Chapter 6: Dissociative, Somatic, & Related Disorders

Question 1

What are the characteristics of dissociative disorders?

Answer 1

• severe maladaptive disruptions or alterations of identity, memory, and consciousness that are beyond one’s control

Question 2

What are the different types of dissociative disorders?

Answer 2

• dissociative amnesia
• dissociative identity disorder
• depersonalization/derealization disorder
• dissociative fugue specifier

Question 3

What is false memory syndrome?

Answer 3

• condition in which people are induced by therapists to remember events that never occurred

Question 4

What is dissociative amnesia?

Answer 4

• real and complete memory loss for extensive and important actions or personal information in the absence of another physical/medical cause
• characterized by sudden onset, usually in response to a traumatic or stressful experience

Question 5

What are the five patterns of memory loss outlined in the DSM-5?

Answer 5

1 - localized amnesia, person fails to remember information during a specific time period

2 - selective amnesia, only parts of trauma are recalled

3 - continuous amnesia, person forgets information from a specific date till the present

4 - systematized amnesia, only certain categories of information are forgotten

5 - generalized amnesia, person forgets their entire life

Question 6

What is a dissociative fugue?

Answer 6

• loss of memory, including personal history
• travel far from home and may adopt new identities and occupations if it lasts long enough
• frequently left behind intolerable situation

Question 7

What is depersonalization?

Answer 7

• experience characterized by a sense of unreality and detachment from self

Question 8

What is depersonalization/derealization disorder?

Answer 8

• persistent and recurring experiences of depersonalization/derealization
• chronic and usually appears in adolescence
• no impairment in memory loss or identity confusion
• brain abnormalities in perceptual pathways play role in process

Question 9

What is realization?

Answer 9

• similar experience characterized by a sense of unreality and detachment like depersonalization but not from the self

Question 10

What is dissociative identity disorder?

Answer 10

• most severe and chronic of the dissociative disorders
• patient presents with two or more distinct personality states that control the patient’s behaviour
• one is the “host”, rest of the personalities are “alters”
  ○ switching can result from stress or environmental cues
• result of intense psychological trauma that encourages child to escape by pretending to be someone else (trauma model)

Question 11

What is the socio-cognitive model of dissociative identity disorder?

Answer 11

• DID is a form of roleplaying in which an individual come to believe they have multiple selves
• act in ways that are consistent with this view and their therapist’s view
• may be an iatrogenic (i.e. caused by treatment) condition
  ○ therapists ask leading questions or suggest this through hypnosis
• not accusing patient of faking or malingering but they really don’t have multiple personalities

Question 12

What is the psychotherapy treatment for DID?

Answer 12

• therapist establishes trust
• clients are assisted in developing new coping skills required to work through difficult histories
• client reaches certain level of acceptance of their history
• integrate personalities

Question 13

What are somatic symptom and related disorders?

Answer 13

• set of disorders where there is an occurrence of physical symptoms for which there is no known physical cause, excessive preoccupation with minor physical symptoms, or excessive concern about normal bodily function

Question 14

What are the disorders that fall under the somatic symptom and related disorders category?

Answer 14

• somatic symptom disorder
• illness anxiety disorder
• conversion disorder
• psychological factors affecting other medical conditions
• factitious disorder

Question 15

What is conversion disorder?

Answer 15

• also called functional neurological symptom disorder
• loss of functioning in a part of their body that appears to be due to to a neurological or other medical cause but without any underlying medical abnormalities
• motor deficits include paralysis, impaired balance, inability to speak

Question 16

What is glove anesthesia?

Answer 16

• loss of all sensation throughout the hand with the loss sharply demarcated at the wrist rather than following a consistent pattern with sensory innervation in hand
• also presents la belle indifference, nonchalant lack of concern for the nature and implications of their symptoms

Question 17

What is somatic symptom disorder?

Answer 17

• used to be somatization disorder and hypochondriasis
• characterized by multiple and recurring complaints of physical ailments that do not appear to have any organic basis
  ○ may include pain, fatigue, nausea, muscle weakness, numbness
• patients usually worry excessively over symptoms and attribute them to serious medical illness

Question 18

What is illness anxiety disorder?

Answer 18

• new diagnosis in DSM-5
• preoccupied with fears of having a serious illness despite the fact that there is nothing wrong with them for at least 6 months
• misinterprets minor bodily symptoms as evidence of serious medical symptoms

Question 19

What is factitious disorder?

Answer 19

• also called Munchausen syndrome

- deliberately fake or generate symptoms of illness or injury to gain medical attention

Question 20

What is body dysmorphic disorder?

Answer 20

• excessive preoccupation with an imagined or exaggerated body disfigurement, sometimes to the point of delusion
• removed from somatoform disorders and placed with obsessive-compulsive disorders

Question 21

What is the integrative biopsychosocial model of somatic symptom and related disorders?

Answer 21

• results from series of vicious cycles involving physiological, psychological, and social factors

PHYSIOLOGICAL:
- stress-related increases in cortisol, adversely affecting immunity and producing feelings of fatigue, pain, and general malaise

PSYCHOLOGICAL:

• excessive attention to and misattribution of bodily symptoms
• high levels of health anxiety

SOCIAL:

• early childhood abuse
• social learning compromising positive and negative reinforcement of illness behaviours and “sick role”