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PSY240H1 (233)


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University of Toronto St. George
Konstantine Zakzanis

Somatoform Disorders & Dissociative Disorders Somatoform disorders: the individual complains of bodily symptoms that suggest a physical defect or dysfunction but for which there is no physiological basis Dissociative disorder: the individual experiences disruptions of consciousness, memory, and identity, as illustrated in the opening case study The onset of both classes of disorders is typically related to some stressful experience, and the two classes sometimes co-occur Somatoform and dissociative disorders are related to anxiety b/c in the early versions of the DSM, all these disorders were under the heading of neuroses b/c anxiety was considered the predominant underlying factor in each case Somatoform Disorders Psychological problems take a physical form Not under voluntary control Thought to be linked to anxiety and all psychologically caused 2 main somatoform disorders: conversion disorder & somatisation disorder Overall DSM-IV categories of somatoform disorder o Pain disorder: Psychological factors play a significant role in the onset and maintenance of pain o Body dysmorphic disorder: preoccupation with imagined or exaggerated defects in physical appearance o Hypochondriasis: preoccupation with fears of having a serious illness o Conversion disorder: sensory or motor symptoms without any physiological cause o Somatization disorder: recurrent, multiple physical complaints that have not biological basis Pain disorder o Person experiences pain that causes significant distress & impairment o Psychological factors are viewed as playing an important role in the onset, maintenance, and severity of the pain o Unable to work and may become dependent on pain killers or tranquilizers o Conflict or stress or avoid some unpleasant activity and to secure attention and sympathy not otherwise available o Hard to find where the pain is coming from o People with true physically based pains describe their pain as more localized and with magnitude, while pain disorder patients cant Body dysmorphic disorder o Person is preoccupied with an imaged/exaggerated defect in appearance, frequently in the face (facial wrinkles, excess facial hair, shape of nose) o Spend hours each day checking on their defect in the mirror o Leads to frequent consultations with the plastic surgeon o Mostly among women o Typically beings in late adolescence o Frequently comorbid with depression & social phobia o Preoccupation with imaged defects in physical appearance may therefore not be a disorder itself, but a symptom that can occur in several disorders (OCD, delusional disorder) Hypochondriasis o Individuals are preoccupied with persistent fears of having a serious disease, despite medical reassurance to the contrary o Typically begins in early adulthood and tends to have a chronic course o They make catastrophic interpretations of symptoms o Prevalence of 5% C h a p t e r 7 : S o m a t o f o r m a n d D i s s o c i a t i v e D i s o r d e r s Page 1o Not well differentiated from somatisation disorder (long history of complaints) o Often co-occurs with anxiety and mood disorders o Health anxiety health related fears and beliefs based on misinterpretations of bodily signs and symptoms as being indicative of serious illness o Health anxiety would be present in both hypochondriases and an illness phobia, whereas hypochondriasis is a fear of having an illness, an illness phobia is fear of contracting an illness. o Illness Attitude Scale (IAS) : self report measure that is used commonly by researchers to assess health anxiety (used to confirm link between health anxiety and trait neuroticism) Worry about illness and pain Disease conviction (illness beliefs) Health habits (safety seeking behaviours) Symptoms interference with lifestyle (eg. Disruptive effects) o Cognitive factors (separate from the IAS) A critical precipitating incident A previous experience of illness and related medical factors The presence of inflexible or negative cognitive assumption are always a sign of serious illness The severity of anxiety Conversions Disorder Conversion disorder: Physically normal people experience sensory or motor symptoms such as a sudden loss of vision or paralysis, suggesting an illness related to neurological damage of some sort, although the body organs and nervous system are found to be fine They may experience paralysis of arms or legs; seizures and coordination disturbances; a sensation of prickling, tingling or creeping on the skin, insensitivity to pain; or loss of impairment of sensations (anaesthesias) They appear suddenly in stressful situati
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