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Abnormal Psychology > Chapter 8: Somatic Symptom and Dissociative Disorders > Flashcards

Chapter 8: Somatic Symptom and Dissociative Disorders Flashcards

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1
Q

T or F: In DSM-5 somatic symptom disorders and dissociative disorders are regarded as distinct diagnostic entities.

A

True.

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2
Q

How many disorders are included in the DSM-5 category of somatic symptom and related disorders?

A

Four.

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3
Q

What conditions are included in the DSM-5 category of somatic symptom and related disorders?

A

Included in this category are conditions that involve physical symptoms combined with abnormal thoughts, feelings, and behaviours in response to those symptoms. People with somatic symptom disorders experience bodily symptoms that cause them significant psychological distress and impairment.

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4
Q

What does “soma” mean?

A

Body.

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5
Q

What are the four disorders that are included in the DSM-5 category of somatic symptom and related disorders?

A

(1) somatic symptom disorder, (2) illness anxiety disorder, (3) conversion disorder, and (4) factitious disorder.

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6
Q

Out of the four disorders in the DSM-5 category of somatic symptom and related disorders, what is regarded as the most major diagnosis?

A

Somatic symptom disorder

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7
Q

The new diagnosis of somatic symptom disorder includes several disorders that were previously considered to be separate diagnoses in DSM-IV. What were those disorders?

A

(1) hypochondriasis, (2) somatization disorder, and (3) pain disorder

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8
Q

For the diagnosis of somatic symptom disorder to be made, individuals must be experiencing chronic somatic symptoms that are _________ to them. They must also be experiencing _______ ________ ______ ______ ___________.

A

distressing; dysfunctional thoughts, feelings, and/or behaviours (*the addition of this psychological component is new).

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9
Q

In DSM-5 only ____ somatic symptom is required.

A

One. If a person has any physical problem that they find distressing (even if it involves only a single symptom and is medically explained), the diagnosis of somatic symptom disorder is possible.

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10
Q

What is a criticism of somatic symptom disorder?

A

New diagnostic criteria are far too loose and will lead to many people being mislabeled as having a mental disorder. It has been recommended that it not be used.

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11
Q

What is the basic model of Somatic Symptom Disorder (causation)?

A
  • Attention to bodily sensations
  • Attribution of sensations to illness
  • Worry/catastrophic thinking
  • Help seeking

*somatic symptom disorder can be viewed as disorder of both perception and cognition.

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12
Q

T or F: Individuals who are especially anxious about their health tend to be very aware of and sensitive to what is happening in their bodies.

A

False. Rather, experimental studies show that these individuals have an attentional bias for illness-related information.

*top-down (cognitive) processes, rather than bottom-up processes (such as differences in bodily sensations), seem to account for the problems that they have.

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13
Q

What is regarded as a risk factor for developing somatic symptom disorder?

A

Negative affect, absorption and alexithymia.

Absorption is a tendency to become absorbed in one’s experiences and is often associated with being highly hypnotizable.

Alexithymia refers to having difficulties identifying one’s feelings.

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14
Q

T or F: Patients with somatic symptom disorder are more likely to be female and to have high levels of comorbid depression and anxiety

A

True.

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15
Q

T or F: Cognitive-behavioural treatments and techniques are widely used to treat somatic symptom disorders.

A

True. The cognitive-behavioural model provides a good explanation of the causes of somatic symptom disorders and therefore it should come as little surprise that cognitive-behavioural treatments are widely used to treat these disorders.

Treatment programs (techniques) generally include relaxation training, support and validation that the pain is real, scheduling of daily activities, cognitive restructuring, and reinforcement of “no-pain” behaviours.

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16
Q

What is illness anxiety disorder?

A

Broadly, people have high anxiety about having or developing a serious illness. This anxiety is distressing and/or disruptive, but there are very few (or very mild) somatic symptoms

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17
Q

How does illness anxiety disorder differ from somatic symptom disorder?

A

Illness anxiety disorder has very few somatic symptoms.

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18
Q

What is conversion disorder?

A

Characterized by the presence of neurological symptoms in the absence of a neurological diagnosis. I.e., the patient has symptoms or deficits affecting the senses or motor behaviour that strongly suggest a medical or neurological condition. However, the pattern of symptoms or deficits is not consistent with any neurological disease or medical problem.

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19
Q

In describing the clinical picture in conversion disorder, it is useful to think in terms of four categories of symptoms, which are?

A

(1) sensory, (2) motor, (3) seizures, and (4) a mixed presentation of the first three categories

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20
Q

For conversion disorder, what are the most common sensory symptoms?

A

The sensory symptoms or deficits are most often in the visual system (especially blindness and tunnel vision), in the auditory system (especially deafness), or in the sensitivity to feeling (especially the anesthesias).

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21
Q

What is glove anesthesia (conversion disorder)?

A

The person cannot feel anything on the hand in the area where gloves are worn, although the loss of sensation usually makes no anatomical sense.

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22
Q

What is aphonia (conversion disorder)?

A

Most common speech-related conversion disorder. A person is able to talk only in a whisper although he or she can usually cough in a normal manner.

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23
Q

T or F: Conversion disorders were once relatively common.

A

True. In World War I, con-version disorder was the most frequently diagnosed psychiatric syndrome among soldiers; it was also relatively common during World War II. Now, conversion disorders are found in approximately 5 percent of people referred for treatment at neurology clinics.

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24
Q

What are the gender differences in conversion therapy?

A

Conversion disorder occurs two to three times more often in women than in men.

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25
Q

T or F: Conversion disorders are thought to develop as a result of stress or internal conflicts of some kind.

A

True.

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26
Q

What is factitious disorder?

A

In factitious disorder the person intentionally produces psychological or physical symptoms (or both). The person’s goal is to obtain and maintain the benefits that playing the “sick role” (even to the extent of undergoing repeated hospitalizations) may provide, including the attention and concern of family and medical personnel.

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27
Q

What is the difference between factious disorder and

malingering?

A

The key difference is that, in factitious disorder, the person receives no tangible external rewards. In contrast, the person who is malingering is intentionally producing or grossly exaggerating his or her physical symptoms and is motivated by external incentives such as avoiding work or military service or evading criminal prosecution.

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28
Q

What is factitious disorder imposed on another (Munchausen’s syndrome by proxy)?

A

The person seeking medical help has intentionally produced a medical or psychiatric illness (or the appearance of an illness) in another person. This person is usually someone (such as a child) who is under his or her care. It can be a type of child abuse.

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29
Q

What are the three dissociative disorders in the DSM-5?

A

Depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder.

30
Q

T or F: Dissociation is inherently pathological.

A

False. Dissociation only becomes pathological when the dissociative symptoms are “perceived as disruptive, invoking a loss of needed information, as producing discontinuity of experience” or as “recurrent, jar-ring involuntary intrusions into executive functioning and sense of self”.

31
Q

T or F: The person avoids stress by pathologically dissociating—in essence, by escaping from his or her own autobiographical memory or personal identity.

A

True.

32
Q

Why are dissociative disorders placed in DSM-5 immediately after trauma and stressor-related disorders.

A

The dissociative disorders are placed in DSM-5 immediately after trauma and stressor-related disorders, to reflect the close relationship that exists between them.

33
Q

What are two of the more common kinds of dissociative symptoms?

A

Derealization and depersonalization.

34
Q

What are two of the more common kinds of dissociative symptoms?

A

Derealization and depersonalization (these sometimes occur in panic attacks too). When these symptoms become persistent and recurrent - depersonalization/ derealization disorder may be diagnosed.

35
Q

What is derealization?

A

In derealization one’s sense of the reality of the outside world is temporarily lost

36
Q

What is depersonalization?

A

One’s sense of one’s own self and one’s own reality is temporarily lost.

37
Q

What is depersonalization/ derealization disorder?

A

People have persistent or recurrent experiences of feeling detached from (and like an outside observer of) their own bodies and mental processes.

38
Q

What is memory fragmentation regarding depersonalization/ derealization disorder?

A

Marked by difficulties forming an accurate or coherent narrative sequence of events (time distortion). This is a key element of the depersonalization experience.

39
Q

What is the lifetime prevalence of depersonalization/derealization disorder?

A

Lifetime prevalence is around 1 to 2 percent of the population.

40
Q

Regarding depersonalization/derealization disorder, are men or women more affected ?

A

Equal numbers of males and females being affected

41
Q

What is the age of onset for depersonalization/derealization disorder?

A

Age of onset is around age 16, with only a minority of people developing it after age 25

42
Q

What is the difference between retrograde amnesia and anterograde amnesia?

A

Retrograde amnesia is the partial or total inability to recall or identify previously acquired information or past experiences; by contrast, anterograde amnesia is the partial or total inability to retain new information

43
Q

What is dissociative amnesia?

A

Dissociative amnesia is usually limited to a failure to recall previously stored personal information (retrograde amnesia) when that failure cannot be accounted for by ordinary forgetting.

44
Q

When does dissociative amnesia usually occur?

A

The gaps in memory most often occur following intolerably stressful circumstances. Forgotten personal information is still there beneath the level of consciousness.

45
Q

Regarding dissociative amnesia, how long do the typical episodes usually last?

A

Amnesic episodes usually last between a few days and a few years.

46
Q

What are the two types of memory affect during dissociative amnesia?

A

Episodic (pertaining to events experienced) or autobiographical memory (pertaining to personal events experienced).

47
Q

What is dissociative fugue?

A

A defense by actual flight—a person is not only amnesic for some or all aspects of his or her past but also departs from home surroundings. Some people may suddenly emerge from the fugue state and find themselves in a strange place, working in a new occupation, with no idea how they got there. In other cases, recovery from the fugue state occurs only after repeated questioning and reminders of who they are.

48
Q

How does dissociative amnesia differ to conversion symptoms?

A

The pattern in dissociative amnesia is essentially simi-ar to that in conversion symptoms, except that instead of avoiding some unpleasant situation by becoming physically dysfunctional, a person unconsciously avoids thoughts about the situation or, in the extreme, leaves the scene.

49
Q

In a review of nine cases of dissociative amnesia for which brain imaging data were available, what was found?

A

The authors concluded there was evidence of significant changes in the brains of these patients, mostly centered on subtle loss of function in the right anterior hemisphere—changes similar to those seen in the brains of patients with organic memory loss

50
Q

What is required to be diagnosed with dissociative identity disorder (DID)?

A

For this diagnosis there must be a disruption of identity characterized by two or more distinct personality states as well as recurrent episodes of amnesia.

51
Q

What is a trance?

A

Said to occur when someone experiences a temporary marked alteration in state of consciousness or identity. It is usually associated with either a narrowing of awareness of the immediate surroundings, or stereotyped behaviours or movements that are experienced as beyond one’s control.

52
Q

What is a possession trance?

A

A possession trance is similar except that the alteration of consciousness or identity is replaced by a new identity that is attributed to the influence of a spirit, deity, or other power.

53
Q

Is a trance or possession trance pathological?

A

When entered into voluntarily for religious or spiritual reasons, trance and possession states are not considered pathological. However, when they occur involuntarily, outside accepted cultural contexts, and cause distress, this is a serious problem.

54
Q

T or F: Pathological possession is a common form of DID in Africa, Asia, and many other non-Western cultures

A

True. This important change makes the diagnosis of DID more inclusive and applicable to a broader range of cultural groups.

55
Q

In DID, what is the host identity?

A

The one identity that is most frequently encountered and carries the person’s real name. In most cases, the host is not the original identity, and it may or may not be the best-adjusted identity.

56
Q

How do the alter identities differ from the host identity in DID?

A

The alter identities may differ in striking ways involving gender, age, handedness, handwriting, sexual orientation, prescription for eyeglasses, predominant affect, foreign languages spoken, and general knowledge.

Alters are not in any meaningful sense personalities but rather reflect a failure to integrate various aspects of a person’s identity, consciousness, and memory.

57
Q

T or F: In DID, some identities may know more about certain alters than do other identities

A

True.

58
Q

T or F: Among patients with diagnoses of DID, the average number of comorbid diagnoses was five, with PTSD being the most common.

A

True.

59
Q

What is the age of onset for DID?

A

DID usually starts in childhood, although most

patients are in their teens, 20s, or 30s at the time of diagnosis.

60
Q

What are the gender differences pertaining to DID?

A

Approximately three to nine times more females than males are diagnosed as having the disorder, and females tend to have a larger number of alters than do males

61
Q

T or F: In contemporary literature, the original major theory of how DID develops is posttraumatic theory

A

True. DID starts from the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse. Lacking other resources or routes of escape, the child may dissociate and escape into a fantasy, becoming someone else.

62
Q

Besides postraumatic theory, what is another theory used to describe how DID develops?

A

Sociocognitive theory. According to this theory, DID develops when a highly suggestible person learns to adopt and enact the roles of multiple identities, mostly because clinicians have inadvertently suggested, legitimized, and reinforced them and because these different identities are geared to the individual’s own personal goals.

*does not view this as being done intentionally or consciously by the person involved.

63
Q

T or F: There is currently more support for the trauma model than sociocognitive model.

A

False. There is somewhat more support for the sociocognitive model than for the trauma model.

64
Q

T or F: Most people with DID have at least some identities that seem completely unaware of the existence and experiences of certain other identities.

A

True.

65
Q

There are also cross-cultural variants on dissociative

disorders. What is an example shared in the textbook?

A
  • Amok, which is often thought of as a rage disorder. Amok occurs when a dissociative episode leads to violent, aggressive, or homicidal behaviour directed at other people and objects.
66
Q

What are some treatment options for depersonalization disorder and dissociative amnesia?

A

virtually no systematic, controlled research has been conducted on treatment of depersonalization dis-order and dissociative amnesia.

67
Q

What is a recent treatment that shows promise for depersonalization/derealization disorder?

A

A recent treatment showing some promise for the treatment of dissociative disorders involves administering rTMS (repetitive trans-cranial magnetic stimulation) to the temporoparietal junction, an area of the brain highly involved in the experience of a unified self and body (Mantovani et al., 2011). After 3 weeks of treatment, half of the subjects showed significant reductions in depersonalization, with nonresponders showing symptom reduction after an additional 3 weeks of treatment.

68
Q

In dissociative amnesia, it is important for the person to be in a _____________, and simply removing her or him from what he or she perceives as a threatening situation sometimes allows for spontaneous recovery of __________.

A

safe environment; memory.

69
Q

For people diagnosed with DID, most current therapeutic approaches are based on the assumption of ________ theory.

A

posttraumatic theory (that the disorder was caused by abuse).

70
Q

What is one treatment that could be used for most dissociative disorders/dissociative amnesia?

A

Hypnosis.

71
Q

(1) for treatment to be successful, it must be ___________, and (2) the more severe the case,
the ___________________.

A

prolonged (often lasting many years); longer that treatment is needed.

Abnormal Psychology (8 decks)

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