5 - Chapters 9 & 10 Dissociative Disorders

Dissociative Disorder

Conditions that involve disruptions or breakdowns or memory, awareness, identity, or perceptions. Nothing Psychotic

Dissociative Identity Disorder (Multiple Personality Disorder)

A disorder in which an individual develops more than one-self or personality. Must have 2 distinct identities when inhabiting one, are not aware that they also inhabit the other identity. As a result, will have large gaps in memory.
Individuals have learned to cope with extremely stressful life circumstances by creating “alter” personalities that unconsciously control their thinking and behavior when they are experiencing stress.

Dissociative Amnesia

The inability to remember important personal details and experiences, usually associated with traumatic or very stressful events.

Fugue state

Travel or wander without knowing their identity

Depersonalization

Condition in which people feel they are detached from their own body

Derealization

Condition in which people feel a sense of unreality or detachment from their surroundingsD

Depersonalization / Derealization disorder

The condition in which the individual experiences recurrent and persistent episodes of depersonalization / derealization

Somatic symptoms

Symptoms involving physical problems and/or concerns about medical symptoms. “Somatic” comes from the Greek word “soma” meaning body.

Somatic symptom disorder

A somatic disorder involving actual physical symptoms that may or may not be accountable by a medical condition, accompanied by maladaptive thoughts, feelings, and behaviors.
Manifests as physical symptoms that suggest illness or injury but cannot be explained fully by a general medical condition or by the direct effect of a substance and are not attributable to another mental disorder.
For diagnosis there must be excessive worry about their symptoms and worry must be judged to be out of proportion.
Must have occurred for at least six months.

Illness anxiety disorder

A somatic symptom disorder characterized by the misinterpretation of normal bodily functions as signs of serious illness. Does not involve actual physical symptoms. Easily alarmed about their health and seek unnecessary medical tests and procedures to rule out or treat imagined illness. Remain unsatisfied with physician reassurance.

Functional Neurological Symptom Disorder (Conversion disorder)

A somatic symptom disorder involving the translation of unacceptable drives or troubling conflicts into physical symptoms. “Conversion” refers to the presumed transformation of psychological conflict to physical symptoms.

• Physical ailments include: “Pseudoseizures”, disorders of movement, paralysis, weakness, disturbances of speech, blindness, and other sensory disorders and cognitive impairment.

Malingering

Involves deliberately fabricating physical or psychological symptoms for some ulterior motive. Want direct benefit or reward. Relief from anxiety or responsibility. Disability, lawsuit, insurance benefits, time off from work)

Fictitious disorder imposed on self

fake symptoms or disorders not for the purpose of any particular gain, but because of an inner need to maintain a sick role. (Munchausen’s syndrome). Faking or exaggerating symptoms for secondary gains: sympathy and attention that a sick persona receives. Motives are internally driven.

Fictitious disorder imposed on another

Inducing physical symptoms in another person who is under their care. (Munchausen’s syndrome by proxy)

Treatment for Dissociative and conversion disorders

• Cognitive Behavioral Therapy (CBT): Help clients identify and change their thoughts linked to their physical symptoms and change their maladaptive behavior that accompanies those irrational thoughts. Focus is on the unusually high level of health anxiety: worry about physical symptoms and illness.

• Hypnotherapy

• Medication

Psychological factors affecting other medical conditions

The disorder in which clients have a medical disease or symptom that appears to be exacerbated by psychological or behavioral factors.

Psychological factors affecting medical conditions include mental disorders, stress, emotional states, personality traits, and poor coping skills. All interact with physiological conditions.

Stress

The unpleasant emotional reaction that a person has when an event is perceived as threatening

Stressful life event

An event that disrupts the individual’s lifeC

Coping

The process through which people reduce stress in a healthy manor

Daily hassles

Relatively minor events that can add up and cause significant stress that can impair mental health

Problem focused coping

Coping in which the individual takes action to reduce stress by changing whatever it is about the situation that makes it stressful

Emotion focused coping

Coping in which a person does not change anything about the situation itself, but instead tries to improve feelings about the situation.

Type A behavior pattern

A pattern of behaviors that include being hard-driving, competitive, impatient, cynical, and suspicious, easily irritated, and hostile towards others. Sees problems as external.

Type D personality

People who experience emotions that include, anxiety, irritation, and depressed mood

Eating disorder

A persistent disturbance of eating or eating related behavior that result in changes in consumption or absorption of food. Must significantly impair the individual’s physical and psychosocial functioning.

Feeding disorder

A disorder characterized by extreme food selectivity (beyond pickiness).

Anorexia Nervosa (NA)

An eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight and distorted body perception.

• Results in serious health changes: Weak and brittle bones, muscles, hair and nails, low blood pressure, slowed breathing and pulse, lethargic, sluggish, and fatigued. Eventually organ failure.

Bulimia Nervosa

The eating disorder involving alternation between the extremes of eating large amounts of food in a short time and then compensating for the added calories either by vomiting or other extreme actions to avoid gaining weight. Must binge and purge once per week.

Binge-eating

When someone eats an excessive amount of food during a short period

Purging

Inappropriate methods of compensating for added calories such as vomiting, laxatives, diuretics, or other medications, fasting or excessive exercise.

Binge-Eating diisorder

The disorder that involves the ingestion of large amounts of food during a short period of time, even when full and a lack of control over what or how much is eaten. Must engage at least twice a week for 6 months. Must involve large food intake, past the point of full, eating while alone, feelings guilt or self-disgust after. Usually significantly overweight. No purging

Other specified feeding or eating disorder (OSFED)

Applicable to individuals who are experiencing significant distress due to symptoms that are similar to disorders such as anorexia, bulimia, and binge-eating disorder, but who do not meet the full criteria for a diganosis.

Eating and feeding perspectives

• Biopsychosocial: Believed to be a genetic vulnerability combined with experiences with eating, body image and exposure to sociocultural influences

• Biological: Studying the role of dopamine

• Psychological: Binge eaters feel relief from depression and anxiety

• Social: Social activities usually paired with food.

Avoidant/Restrictive food intake disorder

A disorder in which individuals avoid eating out of concern about aversive consequences or restrict intake of food with specific sensory characteristics.

Show an apparent lack of interest or concern in eating food. As a result, lose significant amount of weight, nutritional deficiency, and may become dependent on feeding tubes or oral nutritional supplements. No concern about physical appearance.

Pica

A condition in which a person eats inedible substances such as dirt or feces, commonly associated with developmental disabilities

Rumination disorder

A eating disorder in which the infant or child regurgitates food after it has been swallowed and then either spits it out or re-swallows it.

Purging disorder (OSFED)

The individual engages in purging behaviors such as self induced vomiting or laxative misuse, but they do not experience eating binges.

Night eating syndrome (OSFED)

The individual experiences recurring episodes of eating after awakening at night, or of eating excessively after their evening meal. These episodes cause significant distress or impaired functioning.

Elimination disorders

Disorders characterized by age-inappropriate incontinence beginning in childhood

Enuresis

Elimination disorder in which the individual is incontinent of urine and urinates on clothes or in bed after the age of 5

Encopresis

Elimination disorder where the individual is incontinent of feces and has bowel movements in clothes or in other inappropriate places at age 4 or above

Insomnia

A disorder in which you may have trouble falling asleep, staying asleep, or getting good quality sleep. This happens even if you have the time and the right environment. Can be acute or chronic

• Onset: Trouble falling asleep

• Maintenance: trouble staying asleep

• Behavioral

Impulse control disorders

Disorders characterized by repeatedly engaging in behaviors that are harmful and feel they cannot control. Experience tension and anxiety until they follow their impulses and feel a sense of pleasure or gratification, although later may have regrets. Find it extremely difficult or impossible to control impulses or desires.

Oppositional defiant disorder (ODD)

Impulse control disorder characterized by angry or irritable mood, argumentative or defiant behavior, and vindictiveness that results in significant family or school problems. Symptoms begin between ages 5 & 10. Around 2-11% of children in US, more common in males. Involves a long-lasting pattern of defiance, disobedience, and hostility toward parents, teachers, and other authority figures.

• Treatment: Behavioral, cognitive, and social learning approaches

  • Focus on reinforcement, behavioral contracting, modeling, and relaxation training

Common ODD Symptoms

• Frequent temper tantrums

• Irritability, anger, argumentativeness, and/or vindictiveness

• Refusal to obey adults’ rules or follow directions

• Difficulty making and keeping friends

• Frequently getting into trouble at school.

Conduct disorder (CD)

Impulse-control disorder that involves repeated violations of the rights of others and society’s norms and laws. Delinquent behaviors including aggressiveness to people and animals. Onset after adolescence. More likely to have ADHD, mood disorders, and developmental disorders.

• Treatment

  • Naltrexone medication, used with substance abuse.

  • CBT and Aversive therapy, relaxation training, and cognitive restructuring.

Common CD symptoms

• Frequent rule-breaking

• Angry outbursts

• Aggression towards others, including bullying, fighting, and/or sexual assault

• Mistreating children or animals

• Dishonesty, including lying and cheating

• Excessive substance use

• Running away from home

• Truancy (skipping school)

• Criminal behavior such as theft, vandalism, or arson

Intermittent explosive disorder

An impulse control disorder involving an inability to hold back urges to express strong angry feelings and associated violent behaviors

During episodes a person may:

• Be verbally aggressive

• Start arguments

• Phsyically assault others

• Destroy property or possessions

• Threaten others

Keptomania

An impulse-control disorder that involves the persistent urge to steal. The condition can be present at any age. They fail to resist the urge to steal things they don’t want or need. Does not involve stealing for monetary or personal gains, revenge, or necessity. Instead, they feel an intense build up of tension before stealing and stealing brings relief and/or pleasure

Pyromania

An impulse-control disorder involving the persistent and compelling urge to start fires. (Not Arson) More common in teenagers and adult males. People are often fascinated by fire and anything related to fire. They may feel “pent up” and anxious before setting a fire, followed by an intense release of tension while watching it burn.

Other specified disruptive, impulse-control, and conduct disorder

Sexual, internet use, shopping, etc.

Diagnosis that is characterized by a person who exhibits signs and symptoms of an impulse control disorder, but the impulse (or impulses) don't necessarily fall into any of the main categories.