Essentials of Understanding Abnormal Behavior Chapter Five

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Essentials of Understanding Abnormal Behavior
Chapter Five

• Dissociative Disorders and Somatoform Disorders

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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

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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

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Figure 6.1 Disorders Chart Dissociative
Disorders
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Figure 6.1 Disorders Chart Dissociative
Disorders (contd)
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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

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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

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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.

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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

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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

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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

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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

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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

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Figure 6.2 Comparison of Characteristics of
Reported Cases of Dissociative Identity Disorder
(Multiple Personality Disorder)
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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

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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

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Figure 6.3 Psychodynamic Model for Dissociative
Identity Disorder
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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)

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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

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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)

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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

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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

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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

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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.

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Figure 6.4 Disorders Chart Somatoform Disorders
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Figure 6.4 Disorders Chart Somatoform Disorders
(contd)
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Table 6.1 Variables that Distinguish Subgroups
of Confirmed Somatoform Disorder
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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

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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

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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

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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.

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Figure 6.5 Glove Anesthesia
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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

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Figure 6.6 Physical Complaints A Comparison of
Individuals with Pain Disorder Versus Healthy
Controls
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Hypochondriasis

• Persistent preoccupation with ones health and
  physical condition, despite physical evaluations
  that reveal no organic problems
• Prevalence 2-7 of general medical population

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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

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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

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Figure 6.7 Imagined Defects in Patients with
Body Dysmorphic Disorder
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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

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Figure 6.8 Diathesis-Stress Model for Somatoform
Disorders
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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)

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Etiology of Somatoform Disorders (contd)

• Behavioral perspective
• Reinforcement
• Modeling
• Cognitive styles
• Combination of all three
• Sociocultural perspective
• Societal restrictions on women

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Etiology of Somatoform Disorders (contd)

• Biological perspective
• There may be innate physical bases
• Hypochondriacs are more sensitive to bodily
  sensations

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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

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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

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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?