PSYC3606 - Chapter 8: Dissociative and Somatic Symptom Disorders

psychopathology chapter eight dissociative and somatic symptom disorders flashcards

What is Hysteria?

an emotional condition marked by extreme excitability and bodily symptoms for which there is no medical explanation

• not a dsm-5 disorder

• hypnosis was used to treat hysteria

What is Dissociation?

separation of mental processes — such as perception, memory, and self-awareness

behaviour is normally integrated

• individual mental processes is not disturbed, but their normal integrated functioning is disturbed

What are Somatic Symptom Disorders?

characterized by complaints about physical well-being along with cognitive distortions about those bodily symptoms and their meaning: the focus on these bodily symptoms causes significant distress or impaired functioning

What are the main symptoms of Dissociative disorders?

• amnesia (memory loss, temporary — may be permanent)

• identity problems (a person who isn’t sure he or she is or may assume a new identity)

• derealization (external world perceived or experienced as strange or unreal — detached from the environment)

• depersonalization (perception or experience of self is altered to the point where the person feels like an observer)

What is the difference between Normal versus Abnormal Dissociation?

NORMAL: occasionally.
ABNORMAL: consciousness, memory, emotion, perception, body representation, motor control, or identity are associated to the point where the symptoms are pervasive, causing significant distress and interfering with daily function.

What is the case for most Dissociative Disorders?

cannot be explained by a medical disorder, substance use, or other disorders that have dissociation as a key symptom.

What is Dissociative Amnesia?

sufferer has significantly impaired memory for autobiographical information, important experiences or personal information.

What are the three subcategories of Dissociative Amnesia?

• localized: person has a memory gap for a specific period of time, often a period of time just prior to the stressful event.

  • THE MOST COMMON TYPE.

• selective: can only remember some of what happened in an otherwise forgotten period of time.

• generalized: person cannot remember his or her entire life.

  • THE RAREST TYPE.

What are the main symptoms of Dissociative Amnesia?

• inability to recall important autobiographical information, usually a traumatic or stressful nature, that is inconsistent with ordinary forgetting

• cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

• disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition

• disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major/mild neurocognitive disorder

What are the Social Factors for Dissociative Amnesia?

• caused by traumatic events (e.g., combat and abuse) are likely to contribute to dissociative disorders

• report childhood physical or sexual abuse almost 3x more often than people do with a dissociative disorder

What are the Psychological Factors for Dissociative Amnesia?

• dissociation theory posits that very strong emotions narrow the focus of attention and also disorganize the cognitive process — which prevents them from being integrated normally

  • poorly integrated cognitive processes allow memory to be dissociative from other aspects of cognitive functioning

• neo-dissociation theory proposes that an “executive monitoring system” normally coordinates various cognitive systems

  • in traumatic events, these cognitive systems can operate independently of the executive monitoring symptom

What are the Neurological Factors for Dissociative Amnesia?

• not much is known

• may result in part from damage to the hippocampus

  • prolonged stress effects the hippocampus so that it does not operate well when the person is highly aroused

  • hippocampal damage does not explain all cases of the disorder

• hormones may be contributing

  • cortisol can reduce the size of the hippocampus

What is Dissociative Fugue?

involves sudden, unplanned travel, and difficulty remembering the past, which can lead patients to be confused about who they are and sometimes take on a new identity

• episodic

• individual tends to function normally outside of this disorder

What are the neurological, psychological, and social factors that contribute to Dissociative Fugue?

• neurological: frontal lobe problems may underlie

  • reduced activation in the frontal lobes might be a result of high levels of stress-related hormones which could selectively affect processes involved in coordinating voluntary actions and mental events

• psychological: more hypnotizable

• social: in response to significant stressors that involve social factors

What is Depersonalization-Derealization Disorder?

persistent feeling of being detached from one’s mental processes, body, or surroundings.

• may have JUST depersonalization or derealization, OR have BOTH.

What are the main symptoms for Depersonalization-Derealization Disorder?

• presence of persistent or reccurent experiences of depersonalization, derealization, or both

• during the depersonalization or derealization experiences, reality testing remains in tact

• cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

• disturbance is not attributable to the physiological effects of a substance or another medication

• disturbance is not better explained by another mental disorder

What are the Social Factors for Depersonalization-Derealization Disorder?

severe and chronic emotional abuse experienced during childhood seems to play a role in triggering this disorder

What are the Psychological Factors for Depersonalization-Derealization Disorder?

patients with this disorder have cognitive deficits that range from problems with short-term memory to impaired spatial reasoning — root cause appears to be with attention

What are the Neurological Factors for Depersonalization-Derealization Disorder?

• have unusual (high or low) levels of activation in parts of the brain specifically involved with phases of perception

• lower activity in parts of the temporal lobe and higher activity in the parietal lobe

• do not produce normal amounts of norepinephrine

What is Dissociative Identity Disorder (DID)?

• once known as multiple personality disorder

• most controversial of all the dsm-5 disorders

presence of two or more distinct “personality states” (sometimes referred to as alters) or an experience of being “possessed,” which leads to a discontinuity in the person’s sense of self and ability to control his or her functioning

• can affect any aspect of functioning, including:

  • mood

  • behaviour

  • consciousness

  • memory

  • perception

  • thoughts

  • sensory-motor functioning

What are Alters?

• separate characteristics and history

  • take turns controlling the body’s behaviour

• each personality state can have unique medical problems and histories

  • allergies

  • medical conditions

  • or EEG patterns that other do not have

What are the main symptoms of Dissociative Identity Disorder?

• disruption of identity characterized by two or more distinct personalities — marked discontinuity in the sense of self and sense of agency, accompanied by related alterations in effect;

  • behaviour

  • consciousness

  • memory

  • perception

  • cognition

  • sensory-motor functioning

• recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

• clinically significant distress or impairment in social, occupational, or other important areas of functioning

• not a normal part of a broadly accepted cultural or religious practice

  • symptoms are not better explained by imaginary playmates or other fantasy play

• the symptoms are not attributable in the physiological effects of a substance, or another medical condition

What are the Social Factors for Dissociative Identity Disorder?

• posttraumatic model proposes that after frequent episodes of abuse with accompanying dissociation, the child’s dissociated state can develop its own memories, identities, etc.

What are the Psychological Factors for Dissociative Identity Disorder?

• easily hypnotized

What are the Neurological Factors for Dissociative Identity Disorder?

• neurological differences between alters paints a mixed picture

• memories acquired by one alter are not directly accessible to other alters

• inhibited from recalling stored information when a different alter is dominant

• each alter has a different sense of self

What are the main criticisms of Dissociative Identity Disorder?

• dsm-5 does not define the seperate “personality states”

  • criteria permit possibility that normal emotional fluctuations could be considered pethological

• did is often compaired to roleplay — difficult to distinguish from malingering

  • fake symptoms of a disorder

  • the validity of the disorder as a diagnostic entity can be questioned

• difficult to distinguish from rapid-cycling bipolar disorder because both involve sudden changes in mood and demeanour

What is the Posttraumatic Model?

proposes that after frequent episodes of abuse with accompanying dissociation, the child’s dissociated state can develop it’s own memories, identity, and way of interacting with the world, thereby becoming an “alter”

What is the Sociocognitive Model?

proposes that social interactions between therapist and patient (social factor) foster DID by influencing the beliefs and expectations of patients (psychological factor)

• the therapist unintentionally causes the patients to act in ways that are consistent with the symptoms of DID

What are neurological ways to treat Dissociative Disorders?

medication is NOT used for dissociative disorders, but sometimes medication IS used with comorbid disorders

What are psychological and social ways to treat Dissociative Disorders?

• reinterpreting the symptoms so that they don’t create stress or lead the patient to avoid certain situations

• learning additional coping strategies to manage stress

• for DID, addressing the presence of alters and dissociated aspects of their memories or identities

What are feedback loops in treating Dissociative Disorders?

• the “talking cure” — talking about relevant material in a hypnotic and then not in a hypnotic trance

• main treatment is hypnosis

  • creates neurological changes

  • alters brain events

  • can only work on willing patients

What are Somatic Symptoms Disorders?

complaints about physical well-being along with cognitive distortions about bodily symptoms and their meaning; the focus on these bodily symptoms causes significant distress or impaired functioning

• relatively rare

What must occur to be diagnosed with a Somatic Symptom Disorder?

• must be ruled out of all other medical conditions, especially factitious disorder: intentionally inducing symptoms or falsely reporting symptoms

What are the two common features of Somatic Symptom Disorders?

• bodily preoccupation: heightened awareness of panic-related bodily sensations experienced by people with panic disorder — except they can be preoccupied with any bodily functioning

• symptom amplification: directing attention to bodily symptoms intensifies the symptoms

Why is Body Dysmorphic Disorder (BDD) different from other somatic symptom disorders?

only somatic symptom disorder that does not include an actual somatic symptom

What is Somatic Symptom Disorder (SSD)?

is at least one somatic symptom that is distressing or distrupts daily life, which the person have excessive thoughts, feelings, or behaviours.

What are the main symptoms for Somatic Symptom Disorder?

• one or more somatic symptoms that are distressing or result in significant disruption of daily life

• excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated with health concerns as manifested by at least one of the following:

  • disproportionate and persistent thoughts about the seriousness of one’s symptoms

  • persistently high level of anxiety about health or symptoms

  • excessive time and energy devoted to these symptoms or health concerns

• although many one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

What are the Social Factors for Somatic Symptom Disorder?

• observational learning may play a factor

• operant conditioning may be at work

  • people reinforcing a person’s illness behaviour

• may be a way to express helplessness

What are the Psychological Factors for Somatic Symptom Disorder?

• involves bodily preoccupation and symptom amplificaiton

• catastrophic thinking

• attention focused on sensations

What are the Neurological Factors for Somatic Symptom Disorder?

• genetics, but not necessarily inherited

• temperamental

What is Conversion Disorder?

involves sensory or motor symptoms that are incompatible or inconsistent with known neurological or medical conditions

• sometimes referred to as functional neurological symptom disorder;

  • because the neurological symptom relates to the functioning of some aspect of the nervous system but not to the underlying medical cause of the symptom

What are the three main types of Conversion Disorder?

• motor symptoms: tremors that becomes worse when the person pays attention to them

  • tics or jerks

  • muscle spasms

  • swallowing problems

  • staggering

  • paralysis (pseudoparalysis)

• sensory symptoms:

  • blindness

  • double vision

  • deafness

  • auditory hallucinations

  • lack of feeling on the skin

• seizures: often referred to as nonepileptic seizures

What are the main symptoms of Conversion Disorder?

• one or more symptoms altered voluntary motor or sensory function

• clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions

• the symptom or deficit is not better explained by another medical or mental disorder

• symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning that warrants medical evaluation

What are the Social Factors for Conversion Disorder?

• combat may trigger a conversion disorder

• the greater severity or number of stressors, the more severe the conversion symptoms

What are the Psychological Factors for Conversion Disorder?

• no generally accepted explanation for how psychological factors might produce the selective bodily symptoms

• the theory that conversion disorder results from self-hypnosis is supported by finding those areas of the brain activated by hypnotically induced paralysis are similar to those activated by paralysis in patients with conversion disorder

What are the Neurological Factors for Conversion Disorder?

• neuroimaging findings suggest that muscle weakness arising from conversion disorder is not the same as consciously simulated muscle weakness

• chronic pain patients develop sensory deficits and have weakness and sometimes paralysis of a limb

• classified of having both conversion and pain disorder

• may run in families

What is Illness Anxiety Disorder?

a preoccupation with a fear or belief of having a serious disease in the face of either no or minor medical symptoms and excessive behaviours related to this belief.

Is Hypochondriasis in the DSM-5?

NO.

• diagnosed as either SSD or Illness Anxiety Disorder

What are the main symptoms of Illness Anxiety Disorder?

• preoccupation with having or acquiring a serious illness

• somatic symptoms are not present, or if present, are only mild in intensity. if another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate

• there is a high level of anxiety about health, and the individual is easily alarmed about personal health status

• the individual performs excessive health-related or exhibits maladaptive avoidance

• illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time

• the illness-related preoccupation is not better explained by another mental disorder

What are the differences between Illness Anxiety Disorder, Anxiety Disorders, or OCD?

• illness anxiety disorder, phobias, and panic disorders are all characterized by high levels of fear, as well as a faulty belief of harm or danger

  • illness anxiety disorder and panic disorder share the thought that perceived dance is from an internal event that is thought to be producing a bodily sensation

  • phobias are from an external object or a situation

• though they all try their best to avoid certain stimuli or situations

  • both ocd and illness anxiety disorder patients have obsessions and compulsions

    • these compulsions are however different

What are the Social Factors for Illness Anxiety Disorder?

likely to have experienced traumatic sexual contact, physical violence, or major familial upheaval

What are the Psychological Factors for Illness Anxiety Disorder?

• specifies the biases in their reasoning

  • evidence-seeking health threats

    • failing to consider evidence that such threats are minimal or nonexistent

  • focus on unpleasant sensations like a sore throat

  • engage in catastrophic thinking

What are the Neurological Factors for Illness Anxiety Disorder?

• serotonin may not be functioning properly in at least some cases of hypochondriasis

  • supported by the fact that SSRIs can improve the symptoms

• genetics contribute

• genetics account for about a third of the variation in bodily symptoms that are not clearly related to a medical disorder

How do we treat Somatic Symptom Disorders?

• neurological factors: not much research done

  • medications may work with some

    • ssri’s, anxiety, or antipsychotic medications

    • often comorbid with other disorders

  • bio-feedback

• psychological factors:

  • cognitive behavioural theory

    • identifying then modifying irrational thoughts and shifting attention away from the body and bodily symptoms

• social factors:

  • safe-space making

What is the best form of therapy for Somatic Symptom Disorders?

cognitive behavioural therapy (CBT)