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Chapter8 - Chapter 8 Chapter 8 Somatoform and Dissociative...

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Unformatted text preview: Chapter 8 Chapter 8 Somatoform and Dissociative Disorders Somatoform Disorders 0. A group of conditions: 1. That involve physical symptoms and complaints suggesting the presence of a medical condition 2. Without any evidence of physical pathology to account for them 3. Typically first seen in medical setting 0. Costly to health care ­ trying to discover cause and treat Somatoform Disorders 4. Person is preoccupied with health – to extent it impairs functioning 1. Complaints of paralysis, pain, sensory loss 5. Person has no control over symptoms (not faking) – they believe something is wrong Somatoform Disorders 6. Five more or less distinct patterns Somatoform Disorders I: Hypochondriasis 7. People with hypochondriasis are preoccupied with fears of getting a serious disease or the idea that they already have one 8. This is based on the misinterpretation of bodily 8. symptoms 9. Person is not reassured by results of tests 10.Woody Allen – Hannah & Her Sisters Somatoform Disorders I: Hypochondriasis 11.Cognitive­behavioral views of hypochondriasis are most widely accepted 2. Seen as similar to anxiety disorders 3. Misinterpretations; dysfunctional assumptions, excessive attribution 12.Cognitive­behavioral therapy can be a very effective treatment 4. Assess client’s beliefs, modify interpretation Somatoform Disorders II: Somatization 13.Somatization disorder is characterized by many different complaints of physical ailments with the following characteristics: 5. 6. 7. Lasting several years Beginning before age thirty Not adequately explained by independent findings of physical illness or injury 8. Leading to medical treatment or to significant life impairment Somatoform Disorders II: Somatization 14.In addition to the requirement of multiple physical 14. complaints, DSM­IV­TR lists four other symptom criteria needed for a diagnosis of somatization disorder can be made: 9. Four pain symptoms: four different sites 10. Two gastrointestinal symptoms 11. One sexual symptom: sexual dysfunction 12. One pseudoneurological symptom Somatoform Disorders II: Somatization 15.Somatization disorder 13. Usually begins in adolescence 14. Is three to ten times more common in women than in men 15. More common in lower SES 16. Often occurs with other disorders such as major depression or panic disorder Somatoform Disorders II: Somatization 16.There may be a genetic predisposition to somatization disorder (runs in families) 17.Other contributory causal factors may include: 17. 18. 19. Personality (neuroticism) Cognitive (catastrophizing) Learning variables Somatoform Disorders II: Somatization Somatoform Disorders II: Somatization 18.Somatization disorder is extremely difficult to treat 19.A combination of medical management and cognitive­behavioral therapy may be helpful 20. Medical management: regular visits, limited tests and medication 21. Cognitive therapy: changing cognitions (attention, catastrophizing) Somatoform Disorders III: Pain 20.Pain disorder is characterized by the experience of persistent and severe pain in one or more areas of the body 22. (pain is a subjective experience) 21.The symptoms of pain disorder resemble the pain symptoms of somatization disorder, but with pain disorder, the other symptoms are not present Somatoform Disorders: Pain 22.DSM­IV­TR specifies two coded subtypes of pain disorder: 23. Pain disorder associated with psychological factors (no medical condition present) 24. Pain disorder associated with both psychological factors and a general medical condition (increased by attention) Somatoform Disorders III: Pain 23.Cognitive­behavioral techniques are widely used 23. in the treatment of both subtypes of pain disorder 25. Relaxation training, cognitive restructuring Somatoform Disorders IV: Conversion 24.Conversion disorder involves a pattern in which symptoms or deficits affecting sensory or voluntary motor functions lead one to think a patient has a medical condition 26. Not explainable by any known medical condition 27. E.g. partial paralysis, blindness, deafness, loss of sensation Somatoform Disorders IV: Conversion 25.Conversion disorders are considered distinct from malingering disorder or factitious disorder in which a person intentionally produces or grossly exaggerates physical symptoms 28. Malingerer: intentionally produces symptoms – motivated by incentives 29. Factitious: incentive is to maintain sick role 30. Conversion patients feel victimized by symptoms ­ willing to discuss problems Somatoform Disorders IV: Conversion 26.Munchausen by proxy syndrome (MBPS) 31. Factitious: maintaining sick role of another person 32. Involves a parent or caregiver misleading others into thinking that a child or cared for person has medical problems by exaggerating, fabricating, or medical problems by exaggerating, fabricating, or inducing symptoms Somatoform Disorders IV: Conversion 27.The symptoms of conversion disorder fall under one of the following four categories: 33. Sensory symptoms or deficits 0. Inconsistent with anatomy (blindness, deafness) 34. Motor symptoms or deficits 1. Paralysis of single limb, single function (writing) 35. Seizures: pseudo­seizures (no EEG pattern) 36. Mixed presentation from the first three categories Somatoform Disorders IV: Conversion 28.Conversion disorders are no longer as prevalent as they once were 37. Growing sophistication in medicine 38. Common in WWI & WWII (paralysis) 2. (example in Band of Brothers) 29.Very rare today 39. More common in women than men 40. More common in lower SES Somatoform Disorders IV: Conversion 30.Freud believed that the symptoms were an expression of repressed sexual energy 41. Conversion: anxiety is converted into bodily 41. sensations 42. La belle indifference: noted lack of concern about problem Somatoform Disorders IV: Conversion 31.In contemporary terms, the primary gain for conversion symptoms is continued escape or avoidance of a stressful situation (avoidance of responsibility) 32.Secondary gains include attention and financial compensation (disability) Somatoform Disorders IV: Conversion 33.It is crucial that patients receive a thorough medical and neurological examination to rule out organic illness 43. Unfortunately misdiagnosis does occur in about 5 to 10% of time 34.Differentiate from medical by: 44. 45. 46. 47. Dysfunction doesn't fit disease Selective nature of dysfunction Under drugs, dysfunction is gone Functional quality of disorder Somatoform Disorders IV: Conversion 35.Knowledge of how best to treat conversion disorder is extremely limited 36.Behavioral approach – reinforcing improvements in functioning 37.Hypnosis sometimes effective 37. Somatoform Disorders V: Body Dysmorphic 38.People with body dysmorphic disorder are obsessed with some perceived or imagined flaws in their appearance 48. (skin blemish, breast size, facial appearance) 39.Perhaps 1–2% of the general population suffers from the disorder 49. Age of onset – adolescence 50. Equal in men and women Somatoform Disorder V: Body Dysmorphic 40.People with the disorder commonly have a depressive diagnosis 41.Many researchers believe BDD is closely related to OCD and eating disorders 51. Reassurance seeking, mirror checking, obsessive beliefs 52. Body image distortion; preoccupation with body (due to emphasis on ‘looks’) Percentage of People with BDD Who Experienced a Problem Somatoform Disorders V: Body Dysmorphic 42.Causes: biopsychosocial model 53. 54. 55. Genetic predisposition Cultural reinforcement Self­esteem Somatoform Disorders V: Body Dysmorphic Somatoform Disorders V: Body Dysmorphic 43.Treatments include: 44.Antidepressant medications 56. Medicate like OCD 45.Cognitive­behavioral treatment focused on exposure and response prevention 57. Change distorted perceptions 58. Prevent ‘checking’ Dissociative Disorders Dissociative Disorders: Description (I) 46.The dissociative disorders are a group of conditions involving disruptions in a person’s normally integrated functions of 59. Consciousness 60. Memory 61. Identity 62. Perception 63. E.g. Sybil; Three Faces of Eve Dissociative Disorders: Description (II) 47.Features: 64. Dramatic 65. Person cannot recall who they are or where they came from 66. Person who has distinct identities (that control 66. behavior) that are independent from conscious awareness 67. Person is unable to access information that is normally available Dissociative Disorders: Description (III) 48.Distinction from ‘normal’ 68. Mild dissociation when daydream or when lose track regarding what is going on around us 69. A lot of our mental life involves processes that are non­conscious or autonomous (automatic) Dissociative Disorders: Description (IV) 49.In de­realization, one’s sense of the reality of the outside world is temporarily lost (world is experiences as 'strange') 50.In depersonalization, one’s sense of one’s self and one’s reality is temporarily lost (detached from body) 51.Not unusual in mild form 52.Can be due to severe stress Dissociative Disorders: Amnesia 53.Dissociative amnesia involves a failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetting 70. Psychogenic amnesia ­ no medical cause 71. Usually follows stress 72. May be localized & selective 72. 73. Less likely is generalized & continuous Dissociative Disorders: Fugue 54.In a dissociative fugue the person also departs from home surroundings 74. Amnesia with flight 75. In fugue state ­ memory is normal 76. Before fugue state ­ loss of memory 77. If recover from fugue state, can lose memory for fugue state 78. IQ is OK, deficit is in autobiographical memory Dissociative Disorders: DID (I) 55.Dissociative identity disorder (DID) is a dramatic dissociative disorder in which a patient manifests two or more distinct identities or personality states that alternate in some way in taking control of behavior 56.(Multiple personality) 57.Eve White & Eve Black Dissociative Disorders: DID (II) 58.Host identity: most frequently encountered personality; carries person’s real name 59.Alter identities: may differ in gender, handiness, age, hand writing, sexual orientation, eye glasses, affect, language 60.Needs and behaviors inhibited by host may be displayed by alter Dissociative Disorders: DID (III) Dissociative Disorders: DID (III) 61.Alters are not in any meaningful sense personalities 79. They ‘take control’ at different points in time 80. Switches occur quickly 81. Amnesia for events with other identities – but not symmetrical Dissociative Disorders: DID (IV) 62.This disorder is quite rare 63.Increasing in frequency due to: 82. Media attention e.g. Primal Fear 3. United States of Terror (Showtime) 83. Increased acceptance of diagnosis 84. Clinician reinforcement 64.The disorder usually starts in childhood 85. More common in females – possibly due to sexual abuse Presentation – Sybil 65.1976 Movie (remake 2007) 66.16 different personalities Dissociative Disorders: DID (V) 67.Controversies surrounding dissociative identity disorder include 68.Is the disorder real or faked? 69.If the disorder is not faked, how does it develop? 69. 86. Post traumatic abuse? 87. Socio­cognitive theory of overly suggestible individuals Reported Childhood Abuse of Five Separate Studies of DID Patients Dissociative Disorders: DID (VI) 70.Are recovered memories of abuse in the disorder real or false? 88. Could be due to suggestion – no way to tell 71.If abuse has occurred, did it play a causal role? 89. Could be something else – may play non­specific causal role 90. Child escapes abuse by dissociation – escape into fantasy to alleviate pain Treatment and Outcomes in Dissociative Disorders 72.No systematic controlled research has been conducted 91. Typically views based on case histories 73.Possible treatments include 92. Hypnosis with amnesia, fugue, dissociation 93. Integration of separate alters (to develop unified personality Sociocultural Factors in Dissociative Disorders 74.Dissociative disorders found in all cultures 74. 75.Analogous to trance and possession states – alterations in consciousness and identity (possession) End of Chapter 8 ...
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