Chapter 6 Handouts

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Unformatted text preview: 0. 1. 2. 3. 6. 7. 8. 4. 5. Chapter 6 Handouts Chapter 6 Handouts Somatoform and Dissociative Disorders In addition to disorders covered earlier, two other kinds of disorders are commonly linked with stress and anxiety 0. Somatoform disorders 1. Dissociative disorders Somatoform and Dissociative Disorders Somatoform disorders are problems that appear to be _____________________but are due to __________________________ 2. Unlike psychophysiological disorders, in which psychosocial factors interact with physical factors to produce genuine physical ailments and damage, somatoform disorders are ____________ ________________________________________ Somatoform and Dissociative Disorders Dissociative disorders are patterns of memory loss and identity change that are due almost entirely to _________________ rather than ____________________. Somatoform and Dissociative Disorders The somatoform and dissociative disorders have much in common: 3. Both occur in response to traumatic or ongoing stress 4. ________________________________________ ________________________________________ 5. A number of individuals suffer from both a somatoform disorder and a dissociative disorder Somatoform Disorders When a physical illness has no apparent medical cause, physicians may suspect a somatoform disorder ____________________________________ ____________________________________ 0. ______________________________________ There are two main types of somatoform disorders 1. Hysterical somatoform disorders 2. Preoccupation somatoform disorders What Are Hysterical Somatoform Disorders? People with hysterical somatoform disorders suffer actual changes in their physical functioning 9. Often hard to distinguish from genuine medical problems 10. _______________________________________ _______________________________________ _______________________________________ What Are Hysterical Somatoform Disorders? DSM­IV­TR lists three hysterical somatoform disorders: 11. Conversion disorder 12. Somatization disorder 13. Pain disorder associated with psychological factors What Are Hysterical Somatoform Disorders? What Are Hysterical Somatoform Disorders? 14. Conversion disorder 3. In this disorder, a psychosocial conflict or need is _____________________________________________ _____________________________________________ 0. Symptoms often seem neurological, such as paralysis, blindness, or loss of feeling 4. Most conversion disorders begin between late childhood and young adulthood 5. They are diagnosed in women _____________ as in men 6. They usually appear suddenly and are thought to be rare What Are Hysterical Somatoform Disorders? 15. Somatization disorder 7. People with somatization disorder have ______________ ______________________________________________ 1. Also known as Briquet’s syndrome 8. To receive a diagnosis, a patient must have multiple ailments that include several pain symptoms, gastrointestinal symptoms, a sexual symptom, and a neurological symptom 9. Patients usually go from doctor to doctor seeking relief What Are Hysterical Somatoform Disorders? 6. Somatization disorder 16. Patients often describe their symptoms in dramatic and exaggerated terms 10. Many also feel anxious and depressed 17. Between 0.2% and 2% of all women in the U.S. experience a somatization disorder per year (compared with less than 0.2% of men) 18. The disorder often runs in families and begins between adolescence and late adulthood What Are Hysterical Somatoform Disorders? 7. Somatization disorder 19. This disorder typically lasts much longer than a conversion disorder, typically for many years 20. Symptoms may fluctuate over time but ________ ________________________________________ What Are Hysterical Somatoform Disorders? 21. Pain disorder associated with psychological factors 11. Patients may receive this diagnosis when psychosocial factors play a central role in the onset, severity, or continuation of pain 12. The precise prevalence has not been determined, but it appears to be fairly common 2. ___________________________________________________ 13. The disorder may begin at any age, and more women than men seem to experience it What Are Hysterical Somatoform Disorders? 8. Hysterical vs. medical symptoms 22. It often is difficult for physicians to differentiate between hysterical disorders and “true” 22. medical conditions 14. ____________________________________________ 3. For example, hysterical symptoms may be at odds with the known functioning of the nervous system, as in cases of glove anesthesia What Are Hysterical Somatoform Disorders? 9. Hysterical vs. factitious symptoms 23. Hysterical somatoform disorders must also be distinguished from patterns in which individuals are _______________ medical symptoms 15. ___________________________________________ ___________________________________________ 16. ___________________________________________ ___________________________________________ Factitious Disorder 24. People with a factitious disorder often go to extreme lengths to create the appearance of illness 17. May give themselves medications to produce symptoms 25. Patients often research their supposed ailments and become very knowledgeable about medicine 18. May undergo painful testing or treatment, even surgery Factitious Disorder 10. _______________________ is the extreme and chronic form of factitious disorder 11. In ___________________ a related disorder, parents make up or produce physical illnesses in their children 26. When children are removed from their parents, symptoms disappear Factitious Disorder 12. _______________________ have not yet been developed 27. Psychotherapists and medical practitioners often become annoyed or angry at such patients What Are Preoccupation Somatoform Disorders? 13. Preoccupation somatoform disorders include hypochondriasis and body dysmorphic disorder 28. People with these problems _______________ ______________ to bodily symptoms or features 14. Although these disorders also cause great distress, their impact on personal, social, and occupational life differs from that of hysterical disorders What Are Preoccupation Somatoform Disorders? 15. Hypochondriasis 29. People with hypochondriasis unrealistically interpret bodily symptoms as _______________ 19. Often their symptoms are merely normal bodily changes, such as occasional coughing, sores, or sweating 30. Although some patients recognize that their concerns are excessive, many do not What Are Preoccupation Somatoform Disorders? What Are Preoccupation Somatoform Disorders? 16. Hypochondriasis 31. Although this disorder can begin at any age, it starts most often in early adulthood, among men and women in equal numbers 32. Between 1% and 5% of all people experience the disorder 33. For most patients, symptoms wax and wane over time What Are Preoccupation Somatoform Disorders? 34. Body dysmorphic disorder (BDD) 20. This disorder, also known as dysmorphophobia, is characterized by deep and extreme concern over _____________________________________________ 4. Foci are most often wrinkles, spots, facial hair, or misshapen facial features (nose, jaw, or eyebrows) 21. Most cases of the disorder begin in adolescence but are often not revealed until adulthood 22. Up to 2% of people in the U.S. experience BDD, and it appears to be _________________________________ What Causes Somatoform Disorders? 35. Theorists typically explain the preoccupation somatoform disorders much as they do the anxiety disorders: 23. Behaviorists: classical conditioning or modeling 24. Cognitive theorists: oversensitivity to bodily cues 36. In contrast, the hysterical somatoform disorders are widely considered unique and in need of special explanation (although no explanation has received strong research support) What Causes Somatoform Disorders? 17. The psychodynamic view 37. Freud believed that hysterical disorders represented a conversion of underlying emotional conflicts into physical symptoms 38. Because most of his patients were women, Freud looked at the psychosexual development of girls and focused on the phallic stage (ages 3 to 5)… What Causes Somatoform Disorders? 39. The psychodynamic view 0. During this stage, girls experience a pattern of sexual desires for their fathers (the Electra complex) and recognize that they must compete with their mothers for his attention 1. Because of the mother’s more powerful position, however, girls repress these sexual feelings 2. Freud believed that if parents overreact to such feelings, the Electra complex would remain unresolved and the child might re­experience sexual anxiety throughout her life 3. Freud concluded that some women hide their sexual feelings in adulthood by converting them into physical symptoms What Causes Somatoform Disorders? 18. The psychodynamic view 40. Modern theorists propose that two mechanisms are at work in the hysterical disorders: 25. _________________ : hysterical symptoms keep internal conflicts out of conscious 25. awareness 26. _________________ : hysterical symptoms further enable people to avoid unpleasant activities or to receive kindness or sympathy from others What Causes Somatoform Disorders? 41. The behavioral view 27. Behavioral theorists propose that the physical symptoms of hysterical disorders bring __________ to sufferers 5. _______________________________________________ 6. _______________________________________________ 28. In response to such rewards, people learn to display symptoms more and more 29. This focus on rewards is similar to the psychodynamic idea of secondary gain, but behaviorists view the gains as the primary cause of the development of the disorder What Causes Somatoform Disorders? 19. The cognitive view 42. Cognitive theorists propose that hysterical disorders are a form of __________________, providing a means for people to express difficult emotions 30. Like psychodynamic theorists, cognitive theorists hold that emotions are being converted into physical symptoms 7. This conversion is not to defend against anxiety but to communicate extreme feelings What Causes Somatoform Disorders? 20. A possible role for biology 43. The impact of biological processes on somatoform disorders can be understood through research on placebos and the placebo effect 31. Placebos: _________________________________ 32. Treatment with placebos (i.e., sham treatment) has been shown to bring improvement to many – possibly through the power of suggestion or through the release of endogenous chemicals How Are Somatoform Disorders Treated? 21. People with somatoform disorders usually seek psychotherapy as a last resort 22. Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders: 44. _____________________________________ 45. _____________________________________ How Are Somatoform Disorders Treated? 33. Individuals with hysterical disorders are typically treated with approaches that emphasize the cause, and may include treatments similar to those for PTSD: 8. __________ ­ especially antidepressant medication 9. __________ – often psychodynamically oriented 10. __________ – client thinks about traumatic event(s) that triggered the physical symptoms 11. __________ – usually an offering of emotional support that may include hypnosis 11. 12. __________ – a behavioral attempt to change reward structures 13. __________ – an overt attempt to force patients out of the sick role 34. All approaches need more study Dissociative Disorders 23. The key to one’s identity – the sense of who we are, the characteristics, needs, and preferences we have – is memory 46. Our recall of the past helps us to react to the present and guides us toward the future 47. People sometimes experience a major disruption of their memory: 35. They may not remember new information 36. They may not remember old information Dissociative Disorders 24. When such changes in memory have no clear physical cause, they are called “dissociative” disorders 48. In such disorders, one part of the person’s memory typically seems to be dissociated, ________________, from the rest Dissociative Disorders 49. There are several kinds of dissociative disorders, including: 37. Dissociative amnesia 38. Dissociative fugue 39. Dissociative identity disorder (multiple personality disorder) 50. These disorders are often memorably portrayed in books, movies, and television programs 51. DSM­IV­TR also lists depersonalization disorder as a dissociative disorder Dissociative Disorders 25. It is important to note that dissociative symptoms are often found in cases of acute and posttraumatic stress disorders 52. When such symptoms occur as part of a stress disorder, they do not necessarily indicate a dissociative disorder (a pattern in which dissociative symptoms dominate) Dissociative Amnesia 26. People with dissociative amnesia are unable to recall important information, usually of an upsetting nature, about their lives 53. The loss of memory is much more extensive than normal forgetting and is not caused by organic factors 54. Very often an episode of amnesia is directly triggered by a specific upsetting event Dissociative Amnesia 55. Dissociative amnesia may be: 40. __________________ – most common type; loss of all memory of events occurring within a limited period 41. __________________ – loss of memory for some, but not all, events occurring within a period 42. __________________ – loss of memory, beginning with an event, but extending back in 42. time; may lose sense of identity; may fail to recognize family and friends 43. __________________ – forgetting of both old and new information and events; quite rare in cases of dissociative amnesia Dissociative Amnesia 27. All forms of the disorder are similar in that the amnesia interferes primarily with one’s autobiographical memory of personal material 56. _______________________________________ _______________________________________ 28. It is not known how common dissociative amnesia is, but rates increase during times of serious threat to health and safety Dissociative Fugue 29. People with dissociative fugue not only forget their personal identities and details of their past, but also _________________________ 57. For some, the fugue is brief: they may travel a short distance but do not take on a new identity 58. For others, the fugue is more severe: they may travel thousands of miles, take on a new identity, build new relationships, and display new personality characteristics Dissociative Fugue 59. ~ 0.2% of the population experience dissociative fugue 44. It usually follows a severely stressful event, although personal stress may also trigger it 60. Fugues tend to end suddenly 45. When people are found before their fugue has ended, therapists may find it necessary to continually remind them of their own identity and location 46. Individuals tend to regain most or all of their memories and never have a recurrence Dissociative Identity Disorder/ Multiple Personality Disorder 30. A person with dissociative identity disorder (DID; formerly multiple personality disorder) develops two or more distinct personalities – subpersonalities – each with a unique set of memories, behaviors, thoughts, and emotions Dissociative Identity Disorder/ Multiple Personality Disorder 31. At any given time, one of the subpersonalities dominates the person’s functioning more often than the others 62. The transition from one subpersonality to the next (“_________________”) is usually ___________ __________________________ Dissociative Identity Disorder/ Multiple Personality Disorder 32. Cases of this disorder were first reported almost three centuries ago 63. Many clinicians consider the disorder to be rare, but recent reports suggest that it may be more common than once thought Dissociative Identity Disorder/ Multiple Personality Disorder 33. Most cases are first diagnosed in late adolescence or early adulthood 61. Usually one of these subpersonalities – called the primary, or host, personality – appears 64. Symptoms generally begin in childhood after episodes of abuse 64. 47. Typical onset is before the age of 5 65. _________________________________________________________________________ _ Dissociative Identity Disorder/ Multiple Personality Disorder 66. How do subpersonalities interact? 48. The relationship between or among subpersonalities differs from case to case 14. Generally there are three kinds of relationships: 0. ___________________ – subpersonalities have no awareness of one another 1. ___________________ – each subpersonality is well aware of the rest 2. ___________________ – most common pattern; some personalities are aware of others, but the awareness is not mutual 3. Those who are aware (“co­conscious subpersonalities”) are “quiet observers” Dissociative Identity Disorder/ Multiple Personality Disorder 34. How do subpersonalities interact? 67. Investigators used to believe that most cases of the disorder involved two or three subpersonalities 49. Studies now suggest that the average number is much higher – 15 for women, 8 for men 15. There have been cases of more than 100! Dissociative Identity Disorder/ Multiple Personality Disorder 68. How do subpersonalities differ? 50. Subpersonalities often display dramatically different characteristics, including: 16. ____________________ 17. Subpersonalities may differ in terms of age, sex, race, and family history 18. ____________________ 19. Although encyclopedic knowledge is unaffected by dissociative amnesia or fugue, in DID it is often disturbed 20. It is not uncommon for different subpersonalities to have different areas of expertise or abilities, including driving a car, speaking foreign languages, or playing an instrument Dissociative Identity Disorder/ Multiple Personality Disorder 35. How do subpersonalities differ? 69. Subpersonalities often display dramatically different characteristics, including: 51. _______________________ 21. Researchers have discovered that subpersonalities may have physiological differences, such as differences in autonomic nervous system activity, blood pressure levels, and allergies Dissociative Identity Disorder/ Multiple Personality Disorder 36. How common is DID? 70. Traditionally, DID was believed to be rare 70. 52. Some researchers have argued that many or all cases of the disorder are iatrogenic; that is, unintentionally produced by practitioners 22. These arguments are supported by the fact that many cases of DID surface only after a person is already in treatment 23. Not true of all cases Dissociative Identity Disorder/ Multiple Personality Disorder 71. How common is DID? 53. The number of people diagnosed with the disorder has been increasing 54. Although the disorder is still uncommon, thousands of cases have been documented in the U.S. and Canada alone 24. Two factors may account for this increase: 25. ______________________________________________ 26. ______________________________________________ 55. Despite changes, many clinicians continue to question the legitimacy of the category and are reluctant to diagnose the disorder How Do Theorists Explain Dissociative Disorders? 37. A variety of theories have been proposed to explain dissociative disorders 72. Older explanations have not received much investigation 73. Newer viewpoints, which combine cognitive, behavioral, and biological principles, have begun to interest clinical scientists How Do Theorists Explain Dissociative Disorders? 38. The psychodynamic view 74. Psychodynamic theorists believe that dissociative disorders are caused by _____________, the most basic ego defense mechanism 56. People fight off anxiety by unconsciously preventing painful memories, thoughts, or impulses from reaching awareness How Do Theorists Explain Dissociative Disorders? 39. The psychodynamic view 75. In this view, dissociative amnesia and fugue are single episodes of massive repression 76. DID is thought to result from a lifetime of excessive repression, motivated by very traumatic childhood events How Do Theorists Explain Dissociative Disorders? 40. The psychodynamic view 77. Most of the support for this model is drawn from case histories, which report brutal childhood experiences, yet: 57. Not all individuals with DID have had these experiences 58. Child abuse is far more common that DID 27. Why do only a small fraction of abused children develop this disorder? How Do Theorists Explain Dissociative Disorders? 78. The behavioral view 59. Behaviorists believe that dissociation grows from normal memory processes and is a 59. response learned through _____________________: 28. Momentary forgetting of trauma decreases anxiety, which increases the likelihood of future forgetting 29. Like psychodynamic theorists, behaviorists see dissociation as escape behavior 60. Like psychodynamic theorists, behaviorists largely rely on case histories to support their view of dissociative disorders 30. Although the case histories support this model, they are also consistent with other explanations… How Do Theorists Explain Dissociative Disorders? 79. State­dependent learning 61. If people learn something when they are in a particular state of mind, they are likely to remember it best when they are in the same condition 31. This link between state and recall is called __________________ 32. This model has been demonstrated with substances and mood and may be linked to ______________________ 33. It has been theorized that people who develop dissociative disorders have state­to­memory links that are extremely rigid and narrow; each thought, memory, and skill is tied exclusively to a particular state of arousal How Do Theorists Explain Dissociative Disorders? 80. Self­hypnosis 62. While hypnosis can help people remember events that were forgotten long ago, it can also help people forget facts, events, and their personal identity 34. Called “hypnotic amnesia,” this phenomenon has been demonstrated in research studies with word lists 35. The parallels between hypnotic amnesia and dissociative disorders are striking and have led researchers to conclude that dissociative disorders may be a form of self­ hypnosis How Are Dissociative Disorders Treated? 41. People with dissociative amnesia and fugue often recover on their own 81. Only sometimes do memory problems linger and require treatment 42. In contrast, people with DID usually require treatment to regain their lost memories and develop an integrated personality 82. _________________________________________________________________________ _______ How Are Dissociative Disorders Treated? 83. How do therapists help people with dissociative amnesia and fugue? 63. The leading treatments for these disorders are psychodynamic therapy, hypnotic therapy, and drug therapy 36. Psychodynamic therapists ask patients to free associate and search their unconscious 37. In hypnotic therapy, patients are hypnotized and guided to recall forgotten events 37. 38. Sometimes intravenous injections of barbiturates are used to help patients regain lost memories 39. Often called “truth serums,” the key to the drugs’ success is their ability to calm people and free their inhibitions How Are Dissociative Disorders Treated? 43. How do therapists help individuals with DID? 84. Unlike sufferers of dissociative amnesia or fugue, people with DID rarely recover without treatment 64. Treatment for the disorder, like the disorder itself, is complex and difficult How Are Dissociative Disorders Treated? 44. How do therapists help individuals with DID? 85. Therapists usually try to help the client by: 65. ______________________________________ 40. Once a diagnosis of DID has been made, therapists try to bond with the primary personality and with each of the subpersonalities 41. As bonds are forged, therapists try to educate the patients and help them recognize the nature of the disorder 42. Some use hypnosis or video as a means of presenting other subpersonalities 43. Some therapists recommend attending a DID support group How Are Dissociative Disorders Treated? 45. How do therapists help individuals with DID? 86. Therapists usually try to help the client by: 66. _______________________________ 44. To help patients recover missing memories, therapists use many of the approaches applied in other dissociative disorders, including psychodynamic therapy, hypnotherapy, and medication 45. These techniques tend to work slowly in cases of DID How Are Dissociative Disorders Treated? 46. How do therapists help individuals with DID? 87. Therapists usually try to help the client by: 67. _____________________________________ 46. The final goal of therapy is to merge the different subpersonalities into a single, integrated entity 47. Integration is a continuous process; fusion is the final merging 48. ____________________________________________ ____________________________________________ 49. Once the subpersonalities are merged, further therapy is needed to maintain the complete personality and to teach social and coping skills to prevent future dissociations ...
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