Abnormal Psychology Chapter 8 Lecture Slides PDF

PSY 421 Abnormal Psychology Chapter 8 Somatic Symptom and Dissociative Disorders Somatoform Disorders The somatoform disorders are a group of conditions  That involve physical symptoms and complaints suggesting the presence of a medical condition  Without any evidence of physical pat...

PSY 421 Abnormal Psychology Chapter 8 Somatic Symptom and Dissociative Disorders Somatoform Disorders The somatoform disorders are a group of conditions  That involve physical symptoms and complaints suggesting the presence of a medical condition  Without any evidence of physical pathology to account for them They are now classified as: Somatic Symptom and Related Disorders  Changed to be more digestible and useful in medical settings where such patients primarily present Somatoform Disorders DSM-IV DSM-5 Somatoform Disorders used to include: Somatic Symptom & Related Disorders Includes:  Somatization disorder  Somatic Symptom disorder  Hypochondriasis  Illness Anxiety Disorder  Pain disorder  Conversion disorder  Conversion disorder  Factitious Disorder  Body dysmorphic disorder (currently within Obsessive Compulsive and Related Disorders) Somatic Symptom & Related Disorders *For our course we cover Somatic Symptom Disorder, Conversion Disorder, & Factitious Disorder Somatic Symptom Disorder Prevalence & Course Somatic Symptom Disorder is combination or features from previously distinct disorders: Hypochondriasis Somatization Disorder Pain Disorder Prevalence:  Estimated 5-7% general adult population  Higher rates for women than men* Somatic Symptom Disorder Causal Factors Cognitive Behavioral Perspective People with somatic symptom disorder tend to have a cognitive style that leads them to be hypersensitive to their bodily sensations. Another characteristic of such patients is that they tend to think catastrophically about their symptoms, often overestimating the medical severity of their condition. Past experiences with illness prime people’s expectancies and beliefs Somatic Symptom Disorder Treatment No treatment shown to be effective Gold Standard: Cognitive-behavioral treatment  relaxation training  support and validation that the pain is real  cognitive restructuring  Train patient to relate to others without using physical complaints  Social skills training  Interpersonal therapy Medical management  Same physician seeing patient on a regular basis  minimal diagnostic tests and medications  Functional Neurological Symptom Disorder (Conversion Disorder) Common symptoms: paralysis, blindness, deafness, seizures, tremors, speech problems, swallowing problems Not intentionally produced symptoms, though psychological factors are implicated in the development/ exacerbation of the symptoms Accurate diagnosis:  Dysfunction does not clearly conform to symptoms of the particular disease  Highly selective nature of dysfunction  Under hypnosis or narcosis (a sleeplike state induced by drugs), the symptoms can usually be removed, shifted, or reinduced by suggestion Conversion Disorder Prevalence & Course Very rare Causal Explanations Primarily psychodynamic understanding Highest rates in neurology settings (5%) Result of internal conflict (“conversion hysteria” - repressed conflict) More common in women than men (2-3x) Primary gain: Escape or avoidance of emotional and General population estimates ~.005%! interpersonal conflicts or stressors Anxiety reduction Most commonly occurs between early Secondary gain: adolescence and early adulthood Any additional benefits beyond the primary gain [Attention from loved ones, financial, Typically rapid onset, brief duration break from obligations] Conversion Disorder Treatment Behavioral techniques to reinforce motor abilities and not reinforce abnormal/ absent motor behaviors Some research with hypnosis techniques  Intentionally producing or exaggerating symptoms Factitious Disorder NOT in an effort to gain external rewards To maintain the “sick role”, get attention, medical care, etc. ***Not to be confused with malingering What is malingering?  Intentionally producing or exaggerating symptoms  It is motivated by external rewards  E.g. time off from work, disability, access to resources, etc. Factitious Disorder Prevalence  ~1% patients in hospitals More common in women What theories may best explain the causal factors related to this disorder? Factitious Disorder Imposed on Another Formerly Munchausen’s Syndrome Example  https://www.youtube.com/watch ?v=ecbis7tDEZY Somatic symptom disorder distinctions Unconsciously Intentionally produced produced symptoms symptoms Somatic For external Symptom Malingering Disorder incentives Conversion Factitious Disorder Disorder For attention; “sick Factitious role” maintenance Disorder Imposed by Another (Munchausens) Somatoform Disorder Causal Factors Illness behavior and reinforcement Cognitive Cultural  People in Non-Western cultures are less likely to express symptoms of depression or anxiety, and more likely to present these experiences as medical problems Dissociative Disorders Dissociative Disorders Characterized by disruptions in a person’s normally integrated functions of: Consciousness Memory Identity Perception Dissociative Disorders Dissociative amnesia: Dissociative fugue:  a failure to recall previously stored personal  Removed in DSM-5 but included as a Dissociative Amnesia information when that failure cannot be specifier accounted for by ordinary forgetting  amnesia symptoms and the person also departs from home surroundings  Retrograde amnesia  Affects Episodic memory Both are very rare *For our course we only focus on Dissociative Identity Disorder Dissociative Identity A patient manifesting 2 or more Disorder distinct identities that alternate in taking control of behavior Formerly called multiple personality disorder  Alter = identity or personality in DID  Many have at least 1 impulsive alter  Alters of the opposite gender are common DID Host = identity that seeks treatment and tries Descriptors to keep other identities integrated Switch = transition to another identity http://www.oprah.com/oprahshow/Introduction-to-Kim-No bles-Multiple-Personalities-Video DID Prevalence & Course Onset typically in childhood  dissociation often spurred by stress/ trauma Prevalence: very rare  1 year prevalence in US: 1.5%  3-9 times more common among women Course is chronic High comorbidity PTSD, depression, borderline personality disorder High rates of self-injury and suicidality Number of identities varies  women average about 15  men average about 8  50% of those diagnosed have 10% which has increased over time DID Causal Factors Post-traumatic theory  Over 95% of DID patients report memories of severe abuse  Attempt to cope with overwhelming sense of hopelessness and powerlessness  Escape (dissociation) occurs through a process like self- hypnosis  Research shows large majority experience abuse before age 6, aligns with child level tools of adaptation DID Causal Factors Sociocognitive theory  Develops in highly suggestible persons who learn to adopt multiple identities due to therapist suggestions and reinforcement  The different identities allow the individual to achieve personal goals Treatment of Dissociative Disorders Psychotherapy  focused on integration; treatment is typically psychodynamic and insight- oriented Hypnosis No one therapy has been proven truly effective Very difficult to treat  Prolonged treatment (many years) Dissociative Identity Disorder  Controversies surrounding dissociative identity disorder include: Is the disorder real or faked? Are recovered memories of abuse in the disorder real or false? If abuse has occurred, did it play a causal role?  What do you think?? Summary Somatoform disorders involve a focus on physical symptoms that are either not real or are exaggerated Dissociative disorders involve a disturbance in normally integrated functions (memory, identity, etc.) Course is usually chronic Causes and best treatment for most are unclear