Chapter 6 Flashcards
(48 cards)
1
Q
WHAT ARE DISSOCIATIVE DISORDERS?
A
In the dissociative disorders, one or more of these aspects of daily living is disturbed:
- Your unity to consciousness that gives rise to a sense of self.
- Your perception that you are progressing through space & time.
Therefore, it is a disorder characterized by disruption, or dissociation, of identity, memory, or consciousness.
2
Q
WHAT ARE SOMATOFORM DISORDERS?
A
Somatoform disorders involve physical complaints that reflect underlying psychological conflicts or issues.
3
Q
3 major dissociative disorders
A
dissociative identity disorder, dissociative amnesia, dissociative few and depersonalization/ derealization disorder
4
Q
Dissociative identity disorder
A
- A dissociative disorder in which a person has two or more distinct, or alter, personalities.
- Two or more personalities, each with well-defined traits and memories, “occupy” one person.
- Ex. The Three Faces of Eve
5
Q
Features of DID
A
- One of the personalities is identified as the “host” while subsequent ones are identified as “alters” and you have to go through the host to get to the different alters
- In some cases, the host (main) personality is unaware of the existence of the other identities, whereas the other identities are aware of the existence of the host.
- In other cases, the different personalities are completely unaware of one another.
- Sometimes the personalities vie for control of the person.
6
Q
Models that see DID as legitimate
A
Trauma model - Suggests that DID linked with a history of trauma
7
Q
Models that see DID as not legitimate
A
Socio-cognitive model
- Form of role-playing where individuals come to see themselves as possessing multiple personalities
- Then act in ways consistent with their own idea of the disorder (or the therapist’s idea)
- Believe this because DID is diagnosed usually in adults and almost never observed in children but childhood trauma/abuse is reported retrospectively by adults
Iatrogenic
- Largely caused by treatment
- Therapists plant suggestions of DID
- Symptoms become developed in a learned social role
8
Q
Dissociative amnesia
A
- A dissociative disorder in which a person experiences memory loss without any identifiable organic cause
- Memory loss in dissociative amnesia is reversible, although it may last for days, weeks, or even years.
9
Q
Malingering
A
Faking illness so as to avoid or escape work or other duties, or to obtain benefits.
10
Q
Dissociative amnesia is divided into five distinct types of memory problems:
A
- Localized amnesia
- a particular event and time period
- Selective amnesia
- spotty remembering
- Generalized amnesia
- Everything from the past is gone, remember nothing
- Continuous amnesia
- From a certain time point on nothing is remembered
- Systematized amnesia
- loss of memory of specific information
11
Q
Dissociative Fugue
A
- A rare subtype of dissociative amnesia characterized by fugue, or “amnesia on the run.”
- People in a fugue state may suddenly flee from their life situations, travel to a new location, assume a new identity, and have amnesia for personal information.
- The person usually retains skills and other abilities and may appear to others in the new environment to be leading a normal life.
- Subtype of Dissociative Amnesia in DSM 5
12
Q
Depersonalization/derealization disorder
A
A disorder characterized by persistent or recurrent episodes of depersonalization and/or derealization.
13
Q
Depersonalization
A
A temporary loss or change in the usual sense of reality in which people feel detached from themselves and their surroundings
14
Q
Derealization
A
A sense of unreality about the external world involving odd changes in the perception of one’s surroundings or in the passage of time.
15
Q
Psychodynamic views of dissociative disorders
A
dissociative disorders involve the massive use of repression, resulting in the “splitting off” from consciousness of unacceptable impulses and painful memories.
In dissociative amnesia and fugue, the ego protects itself from anxiety by blotting out disturbing memories or by dissociating threatening impulses of a sexual or aggressive nature
16
Q
social-cognitive theory on dissociative disorders
A
- conceptualizes dissociative amnesia or dissociative fugue as a learned response involving the behavior of psychologically distancing oneself from disturbing memories or emotions.
- Nicholas Spanos believed that dissociative identity disorder is a form of role-playing acquired through observational learning and reinforcement
17
Q
Dissociative disorders and the brain
A
- preliminary evidence shows structural differences in brain areas involved in memory and emotion between patients with dissociative identity disorder (DID) and healthy controls.
- another study showed differences in brain metabolic activity between people with depersonalization disorder and healthy subjects
18
Q
Treatment of dissociative disorders
A
- dissociative amnesia and fugue are usually fleeting experiences that end abruptly.
- treating the anxiety or depression connected with the depersonalization will treat the depersonalization.
- integrate the alter personalities into a cohesive personality structure
- work through memories of early childhood trauma
19
Q
Medications for dissociative disorders
A
Not generally useful
SSRIs somewhat effective (if there is also depression)
Truth serum (sodium amytal) – may help bring out memories
20
Q
Cognitive-behavioral therapy and dissociative disorders
A
- Used to work on misinterpretation of normal symptoms of fatigue, stress, or even substance abuse
- Challenge misinterpretations by teaching individuals to explore alternative explanations, and “cognitive restructuring”
- Exposure therapy to face fears
21
Q
Psychoanalysis and dissociative disorders
A
Resolving emotional stress from past traumas
22
Q
Assessment of Somatoform Disorders
A
Must be no physiological cause for the symptoms
Must not be the product of purposeful faking
And psychological factors must be perceived to play a role
23
Q
Factitious disorders (aka Munchausen syndrome)
A
– Deliberately fake or generate symptoms of illness to gain medical attention and positives of adopting the sick role. Ex. take pills that make you sick for the positive social outcomes
24
Q
Factitious disorder imposed on another (aka Münchausen syndrome by proxy)
A
– The inducing of physical or emotional illness in another person, typically a child or dependent person.
25
Features of Somatoform Disorders
- Starts before age 30
- Develops over time
- Moves from body part to body part
- Involves multiple organ systems
- At least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms
- Persistently high level of anxiety about health concerns
- Excessive time and energy devoted to these symptoms or health concerns
26
Pain Disorder
Involves pain lasting beyond expected time span and when physical pathology can’t be identified, it helps to consider psychological factors
27
Pain Disorder diagnosis
- Must be complaints of pain in one or more bodily sites serious enough to warrant clinical attention
- Pain causes significant distress or disruption to life
- Psychological factors judged to have an important role in the onset, exacerbation, severity, or maintenance of the pain
- Pain disorder associated with risk of becoming dependent on pain medication
28
Hypochondriasis
- Long-standing fears about having a serious, undetected illness despite medical reassurance to the contrary.
- Preoccupation with fears of having an illness reflects misinterpretation of bodily symptoms or functions
- Often arises out of excessive sensitivity to minor symptoms
- Able to recognize that they may be exaggerating the extent of the disease or that it may not exist at all but are not faking it – similar to OCD in this way
- equally common in men and women
29
Difference between Panic Disorder and Hypochondriasis
PD – Short-term concerns
| HC – Long-term concerns
30
Conversion disorder
- characterized by symptoms or deficits that affect the ability to control voluntary movements or that impair sensory functions, such as an inability to see, hear, or feel tactile stimulation.
- Loss of functioning in some part of the body
- Believed to involve the conversion or transformation of emotional distress into significant symptoms in the motor or sensory domain.
- Physical symptoms usually come on suddenly in stressful situations, suggesting a psychological connection.
- Must be careful to ensure that a genuine medical condition isn’t misdiagnosed as CD
31
Glove anaesthesia
Loss of all sensation throughout the hand with loss cut off at wrist
32
La belle indifference
Nonchalant lack of concern
| Only found in a minority of cases and isn’t reliable for diagnoses
33
Changes from DSM-IV-TR to DSM 5 for Somatoform Disorders
- ‘Somatoform Disorders’ now called ‘Somatic Symptom and Related Disorders’
- Somatic Symptom Disorder (SSD) involves one or more somatic symptoms that are distressing and/or cause disruption to daily life; excessive thoughts, feelings, and behaviors related to these symptoms
- SSD encompasses somatization disorder, pain disorder, and those with hypochondriasis who have significant somatic symptoms
- Body Dysmorphic Disorder moved to group of ‘Obsessive-Compulsive and Related Disorders’
34
Illness anxiety disorder (IAD)
- applies to a subgroup of people with hypochondriasis who have no bodily symptoms but have excessive preoccupation about becoming ill
- the emphasis is placed on the anxiety associated with illness rather than the distress the symptoms cause.
- 2 general subtypes of the disorder are the care-avoidant subtype (don’t seek care) and the care-seeking subtype (do seek care).
35
Koro syndrome
A culture-bound somatoform disorder, found primarily in China, in which people fear that their genitals are shrinking
36
Dhat syndrome
A culture-bound somatoform disorder, found primarily among Asian Indian males, characterized by excessive fears over the loss of seminal fluid
37
Historical Theoretical Perspectives on Somatoform Disorders
Hippocrates attributed the strange bodily symptoms to a “wandering uterus” creating internal chaos.
He noticed that these complaints were less common among married than unmarried women.
He prescribed marriage as a “cure” on the basis of these observations and also on the theoretical assumption that pregnancy would satisfy uterine needs and fix the organ in place
38
Psychodynamic theory on somatoform disorders
somatic symptoms are functional in that they allow the person to achieve primary gains and secondary gains.
The primary gain of the symptoms is to allow the individual to keep internal conflicts repressed.
Secondary gains from the symptoms are those that allow the individual to avoid burdensome responsibilities and to gain the support—rather than condemnation—of those around them.
39
Learning theorists on somatoform disorders
- focus on the more direct reinforcing properties of the symptom and its secondary role in helping the individual avoid or escape anxiety-evoking situations
- the symptoms in conversion and other somatoform disorders may also carry the benefits, or reinforcing properties, of the “sick role”
- some link hypochondriasis and body dysmorphic disorder to obsessive–compulsive disorder
40
Cognitive theory on somatoform disorders
- Somatic amplification– interpret bodily sensations in a more intense, noxious, and disturbing manner
- Speculation that some cases of hypochondriasis may represent a type of self-handicapping strategy, a way of blaming poor performance on failing health.
- Hypochondriasis and panic disorder may share a common cause: a distorted way of thinking that leads the person to misinterpret minor changes in bodily sensations as signs of pending catastrophe
41
Physiological factors on somatoform disorders
- chronic stress produces activation of HPA axis that leads to high levels of cortisol being produced which can negatively affect the immune system and produce feelings of fatigue, pain, malaise which can help lead individuals to perceiving themselves as having an illness rather than stress
42
Psychoanalysis and somatoform disorders
- began with the treatment of hysteria
- treatment now has moved away from psychoanalytic treatment
- seeks to uncover and bring unconscious conflicts that originated in childhood into conscious awareness
- once the conflict is aired and worked through, the symptom is no longer needed and should disappear
43
Cognitive theory and somatoform disorders
Cognitive restructuring to modify dysfunctional thoughts, interpretations, and preoccupations
44
Behavioural theory and somatoform disorders
Increase enjoyable activities and social interaction
Remove sources of secondary reinforcement
Engage in relaxation techniques
45
Current treatments for somatoform disorders
- focus on the cognitive, affective, and social processes that maintain the disorders
- key to establish a co-operative therapeutic environment
- remember, the subjective experience is real
- important to also treat comorbid anxiety and depression
46
Why may many with somatoform disorders not seek treatment?
- People might think they are faking
- Liable to seek advice from many
- To accept that it is in your head is hard to take
- Continue to seek medical treatment rather than psychological treatment
47
Freud's primary and secondary gains of conversion disorder
Primary gains: conversing anxiety to physical symptoms allows one to avoid unconscious psychological conflicts
Secondary gain: hysterical symptoms allow the person to gain attention or avoid work
48
Online test questions
Discuss the difference in the clinical picture of dissociative disorders and somatoform disorders.
Discuss the treatment process generally used for the treatment of somatoform disorders.
One model of the cause of DID is that it is iatrogenic. Discuss this possibility.
Compare the concepts of repressed memory and false memory.
Describe, in terms of symptoms, the following somatoform disorders: hypochondriasis, somatization disorder, pain disorder, conversion disorder, and body dysmorphic disorder.
Discuss the scientific evidence that supports the theory that DID is a form of role playing. This theory is associated with the work of Nick Spanos.
Discuss the issues and questions with regard to a model of the cause of somatoform disorders.
