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1

Dissociative Disorder (3)

A disorder with disruption, dissociation of identity, memory, or consciousness. Includes dissociative identity disorder, dissociative amnesia, and depersonalization/derealization.

2

Dissociative Identity Disorder
- prevalence

Two or more distinct or alter personalities with distinct traits, mannerisms, style of speech. Clusters of alter personalities serve as a microcosm of conflicting urges and cultural themes. Themes of sexual ambivalence and orientation common. Alternates result of conflicting internal impulses that cannont coexist.
- previously called multiple personality disorder
- more common in women
- more common in N America

3

Controversy of DID

Since 1970 cases have increased. Nick Spanos believes not a true disorder but role-playing; becomes so ingrained that it becomes a reality. Role maintained thru social reinforcement.
- Social reinforcement model may explain why so many clinicians discover DID. They may cue clients to enact DID.

4

Dissociative Amnesia

Most common type of Dissociative disorder; Loss of memory without organic cause; unable to recall personal info especially traumatic events. Memory loss is irreversible.
- formally called psychogenic amnesia
- five types of memory problems:
1. Localized- events during specific time period lost (most are this)
2. Selective- only disturbing parts forgotten
3. Generalized- forget entire life; very rare still retain habits/skills
4. Continuos- forget everything including present
5. Systematized - forget specific category of info

5

Malingering

Falsely claiming amnesia to escape responsibility; faking symptoms for personal gains. Not a DSM disorder

6

Fugue

"amnesia on run" a rare subtype of dissociative amnesia; may travel unexpectedly from home with purposeful wandering; may be unable to recall past personal info; may create new identity. Usually returns within few days or hours.

7

Depersonalization

temporary loss or change in usual sense of our own reality; feeling detached from self and surroundings; dreamlike

8

Derealization

sense of unreality about the external world involving odd changes in perception of ones surroundings or in the passage of time; ppl and objects may change size.

9

Depersonalization/Derealization Disorder
-prevalence
- cultural differences

dissociative disorder characterized by persistent or recurrent episodes of depersonalization and derealization. In both states you maintain contact with reality.
- Half adults have had one experience with either.
- may occur more in individualistic societies

10

Amock

Culture bound dissociative syndrome occurring in Asia; trancelike states where person is suddenly excited and violently attacks others

11

Zar

Culture bound dissociative syndrome in North Africa to describe spiritual possession; engaging in behavior like shouting and banging head.

12

Psychodynamic Theoretical perspective of Dissociative Disorders
- Dissociative disorders
- amnesia
- DID
- derealization

Psychodynamic view: Dissociative disorders involve use of repression resulting in splitting off from consciousness of unacceptable impulses like abuse; Dissociative amnesia may serve function of dissociating ones conscious self from awareness of traumatic experiences. In DID ppl may express imposes thru alters. In depersonalization ppl stand outside themselves sagely distanced from emotional turmoil within.

13

Social- cognitive Theoretical perspective of Dissociative Disorders

A learned response involving the behavior of psychologically distancing oneself from disturbing memories or emotions. The habit of splitting off from conscious is neg reinforced by relief from anxiety, guilt, or shame.
- Nick spans says DID is role playing thru observational learning and reinforcement.

14

Biological Theoretical perspective of Dissociative Disorders (4)

-Brain dysfunction evidenced shows structural diffs in areas for memory and emotion for DID patients.
-Diff in metabolic activity
-Dysfunction in parts involved in body perception
- Irregularity in brain sleep cycle; disruption in normal sleep cycle can lead to dream like experiences in waking state

15

Diathesis stress model of Dissociative disorders (2)

1. Few children who experience trauma or sexual abuse develop DID.
2. Those who are prone to fantasize, prone to hypnosis, more likely.
- these traits create predisposition for developing after trauma as a survival mechanism.

16

Treatments for Dissociative disorders (2)

1)Most of research on treating dissociative identity disorder focuses on integrating alters into personality structure by uncovering memories of early childhood trauma. Disclosure of abuse essential to therapy process. (out of of 20 ppl only 5 were reintegrated)
2)Lack of responsiveness to prozac with depersonalization/derealization so it may not be related to depression.

17

Somatic symptoms and related disorders
includes?
- % of doctor visits

persistent emotional or behavioral problems relating to physical symptoms; formally called somatoform disorders. Include: somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorder
- 20% of visits can not be explained to medical symptoms

18

Somatic symtom disorder
- diagnosis
- prevalence

Excessive concern about physical symptoms to extent that it effects thoughts, feelings, behaviors in daily life.
-Diagnosis: physical symptoms persistent lasting for 6 mos. or longer and assoc with distress.
- unknown but may affect 5 to 7%

19

Hypochondriasis
- Prevalence (2)

Used to be in DSM instead of somatic symptom disorder; Misinterpretations of symptoms as signs of series disease; core of hyponchondriasis is health anxiety (a preoccupation that ones physical symptoms are signs of serious health problem)
They don not fake symptoms; they feel real discomfort
- affects 1 to 5%
- about 5% of population seeking medical care affected

20

Illness anxiety disorder (2)
- prevalence

unduly high levels of anxiety about having a serious illness even though physical symptoms are absent or minor. Because of the mild symptoms SSD does not apply. Emphasis placed on anxiety assoc with illness rather than the distress of symptoms.
-Two subtypes
1. care avoidant- ppl who post pop med visits
2. Care seeking- jump from doc to doc
- in in 4 ppl with hypochondriasis

21

Conversion Disorder AKA?
- history
- prevalence

loss or impairment of physical function in absence of organic cause. AKA neurological symptom disorder) The impairment of voluntary movements or sensory functions. Believe to be caused by conversion of emotional distress into symptoms. Conversion symptoms mimic neurological or general medical conditions involving problems with voluntary motor or sensory functions thru: paralysis, epilepsy, blindness, loss of feeling in limb (ansesthia)
- formerly called hysteria neurosis
- Unknown but reported to be about 5%

22

La belle indifference

"the beautiful indifference" Some with conversion disorders show remarkable lack of concern with symptoms.

23

Factitious Disorder (2)

Intentional fabrication of psychological or physical symptoms for no apparent gain; faking symptoms by sometimes injuring selfs. No external reward so serves an underlying psychological need of playing sick role. Two subtypes:
1. factitious disorder on self (most common)
2. factitious disorder imposed on another

24

Munchausen syndrome
- rates

(factitious disorder imposed on self) fabrication of medical symptoms by faking or making illness for no gain. Named after Baron Karol Von Monchausen.
Munchausen syndrome by proxy (is factitious disorder imposed on another) induce physical or emotional illness on another.
- out of 451 cases by proxy 6% victims died and typically 4 years or younger; moms perpetrators 3 out of 4 times.

25

Koro syndrome

cultural bound somatic syndrome found in China; fear of genitals shrinking into body

26

Dhat syndrome

cultural bound somatic syndrome found in Asia; fear of loss of semen thru nocturnal emission; harmful because it depletes body of energy.

27

Psychodynamic theoretical perspective of conversion disorders
-2?

Was called hysteria in 19th century; Leftover emotion that is cut off from the threatening impulses becomes converted into physical symptoms like hysteria. Hysteria symptoms serve function of allowing person to achieve primary and secondary gains
primary- allows person to keep internal conflicts repressed; symptoms are symbolic of and provides partial solution to conflict (paralysis to arm so no masturbation)
secondary- allow person to avoid burdensome responsibilities and gain support of friends and family.

28

Conversion disorder history

Called hysteria; Hippocrates termed hystera to "wandering uterus" which created internal chaos. Hysteria complaints in single women; marriage was cure because pregnancy would satisfy organ.

29

Learning theory of somatic symptom disorders

Focus on direct reinforcing properties of the symptoms and its secondary role in helping person avoid anxious situations. Reinforcing properties arise from the sick role. Differences in learning experiences explain why women get it more than men: Western women socialized to cope with stress by playing sick role.

30

Cognitive perspective of somatic symptom disorders (3)

1)Hyponchondriasis can be a self-handicapping strategy for blaming poor performance on failing health
2) Cognitive distortions are exaggerating minor complaints
3) Misinterpretations of minor symptoms