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zz Abnormal Psychology week by week > Week 10 - Ch 8 - Dissociative Disorders and Somatic Symptoms (DN) > Flashcards

Week 10 - Ch 8 - Dissociative Disorders and Somatic Symptoms (DN) Flashcards

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0
Q

Why are dissociative & somatic symptom disorders covered in the same chapter?

A

because both are hypothesised to relate to some stressful experience
yet symptoms do not involve direct expressions of anxiety

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1
Q

Learning Goals

A
  • define symptoms of the dissociative and somatic disorders
  • summarize current debate regarding etiology of DID
  • explain etiological models of the somatic symptom disorders
  • describe available treatments for dissociative and somatic symptom disorders
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2
Q

What are the defining features of dissociative & somatic symptoms disorder?

A

dissociative disorders - disruptions of consciosness, loses track of self awareness, memory & identity
somatic symptoms disorder - bodily symptoms suggesting physical defect/dysfunction. No physiological basis may be found or psychological reaction to symptoms appear excessive

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3
Q

Name the 3 major dissociative disorders

A
  • dissociative amnesia
  • depersonalisation/derealisation disorder
  • disocciative identity disorder

p228

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4
Q

Dissociative Amnesia

A

Lack of conscious access to memory (typically stressful one)
- Fugue subtype = loss of memory for entire past or identity
(used to be a separate classification in DSM-IV, became subtype in DSM-5)

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5
Q

Depersonalization/Derealization Disorder

A
  • alteration in experience of self & reality

(derealization added in DSM-5)

p228

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6
Q

Dissociative Identity Disorder

A
  • at least 2 distinct personalities
  • act indepently of each other

DSM-5 added
(not part of accepted cultural/religious paractice)

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7
Q

Is the memory loss more severe in dissociative amnesia or in its subtype fugue?

A

fugue

p231

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8
Q

Is complete recovery possible in Dissociative Amnesia & its subtype Fugue?
If so, does recovery from these disorders differ?

A

Complete recovery usually occurs in both

Dissociative Amnesia:
amnesia disappears as quick as it began & only small chance of recurrence
Memories not completely lost but can’t be retrieved during the amnesia

Fugue:
Memory loss is more extensive in fugue
Recovery takes varying amounts of time. Full memory of life & experiences return except for those during fugue

p231

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9
Q

What kind of memories are typically affected in Dissociative Amnesia & Dissociative Fugue?

A

Explicit memories (requiring conscious recall)

p231

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10
Q

What is a hotly debated component of Dissociative Disorders

A

Memory

Memories with emotional power are more salient
Although research has shown even false memories can have painful physiological responses

Repression: is it responsible for failure to report events
if so more severe events should limit recall (not the case)

Recovered memories of Child abuse & highly painful events

  • are these memories real, or are they false memories
  • therapists suggestion (hypnosis, guided imagery etc)

Getting this wrong :
Injustice to either accused or the accuser

p229-230 Focus on Discovery

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11
Q

Depersonalization/Derealization Disorder

A
  • No disturbance of memory
  • suddenly lose/altered sense of self & perception of surroundings
  • bizarre sensory experiences
  • usually triggered by stress
  • not explained by substances, another disorder or medical condition

Derealization added to DSM-5
(refers to sensation that world has become unreal)

p232

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12
Q

When does Depersonalization/Derealization disorder usually begin?
How does it normally begin & what is its time course?

A
  • adolescence
  • begins either abruptly or insidiously
  • chronic time course
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13
Q

Wh common symptom of panic attacks may trigger depersonalization?

A

hyperventilation

p232

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14
Q

When does Dissociative Identity Disorder usually begin?

A

Childhood, but rarely diagnosed until adulthood

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15
Q

Which is the most severe and extensive of the dissociative disorders?
How does its recovery compare?

A

Dissociative identity disorder
recovery is also less complete than the other dissociative disorders
p233

p233

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16
Q

What are cases of DID sometimes mislabelled as in the popular press?
Why the confusion?

A

schizophrenia
schizo - splitting away from
however a split into 2 or more separate & coherent personalities is entirely different from symptoms of schizophrenia
p233

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17
Q

What are some possible explanations in the increase in DID symptoms over time?

A
  • possible that more people are actually experiencing it
    or
  • possible increased diagnosis coincided with DSM-3 (1980’s) inclusion of it (e.g., China DID is not officially recognised - rates are less than one tenth than countries where it is recognised)
  • Highly popularised by media e.g., Sybil / Three Faces of Eve
  • Therapists suggestions
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18
Q

Describe the two major theories of DID?

A

Posttraumatic model - some are likely to dissociate in response to trauma
Sociocognitive model - DID result of learning social roles. Alters appear by - therapist’s suggestion, media exposure, cultural influences

p234

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19
Q

Does the socio-cultural model imply that DID is a conscious deception?

A

No, this models focus is not on whether DID is real, but how it actually develops

p234

20
Q

What has evidence demonstrated with regard to role-playing and DID?
What caution should be taken when interpreting this evidence?

A

people can adopt a 2nd personality (when the situation demands)
caution: this does not mean that DID results from role-playing

p235

21
Q

What is one of the defining deatures of DID?

A

the inability to recall information experienced by one alter when a different alter is present

p235

22
Q

Which principles of DID treatment are widely agreed upon regardless of clinician orientation?

A

Empathic, gentle approach
Goal:
- to help client function as one wholly integrated person
- show person that splitting is no longer needed to deal with trauma
- teach person more effective ways to cope with stress

p237

23
Q

What are some important concerns particularly with psychodynamic approaches to DID treatment?

A

Psychodynamic approach: goal is to overcome repression (repressed trauma believed to contribute to DID)
- Often use hypnosis & age regression which can worsen symptoms of DID

p237

24
Q

What is age regression?

What is its goal?

A
  • a technique often used in the psychodynamic approach to treating DID
  • client hypnotised and asked to go back in mind to traumatic events in childhood

goal: access traumatic memories to allow person to realise childhood threats are no longer present - that coping mechanisms needed then are not useful as an adult

25
Q

What is the treatment course (time frame) for DID?

What comorbidities often exist with DID?

A

Treatment course:

  • 2 years plus (Kluft)
  • within 10 years (Coons & Bowman)
  • more alters, longer treatment

Comorbid:
- anxiety & depression - lessened with medication
- medication does not effect the DID itself
p237

26
Q

Who is Richard Kluft?

A

a highly experienced DID therapist

  • achieve 84% stable integration
  • 10% at least better functioning

p237

27
Q

What bold step was taken in DSM-5 with the criteria for Somatic Symptom Disorders?

A

the requirement that symptoms be medically unexplainable was removed
- because it became clear over thime that it is close to impossible to distinguish whether some symptoms are biologically caused

p238

p238

28
Q

What was Somatic Symptom Disorders previously called in DSM-IV-TR?

A

Somatoform

to capture fact that symptoms were bodily sensations

29
Q

What are three criticisms of the somatic symptom disorders?

A
  • diversity in basis of condition (e.g., some in context of anxiety/depression, others not)
  • subjective criteria
    (i.e., somatic symptom disorder & illness anxiety disorder defined by causing ‘excessive’ anxiety or involving ‘too much’ time & energy) very subjective thresholds
  • stigma associated with diagnosis > lack of clinical diagnoses
    removal of ‘medical unexplained’ requirement - was hoped to reduce stigma & address hesitation to diagnosis in clinical practise
30
Q

What are the ‘Somatic Symptom & Related Disorders’?

DSM-5

A

Somatic Symptom Disorder
Illness Anxiety Disorder
Conversion (Functional Neurological Symptom Disorder)

taken from lecture slides & DSM-5 p309, as text book DSM-5 predictions differed

31
Q

What is the clinical description of Somatic Symptom Disorder?

A

three core criteria:
- 1 or more symptoms casuing distress/disruption
- excesive anxiety, concern, time & energy devoted to somatic concern
- at least 6 months
p240

32
Q

What is the clinical description of Illness Anxiety Disorder?

A

main feature:

  • preoccupation with fears of having serious disease, despite no significant symptoms
  • excessive care-seeking
  • at least 6 months

p240

33
Q

What is the clinical description of Conversion Disorder (Functional Neurological Symptom Disorder)?

A
  • sudden development of neurological symptoms (e.g., blindness, paralysis)
  • illness suggests neuro damage, but medical tests indicate organs & nervous system are fine
34
Q

What are some symptoms of Conversion Disorder (Functional Neurological Symptom Disorder)?

A

Paralysis: partial or complete (arms, legs)
Seizures
Coordination disturbance
Skin sensations (prickling, crawling, insensitivity to pain)
Vision: seriously impaired, completely blind, tunnel vision
Aphonia: loss of voice other than a whisper
Anosmia: loss of sense of smell

35
Q

What etiological factors have been proposed to increase awareness & distress over somatic symptoms in Somatic Symptom Disorders?

A

Neurobiological Factors

Cognitive Behavioural Factors

36
Q

What two brain regions have Neurobiological models of somatic symptom disorder focussed on?
What other disorders are connected to these regions?

A
  • Anterior Insula & Anterior Cingulate
    these regions are activated by unpleasant body sensations (e.g., heat)
  • both regions have strong connections with somatosensory cortex (involved in processing bodily sensations)
  • Depression & Anxiety - directly related to anterior cingulate
  • Emotional pain - can activate both regions
37
Q

What may the involvement of the anterior insula & anterior cingulate help explain with regard to painful physical & emotional experiences?

A

their activation in depression, anxiety & physical sensations
may explain why emotions and depression can intensify experiences of pain

p245

38
Q

How does the cognitive process in Somatic Symptom Disorder differ to that in Panic Disorder?

A

Underlying Belief:
Panic Disorder: interpret symptoms are sign of ‘immediate’ threat (heart attack)
Somatic Disorder: interpret symptoms as sign of underlying ‘long-term’ disease (cancer, aids)
Physical Cues
Panic Disorder: focuses on symptoms that actually become worse as they become more anxious
Somatic Disorder: cannot actually increase symptoms (e.g., make sun spot on arm bigger)

39
Q

What is the underlying feature of the Cognitive Behavioural model of Somatic Symptom Disorder?

A

Cognitive Bias

  • focus on health cues
  • worst possible negative interpretations of symptoms
40
Q

What can result from the Cognitive Biases in Somatic Symptom Disorder?

A

elevated anxiety and cortisol may exacerbate somatic symptoms & distress over those symptoms

p245

41
Q

What two behavioural consequences of fear that bodily sensations signify illness?
What suggestion has been made as to why people with these disorders seek socially reinforcing interactions in this way?

A
  • Assuming the ‘sick role’
  • help-seeking behaviour (which may reinforce if attention or sympathy are given)
  • people with Somatic Symptom Disorders often have trouble identifying their emotions and describing them directly

p245

42
Q

What does the apparent decrease in incidence of functional neurological disorder suggest?

A

a possible role for social & cultural factors

i.e., Freud & charcot saw lots of females with this disorder yet
contemporary clinicians rarely see it

  • studies show decline in western societies but more common in countries that place less emphasis on ‘psychologizing’ distress (e.g., Libya, China, India)
  • suggesting individuals who do not process distress psychologically, may have it manifest neurologically (DN made this last sentence up)

p247

43
Q

What is one of the major obstacles to treatment with somatic symptom disorders?

A
  • most do not want to consult mental health professionals

- patients may resent referrals, interpreting it as a sign doctor thinks its ‘all in their head’

44
Q

Convincing a patient that somatic symptoms are psychological is not a good idea, what alternatives do GP’s have?

A
  • coaching GP’s & their treatment teams to provide care
  • high level support has better outcomes over 6 weeks than low level support
  • goal: establish strong relationship, building trust & comfort in patient, feeling more reassured about health

p248

45
Q

What are some CBT treatments that have been applied to somatic symptom disorders?

A

Help people to

1) identify & change emotions that trigger emotional concerns
2) change cognitions regarding somatic symptoms
3) change their behaviours so they stop playing ‘sick role’ & gain reinforcement for engaging in other types of social interactions

46
Q

How can psychoeducation programmes help people with somatic symptom disorders?

A

help them recognize the links between their negative moods & somatic symptoms

47
Q

What other techniques/approaches have proven successful in reducing somatic symptoms?

A
  • treating comorbid anxiety & depression
  • relaxation training
  • teaching patients to reframe their experience of a somatic symptom

behavioural tehniques

  • encourage activities to rebuild healthy lifestyle
  • exposure therapy, cognitive restructuring
  • assertiveness training, social skills training

family approaches
- operant conditioning (reduce focus given to somatic symptoms)

antidepressant treatment
- (low dose) helps reduce pain

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