PSYB32: Somantic and Dissociative Disorders
Somatic symptom disorders
Bodily symptoms that suggest a physical disruption but has no evidence of one.
Prevelance rate for somatic symptom disorder
We don' know because we don't know just how much are malingering.
Illness anxiety disorder
Preoccupation with the fears of having a serious illness when there is medical reassurance that you don't.
Other word for illness anxiety disorder
Hypochondriasis
When does hypochondriasis develop
Early adulthood
Why does hypochondriasis develop?
Hypersensitivity to normal bodily sensations and over reactions and catastrophization to them.
Functional neurological disorder and examples of symptoms
Neurological, sensory and moter symptoms with no physiological cause that could end or remiss abruptly and become an excuse for the victim's life problems. When it stops abruptly and start again, it could return in the form of different symptoms.
Ex: paralysis, visual disturbance, aphonia, anosmia, loss of speech, etc.
Other name for functional neurological disorder
Conversion disorder
When does conversion disorder develope?
Adolescene after a life stressor
What causes conversion disorder?
Unconcious motivation from the person themselves. They may have something to gain from acting a certain way, such as empathy, but they are not conciousing producing symptoms for that gain.
La belle indifferenance
Those that malinger will be very dramatic and distressed about their conditions, but those that aren't are very calm about it.
Malingering
Faking incapacity to avoid responsibility or achieve a goal where the conversion-like symptoms are found to be under voluntary control and not unconciously produced.
Other word for somatic symptom disorder
Somatization disorder
Criteria for somatization disorder
- At least one somatic symptom
- Excessive thoughts/feeling and behaviours related to symptoms manifested by at least one:
-- Disporportionate thoughts about the seriousness of the symptoms, high anxiety about symptoms, excessive time/enegery devoted to symptoms.
- Symptoms are persistent.
Hardest mental disorder to treat and why
Somantic symptom disorder because people don't want to hear that their symptoms are not real.
They prefer drug or medical treatments.
Positive effects are less durable than other disorders.
Therapies for somantic disorder
- Addressing secondary gain
- Addressing underlying anxiety and depression
- Cognitive behavioural approach
-- Validating that the pain is real.
-- Relaxation training.
-- Rewards for behaving in way inconsistent with the disorder
Dissociative disorders
Disruptions of conciousness, memory and identity
Reason behind dissociative disorders and what causes an episode
People don't want to deal with the reality they are living in. A precipitative factor is a stressful life event they can't cope with and this is the only way they can run away.
Dissociative memory
inability to recall something traumatic that has happened in the past. Personal information can't be recalled, but it is not pernamently lost and they are still able to learn new things.
Other word for dissociative amnesia
Retrograde amnesia
Dissociative fugue
A type of dissociative amnesia where they suddenly leaving home and assuming a new identity due to even more severe memory loss than in regular dissociative amnesia.
Social contacts are usually kept to a minimum where new complex social lives are not usually established.
Dissociative identitiy disorder (DID)
Victim has at least 2 alter/personalties existing independently from eachother that are in control at different times with one being the primary personality. Each alter is well defined, not just different aspects of the same personality.
Psychogenic illness
instances of group outbreak of symptoms of conversion disorder
Other word for psychogenic illness
mass hysteria
What was somatic symptom disorder known as in the past?
Somatoform disorder
What are somatic symptoms persumed to caused by?
Psychological problems taking physical form, probably by anxiety. Symptoms are not under voluntary control.
Pain disorder
Somatoform disorder where someone complained about severe and prolonged pain not explained by organic pathology.
No longer a distinct DSM-5 disorder.
Body dysmorphic disorder
Preoccupation with imagined or exaggerated defects in physical appearance.
Health anxiety
Health-related fears and beliefs based on interpretations/misinterpretations of bodily signs and symptoms not limited to hypochondriasis
Illness phobia
Fear of contracting an illness instead of having an illness like in hypochondriasis.
Model of health anxiety
Criticial precipitating event, provious experience of illness and related medial patterns, unflexible and negative cognitive assumptoms, severity of anxiety.
Seversity of anxiety increased with percieved likelihood of illness and cost, burden and awdulness of illness.
Severity of anxiety decreased with perceived ability to cope and prescence of rescue patterns.
anaesthesias
Loss/impairment of sensations.
A common symptom in conversion disorders.
Aphonia
Loss of voice except whispered speech
An anaesthesia.
Anosmia
Loss or impairment of sense of smell
An anaesthesias
Hysteria
Older term for conversion disorder from Ancient Greece where a physical incapacity is due to psychological dysfunction.
Distinguishing conversion paralysis from problems with true neurological basis
Easy when it makes no anatomical sense.
Ex: glove anaesthesia is when you can't experience sensation in the hand covered by gloves, but nerves run from the hand up to the arm so it is impossible to lose feeling in only the hand.
Carpal tunnel syndrome
When sensations are lost in the hand when it is being pinched. A conversion disorder.
Somatization disorder (in the past)
Someone continuously seek medical help for physical symptoms with no discoverable physical cause.
Dropped in the DSM.
Who diagnosed with somatization disorder can meet the criteria for somatic symptom disorder?
If they also have maladaptive thoughts, feelings and beliefs.
Diagnostic criteria for old somatization disorder
- 4 pain symptoms in different locations
- 2 gastrointestical symptoms
- 1 sexual symptom other than pain
- pseudoneurological symptom.
4 compnents of general symptom distress factor
- Gastrointestinal symptoms
- Fatigue
- Cardiopulmonary symptoms
- Pain symptoms.
3 causes of somatic symptom disorders
Sensitivity to physical sensation, over-attendinf to those physical sensation and interpretating then catastrophically.
Whhat do behaviourists believe somantic symptom disorders are a manifestation of?
Unrealistic anxiety and bodily systems. This anxiety causes physical symtoms. The maladaptive pattern strengthenes with the attention it recieved and the excuses it provides in case what you worry about happens so that it is less psychologically threatrning.
Illness behaviours as a learned response
From parental illness and health anxiety in childhood where mothers with the disorder will interact with the child in a more health concious wan than normal nothers.
Hysterically blind people
Those that report that they can't see, but visual tests show that they are influenced by visual stimuli (ex: doing worse on a visual test than people who are actually blind so she is conciously/unconciously trying to preserve her blindness).
2 stage defence reaction of hysterically blind people
Reporting themselves blind because perceptions of visual stimuli are blocked fron conciousness.
But information is still extracted from the stimuli.
How could a client behave in behavioural theory
Like their conception of how someone with the disease would act.
2 conditions increasing the likelihood that motor and sensory disabilities will be imitated
Experience (whether it be personal or observational) with the role to be adopted.
Rewards for imitation.
Social and cultural factors accounting for decrease in conversion disorder
Relaxation of sexual mores since repression of sexual attitiudes may have contributed to the disorder.
Greater sophistication in contemporary culture since we are more tolerate of anxiety.
Where are conversion disorders more prevalent?
Low SES and underdeveloped people with less medical and psychological knowledge concepts.
Genetics and conversion disorder
No link
Brain structure and conversion disorder
Linked to right hemisphere functioning because symptoms are likely to occue on the left side of the body,
In left side conversions, stimulation of the right hemisphere results in smaller muscle responses vs left hemisphere stimulation.
In people with left side conversions, they fail to activate the right interior frontal cortex when processing traumatic events.
But differences in the brain might be a consequence instead of cause.
Results of therapy varied depending on whether it cofuses on:
Medically unexplained symptoms where CBT is less effective
Somatoform disorder where CBT is the most effective.
Primary treatment goal of somatic symptom disorder
Improving ability to cope with symptoms instead of getting rid of them.
3 therapies/techniques for hypochondriasis
Cognitive-behavioural approaches
Exposure therapy
Psychodynamic therapy
When does dissociative amnesia start
After a stressful experience and all events in that time after the experience is forgotten.
Behaviour during dissociative amnesia
Unremarkable, disoriented and wandering
Amnesic episode time and appearance
Lasts from several hourse to years.
They can suddenly with a small chance of recurrance and complete recovery where the information is not lost, only unretrievable furing the episode.
Biological causes of dissociative amnesia
Hypometabolism in inferolateral prefrontal cortex (region for autobiographical memory).
Memory of the fugues
Don't remember what happened during the fugues
When do fugues happen?
After severe stress
Depersonalization/derealisation
Althered experience of the self where pople feel unreal and disconnected from the self and surroundings enough to disrupt functioning (no distress means no diagnosis) and it is chronic.
Depersonalisation and derealisation episode
No disturbance in memory, but they lose their sense of self and feel weird sensory experiences.
Ex: watching themselves from a distance, feelign mechanical, voices changing, etc.
Derealisation
Criteria for depersonalisation/derealisation where the loss of sense that your surroundings are real and there are fogginess and detachment for situational context.
When does depersonalisation/derealisation being
Adolescence
Conceptualisation of DID
failuare of normal developmental integration due to early trauma.
Attachment stype of DID
Disorganized and insecure due to frightening/chaotic behaviour of caregiver when they were young.
Alters
Different modes of being and feeling that exist independntly from eachother and are in control at different times.
The 1 primary alter and more may develope and appear. But they don't have knowledge of eachother and each lead their own behaviours, memories, lives, etc. But voices of alters may echo in their heads when it is not in control.
What are DID cases often mislabeled as?
Schizophrenia, except schixophrenia is more like splitting from reality.
Other specified dissociative disorder
symptoms that cause clinically significant impairment/distress but don't meet diagnostic criteria for any dissociative disorder.
Dissociative trance
A types of other specified dissociaitve disorder when there is a narrowing or loss of awareness shwoing unresponsiveness or insensitivity to enviornmental cues.
What might cause dissociative disorders
Disassociation
Early ideas of dissociation
Memories of trauma may be stored in a way not accessible to awareness when someone has returned to their normal state.
Behavioural theories of dissociation
Protective function against stressful events and memories of them
Trauma model of dissociation
DID starts in childhood due to physical or sexual abuse in those with a diathesis for disassociation.
Alters help them escape trauma.
Tauma causes distress and affective disregulation.
Affective dysregulation
inability to tolerate and regulare distress
Associates with dissociation even without trauma.
Fantasy model of disassociation
People who develop DID are prone to engage in fantasy.
DID and social roles
DID could be an unconcious enactment of learned social roles.
Psychoanalytic approaches for dissociative disorders
Lift repression
Focus of therapy for DID
Integration of the alters that splitting into different perosnalities is no longer needed to deal with trauma.
Hypnosisand method in hypnosis
Entering a trance-like dissociative state to deal with stress commonly used in treatment of dissociative disorders.
Agre regression going back to their minds to events of childhood to help them relise that these dangers are no longer present.
Repressed painful memory recovery faciliated by creating state entered into during origonal abuse.