Chapter 7: Somatic Symptom and Dissociative Disorders Flashcards

Question

According to twin studies, health anxiety is mostly learned due to ---------.

Answer 1

environmental factors. *health anxiety has been shown to be moderately heritable, but mostly due to environment.

Answer 2

* A critical precipitating incident * A previous experience of illness and related medical factors * The presence of inflexible or negative cognitive assumptions * The severity of anxiety

Answer 3

Health anxiety will **increase** with increases in (1) the perceived likelihood or probability of illness (2) the perceived costs/burdens of illness. Health anxiety will **decrease** with greater (1) perceived ability to cope (2) the perceived presence/effectiveness of medical help.

Answer 4

True. ## Footnote *conversion disorder used to be called or known as hysteria (where it only applied to women)

Answer 5

A loss or impairment of sensations Occurs within conversion disorders

Answer 6

Aphonia = loss of the voice or all whispered speach Anosmia = loss or impairment of sense of smell

Answer 7

Functional neurological symptom disorder.

Answer 8

A rare syndrome where the individual experiences little or no sensation in the part of the hand that would be covered by a glove.

Answer 9

Less than 1%. More women than men are given the diagnoses Often occurs with mood and anxiety disorders Often history of physical or sexual abuse

Answer 10

Carpal tunnel syndrome (where nerves in the wrist become swollen) ## Footnote Many other conversion disorders can be misdiagnosed and actually be true physical problems (but rate is declining)

Answer 11

STRESS In this cases, it was due to the military.

Answer 12

Conversion disorder Also dissociative disorders were considered "hysterical states"

Answer 13

physical/medical cause. Characterized by frequent complaints from all over the body, presented in a dramatic fashion.

Answer 14

1. Requires the presence of only ONE physical symptom for diagnosis (compared to requireing thirteen in DSM-III to have a somatization disorder) 2. Requires presence of it least ONE psychological feature (ex. health anxiety, repetative thoughts, etc.) As a result of DSM-5 changes, the prevelance of somatic symptom disorders is increasing!

Answer 15

Bias for information that involves physical threat (hyper vigilant) More sensitive to physical sensations in general

Answer 16

Unrealistic anxiety about bodily systems.

Answer 17

Hypothesis that illness behaviors might be learned in response to exposure to parental illness and health anxiety in childhood. Example Study: mother’s with somatization had children who expressed more health and safety needs during play than other children.

Answer 18

Claims that REPRESSED impulses are converted to physical symptoms. Frued proposed tha conversion disorders occur when a person expereinces great emotional arousal from event and the memory of that event dispears from concious expereince

Answer 19

Unresolved Electra complex. (repressed sexual attachment to father)

Answer 20

1. Perceptual representations are blocked from awareness. 2. Information is still extracted from perceptual representations. Explains that hyserically blind people CAN see, but do not know they can see (due to issues in cerebral cortex), making it possible to be truthful in saying they cannot see but provide evidence that they can.

Answer 21

Individuals consciousily and deliberatily adoption of the symptoms as a way of obtaining a desired goal Person behaves how the person with that disease they are expereincing would act.

Answer 22

* Experience with the role (similar physical problems or witnessed them) * Enactment of the sick role is (by reducing stress or other positive consequences)

Answer 23

NO - studies on hysterical blindness do not support this (the person is not "acting" because they demonstrated that they could actually see, which you would not do if it was an act)

Answer 24

They view it as indicating that the illness is just 'in their head' and is quite offensive because they genuinely feel pain.

Answer 25

More common among lower socio-economic status and rural populations. Also more common in women.

Answer 26

There has been a large decrease in prevelence! Some think this is because conversion disorder was so high in 19th century due to repressive sexual attitudes of the time (and there is now lessened anxiety around sexual desires today) Others think it is because the increase in knowledge about medical diseases over time has decreaseed conversion disorder occurance

Answer 27

Symptoms are more likely to occur on the left side of the body. *based on evidence of this - we know it is possible to distinguish actual conversion disorder from faking.

Answer 28

Found that stimulating a numb hand/foot did NOT activate the somatosensory region of the brain. But stimulating each client’s other hand/food that was not numb DID result in activation of the somatosensory region. ## Footnote This acts as evidence for how the brain structure works with conversion disorder

Answer 29

Risk factors (ex. family and socio-cultural factors, cognitive impairment, PTSD) perpetuating factors (ex. impaired emotional processing, supression of expressing distress) triggering events (ex. abuse or life stress) ## Footnote Developed specifically for conversion disorder but can serve to be useful for other somatoform disorders

Answer 30

Daydreaming, viewing oneself from outside the body, engaging in a personal narrative ## Footnote These experiences can occur without significant impairment and are not maladaptive.

Answer 31

1. Dissociative Amnesia 2. Depersonalization/Derealization Disoder 3. Dissociative identity Disorder 4. Other specificed dissociative disorder (ex. dissociative trance - insensitivity to environmental cues)

Answer 32

Majority of people report a few dissociative experiences; but very few report many of them. ## Footnote Most people never experience the most pathological items. (only about 3.3% of the study sample had those items)

Answer 33

* Ignoring pain * Missing part of a conversation * Uncertainty about actions or thoughts ## Footnote These experiences are often not indicative of a disorder.

Answer 34

Stress, fatigue, binge drinking, or use of psychoactive drugs

Answer 35

A dissociative disorder where a person cannot recall important personal information Information is not lost forever (but it cannot be retrived during an episode of amnesia) ## Footnote This cannot be explained by ordinary forgetfulness.

Answer 36

Following a traumatic experience (very rarely does amnesia occur for long periods of time or thoughout the person's life) ## Footnote Examples include witnessing death or being sexually assaulted.

Answer 37

Very rarely An episode can last however for several hours to several years, and usually disappears as suddenly as it came on, with complete recovery and low chance of reoccurance.

Answer 38

No they cannot But they are still able to talk, read, and retain talents and knowledge previously aquired ## Footnote Ex. Dory in finding Nemo accurately protrays "short-term memory loss", a symptom consistent with amnesia.

Answer 39

A disorder where a person experiences total amnesia and establishes a new identity Memory loss is more extensive, making it a specifier of dissociative amnesia. ## Footnote No longer considered a DSM-5 disorder and is now **considered a subtype of dissociative amnesia.**

Answer 40

- reduced glucose utlization in the right inferolateral predrontal cortex (likely associated with hypometabolism in this brain region)

Answer 41

A dissociative disorder where individuals feel unreal and estranged from themselves and surroundings ## Footnote It disrupts functioning but does not involve memory disturbances.

Answer 42

It varies but does usually occur. The person does not recollect at all what happened during their fugue.

Answer 43

Usually stress (same for most other dissociative disordes) | Similar episodes can occur in other disordes (PTSD, BPD, schizophrenia) ## Footnote People may feel as if they are outside their bodies or mechanical (move through the world lost in reality)

Answer 44

A dissociative disorder in which the individual feels unreal and estranged from the self and surroundings enough to disrupt functioning. People with this disorder may feel that their extremities have changed in size or that they are watching themselves from a distance. It involves no disturbances of memory! (makes it controversial to be included as a dissociative disorder)

Answer 45

depersonalization/derealization disorder They instead just feel that they are unreal from the self and surroundings

Answer 46

Included **derealization**, the loss of the sense that surroundings are real derealization = "The world does not feel real" (everything seems fake/dreamlike) depersonalization = "I do not feel real" (watching themselves from a distance)

Answer 47

It is often associated with traumatic events, particularly sexual abuse ## Footnote Individuals may report feelings of detachment and isolation.

Answer 48

a person has at least two separate ego states or alters (different modes of being and feeling and acting) that exist independently of each other and that come in control at different times. ## Footnote Alters can have different memories, behaviors, and identities. There is typically one primary personality (where treatment is sought by the primary alter)

Answer 49

They are usually very different from each other!! Ex. have very different physical characterisics like glasses with different perscriptions, allergies to different things, and often have different ages ## Footnote It vaires on the person if they have awareness of their other identities or not (some can switch right away and have no memory, while other people can hear the voices in their head of the other alters while they are their primary alter)

Answer 50

Begins in childhood; diagnosed most commonly in adulthood ## Footnote Diagnosis is more prevalent in women.

Answer 51

They do not - gaps in memory always occur because it least 1 alter has no contact with the others (Alter A has no memory of Alter B or even any knowledge of having an alternative state) The original and subordinate alters are all aware of lost periods of time → and the voices of other alters may arise in consciousness, but the person does not know who these voices are.

Answer 52

* Substance abuse * Headaches * Phobias * Hallucinations * Suicide ideation/attempts * Sexual dysfunction ## Footnote These symptoms often overlap with dissociative symptoms.

Answer 53

Attachment-related trauma in childhood is linked to symptoms of dissociation.

Answer 54

They are frequently mislabeled as schizophrenia

Answer 55

Concerns about scientific validity and diagnostic legitimacy of DID ## Footnote **Psychoanalytically oriented psychiatrists are MORE accepting of DID than biologically oriented psychiatrists!!!**

Answer 56

The book and movie created an outrage that DID is retained in DSM-5, viewed DID as unscientific Some critics feel this movie caused therapists to strongly suggest to clients that they have DID (huge problem). ## Footnote 'Sybil' presented a dramatic case with 16 personalities.

Answer 57

Studies declined (unlike other disorders) until 1970s which caused the claim that dissociative disorders do not have widespread acceptance and there was not many diagonses Re-emergence of DID in the past 30 years do to either: - DSM-3 outlining diagnosic criteria for DID for the first time - OR clinicians always noticed DID but did not report them until interest in DID grew

Answer 58

Likely due to the popularity of schizophrenia - where people with DID would get diagnosed with this instead (even though the disorders are not very similar)

Answer 59

Initially thought to be 1 in 1 million, researchers in one study suggest to be about 1 in 100 people!

Answer 60

That those students had greater physical and psychological maltreatment from parents, greater psychopathology, and lower university adjustment. *only two students in this study deemed to have another diagnosable disorder, but neither of them met the threshold for dissociative disorder.

Answer 61

Comes from Pierre Janet (a french neurologist) Early idea is that consciousness is usually a unified experience, but under stress, memories of trauma may be stored in a way to not be accessible when the person returns to their normal state (where amnesia or fugue is possible). (the behavioural view is similar to this as it thinks dissociation is an avoidance response from trauamtic events!)

Answer 62

Assumes DID begins in childhood due to severe physical or sexual abuse (or other forms of distress) and leads to dissociation as a response to distress. Person cannot handle the truama so they engage in dissociation ## Footnote Lots of evidence that this model is accurate!!

Answer 63

Assumes people who develop DID are very prone to engage in fantasy. ## Footnote Less evidence for this model

Answer 64

14 cases of DID were found in a sample of 150 convicted murderers, with many having symptoms before incarceration and documentation of childhood abuse present in 11 cases. Ex. several participants showed different hand writing styles well before committing their crimes. ## Footnote Acts as evidence for the truama model of dissociation (that DID begins in childhood and related to extreme stress)

Answer 65

Challenged the validity of DID as a distinct psychiatric disorder, advocating **it as a socially constructed form of role-playing (learned social roles)** Essentiallt thought it DID is not real.

Answer 66

(1) He was a leading advocate of the idea that DID basically involves a socially constructed form of role-playing. (2) Used role-playing studies with students to provide a perspective on the trial of a serial murderer known as the Hillside Strangler.**(revealed that people are able to adopt a second personality - and that role-playing of DID is possible).** (3) His research on people who reported seeing UFOs are caused by congitive constructions and false memories

Answer 67

Lots of debate if these recovered memories are valid for court cases Lots of research reveals that recovered memories are very valid and align with how memory works But... Canada is the first coutnry in English common law to impose a total ban on post-hyptotic evidence (inclusing those of CSA) Might be problematic as dissociation is linked to the forgetting of truamatic information from one's past.

Answer 68

**Psychoanalytic approach** is the most common choice of treatment. This is because dissociative disorders indicate having repressed portions of their life likely due to stress and truama ## Footnote Therapies for PTSD are also used for dissociative disorders (large overlap in these diagnoses)

Answer 69

schizophrenia

Answer 70

Used to help clients gain access to hidden portions of their personality lost due to trauma. Idea is to enter a state of mind to events in their childhood (a technique called **age regression**)

Chapter 7: Somatic Symptom and Dissociative Disorders Flashcards

(94 cards)