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Lecture 6

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Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  6:   Somatoform  and  Dissociative  Disorders  (pp.  174-­‐211)     An  Overview  of  Somatoform  Disorders  (pp.175)   • Soma  –  Meaning  Body   o Overly  preoccupies  with  their  health  or  body  appearance   o No  identifiable  medical  conditions  causing  the  physical  complaints     Hypochondriasis:  An  Overview  (pp.  175-­‐178)   • Problem  is  anxiety   • Chronic  onset   • Hypochondriasis  vs.  Panic  Disorder   o Similarities:    Both  focus  on  bodily  symptoms   o Differences:    Focuses  on  long-­‐term  process  of  illness    Constant  concern    Constant  medical  treatment  seeking    Wider  range  of  symptoms   • Winnipeg  researcher-­‐  co-­‐morbid  with  panic  attack   • Overview  and  Defining  Features   • Physical  complaints  without  a  clear  cause   o Severe  anxiety  focused  on  the  possibility  of  having  a  serious  disease   o Strong  disease  conviction   o Medical  reassurance  do  not  seem  to  help   • Facts  and  Statistics   o Good  prevalence  data  lacking  –  onset  any  age   o Culture  specific     Hypochondriasis:  Causes  and  Treatment  (pp.  178-­‐179)   • Causes   o Cognitive  perceptual  distortions    Sensitivity  to  illness    Ambiguous  bodily  stimuli  are  threatening    Stressful  life,  family  disease  when  young   o Familial  history  of  illness   • Treatment  (CBT)   o Challenge  illness-­‐related  misinterpretations   o Provide  more  substantial  and  sensitive  reassurance   o Stress  management  and  coping  strategies               Somatization  Disorder:  An  Overview  (pp.  179-­‐181)   • Overview  and  Defining  Features   o Extended  history  of  physical  complaints  before  30   o Substantial  impairment  in  social  or  occupational  functioning   o Concerned  over  the  symptoms  themselves,  not  what  they  might  mean   o Symptoms  become  the  person’s  identity   • Facts  and  Statistics   o Rare  condition   o Onset  usually  in  adolescence   o Mostly  affects  unmarried,  low  SES  women   o Runs  a  chronic  course     Somatization  Disorder:  Causes  and  Treatment  (pp.  181-­‐182)   • Causes   o Overly  sensitive/overattend  to  physical  sensations   o Familial  history  of  illness   o Linked  with  antisocial  personality  disorder   o Weak  behavioural  inhibition  system,  not  control  behavioural   activation  system   • Treatment   o No  treatment  exists  with  demonstrated  effectiveness   o Reduce  tendency  to  visit  numerous  medical  specialists  by  assigning   “gatekeeper”  physician   o Reduce  supportive  consequences  of  talk  about  physical  symptoms     Conversion  Disorder:  An  Overview  (pp.  183-­‐186)   • Overview  and  Defining  Features   o Physical  malfunctioning  without  any  physical  organic  pathology   o Freud’s  primary  and  secondary  gain  9secondary  gain  may  not  be   present)   o Malfunctioning  often  involves  sensory-­‐motor  areas;  blindness,   aphonia,  paralysis  (like  a  neurological  disease)   o Malingering  (perform  below  chance  vs.  conversions),  factitious   disorder  (by  proxy)   o CD  shows  la  belle  indifference  –  they  don’t  care   o Retain  most  normal  functions,  but  without  awareness  of  this  ability   • Unconscious  processes   • Facts  and  statistics   o Rare  condition,  with  a  chronic  intermittent  course   o Seen  primarily  in  females,  with  onset  usually  in  adolescents   o More  prevalence  in  less  educated,  low  SES  groups   o Not  uncommon  in  some  cultural  and/or  religious  groups     Conversion  Disorder:  Causes  and  Treatment  (pp.186-­‐189)   • Causes   o Freudian  psychodynamic  view  is  still  popular   o Emphasis  on  the  role  of  trauma,  conversion,  and  primary/secondary   gain   o Social  and  cultural   • Treatment   o Similar  to  somatization  disorder   o Core  strategy  is  attending  to  the  trauma   o Removal  of  sources  of  secondary  gain   o Reduce  supportive  consequence  of  talk  about  physical  symptoms     Pain  Disorder  (pp.  189-­‐190)   • Clinical  Description   o Pain  in  one  or  more  areas    Can  be  due  to  psychological  factors  and/or  medical  conditions   o Significant  impairment   o Psychological  factors  have  an  important  role  in  the  severity,   exacerbation,  or  maintenance   • Statistics   o Fairly  common   o 5-­‐12%   • Treatment   o Combined  medical  and  psychological       Body  Dysmorphic  Disorder  (pp.190-­‐192)   • Overview  and  Defining  Features   o Previously  known  as  dysmorphophobia   o Preoccupation  with  imagined  defect  in  appearance   o Either  fixation  on,  or  avoidance  of,  mirrors   o Suicidal  ideation  and  behaviour  are  common   o Often  display  ideas  of  reference  for  imagined  defect   • Facts  and  Statistics   o More  common  than  previously  thought   o Seen  equally  in  males  and  females,  with  onset  in  early  20s   o Most  remain  single,  and  seek  out  plastic  surgeons   o Usually  runs  a  lifelong  chronic  course     Body  Dysmorphic  Disorder:  Causes  and  Treatment  (pp.  192-­‐194)   • Causes   o Little  is  known;  though  it  tend  to  run  in  families   o Shares  similarities  with  OCD  –  obsessive  thoughts  and  rituals   o Cultural  –  body  size  and  weight,  appearance     • Treatment   o Medications  (SSRIs)  that  work  for  OCD  provide  some  relief   o Exposure  and  response  prevention  is  also  helpful   o Plastic  surgery  is  often  unhelpful    increased  preoccupation   o Can  not  get  surgery  –  fix  it  themselves
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