Chapter 7 - Somatic Symptom and Dissociative Disorders

Depersonalization/Derealization Disorder (DDD)

A dissociative condition characterized by feelings of unreality concerning the self and the environment

Dissociation

A psychological coping mechanism characterized by a sense of disconnection from traumatic circumstances

Dissociative Amnesia

A psychologically based sudden loss of important personal information or recall of events

Dissociative Amnesia with Fugue

An episode involving complete loss of memory of one’s life and identity, unexpected travel to a new location, or assumption of a new identity

Dissociative Disorders

A group of disorders which involve some sort of dissociation, or separation, of a part of the person’s consciousness, memory, or identity

Dissociative Identity Disorder (DID)

A condition in which two or more relatively independent personality states appear to exist in one person, including experiences of possession

Factitious Disorders

A condition in which a person deliberately induces or simulates symptoms of physical or mental illness with no apparent incentive other than attention

Factitious Disorder Imposed on Another

A pattern of falsification or production of physical or psychological symptoms in another individual

Factitious Disorder Imposed on Self

Symptoms of illness are deliberately induced, simulated, or exaggerated, with no apparent external incentive

Functional Neurological Symptom Disorder (FNSD)

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Conversion Disorder

A condition involving sensory or motor impairment suggestive of a neurological disorder but with no underlying medical cause

Iatrogenic Disorder

A condition unintentionally produced by a therapist’s actions and treatment strategies

Illness Anxiety Disorder

Persistent health anxiety and/or concern that one has an undetected physical illness, even when the person has only mild or no physical symptoms

Localized Amnesia

Lack of memory for a specific event or events

Malingering

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Lying on Somatic Symptoms

Feigning illness for an external purpose

Possession

The replacement of a person’s sense of personal identity with a supernatural spirit or power

Psychogenic

Originating from psychological causes

Repressed Memory

A memory of a traumatic event has been repressed and is, therefore, unavailable for recall

Selective Amnesia

An inability to remember certain details of an event

Somatic Symptom and Related Disorders

A broad grouping of psychological disorders that involve physical symptoms or anxiety over illness, including somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder, and factitious disorder

Somatic Symptom Disorder (SSD)

A condition involving a pattern of distressing thoughts regarding the seriousness of one’s physical symptoms combined with excessive time and concern devoted to worrying about these symptoms

Somatic Symptom Disorder with Predominant Pain

A condition involving excessive anxiety or persistent concerns over severe or lingering pain

Somatic Symptoms

Physical or bodily symptoms

Systematized Amnesia

Loss of memory for certain categories of information

Somatic symptom disorder (SSD), illness anxiety disorder, conversion disorder (functional neurological symptom disorder), and factitious disorder.

Name the four main disorders included in the 'somatic symptom and related disorders' category

The presence of at least one distressing somatic symptom combined with excessive thoughts, feelings, or behaviors related to it.

What is the key characteristic of Somatic Symptom Disorder (SSD)?

At least 6 months

How long must the pattern of distressing symptoms and related thoughts/behaviors last for a diagnosis of Somatic Symptom Disorder (SSD)?

SSD involves significant somatic symptoms, whereas Illness Anxiety Disorder involves minimal to no somatic symptoms, with the primary feature being anxiety about illness.

What is the primary difference between Somatic Symptom Disorder and Illness Anxiety Disorder?

In factitious disorder, the motivation is to assume the sick role for attention, whereas malingering involves faking an illness for a clear external goal, such as an insurance settlement or avoiding work.

How does factitious disorder differ from malingering?

Munchausen Syndrome

Historical term for factitious disorder imposed on self

Munchausen Syndrome by proxy

Historical term for factitious disorder imposed on another

Lower pain thresholds, heightened sensitivity to pain, and hypervigilance or exaggerated focus on bodily sensations.

According to the biological dimension, what vulnerabilities may contribute to somatic symptom disorders?

The physical symptoms provide psychological protection from the anxiety associated with unacceptable unconscious desires or conflicts.

From a psychodynamic perspective, what is the 'primary gain' of somatic symptoms?

The person's dependency needs are fulfilled through the attention and sympathy they receive in response to their physical symptoms.

From a psychodynamic perspective, what is the 'secondary gain' of somatic symptoms?

Bodily sensations or changes in bodily functions.

The cognitive-behavioral perspective suggests that somatic disorders can be caused by catastrophic misinterpretations of

A history of sexual abuse, rejection from family, parental attentiveness to somatic complaints, or having family members with chronic physical illness.

Social factors that contribute to the development of somatic symptom disorders

It is a loss of feeling in the hand ending in a straight line at the wrist, which is anatomically inconsistent with the distribution of nerve pathways, indicating a psychological origin.

What is 'glove anesthesia' and why is it indicative of conversion disorder?

Cyberchrondria

The maladaptive use of technology to continually check for information regarding physical disorders is known as

Cognitive-Behavioral Therapy (CBT)

What psychological treatment approach for somatic symptom disorders focuses on correcting misinterpretations and cognitive distortions about bodily sensations?

Interoceptive Exposure

A CBT technique for somatic symptom disorders that involves exposing clients to the bodily sensations they fear (e.g., increased heart rate)

Dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder (DID).

The three main types of dissociative disorders listed in the DSM-5-TR

Depersonalization/derealization disorder.

Which dissociative disorder is characterized by persistent feelings of unreality, detachment, or being an outside observer of one's own thoughts and body?

Derealization

The experience of feeling that things are unreal or a sense of being in a dreamlike state

Depersonalization

The experience of feeling detached from one's own thoughts, feelings, or body

Depersonalization/Derealization Disorder

Which of the dissociative disorders is considered the most common?

Multiple-Personality Disorder

What was the former name for Dissociative Identity Disorder (DID)?

Alters

In the context of DID, what are the alternate personality states often called?

1980s (specifically after the popularization of the story of 'Sybil' in the 1970s)

According to the source, reports of Dissociative Identity Disorder (DID) cases rose sharply after the

Disruptions in memory encoding and retrieval, possibly involving atypical functioning in the hippocampus and prefrontal cortex.

What biological factor has been linked to dissociative disorders, especially in response to acute stress?

Posttraumatic Model

Model of DID that proposes that the disorder develops from exposure to overwhelming childhood stress combined with a biological predisposition and the use of dissociation to cope.

Exposure to overwhelming childhood stress, a genetic or biological capacity to dissociate, and environmental factors preventing the development of a strong sense of self.

What are the three factors necessary for the development of DID according to the posttraumatic model?

Sociocognitive model

Model of DID that suggests that individuals learn about the disorder through mass media and begin to act out its roles, often influenced by therapists.

Treatment focuses on alleviating underlying depression and stress, as symptoms often abate spontaneously.

What is the typical treatment approach for dissociative amnesia and fugue?

The integration of personalities into one cohesive identity.

What is the major therapeutic goal in treating Dissociative Identity Disorder (DID)?

Working on safety issues, emotional stabilization, and symptom reduction.

Trauma-focused therapy for DID often involves a hierarchical approach. What is the focus of the first phase?

Focusing on personality integration and fusion.

What is the focus of the third and final phase of hierarchical treatment for DID?

The requirement that symptoms be 'medically unexplained' was removed, and only one problematic symptom is now necessary for diagnosis.

What major change was made to the diagnostic criteria for somatic symptom disorder in the DSM-5-TR?

Memory War

The controversy and debate over the validity of repressed memories, particularly whether a traumatic memory can be pushed out of consciousness and later accurately retrieved.

Disease Conviction

The firm belief in having a serious illness that cannot be dissuaded by negative lab results in illness anxiety disorder

Body Preoccupation

Obsessive attention to bodily signs or changes as warning signs of an illness in Illness Anxiety Disorder

Somatopsychic Perspective

Within sociocultural perspectives, some cultures hold this perspective, believing that physical problems produce psychological symptoms, as opposed to the Western psychosomatic view.

Koro

A cultural syndrome, found primarily in Southeast Asia, which involves an intense fear that one's genitals are receding into the bod

Recovery is often abrupt, spontaneous, and complete.

Prognosis for dissociative amnesia and fugue states

Normalizing

The focus of therapies for depersonalization/derealization disorder when regarding minor dissociative reactions and thoughts in response to stressful situations.

Dissociative Identity Disorder (DID)

The experience of possession was added to the DSM-5-TR definition of which disorder to include cultural symptoms of dissociation?

The health care system or in a medical laboratory.

Research has found that individuals with factitious disorder often worked or were working in what field?

It may pathologize individuals with legitimate medical conditions (like cancer or long-COVID) who show understandable distress and concern about their illness.

What is a major criticism of the new DSM-5-TR criteria for Somatic Symptom Disorder?

The Psychosomatic Perspective

Dominant Western cultural view on the relationship between mind and body, where psychological conflicts are expressed via physical symptoms

Interidentity Amnesia

A reported inability to recall events experienced by an altered personality In dissociative identity disorder

Psychogenic movement disorders, sensory symptoms (like blindness or dizziness), and psychogenic seizures.

Most common conversion symptoms (FNSD) found in neurological clinic

Altered behavior, mood, sense of self, emotions, cognitions, and perceptions

Other symptoms that are associated with dissociative identity disorder (DID) alongside memory gaps