Chapter 8 (Somatic and Dissociation)

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Questions and Answers

What distinguishes somatic symptom disorders from dissociative disorders?

Dissociative disorders manifest primarily through prominent physical symptoms.

Somatic symptom disorders involve preoccupation with illness rather than loss of identity. (correct)

Dissociative disorders include excessive help-seeking behavior while somatic symptoms do not.

Somatic symptoms involve memory loss while dissociative disorders do not.

Which statement about both somatic symptom and dissociative disorders is true?

Both conditions are characterized solely by physical symptoms.

Both involve some form of dissociation or disconnection. (correct)

Both are primarily treated with physical interventions.

Both are categorized under anxiety disorders in the DSM.

What is a common feature of somatic symptom and related disorders?

Integration of identity.

Involvement of prominent psychological symptoms.

Lack of concern for physical health.

Worry about illness and excessive help-seeking behavior. (correct)

In which area do somatic symptom and dissociative disorders primarily differ?

The presence of physical symptoms. Signup and view all the answers

Which of the following is a characteristic of dissociative disorders?

Disconnection between memory and perception. Signup and view all the answers

What best describes the historical context of somatic symptom and dissociative disorders?

They have varied significantly in their understanding and classification. Signup and view all the answers

Which aspect is most affected in dissociative disorders?

Identity and memory integration. Signup and view all the answers

How are somatic symptom disorders typically treated?

With a combination of psychotherapy and physical health education. Signup and view all the answers

What is a defining feature of Conversion Disorder?

Physical malfunctioning without physical cause Signup and view all the answers

Which demographic is primarily affected by Conversion Disorder?

Females predominantly Signup and view all the answers

What psychological factor is highlighted in the aetiology of Conversion Disorder?

Past trauma and its conversion Signup and view all the answers

What is defined as the intentional production of false symptoms motivated by external incentives?

Malingering Signup and view all the answers

Which of the following is true about Factitious Disorder imposed on self?

It involves fabrication of symptoms without obvious external reward Signup and view all the answers

What symptom might a person with Conversion Disorder display?

Complete paralysis with no medical explanation Signup and view all the answers

What does 'la belle indifference' refer to in Conversion Disorder?

Indifference towards one's physical symptoms Signup and view all the answers

Treatment for Conversion Disorder often focuses on which of the following?

Attending to past trauma Signup and view all the answers

Which disorder is characterized by fabricating symptoms in another individual?

Factitious Disorder imposed on another Signup and view all the answers

What is a common characteristic of Somatic Symptom Disorder?

Exaggerated symptoms without obvious medical cause Signup and view all the answers

What is one key characteristic of Factitious Disorder Imposed on Another?

The individual induces disease in another person. Signup and view all the answers

What defines the deceptive behavior seen in individuals with Factitious Disorder?

It occurs irrespective of external benefits. Signup and view all the answers

Which statement accurately reflects the epidemiological data on Factitious Disorder?

Estimates of prevalence vary significantly in different settings. Signup and view all the answers

Which of the following behaviors is typical in Factitious Disorder?

Self-inflicting injury to simulate symptoms. Signup and view all the answers

In diagnosing Factitious Disorder, which criterion is necessary to rule out?

A different mental disorder, such as delusional disorder. Signup and view all the answers

What is the primary motivation behind individuals with Factitious Disorder?

To receive sympathy or care. Signup and view all the answers

What distinguishes Factitious Disorder from malingering?

Factitious Disorder has no clear external incentives. Signup and view all the answers

How is Factitious Disorder commonly misconceived in terms of gender prevalence?

It is claimed to be more common in men, but this is hard to substantiate. Signup and view all the answers

Which of the following correctly describes psychological or behavioral factors in medical conditions?

They can influence the treatment adherence adversely. Signup and view all the answers

What is a possible consequence of psychological distress on asthma patients?

Reduced exercise capacity. Signup and view all the answers

Which statement accurately reflects the nature of dissociation?

It refers to a disconnection in integrated functions. Signup and view all the answers

Which of the following is an example of maladaptive health behavior?

Manipulating insulin to lose weight. Signup and view all the answers

Which of these is NOT a way psychological factors can affect a medical condition?

Establishing new medical conditions. Signup and view all the answers

How do coping styles influence medical conditions?

They may exacerbate symptoms or delay recovery. Signup and view all the answers

What characterizes dissociative disorders?

A disruption in associated functions. Signup and view all the answers

Which scenario illustrates the influence of psychological factors on a medical condition?

A person ignores the need for medication. Signup and view all the answers

Which factor does NOT generally constitute a health risk related to psychological distress?

Routine medical check-ups. Signup and view all the answers

Which is an accurate description of the relationship between psychological factors and medical conditions?

They can mutually influence one another. Signup and view all the answers

What is derealisation commonly characterized by?

Sense that one’s surroundings are unreal Signup and view all the answers

Identity confusion involves feelings of which of the following?

Puzzlement regarding one’s identity Signup and view all the answers

Which of the following defines identity alteration in dissociative experiences?

Assumption of different identities with behavioral indications Signup and view all the answers

Which disorder involves feelings of disconnection or detachment from self?

Derealisation Disorder Signup and view all the answers

Unusual sensory experiences in depersonalisation/derealisation disorder may include which of the following?

Feeling limbs are enlarged or deformed Signup and view all the answers

A key aspect of depersonalisation experiences includes which of the following?

Feeling like observing oneself from outside the body Signup and view all the answers

Dissociative identity disorder is indicated by which behavior?

Presence of different identities shown by behavior Signup and view all the answers

Which of the following is NOT a criterion for depersonalisation/derealisation disorder?

Experiencing multiple distinct identities Signup and view all the answers

What is a key component in the treatment of Dissociative Identity Disorder (DID) from a posttraumatic model perspective?

Identity integration and rehabilitation Signup and view all the answers

Which of the following is NOT a guideline from the International Society for the Study of Trauma and Dissociation for treating DID?

Focusing on pharmacological interventions Signup and view all the answers

What does the sociocognitive model of therapy for DID typically emphasize?

Ignoring symptoms and social influences Signup and view all the answers

What type of research evidence is lacking for trauma-based approaches in treating DID?

Randomized controlled trials (RCTs) Signup and view all the answers

Which of the following treatment phases is essential for addressing the fragmented sense of self in DID?

Confronting and integrating traumatic memories Signup and view all the answers

What does the evidence suggest about the helpfulness of treatment based on the iatrogenesis model for DID?

There is no meaningful evidence supporting its effectiveness Signup and view all the answers

Which phase of treatment aims at ‘establishing safety’ for patients with DID?

Symptom reduction Signup and view all the answers

What is a common characteristic of treatments focusing on a sociocognitive model for DID?

Emphasis on social and cognitive factors Signup and view all the answers

Study Notes

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Chapter 8: Somatic Symptom and Dissociative Disorders

This chapter covers somatic symptom and dissociative disorders, examining their similarities, differences, and historical understandings.

Learning Objectives

Describe similarities & differences between somatic symptom and dissociative disorders, and their historical interpretations.
Identify features, causes, and treatments of primary disorders in the somatic symptom category.
Identify features, causes, and treatments of primary disorders in the dissociative category.

Somatic Symptom and Dissociative Disorders

Somatic symptom and related disorders:
- Characterized by prominent somatic symptoms, preoccupation/worry about illness, and excessive help-seeking behaviors.
Dissociative disorders:
- Involve a loss of normal integration of identity, memory, perception, emotion, behavior, consciousness, and body/motor control.
- Involve a dissociation or disconnection between mental awareness and normally integrated mental systems.

Historic Approaches to These Disorders

Historical commonality—some somatic symptom and dissociative disorders were historically linked and shared features.
A past general heading— "hysterical neurosis"—was used for disorders with physical symptoms without a clear organic basis.
"Hysteria" (wandering uterus)—associated with both somatic and dissociative experiences in historical contexts.
Early researchers like Freud, Breuer, Janet, Morton Prince, and William James researched these disorders.
The distinctions made—today some researchers distinguish between somatoform and psychoform (psychological) dissociation.

Historically known as "somatoform disorders."
Body Dysmorphic Disorder—moved from OCD and related disorders category.
Hypochondriasis and Somatization Disorder—revised/renamed.
Pain disorder—removed as separate diagnosis
Added factitious disorder to the category.
Psychological factors—added to the section for factors affecting other medical conditions.
"Soma" refers to the body—Historically, the symptoms were thought to have no physical cause. Now, the DSM-5 allows for the possibility of having a diagnosed medical condition.
Symptoms are unintentional and not under voluntary control (except in factitious disorder cases), resulting in medical treatment being sought before psychological treatment.

Somatic Symptom Disorder: Characterized by one or more somatic symptoms that are distressing and have a significant impact on daily life, accompanied by abnormal thoughts, feelings, or behaviors (e.g., persistent worry, excessive time spent on symptoms).
Illness Anxiety Disorder: Preoccupation with having or acquiring a serious illness, despite the absence or mild intensity of somatic symptoms. High health anxiety and excessive health-related behaviors are common features. This aligns with the concept of Hypochondriasis.
Conversion Disorder (Functional Neurological Symptom Disorder): Characterized by symptoms of altered motor or sensory function (e.g., weakness, paralysis, blindness) that are inconsistent with recognized neurological or medical conditions. Causes significant distress or impairment.
Factitious Disorder: Falsification of physical or psychological symptoms (in oneself or another) for no externally obvious reward.

DSM-5 Dissociative Disorders

Emphasizes disruption in consciousness, memory, identity, and other psychological functions. A disruption of normal integration leads to disconnection in functioning.

Types of Dissociative Disorders

Depersonalization/Derealization Disorder: Persistent feelings of detachment from one's mind or body, or surroundings; These symptoms cause significant distress or impairment.
Dissociative Amnesia: Inability to recall important personal information, often related to a traumatic experience, which cannot be explained by ordinary forgetfulness. May be localised (specific time frame), selective (some events), generalised (the entire life), or continuous.
Dissociative Fugue: Sudden, unexpected travel or relocation with inability to recall one's past and confusion about identity. Usually part of dissociative amnesia.
Dissociative Identity Disorder (DID): Two or more distinct identities or personality states recurrently taking control of behaviour; Inability to recall important personal information. This is sometimes referred to as multiple personality disorder.

Dissociative Experiences

Discusses amnesia, depersonalisation, derealisation, and identity confusion or alteration, and how the experiences are connected.

Aetiology of Factitious Disorder

Proposed motivations for factitious behavior include: the need to be the center of attention, longing to be cared for, maladaptive reactions to loss or separation, anger at physicians, experiencing pleasure from deceiving others, controlling chaos in their lives, re-enactments of the abuse and mastery.

Aetiology of Dissociative Disorders

Posttraumatic model (severe trauma in childhood leading to a dissociative ability).
Iatrogenic/sociocognitive/fantasy model (form of role-play in suggestible and fantasy-prone individuals.)

Treatment of Dissociative Identity Disorder (DID)

Treatment depends on the therapist's perspective.
Proponents of the sociocognitive model may minimize or dismiss the symptoms.
Proponents of the posttraumatic model may focus on trauma treatment similar to PTSD, also considering the need for personal stability.
DID treatments usually follow guidelines from the International Society for the Study of Trauma and Dissociation, which aims for safety, stabilization, symptom reduction, confronting/integrating traumatic memories, and identity reconstruction.

Other

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