Chapter 8 abnormal Flashcards
Depersonalization/derealization disorder
experience of detachment from the self and reality
dissociative amnesia
lack of conscious access to memory, typically of a stressful experience. The futuge subtype involves traveling or wandering coupled with loss of memory of one’s identity or past
dissociative identity disorder
at least 2 distinct personalities that act independently of each other
Dissociation
Some aspect of emotion, memory, or experience being inaccessible consciously
Some types of dissociation common (e.g., losing track of time)
What causes dissociation?
What causes dissociation?
Psychodynamic and behavioral theorists
An avoidance response that protects the person from consciously experiencing stressful events
Trauma and sleep disturbance
T/F in regards to the cause of dissociation Psychodynamic and Behavioral theorists agree on the cause
TRUE
- An avoidance response that protects the person from consciously experiencing stressful events
- Trauma and sleep disturbance
Depersonalization/Derealization Disorder
Disconcerting and disruptive sense of detachment from one’s self and surrounding
Symptoms are persistent or recurrent
*Does not involve disturbance of memory
Symptoms are usually triggered by stress
Usually begins in adolescence
Comorbid personality disorders are frequent
90% will experience anxiety disorder and depression
Childhood trauma is often reported
Can co-occur with other disorders
Symptoms should not be entirely explained by other disorders
Derealization
A sense of detachment from one’s surroundings
Depersonalization
A sense of detachment from one’s self or surroundings
E.g., being an observer outside one’s body
DSM-5 Criteria:Depersonalization/Derealization Disorder
Depersonalization: Experiences of detachment from one’s mental processes or body, as though one is in a dream, or
Derealization: Experiences of unreality of surroundings
Symptoms are persistent or recurrent
Reality testing remains intact
Symptoms are not explained by substances, another dissociative disorder, another psychological disorder, or by a medical condition
Dissociative Amnesia
Inability to recall important personal information, usually about a traumatic experience
Typically occurs after severe stress
Too extensive to be ordinary forgetfulness
May last several hours to several years
Usually disappears as suddenly as it began, with complete recovery of memory
Other behavior is unremarkable
Procedural memory remains intact
Rule out other common causes of memory loss:
Substance abuse, brain injury, medication side effects
Dementia
Memory fails slowly over time
Is not linked to stress
Accompanied by inability to learn new information
What causes dissociative amnesia?
*Psychodynamic Theory : Traumatic events are repressed
*Cognitive Theory: Stress enhances encoding of central features of negative events
High levels of stress hormones and chronic stress interfere with memory formation
Dissociative Amnesia: Dissociative Fugue Subtype
Most severe subtype, extensive memory loss
Person typically disappears from home and work
May assume a new identity
New name, job, personality characteristics
Recovery is usually complete
People are able to remember details of their life
Except for those events that took place during the fugue
DSM-5 Criteria:Dissociative Amnesia
Inability to remember important autobiographical information, usually of a traumatic or stressful nature, that is too extensive to be ordinary forgetfulness
The amnesia is not explained by substances, or by other medical or psychological conditions
Specify dissociative fugue subtype if amnesia is associated with bewildered or apparently purposeful wandering
Dissociative Identity Disorder
*A person has at least 2 separate personalities (alters)
Each has different modes of being, thinking, feeling, and acting
Alters exist independently of one another
Alters emerge at different times
Primary alter may be unaware of existence of other alters
Primary alter may have no memory of what other alters do
*Usually the primary alter seeks treatment
Most commonly, 2-4 alters are identified when diagnosed
- Rarely diagnosed until adulthood
- Symptoms may date back to childhood
*Other diagnoses are often present
PTSD, Major Depressive Disorder, Somatic Symptom Disorders, Personality Disorders
Other common symptoms:
Headaches, hallucinations, suicide attempts, self-injurious behaviors, amnesia, depersonalization
DSM-5 Criteria:Dissociative Identity Disorder
- Disruption of identity characterized by two or more distinct personality states (alters) or an experience of possession. These disruptions lead to discontinuities in the sense of self or agency, as reflected in altered cognition, behavior, affect, perceptions, consciousness, memories, or sensory-motor functioning. This disruption may be observed by others or reported by the patient
- Recurrent gaps in memory for events or important personal information that are beyond ordinary forgetting
- Symptoms are not part of a broadly accepted cultural or religious practice
- Symptoms are not due to drugs or a medical condition
- In children, symptoms are not better explained by an imaginary playmate or by fantasy play
The Epidemiology of Dissociative Disorders
Reports of lifetime diagnostic criteria for:
Depersonalization/derealization: 2.5%
Dissociative amnesia: 7.5%
Dissociative identity disorder: 1-3%
Likely overestimations due to measurement issues
No identified reports of DID or dissociative amnesia before 1800s
- Increased rates since 1970s
- Appearance of DID in popular culture
- DSM-III (1980) defined DID for the first time
Posttraumatic Model
Some people are particularly likely to use dissociation to cope with trauma
Children who are abused are at risk for developing dissociative symptoms
Children who dissociate are more likely to develop psychological symptoms after trauma
Sociocognitive Model
People who have been abused seek explanations for their symptoms and distress
Alters appear in response to suggestions by:
Therapists
Exposure to media reports of DID
Other cultural influences
- DID could be iatrogenic (created within treatment)
- Reinforcement of identified alters and suggestive techniques might promote symptoms in vulnerable people
- Not viewed as conscious deception
Evidence in Support of Sociocognitive Model of DID
The symptoms of DID can be role-played
- Some therapists reinforce DID symptoms
- Use of hypnosis, urging clients to unbury unremembered abuse experiences, naming different alters
- Most clients are unaware of having alters before treatment
- Rapid increase in the number of alters as treatment progresses
- Alters share memories, even when they report amnesia
- Implicit memories are transferred between alters
Availability of Treatments for DID
No well-validated treatments available
No randomized controlled trials have assessed psychological treatment
Medications have not been shown to relieve DID symptoms
Psychodynamic Treatment for DID
DID is believed to arise from traumatic events that the person is trying to block from consciousness
Goal: Overcome repression
Use of hypnosis
Age regression - person is encouraged to go back in his or her mind to traumatic events in childhood
Can actually worsen symptoms
Somatic Symptom and Related Disorders
- Excessive concerns about physical symptoms or health:
- Tendency to seek frequent medical treatment
- Often see several physicians for a given health concern
- May try many different medications
- Hospitalization and surgery are common experiences
- Criticisms of diagnostic criteria:
- Conditions are remarkably varied
- Patients often find these diagnoses stigmatizing
Tend to co-occur with anxiety disorders, mood disorders, and personality disorders
**Distress over symptoms is authentic
Availability of Treatments (for DID)
No well-validated treatments available
No randomized controlled trials have assessed psychological treatment
Medications have not been shown to relieve DID symptoms
Psychodynamic Treatment for DID
DID is believed to arise from traumatic events that the person is trying to block from consciousness
Goal: Overcome repression
Use of hypnosis
Age regression - person is encouraged to go back in his or her mind to traumatic events in childhood
Can actually worsen symptoms
T/F if someone has DID they probs are not gonna get good treatment
TRUE
if someone has DID they probs are not gonna get good treatment (not really sure what works)
somatic symptom disorder
excessive throught, distress and behavior related to somatic symptoms
conversion disorder
neurological symptoms that cannot be explained by medical disease or culturally sanctioned behavior
DSM-5 Criteria: Somatic Symptom Disorder
At least one somatic symptom that is distressing or disrupts daily life
Duration of at least 6 months
Specify if predominant pain
- Excessive thoughts, distress, and behaviors related to somatic symptom(s) or health concerns, as indicated by at least one of the following:
- Health-related anxiety
- Disproportionate and persistent concerns about the seriousness of symptoms
- Excessive time and energy devoted to health concerns
Somatic Symptom Disorder
Distress revolves around a somatic symptom that exists
Can be diagnosed regardless of whether symptoms can be explained medically
When psychological factors are the cause of symptoms, an alternative DSM diagnosis, Psychological Factors Affecting Other Medical Conditions, may be appropriately considered
DSM-5 Criteria: Illness Anxiety Disorder
Preoccupation with and high level of anxiety about having or acquiring a serious disease
Excessive behaviors (e.g., checking for signs of illness, seeking reassurance) or maladaptive avoidance (e.g., avoiding medical care)
No more than mild somatic symptoms are present
Not explained by other psychological disorders
Preoccupation lasts at least 6 months
Preoccupation lasts at least 6 months
- Illness Anxiety Disorder
* Somatic Symptom Disorder
Illness Anxiety Disorder
Preoccupation with fears of having a serious disease despite having no significant somatic symptoms
Easily alarmed about their health
May be haunted by visual images of becoming ill or dying
May react with anxiety when they hear about illnesses in their friends or in the community
Fears are not easily calmed
May become frustrated when attempts to soothe worries fail
DSM-5 Criteria: Conversion Disorder
One or more symptoms affecting voluntary motor or sensory function
The symptoms are incompatible with recognized medical disorders
Symptoms cause significant distress or functional impairment or warrant medical evaluation
Conversion Disorder
- Sudden development of neurological symptoms:
- Partial or complete paralysis of arms or legs
- Seizures or coordination problems
- Vision impairment or tunnel vision
- Anesthesia: Insensitivity to pain
- Aphonia: Whispered speech
- The symptoms suggest an illness related to neurological damage
- Medical tests indicate that the bodily organs and nervous system are fine
- Genuinely physical problems are misdiagnosed as conversion disorder about 4% of the time
- Many people with conversion disorder show no signs that they are amplifying their symptoms
- Onset typically adolescence or early adulthood and Onset is usually rapid
Highly likely to meet criteria for another somatic symptom disorder
Malingering
Faking symptoms for personal gain.
Usually to avoid responsibility or for financial gain from insurance/worker’s comp
Measures to detect malingering: SVT’s TOMM WMT PDRT
Factitious Disorder
Fabrication of symptoms without obvious external rewards.
Imposed on Self
Imposed on Another (Munchausen syndrome by proxy)
Why would someone fabricate sx without obvious benefits?
T/F Depersonalization/Derealization Disorder involves a disturbance of memory
FALSE : Does not involve disturbance of memory
Body dysmorphic disorder is ________
more likely to be seen in men.
more likely to be seen in women.
equally likely to be seen in men or women.
most likely to be seen in children.
equally likely to be seen in men or women.
Which of the following have been proposed as likely contributors to the reductions in hippocampal volume observed in people with schizophrenia?
a) stress reactivity and a disrupted amygdala
b) anxiety and brain damage
c) anxiety and limbic over-arousal
d) stress reactivity and a disrupted HPA axis
d) stress reactivity and a disrupted HPA axis
As discussed in your text, much evidence now suggests a number of biological causal factors in obsessive-compulsive disorder including ________
a minimal or absent genetic contribution.
abnormalities in the functioning of the basal ganglia.
abnormalities in dopamine systems.
decreased activity in the orbital frontal cortex.
abnormalities in the functioning of the basal ganglia.
DID : prevalence gender
More common in women than men
conversion disorder prevalence
*Prevalence less than 1%
More common in women than men
illness anxiety disorder
unwarranted fears about serious illness in the absence of any significant somatic symptoms
Measures to detect malingering:
Measures to detect malingering: SVT’s TOMM: test of memory malingering WMT PDRT
Dissociative Disorders : the 3 types
- Dissociative Amnesia
- Dissociative identity disorder
- Depersonalization/ derealization disorder
who agrees on the cause of dissociation?
Psychodynamic and Behavioral theorists
All three OCD-related disorders respond well to
a) serotonin reuptake inhibitors.
b) dopamine inhibitors.
c) GABA enhancers.
d) norepinephrine enhancers.
a) serotonin reuptake inhibitors.
