Somatic and Dissociative Disorders

Question 1

What are dissociative disorders often linked to in terms of trauma?

Answer 1

They can have a basis in trauma and stress exposure, with models implicating a history of sexual and physical abuse.

Question 2

What role does stress exposure play in the development of dissociative disorders?

Answer 2

Stress exposure, particularly chronic or extreme stress, is a significant factor in triggering dissociative symptoms.

Question 2

Which types of trauma are frequently implicated in the development of dissociative disorders?

Answer 2

A history of sexual and physical abuse.

Question 3

Why might individuals with dissociative disorders not recall their trauma experiences easily?

Answer 3

A: Dissociation can serve as a psychological defense mechanism, causing memory gaps or altered awareness to protect the individual from emotional pain.

Question 3

How do trauma aetiology models explain the onset of dissociative disorders?

Answer 3

These models suggest that exposure to severe trauma, such as sexual and physical abuse, can lead to dissociation as a coping mechanism.

Question 4

What is the hallmark feature of dissociative disorders?

Answer 4

The hallmark feature is when a memory—normally involving integrated sensory elements like sight, sound, and smell—becomes fragmented. Instead of being fully recalled, parts of the memory are separated, leading to experiences where an individual feels unexpectedly transported back to the original time and place of the memory.

Question 4

What does the historical view of dissociation suggest about the integration of experiences?

Answer 4

Dissociation is seen as a gap or lack of integration in how we process and experience events. Normally, the brain integrates sensory and mental processes automatically, without conscious awareness. When this integration fails, parts of the experience are split off from awareness.

Question 4

What important similarity is shared between traumatic stress disorders, dissociative disorders, and somatic symptom disorders (SSDs)?

Answer 4

They all involve dissociation, which is the disruption of normally integrated mental processes.

Question 4

Why is dissociation thought to have a protective purpose?

Answer 4

Dissociation is theorized to protect individuals from overwhelming experiences by splitting off complex mental activities, allowing them to avoid processing all aspects of the experience simultaneously. This is similar to protective mechanisms seen in somatic disorders, where avoidance of fear may play a key role.

Question 4

How can dissociation be induced experimentally?

Answer 4

Through the rubber hand illusion, where individuals experience a sense of controlling a hand that is not theirs, leading to confusion about what is part of their body. This demonstrates a distortion of self and shows how the sense of identity can be disrupted, similar to what occurs in identity disorders.

Question 4

What are the specific dissociative disorders recognized in the DSM-5?

Answer 4

Dissociative Amnesia
Depersonalisation/Derealisation Disorder (combined in DSM-5)
Dissociative Identity Disorder (formerly known as multiple identity disorder)
Dissociative Fugue (dropped from DSM-5)

Question 4

What is the core feature of dissociative disorders?

Answer 4

The core feature is a persistent, maladaptive disruption in the integration of memory, consciousness, identity, emotion, perception, body representations, motor control, and behavior.

Question 4

How do trauma and stress influence dissociative disorders?

Answer 4

Trauma and stress can overwhelm coping mechanisms, causing memory to disconnect from experiences. This can lead to fragmented memories, especially in cases of severe trauma, where the memory becomes vulnerable to disintegration from the actual experience.

Question 4

What is the hallmark feature of dissociative disorders, and how does it differ from PTSD?

Answer 4

The hallmark feature of dissociative disorders is dissociation, specifically the inability to remember parts of an experience that stand out. In contrast, PTSD involves trauma or stress as the symptomatic feature, whereas in dissociative disorders, dissociation itself is the defining symptom.

Question 4

How does DSM-5 expand the understanding of DID compared to DSM-IV?

Answer 4

DSM-5 now includes possession-like phenomena and emphasizes that identity disruptions may be observable by others or self-reported. It also highlights recurrent gaps in memory not just for traumatic events, but for everyday occurrences as well.

Question 4

Why was “multiple identity disorder” renamed to “dissociative identity disorder” (DID) in the DSM-5?

Answer 4

The term “personality” was challenging for the field, and the DSM-5 group preferred the term identity over personality to reflect the condition more accurately.

Question 4

How does DSM-5 handle cultural considerations, such as religious experiences, when diagnosing Dissociative Identity Disorder (DID)?

Answer 4

DSM-5 allows for religious experiences, such as possession states, to meet diagnostic criteria if they induce both distress and impairment. However, care is taken to avoid over-expanding the concept to prevent cultural bias.

Question 5

Why are dissociative disorders considered controversial in scientific investigation?

Answer 5

Dissociative disorders are controversial because integration and disintegration of mental processes are difficult to prove, making it challenging to study these phenomena rigorously through scientific methods.

Question 5

What is another definition of dissociation?

Answer 5

Dissociation is the ability to mediate complex mental activities in channels split off from or independent of conscious awareness.

Question 5

What is a distinguishing characteristic of Dissociative Identity Disorder (DID)?

Answer 5

Multiple identities may be present instead of distinct personalities, though this condition is relatively rare.

Question 5

What key changes were made to DID diagnostic criteria from DSM-IV to DSM-5?

Answer 5

Alternate identity states no longer need to be observed by others—they can be self-reported.

Memory loss is now considered amnesia without needing to be connected to trauma.

The DSM-IV required proof of trauma history or personal memory gaps, but DSM-5 allows memory issues to involve any type of information.

These changes might reflect an attempt to lower the diagnostic threshold and adapt to the rarity of DID diagnoses and diagnostic constraints.

Question 5

What are the key diagnostic criteria for Dissociative Identity Disorder (DID) in DSM-5?

Answer 5

A. Presence of two or more distinct identities or personality states, observable by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, personal information, or traumatic events, inconsistent with ordinary forgetting.
C. The symptoms cause distress or impairment.
D. The behavior is not a normal part of cultural or religious practices.
E. Symptoms are not attributable to substance use or medical conditions.

Question 5

How might daydreaming relate to dissociation?

Answer 5

Daydreaming can be seen as a mild form of dissociation, where part of the mind takes a different focus. When dissociation becomes persistent and maladaptive, it can interfere with the ability to integrate experiences and lead to psychopathology.

Question 5

How does DSM-5 address cultural factors in diagnosing Dissociative Identity Disorder (DID)?

Answer 5

DSM-5 ensures that the diagnostic process does not overpathologize cultural or religious practices, emphasizing that behaviors like possession states must cause distress or impairment to meet the diagnostic criteria.

Question 5

What major change in criteria for Dissociative Identity Disorder (DID) occurred between DSM-IV and DSM-5?

Answer 5

In DSM-IV, DID required two or more distinct identities controlling behavior, accompanied by memory loss or gaps beyond ordinary forgetfulness. DSM-5 redefined this as a "disruption of identity", including self-reported or observed identity states, possession-like experiences, and recurrent amnesia for any type of information or events.

Question 5

What does Criterion A for Dissociative Identity Disorder (DID) in DSM-5 describe?

Answer 5

Criterion A defines DID as a disruption of identity involving two or more distinct personality states. This disruption may appear as possession-like experiences in some cultures and includes significant discontinuity in the sense of self and agency. It is accompanied by changes in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor function. These symptoms can be either observed by others or reported by the individual.

Question 6

Why is the geographical distribution of Dissociative Identity Disorder (DID) controversial?

Answer 6

Most DID cases are diagnosed by a small group of "ardent" clinicians and occur primarily in the USA and Canada, which is unusual for a psychopathology and raises questions about the disorder being location-dependent.

Question 7

What was the aim of the Queensland study on DID, and how was it conducted?

Answer 7

Aim: To determine if the cases of DID in Queensland matched those reported in other countries. Design: A descriptive case series with 62 patients, focusing on trauma history, symptom profiles, and dissociative phenomenology, mostly in a specialist setting.

Question 7

What did the Queensland study reveal about patients' time in the mental health system?

Answer 7

On average, patients in Australia spent 12 years in the mental health system before receiving a DID diagnosis, compared to 7 years in other studies.

Question 8

What were the key findings on memory from the Queensland study?

Answer 8

Most patients could give a reasonable outline of their life, despite episodes of amnesia. All patients showed compartmentalization of memory, with varying degrees of completeness.

Question 9

What were the conclusions of the Queensland study on DID?

Answer 9

DID was found in both inpatient and outpatient settings in Brisbane. Dissociation was viewed as part of a complex syndrome associated with severe childhood trauma. There were design limitations, as the study was open and uncontrolled. The study suggested that DID is often underdiagnosed and called for better awareness among Australian psychiatrists.

Question 10

What controversies and limitations are associated with DID?

Answer 10

DID is rare, and most cases come from limited regions and clinicians, raising questions about bias. Suggestibility is considered a potential issue, though the Queensland study claimed that dissociation was mostly independent of suggestion. There is concern that trauma exposure may be underreported compared to other studies.

Question 11

How did the book and movie Sybil contribute to the controversy around DID?

Answer 11

The release of Sybil was followed by a rapid increase in reported cases of DID, raising questions about whether media exposure influences the prevalence of the disorder.

Question 12

What role might suggestibility or iatrogenesis play in the increase of reported DID cases?

Answer 12

Suggestibility and iatrogenesis (disorders created or worsened by medical treatment or suggestion) may contribute to the rising number of reported identities in DID cases, suggesting that external factors could shape symptoms.

Question 13

Is DID real or faked? What is the controversy surrounding this question?

Answer 13

While faked or fakable psychopathology is not unique to DID, the binary view of "real or faked" overlooks nuance. Media exposure may contribute to increased reports of DID, complicating the distinction between real and exaggerated symptoms.

Question 13

Why is DID more challenging to diagnose than depressive disorders?

Answer 13

The symptoms of DID are more extreme and not as clearly represented in the diagnostic criteria, making analysis and diagnosis more difficult compared to disorders like depression.

Question 14

How can malingering or secondary benefits affect reports of DID?

Answer 14

Some individuals may exaggerate or fake symptoms to gain secondary benefits, such as avoiding a sentence. This phenomenon, known as malingering, forces clinicians to carefully assess the validity of reported experiences.

Question 15

What is iatrogenesis, and how does it relate to Dissociative Identity Disorder (DID)?

Answer 15

Iatrogenesis refers to the manufacturing of a disorder through treatment or suggestion. It has been implicated in the formation of recovered or manufactured memories, with some suggesting that clinicians' framing might influence DID symptoms.

Question 15

How do clinical interviews impact the reporting of symptoms in DID?

Answer 15

Clinical interviews may be influenced by power dynamics and the way questions are asked, leading people to admit to experiences or tailor their responses to fit certain narratives.

Question 16

How can the power of suggestion impact the diagnosis of DID?

Answer 16

A therapist might suggest the presence of multiple identities or trauma. Clients, wanting to please the therapist or seeking care, might agree with these suggestions, which can shape the narrative and lead to a clinical picture that fits DID symptoms.

Question 17

What role does the clinician-client power dynamic play in DID cases?

Answer 17

Clients may feel pressure to conform to the clinician’s expectations due to the power differential. This can result in clients aligning with the clinician’s framing of their symptoms or memories, potentially leading to false or exaggerated reports.

Question 17

What do studies say about the controversy over iatrogenesis and DID?

Answer 17

Paper 1 refutes the idea that iatrogenic origins or clinician factors cause DID. Paper 2 argues that DID is not rare or socially constructed and calls for more investment in research to address suicide risks in this population, echoing findings from the Queensland study.

Question 18

How do recovered memories contribute to the controversy around DID?

Answer 18

Therapists might frame questions in ways that lead clients to recall or reconstruct memories, which may not be accurate. This concept aligns with research on false memories by Elizabeth Loftus, highlighting how implanted memories can occur.

Question 19

What is the dominant psychological model for the etiology of Dissociative Identity Disorder (DID)?

Answer 19

The trauma model suggests that DID develops as a response to early childhood trauma and serves as a way to cope with feelings of hopelessness and powerlessness from repeated abuse. This model is supported by the high rate of childhood trauma among people with DID.

Question 19

What does the socio-cognitive theory suggest about the development of DID?

Answer 19

The socio-cognitive theory suggests that DID can develop when a highly suggestible person adopts multiple identities due to therapist cues, legitimization, and reinforcement. The enacted identities may align with personal goals, but they are not deliberately created by the client.

Question 20

Why do some people with trauma not develop DID?

Answer 20

As with PTSD and other disorders related to potentially traumatic experiences (PTE), most individuals exposed to trauma do not develop DID or other dissociative disorders. This suggests that additional factors contribute to DID's development.

Question 21

What is the diathesis-stress variant for DID?

Answer 21

The diathesis-stress model proposes that DID arises from a combination of proneness to fantasy (diathesis) and trauma exposure (stress), leading to dissociation.

Question 22

What evidence supports the socio-cognitive theory of DID?

Answer 22

Hypnotizable individuals can display secondary identities when instructed to do so. DID symptoms often emerge after entering therapy. Simulation studies show how suggestible individuals can develop alternate identities.

Question 23

How is DID related to PTSD?

Answer 23

Some researchers view DID as a form of PTSD due to symptom overlap and the high comorbidity between the two disorders.

Question 24

What additional factors are important in understanding DID beyond trauma?

Answer 24

Suggestive media Fantasy-proneness Sleep disturbances Problematic psychotherapeutic techniques

Question 24

What is the ultimate goal in treating DID according to the trauma-based model?

Answer 24

The goal is either integration of the identities or, more realistically, achieving partial fusion and cooperative arrangements among the alters.

Question 25

Why is research on the treatment of DID limited?

Answer 25

There is virtually no systematic or controlled research, including randomized controlled trials (RCTs), making it difficult to draw conclusions about the efficacy of treatments.

Question 26

How can psychodynamic and insight-oriented approaches help in treating DID?

Answer 26

These approaches aim to uncover trauma that the person may not be aware of, providing education and support to facilitate reintegration.

Question 27

What is the focus of treatment for DID if the trauma model is not applied?

Answer 27

The focus shifts to adaptive coping strategies for trauma and stress exposure rather than reintegration.

Question 28

What are some challenges and considerations in treating DID?

Answer 28

DID does not resolve spontaneously (no spontaneous remission). Patients may resist therapy if they view alters as protective. Some studies report promising outcomes, but many have limited designs, possibly overestimating benefits. Long-term treatment (years or more) may be needed, especially for severe cases.

Question 29

What is the main feature of Somatic Symptom Disorders?

Answer 29

The main feature is the presence of a physical or somatic symptom that has a psychological explanation rather than a purely physical one.

Question 30

Why are Somatic Symptom Disorders included in the DSM-5?

Answer 30

The hallmark feature is the perception that something is wrong with the body, which becomes the primary presenting concern, even though the symptom has a psychological origin.

Question 31

What is the essential feature of Somatic Symptom Disorders (SSD)?

Answer 31

Physical symptoms are present without a medical cause, causing psychological distress or impairment. The symptoms are experienced as bodily and real, similar to ordinary medically explained symptoms.

Question 32

What are some common symptoms associated with SSD?

Answer 32

SSD symptoms are often numerous, evolving, and non-specific, such as chronic pain, upset stomach, and dizziness.

Question 33

How has the classification of somatic disorders changed?

Answer 33

Previously known as somatoform disorders (soma meaning "body"). Now referred to as Functional Neurological Disorder or Functional Neurological Symptom Disorder, emphasizing that the symptoms have a psychological dimension.

Question 34

What is the difference between factitious SSD and other SSDs?

Answer 34

In factitious SSD, the symptom is caused by a deliberate act, such as taking a substance to induce a medical symptom. However, the motivation is psychological rather than for medical reasons.

Question 34

Why is the absence of a medical explanation distressing for individuals with SSD?

Answer 34

It can lead to doubt about tests or second opinions, causing patients to believe there might be something new to science or that something is wrong with them, creating significant psychological distress.

Question 35

What is Conversion Disorder, and how is it related to Somatic Symptom Disorder (SSD)?

Answer 35

Conversion Disorder, formerly classified as a dissociative disorder, involves psychological trauma being converted into physical symptoms, such as blindness or paralysis. It demonstrates how psychological factors can manifest as physical impairments.

Question 35

How did the DSM-IV and DSM-5 differ in their approach to SSD diagnosis?

Answer 35

In DSM-IV, it was important to show "no medical explanation" for the symptoms to suggest a psychological origin. DSM-5 softened this criterion, acknowledging that medical diagnoses may not be immediately clear and that unexplained symptoms can later receive a diagnosis.

Question 35

Why are SSD and Dissociative Disorders (DD) discussed together?

Answer 35

Both conditions involve psychological concerns that are not expressed directly but manifest through clinical symptoms. SSD is often related to anxiety or neurotic states, with the underlying issue expressed as physical symptoms rather than mental distress.

Question 36

What was the historical name for Conversion Disorder?

Answer 36

Conversion Disorder was previously known as hysterical blindness or hysterical paralysis, reflecting the belief that psychology entirely drives physical symptoms.

Question 37

How are SSDs positioned between medicine and psychopathology?

Answer 37

SSDs exist at the interface between psychopathology and medicine, as the focus is on physical symptoms with psychological origins, which can complicate treatment.

Question 37

How do individuals with Conversion Disorder perceive their symptoms?

Answer 37

People often resist the idea that their symptoms have a psychological origin. They view their problem as a physical illness, impacting how they function and navigate their environment.

Question 37

What is Conversion Disorder (CD)?

Answer 37

Conversion Disorder involves psychological conflict or distress being unconsciously converted into physical symptoms, such as neurological impairments like blindness or paralysis.

Question 38

What is a key distinguishing feature of SSDs compared to other psychopathologies?

Answer 38

In SSDs, the physical symptoms take primacy, meaning they are the main focus, often accompanied by abnormal psychological patterns (thoughts, feelings, and behaviors related to the symptoms).

Question 38

What is Illness Anxiety Disorder, and what was it previously known as?

Answer 38

Illness Anxiety Disorder, previously known as hypochondriasis, involves excessive worry about having or developing a serious illness, despite little to no medical evidence.

Question 39

hat are some examples of symptoms in Conversion Disorder?

Answer 39

Symptoms may include visual problems like blindness. A person may walk with a stick or report difficulties despite some intact vision, believing they have a physical impairment, even though no medical cause is found.

Question 39

How does DSM-5 approach the diagnosis of Conversion Disorder?

Answer 39

DSM-5 emphasizes incompatibility between the symptoms and recognized medical or neurological conditions, rather than the absence of symptoms.

Question 39

What are "pseudo" or "functional" neurological features in SSDs?

Answer 39

These are symptoms that mimic neurological issues but lack a medical or biological explanation. They can include sensory, motor, seizure, or mixed symptoms.

Question 39

What role do illness perceptions and bodily concerns play in SSDs?

Answer 39

Illness perceptions and bodily concerns are central to SSDs from the client’s perspective, often driving the experience and expression of the disorder.

Question 40

What is a challenge in researching Conversion Disorder?

Answer 40

Conversion Disorder is rare and often occurs during acute stress, making it difficult to study. Some ideas about it remain untested.

Question 40

How do functional symptoms challenge biological models?

Answer 40

These symptoms do not align with the known distribution of the nervous system, making them biologically implausible and suggesting a psychological origin.

Question 40

How do Conversion Disorder symptoms differ from malingering?

Answer 40

In Conversion Disorder, symptoms are not consciously produced or faked. Individuals truly believe they have a physical illness, even though no neurological explanation is found.

Question 41

What makes functional symptoms in SSD medically incompatible?

Answer 41

These symptoms cannot be explained by biological models or conventional medical understanding, indicating a psychological origin when no other explanation is found.

Question 41

What are some sensory symptoms associated with Conversion Disorder? A:

Answer 41

Loss of touch (e.g., glove anesthesia) Numbness Double or tunnel vision Blindness Deafness

Question 42

What are some examples of motor symptoms in Conversion Disorder?

Answer 42

Impaired coordination Paralysis (affecting one limb or part of a limb, inhibiting some movements but not all) Tics Localised weakness

Question 43

Why is SSD considered a heterogeneous condition?

Answer 43

SSDs present with a wide range of symptoms, meaning each person can experience it differently, making diagnosis and treatment challenging.

Question 44

What is one way to distinguish Conversion Disorder (CD) from a true neurological disturbance?

Answer 44

Discordance between symptom report and function, such as identifying abilities under hypnosis or narcosis, which indicates some level of functional preservatio

Question 45

How can secondary gain or stressors help distinguish CD from true neurological disturbances?

Answer 45

The presence of secondary gain (e.g., attention or avoidance) or recent stressor exposure is often associated with CD but not with true neurological conditions.

Question 45

What is the prevalence of Somatic Symptom Disorders (SSDs) in the general population?

Answer 45

SSDs are considered relatively rare, with a prevalence of less than 1% in the general population.

Question 46

How does paralysis in Conversion Disorder differ from true neurological conditions?

Answer 46

In CD, paralysis occurs without muscle loss, suggesting some functional preservation not seen in true neurological conditions.

Question 46

What role does symptom incompatibility play in diagnosing CD?

Answer 46

CD symptoms show an incompatibility or mismatch with known biological models, indicating that the symptoms may have a psychological origin.

Question 47

How do timing considerations help differentiate CD from other conditions?

Answer 47

CD symptoms may resolve if the linked stressor is removed, which is less typical in true neurological disturbances.

Question 47

Who is more likely to experience SSDs?

Answer 47

Women are about three times more likely to experience SSDs than men. More common in people with lower socioeconomic status (SES) or lower education levels.

Question 48

When do SSDs typically onset?

Answer 48

SSDs commonly begin during adolescence or early adulthood.

Question 49

What are some common comorbidities with SSDs?

Answer 49

Common comorbidities include: Depression Anxiety Antisocial Personality Disorder

Question 49

In which healthcare settings are SSDs more frequently seen?

Answer 49

SSDs are more common in medical and neurological settings than in mental health settings, with about 5% of neurology patients estimated to have Conversion Disorder.

Question 50

Why is the etiology of SSDs difficult to establish?

Answer 50

SDs are diagnosed by exclusion, meaning they are diagnosed only after ruling out medical causes. This process complicates identifying the underlying etiology and is often linked to stressors.

Question 51

What is one biological explanation for SSDs?

Answer 51

The symptoms may mimic medical conditions, suggesting the possibility of a missed organic cause, which requires careful medical testing to rule out a medical explanation.

Question 52

What psychological factors may contribute to SSDs?

Answer 52

Underlying trauma/identity issues (e.g., repressed sexual desire) Difficulty expressing emotions Primary and secondary gain (e.g., gaining attention or avoiding responsibilities) Cognitive tendencies like amplification or alexithymia

Question 53

What is the historical context linking SSDs to stress?

Answer 53

There is a historical link to World War I, where similar disorders were noted in soldiers exposed to extreme stress, suggesting that psychological stress plays a role in SSDs.

Question 53

How are stressors related to SSDs?

Answer 53

SSDs may develop in response to stressor exposure, although neurobiological markers linked to stress are not unique to SSDs and only weakly support this theory.

Question 53

What role does amplification play in SSDs?

Answer 53

Amplification refers to the tendency to exaggerate or focus on bodily sensations, predisposing individuals to experience or report physical symptoms.

Question 53

What are some behavioral and cognitive approaches used to treat SSDs? A:

Answer 53

Operant (behavioral) approaches: Reward successful coping and adaptation. Cognitive restructuring: Change the meaning and interpretation of symptoms (e.g., through Cognitive Behavioral Therapy). This helps prevent symptom amplification and promotes coping strategies to manage the symptoms.

Question 54

How does interpersonal psychotherapy address Conversion Disorder (CD)?

Answer 54

Focuses on emotional expression and psychological conflict resolution, often linked to trauma or unconscious conflicts. Cathartic therapies aim to help surface repressed conflicts to reduce distress, preventing the need for conversion into physical symptoms. The goal is to improve interpersonal functioning and reduce negative affective states without directly attempting to eliminate physical symptoms (e.g., "making someone see" if vision is impaired).

Question 55

What did a meta-analysis reveal about Cognitive Behavioral Therapy (CBT) as a treatment for Somatic Symptom Disorders (SSDs)?

Answer 55

CBT is an effective treatment for SSDs. The meta-analysis included 15 RCTs with a total of 6,700 participants, providing evidence-based support. Recommended delivery is 10-12 group sessions, each lasting 50 minutes. CBT helps patients identify and challenge negative or irrational thought patterns contributing to their condition and teaches problem-solving and life skills for managing stressors. It provides education on adaptive responses to trauma or stress exposure.