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Konstantine Zakzanis

Chapter 7 Somatoform and Dissociative Disorders - somatoform and dissociative disorders are related to anxiety disorders in that, in early versions of the DSM, all these disorders were subsumed under the heading of neuroses because anxiety was considered the predominant underlying factor in each case somatoform disorders disorders in which physical symptoms suggest a physical problem but have no know physiological cause; theyre therefore believed to be lined to psychological conflicts and needs but not voluntarily assumed; examples are somatization disorder (Briquets syndrome), conversion disorder, pain disorder, and hypochondriasis - in somatoform disorders, the individual complains of bodily symptoms that suggest a physical defect or dysfunction sometimes rather dramatic in nature but for which no physiological basis can be found dissociative disorders disorders in which the normal integration of consciousness, memory, or identity is suddenly and temporarily altered; dissociative amnesia, dissociative fugue, dissociative identity disorder (multiple personality), and depersonalization disorder are examples - in dissociative disorders, the individual experiences disruptions of consciousness, memory, and identity - the onset of both classes of disorders is assumed by many to be related to some stressful experience, and the 2 classes sometimes co-occur Somatoform Disorders - soma means body - in these disorders, psychological problems take a physical form - the physical symptoms of somatoform disorders have no know physiological explanation and arent under voluntary control - theyre thought to be linked to psychological factors, presumably anxiety, and are assumed to be psychologically caused - the bodily symptoms of these disorders fall typically into 2 groups: - one group of symptoms reflects arousal in the ANS and is accompanied by palpable distress in the form of anxiety and depression - 2 group of symptoms reflects thoughts and intensions that arent consciously recognized pain disorder a somatoform disorder in which the person complains of severe and prolonged pain that is not explainable by organic pathology; it tends to be stress-related or permits the patient to avoid an aversive activity or to gain attention and sympathy - in pain disorder, the person experiences pain that causes significant distress and impairment; psychological factors are viewed as playing an important role in the onset, maintenance, and severity of the pain - the patient may become unable to work and may become dependent on painkillers or tranquilizers - the pain may have a temporal relation to some conflict or stress, or it may allow the individual to avoid some unpleasant activity and to secure attention and sympathy not otherwise available - accurate diagnosis is difficult because the subjective experience of pain is always a psychologically influenced phenomenon - patients with physically based pain localize it more specifically, give more detailed sensory descriptions www.notesolution.comof their pain and link their pain more clearly to situations that increase or decrease it body dysmorphic disorder (BDD) a somatoform disorder marked by preoccupation with an imagined or exaggerated defect in appearance; for example, facial wrinkles or excess facial or body hair - with BDD its frequently in the face - women tend to focus on the skin, hips, breasts, and legs; men are more inclined to believe theyre too short, that their penises are too small, or that they have too much body hair - some patients with the disorder may spend hours each day checking on their defect, looking at themselves in mirrors; others try to avoid being reminded of the defect, for example, by wearing very loose clothes - BDD occurs mostly among women, typically begins in late adolescence, and is frequently comorbid with depression and social phobia, eating disorders, and thoughts of suicide - BDD is chronic, with only 9% of BDD patients experiencing remission over the course of 1 year - preoccupation with imagined defects in physical appearance may not be a disorder itself, but a symptom that can occur in several disorders hypochondriasis a somatoform disorder in which the person, misinterpreting rather ordinary physical sensations, is preoccupied with fears of having a serious disease and is not dissuaded (talk somebody out of something) by medical opinion; difficult to distinguish from somatizaton disorder - hypochondiasis is a somatoform disorder in which individuals are preoccupied with persistent fears of having a serious disease, despite medical reassurance to the contrary - the disorder typically begins in early adulthood and has a chronic course - the theory is that they overreact to ordinary physical sensations and minor abnormalities, such as irregular heartbeat, sweating, occasional coughing, a sore spot, or a stomach ache, seeing these as evidence for their beliefs - people with high scores on a measure of hypochondriasis are more likely than others to attribute physical sensations to an illness; similarly, patients with hypochondriasis make catastrophic interpretations of symptoms, such as believing that a red blotch on the skin is skin cancer - hypochondriasis is not well differentiated from somatization disorder, which is also characterized by a long history of complaints of medical illnesses - also, hypochondriasis often co-occurs with anxiety and mood disorders - hypochondriasis is a fear of having an illness, an illness phobia is a fear of contracting an illness - the Illness Attitude Scale (IAS) is one self-report measure thats used commonly by researchers to assess health anxiety - the IAS consists reliably of 4 factors: (1) worry about illness and pain (i.e. illness fears); (2) disease conviction (i.e. illness beliefs) (3) health habits (i.e. safety-seeking behaviors) (4) symptom interference with lifestyle (i.e. disruptive effects) - theres a link between health anxiety and trait neuroticism - a recent twin study conducted in Canada found that after controlling for medical morbidity, health anxiety was moderately heritable, but most of the variance in health anxiety, as assessed by the IAS, was due to environmental factors rather than genetic factors; this supports the notion that health anxiety is mostly learned Conversion Disorder
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