PSCY Essay

Dissociative and Somatic Symptom Disorders SSY 230: Lecture 8

Dissociative Disorders

The human mind seems almost endlessly capable of dissociating, or separating attentional focus. You can think intensively about a problem while jogging, perhaps not even realizing that you ran a mile without being aware of your surroundings. In dissociative disorders, this separation of a person’s mental functions occurs to a far more extreme degree than what many people experience in daily life.

Dissociative disorders raise intriguing questions about the ways in which people’s sense of self evolves over time, and the way memory and sense of reality can become fragmented and distinct within the same individual. In contrast, somatic symptom disorders, discussed later in this lecture, raise equally fascinating questions about mind-body relationships.

Dissociative Identity Disorder

DID

In dissociative identity disorder (DID), separate personalities and identities can develop within the same individual. The separate personalities seem to have their own unique characteristic ways of perceiving, thinking, and relating to others.

By definition, people with DID have at least two distinct identities and, when inhabiting the identity of one, are not aware that they also inhabit the other.

As a result, their experiences lack continuity. They have large gaps in important memories about themselves and their lives, often memories of a traumatic nature such as being victimized or abused.

Dissociative Amnesia

People with dissociative amnesia are unable to remember information about an event or set of events in their lives.

This type of memory loss is different from the everyday slips that cause us to misplace objects or forget people’s names. People with dissociative amnesia forget a specific event in their lives, most likely one of a traumatic or stressful nature.

Their amnesia may even invoke a fugue state, an episode of amnesia that leaves them unable to recall some or all of their past and identity, along with either bewildered wandering or travel that seems focused on a particular purpose.

Depersonalization/Derealization Disorder

Your ordinary perception of who you are includes

knowing that you live within your own body.

Depersonalization is the condition in which people

feel their identities have become detached from their

bodies. They may have experiences of unreality, of

being an outside observer, and of emotional or

physical numbing. Derealization is a condition in

which people feel a sense of unreality or detachment

from their surroundings.

Depersonalization/derealization disorder is a

condition in which people have the experience of

depersonalization, derealization, or both.

Theories of Dissociative Disorders

In normal development, people integrate the perceptions and memories they have of themselves and their experiences. You can remember many of the events from your past, which give you a sense of continuity over time. In a dissociative disorder, the individual loses this continuity, trying to block out or separate from conscious awareness events that caused extreme psychological, if not physical, pain.

Clinicians face a daunting task in both diagnosing and treating an individual’s dissociative symptoms. In the first place, they must determine whether the condition is real or fabricated. People may deliberately feign a dissociative disorder to gain attention or avoid punishment. As a result of the potential fabrication of dissociative disorder by people who appear to have its symptoms, DID remains one of the most controversial of psychological disorders .

In true cases of a dissociative disorder, when the symptoms do not appear feigned, the current consensus is that the dissociation is a response to early emotional or physical trauma. One large psychiatric outpatient study demonstrated that people with dissociative symptoms in fact had high prevalence rates of both physical and sexual abuse in childhood. However, many people without a dissociative disorder have been subjected to traumatic events early in life that they do remember. Along similar lines, traumatic experiences in childhood can lead to other types of disorders.

The question remains why some individuals exposed to trauma develop a dissociative disorder, but others do not.

Treatment of Dissociative Disorders

Assuming that people with dissociative disorders are reacting to trauma by developing dissociative symptoms, the treatment goal becomes primarily one of integrating the disparate parts of self, memory, and time within the person’s consciousness. Treatment guidelines for dissociative identity disorder emphasize best practices such as establishing and maintaining a strong therapeutic alliance, not playing favorites with any of the alters, and, from a positive psychology perspective, helping clients see themselves and their worlds in a more favorable manner by restoring their shattered assumptions.

As a specific technique, cognitive-behavioral therapy is well suited to helping clients with dissociative identity disorder develop a coherent sense of themselves and their experiences. To help clients view themselves more favorably, clinicians can stimulate them to question long-held core assumptions about themselves that are contributing to their symptoms. For example, they may believe they are responsible for their abuse, or that it is wrong for them to show anger toward their abusers, or that they can’t cope with their painful memories. By confronting and then changing these cognitions, clients can gain a sense of control that will allow them to incorporate those memories into their sense of self.

Clinicians should also attend to the comorbidity of a dissociative disorder with other symptoms, including post-traumatic stress disorder. Treatment of dissociative disorders often addresses not only these disorders themselves but also associated disorders of mood, anxiety, and post-traumatic stress.

SCID-D-R Items

The Structured

Clinical Interview for DSM–IV

Dissociative

Disorders–Revised (SCID-D-R) includes a careful

structuring,

presentation, and scoring of questions to aid expert

clinicians in

determining an accurate diagnosis.

Scale Items

Amnesia Have you ever felt as if there were large gaps in your memory?

Depersonalization Have you ever felt that you were watching yourself from a point outside of your body, as if you were seeing yourself from a distance (or watching a movie

of yourself)?

Have you ever felt as if a part of your body or your whole being was foreign

to you?

Have you ever felt as if you were two different people, one going through the

motions of life and the other part observing quietly?

Derealization Have you ever felt as if familiar surroundings or people you knew seemed unfamiliar or unreal?

Have you ever felt puzzled as to what is real and what’s unreal in your

surroundings?

Have you ever felt as if your surroundings or other people were fading away?

Identity confusion Have you ever felt as if there was a struggle going on inside of you? Have you ever felt confused as to who you are?

Identity alteration Have you ever acted as if you were a completely different person? Have you ever been told by others that you seem like a different person?

Have you ever found things in your possession (for instance, shoes) that

belong to you, but you could not remember how you got them?

Somatic Symptom and Related Disorders

In the group of disorders in which somatic symptoms are prominent, people experience physical problems and/or concerns about medical symptoms.

The term somatic comes from the Greek word soma, meaning “body.” Somatic symptom disorders are psychological in nature, because although people with these disorders may or may not have a diagnosed medical condition, they seek treatment for their physical symptoms and associated distressing behaviors, thoughts, and feelings.

Somatic Symptom Disorder

People with somatic symptom disorder have physical symptoms that may or may not be accounted for by a medical condition; they also have maladaptive thoughts, feelings, and behaviors. These symptoms disrupt their everyday lives.

People with this disorder think to a disproportionate degree about the seriousness of their symptoms, feel extremely anxious about them, and spend a great deal of time and energy on the symptoms or their concerns about their health. Although it may appear that people with this diagnosis are intentionally manufacturing symptoms, they actually are not consciously attuned to the ways in which they express these psychological problems physically.

The somatic symptoms individuals experience may include pain as the primary focus. A diagnosable medical condition may exist, but it cannot account for the amount and nature of the pain clients report. There are also clients with pain disorder for whom no diagnosable medical condition exists.

Further complicating the picture in the diagnosis and treatment of somatic symptom disorder is the fact that often people with this disorder also have other psychological disorders, including major depressive disorder, panic disorder, and agoraphobia. Researchers are also attempting to rule out the role of diagnosable medical conditions that may be associated with somatic symptom disorder and its comorbid anxiety and depressive disorders.

Illness Anxiety Disorder

People with illness anxiety disorder fear or mistakenly believe that normal bodily reactions represent the symptoms of a serious illness. They easily become alarmed about their health and seek unnecessary medical tests and procedures to rule out or treat their exaggerated or imagined illnesses.

Their worry is not about the symptoms themselves but about the possibility that they have a serious disease. They also are preoccupied with their mistaken beliefs about the seriousness of their symptoms.

They may turn to non-medical abuse of prescription drugs, which in turn can expose them to harmful side effects as well as to dependence on the medications themselves.

Conversion Disorder

The essential feature of conversion disorder (functional neurological symptom disorder) is that the individual experiences a change in a bodily function that is not due to an underlying medical condition. The forms the disorder can take range from movement abnormalities such as paralysis or difficulty walking to sensory abnormalities such as inability to hear or see.

The term conversion in the name of this disorder refers to the transformation of psychological conflict to physical symptoms presumed to underlie the disorder. The term functional neurological symptom disorder in parentheses represents an alternate way of referring to the disorder that some clinicians may prefer. In some ways it is more descriptive than “conversion,” which has historic roots in Freudian psychoanalysis in which the assumption was made that psychological conflicts “convert” or transfer into what look like neurological symptoms, such as paralysis. Functional in this context refers to abnormal functioning of the central nervous system. It is somewhat awkward to use the complete form of the disorder’s name, so we will refer here to “conversion disorder” with the understanding that its formal title includes the parenthetical addition.

Conversion Disorder

Clients with conversion disorder may show a wide range of physical ailments, including “pseudoseizures” (not real seizures, but appearing as such), disorders of movement, paralysis, weakness, disturbances of speech, blindness and other sensory disorders, and cognitive impairment. The symptoms can be so severe that they make it impossible for clients to perform their work duties. Over half are bedridden or require assistive devices. Even though virtually all clients with conversion disorder do not have a medical diagnosis, clinicians must nevertheless rule out medical diagnoses before assigning the diagnosis.

A large review of brain imaging studies on patients with motor

conversion disorder (movement abnormalities) identified alterations

in areas of the frontal and prefrontal regions active in planning and

executing movements, as well as altered activities in brain regions

responsible for emotion. Individuals with this form of conversion

disorder may, then, be unaware of what their bodies are doing and

therefore unable to control their actions.

Malingering

Malingering consists of deliberately feigning the symptoms of physical illness or psychological disorder for an ulterior motive such as receiving disability or insurance benefits. Though a diagnosis in DSM-IV-TR, malingering is not one in DSM-5. It nevertheless remains a concern when diagnoses must be made in a forensic, occupational, or military setting and the possibility that clients are feigning symptoms must at least be ruled out.

Clinicians assume that clients engage in malingering in order to get a direct benefit, such as paid time off from work, insurance payments, or some other tangible reward. Some of these situations can yield what we call primary gain—namely the direct benefits of occupying the sick role. Structured malingering assessments are becoming more widely used, both to improve the evaluation of suspected malingerers and to protect the practitioners who are faced with making the determination.

Factitious Disorder

In factitious disorder imposed on self, people show a pattern of falsifying symptoms that are either physical, psychological, or a combination of the two. The individual falsifies these symptoms not to achieve economic gain but for the purpose of adopting the sick role. In extreme cases, known informally as instances of Munchausen’s syndrome, the individual’s entire existence becomesconsumed with the pursuit of medical care.

The individual may also feign the illness of someone else in cases of factitious disorder imposed on another or Munchausen’s syndrome by proxy. Interestingly, one epidemiological study of individuals with factitious disorder as a diagnosis showed the most frequent occupations to be those in the health professions.

Unlike people with conversion disorder, people with factitious disorder are consciously producing their symptoms, but their motives are internally rather than externally driven. They may be motivated by secondary gain, which is the sympathy and attention they receive from other people when they are ill. They know they are producing their symptoms, but they don’t know why. People with conversion disorder, in other words, believe they are ill and rightfully assume the sick role. People who are malingering know that they are not ill, and therefore, any rewards they receive from sickness are illegally obtained

Breakdown of Somatic Symptom Disorders

Theories and Treatment of Somatic Symptom Disorders

Early psychodynamic theorists were the first to attempt to understand and treat this group of disorders from what they regarded as a scientific perspective. Lacking sophisticated diagnostic tools and basing their work on the concept of unconscious conflict, they referred to conversion disorder as “hysteria”. They could not find a physiological basis for the symptoms, which tended to disappear after the individual received treatment through hypnosis or psychoanalysis, reinforcing the notion that the symptoms were psychologically based. In keeping with Freud’s general formulation of hysteria, clinicians working from a psychodynamic approach today aim to identify and bring into conscious awareness the underlying conflicts that we associate with the individual’s symptoms. Through this process, the client gains insight and self-awareness and becomes able to express emotion directly, rather than through physical manifestation.

From the cognitive-behavioral perspective, the dissociative, somatic symptom, and related disorders are viewed in terms of the thoughts linked to their physical symptoms. The underlying model is based on the premise that people with these disorders are subject to cognitive distortions that lead them to misinterpret normal bodily sensations. Once they start to exaggerate the importance of their symptoms, they become even more sensitized to internal bodily cues, which in turn leads them to conclude that they are truly ill. In applying cognitive-behavioral therapy to clients with somatic symptom and related disorders, clinicians help their clients gain a more realistic appraisal of their body’s reactions. For example, in one study, clients who had no cardiac illness but complained of palpitations or chest pain were exposed to exercise on a treadmill while being taught to interpret their raised heartbeat not as a sign of disease but as a normal reaction to exertion.

Hypnotherapy

Hypnotherapy is an additional approach that clinicians use specifically for treating conversion disorder. In hypnotherapy, the therapist instructs the hypnotized client to move the paralyzed limb. The therapist then makes the posthypnotic suggestion to enable the client to sustain the movement after the therapist brings him or her out of the hypnotic trance.

Psychological Factors Affecting Other Medical Conditions

So far we have looked at disorders in which individuals are experiencing physical symptoms that do not have a physiological cause. The diagnostic category called psychological factors affecting other medical conditions includes conditions in which a client’s physical illness is adversely affected by one or more psychological states. These can include depression, stress, denial of a diagnosis, or engaging in poor or even dangerous health-related behaviors.

The following table outlines several examples of medical conditions that can be affected by psychological factors. Specifying the interaction of psychological factors with medical conditions provides health professionals with a clearer understanding of how the two interact. Once this interaction has been identified, the clinician can address the issues and work to help the client’s medical condition improve.

Medical Condition Possible Psychological Factor

Hypertension (high blood pressure) Chronic occupational stress increasing the risk of high blood pressure. Asthma Anxiety exacerbating the individual’s respiratory symptoms. Cancer Denying the need for surgical interventions.

Diabetes Being unwilling to alter lifestyle to monitor glucose levels or reduce intake. Chronic tension headache Continuing family-related stresses that contribute to worsening of symptoms. Cardiovascular disease Refusing to visit a cardiac specialist for evaluation despite chest discomfort.

Stress and Coping

Within psychology, the term stress refers to the unpleasant emotional reaction experienced when a person perceives an event to be threatening. This emotional reaction may include heightened physiological arousal, reflecting increased reactivity of the sympathetic nervous system. A stressful life event is a stressor that disrupts the individual’s life. A person’s efforts to reduce stress is called coping.

It is when coping is unsuccessful, and the stress does not subside, that the individual may seek clinical attention for medical or psychological problems that have developed as a consequence of the constant physiological arousal caused by the experience of chronic negative emotions.

Stressful Life Events Scales

What types of events qualify as stressors? The most common way to describe stressors is through stressful life event rating scales, which are intended to quantify the degree to which individuals were exposed to experiences that could threaten their health. One of the best known of these is the Social Readjustment Rating Scale (SRRS), which assesses life stress in terms of life change units (LCUs). In developing the LCU index, researchers calculated how strongly each type of event was associated with physical illness. The rationale behind this measure is that the more an event causes you to adjust your life circumstances, the more deleterious it is to your health.

The College Undergraduate Stress Scale (CUSS) is a good example of a stressful life events scale. Unlike the SRRS, which is used with adults of all ages, the CUSS assesses the kinds of stressors most familiar to traditional-age college students (90 percent of the people in the sample were under age 22). The most stressful event in the CUSS is rape, which has an LCU score of 100. Talking in front of class has a score of 72, however, which is also relatively high. Getting straight As has a moderately high score of 51. The least stressful event on the CUSS is attending an athletic event (LCU score = 20).

Life events scales have merit because they are relatively easy to complete and present a set of objective criteria against which we can compare people. However, it is not always easy to quantify stress. You and your best friend may each experience the same potentially stressful event, such as being late for class, but you may be far more perturbed by this situation than your friend. Your day will thus be far less pleasant than your friend’s, and if you are repeatedly late, you might be at risk for a stress-related illness.

Cognitive Model of Stress

The cognitive model of stress places greater emphasis on the way you interpret events than on whether you experienced a given event. Like the cognitive approach in general, the cognitive model of stress proposes that the appraisal of an event as stressful determines whether it will have a negative impact on your emotional state. Not only do people differ in the way they interpret events, the circumstances surrounding the event also affect them. If your friend’s professor doesn’t take class attendance but yours does, this would help explain why you feel more stressed about being late than your friend.

As this example shows, stress is in the eye of the beholder. Even a relatively minor event can lead you to experience stress if you interpret it negatively. The cognitive model assumes, furthermore, that these “little” events can have a big impact, especially when they build up in a short period of time. Events called hassles can have significant effects on health when there are enough of them and you interpret them negatively. If you are not only late for class but get into an argument with your friend, stub your toe, spill your coffee, and miss your bus home, you will have as many potentially stress-causing events in one afternoon as someone experiencing a “bigger” life event such as going out on a first date.

On the positive side, you can balance your hassles with what researchers call uplifts, which are events on a small scale that boost your feelings of well-being. Perhaps you open up your Facebook page and find a pleasant greeting from a former high school acquaintance. The smile this greeting brings to your face can help make up for some of the stress of the hassles you just experienced. Uplifts are especially important within the positive psychology movement, which views them as contributing to people’s feelings of day-to-day happiness.

Cognitive Model of Coping

It’s wonderful when life sends a few uplifts your way, but when it doesn’t, you need to find other ways to reduce stress through coping if you are to maintain your mental health. The two basic ways of coping are problem-focused coping and emotion-focused coping.

In problem-focused coping, you attempt to reduce stress by acting to change whatever it is that makes the situation stressful. If you’re constantly late for class because the bus is overcrowded and tends to arrive 5 or 10 minutes after it’s supposed to, then you can cope by getting an earlier bus, even if it means you have to wake up 10 minutes ahead of schedule.

In contrast, in emotion-focused coping, you don’t change the situation but instead change the way you feel about it. Maybe your professor doesn’t care if you’re a little bit late, so you needn’t be so hard on yourself. Avoidance is another emotion-focused strategy. This coping method is similar to the defense mechanism of denial. Rather than think about a stressful experience, you just put it out of your mind.

Cognitive Model of Coping

Which is the better of the two ways of coping? The answer is, it depends. People cope with some situations more effectively through problem-focused coping. In changeable situations, you are most likely better off if you use problem-focused coping. If you’re stressed because your grades are in a slump, rather than not think about the problem, you would be well advised to try to change the situation by studying harder. If you’re stressed because you lost your cell phone and you truly cannot find it, then you may be better off by using emotion-focused coping such as telling yourself you needed a newer model anyhow (and taking some problem-focused steps as well, such as closing down that lost phone).

Activity prompt:

Come up with an example of a stressor and describe what coping skills someone can use when faced with that stressor (give examples of both emotion-focused and problem-focused coping strategies).

Age and Coping

As people get older, they are able to use coping strategies that more effectively alleviate their stress, perhaps because they are better able to tolerate the mixed emotions that come with experiencing life’s highs and lows.

In comparing samples of community-dwelling older adults and college undergraduates, for example, one study found that younger adults received higher scores on the dysfunctional coping strategies of focusing on and venting emotions, mentally disengaging, and using alcohol and drugs. Older adults, in contrast, were more likely to use impulse control and turn to their religion as coping strategies.

It may in fact be their better use of coping strategies that accounts for the resilience older adults show in the face of the stresses associated with caregiving for an ill spouse or other relative.

Theories of Stress

Personality also plays a role in affecting how much stress individuals experience as a result of exposure to potential stressors. In general, people with high levels of optimism are more resilient to stress.

Sociocultural factors also play a role in causing and aggravating an individual’s level of stress. For example, living in a harsh social environment that threatens a person’s safety, interferes with the establishment of social relationships, and includes high levels of conflict, abuse, and violence is a condition related to lower socioeconomic status. Chronic exposure to the stresses of such an environment can lead to a number of changes in hormones that ultimately have deleterious effects on cardiovascular health, interacting with an individual’s genetic and physiological risk. Both cardiovascular health and immune system functioning seem to be sensitive to the degree of stress a person experiences as a function of being lower in socioeconomic status. The limbic system, which mediates a person’s responses to stress, appears to play a large role in accounting for

these connections between social class and health.

Ample evidence supports the role of stress in a variety of medical conditions through its interaction with immune status and function. A stressful event can initiate a set of reactions within the body that lowers its resistance to disease. These reactions can also aggravate the symptoms of a chronic, stress-related physical disorder. Personality also interacts with stress in influencing health. Studies of workplace stress show that people high in the tendency to overcommit themselves tend to put more effort into their job than is rewarded and, in turn, have poorer cardiovascular health.

Emotional Expression

Coping with stress by controlling your negative emotions is one way to reduce your levels of perceived stress. However, there are times when expressing your emotions, even if they are negative, can improve your physical and mental well-being.

In one classic study, researchers instructed a group of first-year college students to write about the experience of coming to college, a highly stressful one, as noted above. A control group wrote about superficial topics. Those who wrote about coming to college reported being more homesick than the control subjects. Even though they experienced more negative emotions, however, they made fewer visits to physicians and, by the end of

the year, were doing as well as or better than the control subjects in terms of grade point average and the experience of positive moods. The researchers concluded that confronting feelings and thoughts about a stressful experience can have long-lasting positive effects, even though the initial impact of such a confrontation may be disruptive.

Keep in mind, however, that although the person expressing these feelings may feel better, the person who listens to the retelling of a sad or difficult story may suffer negative emotional consequences. This is one of the reasons individuals who work in the helping professions may experience burnout, otherwise known as “compassion fatigue”.

Personality Style Type A

One of the most thoroughly researched connections between personality and health is the type A behavior pattern, a set of behaviors that include being hard-driving, competitive, impatient, cynical, suspicious of and hostile toward others, and easily irritated.

People with a type A behavior pattern experience high levels of emotional arousal that keep their blood pressure and sympathetic nervous system on overdrive, placing them at risk for developing heart disease and at greater risk for heart attacks and stroke. Not only are they at high risk because their bodies are placed under stress, but their hard-driving and competitive lifestyles often include high-risk behaviors including smoking, drinking alcohol to excess, and failing to exercise.

Personality Style Type D

Another significant personality risk factor for heart disease occurs among people who experience strong depressive affect but keep their feelings hidden—the so-called type D personality. Unlike the “A” in type A, which is not an acronym, the “D” in type D stands for “distressed.”

Type D personalities experience emotions that include anxiety, irritation, and depressed mood. These individuals are at increased risk for heart disease due to their tendency to experience negative emotions while inhibiting the expression of these emotions when they are in social situations.

In addition to being at higher risk of becoming ill or dying from heart disease, these individuals have reduced quality of daily life and benefit less from medical treatments. Psychologists think the link between personality and heart disease for these people is due in part to an impaired immune response to stress.

Applications to Behavioral Medicine

Because psychological factors that contribute to a medical condition have such a wide range, clinicians must conduct a careful assessment of the way each particular client’s health is affected by behavior. The field of behavioral medicine applies the growing field in the health sciences regarding mind-body relationships to helping improve people’s physical health by addressing the psychological factors of stress, emotions, behavior patterns, and personality. In addition, clinicians working in behavioral medicine often team up with psychologists and other mental health professionals to help clients learn and maintain behaviors that will maximize their physical functioning. By improving patients’ compliance with medical treatment, clinicians can help them achieve better health and avoid further complications.

Psychoeducation is an important component of behavioral medicine. Clients need to understand how their behavior influences the development or worsening of the symptoms of chronic illness. Then the clinician can work with them to develop specific ways to improve their health habits. For example, diet control and exercise are key to preventing and reducing the serious complications of cardiovascular disease. Time spent outdoors, even if not in active exercise, can also reduce stress levels.. The clinician can teach clients ways to build these new health habits into their daily regimens and train people with sleep disorders to improve their sleep habits. People can manage chronic pain, which contributes to depressive symptoms, through strategies such as biofeedback.

Applications to Behavioral Medicine

Behavioral medicine is also moving increasingly toward interventions the profession once considered alternative, including mindfulness training, relaxation, and meditation. In these approaches, clinicians teach clients to monitor their internal bodily states (such as heart rate and breathing), as well as their perceptions, affective states, thoughts, and imagery, without judging. By observing their bodily reactions in this objective fashion, clients gain a more differentiated understanding of which aspects of their experiences illness affects and which it does not. Thus they can gain self-control over their body’s reactions and see their ailments as having natural roles, not as impeding their ability to enjoy life in general.

For example, people with a type A behavior pattern can benefit from training aimed at improving awareness of their reactions to stress, methods of coping with stressful situations, and behavioral interventions intended to improve their compliance with medical advice aimed at reducing their cardiovascular risk. Particularly important is a sense of mastery—namely, the belief that you have the ability to cope with or control the problems you encounter in life. People who feel they are in greater control over their life circumstances have a reduced risk of developing cardiovascular and related health problems. Increasingly, clinicians are finding that efforts to improve people’s health by addressing only their medical needs do not have the long-term desired effects unless the clinicians also incorporate these psychological issues into treatment.

Dissociative and Somatic Symptom Disorders: The Biopsychosocial Perspective

Although distinct, the disorders we’ve covered in this lecture all reveal the complex interactions between mind and body and call for distinctions between “real” and “fake” psychological symptoms. They also all raise questions about the nature of the self. We’ve also examined the role of stress in psychological disorders and its relationship to medical illnesses and physical symptoms.

Biology clearly plays a role in making some individuals more vulnerable to psychological disorders, and particularly these disorders. A person may have a known or undiagnosed physical condition that certain stressors particularly affect, which then trigger the symptoms for a somatic symptom or related disorder. However, whatever the role of biology,

cognitive-behavioral explanations provide useful approaches for treatment. Even people whose medical condition is clearly documented, as in chronic pain disorder, can benefit from learning how to reframe their thoughts about their disorder, if not also their actual health-related behaviors. At the same time, we are learning more about how stress affects physical functioning, including the impact of social discrimination on chronic conditions such as heart disease and diabetes.

Sources

Image 1: https://www.seattletimes.com/life/wellness/hypochondria-gets-a-new-treatment-and-a-new-name/ Image 2: https://www.therecoveryvillage.com/mental-health/conversion-disorder/related/conversion-disorder-statistics/ Image 3: https://www.youtube.com/watch?v=gaAdSGVgd3Y

Image 4: https://hypnotc.com/how-does-hypnotherapy-work/

Image 5: https://www.verywellmind.com/forty-healthy-coping-skills-4586742

Image 6: https://www.verywellmind.com/type-a-personality-traits-3145240

Image 7: https://www.verywellmind.com/what-does-it-mean-to-have-type-d-personality-4175368 Video: https://www.youtube.com/watch?v=_1GCjggflEU

Text: Whitbourne, Susan Krauss. Abnormal Psychology: Clinical Perspectives on Psychological Disorders. McGraw-Hill Higher Education. Kindle Edition.