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Essentials of Understanding Abnormal Behavior Chapter Five

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Title: Essentials of Understanding Abnormal Behavior Chapter Five


1
Essentials of Understanding Abnormal Behavior
Chapter Five
  • Dissociative Disorders and Somatoform Disorders

2
Dissociative Disorders and Somatoform Disorders
  • Dissociative disorders Mental disorders in which
    a persons identity, memory, and consciousness
    are altered or disrupted
  • Somatoform disorders Involve physical symptoms
    or complaints that have no physiological basis

3
Dissociative Disorders
  • Dissociative disorders Mental disorders in which
    a persons identity, memory, or consciousness is
    altered or disrupted
  • Dissociative amnesia
  • Dissociative fugue
  • Dissociative identity disorder (DID, formerly
    Multiple Personality Disorder)
  • Depersonalization disorder

4
Figure 6.1 Disorders Chart Dissociative
Disorders
5
Figure 6.1 Disorders Chart Dissociative
Disorders (contd)
6
Dissociative Amnesia
  • Dissociative amnesia Partial or total loss of
    important personal information, may occur
    suddenly after stressful/traumatic event
  • Localized Failure to recall all the events that
    happened during a specific period
  • Selective Inability to remember certain details
    of an incident

7
Dissociative Amnesia (contd)
  • Generalized Inability to remember anything about
    ones past life
  • Systematized Loss of memory for selected types
    of information
  • Continuous Inability to recall events occurring
    between specific time in the past and the present

8
Dissociative Amnesia (contd)
  • Possibly due to repression (or closely related
    process) of a traumatic event
  • Posthypnotic amnesia Individual cannot recall
    events occurring during hypnosis with hypnotist
    suggesting what is to be forgotten
  • Dissociative amnesia Both the source and content
    of the amnesia are unknown
  • In posthypnotic and dissociative amnesia, lost
    material can sometimes be retrieved with
    professional help.

9
Dissociative Fugue
  • Confusion over personal identity, together with
    unexpected travel away from home
  • Also called fugue state
  • Usually involves only short periods of time with
    incomplete change of identity
  • In the classic presentation of this disorder
  • Individual travels from home and assumes a
    partial or complete new identity.
  • Results from an urgent wish to escape an
    unbearable situation
  • During the fugue state, the individual has
    amnesia for his or her previous life
  • After recovering from the fugue state, the
    individual has amnesia for activities during the
    fugue state

10
Depersonalization Disorder
  • A dissociative disorder in which feelings of
    unreality concerning the self or the environment
    cause major impairment in social or occupational
    functioning
  • Depersonalization is the most common dissociative
    disorder
  • occurs mostly in adolescents and young adults.
  • Includes loss of the sense of self.
  • Individuals feel they are suddenly different- for
    example,
  • that their bodies have changed
  • Often accompanied by derealization - during which
    the external world is perceived as distorted or
    out of body experiences
  • Precipitated by physical or psychological stress
    evidence that it may be related to emotional
    abuse, especially by parents

11
Culture-Bound Syndromes
  • Koro Intense fear that genitalia are receding
    into the body
  • Latah Mimicking or following instructions or
    behaviors of others, plus trancelike states
  • Brain fag Fatigued brain, neck, or head pain or
    blurred vision related to difficult coursework
  • Dhat Problems related to semen discharge

12
Culture-Bound Syndromes (contd)
  • Nervios Somatic symptoms and anxiety
  • Pibloktoq Dissociative episode, plus extreme
    excitement followed by convulsions and coma
  • Zar Sense of spirit possession

13
Dissociative Identity Disorder (DID)
  • Formerly called Multiple Personality Disorder
  • Dissociative disorder in which two or more
    relatively independent personalities appear to
    exist in one person, with only one evident at a
    time
  • Originates in childhood Reports of extreme
    physical or sexual abuse
  • Comorbid with conversion symptoms, depression,
    and anxiety
  • Highly controversial

14
Figure 6.2 Comparison of Characteristics of
Reported Cases of Dissociative Identity Disorder
(Multiple Personality Disorder)
15
Causal Factors in Dissociative Disorders
  • Little information about causal factors of
    dissociative amnesia, fugue and depersonalization
    disorder
  • Ross suggests DID may arise from childhood abuse
    or neglect, or the disorder may be factitiously
    created, or created iatrogenically (as a result
    of treatment for other disorders).
  • There appear to be no biological causes
  • Psychosocial causes (stressors) are valid

16
Etiology of Dissociative Disorders
  • Difficult to differentiate between genuine and
    faked cases
  • Psychodynamic perspective Repression blocks
    unpleasant/traumatic events from consciousness
  • Amnesia and fugue Part of personal identity
    blocked
  • DID Conflicts in personality structure opposing
    personality components disable egos ability to
    control incompatible elements

17
Figure 6.3 Psychodynamic Model for Dissociative
Identity Disorder
18
Etiology of Dissociative Disorders (contd)
  • Behavioral perspective Indirect avoidance of
    stress
  • Sociocognitive model Rule-governed/goal-directed
    experiences and displays created, legitimized,
    and maintained by social reinforcement
  • Learn behaviors from observing what works for
    others
  • Iatrogenic Created by the therapeutic situation
    (hypnotic suggestibility)

19
Treatment of Dissociative Disorders
  • Medications treat accompanying anxiety or
    depression.
  • Survivors of childhood sexual abuse who have
    dissociated are often treated with
    psychoeducation, use of group resources, and
    cognitive/social skills training.
  • Amnesia and fugue (usually spontaneously remit)
  • Supportive counseling
  • Treat depression and stress

20
Treatment of Dissociative Disorders (contd)
  • Depersonalization disorder (slower spontaneous
    remission)
  • Alleviate feelings of anxiety, depression, fear
    of going insane
  • Occasionally behavioral therapy (reinforcement of
    appropriate responses)

21
Treatment of Dissociative Disorders (contd)
  • Dissociative identity disorder (DID)
  • Controversial treatments, not always successful
  • Psychotherapy and hypnosis
  • Personalities introduce selves to patient and
    recall traumatic experiences/memories
  • Therapist suggests personalities served a purpose
    but now alternative coping strategies will be
    more effective
  • Integrate personalities

22
Treatment of Dissociative Disorders (contd)
  • Dissociative identity disorder (DID) (contd)
  • Progress in therapy
  • Better assessment, greater understanding of DID,
    progress in handling controversial issues, and
    treatment to achieve quick resolution of acute
    symptoms
  • Problem-focused therapy to improve functioning
  • Cognitive behavior strategies

23
Somatoform Disorders
  • Physical symptoms that mimic medical conditions
    with no physiological basis
  • Symptoms are not under voluntary or conscious
    control
  • Somatoform disorders
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Hypochondriasis
  • Body dysmorphic disorder

24
Somatoform Disorders
  • Involve physical complaints or disabilities that
    occur without any evidence of physical cause
  • Patients are NOT faking
  • Individuals suffering from somatoform disorders
    are typically preoccupied with their health, but
    believe they are genuinely ill.

25
Figure 6.4 Disorders Chart Somatoform Disorders
26
Figure 6.4 Disorders Chart Somatoform Disorders
(contd)
27
Table 6.1 Variables that Distinguish Subgroups
of Confirmed Somatoform Disorder
28
Somatoform Disorders (contd)
  • Comorbid disorders Mood, personality, and
    substance use disorders
  • Differentiate from
  • Malingering Faking a disorder to achieve some
    goal, such as an insurance settlement
  • Factitious disorder Symptoms of physical or
    mental illness are deliberately induced or
    simulated with no apparent incentive
  • Cultural differences Psychosomatic versus
    somatopsychic perspectives

29
Somatization Disorder
  • Chronic complaints of many bodily symptoms with
    no physical basis
  • Complaints include at least four pain symptoms in
    different sites (DSM-IV-TR)
  • Two gastrointestinal
  • One sexual
  • One pseudoneurological
  • Undifferentiated somatoform disorder
  • Relatively rare diagnosis world-wide

30
Conversion Disorder
  • Complaints of physical problems or impairments of
    sensory or motor functions controlled by
    voluntary nervous system, suggesting neurological
    disorder, with no underlying physical cause
    often related to stress

31
Conversion Disorder (contd)
  • Most common conversion symptoms
  • Psychogenic pain
  • Disturbances of stance and gait
  • Sensory symptoms
  • Dizziness
  • Psychogenic seizures
  • Some symptoms are easily diagnosed as conversion
    disorders, while others require extensive
    neurological and physical examination.

32
Figure 6.5 Glove Anesthesia
33
Pain Disorder
  • Reports of severe pain, but
  • No physiological or neurological basis (vague
    descriptions)
  • Pain is greatly in excess of that expected with
    an existing condition, OR
  • Pain lingers long after a physical injury has
    healed
  • Frequent visits to doctors with numerous physical
    complaints potential for drug or medication abuse

34
Figure 6.6 Physical Complaints A Comparison of
Individuals with Pain Disorder Versus Healthy
Controls
35
Hypochondriasis
  • Persistent preoccupation with ones health and
    physical condition, despite physical evaluations
    that reveal no organic problems
  • Prevalence 2-7 of general medical population

36
Hypochondriasis (contd)
  • Predisposing factors
  • History of physical illness
  • Parental attention to somatic symptoms
  • Low pain threshold
  • Greater sensitivity to somatic cues
  • Anxiety/stress-arousing event , plus perception
    of somatic symptoms, plus fear that sensations
    reflect disease greater attention to somatic
    cues

37
Body Dysmorphic Disorder
  • Preoccupation with imagined physical defect in a
    normal-appearing person, or excessive concern
    with slight physical defect
  • May be underdiagnosed due to embarrassment to
    discuss the problem
  • Comorbid Functional impairment, mood disorders,
    social phobia, low self-esteem may be suicidal
  • Possibly related to obsessive-compulsive disorder

38
Figure 6.7 Imagined Defects in Patients with
Body Dysmorphic Disorder
39
Etiology of Somatoform Disorders
  • Diathesis-stress models
  • Predisposition may be learned or hard-wired
  • Predisposition involves hypervigilance or
    exaggerated focus on bodily sensations, increased
    sensitivity to weak bodily sensations, and
    disposition to react to somatic sensations with
    alarm
  • Predisposition becomes fully developed disorder
    when person cant deal with trauma or stress
  • Precipitating Circumstances (Antecedents)
  • Desire to escape an unpleasant situation
  • Fleeting wish to be sick in order to escape (wish
    is quickly suppressed)
  • Appearance of physical ailment
  • Patient sees no relation between physical
    symptoms and stress situation

40
Figure 6.8 Diathesis-Stress Model for Somatoform
Disorders
41
Etiology of Somatoform Disorders (contd)
  • Psychodynamic perspective Somatic symptoms
    defend against awareness of unconscious emotional
    issues
  • Freud Hysterical reactions result from
    repression of conflict (usually sexual)
  • Two mechanisms produce and sustain symptoms
  • Primary gain (protection from anxiety)
  • Secondary gain (dependency needs fulfilled)

42
Etiology of Somatoform Disorders (contd)
  • Behavioral perspective
  • Reinforcement
  • Modeling
  • Cognitive styles
  • Combination of all three
  • Sociocultural perspective
  • Societal restrictions on women

43
Etiology of Somatoform Disorders (contd)
  • Biological perspective
  • There may be innate physical bases
  • Hypochondriacs are more sensitive to bodily
    sensations

44
Treatment of Somatoform Disorders
  • Psychodynamic Psychoanalysis and hypnosis to
    help person relive feelings associated with
    repressed trauma
  • Behavioral Many strategies, including exposure
    and response prevention (extinction and
    nonreinforcement of complaints) systematic
    desensitization
  • Cognitive-behavioral Correct cognitive
    distortions and reattribution training

45
Treatment of Somatoform Disorders (contd)
  • Biological Antidepressant medications, increased
    physical activity, SSRIs
  • Family systems treatment Place identified
    patients disorder in perspective, teach family
    adaptive ways of support, prepare family members
    to deal with problems

46
Checkpoint Review
  • When do physical complaints become a type of
    disorder?
  • What are the causes of these conditions?
  • What treatments are used for these conditions?
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