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Week 7.docx

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PSYC 3390
Mary Manson

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Abnormal Psychology: Somatoform & Dissociative Disorders pgs. 284 – 312; Chapter Eight Somatoform Disorders • Soma: body • somatoform disorders: people complain of bodily symptoms/defects suggesting presence of medical problems; no organic basis exists though (e.g. paralysis & pain) • typically preoccupied with their state of health • patients have no control over their symptoms • not intentionally faking symptoms; genuinely/passionately believe there is something terribly wrong • 5 distinct somatoform disorders: hypochondriasis, somatization disorder, pain disorder, conversion disorder, body dysmorphic disorder Hypochondriasis • hypochondriasis: preoccupied with fears of contracting serious disease/have the idea that they actually have the disease even though they don't • it is based on the misinterpretation of bodily changes, symptoms, sensations • preoccupation causes clinically significant distress • not reassured by results of medical exam; fear of the disease persisting; sometimes disappointed when disease not found • must persist for at least 6 months for diagnosis to be made • most commonly seen somatoform disorder; chronic if left untreated • also suffer from mood disorders, panic disorder, and/or other somatoform disorders • major characteristics of hypochondriasis • anxious, highly preoccupied with bodily functions, minor physical abnormalities, vague/ambiguous physical sensations • attribute the symptoms to suspect disease and often have intrusive thoughts about it • patients are not malingering: defined as consciously faking symptoms to achieve specific goals (e.g. To win a lawsuit) • often hostile towards physician • theoretical perspectives on causal factors • it is a disorder of cognition and perception • person's past experiences with illness lead to development of dysfunctional assumptions about symptoms/diseases • these past experiences predisposed person to developing hypochondriasis • once person has misinterpreted a symptom, they look for evidence to prove they are ill and evidence to discount that they are healthy • they think being healthy actually means being symptom-free • also perceive their probability of being able to cope with the illness as low; see themselves as weak and unable to tolerate physical effort/exercise • many hypochondrial patients reported much childhood sickness and missing school, as well as excessive illness in their families, leading to strong memories of being sick/in pain • in turn, hypochondrial patients may also want to reap some of the benefits that the ill receive (e.g. Additional attention, comfort, etc.) • treatment of hypochondriasis • cognitive-behavioural treatment is very effective • focuses on assessing patients' beliefs about illness/modifying misinterpretation of bodily functions • behavioural techniques include: having patients induce symptoms by intentionally focusing on parts of their body, engage in response prevention by not checking their body like they usually do, stop seeking constant reassurance • treatment only requires 6 – 16 sessions; produces large changes in the patients • certain antidepressant medications may also be effective Somatization Disorder • somatization disorder: many different complaints of physical ailments over a period of several years beginning before age 30 that are not explained by independent findings of physical illness/injury that lead to medical treatment/significant life impairment • 4 criteria for diagnosis are: • 1) 4 pain symptoms: patient must report history of pain with respect to at least 4 different sites/functions (e.g. Head, abdomen, rectum, sex during intercourse) • 2) 2 gastrointestinal symptoms: patient must report history of at least 2 symptoms – other than pain – pertaining to GI (e.g. Nausea, bloating, diarrhea, vomiting) • 3) 1 sexual symptom: must report at least 1 reproductive system symptom other than pain (e.g. Sexual indifference, menstrual irregularity)\ • 4) 1 pseudoneurological symptom: must report history of at least 1 symptom suggestive of a neurological condition (e.g. Loss of sensation, involuntary movement) • demographics, comorbidity, and course of illness • somatization disorder was formerly called Briquet's syndrome after the French physician who first described it • usually begins in adolescence; 3 – 10 times more common in women • also tends to occur more in lower socioeconomic classes • commonly co-occurs with several other disorders: major depression, panic disorder, phobic disorders, generalized anxiety disorder • generally considered chronic with a poor prognosis • causal factors in somatization disorder • possible genetic predisposition to developing disorder • other contributory causal factors include interaction of personality, cognitive, and learning variables • selectively attend to bodily sensations and tend to see them as somatic symptoms; tend to catastrophize about minor complaints • patients have elevated levels of cortisol and didn't show normal habituation to psychological stressors • treatment of somatization disorder • recent research suggests cognitive-behavioural therapy works best when combined with medical management • involves a physician who will integrate patients' care by seeing them at regular visits (trying to anticipate appearance of new problems) and providing physical exams focused on new complaints (accepting the symptoms as valid) • physician must also avoid unnecessary diagnostic testing/make minimal use of medications or other therapies • combined with cognitive-behavioural therapy, focusing on promoting better coping/personal adjustment and discouraging inappropriate behaviour • focus on changing way patient thinks about bodily sensations/reducing secondary gain patients may receive from physicians and family members Pain Disorder • pain disorder: experience of persistent/severe pain in one or more areas of the body, pain causes significant distress/impairment in functioning, psychological factors important role in pain, symptom not intentionally produced • 2 coded subtypes identified: pain disorder associated with psychological factors and pain disorder associate with both psychological factors and a medical condition • pain disorder may be acute: less than 6 months, or chronic: over six months • pain increases when reinforced by attention, sympathy, avoidance of unwanted activities • treatment of pain disorder • cognitive-behavioural techniques usually used • include relaxation training, support and validation that pain is real, scheduling daily activities, cognitive restructuring, reinforcement of “no-pain” behaviours • antidepressants also effective Conversion Disorder • conversion disorder: symptoms/deficits affecting sensory/voluntary motor functions lead one to think patient has medical/neurological condition; upon examination it becomes apparent symptoms cannot be explained by known medical condition • examples include: partial paralysis, blindness, deafness, pseudoseizures • symptoms usually start/exacerbated by preceding emotional/interpersonal conflicts or stressors • person must not be faking symptoms • initially, la belle indifference (the beautiful indifference) – a lack of concern in the patient – was an important disgnostic tool; later dropped as criterion because only 30-50% of patients presented with it • conversion disorder grouped together with several other disorders (somatization disorder, hysterical personality) under the term hysteria • Freud used term conversion hysteria for these disorders because he believed symptoms were an expression of repressed sexual energy; e.g. Someone's guilty feelings about desire to masturbate leads to paralyzed hand • precipitating circumstances, escape, and secondary gains • primary gain: continued escape or avoidance of stressful situations without having to take responsibility • it is all unconscious so the person doesn't see a connection between the symptoms and the stressful situation • secondary gain: any external circumstance that would reinforce the maintenance of disability (e.g. Attention from loved ones) • decreasing prevalence and demographic characteristics • conversion disorder common during WWI and WWII; soldiers experienced paralysis of the legs, allowing them to get out of combat without seeming like a coward • conversion disorder not as common today • range of conversion disorder symptoms • 4 categories of symptoms: sensory, motor, seizures, mixed from the first 3 categories • sensory • most often in visual system (e.g. Blindness), auditory system (e.g. Deafness), sensitivity to feeling (i.e. Anesthesias) • most common
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