rare condition ● Primarily in females ○ Onset usually in teens ● More common in less educated groups ● Causes ○ Detachment from trauma and negative reinforcement ○ Behavioral view focuses on similarity to malingering ○ Freudian psychodynamic view is still popular ○ The incidence has declined, suggesting a role for social factors ● Treatment ○ Core strategy is attending to the trauma ○ Removal of sources of secondary gain ○ Reduce supportive consequences of talk about physical symptoms Somatic Symptom Disorder ● Recurrent, multiple somatic complaints with no known physical bases ● Extended history before age 30 ● Substantial impairment in social or occupational functioning ● Concerned over the symptoms themselves, not what they might mean ● Symptoms become the person’s identity ● Rare ● Onset usually in teens ● Mostly affects unmarried, low SES women ● Runs a chronic course ● Causes ○ Familial history of illness ○ Relation with antisocial personality disorder ○ Weak behavioral inhibition system ● Treatment ○ No treatment exists with demonstrated effectiveness ○ Reduce the tendency to visit numerous medical specialists ○ Assign “gatekeeper” physician ○ Reduce supportive consequences of talk about physical symptoms Illness Anxiety Disorder ● Preoccupation with having or acquiring a serious illness ● Somatic symptoms are absent or only mild in intensity ● Anxiety and easily triggered alarm about one’s health ● Performance of excessive health-related behaviors (ex. Checking one’s body for signs of illness) ● Once called hypochondriasis ● Strong disease conviction ● Medical reassurance does not seem to help ● Onset at any age and runs a chronic course ● Causes ○ Cognitive perceptual distortions ○ Familial history of illness ● Treatment ○ Challenge illness-related misinterpretations ○ Provide more substantial and sensitive reassurance ○ Stress management and coping strategies Body Dysmorphic Disorder ● Previously known as dysmorphophobia ● Preoccupation with imagined defect in appearance ● Either fixation or avoidance with mirrors ● Suicidal behavior is common ● Often display ideas of reference for imagined defect ● Usually runs a lifelong chronic course ● Seen equally in men and women ○ Onset in early 20s ● Most remain single and seek out plastic surgeons ● Causes ○ Little is known ○ Tends to run in families ○ Similarities with OCD ○ Detachment from trauma and negative reinforcement ● Treatment ○ Same as for OCD ■ Medications provide for some relief ○ Exposure and response prevention ○ Plastic surgery is often unhelpful Theory & Therapy ● The psychodynamic perspective ○ Somatizing as conflict resolution ○ Uncovering conflict ● The behavioral and sociocultural perspectives ○ The sick role ○ Treatment by nonreinforcement ● The cognitive perspective ○ Over Attention to the body ○ Treatment = challenging faulty beliefs ● The biological perspective ○ Genetic studies ○ Brain dysfunction ○ Drug treatment Dissociative Disorders ● Involves severe alterations of detachments in identity, memory, or consciousness ● Variations of normal depersonalization and derealization experiences ● Depersonalization = distortion is perception of reality ● Derealization = losing a sense of the external world ● Types ○ Amnesia = the inability to recall important personal info ○ Fugue = how seen as a severe form of dissociative amnesia ○ Identity disorder = (DID) involves the presence of two different identities (alters) Dissociative Amnesia ● Usually of a traumatic or stressful nature ● Beyond ordinary forgetting ● Symptoms not attributable to a substance or medical condition ● Usually begin in adulthood (and fugure) ● Both are mostly seen in females ● Causes ○ Trauma and stress ● Treatment ○ Usually get better without treatment ○ Most remember what they have forgotten Dissociative Identity Disorder ● Involves adoption of several new identities (as many as 100) ○ Identities have unique sets of behaviors, voice, and posture ● Unique aspects ○ Alters = the different identities or personalities ○ Host = the identity that seeks treatment ○ Switch = often instantaneous transition from one personality to another ● Average # of identities = 15 ● Ratio of women to men = 9 to 1 ● Onset almost always in childhood ● High comorbidity rates ○ A lifelong chronic course ● Causes ○ Consciousness is normally a unified experience, consisting of cognition, emotion, and motivation ○ Stress may alter the way in which memories are sorted ■ Resulting in amnesia or fugue ○ Almost all patients have histories of horrible child abuse ■ Most are also highly suggestible ○ Believed to be a mechanism to escape from impact of trauma ○ Closely related to PTSD ● Treatment ○ Psychoanalytic therapy seeks to lift repressed memories ○ Hypnosis ○ Goal of therapy ■ Integrate the several personalities ■ Help each alter understand that he’s a part of one person ■ Identify and neutralize cues/triggers that provoke memories of trauma/dissociation ■ Treat the alters with fairness and empathy Diagnostic Considerations ● Separating real problems from faking ○ The problem of malingering = deliberately faking symptoms ● Related conditions = factitious disorders ○ Factitious disorders by proxy ● False memories and recovered memory syndrome ● Well established treatments are generally lacking
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