chapter 6 Flashcards
Dissociative Disorders
Changes, disturbances, or breakdowns in identity, memory, or consciousness that affect the ability to maintain an integrated sense of self
types of dissociative disorders
Dissociative identity disorder
Dissociative amnesia
Depersonalization/derealization disorder
Dissociative Identity Disorder
Two or more personalities, each with its own distinctive traits, memories, mannerisms, and even style of speech, “occupy” one person
Often called multiple personality or split personality
In some cases, the host (main) personality is unaware of the existence of the other identities, whereas the other identities are aware of the existence of the host
- Aka alternate personalities
- May represent different ages, genders, interests, and ways of relating to others
- Repeatedly take full control of individual’s behavior
Forgetfulness about ordinary life events and important personal information occurs that cannot be explained by ordinary forgetfulness
Criteria for Dissociative Identity Disorder
A) disruption of identity by two or more distinct personality states, which may be described in some cultures as an experience of possession
- The disruption in identity involves marked discontinuity in a sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning
- These signs and symptoms may be observed by others or reported by the individual
B) recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting
C) The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning
D) The disruption is not a normal part of a broadly accepted cultural or religious practice
Note: in children, the symptoms are not better explained by imaginary playmates or other fantasy play
E) The symptoms are not attributable to the physiological effects of a substance or another medical condition
fragmentation
alters
fragmentation
Body divides traits and feelings, and groups them into smaller sections, keeping some of them hidden until a safe space for expression is provided
alters
separate identities
dissociative amnesia
A person becomes unable to recall important personal information, usually involving traumatic or stressful experiences, in a way that cannot be accounted for by simple forgetfulness
criteria for dissociative amnesia
A) An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting
- Note: Dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history
B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
C) The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition
D) The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder
specify if (dissociative amnesia)
With dissociative fugue: apparently purposeful travel or bewildered wandering that is associated with amenities for identity or for other important autobiographical information
subtypes of dissociative amnesia
localized
selective
generalized
continuous
systematized
fugue (rare)
localized amnesia
Inability to recall events related to a period of time
selective amnesia
Can remember some but not all for the period of time
generalized amnesia
Failure to recall one’s entire life
continuous amnesia
Failure to recall successive events
systemized amnesia
Categories (family, one person)
fugue amnesia
rare subtype
Where the person may travel suddenly and unexpectedly from his or her home or place of work
depersonalization
Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions
Like a dream
derealization
Experiences of unreality or detachment with respect to surroundings
People and objects may seem to change in size or shape and sounds may seem different
Dizziness; fears of going insane
Depersonalization/Derealization Disorder criteria
A) The presence of persistent to recurrent experiences of depersonalization, derealization, or both
B) During the depersonalization or derealization experiences, reality testing remains intact
C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of important areas of functioning
D) The disturbance is not attributable to the physiological effects of a substance or another medical condition
E) The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder
amnesia psychodynamic theory
Removing self from troubling memories/unacceptable impulses by blotting them out of consciousness
Believed to involve massive use of repression, resulting in the splitting off from consciousness of unacceptable impulses and painful memories, typically involving parental abuse
Ego is protecting itself from anxiety by blotting out disturbing memories or by dissociating threatening impulses of a sexual or aggressive nature
amnesia biological theory
Research demonstrates structural brain differences between patients with dissociative identity disorder and controls
amnesia learning/cognitive theory
Learning not to think about troubling behaviors/thoughts that leads to guilt or shame
Believed that dissociative identity disorder is a form of role playing acquired through observational learning and reinforcement
treatment for amnesia
Therapy aimed at reintegration of parts and personality, working with reinforcement, and some drug treatment
Example: Internal Family Systems ‘
Somatic symptoms and related disorders
May have physical (somatic) symptoms without an identifiable physical cause or have excessive concerns about the nature or meaning of their symptoms
Somatic Symptom Disorder
People not only have troubling physical symptoms but are also excessively concerned about their symptoms to the extent that it affects their thoughts, feelings, and behaviors in daily life
Somatic Symptom Disorder
criteria
A) One or more somatic symptoms that are distressing or result in significant disruption of daily life
B) Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
- Disproportionate and persistent thoughts about the seriousness of one’s symptoms
- Persistently high level of anxiety about health or symptoms
- Excessive time and energy devoted to these symptoms or health concerns
C) Although any one somatic symptom may not continuously present, the state of being symptomatic is persistent (typically more than 6 months)
specify if (Somatic Symptom Disorder)
With predominant pain (previously pain disorder):
- This specifier is for individuals whose somatic symptoms predominantly involve pain
Persistent:
- A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months)
specify current severity (Somatic Symptom Disorder)
Mild
- Only one of the symptoms specified in Criterion B is fulfilled
Moderate
- Two or more of the symptoms specified in Criterion B are fulfilled
Severe
- Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom)
Hypochondriasis
DSM Disorder; applies to people with physical complaints who believed their symptom were due to serious, undetected illness, such as cancer or heart disease, despite medical reassurance to the contrary
Illness Anxiety Disorder
Emphasis placed on the anxiety associated with illness rather than the distress the symptoms cause
- Fear of what the symptoms mean
- such as vague aches and pains or a passing feeling of tightness in the abdomen or chest
Illness Anxiety Disorder
criteria
A) Preoccupation with having or acquiring a serious illness
B) Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate
C) There is a high level of anxiety about health, and the individual is easily alarmed about personal health status
D) The individual performs excessive health-related behaviors or exhibits maladaptive avoidance
E) Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time
F) The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, or delusional disorder, somatic type
specify whether (Illness Anxiety Disorder)
Care seeking type
- Medical care, including physician visits or undergoing tests and procedures, is frequently used
- People who go doctor shopping; jumping from one to another to find someone who can confirm their worst fears
Care avoidant type
- Medical care is rarely used
- Applied to people who postpone or avoid medical visits or lab tests because of high levels of anxiety about what might be discovered
Conversion Disorder
Characterized by symptoms or deficits that affect the ability to control voluntary movements or that impair sensory functions
- Loss of impairment of physical functions is either inconsistent or incompatible with known medical conditions or diseases
Conversion Disorder
criteria
A) One or more symptoms of altered voluntary motor or sensory function
B) Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
C) The symptom or deficit is not better explained by another mental disorder
D) The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
specify SYMPTOM type (Conversion Disorder)
With weakness or paralysis
With abnormal movement (tremor, dystonia, myoclonus, gait disorder)
With swallowing symptoms
With speech symptom (dysphonia, slurred speech)
With attacks or seizures
With anesthesia or sensory loss
With special sensory symptom
With mixed symptoms
specify if (Conversion Disorder)
Acute:
Symptoms present for less than 6 months
Persistent:
Symptoms occurring for 6 months or more
specify with (Conversion Disorder)
With psychological stressor
Without psychological stressor
malingering
Deliberate efforts to fake or exaggerate sx for personal gain
- Not considered a mental disorder
factitious disorder
People with this disorder fake or manufacture physical or psychological symptoms, but without any apparent motive
Puzzlement
Not the same as malingering
Popularly referred to as Müchausen syndrome
Müchausen syndrome
A form of feigned illness in which a person either fakes being ill or makes him or herself ill
Somatic Symptom and Related Disorders psychodynamic theory
Bring conflicts to the level of awareness, rooted in childhood
When worked through, sx are no longer needed as a solution
Somatic Symptom and Related Disorders behavioral theory
Removing sources of reinforcement
Somatic Symptom and Related Disorders learning theory
Focus more on direct reinforcing properties of the symptom and its secondary role in helping an individual avoid or escape anxiety evoking situations
Somatic Symptom and Related Disorders cognitive theory
Response prevention and cognitive restructuring
Role of distorted thinking
Avoiding thinking about other life problems
Psychoanalysis
CBT - best
Somatic Symptom and Related Disorders brain distention
Disconnect or impairment in the neural connections between parts of the brain that control certain functions and other parts involved in regulating anxiety
Psychosomatic disorders
Physical disorders in which psychological factors are believed to play a causal or contributing role
- Ex: ulcers
Psychological Factors in Physiology
headaches
coronary heart disease
asthma attacks
cancer
hiv/aids
headaches
often stress related
coronary heart disease
Unhealthy consumption, persistent negative emotions
Risk factors - age and family history; high blood levels of low density cholesterol, hypertension, smoking, overeating, heavy drinking, consuming a high fat diet
Frequent emotional distress in the form of anger, anxiety, and depression may have damaging effects on the cardiovascular system
Social environmental stress heightens risk
asthma attacks
Depression, stress, and anxiety
Respiratory disorder in which the main tubes of the windpipe, the bronchi, construct and become inflamed, and large amounts of mucus are secreted
Series of attacks can be harmful
Causal factors: smoking, environmental pollutants, genetics
cancer
Behavioral practices like unhealthy diet, alcohol use, and smoking
The development of aberrant, or mutant, cells that form growths (tumors) that spread healthy tissue
Genetics; smoking; fat intake; alcohol consumption
Benefits from coping skills training programs aimed at relieving the stress and pain of coping with cancer
hiv/aids
Attacks the immune system, leaving it helpless to fend off diseases it normally would hold in check
Sexually transmitted
Develop psychological problems - anxiety; depression
Social stigma, risky behaviors
