UNIT 5: SOMATIC SYMPTOM & RELATED DISORDERS AND DISSOCIATIVE DISORDERS PDF

1|Page UNIT 5: SOMATIC SYMPTOM & RELATED DISORDERS AND DISSOCIATIVE DISORDERS Overview For a few individuals, the preoccupation with their health or appearance becomes so great that it dominates their lives. They may be suffering with somatic symptom disorders Commo...

1|Page UNIT 5: SOMATIC SYMPTOM & RELATED DISORDERS AND DISSOCIATIVE DISORDERS Overview For a few individuals, the preoccupation with their health or appearance becomes so great that it dominates their lives. They may be suffering with somatic symptom disorders Common among these disorders: there is an excessive or maladaptive response to physical symptoms or to associated health concerns. Soma means body, and the problems preoccupying these people seem, initially, to be physical disorders Dissociative disorders on the other hand refers to detachment of oneself, experiences of unreality. These experiences are so intense and extreme that they lose their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function. Somatic symptom and dissociative disorders are used to be categorized as “hysterical neurosis” Somatic symptom and dissociative disorders are strongly linked historically, and evidence indicates they share common features Somatic Symptom and Related Disorders A. Somatic Symptom Disorder In 1859, Pierre Briquet, a French physician, described patients who came to see him with seemingly endless lists of somatic complaints. Despite negative findings, patients returned shortly with either the same complaints or new lists containing slight variations. This disorder was called as Briquet’s syndrome but now considered 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 somatic symptom(s) or health concerns, as indicated by at least one of the following: a. health-related anxiety, b. disproportionate and persistent concerns about the medical seriousness of symptoms, and c. excessive time and energy devoted to health concerns d. 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. 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 Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 2|Page 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) Note: With predominant pain (previously pain disorder): This specifier is for individuals whose somatic complaints predominantly involve pain. B. Illness Anxiety Disorder Formerly known as “Hypochondriasis” Physical symptoms are not experienced at the present time or are very mild. The concern is primarily with the idea of being sick instead of the physical symptom itself. Focused on the possibility of having or developing a serious disease. Note: If one or more physical symptoms are relatively severe and are associated with anxiety and distress, the diagnosis would be somatic symptom disorder. Illness Anxiety Disorder is characterized by anxiety or fear that one has a serious disease. Therefore, the essential problem is anxiety, but its expression is different from that of the other anxiety disorders. In illness anxiety disorder, the individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease. Almost any physical sensation may become the basis for concern. Another important feature of this disorder is that reassurances from numerous doctors that all is well, and the individual is healthy have, at best, only a short-term effect. (Disease conviction) 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, 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 or exhibits maladaptive avoidance 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 is not better explained by other psychological disorders 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. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 3|Page C. Psychological Factors affecting medical condition Essential feature: The presence of diagnosed medical condition such as asthma, diabetes, or severe pain clearly caused by a known medical condition such as cancer that is adversely affected by one or more psychological or behavioral factors. These behavioral or psychological factors would have a direct influence on the course or perhaps the treatment of the medical condition. One example would be anxiety severe enough to clearly worsen an asthmatic condition. Another example would be a patient with diabetes who is in denial about the need to regularly check insulin levels and intervene when necessary D. Conversion Disorder (Functional Neurological Disorder) “Functional” refers to a symptom without an organic cause. Conversion disorders generally have to do with physical malfunctioning such as paralysis, blindness, or difficulty speaking (aphonia), without any physical or organic pathology to account for the malfunction. Additionally, the disorder may include total mutism and the loss of the sense of touch. In addition to blindness, paralysis, and aphonia, conversion symptoms may include total mutism and the loss of the sense of touch. Some people have seizures, which may be psychological in origin, because no significant electroencephalogram (EEG) changes can be documented. These “seizures” are usually called psychogenic non-epileptic seizures. Another relatively common symptom is globus hystericus, the sensation of a lump in the throat that makes it difficult to swallow, eat, or sometimes talk Diagnostic Criteria for Conversion Disorder A. One or more symptoms affecting voluntary motor or sensory function B. The symptoms are incompatible with recognized medical disorder C. The symptom or deficit is not better explained by another medical or mental disorder. D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation. Closely Related Disorders E. Malingering (Faking) Disorder symptoms are under voluntary control Motivation of Malingerers: Either trying to get out of something such as work or legal difficulties, or attempting to gain something such as financial statement. Note: Malingerers are fully aware of what they are doing and are clearly attempting to manipulate others to gain a desired end. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 4|Page F. Factitious Disorder The symptoms are under voluntary control, as with malingering, but there is no obvious reason for voluntarily producing symptoms except possibly, to assume the sick role and receive increased attention. May extend to family members. When an individual deliberately makes someone sick, the condition is called factitious disorder imposed on another also known previously as Munchausen syndrome by proxy. In Factitious Disorder Imposed on Self, the person presents himself or herself to others as ill, impaired, or injured In Factitious Disorder Imposed on Another, the person fabricates symptoms in another person and then presents that person to others as ill, impaired, or injured Diagnostic Criteria for Factitious Disorder A. Fabrication of physical or psychological symptoms, 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 DISSOCIATIVE DISORDERS when individuals feel detached from themselves or their surroundings, almost as if they are dreaming or living in slow motion, they are having dissociative experience Three types of Dissociative Disorders: Depersonalization-Derealization, Dissociative Amnesia, and Dissociative Identity Disorder A. Depersonalization-Derealization When feelings of unreality are so severe and frightening that they dominate an individual’s life and prevent normal functioning, this may be diagnosed as depersonalization-derealization disorder. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 5|Page Patients with this disorder may experience “tunnel vision” (perceptual distortions) and “mind emptiness” (difficulty absorbing new information). During an episode of 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. During an episode of derealization, your sense of the reality of the external world is lost. Things may seem to change shape or size; people may seem dead or mechanical. These sensations of unreality are characteristic of the dissociative disorders because, in a sense, they are a psychological mechanism whereby one “dissociates” from reality. Diagnostic Criteria for Depersonalization-Derealization A. A presence of persistent and recurrent experiences of depersonalization, derealization, or both; Depersonalization: Experiences of detachment from one’s mental processes or body, as though one is in a dream, or Derealization: Experiences of unreality/detachment with respect to surroundings 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. Symptoms are not explained by substances, another dissociative disorder, another psychological disorder, or by a medical condition E. The disturbance is not better explained by another mental disorder, such as schizophrenia or panic disorder. B. Dissociative Amnesia Dissociative Amnesia –includes several patterns. o Generalized amnesia –People who are unable to remember anything. o Localized or selective amnesia –a failure to recall specific events. Subtype: Dissociative Fugue –memory loss revolves around a specific incident –an unexpected trip/s. 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. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 6|Page 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. C. Dissociative Identity Disorder People with DID may adopt as many as 100 new identities all simultaneously coexisting, although the average number is closer to 15. In some cases, the identities are complete, each with its own behavior, tone of voice, and physical gestures. But in many cases, only a few characteristics are distinct, because the identities are only partially independent, so it is not true that there are “multiple” complete personalities. Many patients have at least one impulsive alter who handles sexuality and generates income, sometimes by acting as a prostitute. In other cases, all alters may abstain from sex. Cross- gendered alters are not uncommon. For example, a small agile woman might have a strong powerful male alter who serves as a protector Alters –the different identities or personalities in DID. Host –the person who becomes the patient. Switch –the transition from one personality to another. Diagnostic Criteria for Dissociative Identity Disorder A. Disruption of identity characterized by two or more distinct personality states (alters) or an experience of possession, as evidenced by discontinuities in sense of self or agency, as reflected in altered cognition, behavior, affect, perceptions, consciousness, memories, or sensory-motor functioning. This disruption may be observed by others or reported by the patient. B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. 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. Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology 7|Page 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). References: Durand, V. & Barlow, D. (2016). Essentials of Abnormal Psychology. 7th Edition. Boston, MA 02210 USA. Hoeksema, S. (2014). Abnormal Psychology. 6th Edition. McGraw-Hill International Edition. New York. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. American Psychiatric Association. Washington, DC. London, England Compiled by: Ms. Laarni D. Muzones, MSPsy, RPsy ABNPSY330 Abnormal Psychology