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chapter 6.docx

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Western University
Psychology 2030A/B
David Vollick

Chapter 6: somatoform and dissociative disorders Dissociate: from yourself like multiple personality An overview of somatoform disorders - Soma: meaning body o Overly preoccupied with their health or body appearance (we are all preoccupied by appearance but no overly) o No identifiable medical condition causing the physical complaints, the symptom. DSM-IV-TR Hypochondriasis: fear of having a serious disease based of misinterpretation of bodily signs Hypochondriasis: an overview - Problem is anxiety (you are going to die!! So stressful) - Chronic onset - Hypochondriasis versus panic disorder: not the same things: o Similarities:  Both focus on bodily symptoms o Differences:  Hypochondriasis  Focuses on long-term process of illness  Constant concern  Constant medical treatment seeking  Wider range of symptoms (muscles, nerves, intestinal problems) - Physical complaints without a clear cause: o Severe anxiety focused on the possibility of having a serious long-term disease versus panic disorder (having a chest pain without no reason) o Strong disease conviction o Medical reassurance does not seem to help - Facts and statistics: o God prevalence data lacking: seem appears at any age o It’s culture specific: the idea of physical disorder depends of the culture! Causes and treatment: - Causes: o Cognitive perceptual distortions (horrible pain, since they suffer they grab the pain and fix on it)  Sensitive to illness  Ambiguous bodily stimuli are threatening  Stressful life, family disease when young o Familial history of illness - Treatment (CBT: most effective): o Challenge illness-related misinterpretations o Provide more substantial and sensitive reassurance o Stress management and coping strategies DSM-IV-TR: somatization disorder A history before age of 30: different for hypochondriasis in many way (especially with the symptoms) Somatization disorder: an overview - 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 (vs hypochondriasis) o Symptoms become the person’s identity - Facts and statistics o Rare condition o Onset usually in adolescence o Mostly affects unmarried and low SES women o Very chronic Somatization disorder: causes and treatment - Causes: o 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 (they keep a physician and that’s it) o Reduce supportive consequences of talk about physical symptoms (like a punishment) DSM-IV-TR: conversion disorder Affecting voluntary motor or sensory function suggesting a neurological or general medical condition. Conversion disorder: an overview - Overview and defining features: o Physical malfunctioning without any physical or organic pathology o Freud’s primary and secondary gain: I do this to gain something, getting attention that’s kind of things o Malfunctioning often involves sensory-motor areas: blindness, aphonia, paralysis (like a neurological disease) o Difficult to discern between malingering, real physical disorders and conversion disorder o Conversion disorder shows la belle indifference: they don’t care “ how I can’t see, I don’t care”) o Retain most normal functions, but without awareness of this ability - Unconscious processes - Facts and statistics: o Rare condition, with chronic intermittent course o Seen primarily in females, with onset usually in adolescence o More prevalence in less educated, low SES groups o Not uncommon in some cultural and/or religious groups Conversion disorder: causes and treatment - Causes: o Freudian psychodynamic view is still popular  Primary/secondary gain  Lader et al: these patients are concerned not support secondary gain model 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 whatever it is o Reduce supportive consequences of talk about physical symptoms Factitious (artificial) disorder - Voluntarily makes up symptoms with no apparent motivation or malingering (simulation) DSM-IV-TR Pain in one or more anatomical sites focusing of the clinical symptoms Pain disorder - 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 (you can still playing even if there is nothing to complain about, the treatment tries to distract the patient in order to make him forgot) - Statistics o Fairly common o 5-12% - Treatment: - Combined medical and psychological DSM-IV-TR Body dysmorphic disorder: defect in appearance, person concern is extreme, markedly excessive Body dysmorphic disorder - 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 (high risk) and behavior are common o Often display ideas of reference for imagined defect - Facts and statistics
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