Chapter 7 Book Notes
Chapter 7 Book Notes psy 240
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This 10 page Class Notes was uploaded by Alicia Rinaldi on Tuesday September 8, 2015. The Class Notes belongs to psy 240 at University of Miami taught by Dr. Parlade in Fall 2014. Since its upload, it has received 82 views. For similar materials see abnormal psychology in Psychlogy at University of Miami.
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Date Created: 09/08/15
Chapter 7 Disorders Focusing on Somatic Symptoms rst half I Disorders Focusing on Somatic Symptoms A When a physical ailment has no apparent medical cause doctors may suspect that the pattern of physical complaints has more to do with psychological factors than physical ones B Factitious Disorder 1 2 Malingering intentionally faking illness to achieve some external gain such as nancial compensation Factitious disorder Munchausen syndrome a disorder in which an individual induces physical or psychological symptoms typically for the purpose of assuming the role of a sick person People with these disorders are knowledgeable and good at faking their symptoms and when people accuse them of faking they often leave hospital and refuse to pay bills Common among people who a Received extensive treatment for medical problem as children b Carry a grudge against the medical profession c Have worked as a nurse lab technician or medical aide Precise causes aren t understood but could be depression unsupportive parents and need for social support no effective treatments for disorder ln Factitious disorder imposed on another parents make upproduce physical illness in their children when children are taken from parents these symptoms disappear C Conversion Disorder 1 4 5 Conversion disorder a disorder in which medically unexplained bodily symptoms affect voluntary motor and sensory functions People experience neurologicallike symptoms that have no neurological basis Conversion disorder is hard to distinguish from a genuine medical problem but sometimes it is at odds with how the nervous system works People with conversion disorder don t consciously want or purposely produce their symptoms Appears suddenly at times of extreme stress and lasts weeks D Somatic Symptom Disorder 1 A disorder in which persons become excessively distressed concerned and anxious about bodily symptoms they are experiencing 2 Longer lasting but less dramatic than conversion disorders 3 Some concerns are real and some aren t but they are all too extreme 4 2 patterns of somatic symptom disorder a Somatization pattern i the individual experiences a large and varied number of bodily symptoms that have little or no physical basis ii people usually go from doctor to doctor in search of relief iii also feel anxious and depressed pattern uctuates over years b Predominant pain pattern i the person s primary bodily problem is the experience of pain ii source may be known or unknown but the concerns of the pain are disproportionate to the pain itself iii often develops after an accident or during an illness that has caused genuine pain which then takes on a life of its own E What Causes Conversion and Somatic Symptom Disorders 1 Conversion and somatic symptom disorders were referred to as hysterical disorders 2 AmbroiseAuguste Liebault and Hippolyte Bernheim found that you could produce hysterical symptoms in people by hypnotic suggestion 3 The Psychodynamic View a Freud came to believe that hysterical disorders represented a conversion of underlying emotional con icts into physical symptoms and concerns b Believed that girls developed Electra complex a girl s sexual feelings for her father and jealousy of her mother disorder in girls phallic stage c If a child s parents overreact to her sexual feelings the Electra con ict will be unresolved and the child may reexperience sexual anxiety throughout life d Many current psychodynamic theorists don t like Freud s entire reasoning but continue to 4 The believe that sufferers of the disorders have unconscious unresolved con icts from cthhood Believe 2 mechanisms are at work I Primary gain in psychodynamic theory the gain achieved when somatic symptoms keep internal con icts out of awareness ii Secondary gain in psychodynamic theory the gain achieved when somatic symptoms elicit kindness from others or provide an excuse to avoid unpleasant activities Behavioral View Physical symptoms of conversion amp somatic symptom disorders bring rewards to sufferers so sufferers learn to display the body symptoms more Psychodynamic theorists view gains as secondary but behaviorists view them as the primary cause of the development of the disorder 5 The Cognitive View a b C 6 The d Cognitive theorists propose that conversion and somatic symptom disorders are forms of communication people quotexpress themselvesquot The purpose is not to defend against anxiety but to communicate extreme feelings Candidates for these disorders are people who nd it hard to recognize or express their emotions Multicultural View Most Western clinicians believe it is inappropriate to focus on somatic symptoms in response to personal distress Some western biases see somatic reactions as an inferior way of dealing with emotions The transformation of personal distress into somatic complaints is the norm in many non western cultures We can conclude that reactions to life s stressors are often in uenced by one s culture 7 A Possible Role for Biology a Placebo a sham treatment that a patient believes to be genuine 8 b Generally agreed that pretend treatments do bring help to many people c A belief or expectation can trigger certain chemicals throughout the body into action which produces a medicinal effect How are Conversion and Somatic Symptom Disorders Treated a Many people with conversion disorders don t usually seek psychotherapy because they believe their disorder is purely physiological b Therapies focus on causes of disorders trauma or anxiety tied to symptoms and apply insight exposure and drug therapies c Psychodynamic theorists try to make people conscious of their fears d Behavioral therapists use exposure treatment e Biological therapists use antianxiety or antidepressant drugs f Other therapists address physical symptoms with other methods i Suggestion emotional support tell them their symptoms will disappear ii Reinforcement removal of rewards for a client s sickness symptoms and increase of rewards for healthy behavior iii Confrontational forcing patients out of the sick roll by telling them their symptoms have no basis F lllness Anxiety Disorder 1 A disorder in which persons are chronically anxious JUN about and preoccupied with the notion that they have or are developing a serious medical illness despite the absence of substantial somatic symptoms Previously known as hypochondriasis Have these beliefs despite of what doctors say some know their beliefs are ridiculous and some don t Starts in early adulthood men women 15 of people experience the disorder Behaviorists believe illness fears are acquired through classical conditioningmodeling Cognitive theorists think that people misinterpret their bodily cues People with this disorder receive same treatments asOCD a Antidepressant drugs b Behavior and response prevention i pointing out medical problems and preventing them from seeking medical attention ii identify amp challenge illness related beliefs G Body Dysmorphic Disorder 1 JUN A disorder marked by excessive worry that some aspect of one s physical appearance is defective The perceived defect is imagined or greatly exaggerated Also known as dysmorphia Obsessivecompulsive related disorder because it s all the person thinks about May severely limit contact with others to conceal their quotdefectsquot 5 of people suffer many seek out plastic surgery and feel worse after or have suicidal thoughts theorists account for this disorder using psychological amp biological explanations that have been applied to anxiety disorders and OCD treatment is generally effective Chapter 7 p 202221 I Dissociative Disorders A Preface 1 2 3 4 Identity a sense of who we are and where we t in our environment healthy people have identities Memory the faculty for recalling past events and past learning the key to our identity Dissociative disorders disorders marked by major changes in memory that do not have clear physical causes a part of memory is dissociated from the rest Many clinicians believe these diseases are rare B Dissociative Amnesia 1 2 De nition A disorder marked by an inability to recall important personal events and information clinicians aren t sure how common dissociative amnesia is but it is very dangerous to those who haveit Localized amnesia a the most common b person loses all memory of events that took place within a limited period of time c almost always begins with traumatic event d amnestic episode the forgotten period people often seem in a trance during that period 4 selective amnesia a second most common b remember some but not all events within a period of time 5 generalized amnesia a loss of memory extends back to times long before the upsetting period b may forget who you are as well as relatives and fdends 6 continuous amnesia a rare b forgetting continues into the present 7 people usually only forget personal material but still know encyclopedic information like the name of the president or how to use a computer 8 dissociative fugue a form of dissociative amnesia in which a person travels to a new location and may assume a new identity simultaneously forgetting his or her past a some cases are brief some are permanent b 02 of population c follows stressful event d usually ends abruptly person is confused e majority regain all memories and never have recurrence C Dissociative ldentity Disorder Multiple Personality Disorder 1 Preface a Dissociative identity disorder or multiple personality disorder a dissociative disorder in which a person develops two or more distinct personalities b Subpersonalities the two or more distinct personalities found in individuals suffering with dissociative identity disorder i Host personality appears the most often ii Switching from one personality to another may be sudden and dramatic stressful event or hypnotic suggestion c Was considered rare until recently can be diagnosed as young as 5 3x more likely in women and men 2 How Do Subpersonalities Interact a Mutually amnestic relationships subpersonalities have no awareness of each other b Mutually cognizant patterns each subpersonality is aware of the rest may talk to each other c Oneway amnestic relationships most common some personalities are aware of others but awareness isn t mutual d Coconscious subpersonalities watch the actions of the other personalities but don t interact with them e Avg number of subpersonalities is 15 for women and 8 for men 3 How do Subpersonalities Differ a Identifying Features i May feature in age gender race family history b Abilities and Preferences i Memories of abstractencyclopedic information vary from personality to personality ii Have different tastesOpinions c Physiological Responses i May have physiological differences such as differences between systems ii Looking at brain activity of personality involves measuring their evoked potentials brain response patterns recorded on electroencephalograph iii Compared to fake subpersonalities they showed different activity 4 How Common is Dissociative Identity Disorder a Traditionally abeed rare but numbers are increasing i Growing number of clinicians are willing to diagnose it ii Today s diagnostic procedures are more accurate b Sometimes thought to be iatrogenic or unintentionally produced by practitioners i Researcher looking for multiple personalities may inadvertently reinforce them ii Suggested under hypnosis D How Do Theorists Explain Dissociative Amnesia and Dissociative Identity Disorder 1 The a b c 3 Stat a C d Psychodynamic View Dissociative disorders are caused by excessive repression Dissociative amnesia is a single episode of massive repression Dissociative identity disorder is thought to result from a lifetime of excessive repression Try to disown thoughts by assigning them to different personalities or becoming an quotonlookerquot Not always explained by abuse other sources unknown Behavioral View Grows from normal memory processes such as forgetting Dissociation is learned through operant conditioning because they nd relief when they don t focus on stressful event See dissociation as an escape behavior eDependent Learning If people learn something in a particular state of mind they are likely to remember it best when they return to that state of mind Statedependent learning learning that becomes associated with the conditions under which it occurred so that it is best remembered under the same conditions Arousal levels are important for state dependent learning People with dissociative disorders have rigid statetomemory links forget what happens in other emotional states causing multiple personalities to be created 4 Selfhypnosis a b People who are hypnotized enter a sleeplike state and become very suggestible Hypnotic amnesia hypnotism can help people forget facts events and identities can also help them remember Selfhypnosis the process of hypnotizing oneself sometimes for the purpose of forgetting unpleasant events dissociative disorder might be a form of this d Children with traumatic events who would self hypnotize to dissociate themselves from the event are likely to develop disorder e Special process out of the ordinary kind of functioning f Some theorists believe that hypnotic behaviors are caused by common social and cognitive processes such as high motivation focused attention role enactment E How are Dissociative Amnesia and Dissociative Identity Disorder Treated 1 How do Therapists Help People with Dissociative Amnesia a Leading treatments psychodynamic therapy guiding patients to search unconscious in hope of retrieving forgotten experiences hypnotic therapyhypnotherapy a treatment in which the patient undergoes hypnosis and is then guided to recall forgotten events or perform other therapeutic activities drug therapy injections of barbiturates sodium amobarbital or sodium pentobarbital to help regain memory called quottruth serumsquot doesn t always work and usually combined with other treatments 2 How do Therapists Help Individuals with Dissociative Identity Disorder a Recognizing the Disorder Therapist bonds with each personality in order to help patient recognize nature of disorder Group and family therapy helps b Recovering Memories Use psychodynamic therapy hypnotherapy drug treatment One subpersonality might quotprotectquot another to prevent the primary personality pain c Integrating the Subpersonalities Fusion the nal merging of two or more subpersonalities into a dissociative identity disorder comes after integration May be thought of as a form of quotdeathquot to subpersonalities Further therapy must occur after fusion to make sure the personalities stay integrated F DepersonalizationDerealization Disorder 1 De nition a dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization derealization or both a Depersonalization the sense that one s own mental functioning or body are unreal or detached Lecture notes Doubling a sensation where one s mind seems to be oating a few feet above them amp body parts feel foreign to them b Derealization the sense that one s surroundings are unreal or detached Objects may seem to change shape or size Other people may seem removed or dead c Not all episodes of depersonalization or derealization indicate a disorder Symptoms of a disorder are persistent or recurrent cause considerable distress impair social relationships and job performance Tends to occur in people under 40 overcoming a stressful experience Retrograde amnesia not remembering the past Anterograde amnesia not remembering new information Fugue comes with dissociative amnesia not separate Organic amnesia has a physical cause such as head injury Treatment for dissociative identity disorder is least effective less than fugue and dissociative amnesia
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