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Chapters 7-12 (Midterm 2).docx

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Wilfrid Laurier University
John Stephens

Chapter 7 Somatoform and Dissociative DisordersDefinitionsSomatoform disorders individual complains of bodily symptoms that suggest a physical defect or dysfunction but for which no physiological basis can be found Psychological problems take a physical form Dissociative disorders individual experiences disruptions of consciousness memory and identity Onset of both classes of disorders assumed to be related to stressful experienceTwo classes sometimes cooccurDifferent somatoform disorders Disorder Description Pain disorder Psychological factors play a significant role in the onset and maintenance of pain Body dysmorphic disorder Preoccupation with imagined or exaggerated defects in physical appearance Hypochondriasis Preoccupation with fears of having a serious illness Conversion Disorder Sensory or motor symptoms without any physiological cause Somatization Recurrent multiple physical complaints that have no biological basisLess is known about the three DSMIVTR categories of somatoform disorders pain disorder body dysmorphic disorder and hypochondriasisThe two main somatoform disorders are conversion disorder and somatization disorderPain DisorderPerson experiences pain that causes significant distress and impairmentPsychological factors are viewed as playing an important role in the onset maintenance and severity of the painAccurate diagnosis is difficult because the subjective experience of pain is always a psychologically influenced phenomenonIn women diagnosed with pain disorder compared to healthy women fMRI showed significant greymatterdecreases in prefrontal cingulated and insular cortex regions of the brain which are critically involved in the modulation of subjective painThese findings represent a further proof of the important role of central changes in pain disorderBody Dysmorphic DisorderPerson is preoccupied with an imagined or exaggerated defect in appearance frequently in the faceExamples facial wrinkles excess facial hair or the shape or size of the nose Women tend to focus on the skin hips breasts and legsMen tend to focus on height penis size and body hairOccurs mostly among womenTypically begins in late adolescenceComorbid with depression social phobia eating disorders thoughts of suicide substance use and personality disorders HypochondriasisIndividuals are preoccupied with persistent fears of having a serious disease despite medical reassurance to the contrary Typically begins in early adulthood and has a chronic course Comorbid with mood or anxiety disorders Evident in about 5 of the general population The term hypochondriasis has become pejorative and tends to be called health anxiety disorder TheoryHypochondriacs overreact to and misinterpret ordinary physical sensations and minor abnormalities and see these as evidence for their beliefsPeople with hypochondriasis make catastrophic interpretations of symptomsContemporary researchers focus on health anxiety and not hypochondriasis Health AnxietyHealth anxiety has been defined as healthrelated fears and beliefs based on interpretations or perhaps more often misinterpretations of bodily signs and symptoms as being indicative of serious illness Asmundson Taylor SevgurCox 2001 p 4 Often measured with the Illness Anxiety Scale IAS which contains 4 factorsHealth Anxiety could be present in both hypochondriasis and an illness phobia Hypochondriasisfear of having an illnessIllness phobiafear of contracting an illnessHealth Anxiety is related to dysfunctional healthrelated beliefs and selfreported higher levels of somatosensory amplificationIllness Attitude Scale IAS Stewart and Watt 2001 1 Worry about illness and pain ie illness fears 2 Disease conviction ie illness beliefs 3 Health habits ie safetyseeking behaviours 4 Symptom interference with lifestyle ie disruptive effectsSalkovskis and Warwick 2001 Health Anxiety Model 1 A critical precipitating incident2 A previous experience of illness and related medical factors 3 The presence of inflexible or negative cognitive assumptions4 The severity of anxiety Conversion DisorderPhysically healthy people experience sensory or motor symptoms ie 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 ExamplesSudden loss of vision Paralysis of arms or legsSeizures and coordination disturbancesSensation of prickling tingling or creeping on the skinInsensitivity to painAnesthesias loss or impairment of sensationsAphonia loss of the voice and all but whispered speechAnosmia loss or impairment of the sense of smellTends to appear suddenly in stressful situationsPrevalence is less than 1 and is more common in females than in males Frequently comorbid with other AXIS I diagnoses such as depression substance abuse anxiety and dissociative disorders and with personality disordersPeople with conversion symptoms frequently report a history of sexual or physical abuse HysteriaTerm originally used to describe what are now known as conversion disordersHysterical blindness only cure is hypnosis and patients are able to visually describe all locations visited during conversion blindnessIllustrates the role that stress plays in the development of conversion disordersMalingering and Factitious DisorderConversion disorder is difficult to distinguish from malingering In malingeringPeople fake an incapacity in order to avoid a responsibilityPeople fake an incapacity to achieve a goal such as a large insurance settlementMalingering is diagnosed when the conversionlike symptoms are determined to be under voluntary controlClinicians may attempt to determine whether the symptoms have been consciously or unconsciously adopted but how can anyone know whether behavior is consciously or unconsciously motivatedLa belle indiffrence can help differentiate the twoCharacterized by a relative lack of concern or a blas attitude toward the symptoms Clients with conversion disorder sometimes demonstrate this they also appear willing and eager to talk endlessly and dramatically about their symptomsMalingerers in contrast are more likely to be guarded and cautiousSomatization DisorderRecurrent multiple somatic complaints with no apparent physical cause for which medical attention is soughtDiagnostic criteriaFour pain symptoms in different areasTwo gastrointestinal symptomsOne sexual symptom other than painOne pseudoneurological symptom Prevalence is less than 1 and more frequent in women and patients in medical treatmentIt also seems to run in families Symptoms are more pervasive than in hypochondriasis and usually cause impairment Considerable overlap with conversion disorder Comorbid with anxiety and mood disorders substance abuseseveral personality disordersSpecific symptoms may vary across cultures Etiology of Somatization DisordersMore sensitive to physical sensations overattend to them or interpret them catastrophically May have a memory bias for information that connotes physical threat Various aches discomforts and dysfunctions are the manifestation of unrealistic anxiety about bodily systems Patients with somatization disorder have high levels of cortisol they are under stressTheories of Conversion DisordersPsychoanalytic TheoryFreud Unresolved Electra Complex o The young female child becomes sexually attached to her father but these unacceptable impulses are repressedThe result is both a preoccupation with sex and at the same time an avoidance of itAn event reawakens these repressed impulses and creates anxiety which is converted into physical symptomsHe proposed that a conversion disorder is caused when a person experiences an event that creates great emotional arousal but the effect is not expressed and the memory of the event is cut off from conscious experiencePsychodynamic 2stage defensive reaction to account for findings of hysterically blind people 1 Perceptual representations of visual stimuli are blocked from awareness and on the basis people report themselves blind 2 Information is nonetheless extracted from the perceptual representationsIf clients feel they need to deny being privy with this information they perform more poorly on a task than they would by chanceIf clients do not need to deny having such information they perform the task well but still maintain that they are blindBehavioural Theory and Cognitive FactorsSimilar to malingering in that the person adopts the symptom to secure some endThe person with a conversion disorder attempts to behave according to his or her conception of how a person with a disease affecting the motor or sensory abilities would act
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