Anxiety, OCD, Somatic, and Dissociative Disorders
A. Anxiety Disorders
Everybody occasionally experiences anxiety. We fear that things might not turn
out the way we hope they will. Sometimes, we experience physical symptoms that are
related to the stress reactions discussed in the previous chapter, such as a dry mouth or
gastrointestinal (GI) issues. Sleeping issues could arise. Sometimes, our anxiety might
work in our favor by bringing to our attention something we need to pay attention to.
This enables us to be more watchful. Anxiety is a common human feeling in and of itself.
We identify it as an anxiety disorder, though, when the experience persists over time,
causes us distress, and interferes with our daily lives. 19.1% of adults in the US suffer
from anxiety disorders.
The fear of what might occur is anxiety. What if I don't perform well when I
present before a group of influential people? Will I succeed in my endeavors? What if I
am bitten by a snake while in the woods? Suppose the aircraft I'm on crashes. What if I
enter a public restroom and my hands are contaminated? What happens if people don't
like me? In this way, terror typically has a stimulus in the present, whereas anxiety is
focused on the future. When we see a snake, we are terrified and uneasy. We are uneasy
as we peer down from a tall building. When we are anxious, there is frequently nothing to
stimulate us. The stimulation is actually inside of our minds.
A negative possibility is not any less real simply because we are thinking about it
cognitively and emotionally. Our ideas become tangible possibilities in the eyes of our
body, mind, and emotions. When we feel anxious, we give an unwanted event a higher
chance of happening in our minds. A few of these responses seem to be included into our
system. While peering down from a tall structure, most people experience anxiety. When
a stranger removes a baby from their mother, they cry, and they start crying about 9
months old. The development of further phobias seems to involve a number of intricate
steps. It's unclear at the moment what exactly makes up the fear and anxiety system.
We do know that high-level as well as more basic brain functions are involved in
both fear and anxiety. Thinking about all the worst things that could occur in a
circumstance cognitively makes us feel more apprehensive. We experience some anxiety
as we board an airplane. Then, we hear an engine sound that we perceive as a problem.
Hence, we become even more alert and attentive to every sound. As the plane starts to
descend the runway, we tell ourselves it won't make it. Because of this, we experience
anxiety as our body's normally controlled emotional reactions become more pronounced.
Processes in the limbic system have the ability to react to stimuli on their own.
For instance, our amygdala can start an autonomic nervous system reaction in response to
an angry face. Joseph LeDoux demonstrated that there are two pathways for the
processing of fear in rat experiments. The upper pathway, which has excellent spatial
resolution, passes through the cerebral cortex. The lower pathway is faster and more
directly passes through the amygdala, although it has less conscious experience. This
implies that the organism is capable of acting rapidly in the face of possible danger, even
if its response is incorrect at first. The slow path allows for conscious assessment of the
circumstance at the same time. As a result, there are two pathways for responding to
harmful situations: cortical and subcortical. As a result, there is significant survival value
in mistaking a stick for a snake when a snake could be deadly.
According to theories about our evolutionary past, fear mechanisms may have
developed to help us focus on threats or possible dangers while disengaging from the
work at hand. We will jump and turn our attention to the source of an unexpected loud
noise. Despite the fact that everyone goes through this process, it is now known that
anxious people are even more susceptible to the idea of a potential threat than non-
anxious people are. It's interesting to note that in lab experiments, people with anxiety
disorders will pay attention to images that connote danger or are perceived as emotionally
upsetting, even if they are shown to them very fast. Contrarily, people who are depressed
need a presentation time of more than 0.5 seconds before the image catches their
attention. Cognitive bias is the term used to describe this susceptibility.
In many different ways, cognitive bias has been researched. Among them is the
modified Stroop test. Color names are written in a distinct color of ink on the standard
Stroop test. That is, the color red would be used to indicate the word green. People take
longer to name the color of the ink when the name and color do not match than when the
names of the ink and color correspond. A threat word is substituted for the color's name
when utilizing a "threat" Stroop. Use of a dot-probe job is an additional research method.
People are instructed to concentrate on an X in the center of the computer screen in one
variation of the task. There are words on both sides of the X. When a word is replaced by
a dot, the person must hit a computer key. In research on anxiety, both words may be
neutral, may signify various kinds of threat, or may be made up of a neutral and a threat
term.
Despite the fact that fear and anxiety are frequently examined in tandem, research
indicates that various brain regions are involved. Particularly, the regions associated with
anxiety are not those that are primarily in charge of how fear manifests itself. Instead,
anxiety is linked to brain regions that control the fear system. They include the
hippocampus, amygdala, and prefrontal cortex (PFC). They are the cognitive, affective,
and memory systems—all crucial elements in the social and cognitive aspects of anxiety.
These mechanisms also play a role in humans' enhanced vigilance and threat awareness.
The amygdala also contributes to the conditioning of fear.
Gamma-aminobutyric acid (GABA) is a crucial neurotransmitter in the anxiety
process. The main neurotransmitter in the brain that inhibits activity is called GABA.
GABA is assumed to play a significant impact in anxiety, despite being engaged in many
different processes. The basic theory is that people who experience anxiety have
decreased GABA activity, which then causes those parts of the brain that control threat
responses to be less inhibited. Also worth mentioning is the fact that the PFC, amygdala,
and hippocampus all have a significant number of GABA receptors. The GABA system
is influenced by benzodiazepines, a class of drugs frequently used to treat anxiety
disorders, which in turn increases the inhibitory effects of the system. In addition,
serotonin administration in the hippocampus and amygdala decreased fear in animal
models of anxiety, which was accompanied by enhanced GABA activity in the amygdala.
A rat raised and licked from infancy will exhibit more GABA activity in the amygdala as
an adult, as well as less anxiety and stress.
Anxiety and fear follow a natural progression that is inherent to the human
condition. Children and adolescents across cultures exhibit comparable anxiety and fear
profiles; however, cultures that value inhibition, compliance, and obedience exhibit
higher levels of fear.
Fears are typically associated with current events. Little children in their first year
of life, often between 9 and 12 months, react with terror to strangers. Then, they will
respond to separation. When separated from their mothers, infants of other animals
exhibit distress vocalizations. Infants begin to exhibit anxiety in response to specific
stimuli, such as insects, flying bees, and animals. By adolescence, the fear transforms into
anxiety because the source of concern is absent. Teenagers frequently experience social
anxiety about potential situations.
Normal fear and anxiety only become abnormal when they interfere with a kid or
adolescent's capacity to function or cause discomfort. According to a number of
epidemiological studies, 2.5% to 5% of children and adolescents meet diagnostic criteria
for anxiety disorders at any given moment. Separation anxiety disorder is the first anxiety
disorder to develop. Specific phobias, which emerge in early to middle childhood, come
next. The onset of social phobia occurs between early and middle adolescence. The onset
of panic disorder occurs in early adulthood. Due to the nature of adolescence, anxiety
problems have an impact on popularity and social competence at this age. Moreover, they
are related with victimization. The National Comorbidity Replication Adolescent
Supplement is a study of 10,148 13- to 17-year-old teenagers in the United States. The
fact that it is based on interviews with adolescents is one of its merits.
Children learn from their family and culture as they get older. If your parents
feared going in the woods or encountering specific animals, you may develop the same
phobia. In addition, your family's avoidance of similar situations would make it
impossible for you to discover that your anxieties were unfounded. Occasionally, like
with Susan Mineka's monkeys, witnessing someone else display fear may cause you to do
so as well. A number of academics have developed models of anxiety development in an
effort to combine the numerous components that might contribute to anxiety. David
Barlow, with his triple vulnerability approach, accounts for two of these.
According to Barlow's concept of the triple vulnerability viewpoint, there are
three essential factors involved in the emergence of anxiety-related diseases. The primary
vulnerability is a widespread biological one. Temperament is one such instance. Yet,
temperament alone does not cause anxiety. The second vulnerability is a widespread
psycholagical weakness. This would include psychological elements like the perception
that the world is unsafe. You may also begin to feel that you will not be able to manage
the issues you face in life. The third factor is a distinct psychological weakness. This is
when you learn from early experience, as well as what you are taught, that certain
circumstances or items are harmful. When we are in a tough, stressful scenario, we are
less likely to accurately analyze the situation, and the combination of these three
vulnerabilities may cause worry.
The Mineka model of learning in regard to anxiety disorders surpasses the basic
learning techniques of John Watson and Little Albert (explained later in this chapter)
observed in the early 20th century. For instance, Mineka's research on the acquisition of
snake phobias in laboratory monkeys shows that short-term modeling experiences can
have long-lasting consequences. Similarly, witnessing a buddy deliver a speech and be
criticized may increase one's own social anxiety. The social concerns exhibited by each
culture are also revealed through cultural norms. It is considerably different to stand out
in an Eastern society as opposed to a Western culture. Yet, not every individual who has
had a traumatic event involving a specific object or circumstance develops anxiety. This
indicates that the development of an anxiety-related problem in each individual is
contingent on a succession of background factors. The overall approach shows that
biological vulnerabilities such as heredity and temperament are prevalent.
The individual's perception of the situation's controllability is a component of this
second vulnerability. The experience of follows after this. The emotional processing is
prompted by a stressful circumstance. This may result in feelings of worry or panic. In
addition, on a broader scale, our evolutionary past as humans affects the sorts of items
and circumstances that a person learns to dread. For instance, humans and monkeys learn
the fear of snakes more readily than the dread of the vast majority of other stimuli.
There are three major types of major anxiety disorders. There are separation
anxiety disorder, generalized anxiety disorder (GAD), social anxiety disorder (SAD),
agoraphobia, specific phobia, and panic disorder. The first one is separation anxiety
disorder. In order for a child or teenager to be diagnosed with separation anxiety
disorder under DSM-5, the symptoms must endure at least four weeks. Moreover, three
of eight distinct symptom categories must be present. The first type of symptoms
comprises distress when the individual is not at home or with significant attachment
figures. The second defines a person who is concerned about the attachment figure's well-
being. The individual is concerned that an incident such as being abducted or becoming
lost may occur to him or her. The fourth is a reluctance to leave the house due to
separation anxiety. The fifth is an aversion to solitude. Unwillingness to sleep alone or
outside the home is the sixth symptom. The eighth is to have bodily issues such as
headaches and stomachaches.
Under the age of 12, separation anxiety disorder is the most frequent anxiety
condition. The 12-month prevalence of this illness is roughly 4% among children and
1.6% among teenagers, according to DSM-5. The 12-month prevalence ranges between
0.9% and 1.9% in people. In community samples, females are more frequently affected
than males. CBT techniques. A youngster is instructed to recognize his or her nervous
sensations when they occur. The children then learn to cope with these emotions.
Frequently, parents are active in the therapy of their kid. Not all CBT treatments are
effective, though. One study found that children who lacked motivation, were of lower
social standing, and had parents with internalized symptoms had fewer positive
outcomes. Hence, children whose parents experienced anxiety symptoms made less
therapeutic progress. Another research demonstrated improved outcomes when CBT was
administered through the Internet.
The second one is generalized anxiety disorder (GAD). According to the DSM-
5, GAD is defined by over six months of excessive anxiety and concern. Anxiety must be
accompanied by physical symptoms, such as feeling tense and being on edge. Muscle
tightness is one of the most constant physiological manifestations of GAD. Lastly, the
tension must result in at least one of the four behaviors below: (1) avoiding behaviors that
might have negative results, (2) over preparation for tasks that have the potential for bad
consequences, (3) conspicuous procrastination in activities that have the potential for
positive outcomes, (4) repetitively seeking reassurance as a result of anxiety-related
actions.
Depression and GAD are the two most common mental disorders identified in the
United States. In a given year, the prevalence of GAD is 3.1%, while the lifetime
prevalence rate is 5.7% among people aged 18 and older. With evolving DSM criteria,
however, these rates have fluctuated over time. In comparison to men, prevalence rates
are double for women. The incidence of GAD rises throughout middle age and thereafter
falls. The majority of people with GAD (86%) also fit the criteria for a second disease,
primarily major depressive disorder, social anxiety disorder, or panic disorder.H
Anxiety is a regular occurrence that many people may disclose to a variety of
health specialists, including psychologists, psychiatrists, and even their family doctor.
Medications like benzodiazepines or one of the psychotherapies discussed in Chapter 1
are frequently prescribed to these patients. In studies employing psychodynamic,
existential-humanistic, and cognitive behavioral techniques, anxiety reductions have been
documented. Currently, both medicines and psychosocial therapies provide comparable
short-term GAD reductions. Yet, only around 40 to 60 percent of people who are
medicated or undergo psychosocial treatment achieve full recovery. This is in contrast to
other anxiety disorders, such as phobias, which have a greater rate of recovery after
therapy.
Cognitive-behavioral and behavioral therapy have been the most-studied
psychological treatments for GAD. Efficacy has also been demonstrated for dynamic
techniques. Relaxation training and similar methods are included among the behavioral
treatments. The cognitive behavioral strategies place an emphasis on automatic thought.
Standard interventions teach clients to recognize internal and external anxiety cues and to
use new coping strategies that target both psychological and physical symptoms. At the
beginning, customers are instructed to pay particular attention to certain aspects of their
occurrences in daily life that induce worry. In addition, they are advised to pay attention
to the physiological and cognitive processes that accompany the development of anxiety.
In the treatment itself, the client is instructed to picture a circumstance that might
enhance his or her stress or anxiety, or to select a topic about which he or she would be
anxious, and to observe the related thoughts, emotions, and imagery. The primary
cognitive-behavioral therapies are meant to be delivered for a limited length of time.
These strategies teach the client how to lessen anxiety and worry, which is a significant
component of GAD. The following are some essential elements of the CBT approach:
1. Recognizing the thoughts, ideas, and beliefs that are related with anxiety.
2. Explicitly stating their position as causative
3. Inducing clients to examine the veracity of their views and beliefs and to seek
proof.
4. Assisting clients in the development of alternate, less anxiety-provoking
assumptions and interpretations.
5. In homework assignments or investigations, evaluating alternate perspectives
6. Real-world instruction in the aforementioned self-helping coping techniques
.Mindfulness is an additional useful therapy for GAD. The individual with GAD
focuses on the present during mindfulness-based therapies. This attention to the present is
conducted in a nonjudgmental and open manner. This allows for enhanced emotional
regulation and a reduction in anxiety symptoms. In randomized controlled studies for the
treatment of GAD, mindfulness-based therapy has been demonstrated to be more
beneficial than stress reduction approaches. Furthermore incorporated into conventional
CBT are mindfulness-based techniques. Acceptance is one of these attributes Therapeutic
commitment (ACT). This methodology implies that those with GAD frequently fail in
their attempts to manage their internal experiences. Acceptance-based behavioral therapy
is an additional treatment that combines mindfulness and CBT (ABBT). This treatment
entails teaching the individual suffering from GAD about his or her relationship with
internal events, particularly unpleasant reactions to them.
Benzodiazepines have been used to treat anxiety since the 1970s. It is believed
that benzodiazepines, such as Valium and Xanax, alter GABA activation. Anxious
individuals have decreased GABA activity, which results in less regulation of the brain
areas involved in danger reactions. In contrast to antidepressants, benzodiazepines
manifest their effects within a week. Several studies have demonstrated that
benzodiazepines reduce anxiety in roughly 65 to 70 percent of GAD patients. Fewer
individuals have complete remission of anxiety symptoms. Yet, when benzodiazepines
are discontinued, GAD symptoms will return.
In the 1990s, a second family of drugs known as azapirones was developed.
Buspirone (marketed under the trade names Buspar and Wellbutrin) is a common
azapirone that modulates serotonin receptors in the brain. This medication impacts the
cognitive aspects of GAD more than benzodiazepines and has less adverse effects.
Antidepressants are the third type of medication for GAD. It has been demonstrated that
both tricyclic antidepressants, such as imipramine, and serotonin reuptake inhibitors
(SSRIs), such as paroxetine (trade name Paxil), are beneficial in treating GAD. A major
meta-analysis of 25,441 patients with GAD revealed that a variety of medicines are
beneficial in the treatment of GAD compared to placebo.
The third of anxiety disorders is Social Anxiety Disorder. Most people may
recall a moment when they were anxious about meeting someone or delivering a
presentation in front of a group. Perhaps | will make an error in judgment. Perhaps others
will view me as an idiot. As I am eating, I may accidentally splatter my food over my
shirt. These are all frequent responses and are a part of the human experience. But, when
these symptoms are strong and stay longer than six months, they are labeled a social
anxiety disorder (SAD). SAD is characterized by a significant worry or anxiety for one or
more social settings in which the individual is exposed to the possibility of scrutiny from
others. Mood issues and drug misuse are frequently related with the illness.
The individual with social anxiety will dread humiliation, embarrassment, and
rejection. He could also be worried that others may be insulted. He attempts to avoid
anxiety by avoiding social situations because he imagines that social interactions would
have bad outcomes. This, in turn, leads in the individual living a life that is less than
complete and filled with misery and sorrow. In comparison to other anxiety disorders,
social anxiety seems to place a greater emphasis on past events.
Anxiety is convoluted. We see it negatively as something we wish to decrease or
eliminate. As humans, we desire a swift and straightforward solution. It appears simple to
take a tablet. This choice is encouraged by commercials depicting cheerful individuals on
psychotropic drugs. Several of these advertisements feature terms like "consult your
doctor," which supports their usage. Nevertheless, the usage of these drugs is also
associated with the risks of addiction and overdose.
Benzodiazepines are frequently used for the treatment of anxiety and sleep
disorders. Although benzodiazepines have been demonstrated to be useful in the
treatment of anxiety, there were 426,000 visits to emergency departments in 2011 due to
benzodiazepine usage. This compares to 272,000 visitors in 2008. Alcohol and
benzodiazepines were frequently implicated with this phenomenon.
The social brain is comprised of such brain regions as the prefrontal cortex (PFC),
amygdala, anterior cingulate cortex (ACC), and insula. These areas play a significant role
in social and emotional processing throughout normal and anxious states. The amygdala
is responsible for the early processing of emotional memory and arousal, rapid appraisal
of fresh stimuli, and danger perception. Fear, anxiety, and social disengagement are
elicited by electrical stimulation of the amygdala. The social parts of the brain are also
implicated in social anxiety, particularly the amygdala and insula. As a component of the
salience network, the insula may be hyperactive. This, in turn, would result in neutral
cues eliciting excessive reaction in which the individual with social anxiety pays more
attention than is warranted. Similarly, higher cognitive processes might not block
amygdala responses. Those with social anxiety might experience more intense emotional
responses than are necessary by the scenario.
For the treatment of SAD, a variety of psychological treatments have been
established. CBT, exposure therapy, training in social skills, and group CBT are included
in these treatments. These various strategies may also be combined in a variety of ways.
Both CBT-type therapy and medication have proven efficacy in the treatment of SAD.
Compared to pharmaceuticals, CBT-type treatments result in greater improvement with
fewer negative effects. Initial anxiety reduction seems to be accelerated by medications.
Yet, after treatment, when no extra medication or psychotherapy is provided, there is a
larger relapse rate with medication than with CBT.
CBT emphasize that social anxiety is caused by the individual's automatic
thinking in social situations or anticipation of social situations. The objective is to assist
the individual in recognizing and reorganizing these ideas and anticipations. Individual
and group therapy have been used for the treatment of social anxiety. Moreover, CBT has
been demonstrated to be successful with a variety of cultural groupings.
Exposure treatment is placing a person in a dreaded circumstance, despite the
resulting discomfort. One strategy is to have customers develop a hierarchy of
circumstances they would avoid or dread. Students may rate this hierarchy according to
the expected amount of anxiety they would feel. The treatment may then include these
circumstances. Training in social skills is founded on the premise that persons with social
anxiety have weak social interaction abilities. It teaches the person useful social skills via
modeling, corrective feedback, and reinforcement. For the treatment of social anxiety,
psychopharmacological methods have been demonstrated to be effective. Initially,
phenelzine sulfate, a monoamine oxidase (MAO) inhibitor, was regarded as the most
effective treatment. The SSRIs paroxetine and sertraline are among the most modern
pharmaceuticals.
B. Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is defined by recurrent thoughts and
sensations that are often followed by obsessive activities. The ideas are often considered
as undesirable and unwelcome. A difference is a distinction established between
obsessions and compulsions. Moreover, obsessions might be characterized by how they
are perceived by the individual. There are two types of obsessions: autogenous and
reactive. Autogenous obsessions are mental ideas or thoughts that arise spontaneously.
They are often characterized as upsetting and may occur without any environmental
provocation. Examples include impulses to do violent, sexual, or immoral activities that
are unacceptable. In contrast, reactive obsessions are triggered by a real environmental
circumstance. Seeing a filthy restroom, being touched by a stranger, or viewing a
misaligned image may trigger these sorts of obsessions. This form of preoccupation may
result in actions like straightening the crooked in a straight line.
Compulsions are the acts one engages in in response to these intrusive ideas. The
overall purpose of these activities is to decrease anxiety, acquire control, or reject
undesirable ideas. Some activities, like as cleaning or arranging items, indicate a desire to
react to the obsessions. Some compulsions, like as hand washing, come from a dread of
what one could say, do, or feel in a certain setting. Often, people with OCD continuously
check to see whether they have accomplished a certain action, such as turning off the
stove or disconnecting the iron. Individuals with OCD may be aware that their thoughts
and behaviors may seem unusual to others, yet they are unable to reject the ideas or the
impulse to act. OCD is distinguished by two categories of symptoms. The initial
obsessions are characterized by unwelcome, intrusive, and recurring ideas entering the
individual's head. The topics of these ideas may be unique to each individual. In general,
the obsessions entail contamination with a fear of germs, a mistake, aggressiveness, sex,
religion, or a catastrophic sickness such as cancer. The second kind consists of
compulsions or ritualistic behaviors. They may include excessive monitoring of basic
tasks such as turning off a stove or other device, as well as repeated behaviors such as
washing hands, checking locks, checking the stove, counting or repeating routine acts.
People with OCD have difficulty transitioning from one thought to another. They
also have difficulties not considering a certain concept. Overall, particular cognitive
impairments linked with OCD, such as reaction inhibition, the capacity to shift attention,
and the inability to concentrate, might be seen. (DLPFC), insula, temporal and parietal
lobes, as well as the cerebellum. In addition to cognitive problems, networks linking the
basal ganglia to the orbitofrontal cortex have been linked to motor responses (OFC).
People with OCD have a lower OFC volume than normal controls. This holds true for the
ACC, basal ganglia, and thalamus as well. Imaging studies reveal that persons with OCD
have an over activation of these circuits, which is associated with motivating elements of
behavior and the suppression of superfluous reactions.
It has been shown that both psychopharmacological and behavioral therapy are
beneficial for OCD. The most frequent drugs are SSRIs and clomipramine, a tricyclic
antidepressant. Randomized controlled studies (RCTs) indicate that SSRIs are more
effective than placebos. It has been shown that when CBT is combined with other
therapies, the effects of CBT are more pronounced.
In contrast to SSRIs. Nonetheless, their combined effects are the most beneficial.
These have been shown to be beneficial for around 60% of individuals with the illness. In
terms of psychotropic medicines, OCRDs have received less attention from RCTs. CBT
is now regarded as the therapy of choice for several problems. In February of 2009, U.S.
FDA has cleared the use of a deep brain stimulation device to treat OCD. Similar to deep
brain stimulation for severe depression, an electrode is implanted in the brain along with
a generator and battery put under the skin. There are now a number of clinical studies
investigating this medication. Deep brain stimulation breaks the dysfunctional
connections between the frontal regions of the brain and the subcortical structures in
OCD, restoring normal function.
C. Dissociative Disorders
Pierre Janet, a French psychologist, used the term dissociation in 1889 to explain
symptoms such as recurrent behaviors prompted by a distressing memory, inconsistent
personality traits following a trigger event, and limb paralysis under hypnosis. Janet saw
them as amnesic processes, but Freud viewed it as a strong ego attempting to block out
the painful event.
There are three major types of dissociative disorders such as
depersonalization/derealization, dissociative amnesia, and dissociative identity disorder.
The first one is depersonalization/derealization. The impression of not feeling the
reality of oneself is depersonalization. This experience may include feelings of
detachment or the observation of oneself as though by an outsider. In contrast,
derealization is the perception that the external world is not solid. One's perception of the
world is detached, as if in a fog or a dream, or otherwise warped or unreal. Right after a
car accident, for instance, many people describe feeling as if the world and what is
happening are not real. Depersonalization and dereality are seen as natural reactions to
several forms of acute stress. Yet, they qualify as DSM disorders when they cause
discomfort or impairment in significant aspects of a person's life. The lifetime frequency
is around 2%, and there are no significant gender differences.
Depersonalization disorder was associated with diminished autonomic reactions
to unpleasant stimuli. This indicates that persons with depersonalization disorder respond
inhibitively to unpleasant emotional input. Those with anxiety and those in the control
group have greater reactivity to these stimuli. Responses are normalized as range-
corrected scores (skin conductance response magnitudes for each participant were
calculated as a fraction of that participant's biggest response).
The second type of dissociative disorders is dissociative amnesia. Dissociative
amnesia is characterized by an inability to remember significant autobiographical details.
Dissociative fugue, which was formerly classified as a distinct condition in DSM-IV, is
now classified under dissociative amnesia in DSM-85. Fugue dissociative is abrupt,
unexpected departure away from one's home or place of employment accompanied with
an inability to remember the past. In terms of dissociation amnesia, memory loss seems to
be of a specific first-person type as opposed to a worldwide memory problem. In other
words, their memory seems intact until you inquire about their prior experiences. In fact,
talking with these persons might seem normal until they are probed about their personal
histories. They are afterwards unable to recall any of their past
The last type of dissociative disorders is dissociative identity disorder.
Traditionally, DID was defined as possession, in which a person loses his or her identity
and assumes that of another. Possession by external forces was a prevalent conception of
DID. As early as 1787, descriptions alluded to "umgetauschte Personlichkeit," German
for "exchanged personality." Similar to Benjamin Rush, Charcot, Janet, and Morton
Prince reported similar cases in the early 1800s. The famous work The Dissociation of a
Personality was written by Morton Prince in 1905. Swiss physician Eugen Bleuler put
DID within the category of schizophrenia, a term he invented, resulting in the
abandonment of the DID diagnosis around the middle of the twentieth century.
Dissociative identity disorder (DID) has garnered substantial media and popular
press interest. Once known as multiple personality disorder, there is a great deal of
disinformation about its existence. The majority of television and film representations of
DID are inaccurate. The LENS: Multiple Personality and the Media describes a portion of
this material. Modern perspectives imply that it is less a condition of many personalities
than a developmental disorder in which a consistent sense of self does not exist, i.e., the
individual does not perceive her thoughts, emotions, and actions in terms of a well-
developed "I" or sense of self. Rather, the individual experiences distinct "personalities"
at various times. DID is considered a complicated condition associated with trauma
experienced before the age of 5 or 6. Throughout this developmental period, a sense of
self is developing.
According to DSM-5, dissociative identity disorder is characterized by the
existence of two or more different personality states or the sensation of possession. These
may be impacted by a variety of variables, including the individual's psychological
condition, such as his or her present stress level, coping skills, and internal conflicts, as
well as cultural influences. Memory disruptions are also an essential aspect of DID.
These memory impairments might manifest in three distinct ways.HSecondly, the
individual may not recall critical aspects of his or her life, such as what happened
between the ages of 12 and 14 or an incident that would be regarded significant by the
majority of people. Second, the individual may not remember how to do an acquired act
or skill, such as driving or using a computer. Finally, the individual may uncover proof of
behaviors for which he or she has no memory.
While certain dissociative diseases, such as dissociative amnesia, may recover on
their own, others, such as dissociative identity disorder, need long-term care. Often,
people with DID seek therapy for a distinct kind of psychological anguish. Typically,
long-term psychotherapy is the fundamental treatment for DID. In therapy, it is essential
to place emphasis on the client-therapist connection. The focus is on creating a secure
environment where people may explore and integrate their diverse aspects. There are
currently no scientifically validated separation principles that have been tested beyond
the exploratory phases. However, diverse combinations of cognitive behavioral treatment
(CBT), humanistic-existential therapy, and dynamic methods have been applied.
D. Somatic Symptom Disorders
People may experience somatic, or physical, symptoms. We may feel exhausted
and have leg ache may have an abdominal discomfort. It is estimated that 60% to 80% of
the general population has at least one somatic symptom every week. Yet, some
individuals might not feel relieved. They may continue their search for organic disorders
by seeing more doctors or requesting further testing. They are certain there is something
wrong with them. These are two characteristics of somatic symptoms and associated
illnesses. Another element is when a person exhibits the symptoms of a physical
impairment, yet the underlying physiology is not consistent with what we know.
Formerly known as hysteria, these conditions are now known as conversion disorders.
Somatic symptom disorders serve as a link between psychological and medical
processes. These individuals often do not seek out mental health providers. Hence, it is
one group of problems for which the diagnosing professional, often a physician, is not a
specialist in the treatment of mental disorders. This will affect the prevalence estimates of
many illnesses, since few clinicians would use this diagnosis. Somatic symptom disorder
is a condition in which a person's physiological or somatic symptoms produce discomfort
or disturbance in physical health that is not consistent with a medical ailment. For a
diagnosis of the disease, the individual must exhibit at least one of the following
symptoms: persistent concerns about the severity of her symptoms, a high degree of
worry around her health or symptoms, or an obsessive focus on her health. In addition,
these qualities must have persisted longer than six months. These people may travel from
doctor to doctor or emergency room to emergency department in an attempt to get
diagnosed with a medical condition. People are dissatisfied if the expert is unable to
identify the source of their symptoms.
Somatic symptom disorder is a condition in which a person's physiological or
somatic symptoms produce discomfort or disturbance in physical health that is not
consistent with a medical ailment. For a diagnosis of the disease, the individual must
exhibit at least one of the following symptoms: persistent concerns about the severity of
her symptoms, a high degree of worry around her health or symptoms, or an obsessive
focus on her health. In addition, these qualities must have persisted longer than six
months. These folks may travel from doctor to doctor or emergency room to emergency
department in an attempt to get diagnosed with a medical condition. People are
dissatisfied if the expert is unable to identify the source of their symptoms.
There are three major type of somatic symptom disorder such as illness anxiety
disorder, conversion disorder, and factitious disorder. The first one is illness anxiety
disorder. When a person is concerned with the risk of contracting a major disease, it is
known as illness anxiety disorder. Unlike somatic symptom illnesses, however, the
individual feels few, if any, symptoms. This illness was originally known as
hypochondriasis; however, DSM-5 renamed it. The anxiety in illness anxiety disorder is
centered on health concerns; the individual may get worried at the mere hint or idea that
he may have a health condition. A person may conclude that he has cancer, for instance,
after reading an article on cancer symptoms or experiencing a feeling in his body. In
addition to worry, behavioral components such as body scanning may also be present.
While it is normal to be worried if a certain ailment runs in one's family, illness anxiety
disorder takes this worry to a whole new level. The majority of the time, reassurance
from a medical professional will not alleviate worry. Some persons with this problem
avoid visiting a doctor out of concern that he or she may confirm the presence of a
dangerous ailment, which would worsen their anxiety.
In many respects, the defining characteristic of illness anxiety disorder is not the
symptom itself, but the person's response to the condition. DSM—5 differentiates
between those whose primary focus is the symptoms and those whose primary concern is
the likelihood of developing a condition. Diagnosis of somatic symptom disorder would
be used to those whose concern is with the symptom itself. Illness anxiety disorder is a
diagnosis given to those whose main worry is the chance of contracting a certain ailment.
The next one is conversion disorder. Hysteria has long been referred to as
conversion disorder. This is when a person experiences sensory or motor symptoms, such
as inability to hear, see, feel pain, or move a bodily part. Yet, the symptoms do not
correspond to any established physiological or neurological patterns. Glove anesthesia,
for instance, refers to the condition in which a person declares, "I cannot feel anything in
my hand." The pattern of insensitivity resembles that of a glove. The touch receptors in
our hands, however, do not follow this pattern. Beginning with the ring and little fingers
and extending up to the wrist, the ulnar nerve is involved in sensitivity. On the opposite
side of the hand, sensitivity is controlled by the radial nerve. Hence, if one of these
nerves were to sustain injury, we would see a significantly different pattern of
insensitivity. Depending on whether nerve in the hand was destroyed, one would lose
feeling on either the left or right side of the hand.
The kind of conversion disease has been documented for at least 2,000 years and
was thought to be unique to women. The medical literature of the fifth century BCE used
the Greek term for uterus (hysfera) to define the disease as hysteria. In 1859, Pierre
Briquet published Traité Clinique et Thérapeutique de L'hystérie, a seminal book that has
affected how conversion disease is now understood. He adopted the word hysteria to
describe a group of individuals who had medical symptoms without a clear reason. They
provided a dramatic and exaggerated description of their symptoms.
Freud's early work included these types of patients. The phrase conversion
response really alludes to Freud's theory that psychological energy was translated into
bodily symptoms. The fundamental idea is that traumatic memories or trauma are not
consciously experienced emotionally, but rather transformed into bodily processes. Freud
learnt from Charcot that people with a conversion disease, such as glove anesthesia,
would be able to recollect unpleasant experiences and have normal sensation in their
hands when under hypnosis. Nowadays, the term conversion disorder is used in DSM-5
without reference to psychoanalytic philosophy. Although this is a prevalent word in
neurology, the DSM-S also refers to conversion disorder as a functional neurological
symptom condition. Conversion responses are often referred to as psychogenic disorders
or functional disorders in the medical literature.
The last type is factitious disorder. A factitious disorder is a condition in which
an individual produces the symptoms seen by a medical expert. To simulate a real
medical ailment, such as the stomach flu or low blood sugar, this person may use
laxatives or even inject insulin. This is the case, despite the fact that it appears illogical
that someone would intentionally injure himself in order to get medical care. The
individual with a false claim disorder will try to manipulate the health care system by
requesting further diagnostic testing or even surgical operations. If the individual has
medical knowledge, it may be initially difficult to diagnose the disease since they can
properly describe and reproduce symptoms. If the individual does not get the desired
attention, he or she may grow enraged and allege abuse. While epidemiological data are
sparse, there are indications that women are affected more often than males.
The DSM-5 distinguishes between factitious disorder imposed on oneself and
factitious disorder imposed on another. Typically, a caregiver, such as a mom, would
generate symptoms in her kid in a factitious condition imposed on another. She then
seeks medical care for the infant. She may even be seen as a kind mom who cares for her
kid, despite the fact that she is the source of the symptoms. In the past, persons with a
self-imposed factitious condition were also referred to as having Munchausen syndrome.
The condition is named after a German nobleman who embellished his accounts of war
exploits and became known as the "Baron of Lies." People who generate the symptoms in
another are referred to as Munchausen syndrome via proxy.
Factitious disorder should be distinguished from malingering since malingering
includes deception to get external incentives, such as not going to work, earning financial
compensation via an insurance claim, receiving paid sick leave, or avoiding undesirable
activities. In addition, some persons feign symptoms in order to get medicines for
personal or commercial usage. These people would not be diagnosed with a fictitious
condition.
There are three techniques to treating somatic symptom problems. They include
antidepressant medication, cognitive behavioral therapy, and other therapies such as
family counseling or a problem-solving strategy. While there is a paucity of empirical
evidence about the treatment of somatic symptom disorders, cognitive-behavioral therapy
has been shown to be the most effective in decreasing physical symptoms, psychological
distress, and impairment. Effective CBT therapies for sickness anxiety disorder often
resemble those for panic disorder. Unfortunately, therapy research in this field of somatic
symptom disorders is fairly sparse.
