Psychopathology #3 (CHPT SUMMARY)

What are the somatic symptom and related disorders, and what do they have in common? What causes these conditions and how are they treated?

-Somatic symptom and related disorders involve prominent somatic complaints that cause significant distress or impairment in the life of the individual and include somatic symptom, illness anxiety, conversion, and factitious disorders.

-Somatic symptom disorder (SSD) is characterized by at least one physical complaint accompanied by excessive anxiety, thoughts, or behaviors associated with health concerns.

-Illness anxiety disorder is characterized by a belief that one has a serious and undetected illness or physical problem. In contrast to somatic symptom disorder, somatic symptoms are not a major feature of this disorder.

-Conversion disorder (functional neurological symptom disorder) involves neurological-like symptoms that are incompatible with a medical condition.

-Factitious disorders involve self-induced or feigned physical complaints, or symptoms induced in others.

-Biological explanations have suggested that there is increased vulnerability to somatic symptom disorders when individuals have high sensitivity to bodily sensations, a lower pain threshold, or a history of illness or injury.

-Psychological factors include high anxiety or stress, and catastrophic thoughts regarding bodily sensations.

-Social explanations suggest that the role of “being sick” is reinforcing. External stressors such as sexual abuse, bullying, or role models who attend to illness can also be influential.

-From a sociocultural perspective, somatic symptom disorders result from societal restrictions placed on women, who are affected by these disorders to a much greater degree than are men. Additionally, marginalization, social class, limited knowledge about medical concepts, and cultural acceptance of physical symptoms can play a role.

-Treatment involves psychoeducation about physical complaints, altering distorted cognitions, and strategies for tolerating changes in bodily sensations.

What are dissociations? Why do they occur, and how are they treated?

-Dissociation involves a disruption in consciousness, memory, identity, or perception, and may be transient or chronic.

-Dissociative amnesia, including localized amnesia and dissociative fugue, involves a selective form of forgetting in which the person cannot remember information that is of personal significance. Depersonalization/derealization disorder is characterized by feelings of unreality—distorted perceptions of oneself and one’s environment. Dissociative identity disorder (DID) involves the presence of two or more personality states in one individual, or an experience of possession.

-Biological explanations for DID have included atypical neurological connectivity, disruptions in encoding memories, and atypical neural activity that may indicate an inhibition of brain areas associated with memory. Some researchers believe that childhood trauma and chronic stress can result in permanent structural changes within the brain.

-Psychoanalytic perspectives attribute these disorders to the use of repression to block unpleasant or traumatic events from consciousness.

-Social explanations include childhood abuse, subtle reinforcement, mislabeling of dissociative experiences, and responding to the expectations of a therapist.

-Sociocultural explanations for dissociation include exposure to media portrayals of dissociation and role enactment by vulnerable individuals.

-Dissociative amnesia, dissociative fugue, and depersonalization/derealization disorder tend to remit spontaneously; cognitive-behavioral therapy and stress management techniques can be beneficial in preventing symptom recurrence. DID is often treated with trauma-focused cognitive therapy that addresses safety concerns and the integration of the personality states, and incorporates strategies for eliminating cognitive distortions and dealing with current stressors. Newer approaches reframe the perception of alter personalities as modifiable methods of coping with stress or trauma.

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