Abnormal Psychology PDF

ABNORMAL PSYCHOLOGY Prepared by: Ms. Kezia Rapha F. De Guzman, RPsy, RPm  ❏ Somatic Symptoms and Related Disorders ❏ Somatic Symptom Disorder ❏ Illness Anxiety Disorder ❏ Psychological Factors Affecting Medical Condition ❏ Con...

ABNORMAL PSYCHOLOGY Prepared by: Ms. Kezia Rapha F. De Guzman, RPsy, RPm  ❏ Somatic Symptoms and Related Disorders ❏ Somatic Symptom Disorder ❏ Illness Anxiety Disorder ❏ Psychological Factors Affecting Medical Condition ❏ Conversion Disorder (Functional CONTENT Neurological Symptom Disorder) ❏ Dissociative Disorders ❏ Depersonalization - Derealization Disorder ❏ Dissociative Amnesia ❏ Dissociative Identity Disorder  Somatic Symptoms and Related Disorder How do you usually respond to physical symptoms?  Somatic Symptoms and Related Disorder Soma = body - excessive or maladaptive response to physical symptoms or to associated health concerns - “medically unexplained physical symptoms” - In some cases: medical cause of the presenting physical symptoms is known but the emotional distress or level of impairment in response to this symptom is clearly excessive - Used to be: “hysterical neurosis.” - Hysteria: Hippocrates and the Egyptians - hysterical came to refer more generally to physical symptoms without known organic cause; dramatic or “histrionic” behavior of women - Sigmund Freud (1894–1962) suggested that in a condition called conversion hysteria 1. Somatic Symptom Disorder What are the key characteristics?  Somatic Symptom Disorder - individuals are pathologically concerned with the functioning of their bodies. - For many years, this disorder was called Briquet’s syndrome - Pierre Briquet (a French physician): described patients with seemingly endless lists of somatic complaints for which he could find no medical basis - do not always feel the urgency to take action but continually feel weak and ill  Somatic Symptom Disorder Diagnostic Criteria for Somatic Symptom Disorder A. One or more somatic symptoms that are distressing and/or result in significant disruption of daily life. B. Excessive thoughts, feelings, and behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms. 2. High level of health-related anxiety. 3. Excessive time and energy devoted to these symptoms or health concerns.  Somatic Symptom Disorder C. Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic complaints predominantly involve pain. Specify current severity: Mild: Only one of the symptoms in Criterion B is fulfilled. Moderate: Two or more of the symptoms specified in Criterion B are fulfilled. Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom). 2. Illness Anxiety Disorder What are the key characteristics?  Illness Anxiety Disorder - “hypochondriasis,”; physical symptoms are either not experienced at the present time or are very mild, but severe anxiety is focused on the possibility of having or developing a serious disease - the concern is primarily with the idea of being sick instead of the physical symptom itself - This disorder is characterized by: 1. Anxiety or fear that one has a serious disease: the essential problem is anxiety; preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease 2. Reassurances from numerous doctors: an important feature: “disease conviction”: a core feature of the disorder  Illness Anxiety Disorder Diagnostic Criteria for Illness Anxiety Disorder A. Preoccupation with fears of having or acquiring a serious illness. B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate. C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status. D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctors’ appointments and hospitals).  Illness Anxiety Disorder Diagnostic Criteria for Illness Anxiety Disorder E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time. F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, generalized anxiety disorder, or obsessive-compulsive disorder. Specify whether: Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used. Care-avoidant type: Medical care is rarely used  Differences Panic Disorder: also misinterpret physical symptoms as the beginning of the next panic attack, which they believe may kill them Somatic Symptom Disorder: focus on a long-term process of illness and disease; Despite numerous assurances that they are healthy, they remain unconvinced and un-reassured. What about SSD VS IAD?  Culture-specific Syndromes 1. Koro: the belief, accompanied by severe anxiety and sometimes panic, that the genitals are retracting into the abdomen; chinese men; guilty about excessive masturbation, unsatisfactory intercourse, or promiscuity 2. Dhat: india; an anxious concern about losing semen; associated with a vague mix of physical symptoms, including dizziness, weakness, and fatigue  Causes - Faulty interpretation of physical signs and sensations as evidence of physical illness is central - Somatic symptom disorders: experience physical sensations common to all of us, but they quickly focus their attention on these sensations. - the very act of focusing on yourself increases arousal and makes the physical sensations seem more intense than they are - take a “better safe than sorry” approach to dealing with even minor physical symptoms by getting them checked out as soon as possible.  Causes Three other contributing factors - Stressful life event - Tendency to have had a disproportionate incidence of disease in their family when they were children - Social and interpersonal influence  Treatment Psychological Treatment - CBT - Reassurance - Explanatory Therapy - Exposure Therapy Drug Treatment - paroxetine (Paxil), a selective-serotonin reuptake inhibitor (SSRI)  Treatment Example (Clinical Practice): - Concentrate on providing reassurance, reducing stress and help-seeking behavior - Limit hospital visits by having a gatekeeper physician - Redirect attention at reducing the supportive consequences of relating to other on the basis of physical symptoms - Promote social and personal adjustment without relying on being “sick” 2. Other Related Somatic Symptom Disorder  2. Other Related Somatic Symptom Disorder PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITION Psychological Factors Affecting Medical Condition Clinical description: - the presence of a diagnosed medical condition such as asthma, diabetes, or severe pain clearly caused by a known medical condition - behavioral or psychological factors would have a direct influence on the course or perhaps the treatment of the medical condition Psychological Factors Affecting Medical Condition  2. Other Related Somatic Symptom Disorder CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER)  Conversion Disorder - Also called Functional Neurological Symptom Disorder Clinical Description - physical malfunctioning, such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology to account for the malfunction - blindness, paralysis, and aphonia; total mutism and the loss of the sense of touch - Seizures (psychogenic non-epileptic seizures) - Globus hystericus: the sensation of a lump in the throat  Conversion Disorder DIAGNOSTIC CRITERIA - One or more symptoms of altered voluntary motor or sensory function. - Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions. - The symptom or deficit is not better explained by another medical or mental disorder. - The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation - 2. Other Related Somatic Symptom Disorder MALINGERING (V)  Malingering Clinical Description - Faking symptoms - Motivation: trying to get out of something, such as work or legal difficulties, or they are attempting to gain something, such as a financial settlement - fully aware of what they are doing and are clearly attempting to manipulate others to gain a desired end 2. Other Related Somatic Symptom Disorder FACTITIOUS DISORDER  Factitious Disorder - fall somewhere between malingering and conversion disorders. - there is no obvious reason for voluntarily producing the symptoms except, possibly, to assume the sick role and receive increased attention. - factitious disorder imposed on another / Munchausen syndrome by proxy: deliberately makes someone else sick;  Factitious Disorder Diagnostic Criteria for Factitious Disorders A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception. B. The individual presents himself or herself to others as ill, impaired or injured. C. The deceptive behavior is evident even in the absence of obvious external rewards. D. The behavior is not better accounted for by another mental disorder such as delusional belief system or acute psychosis. Specify if: Single episode Recurrent episodes: Two or more events of falsification of illness and/ or induction of injury  CAUSES Freud: Four Basic Processes in the development of Conversion Disorder - Traumatic event - Repression of traumatic or conflicting event - The person “converts” the anxiety into physical symptoms - Receives greatly increased attention and sympathy *marked biological vulnerability to develop conversion disorder when under stress; parts of the brain regulating emotion, such as the amygdala, using brain-imaging procedures; biological contributory factors seem to be less important than the overriding influence of interpersonal factors  TREATMENT - Identify and attend to the traumatic or stressful life event - Reduce any reinforcing or supportive consequences - CBT  RECITATION/ACTIVITY Differential Diagnosis 1. SSD VS IED 2. CONVERSION DISORDER VS MALINGERING 3. FACTITIOUS DISORDER VS MALINGERING 4. CONVERSION DISORDER VS MUNCHAUSEN SYNDROME BY PROXY DISSOCIATIVE DISORDERS  1. Depersonalization - Derealization Disorder Differentiate: Depersonalization vs Derealization  Depersonalization-Derealization Disorder A. Depersonalization: your perception alters so that you temporarily lose the sense of your own reality, as if you were in a dream and you were watching yourself B. Derealization: your sense of the reality of the external world is lost; people may seem dead or mechanical; surrounding is foggy, dreamlike, or lifeless  Depersonalization-Derealization Disorder A.Statistics -Mean age of onset was 16 years -The course tended to be chronic. -Anxiety, mood, and personality disorders B.Unique distinction -Distinct cognitive profile: reflecting some specific cognitive deficits on measures of attention, processing of information, short-term memory, and spatial reasoning - reduced emotional responding - deficits in perception and emotion regulation - dysregulation in the hypothalamic– pituitary–adrenocortical (HPA) axis  Depersonalization-Derealization Disorder Diagnostic Criteria for Depersonalization- Derealization Disorder A. The presence of persistent or recurrent experiences of depersonalization, derealization, or both: Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing). Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).  Depersonalization-Derealization Disorder Diagnostic Criteria for Depersonalization- Derealization Disorder B. During the depersonalization or derealization experience, reality testing remains intact. C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures). E. The disturbance is not better explained by another mental disorder, such as schizophrenia or panic disorder.  2. Dissociative Amnesia Differentiate: Retrograde VS Anterograde Vs Dissociative Amnesia  Dissociative Amnesia Symptoms: - the inability to recall important autobiographical information - either forget specific events or areas in their lives or important information about their identities and those around them; the person with the condition might not be aware that they have suffered a memory loss and will only appear to be confused or flustered ❏ Generalized Amnesia ❏ Localized or Selective Amnesia  Dissociative Amnesia Subtype: - Dissociative fugue: memory loss revolves around a specific incident—an unexpected trip (or trips); individuals just take off and later find themselves in a new place, unable to remember why or how they got there Statistics: - appears before adolescence and usually occurs in adulthood - may continue well into old age - the most prevalent of all the dissociative disorders  Dissociative Amnesia Similar disorders/syndromes/phenomenon - Running Amok: individuals in this trancelike state often brutally assault and sometimes kill people or animals. - Pivloktoq: native peoples of the Arctic - Frenzy witchcraft: the Navajo tribe - Trance or possession: sudden changes in personality are attributed to possession by a spirit important in the particular culture; this spirit demands and receives gifts or favors - in India, Nigeria (Ninvusa); Thailand (phii pob) - Bahamians and African Americans from the South (“falling out.”)  Dissociative Amnesia Diagnostic Criteria for Dissociative Amnesia A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  Dissociative Amnesia Diagnostic Criteria for Dissociative Amnesia C. The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug of abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, or other neurological condition). D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder. Specify if: With dissociative fugue: Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information  3. Dissociative Identity Disorder Why was it change to DID from Multiple Personality Disorder?  Dissociative Identity Disorder Clinical Description - Alters: the different identities or personalities - Host: original personality of the person - Switch: The transition from one personality to another - Posture, facial expressions, patterns of facial wrinkling, and even physical disabilities may emerge - Dissociative amnesia; identity is fragmented  Dissociative Identity Disorder Can it be faked? - Individuals with DID are suggestible - the symptoms of DID could mostly be accounted for by therapists who inadvertently suggested the existence of alters to suggestible individuals, a model known as the “sociocognitive model” - malingerers are usually eager to demonstrate their symptoms and do so in a fluid fashion. Patients with DID, on the other hand, are more likely to attempt to hide symptoms.  Dissociative Identity Disorder Statistics - the average number of alter personalities is as closer to 15 - the ratio of females to males is as high as 9:1 - The onset is almost always in childhood, often as young as 4 years of age - Once established, the disorder tends to last a lifetime in the absence of treatment. - the frequency of switching decreases with age - Different personalities may emerge in response to new life situations  Dissociative Identity Disorder Diagnostic Criteria for Dissociative Identity Disorder A. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.  Dissociative Identity Disorder Diagnostic Criteria for Dissociative Identity Disorder C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).  Dissociative Disorders Causes: - Abused as a child - Escape into a fantasy world; natural tendency to escape or “dissociate” from the unremitting negative affect associated with severe abuse - A lack of social support - Suggestibility - Hypnotic trance - Self-hypnosis - Autohypnotic Model: people who are suggestible may be able to use dissociation as a defense against extreme trauma  Dissociative Disorders Treatment: - Dissociative amnesia/fugue state - usually get better on their own and remember what they have forgotten; recalling what happened during the amnesic or fugue states, often with the help of friends or family - DID - attempts to reintegrate identities through long-term psychotherapy - identify cues or triggers that provoke memories of trauma, dissociation, or both, and to neutralize them - the patient must confront and relive the early trauma and gain control - Hypnosis - Trust is important to any therapeutic relationship, but it is essential in the treatment of DID.  RECITATION/ACTIVITY Differential Diagnosis 1. Dissociative Fugue vs Dissociative Amnesia 2. Depersonalization vs Derealization 3. DID vs Schizophrenia