Dissociative/Somatic Disorders Flashcards
What were the historical perspectives on dissociative and somatic disorders?
Ancient Greece - Hysteria
Demonic possession
What did Freud think caused dissociative and somatic disorders?
Anxiety converted into physical symptoms
- Primary gain: Avoidance of internal conflict
- Secondary gain: Avoidance of responsibilities
Dissociative disorders
Dissociation
Maladaptive disruptions or alterations in identity, memory, and consciousness beyond control
Lack of normal integration in psychological functioning in identity, memory, consciousness, sensorimotor functioning, and behav
Dissociative amnesia
Inability to recall personal info w/out cognitive impairment
Usually localized or selective amnesia for events, generalized amnesia for identity and life history
Types of amnesia:
Localized
Selective
Generalized
Continuous
Systemized
Localized: Uncomfortable when pushed to remember memory
Selective: Only some parts of trauma not remembered
Generalized: Complete loss of memory
Continuous: Forgetting each new event that occurs
Systemized: Forget all memories linked to one thing
Fugue
(Dissociative amnesia)
Sudden unexpected travel away from home or work w/ amnesia for past and identity
- Usually act like they have a certain goal
- May last for days, weeks, or longer
Depersonalization / Derealization disorder
Depersonalization: Sense of unreality and detachment from thoughts, feelings, sensation, actions, body
Derealization: Feelings of unreality and detachment from one’s surroundings
** Must still be aware that something is off when exp these, unlike psychosis
Differential diagnoses of depersonalization / derealization disorder:
Illness anxiety disorder + depression
Obsessive-compulsive disorder
Dissociative identity disorder
Post traumatic stress disorder
Psychotic + substance abuse
Illness anxiety disorder + depression:
Numbness and apathy
Obsessive-compulsive disorder:
Obsessive checking of symptoms and rituals
Dissociative identity disorder:
Memory and identity disturbances
Post traumatic stress disorder:
Depersonalization and derealization
Psychotic + substance abuse:
Depersonalization and derealization from psychosis or substances
Dissociative identity disorder
- Alters
- Age
- Brain regions involved
Alters may or may not be aware of each other
- Switching occurs from cues in enviro
- Usually 2+ alters
Avg age at diagnosis: 29-35
Brain regions linked o memory, consciousness, and emotions
- Orbifrontal cortex
- Hippocampus and parahippocampal gyrus
- Amygdala
Differential diagnoses w/ dissociative identity:
Obsessive-compulsive disorder
Post traumatic stress disorder
Schizophrenia
Obsessive-compulsive disorder:
- Need to act a certain way and loss of sense of self
Post traumatic stress disorder:
- Loss of memory of traumatic event
Schizophrenia:
- Hearing voices; mind feeling controlled
Trauma-repression hypothesis
False memory syndrome
Trauma-repression hypothesis:
- Repressed memory usually real
- Memories repressed as survival response
False memory syndrome:
- Therapist induces memories of trauma that never occurred
- Best way to identify is by confirming signs of abuse from bystander
Etiology of dissociative disorders (trauma model):
Diathesis-stress model
Personality
Genetic heritability
Attachment theory
**Believes DID comes from childhood
- Problem: We don’t see symptoms until adulthood
Diathesis-stress model:
- Defence mechanism activates in response to high lvls of stress
- Diathesis (vulnerabilities) in personality, genetics, or childhood needed
Personality:
- High hypnotizability, fantasy proneness, openness to altered states of consciousness
Genetic heritability
Attachment theory
- Insecure attachment (disorganized) most likely
Etiology of dissociative disorders (socio-cognitive model):
Roleplaying
Iatrogenic
Hypnotizability
Culture
**Believes DID is learned social behav
Roleplaying: Ppl who tend to rp more likely
Iatrogenic: Wording if therapist can influence patient
Hypnotizability: High hypnotizability more prone
Culture: Exposure to media w/ characters w/ DID growing up
Other specified dissociative disorder
- Chronic + recurring syndromes of mixed dissociative symptoms
- Identity disturbance due to brainwashing
- Dissociative reactions to stressful events
- Dissociative trance
**Rare
Somatic symptom disorder
- Primary symptoms
- SSD-predominant pain
Primary symptoms:
- Recurrent somatic symptoms (pain, fatigue, nausea, muscle weakness, numbness, indigestion)
- May not have organic basis
SSD-predominant pain:
- When pain persists beyond expected time span (6+ months), patient can benefit from psychosocial factors
**Involves fear of having disease + pain/illness
Illness anxiety disorder
Formerly hypochondriasis
- Fear of having medical disease even tho there’s nothing wrong
- Fear present for 6+ months
Somatic disorders are highly comorbid with?
Conversion disorders and dissociative disorders
- All have high measures of dissociative exp and hypnotizability
- History of childhood abuse and trauma
Conversion disorder
(Functional neurological symptom disorder)
- Glove anaesthesia
- La belle indifference
Disturbances in motor and sensory functioning caused by neurological problem
- Paralysis, impaired balance, seizures, etc
Glove anaesthesia: Loss of sensation in entire hand only
- Problem: Nerve isn’t separate between arm and hand so doesn’t biologically make sense
La belle indifference: Patients usually don’t seem concerned over their physical symptoms
Factitious disorder (Munchausen Syndrome)
Deliberately faking illness or injury to get medical attention
- Motivation is to get sympathy, care, and attention (not money)
- Can be found in children or parents inflicting on children
Etiology of somatic disorders:
Psychoanalytic explanations
HPA axis
Cognitive factors
Personality
Early life experiences
Social learning
Psychoanalytic explanations:
- Unconscious conflicts cause conversion into anxiety
HPA axis:
- Person thinks they’re sick but it’s actually response to stress
Cognitive factors:
- Dysfunctional beliefs about illness
Personality:
- Negative affectivity and emotion regulation deficits
Early life experiences:
- Early experiences of stress and trauma
Social learning:
- Learn to adopt sick role from seeing others w/ serious illness and positive reinforcement from care
