Dissociative and Somatic Symptom Disorders Flashcards
T or F. The term split personality is a lay term that refers to dissociative identity disorder, not schizophrenia
T
T or F. At some time or another, the majority of adults have episodes of feeling detached from their own bodies or thought processes
T.
The great majority of people with multiple personalities were …
physically or sexually abused as children
In dissociative disorders, one or more of these aspects of daily living is disturbed
Normally, we perceive ourselves as progressing through space and time. A sense of continuity. A unity to self-consciousness that gives rise to a sense of self
Defining characteristic of dissociative disorders
Some aspect of person, personality, or memory is compartmentalized or made alien/inaccessible to other aspects of their consciousness
Somatoform disorders
involve physical complaints that reflect underlying psychological conflicts or issues
Types of Dissociative Disorders
- dissociative identity disorder
- dissociative amnesia
- depersonalization/derealization disorder
Somatic Symptom Disorders
- somatic symptom disorder
- illness anxiety disorder
- conversion disorder
- factitious disorder
Dissociative Identity Disorder
- a condition in which a person has two or more distinct or alternate personalities (previously called multiple personality disorder)
- alters may or may not be aware of each other
- “co-conscious”
- people diagnosed are often highly imaginative children and suggestible adults
- therapeutic goal has been “reintegration”
DID vs. Schizophrenia
- these two sometimes confused by lay persons
- Schizophrenia (split mind) refers to loosening of connections between various psychic functions eg. ideas, perceptions, emotions, behaviours (cracked mirror)
- DID involves the formation of separate, but at least partly integrated personality structures (different faces)
A lot of clinicians and researchers highly skeptical about DID:
- very low base rate (only 1% of ppl have this diagnosis)
- number of alters appears to be increasing with time (Seems to correspond more to movie portrayals)
- types of alters being reported is absurd
- ~only 21% of board certified psychiatrists felt there was strong evidence for the condition
- 51% voiced skepticism and/or thought it should be removed from DSM
- Piper and Merskey = no proof that it results from childhood trauma like broadly believed (childhood trauma is a BROAD risk factor for any mental disordeR)
- Spanos (2011) research
> almost unheard of outside North America
> appearance is highly influenced by cultural factors
> a form of role-playing inadvertently cued by interviewers (eventually becomes habitual; emphasizes the importance of careful interviewing)
Kenneth Bianchi (the so-called Hillside strangler)
You can deliberately give a little bit of misleading information and if they take the bait, that’s a red flag!
For ex: Bianchi was told that people with DID often had three personalities, not two so he came up with a third - Billy.
“Co-conscious” in terms of DID
may communicate indirectly through other people or leaving notes
- at other times may be in apparent conflict
Type of disorder in which a person experiences memory losses in the absence of any identifiable organic cause
Dissociative amnesia
Dissociative amnesia
- would be retrograde except general knowledge, habits, personal tastes, and skills are usually retained
- forgotten material is usually related to trauma
- may be localized (narrow piece of time), selective (around a specific thing or person), or generalized (complete - they don’t know who they are)
- specifier: with fugue
A person undergoes some sort of memory loss but NOT as a result of a head injury or intoxicant (identifiable organic cause)
Dissociative amnesia
Retrograde in Dissociative amnesia
going wayyy back to things we learned early (could be lost)
- but personal taste, general knowledge, etc. is retained
fugue
psychogenic (not something with identifiable organic cause.. external event instead!)
Also flight!!! They leave their lives behind; they forget who they are (but they don’t necessarily seem stressed by it) – they adopt a new identity, etc.
Malingering
- in dissociative disorders, always consider this
- faking illness so as to avoid or escape work or other duties, or to obtain benefits
- faking amnesia is quite common; usually an attempt to escape criminal or other responsibility
- *pretty easy to do as and if there is inconsistent reporting or contradict themselves (usually occurs) = first indication something isn’t right**
Depersonalization/Derealization Disorder
- disorder characterized by persistent or recurrent episodes of depersonalization
- feelings of unreality or detachment from one’s self or one’s body, as if one were a robot, or functioning on automatic pilot, or observing oneself from outside
- patients may interpret as an ‘out-of-body’ or transcendental experience
Depersonalization vs. Derealization
DEPERSONALIZATION:
- temporary alteration from usual sense of reality (like watching yourself on TV), feeling detached from body. Some perceptual interference.
DEREALIZATION:
- episodes of derealization are characterized by the sense that one’s surroundings have become strange or unreal, for example, colours may seem washed out or very bright and time seem to be oddly slowed down or sped up.
- *neither is a psychosis because contact with reality is maintained**
- *both can be triggered by anxiety/trauma**
Age group that experiences prevalent derealization
25-34 age range
experience not a full diagnosable disorder but MOMENTS of depersonalization and derealization
35-44 instances drops
not a disorder unless it is persistent, recurring, and causes harm
Recovered Memory
An ancillary issue: claim is that some traumatic memories may be repressed but lead to depression, anxiety, and other psychological symptoms
- through the use of hypnosis or psychotherapy these can supposedly be recovered
- there is MUCH controversy around this!
False memory
being led to recall a thing that never really occurred and deeply believe that they are true – cannot distinguish between false memory and a genuine memory
**recovered memory = something that was once forgotten is recalled
False vs Recovered memories
Repressed memories may or may not be a real phenomenon, but false memories ARE a reality and can be “induced” in most people
Treatment for dissociative disorders
Psychoanalysis: uncovering early childhood trauma
Cognitive Behaviour Therapy: uncovering maladaptive cognitions; what are your core beliefs
SSRIs: Non-specific effects only; no strong evidence that pharmacotherapy is effective with these disorders
Somatic Symptom Disorders
disorders in which people complain of physical (somatic) problems although no physical abnormality can be found
Illness anxiety disorder
The preoccupation with the idea that one is sick is accompanied by substantial anxiety about health and disease.
Individuals with this disorder are easily alarmed about illness, such as hearing about someone else falling ill or reading a health-related news story.
Their concerns about undiagnosed disease do not respond to appropriate medical reassurance, negative diagnostic tests, or benign course
(hypochondriasis?)
Conversion Disorder (Functional Neurological Symptom Disorder)
- Freudian term (conversion)
- type of somatic symptom disorder characterized by loss or impairment of physical function in the absence of any organic causes that might account for the changes
- formerly called hysteria or hysterical neurosis (sexist term)
La Belle Indifference
French term describing the lack of concern over one’s symptoms displayed by some people with conversion disorder but also by people with real physical disorders
People with conversion disorders do not ___________ fake their symptoms but ____ their symptoms are due to a real illness
consciously; fear
Factitious disorder
- Munchausen’s syndrome
- they don’t think they have it, they CREATE it (ex: inject saliva to cause systemic disorder, etc.)
- falsification of medical or psychological signs and symptoms in oneself or others that are associated with the identified deception
- by proxy: do it to someone else (mom example)
- target group most likely to engage in this behaviour, exp. by proxy = women in the healthcare industry (attracted to being in the hospital, find it deeply comforting)
- *Doing this for their own sake, not malingering; no reward!**
- this is a deception, conversion disorder is NOT**
Primary vs. Secondary Gains
Primary: in psychodynamic theory, the relief (negative reinforcement) from anxiety obtained through the development of a neurotic symptom
Secondary: (social in nature) side benefits associated with neuroses or other disorders, such as expressions of sympathy and increased attention from others and release from ordinary responsibilities
Somatic Symptom Disorders Treatment
- Psychoanalysis: marriage for “hysterical” (hystera = uterus) women
- Behavioural methods: removal of secondary gains (coaching family) ; teaching alternate means of coping with stress/anxiety
- CBT: early, but promising results
- SSRIs: of some use, probably die to anxiolytic effects
Koro Syndrome
- culture-bound dissociative conditions
- closest DSM category is illness anxiety disorder
- supposedly fatal condition in which genitals shrink or retract into body
- young Asian males (sometimes females)
- may try to mechanically prevent retraction (weights)
- ideas spread (when one friend tells another)
- can occur in epidemics
- most prevalent among less educated, geographically isolated individuals
- respond well to reassurance and education
Dhat syndrome
- India, young men
- Dhat = elixir of life - semen
- intense fear that ejaculation will rob the body of vital energy (testes always secreting semen, no menopause)
- primarily through nocturnal emissions, but also during voiding
- not stupid, pathological fear
