DB 6 - Dissociative Identity Disorder

Gillianrich

comerfund9e_lectureslides_ch08.pptx

Home >Psychology homework help >DB 6 - Dissociative Identity Disorder

Disorders Featuring Somatic Symptoms

Chapter 8

Fundamentals of Abnormal Psychology

RONALD J. COMER | JONATHAN S. COMER| ninth edition

Disorders Featuring Somatic Symptoms

DSM-5 categories identify somatic symptoms

Primarily caused by psychological factors

Symptoms trigger excessive anxiety or concern

Factitious disorder

Conversion disorder

Somatic symptom disorder

Illness anxiety disorder

Psychological factors affecting other medical conditions

Factitious Disorder (part 1)

Imposed on self

False creation of physical or psychological symptoms, or deceptive production of injury or disease, even without external rewards

Presentation of oneself as ill, damaged, or hurt

Munchausen syndrome

Imposed on another

False creation of physical or psychological symptoms, or deceptive production of injury or disease, in another person, even without external rewards

Presentation of another person (victim) as ill, damaged, or hurt

Munchausen syndrome by proxy

Factitious Disorder (part 2)

Links

Poor social support or relationships and little family life

Extensive medical treatment in childhood

Grudge against medical profession

Employment as nurse, lab technician, or aide

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Factitious Disorder (part 3)

Causes and treatment

The precise causes of factitious disorder are not understood

Clinicians have been unable to develop dependably effective treatments for this disorder

The precise causes of factitious disorder are not understood, although clinical reports have pointed to factors such as depression, unsupportive parental relationships during childhood, and an extreme need for social support.

Conversion Disorder and Somatic Symptom Disorder (part 1)

Conversion disorder

Neurological-like symptoms inconsistent with known neurological or medical disease

Usually beginning in late childhood and young adulthood; often appears suddenly during extreme stress

Not consciously wanted or purposely produced

Conversion Disorder and Somatic Symptom Disorder (part 2)

Conversion disorder

Glove anesthesia

In this conversion symptom (left figure) the entire hand, extending from the fingertips to the wrist, becomes numb

Patients may be highly susceptible to hypnotic procedures.

Actual physical damage (right figure) to the ulnar nerve, in contrast, causes anesthesia in the ring finger and little finger and beyond the wrist partway up the arm; damage to the radial nerve causes loss of feeling only in parts of the ring, middle, and index fingers and the thumb and partway up the arm. (Information from Gray, 1959.)

Conversion Disorder and Somatic Symptom Disorder (part 3)

Somatization pattern

Long-lasting physical ailment with no physical basis; dramatic and exaggerated

Treatment sought from doctor to doctor

Prevalence: 4 percent

Abuse and genetic links

Predominant pain pattern

Pain source known or unknown

May develop after an accident or illness that initially caused genuine pain

Conversion Disorder and Somatic Symptom Disorder (part 4)

These groups of disorders have much in common

Both may occur in response to severe stress

Both have traditionally been viewed as forms of escape from stress

A number of individuals suffer from both types of disorders

Theorists and clinicians often explain and treat the two groups of disorders in similar ways

MindTech

Can social media spread “mass hysteria”?

Bartholemew

Argues that social media are a major factor in the current increase in mass hysteria

Suggests future outbreaks may be more numerous, wide-ranging, and severe

Do you think this phenomenon is related to social media? Why? Why not?

Conversion Disorder and Somatic Symptom Disorder (part 5)

Somatic symptom disorder

At least one upsetting or repeatedly disruptive physical (somatic) symptom

An unreasonable number of thoughts, feelings, and behaviors

Physical symptoms usually continue to some degree for more than 6 months

Person experiences an unreasonable number of thoughts, feelings, and behaviors regarding the symptoms

Repeated, excessive thoughts about their seriousness

Continual high anxiety about their nature or health implications

Disproportionate amounts of time and energy spent on the symptoms or their health implications

Conversion Disorder and Somatic Symptom Disorder (part 6)

What causes conversion and somatic symptom disorders?

Previously called hysterical disorders

Widely considered unique and in need of special explanation

No explanation has received much research support, and the disorders are still poorly understood

Conversion Disorder and Somatic Symptom Disorder (part 7)

The psychodynamic view (Freud)

First psychodynamic theory of these two disorders

Underlying emotional conflicts converted into physical symptoms and concerns

Two defense mechanisms

Primary gain

Secondary gain

Electra complex goes awry

Freud argued that a hysterical disorder may result when parents overreact to their daughter’s early displays of affection for her father, by repeatedly punishing her, for example. The child may go on to exhibit sexual repression in adulthood and convert sexual feelings into physical ailments.

Conversion Disorder and Somatic Symptom Disorder (part 8)

Contemporary psychodynamic theories

Disagree with Freud on many points

Agree that patients carry unconscious conflicts from childhood, causing anxiety

Anxiety turns into physical pain

Conversion Disorder and Somatic Symptom Disorder (part 9)

Cognitive-behavioral view

Physical symptoms of disorder are rewarded and maintained through reinforcement

Symptoms

Create distance from unpleasant relationships

Bring attention; source of communication influenced by modeling of knowledge of medical problems

Secondary gains

This view has not been widely tested and is not supported by research

Disorders That Have Somatic Symptoms

Disorder	Voluntary Control of Symptoms?	Symptoms Linked to Psychosocial Factor?	An Apparent Goal?
Malingering	Yes	Maybe	No
Factitious disorder	Yes	Yes	No*
Conversion disorder	No	Yes	Maybe
Somatic symptom disorders	No	Yes	Maybe
Illness anxiety disorder	No	Yes	No
Psychophysiological disorder	No	Yes	No
Physical illness	No	Maybe	No

Some cognitive-behavioral theorists propose that the disorders are forms of communication and that people express their emotions through their physical symptoms.

Treatments for these disorders include insight, exposure, and drug therapies and may include techniques such as education, reinforcement, or cognitive restructuring

Conversion Disorder and Somatic Symptom Disorder (part 10)

Multicultural view

Some Western clinicians do not advocate excessive focus on somatic symptom disorders included in DSM-5; others see this as bias

Formation of somatic complaints is the norm in many non-Western cultures

What does this tell us?

Bodily and psychological reactions to life events are often influenced by one’s culture.

Conversion Disorder and Somatic Symptom Disorder (part 11)

How are conversion and somatic symptom disorders treated?

Focus on the cause of the disorder

Insight

Exposure

Drug therapies

Focus on the symptoms

Education

Reinforcement

Cognitive restructuring

Individuals with preoccupation disorders typically receive the kinds of treatments applied to anxiety disorders, particularly OCD:

Antidepressant medication

Exposure and response prevention (ERP)

Cognitive-behavioral therapies

Treatments for these disorders often focus on the cause of the disorder and apply the same kind of techniques used in cases of PTSD:

Insight: Often psychodynamically oriented

Exposure: Client thinks about the traumatic event(s) that triggered the physical symptoms

Drug therapy: Especially antidepressant medication

Illness Anxiety Disorder (part 1)

Preoccupation with thoughts or high anxiety about having or getting a significant illness

Absence of substantial somatic symptoms

Unduly high number of health-related behaviors or dysfunctional health-avoidance behaviors

Concerns continue to some degree for at least 6 months

In reality, the person has no or, at most, mild somatic symptoms.

Previously known as hypochondriasis.

Between 1 and 5 percent of all people experience the disorder.

For most patients, symptoms rise and fall over the years.

Illness Anxiety Disorder (part 2)

The disorder can begin at any age, but starts most often in early adulthood

Affects men and women in equal numbers

Theoretical explanation and treatment are similar to those for anxiety disorders (OCD)

Drug and cognitive-behavioral approaches

Psychological Factors Affecting Other Medical Conditions (part 1)

Early DSM labels

Included psychophysiological (psychosomatic) disorders

DSM-5 label

Includes psychological factors affecting other medical conditions

Characteristics of these disorders

Are different from factitious, conversion, and illness anxiety disorders

Involve significant medical symptoms and conditions

Often result in serious physical damage

Psychological Factors Affecting Other Medical Conditions (part 2)

Psychophysiological disorders

Affected persons have a medical condition

Psychological factors negatively affect the medical condition

Affect the course of the medical condition

Provide obstacles to the treatment of medical condition

Pose new health risks

Trigger or worsen the medical condition

Psychological Factors Affecting Other Medical Conditions (part 3)

Traditional psychophysiological disorders

Ulcers

Asthma

Insomnia

Chronic headaches

Migraine headaches

Hypertension

What do people do to relieve stress?

According to surveys, most of us go on the Internet, watch television, read, or listen to music. Tweeting is on the rise. (Information from BLS, 2016; MHA, 2008; NPD Group, 2008; Pew Research Center, 2016, 2011, 2010; Wagstaff, 2015; IWS, 2011.)

Ulcers

Lesions in the wall of the stomach that result in burning sensations or pain, vomiting, and stomach bleeding

Experienced by more than 25 million people at some point in their lives

Causal psychosocial factors:

Environmental pressures, including intense feelings of anger or anxiety

Bacterial infection

Asthma

A narrowing of the body's airways that makes breathing difficult

Affects up to 25 million people in the United States each year

Causal psychosocial factors:

Environmental pressures or anxiety

Allergies, a slow-acting sympathetic nervous system, or a weakened respiratory system

Insomnia

Difficulty falling asleep or maintaining sleep

Affects 10 percent of people in the United States each year

Causal psychosocial factors:

High levels of anxiety or depression

Overactive arousal system, certain medical ailments

Chronic headaches

Frequent intense aches of the head or neck that are not caused by another physical disorder

Tension headaches affect 45 million Americans each year

Migraine headaches affect 23 million Americans each year

Causal psychosocial factors:

Environmental pressures; general feelings of helplessness, anger, anxiety, depression

Abnormal serotonin activity, vascular problems, muscle weakness

Hypertension

Chronic high blood pressure, usually producing few outward symptoms

Affects 75 million Americans each year

Causal psychosocial factors:

Constant stress, environmental danger, general feelings of anger or depression

10 percent caused by physiological factors alone

Obesity, smoking, poor kidney function, high proportion of collagen (rather than elastic) tissue in an individual's blood vessels

Coronary heart disease

Caused by blockage in the coronary arteries

Encompasses several problems, including myocardial infarction (heart attack)

Nearly 18 million people in the United States have some form of coronary heart disease

The leading cause of death in men older than 35 years and women older than 40 years

Causal psychosocial factors:

Job stress, high levels of anger or depression

High level of cholesterol, obesity, hypertension, the effects of smoking, lack of exercise

Psychological Factors Affecting Other Medical Conditions (part 4)

Several variables contribute to the development of psychophysiological disorders

Biological factors

Defects in the autonomic nervous system (ANS) may contribute to the development of psychophysiological disorders