PSYC 431-Test 3

dissociation

normally integrated elements of consciousness, memory, and personal identity become splintered

dissociation may include…

- impaired memory of important personal experiences

-potential identity confusion

-feeling that surroundings or objects are not real

amnesia

loss or impairment of memory

depersonalization

feeling detached from oneself, as if observing from outside the body

derealization

feeling that events object or ones life are not real or have suddenly changed

identity confusion

feeling uncertain about who you are

identity alteration

behaving in ways that suggest an assumption of a new identity

depersonalization/derealization disorder

experiences depersonalization or derealization without other physical or mental disorders

dissociative amnesia

sudden loss of memory for personally important information, not caused by a medical condition or another disorder it usually follows a stressful event

dissociative amnesia w/dissociative fugue

more extensive memory loss combined with wandering or travel and sometimes a new identity

dissociative identity disorder (DID)

individuals experience “shattering” of their identity into at least two coexisting personalities with different memories emotions and behaviors

depersonalization and derealization usually have…

-no memory loss and no psychosis

-typically triggered by stress

-varied duration of episodes

depersonalization/derealization prevalence

1-2%

depersonalization/derealization onset

adolescence or young adulthood

depersonalization/derealization has a higher prevalence in those…

with panic disorder

depersonalization/derealization highest risk group is…

abusive relationships

about 90% of those with depersonalization/derealization experience…

anxiety/depression

depersonalization/derealization is commonly seen in people with…

personality disorders

amnesia may be localized which means…

a distinct period of time is los

amnesia may be selective which means…

it involves events surrounding a trauma

amnesia may be generalized which means…

it is more severe: could be total life or identity

amnesia may be with dissociative fugue which means

it includes extensive memory loss along with travel to a new location

dissociative amnesia age of onset

young adult/middle age

dissociative amnesia lifetime prevalence

6-7%

dissociative amnesia w dissociative fugue prevalence

very rare

DID is formerly known as…

multiple personality disorder

pathological possession

alternate identity attributed to possession by an external spirit, power,etc.

alter personalities

internal; appear to assume control over the individuals functioning in different situations

host personality

primary identity often has the persons given name

switching

process of changing from one personality to the other

the most common complaint of those with DID and often the reason they seek treatment is…

amnesia

alters are usually…

different ages

DID lifetime prevalence

1-1.5%

DID is more common in

women

DID is linked to…

early and severe childhood trauma

hypothesis of post-traumatic model for DID

unrelenting trauma forced children to rely on psychological escape by imagining themselves to be someone else —> escape from reality and detachment of trauma

Post-traumatic stress model of DID relies on adult memories of childhood trauma which may be…

unreliable

sociocognitive model of DID says that features of DID may be created by…

suggestion (media coverage)

iatrogenesis

therapist may unknowingly influence development of symptoms through suggestive/leading questions and the use of hypnosis to recall traumas—> clients enact alters and become convinced of their diagnosis

absorption

personality dimension describing a tendency to become caught up in ones imaginings or in a current task to the exclusion of external stimuli

the integrative view of DID suggests that…

trauma is not “necessary” but may provoke or intensify dissociation

heritability of dissociation

48-59% (avg: 50%)

DID may be caused by reduced…

serotonin and increased cannabinoids

fMRI studies of DID cases show…

abnormalities in sensory which may increase vulnerability

dissociation if often co-occurring with…

PTSD

in the overlap of PTSD and DID have…

increased prefrontal cortex active

inhibited limbic system activity

some argue DID is likely produced by…

early trauma

depersonalization/derealization cortico-limbic model

prefrontal cortex inhibits connection between events and emotions —> under-responsive to emotional stimuli —> perception of disconnect from reality and inability to integrate bodily perceptions with sense of self

treatment of DID

medication and psychotherapy

somatization

a process by which emotional distress is converted into (or expressed as) physical

general description of somatization

excessive concern about physical symptoms or health combined with the tendency to seek medical treatment repeatedly, doctor shopping, various treatments, multiple hospital stays, and possible surgeries

somatic symptom disorder (SSD)

may devote excessive time to concern, not easily reassured by negative test result

SSD prevalence

5-7%

SSD has higher rates in…

females

older adults

individuals with less education and significant stressful life events

illness anxiety (IAD)

anxiety about having or acquiring a disease but with no significant symptoms for 6+ months

IAD prevalence

1-3%

IAD has a similar prevalence in

males and females

Functional Neurological Symptom Disorder (FNSD) (formerly Conversion Disorder)

loss of sensory or voluntary motor function, causing significant distress or disability or requiring medical evaluation

FNSD onset

rapid and sudden

FNSD prevalence

0.5%

FNSD is more common in

women

rural populations

lower SES groups

conversion disorder is the somatic most likely to affect…

children

Factitious disorder

intentional production of symptoms without obvious external gain

Factitious disorder is..

imposed on self

munchausen’s by proxy

imposed on children

Factitious disorder prevalence

1%

all of the somatic disorders have heritability that is…

lower than any other disorder

those with somatic disorders may have…

increased activity in to somatosensory cortex

psychodynamic model of somatic disorder

unconscious psychological conflict —> physical symptom

cognitive factors of somatic disorder

overly attentive to bodily sensations and overreacting with overly negative interpretations

psychosocial causes of somatic disorders

hypersensitivity to physical and emotional sensations, stress/trauma, reinforced and maintained by cultural factors, modeling shapes how symptoms unfold

psychosocial interventions of somatic symptom and related disorders

CBT

pharmacological treatment of somatic symptom and related disorders

antidepressants to relieve comorbid disorders may reduce symtoms

primary care behavioral health (integrated care) is the…

optimal model of treatment

most are not interested in…

mental healthcare services

anorexia

• restriction of food that leads to very low body weight, weight is significantly below normal

• intense fear of weight gain or repeated behavior interfering w/weight gain

• body image disturbance

• weight loss typically achieved through starvation

• fear of gaining weight is not reduced by weight loss

• even when emaciated they may still believe they are overweight

  • severity rating is based on BMI

restricting type of anorexia

weight loss is achieved by severely limiting food intake

binge-eating/purging type of anorexia

also regularly engaged in binge eating purging

anorexia onset

adolescence

anorexia is usually triggered by

dieting and stress

anorexia is more than…

3x more frequent in females

physical consequences of emaciation and low body weight

• low blood pressure & heart rate

• kidney failure

• sensitivity to cold

• osteoporosis (loss of bone mass)

• brittle nails, dry skin, hair loss, lanugo (fine hair on skin)

• fatigue & weakness

  • altered levels of potassium and sodium electrolytes —> cardiac complications, including heart failure or sudden death

anorexia prognosis

50-70% recover; may take 6-7 years; may relapse

anorexia morality

rates 10x higher than general population

rates 2x higher than other psychological disorders

bulumia nervosa

recurrent episodes of binge eating + compensatory behaviors to prevent weight gain

body shape and weight are extremely important in self-evaluation

severity based on # of episodes

binge episode

an excessive amount of food consumed in a short period of time

bulimia usually…

occurs in secret

bulimia may be triggered by

stress, negative emotions or negative social interactions

typical food choices are high-calorie food

avoiding a craved food can increase a binge episode

reports of dissociation while binging

shame and remorse usually follow

feelings of discomfort, disgust and fear of weight gain (after a binge episode) can lead to…

inappropriate compensatory behaviors

binge/purge episode must occur

at least once a week for 3 months

bulimia onset

later adolescence or early adulthood

bulimia prevalence

1.5%

those with bulimia were typically

overweight before onset

physical consequences of bulimia

• potassium depletion from purging

• laxative use depletes electrolytes —> can cause cardiac irregularities

• enlarged salivary glands

• inability to detect fullness

• gastrointestinal issues

• fatigue

• vomiting —> ruptures in throat, stomach; loss of enamel on teeth (tooth decay); gum disease

• mortality rate higher than other disorders (lower than anorexia)

bulimia prognosis

about 75% recover

10-20% remain fully symptomatic

early intervention linked with improved outcomes

poorer prognosis when depression and substance abuse are comorbid, or with more severe symptomatology

people with anorexia lose a tremendous amount of weight, those with bulimia…

do not

bulimia has a higher

level of awareness

binge eating episodes include at least three of the following

• eating more quickly than usual

• eating until over full

• eating large amounts even if not hungry

• eating alone (due to embarrassment about quantity)

• feeling bad (e.g., disgusted, guilty, or depressed) after the binge

binge eating disorders have

recurrent episodes without compensatory behaviors

severity of binge eating disorders is based on

the number of binges per week