Abnormal Psychology: Lecture 5
Somatoform and Dissociative Disorder
Bodily symptoms that suggest a physical defect of dysfunction but no physiological basis
can be found
Disruptions of consciousness, memory and identity
Difference is that somatoform are very common, but dissociative disorders are rare. However
the similarities are that psychological factors are presumed to cause a major role in
development and growth of both disorders.
Psychological factors play a significant role in the onset and maintenance of pain
DSM includes three subtypes
Pain Disorder associated with Psychological Factors
Pain Disorder associated with both Psychological Factors and a General
Pain Disorder associated with a General Medical Condition
Pain is a biopsycho social factors that can’t be determined by only one factor.
Pain must be life affecting and cause distress and disability before being diagnosed.
Comorbid diagnosis creates an additional problem such as drug abuse.
Acute if less than 6 months and Chronic is more than 6 months
One lady worked hard before her accident and then once she had pain, she didn’t have
to do such hard work and gained sympathy from her family which made her reject her
recovery from pain.
Igotrinetic?? Disability- avoid unpleasant activity to secure attention and sympathy
We distinguish these people from people actual physical pain, because people
with physical pain have a more detailed area of pain rather than general pain
and will tell you what actions make the pain better and what actions make the
pain worse. Also no evidence for the physical pain through physiological
Histrionic Personality Disorder- Someone seeking attention (will also usually have a
pain disorder). For example the case of the lady who claimed to have pain after a car
accident, but it was found that prior to the accident her husband and her were not
sexually satisfying each other and that there was going to be trouble in her marriage
due to his infidelity. After the accident the couple decided to try again, but the pain was
preventing them from moving forward sexually, thus she hung on to this pain. Important
to note, that no pain is solely psychological.
Body dysmorphic disorder
Preoccupation with imagined or exaggerated defects in physical appearance. Differs
between men and women. Both for face. Women with breasts, body shape where as
with men it is hair and genital area.
Must cause distress and disability for diagnosis.
These people will spend so much time trying to fix these defects that it leads them with
financial problems, health problems and more especially through surgery. Only 9% of
people with this disorder are satisfied after surgery.
Affects more female than men and usually starts in late adolescence when individuals
becomes more aware of their looks.
Can be comorbid with depression and social phobia. Can lead to eating disorders,
thoughts of suicide, personality disorders and substance abuse.
Case Example Elephant Man: Shy 30 year old male hospitalized after suicide attempt.
Asks to see psychiatrist in dark room and says that he has no friends no job and no
girlfriend. He blames the marks on his nose which he thinks about every day and has nightmares about it. Psychiatrist couldn’t see the marks on the nose, even in a lighted
room. Started staying home and avoiding any relationship with others.
Case Example: Man who took steroids continually for his muscles (video)
Preoccupation with fears of having a serious illness; more apparent in med students.
Also seen in email from student.
Catastrophic generalization from minor factors.
Characterized by a long history for recurrent of multiple sematic complaints with NO
physical cause and the individual will seek multiple medical treatment
4 pain symptoms in different locations
2 gastrointestinal symptom
1 sexual symptom other than pain
1 pseudo neurological symptom
Comes with anxiety, mood disorders, substance abuse (remedial use).
More common in women. Onset in early adulthood
Different from a pain disorder
Sensory or motor symptoms with any physiological cause
Only neurological cause which differs from somatization such as loss of vision, seizures,
paralysis, coordination and balance problems, insensitivity to pain.
Malingering vs Factitious disorder
Main difference between malingering and factious disorder is that in malingering, the
complains whether neurological, physical, or cognitive are consciously produced.
Through volunteer control and an incentive. Possibly to get out of something. More
Factious disorder has the same symptoms but it’s under unconscious control. Will
intentionally produce symptoms and have no external incentive to do so. Wants to take
on the role of the sick person.
Manchosim - purposely make themselves sick
Biproxy- Sometimes others people diagnose another with disorders in order to assume
the role of care taker.
In order to distinguish between the two there are a couple of tests.
Measures of dissimulation
Forced choice recognition
Atypical/Unlikely NP Scores
Dissociative Disorder- incredibly rare, thus based on case studies
Person is unable to recall important personal information
Usually after some stressful episode.
Interograde vs Retrograde amnesia- in retrograde