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Lecture 5

PSYB32-lecture 5.docx

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Konstantine Zakzanis

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PSYB32- lecture 5  Somatoform & Dissociative Disorders  The difference between the two is that somatoform is very common while dissociative disorders are very rare; the reason they are linked is because psychological factors are presumed to be playing a causal role in the development and maintenance of both of these types of disorders  Somatoform Disorders  Pain disorder- psychological factors play a significant role in the onset and maintenance of pain; DSM includes three subtypes, with the highlighted one being Pain disorder associated with both psychological factors and a general medical condition  Pain is a biopsychosocial process; very complex symptom that we don’t really have an objective way to diagnose it, thus it is impossible to determine if there are only psychological or medical factors involved in its presentation; has to result in distress, and disability to be diagnosed  These patients often have a co morbid diagnosis, often the co morbid diagnosis is the one that results in the disability itself or creates an additional type of problem (substance abuse problems from patients with a pain disorder- alcohol, oxycontin)  Often has a temporal relationship to some sort of stressor in a person’s life, and that’s one way to try to distinguish it from an actual pain disorder where there is a physical cause; temporal relationship is important because what happens over the course of the disorder is that a condition called iatrogenic disability develops  Iatrogenic disability is where the individual will avoid unpleasant activities to secure attention and sympathy  People with actual physical pain will localize their pain more specifically as opposed to a generalized pain condition; also will talk about moderating variables (things that specifically make it worse or better) as opposed to someone with a pain disorder will say everything  DSM specifiers: acute (less than 6 months in duration); chronic (more than 6 months)  Persons with a histrionic personality disorder (someone who is seeking attention) often will have a pain disorder as well  Body dysmorphic disorder: preoccupation with imagined or exaggerated defects in physical appearance (penis size, hair, height-men; breasts, skin, hips, legs-women); must result in distress or disability, and affects mostly women and starts in late adolescence; often co morbid with other types of psychological conditions such as depression; often a social phobia will develop; can lead to eating disorders; thoughts of suicide; substance abuse; personality disorders (namely borderline)  Hypochondrias is: somebody who has a preoccupation with fears of having a serious illness; about 5% of the population will suffer from some sort of hypochondriac state; age of onset is early adulthood;  Somatization disorder: characterized by a long history of recurrent multiple somatic complaints, with no physical cause, and with for which the individual will seek multiple medical treatment; disorder has to satisfy the following criteria- 4 pain symptoms in different locations, 2 gastrointestinal symptoms, 1 sexual symptom other than pain, 1 pseudo neurological symptom; constellation of symptoms has to result in not only impairment but disability; great deal of co morbidity with anxiety and as a result mood disorders; substance abuse; lifetime prevalence is less than .5, more common in women than in men; onset is typically in early adulthood  Different from a conversion disorder is that complaints in a conversion disorder are limited to neurological symptoms such as a sudden loss of vision, paralysis, seizures, balance difficulties, coordination problems, insensitivity to pain  Aphonia is the loss of voice, can’t speak loudly or at normal volumes any more  Anosmeia is the loss of smell; all psychologically caused  Malingering: different from factitious disorder in that in malingering, the complaints are consciously produced (under voluntary control) and fabricating symptoms for some sort of external incentive; and factitious disorder is where a person may be reporting the same symptoms but it is under unconscious control; in factitious disorder people will intentionally produce symptoms and have no external incentive to do so, the motivation is thought to be that the person wants to take on the role of a sick person  Factitious patients don’t show concern for symptoms, but malingering person will say they cannot do anything anymore, etc.  Mown chosen syndrome: when a person purposely makes themselves sick; can happen by proxy  Tests that can be used to differentiate between malingering and factitious- endorsement of improbable or impossible symptoms (checklist done by professor), examine chances of answers on a test (malingering will score below chance while factitious will not)  Dissociative Disorders – incredibly rare (based on case studies, not a lot of experimental studies out there)  Dissociative amnesia: person is unable to recall important personal information; time locked, usually after some stressful episode; enterograde amnesia is the inability to remember anything after the event and characterizes dissociative amnesia; recovery is typically complete  Dissociative states cannot be as a result of substance abuse  Dissociative fugue: when some suddenly leaves home, work, entire social life, picks up and goes to a new destination and creates a new identity; memory loss is more expansive than a dissociative amnesia because there is both retrograde amnesia; recovery is usually complete, but usually have no recollection of the fugue state; typically occurs after a person has experienced some sort of significant stressor in their life  Dissociative identity disorder (DID): (multiple personality disorder) person has at least two separate ego states, or alters, that exist independent of each other; at least one personality is aware of all other personalities but not all other personalities are aware of others; must cause disability; typically long last
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