chapter notes for midterm 2 (22 pages of solid notes)
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Somatoform and Dissociative Disorders
Somatoform is quite common and dissociate is actually the rarest.
Anxiety is the underlying factor to both somatoform and dissociative.
Somatoform disorders are characterized by physical symptoms that have no known
physiological causes. The symptom is not under voluntary control, it is unconscious.
Dissociative disorders is when an individual experiences disruptions of
consciousness, memory, and identity.
Pain disorder – psychological factors play a significant role in the onset and
maintenance of pain. Iatric disability – the belief that one is disabled when they are
not for the sake of attention and benefits that comes with being disabled.
Body dysmorphic disorder – preoccupation with imagined or exaggerated defects in
physical appearance. Co-morbid with depression, anxiety disorders, eating disorders and
Hypochondriasis – preoccupation with fears of having serious illness. Once you are a
hypochondric, you probably will be it for the rest of your life. Treatment is hard to come
Conversion disorder – sensory or motor symptoms without any physiological cause.
Anaesthesias – lose or impairment of sensations. Aphonia – loss of voice Anosmia – loss
or impairment of the sense of smell. Conversion derived from Freud who thought that
the anxiety and psychological conflict were believed to be converted into physical
symptoms. Hysteria – term originally used to describe what is known as conversion –
women and their wandering uterus. Conversion co morbid with depression, substance
abuse, and personality disorders such as borderline and historionic personality
Somatization disorder – know the difference between this and conversion disorder.
Characterized by recurrent, multiple somatic complaints, with no apparent physical
cause. 4 pain symptoms in difference locations, 2 gastrointestinal symptoms, 1
sexual symptom other than pain, 1 pseudoneurological symption (overlap with
conversion). Symptoms usually cause impairment, usually regarding work.
If someone only has pseudoneruolgical symptom, they have conversion
Etiology of Somatoform Disorders
Etiology of Somatization disorder – Behaviour view of somatisation disorder holds
that the various aches, discomforts, and dysfunctions are the manifestation of
unrealistic anxiety of bodily systems. In keeping with the possible role of anxiety,
patients with somatisation disorder have high levels of cortisol, and indication that they
are under stress.
Pyschoanalytic Theory of Conversion Disorder – Breuer and Freud proposed that
a conversion disorder is caused when a person experiences an event that creates great
emotional arousal, but the affect is not expressed and the memory of the event is cut off
from conscious experience. The specific conversion symptoms were said to be related
casually to the traumatic event that preceded them. Research shows that people with
hysterical blindless was affected by the stimuli even when they denied seeing them.
Behavioural theory of conversion disorder - They view conversion disorder as
similar to malingering in that the person adopts the symptom to secure some end. In
their opinion, the person with a conversion disorder attempts to behaviour according to
his or her conception of how a person with a disease affecting the motor or sensory
abilities would act. 1) are people capable of such behaviour ? yes. 2) under what
conditions would such behaviour be most likely to occur? The patient must have some
experience with the role to be adopted and the enactment of a role must be rewarded.
Social and Cultural factors in conversion disorder – conversion disorder is more
common among people with lower socio-economic status and from rural areas.
Biological factors in conversion disorder – genetic factors do no seem to be
important in the development of conversion disorder. Conversion symptoms are more
likely to occur on the left side of the brain.
Therapies For somatoform Disorders
hard to treat. Visit physicians more than psychologists because they define their
problems in physical terms. Effective treatment tend to have the following ingredients –
validating that the pain is real and not just in the patient’s head, relaxation training,
rewarding the person for behaving in ways inconsistent with the pain.
Conversion disorder – sensory or motor symptoms without any physiological cause
La belle indifference – they do not really care about their symptoms. This is used to
determine whether someone has a somatorm disorder or malingering.
There has to be an external reward for it to be malingering?
Factitious disorder – this is unconscious! Malingering is not! Attention is what is
wanted here, not some external reward.
Malingering – atypical symptom endorsement- do they endorse some crazy out of this
world symptom, , measures of dissimulation – forced choice recognition, dot counting
(group vs ungrouped), digit span, overall neuropsychological performance and
mechanism of injury and duration since injury.
Somatoform disorders are really hard to treat!
Dissociative amnesia – person is unable to recall important personal information,
usually after some stressful episode, information is not permanently lost, usually for a
time locked period (does not loose memory for their entire life events, just a period of
Dissociative fugue – person suddenly leaves home and work and assumes a new
identity. The amnesia is extremely profound. Memory loss is more extensive in
dissociative fugue than in dissociative amnesia.
Depersonalization disorder – the person’s perceptions or experience of the self is
disconcertingly and disruptively altered. There is no disturbance of memory!!!!!!!!
Triggered by stress and lose their sense of self. May have the impression that they are
outside of their bodies. Lasts a long time.
Dissociative identity disorder – person has at least two separate ego states, or
alters, that exist independent of each other, alters come forth and are in control at
different times. About two thirds or more of psychiatrists had reservations about
including the DID in the DSM.
Etiology of DID
Two major theories of DID. One assumes that DID begins in childhood as a result of
severe physical abuse or sexual abuse. The abuse causes dissociation and the formation
Somatoform is quite common and dissociate is actually the rarest. Anxiety is the underlying factor to both somatoform and dissociative. Somatoform disorders are characterized by physical symptoms that have no known physiological causes. The symptom is not under voluntary control, it is unconscious. Dissociative disorders is when an individual experiences disruptions of consciousness, memory, and identity. Pain disorder psychological factors play a significant role in the onset and maintenance of pain. Iat ric disability the belief that one is disabled when they are not for the sake of attention and benefits that comes with being disabled. Body dysmorphic disorder preoccupation with imagined or exaggerated defects in physical appearance. Co-morbid with depression, anxiety disorders, eating disorders and social phobia. Hypochondriasis preoccupation with fears of having serious illness. Once you are a hypochondric, you probably will be it for the rest of your life. Conversion disorder sensory or motor symptoms without any physiological cause.