Chapter 5: Dissociative and Somatic Symptom Disorders

Question 1

Dissociative Identity Disorder

Answer 1

dissociative disorder in which a person has two or more distinct or alternate personalities

Question 2

Dissociative Amnesia

Answer 2

type of dissociative disorder in which a person experiences memory losses in the absence of any identifiable organic cause, general knowledge and skills are usually retained

Question 3

Malingering

Answer 3

faking illness to avoid or escape work or other duties, or to obtain benefits

Question 4

Depersonalization

Answer 4

feelings of unreality or detachment from one’s self or one’s body, as if one were a robot or functioning on automatic pilot or observing oneself from the outside

Question 5

Derealization

Answer 5

loss of the sense o reality of one’s surroundings, experienced in terms of strange changes in one’s environment (e.g. people or objects changing size or shape) or in the sense of the passage of time

Question 6

Depersonalization/Derealization Disorder

Answer 6

disorder characterized by persistent or recurrent episodes of depersonalization

Question 7

Somatic System and Related Disorders

Answer 7

disorder in which people complain of physical (somatic) problems although no physical abnormality can be found

Question 8

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer 8

a disorder characterized by symptoms or deficits that affect the ability to control voluntary movements or that impair sensory functions and that are inconsistent or incompatible with known medical conditions or diseases

formerly called hysteria or hysterical neurosis

Question 9

La Belle Indifference

Answer 9

French term describing the lack of concern over one’s symptoms displayed by some people with conversion disorder but also by people with real physical disorders

Question 10

Somatic Symptom Disorder

Answer 10

a disorder involving one or more somatic symptoms which cause excessive concern to the extent that it affects the individual’s thoughts, feelings, and behaviors in daily life

Question 11

Factitious Disorder

Answer 11

type of psychological disorder characterized by the intentional fabrication of psychological or physical symptoms for no apparent gain

Question 12

Koro Syndrome

Answer 12

culture-bound somatoform disorder, found primarily in China, in which people fear that their genitals are shrinking and retracting into the body

Question 13

Dhat Syndrome

Answer 13

usually diagnosed among young Indian men who describe an intense fear or anxiety over the loss of semen

Question 14

What are dissociative disorders?

Answer 14

normally speaking, there is a unit to consciousness that gives rise to a sense of self

we perceive ourselves as progressing through space and time, a sense of continuity

in the dissociative disorders, one or more of these aspects of daily living is disturbed

Question 15

What are somatoform disorders?

Answer 15

somatoform disorders involve physical complaints that reflect underlying psychological conflicts or issues

you would think they are caused by physiological problems but they are not

Question 16

What are some examples of dissociative disorders?

Answer 16

dissociative identity disorder

dissociative amnesia

depersonalization/derealization disorder

Question 17

What are some examples of somatic symptom disorders?

Answer 17

somatic symptom disorder

illness anxiety disorder

conversion disorder

factitious disorder

Question 18

What is dissociative identity disorder?

Answer 18

a condition in which a person has two or more distinct or alternate personalities

previously called multiple personality disorder

Question 19

What is the DSM-5 criteria for dissociative identity disorder?

Answer 19

two or more distinct personality states

marked discontinuity in sense of self and sense of agency, accompanied by related alterations in cognitive functions

recurrent gaps in recall

cause clinically significant distress

not a normal part of broadly accepted cultural or religious practice

the symptoms are not attributable to the physiological effects of a substance

Question 20

What are the differences between DID and schizophrenia?

Answer 20

these two are sometimes confused by laypersons

schizophrenia refers to loosening of connection between the various psychic functions (e.g. ideas, perceptions, emotions, behaviors), mirror analogy: aspects of the face are disjointed and don’t form a cohesive whole

DID involves the formation of separate, but (at least partly) integrated personality structures, mirror analogy: each crack has a distinct image, separate pieces recognizable as a distinct image

Question 21

What are the controversies surrounding dissociative identity disorder?

Answer 21

a lot of clinicians and researchers are highly skeptical about this disorder

about 21% of Board certified psychiatrics felt there was strong evidence for the condition

58% voiced skepticism and/or thought it should removed from DSM

Piper and Merskey (2004): no proof that it results from childhood trauma as broadly believed, very low base rate

number of alters appears to be increasing with time, seems to correspond to more movie protrayaks

types of alters being reported is absurd

Spanos (2001): almost unheard of outside North America, appearance is highly influences by cultural factors, might be a form of role-playing inadvertently cued interviewers, eventually becomes habitual, emphasizes the importance of careful interviewing

Question 22

What are alters in dissociative identity disorders?

Answer 22

alters may or may not be aware of each other

“co-conscious” or may communicate indirectly through other people or leaving notes, at other times may be in apparent conflict

people diagnosed with DID were often highly imaginative children and suggestible adults

therapeutic goal has traditionally been “reintegration”

Question 23

What is dissociative amnesia?

Answer 23

type of dissociative disorder in which a person experiences memory losses in the absence of any identifiable organic cause

would be retrograde except general knowledge, habits, personal tastes, and skills are usually retained

forgotten material is usually related to trauma

may be localized (pertained to time), selective (pertained to things), or generalized (can’t remember from a couple weeks ago)

may adopt another identity to fill in the blanks, not creating and alter

Question 24

What are the DSM-5 criteria for dissociative amnesia?

Answer 24

an inability to recall important autobiographical information

cause clinically significant distress

the disturbance is not attributable to the physiological effects of a substance

the disturbance is not better explained by DID, PTSD, acute stress disorder, somatic symptom disorder,

Question 25

What is dissociative amnesia with dissociative fugue?

Answer 25

apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information

type of dissociative disorder in which one suddenly flies from one’s life situation, travels to a new location, assumes a new identity, and has amnesia for past personal material

the person usually retains skills and other abilities and may appear to others in the new environment to be leading a normal life

Question 26

What is malingering?

Answer 26

faking illness so as to avoid or escape work or other duties, or to obtain benefits, not a dissociative disorder

faking amnesia is quite common, usually an attempt to escape criminal or other responsibility

Question 27

What is depersonalization/derealization disorder?

Answer 27

disorder characterized by persistent or recurrent episodes of depersonalization

feelings of unreality or detachment from one’s self or one’s body, as if one were a robot, or functioning on automatic pilot, or observing oneself from outside

patients may interpret as an “out-of-body” or transcendental experience

neither is a psychosis because contact with reality is maintained

both can be triggered by anxiety/trauma

Question 28

What is depersonalization?

Answer 28

temporary alteration from usual sense of reality

e.g. like watching oneself on TV, feeling detached from body or thought processes, some perceptual interference

Question 29

What is derealization?

Answer 29

episodes of derealization are characterized by the sense that one’s surrounding have become strange or unreal and time may seem to be oddly slowed down or sped up

for example, colors may seem washed out or very bright

Question 30

What are theoretical perspectives of dissociative disorders?

Answer 30

psychodynamic: repression, “splitting off” + retreat to an alternate personality

learning: “not thinking” plus negative reinforcement, avoiding conscious consideration of unpleasant matter

Spanos: role playing via observational learning

Question 31

What are the controversies associated with recovered memories?

Answer 31

an ancillary issue: claim is that some traumatic memories may be repressed but lead to depression, anxiety, and other psychological symptoms

through the use of hypnosis or psychotherapy these can supposedly be recovered

there is much controversy around this

repressed memories may or may not be a real phenomenon, but false memories are a reality and can be “induced” in most people

hundreds of people have been charged for crimes they never committed on the basis of “recovered memories”

false memories can be produced in experiments

Question 32

What are treatments of dissociative disorders?

Answer 32

psychoanalysis: uncovering early childhood traumas, try to find inner conflicts, treatment for any dissociative disorders

cognitive behavior therapy: uncovering maladaptive cognitions, negative reinforcement

SSRIs; no specific effects only, no strong evidence that pharmacotherapy is effective with these disorders

Question 33

What are somatic symptom disorders?

Answer 33

disorders in which people complain of physical (somatic) problems although no physical abnormality can be found

Question 34

What is the DSM-5 criteria for somatic symptom disorders?

Answer 34

somatic symptoms that are distressing or result in disruption of daily life

excessive thoughts, feelings, or behaviors related to the somatic symptoms: disproportionate and persistent thoughts, high level of anxiety, excessive time and energy devoted to these symptoms

specifiers: with predominant pain; persistent (>6 months); mild/moderate/severe

Question 35

What is illness anxiety disorder?

Answer 35

the preoccupation with the idea that one is sick is accompanied by substantial anxiety about health and disease

individuals with illness anxiety disorder are easily alarmed about illness, such as by hearing about someone else falling ill or reading a health-related news story

their concerns about undiagnosed disease do not respond to appropriate medical reassurance, negative diagnostic tests, or benign course

Question 36

What is the DSM-5 criteria for illness anxiety disorder?

Answer 36

preoccupation with having or acquiring a serious illness

somatic symptoms are not present, or only mild in intensity

high level anxiety about health

performs excessive health-related behaviors or exhibits maladaptive avoidance

specifiers: care-seeking type (see many doctors), avoidant type (avoid doctors)

Question 37

What is conversion disorder?

Answer 37

functional neurological symptom disorder

type of somatic symptom disorder characterized by loss or impairment of physical function in the absence of any organic causes that might account for the changes

formerly called hysteria or hysterical neurosis

Question 38

What is La Belle Indifference?

Answer 38

French term describing the lack of concern over one’s symptoms displayed by some people with conversion disorder but also by people with real physical disorders

Question 39

What is the DSM-5 criteria for conversion disorders?

Answer 39

altered voluntary motor or sensory function

incompatibility between the symptom and recognized neurological and medical conditions

is not better explained by another medical or mental disorder

significant distress or impairment

with/without psychological stress

acute/persistent

Question 40

Are people with conversion disorders faking it or not?

Answer 40

people with conversion disorders do not consciously fake their symptoms but fear their symptoms but fear their symptoms are due to a real illness

feeling resentful toward their own doctor, they often go “doctor shopping”

Question 41

What is factitious disorder (Munchausen’s Syndrome)?

Answer 41

the essential feature of factitious disorder is the falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception

individuals with factitious disorder can also seek treatment for themselves or another following induction of injury or disease

Question 42

What is the DSM-5 criteria for factitious disorder?

Answer 42

falsification of physical or psychological symptoms, or induction of injury or disease

the individual presents another individual (victim) to others as ill, impaired, or injured

the deceptive behavior is evident even in the absence of obvious external rewards

the behavior is nor better explained

the perpetrator, not the victim, receives this diagnosis

Question 43

What are the primary gains in somatic disorders?

Answer 43

in psychodynamic theory, the relief from anxiety obtained through the development of a neurotic symptom

rather than using the coping mechanisms Freud described, do other behaviors

Question 44

What are the secondary gains in somatic disorders?

Answer 44

side benefits associated with neuroses or other disorders, such as expressions of sympathy and increased attention from other and release from ordinary responsibilities

positive reinforcement, attention, gifts

Question 45

What is the treatment of somatic disorders?

Answer 45

psychoanalysis: hystera (greek) = uterus, Freud thought it was less common among married women, prescribed marriage for “hysterical” women

behavioral methods: removal of secondary gains (coaching family), teach alternative means of coping with stress/anxiety

CBT: early, but promising results, carefully correct bad cognitions

SSRIs: of some use, probably die to anxiolytic effects

Question 46

What is koro syndrome?

Answer 46

supposedly fatal condition in which the genitals shrink or retract into the body

primarily among young Asian males

may try to mechanically prevent retraction

can occur in epidemics

based in acceptance of Koro folk tales

most prevalent among less educated, geographically isolated individuals

typically responds well to reassurance and education

Question 47

What is Dhat syndrome?

Answer 47

India, young men

Dhat = “elixir of life” (semen)

intense fear that ejaculation will rob the body of vital energy

primarily through nocturnal emissions, but also during voiding