Chapter 8 – Somatoform And Dissociative Disorders Flashcards
This disorder is characterized by many different complaints of physical ailments, over at least several years beginning before age 30, that are not adequately explained by independent findings of physical illness or injury and that lead to medical treatment or to significant life impairment.
Somatization disorder
What are four symptom categories that must be met at sometime during the course of the disorder before a diagnosis of Somatization disorder can be made?
- For pain symptoms: experienced with respect to at least four different sites or functions, for example, head, abdomen, back, joints, or rectum, or during sexual intercourse or urination
- Two gastrointestinal symptoms: other than pain, such as nausea, bloating, diarrhea, or vomiting when not pregnant
- One sexual symptom: other than pain, such as sexual indifference or dysfunction, menstrual irregularity, or vomiting throughout pregnancy
- One pseudoneurological symptom: suggestive of a neurological condition such as various symptoms that mimic sensory or motor impairment like loss of sensation or involuntary muscle contraction in a hand
Note the similarities and differences between Somatization disorder and hypochondriasis
Although both disorders are characterized by preoccupation with physical symptoms, only people with hypochondriasis tend to be convinced that they have an organic disease. Moreover, with hypochondriasis the person usually has only one or a few primary symptoms, but in somatization disorder, by definition, there are multiple symptoms.
Explain what is meant by a pain disorder. Discuss the difficulties of determining that pain is of psychological rather than a physical origin and of reliably assessing an entirely subjective phenomenon
Pain disorder is characterized by the experience of persistent and severe pain in one or more areas of the body that is not intentionally produced or feigned. Although a medical condition may contribute to the pain, psychological factors must be judged to play in important role. The pain that is experienced is very real and can hurt as much as pain with purely medical causes.
Pain is always, in part, a subjective experience that is private and cannot be objectively identified by others. Persons engaged in malingering and those who have factitious disorder are consciously perpetrating fraud by faking the symptoms of their diseases or disabilities, and this fact is often reflected in their demeanor. In contrast, individuals with conversion disorders as well as with somatization and pain disorders are not consciously producing their symptoms, feel themselves to be the victims of their symptoms, and are very willing to discuss them, often in excruciating detail. When inconsistencies in their behaviours are pointed out, they are usually unperturbed. Any secondary gains experience are byproducts of the conversion symptoms them selves and are not involved in motivating symptoms. In contrast, persons who are feigning symptoms are inclined to be defensive, evasive, and suspicious when asked about them; they are usually reluctance to be examined and slow to talk about their symptoms lest the pretense be discovered.
Characterize the symptoms of conversion disorder, trace the history of the concept of “conversion”, and describe the likely cause and chain of events in the development of a conversion disorder
Conversion disorder involves a pattern in which symptoms or deficits affecting sensory or voluntary motor functions lead one to think that a patient has a medical or neurological condition. However, upon a thorough medical examination, it becomes apparent that the pattern of symptoms or deficits cannot be fully explained by any known medical condition. Examples include partial paralysis, blindness, deafness, and pseudoseizures. In addition, psychological factors must be judged to play an important role in the symptoms or deficits because the symptoms usually either start or are exacerbated by proceeding emotional or interpersonal conflicts or stressors. Finally, the person must not be intentionally producing or faking the symptoms.
Early observations dating back to Freud suggested that most people with conversion disorder showed very little of the anxiety and fear that would be expected in a person with a paralyzed arm or loss of sight. This is seeming lack of concern, known as la belle indifférence- French for the beautiful indifference, in the way the patient describes what is wrong with that for a long time to be an important diagnostic criteria in. However, MarkAir for research later showed that it only occurs in about 20% of patients, so it has been dropped as a criterion. The term conversion disorder is relatively recent, and historically this disorder was one of several disorders that were grouped together under the term Hysteria. Freud used the term conversion hysteria for these disorders because he believed that the symptoms were an expression of repressed sexual energy, that is, the unconscious conflict that a person felt about his or her sexual desires. In Freud’s view, the repressed anxiety threatens to become conscious, so it is unconsciously converted into a bodily disturbance, thereby allowing the person to avoid having to deal with the conflict.
Today, the physical symptoms are usually seen as serving the rather obvious function of providing a plausible bodily excuse enabling an individual to escape or avoid and intolerably stressful situation without having to take responsibility for doing so. Typically, it is thought that the person first experiences a traumatic event that motivates the desire to escape the unpleasant situation, but literal escape may not be feasible or socially acceptable. Although becoming sick or disabled is more socially acceptable, this is true only the person’s motivation to do so is unconscious.
The primary gain for conversion symptoms is continued escape or avoidance of a stressful situation. Because this is all unconscious, the symptoms go away only if the stressful situation has been removed or resolved. The term secondary gain, which originally referred to advance beyond the primary gain of neutralizing intrapsychic conflict, has also been retained. This term is used to refer to any external circumstances, such as attention from loved ones or financial compensation, that would tend to reinforce the maintenance of disability.
These disorders were once relatively common in civilian and especially military life. In World War I, conversion disorder was the most frequently diagnosed psychiatric syndrome among soldiers and was also relatively common during World War II.
In describing the clinical picture in conversion disorder, it is useful to think in terms of four categories of symptoms:
Sensory, motor, seizures, and mixed presentation of the first three categories
Describe the sensory symptoms or deficits in conversion disorders
Today 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 anaesthesias. In the anaesthesias, The person loses her or his sense of feeling in a part of the body. One of the most common is glove anaesthesia in which 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.
With conversion blindness, the person reports that he or she cannot see and yet can often navigate about a room without bumping into furniture or other objects. With conversion deafness, the person reports not being able to hear and yet orients appropriately upon hearing his or her own name.
Evidence supports the idea that the sensory input is registered but is somehow screen from explicit conscious recognition. implicit perception
Describe motor symptoms or deficits in conversion disorder
Conversion paralysis is usually confined to a single limb such as an arm or a leg, and the loss of function is usually selective for certain functions, for example, a person may not be able to write but may be able to use the same muscles for scratching.
The most common speech-related conversion disturbance is aphonia, in which a person is able to talk only in a whisper although he or she can usually cost in a normal manner. Another common motor symptom called Globus hystericus is difficulty swallowing or the sensation of a lump in the throat
Describe seizures as they relate to conversion disorder
Conversion seizures involve pseudoseizures, which resemble epileptic seizures in some ways but can usually be fairly well differentiated be a modern medical technology. For example, these patients do not show any EEG abnormalities and do not show confusion and loss of memory afterward, as patients with true epileptic seizures due. Patients with conversion seizures also often show excessive thrashing about and reading not seen with two seizures, and they rarely injure themselves in Falls or lose control over their bowels or bladder or, as patients with true seizures frequently do
Describe criteria commonly used for distinguishing between conversion disorders and true organic disturbances
- The frequent failure of the disfunction to conform clearly to the symptoms of the particular disease or disorder simulated
- The selective nature of the dysfunction.
- under hypnosis or narcosis, the symptoms can usually be removed, shifted, or re-induced at the suggestion of the therapist. Similarly, a person abruptly awakened from a sound sleep may suddenly be able to use a paralyzed limb
What kinds of memory is not affected in dissociative amnesia
Individuals cannot remember certain aspects of their personal life history or important facts about their identity. Yet their basic habit patterns such as their abilities to read, talk, perform skilled work, and so on, remain intact, and they seem normal aside from the memory deficit. Therefore, the only type of memory that is affected is episodic or pertaining to events experienced or autobiographical memory pertaining to personal events experienced. The other recognized forms of memory, semantic which means pertaining to language and concepts, procedural which is how to do things, and short-term storage, seem usually to remain intact
Describe the theories of the causal factors of dissociative identity disorder
The original major theory is posttraumatic theory. The vast majority of patients with the ID report memories of severe and horrific abuse as children. According to this view, DAD 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 roots of the scape, the child may dissociate and escape into a fantasy, becoming someone else. If this helps to alleviate some of the pain it will be reinforced and occur again in the future.
At the other extreme is socio-cognitive theory, which claims that DID develops when a highly suggestive 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 individuals own personal goals. This perspective maintains that this is not done intentionally or consciously by the afflicted individual but, rather, occur spontaneously with little or no awareness.
Describe the critical difficulty caused by the fallibility of memory in determining the contribution of childhood abuse to dissociative disorders
Critics argue that many of these reports, which generally come up in the course of therapy, may be the result of false memories, which are in turn a product of highly leading questions and suggestive techniques applied by well-meaning by inadequately skilled and careless psychotherapists.
A cultural rage disorder that occurs when a dissociative episodes leads to violence, aggressive, or homicidal behaviour directed at other people and objects. Occurs mostly in men and is often precipitated by a perceived slight Or insult. The person often has ideas of persecution, anger, and amnesia, often followed by a period of exhaustion and depression
Amok
Occurs when someone experiences a temporary marked alteration in state of consciousness or identity but with no replacement by and alternative identity. Usually associated with either a narrowing of awareness of the immediate surroundings, or stereotyped behaviours are movements that are experienced as beyond one’s control
Trance or dissociative trance disorder
