Chapter 5: Dissociative and Somatic Symptom Disorders Flashcards
Dissociative Identity Disorder
dissociative disorder in which a person has two or more distinct or alternate personalities
Dissociative Amnesia
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
Malingering
faking illness to avoid or escape work or other duties, or to obtain benefits
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 the outside
Derealization
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
Depersonalization/Derealization Disorder
disorder characterized by persistent or recurrent episodes of depersonalization
Somatic System and Related Disorders
disorder in which people complain of physical (somatic) problems although no physical abnormality can be found
Conversion Disorder (Functional Neurological Symptom Disorder)
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
La Belle Indifference
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
Somatic Symptom Disorder
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
Factitious Disorder
type of psychological disorder characterized by the intentional fabrication of psychological or physical symptoms for no apparent gain
Koro Syndrome
culture-bound somatoform disorder, found primarily in China, in which people fear that their genitals are shrinking and retracting into the body
Dhat Syndrome
usually diagnosed among young Indian men who describe an intense fear or anxiety over the loss of semen
What are dissociative disorders?
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
What are somatoform disorders?
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
What are some examples of dissociative disorders?
dissociative identity disorder
dissociative amnesia
depersonalization/derealization disorder
What are some examples of somatic symptom disorders?
somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
What is dissociative identity disorder?
a condition in which a person has two or more distinct or alternate personalities
previously called multiple personality disorder
What is the DSM-5 criteria for dissociative identity disorder?
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
What are the differences between DID and schizophrenia?
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
What are the controversies surrounding dissociative identity disorder?
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
What are alters in dissociative identity disorders?
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”
What is dissociative amnesia?
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
What are the DSM-5 criteria for dissociative amnesia?
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,
What is dissociative amnesia with dissociative fugue?
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
What is malingering?
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
What is depersonalization/derealization disorder?
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
What is depersonalization?
temporary alteration from usual sense of reality
e.g. like watching oneself on TV, feeling detached from body or thought processes, some perceptual interference
What is derealization?
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
What are theoretical perspectives of dissociative disorders?
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
What are the controversies associated with recovered memories?
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
What are treatments of dissociative disorders?
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
What are somatic symptom disorders?
disorders in which people complain of physical (somatic) problems although no physical abnormality can be found
What is the DSM-5 criteria for somatic symptom disorders?
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
What is illness anxiety disorder?
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
What is the DSM-5 criteria for illness anxiety disorder?
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)
What is conversion disorder?
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
What is La Belle Indifference?
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
What is the DSM-5 criteria for conversion disorders?
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
Are people with conversion disorders faking it or not?
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”
What is factitious disorder (Munchausen’s Syndrome)?
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
What is the DSM-5 criteria for factitious disorder?
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
What are the primary gains in somatic disorders?
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
What are the secondary gains in somatic disorders?
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
What is the treatment of somatic disorders?
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
What is koro syndrome?
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
What is Dhat syndrome?
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
