Abnormal Psychology: Dissociative Disorders

• APSY-UE 1038 Abnormal Psychology covers Dissociative Disorders, Somatic Symptom and Related Disorders, and Psychological Factors Affecting Physical Health.
• The course is taught by Professor Kevin Goldwater at New York University on Mondays and Wednesdays at 238 Thompson St (GCASL) Room 275.

Exam 1 Recap

• The maximum score was 103.704%.
• The average score was 90.196%.
• The mode was 96.296%.
• The median score was 92.593%.
• The standard deviation was 8.932%.
• One question was dropped, and each student's score had (+1 added).

Dissociative Disorders

• Dissociative disorders involve changes, disturbances, or breakdowns in identity, memory, or consciousness
• These changes affect the ability to maintain an integrated sense of self.

Dissociative Identity Disorder

• Involves disruption of identity characterized by two or more distinct personality states
• These personality states may be described in some cultures as an experience of possession.
• The disruption in identity leads to a discontinuity in the sense of self and agency.
• This is accompanied by alterations in affect, behavior, consciousness, memory, perception, cognition, or sensory-motor functioning.
• Signs and symptoms may be observed by others or self-reported.
• There are recurrent gaps in the recall of everyday events, personal information, or traumatic events
• These gaps are inconsistent with ordinary forgetting.
• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is distinct from accepted cultural or religious practices.
• In children, the symptoms are not better explained by imaginary playmates or fantasy play.
• The symptoms are not attributable to the physiological effects of a substance or general medical condition.
• Fragmentation: The body divides traits and feelings into smaller sections, and groups them, while keeping some hidden until expression is safe
• Alters refer to separate identities.

Dissociative Amnesia

• Dissociative Amnesia involves inability to recall important autobiographical information, typically of a traumatic or stressful nature, beyond ordinary forgetting.
• Dissociative Amnesia often results in localized or selective amnesia for a specific event or it results in generalized amnesia for identity and life history.
• Symptoms cause clinically significant distress or impairment in functioning.
• The issue is not attributable to substance use, neurological, or other medical conditions.
• The symptoms aren't better explained by related disorders.
• F44.1 With dissociative fugue involves purposeful travel or bewildered wandering, as well as identity amnesia or amnesia for important autobiographical details.
• Localized subtype: Inability to recall events related to a period of time
• Selective subtype: Ability to remember some, but not all, events for a period of time
• Generalized subtype: Failure to recall one's entire life
• Continuous subtype: Failure to recall successive events
• Systematized subtype: Amnesia is categorized (e.g., family, one person)

Depersonalization/Derealization Disorder

• The disorder involves persistent or recurrent experiences of depersonalization, derealization, or both.
• Depersonalization: Experiencing unreality, detachment, or being an outside observer of one's thoughts, feelings, sensations, body, or actions
• Derealization: Experiencing unreality or detachment with respect to surroundings, leading to perceptions of individuals or objects as unreal, dreamlike, foggy, lifeless, or visually distorted
• Reality testing remains intact during these experiences.
• Symptoms cause clinically significant distress or impairment in functioning.
• The issue is not attributable to a substance or medical condition.
• The symptoms aren't better explained by related disorders.

Theories

• Psychodynamic theory suggests removing oneself from troubling memories or impulses by blotting them from consciousness.
• Biological: Research indicates structural brain differences in dissociative identity disorder patients.
• Learning/Cognitive theory suggests that learning not to think about troubling behaviors or thoughts leads to guilt or shame
• Such learning can be negatively reinforced through dissociation.
• Treatment involves therapy to reintegrate personality parts, reinforcement, and possibly drug treatment.

Internal Family Systems

• Managers: Primary parts that maintain security by controlling people and parts, while carrying responsibility and fearing loss of control.
• Common behaviors include controlling, analyzing, criticizing, judging, care-taking, and numbing.
• Self: The core essence, differentiated Self Energy acts as a wise, compassionate leader.
• Qualities of Self Energy include Courage, Compassion, Connectedness, Creativity, Confidence, Curiosity, Calmness, and Clarity.
• Exiles: Rejected or traumatized parts holding terror, pain, and shame from childhood, often frozen in time and desperate to share their story.
• Common behaviors and traits include sensitivity, anger, dependency, innocence, spontaneity, and openness.
• Firefighters: Protectors that act when pain from other parts threatens to overwhelm
• They repress emerging Exiles by releasing pressure and exiting dangerous situations swiftly.
• Common behaviors involve substance abuse, suicidal attempts, binge eating, affairs, dissociation, distraction, and self-cutting

Somatic Symptom Disorder

• The disorder involves one or more somatic symptoms that are distressing or disrupt daily life.
• There are excessive thoughts, feelings, or behaviors related to somatic symptoms or health concerns, as manifested by:
• Disproportionate thoughts about the seriousness of one's symptoms
• Persistent high anxiety about health or symptoms
• Excessive time and energy devoted to symptoms or health concerns.
• The state of being symptomatic is persistent, typically lasting more than 6 months even if individual symptoms are not continuously present.
• With predominant pain: Somatic symptoms predominantly involve pain.
• Persistent course: Severe symptoms, marked impairment, and long duration define a persistent course.
• Mild: Only one Criterion B symptom is fulfilled.
• Moderate: Two or more Criterion B symptoms are fulfilled.
• Severe: Two or more Criterion B symptoms are fulfilled, plus multiple somatic complaints or one very severe symptom.

Illness Anxiety Disorder

• The disorder involves preoccupation with having or acquiring a serious illness.
• Somatic symptoms are either not present or are only mild in intensity.
• Preoccupation is disproportionate, even if risk factors exist
• The effected individual has a high level of anxiety and is easily alarmed.
• Individuals do excessive health-related behaviors or exhibit maladaptive avoidance.
• Illness preoccupation has been present for at least 6 months, though the specific illness feared may change in that time.
• The preoccupation isn't better explained by a mental disorder.
• Care-seeking type: Frequent use of medical care, including physician visits or tests.
• Care-avoidant type: Medical care is rarely used.

Conversion Disorder

• Conversion disorder involves one or more symptoms of altered voluntary motor or sensory function.
• Clinical findings reveal incompatibility between the symptom and recognized neurological or medical conditions.
• The condition is not better explained by another condition.
• The symptoms result in significant distress, impairment in functioning, or they merit medical evaluation.
• Symptoms include weakness, paralysis, abnormal movement, swallowing problems, attacks, seizures, anesthesia, sensory loss, and/or special sensory phenomena.
• Symptoms can be categorized as either Acute (less than 6 months) or Persistent (6 months or more).
• The disorder may or may not be associated with a psychological stressor.

Malingering vs. Factitious Disorder

• Malingering: Deliberate efforts to fake or exaggerate symptoms for personal gain and isn't considered a mental disorder.
• Factitious Disorder: Fabricated absence of gain; and is considered a mental disorder.
• Munchausen syndrome is a deliberate fabrication to assume the patient role.
• Munchausen by proxy is done to assume the caretaking role.
• Factitious disorder imposed on another.

Somatic Symptom and Related Disorders: Theories

• Unconscious conflicts motivate which is reinforced by relief from Anxiety.
• Psychodynamic Theory: Symptoms prevent anxiety by blocking awareness of unconscious conflicts and also relieve burdensome responsibilities.
• Learning Theory: Adoption of sick role reduces anxiety by relieving stressful responsibilities and is also reinforced by support and sympathy from others.

Somatic Symptom and Related Disorders Treatment

• Psychodynamic: Bring conflicts from childhood to the level of awareness, resolves sx when worked through
• Behavioral: Removing sources of reinforcement
• Cognitive: Response prevention and cognitive restructuring

Psychological Factors in Physiology

• Headaches are often stress related.
• Coronary Heart Disease: Unhealthy consumption and persistent negative emotions
• Asthma Attacks: Influenced by Depression, stress, and anxiety
• Cancer: Influenced by unhealthy diet, alcohol use, and smoking
• HIV/AIDS: Influenced by Social stigma and risky behaviors