and Dissociative Somatoform Disorders
Abnormal Psychology Robin Rosenberg and Stephen Kosslyn
PowerPoint Slides prepared by: Nicholas Greco IV, M.S. College of Lake County
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Read the textbook's discussion of Anna O. and her treatment. There's more to this story than is in your textbookand she was a really interesting person!
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Hysteria is an emotional condition marked by extreme excitability and bodily symptoms for which there is no medical explanation; hysteria _________ a DSMIVTR disorder. Dissociation is the separation of psychological processes such as perception, memory, and self awareness that are normally ________. This is the central feature of dissociative disorders. Somatoform disorders are marked by persistent bodily symptoms for which there is no medically identifiable cause.
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Four types of dissociative symptoms are noted in the DSMIV TR: Amnesia, or memory loss, which is usually temporary but, in rare cases, may be permanent Identity problem, in which an individual is not sure who he or she is or may assume a new identity Derealization, in which the external world is perceived or experienced as strange or unreal ______________, in which the perception or experience of self either one's body or one's mental processes is altered to the point of feeling like an observer, as though seeing oneself from the "outside"
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Dissociative disorders are a category of psychological disorders in which perception, consciousness, memory, or identity are dissociated to the point where the symptoms are pervasive, cause significant distress, and interfere with daily functioning. Dissociative disorders are almost certainly mediated through ______________. Only 2% of the U.S. population reports having experienced dissociation to the extent that would be considered abnormal.
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There are four types of dissociative disorders: Dissociative amnesia Dissociative fugue Depersonalization disorder Dissociative identity disorder Dissociative identity Disorder _______________ _________ (DDNOS) is given to a person with some, but not all, of the symptoms required for a diagnosis of one of the dissociative disorders, but whose functioning is nonetheless impaired because of the symptoms.
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Dissociative Amnesia is a dissociative disorder in which the sufferer has significantly impaired memory for important experiences or personal information that cannot be explained by ordinary forgetfulness.
The memory problems in dissociative amnesia can take any of several forms:
Generalized amnesia--person's total life __________ amnesiasome things are forgotten and others not Localized amnesiaa memory gap
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Because the disorder is so rare, not much is known about either the specific factors that give rise to it or how those factors might influence each other. Dissociative amnesia may result in part from damage to the __________. Prolonged stress affects the hippocampus so that it does not operate well when the person is highly aroused. Hippocampal damage does not explain all cases of the disorder. Hormones may be contributing, namely ______, which can reduce the size of the hippocampus.
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Dissociation theory posits that very strong emotions narrow the focus of attention and also disorganize cognitive processes, which prevent them from being integrated normally.
The poorly integrated cognitive processes allow _________ to be dissociated from others aspects of cognitive functioning.
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Neodissociation theory proposes that an "_________ monitoring system" normally coordinates various cognitive systems.
In a traumatic event, these cognitive systems can operate independently of the executive monitoring system. That is, when under extreme stress a person's voluntary integration of all the aspects of their sense of self may be lost and their sense of self become fragmented.
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Traumatic events, such as combat and abuse, are likely to contribute to dissociative disorders. People with a dissociative disorder report childhood physical or sexual abuse almost ________ times more often than do people without a dissociative disorder.
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Dissociative fugue is a dissociative disorder that involves sudden, unplanned ________ and difficulty remembering the past, which can lead patients to be confused about who they are and sometimes to take on a new identity. The episode may last anywhere from a few hours to weeks or even months. The individual tends to function normally during the period when they have dissociated.
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____________ problems may underlie dissociative fugue.
People who have had dissociative fugue are more ___________ than the general population. From a social factor, dissociative fugue occurs in response to significant stressors that involve social factors.
The reduced activation in the frontal lobes might be a result of high levels of stressrelated hormones which could selectively affect processes involved in coordinating voluntary actions and mental events.
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Depersonalization disorder is a dissociative disorder whose primary symptom is a persistent feeling of being _________ from one's mental processes or body, although people who have this disorder may also experience derealization. Feelings of "detachment from one's body," "feeling like a robot." They do not believe that they are truly detached or actually a robot.
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In a PET study, patients with depersonalization disorder were found to have unusual levels of activation (too high or too low) in parts of the brain specifically involved in various phases of perception. There is lower activity in parts of the __________ lobe and higher activity in the __________ lobe. Patients do not produce normal amounts of norepinephrine.
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Patients with depersonalization disorder have cognitive deficits that range from problems with shortterm memory to impaired spatial reasoning. The root cause appears to be with _____________. Severe and chronic emotional abuse experienced during childhood seems to play a role in triggering depersonalization disorder.
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Figure 8.1 Feedback Loops in Action: Depersonalization Disorder
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Dissociative Identity Disorder (DID) is characterized by the presence of two or more distinct ___________ (personality states or identities), each with their own characteristics and history, that take turns controlling the person's behavior. Most people diagnosed with DID have 10 or fewer alters3 is the most common. Formerly known as multiple personality disorder (MPD) There are significant diagnostic issues that plague the DSMIVTR.
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My wife worked with at least four patients with DID. Most DID patients are women, but not all. It seems to arise fairly early in life, and may arise from a failure to abandon the "imaginary playmate" when the individual needs to escape into the imaginary playmate to escape intolerable abuse. Personality #1 is generally depressed and anxious. Personality #2 is sociopathic. Patients with DID almost always also meet criteria for Borderline Personality Disorder.
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Neurological differences between alters paints a mixed picture. One hallmark of DID is that memories acquired by one alter are __________________ to other alters. Patients with DID are inhibited from recalling stored information when a different alter is dominant. Each alter has a different sense of self. DID is thought to be associated with early childhood abuse.
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The primary psychological factor associated with DID is _____________. Patients can easily be hypnotized and dissociate. DID was rare before 1976. In 1976 the movie Sybil was aired and received widespread attention. Years later, the patient known as Sybil said she did not have alters, but had been encouraged by the therapist to name her different feelings as if they were alters. However, "The Three Faces of Eve" was a popular movie made much earlier, in the 1950s. India and China have extremely low incidence of DID.
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The ______________ model proposes that after frequent episodes of abuse with accompanying dissociation, the child's dissociated state can develop its own memories, identity, and way of interacting with the world. The sociocognitive model proposes that social interactions between therapist and patient foster DID by influencing the beliefs and expectations of the patient.
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There is much debate about the "existence" of DID, since it so clearly involves selfhypnosis. Read the section of the textbook dealing with DID (pp. 344349). It is REALLY interesting, and has all sorts of interesting ideas and data to chew on.
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Dissociative disorders usually improve spontaneously, or with treatment. This especially of true dissociative amnesia and dissociative fugue As dissociative disorders are rare, few systematic studies have been conducted. __________ is not usually used because it is not helpful for dissociative symptoms.
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Treatments that target psychological factors focus on three elements:
Reinterpreting the symptoms so that they don't create stress or lead the patient to avoid certain situations Learning additional coping strategies to manage stress For DID patients, addressing the presence of alters and dissociated aspects of their memories or identities _________ a useful way of dealing with stress. The book's description of hypnosis is silly, though hypnosis is a valid treatment.
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Somatoform disorders are characterized by complaints about physical wellbeing that cannot be entirely explained by a medical condition, substance use, or another psychological disorder. These disorders are "______" diagnoses. Relatively rare in the general population Patients with these disorders account for $250 billion in medical costs each year.
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Somatoform disorders date back to ancient Greek times. Hippocrates thought that somatoform symptoms (generally reported by women) were caused by a wandering __________, wherein the term hysteria is derived. Hysteria was often used to refer to bodily symptoms that lack a medical explanation. Somatoform disorders must be distinguished from factitious disorder. Those with a somatoform disorder neither pretend to have symptoms nor intentionally induce physical symptoms for gain.
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Somatoform disorders share two common features:
Bodily preoccupation Symptom amplification
Body ___________ disorder (BDD) is the only somatoform disorder that does not include an actual somatic symptom. Somatoform and dissociative disorders are classified separately only because of the bodily aspect of somatoform symptoms.
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Somatization disorder (SD) is characterized by multiple physical symptoms that are medically _________ and impair an individual's ability to function. To be diagnosed with SD, the individual must have had each of four different types of medically unexplained symptoms:
Pain Gastrointestinal Sexual Pseudoneurological
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Pain disorder occurs when psychological factors significantly affect the onset, severity, or _____________ of significant pain. The pain must cause significant distress or impair functioning and malingering or factitious disorder must be ruled out. When the pain arises from a medical condition, pain disorder is not diagnosed on Axis I, but the medical condition is noted on Axis III. Pain disorder and somatization disorder involve genuine pain to which psychological factors contribute.
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SD involves bodily preoccupation and symptom amplification, as well as catastrophic thinking about physical sensations or fears of illness. Social stressors, modeling, and reinforcement of illness behavior, and cultural influences on symptoms contribute to SD. Social stress death of a loved one Social learning observational learning from an ill parent Somatic symptoms may be an acceptable way to express ____________ in the U.S. The nature of symptoms varies across cultures
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DSMIVTR criteria for SD have been criticized because they depend on a simple count of symptoms, with no research basis for the numbers. In addition, no mention is made of whether there is medical verification of medical conditions underlying the complaints.
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Conversion Disorder involves sensory or motor symptoms that _________ correspond to symptoms that arise from known medical conditions.
Patients do not consciously produce the symptoms they experience and are significantly distressed or their functioning is impaired. (?) Limited to sensory and motor symptoms that appear to be neurological. Diagnosis is made after all possible medical causes are ruled out.
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Conversion Disorder is characterized by three types of symptoms: Motor symptoms tremors, tics, jerks, muscle spasms, staggering that worsen when attention is paid to them Sensory symptoms blindness, double vision, deafness, auditory hallucinations Seizures twitching or jerking of some part of the body and loss of consciousness with uncontrollable spasms of the large muscles of the body, Known as ________________ because they do not have a neurological origin and are unaffected by seizure medication
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Glove anesthesia
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Effects of stimulating an affected limb (below) and an unaffected limb (above)
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______________ findings suggest that muscle weakness arising from conversion disorder is not the same as consciously simulated muscle weakness. Some patients with chronic pain develop sensory deficits and have weakness and sometimes paralysis of a limb. They are typically classified as having both conversion disorder and pain disorder. Conversion disorder may run in families, but it is difficult to disentangle the role of genes from that of ____________ the behavior of family members.
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There is no generally accepted explanation for how psychological factors might produce the selective bodily symptoms in conversion disorder. The theory that conversion disorder results from self hypnosis is supported by the finding that areas of the brain activated by hypnotically induced paralysis are similar to those activated by paralysis in patients with conversion disorder. Combat may trigger a conversion disorder. The greater the severity or number of stressors, the more severe the conversion symptoms. "_____________" is key.
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Hypochondriasis is marked by preoccupation with a fear or belief of having serious disease, but this preoccupation arises because the individual has ____________ his or her bodily sensations or symptoms.
Patients persist or cling strongly to their conviction that they have a serious disease despite medical evidence to the contrary. Patients have poor insight into their condition. The person must have had preoccupation with a perceived health problem for at least six months and caused significant distress or impairment in functioning. Hypochondriasis and anxiety disorders share common features.
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____________ may not be functioning properly in at least some cases of hypochondriasis.
This is supported by the fact that SSRIs can improve the symptoms.
However, it's not like OCD. One twin study found that genetic differences do contribute to hypochondriasis. Genetics account for about a third of the variation in bodily symptoms that are not clearly related to a medical disorder.
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People with hypochondriasis have specific biases in their reasoning.
People with hypochondriasis are more likely to have experienced traumatic sexual contact, physical violence, or major familial upheaval.
They tend to seek evidence of health threats and may fail to consider evidence that such threats are minimal or nonexistent. They focus on unpleasant sensations like a sore throat. They may engage in ____________ thinking.
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Body Dysmorphic Disorder (BDD) is characterized by excessive preoccupation with a perceived defect or defects in appearance. These "defects" may be thinning or excessive hair, acne, wrinkles, scars, complexion, shape of some part of the body, or facial asymmetry. Up to half of those with BDD are ____________. Patients with BDD may compulsively exercise, diet, shop for beauty aids, pick at their skin, or spend hours looking at the mirror. They may seek reassurance from others about their appearance which causes more anxiety.
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BDD patients may have impaired functioning of serotonin People with anxiety disorders such as OCD often have low levels of serotonin. BDD is related to anxiety disorders. Patients with BDD exhibit a variety of cognitive biases: They are easily distracted by emotional information They tend to focus their attention on isolated parts and are ____________ for possible bodily imperfections They engage in catastrophic thinking The specific body parts that are the focus of attention vary by culture.
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Clinicians target neurological, psychological, and social factors individually or in combination. SSRIs or _____________ may be used to treat some anxietyrelated symptoms of somatoform disorders although there has not been a great deal of research for this treatment. CBT is the psychological treatment of choice as the focus is on identifying and modifying irrational thoughts and shifting attention away from the body and bodily symptoms. Support from the therapist in terms of understanding the pain and distress of the patient can be effective. Treatment may also focus on the family psychoeducation.
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