Abnormal Psychology: Personality Disorders (PDF)

ABNORMAL PSYCHOLOGY 4. Later Life Some individuals may still experience An Overview of Personality Disorders higher than average interpersonal difficulties.  Personality disorders are persistent patterns of emotions, cognitions...

ABNORMAL PSYCHOLOGY 4. Later Life Some individuals may still experience An Overview of Personality Disorders higher than average interpersonal difficulties.  Personality disorders are persistent patterns of emotions, cognitions, and behaviors that cause Gender Differences in Personality Disorders significant distress or impairment in various  Gender differences in personality disorders aspects of a person's life. Unlike many other have been observed, but their interpretation psychological disorders, personality disorders remains controversial. Men diagnosed with are chronic. personality disorders tend to display more  DSM-5 lists 10 specific personality disorders, aggressive, structured, self-assertive, and grouped into three clusters based on their detached traits, while women tend to present similarities. These disorders are controversial with more submissive, emotional, and insecure due to unresolved issues regarding their characteristics. conceptualization and diagnosis.  Some disorders, like antisocial personality disorder, are more prevalent in males, while Personality Disorder Clusters others, like dependent personality disorder, DSM-5-TR divides personality disorders into three are more common in females. However, recent clusters based on similarities: studies suggest that the prevalence of certain Cluster A: Odd or Eccentric disorders, such as histrionic and borderline  Includes paranoid, schizoid, and schizotypal personality disorders, may be more equal personality disorders. between genders than previously thought. o Men More aggressive, structured, self- Cluster B: Dramatic, Emotional, or Erratic assertive, and detached traits.  Consists of antisocial, borderline, histrionic, o Women More submissive, emotional, and narcissistic personality disorders. and insecure characteristics. Cluster C: Anxious or Fearful  Includes avoidant, dependent, and obsessive compulsive personality disorders. Prevalence and Development  Studies suggest that approximately 1 in 10 adults in the United States may have a diagnosable personality disorder. Worldwide, about 6% of adults may have at least one personality disorder. These disorders were traditionally thought to originate in childhood and continue into adulthood.  Recent research indicates that personality disorders can remit over time, but they may be replaced by other personality disorders. The developmental course of these disorders is not fully understood, partly due to the difficulty in studying individuals from the early stages of their disorder. 1. Childhood Personality disorders often originate in childhood. 2. Early Adulthood Symptoms may become more pronounced and disruptive. 3. Middle Adulthood Some disorders may "burn out" or improve, while others persist. Personality Disorders Under Study 1. Suspects, without sufficient basis, that others  The field of personality disorders continues to are exploiting, harming, or deceiving him or evolve, with researchers studying potential her. new categories for inclusion in future 2. Is preoccupied with unjustified doubts about diagnostic manuals. Two examples of the loyalty or trustworthiness of friends or personality disorders that have been studied associates. but not included in DSM-5 are: 3. Is reluctant to confide in others because of Sadistic Personality Disorder unwarranted fear that the information will be  Characterized by individuals who receive used maliciously against him or her. pleasure from inflicting pain on others. 4. Reads hidden demeaning or threatening Passive-Aggressive Personality meanings into benign remarks or events.  Disorder Includes people who are defiant and 5. Persistently bears grudges (i.e., is unforgiving refuse to cooperate with requests, attempting of insults, injuries, or slights). to undermine authority figures. 6. Perceives attacks on his or her character or Ongoing Research reputation that are not apparent to others and  Continued study of these and other potential is quick to react angrily or to counterattack. personality disorders to determine their 7. Has recurrent suspicions, without justification, validity and clinical utility. regarding fidelity of spouse or sexual partner. Cluster A Personality Disorders B. Does not occur exclusively during the course of  Cluster A personality disorders encompass schizophrenia, a bipolar disorder or depressive three conditions that share features disorder with psychotic features, or another psychotic resembling psychotic symptoms seen in disorder and is not attributable to the physiological schizophrenia: paranoid, schizoid, and effects of another medical condition. schizotypal. These disorders are characterized as odd or eccentric. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid Clinical Description of Paranoid Personality Disorder personality disorder (premorbid).”  The defining characteristic of paranoid personality disorder is a pervasive, unjustified Biological Causes of Paranoid Personality Disorder distrust of others. Individuals with this disorder  Evidence for biological contributions to interpret neutral events as personal attacks paranoid personality disorder is limited. Some and struggle to form meaningful relationships research suggests a slightly higher prevalence due to their suspicions. This can lead to among relatives of individuals with argumentative behavior, complaints, or schizophrenia, although the association is not quietness, often resulting in discomfort for strong. Genetics appear to play a significant those around them. role in the development of paranoid 1. Key Characteristics Excessive mistrust and personality disorder. suspicion  There seems to be some relationship with 2. Behavioral Manifestations Argumentative, schizophrenia, leading some researchers to complaining, or quiet demeanor suggest eliminating it as a separate disorder. 3. Associated Risks Increased suicide attempts However, more research is needed to fully and violent behavior understand the biological underpinnings of 4. Life Impact Poor overall quality of life this condition. Diagnostic Criteria 1. Genetic Factors Strong role of genetics in A. A pervasive distrust and suspiciousness of others paranoid personality disorder development such that their motives are interpreted as malevolent, 2. Schizophrenia Connection Slightly higher beginning by early adulthood and present in a variety prevalence among relatives of individuals with of contexts, as indicated by four (or more) of the schizophrenia following: 3. Ongoing Research Further studies needed to understand biological contributions fully Psychological Contributions to Paranoid Personality o Hearing Impaired Potential for Disorder misinterpreting social cues  Psychological factors contributing to paranoid o Older Adults Unique experiences personality disorder are less certain, but some affecting perception interesting speculations have been made. Retrospective research suggests that early Treatment Challenges for Paranoid Personality mistreatment or traumatic childhood Disorder experiences may play a role in its  Treatment of paranoid personality disorder development. However, caution is warranted presents significant challenges. Due to their when interpreting these results due to mistrustful nature, individuals with this potential recall bias. disorder are unlikely to seek professional help  Some psychologists focus on the thoughts or and struggle to develop the trusting "schemas" of individuals with this disorder. relationships necessary for successful therapy. They may hold basic mistaken assumptions Establishing a meaningful therapeutic alliance about others, such as "People are malevolent becomes a crucial first step. and deceptive" or "They'll attack you if they get 1. Mistrust Barrier Difficulty in seeking and the chance." These maladaptive views pervade accepting professional help every aspect of their lives. 2. Crisis Trigger Therapy often sought due to external crises or related issues  Early Experiences 3. Trust Building Establishing therapeutic alliance o Possible role of childhood trauma or as a crucial first step mistreatment 4. Cognitive Approach Focusing on changing  Cognitive Schemas beliefs about others' intentions o Mistaken assumptions about others' intentions Treatment Effectiveness and Prognosis  Pervasive Beliefs  This poor prognosis highlights the need for o Maladaptive views affecting all aspects further research into effective treatment of life methods and the importance of early intervention. It also underscores the challenges faced by both individuals with the Cultural Factors in Paranoid Personality Disorder disorder and the mental health professionals  Cultural factors have been implicated in the attempting to help them. development of paranoid personality disorder. Certain groups, such as prisoners, refugees, people with hearing impairments, and older adults, are thought to be particularly susceptible due to their unique experiences. For example, immigrants who struggle with language and customs in a new culture might Schizoid Personality Disorder misinterpret innocent behaviors as directed at  Schizoid Personality Disorder (SPD) is them. characterized by a pervasive pattern of  The late musician Jim Morrison of The Doors detachment from social relationships and a described this phenomenon in his song limited range of emotional expression. "People Are Strange" (1967): "People are Individuals with this disorder often appear strange, / When you're a stranger, / Faces look aloof, cold, and indifferent to others, ugly, / When you're alone." This illustrates how preferring solitude over social interaction. This someone could misinterpret ambiguous condition significantly impacts a person's situations as malevolent. ability to form close relationships and engage o Prisoners Susceptible due to their in normal social activities. environment  The term "schizoid" was first used by Bleuler in o Refugees Challenges in adapting to 1924 to describe people who tend to turn new cultures inward and away from the outside world. These individuals typically lack emotional  expressiveness and pursue vague interests, Treatment Approaches for Schizoid Personality leading to a life of isolation and detachment. Disorder 1. Emphasize Social Value Therapists often begin Diagnostic Criteria by highlighting the importance and benefits of A. A pervasive pattern of detachment from social social relationships. relationships and a restricted range of expression of 2. Social Skills Training Patients receive training emotions in interpersonal settings, beginning by early to establish and maintain social relationships, adulthood and present in a variety of contexts, as often through role-playing exercises. indicated by four (or more) of the following: 3. Identify Support Network Therapists help 1. Neither desires nor enjoys close relationships, identify a social network of supportive including being part of a family. individuals to aid in treatment. 2. Almost always chooses solitary activities. 4. Emotional Education Patients may be taught 3. Has little, if any, interest in having sexual about emotions and empathy to improve experiences with another person. interpersonal understanding. 4. Takes pleasure in few, if any, activities. 5. Lacks close friends or confidants other than Overlap with Autism Spectrum Disorder first-degree relatives. 6. Appears indifferent to the praise or criticism of others. 7. Shows emotional coldness, detachment, or flattened affectivity. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not Research demonstrates significant overlap in the attributable to the physiological effects of another occurrence of autism spectrum disorder and schizoid medical condition. personality disorder. This overlap suggests possible shared biological dysfunctions, which may combine Note: If criteria are met prior to the onset of with early learning or interpersonal problems to schizophrenia, add “premorbid,” i.e., “schizoid produce the social deficits characteristic of both personality disorder (premorbid).” conditions. Causes of Schizoid Personality Disorder Schizotypal Personality Disorder 1. Childhood Factors Childhood shyness is  Schizotypal Personality Disorder (SPD) is a reported as a precursor to adult SPD. Abuse complex mental health condition and neglect in childhood are also reported characterized by social isolation, unusual among individuals with this disorder. behaviors, and odd beliefs. It is considered to 2. Genetic Factors Inherited personality traits be on a continuum with schizophrenia, sharing may serve as important determinants in the some similarities but without the more severe development of SPD. symptoms like hallucinations and delusions. 3. Biological Factors Research suggests overlap This disorder presents unique challenges in between autism spectrum disorder and SPD, social interactions, cognitive processes, and indicating possible shared biological overall functioning. dysfunctions.  Understanding SPD is crucial for mental health 4. Environmental Factors Early learning professionals and those affected by the problems or difficulties with interpersonal disorder. It requires careful diagnosis, relationships may contribute to the social considering cultural factors, and a deficits defining SPD. multifaceted approach to treatment. Clinical Description of Schizotypal Personality associated with paranoid fears rather than Disorder negative judgments about self. 1. Psychotic-like Symptoms Individuals with SPD experience psychotic-like B. Does not occur exclusively during the course of symptoms without full psychosis. They may schizophrenia, a bipolar disorder or depressive believe everything relates to them personally disorder with psychotic features, another psychotic but can acknowledge the unlikelihood of such disorder, or autism spectrum disorder. beliefs. 2. Social Deficits Note: If criteria are met prior to the onset of People with SPD often have significant social schizophrenia, add “premorbid,” e.g., “schizotypal deficits, leading to isolation and difficulty in personality disorder (premorbid).” interpersonal relationships. 3. Unusual Perceptions and Beliefs Causes and Genetic Factors of Schizotypal Personality Those with SPD may report unusual perceptual Disorder experiences and engage in magical thinking, 1. Historical Perspective such as believing they have clairvoyant or The term "schizotype" was originally used telepathic abilities. to describe individuals predisposed to 4. Behavioral Oddities develop schizophrenia. Schizotypal PD is Individuals may dress or behave in unusual viewed by some as one phenotype of a ways, such as wearing multiple layers of schizophrenia genotype. clothing in summer or mumbling to 2. Genetic Research themselves. Family, twin, and adoption studies have shown an increased prevalence of Diagnostic Criteria Schizotypal PD among relatives of people A. A pervasive pattern of social and interpersonal with schizophrenia. This suggests a genetic deficits marked by acute discomfort with, and reduced link between the two disorders. capacity for, close relationships as well as by cognitive 3. Environmental Factors or perceptual distortions and eccentricities of Research indicates that environmental behavior, beginning by early adulthood and present in factors, particularly childhood a variety of contexts, as indicated by five (or more) of maltreatment, can strongly influence the the following: development of Schizotypal PD. In men, 1. Ideas of reference (excluding delusions of it's associated with schizotypal symptoms, reference). while in women, it's linked to PTSD 2. Odd beliefs or magical thinking that symptoms. influences behavior and is inconsistent 4. Neurological Findings with subcultural norms (e.g., Cognitive assessments and neuroimaging superstitiousness, belief in clairvoyance, studies have revealed mild-to-moderate telepathy, or “sixth sense”; in children and decrements in memory and learning adolescents, bizarre fantasies or abilities, as well as generalized brain preoccupations). abnormalities in individuals with SPD. 3. Unusual perceptual experiences, including bodily illusions. Treatment Approaches for Schizotypal Personality 4. Odd thinking and speech (e.g., vague, Disorder circumstantial, metaphorical, 1. Initial Assessment overelaborate, or stereotyped). People with Schizotypal PD often seek help due 5. Suspiciousness or paranoid ideation. to anxiety or depression. The presence of 6. Inappropriate or constricted affect. Schizotypal PD significantly increases the risk 7. Behavior or appearance that is odd, of developing major depressive disorder. eccentric, or peculiar. 2. Medical Interventions 8. Lack of close friends or confidants other Treatment may include medical approaches than first-degree relatives. similar to those used for depression. Some 9. Excessive social anxiety that does not studies have explored the use of antipsychotic diminish with familiarity and tends to be medications to manage symptoms.  3. Psychological Therapies others' concerns, and show no remorse for Psychological treatments for depression are their actions. Lying, cheating, and substance often employed. Cognitive behavior therapy abuse are common. The long-term outcome is and social skills training have shown promise in usually poor, with higher rates of unnatural managing SPD symptoms. death. 4. Integrated Approach  This disorder has been known by various A combination of antipsychotic medication, names, including moral insanity, sociopathy, community treatment, and social skills training and psychopathy. There is ongoing debate has been found effective in reducing about whether psychopathy and antisocial symptoms or postponing the onset of personality disorder are distinct disorders. schizophrenia in some cases.  Key Traits o Aggression, indifference, lack of Prevention Strategies and Early Intervention remorse  Early Detection  Common Behaviors o Identifying Schizotypal PD symptoms o Lying, cheating, substance abuse in younger individuals is crucial for  Long-term Outcome implementing preventive measures. o Generally poor, higher risk of  Medication unnatural death o Antipsychotic medications may be used as part of a preventive strategy to Diagnostic Criteria manage symptoms and potentially A. A pervasive pattern of disregard for and violation of delay the onset of schizophrenia. the rights of others, occurring since age 15 years, as  Cognitive Therapy indicated by three (or more) of the following: o Cognitive behavior therapy is 1. Failure to conform to social norms with employed to help individuals manage respect to lawful behaviors, as indicated by their thoughts and behaviors repeatedly performing acts that are associated with Schizotypal PD. grounds for arrest.  Social Skills Training 2. Deceitfulness, as indicated by repeated o Developing social skills is crucial in lying, use of aliases, or conning others for helping individuals with Schizotypal PD personal profit or pleasure. improve their interpersonal 3. Impulsivity or failure to plan ahead. relationships and overall functioning. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. These prevention strategies aim to address Schizotypal 5. Reckless disregard for safety of self or PD symptoms early and potentially prevent the onset others. of more severe conditions like schizophrenia. The 6. Consistent irresponsibility, as indicated by combination of medication, therapy, and skills training repeated failure to sustain consistent work shows promise in managing Schizotypal PD and behavior or honor financial obligations. improving long-term outcomes for affected 7. Lack of remorse, as indicated by being individuals. indifferent to or rationalizing having hurt, mistreated, or stolen from another. Cluster B Personality Disorders  Cluster B personality disorders include B. The individual is at least age 18 years. antisocial, borderline, histrionic, and C. There is evidence of conduct disorder with onset narcissistic types. These disorders are before age 15 years. characterized by dramatic, emotional, or D. The occurrence of antisocial behavior is not erratic behaviors. exclusively during the course of schizophrenia or bipolar disorder. Clinical Description of Antisocial Personality Disorder  Individuals with antisocial personality disorder Psychological and Social Dimensions have a long history of violating others' rights.  Research on reward processing suggests that They are often aggressive, indifferent to individuals with psychopathy are less likely to be deterred from pursuing a goal, even when it  becomes unattainable. This may explain their and adult antisocial behavior. While long-term persistent antisocial behaviors despite impacts are still being assessed, prevention is negative consequences. considered the most promising approach given  Antisocial behaviors often change form as the challenges of treating adults. individuals age, from childhood truancy to adult criminal activities. However, rates of 1. Early Intervention Parent training for antisocial behavior tend to decline around age toddlers shows promise in reducing 40 for reasons not yet fully understood. aggression 1. Childhood Conduct problems, truancy 2. School-Based Programs Focus on 2. Adolescence/Early Adulthood Criminal behavioral supports and social activities increase competence training 3. Middle Age Decline in antisocial behaviors 3. Sports Participation May weaken link around 40 between childhood conduct disorder and adult antisocial behavior Treatment Approaches  Treatment of antisocial personality disorder in Borderline Personality Disorder adults is challenging, as individuals rarely seek  Borderline Personality Disorder is a prevalent help voluntarily and can be manipulative in and complex mental health condition therapy. Most clinicians are pessimistic about characterized by unstable moods, treatment outcomes for adults. Emphasis is relationships, and self-image. Affecting 1-2% of placed on early identification and intervention the general population across cultures, for high-risk children. Borderline PD presents significant challenges  Cognitive behavior therapy has shown some for those diagnosed and their loved ones. This success in reducing violence among offenders, disorder is marked by intense emotions, fear of though effectiveness decreases with higher abandonment, and a high risk of self-harm and psychopathy scores. For children, parent suicide. training programs are common, teaching parents to recognize and address behavior Clinical Description and Prevalence problems early. 1. Prevalence BPD affects 1-2% of the general population across all cultures.  Cognitive Behavior Therapy 2. Core Features Instability in emotions, o Shows some success in reducing relationships, self-concept, and behavior. violence 3. Risk Factors High risk of suicide, with  Parent Training nearly 10% dying by suicide. o Common approach for children with 4. Long-term Outlook Approximately 90% of conduct problems patients achieve remission within a decade  Treatment Challenges of seeking treatment. o Adults rarely seek help, can be manipulative in therapy Diagnostic Criteria A. A pervasive pattern of instability of Prevention Strategies interpersonal relationships, self-image, and  Prevention efforts focus on children at risk for affects, and marked impulsivity, beginning by later antisocial personality disorder. early adulthood and present in a variety of Aggressive behaviors in young children are contexts, as indicated by five (or more) of the remarkably stable and can escalate over time. following: School-based programs emphasize behavioral 1. Frantic efforts to avoid real or imagined supports and social competence training. abandonment. (Note: Do not include suicidal  Early intervention, such as parent training for or self-mutilating behavior covered in Criterion toddlers, shows promise in reducing 5.) aggression and improving social skills. 2. A pattern of unstable and intense Participation in high school sports may weaken interpersonal relationships characterized by the link between childhood conduct disorder alternating between extremes of idealization and devaluation.  3. Identity disturbance: markedly and  Similar to PTSD treatment, this approach helps persistently unstable self-image or sense of patients reexperience and process traumatic self. events. 4. Impulsivity in at least two areas that are Skill Building potentially self-damaging (e.g., spending, sex,  Patients learn to identify and regulate substance abuse, reckless driving, binge emotions, develop problem-solving skills, and eating). (Note: Do not include suicidal or self- build self-trust. mutilating behavior covered in Criterion 5.) 5. Recurrent suicidal behavior, gestures, or Effectiveness of Dialectical Behavior Therapy threats, or self-mutilating behavior.  Reduction in Harmful Behaviors DBT has been 6. Affective instability due to a marked reactivity shown to reduce suicide attempts, treatment of mood (e.g., intense episodic dysphoria, dropouts, and hospitalizations. irritability, or anxiety usually lasting a few  Improved Social Adjustment Follow-up hours and only rarely more than a few days). studies indicate that DBT patients show less 7. Chronic feelings of emptiness. suicidal ideation, reduced anger, and better 8. Inappropriate, intense anger or difficulty social adjustment. controlling anger (e.g., frequent displays of  Inpatient Treatment Benefits Even short-term temper, constant anger, recurrent physical inpatient DBT treatment (about 5 days) can fights). lead to improvements in depression, 9. Transient, stress-related paranoid ideation or hopelessness, anger expression, and severe dissociative symptoms. dissociation.  Long-term Effectiveness A growing body of Causes and Genetic Factors evidence supports the long-term effectiveness  Genetic Influence of DBT in treating Borderline PD. o Family and twin studies suggest a genetic component to Borderline PD. Histrionic Personality Disorder Higher concordance rates are  Histrionic Personality Disorder (HPD) is observed in monozygotic twins characterized by overly dramatic and theatrical compared to dizygotic twins. behavior. Individuals with this disorder tend to  Neurochemical Factors express emotions in an exaggerated manner, o Research focuses on the serotonin often seeming as if they are acting. This system, as dysfunction in this area is presentation will explore the clinical linked to emotional instability, suicidal description, causes, and treatment approaches behaviors, and impulsivity seen in for Histrionic PD, as well as the controversies Borderline PD. surrounding its diagnosis.  Brain Imaging Studies Clinical Description of Histrionic Personality Disorder o Neuroimaging points to the limbic 1. Emotional Expression Individuals with network's involvement in Borderline Histrionic PD express emotions in an PD, which is crucial for emotion exaggerated fashion, such as hugging strangers regulation and neurotransmission. or crying uncontrollably during sad movies. 2. Attention-Seeking Behavior They are often Treatment Approaches vain, self-centered, and uncomfortable when Medication not in the limelight. They seek constant  Mood stabilizers, anticonvulsants, and reassurance and approval. antipsychotics can be effective for managing 3. Impulsivity People with Histrionic PD tend to affect disturbances. be impulsive and have difficulty delaying Dialectical Behavior Therapy (DBT) gratification.  Developed by Marsha Linehan, DBT is a 4. Cognitive Style Their cognitive style is thoroughly researched cognitive behavioral impressionistic, viewing situations in global, treatment for Borderline PD. black-and-white terms. Speech is often vague Trauma-Focused Therapy and exaggerated.  empathy. When confronted with other Diagnostic Criteria successful people, they can be extremely A pervasive pattern of excessive emotionality and envious and arrogant. attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or Diagnostic Criteria more) of the following: A pervasive pattern of grandiosity (in fantasy or 1. Is uncomfortable in situations in which he or behavior), need or admiration, and lack of empathy, she is not the center of attention. beginning by early adulthood and present in a variety 2. Interaction with others is often characterized of contexts, as indicated by five (or more) of the by inappropriate sexually seductive or following: provocative behavior. 1. Has a grandiose sense of self-importance (e.g., 3. Displays rapidly shifting and shallow exaggerates achievements and talents, expression of emotions. expects to be recognized as superior without 4. Consistently uses physical appearance to draw commensurate achievements). attention to self. 2. Is preoccupied with fantasies of unlimited 5. Has a style of speech that is excessively success, power, brilliance, beauty, or ideal impressionistic and lacking in detail. love. 6. Shows self-dramatization, theatricality, and 3. Believes that he or she is “special” and unique exaggerated expression of emotion. and can only be understood by, or should 7. Is suggestible (i.e., easily influenced by others associate with, other special or high-status or circumstances). people (or institutions). 8. Considers relationships to be more intimate 4. Requires excessive admiration. than they actually are. 5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment Treatment Approaches for Histrionic Personality or automatic compliance with his or her Disorder expectations). 1. Behavior Modification Some therapists have 6. Is interpersonally exploitative (i.e., takes attempted to modify attention-seeking advantage of others to achieve his or her own behavior through reward and punishment ends). systems. 7. Lacks empathy: is unwilling to recognize or 2. Interpersonal Focus Therapy often focuses on identify with the feelings and needs of others. problematic interpersonal relationships and 8. Is often envious of others or believes that teaching more appropriate ways of negotiating others are envious of him or her. wants and needs. 9. Shows arrogant, haughty behaviors or 3. Cognitive Restructuring Patients are shown attitudes. how short term gains from manipulative behavior result in long-term costs. Causes 4. Limited Research Despite various approaches, 1. Some writers, including Kohut (1971, 1977), little research demonstrates consistent believe that narcissistic personality disorder success in treating Histrionic PD. arises largely from a profound failure by the parents of modeling empathy early in a child’s Narcissistic Personality Disorder development.  Narcissistic Personality Disorder have an 2. In a sociological view, Christopher Lasch (1978) unreasonable sense of self-importance and are wrote in his popular book The Culture of so preoccupied with themselves that they lack Narcissism that this personality disorder is sensitivity and compassion for other people. increasing in prevalence in most Western They aren’t comfortable unless someone is societies, primarily as a consequence of large- admiring them. Their exaggerated feelings and scale social changes, including greater their fantasies of greatness, called grandiosity, emphasis on short-term hedonism, create a number of negative attributes. They individualism, competitiveness, and success require and expect a great deal of special attention. They also tend to use or exploit others for their own interests and show little Treatment Causes 1. Cognitive therapy strives to replace their 1. Biological Influences - individuals may be born fantasies with a focus on the day-to-day with a difficult temperament or personality pleasurable experiences that are truly characteristics. attainable. 2. Psychological Influences - Stravynski, Elie, and 2. Coping strategies such as relaxation training Franche (1989) questioned a group of people are used to help them face and accept with avoidant personality disorder and a group criticism. Helping them focus on the feelings of of control participants about their early others is also a goal. treatment by their parents. Those with the disorder remembered their parents as more Cluster C Personality Disorders rejecting, more guilt engendering, and less  Cluster C personality disorders include affectionate than the control group, avoidant, dependent, and obsessive- suggesting parenting may contribute to the compulsive—share common features with development of this disorder. Similarly, people who have anxiety disorders. research has consistently found that these individuals are more likely to report childhood Clinical Description of Avoidant Personality Disorder experiences of neglect, isolation, rejection,  People with avoidant personality disorder are and conflict with others extremely sensitive to the opinions of others and although they desire social relationships, Treatment their anxiety leads them to avoid such 1. Behavioral intervention techniques for associations. anxiety and social skills problems have had o Extreme low self-esteem coupled with some success fear of rejection 2. Therapeutic alliance—the collaborative o Limited friends connection between therapist and client— o Dependent on those they feel appears to be an important predictor for comfortable with treatment success in this group. Diagnostic Criteria Clinical Description of Dependent Personality A pervasive pattern of social inhibition, feelings of Disorder inadequacy, and hypersensitivity to negative  Individuals with dependent personality evaluation, beginning by early adulthood and present disorder sometimes agree with other people in a variety of contexts, as indicated by four (or more) when their own opinion differs so as not to be of the following: rejected. 1. Avoids occupational activities that involve o Their desire to obtain and maintain significant interpersonal contact because of supportive and nurturant relationships fears of criticism, disapproval, or rejection. may lead to their other behavioral 2. Is unwilling to get involved with people unless characteristics, including certain of being liked. submissiveness, timidity, and 3. Shows restraint within intimate relationships passivity. because of the fear of being shamed or o Similar to those with avoidant ridiculed. personality disorder in their feelings of 4. Is preoccupied with being criticized or rejected inadequacy, sensitivity to criticism, in social situations. and need for reassurance. 5. Is inhibited in new interpersonal situations o Respond to these feelings by avoiding because of feelings of inadequacy. relationships 6. Views self as socially inept, personally unappealing, or inferior to others. Diagnostic Criteria 7. Is unusually reluctant to take personal risks or A pervasive and excessive need to be taken care of that to engage in any new activities because they leads to submissive and clinging behavior and fears of may prove embarrassing separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:  1. Has difficulty making everyday decisions Interpersonal control, at the expense without an excessive amount of advice and of flexibility, openness, and efficiency reassurance from others. o Also common to find obsessive- 2. Needs others to assume responsibility for most compulsive personality disorder major areas of his or her life. among Gifted children, whose quest 3. Has difficulty expressing disagreement with for perfectionism can be quite others because of fear of loss of support or debilitating approval. (Note: Do not include realistic fears of retribution.) Diagnostic Criteria 4. Has difficulty initiating projects or doing things A pervasive pattern of preoccupation with orderliness, on his or her own (because of a lack of self- perfectionism, and mental and interpersonal control, confidence in judgment or abilities rather than at the expense of flexibility, openness, and efficiency, a lack of motivation or energy). beginning by early adulthood and present in a variety 5. Goes to excessive lengths to obtain nurturance of contexts, as indicated by four (or more) of the and support from others, to the point of following: volunteering to do things that are unpleasant. 1. Is preoccupied with details, rules, lists, order, 6. Feels uncomfortable or helpless when alone organization, or schedules to the extent that because of exaggerated fears of being unable the major point of the activity is lost. to care for himself or herself 2. Shows perfectionism that interferes with task 7. Urgently seeks another relationship as a completion (e.g., is unable to complete a source of care and support when a close project because his or her own overly strict relationship ends. standards are not met). 8. Is unrealistically preoccupied with fears of 3. Is excessively devoted to work and productivity being left to take care of himself or herself. to the exclusion of leisure activities and friendships (not accounted for by obvious Causes economic necessity). 1. It was thought that disruptions as the early 4. Is over conscientious, scrupulous, and death of a parent or neglect or rejection by inflexible about matters of morality, ethics, or caregivers could cause people to grow up values (not accounted for by cultural or fearing abandonment. religious identification). 2. Genetic influences are important in the 5. Is unable to discard worn-out or worthless development of this disorder. objects even when they have no sentimental value. Treatment 6. Is reluctant to delegate tasks or to work with 1. People with dependent personality disorder others unless they submit to exactly his or her are ideal patients. They are very way of doing things. submissiveness, however, negates one of the 7. Adopts a miserly spending style toward both major goals of therapy, which is to make the self and others; money is viewed as something person more independent and personally to be hoarded for future catastrophes. responsible. 8. Shows rigidity and stubbornness. 2. Therapy therefore progresses gradually as the patient develops confidence in his ability to Causes make decisions independently. 1. Moderate genetic contribution to obsessive- compulsive personality disorder. Clinical Description of Obsessive-Compulsive 2. Some people may be predisposed to favor Personality Disorder structure in their lives pre-encoded.  Individuals with obsessive-compulsive personality disorder are characterized by a Treatment fixation on things being done “the right way”. 1. Therapists help the individual relax or use o General rigidity – tend to have poor cognitive reappraisal techniques to reframe interpersonal relationship compulsive thoughts. This form of cognitive o Preoccupation with orderliness, behavioral therapy—following along the lines perfectionism, and mental and of treatment for obsessive-compulsive  disorder—appears to be effective for people 4. Improved Clinical Utility with this personality disorder. o Made diagnoses more understandable and useful for non-psychiatric Somatic Symptom and Related Disorders physicians. Disorders Contributing Factors to Somatic Symptom and  This chapter introduces a group of disorders Related Disorders characterized by the prominence of somatic Genetic and Biological Vulnerability symptoms and/or illness anxiety, causing  Increased sensitivity to pain and other somatic significant distress and impairment. These sensations. conditions are commonly encountered in Early Traumatic Experiences primary care and medical settings, but less  Violence, abuse, or deprivation in early life. frequently in psychiatric contexts. The DSM - 5 Medical Iatrogenesis has reconceptualized these diagnoses, moving  Reinforcement of the sick role, excessive away from the DSM -IV's somatoform referrals and diagnostic testing. disorders to provide a more comprehensive Sociocultural Factors and accurate reflection of the clinical picture.  Norms that minimize or stigmatize psychological suffering compared to physical Key Features of Somatic Symptom Symptom suffering. Disorders 1. Somatic Symptoms Comorbidity and Differential Diagnosis o Presence of distressing physical Medical Comorbidity symptoms that may or may not be  Considerable medical comorbidity is common explained by recognized medical among individuals with somatic symptom and conditions. related disorders. 2. Cognitive and Behavioral Responses Anxiety and Depression o Abnormal thoughts, feelings, and behaviors in response to these  These disorders may accompany somatic symptoms, often disproportionate to symptom and related disorders, adding their severity. severity and complexity. 3. Impairment Other Mental Disorders o Significant distress and functional  Some mental disorders (e.g., major depressive impairment resulting from the disorder, panic disorder) may initially manifest symptoms and associated responses. with primarily somatic symptoms. 4. Medical Setting Presentation Delusional Disorder o Individuals with these disorders  In rare instances, severe preoccupation may primarily present in medical rather warrant consideration of a delusional disorder than mental health settings diagnosis. Changes from DSM-IV to DSM-5 Cultural Considerations 1. Terminology Change  Cultural contexts significantly affect the o Replaced "somatoform disorders" presentation, recognition, and management of with "somatic symptom and related somatic symptom and related disorders. disorders" to reduce confusion. Variations in symptom presentation likely 2. Diagnostic Criteria result from the interaction of multiple factors o Shifted focus from unexplained within cultural contexts. These factors symptoms to the presence of positive influence how individuals identify and classify symptoms and associated thoughts, bodily sensations, perceive illness, and seek feelings, and behaviors. medical attention. 3. Reduced Overlap  Cultural differences in medical care practices o Decreased the total number of also play a role in shaping the manifestation disorders and subcategories to and treatment of these disorders. It's crucial address previous diagnostic overlap. for clinicians to be aware of these cultural  variations to provide culturally sensitive and  Mental health professionals and students must effective care. understand that Somatic Symptom Disorder is not about imaginary symptoms; the physical 1. Cultural Perception discomfort experienced by these individuals is How bodily sensations are interpreted within a real and often debilitating. cultural context.  The disorder's core feature lies in the 2. Illness Beliefs disproportionate and persistent thoughts, Cultural norms and beliefs about the nature feelings, and behaviors related to these and causes of illness. somatic symptoms. 3. Help-Seeking Behavior  This heightened response to bodily sensations Cultural influences on when and how can lead to a cyclical pattern of anxiety, individuals seek medical attention. symptom focus, and increased distress, 4. Treatment Approaches significantly impacting the individual's quality Variations in medical care practices across of life and healthcare utilization. different cultural settings. Diagnostic Criteria Clinical Implications and Future Directions A. One or more somatic symptoms that are distressing  The DSM-5 changes in somatic symptom and or result in significant disruption of daily life. related disorders aim to improve clinical utility, B. Excessive thoughts, feelings, or behaviors related to especially for non-psychiatric physicians. The the somatic symptoms or associated health concerns focus on positive symptoms and associated as manifested by at least one of the following: cognitive-behavioral features provides a more 1. Disproportionate and persistent thoughts comprehensive approach to diagnosis and about the seriousness of one’s treatment. This shift may help reduce stigma 2. symptoms. and improve patient provider communication. 3. Persistently high level of anxiety about health  Future research should focus on validating or symptoms. these new diagnostic criteria, exploring 4. Excessive time and energy devoted to these cultural variations in presentation, and symptoms or health concerns. developing targeted interventions. Continued collaboration between mental health C. Although any one somatic symptom may not be professionals and primary care providers is continuously present, the state of being symptomatic essential for effective management of these is persistent (typically more than 6 months). complex disorders. Specify if: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain. Specify if: Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long Somatic Symptom Disorder duration (more than 6 months).  Somatic Symptom Disorder represents a Specify current severity: complex interplay between physical sensations Mild: Only one of the symptoms specified in Criterion and psychological distress. B is fulfilled.  This condition, classified in the DSM-5, is Moderate: Two or more of the symptoms specified in characterized by an individual's intense focus Criterion B are fulfilled. on physical symptoms that significantly disrupt Severe: Two or more of the symptoms specified in daily life. Criterion B are fulfilled, plus there are multiple somatic  Unlike hypochondriasis, which centers on fear complaints (or one very severe somatic symptom). of having a serious illness, Somatic Symptom Disorder emphasizes the distress and Illness Anxiety Disorder Disorder dysfunction caused by the symptoms  Illness Anxiety Disorder is a mental health themselves. condition characterized by an excessive  preoccupation with having or acquiring a tests and procedures. They may visit multiple serious medical illness. This disorder, healthcare providers, seeking reassurance previously known as hypochondriasis, about their health concerns. This behavior can represents a significant shift in diagnostic lead to unnecessary medical interventions and criteria from DSM-IV to DSM-5. Unlike somatic strain on healthcare resources. symptom disorder, individuals with Illness  Clinical management focuses on addressing Anxiety Disorder typically experience minimal the underlying anxiety and developing or no somatic symptoms. strategies to reduce excessive healthcare  The core feature of Illness Anxiety Disorder is utilization. Cognitive-behavioral therapy (CBT) an intense and persistent fear of being can be particularly effective in challenging seriously ill, despite medical reassurance and a illness-related beliefs and reducing anxiety- lack of significant physical symptoms. This driven behaviors. preoccupation can severely impact an individual's daily functioning, relationships, Care-Avoidant Type and overall quality of life. Understanding this  These individuals rarely use medical services, disorder is crucial for mental health often avoiding doctor appointments and professionals and students to provide hospitals due to fear or anxiety. This avoidance appropriate diagnosis and treatment for can potentially lead to delayed diagnosis of affected individuals. actual medical conditions, posing significant health risks. Clinical Descriptions  Treatment approaches for this subtype may 1. Preoccupation with Illness include gradual exposure to medical settings The individual exhibits a persistent fixation on and professionals, alongside anxiety having or developing a serious medical management techniques. Addressing the condition, often without significant physical underlying fears and misconceptions about symptoms. This preoccupation persists for at healthcare is crucial for improving overall least six months, although the specific feared health outcomes. illness may change over time 2. Heightened Health Anxiety Clinical Implications There is a high level of anxiety related to health  Both subtypes present unique challenges in concerns, with the individual being easily clinical management. Healthcare providers alarmed about their health status. This anxiety must balance addressing the patient's often persists despite medical reassurance or concerns while avoiding reinforcement of negative test results. illness anxiety. A multidisciplinary approach, 3. Excessive Health Behaviors involving mental health professionals and The person engages in excessive health- primary care providers, is often necessary for related behaviors, such as frequent body effective treatment. checking or researching symptoms online.  Psychoeducation about normal bodily Alternatively, they may exhibit maladaptive sensations and the nature of illness anxiety is avoidance of medical care or health-related crucial. Long-term management strategies situations may include ongoing therapy, stress reduction 4. Differential Diagnosis techniques, and regular check-ins with a The illness preoccupation is not better trusted healthcare provider. explained by other mental disorders such as somatic symptom disorder, panic disorder, or Diagnostic Criteria obsessive-compulsive disorder. This distinction A. Preoccupation with having or acquiring a serious is crucial for accurate diagnosis and treatment illness. planning B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is Subtypes and Clinical Implications present or there is a high risk for developing a medical Care-Seeking Type condition (e.g., strong family history is present), the  Individuals with this subtype frequently seek preoccupation is clearly excessive or disproportionate. medical care, often undergoing numerous C. There is a high level of anxiety about health, and the Chinese rates of when evaluating individual is easily alarmed about personal health cultures, medically somatic status. characterized unexplained complaints. D. The individual performs excessive health-related by anxiety physical behaviors (e.g., repeatedly checks his or her body for about genital symptoms signs of illness) or exhibits maladaptive avoidance (e.g., retraction, and across dhat in India, different avoids doctor appointments and hospitals). involving countries, with E. Illness preoccupation has been present for at least 6 concern about a consistent months, but the specific illness that is feared may semen loss. 2:1 female to change over that period of time. These disorders male ratio in F. The illness-related preoccupation is not better reflect cultural severe cases. explained by another mental disorder, such as somatic beliefs and symptom disorder, panic disorder, generalized anxiety anxieties. disorder, body dysmorphic disorder, obsessive- compulsive disorder, or delusional disorder, somatic Impact and Prognosis of Somatic Symptom Disorders type. 1. Healthcare Utilization  Individuals with somatic symptom Specify whether: disorders significantly overuse and Care-seeking type: Medical care, including physician misuse the healthcare system. Their visits or undergoing tests and procedures, is frequently medical bills can be up to 9 times used. higher than those of average patients. Care-avoidant type: Medical care is rarely used. 2. Disability and Chronic Nature  These disorders can lead to substantial Statistics of Illness Anxiety Disorder disability, with one study reporting 19  Somatic symptom disorders, including illness % of affected individuals on disability. anxiety disorder, are estimated to affect 1% to The symptoms and associated sick role 5% of the general population. In primary care behavior often persist into old age. settings, the prevalence can be as high as 3. Psychological Comorbidities 16.6% for distressing somatic symptoms.  Patients may experience a wide range These disorders typically develop later in life, of psychological complaints, including though some cases, like Linda's, can onset anxiety, mood disorders, and even during adolescence. psychotic symptoms in some cases.  Individuals with somatic symptom disorders Suicidal attempts, often appearing as are more likely to be women, unmarried, and manipulative gestures, are frequent. from lower socioeconomic groups. They often experience psychological complaints alongside Causes and Contributing Factors their physical symptoms, particularly anxiety 1. Genetic Factors and mood disorders. These conditions  Evidence suggests a modest genetic frequently lead to overuse of healthcare contribution, possibly a nonspecific services and can result in significant disability. tendency to over respond to stress, similar to anxiety disorders. Cultural Aspects and Global Prevalence 2. Family Influence Culture- Global Medical  Children often report symptoms Specific Prevalence Considerations similar to those of family members, Syndromes Contrary to In developing suggesting learned behavior. Somatic earlier beliefs, countries, it's 3. Life Events symptom "somatizing" crucial to rule  Stressful life events, often involving disorders often psychological out medical death or illness, can trigger the manifest as distress is causes like culturespecific fairly uniform parasitic development of these disorders. syndromes. worldwide. A infections or 4. Social Factors Examples WHO study nutritional  The "benefits" of being sick, such as include koro in found similar deficiencies increased attention or avoiding  responsibilities, may contribute to the underlying medical cause. This disorder's development. phenomenon, rooted in unconscious mental processes, challenges our Treatment Approaches understanding of the mind-body Cognitive Behavioral Therapy (CBT) connection. The disorder often  CBT has shown effectiveness in emerges following traumatic treating health anxiety and somatic experiences, with symptoms ranging symptom disorder. It focuses on from paralysis to sensory loss. identifying and challenging illnessrelated misinterpretations and The Case of Anna O.: A Historical Perspective demonstrating how symptoms can be 1. Onset of Symptoms self-induced through attention. Anna O., at 21, experienced hallucinations and Explanatory Therapy paralysis while nursing her dying father. Her  This approach involves detailed symptoms included inability to move her right explanations of the source and origins arm and speak German. of symptoms, which has shown 2. Treatment Process promise in reducing fears and health- Josef Breuer treated Anna O. using hypnosis, care usage. allowing her to relive and process traumatic Exposure Therapy experiences.  Repeatedly confronting patients with 3. Recovery health anxiety-related stimuli without Through catharsis, Anna O. regained her ability avoidance behaviors has shown large- to move and speak German, demonstrating sized effects in improving symptoms. the effectiveness of emotional processing in treating conversion symptoms. Additional Treatment Considerations 1. Medication This case illustrates the complex nature of Functional Some studies suggest that antidepressants, Neurological Symptom Disorder (conversion disorder), particularly SSRIs like paroxetine, may be where psychological distress manifests as physical helpful for some patients with somatic symptoms. It highlights the role of unconscious symptom disorders. processes and the potential for recovery through 2. Gatekeeper Physician therapeutic interventions that address underlying Assigning a primary physician to screen all emotional trauma. physical complaints and authorize specialist visits can help limit excessive medical Functional Neurological Symptom Disorder consultations. (Conversion Disorder) 3. Social Interaction Focus 1. Motor Symptoms Treatment often includes encouraging more Includes weakness, paralysis, abnormal appropriate methods of interacting with movements (tremor, jerks, dystonic others, reducing reliance on being "sick" for movements), and gait abnormalities. social support. 2. Sensory Symptoms 4. Occupational Goals Involves altered, reduced, or absent skin For patients receiving disability, treatment sensation, vision, or hearing. may include encouraging part-time 3. Speech and Other Symptoms employment with the ultimate goal of Includes reduced speech volume, altered discontinuing disability payments. articulation, sensation of a lump in the throat, and diplopia. Understanding Functional Neurological Symptom 4. Diagnostic Approach Disorder (Conversion Disorder) Based on clinical findings incompatible with  Functional Neurological Symptom recognized neurological disease, interpreted Disorder (Conversion disorder) is a by experts in neurological conditions. complex psychological condition where emotional distress manifests as physical symptoms without an Diagnostic Features of Functional Neurological Specify if: Symptom Disorder With psychological stressor (specify stressor) 1. Internal Inconsistency Without psychological stressor Demonstrating that physical signs elicited through one examination method are no Distinguishing Functional Neurological Symptom longer present when tested differently. Disorder (Conversion Disorder) from Malingering 2. Hoover's Sign True Functional Malingering Genuine Weakness of hip extension returns to normal Neurological Individuals Blindness strength with contralateral hip flexion against Symptom intentionally Truly blind resistance. Disorder perform individuals 3. Tremor Entrainment Test Patients poorly on perform at Tremor changes when the individual is perform well on visual tasks, chance levels visual often scoring on visual distracted by copying rhythmical movements discrimination below chance discrimination with the contralateral hand or foot. tasks despite levels, tasks, reflecting 4. Functional Dystonia reporting suggesting an actual Typically presents with fixed inverted position blindness, deliberate inability to of the ankle, a clenched fist, or unilateral indicating attempts to process visual contraction of platysma, often with sudden unconscious appear blind. information. onset. processing of visual Diagnostic Criteria information. A. One or more symptoms of altered voluntary motor These distinctions are crucial for accurate diagnosis or sensory function. and appropriate treatment. Functional Neurological B. Clinical findings provide evidence of incompatibility Symptom Disorder (Conversion disorder) involves between the symptom and recognized neurological or unconscious processes, while malingering is a conscious attempt to feign symptoms. medical conditions. Understanding these differences helps clinicians C. The symptom or deficit is not better explained by provide targeted interventions and avoid another medical or mental disorder. misdiagnosis. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other Prevalence and Comorbidity of Conversion Disorder important areas of functioning or warrants medical 1. Prevalence in Neurological Settings evaluation. Functional Neurological Symptom Disorder (Conversion disorder) is relatively common in Coding note: The ICD-10-CM code depends on the neurological settings, with an average symptom type (see below). prevalence of about 30%. In epilepsy centers, approximately 30% of referred patients have Specify symptom type: psychogenic, non-epileptic seizures. F44.4 With weakness or paralysis 2. Gender and Age Distribution F44.4 With abnormal movement (e.g., tremor, Functional Neurological Symptom Disorder dystonia, myoclonus, gait disorder) (Conversion disorder) is found primarily in F44.4 With swallowing symptoms women and typically develops during F44.4 With speech symptom (e.g., dysphonia, slurred adolescence or early adulthood. It has also speech) been reported in soldiers exposed to severe F44.5 With attacks or seizures combat, particularly during World Wars I and F44.6 With anesthesia or sensory loss II. F44.6 With special sensory symptom (e.g., visual, 3. Comorbid Conditions olfactory, or hearing disturbance) Functional Neurological Symptom Disorder F44.7 With mixed symptoms (Conversion disorder) often co-occurs with Specify if: other conditions, including somatic symptom Acute episode: Symptoms present for less than 6 disorder, anxiety disorders, and mood months. disorders. Dissociative symptoms are also Persistent: Symptoms occurring for 6 months or more. significantly more common in patients with  conversion disorder compared to other falsification, not manipulating laboratory psychiatric patients. individual motivations. tests, or physically inducing illness in These statistics highlight the complexity of conversion oneself or another. disorder and its frequent overlap with other mental health conditions, emphasizing the need for Diagnostic Criteria comprehensive assessment and treatment Factitious Disorder Imposed on Self on Self approaches. A. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated Causes and Cultural Influences in Functional with identified deception. Neurological Symptom Disorder (Conversion B. The individual presents himself or herself to others Disorder) as ill, impaired, or injured. 1. Traumatic Events C. The deceptive behavior is evident even in the Functional Neurological Symptom Disorder absence of obvious external rewards. (Conversion disorder) often develops following D. The behavior is not better explained by another traumatic experiences or impossible mental disorder, such as delusional disorder or another interpersonal situations. psychotic disorder. 2. Psychological Stress Major mood disorders and severe traumatic Specify: stress, especially sexual abuse, are common Single episode among patients with conversion disorder. Recurrent episodes (two or more events of falsification of illness and/or induction of injury) 3. Social and Cultural Factors The disorder tends to occur more frequently in Factitious Disorder Imposed on Another (Previously less educated, lower socioeconomic groups Factitious Disorder by Proxy) where knowledge about medical illnesses is A. Falsification of physical or psychological signs or limited. symptoms, or induction of injury or disease, in another, 4. Neurobiological Connections associated with identified deception. Recent research indicates strong connectivity B. The individual presents another individual (victim) to between conversion symptoms and brain others as ill, impaired, or injured. regions regulating emotion, such as the C. The deceptive behavior is evident even in the amygdala. absence of obvious external rewards. D. The behavior is not better explained by another The etiology of Functional Neurological Symptom mental disorder, such as delusional disorder or another Disorder (conversion disorder) is multifaceted, psychotic disorder. involving psychological, social, and biological factors. Note: The perpetrator, not the victim, receives this Cultural influences play a significant role, with some diagnosis. conversion symptoms being accepted as part of Specify: religious or healing rituals in certain cultures. Single episode Understanding these diverse influences is crucial for Recurrent episodes (two or more events of falsification effective diagnosis and treatment. of illness and/or induction of injury) Factitious Disorder Causes and Treatment for Functional Neurological Essential Feature Methods of Falsification Symptom Falsification of medical Exaggeration, Symptom Disorder and Factitious Disorder Causes: or psychological signs fabrication, simulation,  Traumatic Experience During Childhood – and symptoms in oneself and induction of illness physical, emotional, verbal abuse or others, associated or injury.  Primary Gain – reduction of negative with identified emotions after faking the symptoms deception.  Secondary Gain – faking symptom is Diagnostic Focus Presentation reinforced by some benefits of being in Emphasis on objective May involve falsely the sick role. identification of reporting symptoms, Treatment: Severe: Results in medical hospitalization or  Cognitive Behavioral Therapy emergency room visit.  Trauma Therapy (Factitious Disorder imposed Extreme: Results in severe, life-threatening risk (e.g., on another) ignoring heart attack symptoms). Psychological Factors Affecting Other Medical Impact of Psychological Factors Medical Conditions Factors on Medical Conditions Conditions Essential Influencing Examples 1. Acute Effects Feature Factors Anxiety- Immediate medical consequences, such as Presence of Psychological exacerbating Takotsubo cardiomyopathy. clinically distress, asthma, denial 2. Chronic Effects significant interpersonal of need for Long-term impacts, like chronic occupational psychological interaction treatment for stress increasing risk for hypertension. or behavioral patterns, coping acute chest 3. Affected Conditions factors that styles, and pain, and Range from clear pathophysiology (e.g., adversely maladaptive manipulation affect a health behaviors of insulin by an diabetes, cancer) to functional syndromes medical can influence the individual with (e.g., migraine, irritable bowel syndrome) and condition by course, diabetes idiopathic medical symptoms. increasing the treatment, or wishing to lose risk for underlying weight. Other Specified Somatic Symptom and Related suffering, pathophysiology Disorder death, or of medical disability. conditions. Diagnostic Criteria A. A medical symptom or condition (other than a mental disorder) is present. B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways: 1. The factors have influenced the course of the medical condition as shown by a close temporal association between the Unspecified Somatic Symptom and Related Disorder psychological factors and the development or 1. Insufficient Information exacerbation of, or delayed recovery from, the Used when there is not enough information to medical condition. make a more specific diagnosis. 2. The factors interfere with the treatment of the 2. Clinically Significant Distress medical condition (e.g., poor adherence). Symptoms cause significant impairment in 3. The factors constitute additional well- social, occupational, or other important areas established health risks for the individual. of functioning. 4. The factors influence the underlying 3. Unusual Situations pathophysiology, precipitating or exacerbating Reserved for decidedly unusual situations symptoms or necessitating medical attention. where a more specific diagnosis cannot be made. C. The psychological and behavioral factors in Criterion B are not better explained by another mental disorder Understanding Dissociative Disorders (e.g., panic disorder, major depressive disorder,  Dissociative disorders are characterized by posttraumatic stress disorder). disruptions in the normal integration of consciousness, memory, identity, emotion, Specify current severity: perception, body representation, motor Mild: Increases medical risk (e.g., inconsistent control, and behavior. These disorders can adherence with antihypertension treatment). potentially affect every area of psychological Moderate: Aggravates underlying medical condition functioning and are often associated with (e.g., anxiety aggravating asthma). traumatic experiences.   The DSM-5 places dissociative disorders next 3. Functional Impairments to, but separate from, trauma- and stressor- Dissociative symptoms can disrupt every area related disorders, reflecting their close of psychological functioning, affecting relationship. This category includes memory, identity, and perception. dissociative identity disorder, dissociative 4. Stress-Related Exacerbation amnesia, and depersonalization/derealization Stress often produces transient exacerbation disorder. of dissociative symptoms, making them more evident. Types of Dissociative Disorders Dissociati Dissociative Depersonalization/Der Risk Factors and Cultural Considerations ve Amnesia ealization Disorder 1. Early Life Trauma Identity Involves an Characterized by Earlier onset of trauma, neglect, and various Disorder inability to persistent or recurrent forms of abuse by parents are significant risk Characteri recall experiences of unreality factors for dissociative disorders. zed by the autobiograp or detachment from 2. Cumulative Adversities presence hical one's mind, self, body, Accumulation of early life trauma and of two or information or surroundings,