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Psychology 2030A/B
David Vollick

Chapter 6 Somatoform and Dissociative Disorders February-04-13 7:09 PM Overview of somatoform disorders  Overly preoccupied with their health or bodily appearance  No identifiable medical condition causing the physical complaints  Table 6.1 hypochondriasis Hypochondriasis  Overview  Problem is anxiety  Chronic onset  Hypochondriasis vs panic disorder  Similarities - both focus on bodily symptoms i.e. pain or tightness in the chest  Differences - hypochondriasis focusses on the long term process of illness, constant concern, constant medical treatment seeking, involves a wider range of symptoms than  Defining features  Physical complaints without a clear cause  Severe anxiety focused on the possibility of having a serious long term disease v.s. panic disorder  Strong disease conviction  Medical reassurance does not seem to help  Facts and Stats  Good prevalence, data lacking - onset, any age  Culture specific towards the symptoms they fear i.e. warts v.s. chest pain  Causes  Cognitive perceptual distortions  Sensitivity to illness, everything is threatening for these people  Ambiguous bodily stimuli are threatening  Stressful life, family disease when young  Familial history of illness  Treatment  CBT is most effective  Challenge illness-related misinterpretations  Provide more substantial and sensitive reassurance  Stress management and coping strategies DSM-IV-TR for somatization disorder in table 6.2 Somatization Disorder  Overview  Extended history of physical complaints before 30  Substantial impairment in social or occupational functioning  Concerned over the symptoms themselves or on the pain itself, not what they might mean (as in hypercondriasis, who focus on what the pain might mean)  Symptoms become the persons identity  Facts and Stats  Rare condition  Onset usually in adolescence  Mostly effects unmarried, low SES women  Runs a chronic course  Causes  Over-attend to physical sensations  Familial history of illness  Linked with antisocial personality disorder "the ends justify the means"  Have a weak behavioral inhibition system not control behavioral activation system  Treatment  No treatment exists with demonstrated effectiveness  Reduce tendency to visit numerous medical specialists by assigning "gatekeeper" physician to avoid shopping around for physicians  Reduce supportive consequences of talk about physical symptoms "oh you're complaining again, come talk to me when you're not complaining" Conversion Disorder Table 6.3  Overview and defining features  Physical malfunctioning without any physical or organic pathology  Freud's primary and secondary gain (I do this in order to get something i.e. attention)  Malfunctioning often involves sensory-motor areas - blindness, aphonia (trouble speaking) paralysis - like a neurological disease  Difficult to discern between malingering, real physical disorders and conversion disorder  CD shows la belle indifference - they can't move their hand but ah, they don't care  Retain most normal functions but without awareness of this ability. i.e. they think they are blind but when given a seeing tasks they will perform better than chance so it shows that they do see and are unaware of it. Malingerers will do worse than chance here because they are trying to prove something.  Facts and Stats  Rare condition, with a chronic intermittent course  Seen primarily in females with inset usually in adolescence  More prevalence in less educated, low SES groups - may not be able to develop the skills to deal with stress e.t.c could have poor nutrition, the neighborhood you live in affects your perception of the world, they may not have access to quality healthcare.  Not uncommon in some cultural or religious groups  Causes  Freudian psychodynamic view is still popular  Primary gain (gets rid of anxiety) secondary gain (gets you attention)  Lader et al - these patients are concerned, therefore it doesn’t support the secondary gain model, they are concerned about it - they don’t do it just for the attention  Social and cultural  Treatment  Similar to somatization disorder  Core strategy is attending to the trauma if a trauma were involved  Removal of sources of secondary gain  Reduce supportive consequences of talk about physical symptoms Facticious Disorder  Voluntarily makes up symptoms with no apparent motivations - contrasts with malingering b.c it is not for financial gain Pain Disorder Table 6.5  Clinical description  Pain in one or more areas  Can be sue to psychological factors and or medical conditions  Significant impairment  Psychological factors have an important role in the severity, exacerbation or maintenance of the pain  Stats  Fairly common  5-12% of population suffer from it  Treatment  Combined medical and psychological Body Dysmorphic Disorder Table 6.6  Overview and defining features  Previously known as dysmorphophobia  Preoccupation with imagined defect in appearance - very rare, but serious will go to great lengths  Either fixation, or avoidance of mirrors  Suicidal ideation (high risk) and behaviour are common  Often display idea of reference or imagined defect - everything bad that happens to them is bc of their imagined defect  Facts and Stats 
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