chapter 6 textbook dissociative disorders

dissociative identity disorder

dissociative disorder in which a person has two or more personalities or alters

• each has their own distinctive traits, memories, mannerisms, even style of speech

DID three faces of eve

• Eve White: main personality

  • timid housewife

• Eve Black: alter

  • sexually provocative

  • anti social personality

• Jane: merge of three

  • balanced

  • developing personality who can balance her sexual needs with demands of social acceptability

• movie based off of Chris Sizemore

  • failed to maintain integrated personality like Eve

  • split into 22 personalitie

clinical features of DID

• two or more distinct personalities

• may have one dominant or core personality or several subordinate personalities

• changes between alters may seem like possession

• some personalities can show psychotic breaks

• main personality can be unaware of existence of other personalities

• some personalities (alter personalities) can even have different eyeglass prescriptions, allergic reactions, etc

• shifting of levels of sexuality and sexual orientation is common

controversies of DID

• many professionals have doubts on the existence of the disorder

• very rare

• Nicholas Spanos → believed DID was roleplaying until person believed it was real

• 72% of DID attempted suicide

dissociative amnesia

dissociative disorder in which a person experiences memory

loss without an explanation → reversible, memory can come back

• divided into 5 types of problems

• fugue: rare subtype — amnesia on the run

  • travels suddenly either purposefully or wandering

  • unable to recall past personal informationextbook 3

  • may appear normal

• malingering: faking symptoms or making false claims for personal gain

1. localized amnesia

events occurring during a specific time period are lost to memory → person may forget events after traumatic event for a certain amount of time

2. selective amnesia

forget disturbing particulars that take place during a certain period of time → a soldier may remember most of battle but not the death of his friend

3. generalized amnesia

people forget their entire lives

4. continuous amnesia

forgets everything that occurred from a particular point in time up to and including the present

5. systematized amnesia

specific to a particular category of information, such as memory about one’s family or particular people in one’s life

depersonalization / derealization disorder

recurrent episodes and impair daily functioning

depersonalization

temporary loss or change in the usual sense of our own reality

• feel detached from themselves and surroundings

• may feel like a robot or dreaming

derealization

sense of unreality about the external world involving odd changes in the perception of one’s surroundings or in the passage of time

• people and objects may seem to change in shape or size, sounds may sound different

• associated with dizziness, fears of going insane, depression

features of DID

• memories are intact, people know who they are unlike amnesia

• sometimes feelings of DPDR can come on and fade

• associated more with anxiety disorders

• more common in US because we emphasize individualism

amok

• culture bound dissociative syndrome

• southeast asian and pacific island cultures

• trancelike state in which a person suddenly becomes highly excited and violently attacks other people and destroys object

zar

• culture bound dissociative syndrome

• north africa and middle east

• dissociative states used to reflect spirit possession

• shouting banging head against wall

psychodynamic perspective dissociative

• involve massive use of repression

• disconnecting or dissociating ones conscious self from awareness of traumatic experiences or other sources of psychological pain or conflict

social cognitive theory of DD

• learned response involving the behavior of psychologically distancing oneself from disturbing memories or emotions

• nicholas spanos → roleplaying

brain dysfunction of DD

• structural brain differences in those who have dissociative disorders

• brain functioning in sleep

vulnerability-stress model of DD

people prone to fantasize are open to altered states of consciousness are more likely than others to develop dissociative experiences in the face of traumatic events

treatment of DD

• help patients uncover and work through memories of early childhood trauma

• therapists recommend establishing connections with dominant and alter personalities

• help safely relive traumatic experiences and make them conscious

somatic symptom and related disorders

• people who display physical symptoms without an identifiable physical cause orhave excessive concerns about the nature or meaning of their symptoms

  • symptoms significantly interfere with the people’s lives

  • lead them to go doctor shopping in hopes of finding a medical practitioner to explain and treat their ailments

somatic symptom disorder

excessive concern about one’s physical symptoms

somatic symptom disorder diagnosis requirements

• physical symptoms that are persistent for at least 6 months or longer

• associated with either significant personal distress or interference with daily functioning

SSD hypochondrasis

• previously in older versions of DSM

• applied to people with physical complaints who believed their symptoms were due to a serious, undetected illness, despite medical reassurance to the contrary

• health anxiety-illness anxiety disorder

illness anxiety disorder

somatic symptom disorder categorized by high levels of anxiety or concerns about having a serious illness even though physical symptoms are either absent or minor

• fear of what symptoms mean

subtypes of illness anxiety disorder

care-avoidant:

• postpone or avoid medical visits or lab tests due to high levels of anxiety about what may be discovered

care-seeking:

• doctor shopping

• become angry at doctors who try to convince them their fears are unwarranted

conversion disorder

characterized by symptoms or deficits that affect ability to control voluntary movement or impair sensory functions

conversion disorder features

• inconsistent or incompatible with known medical conditions or diseases

• conversion or transformation of emotional distress into significant symptoms in the motor or sensory domains

• named from psychodynamic belief that represents conversion of repressed sexual or aggressive energies into physical symptoms

  • formally called hysteria or hysterical neurosis

• symptom patterns can take form of paralysis, epilepsy, problems in coordination, blindness, loss of sense of hearing or smell, loss of feeling in limb

• la belle indifference: remarkable indifference to their symptoms

factitious disorder

fake or manufacture physical or psychological symptoms

• sometimes take medication or injure themselves to have symptoms

• symptoms don’t bring obvious gain

• not the same as malingering

malingering

faking illness to avoid work or duty

subtypes of factitious disorder

factitious disorder on self

• muchausen syndrome

  • form of feigned illness in which a person either fakes being ill or makes themself ill

factitious disorder on another

• muchausen sydrome by proxy

  • intentionally falsify or induce physical or emotional illness or injury in another person → typically child

koro syndrome

characterizes people who fear that their genitals are shrinking or retracting into their bodies which will result in death

koro syndrome features

• primarily found in china and southeast asian cultures

• mainly found in young men

• includes episodes of acute anxiety

• physiological symptoms: sweating, breathlessness, heart palpitations

• may use mechanical devices such as chopsticks to try to prevent retraction

• pass with time

dhat syndrome

excessive fears over the loss of seminal fluid in nocturnal emissions, in urine or masturbation

• found in India

• semen is viewed to be a vital body fluid; elixir of life

hippocrates perspectives of somatic symptoms and related disorders

Hippocrates: termed the word hysteria

• attributed the strange bodily symptoms to a wandering uterus resulting in internal chaos

• prescribed marriage as a cure

psychodynamic theory of SSRD

• believed hysteria was rooted in psychological rather than physical causes → lead freud to develop theory of unconscious mind

• left over emotion is converted into physical symptoms

• does not explain how energies left over from unconscious conflicts become transformed into physical symtpoms

• hysterical symptoms are functional

  • allows person to achieve primary and secondary gains

    primary gain:

  • allow an individual to keep internal conflicts repressed

  • aware of physical symptom but not of the conflict it represents

secondary gains

• allow individuals to avoid burdensome responsibilities and gain

support from those around them

learning theory of SSRD

• people with somatic symptom disorders also carry benefits or reinforcing properties of the sick role

• people with disorders may be relieved of chores and responsibilities

• women in western culture are more likely to be socialized to cope with stress by enacting a sick role

cognitive theory of SSRD

• type of self handicapping → way of blaming poor performance on failing health

• focuses on the role of distorted thinking

• tend to exaggerate the significance of minor physical complaints

• misinterpret benign symptoms which creates anxiety

brain dysfunction of SSRD

may involve disconnect or impairment to the neural connections between parts of the brain that control certain functions and other parts involved in regulating anxiety

treatment of SSRD

Behavior approach

• removes sources of secondary reinforcement that may be connected with physical complaints

• reinforces depended and complaining behaviors

• may teach family members to reward attempts to assume responsibility and ignore nagging or complaining

CBT

• challenges and corrects distorted beliefs and help replace exaggerated illness related beliefs with rational alternatives

• best treatment option

psychosomatic disorders

psychological factors contribute to physical disorders (headaches, asthma)

tension headache

• stress can lead to contractions of muscles of scalp, face, neck, and shoulders

• develop gradually and is dull, steady pain on both sides of head, feelings of pressure or tightness

migranes

• piercing or throbbing sensations on one side of head or centerned behind an eye

• can be intolerable

• aura: cluster of warning sensations

  • perceptual distorions: flashing lights, bizarre images, blind spots

• leads to disturbances of sleep, mood, thinking processes

theoretical perspectives on headaches

tension headaches: increased sensitivity of neural pathways that send pain signals to brain from face and head

migraines: involve underlying central nervous symptom disorder involving nerves and blood vessels in brain

serotonin: falling levels may cause blood vessels in the brain to contract then dilate → stimulates sensitized nerve endings giving throbbing sensations with migraines

factors that trigger headache attack

• emotional stress

• stimuli (bright lights)

• menstration

• sleep deprivation

• altitude

• weather or seasonal change

• drugs

• monosodium glutamate

• alcohol

• hunger

treatments to headache

• pain relievers : aspirin, ibuprofen

• biofeedback training (BFT)

  • helps people gain control over various bodily functions such as muscle tension and brain waves by giving them information about these functions in form of auditory signals or visual displays

  • learn to make the signal change in desired direction

• EMG (electromyographic biofeedback)

  • involves relaying info about muscle tension in forehead

• thermal BFT

  • modifies patterns of blood flow to help control migraines

cardiovascular disease

heart or artery disease

coronary heart disease

major form of cardiovascular disease → leading cause of death for both men and women

• flow of blood to heart is insufficent to meet the hearts needs

• arteriosclerosis: hardening of arteries — makes artery walls become thicker, harder, and makes blood flow more difficult

• atherosclerosis: underlying cause of ^ involving buildup of fatty deposits along artery walls which leads to artery clogging plaque

how can we lower risk of HD

adopting healthier behaviors

• stopping smoking, overeating, heavy drinking, consuming high fat diet, leading a sedentary lifestyle

negative emotions of HD

• frequent emotional distress may have damaging effects on cardiovascular system

• chronic anger

  • linked to increased risk of coronary heart disease

• Type A behavior pattern

  • characterizes people who are hard driving, ambitious, impatient and highly competitive

  • higher risk of CHD

• stress of hormones

  • epinephrine and norepinephrine

  • adrenal glands

  • increase heart rate, breathing rate, and blood pressure

  • can damage heart and blood vessels

• episodes of acute anger can trigger heart attacks with people with established heart disease

• depression

  • places additional stress on the body

factors of HD cont

• social environmental stress

  • factors such as overtime work, exposure to conflicting demands, assembly line labor — linked to CHD

• ethnicity and CHD

  • european americans and african americans have highest rates of death due to CHD

  • racial issues → african americans do not receive as well quality care as whites

asthma

respiratory disorder in which main tubes of windpipe— the bronchi— constrict and become inflamed and large amounts of mucus are secreted

features of asthma

• may feel like suffocating

• effects about 26 million people

• can last from a few minutes to several hours and vary in intensity

theoretical perspectives of asthma

• causal factors

• allergic reactions, exposure to environmental pollutants, and genetic and immunological factors

• stress, anxiety and depression

treatment of asthma

• reduction of exposure to allergens

• desensitization therapy (allergy shots)

• inhalers or drugs ( help bronchial passages during asthma attacks

• antiinflammatories

• behavioral techniques help develop breathing and relaxation skills to improve breathing

cancer

involves development of aberrant, or mutant cells that form growths (tumors) that spread to healthy tissue

causes of cancer

• genetic factors

• exposure to cancer causing chemicals

• exposure to some viruses

• unhealthy habits

• smoking, high fat intake, excess body weight, alcohol consumption, not exercising, and sun exposure

stress and cancer

• weakened immune system may increase susceptibility to cancer

• psychological counseling and group support programs can improve the quality of life of patients and help them cope with serious emotional consequences of cancer

• avoidant type of coping → more likely to become depressed

• pairing relaxation, pleasant imagery, and attention distraction can help reduce nausea associated with chemotherapy

acquired immunodeficiency syndrome

AIDS

• caused by HIV (human immunodeficiency virus)

• attacks the immune system, leaving it helpless to fend off diseases it normally would hold in check

how hiv is stransmitted

• sexual contact

• direct infusion of contaminated blood

• accidental pricks from needles used previously on infected person

• infected mother to child during pregnancy, childbirth, or through breast feeding

adjustment of people with HIV and AIDS + coping skills

• because of the nature of the diseases, many people develop psychological problems — most commonly anxiety and depression

• coping skills

  • CBT can improve body’s immune response, reduce anxiety and depression, enhance self care behaviors and ability to handle stress, and improve quality of life

treatment of HIV and AIDS

• stress management techniques

  • relaxation training

  • positive mental imagery

• cognitive strategies to control intrusive negative thoughts

  • antidepressant medication

• psychological interventions to reduce risky behaviors

  • spreading awareness of unsafe sexual and injection behaviors