Chapter 8 abnormal

Question 1

Depersonalization/derealization disorder

Answer 1

experience of detachment from the self and reality

Question 2

dissociative amnesia

Answer 2

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

Question 3

dissociative identity disorder

Answer 3

at least 2 distinct personalities that act independently of each other

Question 4

Dissociation

Answer 4

Some aspect of emotion, memory, or experience being inaccessible consciously
Some types of dissociation common (e.g., losing track of time)

Question 5

What causes dissociation?

Answer 5

What causes dissociation?
Psychodynamic and behavioral theorists
An avoidance response that protects the person from consciously experiencing stressful events
Trauma and sleep disturbance

Question 6

T/F in regards to the cause of dissociation Psychodynamic and Behavioral theorists agree on the cause

Answer 6

TRUE

• An avoidance response that protects the person from consciously experiencing stressful events
• Trauma and sleep disturbance

Question 7

Depersonalization/Derealization Disorder

Answer 7

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

Question 8

Derealization

Answer 8

A sense of detachment from one’s surroundings

Question 9

Depersonalization

Answer 9

A sense of detachment from one’s self or surroundings

E.g., being an observer outside one’s body

Question 10

DSM-5 Criteria:Depersonalization/Derealization Disorder

Answer 10

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

Question 11

Dissociative Amnesia

Answer 11

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

Question 12

What causes dissociative amnesia?

Answer 12

*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

Question 13

Dissociative Amnesia: Dissociative Fugue Subtype

Answer 13

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

Question 14

DSM-5 Criteria:Dissociative Amnesia

Answer 14

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

Question 15

Dissociative Identity Disorder

Answer 15

*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

Question 16

DSM-5 Criteria:Dissociative Identity Disorder

Answer 16

• 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

Question 17

The Epidemiology of Dissociative Disorders

Answer 17

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

Question 18

Posttraumatic Model

Answer 18

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

Question 19

Sociocognitive Model

Answer 19

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

Question 20

Evidence in Support of Sociocognitive Model of DID

Answer 20

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

Question 21

Availability of Treatments for DID

Answer 21

No well-validated treatments available

No randomized controlled trials have assessed psychological treatment

Medications have not been shown to relieve DID symptoms

Question 22

Psychodynamic Treatment for DID

Answer 22

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

Question 23

Somatic Symptom and Related Disorders

Answer 23

• 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

Question 24

Availability of Treatments (for DID)

Answer 24

No well-validated treatments available

No randomized controlled trials have assessed psychological treatment

Medications have not been shown to relieve DID symptoms

Question 25

Psychodynamic Treatment for DID

Answer 25

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

Question 26

T/F if someone has DID they probs are not gonna get good treatment

Answer 26

TRUE

if someone has DID they probs are not gonna get good treatment (not really sure what works)

Question 27

somatic symptom disorder

Answer 27

excessive throught, distress and behavior related to somatic symptoms

Question 28

conversion disorder

Answer 28

neurological symptoms that cannot be explained by medical disease or culturally sanctioned behavior

Question 29

DSM-5 Criteria: Somatic Symptom Disorder

Answer 29

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

Question 30

Somatic Symptom Disorder

Answer 30

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

Question 31

DSM-5 Criteria: Illness Anxiety Disorder

Answer 31

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

Question 32

Preoccupation lasts at least 6 months

Answer 32

• Illness Anxiety Disorder

* Somatic Symptom Disorder

Question 33

Illness Anxiety Disorder

Answer 33

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

Question 34

DSM-5 Criteria: Conversion Disorder

Answer 34

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

Question 35

Conversion Disorder

Answer 35

• 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

Question 36

Malingering

Answer 36

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

Question 37

Factitious Disorder

Answer 37

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?

Question 38

T/F Depersonalization/Derealization Disorder involves a disturbance of memory

Answer 38

FALSE : Does not involve disturbance of memory

Question 39

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.

Answer 39

equally likely to be seen in men or women.

Question 40

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

Answer 40

d) stress reactivity and a disrupted HPA axis

Question 41

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.

Answer 41

abnormalities in the functioning of the basal ganglia.

Question 42

DID : prevalence gender

Answer 42

More common in women than men

Question 43

conversion disorder prevalence

Answer 43

*Prevalence less than 1%

More common in women than men

Question 44

illness anxiety disorder

Answer 44

unwarranted fears about serious illness in the absence of any significant somatic symptoms

Question 45

Measures to detect malingering:

Answer 45

Measures to detect malingering:
SVT’s
TOMM: test of memory malingering
WMT
PDRT

Question 46

Dissociative Disorders : the 3 types

Answer 46

• Dissociative Amnesia
• Dissociative identity disorder
• Depersonalization/ derealization disorder

Question 47

who agrees on the cause of dissociation?

Answer 47

Psychodynamic and Behavioral theorists

Question 48

All three OCD-related disorders respond well to

a) serotonin reuptake inhibitors.
b) dopamine inhibitors.
c) GABA enhancers.
d) norepinephrine enhancers.

Answer 48

a) serotonin reuptake inhibitors.