Abnormal notes week 7
Abnormal notes week 7 PSYC 3560
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This 7 page Class Notes was uploaded by Ashlyn Masters on Thursday March 24, 2016. The Class Notes belongs to PSYC 3560 at Auburn University taught by Dr. Fix in Spring 2016. Since its upload, it has received 10 views. For similar materials see Abnormal Psychology in Psychlogy at Auburn University.
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Date Created: 03/24/16
Dissociative Disorders 3/22/16 Dissociative Disorders • Often observed in aftermath of trauma o Dissociative amnesia: mind may block out memory o Depersonalization: mind may alter experience o Dissociative identity: mind may block identity • Not due to brain damage or injury • IS a psychological process; protective in a way o Amnesia § Localized- forget all or part of a specific event § Systematized- forget a specific place, a specific person, or everything § Fugue- forget own identity and become a new person o Can also lose bodily functions (e.g., sight, haptic sensation) • Often people feel confused or embarrassed about symptoms (want to hide them) • Symptoms o Disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior Dissociative Amnesia • Characterized by an inability to recall autobiographical information. May be: o Localized (i.e., an event or period of time) o Selective (i.e., a specific aspect of an event) o Generalized (i.e., identity and life history) • Inconsistent with normal forgetting • Some individuals notice that they have “lost time” or have a gap in their memory o Most individuals are initially unaware of their amnesias Depersonalization Disorder • Depersonalization: experiences of unreality or detachment from one’s mind, self or body • Derealization: experiences of unreality or detachment from one’s surroundings • Accompanied by intact reality testing o What is your name? o What is the year? o What day of the week is it? o Count backwards by 7’s from 100 (100, 93, …) • Individuals with this disorder can have depersonalization, derealization, or both Dissociative Identity Disorder (2 videos were watched in class- one about a killer and a Halle Berry movie trailer) • Presence of two or more distinct personality states or an experience of possession • Recurrent episodes of amnesia • Fragmentation of identity may vary with culture (e.g., possession-form presentations) and circumstance • Individuals may experience discontinuities in identity and memory that may not be immediately evident to others • Individuals may attempt to hide dysfunction • Host and alters • Alters may have different… o Demographic characteristics o Language or speech patterns o Physiology (blood pressure, handwriting, EEG responses, reactions to medications, allergies) • Recurrent, inexplicable intrusions into conscious functioning and sense of self o Voices, actions and speeches, intrusive thoughts, emotions and impulses • Alterations of sense of self o Attitudes, preferences, feeling like one’s body or actions are not one’s own • Odd changes of perception o Depersonalization or derealization • Stress often exacerbates dissociative symptoms o Overt changes in identity may be triggered by… § Removal from the traumatizing situation (e.g., through leaving home) § The individual’s children reaching the same age at which the individual was originally abused or traumatized § Later traumatic experiences, even seemingly inconsequential ones, like a minor motor vehicle accident § The death of, or onset of a fatal illness in, their abuser(s) • Three manifestations of dissociative amnesia: o Gaps in remote memory of personal life events § Periods of youth; important life events, like death of a grandparent, getting married, giving birth o Lapses in dependable memory § What happened today; well-learned skills such as how to do their job, use a computer, read, drive o Discovery of evidence of their everyday actions and tasks that they do not recollect doing § Finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; “coming to” in the midst of doing something Somatoform Disorders 3/22-24/16 What are “somatic symptom disorders”? • “Soma” = Greek word for “body” • Characterized by complaints of bodily symptoms or defects that suggest the presence of medical problems • Sometimes no organic basis (i.e., medical pathophysiology) can be found that satisfactorily explains the symptoms such as pain or paralysis o Diagnosed medical disorders can accompany somatic symptom disorders Conversion Disorder (Video in class- Ricky Bobby from Talladega Nights thinking he can’t walk so he stabs himself) • Conversion disorder: altered sensory or voluntary motor functions leading one to think there is a medical or neurological problem (in the absence of physical pathology) • 1+ symptoms affecting voluntary motor or sensory function that suggest medical condition • Clinical evidence of incompatibility between the symptom and recognized neurological or medical conditions • Range of symptoms (symptoms present in some situations, but not all; mixed episodes)- typically have one symptom at a time o Sensory § Special sensory symptoms (blindness, deafness, skin sensations) § Anesthesia (loss of sensation) o Motor § Weakness or paralysis § Aphonia (faint speech) § Swallowing symptoms o Seizures (very intense and dangerous symptom) § Pseudoseizures § Coma (medical testing can rule out) • Conversion Disorder and stressful events o Primary gain à escape or avoidance of stressful situation (unconscious) § The individual gets to avoid doing what traumatized them o Secondary gain à external circumstances that maintain disability (e.g., attention from family) § The individual get extra attention from people o Little is known about the link between stressful life events and conversion disorder, despite the role it is proposed to play • Diagnostic considerations o Sometimes difficult to rule out true medical problems, though modern medicine has helped § Medical and neuropsychological exams are helpful o Generally need to find behavior showing incompatibility with neurological disease (test for proof and exceptions) § Atrophy of muscles in paralysis § Selective nature of the dysfunction – i.e., only occur in certain situations § Requires substantial medical knowledge • Epidemiology o Prevalence § <1%, but accounts for 1-3% of disorders referred for treatment § 5% in neurology clinics o Gender ratio: 2-3x more common in women o Course § Rapid onset after stressor, resolves within 2 weeks if stressor is removed § Commonly recurs § Chronic for some; can cause substantial disability • Treatment o Not much known due to lack of research o Behavioral approaches § Identify and remove any reinforcement for “abnormal” behaviors- remove any primary and secondary goals § Reinforce “normal” behaviors § Exposure therapy if trauma identified o Hypnosis may be useful Malingering • Malingering: deliberately faking a symptom or disorder to avoid an unwanted situation or to gain something o Example: to get drugs • This is not a disorder • When might it be beneficial for someone to malinger? o Get more time to prepare for something (like in classes) o To get money or drugs • Stroop – one malingering test o Congruent vs. incongruent trials § Congruent: red is written in red, green written in green, etc. § Incongruent: o Can switch up the words, too o Let’s try the basic approach Somatic Symptom Disorder • Somatic symptom disorder: one or more somatic symptoms that are distressing or result in significant disruption of daily life • Excessive thoughts, feelings, behaviors OR associated health concerns as manifested by: o Disproportionate and persistent thoughts about the seriousness of one’s symptoms o Persistently high level of anxiety about health or symptoms o Excessive time and energy devoted to these symptoms or health concerns • Symptoms can change, fluctuate, but person is often symptomatic for at least 6 months • Can include: o Gastrointestinal symptoms other than pain o Pain symptoms, in different sites o Sexual symptoms other than pain (e.g., sexual dysfunction) o One pseudoneurological symptom (e.g., loss of sensation) o Nonspecific symptoms (e.g., fatigue) • After appropriate investigation, cannot be accounted for by medical condition • When there is a medical condition, the physical complaints are in excess of what would be expected o Example: ovarian cysts, shortness of breath o Family history of cancer, hypervigilant re: pain • Symptoms are not intentionally produced or faked • Other information o Often seeks medical care excessively o May see multiple practitioners for the same symptoms o Interventions often exacerbate symptoms o Can be highly susceptible to medication side effects o Often do not feel medical care/assessment is adequate o Attribute normal sensations to illness o Often outright refuse psychological intervention • Prevalence: 5-7% o Believed to be more common among females • Causal Factors o Genetic/biological vulnerability § Increased sensitivity to pain • Enzymes/cofactor (GCH1, BH4) § Nervous system hard-wired to be soft-wired § Significant or repetitive pain in preterm babies o Environmental Factors § Early trauma (e.g., neglect, violence) § Learning to use illness to get attention § Non-somatic complaints may not produce desired level of attention or treatment § Less education Illness Anxiety Disorder • Illness anxiety disorder: preoccupation with having or acquiring a serious illness • Somatic symptoms are not present or are mild in intensity • There is a high level of anxiety about health • The individual performs excessive health-related behaviors or exhibits maladaptive avoidance (avoids doctor appointments) • Has these concerns for at least 6 months • Alarmed in response to illness of others o Hearing about people they know getting sick o Reading health news-related article/story • Anxiety is often not reduced following negative diagnostic testing, etc. • Concerns about illness are prominent in the mind of the afflicted individual, becomes a part of their identity • Often research illnesses • Two types o Care-seeking type: frequently uses services of medical practitioners o Care-avoidant type: rarely uses services of medical practitioners • Similar to somatic symptom disorder o May see multiple practitioners for the same symptoms o Will seek the same diagnostic tests from different physicians, especially following negative results o Interventions can exacerbate symptoms; don’t reduce anxiety o Go to medical doctor instead of psychologist for care • Unlike somatic symptom disorder o Seeks medical care at a comparable rate to general public o Often feel they are not being taken seriously by physicians • Prevalence o 2-10% o Similar rates in males and females o Rare in children o Different concerns depending on age (older adults worry about memory loss) • iClicker question: what might encourage someone with Illness Anxiety Disorder to worry? o Hearing about a recent Zika virus case Factitious Disorder (Watched a video about Kathy having factitious disorder imposed on another [she placed it on her daughter]) • Factitious disorder (Munchausen’s syndrome): intentionally produces symptoms to obtain and maintain the personal benefits that playing the “sick role” may provide (including attention from others) • Factitious disorder imposed on another: intentionally causing symptoms in another person or pet • Perpetrator (not victim) gets diagnosis • iClicker question: which somatic or related disorder is characterized by a persistent fear or illness (but the person does not typically have somatic symptoms) o Illness anxiety disorder Pseudocyesis • Pseudocyesis: false pregnancy o Many, if not all, symptoms of pregnancy o Can happen to biological males or females • Intense desire to get pregnant • Infertility, repeat miscarriages • Impending menopause • Desire to get married • Brain misinterprets desires o Hormonal fluctuations (estrogen, prolactin)
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