Dissociative Disorders and Somatic Symptom-Related Disorders (Psych Exam #2)

Experience of detachment from the self and reality/surrounding

Depersonalization/derealization disorder

Depersonalization=disconnect from body/aspect of self

Derealization=surreality, detachment from one’s surroundings

*NO DISTURBANCE OF MEMORY

Lack of conscious access to memory, typically of a stressful experience

May last several hours to several years

Dissociative amnesia

At least two distinct personalities that act independently of each other and emerge at different times

Dissociative identity disorder (DID)

Some aspect of emotion, memory or experience being inaccessible consciously

Ex. losing track of time

Dissociation

What causes dissociation?

An avoidant response to a stressful event

Trauma (maybe childhood) and sleep disturbance

*Defense NOT psychosis

Running away/”to flea” from self, protect self from being overwhelmed, gap in memory, responds to intense trauma, recovery is complete, people are able to remember details of their life

Fugue Subtype (most severe subtype)

2 types of criteria for depersonalization

1. Unusual sensory experiences (limbs feel deformed/enlarged, voice sounds different/distant)

2. Feelings of detachment or disconnection (watching self from outside, floating above one’s body)

*Symptoms are persistent or recurrent

Criteria of derealization

World has become unreal as strange, peculiar, foreign, and dream-like

Objects are diminished in size

Incapable of experiencing emotions

Feeling as if they were dead, lifeless

Dissociative amnesia not like other forms of memory loss such as what?

Substance abuse, brain injury, medication side effects

Dementia: memory fails slowly over time, not linked to stress, accompanied by inability to learn new information

What two theories are said to be the cause of dissociative amnesia?

Psychodynamic Theory: Traumatic events are repressed

Cognitive Theory: Stress enhances encoding of central features of negative events, high levels of stress hormones and chronic stress interfere with memory formation

Which alter of dissociative identity disorder seeks treatment?

Primary alter

When is dissociative identity disorder diagnosed and is it more common in women or men?

Diagnosed in adulthood (symptoms may date back to childhood)

More common in women

Other common diagnoses present with dissociative identity disorder?

PTSD, Major Depressive Disorder, Somatic Symptom Disorders, Personality Disorders

Common symptoms of dissociative identity disorder

Headaches, hallucinations, suicide attempts, self-injurious behaviors, amnesia, depersonalization

People use dissociation to cope with what?

Trauma (Posttraumatic Model)

People who have been abused seek explanations for their symptoms and distress

Sociocognitive Model

DID could be iatrogenic

Created within or caused by treatment

Reinforcement of identified alters and suggestive techniques might promote symptoms in vulnerable people and increase number of alters

Are there any available treatments for DID?

No, no medications have been shown to relieve DID

Integration of alters into one fully functioning individual

Improve coping skills

Overcome repression

How can hypnosis help with DID?

Age regression: Person encouraged to go back in his or her mind to traumatic events in childhood

This can actually worsen symptoms

Soma means what

Body

Criticisms of diagnostic criteria

Conditions are remarkably varied

Patients often find these diagnoses stigmatizing

This is more authentic over symptoms

Distress

Excessive thought, distress, and behavior related to somatic symptoms

Somatic symptom disorder

Unwarranted fears about a serious illness in the absence of any significant somatic symptoms

Excessive behaviors (checking for signs of illness) and maladaptive avoidance (avoiding medical care)

Illness anxiety disorder

Neurological symptoms affecting voluntary motor or sensory function that cannot be explained by medical disease or culturally sanctioned behavior

Conversion disorder

Intentionally faking psychological or somatic symptoms to gain from those symptoms

Malingering

Falsification of psychological or physical symptoms, without evidence of gains from those symptoms

Factitious disorder

Must have at least one somatic symptom that is distressing or disrupts daily life, while lasting a duration of at least 6 months

Somatic Symptom Disorder

Somatic symptoms may include (3)

Health-related anxiety

Disproportionate and persistent concerns about seriousness of symptoms

Excessive time and energy devoted to health concerns

Symptoms of conversion disorder

Partial or complete paralysis of arms or legs

Seizures or coordination problems

Vision impairment or tunnel vision

Anesthesia (insensitivity to pain)

Aphonia (whispered speech)

Anosmia (loss of sense of smell)

Onset is rapid in adolescence or early adulthood

Conversion disorder more common in men or women?

Women

Are somatic symptom-related disorders heritable?

No

Somatic symptoms and pain are increased by what hormones?

Anxiety, depression, and stress

What are two important cognitive variables?

Attention to bodily sensations (autonomic focus on physical health cues)

Interpretation of those sensations (overreact with overly negative interpretations)

Believed conversion disorder only occurred in women, attributing it to a wandering uterus (originally known as hysteria)

Hippocrates

Coined the term conversion, anxiety and conflict converted into physical symptoms

Freud

Physical symptom is a response to an unconscious psychological conflict

Psychodynamic

Much of our perpetual processing may operate outside of our conscious awareness

Neuroscience

Conversion disorder is most common in what kind of people

Those from rural areas of lower socioeconomic status

Conversion disorder is comorbid with what other disorders?

Somatic symptom disorder

Major depressive disorder

Substance use disorder

Cognitive and Behavioral Strategies may include what?

• Identifying and changing triggering emotions

• Change cognitions about symptoms

• Change behaviors to improve social interactions

• Train people to pay less attention to their body

• Help people resume healthy activities and rebuild life

• Involve family members to reduce attention given to somatic symptoms

• Mindfulness

Beneficial effects for what kind of treatment for conversion disorder?

Cognitive Behavioral Therapy (CBT)

Including patients reinforced for taking part in physical training to improve area of difficulty

Treatment team ignoring ongoing signs of conversion symptoms

What was Essie’s trauma in “The Enchanted Doll”?

When Essie was 15, her parents passed away and it resulted in her injury (physical but not permanent), and she was awarded guardianship to her cousin, Rose Callamit, where she was psychologically abused (“nobody would want you”) with no supportive environment (adding to the original trauma)

What was Essie’s conversion?

Lameness, being crippled (paralysis and inability to walk) but could have been fixed

How did Essie’s conversion protect her psychologically?

Encourages dependence so she doesn't have to forge relationships and risk abandonment again

What was the primary gain from Essie’s conversion?

Unconscious protection from emotional gain

What is Essie’s hobby and how does it relate back to her trauma?

Making dolls (almost life-like) because she was told she was never able to have kids, something for her to care for (nurturing effect) and love

Cousin encourages this hobby to sell the dolls and make money for herself so Essie is re-experiencing trauma again with this loss of her dolls

When Essie stops making dolls what happens?

She stops eating she becomes depressed (comorbidity)

What defense mechanism does Essie use?

Doll making is sublimation for her need for love

Special case of displacement

What defense mechanism does Essie’s cousin use?

Denial in saying “get out!” to doctor when he says Essie is not lame and can be “cured”

What is the positive reinforcement that keeps Essie with her cousin?

Dependency on cousin to satisfy basic needs (roof over her head, being fed), she does not have to work

What is the negative reinforcement that keeps Essie with her cousin?

“You need me to survive” and it must be with me - Rose

Behavioral reinforces that conversion (secondary gain)

What is Essie’s treatment?

Love and the doctor coming in to profess that and treat Essie how she should be treated

“You can walk.” - doctor

This level of care (like from her parents) lifts conversion, Essie is able to walk