Dissociative and Somatic Symptom Disorders

Question 1

T or F. The term split personality is a lay term that refers to dissociative identity disorder, not schizophrenia

Answer 1

T

Question 2

T or F. At some time or another, the majority of adults have episodes of feeling detached from their own bodies or thought processes

Answer 2

T.

Question 3

The great majority of people with multiple personalities were …

Answer 3

physically or sexually abused as children

Question 4

In dissociative disorders, one or more of these aspects of daily living is disturbed

Answer 4

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

Question 5

Defining characteristic of dissociative disorders

Answer 5

Some aspect of person, personality, or memory is compartmentalized or made alien/inaccessible to other aspects of their consciousness

Question 6

Somatoform disorders

Answer 6

involve physical complaints that reflect underlying psychological conflicts or issues

Question 7

Types of Dissociative Disorders

Answer 7

• dissociative identity disorder
• dissociative amnesia
• depersonalization/derealization disorder

Question 8

Somatic Symptom Disorders

Answer 8

• somatic symptom disorder
• illness anxiety disorder
• conversion disorder
• factitious disorder

Question 9

Dissociative Identity Disorder

Answer 9

• 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”

Question 10

DID vs. Schizophrenia

Answer 10

• 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)

Question 11

A lot of clinicians and researchers highly skeptical about DID:

Answer 11

• 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)

Question 12

Kenneth Bianchi (the so-called Hillside strangler)

Answer 12

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.

Question 13

“Co-conscious” in terms of DID

Answer 13

may communicate indirectly through other people or leaving notes
- at other times may be in apparent conflict

Question 14

Type of disorder in which a person experiences memory losses in the absence of any identifiable organic cause

Answer 14

Dissociative amnesia

Question 15

Dissociative amnesia

Answer 15

• 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

Question 16

A person undergoes some sort of memory loss but NOT as a result of a head injury or intoxicant (identifiable organic cause)

Answer 16

Dissociative amnesia

Question 17

Retrograde in Dissociative amnesia

Answer 17

going wayyy back to things we learned early (could be lost)

- but personal taste, general knowledge, etc. is retained

Question 18

fugue

Answer 18

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.

Question 19

Malingering

Answer 19

• 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**

Question 20

Depersonalization/Derealization Disorder

Answer 20

• 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

Question 21

Depersonalization vs. Derealization

Answer 21

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**

Question 22

Age group that experiences prevalent derealization

Answer 22

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

Question 23

Recovered Memory

Answer 23

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!

Question 24

False memory

Answer 24

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

Question 25

False vs Recovered memories

Answer 25

Repressed memories may or may not be a real phenomenon, but false memories ARE a reality and can be “induced” in most people

Question 26

Treatment for dissociative disorders

Answer 26

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

Question 27

Somatic Symptom Disorders

Answer 27

disorders in which people complain of physical (somatic) problems although no physical abnormality can be found

Question 28

Illness anxiety disorder

Answer 28

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?)

Question 29

Conversion Disorder (Functional Neurological Symptom Disorder)

Answer 29

• 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)

Question 30

La Belle Indifference

Answer 30

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

Question 31

People with conversion disorders do not ___________ fake their symptoms but ____ their symptoms are due to a real illness

Answer 31

consciously; fear

Question 32

Factitious disorder

Answer 32

• 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**

Question 33

Primary vs. Secondary Gains

Answer 33

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

Question 34

Somatic Symptom Disorders Treatment

Answer 34

• 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

Question 35

Koro Syndrome

Answer 35

• 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

Question 36

Dhat syndrome

Answer 36

• 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